Determinación de la calidad de imágenes clínicas de proyecciones postero anterior y lateral de tórax / Determination of clinical image quality of posteroanterior and lateral chest images

RESUMEN Los estudios radiológicos son fundamentales en el diagnóstico y tratamiento de diversas patologías. Su calidad depende de múltiples variables, entre las que destacan, los parámetros de adquisición, interpretación, entre otros. Se propone una metodología estandarizada, sencilla, de fácil interpretación, permitiendo la evaluación regular de la calidad de las imágenes, dando indicios de la propiedad del trabajo en el centro de salud y poder realizar comparaciones entre centros y autores, a partir de los criterios anatómicos establecidos por la Unión Europea, definiendo el parámetro de calidad de la imagen (CI), representadas en una escala de Likert para el análisis de frecuencia, demostrando que puede ser una herramienta de utilidad para la evaluación reiterada de los centros de radiología. Evaluando 140 proyecciones postero anterior y 85 laterales de tórax, con una muestra de 225 estudios, realizados en un centro de salud, ubicado en la ciudad de Mérida, República Bolivariana de Venezuela, escogiendo estas proyecciones, ya que, representan el 32% de los estudios de radiología convencional. Permitiendo la comparación entre proyecciones y autores, obteniéndose para la proyección postero anterior un CI de 5,07 ± 1,53 criterios de los ocho establecidos, normalizado un CI de 0,62 ± 0,19; las imágenes excelentes solo representan el 22,78%. Comparado con un CI de 4,91 ± 1,17 criterios de los seis establecidos, normalizado un CI de 0,82 ± 0,19, e imágenes excelentes en un 64,71% para la proyección lateral. Se observa las notorias diferencias entre la calidad de las imágenes clínicas en hombres y mujeres para ambas proyecciones

ABSTRACT Radiological studies are essential in the diagnosis and treatment of various pathologies. Their quality depends on multiple variables, among which the acquisition and interpretation parameters, among others, stand out. A standardized methodology is proposed, simple, of easy interpretation, allowing the regular evaluation of the quality of the images, giving indications of the property of the work in the health center and being able to make comparisons between centers and authors, from the anatomical criteria established by the European Union, defining the parameter of image quality (IQ), represented on a Likert scale for frequency analysis, demonstrating that it can be a useful tool for the repeated evaluation of radiology centers. Evaluating 140 postero anterior and 85 lateral projections of the thorax, with a sample of 225 studies, performed in a health center, located in the city of Merida, Bolivarian Republic of Venezuela, taking these projections, since they represent 32% of the conventional radiology studies. Allowing the comparison between projections and authors, obtaining for the postero anterior projection an IQ of 5.07 ± 1.53 criteria of the eight established, normalized an IQ of 0.62 ± 0.19; the excellent images only represent 22.78%. Compared with an IQ of 4.91 ± 1.17 criteria of the six established, normalized IQ of 0.82 ± 0.19, and excellent images in 64.71% for the lateral projection. It is observed the notorious differences between the quality of clinical images in men and women for both projections

Frailty and Risk of Falls in Community-Dwelling Older Adults Living in a Rural Setting. The Atahualpa Project.

