Siloxane-inorganic chemical crosslinking of hyaluronic acid - based hybrid hydrogels: Structural characterization.

HA-based hybrid hydrogels were successfully developed. The polysaccharide (HA) chains were chemically modified and hybridized via amidation of their carboxylic groups with aminosilane molecules. HA-polysaccharide chains were crosslinked by a 3D siloxane organic-inorganic matrix via sol-gel. The novel inorganic crosslinking network (PDMS-SiO2) provided to sodium hyaluronate (HA) strong chemical bonds, giving restriction to their natural hydrophilicity and stiffness to its structure (improved rheological properties). It was observed that synthesis conditions such as starting HA concentration solution and temperature determined gelling times, efficiency in the polysaccharide chemical modification and in crosslinking hydrolysis-condensation reactions, resulting in the siloxane organic-inorganic matrix. Drying processes influenced crosslinking in HA hybrid hydrogels, either by enhancing polycondensation reactions or inhibiting them. Room temperature-drying produced more densified hybrid structures. Freeze-drying increased porosity and surface hydroxyl groups (-OH) resulting in more Q3 structural units. 60 °C-drying boosted polycondensation of monodendate structural units, enhancing the formation of hybrid D-Q bonds.

Eficacia de medicamentos antihomotóxicos en el tratamientodel síndrome miofascial cervical y de cintura escapular: estudio comparativo versus toxina botulínica tipo A / Efficacy of antihomotoxic medicine in treatment of cervical miofascial síndrome and shoulder girdle: comparative study versus botulinum toxin type A

Introducción: El síndrome de dolor miofascial es una causa común de dolor muscular en región cervical y cintura escapular. El tratamiento ha incluido medios conservadores y procedimientos invasivos; los medios conservadores incluyen fármacos, modalidades de terapia física, masaje y ejercicio terapéutico; los procedimientos invasivos incluyen punción seca e inyecciones en los puntos gatillo de diversas sustancias como toxina botulínica tipo A, esteroides, anestésicos locales e incluso se ha reportado eficacia con la inyección de medicamentos homeopáticos complejos conocidos como medicamentos antihomotóxicos. Objetivo: Comparar la eficacia de las inyecciones intramusculares en puntos gatillo, usando toxina botulínica tipo A versus medicamentos antihomotóxicos. Materiales y métodos: Se realizó un estudio experimental, longitudinal, prospectivo, aleatorizado y ciego, tipo ensayo clínico controlado, que incluyó 31 pacientes con diagnóstico de síndrome miofascial de región cervical y cintura escapular, divididos en 3 grupos; cada grupo recibió inyecciones intramusculares en puntos gatillo. Un grupo fue tratado con toxina botulínica tipo A con una dosis de 10 U por punto gatillo, otro grupo se trató con una combinación de medicamentos antihomotóxicos que incluyó una mezcla de Traumeel(R) S, Spascupreel Traumeel(R), Gels Homaccord Traumeel(R) y Lymphomyosot Traumeel(R) a razón de 1 ml de esta combinación por punto gatillo; el tercer grupo recibió tratamiento placebo con solución salina al 0,9 % a razón de 1 ml por punto gatillo. A los tres grupos se les evaluó arcos de movilidad, fuerza muscular, intensidad del dolor con la EVA, número de puntos gatillo e índice de discapacidad del cuello al inicio del tratamiento y a las 6 semanas. Resultados: Se observó una disminución del dolor y del número de puntos gatillo en los 3 grupos, sin embargo solo fue estadísticamente significativa en el grupo tratado con medicamentos antihomotóxicos. Conclusiones: El uso de medicamentos antihomotóxcos aplicados mediante inyección intramuscular en los puntos gatillo puede ser una opción de tratamiento eficaz en pacientes con síndrome doloroso miofascial cervical

