Analysis of apheresis outcomes in a cohort of Chilean patients treated with autologous stem cell transplantation: A single center real-world experience.

Adequate stem cell harvesting is required for autologous hematopoietic transplantation. In deficient mobilizer patients, the collection of stem cells can be challenging because of the impossibility of achieving satisfactory CD34 cell counts with GCSF + - chemotherapy. Plerixafor is a potent and expensive drug that promotes the release of stem cells from the medullary niche to the peripheral blood and allows satisfactory harvests. We performed a retrospective analysis of 370 patients with myeloma and lymphoma harvested at our institution. 99 % of patients achieved satisfactory apheresis using Plerixafor in 45 %. Satisfactory harvests were obtained in patients mobilized with GCSF or plerixafor. In patients who used plerixafor, it was necessary to perform fewer apheresis procedures (P = 0.05). In multivariate analysis, the only factor that predicted the need for plerixafor was the presence of less than 30,000 CD34 / ul on the day of apheresis (OR 0.3. p < 0.001). Since we adopted the plerixafor protocol guided by CD34 counts, the number of patients with harvest failure has decreased. In conclusion, the rational and standardized use of plerixafor favors satisfactory harvest in patients who require autologous transplantation in South-American patients.

A Mathematical Dimensional Model for Predicting Bulk Density of Inconel 718 Parts Produced by Selective Laser Melting.

In this work, dimensional analysis is used to develop a general mathematical model to predict bulk density of SLMed components taking volumetric energy density, scanning speed, powder's thermal conductivity, specific heat capacity, and average grain diameter as independent variables. Strong relation between dependent and independent dimensionless products is observed. Inconel 718 samples were additively manufactured and a particular expression, in the form of a power-law polynomial, for its bulk density, in the working domain of the independent dimensionless product, was obtained. It is found that with longer laser exposure time, and lower scanning speed, better densification is attained. Likewise, volumetric energy density has a positive influence on bulk density. The negative effect of laser power in bulk density is attributed to improper process conditions leading to powder particle sublimation and ejection. A maximum error percentage between experimental and predicted bulk density of 3.7119% is achieved, which corroborates the accuracy of our proposed model. A general expression for determining the scanning speed, with respect to laser power, needed to achieve highly dense components, was derived. The model's applicability was further validated considering SLMed samples produced by AlSi10Mg and Ti6Al4V alloys. This article elucidates how to tune relevant manufacturing parameters to produce highly dense SLM parts using mathematical expressions derived from Buckingham's π- theorem.

Conversion to Roux-en-Y gastric bypass surgery through a robotic-assisted hybrid technique after failed sleeve gastrectomy: Short-term results. / Conversión por técnica híbrida robótica a bypass gástrico en Y de Roux posterior a falla de manga gástrica: resultados a corto plazo.

INTRODUCTION AND AIMS: Laparoscopic sleeve gastrectomy (LSG) is the most widely performed bariatric surgery worldwide but complications and failed procedures are on the rise. AIMS: To determine the reasons for failed LSGs and report the results of conversion to gastric bypass surgery, comparing the outcomes with those of primary gastric bypass surgery. MATERIALS AND METHODS: Patients with failed LSG that underwent conversion to gastric bypass surgery through a robotic-assisted and laparoscopic (hybrid) technique were evaluated. Outcomes and follow-up related to weight loss failure (WLF) were compared with those in patients that underwent primary laparoscopic gastric bypass (pLGB) surgery. RESULTS: Revisional surgery was performed on 13 patients due to WLF, on 3 patients because of refractory gastroesophageal reflux disease (GERD), and on 2 patients due to gastric stricture. There were no differences between the preoperative characteristics of the patients with WLF before undergoing conversion to gastric bypass and the patients that underwent pLGB surgery. At postoperative month 36, the percentage of excess weight loss was greater in the patients that underwent pLGB surgery, than in those with WLF that underwent conversion to gastric bypass (69.17±23.73 vs. 54.17±12.48, respectively; P<0.05). Refractory GERD, symptoms due to gastric stricture, and comorbidities all improved after the revisional surgery. CONCLUSION: Revisional surgery resulted in acceptable weight loss at 36 months of follow-up and favored comorbidity remission. In addition, it resolved symptoms of refractory GERD and gastric stricture.

