Efficient removal of metal ions from aqueous solutions using MoS2 functionalized chitosan Schiff base incorporated with Fe3O4 nanoparticle.

In the present work a novel pyrazole based chitosan Schiff base material was prepared using 5-azido-3-methyl-1-phenyl-1H-pyrazole-4-carbaldehyde and functionalized using Fe3O4-MoS2, where the nanoparticles get embedded within the gel matrix. The composite material was characterized using various techniques such as XRD, SEM, FTIR, EDS and TGA. The adsorbent material was analysed for the adsorptive take up process from the aqueous solutions of metal ion concentration ranging 20-100 mgL-1. The maximum adsorption capacity obtained for the material was 200.00 and 125.00 mg/g for Cr(VI) and Cu(II) respectively. Adsorptive mechanism was found to have pseudo second order kinetics and the adsorption isotherm followed Langmuir adsorption model following the monolayer adsorptive process. Further the evaluated thermodynamic parameter showed the adsorption process to be spontaneous and endothermic in nature. Reusability of the composite material was achieved using suitable stripping solutions.

Comparison of open gastrectomy and the laparoscopic procedure in advanced gastric cancer. / Comparación de gastrectomía abierta frente a laparoscópica en cáncer gástrico avanzado.

INTRODUCTION AND AIM: Gastric cancer is one of the most frequent neoplasias in Peru and worldwide, with surgery as the only potentially curative or palliative treatment. Laparoscopic gastrectomy is the most frequent alternative surgical technique utilized, but one of its main drawbacks is the technical difficulty involved in perigastric lymphadenectomy. The aim of the present study was to evaluate the clinical and surgical characteristics, postoperative complications, and survival rate in patients with advanced gastric cancer that underwent open gastrectomy or laparoscopic gastrectomy at the Hospital Nacional P.N.P "Luis N. Sáenz" in Lima, Peru, within the time frame of 2005 to 2014. MATERIALS AND METHODS: An analytic, longitudinal, retrospective cohort study was conducted on 482 patients that underwent surgery for gastric cancer, within the time frame of January 2005 to December 2014. The clinical, epidemiologic, and postoperative characteristics were evaluated, and a survival analysis was carried out. RESULTS: Of the 475 patients included in the study, 236 underwent open gastrectomy and 239 had laparoscopic gastrectomy. Median follow-up time was 61.9 months in the open surgery group and 46.7 months in the laparoscopy group. There were fewer postoperative complications in the laparoscopy group and no statistically significant difference between the two groups in relation to the survival analysis. CONCLUSIONS: In our study, laparoscopic gastrectomy resulted in fewer postoperative complications, compared with the open procedure, but did not modify overall survival during the follow-up period.

Detección de las dudas y necesidades formativas de los médicos de familia en un centro de salud / Detecting doubts and training needs of family doctors of a health centre

OBJETIVO: Detectar las dudas y las necesidades formativas de los médicos de familia de un centro de salud urbano y docente durante la práctica clínica habitual. MATERIAL Y MÉTODOS: Estudio descriptivo transversal de un mes de duración en un centro de salud urbano de Madrid. Los médicos de familia del equipo fueron entrevistados tras la consulta sobre las dudas que habían tenido, eligiendo dos de ellas. Las dudas no resueltas en las dos semanas siguientes se agruparon por materias y según las taxonomías vigentes. Posteriormente se elaboró un programa docente para resolverlas. RESULTADOS: Participaron 19 de los 21 médicos del centro, y en el periodo de estudio atendieron a 10.678 pacientes. Se detectaron 0,44 dudas por cada 10 pacientes atendidos. De las 384 dudas elegidas, el 83,34% fueron clínicas y el 16,66%, no clínicas. El 51,2% de estas quedaron sin resolver en los 15días tras la consulta. Los métodos para su resolución fueron las bases científicas de internet (PubMed, UpToDate y guías de práctica clínica, principalmente; 38%), seguido de la consulta a otros colegas (34,9%). CONCLUSIONES: La mayoría de las dudas generadas durante la consulta son clínicas, aunque existe una carga importante de preguntas burocráticas. Más de la mitad de las dudas no se resuelven durante la consulta ni en los 15días posteriores. Las bases de datos científicas en internet son la principal fuente de información, seguida de la consulta a otros colegas. Deberían mejorar los tiempos por paciente y el acceso a fuentes de información fiables y ágiles, para mejorar estos aspectos

