Multidisciplinary analysis of a mummy from the War of the Pacific.

The War of the Pacific (1879-1884) was a big scale war between Chile against the alliance of Peru and Bolivia. One of the most important battles, the "Batalla del Campo de la Alianza" was situated in the desert near Tacna, Peru. The conditions of this environment favored the conservation of the dead soldiers after many years. Decades ago, the Natural History Museum of Concepción in Chile, received a naturally mummified individual of a probably Chilean soldier as a donation; its uncertain context was never studied nor confirmed. Considering this, our investigation analyzed this body under exploratory methods, ballistic analysis, archaeological contrast, 14C radiocarbon dating, ancient DNA, and isotopic analysis to reconstruct the biological profile of this mummy. The results indicated that the mummy belongs to an adult man between 33-39 years of age (> 1.50 m) and has a perimortem wound in the left flank of the abdomen. CT scan and X-rays revealed the presence of a bullet (Comblain II or Gras) hosted near the L2 vertebra. It is possible that the individual died of bleeding from a gunshot wound done by a long-distance firearm projectile from an inferior level, whose trajectory was from left to right, with slight inclination towards the top, and without a projectile exit. Other analyses confirmed the historical context and suggests the Chilean origin of the mummy. Despite the passage of time and other factors, it was possible to reconstruct the death of this individual thanks to technology and approaches from different disciplines.

Diabetes Second-Line Medication Prescription Patterns in Costa Rica and Panama: Evidence From the DISCOVER Registry.

AIM: This study aimed to describe the prescription patterns of second-line medications for patients with diabetes from selected centers in Costa Rica and Panama. METHODS: DISCOVER is a registry of patients with type 2 diabetes switching from first- to second-line medications. We analyzed medication choice and the reasons to switch for each country.  Results: A total of 219 patients were included during 2014-2016, 127 in Costa Rica and 92 in Panama. The most frequently prescribed first-line medication was metformin, followed by sulphonylureas in Panama, and a combination of metformin and dipeptidyl peptidase-4 inhibitor (iDPP4) in Costa Rica. DPP4 inhibitors plus metformin was the most commonly prescribed second-line medication, followed by metformin combined with sodium-glucose transport protein-2 inhibitor (iSGLT2) in Costa Rica and iDPP4 in monotherapy in Panama. The main reason to switch being efficacy. When choosing the second-line medication, the main reasons behind the switch were efficacy, weight loss, and hypoglycemia risk in both countries (tolerability being also common in Panama). CONCLUSIONS: According to the DISCOVER registry, in Costa Rica and Panama, efficacy is the most common reason to switch to second-line medication. Metformin plus iDPP4 was the most commonly prescribed agent.

Prevalencia de Helicobacter pylori en pacientes asintomáticos en Ecuador

Resumen La infección por Helicobacter pylori se adquiere generalmente durante la niñez y permanece de forma asintomática durante años causando cuadros crónicos. Su asociación con enfermedades gastrointestinales incluye la úlcera péptica, gastritis crónica y los linfomas tipo MALT. En países desarrollados la prevalencia de la infección por este agente es de 14%, contrario a países subdesarrollados con 92%, no obstante, los cuadros asintomáticos son poco descritos en la literatura. El objetivo de este artículo es caracterizar la infección de Helicobacter pylori en pacientes asintomáticos en el área de consulta externa, según la prevalencia en el Hospital "Dr. Efrén Jurado López" de la ciudad de Guayaquil en Ecuador, durante el primer trimestre del año 2019. La investigación se basó en un estudio descriptivo, observacional de corte transversal en 684 pacientes asintomáticos. Los resultados encontrados muestran que en Ecuador la prevalencia para la infección de H. pylori en pacientes asintomáticos fue de 47.66%, respecto a la edad el 8% y 15.1 % corresponden a preinfancia e infancia, el 29.8% juventud, 55.1% adultez, persona mayor el 94.6 %. La distribución según el sexo es el 43.9% femenino y 51.5% masculino, observando que los hábitos de higiene influyen en el aumento significativo de casos. La identificación de casos de pacientes con infección con H. pylori asintomáticos es importante para ejecutar acciones que permitan estratificar el riesgo y tratar de forma oportuna a estos pacientes, evitando el avance de cuadros complicados como hemorragias o neoplasias sobre todo en infantes.