Novel Classes of Antibacterial Drugs in Clinical Development, a Hope in a Post-antibiotic Era.

Bacterial resistance is a growing problem worldwide and is estimated that deaths by infectious diseases associated with resistant pathogens will generate 10 million deaths per year in 2050. This problem becomes more serious due to the low level of research and development of new drugs, which has fallen drastically in the last 40 years. For example, in the last decade of a total of 293 new drugs approved by the FDA, only 9 corresponded to antimicrobial drugs and none constituted a new structural class. The majority of the molecules in the clinical phase II or III, coming from modifications of drugs in clinical use, this strategy makes easier the bacterial susceptibility to generate resistance through the mechanisms expressed for their drug predecessors. Under this scenario, it is urgent to generate the most novel strategies for the development of antibacterial compounds with new targets or mechanism of action, without a structural relationship with the antibiotic drugs predecessors. Under this look, the present review addresses the development of the latest antibacterial drugs in clinical phases II and III, analyzing the design strategies by which these new molecules were obtained and the structure-activity relationship of these new families of antibiotics, in order to define the state of the vanguard antibacterial drugs in the post-antibiotic era.

Radiotherapy volume delineation using 18F-FDG-PET/CT modifies gross node volume in patients with oesophageal cancer.

PURPOSE: Evidence supporting the use of 18F-FDG-PET/CT in the segmentation process of oesophageal cancer for radiotherapy planning is limited. Our aim was to compare the volumes and tumour lengths defined by fused PET/CT vs. CT simulation. MATERIALS AND METHODS: Twenty-nine patients were analyzed. All patients underwent a single PET/CT simulation scan. Two separate GTVs were defined: one based on CT data alone and another based on fused PET/CT data. Volume sizes for both data sets were compared and the spatial overlap was assessed by the Dice similarity coefficient (DSC). RESULTS: The gross tumour volume (GTVtumour) and maximum tumour diameter were greater by PET/CT, and length of primary tumour was greater by CT, but differences were not statistically significant. However, the gross node volume (GTVnode) was significantly greater by PET/CT. The DSC analysis showed excellent agreement for GTVtumour, 0.72, but was very low for GTVnode, 0.25. CONCLUSIONS: Our study shows that the volume definition by PET/CT and CT data differs. CT simulation, without taking into account PET/CT information, might leave cancer-involved nodes out of the radiotherapy-delineated volumes.

Diarrea por Clostridium difficile en pacientes hospitalizados / Diarrhea due to Clostridium difficile in hospitalized patients

Resumen ANTECEDENTES: La infección por Clostridium difficile es la causa más importante de enfermedad gastrointestinal relacionada con el sistema hospitalario que conlleva alta morbilidad y mortalidad y costos estimados en 3.2 mil millones de dólares anualmente. OBJETIVO: Conocer el comportamiento de la diarrea intrahospitalaria por C. difficile, así como las características de la enfermedad y de los pacientes. MATERIAL Y MÉTODO: Estudio longitudinal, efectuado del 1 de julio de 2015 al 30 de abril de 2016, en el que se incluyeron los casos de diarrea intrahospitalaria atendidos en todos los servicios del Hospital Regional Lic. Adolfo López Mateos, Ciudad de México. Con el apoyo del Laboratorio de Vigilancia Epidemiológica del ISSSTE, ubicado en el Centro Médico Nacional 20 de Noviembre, a todos los casos se les realizó prueba de inmunoensayo para la identificación de toxinas A, B o ambas. RESULTADOS: Se identificaron 220 casos de diarrea intrahospitalaria en el periodo de estudio, de los que 106 (48.2%) resultaron positivos a la prueba de inmunoensayo para toxinas A, B (o ambas) de C. difficile y correspondieron a los servicios de Medicina Interna, Cirugía General y Unidad de Cuidados Intensivos. Se realizó seguimiento a 100 pacientes de los que 75 fueron dados de alta y 25 fallecieron (tasa de mortalidad de 25%). El servicio en el que se identificaron más casos fue Medicina Interna con 58 (54.7%), seguido de Cirugía General con 14 (13.2%) y de Ortopedia con 10 (10.6%). Los 106 pacientes incluidos que resultaron positivos habían recibido durante su estancia hospitalaria y antes de manifestar el cuadro diarreico al menos un antimicrobiano, 41.4% monoterapia y 58.6% dos o más antibióticos. El antibiótico más frecuente en los casos de monoterapia fue ceftriaxona (50%), seguido de meropenem (20.6%) y en los casos de combinaciones se observó una variedad de ellas. La mediana de días de estancia hospitalaria en los pacientes que fallecieron fue de 24 días (intervalo: 5-112) y en los que fueron dados de alta la mediana fue de 20 días (intervalo: 2-85). CONCLUSIONES: Este estudio aporta información muy similar a la reportada en las escasas publicaciones mexicanas referidas en este trabajo en cuanto a los factores de riesgo, variabilidad de las manifestaciones clínicas, oportunidad del tratamiento, evidencia, consecuencias de la administración indiscriminada de antibióticos con fines profilácticos, terapéuticos o ambos y necesidad del tratamiento multidisciplinario de los pacientes con enfermedad grave o severa. Destaca también la participación de los bloqueadores H2 como un importante factor de riesgo encontrado en más de 70% de los casos y la administración de mesalazina y probióticos como coadyuvantes en el tratamiento.

