Buoyancy-Induced Convection Driven by Frontal Polymerization.

In this Letter, we study the interaction between a self-sustaining exothermic reaction front propagating in a direction perpendicular to that of gravity and the buoyancy-driven convective flow during frontal polymerization (FP) of a low-viscosity monomer resin. As the polymerization front transforms the liquid monomer into the solid polymer, the large thermal gradients associated with the propagating front sustain a natural convection of the fluid ahead of the front. The fluid convection in turn affects the reaction-diffusion (RD) dynamics and the shape of the front. Detailed multiphysics numerical analyses and particle image velocimetry experiments reveal this coupling between natural convection and frontal polymerization. The frontal Rayleigh (Ra) number affects the magnitude of the velocity field and the inclination of the front. A higher Ra number drives instability during FP, leading to the observation of thermal-chemical patterns with tunable wavelengths and magnitudes.

Tuberculosis-Related Uveitis in Patients under Anti-TNF-alpha Therapy: A Case Series.

Tumor necrosis factor inhibitors (anti-TNF) have emerged as an effective treatment in noninfectious uveitis (NIU). Anti-TNF may increase the predisposition to infectious disease as tuberculosis (TB). TB-related uveitis in the context of an uveitogenic concurrent systemic immune-mediated disease under anti-TNF treatment remain a diagnostic challenge, deserving special focus on this rare context. Retrospective chart review of patients on anti-TNF drugs for systemic immune-mediated diseases that developed a multicentric microbiologically confirmed active TB with concurrent intraocular involvement.Three patients were recorded. Screening for TB before starting anti-TNF resulted negative in two patients. The other patient had received anti-tuberculous treatment in the past. All showed a microbiologically confirmed extraocular TB after unexpected atypical reactivation of the uveitis shifting to chronic granulomatous pattern.Specialists should be aware of TB reactivation, even with previous negative screening, when ocular uveitis signs and activity do not match with the expected pattern in a patient on anti-TNF drugs.

Estimation of Anadara tuberculosa genetic diversity in five mangroves from Tumaco, using Cytochrome oxidase I enzyme / Estimación de la diversidad genética de Anadara tuberculosa en cinco manglares de Tumaco, utilizando la enzima citocromo oxidasa I

ABSTRACT Objective . To estimate the genetic diversity of the Anadara tuberculosa en five mangrove swams of Tumaco, Nariño, Colombia using as a mitocondrial molecular marker the cytochromo oxidase sub-unit I (COI). Materials and methods. A total of 50 individuals were collected from the San Jorge, La Tiburonera, El Pajal, La Playa y Bajito Vaquería mangrove swamps, randomly selecting 10 specimens of each zone. The tissue sample was worked with absolute alcohol at ambient temperature in microtubes. DNA was extracted, and the mitocondrial DNA was amplified using the PCR technique (polymerase chain reaction). The amplified and quantified products of PCR were sequenced on both sides (Macrogen). Each one of the obtained sequences was edited and aligned. Later, the parameters of genetic diversity (haplotypical and nucleotidical) were measured, and the analysis of distribution between frequency pairs (Mistmach distribution) was elaborated. Finally, the analysis of nucleotidic variation and population structure (AMOVA) was completed. Results. The amplified product gene weighed 710 bp. The haplotypical diversity reported for all the populations was high (0.683±0.060) and the reported nucleotídical diversity was low for all the populations (0.040±0.020). The AMOVA results indicate that the variance amongst populations is low (4.20%) and that the variance within populations is high (95.80%). Conclusions. The studied populations are not structured and although there is a decrease of natural banks, the genetic diversity is high.