OBJECTIVE: To detect doubts and training needs in an urban health and family doctor training centre during the usual practice. MATERIAL AND METHODS: A cross-sectional descriptive study was conducted for one month in an urban health centre in Madrid. Family doctors were interviewed after their daily clinics about the doubts they had identified, choosing two of them. Unresolved questions were grouped by subject and according to the current taxonomies. A teaching program was then developed to tackle them. RESULTS: Out of a total 21 physicians of the centre, 19 attended 10,678 patients during the period. The doubt detection rate was 0.44 doubts for every 10 patients attended. Of the 384 questions chosen, 83.34% were clinical and 16.66% were non-clinical. Just over half (51.2%) of these were still unresolved 15days later the consultation event. The main methods for their resolution were using the scientific bases on the internet (mainly PubMed, UpToDate and Clinical Practice Guidelines; 38%), followed by consultation with other colleagues (34.9%). CONCLUSIONS: Most of the doubts generated during clinics were clinical, although there is a significant burden of bureaucratic questions. More than half of the doubts are not resolved during the consultation or within the following 15days. The scientific databases on the internet are the main sources of information, although consulting other colleagues was often used as well. Additional time for dealing with patients and enhanced access to solve complex questions should be available to improve the success rate

[Detecting doubts and training needs of family doctors of a health centre]. / Detección de las dudas y necesidades formativas de los médicos de familia en un centro de salud.

OBJECTIVE: To detect doubts and training needs in an urban health and family doctor training centre during the usual practice. MATERIAL AND METHODS: A cross-sectional descriptive study was conducted for one month in an urban health centre in Madrid. Family doctors were interviewed after their daily clinics about the doubts they had identified, choosing two of them. Unresolved questions were grouped by subject and according to the current taxonomies. A teaching program was then developed to tackle them. RESULTS: Out of a total 21 physicians of the centre, 19 attended 10,678 patients during the period. The doubt detection rate was 0.44 doubts for every 10 patients attended. Of the 384 questions chosen, 83.34% were clinical and 16.66% were non-clinical. Just over half (51.2%) of these were still unresolved 15days later the consultation event. The main methods for their resolution were using the scientific bases on the internet (mainly PubMed, UpToDate and Clinical Practice Guidelines; 38%), followed by consultation with other colleagues (34.9%). CONCLUSIONS: Most of the doubts generated during clinics were clinical, although there is a significant burden of bureaucratic questions. More than half of the doubts are not resolved during the consultation or within the following 15days. The scientific databases on the internet are the main sources of information, although consulting other colleagues was often used as well. Additional time for dealing with patients and enhanced access to solve complex questions should be available to improve the success rate.

Bilateral agenesis of the internal carotid artery associated with basilar artery aneurysm treated via the endovascular route. A case report.

Bilateral agenesis of the internal carotid artery is a rare anomaly of embryonic development frequently associated with intracranial aneurysm. We describe a case involving an aneurysm that burst in the third middle of the basilar artery and exhibited a bilateral agenesis of the internal carotid artery. The aneurysm was treated via an endovascular route using detachable coils.

Spontaneous treatment discontinuation in panic disorder patients treated with antidepressants.

OBJECTIVE: We examined the relationships between long-term treatment response, side-effects and drug discontinuation in panic disorder (PD)-agoraphobia. METHOD: A total of 326 patients were naturalistically treated with antidepressants and followed for a period of 3 years. All patients were evaluated by means of the Panic Disorder/Agoraphobia Interview and the Longitudinal Interview Follow-up Examination (LIFE-UP). RESULTS: A total of 179 patients interrupted pharmacological treatment. Among them, 26.8% were not traceable; 36.9% had deemed further contact with the psychiatrist unnecessary because of remission. Other reasons for interruption were: ineffectiveness (18.4%), side-effects (10.6%) and personal reasons (7.3%). Patients who interrupted pharmacological treatment because of symptom remission remained in the study for a longer period than those patients who interrupted their treatment because of inefficacy. CONCLUSION: In the long-term treatment of PD with antidepressants, a high percentage of patients who have achieved symptom remission tend to default from further treatment; adherence to long-term treatment with antidepressants was predicted by severe and long-lasting symptomatology.

Bipolar II and unipolar comorbidity in 153 outpatients with social phobia.

