Regulation of CO2 by the sea in areas around Latin America in a context of climate change.

Anthropogenic activities are increasing the atmospheric carbon dioxide (CO2); around a third of the CO2 emitted by these activities has been taken up by the ocean. Nevertheless, this marine ecosystem service of regulation remains largely invisible to society, and not enough is known about regional differences and trends in sea-air CO2 fluxes (FCO2), especially in the Southern Hemisphere. The objectives of this work were as follows: first to put values of FCO2 integrated over the exclusive economic zones (EEZ) of five Latin-American countries (Argentina, Brazil, Mexico, Peru, and Venezuela) into perspective regarding total country-level greenhouse gases (GHG) emissions. Second, to assess the variability of two main biological factors affecting FCO2 at marine ecological time series (METS) in these areas. FCO2 over the EEZs were estimated using the NEMO model, and GHG emissions were taken from reports to the UN Framework Convention on Climate Change. For each METS, the variability in phytoplankton biomass (indexed by chlorophyll-a concentration, Chla) and abundance of different cell sizes (phy-size) were analyzed at two time periods (2000-2015 and 2007-2015). Estimates of FCO2 at the analyzed EEZs showed high variability among each other and non-negligible values in the context of greenhouse gas emissions. The trends observed at the METS indicated, in some cases, an increase in Chla (e.g., EPEA-Argentina) and a decrease in others (e.g., IMARPE-Peru). Evidence of increasing populations of small size-phytoplankton was observed (e.g., EPEA-Argentina, Ensenada-Mexico), which would affect the carbon export to the deep ocean. These results highlight the relevance of ocean health and its ecosystem service of regulation when discussing carbon net emissions and budgets.

Implantación del servicio de indicación farmacéutica en farmacia comunitaria en España: INDICA+PRO Implantación (2020-2021) / Implementation of the pharmaceutical indication service in community pharmacies in Spain: INDICA+PRO Implementation (2020-2021)

JUSTIFICACIÓN: INDICA+PRO es un estudio de implantación que tiene como objetivo la incorporación del servicio de indicación farmacéutica (SIF) protocolizado en la práctica diaria de la farmacia comunitaria (FC). Se ha estimado que el 25 % del tiempo del farmacéutico en España se dedica a la atención del paciente con síntomas menores. Tras la evaluación de un estudio de impacto que mostró resultados clínicos, humanísticos y económicos positivos en Valencia, se llevó a cabo el estudio INDICA+PRO Implantación para incrementar dicho impacto a escala nacional.OBJETIVOS: desarrollar y evaluar los resultados de un programa de implantación del SIF en la farmacia comunitaria española.MATERIAL Y MÉTODOS: diseño híbrido de efectividad-implantación tipo 3 con una duración inicial de 14 meses. La intervención constaba de diferentes elementos: procedimiento general del SIF establecido por Foro de Atención Farmacéutica en Farmacia Comunitaria, protocolos consensuados entre sociedades médicas (Semergen y SemFyC), asociaciones farmacéuticas (SEFAC y MICOF) y universidad (GIAF-UGR) específicos para 31 síntomas menores incluidos en una plataforma digital (SEFAC e_XPERT®) y la formación de los farmacéuticos con el seguimiento de 33 farmacéuticos facilitadores del cambio de práctica. Los pacientes recibieron seguimiento tras 10 días de la consulta en farmacia. Se utilizó un marco teórico para la implantación de servicios en FC. (AU)

Servicio cribado SARS-COV2 con emisión certificado en farmacia comunitaria con test diagnóstico y autodiagnóstico / SARS-COV2 screening service with certified issue in community pharmacies with diagnostic test and self-testing

