Acoustic recognition of predators by mantled howler monkeys (Alouatta palliata): A playback experiment with naïve and experienced subjects.

OBJECTIVES: When the production of antipredator behaviors is costly, prey is expected to stop displaying such behaviors and lose the ability to recognize extirpated predators. However, the loss or maintenance of predator recognition abilities is conditional on the eco-evolutionary context of prey. Here, we examined the behavioral responses of naïve and experienced mantled howler monkeys (Alouatta palliata) to simulated acoustic cues from natural predators. METHODS: We studied experienced individuals in the Uxpanapa Valley and naïve individuals in Los Tuxtlas (Veracruz, México). Jaguars (Panthera onca) and harpy eagles (Harpia harpyja), the main predators of howler monkeys, are extant in the Uxpanapa Valley but have been extirpated in Los Tuxtlas for approximately 70 and 45 years, respectively. We exposed six naïve and six experienced groups to playbacks of acoustic stimuli from the two predators and a non-predator control species (plain chachalacas, Ortalis vetula), and recorded the latency, frequency, and duration of antipredation behaviors (n = 127 trials). RESULTS: In contrast with experienced mantled howler monkeys, naïve subjects did not respond to trials from harpy eagles. However, response patterns were generally similar between naïve and experienced individuals when exposed to jaguar stimuli. DISCUSSION: Our findings suggest that naïve mantled howler monkeys do not recognize harpy eagle calls, but they respond to jaguar calls in a manner consistent with experienced individuals. These results illustrate how different mechanisms for the recognition of extirpated predators operate within a single species according to evolutionary and ecological experience.

Alergia al níquel y colocación de endoprótesis aórticas con nitinol / Nickel allergy and placement of aortic endoprostesis with nitinol

Introducción: las alergias al níquel son muy frecuentes. En diversos materiales implantables utilizado en cirugía endovascular, la estructura metálica es de nitinol. Caso clínico: se presenta el caso de un paciente con alergia conocida al níquel y que necesitó una endoprótesis aórtica con ramas en cuya fabricación se sustituyó el níquel por el acero inoxidable. Discusión: a raíz del caso, se recomienda ser estrictos con las instrucciones de uso y se alerta sobre algunas reacciones posoperatorias.(AU)

Introduction: nickel allergies are very common. In various implantable material used in endovascular surgery, the metal structure is made of nitinol. Case report: We present a case of a patient with known nickel allergy who needed an aortic endoprosthesis with branches in which manufacture nickel was replaced with stainless steel. Discussion: as a result of this case it is recommended to be strict with the instructions and to be alert in case of postoperative reactions.(AU)

Justificación y diseño del estudio multicéntrico prospectivo de cohortes para evaluar los resultados del cierre percutáneo en procedimientos de reparación aórtica endovascular. Registro SPAIN / Justification and design of the prospective multicentre cohort study to evaluate the results of percutaneous closure in endovascular aortic repair procedures. SPAIN Registry

Introducción: el cierre percutáneo es una herramienta esencial en el tratamiento endovascular actual. Los procedimientos de patología aórtica precisan abordajes arteriales de gran calibre a nivel inguinal, lo que conlleva mayor posibilidad de complicaciones en el cierre. Es por esto que actualmente continúan conviviendo la técnica quirúrgica abierta y el abordaje percutáneo, siendo también así en el territorio nacional, con resultados a día de hoy no cuantificados. La literatura actual aporta buenos resultados para la técnica de presutura en patología aórtica, sin embargo aún existen dudas respecto a determinados factores de riesgo como la obesidad, calcificación severa o arterias de pequeño calibre. Tampoco existen suficientes datos que estudien cómo afecta este procedimiento a la calidad de vida, lo cual es un punto esencial, especialmente en pacientes mayores. Dado que un alto porcentaje de los pacientes que se someten a estas intervenciones son ancianos con patologías concomitantes (los llamados pacientes frágiles), minimizar la agresión quirúrgica y mejorar su calidad de vida inmediata post-procedimiento puede ser determinante. Objetivos: primarios: estimar la tasa de éxito técnico del procedimiento de cierre percutáneo en intervenciones aórticas, estimación del impacto en la calidad de vida así como encontrar posibles diferencias en la morbimortalidad a 30 días en relación a la puntuación de cada paciente en la escala de fragilidad modificada; secundarios: evaluar el tiempo de presutura, tiempo de hemostasia, complicaciones derivadas del cierre, estancia hospitalaria y el dolor posoperatorio. Material y métodos: el Registro SPAIN es un estudio multicéntrico prospectivo de pacientes sometidos a procedimientos percutáneos sobre la aorta y sus ramas con dispositivos ≥ 10 French (F), en el que serán recogidas variables relacionadas con el cierre de sus accesos inguinales. El periodo de seguimiento será de 30 días...(AU)

Introduction: percutaneous closure is an essential tool in current endovascular treatment. Aortic pathology procedures require large-caliber arterial approaches, leading to a greater possibility of closure complications. For this reason, nowadays, both open surgical and the preclose technique coexist in almost every center worldwide, as it does in Spain with no contrasted results. The current literature provides good results for the pre-closing technique in aortic pathology, however there are still doubts regarding certain risk factors such as obesity, severe calcification or small-caliber arteries. There is not enough data to study how this procedure affects quality of life, an essential point, especially in older patients. Minimizing surgical aggression and improving their immediate post-procedure quality of life can be decisive because most of the patients are elderly with concomitant pathologies (fragile patients). Objetives: primary objectives: to estimate the technical success rate of the percutaneous closure procedure in aortic interventions, estimate the impact on quality of life and find possible differences in morbidity and mortality at 30 days in relation to the score of each patient on the frailty scale; secondary objectives: To evaluate the pre-suture time, hemostasis time, complications derived from closure, hospital stay and post-operative pain. Material and methods: the SPAIN Registry is a prospective multicenter study of patients undergoing percutaneous procedures on the aorta and its branches with ≥ 10 French (F) devices. Variables related to the closure of their inguinal access will be collected. The follow-up period will be 30 days. The duration of the recruitment period will be one year initially. Participants must certify that they have performed the closure of at least 10 large caliber percutaneous approaches (≥ 10 F) in national units of the specialties of Angiology and Vascular Surgery and Cardiology...(AU)