BACKGROUND: Data supporting a link between frailty and risk of falls is mostly confined to individuals living in urban centers, where risk factors and lifestyles are different from that of rural settings. OBJECTIVE: To assess the association between frailty and risk of falls in older adults living in rural Ecuador. DESIGN: Population-based cross-sectional study. PARTICIPANTS: Community-dwellers aged ≥60 years living in a rural Ecuadorian village, in whom frail status and risk of falls were assessed. MEASUREMENTS: Frailty was evaluated by the Edmonton Frailty Scale (EFS) and risk of falls by the Downton Fall Risk Index (DFRI). Multivariate models were fitted to evaluate whether frailty was associated with risk of falls (dependent variable), after adjusting for demographics, alcohol intake, cardiovascular risk factors, sleep quality, symptoms of depression, and history of an overt stroke. Correlation coefficients were constructed to assess confounders modifying this association. RESULTS: A total of 324 participants (mean age: 70.5±8 years) were included. The mean EFS score was 4.4±2.5 points, with 180 (56%) participants classified as robust, 76 (23%) as pre-frail and 68 (21%) as frail. The DFRI was positive in 87 (27%) participants. In univariate analysis, the EFS score was higher among participants with a positive DFRI (p<0.001). The number of frail individuals was higher (p<0.001), while that of robust individuals was lower (p<0.001) among those with a positive DFRI. Adjusted logistic regression models showed no association between frailty and the DFRI. Correlation coefficients showed that age, high glucose levels, and history of an overt stroke tempered the association between frailty and the risk of falls found in univariate analyses. CONCLUSIONS: Frailty is not independently associated with risk of falls in older adults living in a remote rural setting. Further studies are needed to assess the impact of frailty on the risk of falls in these populations.

Calcium intake improvement after nutritional intervention in paediatric patients with osteogenesis imperfecta.

BACKGROUND: In several bone disorders, adequate calcium intake is a coadjuvant intervention to regular treatment. Osteogenesis imperfecta (OI) is a collagen disorder with a range of symptoms, ranging from fractures to minimum trauma, and it is typically treated with bisphosphonates. In the present study, we evaluate the impact of a nutritional intervention (NI) on dietary calcium intake and bone mineral density (BMD) in paediatric patients with OI. METHODS: A nonrandomised clinical trial was designed with a NI. Dietary calcium intake, anthropometry and clinical features were assessed at baseline, including anthropometry, basal metabolic rate (BMR), BMD. In addition, a food guidance form was developed and sent to patients by mail. After 12 months, clinical features of patients were reassessed and compared with the baseline data. RESULTS: Fifty-two children and adolescents were enrolled. Significant increases in total calcium intake (mg day-1 ), percentage of adequate calcium intake (%) and number of cups of milk ingested were observed after NI. We detected a positive correlation between the variation of BMD and milk consumption in patients treated with bisphosphonate. CONCLUSIONS: We observed an increase in calcium intake in patients with OI. This finding demonstrates the importance of nutrition therapy as part of a multidisciplinary treatment approach for bone health.

Estimación de la huella hídrica asociada al proceso de beneficio bovino de la cadena cárnica en los frigoríficos Vijagual y Jongovito (Colombia) / Estimation of the water footprint associated with the bovine benefit process of the network of meat in the Vijagual and Jongovito meat plant (Colombia)

RESUMEN La huella hídrica es un indicador de la apropiación de los recursos de agua dulce y aporta una valiosa información sobre el impacto ambiental que ocasiona un bien o servicio. Por ello, es interesante conocer el consumo de agua y los niveles de contaminación detrás de todo proceso productivo. El objetivo de este estudio fue dar una primera aproximación a la estimación de la huella hídrica en el proceso de beneficio bovino en el Frigorífico Vijagual S.A.S. de la ciudad de Bucaramanga y en el Frigorífico Jongovito S.A de la ciudad de San Juan de Pasto. Para el cálculo de la huella hídrica azul se hizo necesario conocer el volumen de agua empleada en el proceso y el del agua que retorna a la fuente hídrica después de su tratamiento. Para el cálculo de la huella hídrica gris se tomó como indicador la carga contaminante de materia orgánica expresada en DQO, por ser el parámetro de mayor concentración. La huella hídrica verde no se determinó por no tratarse de un proceso agroforestal. Para el Frigorífico Vijagual se obtuvo como resultado una huella hídrica total de 2.583l/res, mientras que para el Frigorífico Jongovito se obtuvo una huella hídrica de 1.358 l/res. Si bien es cierto estos valores son inferiores a datos nacionales e internacionales, en términos de sostenibilidad es muy importante disminuir el consumo de agua, mejorar cada vez más los sistemas de tratamiento y realizar un esfuerzo en concienciar respecto al uso responsable del agua a sus operarios, en beneficio de las generaciones presentes y futuras.

