Manejo y factores de riesgo de mortalidad del estatus epiléptico: estudio retrospectivo / Status epilepticus management and mortality risk factors: A retrospective study

Introducción: El estatus epiléptico (SE, por sus siglas en inglés) es una urgencia neurológica con altas tasas de mortalidad. En este estudio analizamos el manejo del SE e identificamos factores de riesgo de mortalidad en los que realizar intervenciones de mejora o modificaciones en los protocolos de actuación hospitalarios. Métodos: Retrospectivamente se analizaron los datos demográficos de tratamiento y pronóstico de 65 pacientes (59 [44,5-77] años, 53,8% mujeres) que ingresaron en un hospital terciario cumpliendo los criterios de SE de la ILAE 2015, durante un periodo de 18 meses. Resultados: Treinta (46,2%) pacientes tenían antecedentes de epilepsia. Las causas más frecuentes de SE fueron enfermedad cerebrovascular (27,7%) e infección sistémica (16,9%). Se registraron desviaciones respecto al tratamiento habitual: la administración de las benzodiazepinas como primer fármaco solo en 33 (50,8%) pacientes, la combinación de 2 benzodiazepinas en 7 (10,8%) pacientes y el uso off-label de lacosamida en 5 (7,7%) pacientes. El electroencefalograma (EEG) fue realizado únicamente en 26 (40%) pacientes y solo 5 EEG (7,7% de pacientes) en las primeras 12 h. La tasa de mortalidad fue del 21,5%. Ictus agudo y complicaciones cerebrovasculares se asociaron con mortalidad, mientras que epilepsia previa e ingreso en la unidad de cuidados intensivos (UCI) fueron factores de buen pronóstico (p < 0,05). Conclusiones: Para mejorar el manejo del SE y reducir la tasa de mortalidad, sería recomendable implementar actividades formativas dirigidas a los profesionales del departamento de urgencias, así como el ingreso electivo en la UCI para pacientes con factores de riesgo (primera crisis epiléptica, con ictus agudo o complicaciones cardiovasculares). (AU)

Introduction: Status epilepticus (SE) is a neurological emergency with relatively high mortality rates. In this study, we analysed the management of SE and identified mortality risk factors that may be addressed with educational interventions or modifications to hospital protocols. Methods: In this retrospective study, we analysed demographic, treatment, and outcome data from 65 patients (mean age, 59 years [range, 44.5-77]; 53.8% women) who were admitted to our tertiary hospital during an 18-month period and met the 2015 International League Against Epilepsy criteria for SE. Results: Thirty patients (46.2%) had history of epilepsy. The most frequent causes of SE were cerebrovascular disease (27.7%) and systemic infection (16.9%). The following deviations were observed in the administration of the antiepileptic drugs: benzodiazepines were used as first option in only 33 (50.8%) patients; the combination of 2 benzodiazepines was recorded in 7 cases (10.8%); and lacosamide was used as an off-label drug in 5 patients (7.7%). Electroencephalography studies were performed in only 26 patients (40%); and only 5 studies (7.7% of patients) were performed within 12 hours of seizure onset. The mortality rate was 21.5%. Acute stroke and cerebrovascular complications were associated with higher mortality rates, while previous history of epilepsy and admission to intensive care were related to better prognosis (P <.05). Conclusions: To improve SE management and reduce mortality rates, training activities targeting emergency department physicians should be implemented, together with elective intensive care admission for patients with multiple mortality risk factors (eg, absence of history of epilepsy, acute stroke, or cardiovascular complications). (AU)

Status epilepticus management and mortality risk factors: a retrospective study.