JUSTIFICACIÓN: la pandemia de COVID-19, derivada de la enfermedad causada por el virus SARS-COV-2,​ fue detectada por primera vez en diciembre de 2019 en la ciudad china de Wuhan. Las medidas de prevención utilizadas hasta ahora (mascarillas, tanto quirúrgicas como FFP2, distancia interpersonal, higiene de manos y ventilación) han demostrado ser eficaces para todas las variantes del COVID19, incluidas las variantes de mayor impacto para la salud pública. En julio de 2021, el Real Decreto 588/2021, en España se autoriza la dispensación sin prescripción médica de test de autodiagnóstico de la COVID-19 (tanto de anticuerpos como de antígenos) y en agosto se firma en Aragón el "Acuerdo de colaboración entre el Departamento de Sanidad del Gobierno de Aragón y el Consejo Oficial de Colegios de Farmacéuticos de Aragón para la trazabilidad y el correcto seguimiento de la información derivada de la realización de test de antígenos SARS-COV2" por el que las farmacias aragonesas pueden realizar test de diagnóstico o autodiagnóstico para la emisión de certificados COVID europeos y vigilar la trazabilidad de las pruebas autodiagnósticas dispensadas a través de las farmacias comunitarias.OBJETIVOS: describir proceso de la realización de pruebas diagnósticas en nuestra farmacia.MATERIAL Y MÉTODOS: - Zona de atención personalizada.- Formación: "Test de detección del coronavirus SARS-COV-2" (SEFAC).- Acreditación. - Protocolos: "Síntomas menores y COVID-19. Protocolo de actuación en farmacia comunitaria" a través de SEFAC e_XPERT y “Realización de test de detección de antígenos de COVID-19 en farmacias aragonesas”, editado por el COFZ.- Test de diagnóstico y autodiagnóstico (listado AEMPS, marcado CE).- Material de protección y desinfección.- PNT de limpieza. (AU)

Servicio de indicación farmacéutica en farmacia comunitaria según protocolos de indicación en síntomas menores y registro en ‘SEFAC e_XPERT ‘ / Pharmaceutical indication service in community pharmacies according to indication protocols for minor symptoms and registration in 'SEFAC e_XPERT '

JUSTIFICACIÓN: el Servicio Profesional Farmacéutico Asistencial (SPFA) de Indicación Farmacéutica (SIF) es el segundo SPFA más demandado en la Farmacia Comunitaria (FC) después de la dispensación. Según la definición propuesta por el Foro de Atención Farmacéutica - Farmacia Comunitaria, éste se define como "el servicio profesional prestado ante la demanda de un paciente o usuario que llega a la farmacia sin saber qué medicamento debe adquirir y solicita al farmacéutico el remedio más adecuado para un problema de salud concreto”. También incluimos dentro de este servicio la actuación del farmacéutico ante la demanda de un producto o medicamento, sujeto o no a prescripción, para el tratamiento de un síntoma menor (SM).En este estudio analizamos las indicaciones realizadas y registradas en nuestra farmacia según el "Protocolo de Indicación Farmacéutica y Criterios de Derivación al Médico en Síntomas Menores" a través de la plataforma SEFAC e_XPERT.OBJETIVOS:-Describir la labor asistencial del farmacéutico comunitario abordando las consultas de SM mediante la herramienta SEFAC e_XPERT.- Valorar la eficacia de las intervenciones realizadas con el SIF.MATERIAL Y MÉTODOS:- Herramienta SEFAC_EXPERT, Servicio de Indicación, para el registro, realización del protocolo y seguimiento de la intervención.- Informes y hojas de derivación.- Fichas de recomendaciones para pacientes, relativos a cada SM.RESULTADOS / DISCUSIÓN: durante el periodo del estudio hemos realizado 203 registros de las indicaciones realizadas en la farmacia. El 84,73% (172) de las consultas registradas fueron por consulta de un SM. El 15,27% (31) ante la demanda de un medicamento. De las 172 consultas por SM, el 27,32% (47) cumplían con algún criterio de derivación al médico (MAP) y se derivaron un 38,30% (18) de las mismas. (AU)

Servicio de indicación farmacéutica. Caso clínico. Resolución síntoma menor con criterio de derivación sin derivar. Flatulencia / Pharmaceutical indication service. Clinical case. Resolution of minor symptom with criteria for referral without referral. Flatulence