Abstract BACKGROUND: Infection due to Clostridium difficile is the most important cause of gastrointestinal disease related to the hospitality system leading to high morbidity and mortality and costs estimated in 3.2 billion dollars each year. OBJECTIVE: To know the behavior of intrahospitalary diarrhea due to C. difficile, as well as the characteristics of the disease and patients. MATERIAL AND METHOD: A longitudinal study done from July 1st 2015 to April 30 2016, in which cases of intrahospitalary diarrhea attended in all services of the Reginal Hospital Lic. Adolfo López Mateos, Mexico City, were included. With the support of the Laboratory of Epidemiological Surveillance of ISSSTE, at Centro Médico Nacional 20 de Noviembre, Mexico City, all cases were submitted to immunoassay test to the identification of toxins A, B or both. RESULTS: There were identified 220 cases of intrahospitalary diarrhea in the study period, from which 106 (48.2%) were positive to immunoassay test for toxins A, B (or both) of C. difficile and corresponded to services of Internal Medicine, General Surgery and Intensive Care Unit. One hundred patients were followed, from which 75 were discharged and 25 died (mortality rate of 25%). Service in which most cases were identified was Internal Medicine with 58 (54.7%), followed by General Surgery with 14 (13.2%) and Orthopedics with 10 (10.6%). The 106 patients included that resulted positive had received during their hospitalization and before presenting diarrhea at least one antimicrobial, 41.4% monotherapy and 58.6% two or more antimicrobials. The most frequently prescribed antibiotic in cases of monotherapy was ceftriaxone (50%), followed by meropenem (20.6%) and in all cases of combinations it was observed a variety of them. The mean days of hospitalization of patients who died was of 24 days (range: 5-112) and of discharged patients was of 20 days (range: 2-85). CONCLUSIONS: This study gives information very similar to that reported in the little Mexican publications referred in this paper about risk factors, variability of clinical manifestations, opportunity of treatment, evidence, consequences of the indiscriminate administration of antibiotics with prophylactic and/or therapeutic objectives and the need of multidisciplinary treatment of patients with severe disease. It is also highlighted the participation of H2 blockers as an important risk factor found in more than 70% of cases and the administration of mesalazine and probiotics as adjuvant in the treatment.

Recommendations for the prevention and diagnosis of asthma in children: Evidence from international guidelines adapted for Mexico.

