Effects of Drought on Mortality in Macro Urban Areas of Brazil Between 2000 and 2019.

A significant fraction of Brazil's population has been exposed to drought in recent years, a situation that is expected to worsen in frequency and intensity due to climate change. This constitutes a current key environmental health concern, especially in densely urban areas such as several big cities and suburbs. For the first time, a comprehensive assessment of the short-term drought effects on weekly non-external, circulatory, and respiratory mortality was conducted in 13 major Brazilian macro-urban areas across 2000-2019. We applied quasi-Poisson regression models adjusted by temperature to explore the association between drought (defined by the Standardized Precipitation-Evapotranspiration Index) and the different mortality causes by location, sex, and age groups. We next conducted multivariate meta-analytical models separated by cause and population groups to pool individual estimates. Impact measures were expressed as the attributable fractions among the exposed population, from the relative risks (RRs). Overall, a positive association between drought exposure and mortality was evidenced in the total population, with RRs varying from 1.003 [95% CI: 0.999-1.007] to 1.010 [0.996-1.025] for non-external mortality related to moderate and extreme drought conditions, from 1.002 [0.997-1.007] to 1.008 [0.991-1.026] for circulatory mortality, and from 1.004 [0.995-1.013] to 1.013 [0.983-1.044] for respiratory mortality. Females, children, and the elderly population were the most affected groups, for whom a robust positive association was found. The study also revealed high heterogeneity between locations. We suggest that policies and action plans should pay special attention to vulnerable populations to promote efficient measures to reduce vulnerability and risks associated with droughts.

Metal-organic frameworks as template for synthesis of Mn3+/Mn4+ mixed valence manganese cobaltites electrocatalysts for oxygen evolution reaction.

Cobalt-based oxides are among the most promising electrocatalysts for oxygen evolution reactions (OER). In this context, this work reports the synthesis of manganese-doped cobaltites using the Zeolitic-Imidazolate Frameworks 67 (ZIF-67) as template. The incorporation of manganese ions into ZIF-67 structure was evaluated in ethanol and methanol, in order to obtain the best synthetic route. Non-doped (ZIF-67C) and Mn-doped cobaltites (Mn/ZIF-67C(E) and Mn/ZIF-67C(M)) were obtained after thermal treatment at 350 °C. Structural and morphological properties were investigated and presence of Mn3+ and Mn4+ was confirmed by X-ray photoelectron spectroscopy (XPS) data and magnetization curves. The electrocatalytic activity in OER was investigated in alkaline medium for manganese cobaltites, and compared to the ZIF-67C. Overpotentials to generate a current of 10 mA cm-2 were 338 mV and 356 mV for Mn/ZIF-67C(E) and Mn/ZIF-67C(M), respectively. These results are superior to those found for similar materials in the literature. The material obtained in methanol (Mn/ZIF-67C(M)) presents lower overpotential, however, shows superior electrocatalytic performance for current density above 100 mA cm-2, therefore being an efficient electrode for commercial electrolysers.

BRAZILIAN CONSENSUS ON INCIDENTAL GALLBLADDER CARCINOMA.

BACKGROUND: Incidental gallbladder cancer is defined as a cancer discovered by histological examination after cholecystectomy. It is a potentially curable disease. However, some questions related to their management remain controversial and a defined strategy is associated with better prognosis. AIM: To develop the first evidence-based consensus for management of patients with incidental gallbladder cancer in Brazil. METHODS: Sixteen questions were selected, and 36 Brazilian and International members were included to the answer them. The statements were based on current evident literature. The final report was sent to the members of the panel for agreement assessment. RESULTS: Intraoperative evaluation of the specimen, use of retrieval bags and routine histopathology is recommended. Complete preoperative evaluation is necessary and the reoperation should be performed once final staging is available. Evaluation of the cystic duct margin and routine 16b1 lymph node biopsy is recommended. Chemotherapy should be considered and chemoradiation therapy if microscopically positive surgical margins. Port site should be resected exceptionally. Staging laparoscopy before reoperation is recommended, but minimally invasive radical approach only in specialized minimally invasive hepatopancreatobiliary centers. The extent of liver resection is acceptable if R0 resection is achieved. Standard lymph node dissection is required for T2 tumors and above, but common bile duct resection is not recommended routinely. CONCLUSIONS: It was possible to prepare safe recommendations as guidance for incidental gallbladder carcinoma, addressing the most frequent topics of everyday work of digestive and general surgeons.