Dolor abdominal secundario a disección espontánea de arteria mesentérica superior complicada / Abdominal pain at complicated spontaneous superior mesenteric artery dissection

La disección espontánea de la arteria mesentérica superior (AMS) es una entidad que se describe como un desgarro o rotura de la íntima y de las capas internas de la media permitiendo el paso de sangre creando una luz falsa en la capa media. El diagnóstico clínico se establece tras la aparición de dolor abdominal súbito en pacientes con factores de riesgo cardiovascular y su manejo puede ser endovascular o mediante cirugía a cielo abierto, dependiendo de diversos factores que mencionaremos. La clasificación se describió en base a los hallazgos por TAC. Se presenta el caso de un paciente de 48 años con disección espontánea de la AMS.(AU)

Spontaneous dissection of the superior mesenteric artery is described as a tear or rupture of the intima and the inner layers of the stocking, allowing the passage of blood creating a false light in the middle layer. The clinical diagnosis is established after the appearance of sudden abdominal pain in patients with cardiovascular risk factors and its management can be endovascular or by open surgery, depending on factors that we will mention. The classification was described based on the CT findings. We present the case of a 48-year-old patient with spontaneous AMS dissection.(AU)

Guías de diagnóstico de la enfermedad cerebrovascular extracraneal / Diagnostic guidelines for extracranial cerebrovascular disease

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Cold weather is a predisposing factor for testicular torsion in a tropical country. A retrospective study / Clima frio é um fator predisponente para torção testicular num país tropical. Um estudo retrospectivo

CONTEXT AND OBJECTIVE: Testicular torsion is a medical and urological emergency because it can lead to loss of the organ. The theory of seasonal testicular torsion occurrence is based on studies from institutions located in cold and temperate regions. The objective here was to determine whether cold weather is associated with higher incidence of testicular torsion in a tropical country, such as Brazil. DESIGN AND SETTING: Retrospective study, conducted in a tertiary and teaching hospital. METHODS: Patients with acute testicular torsion confirmed by surgery between April 2006 and March 2011 were studied. Information on weather conditions at the time of symptom onset was collected. RESULTS: A total of 64 testicular torsion cases were identified. The months with the highest incidences of testicular torsion were June (16%), July (19%) and August (11%), which had the lowest mean temperatures, of 17.6 °C, 16.4 °C and 18.2 °C, respectively. Eleven percent of cases occurred during spring (October to December), 16% occurred in summer (January to March), 34% occurred in fall (April to June) and 39% occurred in winter (July to September). There was a significant association between the incidence of testicular torsion and the season (fall and winter), P < 0.001. CONCLUSIONS: Testicular torsion follows a seasonal association even in a tropical country, and is more frequent in the colder months of the year, namely fall and winter, when almost three-quarters of the cases occurred. These observations add further evidence that cold weather has an etiologic role in testicular torsion occurrence. .

CONTEXTO E OBJETIVO: A torção testicular é uma emergência médica e urológica, pois pode levar à perda do órgão. A teoria da ocorrência sazonal da torção testicular é baseada em estudos de instituições localizadas em regiões frias e temperadas. O objetivo foi determinar se o clima frio está associado a uma maior incidência de torção testicular em um país tropical, como o Brasil. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo, realizado em um hospital terciário e de ensino. MÉTODOS: Foram estudados pacientes com torção testicular aguda confirmada na cirurgia, durante o período de abril de 2006 a março de 2011. Informações sobre as condições climáticas no início dos sinto-mas foram coletadas. RESULTADOS: Um total de 64 casos de torção testicular foi identificado. Os meses com maiores incidên-cias foram junho (16%), julho (19%) e agosto (11%), que assinalaram as menores temperaturas médias, de 17,6 °C, 16,4 °C e 18,2 °C, respectivamente. Onze por cento dos casos ocorreram durante a primavera (outubro a dezembro), 16% no verão (janeiro a março), 34% no outono (abril a junho) e 39% no inverno (julho, agosto, setembro). Houve associação significante entre a incidência de torção testicular e a estação (outono e inverno), P < 0,001. CONCLUSÃO: Torção testicular obedece a uma predileção sazonal mesmo num país tropical, sendo mais fre-quente nos meses mais frios do ano, particularmente no outono e inverno, quando ocorrem quase três quartos dos casos. Estes achados acrescentam evidência a um papel etiológico do clima frio na torção testicular. .

