Tratamiento de las cefaleas en sala de emergencia pediatrica / Headache treatment in the pediatric emergency depart ment

Resumen Introducción : Las cefaleas son la segunda causa de consultas neurológicas en la sala de emergencia pediá trica. Muchos pacientes realizan varias visitas al año por este mismo problema, debemos conocer el tratamiento basado en evidencia. Métodos : Se realizó una búsqueda de publicaciones realizadas en los últimos 5 años en diferentes bases de datos. Discusión : Se presentan recursos para investigar sistemáticamente signos de alarma, recomendaciones para el uso racional de estudio de imágenes. Las cefaleas primarias son causa frecuente de consulta en la sala de emergencia. Se presenta tratamiento que cumple el res paldo científico para su utilización en pacientes con ce faleas primarias de tipo migraña en sala de emergencia.

Abstract Introduction : Headache is the second most frequent cause of neurological consultations in the pediatric emergency department. Patients become frequent visi tors per year due to headaches, evidence-based treat ment should be used. Methods : A search of publications within the last 5 years was conducted in different databases. Discussion : Strategies for a systematic approach in the evaluation of red flags, and recommendations for a rational use in neuroimaging studies are presented. Primary headaches are frequently seen in the emergency department. Migraine evidence-based treatment in the emergency department is reviewed.

[Headache treatment in the pediatric emergency department]. / Tratamiento de las cefaleas en sala de emergencia pediátrica.

INTRODUCTION: Headache is the second most frequent cause of neurological consultations in the pediatric emergency department. Patients become frequent visitors per year due to headaches, evidence-based treatment should be used. METHODS: A search of publications within the last 5 years was conducted in different databases. DISCUSSION: Strategies for a systematic approach in the evaluation of red flags, and recommendations for a rational use in neuroimaging studies are presented. Primary headaches are frequently seen in the emergency department. Migraine evidence-based treatment in the emergency department is reviewed.

Introducción: Las cefaleas son la segunda causa de consultas neurológicas en la sala de emergencia pediátrica. Muchos pacientes realizan varias visitas al año por este mismo problema, debemos conocer el tratamiento basado en evidencia. Métodos: Se realizó una búsqueda de publicaciones realizadas en los últimos 5 años en diferentes bases de datos. Discusión: Se presentan recursos para investigar sistemáticamente signos de alarma, recomendaciones para el uso racional de estudio de imágenes. Las cefaleas primarias son causa frecuente de consulta en la sala de emergencia. Se presenta tratamiento que cumple el respaldo científico para su utilización en pacientes con cefaleas primarias de tipo migraña en sala de emergencia. Palabras clave: signos de alarma, migraña, tratamiento basado en evidencia, Sala de emergencia pediátrica.

Effect of Processed Volcanic Ash as Active Mineral Addition for Cement Manufacture.

In the last quarter of 2021, there was a very significant eruption of the Cumbre Vieja volcano on the island of La Palma, belonging to the Canary Islands, Spain. It generated a large amount of pyroclastic volcanic materials, which must be studied for their possible applicability. This work studies the properties and applicability of the lava and volcanic ash generated in this process. The need for reconstruction of the areas of the island that suffered from this environmental catastrophe is considered in this study from the point of view of the valuation of the waste generated. For this purpose, the possibility of using the fine fraction of ashes and lava as a supplementary cement material (SCM) in the manufacture of cement is investigated. The volcanic material showed a chemical composition and atomic structure suitable for replacing clinker in the manufacture of Portland cement. In this study, the cementing and pozzolanic reaction characteristics of unprocessed volcanic materials and those processed by crushing procedures are analysed. To evaluate the cementitious potential by analysing the mechanical behaviour, a comparison with other types of mineral additions (fly ash, silica fume, and limestone filler) commonly used in cement manufacture or previously studied was carried out. The results of this study show that volcanic materials are feasible to be used in the manufacture of cement, with up to a 22% increase in pozzolanicity from 28 to 90 days, showing the high potential as a long-term supplementary cementitious material in cement manufacturing, though it is necessary to carry out crushing processes that improve their pozzolanic behaviour.

Dietary Supplementation with Agave tequilana (Weber Var. Blue) Stem Powder Improves the Performance and Intestinal Integrity of Broiler Rabbits.