INTRODUCTION: Status epilepticus (SE) is a neurological emergency with relatively high mortality rates. In this study, we analysed the management of SE and identified mortality risk factors that may be addressed with educational interventions or modifications to hospital protocols. METHODS: In this retrospective study, we analysed demographic, treatment, and outcome data from 65 patients (mean age, 59 years [range, 44.5-77]; 53.8% women) who were admitted to our tertiary hospital during an 18-month period and met the 2015 International League Against Epilepsy criteria for SE. RESULTS: Thirty patients (46.2%) had history of epilepsy. The most frequent causes of SE were cerebrovascular disease (27.7%) and systemic infection (16.9%). The following deviations were observed in the administration of the antiepileptic drugs: benzodiazepines were used as first option in only 33 (50.8%) patients; the combination of 2 benzodiazepines was recorded in 7 cases (10.8%); and lacosamide was used as an off-label drug in 5 patients (7.7%). Electroencephalography studies were performed in only 26 patients (40%); and only 5 studies (7.7% of patients) were performed within 12 hours of seizure onset. The mortality rate was 21.5%. Acute stroke and cerebrovascular complications were associated with higher mortality rates, while previous history of epilepsy and admission to intensive care were related to better prognosis (P <  .05). CONCLUSIONS: To improve SE management and reduce mortality rates, training activities targeting emergency department physicians should be implemented, together with elective intensive care admission for patients with multiple mortality risk factors (eg, absence of history of epilepsy, acute stroke, or cardiovascular complications).

Manejo con control de temperatura en los cuidados posparada cardiaca: documento de expertos / Management of temperature control in post-cardiac arrest care: an expert report

Actualmente, el control estricto de temperatura mediante hipotermia inducida (entre 32 y 36 oC) se considera un tratamiento de primera línea en el manejo de pacientes con parada cardiaca recuperada que ingresan en Unidades de Cuidados Intensivos. Su objetivo es disminuir el daño neurológico secundario a anoxia cerebral. Aunque existen múltiples evidencias sobre sus beneficios, el empleo de esta técnica en nuestro país es pobre y todavía existen temas controvertidos como temperatura óptima, velocidad de instauración, duración y proceso de calentamiento. El objetivo de este trabajo es desarrollar la evidencia científica actual y las recomendaciones de las principales guías internacionales. El enfoque de este documento se centra también en aplicación práctica del control estricto de la temperatura en la parada cardiaca recuperada en nuestras Unidades de Cuidados Intensivos Generales o Cardiológicas, principalmente en los métodos de aplicación, protocolos, manejo de las complicaciones y elaboración del pronóstico neurológico. (AU)

Targeted temperature management (TTM) through induced hypothermia (between 32-36 oC) is currently regarded as a first-line treatment during the management of post-cardiac arrest patients admitted to the Intensive Care Unit (ICU). The aim of TTM is to afford neuroprotection and reduce secondary neurological damage caused by anoxia. Despite the large body of evidence on its benefits, the TTM is still little used in Spain. There are controversial issues referred to its implementation, such as the optimal target body temperature, timing, duration and the rewarming process. The present study reviews the best available scientific evidence and the current recommendations contained in the international guidelines. In addition, the study focuses on the practical implementation of TTM in post-cardiac arrest patients in general and cardiological ICUs, with a discussion of the implementation strategies, protocols, management of complications and assessment of the neurological prognosis. (AU)

Management of temperature control in post-cardiac arrest care: an expert report. / Manejo con control de temperatura en los cuidados posparada cardiaca: documento de expertos.

Targeted temperature management (TTM) through induced hypothermia (between 32-36 oC) is currently regarded as a first-line treatment during the management of post-cardiac arrest patients admitted to the Intensive Care Unit (ICU). The aim of TTM is to afford neuroprotection and reduce secondary neurological damage caused by anoxia. Despite the large body of evidence on its benefits, the TTM is still little used in Spain. There are controversial issues referred to its implementation, such as the optimal target body temperature, timing, duration and the rewarming process. The present study reviews the best available scientific evidence and the current recommendations contained in the international guidelines. In addition, the study focuses on the practical implementation of TTM in post-cardiac arrest patients in general and cardiological ICUs, with a discussion of the implementation strategies, protocols, management of complications and assessment of the neurological prognosis.

Large deep-sea zooplankton biomass mirrors primary production in the global ocean.