Resistencia a fármacos antituberculosos de primera línea en Españna durante 2010-2011. Estudio RETUBES / Resistance to First-Line Antituberculosis Drugs in Spain, 2010-2011. RETUBES Study

Introducción: La magnitud de la resistencia actual a fármacos antituberculosos en España es desconocida. El objetivo del estudio es describir la resistencia a fármacos antituberculosos de primera línea y determinar sus factores asociados. Métodos: Estudio prospectivo multicéntrico de pacientes tuberculosos adultos con aislamiento de Mycobacterium tuberculosis y antibiograma de fármacos de primera línea en 32 hospitales y un centro extrahospitalario del sistema sanitario nacional durante los años 2010 y 2011. Resultados: Se estudió a 519 pacientes, 342 españoles y 177 (34,1%) extranjeros, 48 de ellos (9,2%) con resistencia a cualquier fármaco, de los que 35 (6,7%) eran resistentes a isoniacida. Hubo 10 casos multirresistentes (1,9%) y ninguno extremadamente resistente. Se detectó resistencia inicial a isoniacida en 28 de los 487 (5,7%) pacientes sin antecedentes de tratamiento antituberculoso previo, afectando más a los extranjeros (p < 0,01), y resistencia adquirida en 7 (22,6%) casos previamente tratados. La multirresistencia fue inicial en 6 casos (1,2%) y adquirida en otros 4 (12,9%). Los factores asociados a tener resistencia inicial a isoniacida fueron ser inmigrante y la convivencia en grupo (OR = 2,3; IC del 95%, 0,98- 5,67, y OR = 2,2; IC del 95%, 1,05-7,07, respectivamente). El factor asociado a la existencia de resistencia adquirida a isoniacida fue la edad inferior a 50 años (p = 0,03). Conclusiones: La tasa de resistencia inicial a isoniacida es superior a la estimada, probablemente debida al aumento de la inmigración durante los últimos años, lo que aconseja su vigilancia nacional sistemática. Los individuos inmigrantes y los que conviven en grupo tienen mayor riesgo de tener resistencia a isoniacida

Introduction: The magnitude of current resistance to antituberculosis drugs in Spain is unknown. The objective of this study is to describe resistance to first-line antituberculosis drugs and determine the associated factors. Methods: Prospective multicenter study of adult tuberculosis patients with positive Mycobacterium tuberculosis culture and antibiogram including first-line drugs in 32 hospitals and one out-patient center of the Spanish Health System between 2010 and 2011. Results: A total of 519 patients, 342 Spanish nationals and 177 (34.1%) foreigners were studied. Drug resistance was found in 48 (9.2%), of which 35 (6.7%) were isoniazid-resistant. There were 10 (1.9%) multiresistant cases and no strain was extremely resistant. Initial isoniazid resistance was detected in 28 of the 487 (5.7%) antituberulosis-naïve patients, most of whom were foreigners (P<.01). Acquired resistance was seen in 7 (22.6%) previously treated cases. Multiresistance was initial in 6 cases (1.2%) and acquired in another 4 (12.9%). Factors associated with initial isoniazid resistance were immigrant status and group cohabitation OR = 2.3; 95%CI: .98-5.67 and OR = 2.2; 95%CI: 1.05-7.07 respectively). The factor associated with acquired resistance to isoniazid was age below 50 years (P=.03). Conclusions: The rate of initial isoniazid resistance is greater than estimated, probably due to the increase in immigration during recent years, suggesting that systematic national monitoring is required. Immigrants and those who cohabit in groups have a higher risk of isoniazid resistance

Factores asociados a la evolución de la función pulmonar en pacientes con déficit de alfa-1-antitripsina del registro español / Factors Associated with the Evolution of Lung Function in Patients With Alpha-1 Antitrypsin Deficiency in the Spanish Registry

Introducción: El presente estudio pretende describir las características de los pacientes diagnosticados de déficit grave de alfa-1-antitripsina (AAT) en España, calcular la tasa de descenso del FEV1 con y sin tratamiento sustitutivo, e identificar factores asociados a una tasa de descenso acelerada del FEV1.Método: Estudio retrospectivo de la evolución de los individuos con déficit de alfa-1-antitripsina (DAAT) incluidos en el registro español. La variable principal evaluada en el estudio fue la tasa anual de descenso del FEV1.Resultados: Se identificaron 303 pacientes con DAAT grave y fenotipo Pi ZZ. Se dispuso del seguimiento espirométrico de 117 pacientes. Ser fumador activo o ex fumador frente a nunca fumador (odds ratio [OR]=10,31; intervalo de confianza (IC) del 95%=1,8-58,8; p=0,008) y tener un mayor FEV1(%) posbroncodilatador (OR=1,03; IC del 95%=1,005-1,06; p=0,018), se asociaron de manera independiente a una tasa más acelerada de descenso del FEV1. Se apreció una tendencia entre tener un índice de masa corporal (IMC) bajo y experimentar una mayor tasa de deterioro del FEV1 (OR=1,14; IC del 95%=0,98-1,33; p=0,085). Conclusiones: Ser fumador o ex fumador, tener una función pulmonar preservada y un bajo IMC fueron los principales factores de riesgo asociados a una tasa acelerada de descenso del FEV1. Este hallazgo justificaría la necesidad de efectuar un seguimiento estrecho de los pacientes jóvenes con un FEV1 más preservado(AU)

Introduction: The present study intends to describe the characteristics of patients diagnosed with severe alpha-1 antitrypsin deficiency (AATD) in Spain, to observe the rate of decline in forced expiratory volume in 1 second (FEV1) with and without substitutive therapy, and to identify factors associated with a rapid rate of decline in FEV1. Method: A retrospective study of the evolution of individuals with AATD was carried out based on data collected from the Spanish registry. The primary response variable was the annual rate of decline in FEV1, calculated using the baseline and last postbronchodilator FEV1 values in an endpoint analysis. Results: 303 patients with severe AATD and Pi ZZ phenotype were identified. Follow-up spirometric data were collected for 117 subjects. Being a smoker or ex-smoker versus never smoker (odds ratio [OR]=10.31; 95% confidence interval (CI)=1.8-58.8; p=0.008) and having a higher baseline postbronchodilator FEV1 (% predicted) (OR=1.03; 95% CI=1.005-1.06; p=0.018) were independently associated with a more rapid rate of decline in FEV1. There was also a trend towards a relationship between low body mass index (BMI) and a greater rate of deterioration in lung function (OR=1.14; 95% CI=0.98-1.33; p=0.085). Conclusion: Being a smoker or ex-smoker, greater baseline lung function, and low BMI were the main risk factors associated with an accelerated rate of decline in FEV1. This finding warrants the close observation of younger patients with a better-preserved FEV1(AU)