Abstract Helicobacter pylori infection is generally acquired during childhood and remains asymptomatic for years causing chronic conditions. Its association with gastrointestinal diseases includes peptic ulcer, chronic gastritis, and MALT-type lymphomas. In developed countries, the prevalence of infection by this agent is 14%, contrary to underdeveloped countries with 92%; however, asymptomatic conditions are little described in the literature. The objective of this article is to characterize Helicobacter pylori infection in asymptomatic patients in the outpatient area, according to the prevalence in the Hospital "Dr. Efrén Jurado López" from the city of Guayaquil in Ecuador, during the first quarter of 2019. The research was based on a descriptive, observational, cross-sectional study in 684 asymptomatic patients. The results found show in Ecuador the prevalence for H. pylori infection in asymptomatic patients was 47.66%, with respect to age 8% and 15.1% correspond to pre-childhood and childhood, 29.8% youth, 55.1% adulthood, older person 94.6%. The distribution according to sex is 43.9% female and 51.5% male, observing that hygiene habits influence the significant increase in cases. The identification of cases of patients with asymptomatic H. pylori infection is important to carry out actions that allow stratifying the risk and treating these patients in a timely manner, avoiding the progression of complicated conditions such as hemorrhages or neoplasms, especially in infants.

Resumo A infecção por Helicobacter pylori é geralmente adquirida durante a infância e permanece assintomática durante anos, causando condições crônicas. Sua associação com doenças gastrointestinais inclui úlcera péptica, gastrite crônica e linfomas MALT. Nos países desenvolvidos a prevalência de infecção por este agente é de 14%, em contraste com 92% nos países subdesenvolvidos, porém, os casos assintomáticos são pouco descritos na literatura. O objetivo deste artigo é caracterizar a infecção por Helicobacter pylori em pacientes assintomáticos na área ambulatorial, de acordo com a prevalência no Hospital "Dr. Efrén Jurado López" na cidade de Guayaquil no Equador, durante o primeiro trimestre de 2019. A pesquisa foi baseada em um estudo descritivo, observacional e transversal de 684 pacientes assintomáticos. Os resultados encontrados mostram que no Equador a prevalência da infecção pelo H. pylori em pacientes assintomáticos foi de 47,66%, com relação à idade, 8% e 15,1% corresponderam à pré-infância e infância, 29,8% à juventude, 55,1% à idade adulta, e 94,6% aos idosos. A distribuição por sexo é de 43,9% de mulheres e 51,5% de homens, observando que os hábitos de higiene influenciam o aumento significativo do número de casos. A identificação de casos de pacientes assintomáticos com infecção por H. pylori é importante para realizar ações para estratificar o risco e tratar esses pacientes em tempo hábil, evitando a progressão de condições complicadas como hemorragias ou neoplasias, especialmente em bebês.

Protocolo de profilaxis antibiótica preoperatoria para pacientes ortopédicos del Hospital México: un análisis de cumplimiento / Hospital Mexico’s preoperative antibiotic prophylaxis protocol for orthopedic patients: a compliance analysis

Objetivo: Analizar el cumplimiento en la prescripción de la profilaxisantibiótica prequirúrgica, según el protocolo establecido por el Programade Optimización de Antibióticos y el Servicio de Ortopedia del HospitalMéxico, Caja Costarricense del Seguro Social, ubicado en San José,Costa Rica, de febrero a marzo de 2019. Desde la instauración del protocolo en 2018 no se ha realizado una evaluación de su cumplimiento nise ha determinado la tasa de infección del sitio quirúrgico.Método: Estudio observacional retrospectivo; se identificaron lospacientes hospitalizados en el Servicio de Ortopedia desde el 1 defebrero al 31 de marzo de 2019. Se accedió al expediente digitalde cada paciente, se caracterizó la profilaxis antibiótica prescrita y seanalizó el cumplimiento según el protocolo vigente. Se estimó la tasade infección de sitio quirúrgico. Se realizó un análisis descriptivo de lapoblación.Resultados: El estudio incluyó 110 expedientes clínicos. Los antibióticos más prescritos fueron clindamicina y gentamicina de manera concomitante. El cumplimiento de la prescripción de profilaxis antibiótica oscilóentre 89,1% y 100% para los criterios considerados en el protocolo,exceptuando dosis y antibiótico al alta (14,3 y 65,8%, respectivamente). (AU)