PRESENTACIÓN DEL CASO / ANTECEDENTES: Gustavo es un paciente de 77 años, en tratamiento con Ebymect 50/1000 mg (1-0-1), Vesomni 6/0,4 mg (0-0-1), Spiraxin (2-0-2 1 semana al mes) y Rabeprazol 20 mg (1-0-1). Está incluido en el servicio de SPD desde junio de 2020 y desde el comienzo del mismo se le recomienda la toma de probióticos por la toma discontinua de Rifaximina, el cual, acepta. Entre sus antecedentes de historia clínica de patología digestiva aparece hernia de hiato y diverticulosis. Control glucémico correcto. Acude a consulta refiriendo dolor a nivel de boca del estómago y también refiere refiere distensión abdominal. Le incluimos en el servicio de indicación para su evaluación y seguimiento, a través de la plataforma SEFAC_EXPERT.EVALUACIÓN: siguiendo el protocolo PASITAMAE del servicio de indicación, nos encontramos con dos criterios de derivación ante la sintomatología referida:- mayor de 75 años con patologías asociadas, ya que habría que extremar precauciones por la mayor incidencia de patologías graves.- dolor abdominal o hinchazón excesivo, ya que si las molestias son excesivas es necesario descartar otras posibles patologías digestivas (recordemos que el paciente está en tratamiento con Rifaximina para diverticulosis). No refiere fiebre, estreñimiento, por lo que decidimos instaurar un tratamiento sintomático antes de realizar la derivación si no mejorara. Tenemos en cuenta que SOLIFENACINA (VESOMNI) puede agravar patologías digestivas como la hernia de hiato (dolor epigástrico referido) así como el estreñimiento, aunque el paciente refiere un tránsito normal.INTERVENCIÓN: una vez realizada la evaluación del caso, realizamos la intervención a 3 niveles:- Tratamiento farmacológico: pautamos SIMETICONA 240 mg (1-0-1) y ALMAX 500 mg 18 comp (2-2-2). - Información sobre el tratamiento y medidas higiénico-dietéticas (se le entrega hoja de recomendaciones sanitarias).- Educación sanitaria. (AU)

Disminución de glucemia, tras inclusión de un paciente en servicio de indicación farmacéutica y derivación al servicio de asesoramiento nutricional / Decrease in glycaemia, after inclusion of a patient in the pharmaceutical indication service and referral to the nutritional counselling service

PRESENTACIÓN/ANTECEDENTES: paciente, 50 años, que acude a la farmacia comunitaria, solicitando algún tratamiento coadyuvante para regular los niveles de glucosa en sangre, dado que tras analítica de control, se le detectan valores de glucosa de 132 mg/dl, por encima de los márgenes de referencia (>100 mg/dl), para ello su médico pautó Metformina 0,5-0-0. Era la primera vez que consultaba por este problema de salud y nos comentó que en la familia (madre, tías) eran diabéticas. Iniciamos el servicio de indicación farmacéutica ante la demanda del paciente y realizamos una pequeña entrevista, siguiendo los pasos y el protocolo de indicación.EVALUACIÓN: debido a los antecedentes familiares y a los valores de glucosa en ayunas, gracias a la herramienta SEFAC e_XPERT y mediante el servicio de indicación farmacéutica, derivamos a nuestro servicio de asesoramiento nutricional.INTERVENCIÓN: citamos a la paciente y en la primera visita se realizó bioimpedancia que nos mostró un índice de masa corporal (IMC) de 23,8; un porcentaje de grasa corporal de 32,1 y un nivel de grasa visceral = 9. Nos mostró también un objetivo de bajada de grasa corporal de 7,2 Kg. Recomendamos pautas higiénico- dietéticas, acordes a las necesidades del paciente, dieta normocalórica, aporte de fibra de 20-30 g/día, ingesta adecuada de hidratos de carbono e hicimos educación al paciente. Incidimos en la necesidad de acompañar estos cambios nutricionales con actividad física. Citamos a la paciente cada 15 días para valorar el estado de salud. En cada visita tomamos medidas antropométricas, se puso de manifiesto una pérdida de peso progresiva. El proceso tuvo una duración de 7 meses, se hicieron visitas presenciales y telefónicas.RESULTADOS/SEGUIMIENTO: transcurridos 5 meses, se repite la bioimpedancia y observamos que el índice de masa corporal fue 21,3 ; el porcentaje de grasa corporal fue 25,3 y el nivel de grasa visceral 6. (AU)

Electrical conductivity as a driver of biological and geological spatial heterogeneity in the Puquios, Salar de Llamara, Atacama Desert, Chile.