Documento de consenso sobre diagnóstico, tratamiento y prevención de la tuberculosis / Consensus Document on the Diagnosis, Treatment and Prevention of Tuberculosis

Debe sospecharse tuberculosis pulmonar en pacientes con síntomas respiratorios durante más de 2-3 semanas. La inmunodepresión puede modificar la presentación clínica y radiológica. La radiografía de tórax presenta manifestaciones muy sugerentes de tuberculosis, aunque en ocasiones atípicas. Las pruebas radiológicas complejas (tomografía computarizada, resonancia magnética) son más útiles en la tuberculosis extrapulmonar. En el diagnóstico, siempre que sea posible, se utilizarán al menos 3 muestras seriadas representativas de la localización clínica. La baciloscopia y el cultivo con medios líquidos deben realizarse en todos los casos. Las técnicas de amplificación genética son coadyuvantes en la sospecha moderada o alta de tuberculosis. En los casos nuevos de tuberculosis, se recomienda administrar isoniacida, rifampicina, etambutol y piracinamida (HREZ) durante 2 meses e isoniacida más rifampicina durante 4 meses más, con las excepciones de los casos de meningitis, en que se alargará hasta 12 meses, y de la tuberculosis espinal con afección neurológica y la silicosis, hasta 9 meses. Se recomiendan las formulaciones combinadas. En pacientes con infección por el VIH deben realizarse los ajustes necesarios con el tratamiento antirretroviral. Debe realizarse antibiograma para fármacos de primera línea a todos los aislamientos iniciales de pacientes nuevos. El control del tratamiento es una de las actividades más importantes en el abordaje de la tuberculosis. En la infección tuberculosa la prueba de tuberculina (PT) es positiva cuando es ≥ 5 mm y los métodos de detección de producción de interferón gamma (IGRA) se recomiendan en combinación con la prueba de la tuberculina. La pauta estándar de tratamiento de la infección es de 6 meses con isoniacida. En la tuberculosis pulmonar se aplicará aislamiento respiratorio durante 3 semanas o hasta obtener 3 muestras con baciloscopia negativa (AU)

Pulmonary TB should be suspected in patients with respiratory symptoms longer than 2–3 weeks. Immunosuppression may modify clinical and radiological presentation. Chest X-ray shows very suggestive, albeit sometimes atypical, signs of TB. Complex radiological tests (CT scan, MR) are more useful in extrapulmonary TB. At least 3 serial representative samples of the clinical location are used for diagnosis whenever possible. Bacilloscopy and liquid medium cultures are indicated in all cases. Genetic amplification techniques are coadjuvant in moderate or high TB suspicion. Administration of isoniazid, rifampicin, ethambutol and pyrazinamide (HREZ) for 2 months and HR for 4 additional months is recommended in new cases of TB, except in cases of meningitis in which treatment should continue for up to 12 months and up to 9 months in spinal TB with neurological involvement, and in silicosis. Appropriate adjustments with antiretroviral treatment should be made in HIV patients. Combined therapy is recommended to avoid development of resistance. An antibiogram to first line drugs should be performed in all the initial isolations of new patients. Treatment control is one of the most important activities in TB management. The Tuberculin Skin Test (TST) is positive in TB infection when ≥5 mm, and Interferon-Gamma Release Assays (IGRA) are recommended in combination with TT. The standard treatment schedule for infection is 6 months with isoniazid. In pulmonary TB, respiratory isolation is applied for 3 weeks or until 3 negative bacilloscopy samples are obtained (AU)

Satisfaction level and masticatory performance of patient rehabilitated with implant-supported overdentures / Nível de satisfação e performance mastigatória de pacientes reabilitados com sobredentaduras suportada por implantes

Purpose: To compare the masticatory performance and satisfaction levels of subjects with normal dentition and subjects with implant-supported overdentures with two types of attachments (ball and bar-clip retention systems). Methods: The sample comprised 24 subjects, 12 edentulous patients and 12 dentate subjects. The denture wearers received two dental implants and new maxillary and mandibular dentures. Three months after the first surgical phase, the mandibular dentures were connected to the implants by a gold ball attachment. Two months later new mandibular overdentures were made with a bar-clip attachment. Satisfaction levels (modified OHIP-EDENT and verbal rating scale) and masticatory performance (chewing for 40 masticatory cycles) were measured with the old dentures, with the unattached new dentures, and with the new dentures with ball and bar-clip attachments. Data were analyzed by Friedman and chi-square tests. Results: Both masticatory performance and satisfaction levels significantly improved after implant treatment. No significant differences were observed between the overdentures with ball and bar attachments. However, the masticatory performance after treatment was still significantly lower than the performance of the healthy subjects. Conclusion: The rehabilitation of edentulous patients with overdenture with ball or bar-clip attachment improves both satisfaction and masticatory performance, but the outcomes levels are not equal as those found for dentate subjects.