The biological pump transports organic carbon produced by photosynthesis to the meso- and bathypelagic zones, the latter removing carbon from exchanging with the atmosphere over centennial time scales. Organisms living in both zones are supported by a passive flux of particles, and carbon transported to the deep-sea through vertical zooplankton migrations. Here we report globally-coherent positive relationships between zooplankton biomass in the epi-, meso-, and bathypelagic layers and average net primary production (NPP). We do so based on a global assessment of available deep-sea zooplankton biomass data and large-scale estimates of average NPP. The relationships obtained imply that increased NPP leads to enhanced transference of organic carbon to the deep ocean. Estimated remineralization from respiration rates by deep-sea zooplankton requires a minimum supply of 0.44 Pg C y-1 transported into the bathypelagic ocean, comparable to the passive carbon sequestration. We suggest that the global coupling between NPP and bathypelagic zooplankton biomass must be also supported by an active transport mechanism associated to vertical zooplankton migration.

Role of coronary angiography in patients with a non-diagnostic electrocardiogram following out of hospital cardiac arrest: Rationale and design of the multicentre randomized controlled COUPE trial.

BACKGROUND: Coronary artery disease (CAD) is a major cause of out-of-hospital cardiac arrest (OHCA). The role of emergency coronary angiography (CAG) and percutaneous coronary intervention (PCI) following cardiac arrest in patients without ST-segment elevation myocardial infarction (STEMI) remains unclear. AIMS: We aim to assess whether emergency CAG and PCI, when indicated, will improve survival with good neurological outcome in post-OHCA patients without STEMI who remain comatose. METHODS: COUPE is a prospective, multicentre and randomized controlled clinical trial. A total of 166 survivors of OHCA without STEMI will be included. Potentially non-cardiac aetiology of the cardiac arrest will be ruled out prior to randomization. Randomization will be 1:1 for emergency (within 2 h) or deferred (performed before discharge) CAG. Both groups will receive routine care in the intensive cardiac care unit, including therapeutic hypothermia. The primary efficacy endpoint is a composite of in-hospital survival free of severe dependence, which will be evaluated using the Cerebral Performance Category Scale. The safety endpoint will be a composite of major adverse cardiac events including death, reinfarction, bleeding and ventricular arrhythmias. CONCLUSIONS: This study will assess the efficacy of an emergency CAG versus a deferred one in OHCA patients without STEMI in terms of survival and neurological impairment.

Status epilepticus management and mortality risk factors: A retrospective study. / Manejo y factores de riesgo de mortalidad del estatus epiléptico: estudio retrospectivo.

INTRODUCTION: Status epilepticus (SE) is a neurological emergency with relatively high mortality rates. In this study, we analysed the management of SE and identified mortality risk factors that may be addressed with educational interventions or modifications to hospital protocols. METHODS: In this retrospective study, we analysed demographic, treatment, and outcome data from 65 patients (mean age, 59 years [range, 44.5-77]; 53.8% women) who were admitted to our tertiary hospital during an 18-month period and met the 2015 International League Against Epilepsy criteria for SE. RESULTS: Thirty patients (46.2%) had history of epilepsy. The most frequent causes of SE were cerebrovascular disease (27.7%) and systemic infection (16.9%). The following deviations were observed in the administration of the antiepileptic drugs: benzodiazepines were used as first option in only 33 (50.8%) patients; the combination of 2 benzodiazepines was recorded in 7 cases (10.8%); and lacosamide was used as an off-label drug in 5 patients (7.7%). Electroencephalography studies were performed in only 26 patients (40%); and only 5 studies (7.7% of patients) were performed within 12 hours of seizure onset. The mortality rate was 21.5%. Acute stroke and cerebrovascular complications were associated with higher mortality rates, while previous history of epilepsy and admission to intensive care were related to better prognosis (P <.05). CONCLUSIONS: To improve SE management and reduce mortality rates, training activities targeting emergency department physicians should be implemented, together with elective intensive care admission for patients with multiple mortality risk factors (eg, absence of history of epilepsy, acute stroke, or cardiovascular complications).