Reputed to be the driest desert in the world, the Atacama Desert in the Central Andes of Northern Chile is an extreme environment with high UV radiation, wide temperature variation, and minimum precipitation. Scarce lagoons associated with salt flats (salars) in this desert are the surface expression of shallow groundwater; these ponds serve as refugia for life and often host microbial communities associated with evaporitic mineral deposition. Results based on multidisciplinary field campaigns and associated laboratory examination of samples collected from the Puquios of the Salar de Llamara in the Atacama Desert during austral summer provide unprecedented detail regarding the spatial heterogeneity of physical, chemical, and biological characteristics of these salar environments. Four main lagoons ('Puquios') and more than 400 smaller ponds occur within an area less than 5 km2, and are characterized by high variability in electrical conductivity, benthic and planktonic biota, microbiota, lagoon bottom type, and style of mineral deposition. Results suggest that electrical conductivity is a driving force of system heterogeneity. Such spatial heterogeneity within the Puquios is likely to be expanded with temporal observations incorporating expected seasonal changes in electrical conductivity. The complexity of these Andean ecosystems may be key to their ability to persist in extreme environments at the edge of habitability.

Endoftalmitis tras inyecciones intravítreas. Incidencia, manejo y pronóstico / Endophthalmitis after intravitreal injections. Incidence, management and prognosis

OBJETIVO: Averiguar la incidencia de la endoftalmitis tras inyecciones intravítreas (IVT) en «sala limpia» de un centro terciario, siguiendo los protocolos de la Sociedad Española de Retina y Vítreo (SERV). Identificar agentes causales, observar la respuesta al tratamiento y el resultado funcional final. MATERIAL Y MÉTODOS: Estudio retrospectivo, observacional, en una serie de casos clínicos, de las endoftalmitis tras IVT realizadas en nuestro centro entre 2010 y 2015. En estos casos, se efectuó tratamiento intravítreo y sistémico, siguiendo las pautas de la SERV, así como una vitrectomía diagnóstico-terapéutica, con seguimiento hasta la resolución definitiva del caso. RESULTADOS: Se produjeron 5 casos de endoftalmitis en 9.467 IVT (incidencia 0,053%). Se obtuvieron muestras de acuoso o vítreo, con cultivo positivo en todos los casos: Staphylococcus epidermidis fue el principal agente causal en 4 de los 5 casos. En 2 casos la agudeza visual fue de no percepción luminosa por desprendimiento de retina irreductible tras la resolución del proceso infeccioso. CONCLUSIONES: Las IVT realizadas en «sala limpia» tiene una baja incidencia de endoftalmitis: la especie Staphylococcus es la responsable más frecuente. Dos de los casos acabaron con un mal pronóstico funcional

OBJECTIVE: To assess the rate of endophthalmitis after intravitreal injection (IVI) in a «clean room» of a single health centre, following the guidelines of the Spanish Vitreo-Retinal Society (SERV). An analysis was performed on the culture specimens, response to treatment, and final outcomes (guidelines). MATERIAL AND METHODS: A retrospective, observational study was conducted on a consecutive case series of patients diagnosed with infectious endophthalmitis after IVI in a single health centre between 2010 and 2015. Intravitreal and systemic treatment was given following the SERV guidelines. The patients were followed up the case was resolved. RESULTS: There were 5 cases of endophthalmitis out of 9467 IVI (incidence 0.053%). Positive cultures were obtained in aqueous and/or vitreous fluid in all cases, with Staphylococcus epidermidis being involved in 4 out of 5 cases. In 2 cases, final visual acuity was non-light perception due to intractable retinal detachments after resolution of the infectious process. CONCLUSIONS: IVI performed in a «clean room» have a low incidence of endophthalmitis. The most common infectious agent was Staphylococcus species. In 2 cases the functional prognosis was poor

Endophthalmitis after intravitreal injections. Incidence, management and prognosis. / Endoftalmitis tras inyecciones intravítreas. Incidencia, manejo y pronóstico.