This study evaluated the effect of Agave tequilana (Weber var. azul) stem powder on the growth performance and the intestinal integrity in rabbits. A total of 120 male rabbits [New Zealand × California] were weaned for 35 days and randomized into four dietary treatments, 15 replicates per treatment, and two rabbits per replicate. The treatments consisted of a basal diet (T0) and dietary supplementation with 0.5% (T1), 1.0% (T2) and 1.5% (T3) of Agave tequilana stem powder. The T3 treatment improved the body weight and average daily gain (p < 0.05) compared to the other groups, without affecting viability and feed conversion ratio (p > 0.05). Furthermore, the T3 treatment enhanced (p < 0.05) the thickness of the muscular and mucous layers, and the height, thickness, and number of villi in the duodenum (p < 0.05). However, this treatment (T3) significantly decreased (p < 0.05) values for the area and depth of the crypts in the duodenum and the villus/crypt ratio. Likewise, in the cecum, T3 treatment provoked a marked decrease (p < 0.05) in the depth and thickness of the crypts. The results indicate that the dietary use with 1.5% of A. tequilana stem powder had a natural growth-promoting effect and enhanced the histomorphometry of the concentric layers (muscle and mucosa), villi, and crypts as indicators of intestinal health in rabbits.

Pediatric Medication-overuse Headache and Global Headache Research. A Systematic Review.

Medication-overuse headache (MOH) is a relevant topic of interest but pediatric studies are scarce. Some authors have expressed their opinion regarding geographical differences in the perceived importance of adult MOH between European and North American research. To determine if there is a geographic difference in the research efforts on pediatric MOH; and to study pediatric MOH prevalence of published studies. An analysis of the Global Burden of Disease database focusing on Headache disorders prevalence per region was correlated with the region where research was conducted via PubMed search on pediatric MOH from 2006-2021. Analysis of databases from PubMed, HINARI, and ScienceDirect found 13 studies that fulfilled inclusion criteria to evaluate pediatric MOH prevalence. 6 regions were analyzed North America, Latin America, Europe, Asia, Africa, Oceania. Regions with higher prevalence of headache disorders were North America (28.45%) and Europe (28.54%).  Most pediatric MOH publications were from North America (44.2%) and Europe (37.2%). The prevalence found of pediatric MOH among pediatric headache patients is 4-11%. Prevalence increases to 20-70% among patients having a diagnosis of chronic headache. Higher prevalence was found in patients suffering post traumatic headaches. The perceived importance for pediatric MOH is similar between North America and Europe based on the research published. The prevalence varies greatly between published studies. Relationship between Post-traumatic headache and pediatric MOH prevalence should be further studied.

Correction: The Impact of COVID-19 Management Policies Tailored to Airborne SARS-CoV-2 Transmission: Policy Analysis.

[This corrects the article DOI: 10.2196/20699.].

The Impact of COVID-19 Management Policies Tailored to Airborne SARS-CoV-2 Transmission: Policy Analysis.

BACKGROUND: Daily new COVID-19 cases from January to April 2020 demonstrate varying patterns of SARS-CoV-2 transmission across different geographical regions. Constant infection rates were observed in some countries, whereas China and South Korea had a very low number of daily new cases. In fact, China and South Korea successfully and quickly flattened their COVID-19 curve. To understand why this was the case, this paper investigated possible aerosol-forming patterns in the atmosphere and their relationship to the policy measures adopted by select countries. OBJECTIVE: The main research objective was to compare the outcomes of policies adopted by countries between January and April 2020. Policies included physical distancing measures that in some cases were associated with mask use and city disinfection. We investigated whether the type of social distancing framework adopted by some countries (ie, without mask use and city disinfection) led to the continual dissemination of SARS-CoV-2 (daily new cases) in the community during the study period. METHODS: We examined the policies used as a preventive framework for virus community transmission in some countries and compared them to the policies adopted by China and South Korea. Countries that used a policy of social distancing by 1-2 m were divided into two groups. The first group consisted of countries that implemented social distancing (1-2 m) only, and the second comprised China and South Korea, which implemented distancing with additional transmission/isolation measures using masks and city disinfection. Global daily case maps from Johns Hopkins University were used to provide time-series data for the analysis. RESULTS: The results showed that virus transmission was reduced due to policies affecting SARS-CoV-2 propagation over time. Remarkably, China and South Korea obtained substantially better results than other countries at the beginning of the epidemic due to their adoption of social distancing (1-2 m) with the additional use of masks and sanitization (city disinfection). These measures proved to be effective due to the atmosphere carrier potential of SARS-CoV-2 transmission. CONCLUSIONS: Our findings confirm that social distancing by 1-2 m with mask use and city disinfection yields positive outcomes. These strategies should be incorporated into prevention and control policies and be adopted both globally and by individuals as a method to fight the COVID-19 pandemic.