BACKGROUND: With the availability of high-quality asthma guidelines worldwide, one possible approach of developing a valid guideline, without re-working the evidence, already analysed by major guidelines, is the ADAPTE approach, as was used for the development of National Guidelines on asthma. METHODS: The guidelines development group (GDG) covered a broad range of experts from medical specialities, primary care physicians and methodologists. The core group of the GDG searched the literature for asthma guidelines 2005 onward, and analysed the 11 best guidelines with AGREE-II to select three mother guidelines. Key clinical questions were formulated covering each step of the asthma management. RESULTS: The selected mother guidelines are British Thoracic Society (BTS), GINA and GEMA 2015. Responses to the questions were formulated according to the evidence in the mother guidelines. Recommendations or suggestions were made for asthma treatment in Mexico by the core group, and adjusted during several rounds of a Delphi process, taking into account: 1. Evidence; 2. Safety; 3. Cost; 4. Patient preference - all these set against the background of the local reality. Here the detailed analysis of the evidence present in BTS/GINA/GEMA sections on prevention and diagnosis in paediatric asthma are presented for three age-groups: children with asthma ≤5 years, 6-11 years and ≥12 years. CONCLUSIONS: For the prevention and diagnosis sections, applying the AGREE-II method is useful to develop a scientifically-sustained document, adjusted to the local reality per country, as is the Mexican Guideline on Asthma.

First record of the nymph of Nanomis rasmusseni Chacon, Pescador & Segnini, 2013 (Ephemeroptera: Baetidae) from Colombia

Herein, we present the first record of the nymph of Nanomis rasmusseni Chacón, Pescador & Segnini, 2013, from two biogeographic regions in Colombia. This species was originally described for the Venezuelan Andes. Both Colombian and Venezuelan populations occur at high elevations, in streams with similar altitudes. We also found that both populations can be distinguished from each other by the terga II, VII, and IX coloration, in addition to the branching pattern of the abdominal gills.

First record of the nymph of Nanomis rasmusseni Chacon, Pescador & Segnini, 2013 (Ephemeroptera: Baetidae) from Colombia

Herein, we present the first record of the nymph of Nanomis rasmusseni Chacón, Pescador & Segnini, 2013, from two biogeographic regions in Colombia. This species was originally described for the Venezuelan Andes. Both Colombian and Venezuelan populations occur at high elevations, in streams with similar altitudes. We also found that both populations can be distinguished from each other by the terga II, VII, and IX coloration, in addition to the branching pattern of the abdominal gills.(AU)

Gold nanoparticles stabilized with ßcyclodextrin-2-amino-4-(4-chlorophenyl)thiazole complex: A novel system for drug transport.

While 2-amino-4-(4-chlorophenyl)thiazole (AT) drug and thiazole derivatives have several biological applications, these compounds present some drawbacks, such as low aqueous solubility and instability. A new complex of ßCD-AT has been synthesized to increase AT solubility and has been used as a substrate for the deposit of solid-state AuNPs via magnetron sputtering, thus forming the ßCD-AT-AuNPs ternary system, which is stable in solution. Complex formation has been confirmed through powder X-ray diffraction and 1D and 2D nuclear magnetic resonance. Importantly, the amine and sulfide groups of AT remained exposed and can interact with the surfaces of the AuNPs. The complex association constant (970 M-1) has been determined using phase solubility analysis. AuNPs formation (32 nm average diameter) has been studied by UV-Visible spectroscopy, transmission/scanning electron microscopy and energy-dispersive X-ray analysis. The in vitro permeability assays show that effective permeability of AT increased using ßCD. In contrast, the ternary system did not have the capacity to diffuse through the membrane. Nevertheless, the antibacterial assays have demonstrated that AT is transferred from ßCD-AT-AuNPs, being available to exert its antibacterial activity. In conclusion, this novel ßCD-AT-AuNPs ternary system is a promising alternative to improve the delivery of AT drugs in therapy.

Purification of phlorotannins from Macrocystis pyrifera using macroporous resins.

Phlorotannins are secondary metabolites produced by brown seaweed, which are known for their nutraceutical and pharmacological properties. The aim of this work was to determine the type of macroporous resin and the conditions of operation that improve the purification of phlorotannins extracted from brown seaweed, Macrocystis pyrifera. For the purification of phlorotannins, six resins (HP-20, SP-850, XAD-7, XAD-16N, XAD-4 and XAD-2) were assessed. The kinetic adsorption allowed determination of an average adsorption time for the resins of 9h. The highest level of purification of phlorotannins was obtained with XAD-16N, 42%, with an adsorption capacity of 183±18mgPGE/g resin, and a desorption ratio of 38.2±7.7%. According to the adsorption isotherm the best temperature of operation was 25°C, and the model that best described the adsorption properties was the Freundlich model. The purification of phlorotannins might expand their use as a bioactive substance in the food, nutraceutical and pharmaceutical industries.