RESUMEN Objetivo . Estimar la diversidad genética de Anadara tuberculosa en cinco manglares de Tumaco Nariño, Colombia utilizando como marcador molecular mitocondrial la subunidad I de la citocromo oxidasa (COI). Materiales y métodos. Se colectaron en total 50 individuos de los manglares San Jorge, La Tiburonera, El Pajal, La Playa y Bajito Vaquería, tomando 10 ejemplares al azar de cada zona. La muestra de tejido se fijó con alcohol absoluto a temperatura ambiente en microtubos. Se extrajo y amplificó el ADN mitocondrial mediante la técnica de PCR (Polymerase Chain Reaction). Los productos de PCR amplificados y cuantificados se secuenciaron por ambos lados (Macrogen). Una vez se obtuvo las secuencias, se editó y alineo cada secuencia. Posteriormente, se midió los parámetros de diversidad genética (haplotípica y nucleotídica) y se elaboró el análisis de distribución entre pares de frecuencias (Mistmach distribution). Finalmente se efectuó el análisis de variación nucleotídica y la estructura poblacional (AMOVA). Resultados. El gen amplificado tuvo una longitud de 710 pb. La diversidad haplotípica reportada para todas las poblaciones fue alta (0.683±0.060) y la diversidad nucleotídica reportada fue baja para todas las poblaciones (0.040±0.020). Los resultados del AMOVA indican que la varianza entre poblaciones es baja (4.20%) y la varianza dentro de las poblaciones es alta (95.80%). Conclusiones. Las poblaciones estudiadas no se encuentran estructuradas y a pesar de la disminución de los bancos naturales de las poblaciones de Anadara tuberculosa, se estima que la diversidad genética es alta.

Escoliosis en niños y adolescentes / Scoliosis in children and adolescents

La escoliosis es una deformidad de la columna que se presenta como una curva estructural que determina un grado variable de deformidad del tronco. La forma más común es la escoliosis idiopática del adolescente, que se desarrolla en la columna, en la fase de crecimiento y puede tener importantes efectos cosméticos y funcionales, pero es siempre un diagnóstico de exclusión. La escoliosis puede ser tratada con observación seriada, uso de ortesis o cirugía, según su magnitud y potencial evolución de severidad. Sin embargo, el comportamiento de la curva es frecuentemente difícil de predecir durante el desarrollo, por lo que el seguimiento clínico y radiológico seriado es clave en la decisión de tratamiento. Aparte de la cirugía, sólo el tratamiento con corset puede frenar la progresión de una curva, si bien no corregirla. Las curvas severas o que progresen dentro del corset tienen indicación de corrección y fusión quirúrgica. Las curvas noidiopáticas se comportan en forma diferente y su manejo es también distinto. El objetivo de este artículo es presentar los aspectos clave de la evaluación inicial de un paciente con escoliosis y entregar una visión actualizada del tratamiento de las distintas formas de presentación de esta afección.

Scoliosis is a structural deformity of the spine that can determine a varying degree of trunk deformity. It's most common presentation is that of Adolescent Idiopathic Scoliosis. This is a diagnosis of exclusion presenting itself in the growing spine and may result in significant cosmetic and functional effects. Depending on its severity, treatment may consist in serial observation, use of an orthosis or corrective surgery. Curve behaviour is however sometimes difficult to predict and clinical follow-up and serial radiographic review are fundamental during the developmental period. Aside from surgery, only brace treatment has demonstrated a capacity of containing curve progression for some cases. Severe curves or those that exhibit progression in spite of adequate brace treatment should be treated by surgical correction. Nonidiopathic forms of scoliosis present a different behaviour and require specific management. This article is to provides key aspects of the initial evaluation of a patient with scoliosis and offers an update on the management of it's most frequent forms of presentation.