Asociación entre la morfología alar y el uso del hábitat en seis especies de palomas (Columbidae) neotropicales

Los factores biomecánicos, el comportamiento e historia natural de las especies pueden influenciar la forma y dimensión del ala en las aves. Por lo tanto, la morfología de las alas de cada especie podría estar adaptada al ambiente en el que habitan. En palomas (familia Columbidae) existe un gradiente de especies que tienden a volar mucho y otras que vuelan muy poco. El objetivo de esta investigación es determinar si la forma de las alas de seis especies de palomas se asocia con su capacidad de vuelo. Predecimos que las especies Patagioenas flavirostris y P. nigrirostris que tienden a volar largas distancias presentan alas relativamente largas y puntiagudas; mientras que Geotrygon montana que se desplaza principalmente caminando presenta alas relativamente anchas y redondeadas. Especies con capacidad de vuelo intermedio (Leptotila verreauxi, L. cassini y Zenaida asiatica) van a presentar alas con características intermedias. Estimamos la carga alar, proporción de la forma, conicidad alar, largo relativo y el área alar promedio para cada especie. Realizamos un análisis discriminante para determinar cuál combinación de variables explica mejor la diferencia morfológica de las alas entre las seis especies y probamos que tan robusto es este modelo mediante una prueba binomial. El modelo clasificó correctamente el 57 % de los individuos en su propia especie. Por lo tanto, encontramos que el tipo de desplazamiento predominante en cada una de las seis especies de Columbidae analizadas, se asocia con la morfología alar: alas adaptadas para vuelos en zonas abiertas en P. flavirostris y P. nigrirostris, alas adaptadas para vuelos muy maniobrables en hábitats densos en G. montana, y alas con características intermedias en L. verreauxi, L. cassini y Z. asiatica.

Biomechanics, behavior, and natural history influence wing dimension and shape. Wing design often correlates with features of the habitat in which each species is found. Doves and pigeons (Columbidae family) range from long-distance fliers (e.g., canopy and open area species) to very short-distance fliers (e.g., species adapted to dense understory forests) and such variation makes this group fit to test the association between flying habits and wing morphology. Our objective in this study is to determine whether the wing morphology (shape and dimensions) of six dove species is associated to their flying capability. We predict that the long-distance fliers Patagioenas flavirostris and P. nigrirostris will have long and sharp wings; while the very short-distance flier Geotrygon montana will have broad and rounded wings. Other species (e.g., Leptotila verreauxi, L. cassini and Zenaida asiatica) whose flying capability fits in between these two will have wings with intermediate morphological features. We measured the wing disc loading, shape ratio, the ratio of mean to maximum wing chord, relative wing length, and wing area for each species. We conducted a discriminant function analysis to compare which variables explain better the differences in wing morphology across the six species, and used a binomial test to evaluate the power of the model. The model correctly classified 57 % of individuals within their own species. The flying capability is associated with the wing morphology of the six Columbidae species; with a wing design for long-distance fliers in P. flavirostris and P. nigrirostris, wing design for maneuvering in dense habitats in G. montana, and wings with an intermediate design in L. verreauxi, L. cassini and Z. asiatica.

Síndrome de tako-tsubo complicado con taponamiento cardiaco y shock cardiogénico / Tako-tsubo cardiomyopathy complicated with cardiac tamponade and cardiogenic shock

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Low intensity sonosynthesis of iron carbide@iron oxide core-shell nanoparticles.

Here we demonstrate a simple method for the organic sonosynthesis of stable Iron Carbide@Iron Oxide core-shell nanoparticles (ICIONPs) stabilized by oleic acid surface modification. This robust synthesis route is based on the sonochemistry reaction of organometallic precursor like Fe(CO)5 in octanol using low intensity ultrasonic bath. As obtained, nanoparticles diameter sizes were measured around 6.38 nm ±â€¯1.34 with a hydrodynamic diameter around 25 nm and an estimated polydispersity of 0.27. Core-Shell structure of nanoparticles was confirmed using HR-TEM and XPS characterization tools in which a core made up of iron carbide (Fe3C) and a shell of magnetite (γ-Fe2O3) was found. The overall nanoparticle presented ferromagnetic behavior at 4 K by SQUID. With these characteristics, the ICIONPs can be potentially used in various applications such as theranostic agent due to their properties obtained from the iron oxides and iron carbide phases.

[Influence of depression on the initial diagnosis and the evolution of cognitive impairment]. / Influencia de la depresion en el diagnostico inicial y evolutivo del deterioro cognitivo.