Chemical composition of Schinus areira essential oil and antimicrobial action against Staphylococcus aureus.

The antimicrobial activities of plant extracts have formed the basis of many alternative medicines. In this context, the genus Schinus L. (Anacardiaceae), exhibits many traditional uses in medicine. However, a few studies on the antimicrobial properties of Schinus areira essential oils were conducted. The essential oil from S. areira leaves from Santiago del Estero was obtained by hydrodistillation and twenty-eight compounds were identified using CG-MS-EI spectrometry. The sesquiterpenoid alcohol 1-epi-cadinol was the major compound, followed by δ-cadinene, alloaromadendrene, ß-pinene, ß-caryophyllene, and γ-cadinene. The essential oil obtained exhibited antimicrobial activity against Staphylococcus aureus, showing a bacteriostatic activity at 64 µg/mL and bacteriolytic activity at 256 µg/mL; in contrast, non antibacterial effect was observed in Escherichia coli in the assayed conditions. The antibacterial activity was accompanied by significant changes in Zeta potential on the S. aureus surface. The data obtained suggest that the essential oil of S.areira leaves presents potential use in pharmaceutical industries.

Reactivation of Chagas disease after autologous hematopoietic stem cell transplantation

Abstract Chagas disease (CD) is a protozoan zoonosis caused by Trypanosoma cruzi. Reactivation of CD occurs via drug-induced immunosuppression before and during transplantation. Here, we report the case of a 62-year-old man diagnosed with classic Hodgkin lymphoma who received highly aggressive conditioning chemotherapy before undergoing stem cell transplantation (SCT). The patient tested positive for CD in pre-transplantation evaluation. The patient exhibited persistent fever and elevated C-reactive protein levels before and after SCT, and was treated with antibiotics. Micro-Strout test showed evidence of trypomastigotes and he was treated with benznidazole until tested negative. Post-transplantation seropositive patients should be screened for possible reactivation.

Reactivation of Chagas disease after autologous hematopoietic stem cell transplantation.

Chagas disease (CD) is a protozoan zoonosis caused by Trypanosoma cruzi. Reactivation of CD occurs via drug-induced immunosuppression before and during transplantation. Here, we report the case of a 62-year-old man diagnosed with classic Hodgkin lymphoma who received highly aggressive conditioning chemotherapy before undergoing stem cell transplantation (SCT). The patient tested positive for CD in pre-transplantation evaluation. The patient exhibited persistent fever and elevated C-reactive protein levels before and after SCT, and was treated with antibiotics. Micro-Strout test showed evidence of trypomastigotes and he was treated with benznidazole until tested negative. Post-transplantation seropositive patients should be screened for possible reactivation.

The Effects of Agave fourcroydes Powder as a Dietary Supplement on Growth Performance, Gut Morphology, Concentration of IgG, and Hematology Parameters in Broiler Rabbits.