Mal de Pott. Reporte de Caso Clínico / Pott's disease. Clinical Case Report

Introducción: La Tuberculosis (TB) es una enfermedad endémica en Paraguay, en el año 2010 se reportaron 2313 casos. La presentación extrapulmonar se observa en un 10-20% de los casos y en pacientes inmunocomprometidos puede llegar al 60%. La tuberculosis vertebral puede afectar la columna vertebral, con mayor frecuencia las vértebras T8 hasta L3. Tiene su origen en un foco primario pulmonar, que favorece uno secundario a nivel óseo. El diagnostico oportuno de la TB delimita la progresión a esta complicación y a las consecuencias para la vida del paciente. Caso Clínico: Paciente de sexo femenino de 42 años, fumadora de larga data, consulta por dolor en columna dorsal de 3 meses de evolución y pérdida de peso progresiva de aproximadamente 5 kg, con deformidad ósea progresiva de la columna dorsal. Al cuadro se agrega tos de 2 meses de evolución, seca al inicio y volviéndose productiva 15 días antes de la consulta. Niega sensación febril. Al examen físico se observa cifosis dorsal marcada y relieves óseos prominentes. En la Rx de torax se observan infiltrados bilaterales difusos miliariformes y leve desviación de la columna. El diagnostico definitivo fue Tuberculosis vertebral por lo que se inicia el tratamiento con HRZE (Rifampicina, Pirazinamida, Isoniazida, Etambutol) y se la deriva a neurocirugía para corrección de la deformidad ósea. Actualmente la paciente se encuentra en fase de recuperación con buena evolución tras cirugía correctiva. Discusión: Como en la mayoría de los casos reportados el síntoma cardinal fue el dolor. La imagenología es un pilar fundamental del diagnostico, brinda evidencia de la extensión de la lesión vertebral para decidir conducta. El alivio sintomático solo se logra con la cirugía correctiva. Debemos pensar y buscar tuberculosis en todo paciente sintomático respiratorio; las complicaciones extrapulmonares pueden evitarse mediante el diagnostico precoz y tratamiento adecuado de esta enfermedad de elevada prevalencia en nuestro país. Palabras clave: Espondilitis; Tuberculosis espinal; Mal de Pott.

Introduction: Tuberculosis (TB) is an endemic disease in Paraguay; in 2010 2313 cases were reported. Extrapulmonary presentation occurred in about 10 to 20% of cases, and in immunocompromised patients can go up to 60%. Vertebral tuberculosis can affect the spine, and is more frequent from T8 to L3. It has its origin in a primary pulmonary nodule from which can seed a secondary process in these bones. Early diagnosis of TB limits this complication and improved the quality of life of these patients. Case: 42 years old female, smoker, came for an evaluation of pain on her dorsal spine for the past 3 months, progressive loss weight of about 5 kilos, and bone deformity of the dorsal spine. 2 months prior this visit, she started coughing, described as dry, and then becomes wet 15 days before this visit. She denies fever and on physical examination there is a severe dorsal kyphosis with prominent bony prominence. CXR showed a miliary, diffuse, bilateral infiltrates with a slight deviation of the dorsal spine. Final diagnosis was vertebral tuberculosis, and treatment with HRZE (Rifampin, Pyrazinamide, Isoniazid and Ethambutol) was started. The patient was sent to neurosurgery for correction of the spine deformity. Currently she is stable, after corrective spine surgery. Discussion: Lijke in most reported cases, de cardinal symptom was pain, and imaging is fundamental for making a diagnosis and helps determine the extension of the vertebral disease to decide the treatment approach. Pain is controlled only with corrective surgery. We should think and look for TB in every patient with respiratory symptoms; the extrapulmonary complications could be avoided throu and early diagnosis and appropriate treatment of this disease, which has a high prevalence in our country. Key words: Spondylitis, spinal tuberculosis,Pott´s disease.

Effects of concentrated supernatants recovered from Lactobacillus plantarum on Escherichia coli growth and on the viability of a human promyelocytic cell line.

AIMS: The ability of concentrated supernatants from Lactobacillus plantarum to produce a disruption of plasma membrane in eukaryotic and prokaryotic cells has been examined. METHODS AND RESULTS: A strain of Lact. plantarum (tolerant to acid and bile salts and resistant to several antibiotics) was used. It inhibited the growth of pathogenic Escherichia coli and L. monocytogenes. Supernatants from Lact. plantarum were concentrated by centrifugation. Either E. coli or HL-60 cells (a human promyelocytic cell line) were treated in the presence of the concentrated supernatants. The effect of concentrated supernatants from Lact. plantarum on E. coli growth demonstrated a bacteriostatic activity and a loss of cell viability measured by sytox green staining. Concentrated supernatants were capable of disturbing plasma membrane in E. coli and of promoting a cytotoxic and lyctic action on HL-60 cells and on human erythrocytes, respectively. CONCLUSIONS: These results suggest that Lact. plantarum release an effective compound responsible for an important effect in the disruption of E. coli plasma membrane and for a cytototoxic activity on promyelocytic leukaemia cells. SIGNIFICANCE AND IMPACT OF THE STUDY: This is the first in vitro study about the antimicrobial and biological activities of concentrated supernatants from Lact. plantarum.