INTRODUCTION: Depression and cognitive impairment maintain a close and complex relationship, which could be modified by pharmacological treatment. AIM: To analyze the influence of depression and antidepressive medication on the initial diagnosis and the evolution of cognitive impairment. PATIENTS AND METHODS: All the patients derived to a Neurology clinic due to complaints or suspicion of cognitive impairment, during a period of nine years, were studied. The influence of demographic and depression-related variables on initial cognitive diagnosis, cognitive-functional situation and 1-year evolution were analyzed. RESULTS: A total of 582 patients were included (mean age: 77.6 ± 7.0; 64.9% women). Frequency of current and past depression were, respectively, 25.4% and 17.2%. In addition, 20.6% of the patients were taking antidepressant medication and 31.2% were on anxiolytic/hypnotic treatment. One-year follow-up visit was available in 320 (59.8%) of patients. In the adjusted analysis, anxiolytic/hypnotic treatment was associated with a worse cognitive-functional situation in the initial visit, while past depression and presence of dystimia were associated with a favorable evolution (p < 0.05). CONCLUSIONS: Past or current depression are not associated with bad prognosis in patients derived to neurologist due to possible cognitive impairment.

TITLE: Influencia de la depresion en el diagnostico inicial y evolutivo del deterioro cognitivo.Introduccion. La depresion y el deterioro cognitivo mantienen una estrecha y compleja relacion, que podria verse alterada por el tratamiento antidepresivo. Objetivo. Analizar la influencia de la depresion y del tratamiento antidepresivo en el diagnostico cognitivo inicial y evolutivo de los pacientes remitidos a neurologia por quejas o sospecha de deterioro cognitivo. Pacientes y metodos. Se estudio a todos los pacientes remitidos a una consulta de neurologia por quejas o sospecha de deterioro cognitivo durante un periodo de nueve años. Se analizo la influencia de las variables demograficas y de las variables relacionadas con la depresion en el diagnostico cognitivo y en la situacion cognitivo-funcional inicial y tras un año de seguimiento. Resultados. Se incluyo a 582 pacientes (edad media: 77,6 ± 7 años; mujeres, 64,9%). La frecuencia de depresion actual o en el pasado era, respectivamente, del 25,4% y 17,2%. El 20,6% de los pacientes recibia tratamiento con farmacos antidepresivos y el 31,2% tomaba ansioliticos/hipnoticos. Se dispuso de seguimiento al cabo de un año en 320 pacientes (59,8%). En el analisis ajustado, el tratamiento ansiolitico/hipnotico se asocio a una peor situacion cognitiva y funcional inicial, mientras que la depresion en el pasado y la presencia de distimia en la visita inicial se asociaron a una evolucion favorable (p < 0,05). Conclusiones. La depresion pasada o actual no es un factor de mal pronostico en los pacientes remitidos al neurologo por posible deterioro cognitivo.

Pancreatitis inducida por drogas / DRUG-INDUCED ACUTE PANCREATITIS

Introducción. Las Reacciones Adversas Medicamentosas (RAM) son una de las principales causas de hospitalización y mortalidad en el sistema de salud (en países desarrollados y en vías de desarrollo), y la relevancia va creciendo año tras año. El objetivo de este estudio fue determinar la incidencia de pancreatitis aguda inducida por drogas y los grupos de drogas que más frecuentemente se ven involucrados. Material y Métodos: Se realizó un estudio retrospectivo tomando como fuente una base de datos de farmacovigilancia del Hospital General de Agudos ¨Dr. Cosme Argerich¨ con información de los últimos cinco años. Resultados: Se detectaron siete casos de pancreatitis inducida por drogas de los cuales fueron dos por quimioterápicos (lapatinib e imatinib), tres por antirretrovirales, uno por inmunosupresores y uno por antihipertensivos (enalapril). En cinco casos fue necesaria la hospitalización y un evento fue mortal. Conclusión: De acuerdo a la bibliografía internacional, a pesar de que los fármacos son solo responsables del 1-2% de casos de pancreatitis aguda inducida por drogas, es importante destacar que es difícil encontrar la causalidad entre el fármaco y el cuadro del paciente, lo que lleva muchas veces a un subdiagnóstico como una pancreatitis idiopática. En el presente estudio, estos casos deben considerarse por su impacto, no solo a nivel de la salud del paciente