Brazilian consensus on incidental gallbladder carcinoma / Consenso brasileiro de carcinoma incidental de vesícula biliar

ABSTRACT Background: Incidental gallbladder cancer is defined as a cancer discovered by histological examination after cholecystectomy. It is a potentially curable disease. However, some questions related to their management remain controversial and a defined strategy is associated with better prognosis. Aim: To develop the first evidence-based consensus for management of patients with incidental gallbladder cancer in Brazil. Methods: Sixteen questions were selected, and 36 Brazilian and International members were included to the answer them. The statements were based on current evident literature. The final report was sent to the members of the panel for agreement assessment. Results: Intraoperative evaluation of the specimen, use of retrieval bags and routine histopathology is recommended. Complete preoperative evaluation is necessary and the reoperation should be performed once final staging is available. Evaluation of the cystic duct margin and routine 16b1 lymph node biopsy is recommended. Chemotherapy should be considered and chemoradiation therapy if microscopically positive surgical margins. Port site should be resected exceptionally. Staging laparoscopy before reoperation is recommended, but minimally invasive radical approach only in specialized minimally invasive hepatopancreatobiliary centers. The extent of liver resection is acceptable if R0 resection is achieved. Standard lymph node dissection is required for T2 tumors and above, but common bile duct resection is not recommended routinely. Conclusions: It was possible to prepare safe recommendations as guidance for incidental gallbladder carcinoma, addressing the most frequent topics of everyday work of digestive and general surgeons.

RESUMO Racional: Carcinoma incidental da vesícula biliar é definido como uma neoplasia descoberta por exame histológico após colecistectomia videolaparoscópica. É potencialmente uma doença curável. Entretanto algumas questões relacionadas ao seu manuseio permanecem controversas e uma estratégia definida está associada com melhor prognóstico. Objetivo: Desenvolver o primeiro consenso baseado em evidências para o manuseio de pacientes com carcinoma incidental da vesícula biliar no Brasil. Métodos: Dezesseis questões foram selecionadas e para responder as questões e 36 membros das sociedades brasileiras e internacionais foram incluídos. As recomendações foram baseadas em evidências da literatura atual. Um relatório final foi enviado para os membros do painel para avaliação de concordância. Resultados: Avaliação intraoperatória da peça cirúrgica, uso de bolsas para retirar a peça cirúrgica e exame histopatológico de rotina, foram recomendados. Avaliação pré-operatória completa é necessária e deve ser realizada assim que o estadiamento final esteja disponível. Avaliação da margem do ducto cístico e biópsia de rotina do linfonodo 16b1 são recomendadas. Quimioterapia deve ser considerada e quimioradioterapia indicada se a margem cirúrgica microscópica seja positiva. Os portais devem ser ressecados excepcionalmente. O estadiamento laparoscópico antes da operação é recomendado, mas o tratamento radical por abordagem minimamente invasiva deve ser realizado apenas em centros especializados em cirurgia hepatopancreatobiliar minimamente invasiva. A extensão da ressecção hepática é aceitável até que seja alcançada a ressecção R0. A linfadenectomia padrão é indicada para tumores iguais ou superiores a T2, mas a ressecção da via biliar não é recomendada de rotina. Conclusões: Recomendações seguras foram preparadas para carcinoma incidental da vesícula biliar, destacando os mais frequentes tópicos do trabalho diário do cirurgião do aparelho digestivo e hepatopancreatobiliar.

A doubly anharmonic oscillator in an induced electric dipole system.