Intellectual capacity measurement in schizophrenia.

INTRODUCTION: The measurement of the intellectual capacity (IC) in schizophrenic patients has been found to be of clinical relevance. A user-friendly tool such as the Cattell's intelligence test might facilitate this measurement in daily clinical practice. METHOD: In this study, we measured the intelligence quotient (IQ) using Cattell's test in 35 schizophrenic patients before and after treatment with risperidone. RESULTS: At baseline, the sample showed an average intelligence of 78.3 points (standard deviation [SD]: 14.3), in the low-medium range. After 1 year on risperidone, the IQ significantly improved (mean: 84.8; SD: 17.0; p = 0.028). This IQ elevation was positively correlated with the improvement in the psychotic symptoms rated with the PANSS. CONCLUSIONS: Cattell's intelligence test could be a valid instrument to measure cognitive performance in schizophrenic patients. Antipsychotic therapy with risperidone could be effective to improve cognitive functioning in these subjects.

A 6-month prospective, observational, naturalistic, uncontrolled study to evaluate the effectiveness and tolerability of oral ziprasidone in patients with schizophrenia.

This multicenter, uncontrolled, naturalistic study evaluated the effectiveness and tolerability of 6 months of treatment with ziprasidone in 1266 patients with a diagnosis of schizophrenia. The percentage of responders (at least 30% reduction in PANSS total score) in the primary analysis sample (n=1022) was 47.3% (95% CI 44.2-50.4) at the end of the study. Patients showed a significant and clinically relevant reduction in the PANSS total, positive, negative and general psychopathology subscales scores (effect size of 1.60, 1.83, 0.62 and 1.40 respectively). Overall, 453 (35.8%) patients withdrew from the study; 9.3% withdrew owing to adverse events. Ziprasidone doses greater than 120 mg/day were associated with a lower risk of discontinuation for any cause (OR 0.46, 95% CI 0.33-0.65) Ziprasidone was well tolerated. Most common side effects were: insomnia, somnolence and nervousness. The effectiveness and tolerability of ziprasidone in clinical practice are consistent to those previously shown in the more restricted and homogeneous populations of clinical trials.

Cross validation with the mood disorder questionnaire (MDQ) of an instrument for the detection of hypomania in Spanish: the 32 item hypomania symptom check list (HCL-32).

BACKGROUND: The detection and diagnosis of present or past hypomanic episodes is of key importance for the differential diagnosis between depressive disorders and type II bipolar disorder. However, there are few instruments available to satisfactorily screen for the latter condition. The Hypomania Symptom Checklist-32 (HCL-32) is a self-applied questionnaire with 32 hypomania items and 8 severity and functional impact items which is being developed in several European countries for this purpose. Our aim was to develop and validate the psychometric properties of the HCL-32 scale in Spain in patients with bipolar disorder and to compare its properties with other instruments available for the detection of bipolar II disorder. METHODS: Patients were selected from 15 psychiatric outpatient departments, diagnosed with type I or type II bipolar disorder (BDI and BDII) and unipolar major depression (MD) according to DSM-IV-TR criteria. A control group of healthy subjects (HS) was likewise assessed. The patient selection criteria included a well-established diagnosis and a stable disorder and pharmacological treatment. The HCL-32 was administered to 237 subjects distributed among the above groups, on two occasions four weeks apart. We analysed the internal consistency, test-retest reliability and discriminative capacity of the HCL-32. RESULTS: The internal consistency of the Spanish version of the HCL-32, evaluated by Cronbach's alpha, was 0.94. Mean of affirmative questions by group were 21.2 (SD 5.8) for BDI, 19.3 (SD 6.2) for BDII, 8.6 (SD 6.6) for MD and 6.6 (SD 6.1) for HS, with statistically significant differences between them (Kruskal-Wallis test, p<0.001). Concurrent validity using the diagnosis variable was 0.72. Test-retest reliability was 0.90. We analysed the best cut-off point by means of a ROC curve analysis; for 14 affirmative responses, a sensitivity of 0.85 95%CI (0.78, 0.91) and specificity of 0.79, 95%CI (0.72, 0.87) were obtained. The positive and negative probability ratios were 4.1 and 5.3 (1/0.19 respectively). HCL-32 shows a dual factor structure of items, one as an energy-activity factor and another one as a factor involving items related to disinhibition and problems with self-control and attention. LIMITATIONS: The sample size of bipolar patients (particularly type BDII) should be increased in further studies. CONCLUSIONS: The Spanish version of the HCL-32 has good psychometric properties and sufficient sensitivity and specificity, detecting 8 out of every 10 patients with BD. The HCL-32 is a useful screening tool of patients with bipolar disorder in clinical settings. In its present form it adequately discriminates between bipolar and unipolar or healthy subjects, but not between BD I and BII.