Percepción del paciente quirúrgico acerca de la seguridad en el ámbito hospitalario / Surgical patient’s perception about safety in the hospital context

Introducción: La construcción de lazos entre los pacientes y los profesionales de la salud después de la presentación de un evento tiene importancia crítica. El Foro Nacional para la Calidad recientemente publicó en su reporte (2010), “Prácticas Seguras para una Mejor Atención en Salud”, recomendando, que el paciente debe recibir información oportuna, transparente y clara en relación con lo que se refiere al evento adverso. Objetivos: Determinar la percepción de seguridad que tienen los pacientes con la atención de la salud, identificar el número de pacientes que refieran haber sufrido un error y las respuestas a las preguntas de cómo se resolvió el error durante su hospitalización el servicio de cirugía de un hospital de seguridad social. Materiales y Métodos: Diseño descriptivo, población 127 pacientes hospitalizados en el servicio de cirugía, que cumplieron con los criterios de inclusión. Resultados y Discusión: La media de percepción fue de 40.77 con una (DE=8.37). Los errores que refirieron los pacientes fueron: Infección 7.1 %, 4.75 % reacción alérgica, 10.2 % intervenido por segunda ocasión y 100% de los pacientes contestaron no haberse caído. El 1.6% (2) estuvo completamente de acuerdo al preguntarles si se resolvió satisfactoriamente el error, el 3.1% mencionó que el error se resolvió rápido, 1.6% (2) mencionó estar completamente de acuerdo referente a la información recibida acerca del error. El 2.4% (3) de los pacientes contestaron en desacuerdo respecto a la información de si se tomarían medidas para evitar que el error se volviera a presentar. Conclusiones: La mayoría de los pacientes refirieron percibirse seguros durante su hospitalización, un porcentaje menor mencionó haber tenido incidentes y al preguntarles sobre si se habían sentido seguros durante su estancia hospitalaria la mayoría dijo haberse sentido bastantes seguros.

Introduction: Building bridges between patients and health professionals after the presentation of an event is critical. The National Forum for Quality recently released its report (2010), "Safe Practices for Better Health Care", recommending that the patient should get timely, transparent and clear information regarding what concerns the adverse event. Objectives: To determine the patient perception of safety within health care, to identify the number of patients reporting to have suffered an error and the answers to questions about how the surgery service resolved the failure during hospitalization in a social security hospital. Materials and Methods: A descriptive design, population of 127 patients hospitalized in the surgery department, who met the inclusion criteria. Results and Discussion: The mean perception was 40.77 (SD = 8.37). The errors reported by patients were: infection 7.1%, 4.75% allergic reaction, 10.2% being operated on for the second time and, 100% of the patients reported not having fallen. The 1.6% (2) fully agreed when asked whether the error was resolved successfully, the 3.1% mentioned that the error was resolved quickly, 1.6% (2) mentioned to agree completely regarding information received about the error. Only 2.4% (3) of the patients disagreed about the information whether they would take measures to prevent the error to occur again. Conclusions: Most patients perceived themselves as safe during their hospitalization, a lower percentage reported having had incidents and when asked whether they felt safe during their hospital stay, the most said they felt pretty safe.

Percepción del personal de enfermería hacia la cultura de seguridad en un hospital pediátrico en México / Nursing staff perception towards a culture of safety in a pediatric hospital in Mexico