The behaviour of the interaction of the induced electric dipole moment of an atom with a uniform magnetic field and a non-uniform electric field are investigated in a rotating reference frame. An interesting aspect of this interaction is that it gives rise to an analogue of a spinless particle subject to the doubly anharmonic oscillator. Then, it is shown that analytical solutions to the Schrödinger equation can be obtained. Another point raised is that the quantum effects on the induced electric dipole moment can be observed if the uniform magnetic field possesses a discrete set of values.

Resection of liver metastasis from neuroendocrine tumors: evaluation of results and prognostic factors.

OBJECTIVES: to determine the prognostic factors that may impact on morbidity and mortality and survival of patients undergoing surgical treatment of liver metastases from neuroendocrine tumors. METHODS: We studied 22 patients undergoing liver resection for metastases from neuroendocrine tumors between 1997 and 2007. Epidemiological and clinical data were correlated with morbidity and mortality and overall and disease-free survivals. RESULTS: twelve patients were male and ten female, with a mean age of 48.5 years. Bilobar disease was present in 17 patients (77.3%). In ten patients (45.5%) the primary tumor originated in the pancreas, terminal ileum in eight, duodenum in two, rectum in one and jejunum in one. Complete surgical resection (R0) was achieved in 59.1% of patients. Eight patients (36.3%) developed complications in the immediate postoperative period, one of them dying from septicemia. All patients undergoing re-hepatectomy and/or two-stage hepatectomy had complications in the postoperative period. The overall survival at one and five years was 77.3% and 44.2%. The disease-free survival at five years was 13.6%. The primary pancreatic neuroendocrine tumor (p = 0.006) was associated with reduced overall survival. Patients with number of metastatic nodules < 10 (p = 0.03) and asymptomatic at diagnosis (p = 0.015) had higher disease-free survival. CONCLUSION: liver metastases originating from pancreatic neuroendocrine tumors proved to be a negative prognostic factor. Symptomatic patients with multiple metastatic nodules showed a significant reduction in disease-free survival.

Variation in the Presence of Anti-Batrachochytrium dendrobatidis Bacteria of Amphibians Across Life Stages and Elevations in Ecuador.

Amphibian populations are decreasing worldwide due to a variety of factors. In South America, the chytrid fungus Batrachochytrium dendrobatidis (Bd) is linked to many population declines. The pathogenic effect of Bd on amphibians can be inhibited by specific bacteria present on host skin. This symbiotic association allows some amphibians to resist the development of the disease chytridiomycosis. Here, we aimed (1) to determine for the first time if specific anti-Bd bacteria are present on amphibians in the Andes of Ecuador, (2) to monitor anti-Bd bacteria across developmental stages in a focal amphibian, the Andean marsupial tree frog, Gastrotheca riobambae, that deposits larvae in aquatic habitats, and (3) to compare the Bd presence associated with host assemblages including 10 species at sites ranging in biogeography from Amazonian rainforest (450 masl) to Andes montane rainforest (3200 masl). We sampled and identified skin-associated bacteria of frogs in the field using swabs and a novel methodology of aerobic counting plates, and a combination of morphological, biochemical, and molecular identification techniques. The following anti-Bd bacteria were identified and found to be shared among several hosts at high-elevation sites where Bd was present at a prevalence of 32.5%: Janthinobacterium lividum, Pseudomonas fluorescens, and Serratia sp. Bd were detected in Gastrotheca spp. and not detected in the lowlands (sites below 1000 masl). In G. riobambae, recognized Bd-resistant bacteria start to be present at the metamorphic stage. Overall bacterial abundance was significantly higher post-metamorphosis and on species sampled at lower elevations. Further metagenomic studies are needed to evaluate the roles of host identity, life-history stage, and biogeography of the microbiota and their function in disease resistance.