Análisis de la resistencia inmune en un modelo murino experimental alimentado con dietas lipídicas e infectado con Listeria monocytogenes / Analysis of the immune resistance in an experimental murine model fed dietary lipids and infected with Listeria Monocytogenes

Algunas dietas lipídicas están implicadas en la reducción de ciertas funciones inmunes. Sin embargo, la acción inmunosupresora de estas dietas puede tener efectos adversos sobre la resistencia inmune del individuo frente a enfermedades de naturaleza infecciosa. En el presente estudio tratamos de valorar el estado inmune de ratones alimentados con dietas lipídicas e infectados experimentalmente con una cepa virulenta de Listeria monocytogenes. Ratones de la raza Balb/c fueron divididos en cuatro grupos alimentados cada uno de ellos con su respectiva dieta: dieta baja en lípidos (control, 2,5 por ciento), dieta rica en aceite de oliva (AO, 20 por ciento), dieta rica en aceite de pescado (AP, 20 por ciento) y dieta rica aceite de coco (AC, 20 por ciento). Los animales fueron alimentados durante un mes y posteriormente infectados con L. monocytogenes por vía endovenosa. Los resultados han mostrado una reducción de la supervivencia en animales alimentados con AP, así como un incremento significativo en el número de bacterias viables aisladas a partir de bazo. Además hemos podido observar un aumento de la capacidad bactericida de células peritoneales procedentes de ratones alimentados con AO, aunque la invasividad de L. monocytogenes en este grupo fue mayor que en el resto. Finalmente, una reducción significativa de la linfoproliferación fue observada en el grupo alimentado con AP, mientras que la actividad de células natural killer (NK) no se ha visto modificada. Estos resultados indican que dietas lipídicas constituidas por ácidos grasos poliinsaturados de la serie n-3 reducen la resistencia inmune de los ratones, mientras que una dieta constituida por AO no produce un efecto inmusupresor tan relevante y por consiguiente no reduce drásticamente la resistencia inmune siendo más eficiente en la eliminación de L. monocytogenes (AU)

Several dietary lipids are capable of exerting an immunosupressor effect. This action may have undiserable effects on the host immune resistance to infectious diseases. The purpose of the present study was to determinate the immune status of mice fed dietary lipids and experimentally infected with a virulent strain of Listeria monocytogenes. Balb/c mice were divided into four groups and were fed with their respective diet: low fat diet (LF, 20%), olive oil diet (OO, 20%), fish oil diet (FO, 20%) and hydrogenated coconut oil (HCO, 20%). Mice were fed for four weeks and infected with L. monocytogenes by endovenous route. Results have shown a survival reduction in mice fed a diet containing FO, as well as a significant increase in the number of viable bacteria from spleen. In addition, we have observed an increase in the bactericidal activity in peritoneal cells from OO group, although the invasion of L. monocytogenes in cells from this group was larger. Finally, a significant reduction of lymphocyte proliferation was observed in the group fed an FO diet, whereas natural killer (NK) cell activity was not modified. These results indicate that dietary lipids constituted by polyunsaturated n-3 fatty acids reduce the murine immune resistance, whereas a diet constituted by OO-does not exert an immunosuppressor effect as relevant as FO diet, and it does not reduce the immune resistance leading to an efficient L. monocytogenes elimination (AU)

[Analysis of the immune resistance in an experimental murine model fed dietary lipids and infected with Listeria monocytogenes]. / Análisis de la resistencia inmune en un modelo murino experimental alimentado con dietas lipídicas e infectado con Listeria monocytogenes.