Introduction: Myofascial pain syndrome is a common cause of muscle pain in cervical region and shoulder girdle. Treatment has included conservative means and invasive procedures; conservative means include drugs, modalities of physical therapy, massage and therapeutic exercise; Invasive procedures include dry nedling and trigger point injections of various substances such as botulinum toxin type A, steroids and local anesthetics and even has been reported effective with the injection of complex homeopathic medicines known as antihomotoxic drugs. Objective: To compare the effectiveness of the intramuscular injections in trigger points using a Botulinum toxin type A versus antihomotóxic drugs. Materials and methods: We conducted a pilot study, longitudinal, prospective, randomized and blind, type controlled clinical trial, which included 31 patients with diagnosis of myofascial syndrome of cervical region and shoulder girdle, divided in 3 groups; each group received intramuscular injections in trigger points. One group was treated with botulinum toxin type A with a dose of 10U by trigger point, another group was treated with a combination of antihomotoxic drugs that included a mixture of Traumeel(R) S, Spascupreel Traumeel(R), Gels Homaccord(R) y Lymphomyosot Traumeel(R) at a rate of 1 ml of this combination by trigger point; the third group received placebo treatment with saline solution at 0.9 % at the rate of 1 ml. for trigger point. The three groups were evaluated mobility, muscular strength, pain intensity with EVA, number of trigger points and disability index of the neck at the start of treatment and at 6 weeks. Results: It was observed a decrease of pain and the number of trigger points in the 3 groups, however it was only statistically significant in the group treated with antihomotoxic drugs. Conclusions: The use of antihomotoxic drugs applied by intramuscular injection in the trigger points can be an effective treatment option in patients with cervical myofascial pain síndrome

Intraspecific variations in dispersal ability of saproxylic beetles in fragmented forest patches.

The extrapolation of metapopulation concepts to saproxylic insects suggests that the occupancy of forest patches and the colonization of ephemeral deadwood substrates are driven by micro-evolutionary processes that are related to adaptive plasticity and intraspecific sex-dependent polymorphism of dispersal traits. We hypothesized that forest fragmentation could favor more mobile individuals within populations, but little empirical data have been published on the potentially sex-biased response of insect populations to habitat availability. We selected 88 fragmented woodlots in two European agricultural landscapes to cover different degrees of spatio-temporal fragmentation, from small, isolated and recently established woodlots to large, inter-connected ancient woodlots. In line with our hypothesis, the average wing loading (WL), used as a proxy for dispersal ability, for each of nine flight-dispersing saproxylic beetle species should be lower in recent, small, isolated woodlots than in ancient, large, inter-connected woodlots, respectively (i.e. ancient vs. recent, small vs. large, isolated vs. connected). Forest patch size did not significantly influence the average dispersal ability of beetle colonizers. However, WL of one-third of the tested species did significantly respond to forest ancientness or connectivity. Significant patterns were sex-biased, probably due to the contrasting role of males and females in species colonization dynamics. WL was lower in recent than in ancient forest plots for Melandrya barbata males, and it was lower in isolated than in connected woodlots for Tetratoma ancora and Phymatodes testaceus males. Contrary to expectations, we did not observe any decrease in polymorphism of dispersal abilities with decreasing woodlot size or increasing isolation. Our findings give support to the usefulness of gender consideration in insect conservation ecology studies.

Influence of trial registration on reporting quality of randomized trials: study from highest ranked journals.

OBJECTIVE: To evaluate the reporting quality of key methodological items of randomized control trials (RCTs) in 55 of the highest ranked journals. STUDY DESIGN AND SETTING: A list of the highest top ranked journals was identified, and a search for detecting RCTs in those journals was made. Two hundred sixty four journals were screened and 55 of them were identified having at least one RCT. Three RCTs were randomly selected a priori from each journal; 148 RCTs were finally included. RCTs were assessed by two reviewers using the Consolidated Standards of Reporting Trials (CONSORT) statement. RESULTS: Only 11 (8%) RCTs had all items adequately reported. In addition, 36% of RCTs reported that the study was registered in any trial registry. We found a significant difference in the quality of reporting for baseline characteristics, recruitment, participant's flow, and randomization implementation between those studies having reported the registration of their RCT in a trial registry and those that have not. Adherence to key methodological items of the CONSORT statement was as follows: sample size determination (60%), sequence generation (49%), allocation concealment (40%), and blinding (25%). CONCLUSIONS: Reporting of varied CONSORT items remains suboptimal. Registration in a trial registry was associated with improved reporting. Further efforts to enhance RCT registration could contribute to this improvement.