This study was conducted to determine the effects of Agave fourcroydes powder as a dietary supplement on the growth performance, gut morphology, serum concentration of IgG, and the hematology parameters of broiler rabbits. A total of 32 rabbits [New Zealand × Californian] were weaned at 35 days. They were randomly selected for two dietary treatments (eight repetitions per treatment), which consisted of a basal diet and a basal diet supplemented with 1.5% dried-stem powder of A. fourcroydes. On day 60 from the initiation of treatment, gut histomorphology (duodenum and cecum), serum concentration of IgG, and hematology parameters were all measured. The results showed that A. fourcroydes powder supplementation improved (P < 0.05) the ADFI, ADG, and final BW. Correspondingly, this treatment increased (P < 0.05) the muscle and mucosa thickness and height and width of villi. However, duodenum crypts depth was lower (P < 0.05) when rabbits were fed with this natural product, compared with the basal diet treatment. Results also indicated that the A. fourcroydes powder increased (P < 0.05) the serum concentration of IgG but did not change the hematology parameters. This data indicates that A. fourcroydes powder, as a supplement, had beneficial effects on increasing the growth performance and serum concentration of IgG, as well as improving the gut morphology without affecting the hematology parameters in broiler rabbits.

Validación estructural del wong-law emotional intelligence scale (wleis): estudio preliminar en adultos / Structural validation of the wong-law emotional intelligence scale (wleis): preliminary study in adults

La medición de la inteligencia emocional ha tenido muchas propuestas en formato de autorreporte. Una de estas es el Wong-Law Emotional Intelligence Scale (WLEIS), creada para el contexto laboral y que evalúa valoración y expresión de las emociones propias, valoración y reconocimiento de las emociones en otros, regulación de las propias emociones y uso de la emoción para facilitar el desempeño. Hay poca evidencia psicométrica sobre el Wong-Law Emotional Intelligence Scale en habla hispana, lo que posiblemente conduce a que sea también poco utilizado en la investigación y práctica profesional. El objetivo del presente estudio es presentar los primeros resultados de la validez de la estructura interna del WLEIS en adultos peruanos. Fueron 120 participantes (72 mujeres) entre 17 y 59 años, quienes respondieron al cuestionario mediados por internet. Se analizó la estructura interna mediante metodología de ecuaciones estructurales. Se halló una satisfactoria estructura de 4 factores y elevadas cargas factoriales de los ítems; las correlaciones interfactores fueron altas o moderadamente altas; y la consistencia interna fue buena. Se concluye que los primeros resultados son aceptables para asumir que el modelo de Wong-Law también es aparentemente generalizable.

The measurement of emotional intelligence has had many proposals in the form of self-report. One of these is the Wong-Law Emotional Intelligence Scale (WLEIS), created for the job context and which evaluates valuation and the expression of self-emotions; valuation and recognition of emotions in others; regulation of oneÆs own emotions and the use of emotion to facilitate performance. There is little psychometric evidence regarding the Wong-Law Emotional Intelligence Scale in the Spanish speaking world, which could lead to it also being little used in research and professional practice. The objective of this study is to present the first results of the internal structure validity of the WLEIS in Peruvian adults. There were 120 participants (72 women) between 17 and 59 years old who responded to the questionnaire mediated by the internet. The internal structure was analyzed using structural equations methodology. A satisfactory structure of 4 factors and high factorial loads of items was found. The inter-factorial correlations were high or moderately high û and the internal consistency was good. It is concluded that the first results are acceptable û to assume that the Wong-Law model is also apparently generalizable.

Goma sifilítica intracraneal en un paciente adolescente VIH seronegativo: reporte de un caso / Intracranial syphilitic gummain an HIV negative adolescent patient: a case report

La sífilis es una enfermedad sistémica causada por la espiroqueta Treponema pallidum que compromete al sistema nervioso central en cualquier etapa y cuyas presentaciones clínicas se modificaron en las últimas décadas. Se presenta el caso de un varón de 16 años con antecedentes de conducta sexual de riesgo y sífilis hace 3 años, sin recibir tratamiento. Acude por cefalea y disminución de visión hace 4 meses. Evaluación inicial objetiva hemianopsia homónima derecha, edema papilar bilateral y retinopatía exudativa izquierda. Pruebas serológicas de sífilis reactivas, VIH: no reactivo. Resonancia magnética de encéfalo: proceso expansivo en lóbulo occipital izquierdo captador de contraste. Recibió tratamiento para sífilis por 3 días y por sospecha inicial de proceso neoproliferativo se realizó biopsia que evidenció proceso granulomatosocrónico sifilítico. En su reingreso, mostró mayor compromiso de agudeza y defecto del campo visual. Potenciales evocados visuales: ausente en ambos ojos. Se inició Penicilina G sódica por 4 semanas (por evidencia de mejoría imagenológica) asociado a corticoides, encontrando disminución serológica y discreta mejoría clínica al término del tratamiento. La neurosífilis gomatosa esuna presentación infrecuente de la sífilis terciaria debiéndose considerar como diagnóstico diferencial en lesiones expansivas intracraneales en individuos VIHseronegativos con serología de sífilis reactiva.