Several dietary lipids are capable of exerting an immunosupressor effect. This action may have undiserable effects on the host immune resistance to infectious diseases. The purpose of the present study was to determinate the immune status of mice fed dietary lipids and experimentally infected with a virulent strain of Listeria monocytogenes. Balb/c mice were divided into four groups and were fed with their respective diet: low fat diet (LF, 20%), olive oil diet (OO, 20%), fish oil diet (FO, 20%) and hydrogenated coconut oil (HCO, 20%). Mice were fed for four weeks and infected with L. monocytogenes by endovenous route. Results have shown a survival reduction in mice fed a diet containing FO, as well as a significant increase in the number of viable bacteria from spleen. In addition, we have observed an increase in the bactericidal activity in peritoneal cells from OO group, although the invasion of L. monocytogenes in cells from this group was larger. Finally, a significant reduction of lymphocyte proliferation was observed in the group fed an FO diet, whereas natural killer (NK) cell activity was not modified. These results indicate that dietary lipids constituted by polyunsaturated n-3 fatty acids reduce the murine immune resistance, whereas a diet constituted by OO-does not exert an immunosuppressor effect as relevant as FO diet, and it does not reduce the immune resistance leading to an efficient L. monocytogenes elimination.

Prevalence and antimicrobial-resistance of S. pneumoniae and S. pyogenes in healthy children in the region of Madrid.

UNLABELLED: Streptococcus pneumoniae and Streptococcus pyogenes are common agents of respiratory or ORL pathology. Pneumococcus sensitivity has progressively decreased to penicillin and other antimicrobial agents, mainly in south of Europe, but this resistance report can be erroneous by a selection bias, because they sampled only hospital cases. OBJECTIVES: To determine the prevalence, antimicrobial susceptibility and risk factors of S. pneumoniae and S. pyogenes in healthy children under 5 years of age who go to infant school. SUBJECT AND METHODS: Cross sectional study in six infant schools. An epidemiological inquiry (risk factors of carrier state) was filled out and a nasopharyngeal specimen was taken from each child, S. pneumoniae and S. pyogenes were identified and antimicrobial tests were performed. RESULTS: We have studied 156 children with a mean age of 2.24 (standard deviation (S.D.), 0.85) and 58% have been treated with antibiotic in the last 3 months. The prevalence of S. pneumoniae or S. pyogenes were 12.2 and 5.1%, respectively. S. pyogenes only was isolated in two schools. Age was associated with S. pyogenes carrier but the rest of studied factors have no statistical significance with both microorganisms. All the S. pneumoniae showed resistance to one or more antibiotic (mainly to clavunate-amoxycillin: 94.7%), while S. pyogenes only was resistant to clavunate-amoxycillin. CONCLUSION: Healthy children (0-4 years) with antibiotherapy in last 3 months have a great frequency of resistant S. pneumoniae. It is necessary to reduce the antibiotic use at home (Medical education).

Comparative cost analysis of autologous peripheral blood progenitor cell and bone marrow transplantation in pediatric patients with malignancies.

