Epidemiología y fisiopatología de la COVID-19 / Epidemiology and physiopathology of COVID-19

Desde 2002, tras la epidemia de síndrome respiratorio agudo grave (SARS), expertos virólogos y epidemiólogos han alertado durante años de la posibilidad de una pandemia. En diciembre de 2019 se produjo un brote epidémico por un nuevo coronavirus, el SARS-CoV-2, que, a fecha de 2 de noviembre de 2020, ha causado 46.597.299 casos de infección en el mundo y 1.201.162 muertes. España es el segundo país con mayor incidencia de la Unión Europea, con 530,7 casos por 100.000 habitantes, con una tasa de letalidad del 4,5%. El SARS-CoV-2 es un virus de cadena simple de ácido ribonucleico de sentido positivo compactada en forma helicoidal por la proteína N, con una envoltura proteica donde destaca la proteína S, responsable de la entrada del virus en el citoplasma celular a través de la enzima conversora de la angiotensina 2. La actual revisión pretende realizar un resumen de los datos claves de la enfermedad que conocemos hasta este momento

Since 2002, after the Severe acute respiratory syndrome (SARS) epidemic, virologists and epidemiologists have warned for years of the possibility of a pandemic. In December 2019, there was an epidemic outbreak caused by a new coronavirus, SARS-CoV-2, which has caused 46,597,299 cases worldwide and 1,202,162 deaths. Spain is the second country with the highest incidence in the European Union with 530,7 cases per 100,000 inhabitants, with a fatality rate of 4,5%. SARS-CoV-2 is a positive-sense ribonucleic acid single chain virus helically compacted by protein N. Protein S is part of the envelope and responsible for the entry of the virus into the cell cytoplasm through the angiotensin converting enzyme 2. The current review is intended to summarize the key data of the disease that we know so far

Degradation of a series of fluorinated acrylates and methacrylates initiated by OH radicals at different temperatures.

Rate coefficients for the gas-phase reactions of OH radicals with a series of fluorinated acrylates and methacrylates: 2,2,2-trifluoroethylmethacrylate (k 1), 1,1,1,3,3,3-hexafluoroisopropylacrylate (k 2), 1,1,1,3,3,3-hexafluoroisopropylmethacrylate (k 3), and 2,2,2-trifluoroethylacrylate (k 4) have been measured for the first time as a function of temperature in the range 290-308 K. The kinetic data obtained were used to derive the following Arrhenius expressions (in units of cm3 per molecule per s): k 1 = (2.13 ± 0.68) × 10-18 exp[(4745 ± 206)/T], k 2 = (8.72 ± 0.68) × 10-15 exp[(2166 ± 205)/T], k 3 = (6.30 ± 0.51) × 10-17 exp[(3721 ± 153)/T] and k 4 = (3.93 ± 0.43) × 10-16 exp[(3140 ± 129)/T]. The experiments were performed at normal atmospheric pressure in synthetic air using a 1080 L photoreactor and coupled with FTIR analysis to monitor the decay of the substances of interest and the reference compounds. The obtained negative temperature dependencies are in agreement with a mechanism implying an initial addition of the OH radical to the double bond. Atmospheric implications are discussed with reference to the rate coefficients obtained as a function of the temperature.

20 años en enfermedad pulmonar obstructiva crónica (EPOC) / 20 years in chronic pulmonary obstructive disease (COPD)

No disponible

Impact Evaluation of Malaria Control Interventions on Morbidity and All-Cause Child Mortality in Rwanda, 2000-2010.

The impressive decline in child mortality that occurred in Rwanda from 1996-2000 to 2006-2010 coincided with a period of rapid increase of malaria control interventions such as indoor residual spraying (IRS); insecticide-treated net (ITN) distribution and use, and improved malaria case management. The impact of these interventions was examined through ecological correlation analysis, and robust decomposition analysis of contextual factors on all-cause child mortality. Child mortality fell 61% during the evaluation period and prevalence of severe anemia in children 6-23 months declined 71% between 2005 and 2010. These changes in malaria morbidity and mortality occurred concurrently with a substantial increase in vector control activities. ITN use increased among children under five, from 4% to 70%. The IRS program began in 2007 and covered 1.3 million people in the highest burden districts by 2010. At the same time, diagnosis and treatment with an effective antimalarial expanded nationally, and included making services available to children under the age of 5 at the community level. The percentage of children under 5 who sought care for a fever increased from 26% in 2000 to 48% in 2010. Multivariable models of the change in child mortality between 2000 and 2010 using nationally representative data reveal the importance of increasing ITN ownership in explaining the observed mortality declines. Taken as a whole, the evidence supports the conclusion that malaria control interventions contributed to the observed decline in child mortality in Rwanda from 2000 to 2010, even in a context of improving socioeconomic, maternal, and child health conditions.