Casuística de pacientes con cáncer de piel: biopsiados en Hospital Regional Valdivia en un período de 20 años (1982-2002) / Pool of skim cancer patients´byopses in the regional Hospital of Valdivia in a period of 20 years (1982-2002)

El cáncer cutáneo es un problema que va en aumento, dada la destrucción de la capa de Ozono y el daño de los rayos. Ultravioleta sobre la piel, lo que causa diferentes tipos de cáncer como el Carcinoma Basocelular, Carcinoma Espinocelular y Melanoma. El objetivo del presente estudio fue analizar 620 muestras histológicas registradas en el Servicio de Anatomía Patológica del Hospital Regional de Valdivia en cuanto a sexo, edad, frecuencia por tipo histológico y localización. Resultados: se obtuvo 315 casos de Carcinoma Basocelular, 199 de Carcinoma Espinocelular y 106 de Melanoma; 299 fueron hombres y 321 mujeres. La mayoría de los casos se dio en la zona de cabeza y cuello. El cáncer más frecuente fue el Carcinoma Basocelular (50.8 por ciento), luego el Carcinoma Espinocelular (32.1 por ciento) y en tercer lugar el Melanoma (17.1 por ciento). Sólo el Carcinoma Espinocelular afectó a más hombre que mujeres. Las edades afectadas van desde los 15 a los 99 años de edad, correspondiendo al número mayor de casos entre los 70 y 79 años para el Carcinoma Basocelular y Carcinoma Espinocelular; y entre los 60 y 69 años de edad para el Melanoma. Las áreas más afectadas del cuerpo son las fotoexpuestas, probablemente por disminución de factores protectores como la capa de Ozono. En Valdivia hay mayor cantidad de casos de Melanoma que en el ámbito nacional.

Heridas penetrantes abdominales en el Hospital Clínico Regional de Valdivia entre los años 2001-2003 / Penetrating abdominal wounds in the clinic regional hospital of Valdivia from 2001-2003 years

Se presentan 124 casos de heridas penetrantes abdominales, en revisión retrospectiva desde enero 2001 hasta diciembre 2003, excluyendo las heridas toracoabdominales. Afectaron predominantemente al sexo masculino (95.1 por ciento), relacionándose en forma directa con la ingesta de alcohol en el 75 por ciento de los casos. La etiología más frecuente fue el arma blanca (93.5 por ciento). Las manifestaciones clínicas cardinales fueron: signos peritoneales (34.6 por ciento), dolor abdominal (33 por ciento), fiebre (19.3 por ciento), exteriorización de epiplón (14.5 por ciento) y signos y síntomas de shock (11.2 por ciento). El 63.7 por ciento de los individuos afectados fue operado y hubo un 8,9 por ciento de laparotomías en blanco. En el grupo de pacientes que no requirió cirugía, el tiempo promedio de observación previo al alta fue 23 horas. En el grupo de operados el tiempo promedio de observación, previo a la cirugía, fue 5 horas, la profilaxis antibiótica se efectuó en el 91.1 por ciento y el esquema más usado fue Penicilina, Quemicetina y Gentamicina i.v. (44.3 por ciento). Los órganos más lesionados fueron intestino delgado (44.3 por ciento) y colon (20,3 por ciento); la técnica quirúrgica más empleada correspondió a enterorrafia primaria (63.2 pòr ciento). Los hallazgos intraoperatorios más frecuentes resultaron ser: hemoperitoneo (39,2 por ciento) y peritonitis (15.2 por ciento). Morbilidad 29.1 por ciento, la más frecuente fue causada por la colección residual (8.9 por ciento) seguida de infección de herida operatoria (5 por ciento). El tiempo promedio de hospitalización fue de 6 días. A pesar del avance tecnológico, la herida penetrante abdominal sigue siendo un cuadro en el que el cirujano debe indicar un manejo quirúrgico basado, casi exclusivamenete, en su experiencia y buen juicio clínico.