BACKGROUND AND OBJECTIVES: This study was conducted in order to compare and analyze clinical and economic outcomes of autologous transplantation using bone marrow or peripheral blood as the source of hematopoietic progenitor cells in pediatric patients with malignancies. DESIGN AND METHODS: We collected clinical information and resource utilization from 131 consecutive autologous transplantations (102 peripheral blood progenitor cell (PBPC) and 29 bone marrow (BM) transplants) at a single institution between January 1989 and December 1998 in children with a variety of malignancies. Multivariable linear regression was used to evaluate the associations between pre-transplantation variables, post-infusion events and overall costs. A cost-effectiveness analysis of transplantation for acute lymphoblastic leukemia (ALL) and acute myeloblastic leukemia (AML) patients was also performed. RESULTS: Hematopoietic recovery was faster in the PBPCT group (days to neutrophil and platelet engraftment: 9 and 13, respectively, versus 14 and 21 for BMT, p<0.0001). There were less transfusion, antibiotic and parenteral nutrition requirements and hospital stay was shorter (median 17 days; range 8-38) in the PBPCT group than in the BMT one (median 28 days; range 11-65) (p<0.0001) resulting in a median lower overall cost for PBPCT (US$ 7895) compared to BMT (US$ 11820)(p<0.0001). Major determinants of overall costs for both groups were total body irradiation (TBI)-based conditioning regimen, days of hospitalization and number of transfused platelets. In PBPCT patients, a graft containing > or = 5 x 10(6)/kg CD34+ cells decreased the total cost of transplantation by 27%. Cost-effectiveness was higher for PBPCT than BMT for pediatric AML patients (p<0.0001) whereas in ALL patients the cost-effectiveness of the two transplant strategies was not significantly different. INTERPRETATIONS AND CONCLUSIONS: We conclude that, compared to BMT, autologous PBPCT in children is associated not only with clinical benefits but also economic advantages.

[The use of electroconvulsive therapy in acute services at the general hospital]. / Utilización de la terapia electroconvulsiva en una unidad de agudos de hospital general.

GOAL: The aim of the investigation focused on a retrospective analysis of the clinical use of ECT in the Acute Psychiatric Unit of The University Hospital of Guadalajara. METHOD: All patients admitted to our psychiatric unit from 1993 to 1998 and who underwent ECT along their hospitalization, were included in the analysis. Age of the sample ranged from 17 to 79. Several variables were controlled, including technical parameters of ETC application. RESULTS: All patients with a diagnosis of bipolar disorder or schizoaffective disorder showed full remission after ECT. Among patients diagnosed of schizophrenia, 60% experimented full remission and 40% partial remission. In the group of subjects with depression, 66.6% showed full remission, 27.7% partial remission and 5.7% no response. Besides, ETC appeared to be more effective in subjects without psychiatric comorbidity. CONCLUSION: The present retrospective analysis support that ECT still must be considered an effective, useful and safe therapeutic technique. In our review, adverse reactions to ECT have been limited and rare, and mostly reversible.

Tratamiento de las fracturas de la extremidad distal del radio con un cemento óseo remodelable / Treatment of distal radius fractures with remodelable bone cement

Objetivo: Comparar los resultados clínico-radiológicos y complicaciones del tratamiento de las fracturas de radio distal con un cemento óseo remodelable (Norian SRS) frente al tratamiento conservador.Diseño experimental: Estudio prospectivo y aleatorizado de fracturas tipos A3 o C2 de la clasificación AO en pacientes de 50 a 85 años de edad distribuidas en dos grupos de tratamiento: reducción cerrada e inmovilización con yeso 6 semanas (grupo Control) o reducción cerrada, estabilización con Norian SRS e inmovilización con yeso 2 semanas (Grupo SRS).Pacientes: 110, 55 por grupo.Resultados: El grupo SRS presentó menor incidencia de dolor y una recuperación más precoz de movilidad, fuerza de prensión y desarrollo de actividades. A los seis meses, la tasa de resultados satisfactorios fue del 81,5 por ciento en el grupo SRS y del 54,5 por ciento en el Control.Las fracturas estabilizadas con SRS presentaron una incidencia de redesplazamiento significativamente menor. La incidencia de consolidación en mala posición fue del 18,2 por ciento en el grupo SRS y del 41,8 por ciento en el grupo Control. Hubo una relación estadísticamente significativa entre los resultados funcionales y los radiológicos.Un 69,1 por ciento de los casos tratados con SRS tuvieron depósitos extraóseos, que con frecuencia causaron molestias transitorias pero presentaron tendencia a desaparecer.Conclusiones: El relleno del defecto trabecular de las fracturas de radio distal con un cemento óseo remodelable asociado a inmovilización con yeso 2 semanas proporciona mejores resultados clínicos y radiológicos que el tratamiento conservador, siendo su principal complicación los depósitos extraóseos de cemento, que ocasionan molestias locales y tienden a desaparecer (AU)

