Imaging leachate runoff from a landfill using magnetotellurics: The Garraf karst case.

Electrical and active source electromagnetic geophysical methods have been traditionally employed to approach and tackle environmental problems, such as those caused by landfills. However, since these problems are more consequential and cover broader areas, it is necessary to use deeper penetration methods, such as magnetotellurics. In the Garraf Massif (Catalan Coastal Ranges, NE Spain), an urban waste disposal landfill had been in operation from 1974 to 2006, during which >26 million metric tons of garbage had been deposited. This landfill overlies karstic terrain, thus principally impacting groundwater circulation. Previous electrical resistivity tomography profiles had partially imaged the infill but were not able to penetrate below the base of the original landfill. During 2019 and 2020 we performed a magnetotelluric study over the landfill and its surrounding with the goals of characterizing the electrical resistivity of the infill and below it. The 2D and 3D resistivity models confirmed the highly conductive nature of the leachate and allowed us to identify its presence below the landfill base, which we quantified with maximum thicknesses of 90 m. This proved that landfill leachate had filtered through the original impermeable layer, enhanced by the karstic drainage structure.

Volcanic monitoring of the 2021 La Palma eruption using long-period magnetotelluric data.

Between September and December 2021, the first subaerial volcanic eruption in the Canary Islands in 50 years took place on the island of La Palma. Since November 2021, we have been conducting a long-period magnetotelluric (MT) monitoring experiment at a site located 2.4 km east of the volcanic cone. Having continuously recorded data since then, the obtained dataset shows significant changes in resistivity over the fourteen months following the eruption: more than ± 20% in apparent resistivity and ± 2 degrees in phase. These temporal variations in electrical resistivity, recorded continuously using long-period MT during both the syn- and post-eruptive stages, have not been reported to date, making this dataset unique. Four estimated impedances have been selected as representatives of the major temporal changes observed and inverted to generate new 3-D resistivity models. The results provide novel key information on the spatiotemporal evolution of the subsoil's electrical resistivity, enabling the characterization of a set of structures acting as preferred magmatic fluid pathways. Therefore, our study highlights the strong potential of MT as a volcanic monitoring tool and provides new insights about the evolution of the fluid pathways during the post-eruptive stage. These findings enhance our understanding of the magmatic system and may contribute to volcanic hazard mitigation in the future.

Behavioral changes in dairy cows with metritis in seasonal calving pasture-based dairy system.

The aims of this study were to determine changes in lying and rumination behavior of transition dairy cows that were healthy or affected by metritis during the autumn and spring calving season in a temperate climate and determine the effect of some weather variables (precipitation and heat stress) on these behaviors. A total of 103 multiparous cows were monitored during the autumn (February to April) and spring calving season (July to October) from 10 d before to 10 d after calving. Cows were chosen retrospectively by diagnosis of metritis [autumn season, (n = 11); spring season, (n = 13)] or as healthy [autumn season, (n = 25); spring season, (n = 25)] based on vaginal discharge characteristics evaluated during the first 10 days in milk. In all animals, electronic data loggers recorded lying (Hobo Pendant G Acceleration, Onset Computer Corp.) and rumination behavior (Hi-Tag rumination monitoring system, SCR Engineers Ltd.) during the study period. We included precipitation level (>1 mm/d = with rain, and ≤1 mm/d = without rain) and heat stress [no heat stress = temperature-humidity index (THI) < 68 vs. heat stress = THI ≥ 68] as weather factors that may have affected lying and rumination behavior during the spring and autumn season in a temperate climate, respectively. Metritis during the spring calving season was associated only with longer lying times (≥1.3 h/d) after calving. During the autumn calving season cows with metritis lay down longer the day of calving (~2.1 h/d) and had fewer lying bouts of longer duration during the prepartum period compared with healthy cows. Rumination time did not differ by health status during the spring calving season, whereas cows with metritis during autumn ruminated 30, 21, and 24 min/d less than healthy cows during the prepartum, calving, and postpartum period, respectively. Precipitation and heat stress were associated with decreased daily lying and rumination time in sick cows. Our results indicate that differences in lying and rumination behavior depended on the metritis status, and support the idea that weather factors such as rainfall or heat stress requires to be considered in analyses of transition cow behavior in seasonal calving pasture-based dairy systems.