Objective: To analyze compliance with a prescribed pre-surgical antibiotic prophylaxis protocol established by the Antimicrobial StewardshipProgram team and the Orthopedics Department of Hospital Mexico, apublic hospital located in Costa Rica, from February to March 2019. Noassessments of compliance with the protocol had been conducted sinceits introduction in 2018, nor had variations in surgical site infection ratesbeen determined.Method: This is a retrospective observational study that extended fromFebruary 1st to March 31st, 2019. We identified patients hospitalizedduring the study period in the hospital’s Orthopedics Department. Wereviewed each patient’s medical record to record their prescribed antibiotic prophylaxis. Following an analysis of the overall compliance with theprotocol, we made an estimation of the surgical site infection rate as wellas a descriptive analysis of the studied population.Results: The study included 110 clinical records. The most frequentlyprescribed antibiotics were clindamycin and gentamicin. Compliancewith the protocol ranged between 89.1% and 100% across the differentcriteria, except for dosing appropriateness and prescription of antibioticsat discharge (14.3% and 65.8%, respectively). The most common noncompliance factor was gentamicin´s dosing. The surgical site infection ratewas 5%. (AU)

Hospital Mexico's preoperative antibiotic prophylaxis protocol for orthopedic patients: a compliance analysis.

OBJECTIVE: To analyze compliance with a prescribed pre-surgical antibiotic prophylaxis protocol established by the Antimicrobial Stewardship Program team and the Orthopedics Department of Hospital Mexico, a public hospital located in Costa Rica, from February to March 2019. No assessments of compliance with the protocol had been conducted since its introduction in 2018, nor had variations in surgical site infection rates been determined. METHOD: This is a retrospective observational study that extended from February 1st to March 31st, 2019. We identified patients hospitalized during the study period in the hospital's Orthopedics Department. We reviewed each patient's medical record to record their prescribed antibiotic prophylaxis. Following an analysis of the overall compliance with the protocol, we made an estimation of the surgical site infection rate as well as a descriptive analysis of the studied population. RESULTS: The study included 110 clinical records. The most frequently prescribed antibiotics were clindamycin and gentamicin. Compliance with the protocol ranged between 89.1% and 100% across the different criteria, except for dosing appropriateness and prescription of antibiotics at discharge (14.3% and 65.8%, respectively). The most  common non compliance factor was gentamicin´s dosing. The surgical site infection rate was 5%. CONCLUSIONS: The preoperative antibiotic prophylaxis protocol established between the Antimicrobial Stewardship Program team and the Orthopedic Department reduced the length of exposure to postoperative antibiotics to only 24 hours and enjoyed widespread acceptance and a high compliance rate. However, compliance with some criteria must be improved, such as dosing appropriateness and prescription of antibiotics at discharge. Involvement of the pharmacist is vital for the compliance with and auditing of these types of protocols as pharmacists are uniquely positioned to ensure that high-quality antibiotic prophylaxis is provided in all surgical procedures that require it.

Objetivo: Analizar el cumplimiento en la prescripción de la profilaxis antibiótica prequirúrgica, según el protocolo establecido por el Programa de Optimización de Antibióticos y el Servicio de Ortopedia del Hospital México, Caja Costarricense del Seguro Social, ubicado en San José, Costa Rica, de febrero a marzo de 2019. Desde la instauración del protocolo en 2018 no se ha realizado una evaluación de su cumplimiento ni se ha determinado la tasa de infección del sitio quirúrgico.Método: Estudio observacional retrospectivo; se identificaron los pacientes hospitalizados en el Servicio de Ortopedia desde el 1 de febrero al 31 de marzo de 2019. Se accedió al expediente digital de cada paciente, se caracterizó la profilaxis antibiótica prescrita y se analizó el cumplimiento según el protocolo vigente. Se estimó la tasa de infección de sitio quirúrgico. Se realizó un análisis descriptivo de la población.Resultados: El estudio incluyó 110 expedientes clínicos. Los antibióticos más prescritos fueron clindamicina y gentamicina de manera  concomitante. El cumplimiento de la prescripción de profilaxis antibiótica osciló entre 89,1% y 100% para los criterios considerados en el protocolo, exceptuando dosis y antibiótico al alta (14,3 y 65,8%, respectivamente).  El criterio de incumplimiento más frecuente fue la dosis de gentamicina. La tasa de infección de sitio quirúrgico fue del 5%.Conclusiones: El protocolo de profilaxis antibiótica prequirúrgica establecido entre el equipo Programa de Optimización de Antibióticos y el Servicio de Ortopedia disminuyó el tiempo de exposición a antibióticos postoperatorios a únicamente 24 horas, y tiene una aceptación y cumplimiento positivo. Sin embargo, deben mejorarse puntos como la prescripción adecuada de la dosis y la no prescripción de antibiótico al egreso. La participación del farmacéutico es vital para el cumplimiento y auditoría de este tipo de protocolos, de modo que la calidad de la profilaxis antibiótica sea garantizada en todos los procedimientos quirúrgicos que así lo requieran.