ABSTRACT The water footprint is an indicator of the appropriation of freshwater resources that contributes a valuable information on the environmental impact caused by a good and/or service. Therefore, it is interesting to know the water consumption and the pollution behind all productive processes. The objective of this study was to give a first approximation to the accounting of the water footprint in the process of bovine benefit in the Vijagual S.A.S. meat procesing plant in Bucaramanga city and the Jongovito S.A. meat plant in San Juan de Pasto City. To calculate the blue water footprint it was necessary to know the volume of water used in the process and the water that returns to the water source after its treatment. For the calculation of the gray water footprint, the pollutant load of organic matter expressed in DQO was taken as indicator, since it is the parameter with the highest concentration. The green water footprint was not determined because it was not an agroforestry process. As a result, the Vijagual meat plant the water footprint is 2.583 l/bovine, while the Jongovito meat plant the water footprint of 1.358 l/bovine was obteined. Altough it is true that these values are lower than national and international data, in terms of sustainability, it is very important to reduce water consumption, improve treatment systems more and more, and make an effort to raise awareness about the responsible use of water by its operators, for the benefit of present and future generations.

Pyrogallol Induces Apoptosis in Human Platelets.

Pyrogallol is a polyphenol that generates the superoxide anion. In this study, we investigated the influence of pyrogallol on human platelets. Our data showed that exposure of platelets to pyrogallol induced numerous manifestations of apoptosis including depolarization of mitochondrial inner membrane and release of cytochrome c from the mitochondria. Pyrogallol also induced downstream extra-mitochondrial apoptotic responses, including activation of caspase-3 and phosphatidylserine exposure on the outer leaflet of the plasma membrane. Addition of glutathione significantly rescued cells from pyrogallol- induced apoptosis, as evidenced by a decrease of all markers of apoptosis. Thus, pyrogallol appears to produce depletion of intracellular glutathione content in platelets, the main non-protein antioxidant in the cells. Furthermore, inhibition of γ-glutamyl transpeptidase, an enzyme that plays the main role in the cellular supply of glutathione, reverted the glutathione (GSH) protection over platelet apoptosis. Our results indicate that pyrogallol induces apoptosis by suppressing the natural anti-oxidation in human platelets.

Aporte calórico y macronutrimental de los menús infantiles de la comida rápida y convencional / Caloric and macronutrient contribution of the children's menu of fast and conventional food

The caloric and macronutrient contribution of the children's menu in fast food restaurants and conventional restaurants was analyzed, according to mealtimes and recommended intakes for children between 4 and 8 years old in a city in the Northeastern of Mexico with the highest childhood obesity rate in the world. This is an observational, descriptive and transversal study. The sampling was by convenience and directed when typical cases of children's menus were selected from 152 restaurants. The range of carbohydrates contribution of the children's menu varied from 53.8% to 97.9% of the recommendation; in any case the protein contribution was less than 82.2%. With regard to fats, contribution ranges were from 63% to 165.3%. These contributions increase considerably when they are analyzed by mealtimes: from 97.8% to 373.4%. In conclusion, fast food and conventional restaurants offer unhealthy meals in big portions to child population.

Se analizó el aporte calórico y de macronutrientes de me-nús infantiles en restaurantes de comida rápida y restaurantes convencionales según tiempos de comidas e ingesta recomendada para niños de 4 a 8 años en una ciudad del noreste mexicano que presenta una prevalencia de obesidad infantil de las más altas del mundo. Es un estudio observacional, descriptivo y transversal. El muestreo fue por conveniencia y dirigido al ser seleccionados casos típicos de menús infantiles de cadenas de restaurantes de mayor presencia (152 establecimientos). Los resultados muestran que el rango de aporte de hidratos de carbono varió del 53,8% a 97,9% de la recomendación; el aporte de proteína no fue menor al 82,2%; el aporte de lípidos fue de 63.0% a 165,3%. Estos aportes aumentan considerablemente al analizarlos por tiempos de comida: de 97,8% a 373,4%. Se concluye que tanto los restaurantes de comida rápida como los restaurantes convencionales ofrecen a la población infantil alimentos y porciones poco saludables.