Sistema de guía farmacoterapéutica en un servicio de urgencias y emergencias extrahospitalario / Pharmacotherapeutic guide system in an extrahospitalary emergency service

Objetivos: Una adecuada atención sanitaria implica un correcto uso de medicamentos, la amplitud y complejidad del mercado farmacéutico hace necesario un programa de evaluación, selección y utilización de medicamentos en las instituciones sanitarias. La Comisión de Farmacia y Terapéutica (CFT), aplicando un sistema de Guía Farmacoterapéutica (GFT), posibilita que el personal sanitario intervenga en dichos procesos. Este trabajo presenta la segunda edición de la GFT del Servicio Especial de Urgencias-061 (SEU-061) y su metodología de elaboración en el marco de un sistema de GFT. Métodos: Todo el personal sanitario puede participar en la valoración y selección de medicamentos. La GFT se diseñó con cuatro partes: información general, información especial, descripción detallada de medicamentos e índice alfabético. Los criterios principales de selección fueron seguridad, eficacia y coste-efectividad, basándose en información objetiva e independiente y procurando seleccionar el menor número de medicamentos que garantice la atención de las patologías que se atienden. Se diseña el formato más adecuado y la estrategia de distribución. Resultados: La información citada se plasma en un documento con un formato de fácil manejo y resistente, distribuido entre todos los sanitarios, asegurándose que conocen la existencia del sistema de GFT. La CFT efectúa una revisión continua y actualización periódica de la GFT. Conclusiones: La elaboración de la GFT, en el marco de un sistema de GFT, con la participación de todo el personal sanitario que lo ha deseado, pensamos que puede plasmarse en una atención al usuario mejor y más económica, tal como se ha demostrado en el ámbito hospitalario (AU)

Estudio multicentrico, abierto, no comparativo sobre la seguridad y eficacia de sulbactam cefoperazona en infecciones bacterianas moderadas y severas / Non comparative multicentric study over security and efficacy of sulbactam cefoperazone in moderate and severe in bacterials infections

La eficacia y seguridad de sulbactam/cefoperazona fue evaluada en un estudio multicéntrico, abierto, no comparativo, usado como monoterapia. Doscientos dieciseis pacientes entraron inicialmente al estudio, siendo excluidos 42, por haber recibido antibioticoterapia concomiante. Ciento setenta y cuatro pacientes adultos (99M, 75 F), con rango de edad de 13 a 83 años fueron tratados con sulbactam/cefoperazona como monoterapia, en proporción 1:2, vía endovenosa, presentando 102 (59 por ciento) pacientes infecciones severas, y, 72(41 por ciento) infecciones moderadas. La localización de las infecciones fueron: piel y tejidos blandos (n=54,31 por ciento), abdominales (n=54,31 por ciento), infecciones respiratorias bajas (n=40,23 por ciento), tracto biliar (n=9,5 por ciento), tracto urinario (n=9,5 por ciento), área ginecológica (n=3,2 por ciento) y otras (n=5,3 por ciento). Ciento sesenta y uno (93 por ciento) de las infecciones fueron agudas, nueve (5 por ciento) crónicas y, 4 (2 por ciento) recurrentes. Los gérmenes obtenidos con mayor frecuencia el cultivo inicial fueron P. aeruginosa (27,16 por ciento), E.coli (n=23,13 por ciento), E.cloacae (n=14,8 por ciento), S. aureus (n=7,4 por ciento). La dosis diaria administrada de sulbactam/cefoperazona osciló entre 3 y 9 gr/día (media 4,6g/día), durante 1-70 días (media 10 días). Ciento cuarenta y cuatro pacientes fueron evaluados clínicamente, obteniéndose curación en 112 pacientes (78 por ciento), mejoría en 24 (17 por ciento), y falla en 8 pacientes (5 por ciento). Se incluyeron 96 pacientes para evaluación bacteriológica, reportándose erradicación en 88 (91 por ciento) y, persistencia en 8 (9 por ciento). Se presentaron efectos adversos en 9 pacientes (5 por ciento): rash, prolongación del PTT, cefalea, escalofríos y diarrea. Con un 95 por ciento de respuesta clínica satisfactoria, 91 por ciento de erradicación bacteriológica y buena tolerancia concluimos que sulbactam/cefoperazona usado como monoterapia es una buena elección para el tratamiento de infecciones moderadas y severas.