Resection of liver metastasis from neuroendocrine tumors: evaluation of results and prognostic factors / Ressecção de metástases hepáticas de tumores neuroendócrinos: avaliação dos resultados e fatores prognósticos

OBJECTIVES: To determine the prognostic factors that may impact on morbidity and mortality and survival of patients undergoing surgical treatment of liver metastases from neuroendocrine tumors. METHODS: We studied 22 patients undergoing liver resection for metastases from neuroendocrine tumors between 1997 and 2007. Epidemiological and clinical data were correlated with morbidity and mortality and overall and disease-free survivals. RESULTS: twelve patients were male and ten female, with a mean age of 48.5 years. Bilobar disease was present in 17 patients (77.3%). In ten patients (45.5%) the primary tumor originated in the pancreas, terminal ileum in eight, duodenum in two, rectum in one and jejunum in one. Complete surgical resection (R0) was achieved in 59.1% of patients. Eight patients (36.3%) developed complications in the immediate postoperative period, one of them dying from septicemia. All patients undergoing re-hepatectomy and/or two-stage hepatectomy had complications in the postoperative period. The overall survival at one and five years was 77.3% and 44.2%. The disease-free survival at five years was 13.6%. The primary pancreatic neuroendocrine tumor (p = 0.006) was associated with reduced overall survival. Patients with number of metastatic nodules < 10 (p = 0.03) and asymptomatic at diagnosis (p = 0.015) had higher disease-free survival. CONCLUSION: liver metastases originating from pancreatic neuroendocrine tumors proved to be a negative prognostic factor. Symptomatic patients with multiple metastatic nodules showed a significant reduction in disease-free survival.

OBJETIVOS: Determinar fatores prognósticos com possível impacto na morbimortalidade e sobrevida de pacientes submetidos ao tratamento cirúrgico das metástases hepáticas de tumores neuroendócrinos. MÉTODOS: foram estudados 22 pacientes submetidos à ressecção hepática por metástases de tumores neuroendócrinos entre 1997 e 2007. Dados epidemiológicos e clínicos foram correlacionados com morbimortalidade e sobrevidas global e livre de doença. RESULTADOS: doze pacientes eram do sexo masculino e dez do feminino com média de idade de 48,5 anos. Doença bilobar esteve presente em 17 pacientes (77,3%). Em dez pacientes (45,5%) o tumor primário se originou no pâncreas, em oito no íleo terminal, em dois no duodeno, em um no reto e em um no jejuno. Ressecção cirúrgica completa (R0) foi alcançada em 59,1% dos pacientes. Oito pacientes (36,3%) evoluíram com complicações no pós-operatório imediato, com um paciente evoluindo ao óbito por septicemia. Todos os pacientes submetidos à re-hepatectomia e/ou hepatectomia em dois tempos evoluíram com complicações no período pós-operatório. A sobrevida global em um e cinco anos foi 77,3% e 44,2%. A sobrevida livre de doença em cinco anos foi 13,6%. O tumor neuroendócrino primário do pâncreas (p=0,006) foi associado à redução na sobrevida global. Os pacientes com número de nódulos metastáticos <10 (p=0,03) e os assintomáticos ao diagnóstico (p=0,015), apresentaram maior sobrevida livre de doença. CONCLUSÃO: metástases hepáticas oriundas de tumores neuroendócrinos pancreáticos demonstraram ser um fator prognóstico negativo. Pacientes sintomáticos e com múltiplos nódulos metastáticos apresentam redução significativa na sobrevida livre de doença.

Evaluation of abundance indexes in open population studies: a comparison in populations of small mammals in southern Brazil.

Many manuscripts comparing populations and/or analysing the structure of animal communities use indexes of captures as synonymous of abundance. However, the basic methods more suitable to this assumption - probabilistic estimates based on equal capture probability - have not been considered. In this study, the deviations caused by different types of capture indexes are compared with a common probabilistic population estimator (Cormack-Jolly-Seber). The analyses showed that Minimum Number Known Alive (MNKA) and the number of individuals showed greater association with the population estimator than with non-probabilistic indexes based on recaptures. Therefore, none of the indexes presented the same performance to estimate population size estimation which can lead to ecological misinterpretation. Some recommendations were also described.