Envelope molecular-orbital theory of extended systems. I. Electronic states of organic quasilinear nanoheterostructures.

A conceptually appealing and computationally economical course-grained molecular-orbital (MO) theory for extended quasilinear molecular heterostructures is presented. The formalism, which is based on a straightforward adaptation, by including explicitly the vacuum, of the envelope-function approximation widely employed in solid-state physics leads to a mapping of the three-dimensional single-particle eigenvalue equations into simple one-dimensional hole and electron Schrödinger-like equations with piecewise-constant effective potentials and masses. The eigenfunctions of these equations are envelope MO's in which the short-wavelength oscillations present in the full MO's, associated with the atomistic details of the molecular potential, are smoothed out automatically. The approach is illustrated by calculating the envelope MO's of high-lying occupied and low-lying virtual π states in prototypical nanometric heterostructures constituted by oligomers of polyacetylene and polydiacetylene. Comparison with atomistic electronic-structure calculations reveals that the envelope-MO energies agree very well with the energies of the π MO's and that the envelope MO's describe precisely the long-wavelength variations of the π MO's. This envelope MO theory, which is generalizable to extended systems of any dimensionality, is seen to provide a useful tool for the qualitative interpretation and quantitative prediction of the single-particle quantum states in mesoscopic molecular structures and the design of nanometric molecular devices with tailored energy levels and wavefunctions.

Green liquor dregs effect on Kraft mill secondary sludge composting.

Increased Kraft pulp mill production generates increased solid wastes. In response, composting has emerged as an interesting alternative for disposal of these solid wastes. A central composite factor design was used to investigate the influence of incubation conditions (dregs addition and operation time) on chemical and biological parameters, determining the best in-vessel conditions in order to develop a correct composting design. Dregs helped reduce the pH drop that occurs at the beginning of the process. Biological activities presented high values during the active phase, followed by a decrease with stable final values along with N-NH(4)(+) and N-NO(3)(-) trend, which were indicative of mature compost. Dregs addition had not significant effect on the biological activities during composting of Kraft mill sludge. However, moderate amounts of dregs (between 5% and 8%) at operation time of 60-70 days would be the best compromise.

Efficient removal of hexavalent chromium by a tolerant Streptomyces sp. affected by the toxic effect of metal exposure.

AIMS: To isolate and analyse chromium-resistant micro-organisms suitable for bioremediation. METHODS AND RESULTS: Strain CG252, with a minimal inhibitory concentration of 500 microg ml(-1), was isolated from contaminated soils and identified as a Streptomyces sp. by 16S rDNA sequence analysis. Assays carried out at various Cr(VI) concentrations indicated that chromium removal was more efficient at lower concentrations and that this activity resulted in accumulation of Cr(III). Atomic adsorption analysis indicated that the chromium removed was not associated with cell mass and activity assays showed that the capacity to reduce Cr(VI) was most probably due to a soluble cytosolic enzyme. Cells grown as biofilms showed enhanced removal of Cr(VI) with respect to planktonic cells, while analysis of growth and colony morphology indicated that Cr(VI) had a toxic effect on this strain. CONCLUSIONS: Streptomyces sp. CG252 tolerated heavy metals and elevated levels of chromium, despite its negative effect on growth and development, and was efficient at removing Cr(VI) by promoting reduction to Cr(III). SIGNIFICANCE AND IMPACT OF THE STUDY: Strain CG252's capacity to tolerate heavy metals and to reduce Cr(VI) to the less toxic Cr(III), especially when forming biofilms, makes it a promising candidate for detoxification of sites containing this heavy metal.

Using a second-order polynomial model to determine the optimum dregs/bark ratio for industrial-biosolid composting: the initial conditioning stage.

