From animal studies into clinical trials: the relevance of animal models to develop vaccines and therapies to reduce disease severity and prevent hRSV infection.

INTRODUCTION: Human respiratory syncytial virus (hRSV) is an important cause of lower respiratory tract infections in the pediatric and the geriatric population worldwide. There is a substantial economic burden resulting from hRSV disease during winter. Although no vaccines have been approved for human use, prophylactic therapies are available for high-risk populations. Choosing the proper animal models to evaluate different vaccine prototypes or pharmacological treatments is essential for developing efficient therapies against hRSV. AREAS COVERED: This article describes the relevance of using different animal models to evaluate the effect of antiviral drugs, pharmacological molecules, vaccine prototypes, and antibodies in the protection against hRSV. The animal models covered are rodents, mustelids, bovines, and nonhuman primates. Animals included were chosen based on the available literature and their role in the development of the drugs discussed in this manuscript. EXPERT OPINION: Choosing the correct animal model is critical for exploring and testing treatments that could decrease the impact of hRSV in high-risk populations. Mice will continue to be the most used preclinical model to evaluate this. However, researchers must also explore the use of other models such as nonhuman primates, as they are more similar to humans, prior to escalating into clinical trials.

[Intestinal and mesenteric trauma]. / Traumatismo intestinal y mesentérico.

The different aspects of closed and penetrating intestinal and mesenteric trauma are presented in this article, with emphasis on its pathophysiology and on an updated diagnostic imaging. Particular details are given on the characteristics of Multidetector Computed Tomography. The direct and indirect signs using this technique are also described, along with their respective sensitivity and specificity values.

El servicio en tenis profesional femenino: influencia del ranking y la lateralidad / Tennis Service Performance in Professional Women Players: Influence of Ranking Position and Opponent's Laterality

A pesar de que el saque es el golpe más determinante en el tenis moderno, existen hasta la fecha pocas investigaciones en tenis profesional femenino. El objetivo del presente estudio fue identificar las diferencias en la dirección y eficacia del saque en función del ranking; así como observar las diferencias según la lateralidad de la jugadora rival (diestra o zurda) en torneos de Grand Slam. Se analizaron un total de 108 partidos femeninos disputados en los torneos del Abierto de los Estados Unidos y Wimbledon. Los resultados mostraron una mayor variabilidad en la táctica del saque en Wimbledon frente al Abierto de Estados Unidos. Además, se identificaron diferencias en la dirección y eficacia del saque de las jugadoras diestras en función de la lateralidad del rival, en especial cuando se sacó a jugadoras zurdas. Estos resultados contribuyen al conocimiento de las dinámicas y rendimiento del saque en las jugadoras de tenis profesionales. (AU)

Serve is the most important stroke in modern tennis, but the number of studies on professional women’s tennis is scarce. The aim of the present study was to identify differences in service direction and effectiveness regarding players’ ranking position; as well as to observe the differences according to the opponent’s laterality (right-handed or left-handed). A total of 108 matches from the US Open and Wimbledon tournaments were analysed. Results showed a larger variability in service tactics in Wimbledon compared to the US Open. In addition, the direction and effectiveness of the service of right-handed players differed depending on the opponent’s laterality, especially against left-handed players. These results contribute to the knowledge of the service dynamics and performance in professional women’s tennis players. (AU)

Relationship between renal function and renal volume in autosomal dominant polycystic kidney disease: cross-sectional study.

OBJECTIVE: To determine in patients with autosomal dominant polycystic kidney disease the relationship between total renal volume (the sum of both kidneys, TRV) as measured by magnetic resonance and renal function; and its behaviour according to sex and the presence of arterial hypertension, hypercholesterolaemia and hyperglycemia. METHOD: Cross-sectional study including patients with autosomal dominant polycystic kidney disease who underwent periodic reviews at Nephrology external consultations at Hospital de las Nieves de Granada, and who underwent an magnetic resonance to estimate renal volume between January 2008 and March 2011. RESULTS: We evaluated 67 patients (59.7% women, average age of 48±14.4 years) and found a significant positive association between TRV and serum creatinine or urea, which was reversed compared with estimated glomerular filtration by MDRD-4 and Cockcroft-Gault. Women showed an average serum creatinine level and a significantly lower TRV level compared with males. Subgroups affected by arterial hypertension and hyperuricemia presented average values for serum creatinine and urea, higher for TRV and lower for estimated glomerular filtration. The hypercholesterolaemia subgroup showed higher average values for urea and lower for estimated glomerular filtration, without detecting significant differences compared with TRV. CONCLUSION: The volume of polycystic kidneys measured by magnetic resonance is associated with renal function, and can be useful as a complementary study to monitor disease progression. The presence of arterial hypertension, hyperuricemia or hypercholesterolaemia is associated with a poorer renal function.