Malaria Control Interventions Contributed to Declines in Malaria Parasitemia, Severe Anemia, and All-Cause Mortality in Children Less Than 5 Years of Age in Malawi, 2000-2010.

Malaria control intervention coverage increased nationwide in Malawi during 2000-2010. Trends in intervention coverage were assessed against trends in malaria parasite prevalence, severe anemia (hemoglobin < 8 g/dL), and all-cause mortality in children under 5 years of age (ACCM) using nationally representative household surveys. Associations between insecticide-treated net (ITN) ownership, malaria morbidity, and ACCM were also assessed. Household ITN ownership increased from 27.4% (95% confidence interval [CI] = 25.9-29.0) in 2004 to 56.8% (95% CI = 55.6-58.1) in 2010. Similarly intermittent preventive treatment during pregnancy coverage increased from 28.2% (95% CI = 26.7-29.8) in 2000 to 55.0% (95% CI = 53.4-56.6) in 2010. Malaria parasite prevalence decreased significantly from 60.5% (95% CI = 53.0-68.0) in 2001 to 20.4% (95% CI = 15.7-25.1) in 2009 in children aged 6-35 months. Severe anemia prevalence decreased from 20.4% (95% CI: 17.3-24.0) in 2004 to 13.1% (95% CI = 11.0-15.4) in 2010 in children aged 6-23 months. ACCM decreased 41%, from 188.6 deaths per 1,000 live births (95% CI = 179.1-198.0) during 1996-2000, to 112.1 deaths per 1,000 live births (95% CI = 105.8-118.5) during 2006-2010. When controlling for other covariates in random effects logistic regression models, household ITN ownership was protective against malaria parasitemia in children (odds ratio [OR] = 0.81, 95% CI = 0.72-0.92) and severe anemia (OR = 0.82, 95% CI = 0.72-0.94). After considering the magnitude of changes in malaria intervention coverage and nonmalaria factors, and given the contribution of malaria to all-cause mortality in malaria-endemic countries, the substantial increase in malaria control interventions likely improved child survival in Malawi during 2000-2010.

Implementing Impact Evaluations of Malaria Control Interventions: Process, Lessons Learned, and Recommendations.

As funding for malaria control increased considerably over the past 10 years resulting in the expanded coverage of malaria control interventions, so did the need to measure the impact of these investments on malaria morbidity and mortality. Members of the Roll Back Malaria (RBM) Partnership undertook impact evaluations of malaria control programs at a time when there was little guidance in terms of the process for conducting an impact evaluation of a national-level malaria control program. The President's Malaria Initiative (PMI), as a member of the RBM Partnership, has provided financial and technical support for impact evaluations in 13 countries to date. On the basis of these experiences, PMI and its partners have developed a streamlined process for conducting the evaluations with a set of lessons learned and recommendations. Chief among these are: to ensure country ownership and involvement in the evaluations; to engage stakeholders throughout the process; to coordinate evaluations among interested partners to avoid duplication of efforts; to tailor the evaluation to the particular country context; to develop a standard methodology for the evaluations and a streamlined process for completion within a reasonable time; and to develop tailored dissemination products on the evaluation for a broad range of stakeholders. These key lessons learned and resulting recommendations will guide future impact evaluations of malaria control programs and other health programs.

Identification of microsatellite markers in coffee associated with resistance to Meloidogyne exigua.

Meloidogyne species are destructive phytonematodes that result in reduced yields of coffee. The classic test for resistance to Meloidogyne exigua in coffee progenies is both expensive and time-consuming. The use of molecular marker techniques can assist the selection process when it is difficult to measure the phenotype, such as in cases of resistance to nematode infestation. The objective of this study was to identify microsatellite markers associated with resistance to M. exigua in F5 progenies of coffee derived from a cross between Híbrido de Timor 440-10 and Catuaí Amarelo IAC 86. Of the 44 simple sequence repeat (SSR) markers evaluated, 11 showed a polymorphic pattern with a mean number of 4.5 alleles per marker. Clustering analysis classified 82 progenies into three groups related to the response to nematodes and parental genotypes allocated to different groups (resistant and susceptible). SSRCafé 40 allele 2, SSRCafé 15 allele 3, SSRCafé 20 allele 3, and SSRCafé 13 allele 1 were negatively correlated with reproduction factor. In addition, SSRCafé 13 allele 2, SSRCafé 19 allele 3, SSRCafé 40 allele 2, SSRCafé 15 allele 3, and SSRCafé 20 allele 3 were correlated with the root gall index of M. exigua. These SSR markers, which have been validated in this population, represent a potential method to select progenies resistant to nematodes in coffee-breeding programs.