Introducción: La seguridad del paciente es un tema que en los últimos años ha mostrado pleno desarrollo. Ya que en, 2004 la Organización Mundial de la Salud (OMS) creó la Alianza Mundial para la Seguridad del paciente. La alianza promueve la sensibilización y el compromiso político para mejorar la seguridad de la atención y apoya a los estados miembros en la formulación de políticas y prácticas para la seguridad de los pacientes en todo el mundo. Objetivo: Determinar las Fortalezas y oportunidades de mejora hacia la cultura de la seguridad con que cuenta el personal de enfermería que labora en los diferentes servicios y turnos del Hospital de Pediatría de México y el grado global de seguridad percibido. Materiales y Métodos: Diseño descriptivo y transversal en una muestra de 247 enfermeras del hospital de pediatría. Resultados: La media de edad de los encuestados fue de 49 años el 91 % fueron mujeres y el 70 son enfermeras generales, las dimensiones que calificaron como fortalezas fueron cuatro y ocho de las doce calificaron como oportunidad de mejora, el grado global de seguridad lo calificaron en el rango de 7-8 que significa muy buena. Discusión: Los resultados del estudio difieren de lo reportado por: diversos autores ya que ellos en sus investigaciones reportaron como fortaleza las dimensiones que en este estudio calificaron como oportunidad de mejora y son similares con lo reportado por otros autores en lo que se refiere a la notificación de eventos adversos y dotación de personal, que en este estudio también calificaron como fortalezas. Conclusiones: El personal de enfermeria considera que las fortalezas con que se cuenta en el hospital son pocas y que faltan muchas cosas por mejorar para garantizar la seguridad del paciente.

Introduction: Patient safety is an issue that in recent years has shown full development. Since 2004, the World Health Organization (WHO) created the World Alliance for Patient Safety. The alliance promotes awareness and political commitment to improve the safety of care and support to member states in the formulation of policies and practices for patient safety worldwide. Objective: To determine the strengths and opportunities for improvement to the safety culture available to the nursing staff working in the various departments and shifts of the Mexico Hospital of Pediatrics and the overall degree of perceived safety. Materials and Methods: A descriptive cross-sectional design in a sample of 247 nurses from the pediatric hospital. Results: The mean age of respondents was 49 years, 91% were women and 70 were general nurses, the dimensions rated as strengths were four, and eight of the twelve were rated as opportunities for improvement, they scored the overall level of safety as 7-8, which means ‘very good’. Discussion: The results of the study differ from those reported by several authors as they reported in their research as strength dimensions those which in this study were rated as an opportunity for improvement and are similar to those reported by other authors in regard to the adverse event reporting and staffing, which in this study also were rated as strengths. Conclusions: The nursing staff considers the strengths available in the hospital as few and missing many things to improve to ensure patient safety.

Panhipopituitarismo congénito secundario a interrupción del tallo hipofisario: informe de caso / Congenital panhypopituitarism secondary to pituitary stalk interruption: case report / Pan-hipopituitarismo congênito secundário na interrupção da haste hipofisária: relato de caso

La disrupción del tallo hipofisario es una patología infrecuente que causa hipogenesia de la pituitaria anterior y agenesia o ectopia \r\nde la hipófisis posterior. El diagnóstico se realiza tardíamente cuando aparecen mayores alteraciones antropométricas o disminu\r\n-\r\nciones en la velocidad de crecimiento. Se estima que solo el 23% de los casos se diagnostica en el periodo neonatal, con lo cual \r\nse logra disminuir la mortalidad y morbilidades secundarias. Este estudio describe el caso de un recién nacido con hipoglicemia \r\npersistente desde el nacimiento, micropene e incisivo único central. Se solicitó resonancia magnética cerebral y determinación \r\nsérica hormonal para confirmar el diagnóstico de panhipopituitarismo congénito secundario a la disrupción del tallo hipofisario. \r\nSe inició el reemplazo hormonal de forma temprana.

The disruption of the pituitary stalk is a rare disease that causes \r\nhypogenesis of the anterior pituitary and agenesis or ectopic \r\nposterior hypophysis. The diagnostic is carried out late, when \r\ngreater anthropometric alterations or decreases in the growth \r\nspeed materialize. Only 23% of the cases are diagnosed during \r\nthe neonatal period, therefore decreased in mortality and \r\nsecondary morbidities is achieved. This study describes the \r\ncase of a newborn that had persistent hypoglycemia from \r\nbirth, micropenis, and a single central incisor. A brain magnetic \r\nresonance and determination of serum hormones were \r\nrequested to confirm the diagnostic of congenital panhypo\r\n-\r\npituitarism secondary to the disruption of the pituitary stalk. \r\nHormone replacement was initiated early.