Objetivo: Comparar o nível de satisfação e a performance mastigatória dos indivíduos com dentição normal e pacientes reabilitados com uma sobredentadura suportada por implantes com dois tipos de conectores diferentes, sistema de retenção bola e barra. Metodologia: Vinte e quatro indivíduos participaram do estudo, sendo 12 pacientes desdentados e 12 indivíduos dentados totais. Os desdentados receberam dois implantes e novas dentaduras, superiores e inferiores. Três meses depois da primeira fase cirúrgica, a dentadura inferior foi conectada aos implantes através do sistema bola. Dois meses depois, uma nova sobredentadura inferior foi realizada, porém desta vez conectado através do sistema barra-clipe. O nível de satisfação (OHIP-EDENT adaptado e escala verbal de medição) e a performance mastigatória (mastigação por 40 ciclos mastigatórios) foram medidos em vários momentos do tratamento, com as dentaduras antigas, novas não conectadas por implantes, e depois de ter conectado a sobredentadura pelo sistema bola e barra-clipe. O teste de Friedman e o teste qui-quadrado foram aplicados para analisar os resultados.Resultados: O nível de satisfação e a performance mastigatória melhoraram significativamente após a reabilitação com os implantes. Nenhuma diferença foi observada entre as sobredentaduras com sistema bola e barra-clipe. Entretanto, a performance mastigatória ainda permaneceu significativamente menor que a performance dos indivíduos dentados. Conclusão: A reabilitação de pacientes edêntulos reabilitados com sobredentadura com bola ou barra-clipe melhora tanto o nível de satisfação quanto a performance mastigatória, porém ainda abaixo do nível dos indivíduos com dentição normal.

Diagnóstico y tratamiento de la tuberculosis / No disponible

No disponible

Efectividad y tolerancia de las pautas de tratamiento antituberculoso sin isoniacida y/o rifampicina. Análisis de 85 casos / Effectiveness and tolerance of antituberculosis treatment regimens without isoniazid and rifampicin: analysis of 85 aases

OBJETIVO: Determinar si las pautas de tratamiento antituberculoso sin isoniacida y/o rifampicina (PsHR) son efectivas y seguras, y conocer los factores que obligan a cambiarlas. PACIENTES Y MÉTODOS: Se ha realizado un estudio retrospectivo de los pacientes tratados con PsHR entre 1995 y 2005 en 2 centros especializados de Barcelona. Los factores predictores se estudiaron mediante regresión logística, calculándose las odds ratio y sus intervalos de confianza del 95%. RESULTADOS: Se incluyó en el estudio a 85 pacientes. Un 35% eran inmigrantes y un 34% estaban infectados por el virus de la inmunodeficiencia humana. La causa de no administrar isoniacida y/o rifampicina fue sobre todo la toxicidad (53%), seguida de resistencia a fármacos antituberculosos (39%). Las pautas sin rifampicina fueron las más frecuentes (42%). Fue preciso cambiar la PsHR en el 30% de los casos y esto se asoció a no ser inmigrante. La toxicidad de las pautas fue más elevada (36%), aunque su evolución fue siempre favorable. El 77% de los pacientes tuvo una evolución satisfactoria y fue dado de alta. CONCLUSIONES: Las PsHR, con un buen seguimiento, poseen una efectividad similar a las pautas estándar y, aunque su toxicidad es más elevada, ésta sigue una evolución correcta

OBJECTIVE: To determine if isoniazid- and/or rifampicin-free antituberculosis treatment regimens are safe and effective and to identify any factors that might require changes in the regimens. PATIENTS AND METHODS: We carried out a retrospective study of patients treated with isoniazid- and/or rifampicin-free regimens between 1995 and 2005 at 2 specialized hospitals in Barcelona, Spain. Predictive factors were studied by logistic regression and the odds ratio; 95% confidence intervals were calculated. RESULTS: Eighty-five patients were included in the study: 35% were immigrants and 34% were infected with human immunodeficiency virus. The reason for omitting isoniazid or rifampicin was toxicity (53%), followed by multidrug resistance (39%). Rifampicin-free regimens were most common (42%). A change in the isoniazid- and/or rifampicin-free regimen was required in 30% of cases, but was not associated with being an immigrant. The rate of toxicity with these regimens was higher (36%), although progress was always satisfactory. Clinical course was satisfactory in 77% of patients and they were discharged. CONCLUSIONS: Isoniazid- and/or rifampicin-free regimens with adequate follow-up showed similar treatment outcomes compared with standardized treatment regimens. Although these regimens were more toxic, patient progress was good

Estado de la neumología pública en Cataluña: estudio comparativo entre 1993 y 2003 / State of public pneumology in Catalonia [Spain]: 1993 versus 2003

El objetivo de este estudio era realizar un análisis descriptivo de la situación de la neumología pública en Cataluña en el año 2003 y comparar los resultados con datos de 1993. Se remitió un cuestionario a todos los hospitales de la red pública de Cataluña (XHUP) solicitando información sobre el número de neumólogos. También se contactó con los servicios de atención primaria (SAP) de Cataluña para conocer el número de neumólogos que trabajan en atención primaria. Se ha obtenido respuesta del 100% de los hospitales y SAPcontactados. El 83% de los hospitales de la XHUP disponende servicio de neumología, y se observa un incremento significativo en la proporción de hospitales que disponen de la especialidad respecto a 1993. La tasa de neumólogos por 100.000 habitantes para toda Cataluña es de 3,15.El grado de implantación de la neumología en la XHUP hamejorado significativamente en el decenio 1993-2003

The aim of this study was to perform a descriptive analysis of the state of public pneumology in Catalonia (Spain) in 2003 and to compare the results with data from 1993.A questionnaire was sent to all hospitals of the public hospitals network in Catalonia requesting information on the number of pulmonologists. To determine the number of pulmonologists working in primary care, we also contacted all the primary care services (PCS) in Catalonia.All the hospitals and PCS contacted responded. Eighty-three percent of the public network hospitals had a pneumology service. From 1993-2003, the proportion of hospitals with this specialty increased. The rate of pulmonologists per 100,000 persons for the whole of Catalonia was 3.15.The degree of implantation of pneumology in the public hospitals network of Catalonia significantly improved in the decade between 1993 and 2003