Are short (blue) wavelengths necessary for light treatment of seasonal affective disorder?

Despite widely published speculation regarding a potential potency advantage of short-wavelength (blue-appearing) light for Seasonal Affective Disorder (SAD) treatment, there have been few systematic studies. Those comparing short-wavelength to broad-wavelength (white) light under actual clinical conditions suggest equivalent effectiveness. This multicenter, parallel-group design trial was undertaken to compare the effects of light therapy on SAD using blue (~465 nm) versus blue-free (595-612 nm) LED lights. Fifty-six medication-free subjects aged 21-64 years who met DSM-IV-TR criteria for recurrent major depression with winter-type seasonal pattern were enrolled in this blinded study at five participating centers between January and March 2012. Thirty-five subjects met the criteria for randomization to 30 min of either blue (~465 nm) or blue-free (595-612 nm) daily morning light therapy. Twenty-nine subjects completed the study; three subjects withdrew due to treatment-related adverse events, including migraines, and three withdrew for non-study-related reasons. The primary effectiveness variable was depression score (SIGH-ADS) after six weeks of daily light treatment. Secondary effectiveness variables included quality-of-life (QoL) and suicidality ratings. Using an intent-to-treat analysis, mean depression scores were different at baseline for the blue group (29 ± 5 versus 26 ± 5, p = 0.05 blue versus blue-free, respectively), and the initial score was used as a covariate. Baseline scores were not significantly different between treatment groups among those who completed the study, and no significant differences in depression scores were observed after 6 weeks (mean ± SD scores at 6 weeks: 5.6 ± 6.1 versus 4.5 ± 5.3, p = 0.74, blue versus blue-free, respectively). In addition, the proportion of subjects who met remission criteria, defined as a depression score ≤8, was not significantly different between the two groups (p = 0.41); among the 29 subjects who completed the study, 76% of subjects experienced remission by the end of the trial, which coincided with the beginning of spring. The QoL and suicidality ratings were also significantly improved from pre- to post-treatment, with no significant difference between treatments. No subject experienced worsening or non-improved symptoms over the 6-week trial. The main finding of this study is that subjects treated with blue light did not improve more than subjects treated with blue-free light; both showed substantial improvement on multiple measures. Failure to find differences may have resulted from methodological constraints, including a small sample size. Recruitment began mid-winter during an unusually mild season, and the trial was terminated earlier than planned by the study sponsor due to a failure to detect a difference. However, if confirmed in a larger randomized sample, these results suggest that blue wavelengths are not necessary for successful SAD treatment.

Validity and reproducibility of a food frequency questionnaire focused on the Mediterranean diet for the Quebec population.

BACKGROUND AND AIMS: Validated dietary assessment methods specific to population and food habits are needed to conduct randomized clinical trials evaluating the efficacy of the Mediterranean diet in primary and secondary prevention of cardiovascular disease. Therefore, the aim of our study was to assess the reproducibility and the relative validity of a French language semi-quantitative food frequency questionnaire (FFQ) focused on the Mediterranean diet within the population of Quebec. METHODS AND RESULTS: Fifty-three participants aged 19-86 years with and without coronary heart disease were recruited, and randomized in 3 groups in a crossover design where the sequence of administration of two FFQs and a dietary record (DR) differed in each group. The FFQ includes 157 food items and was designed to measure food intake over one month. It was administered twice 3-5 weeks apart to assess reproducibility and was compared to a 12-day DR to assess validity. For reproducibility (n = 47), intraclass correlation coefficients (ICCs) for energy and 33 nutrients ranged from 0.38 to 0.91 (mean 0.63). For validity, the Pearson's correlation coefficients between the DR and the FFQ pre-DR ranged from 0.26 to 0.84 (mean 0.55) and ICCs ranged from 0.25 to 0.84 (mean 0.54). As for the DR and the FFQ post-DR, the Pearson's correlation coefficients ranged from 0.36 to 0.83 (mean 0.55) and the ICCs ranged from 0.36 to 0.83 (mean 0.53). CONCLUSION: This FFQ demonstrates good reproducibility and validity for most key nutrients of the Mediterranean diet for the Quebec population.