Provision of shelter during the prepartum period: Effects on behavior, blood analytes, and health status in dairy cows in winter.

This study aimed to assess the effect of shelter provision during the prepartum period on lying, ruminating, and feeding behavior in outdoor-housed dairy cows exposed to winter weather conditions in a temperate climate. We also aimed to determine whether shelter provision during the prepartum period influenced blood analytes related to energy metabolism, body cleanliness, and health status. In this study, 2 cohorts of 12 multiparous Holstein prepartum cows were tested in winter. Twenty-five days before their expected calving date, the cows in each cohort were paired and randomly assigned to an open paddock without shelter or to one with access to an artificial shelter until calving. Shelter use, lying time, number of lying bouts, duration of lying bouts, rumination time, and feeding time were continuously recorded during the 3 wk before calving. Cows were assessed weekly for body cleanliness throughout the 3-wk prepartum period. A blood sample was taken from the coccygeal vein of each cow at wk -3, -2, -1, 1, 2, and 3 relative to calving date, and were assayed for nonesterified fatty acids (NEFA), ß-hydroxybutyrate, and haptoglobin concentrations. Cases of clinical health disorders after calving were also recorded. The cows spent 60% of their daily time in the shelters, and for 75% of that time they were lying down. Cows with access to shelter during the prepartum period lay down around 3.2 h/d more than cows without shelter on wk -3 and -2 relative to calving. The cows with shelter access spent less time feeding during the morning (wk -3: 29.7 min; wk -2: 12.1 min; wk -1: 17.3 min) and afternoon (wk -3: 18.2 min; wk -2: 21.9 min) than cows without shelter access. As well, cows with shelter access showed a higher body cleanliness score (∼92 vs. ∼48%) and lower NEFA concentrations (wk -2: 0.27 vs. 0.44 mmol/L; wk -1: 0.46 vs. 0.64 mmol/L) in the precalving period, and lower haptoglobin concentrations in the first week postpartum (0.34 vs. 0.79 mg/mL) than cows without shelter access. We observed no treatment differences in daily rumination time, ß-hydroxybutyrate concentrations, or postpartum health disorders. Despite the small number of dairy cows used in this study, these findings suggest that having access to a shelter during the prepartum period increases lying time, improves body cleanliness, and reduces adipose mobilization. Therefore, it is important to provide a protected area for the welfare of prepartum dairy cows exposed to winter climate conditions.

Milk production responses, rumen fermentation, and blood metabolites of dairy cows fed increasing concentrations of forage rape (Brassica napus ssp. Biennis).

The aim of this study was to determine animal performance, rumen fermentation, and health-related blood metabolites of dairy cows in mid lactation fed with increasing levels (30 and 45%) of forage rape (FR) in the diet. Twelve pregnant multiparous lactating Holstein-Friesian dairy cows were randomly allocated to 1 of 3 dietary treatments in a replicated 3 × 3 Latin square design. The experiment was divided into three 21-d periods. For the control diet, 13.0 kg (dry matter, DM) of grass silage, 3.0 kg DM of commercial concentrate, 2.7 kg of DM cold-pressed extracted canola meal, and 0.45 kg DM of solvent-extracted soybean meal were offered daily. For the other two treatments, 30 and 45% of the DM from silage, canola meal, and commercial concentrate were replaced in equal proportions with FR. Data were analyzed individually using linear and quadratic orthogonal polynomials. Ingestive behavior was altered by the inclusion of FR. We observed a linear increase in eating time at the expense of rumination time. Nevertheless, total DM intake was not affected by dietary treatments, averaging 19.5 ± 0.24 kg of DM/d. Milk yield increased linearly with increasing concentration of FR in the diet. Thus, feed efficiency of cows (kg of milk/kg of DM intake) increased linearly with the percentage of FR in the diet. Inclusion of FR in the diet had no effect on milk composition or milk sensory characteristics. Mean rumen pH of cows decreased linearly from the control to the 45% FR diet; however, dietary treatments had no effect on the daily amount of time that rumen pH was below 5.8 (252 ± 71.4), indicating no risk of subacute ruminal acidosis. Concentrations of total volatile fatty acids in the rumen and molar proportions of acetate and butyrate were increased with FR inclusion, whereas the proportion of propionate was linearly reduced. Excretion of uric acid and total purine derivatives tended to be greater for cows fed FR, which resulted in a trend toward a linear increase in estimated microbial N flow. However, N use efficiency was not affected by FR inclusion. Although differences for some hematological measures (increased white blood cell and neutrophils counts) and a quadratic response for glutamate dehydrogenase for cows fed FR in the diet (decreased with inclusion of 30% and increased with 45% in the diet) were observed, all values were within appropriate ranges for dairy cows. These results indicated that including FR to dairy cow diets, up to 45% of diet DM, improved milk production due to changes in volatile fatty acids and predicted microbial N flow and had no negative effects on dairy cow health or sensory characteristics of milk.