Panhipopituitarismo secundario a hemorragia obstétrica profusa / Panhypopituitarism secondary to profuse obstetric haemorrhage

El síndrome de Sheehan o necrosis hipofisaria posparto, constituye la causa más importante de panhipopituitarismo, que de forma ocasional se asocia a hemorragia obstétrica profusa asociada a choque hipovolémico hemorrágico, ocasionando un colapso circulatorio intenso debido a isquemia de la adenohipófisis durante el parto o después del mismo, debido a que esta glándula endócrina sufre importantes cambios anatómicos e histológicos durante el embarazo, los cuales incrementan su volumen hasta en 40%. De esta forma, se produce una secreción reducida de las hormonas que ayudan a regular el crecimiento, la reproducción y el metabolismo, evidenciando en el examen hormonal detallado insuficiencia específicamente de la hormona de crecimiento, foliculoestimulante, luteinizante, estimulante de tiroides, adrenocorticotropica y prolactina predisponiendo a la paciente a inestabilidad hemodinámica a corto plazo así como desequilibrio hormonal permanente. Por esta importancia, es que se presenta el caso de una paciente que ingresó a la Unidad de Terapia Intensiva tras cesárea iterativa debido a acretismo placentario llegando a la histerectomía total intercurriendo con choque hemorrágico, quien cursó durante su estancia en la Unidad con ausencia de recuperación neurológica total y características propias de síndrome de Sheehan, confirmándose el mismo por los niveles hormonales bajos y la ausencia de imagen en la silla turca correspondiente a la necrosis hipofisaria evidenciado por resonancia magnética, realizándose además una sucinta revisión acerca de la literatura relacionada actual.

ABSTRACT Sheehan syndrome or postpartum pituitary necrosis is the most common cause of hypopituitarism and occurs secondary to profuse obstetric haemorrhage with subsequent hypovolemic hemorrhagic shock, with intense circulatory collapse, predisposing to pituitary ischemia during delivery or after the same, due to the hypertrophic changes that occur in this gland during pregnancy. In this syndrome exists a reduced secretion of the hormones that regulate growth, reproduction and metabolism. We present the case of a female patient admitted to the Critical Care Unit after iterative cesarean due to placenta accreta and total hysterectomy, in hypovolemic shock secondary to severe hemorrhage, being suspicious of Sheehan´s syndrome, with characteristic clinical features, low hormone levels and the absence of image in the Turkish chair corresponding to the pituitary necrosis.

Gasometría arterial en residentes a gran altura, El Alto ­ Bolivia 2020 / Arterial blood gas analysis in residents at high altitude, El Alto, Bolivia 2020

INTRODUCCIÓN: la presión barométrica determina la presión parcial de los gases tanto en el medio ambiente como a nivel alveolar pulmonar, por lo que, para una determinada presión barométrica, la presión de oxígeno y dióxido de carbono es distinta. OBJETIVO: el objetivo del presente estudio es caracterizar los valores de gasometría arterial en residentes adultos sanos a muy alta altitud en la ciudad de El Alto. METODOLOGÍA: Estudio serie de casos, realizado durante la gestión 2019 en 22 (73%) mujeres y 8 varones (27%), con una media de edad de 36.07 años. El estudio contó con la aprobación del Comité de Ética Hospitalario. RESULTADOS: a 4150 metros sobre el nivel del mar, el pH tiende hacia la alcalosis (7.43) así como la PaO2 es menor (58.69mmHg), el valor de PaCO2 (26.14mmHg) es menor correspondiente a una ciudad con mayor altitud, el valor de bicarbonato sérico (20.14mmol/L) se encuentra disminuido en compensación a la disminución de la PaCO2 y el valor de la SatO2% (91.7%) es menor al reportado a nivel del mar. Hay que destacar que el índice PaO2/FiO2 no concuerda con el cálculo realizado según la fórmula propuesta dentro de la definición de los Criterios de Berlín. Se evidencia también que, en la muestra, si bien la correlación entre la PaO2 y la SatO2% resulta como alta, no resulta perfectamente lineal. CONCLUSIÓN: resulta imperativo precisar las características propias a la fisiología correspondientes a cada altitud, buscando aplicar parámetros propios como los de la gasometría arterial para el tratamiento de las enfermedades prevalentes en cada región, así como desarrollar investigaciones específicas a gran altura, ensayar posibilidades y documentarlas.