OBJECTIVE: To assess the rate of endophthalmitis after intravitreal injection (IVI) in a «clean room¼ of a single health centre, following the guidelines of the Spanish Vitreo-Retinal Society (SERV). An analysis was performed on the culture specimens, response to treatment, and final outcomes (guidelines). MATERIAL AND METHODS: A retrospective, observational study was conducted on a consecutive case series of patients diagnosed with infectious endophthalmitis after IVI in a single health centre between 2010 and 2015. Intravitreal and systemic treatment was given following the SERV guidelines. The patients were followed up the case was resolved. RESULTS: There were 5 cases of endophthalmitis out of 9467 IVI (incidence 0.053%). Positive cultures were obtained in aqueous and/or vitreous fluid in all cases, with Staphylococcus epidermidis being involved in 4 out of 5 cases. In 2 cases, final visual acuity was non-light perception due to intractable retinal detachments after resolution of the infectious process. CONCLUSIONS: IVI performed in a «clean room¼ have a low incidence of endophthalmitis. The most common infectious agent was Staphylococcus species. In 2 cases the functional prognosis was poor.

Chronic consumption of dietary proanthocyanidins modulates peripheral clocks in healthy and obese rats.

Circadian rhythm plays an important role in maintaining homeostasis, and its disruption increases the risk of developing metabolic syndrome. Circadian rhythm is maintained by a central clock in the hypothalamus that is entrained by light, but circadian clocks are also present in peripheral tissues. These peripheral clocks are trained by other cues, such as diet. The aim of this study was to determine whether proanthocyanidins, the most abundant polyphenols in the human diet, modulate the expression of clock and clock-controlled genes in the liver, gut and mesenteric white adipose tissue (mWAT) in healthy and obese rats. Grape seed proanthocyanidin extracts (GSPEs) were administered for 21 days at 5, 25 or 50 mg GSPE/kg body weight in healthy rats and 25 mg GSPE/kg body weight in rats with diet-induced obesity. In healthy animals, GSPE administration led to the overexpression of core clock genes in a positive dose-dependent manner. Moreover, the acetylated BMAL1 protein ratio increased with the same pattern in the liver and mWAT. With regards to clock-controlled genes, Per2 was also overexpressed, whereas Rev-erbα and RORα were repressed in a negative dose-dependent manner. Diet-induced obesity always resulted in the overexpression of some core clock and clock-related genes, although the particular gene affected was tissue specific. GSPE administration counteracted disturbances in the clock genes in the liver and gut but was less effective in normalizing the clock gene disruption in WAT. In conclusion, proanthocyanidins have the capacity to modulate peripheral molecular clocks in both healthy and obese states.

Maternal exposure to the synthetic cannabinoid HU-210: effects on the endocrine and immune systems of the adult male offspring.

Natural and synthetic cannabinoid receptor agonists have been described to exert profound effects on both the neuroendocrine integration and the functional responses of the immune system. In the present study, Wistar rats were exposed to the highly potent cannabinoid agonist HU-210 (1, 5 and 25 microg/kg) during gestation and lactation and the ensuing effects on several endocrine and immune parameters of the adult male offspring were analyzed. Perinatal exposure to HU-210 partially affected the distribution of lymphocyte subpopulations in the spleen and peripheral blood. The major changes observed occur after maternal exposure to the 25 microg/kg dose of HU-210. There was a reduction in the T-helper subpopulation in the spleen and a dose-related decrease in the rate of T(helper)/T(cytotoxic) in peripheral blood lymphocytes. Concanavalin-A and lipopolysaccharide-induced proliferation were normal in all the groups tested. In the same animals, perinatal exposure to HU-210 did not affect basal levels of growth hormone, IGF-1, prolactin, or follicle-stimulating hormone. Basal values of luteinizing hormone were elevated in animals given the 1 microg/kg dose of HU-210. Corticosterone levels were reduced in the animals exposed to the higher dose of HU-210 during gestation and lactation. These animals exhibited a decreased responsiveness of the hypothalamo-pituitary-adrenal (HPA) axis to the stimulation with a single injection of HU-210 (20 microg/kg, i.v.) at adult ages, which may reflect the onset of long-lasting tolerance to the HPA-activating properties of cannabinoids. The opposite pattern of response was found in the animals given the 1 microg/kg dose, in which a sensitization of the corticosterone response to acute HU-210 was observed. The present work reveals that maternal exposure to cannabinoids results in minor changes in the development of the immune system, but may induce long-lasting alterations in the functional status of the HPA axis.