Análisis de riesgo en la Medicina Nuclear Terapéutica en Cuba con enfoque integrador / Risk assessment in Therapeutic Nuclear Medicine in Cuba with an integrated approach

Introducción: El análisis de riesgo en la gestión de la calidad y seguridad permite la mejora continua de los servicios médicos en Cuba. En Medicina Nuclear Terapéutica es requisito regulador que permite la continuidad de estos servicios a la población. Objetivo: Analizar los riesgos radiológicos con enfoque integrador dirigido a causas básicas de fallo en la práctica citada. Material y métodos: Se revisó y adaptó el modelo genérico de riesgo para cada caso de estudio. Los métodos prospectivos de matriz de riesgo y análisis de modos y efectos de fallo y reactivo de aprendizaje de las lecciones de sucesos registrados fueron utilizados con el código cubano SECURE MR-FMEA versión 3.0. Se determinó el riesgo inherente, su tratamiento y el riesgo residual por práctica. Se identificaron las etapas del proceso, las medidas y las causas básicas más contribuyentes. Resultados: No se obtuvo riesgo superior al del nivel alto. La radiosinoviortesis y el tratamiento radiactivo de la policitemia vera tuvieron la mayor cantidad de modificaciones al modelo genérico. Las etapas más significativas son prescripción clínica, preparación del radiofármaco y administración. Las medidas preventivas de mayor importancia son mantener una carga de trabajo moderada para el personal, las capacitaciones de los médicos nucleares y del técnico que realiza la administración. Conclusiones: Existe una no uniformidad en el nivel de calidad y seguridad entre los servicios analizados. Para el cambio, la adopción de decisiones se ve beneficiada en su eficacia y eficiencia, al integrarse los métodos prospectivos y reactivos de análisis de riesgo(AU)

Introduction: Risk assessment in quality and safety management allows the continuous improvement of the medical services in Cuba. In Therapeutic Nuclear Medicine, it is a regulatory requirement which allows the continuity of these services to the population. Objective: To assess radiological risks with an integrated approach focused on underlying causes of failure in the mentioned practice. Material and Methods: The generic risk model was reviewed and adapted for each case study. The prospective methods of risk assessment matrix of failure modes and effects and incident learning lessons from the events registered were used applying the Cuban code SECURE MR-FMEA version 3.0. The inherent risk, treatment, and residual risk in the practice were determined. The stages of the process, measurements, and the main contributing causes were identified. Results: There was no risk higher than the high level. Radiosynoviorthesis and the radioactive treatment of the Polycythemia Vera had the greatest amount of modifications to the generic model. The most significant stages are clinical prescription, preparation of the radiopharmaceutical formulation and administration. The most important preventive measures are to maintain a moderate workload for the personnel, and the training of the nuclear physicians and the technician who performs the administration. Conclusions: There is a non-uniformity in the level of quality and safety among the NTM services in Cuba. For change, decision-making is benefited in terms of effectiveness and efficiency by integrating prospective and reactive risk assessment methods(AU)

Evaluation of the overdiagnosis in breast screening programmes using a Monte Carlo simulation tool: a study of the influence of the parameters defining the programme configuration.

OBJECTIVES: To build up and test a Monte Carlo simulation procedure for the investigation of overdiagnosis in breast screening programmes (BSPs). DESIGN: A Monte Carlo tool previously developed has been adapted for obtaining the quantities of interest in order to determine the overdiagnosis: the annual and cumulative number of cancers detected by screening, plus interval cancers, for a population following the BSP, and detected clinically for the same population in the absence of screening. Overdiagnosis is obtained by comparing these results in a direct way. RESULTS: Overdiagnosis between 7% and 20%, depending on the specific configuration of the programme, have been found. These range of values is in agreement with some of the results available for actual BSPs. In the cases analysed, a reduction of 11% at most has been found in the number of invasive tumours detected by screening in comparison to those clinically detected in the control population. It has been possible to establish that overdiagnosis is almost entirely linked to ductal carcinoma in situ tumours. CONCLUSIONS: The use of Monte Carlo tools may facilitate the analysis of overdiagnosis in actual BSPs, permitting to address the role played by various quantities of relevance for them.