INTRODUCTION: barometric pressure determines the partial pressure of gases both in the environment and at the pulmonary alveolar level, so for a given barometric pressure, the pressure of oxygen and carbon dioxide is different. The objective of this paper is to characterize arterial blood gas values in healthy adult residents at very high altitude in the city of El Alto. METHODOLOGY: case series study, carried out during 2019; 22 volunteers (73%) women and 8 men (27%), mean age 36.07 years are included. The study was approved by the Hospital Bioethics Committee. RESULTS: at 4150 meter above sea level, pH tends towards alkalosis (7.43) as well as PaO2 is lower (58.69mmHg), the value of PaCO2 (26.14mmHg) is lower corresponding to a city with higher altitude, the value of serum bicarbonate (20.14mmol/L) is lower in compensation at the decrease in PaCO2 and the value of SatO2% (91.7%) is lower than that reported at sea level. The PaO2/FiO2 index does not match the calculation made according to the proposed formula within the definition of the Berlin Criteria. It is also evident that, although the correlation between PaO2 and SatO2% is high, it is not perfectly linear. CONCLUSION: it is imperative to precise the characteristics corresponding to the physiology corresponding to each altitude, looking forward to apply these parameters, such as those of arterial blood gas, in the treatment of prevalent diseases for each region, and so as develop specific studies at high altitude, also testing and reporting them.

Purification and characterization of saxitoxin from Mytilus chilensis of southern Chile.

In the current communication we describe an innovative method to purify saxitoxin (STX), a toxin presents in contaminated muscle of Mylitus chilensis extracted in the southern part of Chile, using a liquid chromatographic methodology based on ionic pairs. The STX was extracted using HCl and treated with ammonium sulfate following a treatment with trichloroacetic acid and hexane/diethyl ether (97/3). The samples were analyzed by a semi-preparative HPLC in order to collect pure fractions of STX and these fractions were eluted in solid-phase cationic interchange SCX extraction columns. The purified STX was stable and homogeneous and its identity was confirmed by LC-MS-MS, which demonstrated a high quality purification of STX, without presence of analogs such as neosaxitoxin (Neo) and decarbamoyl saxitoxin (dcSTX). The STX biological activity was analyzed in a bioassay in mice model and compared to the standard STX produced by the FDA and no significant differences were observed.

Validity of substance use self-reports in dually diagnosed outpatients.

OBJECTIVE: The purpose of this study was to assess the validity of self-reports of substance use among outpatients dually diagnosed with substance use disorder and either bipolar disorder or posttraumatic stress disorder. METHOD: Self-reports of substance use were compared with supervised urine samples collected on the same day for 55 subjects. RESULTS: Self-reports were highly valid. Only 4.7% of cases involved subjects not reporting substance use detected by urine screens. CONCLUSIONS: Self-reports of substance use may be highly valid in nonpsychotic, dually diagnosed outpatients under certain conditions, i.e., when patients are in treatment, when urine samples are collected with patients' prior knowledge, when patients are well-known to staff, and when honest self-reporting is encouraged.

Group therapy for patients with bipolar disorder and substance dependence: results of a pilot study.