A interrupção da haste hipofisária é uma patologia pouco \r\nfrequente que causa hipogenesia da pituitária anterior e \r\nagenesia, ou ectopia, da hipófise posterior. O diagnóstico é \r\nrealizado tardiamente quando aparecem maiores alterações \r\nantropométricas ou diminuições na velocidade do crescimento. \r\nEstima-se que apenas 23% dos casos são diagnosticados no \r\nperíodo neonatal, com o que se atinge redução da morta\r\n-\r\nlidade e morbidades secundárias. Este estudo descreve o \r\ncaso de um recém-nascido com hipoglicemia persistente \r\ndesde o nascimento, micro pênis e incisivo central único. Foi \r\nsolicitada ressonância magnética cerebral e determinação \r\nsérica hormonal para confirmar o diagnóstico de pan-hipo\r\n-\r\npituitarismo congênito secundário na interrupção da haste \r\nhipofisária. A reposição hormonal foi iniciada precocemente.

Single fraction volumetric modulated arc radiosurgery of brain metastases.

PURPOSE: To show the clinical results of the treatment of brain metastases via radiosurgery using Volumetric Modulated Arc Therapy (VMAT). MATERIALS AND METHODS: 52 patients having lung (62 %), breast (17 %), colorectal (8 %) and other cancers (13 %) with one to three brain metastases were treated with 5 non-coplanar VMAT arcs. The treatment dose varied from 12 to 20 Gy, administered in one single session. The volume of metastases ranged from 0.04 to 24.92 cc. Radiosurgery alone was used for 54 % of cases, while 19 % received whole brain radiotherapy due to relapse. Patients were classified according to the Disease-specific graded prognostic assessment (DS-GPA) index and survival was assessed via the Kaplan-Meier model. RESULTS: The median survival time was 7.2 months from the date of radiosurgery. The Karnofsky and DS-GPA indices were the most significant with regard to survival. Patients with a Karnofsky performance status (KPS) over 70 had a longer survival time of 9.2 months, as opposed to those with a KPS below 70 of 3.5 months. No significant differences were found with regard to the type of cancer or the number of lesions. Local tumour control was achieved for 42 metastases (82 %), of which a complete response was achieved for 7 lesions, a partial response for 21; 15 lesions were stabilized. Local progression was observed in 8 lesions (15 %). The median treatment time per patient was 29 min. CONCLUSIONS: The VMAT technique proves to be safe and effective for treating brain metastases via radiosurgery.

Detection of hotspots and rapid determination of methane emissions from landfills via a ground-surface method.

We present a method for the rapid determination of methane emissions from landfills based on atmospheric dispersion theory, which suggests that the methane concentration, at a small distance from the soil/atmosphere interface, is proportional to its flux. Thus, after suitable calibration, the determination of methane concentrations close to the ground allows for flux determination in a shorter time than with standard enclosure techniques. This concept was tested using a surface probe in direct contact with the ground. The probe extracts a continuous sample of the air at the probe/ground interface and transports it to a portable methane analyzer. It was observed that stable methane concentrations were measured 30 s after the probe was positioned at the measurement point. These concentrations correlated well with the fluxes measured by standard static chambers. The method was used to determine the fluxes at 217 points within a 90,000 m(2) landfill. These measurements facilitated mapping of the CH4 emissions and the localization of hotspots. We conclude that the method is simple, effective, and relatively quick, compared to existing standard methods.

Characterization of pressurized hot water extracts of grape pomace: chemical and biological antioxidant activity.

Pressurized hot water extracts obtained at different temperatures possess different compositions and antioxidant activities and, consequently, different bioactivities. We characterized two pressurized hot water extracts from grape pomace obtained at 100°C (GPE100) and 200°C (GPE200) in terms of antioxidant activity and composition, as well as protective effect on cell growth and mitochondrial membrane potential (Δψm) in a HL-60 cell culture under oxidative conditions. GPE100 extracts were richer in polyphenols and poorer in Maillard reaction products (MRPs) than were GPE200 extracts. Moreover, hydroxymethylfurfural was detected only in GPE200. Both extracts exhibited similar protective effects on cell growth (comparable to the effect of trolox). In addition, GPE100 strongly decreased the Δψm loss, reaching values even lower than those of the control culture. This protective effect may be related to its high polyphenols content. At the highest concentration assessed, both extracts showed strong cytotoxicity, especially GPE200. This cytotoxicity could be related to their MRPs content.