Obtaining Microbiological and Pharmacokinetic Highly Predictive Equations.

In this paper, a Multilinear Regression (MLR) analysis has been carried out in order to accurately predict physicochemical properties and biological activities of a group of antibacterial quinolones by means of a set of structural descriptors called topological indices. The aim of this work is to develop prediction equations for these properties after collecting the maximum number of data from the literature on antibacterial quinolones. The five regression functions selected by presenting the best combination of various statistical parameters, subsequently validated by means of internal validation (intercorrelation, Y-randomization and leave-one-out cross-validation tests), allowed the reliable prediction of minimum inhibitory concentration 50 versus Staphylococcus aureus (MIC50Sa), Streptococcus pyogenes (MIC50Spy) and Bacteroides fragilis (MIC50Bf), Mean Residence Time (MRT) after oral administration and volume of distribution (VD). We conclude that the combination of molecular topology methods and MLR provides an excellent tool for the prediction of pharmacological properties.

Topological pattern for the search of new active drugs against methicillin resistant Staphylococcus aureus.

Molecular topology was used to develop a mathematical model capable of classifying compounds according to antimicrobial activity against methicillin resistant Staphylococcus aureus (MRSA). Topological indices were used as structural descriptors and their relation to antimicrobial activity was determined by using linear discriminant analysis. This topological model establishes new structure activity relationships which show that the presence of cyclopropyl, chlorine and ramification pairs at a distance of two bonds favor this activity, while the presence of tertiary amines decreases it. This model was applied to a combinatorial library of a thousand and one 6-fluoroquinolones, from which 117 theoretical active molecules were obtained. The compound 10 and five new quinolones were tested against MRSA. They all showed some activity against MRSA, although compounds 6, 8 and 9 showed anti-MRSA activity similar to ciprofloxacin. This model was also applied to 263 theoretical antibacterial agents described by us in a previous work, from which 34 were predicted as theoretically active. Anti-MRSA activity was found bibliographically in 9 of them (ensuring at least 26% of success), and from the rest, 3 compounds were randomly chosen and tested, finding mitomycin C to be more active than ciprofloxacin. The results demonstrate the utility of the molecular topology approaches for identifying new drugs active against MRSA.

Video approach to chemiluminescence detection using a low-cost complementary metal oxide semiconductor (CMOS)-based camera: determination of paracetamol in pharmaceutical formulations.

A new system for continuous flow chemiluminescence detection, based on the use of a simple and low-priced lens-free digital camera (with complementary metal oxide semiconductor technology) as a detector, is proposed for the quantitative determination of paracetamol in commercial pharmaceutical formulations. Through the camera software, AVI video files of the chemiluminescence emission are captured and then, using friendly ImageJ public domain software (from National Institutes for Health), properly processed in order to extract the analytical information. The calibration graph was found to be linear over the range 0.01-0.10 mg L-1 and over the range 1.0-100.0 mg L-1 of paracetamol, the limit of detection being 10 µg L-1. No significative interferences were found. Paracetamol was determined in three different pharmaceutical formulations: Termalgin®, Efferalgan® and Gelocatil®. The obtained results compared well with those declared on the formulation label and with those obtained through the official analytical method of British Pharmacopoeia. Graphical abstract Abbreviated scheme of the new chemiluminescence detection system proposed in this paper.

A Monte Carlo analysis of breast screening randomized trials.

PURPOSE: To analyze breast screening randomized trials with a Monte Carlo simulation tool. METHODS: A simulation tool previously developed to simulate breast screening programmes was adapted for that purpose. The history of women participating in the trials was simulated, including a model for survival after local treatment of invasive cancers. Distributions of time gained due to screening detection against symptomatic detection and the overall screening sensitivity were used as inputs. Several randomized controlled trials were simulated. Except for the age range of women involved, all simulations used the same population characteristics and this permitted to analyze their external validity. The relative risks obtained were compared to those quoted for the trials, whose internal validity was addressed by further investigating the reasons of the disagreements observed. RESULTS: The Monte Carlo simulations produce results that are in good agreement with most of the randomized trials analyzed, thus indicating their methodological quality and external validity. A reduction of the breast cancer mortality around 20% appears to be a reasonable value according to the results of the trials that are methodologically correct. Discrepancies observed with Canada I and II trials may be attributed to a low mammography quality and some methodological problems. Kopparberg trial appears to show a low methodological quality. CONCLUSION: Monte Carlo simulations are a powerful tool to investigate breast screening controlled randomized trials, helping to establish those whose results are reliable enough to be extrapolated to other populations and to design the trial strategies and, eventually, adapting them during their development.