Valor pronóstico de los hallazgos electrocardiográficos en pacientes estables hemodinámicamente con tromboembolia de pulmón aguda sintomática / Prognostic value of electrocardiographic findings in hemodynamically stable patients with acute symptomatic pulmonary embolism

Introducción y objetivos. El objetivo de este estudio es evaluar el valor pronóstico del electrocardiograma (ECG) en pacientes estables hemodinámicamente con diagnóstico de tromboembolia pulmonar (TEP) aguda sintomática. Métodos. Se incluyó de forma prospectiva a todos los pacientes ambulatorios estables hemodinámicamente diagnosticados de TEP aguda sintomática en un hospital universitario terciario. Las anomalías electrocardiográficas consideradas fueron: a) taquicardia sinusal (> 100 lat/min); b) alteraciones del segmento ST o de la onda T; c) bloqueo de la rama derecha del haz de His (BRDHH); d) patrón S1Q3T3, y e) arritmias auriculares de reciente comienzo. Resultados. Se incluyó a 644 pacientes en el estudio. Un 5% de los pacientes con ECG anormal fallecieron por TEP en los 15 días posteriores al diagnóstico, comparado con un 2% de los pacientes con ECG normal (razón de riesgo [RR] = 2,4; intervalo de confianza [IC] del 95%, 1-5,8; p = 0,05). En el análisis multivariable, la taquicardia sinusal multiplicó por 2,2 el riesgo de muerte por todas las causas en el mes posterior al diagnóstico de TEP. Tras ajustar por edad, antecedentes de cáncer, inmovilización, un ECG alterado y la presencia de taquicardia sinusal, las arritmias auriculares de reciente diagnóstico se asociaron de forma significativa a la muerte por TEP durante los primeros 15 días (RR = 2,8; IC del 95%, 1-8,3; p = 0,05). Las arritmias auriculares mostraron un alto valor predictivo negativo de muerte por TEP a los 15 días (97%), pero la razón de probabilidad negativa fue 0,79. Conclusiones. En pacientes estables hemodinámicamente con TEP aguda sintomática, la taquicardia sinusal y las arritmias auriculares son predictoras independientes de mal pronóstico. Sin embargo, su utilidad en la estratificación pronóstica de estos pacientes es limitada

Introduction and objectives. The aim of this study was to determine the prognostic value of electrocardiography in hemodynamically stable patients with a diagnosis of acute symptomatic pulmonary embolism (PE). Methods. This prospective study included all hemodynamically stable outpatients who were diagnosed with PE at a university hospital. The electrocardiographic abnormalities investigated were: a) sinus tachycardia (>100 beats/min); b) ST-segment or T-wave abnormalities; c) right bundle branch block; d) an S1Q3T3 pattern, and e) recent-onset atrial arrhythmia. Results. The study included 644 patients. Overall, 5% of those with an ECG abnormality died due to PE in the 15 days after diagnosis compared with 2% of those with normal ECG findings (relative risk [RR]=2.4; 95% confidence interval [CI], 1­5,8; P=.05). Multivariate analysis showed that sinus tachycardia was associated with a 2.2-fold increased risk of death due to all causes in the month after PE diagnosis. After adjusting for age, a history of cancer, immobility, ECG abnormalities, and sinus tachycardia, the presence of recent-onset atrial arrhythmia was significantly associated with death due to PE in the first 15 days (RR=2.8; 95% CI, 1­8.3; P=.05). The negative predictive value of atrial arrhythmia for 15-day PE-related mortality was 97%, while the negative likelihood ratio was 0.79. Conclusions. In hemodynamically stable patients with acute symptomatic PE, the presence of sinus tachycardia and atrial arrhythmia were independent predictors of a poor prognosis. However, the usefulness of these factors for stratifying risk in PE patients is limited

Valor pronóstico de la ecocardiografía transtorácica en pacientes estables hemodinámicamente con tromboembolia de pulmón aguda sintomática / Prognostic value of transthoracic echocardiography in hemodynamically stable patients with acute symptomatic pulmonary embolism

Objetivo: El objetivo de este estudio ha sido evaluar el valor pronóstico de la ecocardiografía transtorácica en pacientes estables hemodinámicamente con diagnóstico de tromboembolia pulmonar (TEP) aguda sintomática. Pacientes y métodos: Se incluyó prospectivamente en el estudio a todos los pacientes ambulatorios, estables hemodinámicamente, diagnosticados de TEP aguda sintomática en un hospital universitario terciario. Se realizó a todos ellos una ecocardiografía transtorácica en las 48 h posteriores al diagnóstico. El criterio de evaluación principal fue la muerte por todas las causas a un mes. Resultados: La prevalencia de criterios ecocardiográficos de disfunción del ventrículo derecho fue de un 40% en nuestra serie (86/214). Durante el primer mes de seguimiento se produjeron 7 fallecimientos, 4 en el grupo con ecocardiografía positiva y 3 en el grupo con ecocardiografía negativa (odds ratio = 2,0; intervalo de confianza del 95%, 0,4-9,3; p = 0,41). La ecocardiografía transtorácica demostró un valor predictivo negativo del 98%, un valor predictivo positivo del 5% y un cociente de probabilidad negativo de 0,7 respecto al parámetro de valoración principal. Cuando sólo se consideró la muerte por TEP, el valor predictivo negativo fue del 100% y el valor predictivo positivo, del 3%. Conclusiones: En nuestro medio la ecocardiografía transtorácica carece de utilidad en la estratificación pronóstica de los pacientes estables hemodinámicamente con TEP