BACKGROUND: The authors' goal was to pilot test a newly developed manual-based group psychotherapy, called Integrated Group Therapy (IGT), for patients with bipolar disorder and substance dependence. METHOD: In this open trial, patients with DSM-IV bipolar disorder and substance dependence (N = 45) were recruited in sequential blocks to receive either group therapy (N = 21) or 6 monthly assessments, but no experimental treatment (N = 24). RESULTS: When compared with patients who did not receive group therapy, patients who received IGT had significantly better outcomes on the Addiction Severity Index drug composite score (p < .03), percentage of months abstinent (p < .01), and likelihood of achieving 2 (p < .002) or 3 (p < .004) consecutive abstinent months. CONCLUSION: IGT is a promising treatment for patients with bipolar disorder and substance dependence, who have traditionally had poor outcomes. It is unclear, however, how much of the improvement among the group therapy patients is attributable to the specific content of the treatment. A study comparing this treatment with another active psychotherapy treatment is warranted.

Medication compliance among patients with bipolar disorder and substance use disorder.

BACKGROUND: This study examined patterns of medication compliance and reasons for noncompliance among patients with bipolar disorder and substance use disorder. METHOD: Forty-four patients with current bipolar disorder and substance use disorder were administered a structured interview regarding lifetime compliance with prescribed psychotropic medications. RESULTS: Patients who were prescribed both lithium and valproate were significantly (p = .03) more likely to report full compliance with valproate than with lithium. Side effects were the most common reason for lithium noncompliance, but were not cited as a reason for valproate noncompliance. Also, a common pattern of noncompliance among patients prescribed benzodiazepines, neuroleptics, and tricyclic antidepressants was the use of more medication than prescribed. CONCLUSION: Valproate may have greater acceptability than lithium among patients with bipolar disorder and substance use disorder. Clinicians should also be aware that these patients may take higher doses of medication than prescribed.

Perceptual responses in the heat after brief intravenous versus oral rehydration.

PURPOSE: The purpose of the study was to compare the effects of a brief period (20 min) of intravenous (IV) fluid rehydration and oral (ORAL) rehydration on ratings of perceived exertion (RPE), thirst, and thermal sensation (TS) during exercise in the heat. METHODS: After dehydration (-4% of body weight), eight nonacclimated highly trained cyclists (age = 24 +/- 1 yr; VO2 = 61.4 +/- 0.8 mL.kg.min-1) performed three experimental trials. Rehydration (randomized, cross-over design) included: 1) ORAL (0.45% NaCl) equal to 50% of prior dehydration; 2) IV (0.45% NaCl) equal to 50% of prior dehydration; and 3) a control (CON), no fluid trial. Subjects then cycled at 74% VO2peak until volitional exhaustion in a hot environment (37 degrees C). RESULTS: Central (C-), local (L-), and overall-RPE (O-RPE) were significantly higher in CON compared to ORAL and IV at minutes 5 and 15 of exercise. C-RPE responses at minute 5 of exercise were lower (P < 0.05) during ORAL compared with IV, and C-RPE and O-RPE responses at minute 15 were lower (P < 0.05) during ORAL compared with IV. TS responses during CON were higher (P < 0.05) than ORAL and IV at minute 5, and TS was higher (P < 0.05) during IV versus ORAL at minute 15. TS were significantly correlated with all RPE responses at minute 15 in all trials. Thirst ratings were lower (P < 0.05) during ORAL compared with CON and IV at minutes 0, 5, and 15. CONCLUSION: It was concluded that ORAL resulted in lower RPE, thirst, and TS compared with CON and IV during exercise in the heat.

Magnetic resonance cholangiopancreatography of the biliary ducts: techniques, clinical applications, and limitations.

Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive method capable of generating images of the biliary tree that resemble those provided by direct invasive cholangiographic techniques. MRCP is based on the ability of heavily T2-weighted sequences to obtain images in which static fluid in the bile ducts appears bright against a dark background. MRCP allows display of both cross-sectional and projectional information without the need for contrast media injection. Because the projectional images resemble those of direct cholangiography, they are readily accepted by gastroenterologists and surgeons. Although the exact role of MRCP for the evaluation of the biliary system has not been fully defined, continued advances in both technique and experience have begun to clarify the potential uses of MRCP in the workup of biliary diseases. This review will discuss these developing clinical roles and their implications for patient management as well as the imaging principles, techniques, limitations, and artifacts of MRCP.