Milk production responses and rumen fermentation of dairy cows supplemented with summer brassicas.

Forage brassicas, such as summer turnip (ST; Brassica rapa) and forage rape (FR; Brassica napus), are used as supplementary crops during summer. However, studies with lactating dairy cows fed these forages are limited and report inconsistent productive responses. The aim of this study was to determine dry matter intake, rumen fermentation and milk production responses of dairy cows in mid-lactation supplemented with and without summer ('ST' or 'FR') brassicas. Twelve multiparous lactating dairy cows were randomly allocated to three dietary treatments in a replicated 3 × 3 Latin square design balanced for residual effects over three 21-day periods. The control diet consisted of 16.2 kg DM of grass silage, 2.25 kg DM of commercial concentrate and 2.25 kg DM solvent-extracted soybean meal. For the other two dietary treatments, 25% of the amounts of silage and concentrates were replaced with FR or ST. The inclusion of forage brassicas had no effects on milk production (24.2 kg cow/day average) and composition (average milk fat and protein 43.2 and 33.6 g/l, respectively). Dry matter intake was 0.98 kg and 1.12 kg lower for cows supplemented with FR and ST, respectively, resulting in a greater feed conversion efficiency (1.35 kg milk/kg DM for ST and FR v. 1.27 kg milk/kg DM for the control diet). Intraruminal pH was lower for cows supplemented with ST compared to the control diet; however, it did not decrease below pH 5.8 at any time of the day. After feeding, the concentrations of total short-chain fatty acids (SCFAs) in rumen contents increased with ST supplementation compared to the control diet. Inclusion of FR in the diet increased the molar proportion of acetate (68.5 mmol/100 mmol) in total SCFA at the expense of propionate, measured 6 h after feeding of the forage. The molar proportion of butyric acid was greater with ST and FR supplementation (13.1 and 12 mmol/100 mmol, respectively) than in control cows. The estimated microbial nitrogen (N) flow was 89.1 g/day greater when supplementing FR compared to the control diet. Based on the haematological measures, the inclusion of summer brassica forages did not affect the health status of the animals. These results indicate that mid-lactation dairy cows fed brassicas are able to maintain production despite the reduced intake, probably due to improved rumen fermentation and therefore nutrient utilization.

Claw horn lesions in mid-lactation primiparous dairy cows under pasture-based systems: Association with behavioral and metabolic changes around calving.