Adverse Drug Reactions (ADR) are nowadays an increasing problem in health systems and represents between the 4th and the 6th cause of death in developing countries. Drug induced pancreatitis in a rare ADR but reports are increasing with antiretroviral drugs and new antiviral and anticancer drugs. The aim of this study was to determine the incidence of drug ­ induced pancreatitis in a tertiary care hospital. We used a pharmacovigilance database applying de Naranjo Score for drug causality in adverse medical events. From a total of 2990 ADR we detected 7 cases of pancreatitis. Antiretroviral and anticancer drugs were the drugs most frequently involved.

Evaluación de indicación de linfadenectomía en prostactectomía radical laroscópica según grupo de riesgo y capra -score / Evaluation of indication of lymphadenectomy in radical laparoscopy proststectomy risk gropu and capra-Score

Introducción. El beneficio de la linfadenectomía en el cáncer de próstata sigue siendo controversial. Es el único procedimiento que permite un estadiaje anatomopatológico más preciso. Antiguamente se indicaba en pacientes de riesgo intermedio o mayor. Actualmente utilizamos el Score de CAPRA sobre 2 para indicar el procedimiento con el fin de seleccionar de mejor manera los pacientes que se beneficiarían de este procedimiento. Objetivo. Analizar la utilidad de CAPRA-Score para indicar la linfadenectomía. Pacientes y Métodos. Estudio prospectivo de carácter descriptivo. De un universo de 155 Pacientes sometidos a prostatectomía radical laparoscópica entre 2003-2013 por un único cirujano, se analizaron 34 pacientes a los que se le realizó linfadenectomía . Los datos se recopilaron en el momento de la cirugía y controles postoperatorios. Se agruparon datos: edad, PSA, Estadio Clínico, Gleason y porcentaje de cilindros (+) en biopsia TR. Se agruparon según indicación por Riesgo o CAPRA-S y se compararon los resultados obtenidos en la histología de los ganglios extraídos (linfadenectomías +). Los datos se analizaron considerando p<0,05 estadísticamente significativo según prueba de T de Student. Resultados. Se incluyeron en total 34 pacientes. Hasta el año 2010 un total de 23 linfadenectomía indicadas a grupo de riesgo intermedio-alto, el 78 por ciento (18) indicado por Gleason. Se sacó en promedio 12 ganglios por paciente, 72 por ciento linfadenectomía ampliadas. Ningún paciente tuvo ganglios (+). Desde el año 2011 un total de 11 linfadenectomía por CAPRA-Score >2, sacándose promedio 15 ganglios, 9 fueron linfadenectomías ampliadas. Se obtuvo 18 por ciento linfadenectomías (+) para compromiso metastásico. Conclusiones. De los pacientes previo a CAPRA-Score, un 17 por ciento pacientes estarían sobreindicados según éste y coincide con la negatividad del resultado histológico. Hubo diferencia estadísticamente significativa en la aparición de ganglios (+) en pacientes que se aplicó CAPRA-Score. (P<0.05). Según la serie de pacientes presentados, CAPRA-Score seleccionaría mejor los pacientes que se beneficiarían con una linfadenectomía, sin embargo se requieren estudios de mayor cantidad de pacientes.AU