Encuesta sobre la broncoscopia en los hospitales públicos de la Comunidad de Madrid y de Guadalajara: situación actual / No disponible

Introducción: La broncoscopia es una técnica de gran utilidad en el estudio y tratamiento de las enfermedades respiratorias. Ha experimentado un avance relevante en los últimas décadas con el desarrollo de nuevos dispositivos y procedimientos. La incorporación de estas nuevas técnicas ha sido paulatina y, de forma asimétrica, en los diferentes centros dependiendo de su complejidad, demanda y recursos. El Grupo de Trabajo de Técnicas y Oncología de Neumomadrid se propuso realizar una encuesta para conocer con exactitud cuál es la situación actual de las técnicas broncoscópicas en la Comunidad de Madrid y Guadalajara. Material y métodos: Se remitió una encuesta a 26 hospitales públicos de la Comunidad de Madrid y de Guadalajara, dirigida a la jefatura de servicios y responsables de broncoscopia de los Servicios de Neumología, Cirugía Torácica, Pediatría y Cirugía Pediátrica sobre la actividad realizada en 2014. Se preguntó por el número aproximado de broncoscopias anuales, especialistas que la realizan, número de broncoscopistas a dedicación parcial y completa, existencia de broncoscopista de guardia, ubicación de la broncoscopia, sedación durante la técnica y especialista que la realiza, disponibilidad de enfermería especializada, especialidad que realiza intubación con broncoscopio y las técnicas intervencionistas disponibles. La encuesta fue respondida mediante correo ordinario y correo electrónico. Resultados: Se realiza broncoscopia en adultos en 25 centros de la Comunidad de Madrid (CAM) y de Guadalajara, con una actividad total de 14.051 broncoscopias al año. El 92% de los centros tienen una sala específica para la realización de broncoscopias. Los neumólogos son los responsables de la broncoscopia flexible (BF) en todos los centros (100%), pero solo en el 28% hay broncoscopista con dedicación completa. La broncoscopia rígida (BR) se realiza en el 32% de los hospitales por neumólogos y en el 32% por cirujanos torácicos, siempre en centros de alta complejidad y en quirófano. Únicamente el 20% de los centros disponen de broncoscopista de guardia. En el 96% de los centros realiza sedación para la broncoscopia flexible, siendo el neumólogo el responsable de la sedación en el 84% de los hospitales. En el 60% de los hospitales se realiza alguna técnica mediante BF, la más extendida es la ecobroncoscopia (EBUS), que está disponible en el 40% de los centros. La experiencia media de los centros que realizan EBUS es de 3,5 años. Con respecto a la broncoscopia pediátrica, en el 40% de los centros en la CAM la realizan. La variabilidad en el nº de broncoscopias flexibles/año es grande, ya que 3 realizan más de 100 y 4 efectúan menos de 10. El nº de broncoscopias rígidas realizadas es significativamente menor que el de flexibles. Tanto especialistas de adultos como pediátricos realizan broncoscopia pediátrica pero estos últimos son los únicos actores en los hospitales infantiles. Los responsables de la sedación/anestesia general son los anestesistas o intensivistas pediátricos por lo que los procedimientos se realizan en el quirófano o en la UCI. Diversas técnicas de broncoscopia terapéutica o intervencionista se han ido incorporando progresivamente a la práctica pediátrica, como el uso de láser e implantación de endoprótesis. Conclusiones: La broncoscopia flexible es una técnica consolidada en los hospitales de la Comunidad de Madrid y de Guadalajara, tanto en hospitales de referencia como de menor complejidad. La broncoscopia intervencionista se realiza, fundamentalmente, en centros de referencia. Los centros de mayor complejidad disponen de personal con dedicación completa a la broncoscopia, a pesar de lo cual, no se dispone de broncoscopista de guardia en todos ellos. La sedación durante la broncoscopia se utiliza de forma rutinaria en la mayoría de los hospitales y la suele realizar el neumólogo en adultos y el anestesista en niños. La EBUS es la técnica broncoscópica de mayor difusión en los hospitales encuestados. La broncoscopia pediátrica se realiza, fundamentalmente, en centros de referencia; la BF pediátrica está en manos de diferentes especialistas con formación específica (cirugía pediátrica, neumólogos pediátricos y de adultos y ORL), mientras la BR pediátrica se realiza, en su mayoría, por cirujanos pediátricos