Evaluation of abundance indexes in open population studies: a comparison in populations of small mammals in southern Brazil / Avaliação de índices de abundância em estudos de populações abertas: uma comparação em populações de pequenos mamíferos do sul do Brasil

Many manuscripts comparing populations and/or analysing the structure of animal communities use indexes of captures as synonymous of abundance. However, the basic methods more suitable to this assumption - probabilistic estimates based on equal capture probability - have not been considered. In this study, the deviations caused by different types of capture indexes are compared with a common probabilistic population estimator (Cormack-Jolly-Seber). The analyses showed that Minimum Number Known Alive (MNKA) and the number of individuals showed greater association with the population estimator than with non-probabilistic indexes based on recaptures. Therefore, none of the indexes presented the same performance to estimate population size estimation which can lead to ecological misinterpretation. Some recommendations were also described.

Muitos estudos comparam populações e/ou analisam a estrutura de comunidades animais usando índices de captura como se fossem sinônimos de abundância. No entanto, os métodos mais adequados considerando o pressuposto - estimativas probabilísticas baseadas na igualdade da probabilidade de capturas - não têm sido considerados. Neste estudo, os desvios causados por diferentes tipos de índices de captura são comparados com um dos mais comuns estimadores populacionais probabilísticos (Cormack-Jolly-Seber). As análises mostraram que o número mínimo de animais conhecidos vivos (MNKA) e o número de indivíduos apresentaram maior associação com o estimador populacional do que com os índices não probabilísticos baseados em recapturas. Entretanto, nenhum dos índices apresentou o mesmo desempenho do estimador populacional o que pode levar a interpretações equivocadas. Algumas recomendações foram também descritas.

Evaluation of abundance indexes in open population studies: a comparison in populations of small mammals in southern Brazil / Avaliação de índices de abundância em estudos de populações abertas: uma comparação em populações de pequenos mamíferos do sul do Brasil

Many manuscripts comparing populations and/or analysing the structure of animal communities use indexes of captures as synonymous of abundance. However, the basic methods more suitable to this assumption - probabilistic estimates based on equal capture probability - have not been considered. In this study, the deviations caused by different types of capture indexes are compared with a common probabilistic population estimator (Cormack-Jolly-Seber). The analyses showed that Minimum Number Known Alive (MNKA) and the number of individuals showed greater association with the population estimator than with non-probabilistic indexes based on recaptures. Therefore, none of the indexes presented the same performance to estimate population size estimation which can lead to ecological misinterpretation. Some recommendations were also described.(AU)

Muitos estudos comparam populações e/ou analisam a estrutura de comunidades animais usando índices de captura como se fossem sinônimos de abundância. No entanto, os métodos mais adequados considerando o pressuposto - estimativas probabilísticas baseadas na igualdade da probabilidade de capturas - não têm sido considerados. Neste estudo, os desvios causados por diferentes tipos de índices de captura são comparados com um dos mais comuns estimadores populacionais probabilísticos (Cormack-Jolly-Seber). As análises mostraram que o número mínimo de animais conhecidos vivos (MNKA) e o número de indivíduos apresentaram maior associação com o estimador populacional do que com os índices não probabilísticos baseados em recapturas. Entretanto, nenhum dos índices apresentou o mesmo desempenho do estimador populacional o que pode levar a interpretações equivocadas. Algumas recomendações foram também descritas.(AU)

Body size of commom opossum Didelphis aurita Wied-Neuwied 1826 (Didelphimorphia: Didelphidae) on southern brazilian islands.

The body size of vertebrates isolated on islands can undergo changes due to ecological features of these environments. This study aimed to compare the body size of the common opossum, Didelphis aurita, from different insular populations within the same archipelago in southern Brazil. The opossum populations showed corporal variation and different hypotheses were raised to understand the results. This study constitutes the most detailed body size comparison of a marsupial within different insular populations in the Neotropical zone and the data gathered represents an initial contribution for regional fauna biometric knowledge.