Previous studies on social phobia (SP) have focused largely on comorbidity between SP and major depression. Less attention has been devoted to the comorbidity between SP and bipolar disorder. In this retrospective study, we investigated family history, lifetime comorbidity, and demographic and clinical characteristics among 153 outpatients who met DSM-III-R diagnostic criteria for SP. Information regarding axis I diagnoses was obtained using the Structured Clinical Interview for DSM III-R (SCID-UP-R). Social phobic symptoms and the severity of the illness were assessed by the Liebowitz Social Anxiety Scale (LSAS) and the Liebowitz Social Phobic Disorders Rating Scale, Severity (LSPDRS). Patients completed the Hopkins Symptom Checklist (HSCL 90). Fourteen patients (9.1%) satisfied DSM-III-R criteria for lifetime bipolar disorder not otherwise specified (NOS) (bipolar II), while 71 (46.4%) had unipolar major depression and 68 (44.4%) had no lifetime history of major mood disorders. Comorbid panic disorder/agoraphobia (PDA), obsessive-compulsive disorder (OCD), and alcohol abuse were reported more frequently in the bipolar group than in the other two subgroups. Unipolar patients showed higher rates of comordid PDA and OCD compared with SP patients without mood disorders. Severity and generalization of the SP symptoms, prevalent interactional anxiety, multiple comorbidity, and alcohol abuse appeared to be the most relevant consequences of SP-bipolar coexistence. In a significant minority of cases, protracted social anxiety may hypothetically have represented, along with inhibited depression, the dimensional opposite of gregarious hypomania.

Paroxetine in child and adolescent outpatients with panic disorder.

Paroxetine has repeatedly been shown to be effective in the treatment of panic disorder (PD) in adults, and, according to previous case observations, it may be useful in treating children and adolescents with PD as well. This preliminary naturalistic study examines effectiveness and safety of paroxetine in the treatment of children and adolescents with PD. A chart review was conducted on 18 patients with Diagnostic and Statistical Manual of Mental Disorders PD admitted to the Division of Child Neurology and Psychiatry and to the Department of Psychiatry at the University of Pisa. Paroxetine was given at an initial mean dosage of 8.9 +/- 2.1 mg/day and was gradually increased up to 40 mg/day, depending on clinical response and side effects. Clinical status was assessed with the Clinical Global Impression (CGI) and adverse effects were assessed retrospectively at each visit. Patients with final CGI-Improvement scores of 1 or 2 were considered responders. Mean paroxetine treatment duration was 11.7 +/- 8.3 months, with a mean final dosage of 23.9 +/- 9.8 mg/day (range, 10-40 mg/day). No patient had to interrupt the treatment because of side effects. Fifteen patients (83.3%) were considered responders. The mean change on the CGI-Severity scale was statistically significant (p < 0.0001). Paroxetine was well tolerated and effective in the treatment of PD in these children and adolescents.

Is mood-incongruent manic psychosis a distinct subtype?

BACKGROUND: Despite several research reports on incongruent psychotic features in mania, whether such features define a distinct disorder is unsettled. METHOD: One hundred and fifty-five inpatients with mania according to DSM-III-R were systematically evaluated in order to collect demographic and clinical information. The symptomatological evaluation was conducted by means of the Comprehensive Psychopathological Rating Scale (CPRS) and the Scale for the Assessment of Positive Symptoms (SAPS). The presence/absence of incongruent psychotic symptoms at the index episode defined two subgroups of patients, whose familial, symptomatological, clinical and course characteristics were compared. RESULTS: Eighty-six (55.5%) patients presented mood-incongruent psychotic features (MIP+). When this group was compared with the remainder of manic patients without such features (MIP-), we found substantial similarities in most demographic, familial and clinical characteristics. Despite these fundamental similarities, 4% of MIP+ vs 0% of MIP- had family history for schizophrenia (p < 0.05). We also observed a longer duration of the current episode, a higher percentage of chronic course, more suicide attempts and hospitalisations in MIP+. Moreover, other than psychotic symptoms, MIP+ showed more frequently depressive features and hostility. They also reported higher scores in social disability, especially in family and social settings. CONCLUSION: Although our findings suggest that incongruent psychotic features in the main do not distinguish two separate entities--and can be considered as hallmarks of overall severity of mania--in a small minority of cases such features appear linked to familial schizophrenia. The numerous overlapping clinical characteristics in MIP+ and MIP- raise questions about the general nosographic utility of this categorisation.

The contrasting influence of depressive and hyperthymic temperaments on psychometrically derived manic subtypes.