Introduction: Bronchoscopy is a useful technique in the study and treatment of respiratory diseases. It has experienced a significant progress in recent decades with the development of new devices and procedures. The incorporation of these new techniques has been done gradually and asymmetrically at different locations depending on their complexity, demand and resources. Neumomadrid Techniques and Oncology Workgroup proposed a survey to know exactly what the current situation of bronchoscopic techniques in Autonomous Community of Madrid and Guadalajara is. Methods: A survey was sent to 26 public hospitals in the Autonomous Community of Madrid and Guadalajara addressed to the head of service and responsible for bronchoscopy (Pneumology, Thoracic Surgery, Pediatrics and Pediatric Surgery Services) about their activity in 2014. The questionnaire included the approximate number of annual bronchoscopies, the specialists who perform them, the bronchoscopists half-time and full time employed and bronchoscopist on call, the allocation of the bronchoscopy room and whether sedation during the technique is performed, the specialist who would perform sedation, the availability of trained nursing, the specialtist who performs bronchoscopic intubation and the available interventional techniques in each center. The survey was answered by regular mail and email. Results: Bronchoscopy is performed on adults in 25 centers in Madrid and Guadalajara, with a total activity of 14,051 bronchoscopy/year. 92% of the centers have a specific room for performing bronchoscopy. Pulmonologists are responsible for flexible bronchoscopy (FB) in every hospital (100%) but only 28% of the centers have full time bronchoscopist. Rigid bronchoscopy (RB) is performed in 32% of hospitals by pulmonologists and 32% by thoracic surgeons, always carried out in high complexity centers and operating theaters. Only 20% of the centers have bronchoscopist on call. The 96% of the centers perform sedation for flexible bronchoscopy; pulmonologist is responsible for sedation in 84% of the hospitals. Advanced FB is performed in 60% of the hospitals, the most widespread technique is the endobronchial ultrasound (EBUS) which is available in 40% of the centers. The average experience time of centers performing EBUS is 3.5 years. Pediatric bronchoscopy is performed in 40% of the centers in Madrid. There is a wide variability in the number of FB performed, 3 centers carried out over 100 procedures but 4 done less than 10. There are significantly fewer RB procedures than FB ones. Both adult and pediatric specialists perform pediatric bronchoscopy but pediatric specialists are the only actors in children’s hospitals. Sedation in paediatric patients is performed by anesthesiologists and pediatric intensive care thus the procedures are done in the operating room or Intenseive Care Units. Various techniques of therapeutic or interventional bronchoscopy have been incorporated progressively in pediatric practice such as the use of laser and stenting. Conclusions: Flexible bronchoscopy is an established technique at the hospitals in Madrid and Guadalajara, in referral hospitals as well as in less complex hospitals. Interventional bronchoscopy is performed mainly in referral centers. The high complex centers have full time bronchoscopists, however not all of them have bronchoscopist on call. Sedation during bronchoscopy is routinely used in most of the hospitals and is usually performed by pulmonologist in adults and by anesthesiologist in children. EBUS is the most widely used advanced bronchoscopic technique in surveyed hospitals. Pediatric bronchoscopy is performed mainly in referral centers; pediatric FB is held by different specialists with specific training for it (pediatric surgery, pediatric and adult pulmonologists and ENT) while pediatric RB is done mostly by pediatric surgeons

Impact of Malaria Control on Mortality and Anemia among Tanzanian Children Less than Five Years of Age, 1999-2010.

BACKGROUND: Mainland Tanzania scaled up multiple malaria control interventions between 1999 and 2010. We evaluated whether, and to what extent, reductions in all-cause under-five child mortality (U5CM) tracked with malaria control intensification during this period. METHODS: Four nationally representative household surveys permitted trend analysis for malaria intervention coverage, severe anemia (hemoglobin <8 g/dL) prevalence (SAP) among children 6-59 months, and U5CM rates stratified by background characteristics, age, and malaria endemicity. Prevalence of contextual factors (e.g., vaccination, nutrition) likely to influence U5CM were also assessed. Population attributable risk percentage (PAR%) estimates for malaria interventions and contextual factors that changed over time were used to estimate magnitude of impact on U5CM. RESULTS: Household ownership of insecticide-treated nets (ITNs) rose from near zero in 1999 to 64% (95% CI, 61.7-65.2) in 2010. Intermittent preventive treatment of malaria in pregnancy reached 26% (95% CI, 23.6-28.0) by 2010. Sulfadoxine-pyrimethamine replaced chloroquine in 2002 and artemisinin-based combination therapy was introduced in 2007. SAP among children 6-59 months declined 50% between 2005 (11.1%; 95% CI, 10.0-12.3%) and 2010 (5.5%; 95% CI, 4.7-6.4%) and U5CM declined by 45% between baseline (1995-9) and endpoint (2005-9), from 148 to 81 deaths/1000 live births, respectively. Mortality declined 55% among children 1-23 months of age in higher malaria endemicity areas. A large reduction in U5CM was attributable to ITNs (PAR% = 11) with other malaria interventions adding further gains. Multiple contextual factors also contributed to survival gains. CONCLUSION: Marked declines in U5CM occurred in Tanzania between 1999 and 2010 with high impact from ITNs and ACTs. High-risk children (1-24 months of age in high malaria endemicity) experienced the greatest declines in mortality and SAP. Malaria control should remain a policy priority to sustain and further accelerate progress in child survival.