The objectives of this study were to describe the lying behavior of primiparous dairy cows under pasture-based systems during the pre- and postcalving period and characterize the association of lying behavior and analytes related to energy metabolism during this period with claw horn disruption lesion development later in lactation. Our convenience sample included 39 primiparous Holstein cows from 3 commercial farms that were assessed for body condition score (BCS; 5-point scale, 0.25-point increments) and had blood collected at wk -3, -2, -1, 1, 2, and 3 relative to calving date. Blood samples were assayed for nonesterified fatty acids, ß-hydroxybutyrate (BHB), and cholesterol concentrations. Electronic data loggers (HOBO Pendant G Acceleration, Onset Computer Corporation, Bourne, MA) recorded lying behavior at 1-min intervals from 3 wk before calving to 3 wk after calving. Starting at 4 wk after calving and until 16 wk after calving, cows were examined for claw lesions at approximately 4-wk intervals. Sole lesions and white line lesions were scored on a 0 to 10 scale. Of the 39 primiparous cows, 19 cows scored 0 at all exams during the entire study period and 20 cows had at least 1 severe lesion (score ≥4) between 8 and 16 wk after calving. Time spent lying before calving averaged 10.3 ± 0.3 h/d, but declined to 7.3 ± 0.3 h/d after calving (least squares means ± standard error). At calving, we noted an increase in the number of lying bouts (12.9 ± 0.45 bouts/d) compared with the pre- and postcalving averages of 11.6 (±0.53) and 9.1 (±0.47) bouts, respectively. Cows that developed claw lesions later in mid lactation spent less time lying down than cows without lesions during wk 3 after calving compared with healthy cows (7.29 ± 0.22 vs. 8.51 ± 0.16 h/d). Lesion cows had fewer lying bouts per day, and these bouts were of longer duration than no-lesion cows after calving. Increased odds of lesion were found to be associated with shorter lying times and fewer number of lying bouts during wk 3 (odds ratio = 1.23). Nonesterified fatty acids (747 ± 58 vs. 990 ± 86.85 µmol/L) and BHB (0.77 ± 0.06 vs. 0.60 ± 0.04 mmol/L) concentrations during wk 1 were greater in cows that developed claw lesions relative to cows that did not develop lesions. The BHB concentrations also remained higher in wk 2 for cows that developed claw lesions (0.63 ± 0.04 vs. 0.46 ± 0.03 mmol/L) compared with cows that did not develop any lesions. Cows that developed lesions experienced greater losses in BCS from wk -3 to 3 than cows without lesions (0.74 ± 0.01 and 0.61 ± 0.01 BCS change, respectively). In summary, changes in lying behavior and energy metabolic status after calving were associated with claw horn disruption lesions in mid-lactation primiparous cows under pasture-based systems.

Lying behavior and postpartum health status in grazing dairy cows.

Many cows have difficulty making the transition from pregnancy to lactation, as evidenced by the high incidence of disease that occurs in the weeks after calving. Changes in lying behavior can be used as an indicator of illness, yet no work to date has evaluated this relationship in dairy cows on pasture. The objectives of this study were to describe the lying behavior of grazing dairy cows during the first 3 wk after calving and determine the relationships between transition diseases and lying behavior. Our convenience sample included 227 multiparous and 47 primiparous Holstein cows from 6 commercial farms. Cows were recruited as they calved during the spring calving period. Electronic data loggers (Hobo Pendant G Acceleration, Onset Computer Corp., Pocasset, MA) recorded lying behavior at 1-min intervals. Diseases were recorded up to 21 d in milk, and cows were subsequently categorized into 3 health categories: (1) healthy, not lame and had no other signs of clinical (retained placenta, milk fever, metritis, mastitis) or subclinical (ketosis, hypocalcemia) postpartum diseases; (2) lame, identified as being clinically or severely lame with no other signs of clinical or subclinical postpartum disease; and (3) sick, diagnosed as having one or more clinical postpartum diseases (with or without a subclinical disease) but not lame. This last group was further divided into 2 groups: those that were diagnosed with a single clinical health event and those diagnosed with more than one clinical event. Lying behavior differed between primiparous and multiparous cows; primiparous cows divided their lying time into more bouts than did multiparous cows (9.7 ± 0.54 vs. 8.4 ± 0.26 bouts/d) and spent less time lying down than multiparous cows (7.5 ± 0.38 h/d vs. 8.5 ± 0.19 h/d). Lying behavior was also affected by illness; primiparous cows that developed more than one clinical disease, excluding lameness, spent more time lying, and tended to have longer lying bouts in the days following calving compared with healthy cows; multiparous severely lame cows spent more time lying down (1.7 h longer per day) compared with multiparous cows that were nonlame. Clinically lame cows had fewer lying bouts per day and these bouts were of longer duration than healthy nonlame cows. In summary, changes in lying behavior after calving were associated with postpartum health status in grazing dairy cows.