Influence of age, sex, and hepatitis C virus infection on peripheral blood lymphocyte subsets in stable kidney transplantation.

BACKGROUND: Young age and hepatitis C virus infection (HCVI) are believed to be risk factors in kidney transplantation recipients. The first group is treated empirically with an intensive immunosuppressive regimen, because it is considered to have high immune alloreactivity. The other cohort usually receives a less intensive regimen to avoid excessive immunosuppressive effects. Our aim was to investigate the influence of age, sex, and HCVI on immune status in stable kidney transplant recipients through measurement of peripheral blood lymphocyte subsets. METHODS: Absolute CD3+, CD3+, CD4+, CD3+, CD8+, CD19+, CD16+ CD3- lymphocyte counts and CD4/CD8 ratios were assessed at five time points in 65 stable kidney allograft patients over 12 months. The subsets were compared according to age, sex, and HCVI of the recipients. RESULTS: An inverse association was observed between recipient age and absolute CD19+ and CD3+ CD4+ lymphocyte counts, which was significant at all time points with respect to CD19+ counts, and at three time points with respect to CD3+ CD4+ counts. A significant positive association was observed between recipient age and absolute CD3- CD16+ lymphocyte counts at three time points. Female recipients showed significantly lower CD3+ CD8+ counts and significantly higher CD4/CD8 ratios than male recipients at four time points. HCVI recipients showed significantly lower CD16+ CD3- counts at four time points. CONCLUSIONS: We observed links between immune status and age, sex and HCVI in stable kidney transplant recipients that could offer new insights into recommendations for maintenance immunosuppression.

Effect of mycophenolate mofetil regimen on peripheral blood lymphocyte subsets in kidney transplant recipients.

BACKGROUND AND AIMS: There is growing evidence of the effects of immunosuppressive agents on "immune targets" in renal transplantation. Immunological monitoring could indirectly measure the suppressive effect of these drugs and guide early preventive interventions in transplant recipients. Due to the selective antiproliferative effect of mycophenolate mofetil (MMF) on lymphocytes, our goal was to determine whether MMF modulates peripheral blood lymphocyte subsets (PBLS) in kidney allograft patients. METHODS: We assessed absolute CD3(+), CD3(+)CD4(+), CD3(+)CD8(+), CD19(+), CD16(+)CD3(-) PBLS counts and CD4/CD8 ratios for 12 months in three groups of kidney allograft patients stratified according to maintenance immunosuppressive regimen: group A (n = 31), which started MMF with prednisone (P) + cyclosporine A (CyA), and two control groups, B (n = 19) and C (n = 15) on P + CyA + azathioprine (Aza) and P + CyA regimens, respectively. We compared intra- and intergroup lymphocyte counts and ratios. RESULTS: Intergroup comparisons showed a significant reduction in all PBLS in group A (CD19(+) from 3 months and other subsets from 6 months), whereas there were no significant changes in PBLS in the other group analyses or comparisons. CONCLUSIONS: Our findings suggest that (1) MMF modulates all PBLS in kidney allograft patients, causing a progressive reduction occurring earlier in CD19(+), and (2) we can rule out that these changes were caused by the "natural immunological evolution" of the transplantation. These results could offer a new method for immunological monitoring of transplant patients.

Bile duct stones: diagnosis with MR cholangiography and helical CT.

MR cholangiography (MRC) is a highly accurate, noninvasive method for diagnosing bile duct stones. Various breath-hold and non-breath-hold techniques for MRC have been used successfully to depict stones in the intrahepatic and extrahepatic biliary tree. Although detection of stones with MRC is usually straightforward, attention to technical details is important to avoid false-negative and false-positive interpretations. With the advent of helical CT, other options for noninvasive imaging of the bile ducts, such as CT cholangiography, are now available. CT techniques are especially useful when MRI is unavailable or contraindicated, or when the quality of MRC images is suboptimal.