The present investigation focused on symptomatological subtypes of mania and their relationships with affective temperaments and other clinical features of bipolar disorder. In 153 inpatients with mania diagnosed according to DSM-III-R, symptomatological subtypes have been investigated by means of principal component factor analysis of 18 selected items of the Comprehensive Psychopathological Rating Scale (CPRS). We compared other clinical features, depressive and hyperthymic temperamental attributes, and first degree-family history for mood disorders among the various manic subtypes on the basis of the highest z-scores obtained on each CPRS factor (dominant CPRS factor groups). Five factors--Depressive, Irritable-Agitated, Euphoric-Grandiose, Accelerated-Sleepless, Paranoid-Anxious--emerged, accounting for 59.8% of the total variance. When the factor-based groups were compared, significant differences emerged in terms of the duration of the current episodes, rates of chronicity and incongruent psychotic features--being highest in the 'Depressive' and 'Paranoid-Anxious' dominant groups. The patients with highest z-scores for the 'Euphoric-Grandiose', 'Paranoid-Anxious' and 'Accelerated-Sleepless' factors were those most likely to belong to the hyperthymic temperament, while the 'Depressive' dominant group had the highest rate of depressive temperament. Finally, it is noteworthy that the 'Irritable-Agitated' group was high for both temperaments. The foregoing multidimensional structure of mania--revealing five factors--is generally concordant with the emerging literature. Consistently with our original hypothesis, a hyperthymic temperament seems to underlie the most extreme manic excitement with euphoric-accelerated-paranoid phenomenology. By contrast, the depressive temperament seemed to mute the expression of mania into a depressive-manic phenomenology.

A prospective naturalistic study of 326 panic-agoraphobic patients treated with antidepressants.

OBJECTIVE: How far the results of randomized controlled studies apply to everyday care cannot be judged without regular measurements of outcomes in daily practice. We report on systematic data from a 3-year naturalistic prospective study on panic disorder-agoraphobic (PDA) patients treated with antidepressants in a setting of routine clinical practice. Our aim is to describe the evolution of PDA in relation to the treatments employed, and to explore demographic and clinical characteristics that might be predictive of outcome. METHODS: 326 DSM-III-R PDA patients treated with antidepressants in a setting of routine clinical practice were included in a 3-year naturalistic prospective study. We utilized structured and semi-structures instruments, including the Structured Clinical Interview for Diagnosis and the Longitudinal Interview Follow-up Examination. The main antidepressants used were imipramine (39%), clomipramine (28.5%) and paroxetine (23.3%); only 9% of patients received other antidepressants. RESULTS: 147 patients (45.1%) stayed on medication throughout the entire period of the follow-up. Of those who interrupted the treatment, 38% stayed in remission. The probability of achieving at least one remission during the 3-year follow-up period was 96.5% for PD and 95.9% for Agoraphobia. Relapses after a period of at least 2 months of complete remission were also common, and the probability of presenting at least one relapse during the 3-years follow-up period was 67.1% for PD and 39% for Agoraphobia. The longest period of remission of PD is associated with low severity, medium-lasting course in patients with an onset of the illness in young adulthood. Less severe agoraphobia associated with moderately severe panic attacks appears to confer a better control of phobic behavior. All three major drugs were reasonably well tolerated (only 9% dropped out because of side effects), with sexual dysfunction and increased appetite being the most common side effects at the last evaluation; in the first phase of the treatment anticholinergic effects and jitteriness were more common with TCAs. CONCLUSION: Both classical antidepressants and paroxetine emerge as a useful treatment in the long-term management of PDA; paroxetine appears particularly useful in PDA patients because it was significantly less likely to induce jitteriness, thereby reducing barriers to compliance.

Hypochondriasis and illness phobia in panic-agoraphobic patients.

In a sample of 131 patients with panic disorder, we explored both the presence of DSM-III-R criteria for hypochondriasis and the occurrence of illness phobia before the onset of panic disorder. To explore further the possible relationship between hypochondriacal features and panic-agoraphobic syndrome, we compared patients both with and without current hypochondriasis and then patients both with and without illness phobia before the onset of panic disorder. Finally, we investigated the relationship between premorbid phobic-anxious traits and hypochondriasis during panic disorder. No differences were found between patients with and without hypochondriasis, either in terms of clinical features or in the course of panic disorder. Patients with illness phobia before the onset of panic disorder reported higher levels of anticipatory anxiety in nonagoraphobic situations and more depersonalization and derealization during panic attacks, and they met our definition of phobic-anxious temperament more frequently than the rest of the sample. This would suggest that illness phobia before the onset of panic disorder may be viewed either as a separate disorder, a prodrome, or a mild, early-onset form of panic disorder without full-blown attacks. Although patients with premorbid illness phobia are more likely to develop hypochondriasis after the onset of panic disorder, approximately 40% of them do not; therefore, illness phobia should not be considered the only factor that influences the development of hypochondriasis during panic disorder.