Topological Model for the Search of New Antibacterial Drugs. 158 Theoretical Candidates.

In this paper, molecular topology was used to develop a mathematical model capable of classifying compounds according to their antibacterial activity. Topological indices were used as structural descriptors and their relation to antibacterial activity was determined by applying linear discriminant analysis (LDA) on a group of quinolones, widely used nowadays because of their broad spectrum of activity, well tolerance profile and advantageous pharmacokinetic properties. The topological model of activity obtained included two discriminant functions, selected by a combination of various statistical paremeters such as Fisher-Snedecor F and Wilk's lambda, and allows the reliable prediction of antibacterial activity in any organic compound. After a virtual pharmacological screening on a library of 6375 compounds, the model has selected 263 as active compounds, from which 40% have proven antibacterial activity. The results obtained clearly reveal the high efficiency of molecular topology for the prediction of pharmacological activities. These models are very helpful in the discovery of new applications of natural and synthetic molecules with different chemical or biological properties. Therefore, we finally present 158 strong candidates to be developed as novel antibacterials.

Determination of organothiophosphorus pesticides in water by liquid chromatography and post-column chemiluminescence with cerium(IV).

A new, fast, selective and sensitive method has been developed for the simultaneous determination of nine organothiophosphorus (OTP) pesticides, namely omethoate, dimethoate, disulfoton-sulfoxide, methidathion, phosmet, malathion, diazinon, pirimiphos-methyl and chlorpyrifos. The pesticides were separated on a Kinetex C18 column by gradient elution with acetonitrile:water. A post-column basic hydrolysis of the pesticides and later a chemiluminescence (CL) reaction with cerium (IV) in acid medium was carried out. Hexadecylpyridinium chloride highly enhanced the CL emission. Under optimized conditions, linearity, precision, limits of detection and quantification, and accuracy were determined. Both selectivity and sensitivity were compared with those obtained with UV detection. In combination with SPE, limits of detection in the range 15-80ng/L and 5-30ng/L were obtained when 250mL and 1000mL of solution were treated, respectively. When applied to 250mL of sample the inter-day precision of the method was between 3.5% and 7.3% and the intra-day precision between 2.9% and 6.0%. The method was applied to determine OTP pesticides in spiked water samples from different origins: irrigation, river, sea, ground, spring, mineral and tap waters, being the percentage of recovery of added amounts near 100% form most of the pesticides.

Percutaneous sclerotherapy for vascular malformations: a systematic review.

BACKGROUND: This systematic review assessed the available published evidence on the safety and efficacy of percutaneous sclerotherapy for patients with congenital vascular malformations. METHODS: A systematic search of various electronic bibliographic databases was conducted in May 2013. A grey literature search was also performed. Study selection, data extraction, and assessment of study quality were undertaken by one reviewer and checked by another reviewer. RESULTS: One systematic review, one randomized controlled trial, one nonrandomized controlled trial, and 24 case series studies were included. However, deficiencies in reporting, small sample sizes, and marked inter-study heterogeneity precluded a definitive synthesis of the data. Ethanol sclerotherapy appeared to be potentially effective in treating venous malformations, with the majority of patients achieving some lesion regression. However, it is associated with a 16% risk of major complications, including deep tissue injury, deep vein thrombosis, and nerve injury. While there was limited evidence that sclerotherapy with OK-432 was an effective treatment for lymphatic malformations, evidence for the use of sclerotherapy in patients with arteriovenous malformations was unclear. CONCLUSIONS: Very limited evidence from case series studies suggested that sclerotherapy with ethanol and OK-432, administered over multiple sessions, was effective in the treatment of venous and lymphatic malformations, respectively. However, the value of percutaneous sclerotherapy as a pretreatment for or an alternative to surgery is not known. Further evidence is required to delineate which patients will benefit most from percutaneous sclerotherapy to ensure that the advantages of treatment will outweigh the risks.

Systematic review of computer-navigated total knee arthroplasty.