Ablation therapies for pancreatic cancer: an updated review.

While impressive strides have been made in the detection and management of numerous somatic malignancies over the past two decades, safe and effective treatments for pancreatic cancer have remained elusive. However, a number of emerging new therapies hold the promise of improving survival and quality of life for those stricken with the disease. Ablative therapies in particular, including those utilizing radiofrequency waves, microwaves, thermal energy, photodynamic energy and focused ultrasound waves provide an opportunity to target neoplasms while sparing healthy surrounding tissue. Paired with endoscopic ultrasound, these therapies offer a safe, effective and minimally invasive means to care of patients with otherwise inoperable tumors.

Evaluation of genetic diversity in fig accessions by using microsatellite markers.

Fig (Ficus carica L.) is a fruit of great importance worldwide. Its propagation is carried out with stem cuttings, a procedure that favors the occurrence of synonymy among specimens. Thus, molecular markers have become an important tool for studies of DNA fingerprinting, germplasm characterization, and genetic diversity evaluation in this plant species. The aim of this study was the analysis of genetic diversity among accessions of fig and the detection of synonyms among samples using molecular markers. Five microsatellite markers previously reported as polymorphic to fig were used to characterize 11 fig cultivars maintained in the germplasm bank located in Lavras, Minas Gerais. A total of 21 polymorphic DNA fragments were amplified, with an average of 4.2 alleles per locus. The average allelic diversity and polymorphic information content were 0.6300 and 0.5644, respectively, whereas the total value for the probability of identity was 1.45 x 10(-4). The study allowed the identification of 10 genotypes and 2 synonymous individuals. The principal coordinate analysis showed no defined clusters despite the formation of groups according to geographical origin. However, neighbor-joining analysis identified the same case of synonymy detected using principal coordinate analysis. The data also indicated that the fig cultivars analyzed constitute a population of individuals with high genetic diversity and a broad range of genetic variation.

Arsenic speciation in edible alga samples by microwave-assisted extraction and high performance liquid chromatography coupled to atomic fluorescence spectrometry.

Twelve commercially available edible marine algae from France, Japan and Spain and the certified reference material (CRM) NIES No. 9 Sargassum fulvellum were analyzed for total arsenic and arsenic species. Total arsenic concentrations were determined by inductively coupled plasma atomic emission spectrometry (ICP-AES) after microwave digestion and ranged from 23 to 126 µg g(-1). Arsenic species in alga samples were extracted with deionized water by microwave-assisted extraction and showed extraction efficiencies from 49 to 98%, in terms of total arsenic. The presence of eleven arsenic species was studied by high performance liquid chromatography-ultraviolet photo-oxidation-hydride generation atomic-fluorescence spectrometry (HPLC-(UV)-HG-AFS) developed methods, using both anion and cation exchange chromatography. Glycerol and phosphate sugars were found in all alga samples analyzed, at concentrations between 0.11 and 22 µg g(-1), whereas sulfonate and sulfate sugars were only detected in three of them (0.6-7.2 µg g(-1)). Regarding arsenic toxic species, low concentration levels of dimethylarsinic acid (DMA) (<0.9 µg g(-1)) and generally high arsenate (As(V)) concentrations (up to 77 µg g(-1)) were found in most of the algae studied. The results obtained are of interest to highlight the need to perform speciation analysis and to introduce appropriate legislation to limit toxic arsenic species content in these food products.

Parto y nacimiento humanizado: evaluación de una vía clínicabasada en la evidencia / Delivery and humanized birth: Evaluation of a clinical route based on evidence

Objetivo: Evaluar los resultados de la implantación y el grado de cumplimientode una vía clínica de atención al parto basada en la evidenciacientífica.Material y métodos: Estudio observacional descriptivo. Se estudiaronlos 943 partos de las mujeres atendidas en el Hospital do Salnésdurante los periodos analizados (abril-diciembre de 2007 y abril-diciembrede 2008), divididos en dos grupos similares: uno prospectivo alque se aplicó la vía clínica en 2008 (n= 500) y otro grupo control, histórico,retrospectivo, formado por mujeres que dieron a luz en 2007 (n=443). Se compararon variables perinatales para evaluar la eficacia de lavía clínica. En una segunda etapa, se evaluó el grado de cumplimientode indicadores y estándares de calidad, incluida una encuesta de satisfacción.La comparación estadística se realizó aplicando la prueba de laji al cuadrado.Resultados: Mediante la aplicación de la vía clínica, se redujo la tasade cesáreas, el número de partos estimulados con oxitocina, y el uso dela anestesia epidural y de la episiotomía en los partos vaginales. Aumentaronlos partos eutócicos, los partos vaginales tras cesárea y el númerode recién nacidos con pH venoso umbilical <7,20. En la evaluacióndel cumplimiento, se alcanzaron los estándares en la postura delparto eutócico, número de partos en vertical, consumo de líquidos duranteel trabajo de parto y tasa de desgarros de tercer y cuarto grado.No se logró cumplir la tasa de lactancia materna exclusiva al alta, laentrega del plan de parto y el uso de bañera.Conclusiones: Esta evaluación permite afirmar que la implantaciónde la vía clínica mejoró la calidad de la atención, acercándola a las recomendacionesde la OMS (AU)