Uso de stents intracoronarios sin anticoagulantes. Experiencia del Hospital Español de México / The use of intracoronary stens without anticoagulation. experience at the Hospital Español de Mexico

De diciembre de 1994 a diciembre de 1995, se implantaron 58 stents en 43 pacientes (36 hombres). La indicación fue: retracción 1, reestenosis 3, disección 8, fase aguda del infarto 13 y de novo 33. Todos los pacientes recibieron ticlopidina, aspirina y diltiazem antes del procedimiento, heparina y nitroglicerina intracoronaria durante el procedimiento, y aspirina y ticlopidina durante las 6 semanas siguientes. Se utilizaron balones de material no distensible a 14-16 atmósferas para la colocación del stent. Se mantuvo una relación balón/arteria de 1:1. El sitio de implante fue: 29 en la descendente anterior, 17 en la coronaria derecha, 7 en la circunfleja y 5 en puentes de safena. El procedimiento tuvo éxito en 40/43 (93 por ciento) pacientes. Se presentó una oclusión aguda, que fue operada oportunamente, y otra que se solucionó con una nueva dilatación a mayor presión. Hubo un deceso y no hubo ningún caso de oclusión subaguda. Durante el seguimiento, promedio de 140 días, sólo 2 pacientes con revascularización incompleta tienen angina, 27 tienen prueba de esfuerzo negativa y en 14 no se practicó; no hay ningún caso de muerte o infarto. El implante de stents en arterias coronarias mayores de 3.0 mm con balones de alta presión y sin el uso de anticoagulantes orales, representa un método efectivo y seguro, con mínima presencia de complicaciones agudas y alto porcentaje de éxito

Division nuclear y presencia de microtubulos en la diferenciacion de Entamoeba invadens. / Nuclear division and presence of microtubules in the differentiation invadens

El curso de la division nuclear, asi como el tiempo en el que ocurren las divisiones nucleares durante la diferenciacion de Entamoeba invadens IP-1 fueron estudiados a traves de microscopia optica y microscopia electronica. Las divisiones nucleares ocurrieron entre las 28 y 32 h de iniciado el enquistamiento, alcanzando una maxima proporcion de aproximadamente 50 por ciento a las 30 horas.Durante la division nuclear es carecteristica la presencia de una estructura central densa que desaparecee antes de la metafase y alrededor de la cual se inicia la condensacion de cromatina. Los cromosomas, atipicos en relacion a los de eucariotes superiores, son evidentes particularmente durante la anafase. Condensaciones de cromatina asociadas a la membrana nuclear no participan en la formacion de cromosomas y la membrana nuclear permanece intacta durante todo el proceso de division nuclear. Existe la formacion de un huso intranuclear formado por microtubulos de aproximadamente 240 A de diametro. No fueron detectados centriolos

[Cellular behavior of axenic amebas cultured in the presence of different carbohydrates]. / Comportamiento celular de amibas axénicas cultivadas en presencia de diferentes carbohidratos.

Carbohydrates are an essential requirement of the culture medium in many cells. Axenic cultures of amebas require a concentration of 0.5 to 1.0 per cent glucose. The purpose of this work is to demonstrate possible differences on the carbohydrates requirements between pathogenic and nonpathogenic amebas strains. The experimental work was done in two phases: a) observation of the cultures growing at different concentrations of glucose in TP-S-1 medium (0, 0.25, 0.50, 1.0 and 2.0 g/100 ml), and b) the substitution of glucose by other carbohydrates: D-fructose; D-galactose; D-manitol, maltose, lactose, sucrose and soluble starch. Four axenic strains were used: Entamoeba histolytica HM-2:IMSS and HK-9:NIH; E. invadens PZ and E. moshkovskii FIC. Enumeration of cultured protozoa was determinated with the aid of an hemacytometer. The results obtained indicate no difference between pathogenic strains (HM-2, HK-9 and PZ), at the concentrations of glucose in the medium (0.5 g/100 ml), however FIC strain (unique non-pathogenic strain tested), had the highest growth when 0.25 per cent glucose was used. All strains supported without any significant difference in growth, the substitution of glucose by maltose and starch.