Objective: To determine the prognostic value of transthoracic echocardiography in hemodynamically stable patients diagnosed with acute symptomatic pulmonary embolism. Patients and Methods: Hemodynamically stable outpatients diagnosed with acute symptomatic pulmonary embolism at a tertiary university hospital were prospectively included in the study. All patients underwent transthoracic echocardiography within 48 hours of diagnosis. The primary endpoint was all-cause mortality at 1 month. Results: Right ventricular dysfunction was documented by echocardiography in 86 of the 214 patients (40%) in our series. In the first month of follow-up, 7 patients died--4 with positive echocardiographic findings and 3 with negative findings (odds ratio, 2.0; 95% confidence interval, 0.4-9.3; P=.41). For the primary endpoint, the negative predictive value of transthoracic echocardiography was 98%, the positive predictive value was 5%, and the negative likelihood ratio was 0.7. The negative predictive value was 100% and the positive predictive value was 3% when we analyzed death due to pulmonary embolism only. Conclusions: In our setting, transthoracic echocardiography is not useful for prognostic stratification of hemodynamically stable patients with pulmonary embolism

Sensibilidad, especificidad y fiabilidad de la ecografía Doppler arterial en el diagnóstico de la isquemia crítica de los miembros inferiores con relación a la arteriografía / The sensitivity, specificity and reliability of arterial Doppler ultrasonography in the diagnosis of critical ischaemia of the lower limbs compared to arteriography

Introducción. La arteriografía sigue considerándose como el patrón estándar en el diagnóstico de la isquemia crítica. Sin embargo, puede ocasionar daños arteriales locorregionales, así como cuadros alérgicos y nefrotoxicidad; además, no valora hemodinámicamente las lesiones. La ecografía Doppler arterial (EDA) ha demostrado validez y fiabilidad en miembros inferiores y troncos supraaórticos, pero es necesaria una validación individual y del laboratorio, por ser una técnica dependiente del explorador. Objetivo. Analizar y validar la EDA como prueba diagnóstica en pacientes con isquemia crítica, en comparación con la arteriografía. Pacientes y métodos. Diseño transversal y aleatorio, con EDA aplicada de forma ciega e independiente con respecto a la arteriografía, en una muestra de 60 pacientes con isquemia crítica de miembros inferiores en estudio preoperatorio. La fiabilidad se determina mediante el porcentaje de acuerdo global e índice kappa. La validez se determina por la sensibilidad, especificidad, valores pronósticos positivos (VPP) y razón de probabilidad diagnóstica (RPD). Resultados. Tiempo medio de exploración por extremidad: 39 min. Índices kappa buenos o muy buenos en todos los sectores, salvo en la arteria peronea (moderada). Alta sensibilidad en territorios proximales. Especificidad por encima del 90%, excepto en la arteria peronea (88%). VPP siempre superior al 90%. Altos valores de RPD. Conclusión. La EDA, a tenor de los resultados obtenidos en nuestro laboratorio, es una prueba diagnóstica muy útil como alternativa a la arteriografía, ya que su fiabilidad es buena o muy buena y su validez, en términos de sensibilidad, especificidad, VPP y RPD, es muy alta. No obstante, en el sector distal, con especial atención sobre la arteria peronea, resulta necesaria en todo caso otra prueba de imagen antes de sentar una indicación quirúrgica

Introduction. Arteriography is still considered to be the gold standard in the diagnosis of critical ischaemia. Nevertheless, it can cause locoregional arterial damage, as well as allergic reactions and nephrotoxicity, and it does not evaluate the lesions haemodynamically. Arterial Doppler ultrasonography (ADU) has proved to be valid and reliable in the lower limbs and supra-aortic trunks but, because it is an examiner-dependent technique, individual and laboratory validation of findings is required. Aim. To analyse and validate ADU as a diagnostic test in patients with critical ischaemia, as compared to arteriography. Patients and methods. A cross-sectional random design, with ADU applied blind and independently with respect to arteriography conducted in a sample of 60 patients with critical lower limb ischemia undergoing their preoperative study. Reliability is determined by means of the percentage of overall agreement and the kappa index. Validity is determined by the sensitivity, specificity, predictive positive value (PPV) and diagnostic likelihood ratio (DLR). Results. Mean examination time per limb: 39 min. Good or very good kappa indexes in all sectors, except in the fibular artery (moderate). Highly sensitive in proximal territories. Specificity above 90%, except in the fibular artery (88%). PPV always above 90%. High DLR values. Conclusions. In the light of the results obtained in our laboratory, ADU can be considered to be a diagnostic test that is very useful as an alternative to arteriography, since its reliability is good or very good and its validity, in terms of sensitivity, specificity, PPV and DLR, is very high. Yet, in the distal sector, with special attention to the fibular artery, another imaging test must always be carried out before setting an indication for surgery

Revascularización infragenicular con aloinjerto arterial criopreservado / Below-the-knee revascularisation with a cryopreserved arterial allograft