Introduction. The benefit of lymphadenectomy in prostate cancer remains controversial. It is the only procedure that allows a more accurate anatomopathological staging. It was formerly indicated in patients of intermediate or greater risk. We currently use the CAPRA Score of 2 to indicate the procedure in order to better select patients who would benefit from this procedure. Objective. Analyze the utility of CAPRAScore to indicate lymphadenectomy. Patients and Methods. Prospective descriptive study. From a universe of 155 patients who underwent laparoscopic radical prostatectomy between 2003 and 2013 by a single surgeon, 34 patients who underwent lymphadenectomy were analyzed. Data were collected at the time of surgery and postoperative controls. Data were grouped: age, PSA, Clinical Stage, Gleason and percentage of cylinders (+) in TR biopsy. They were grouped according to indication by Risk or CAPRA-S and the results obtained were compared in the histology of the extracted ganglia (lymphadenectomies +). Data were analyzed considering p <0.05 statistically significant according to Student's T test. Results. A total of 34 patients were included. Until the year 2010 a total of 23 lymphadenectomy Original Works indicated to group of intermediate-high risk, 78% (18) indicated by Gleason. An average of 12 lymph nodes per patient, 72% enlarged lymphadenectomy. No patient had lymph nodes (+). Since 2011 a total of 11 lymphadenectomy for CAPRAScore> 2, with a mean of 15 lymph nodes, 9 were enlarged lymphadenectomies. We obtained 18% lymphadenectomies (+) for metastatic compromise. Conclusions. Of the patients prior to CAPRA-Score, 17% patients would be over-reported according to this and coincides with the negativity of the histological result. There was a statistically significant difference in the appearance of lymph nodes (+) in patients who underwent CAPRA-Score. (P <0.05). According to the series of patients presented, CAPRAScore would better select patients who would benefit from lymphadenectomy, however, more studies are required.AU

Correlación del score de gleason en biopsia prostática con el de pieza operatoria. ¿Cuál es nuestro porcentaje de upgrading? / Correlation between Gleason Score of prostate biopsy and prostatectomy specimen. ¿How high is our upgrading rate?

Introducción. El cáncer de próstata es el segundo cáncer más prevalente del mundo y ocupa el quinto lugar en mortalidad en hombres. El score de Gleason es el factor pronósticos más importante. Sin embargo, numerosos estudios han reportado diferencias entre el score de Gleason de la biopsia prostática y el obtenido de la pieza operatoria. Es por este motivo que el objetivo del presente estudio, es evaluar la concordancia entre el score de Gleason de la biopsia prostática transrectal comparado con el de la pieza operatoria de la prostatectomia radical.(AU)

Introduction. Prostate cancer is the second most prevalent cancer in the world, and occupies the fifth place in mortality among men. Gleason score (GS) is the most important prognostic factor. However, a number of studies have reported differences between the GS of the trans rectal biopsy and the prostatectomy specimen. That is the reason of the this study, our objective is to evaluate concordance between Gleason scores, of the biopsy and the prostatectomy specimen.(AU)

Cubic PdNP-based air-breathing cathodes integrated in glucose hybrid biofuel cells.

Cubic Pd nanoparticles (PdNPs) were synthesized using ascorbic acid as a reducing agent and were evaluated for the catalytic oxygen reduction reaction. PdNPs were confined with multiwalled carbon nanotube (MWCNT) dispersions to form black suspensions and these inks were dropcast onto glassy carbon electrodes. Different nanoparticle sizes were synthesized and investigated upon oxygen reduction capacities (onset potential and electrocatalytic current densities) under O2 saturated conditions at varying pH values. Strong evidence of O2 diffusion limitation was demonstrated. In order to overcome oxygen concentration and diffusion limitations in solution, we used a gas diffusion layer to create a PdNP-based air-breathing cathode, which delivered -1.5 mA cm(-2) at 0.0 V with an onset potential of 0.4 V. This air-breathing cathode was combined with a specially designed phenanthrolinequinone/glucose dehydrogenase-based anode to form a complete glucose/O2 hybrid bio-fuel cell providing an open circuit voltage of 0.554 V and delivering a maximal power output of 184 ± 21 µW cm(-2) at 0.19 V and pH 7.0.

Prescripción off-label inducida. Responsabilidad ¿compartida? / Induced off-label drug prescribing. Shared responsability?

La prescripción off-label es una práctica tan frecuente como incorrectamente manejada por los pediatras. Solo dos de cada diez pediatras completan todos los pasos necesarios para el registro correcto del uso off-label de medicamentos para niños. Es necesario conocer conceptos básicos relacionados con esta práctica, especialmente cuando se trata de una prescripción inducida, por sus connotaciones éticas y legales (AU)

Although off-label prescribing is common practice among pediatricians, it is surprising how rarely it is carried out properly. Only two out of ten pediatricians complete all the steps necessary for the correct registration of off-label drug use in pediatric patients. It is necessary to know the basic concepts related to this practice, especially when it comes to induced prescribing, due to its ethical and legal connotations (AU)