Abscesos renales y peri-renales: análisis de 44 casos / Renal and perinephric abscesses: a series of 44 cases

Renal abscesses are infrequent event and may occasionally be fatal. In order to characterize its main clinical features, its diagnosis and evolution, a retrospective-descriptive study was done with cases identified between 1996 and 2006 in a teaching hospital. Forty-four cases were collected (mean age 49.9 years). Diabetes mellitus was present in 38.6 percent, urinary calculi in 36.4 percent, and previous urinary tract infection in 11.4 percent of the studied population. Enterobacteriaceae were the most frequent isolated microorganisms (44.4 percent), and 33.3 percent had a poli-microbial culture in abscess samples. S. aureus was rarely identified. Main therapeutic approaches were minimally invasive procedures (pigtails, percutaneous drainage or nephrostomy) in 50 percent followed by surgical interventions (nephrectomy or surgical debridement) in ~30 percent. Only 20.5 percent of patients were treated exclusively by antibiotics. Minimally invasive procedures were applied progressively after 2001 (p < 0.005). In this series case-fatality rate was 4.5 percent; 13.6 percent (n = 6) developed septic shock. Nephrectomy was performed in 9 cases (20.5 percent). Patients selected for nephrostomy had a lower risk for ICU admission (Odds Ratio 0.083 IC95 0.008-0.911). Renal abscesses are cause of morbidity but had a low case-fatality ratio; the therapeutic approach has changed in recentyears favoring at present minimally invasive procedures.

Los abscesos renales son eventos infrecuentes pero potencialmente letales. Objetivo: Conocer sus características clínicas, diagnóstico y evolución. Metodología: Se efectuó un trabajo descriptivo-retrospectivo con los casos detectados entre 1996 y el 2006 en un centro universitario. Resultados: Se identificaron 44 pacientes (edad promedio 49,9 años) asociados en algunos casos a diabetes mellitus (38,6 por ciento), litiasis urinaria (36,4 por ciento) o infección urinaria previa (11,4 por ciento). Los microorganismos más frecuentes fueron Enterobacteriaceae (44,4 por ciento) y 33,3 por ciento> de los cultivos fueron polimicrobianos. Staphylococcus aureus se identificó infrecuentemente. La estrategia terapéutica principal fue el uso de técnicas mínimamente invasoras (pigtails, drenaje percutáneo o nefrostomía; 50 por ciento), y luego quirúrgicas (nefrectomía o aseos quirúrgicos; ~30 por ciento>). Sólo 20,5 por cientoo fue tratado exclusivamente con antimicrobianos. Los procedimientos mínimamente invasores se usaron en forma progresiva después del 2001 (p < 0,005). La letalidad en esta serie fue 4,5 por ciento> (n = 2) y 13,6 por ciento (n = 6) desarrolló shock séptico. La nefrectomía se aplicó en 9 casos (20,5 por ciento). Los pacientes seleccionados para nefrostomía tuvieron menos riesgo de ingresar a UCI (Odds Ratio 0,083 IC95 0,008-0,911). Conclusiones: Los abscesos renales son causa de morbilidad mayor aunque de baja letalidad. Su estrategia terapéutica ha ido cambiando en los últimos años a favor de procedimientos mínimamente invasores como los drenajes percutáneos y/o endoscópicos.

El órgano vomeronasal humano: [revisión] / Human vomeronasal organ: [revision]

El órgano vomeronasal (OVN) es una estructura que estudiamos alguna vez en anatomía, sin embargo su ubicación, frecuencia y función específica en humanos ha sido poco estudiada. Por este motivo se realizó una revisión bibliográfica actualizada acerca del OVN humano, enfatizando en puntos importantes como su anatomía y relación con algunas conductas. Hoy en día es considerado como un órgano olfatorio accesorio, capaz de percibir la presencia de vomeroferinas. Estas corresponden a un grupo de sustancias químicas identificadas, capaces de provocar cambios conductuales tanto a nivel social, sexual como maternal. Se localiza lateralmente al septo nasal y posee células periféricas, capaces de actuar como receptores, los cuales al ser estimuladas son capaces de generar una respuesta, susceptible de ser medida a través de un electrodo ubicado en el epitelio vomeronasal. Los últimos estudios sugieren que además tendría una conexión directa hacia el sistema nervioso central, mediante neuronas sensoriales bipolares, lo que implica un cuidado adicional en pacientes sometidos a cirugías cercanas a su ubicación.