Efficacy of audio-prompted rate guidance in improving resuscitator performance of cardiopulmonary resuscitation on children.

OBJECTIVE: To evaluate the effect of audio-prompted rate guidance during chest compressions on the performance of cardiopulmonary resuscitation (CPR) on children. METHODS: This 24-month prospective study occurred in the pediatric intensive care units of a university hospital and a children's hospital. Intubated children with nontraumatic cardiac arrest were eligible. After placement of an infrared capnometer between the endotracheal tube and resuscitation bag, an audiotape instructed the resuscitator to perform chest compressions at 100 per minute or 140 per minute for one minute, followed by another minute at the other rate. End-tidal carbon dioxide partial pressure (PETCO2) was recorded prior to audiotape instruction and after one minute of CPR at each rate. RESULTS: Six patients, two boys and four girls, with a mean age of 15 +/- 13 months (range 2-36 months) were studied. All had asystole or pulseless electrical activity. CPR was provided for 14 +/- 9 minutes prior to institution of the study protocol. PETCO2 at 140/min was higher than at baseline (12 +/- 7 torr verus 4 +/- 3 torr, p < 0.05). There was a trend towards higher PETCO2s at 100/min compared with baseline (11 +/- 12 torr versus 4 +/- 3 torr, p = 0.08). PETCO2s did not differ at 100/min compared with 140/min. CONCLUSIONS: In support of prior adult and animal investigations suggesting that basic CPRR is often performed poorly and at inappropriately slow rates, audio- prompted rate guidance during CPR in children resulted in higher PETCO2, suggesting improved CPR performance.

Dexamethasone in the prevention of postextubation stridor in children.

To assess whether there is any advantage in the use of corticosteroid to prevent postextubation stridor in children, we conducted a prospective, randomized, double-blind trial of dexamethasone versus saline solution. The patients were evaluated and then randomly selected to receive either dexamethasone or saline solution according to a stratification based on risk factors for postextubation stridor: age, duration of intubation, upper airway trauma, circulatory compromise, and tracheitis. Dexamethasone, 0.5 mg/kg, was given every 6 hours for a total of six doses beginning 6 to 12 hours before and continuing after endotracheal extubation in a pediatric intensive care setting. There was no statistical difference in incidence of postextubation stridor in the two groups; 23 of 77 children in the placebo group and 16 of 76 in the dexamethasone group had stridor requiring therapy (p = 0.21). We conclude that the routine use of corticosteroids for the prevention of postextubation stridor during uncomplicated pediatric intensive care airway management is unwarranted.

An ovine model of maternal iron poisoning in pregnancy.

An ovine model of maternal iron poisoning in pregnancy was used to examine the placental transport of deferoxamine and ferrioxamine and to follow maternal and fetal serum iron concentrations when maternal serum iron levels exceeded total iron-binding capacity. Ewes in the third stage of gestation underwent hysterotomy and delivery of the fetal head through an abdominal incision while under ketamine and halothane anesthesia. The fetal external jugular vein was catheterized for sampling of venous blood while the fetus remained in utero. Administration of deferoxamine mesylate or ferrioxamine mesylate IV to ewes was not accompanied by measurable deferoxamine or ferrioxamine in fetal blood. In a final experiment, four gravid ewes in a control group received 2 mg/kg maternal body wt iron IV over 60 minutes. An experimental group comprising another four ewes received similar doses of iron but then received 50 mg/kg deferoxamine mesylate IV over 15 minutes. Control and deferoxamine ewes reached similar peak maternal serum iron concentrations (2,479 +/- 266 and 2,121 +/- 343 micrograms/dL, respectively). The markedly elevated maternal serum iron concentrations were not accompanied by meaningful elevations in fetal serum iron levels over baseline values. Maternal deferoxamine infusion resulted in a more rapid fall in maternal serum iron concentrations but had no effect on fetal serum iron levels. The ovine fetus appears to be protected from elevated maternal serum iron concentrations in the last trimester of pregnancy. It could not be demonstrated that meaningful quantities of deferoxamine or ferrioxamine cross the placenta in the last trimester.(ABSTRACT TRUNCATED AT 250 WORDS)

Positive inotropic effects mediated by alpha 1 adrenoceptors in intact human subjects.