Syphilis is a systemic disease caused by the spirochete Treponema pallidum which can compromise the central nervous system at any stage and whose clinical presentations have been modified in recent decades. Were port the case of a 16 years old male with a 3-years history of sexual risk behavior and syphilis with no treatment who experienced headache and decreased vision for four months. Initial assessment showed right homonymous hemianopia, bilateral papilledema and left exudative retinopathy. Serological tests for syphilis: reactive HIV: non-reactive. Brain MRI revealed a single irregularly enhancing lesion in the left occipital lobe. He received treatment for syphilis for three days, and stereotactic biopsies were performed by the initial suspicion of brain tumour. Histological examination showed a chronic granulomatous consistent with neurosyphilis. In his read mission, greater affectation of acuity and visual field defect was evident. Visual evoked potentials: absent in both eyes. Penicillin G sodium was initiated for 4weeks (for evidence of improvement imagenological)associated with corticosteroids, showing serological and discrete clinical improvement at the end of treatment decreased. The gummatous neurosyphilisis a rare form of tertiary syphilis which ever considered as differential expansive intracranial lesions in HIV-seronegative individuals with reactive syphilis serology.

Consenso sobre diagnóstico y tratamiento de Leucemia Mieloide Crónica En Colombia / Consensus on diagnosis and treatment of chronic Myeloid Leukemia in Colombia

Objetivo: Unificar criterios para organizar el diagnóstico de la Leucemia Mieloide Crónica (LMC) y racionalizar el uso de nuevos medicamentos para su tratamiento. Métodos: se realizó una búsqueda estructurada de la literatura médica en la base de datos Medline en el Registro de Estudios Clínicos (CCTR) de la Biblioteca Cochrane y EMBSE, usando la plataforma OVID. Todoso los artículos fueron revisados por un comité central y los resultados fueron validados por hematólogos, oncólogos y otros especialistas en una reunión de consenso. Resultados: Se generaron 11 recomedaciones sobre diagnóstico (criterios definitorios), tratamiento (fase crónica, fase acelerada, crisis molecular, evolución clonal, etc), y seguimiento según fase y tratamiento base (remisión hematológica, respuesta citogenética, respuesta molecular, evolución clonal, etc). Conclusiones. los esquemas de tratamiento disponibles permiten mejorar la supervivencia y calidad de vida de los pacientes. Todo paiente con LMC requiere confirmación histológica y citogenética de su enfermedad. El inicio temprano del tratamiento con inhibidores de la tirosina-quinasa y el seguimiento estricto de las respuestas hematológica, citogenética y molecular permitirán adecuar o modificar la terapia de manera oportuna en pacientes resistentes primarios o secundarios.

Síndrome de Hoffmann: manifestación inicial del hipotiroidismo / Hoffmann's syndrome: inicial manifestation of hypothyroidism

Introducción: El síndrome de Hoffmann es definido como la combinación de hipotiroidismo con miopatía, rigidez, calambres e hipertrofia muscular. Dicha forma de miopatía tiroidea es rara y generalmente acompaña a los pacientes con hipotiroidismo severo y de larga evolución. Caso clínico: Paciente que ingresa por calambres, debilidad muscular generalizada a predominio proximal y aumento de las masas musculares en miembros inferiores, con síntomas y signos sugestivos de hipotiroidismo que fueron confirmados por estudios hormonales de T3,T4,TSH y la miopatía por estudios enzimáticos del tejido muscular y biopsia muscular. La Electromiografía fue normal. Conclusión: Comunicamos un caso de síndrome de Hoffmann por ser la manifestación inicial de hipotiroidismo y de rara presentación.