The human vomeronasal organ (OVN) is a structure that is once studied in Anatomy, but commonly Iittie is known about its location, frequency and specific function. For this reason recent literature on the subject was reviewed, emphasizing important topics such as its anatomy and relation to some behaviors. The vomeronasal organ is nowadays considered an accessory olfactory organ, capable of detecting the presence of vomeropherins. These belong to a group of identified chemical substances, capable of induce behavioral changes at the social, sexual and maternal level. It is located lateral to the nasal septum, and it contains peripheral cells that act as receptors, which upon stimulation are capable of triggering a response that can be recorded via an electrode located in the vomeronasal epithelium. In addition, recent studies suggest that the vomeronasal organ has a direct connection to the central nervous system, by way of bipolar sensory neurons, which would demand additional care in patients having surgery in its vicinity.

Reflujo faringolaríngeo: revisión bibliográfica: [revisión] / Pharyngolaryngeal reflux: a literature review: [revision]

El reflujo faringolaríngeo (RFL) es un síndrome que se asocia a una constelación de síntomas. Entre ellos los más frecuentemente descritos son la disfonía, la fatiga vocal, el globus faríngeo, la tos crónica y la carraspera. Se realizó una búsqueda exhaustiva en bases de datos internacionales y nacionales en relación a RFL. Se utilizaron palabras clave como globus, carraspera, laringitis, disfonía y reflujo gastroesofágico. Se obtuvieron alrededor de 35 referencias en relación al tema estudiado, siendo la mayoría publicadas con posterioridad al año 2000. En relación a su etiología, se cree que el flujo retrógrado de contenido gástrico hacia la faringe sería el hecho más importante para su génesis, pero recientemente se ha demostrado que si bien este hecho patológico es fundamental en la producción de los síntomas, existen factores adicionales, capaces de perpetuarlo, permitiendo considerar al RFL como una entidad diferente del reflujo gastroesofágico (RGE).

Pharyngolaryngeal reflux (RFL) is a syndrome associated to a variety of symptoms. Among them, the most frequently described are dysphonia, vocal fatigue, pharyngeal globus, chronic coughing and throat clearing. An exhaustive search of international and national databases was performed. Globus, throat clearing, laryngitis and gastroesophageal reflux were used as keywords. Some 35 search-related references were retrieved, of which most were published from 2000 to date. Respect to the etiology of pharyngolaryngeal reflux, the current view is that gastric contain reflux to the pharynx is the most important factor, but recently it has been demonstrated that, although this pathological trait is pivotal for symptoms appearance, there are additional factors that could perpetuate the symptoms in time, which contribute to consider RFL as a different entity from gastroesophageal reflux (RGE).

Tratamiento selectivo de los episodios de neutropenia febril en niños con cáncer: Comité de Infectología, Programa Infantil Nacional de Drogas Antineoplásicas (PINDA) / Selective treatment of febrile neutropenia in pediatric cancer patients

El manejo de los pacientes pediátricos con cáncer y neutropenia febril (NF) requiere de su clasificación en alto o bajo riesgo de adquirir infecciones bacterianas invasoras (IBI), con el fin de implementar estrategias selectivas de tratamiento. Basados en nuestra experiencia y publicaciones internacionales al respecto, proponemos recomendaciones para el diagnóstico y manejo de niños con cáncer y NF, categorizadas según riesgo de IBI. Todos los pacientes pediátricos que presenten episodios de NF deben ser ingresados al hospital por al menos 24 horas. Durante este lapso se efectuará su evaluación clínica y de laboratorio con el objeto de clasificar el riesgo de este episodio y precisar el (los) posible(s) foco(s). Los pacientes de alto riesgo deben continuar internados hasta su recuperación. Los de bajo riesgo pueden ser manejados en forma ambulatoria. La elección de la terapia antimicrobiana inicial y los criterios para su ajuste deberán basarse en el hallazgo o no de focos infecciosos y en los patrones epidemiológicos e institucionales de susceptibilidad. La reevaluación de ambos grupos debe ser periódica (al menos en los días 3, 5 y 7 de evolución), y la respuesta terapéutica será clasificada como favorable o desfavorable según criterios clínicos y parámetros de laboratorio preestablecidos.