Depuración de lactato a gran altitud / Lactate clearance at high altitude

OBJETIVO: el estudio pretende caracterizar la depuración de lactato (DL) en pacientes críticamente enfermos, a gran altitud. DISEÑO: estudio prospectivo de cohorte. ÁMBITO: unidad de Cuidados Intensivos de Adultos del Hospital del Norte de la ciudad de El Alto, La Paz (Bolivia), a 4 150 metros sobre el nivel del mar, periodo 25 de abril 2016-01 de junio 2018. PACIENTES: todos los pacientes ingresados a la Unidad de Cuidados Intensivos de Adultos, nativos de gran altitud, así como residentes de la misma por lo menos los últimos 6 meses. RESULTADOS: se incluyeron 250 pacientes, con sobrevida de 68%, promedio de edad 50 años; en el grupo de 170 supervivientes, poco más de la cuarta parte del lactato de ingreso fue depurado (26%), a comparación del grupo de 80 fallecidos, en el cual incluso el valor de lactato se vio incrementado alrededor de la quinta parte del lactato de ingreso (21%), ambos con p ≤ 0.05 mediante el test de ANOVA. En pacientes críticamente enfermos a gran altitud, el riesgo relativo entre depuración de lactato ≥ 26% y sobrevida es de 2.7 con sensibilidad 0.72 y especificidad de 1. DISCUSIÓN Y CONCLUSIONES: la depuración de lactato en individuos críticamente enfermos nativos de gran altitud, se asocia a mayor sobrevida y debería ser considerado como un objetivo durante la reanimación en pacientes críticos, de forma similar a estudios realizados en otras latitudes

OBJECTIVE: to characterize the lactate clearance on critically ill patients, at high altitude. DESIGN: prospective cohort study. FIELD: critical Care Unit of "Hospital del Norte" in El Alto, La Paz (Bolivia), during the period April 25, 2016 ­ June 01, 2018. PARTICIPANTS: critically ill patients residents of high altitude at least the last 6 months, admitted to the Adult Critical Care Unit. RESULTS: 250 patients were included, with survival of 68%, age average of 50 years; in the 170 survivors, lactate clearance average was 26%, in contrast with 80 deceased patients who presented an increased lactate level of 25%, p ≤ 0.05, both of them through ANOVA test. In high landers critically ill patients, relative risk of lactate clearance ≥ 26% and survival was 2.7 with sensitivity 0.72 and specificity 1. DISCUSSION AND CONCLUSIONS: lactate clearance in critically ill high landers dwellers, is associated with survival and it should be considered also as a reanimation objective, comparable to other studies developed in different latitudes

Cuidado intensivo en un centro de trauma / Intensive care in a trauma center

OBJETIVO: El traumatismo grave es la causa principal de muerte en pacientes menores de 40 años, siendo el trauma craneoencefálico la primera causa de discapacidad severa, mientras que la hemorragia se mantiene como principal causa prevenible de muerte. El objetivo del presente trabajo es describir la casuística de los pacientes atendidos en la Unidad de Cuidados Intensivos Adultos del Centro de Trauma Hospital Corazón de Jesús de la ciudad de El Alto en La Paz (Bolivia). METODOLOGÍA: Estudio retrospectivo. Se incluyen todos los pacientes internados en la Unidad de Cuidados Intensivos Adultos del Centro de Trauma Hospital Corazón de Jesús, Unidad Polivalente, ingresados en el periodo 01 Octubre 2016-01 Abril de 2019. RESULTADOS: Se ingresaron 485 pacientes, 273 (56%) varones así como 212 (44%) mujeres, la sobrevida llega al 91% y el 9% de mortalidad corregida. La media de edad corresponde a 48 años (desviación estándar 19 años), la media de estancia en la Unidad de Cuidados Intensivos es de 112 horas (desviación estándar 87 horas). La mayor parte de pacientes proviene del Servicio de Urgencias y Quirófano, con diagnósticos de trauma craneoencefálico grave y hemorragia secundaria a trauma. CONCLUSIÓN: Este estudio muestra la casuística de una Unidad de Cuidados Intensivos de un Centro de Trauma, resultando imperativo describir la casuística concerniente a nuestros Centros Asistenciales con fines de la realización de investigación ulterior de forma multicéntrica.