Body size of commom opossum Didelphis aurita Wied-Neuwied 1826 (Didelphimorphia: Didelphidae) on southern Brazilian islands / Tamanho corpóreo de gambás Didelphis aurita Wied-Neuwied 1826 (Didelphimorphia: Didelphidae) em ilhas no sul do Brasil

The body size of vertebrates isolated on islands can undergo changes due to ecological features of these environments. This study aimed to compare the body size of the common opossum, Didelphis aurita, from different insular populations within the same archipelago in southern Brazil. The opossum populations showed corporal variation and different hypotheses were raised to understand the results. This study constitutes the most detailed body size comparison of a marsupial within different insular populations in the Neotropical zone and the data gathered represents an initial contribution for regional fauna biometric knowledge.

O tamanho corpóreo de vertebrados isolados em ilhas pode sofrer alterações em função das particularidades ecológicas desses ambientes. O presente trabalho comparou o tamanho corpóreo de gambás, Didelphis aurita, em ilhas costeiras de um mesmo arquipélago no Sul do Brasil e encontrou diferenças de tamanho entre as localidades. Os gambás apresentaram variações para as medidas corporais e diferentes hipóteses foram consideradas para entender os resultados. Esta é a comparação mais detalhada de tamanho corpóreo entre populações insulares de um marsupial neotropical e uma contribuição inicial para o conhecimento da biometria da fauna regional.

Relationship between psychological complaints and vasomotor symptoms during climacteric.

BACKGROUND: It has been suggested that hormonal changes and environmental alterations during the climacteric period are important in the development of psychological symptoms. OBJECTIVE: To evaluate the role of biological and psycho-social factors in the prevalence of climacteric symptoms. DESIGN: Open, cross-sectional, observational and descriptive study. MATERIAL AND METHODS: A total of 300 women between 40 and 59 years of age were evaluated using Greene scale for climacteric symptoms, Cooper questionnaire for psychosomatic symptoms of stress, Smilkstein family apgar for family dysfunction, Duke-UNC questionnaire for social support and Israel scale for vital events. All these tests have been previously validated in Spanish. RESULTS: Postmenopausal women do not have higher prevalence of psychological symptoms, they only have more vasomotor symptoms. Premenopausal women with vasomotor symptoms have more psychological and somatic symptoms and stress, independently of the vital events, family dysfunction or poor social support. Vasomotor symptoms in the premenopause are associated with increased risk of anxiety (OR: 3.7, IC: 1.4-9.7; P<0.008), depression (OR: 8.1, IC: 2.5-26.4; P<0.0005), somatic symptoms (OR: 14.9, IC: 3.4-65.3; P<0.0003), sexual dysfunction (OR: 7.2, IC: 2.5-20.6; P<0.0002) and stress (OR: 7.5, IC: 3.5-15.9; P<0.0001). Negative vital events and family dysfunction increase in minor intensity the risk of anxiety, depression and stress. CONCLUSION: In conclusion, psychological symptoms are frequent in the premenopause and are associated to vasomotor symptoms. This observation links psychological symptoms with menopausal transition and might suggest an organic base in their origin. The negative psycho-social environment is a factor that favours the development of these symptoms.

Modulation of a calcium-activated chloride current by Maitotoxin.

The effect of Maitotoxin (MTX) on the calcium-activated chloride current (ICl-Ca) from Xenopus oocytes was studied, applying the two-electrode voltage clamp technique. MTX increased the current amplitude at all the voltages explored and reduced the time to reach the maximum current level (time to peak). At low toxin concentrations (15 pM), both effects were fully reversible. Activation of ICl-Ca by MTX was secondary to the increment in the intracellular Ca2+ concentration induced by this toxin, since incubation of the oocytes with the cell-permeant Ca2+ chelator BAPTA-AM, greatly reduced the effect of MTX on ICl-Ca. Furthermore, external chloride ions removal also diminished the MTX effect on the current, strongly suggesting that the main current activated by MTX is ICl-Ca. Subsequent applications of a fixed toxin concentration after toxin washout resulted in enhanced ICl-Ca, suggesting that the toxin effect potentiates.