Introduction: Hoffmann´s syndrome has been described as a combination of hypothyroidism and muscular stiffness, cramps and muscular hypertrophy. This form of thyroid myopathy is rare, and generally occurs in patients with a long history of severe hypothyroidism. Clinical case: a patient is admitted to the hospital complaining of muscular cramps and weakness, and experiencing an increase of muscular mass predominantly in the lower extremities, with symptoms and signs suggestive of hypothyroidism documented by T3, T4 and TSH levels. Enzyme muscular tissue assays support the diagnosis of myopathy. Electromyographic findings were unremarkable. Conclusion: We report a case of Hoffmann´s syndrome as the initial hypothyroidism presentation of for being a rare presentation of the condition.

Leucemia mieloide crónica en crisis: blástica bases moleculares y diagnóstico / Chronic myelogenous leukemia in blastic crisis: molecular basis and diagnostic

La leucemia mieloide crónica es una enfermedad con comportamiento bifásico o trifásico, 90 por ciento de los pacientes debuta en fase crónica, 50 por ciento asintomáticos al diagnóstico. Un porcentaje con enfermedad crónica desarrollan en tiempo variable una enfermedad más agresiva definida por un período intermedio y crisis blástica. Se diagnostica al encontrar más del 20 por ciento de blastos en médula ósea, 30 por ciento en sangre periférica o enfermedad extramedular. El pronóstico es pobre, al lograr respuesta completa, con una mediana de sobrevida de 3-12 meses, independiente del fenotipo. El 50 por ciento de los pacientes tendrán una mieloide, 25 por ciento linfoide y 25 por ciento fenotipo indiferenciado. Un grupo de expertos clínicos de Bogotá, Colombia, revisaron la mejor evidencia sobre diagnóstico y tratamiento. La información se obtuvo de búsquedas estructuradas y varios registros de experimentos clínicos en curso. Presentamos conclusiones y recomendaciones para la toma de decisiones basadas en la mejor evidencia.

Leucemia mieloide crónica en crisis blástica: bases moleculares y diagnóstico (Parte I) / Chronic myelogenous leukemia in blastic phase: molecular bases and diagnosis (Part I)

La leucemia mieloide crónica es una enfermedad de comportamiento bifásico o trifásico, en la que cerca del 90 porciento de los pacientes comienzan en fase crónica y el 50 porciento de ellos serán asintomáticos al momento del diagnóstico. Un porcentaje de los sujetos con enfermedad crónica desarrollan, en un periodo variable, una enfermedad más agresiva, definida por un periodo intermedio o fase acelerada y por un estado avanzado o crisis blástica (CB). La CB se diagnostica al encontrar más del 20 porciento de blastos en la médula ósea y más del 30porciento en la sangre periférica o enfermedad extramedular. En la actualidad, el pronóstico de los pacientes con CB es pobre y depende especialmente de lograr una respuesta completa, con una mediana de supervivencia entre los tres y los doce meses, independientemente del fenotipo de la enfermedad. Aproximadamente, el 50porciento de los pacientes tendrán una CB mieloide; el 25porciento, linfoide, y el 25porciento, un fenotipo indiferenciado. Un grupo de expertos conformado por hematólogos, oncólogos y epidemiólogos clínicos de Bogotá D. C., Colombia, se encargó de revisar y seleccionar la mejor evidencia sobre el diagnóstico y tratamiento de la CB. La información se obtuvo a partir de búsquedas estructuradas realizadas en MedLine, Embase, Cochrane, Biosis, Cinhal, Lilacs y varios registros de experimentos clínicos en curso. Este documento presenta las principales conclusiones y recomendaciones para mejorar los principales desenlaces de la CB, al permitir la toma de decisiones basadas en la mejor evidencia, que promoverá el uso racional de los recursos en salud.

Chronic myeloid leukemia has traditionally been characterized by a biphasic or triphasic course. 85% to 90% of patients are diagnosed in the chronic phase, which is asymptomatic in up to 50%. A varying percentage of patients in chronic phase develop a more aggressive disease, frequently passing through an intermediate or accelerated phase, and finally evolving to an acute leukemia like blastic phase (BP). BP is characterized by extramedullary disease or by the presence ofblasts more than 20% in the bone marrow or more than 30% in the peripheral blood. An expert panel of hematologists, oncologists and clinical epidemiologists of Bogota-Colombia reviewed selected literature related with BP of chronic myeloid leukemia obtained from advanced searches in Medline, Embase, Cochrane, Biosis, Cinhal, Lilacs, and from in course clinical trials databases. The following document presents the main conclusions and some recommendations to improve outcomes of BP, to assist practitioners to apply the best available evidence, and to promote an accountable use of health care resources.

