Packing core-corona particles on a spherical surface.

We explore the non-trivial structures that can be obtained by the assembly of repulsive core-corona particles confined on a spherical surface. Using Monte Carlo simulations, we study the low-temperature equilibrium configurations as a function of the size of the confining (spherical) surface for a small number of particles (N ≤ 12) and obtain a large variety of minimal-energy arrangements including anisotropic and chiral structures. For a small cluster (N = 4), we construct a phase diagram in the confining surface radius vs corona range plane that showed regions where configurations with a certain energy are not accessible. Also, a phase diagram in the temperature and confining surface radius plane showed the presence of reentrant phases. The assembly of Platonic and Archimedean solids and the emergence of helical structures are also discussed. When the number of particles is large (N ≥ 100), apart from the appearance of defects, the overall configurations correspond closely to the ones formed in an unconfined two-dimensional case. Interestingly, the present model reproduces the symmetry of experimentally obtained small clusters of colloidal spheres confined at the surface of evaporating liquid droplets which cannot be explained in terms of packing of hard spheres. Thus, our simulations provide insight on the role that the softness of the particles may have in the assembly of clusters of nanoparticles.

Colocación de stent y traqueobroncoplastia en el síndrome de Mounier-Kuhn: reporte de un caso / Stent placement and tracheobronchoplasty in Mounier-Kuhn syndrome: a case report

Se presenta el caso de un paciente diagnosticado a raíz de cuadros de disnea recurrentes de traqueobroncomegalia o Síndrome de Mounier-Kunh, patología congénita, muy infrecuente, clasificada como una clase de traqueomalacia del tipo cartilaginosa, cursando por ello con un colapso dinámico de la vía aérea causante de los episodios de disnea. Otros síntomas frecuentemente observados son la tos no productiva, retención de secreciones o infecciones recurrentes.El paciente es tratado inicialmente de forma conservadora mediante la colocación de una prótesis intratraqueal de silicona (Stent Dumon) en forma de "Y" que permite, de forma provisional, la estabilización de la vía aérea y mejoría de su calidad de vida. Posteriormente, se le practica un tratamiento quirúrgico definitivo o traqueobroncoplastia, que reconfigura la estructura traqueal evitando el colapso espiratorio y permitiendo la retirada del stent intratraqueal

We present the case of a patient diagnosed based on recurrent dyspnea from tracheobronchomegaly or Mounier-Kuhn syndrome, a very rare congenital disease classified as a type of cartilaginous tracheomalacia, leading to a dynamic collapse of the airway causing episodes of dyspnea. Other frequently observed symptoms are nonproductive cough, secretion retention and recurrent infections.The patient is initially treated conservatively by placing a Y-shaped silicone intratracheal prosthesis (Dumon stent) which provisionally allows for airway stabilization and improved quality of life. Later, the patient undergoes a definitive surgical treatment or tracheobronchoplasty, which reconfigures the tracheal structure, avoiding expiratory collapse and allowing the intratracheal stent to be removed

Peer review audit of non-specialist occupational physician reports.

BACKGROUND: With declining specialist occupational physician (OP) numbers, there is increasing recognition of the importance of non-specialist physicians in occupational health (OH) service delivery, yet to date, this physician group remains understudied and their competency requirements poorly understood. AIMS: To evaluate the quality of a sample of non-specialist OH reports and compare these with specialist reports. METHODS: A retrospective peer review audit of a convenience sample of 200 consecutive non-specialist and specialist OH reports from an Irish OH service using an assessment form based on the modified Sheffield Assessment Instrument for Letters SAIL(OH)1. RESULTS: Of the 200 peer reviewed OH reports, 159 (80%) were from non-specialists. For all questions, 87% and above of non-specialist reports were 'satisfactory' or 'above expected'. On the overall assessment, out of 10, the mean non-specialist report score was 6.8 (standard deviation (SD) 3-10) and the specialist score was 7.3 (SD 3-10). Comparatively, non-specialist reports highlighted legal/ethical issues marginally more and adhered slightly better to contractual/ethical/legal boundaries, while specialist reports fared better in addressing manager's questions, in their structure and clarity and in covering all significant aspects of the case, particularly if the case was complex. CONCLUSIONS: Our findings demonstrate a high standard of OH report quality in this sample of non-specialist OPs that is consistent across all key OH report components. Potential development areas are also identified that can inform education/training tailored to this physician group and assist in competency standard-setting.