Specific prognostic factors for secondary pancreatic infection in severe acute pancreatitis.

BACKGROUND/AIMS: The aim of the present study was to investigate whether there are specific prognostic factors to predict the development of secondary pancreatic infection (SPI) in severe acute pancreatitis in order to perform a computed tomography-fine needle aspiration with bacteriological sampling at the right moment and confirm the diagnosis. METHODS: Twenty-five clinical and laboratory parameters were determined sequentially in 150 patients with severe acute pancreatitis (SAP) and univariate, and multivariate regression analyses were done looking for correlation with the development of SPI. RESULTS: Only APACHE II score and C-reactive protein levels were related to the development of SPI in the multivariate analysis. A regression equation was designed using these two parameters, and empiric cut-off points defined the subgroup of patients at high risk of developing secondary pancreatic infection. CONCLUSION: The results showed that it is possible to predict SPI during SAP allowing bacteriological confirmation and early treatment of this severe condition.

[Prevalence of malnutrition in minors under 5 years of age in Tabasco]. / Prevalencia de desnutrición en menores de cinco años de Tabasco.

OBJECTIVE: To evaluate malnutrition prevalence in children under five years-old in Tabasco, Mexico, during 1996, and their evolution in 1991-1996. MATERIAL AND METHODS: A cross-sectional study, including 1,256 children under five years-old in 593 communities (31 urban and 562 rural) from 17 sanitary districts. RESULTS: The weight/age indicator for malnutrition in children under five years old showed 59% of children had normal nutrition and 41% with malnutrition, distributed as follows: 26.12% slight, 12.62% moderate and 2.39% severe. In children between 1-5 years old, malnutrition prevalence was 45%. CONCLUSIONS: The number of children with malnutrition in Tabasco during the study period (1991-1996) has decreased in proportion to the increase of those with normal nutrition. Based on the health system activities, the number of health districts with critical malnutrition indicators decreased from 6 to 4.

Methods for analysis of the occurrence of abscess in patients with pancreatitis.

OBJECTIVE: Standard survival analysis methods are useful for data involving censored cases when cures do not generally occur. If the object is to study, for instance, the development of a complication in the progress of an infectious disease, some people may be cured before complications develop. In this article, we provide methods for the analysis of data when cures do occur. An example is a study of prognostic factors for pancreatic abscess in patients with pancreatitis, some of whom leave the risk set because the pancreatitis clears. DESIGN: We present methods for estimating the survival curves and comparing hazard function for two objectives: (1) the occurrence of an abscess, irrespective of whether the patients are cured or not, and (2) the occurrence of an abscess for patients who, at that stage, have not been cured. PATIENTS: We illustrate the applications of the methods using a sample of 50 patients with severe pancreatitis. RESULTS: To study the occurrence of an abscess, regardless of whether the patients are cured or not, we show that the appropriate strategy is to assign to the cured patients an infinite time to the appearance of an abscess. If the cured were considered censored at the moment the pancreatitis cleared, this would result in an overestimation of the hazard of presenting an abscess. On the other hand, if the objective is to compare the occurrence of abscess according to an exposure for patients who have not been cured, one needs to censor the cured patients at the time they are cured. CONCLUSIONS: For the analysis of survival data in the context of infectious diseases when cure is possible, it is important to use a censoring strategy that is pertinent to the specific aims of the study. Considering cures as censored at the time of cure is not always appropriate.

Laryngeal carcinoma: sclerotic appearance of the cricoid and arytenoid cartilage--CT-pathologic correlation.

PURPOSE: To assess the significance of sclerotic-appearing cricoid and arytenoid cartilage with computed tomography (CT) in patients with laryngeal carcinoma. MATERIALS AND METHODS: CT scans obtained in 75 patients with laryngeal carcinoma were prospectively studied; laryngeal CT studies obtained in 50 patients without laryngeal carcinoma were retrospectively reviewed. RESULTS: Twenty-four of the 75 patients (32%) with laryngeal carcinoma had sclerotic cartilage. Evaluation of pathologic specimens obtained in 12 of these 24 patients showed 11 cases of sclerotic arytenoid cartilage and two cases of sclerotic cricoid cartilage. Tumor infiltration was demonstrated in six of these cases but not in the seven others. In 11 of the 12 cases with pathologic proof, however, tumor was adjacent to the perichondrium. In the 12 cases without pathologic proof, the proportion was similar. The positive predictive value of this sign for cartilaginous invasion was 46%. CONCLUSION: Although it is not a reliable sign of cartilaginous invasion, sclerotic-appearing cricoid and arytenoid cartilage in patients with laryngeal carcinoma is predictive of the tumor to this cartilage.