Leucemia mieloide crónica en crisis blástica: perspectiva terapéutica según la evidencia (Parte II) / Chronic myelogenous leukemia in blastic phase: therapeutic perspective according to clinical evidence (Part II)

En la actualidad, el pronóstico de los pacientes con crisis blástica (CB) es pobre y depende, especialmente, de lograr una respuesta completa, con una mediana de supervivencia entre los tres y los doce meses, independientemente del fenotipo de la enfermedad. Hasta el momento, no existe un tratamiento estándar para la CB, que habitualmente manifiesta un curso similar al de las leucemias agudas quimiorresistentes; las aproximaciones más recientes han mostrado que el uso de regímenes similares a los empleados en el manejo de las leucemias agudas asociados al imatinib permiten mejorar las tasas de supervivencia global y libres de progresión de la enfermedad. No obstante, los pacientes con esta condición deberán ser considerados candidatos para estudios experimentales. A pesar de que la posibilidad de lograr respuesta completa es baja, la población que logra llegar a ella deberá consolidarse con trasplante alogénico de médula ósea. Un grupo de expertos conformado por hematólogos, oncólogos y epidemiólogos clínicos de Bogotá D. C., Colombia, se encargó de revisar y seleccionar la mejor evidencia sobre el diagnóstico y tratamiento de la CB. La información se obtuvo a partir de búsquedas estructuradas realizadas en MedLine, Embase, Cochrane, Biosis, Cinhal, Lilacs y de varios registros de experimentos clínicos en curso. Este documento presenta las principales conclusiones y algunas recomendaciones para mejorar los principales desenlaces de la CB, y permitir así la toma de decisio- nes basadas en la mejor evidencia, que promoverá el uso racional de los recursos en salud.

Chronic myelogenous leukemia traditionally has been characterized by a biphasic or triphasic course. Blastic phase overall prognosis is poor, with a median survival of 3 to 12 months. Approximately 50% of patients have a myeloid phenotype, 25% have a lymphoid phenotype, and 25% have an undifferentiated phenotype. There is currently no standard treatment for the blastic phase of chronic myeloid leukemia, which is a chemoresistant form of acute leukemia. Current approaches include using standard acute myeloid leukemia regimens associated with imatinib in an effort to induce remission, variations of these approaches with drugs that seem more active in this specific leukemia, and the direct entry of patients into studies of investigational agents. Although the likelihood of achieving remission is small, immediate bone marrow transplantation in remission should be considered because it provides the only opportunity for long-term survival at this time. An expert panel of hematologists, oncologists and clinical epidemiologists of Bogotá, D.C., Colombia reviewed selected literature related with BP of chronic myeloid leukemia obtained from advanced searches of medial literature in MedLine, Embase, Cochrane, Biosis, Cinhal, Lilacs and from several in course clinical trials databases. The following document present the principal conclusions and some recommendations to improve outcomes of BP, to assist practitioners to apply the best available research evidence to clinical decisions, and to promote responsible use of health care resources.

The schistosomiasis problem in the Philippines: a review.

A descriptive study was carried on the schistosomiasis problem in the Philippines from the time the disease was discovered in 1906 to the latter part of the 1990 s. Some research findings were reviewed including the nature of the disease itself. Based on the thrust of the control program which is centered mainly on selective mass treatment and progressed to disease stratification and mass treatment using praziquantel, a downward trend in the prevalence of the disease was observed-from an average of 10.4% in 1981-1985 to 4.1% in 1996. Recommended prospective action, among others, include the development of strategies on environmental sanitation and snail control/eradication in the thrust of the schistosomiasis control program. Other policy related concerns should be formulated subject to the results of further research activities such as on (a) chemotherapy; (b) drug delivery schemes; (c) diagnosis; (d) search for a safe, economical and effective chemical(s) for vector control; and (e) prophylaxis and vaccine production for protection against infection for disease modulation or reduction of pathology.