Utilización de la terapia electroconvulsiva en una unidad de agudos de hospital general / ECT (electroconvulsive therapy) in a General Hospital Psychiatric Inpatient Unit

Objetivo: Nuestro objetivo en este trabajo ha sido hacer un análisis descriptivo retrospectivo de la utilización de la TEC en la Unidad de Hospitalización Breve del Hospital General de Guadalajara. Material y métodos: Se recogen todos los casos comprendidos en el período de tiempo 1993, primer semestre de 1998, de aplicación de TEC en pacientes hospitalizados en nuestra unidad de agudos. Los pacientes tienen edades comprendidas entre 17 y 79 años. Se definen una serie de variables, algunas de ellas inherentes a la propia técnica, otras de ellas al individuo. Resultados: Entre otras variables, se analiza la respuesta a esta técnica agrupando a los pacientes por diagnósticos: esquizofrenia, trastornos esquizoafectivo, manía y depresión. En los pacientes esquizoafectivos y con manía (en el trastorno bipolar), se observó una remisión del 100 por ciento de los pacientes. En el grupo de pacientes esquizofrénicos se apreció una remisión total en el 60 por ciento y una remisión parcial en el 40 por ciento. En los casos de depresión se analizan cuatro subgrupos diferentes, observándose globalmente un 66 por ciento de remisión total y un 27,7 por ciento de remisión parcial. Sólo en un 5,5 por ciento la técnica no resultó eficaz. Se observó también que la respuesta al TEC es mejor en aquellos pacientes en los que no existe otro trastorno comórbido grave. Conclusiones: Este estudio retrospectivo avalaría que la TEC continúa siendo una opción de tratamiento útil, seguro y eficaz. Las complicaciones y efectos adversos relacionados con la TEC han sido pocos, de escasa relevancia clínica, tolerables para el paciente y reversibles (AU)

[Subsyndromal depressive semiology in severe alcoholism]. / Semiología depresiva subsindrómica en el alcoholismo severo.

INTRODUCTION: Several investigations have communicated frequent association between alcohol dependence and depression. METHOD: 21 subjects with DSM-IV criteria for alcohol dependence were included in an open label trial for alcohol withdrawal. At inclusion and along the follow-up none of the probands met DSM-IV criteria for mood disorder. Follow-up included a 15-day detoxification period and 195 days of withdrawal program, including treatment with 20 mg/d of fluoxetine. Occurrence of depressive semiology was measured using the Beck Depression Inventory (BDI) on day 15 (after detoxification), day 75 and day 210 (after withdrawal from ethanol of 195 days). RESULTS: 67% of the sample showed a positive basal BDI (after-detoxification-BDI> 9). Global retention rate after 210 days of follow-up was 57%. All patients who dropped out the investigation before completing the protocol showed a basal BDI in the depressive rank (BDI= 10-63), and maintained depressive scores in this instrument until their abandonment. CONCLUSIONS: Prevalence of <> in this population appears to be high. This clinical feature is frequently ignored because most of the patients do not meet standardized diagnostic criteria for mood disorders. Post-detoxification BDI could be used as a predictive factor of therapeutic result in long-term alcohol withdrawal programs. In addition, in our study fluoxetine showed efficacy in maintaining long-term alcohol abstinence.

[Delirium in delusions of negations of Cotard: syndrome versus disorder]. / Delirio de negaciones de Cotard: síndrome versus trastorno.

This article constitutes the first of a series directed to review fundamental disorders in clinical psychogeriatrics. This sort of publication is intended to retrieve clinical practice as the cornerstone for research and teaching in psychiatry. Besides, and particularly in geriatry, we try to expand the strategy of liaison work with primary physicians. In this case, a nosological review of the so called "delusion of negations" is presented. The Jules Cotard's original concept of subtype of delusional melancholia is contrasted to the view of numerous authors in this century who have described it as a form of non-specific delusional syndrome.