Consenso Latinoamericano sobre infecciones en bronquitis crónica / Latin American consensus on infections in chronic bronchitis

Dos tercios de las exacerbaciones agudas de la bronquitis crónica (EABC) se asocian con infección bacteriana y se caracterizan por recrudecimiento súbito de la tos, disnea y aumento en el volumen y el aspecto purulento del esputo. Las infecciones bacterianas crónicas o recurrentes, inician y perpetúan un círculo vicioso de daño a las vías aéreas, que se produce mediante la estimulación persistente de la cascada inflamatoria por los productos bacterianos. De los microorganismos causales, el más común es H. influenzae. Otros patógenos frecuentes incluyen M. catarrhalis, la mayoría resistentes a aminopenicilinas y S. Pneumoniae, el cual ha incrementado recientemente a su resistencia a penicilinas y macrólidos a nivel orbital. Si bien algunos estudios recientes han demostrado de manera clara el beneficio del tratamiento antibiótico de los EABC, existen ciertas dudas relacionadas con la manera de clasificar la enfermedad y con los criterios utilizados para la inclusión y exclusión de los pacientes, que permitan esclarecer de manera definitiva el beneficio del antimicrobiano en cada uno de los grupos en los que se ha clasificado su severidad. Con el fin de lograr un consenso sobre algunas de estas variables y establecer lineamientos racionales que permitan abordar el tratamiento de estos pacientes, se reunieron recientemente (noviembre del 96 y marzo del 97) un grupo de destacados expertos latinoamericanos en infectología y neumología. El consenso identificó una serie de factores de riesgo que permitieron diseñar una clasificación de EABC que establece cuatro grados de severidad; estos a su vez están relacionados con un grupo específico de microorganismos que varían con las circunstancias y desde luego en la sensibilidad a los antibióticos. Asimismo el grupo de expertos estableció que la resistencia de los gérmenes que comúnmente afectan a estos enfermos (H. influenzae, S. pneumoniae y M. catarrhalis) requieren de antimicrobianos que sean activos contra más del 90 por ciento de las cepas causantes. Como lineamientos prácticos terapéuticos, se sugirió que la traqueobronquitis aguda (clase I) no requiere en general de antibióticos; que la amoxicilina permanece como el tratamiento de elección para las exacerbaciones leves (clase II), mientras que para la bronquitis crónica complicada (clase III), algunas fluoroquinolonas (p.ej.: ciprofloxacina), los nuevos macrólidos, combinaciones con inhibidores de betalactamasa o cefalosporina orales de 3º generación...(AU)

Consenso Latinoamericano sobre infecciones en bronquitis crónica / Latin American consensus on infections in chronic bronchitis