Increasing pulp industry production has generated additional solid waste (i.e. biological sludge, dregs, etc.) and therefore an increasing disposal problem. On the other hand, composting is emerging as an interesting alternative for the disposal of residues. The objective of this study was to evaluate the physical and chemical properties of sludge, dregs and bark and the effect on their initial conditioning stage prior to composting, using pine chips as bulking agent. After their characterization, these solid wastes were combined in different mixture proportions defined by a 32 experimental design based on the response surface methodology (RSM), in which 18 observations were required for the independent variables (dregs and bark) and the C: N ratio, moisture content and pH were the dependent variables. The characterization indicated that the dregs have alkaline properties with the presence of some essential plant nutrients, such as phosphorous (0.37%), potassium (0.76%), magnesium (1.4%) and calcium (27%). The combination of the macronutrients (phosphorous: 0.39%, potassium: 0.24%, calcium: 1.7%, magnesium: 0.44%) and micronutrients such as ferrous material (0.47%) and zinc (0.12%) found in the sludge suggest a promising alternative despite the potential problem due to the high pH of the dregs. The RSM design indicated a feasible region that satisfied the optimal dregs: bark ratio of 0.25 without exceeding the addition of 12.5% dregs, due to the alkaline properties of these inorganic wastes and the quadratic influence over the C:N ratio. The experimental results indicated that the composting process of dregs, bark and sludge is technically suitable, although the use of a rapidly available C source needs to be evaluated.

Estudio epidemiológico del cáncer cutáneo en el Hospital Dr. Sótero del Río (1992-2000) / Epidemiologic study of the skin cancer in the Dr. Sótero del Río Hospital (1992-2000)

Durante la última década se ha registrado un incremento de la incidencia de cáncer cutáneo a nivel mundial. Un estudio previo de cuatro hospitales de Santiago, Chile mostró un aumento en las tasas de incidencia de cáncer cutáneo. En este estudio, analizamos los datos de otro nosocomio de Santiago, Hospital Dr. Sótero del Río, durante el período 1992-2000. Se revisaron 107.788 informes histopatológicos. La población asignada a este hospital es variable, 1.056.465 habitantes en 1992 y 1.347.210 habitantes en el año 2000. Un total de 833 tumores cutáneos fueron registrados: 564 Carcinomas Basocelulares (CBC), 180 Carcinomas Espinocelulares (CEC) y 89 melanomas Malignos (MM). La mayoría de los casos eran mujeres y mayores de 60 años. MM se ubicaba principalmente en el pie en los varones; en cambio, en la mujer, la principal localización de MM fue en las piernas. CBC se presentó más frecuentemente en la zona medio facial. CEC fue principalmente localizado en la zona genital en mujeres y en la zona mediofacial en varones. 45,6 por ciento de los MM eran índice de Breslow III y IV. Un aumento significativo en las tasas de incidencia de cáncer cutáneo se observa a partir del año 1996. El alto porcentaje de CEC en zona genital en mujeres y el alto porcentaje de MM invasivos obtenidos en este estudio, nos muestran una población de alto riesgo. Futuras campañas deberían realizarse en relación a mejorar el diagnóstico precoz del MM y también destinadas a disminuir los factores de riesgo asociados a CEC genital.

[Efficacy of quadruple therapy in the eradication of Helicobacter pylori and prevention of recurrent duodenal ulcer]. / Eficacia de la terapia cuádruple en la erradicación del Helicobacter pylori y la prevención de la úlcera duodenal recidivante.