Effect of repeated suboptimal chlorate treatment on ruminal and fecal bacterial diversity.

The minimal effective dose of sodium chlorate as an intervention to reduce the carriage of pathogenic bacteria in food-producing animals has not been clearly established. The effect of low-level oral chlorate administration to ewes was assessed by comparing the diversity of prominent bacterial populations in their gastrointestinal tract. Twelve lactating crossed Pelibuey and Blackbelly-Dorper ewes (average body weight, 65 kg) were randomly assigned (four per treatment) to receive a control treatment (TC; consisting of 3 g of NaCl per animal per day) or one of two chlorate treatments (T3 or T9; consisting of 1.8 or 5.4 g of NaClO3 per animal per day, respectively). Treatments were administered twice daily via oral gavage for 5 days. Ruminal and fecal samples were collected daily, starting 3 days before and ending 6 days after treatment, and were subjected to denaturing gradient gel electrophoresis of the 16S rRNA gene sequence amplified from total population DNA. For ruminal microbes, percent similarity coefficients (SCs) between groups varied from 23.0 to 67.5% and from 39.4 to 43.3% during pretreatment and treatment periods, respectively. During the treatment period, SCs within groups ranged from 39.4 to 90.3%, 43.3 to 86.7%, and 67.5 to 92.4% for TC, T3, and T9, respectively. For fecal microbes, SCs between groups varied from 38.0 to 85.2% and 38.0 to 94.2% during pretreatment and treatment periods, respectively. SCs for fecal populations during treatment were most varied for TC (38.0 to 67.9%), intermediate for T9 (75.6 to 92.0%), and least varied for T3 (80.6 to 90.6%). Heterogeneity within and between groups provided no evidence of an effect of chlorate treatment on ruminal or fecal microbial populations.

Semen preservation and artificial insemination in domesticated South American camelids.

Semen preservation and artificial insemination in South American camelids are reviewed giving emphasis to work done in Peru and by the authors. Reports on semen evaluation and the preservation process indicate that semen of alpacas and llamas can be manipulated by making it liquid first. Collagenase appears to be the best enzyme to eliminate viscosity. Tris buffer solution maintains a higher motility than egg-yolk citrate, phosphate buffered saline (PBS), Triladyl, and Merck-I extenders. Cooling of semen took 1h after collected, and equilibrated with 7% glycerol presented a better motility and spermatozoa survival at 1, 7, 15 and 30days after being slowly frozen in 0.25mL plastic straws. Trials of artificial insemination with freshly diluted semen and frozen-thawed semen are encouraging and needs to be tested extensively under field conditions. Recently, fertility rates varied from 3 to 67%. Semen preservation and most important, artificial insemination appear to be a reality, and could be used to improve the genetic quality of alpacas and llamas.

Delays in the diagnosis of pulmonary tuberculosis in Coahuila, Mexico.

OBJECTIVE: To determine diagnostic delay in pulmonary tuberculosis (PTB) cases and analyse associated factors. METHODS: New PTB cases were studied in Coahuila, Northern Mexico, between 2008 and 2009. We obtained census data and data on residential address, symptoms and diagnosis from the national patient database; sociodemographic variables were obtained during home visits. Bivariate analyses used the Kaplan-Meier method; multivariate analysis consisted of modelling survival. RESULTS: We studied 458 subjects (median age 48 years), who were predominantly males (56.1%); the median years of schooling was 6.0 years, 83.4% were urban residents, 50.3% were unemployed, and 87.7% suffered from food poverty. The median delay between the onset of symptoms and the first medical consultation was 53.5 days. Lack of formal education (P = 0.050) and living ≥5 km from a health unit (P = 0.034) were associated with longer delays and consequently with severe symptoms (cough ≥2 weeks, P = 0.001; chest pain, P = 0.032; malnutrition, P = 0.003). Mean health system delay (between first consultation and smear test result) was 18.5 days, and was significantly longer when the first consultation was with a private physician (P < 0.001) and when patient age was ≥46 years (P = 0.001). CONCLUSIONS: In Coahuila, lack of formal education, living ≥5 km from a health unit, first consultation with a private physician, and being aged ≥46 years contributed to delays in PTB diagnosis.