Dos tercios de las exacerbaciones agudas de la bronquitis crónica (EABC) se asocian con infección bacteriana y se caracterizan por recrudecimiento súbito de la tos, disnea y aumento en el volumen y el aspecto purulento del esputo. Las infecciones bacterianas crónicas o recurrentes, inician y perpetúan un círculo vicioso de daño a las vías aéreas, que se produce mediante la estimulación persistente de la cascada inflamatoria por los productos bacterianos. De los microorganismos causales, el más común es H. influenzae. Otros patógenos frecuentes incluyen M. catarrhalis, la mayoría resistentes a aminopenicilinas y S. Pneumoniae, el cual ha incrementado recientemente a su resistencia a penicilinas y macrólidos a nivel orbital. Si bien algunos estudios recientes han demostrado de manera clara el beneficio del tratamiento antibiótico de los EABC, existen ciertas dudas relacionadas con la manera de clasificar la enfermedad y con los criterios utilizados para la inclusión y exclusión de los pacientes, que permitan esclarecer de manera definitiva el beneficio del antimicrobiano en cada uno de los grupos en los que se ha clasificado su severidad. Con el fin de lograr un consenso sobre algunas de estas variables y establecer lineamientos racionales que permitan abordar el tratamiento de estos pacientes, se reunieron recientemente (noviembre del 96 y marzo del 97) un grupo de destacados expertos latinoamericanos en infectología y neumología. El consenso identificó una serie de factores de riesgo que permitieron diseñar una clasificación de EABC que establece cuatro grados de severidad; estos a su vez están relacionados con un grupo específico de microorganismos que varían con las circunstancias y desde luego en la sensibilidad a los antibióticos. Asimismo el grupo de expertos estableció que la resistencia de los gérmenes que comúnmente afectan a estos enfermos (H. influenzae, S. pneumoniae y M. catarrhalis) requieren de antimicrobianos que sean activos contra más del 90 por ciento de las cepas causantes. Como lineamientos prácticos terapéuticos, se sugirió que la traqueobronquitis aguda (clase I) no requiere en general de antibióticos; que la amoxicilina permanece como el tratamiento de elección para las exacerbaciones leves (clase II), mientras que para la bronquitis crónica complicada (clase III), algunas fluoroquinolonas (p.ej.: ciprofloxacina), los nuevos macrólidos, combinaciones con inhibidores de betalactamasa o cefalosporina orales de 3º generación...

La Figura Compleja de Rey para niños: propiedades psicométricas / The Rey's Complex Figure for Children: psychometric properties

Este trabajo presenta los resultados de la aplicación de la Figura Compleja de Rey, a una muestra de 750 sujetos, con un rango de edad de 4 a 8 años, a partir de los cuales se calcularon las medias y desviaciones estándar para los ensayos de copia y de memoria del instrumento, en 5 grupos de edad. El análisis psicométrico indicó, que con el nuevo sistema de calificación utilizado, todas las unidades perceptuales discriminan adecuadamente los puntajes altos de los bajos en ambos ensayos. La confiabilidad alcanzada fue de a=0.765 para la copia y de a =0.664 para la memoria. El análisis factorial mostró que las 9 unidades perceptuales se agrupan en forma congruente en un solo factor, que explica 20.7 por ciento de la varianza total de la copia y 29.3 por ciento de la memoria. Los resultados aquí presentados pueden considerarse como parámetros de estandarización válidos y confiables para los sujetos de 4 a 8 años de edad

Diseño de un procedimiento para calificar la Figura Compleja de Rey para niños: confiabilidad interevaluadores / Desing of a score system for te Rey's Complex Figure Test for children: interater reliability

El presente trabajo propone un sistema original de calificación de la Figura Compleja de Rey para niños, basado, tanto en el marco teórico neuropsicológico y de la psicología experimental, como en un amplio proceso de muestreo en 750 sujetos de 4 a 8 años. Se presenta el estudio de confiabilidad interjueces, con la participación de 14 evaluadores, que calificaron la copia y la reproducción de memoria de 15 sujetos en forma independiente, y en el que se demuestra que este sistema es muy confiable

Propiedades cualitativas en la ejecución de la figura compleja de Rey a lo largo del desarrollo en población abierta / Qualitive properties in the execution of the Rey's Complex Figure along the development in the general population

Este trabajo presenta el análisis de los principales aspectos cualitativos en el desempeño de 3,562 sujetos en la prueba de la Figura compleja de Rey, con un rango de edad entre los 8 y los 80 años, a partir de un registro sistematizado de los posibles errores que comete la población abierta a lo largo del desarrollo, de la prueba al copiar o al evocar la figura. Se calculó por grupo de edad la frecuencia de los distintos tipos de error para cada una de las 18 unidades. Los resultados se presentan convertidos a percentiles para su manejo psicométrico y así quedan establecidos los parámetros cualitativos que determinan la calidad de desempeño de un individuo en relación con su población, para poder conocer en qué aspecto en particular su desempeño se desvía de la norma