OBJECTIVE: Severe trauma is leading cause of death in patients younger than 40 years, traumatic brain injury is also the leading cause of severe disability, while hemorrhage remains as main cause of preventable death. The objective of this paper is to describe the casuistic of patients treated in the Intensive Care Unit of Trauma Center Hospital Corazón de Jesús of El Alto City in La Paz (Bolivia). METHODOLOGY: Retrospective study. Includes all patients admitted at Intensive Care Unit, Polyvalent Unit, during the period 01 October 2016-01 April 2019. RESULTS: 485 patients were admitted, 273 (56%) male and 212 (44%) female, survival reaches 91% and 9% of adjusted mortality. Mean age is 48 years (standard deviation 19 years), mean length-of-stay in Intensive Care Unit is 112 hours (standard deviation 87 hours). The majority of patients arrived from the Emergency Department and Operating Room, with main diagnoses of severe traumatic brain injury and hemorrhage secondary to trauma. CONCLUSION: This study shows the casuistic of an Intensive Care Unit of a Trauma Center, resulting imperative to describe the casuistic of other Hospitals for the purpose of conducting further multicentric research.

[Clinical applications of magnetic resonance cholangiopancreatography]. / Aplicaciones clínicas de la colangiopancreatografía por resonancia magnética.

Magnetic resonance cholangiopancreatography (MRCP) is the most important diagnostic alternative that has been developed in recent years for the evaluation of the biliary and pancreatic ducts. The advantages of this technique are: it does not use contrast media or ionizing radiation; it is noninvasive and complication free; and, the examination is relatively short (approximately 20 to 30 minutes). MRCP has high sensitivity and specificity for diagnosing biliary dilatation and for determining the site and cause of stenosis. Its diagnostic precision for biliary and pancreatic stones is similar to that of endoscopic retrograde cholangiopancreatography (ERCP). MRCP has replaced ERCP in biliary and pancreatic anatomic variants. In unsuccessful ERCP, MRCP is nearly the only diagnostic modality for the evaluation of the biliary tract. Other applications include primary sclerosing cholangitis, stenosis after liver transplantation, and the evaluation of bilioenteric anastomoses. This article reviews the clinical applications of MRCP in the evaluation of biliopancreatic diseases.

[Effectiveness and tolerability of addition of risperidone in obsessive-compulsive disorder with poor response to serotonin reuptake inhibitors]. / Efectividad y tolerancia de la adición de risperidona en el trastorno obsesivo-compulsivo con mala respuesta terapéutica a inhibidores de la recaptación de serotonina.

INTRODUCTION: The addition of typical and atypical antipsychotics in patients with obsessive-compulsive disorder (OCD) resistant to serotonin reuptake inhibitors (SRI) has been reported as a useful augmentation strategy. Although antipsychotic monotherapy has been associated with ineffectiveness and even increase of psychotic symptoms (especially in psychotic patients), antipsychotics as concomitant medications have proven to be effective in several case series and pilot clinical trials. The objective of this case series was to evaluate effectiveness of risperidone as add on therapy to current SRIs treatment in OCD refractory to treatment patients. MATERIAL AND METHOD: Risperidone add on therapy in moderate and severe treatment resistant OCD patients was reviewed. Case reports were patients fulfilling the following criteria: a) treatment follow-up of at least 12 weeks; b) SRI adequate doses, y c) Y-BOCS score higher than 16 score before starting treatment. A three month follow-up period was reviewed. Risperidone starting dose was low (mean 1.5 mg/day) and was increased following clinical criteria. Therapeutic response and tolerability were evalated with the following scales: Y-BOCS, CGI of change, UKU (neurological subscale) and spontaneous reported adverse events. Response criteria were the following: at least 35% of reduction in Y-BOCS from basal score and final score less than 16 and CGI-C "much improved" or "very much improved" (score 1 or 2). Intention to treat analysis was performed (patients who reported at least one risperidone dose and effectiveness measure). RESULTS: 31 patients had at least one effectiveness evaluation and 21/31 patients (67.8 %) were considered treatment responders. Mean risperidone dose was 3.8 mg/day. In general, risperidone was well tolerated: serious or unexpected adverse event were not reported. CONCLUSION: Risperidone as add on therapy to SRI in moderate-severe, refractory to treatment OCD patients, may be an effective and safe strategy.