[Clinical characterization of 450 patients with cerebrovascular disease admitted to a public hospital during 1997]. / Caracterización clínica de 450 pacientes con enfermedad cerebrovascular ingresados a un hospital público durante 1997.

BACKGROUND: In Chile, cerebrovascular diseases are the fifth cause of death among men and the third cause among women. AIM: To assess the clinical features and management of patients with cerebrovascular disease admitted to a public hospital during 1997. PATIENTS AND METHODS: A retrospective analysis of clinical records of patients discharged with a diagnosis of cerebrovascular disease. Those records in which there was discordance between the discharge diagnosis and the clinical picture were not considered in the analysis. RESULTS: Of the 563 discharges from the hospital with the diagnosis of cerebrovascular disease, 487 records were located and 450 were considered in the analysis. Fifty four percent of patients were male and ages ranged from 17 to 96 years old. Fifty-one percent of patients had an ischemic stroke, 34% a cerebral hemorrhage, 12% a subarachnoidal hemorrhage and 3% a transient ischemic attack. There was a history of hypertension in 64% patients and 20% had an adequate treatment. Eighteen percent were diabetics, 34% had a heart disease and 20% had a previous episode of stroke. Mean hospital stay was 6.3 days in the emergency room and 11 days in the neurology ward. Hospital infections appeared in 21% of patients (respiratory in 68% and urinary in 22%), lethality was 30.5% and a CAT scan was done in 94%. At the moment of admission, 10% of patients had an evolution of less than 2 hours, 27% had an evolution between 2 and 6 hours and nine cases were potential eligible for thrombolysis. CONCLUSION: This is a picture of the local features of patients with cerebrovascular diseases that can be used as a reference for future studies.

Complicaciones asociadas al uso de catéteres Hickmann / Complications associated to Hickmann catheter use

Entre enero de 1994 y junio de 1996 se colocaron en el Servicio de Pediatría del Hospital San Juan de Dios, 55 catéteres Hickmann en 53 niños, con edades de 4 meses a 16 años 6 meses. De ellos, 39 eran portadores de leucemia, 9 de linfoma, 3 de tumores sólidos, 1 de intestino corto y 1 de anemia aplástica. Se colocaron catéteres 4, 2,6,6 ó 9,6 french acorde a la edad y peso del paciente. Se usaron para administración de quimioterapia, nutrición parenteral, antibióticos, hemoderivados y toma de exámenes. En 12.605 días de uso, hubo una complicación cada 233,4 días y que correspondieron a 15 bacteremias, 9 catéteres migrados, 6 obstrucciones, 13 infecciones del sitio de salida, 2 infecciones de herida operatoria, 7 infecciones tardías por granuloma del cuff, 1 ruptura del catéter y 1 episodio de edema de la extremidad. Al finalizar el estudio se habían perdido 7 catéteres en forma accidental, se habían retirado 4 catéteres por fin de tratamiento, 6 por complicaciones, 7 por muerte del paciente y 31 continuaban en usoEntre enero de 1994 y junio de 1996 se colocaron en el Servicio de Pediatría del Hospital San Juan de Dios, 55 catéteres Hickmann en 53 niños, con edades de 4 meses a 16 años 6 meses. De ellos, 39 eran portadores de leucemia, 9 de linfoma, 3 de tumores sólidos, 1 de intestino corto y 1 de anemia aplástica. Se colocaron catéteres 4, 2,6,6 ó 9,6 french acorde a la edad y peso del paciente. Se usaron para administración de quimioterapia, nutrición parenteral, antibióticos, hemoderivados y toma de exámenes. En 12.605 días de uso, hubo una complicación cada 233,4 días y que correspondieron a 15 bacteremias, 9 catéteres migrados, 6 obstrucciones, 13 infecciones del sitio de salida, 2 infecciones de herida operatoria, 7 infecciones tardías por granuloma del cuff, 1 ruptura del catéter y 1 episodio de edema de la extremidad. Al finalizar el estudio se habían perdido 7 catéteres en forma accidental, se habían retirado 4 catéteres por fin de tratamiento, 6 por complicaciones, 7 por muerte del paciente y 31 continuaban en uso