OBJECTIVE: We studied during a 12-months follow-up the effect of the eradication of Helicobacter pylori (Hp) on the recurrence of duodenal ulcer (DU). BACKGROUND: The eradication of Hp from the gastric mucosa has been the objective of numerous therapeutic trials for preventing DU recurrence; however, an optimal treatment has not yet been established. METHODS: 51 patients with Hp infection and active DU confirmed by endoscopy were randomized in two groups. All patients received ranitidine 300 mg daily for eight weeks. Group A (26 patients) received a 5 day course of amoxycillin 500 mg t.i.d., metronidazole 500 mg t.i.d., and furoxone 100 mg t.i.d., during the 3rd week. After ranitidine treatment, none patient of this group received further treatment. Group B (25 patients) received 150 mg of ranitidine daily during 12 months. Endoscopy was performed at the end of the first eight weeks of the ranitidine treatment as well as at the 6th and 12th month of follow-up or sooner if symptoms recurred. Two biopsies were taken from gastric antrum at each endoscopy examination for Hp detection with Giemsa and hematoxylin/eosine stains. Each patient gave informed consent and this trial was approved by the regional Ethics Committee. Statistical analysis was performed using chi 2 test. RESULTS: After eight weeks of ranitidine treatment, the ulcer of all patients from both groups was healed. The percentage of Hp eradication was 92% (24/26 pt) in group A and none in group B (p < 0.001). Recurrence of Hp infection occurred in 9/24 patients (37.5%) during a 12 months follow-up (group A) and of these, one patient had recurrence of DU. In contrast, all 25 patients of group B were persistently Hp positive and 7 developed recurrent DU (p < 0.05). Both treatments were well tolerated. CONCLUSIONS: The combined therapy with amoxycillin, metronidazole, furoxone and ranitidine is highly effective in both Hp eradication and prevention of DU recurrence.

El médico y la industria farmacéutica

El médico ecuatoriano desconoce la realidad en que se desenvuelve la industria farmaceútica, en nustro país. En los últimos años, ha existido una gran preocupación en cuanto a las normas de información farmacéutica, en relación con la promoción de medicamentos. Incluyendo la intervención de los representantes farmacéuticos o visitadores a médicos.

Neuroradiology and clinical aspects of Usher syndrome.

We describe the neurological evaluation and MRI analysis of 30 patients, belonging to 16 families with Usher syndrome (US) type I and type II (US1 and US2). In addition to the classic visual and audiological abnormalities seen in these patients, we observed abnormal gait in 88.9% of US1 and in 66.7% of US2 patients and abnormal coordination in 33.4% of US1, and in 58.3% of US2. Borderline mental retardation, depression or bipolar affective disorder were observed in 16.7% of US1 and 33.3% of US2 patients. MRI analysis showed cerebellar abnormalities in 50% of US1 and 75% of US2 patients, but no clear correlation was observed between structural abnormalities and clinical findings. A pattern for the MRI classification of US patients is suggested.

Hemorragia intestinal por strongyloides s

Se presenta el caso de un hombre joven que acudió en febrero de 1992 al hospital Eugenio Espejo con un cuadro de sangrado digestivo alto, Fallecido 48 horas después por choque hipovolemico. La autopsia realizada demostró la presencia de una úlcera activa en la 3ra. porción del duodeno, en cuyo nicho se evidencia la luz de un vaso sanguíneo. Además en el proyecto del intestino delgado se observó la presencia de numerosos pseudo-tumores inflamatorios y la presencia de un pólipo inflamatorio. El Estudio microscópico demostró la presencia de numerosas larvas rabditiformes de stronglydes stercolaris, penetrando incluso la pared de los vasos. Siendo este un hallazgo patológico inusual, a pesar de la endemicidad de las enfermedades parasitarias en nuestro medio, se recomienda que en el diagnóstico diferencial de sangrado digestivo se incluya también esta helmintiasis.

Cutaneous pythiosis in horses from Brazil.

Equine pythiosis was studied in five animals from two farms located in a swampy region of southern Brazil (Rio Grande do Sul State). Granulomatous lesions exuding necrotic material and containing a central yellow and firm tissue core, the 'kunker', were observed on the top of the nose of one horse, on the abdomen of two horses and on the hind limbs of two other animals. Direct microscopic preparations, histopathological examination of lesion material, and macroscopic and microscopic characteristics of the isolates confirmed the diagnosis of pythiosis. Surgical intervention of the inflammatory processes, intravenous potassium iodide and topical application of copper sulphate were used without success.