BACKGROUND: Conventional total knee arthroplasty (TKA) and the more recently available computer-navigated total knee arthroplasty (CNTKA) use alternative methods to achieve correct limb alignment. This systematic review was undertaken to assess the safety and effectiveness of CNTKA compared with conventional TKA. METHODS: A systematic search of multiple databases identified relevant randomized controlled trials published to August 2012. Study inclusion was established through application of a predetermined protocol, with independent assessment by two reviewers. RESULTS: Thirty randomized controlled trials were included. The majority of adverse events associated with CNTKA were minor and comparable with those seen with conventional TKA. Conversion to conventional TKA was required in 1% of patients undergoing CNTKA. Thirteen trials reporting on satisfactory post-operative radiological alignment of the mechanical axis in the frontal plane were suitable for meta-analysis, which showed a significant total odds ratio (non-event) of 2.32 (95% confidence interval: 1.77-3.04) in favour of CNTKA (P < 0.00001). Clinical outcomes were comparable between the two techniques, with longer-term follow-up suggesting that CNTKA provided no benefit over conventional TKA in terms of sustained functional improvements. CONCLUSIONS: At present, it is unclear whether the significant improvements shown in radiological outcomes after CNTKA translate to measurable clinical benefits. Although an assumption could be made that an improvement in post-operative alignment should lead to an improvement in patient-related outcomes, the available literature did not clearly show this. Further, long-term trials are required to address this issue.

A Monte Carlo tool to study the mortality reduction due to breast screening programs.

PURPOSE: To develop a Monte Carlo tool that permits to study the reduction in breast cancer mortality rate due to breast screening programs. METHODS: Simulations implement woman histories undergoing a screening program, include a model of survival after local treatment of invasive cancers and use distributions of time gained due to screening detection against symptomatic detection and overall sensitivity of the screening obtained previously. Mortalities for the whole woman population and for those women with ages within the range considered in the program have been calculated. RESULTS: For the whole woman population, a reduction in breast cancer mortality up to 29% has been found for a configuration that includes women aged between 50 and 70 years, with a screening interval of two years and 100% acceptance rate. If an acceptance of 70% is considered, this percentage reduces to 20%. If, in the same conditions, the program starts at 40 years, the reduction of the mortality reaches 24% while if the screening interval is one year, this percentage raises to 28%. If mortalities are calculated for those women with ages within the range included in the program these reductions are greater and no significant differences are found between the programs with age ranges [50-70] and [40-70]. In the model, radio-induced cancers have no effect in survival. CONCLUSIONS: The results agree reasonably well with those of different trials. Mortality reductions of 12%-20% (between two and four deaths per year and 10(5) women) are obtained only for acceptances above 50%. This could be considered as a threshold for the acceptance, which appears to be a critical parameter.

Behavior of varroa mites in worker brood cells of Africanized honey bees.

The ectoparasitic mite Varroa destructor is currently the most important pest of the honey bee, Apis mellifera. Because mite reproduction occurs within the sealed cell, the direct observation of varroa activity inside the cell is difficult. A video observation method using transparent polystyrol cells containing infested brood was used to analyze the behavior of varroa mites in worker brood of Africanized honey bees. We recorded how mites feed on the larva and pupa, construct a fecal accumulation site and how the bee larva carried out some longitudinal movements around the cell. The feeding activity of the foundress mite varies during the course of the cycle. On the prepupa mites were found to feed often (0.3 +/- 0.2 bouts h(-1)) for a period of 8.7 +/- 8.4 min h(-1) and there was no preference for a specific segment as feeding site. On the opposite, during the pupal stage mites fed less often (0.1 +/- 0.1 bouts h(-1)) for a period of 6.2 +/- 4.0 min h(-1) and almost always at a particular site (92.4%). On pupa, 83.7% of the feeding was on the 2nd abdominal segment (n = 92), and only few perforations were found on the thorax. Varroa shows a preference for defecation in the posterior part of the cell (cell apex), close to the bee's anal zone. We found a high correlation between the position of the feeding site on the pupa and the position of the fecal accumulation on the cell wall. Most infested cells have only one fecal accumulation site and it was the favorite resting site for the mite, where it spent 24.3 +/- 3.9 min h(-1). Longitudinal displacements were observed in 28.0% (n = 25) of the analyzed bee larvae. Turning movements around the cell, from the bottom to the top, were carried out by these larvae, mainly during the second day (47.7 +/- 22.5 min h(-1)), just before pupation, with a total time of 874.9 +/- 262.2 min day(-1) (n = 7 individuals). These results in worker brood of Africanized bees demonstrate adaptations of varroa mites to parasitizing the developing bee inside the capped brood cells.