[Experience with 150 subcutaneous venous reservoirs for venous access and infusion for the treatment of adult patients with oncologic and hematologic disorders and acquired immunodeficiency syndrome]. / Experiencia con 150 reservorios venosos subcutáneos como acceso venoso e infusión de tratamiento en pacientes adultos oncológicos, hematológicos y afectos de síndrome de inmunodeficiencia adquirida.

BACKGROUND: In the present study the year experience of a multidisciplinary team (oncologic, unit for the acquired immunodeficiency syndrome, and surgery) with the use of a new method of central intravenous administration of medication such as that of subcutaneous venous reservoirs (SVR) is reviewed. METHODS: The subcutaneous injection capsules were implanted as a venous access in 150 surgical procedures in 146 patients from October 1985 to April 1991 with a total follow up of 29.190 days and a mean length of 251 days for SVR. Sixty-two percent (94 implantations) of the SVR were implanted in the out patient clinic, 20% (30 patients) were admitted for placement of the reservoir although this was only indicated in the first two years of the series, 13% (20 patients) during hospitalization for the base disease and only 4% (6 patients) were specifically admitted for surgical preparation (plasma, platelets, and others). SVR were used for chemotherapy (124 cases, 82%), repeated transfusions (6 cases, 4%) and chronic medication (acquired immunodeficiency syndrome, infections) (30 patients, 20%). Forty-two percent permitted chemotherapy administration by continual transfusion on an out patient regime. RESULTS: A series of mechanical complications (3 cases, 2%), septic (9 episodes in 7 patients, 5%) and thrombotic (8 of the catheter) (5%) and 4 of the central veins (2%) were observed. In the present series the rate of infections (5%) (0.072 episodes of bacteremia per 100 days/patient) and thrombosis (3%) was very low due to a strict protocol of maintenance and control by the medical team and hospital staff. The need for radiologic control during surgery is emphasized although, as demonstrated in the present review, the technique of localization by a cath-finder (external detector) permits greater speed with the same security. CONCLUSIONS: The degree of patient satisfaction and the minimum incidence of serious complications in determined risk groups (neutropenia, acquired immunodeficiency syndrome) demonstrates that subcutaneous venous reservoirs (SVR) constitute an excellent method as a chronic venous access. The SVR present a lower rate of complications if compared with any historic series of external vascular catheterization.

[Septic thrombosis of cavernous sinuses. Report of 2 cases]. / Trombosis séptica de senos cavernosos. Informe de 2 casos.

We report two male adolescents who developed septic thrombosis of the cavernous sinuses after manipulation of a furuncle on the nasal dorsum. We noted in both patients, besides the clinical findings of a generalized infectious process, palpebral edema, proptosis, ptosis, altered pupillary reactivity and bilateral III, IV and VI nerve palsies, as well as dysfunction of the ophthalmic branch of the fifth cranial nerve. One of the patients also had bacterial meningitis. Their cerebral angiograms demonstrated narrowing of the intracavernous portion of both internal carotid arteries. They improved with the antimicrobial treatment, but were left with ptosis and ocular palsies as sequelae. The adequate management of facial furuncle to prevent such a serious complication is emphasized.

[Cerebral infarct secondary to an intraoral injury from a spoon. A case report]. / Infarto cerebral secundario a traumatismo intrabucal con una cuchara. Informe de un caso.

We report the case of a 4-year-old female who developed an extensive cerebral infarction after trauma to the right peritonsillar area with a spoon. Blunt injury to the intima of the interna carotid artery promotes thrombus formation or clot embolization which results in an ischemic cerebrovascular event. We emphasize the need to prevent this rare complication of intraoral trauma in childhood.