The role of alpha 1-adrenergic receptors (adrenoceptors) on cardiac contractility was investigated in human subjects. The effect of methoxamine, a selective alpha-adrenoceptor agonist, and angiotensin II, on cardiac contractility was determined by means of noninvasive assessment of the slope of the end-systolic pressure (ESP)/end-systolic dimension (ESD) relationship. The slope (m) of this ratio was significantly higher with methoxamine (17.0; SD = 9.0 mm Hg/mm) than with angiotensin II (4.8; SD = 1.9 mm Hg/mm) (p less than 0.05). Slopes with methoxamine were higher when heart rates (HRs) were reflexly reduced, and were significantly diminished when reflex bradycardia was prevented by atropine (p less than 0.05) or atrial pacing (p less than 0.01). Previous treatment with propranolol did not modify m values with methoxamine (m = 15.5; SD = 4.4 mm Hg/mm). Phentolamine, given at peak methoxamine effect, did not consistently modify m values, resulting in an average slope not significantly different from that obtained with methoxamine alone. However, the addition of phentolamine did not cause an increase in ESDs at each level of ESP with respect to methoxamine. In the same subjects, infusion of phentolamine after angiotensin did not modify ESDs at comparable ESP levels. These findings suggest the existence of a positive inotropic effect mediated by alpha 1 adrenoceptors in the intact human heart.

Esophageal rupture in an infant secondary to esophageal placement of a Foley catheter gastrostomy tube.

We report a case of esophageal rupture in a five-month-old female infant caused by a Foley catheter gastrostomy tube inadvertently placed into the esophagus at the time of tube change. The patient presented with vomiting and progressive respiratory distress and when first evaluated had a left-sided pneumothorax. The esophageal location of the Foley balloon was not initially apparent. Metrizamide radiography demonstrated the esophageal rupture. The patient recovered with drainage of the mediastinal and pleural collections. Physicians and caretakers should be alerted to the mechanical complications of Foley catheter tube gastrostomy, since these complications are mostly preventable and easily diagnosed.

Blunt cardiac injury in children.

Thirty-nine children admitted to the pediatric intensive care unit with multiple injuries from blunt trauma underwent serial EKGs, determination of creatinine phosphokinase (CPK) isoenzymes, echocardiography, and radionuclide angiography studies. Motor vehicle injuries were responsible for 83% (32 of 39) of admissions, the remainder (7 of 39) caused by falls from heights. Thirteen children sustained serious (Modified Injury Severity Score [MISS] greater than 25) multiple system injury. Chest injuries were sustained by 12 children, nine being serious thoracic injuries (MISS chest score greater than 2). Three children (7.7%) showed elevations of MB fraction of CPK isoenzymes in addition to EKG abnormalities and/or ejection fraction depression on radionuclide angiography and were considered to have sustained cardiac contusion. Eight other children (20%) had normal or borderline elevation of CPK-MB fraction and EKG abnormalities combined with abnormal echocardiograms or radionuclide angiograms, and were considered to have sustained cardiac concussion. An additional 14 children (36%) had EKG or radionuclide angiography abnormalities alone. Two children required lidocaine therapy for cardiac irritability manifesting as multifocal PVCs and ventricular tachycardia. Based on this study, a comprehensive diagnostic evaluation of the heart in all children sustaining multiple injuries from blunt trauma cannot be justified. Continuous cardiac monitoring should be initiated in the emergency room and maintained throughout intensive care unit confinement to identify transient dysrhythmias. In patients with significant dysrhythmias and in those with obvious thoracic injuries serial EKG and cardiac isoenzyme assay should be obtained. Dysrhythmias should be man-aged with appropriate anti-arrhythmic therapy.(ABSTRACT TRUNCATED AT 250 WORDS)