Heparina con vancomicina en la prevención de bacteremias asociadas a cateter venoso permanente en pacientes oncológicos: resultados preliminares de un estudio randomizado de doble ciego / Heparin plus vancomycin in prophylaxis of catheter associated bacteremias in oncological patients: preliminar results of a double blind, randomized study

Objetivos: probar si la adición de vancomicina en microdosis (25 mcg/ml) a la solución de heparinización de catéteres venosos centrales permanentes (CVP) previene la ocurrencia de bacteremias por gérmenes vancomicina sensibles en pacientes oncológicos. Métodos: 39 pacientes con patología oncológica portadores de CVP externo (Hickman-Broviac) participaron en un estudio prospectivo, randomizado de doble ciego y fueron asignados a recibir una solución de heparina sola (Hep) o de heparina-vancomicina (HepVan). Todos los episodios febriles fueron registrados, realizándose hemograma y hemocultivo central y periférico. Los episodios febriles fueron tratados con antibióticos según normas establecidas. Resultados: se observaron en 14 meses 6.519 días catéter. Hubo 70 episodios febriles y 16 episodios de bacteremia, de los cuales 9 fueron por gérmenes sensibles a la vancomicina, 6 en el grupo Hep y 3 en el grupo HepVan (p = 0,31). En los episodios no neutropénicos (recuento absoluto de neutrófilos > 500/cm3) hubo 4 bacteremias en el grupo Hep y 0 en el grupo HepVan (p = 0,057). Conclusiones: la adición de vancomicina a la solución de heparinización de CVP no previene bacteremia asociada a CVP. La menor incidencia de bacteremias por gérmenes sensibles a la vancomicina en pacientes no neutropénicos versus neutropénicos en el grupo HepVan apoya la hipótesis de que la colonización intraluminal del CVP es un factor importante en las bacteremias en pacientes no neutropénicos

Fundamentos clínicos y neurobiológicos del uso de benzodiazepinas en la esquizofrenia / Clinical and neurobiological basis of the use of benzodiazepines in schizophrenia

En este trabajo se revisan los fundamentos clínicos y nerobiológicos del uso de benzodiazepinas en la esquizofrenia. Del análisis de los estudios clínicos se concluye que estos fármacos mejoran los síntomas psicóticos en algunos pacientes, mientras en otros son totalmente inefectivos. Desde el punto de vista neurobiológico se analiza el sistema gabaérgico y sus relaciones con el sistema dopaminérgico. Luego se revisan los estudios sobre Gaba en LCR y plasma de esquizofrénicos, y los estudios con drogas gabaérgicas. Se discuten las dificultades en la realización e interpretación de estos estudios. Se concluye que la fisiopatología de la esquizofrenia puede ser bastante compleja y que es necesario considerar las relaciones del sistema dopaminérgico con otros sistemas de neurotransmisión, y las variaciones temporales de estos sistemas interrelacionados. Se plantea la necesidad de investigar más el papel terapéutico de las benzodiazepinas en la esquizofrenia, ya que los pacientes que mejoran con estos fármacos pueden tener fisiopatología diferente

Encuesta sobre el uso de psicofármacos en pacientes internados en un hospital universitario de adultos / Use of psychotropic drugs in patients admitted to a university hospital for adults

We performed a survey concerning the use of psychotropic drugs among 223 patients admitted to a university hospital in november 1986. 39% of patients were receiving some psychotropic drug, and 73% of these corresponded to benzodiazepines. Insomnia and anxiety were reported as the main causes for drug use. Patients above age 50 were most affected. 61% of drugs had been in use for more than 6 months. These results confirm previous findings regarding psychotropic drug use in adults