Objective: To evaluate the results of implantation and the level ofcompliance of a clinical route in the delivery attention based on scientificevidence.Material and methods: Observational descriptive study. A total of943 deliveries have been studied of women assisted at the Hospital doSalnés during the analyzed periods, divided in two similar groups. Oneprospective group to which a clinical route has been applied in 2008(n=500), versus a control group, historical, retrospective made up ofwomen who gave birth in 2007 (n=443). Perinatal variables have beencompared in order to evaluate the efficacy of the clinical route. In a secondstage, the compliance level of quality indicators and standards areevaluated, included a satisfaction survey. The statistical comparison wasperformed applying the chi-square test.Results: With the application of the clinical route, the rate of caesarean,deliveries stimulated with oxytocin, the use of epidural anaesthesiaand the episiotomy in vaginal deliveries has been reduced. The eutocicdeliveries have increased as well as the vaginal deliveries after caesareanand the number of newborns with umbilical venous pH <7.20. Inthe compliance evaluation, the standards have been reached as regardsto the eutocic delivery position, number of vertical deliveries, intake ofliquids during the labor and tear rate of 3°-4° degrees. It has not beenachieved the compliance of the exclusive mother lactation rate at discharge,the submission of delivery plan and the use of the bath tub.Conclusions: This evaluation allows us to assert that the implantationof the clinical route improved the attention quality, approaching it to therecommendations of the WHO (AU)

[Endonasal tubes as cause of pressure ulcers in the critical patient]. / Sondas endonasales como causa de las úlceras por presión en el paciente crítico.

INTRODUCTION: One of the risks of using endonasal tubes (ET) is the appearance of pressure ulcers (PU). OBJECTIVE: To ascertain the proportion of patients with nasal PU, study the risk factors of appearance, and find predictive variables. MATERIAL AND METHODS: A six-month prospective, observational study of intensive care unit patients with ET. VARIABLES: Variable response: "the appearance of pu as a result of the use of ET". Explanatory variables: age, duration of stay, length of time with ET, gender, sedation, norepinephrine perfusion, mechanical ventilation, anemia, nutritional state. ANALYSIS: multivariate statistical techniques (multiple logistical regression). Statistics program g-stat 2.0. Significance level p < 0.05. RESULTS: Sample of 48 patients. Proportion of patients with PU: 29.2%. Those patients with PU had similar ages, duration of stay and longer length of time with ET. Results of the Logistic Regression model: only the variable "time with ET" was statistically significant (p = 0.03; odds ratio: 1.047). CONCLUSIONS: The length of time the patient is using an ET influences the appearance of nasal PU (risk increases 1.047 for each day with ET). None of the variables dealt with could be used as a predictive factor in the appearance of PU.

Atrofia gástrica en niños: Características clínicas, endoscópicas y anatopatológicas

La atrofia gástrica en niños es rara, existen pocos datos sobre la prevalencia de atrofia gástrica o metaplasia intestinal en estas edades. Objetivo: investigar y describir las características clínicas, endoscópicas y anatopatológicas de pacientes pediátricos con gastritis crónica que tenían reporte de atrofia gástrica, para identificar factores etiológicos asociados a esta patología. Pacientes, Materiales Y Métodos: Se revisaron las historias clínicas de los pacientes atendidos en la Unidad desde 1994 a 2006, con reporte de biopsia con gastritis crónica y atrofia gástrica. Resultados: 23 niños con gastritis crónica y atrofia gástrica, una prevalencia general de 0,98%; con respecto a pacientes infectados con H. pylori la prevalencia de atrofia gástrica fue de 1,20% y en los no infectados de 0,71%. Se determino que la bacteria se identifico con más frecuencia en las biopsias, con una diferencia significativa con respecto al grupo de gastritis crónica y atrofia gástrica sin infección (p = 0.0001); la presencia de cúmulos linfoides, fue mas frecuente entre infectados (p = 0.0001). La atrofia gástrica focal leve se detectó en el 86,95% (20/23), 2 atrofia moderada y una severa. Se encontró que la atrofia gástrica focal leve fue más reportada en gastritis crónica moderada (p = 0.0004). Discusión: existe atrofia gástrica en niños con un predomino entre los infectados con H pylori. Se debe seguir un programa de vigilancia endoscópica para determinar la frecuencia de los cambios histológicos en la edad pediátrica, las estrategias de prevención y su consideración en el desarrollo de lesiones neoplásicas.