Objetivo. Valorar los resultados preliminares obtenidos en nuestro servicio en revascularización infragenicular con aloinjerto arterial criopreservado (AAC) en caso de ausencia de injerto autólogo. Pacientes y métodos. Entre junio de 2001 y agosto de 2005, realizamos ocho procedimientos en ocho pacientes (dos mujeres y seis varones) con una edad media de 73 años (rango: 55-82 años). En dos casos los injertos fueron compuestos AAC-segmento venoso residual. En otros dos casos se emplearon dos AAC. Las indicaciones para intervenir fueron isquemia crítica (siete) e infección protésica (uno). En cinco casos había al menos una revascularización previa. Los AAC se obtuvieron de donante cadáver. La anastomosis distal se realizó sobre poplítea (dos), arteria tibial (cinco) o arteria perimaleolar (uno). En todos los casos se descartó la existencia de segmento venoso autólogo suficiente mediante eco-Doppler. El seguimiento fue clínico y ecográfico. Resultados. Durante el primer mes se produjeron una rotura de AAC y una trombosis precoz, ambas con reparación satisfactoria. Durante un seguimiento medio de 14 meses (rango: 1-46 meses), cuatro injertos sufrieron un fallo primario: dos trombosis, una estenosis y una degeneración aneurismática. Ello derivó en una amputación mayor, una trombectomía y una sustitución del injerto. La permeabilidad global fue del 75% (6/8) y la salvación de extremidad del 87,5% (7/8). Una paciente falleció a los cuatro y otro a los 46 meses, ambos con injerto permeable. Conclusión. A pesar de ser una serie pequeña, los AAC pueden ser una opción en las revascularizaciones infrageniculares en caso de ausencia de injerto autólogo suficiente para ésta

Aim. To assess our preliminary results of infrapopliteal bypass grafting performed with cryopreserved arterial allografts (CAA) in case of absence of alternate autologous veins. Patients and methods. Between June 2001 and August 2005, eight procedures were performed in eight patients (two female and six male), with a mean age of 73 years (range: 55-82 years). In two cases a composite CAA-residual vein bypass was realized. In another two cases two segments of CAA were used. Indications for operation were critical leg ischaemia in seven cases and infection in the other. In five cases, there was at least one previous revascularization on the same limb. CAA were obtained from cadaveric donors in a multidisciplinary organs explant program. Distal anastomosis was to the bellow knee popliteal artery in two cases, to a tibial artery in five cases and to a perimaleolar artery in one case. In all cases we searched for the existence of alternate autologous vein with Doppler scan. The surveillance was clinic and with Doppler scan. Results. During follow-up (mean: 14 months; range: 1-46 months), four grafts failed. These failures were two thrombosis, one stenosis and one aneurysmatic degradation. Due to this, a major amputation and a CAA-prosthetic replacement were performed. The global patency rate was 75% (6/8) and the limb salvage rate was 87.5% (7/8). One patient died at four month after procedure, with patent bypass. Conclusion. Even knowing that this is a small group of patients, we think CAA could be an option in infrapopliteal bypass surgery in case of absence of autologous vein

¿Síndrome de la clase turista o síndrome del viajero inmovilizado? / Economy class syndrome or immobile traveler´s syndrome?

El síndrome de la clase turista es el que se asocia a personas que presentan una embolia pulmonar a consecuencia de una inmovilización prolongada tras un viaje por vía aérea de larga duración. El objetivo del presente trabajo ha sido analizar si existe riesgo de tromboembolia pulmonar tras un viaje de larga duración por vía terrestre. Se ha estudiado a 100 pacientes consecutivos diagnosticados de tromboembolia pulmonar. De ellos, 9 presentaban el antecedente de haber realizado un viaje prolongado (> 5 h) y en 6 de estos casos el transporte fue terrestre. Por este motivo pensamos que las medidas preventivas propuestas para los viajeros por vía aérea deben extenderse a quienes utilizan otro medio de transporte

Economy class syndrome describes the situation of patients who suffer pulmonary embolism following prolonged immobility in a long distance flight. The objective of the present study was to analyze whether there is a risk of pulmonary thromboembolism after a long overland journey. The study consecutively enrolled 100 patients diagnosed with pulmonary thromboembolism. Nine of them had previously undertaken a long journey (>5 h), 6 of which had been over land. Consequently, we think that the preventative measures recommended for airline passengers should be extended to users of other means of transport

Satisfaction level and masticatory capacity in edentulous patients with conventional dentures and implant-retained overdentures

The difficulty of totally edentulous individual in performing the basic oral functions in a satisfactory and pleasant way directs the investigations for improvement of the rehabilitation techniques. This study aimed to perform an intra-patient analysis of the satisfaction level and masticatory capacity during the phases of the rehabilitation treatment with osseointegrated implants. Twelve edentulous patients (mean age: 61 years) participated. Satisfaction level and masticatory capacity were analyzed based on specific questionnaires for edentulous patients and by a verbal rating scale from 0 to 10, at three moments: with the old dentures, with conventional new ones after they had been received two osseointegrated implants in the mandible (after 60 days of use). After 5 months of the first surgical phase, gold cap ball attachments were adapted and the last evaluation was performed with the upper denture and the lower overdenture, after 30 days of use. The Friedman test was applied. The rehabilitation with implants produced a significant improvement in the satisfaction level (95.83%) and the masticatory capacity (94.07%). The new full dentures produced a better satisfaction and masticatory capacity than the old dentures. Besides, lower overdenture supported by two osseointegrated implants and a new upper conventional denture produced a higher scores than the conventional new dentures.

Otimização de estética e função em próteses implantossuportadas através da personalização de pilares: relato de caso clínico / Esthetics and function optimization in implant-supported prostheses with customized abutments: case report

Os pilares personalizados, preparados individualmente para cada situação, vêm sendo cada vez mais utilizados pelos odontólogos devido ao fato de minimizarem problemas de angulação e alinhamento de implantes dando à coroa um perfil de emergência mais natural. O presente estudo relata um caso clínico onde foram utilizados pilares protéticos tipo UCLA personalizados para otimizar função e estética numa reabilitação protética.