[Evaluation of the potential adulteration of commercial honey distributed in Costa Rica compared with artesanian honey samples coming from specific apiaries]. / Evaluación de la posible adulteración de mieles de abeja comerciales de origen costarricense al compararlas con mieles artesanales provenientes de apiarios específicos.

Honey is the principal apiculture product, produced by Apis mellifera bee. This, as any other food product, has to accomplish certain quality standards, including physicochemical, organoleptic and microbiological properties. Within these parameters, different measures are considered as adulteration indicators, including hydroxymethylfurfural and diastase enzyme activity which are associated to overheating, and the sucrose, glucose and fructose content. In this study, a determination of previous parameters, additional to glucose, fructose and fructose/glucose index was performed to 35 artisan samples, obtained directly from beekeeper, previously characterized as having good productive practices and 25 commercial samples. Same time, the results obtained were compared and interpreted, in order to determine the kind of adulteration present in the honey sample. The 89% of artesian samples accomplished the parameters established by the Codex Alimentarius for HMF content, diastase activity, sucrose and simple sugars content. Nevertheless, only 20% (5) of the commercial samples accomplished the international and national normative. 24% of these samples presented succrose addition, 32% overheating or inverted sugar syrup addition, and 24% were adulterated with inverted sugar syrup.

A comparison of the reproductive ability of Varroa destructor (Mesostigmata:Varroidae) in worker and drone brood of Africanized honey bees (Apis mellifera).

Colony infestation by the parasitic mite, Varroa destructor is one of the most serious problems for beekeeping worldwide. In order to reproduce varroa females, enter worker or drone brood shortly before the cell is sealed. To test the hypothesis that, due to the preference of mites to invade drone brood to reproduce, a high proportion of the mite reproduction should occur in drone cells, a comparative study of mite reproductive rate in worker and drone brood of Africanized honey bees (AHB) was done for 370 mites. After determining the number, developmental stage and sex of the offspring in worker cells, the foundress female mite was immediately transferred into an uninfested drone cell. Mite fertility in single infested worker and drone brood cells was 76.5 and 79.3%, respectively. There was no difference between the groups (X(2)= 0.78, P = 0.37). However, one of the most significant differences in mite reproduction was the higher percentage of mites producing viable offspring (cells that contain one live adult male and at least one adult female mite) in drone cells (38.1%) compared to worker cells (13.8%) (X(2)= 55.4, P < 0.01). Furthermore, a high level of immature offspring occurred in worker cells and not in drone cells (X(2)= 69, P < 0.01). Although no differences were found in the percentage of non-reproducing mites, more than 74% (n = 85) of the mites that did not reproduce in worker brood, produced offspring when they were transferred to drone brood.

Estudio aleatorizado del dispositivo liberador de levonorgestrel frente a resección endometrial para el tratamiento de la menorragia / Levonorgestrel intrauterine system versus endometrial resection for the treatment of menorrhagia: a randomized study

Objetivo: Tratamiento de la menorragia mediante resección endometrial y dispositivo liberador de levonorgestrel (LNG-IUS). Material y métodos: Estudio aleatorizado; en 25 pacientes se realiza una resección endometrial y en 25 se coloca un LNG-IUS, con un seguimiento a 12 meses. Las variables estudiadas fueron la concentración de hemoglobina, el patrón de sangrado menstrual y el grado de satisfacción. Resultados: En ambos grupos se incrementó la hemoglobina y el patrón de sangrado más frecuente fue el de amenorrea o hipomenorrea. El spotting fue el síntoma adverso más común para el LNG-IUS. El grado de satisfacción fue del 94% en el grupo de resección y el 86% en el de LNG-IUS. Conclusiones: Ambos tratamientos son efectivos para reducir el sangrado menstrual

Objective: To asses the efficacy of endometrial resection and the levonorgestrel intrauterine system (LNG-IUS) in the treatment of menorrhagia. Material and methods: Fifty women were randomized to either insertion of a LNG-IUS or endometrial resection. Hemoglobin levels, menstrual bleeding patterns and degree of satisfaction were evaluated during a 12-month follow-up. Results: Hemoglobin levels increased in both groups. The most frequent bleeding patterns were amenorrhea and hypomenorrhea. The most common adverse effect in the LNG-IUS group was the presence of spotting. Ninety-four percent of the patients in the resection group and 86% of those in the LNG-IUS group were satisfied with the treatment. Conclusions: Both treatments were effective in reducing menstrual blood loss