Gastric atrophy in children is rare, few data exists about atrophy and metaplasia prevalence at these ages. Aims: To investigate and describe clinical, endoscopic and histological characteristics in pediatric patients with chronic gastritis who had gastric atrophy in order to identify etiologic factors asociated with this patology. Patients, Materials And Methods: clinical histories of patients attended in the unit from 1994 to 2006, with report of chronic gastritis, were reviewed. Results: 23 children with chronic gastritis and gastric atrophy, with a general prevalence of 0, 98%. In patients with Helicobacter pylori infection, the prevalence of gastric atrophy was 1, 20% and in non infected patients was 0, 71%. It was determined that the bacteria was identified more frequently in biopsies with chronic gastritis and atrophy with infection with a significative difference (p=0, 0001). The presence of limphoid cumulus was more frecuent among infected patients (p=0, 0001). Mild gastric atrophy was detected in 86, 95% (20/23), 2 moderate atrophy and one severe atrophy. It was found that mild gastric atrophy was reported in mayor number in moderate chronic gastritis (p=0, 0004). Discussion: Gastric atrophy exists in children with a predominance among Helicobacter pylori infected children. There has to be an endoscopic vigilance program to determine the frecuency of histologic changes in pediatric ages, prevention strategies and its consideration in the development of neoplasic lesions.

Assessment of total arsenic and arsenic species stability in alga samples and their aqueous extracts.

In order to achieve reliable information on speciation analysis, it is necessary to assess previously the species stability in the sample to analyse. Furthermore, in those cases where the sample treatment for species extraction is time-consuming, an assessment of the species integrity in the extracts is of paramount importance. Thus, the present paper reports total arsenic and arsenic species stability in alga samples (Sargassum fulvellum and Hizikia fusiformis), as well as in their aqueous extracts, which were stored in amber glass and polystyrene containers at different temperatures. Total arsenic determination was carried out by inductively coupled plasma atomic emission spectroscopy (ICP-AES), after sample acid digestion in a microwave oven, while arsenic speciation was conducted by anion exchange high performance liquid chromatography on-line coupled to ICP-AES, with and without sample introduction by hydride generation (HPLC-ICP-AES and HPLC-HG-ICP-AES), after aqueous microwave-assisted extraction. The results obtained for solid alga samples showed that total arsenic (for Hijiki alga) and arsenic species present (As(V) for Hijiki and NIES No. 9 Sargasso) are stable for at least 12 months when samples are stored in polystyrene containers at +20 degrees C. On the other hand, a different behaviour was observed in the stability of total arsenic and As(V) species in aqueous extracts for both samples, being the best storage conditions for Sargasso extracts a temperature of -18 degrees C and polystyrene containers, under which they are stable for at least 15 days, while Hijiki extracts must be stored in polystyrene containers at +4 degrees C in order to ensure the stability for 10 days.

Micosis fungoide unilesional: caso clínico y revisión de la literatura / Unilesional mycosis fungoides: clinical case and literature review

Introducción. La Micosis Fungoide Unilesional (MFU) es una rara variante dentro del espectro de las Micosis Fungoides (MF) que se caracteriza por la aparición de lesiones, que pueden ser solitarias o con escaso compromiso de la piel, menos del 5% de la superficie corporal. Caso clínico. Reportamos el caso de un paciente con diagnóstico de Micosis fungoide unilesional que fue tratado con PUVA terapia con remisión parcial. Discusión: La diseminación cutánea de la MFU y el potencial metastático de la misma son limitados, por consiguiente, debe ser tratada con métodos conservadores. Se han observado algunas recurrencias y fallas terapéuticas, por lo que es importante un adecuado seguimiento a todos los pacientes.

Introduction: Unilesional mycosis fungoides is a rare variant in the spectrum of mycosis fungoides (MF), characterized by the appearance of lesions that may be solitary or with limited skin involvement. Clinical case: Patient with diagnusis of unilesiunal mycosis fungoides, treated with PUVA, with paitial remission. Discussion: Cutaneous dissemination of unilesional mycosis fungoldes and metastatic potential are limited, so conservative therapy methods are recommended for this disease. Recurrence and therapeutic failures have been observed, so and adequate and close follow-up of patients is very important.