Hybrid ADFT Study of the C104 and C106 IPR Isomers.

This work presents a hybrid auxiliary density functional theory (ADFT) study of the neutral and hexaanionic C104 and C106 fullerenes with the aim to determine their ground state structures. To this end, all C104 and C106 fullerene structures that obey the isolated pentagon rule (IPR) were optimized with the Perdew-Burke-Ernzerhof generalized gradient approximation followed by a single-point energy calculation with the PBE0 hybrid functional. Our studies show that this composite approach yields relative energies of giant fullerenes that are accurate to around 1 kcal/mol. As a result, the ground states of C104, C1046-, and C1066- can be assigned to the isomers 234:Cs, 821:D2, and 891:Cs, respectively. On the other hand, the energetically lowest lying IPR isomers of C106, 331:Cs, 1194:C2, 534:C1 are separated by less than 1 kcal/mol which makes an unequivocal ground state assignment by hybrid DFT methods impossible. To guide future experiments, we also report the simulated IR and Raman spectra of the most stable neutral and hexaanionic C104 and C106 fullerenes.

[Leucocyte esterase as a reliable diagnostic, cost-effective and fast in knee infections]. / Esterasa leucocitaria como prueba diagnóstica eficaz, económica y rápida ante un proceso infeccioso articular de rodilla.

BACKGROUND: The articular infection represents a challenge due to its complexity and its devastating effect when not treated promptly. We have various diagnostic studies: cultures, ESR, CRP, count of leukocytes, among others but none is specific, it takes more than 30 minutes to complete and require complex infrastructure. In this study we determine the sensitivity and specificity of the leukocyte esterase for detection of an infectious process joint in Mexican population. MATERIAL AND METHODS: From November 2015 to April 2016 was obtained synovial fluid from patients with diagnosis of knee infection with or without implant and without infection with degenerative pathology of the knee. It assessed the sample through the COMBI-SCREEN 11SYS leukocyte esterase with reading colorimetric test at two minutes determining positive for infection: two crosses, the remainder of the sample was sent to culture. RESULTS: We perform the test in 64 samples of synovial fluid of knee joint 19 diagnosed with infection and 45 without infection. Was obtained a sensitivity 100%, specificity of 88.24%, PPV 68.42% and PNV 100%, kappa index 0.753 using the program IBM SPSS Statistics 22, Python ver. 2.7. CONCLUSIONS: Leukocyte esterase is a fast, economical and effective to detect an infectious process against one inflammatory with high probability of success. This study showed an index of concordance 0.753 Kappa, proving to be reproducible so recommend be implemented in the emergency department at the national level.

ANTECEDENTES: La infección articular es un reto ortopédico por la complejidad diagnóstica y sus efectos devastadores al no tratarse oportunamente. Se cuenta con diversos estudios de diagnóstico: cultivo, VSG, PCR, conteo de leucocitos, entre otros, pero ninguno es preciso, tardan más de 30 minutos en realizarse y requieren una infraestructura compleja. En este estudio se determina la sensibilidad y especificidad de la esterasa leucocitaria para la detección de un proceso infeccioso articular en población mexicana. MATERIAL Y MÉTODOS: de Noviembre de 2015 a Abril de 2016 se obtuvo líquido sinovial de pacientes con diagnóstico de infección articular con o sin implante y sin infección con patología degenerativa de rodilla. Se evaluó la muestra mediante el test de esterasa leucocitaria COMBI-SCREEN 11SYS con lectura colorimétrica a los dos minutos, determinando positivo para infección: dos cruces, el resto de la muestra fue enviado a cultivo. RESULTADOS: Se aplicó el test a 64 muestras de líquido sinovial de rodilla, 19 diagnosticadas con infección articular y 45 sin infección. Se obtuvo una sensibilidad 100%, especificidad 88.24% VPP 68.42% y VPN 100%, índice de concordancia kappa 0.753 mediante el programa IBM SPSS Statistics 22, Python versión 2.7. CONCLUSIONES: La esterasa leucocitaria es una prueba rápida, económica y eficaz para detectar un proceso infeccioso contra un proceso inflamatorio con alta probabilidad de acierto. Este estudio presentó un índice de concordancia kappa de 0.753, demostrando ser reproducible, por lo que se recomienda implementarse en los servicios de urgencias a nivel nacional.

Hematoma esofágico espontáneo: a propósito de un caso / Spontaneous esophagic hematoma: about a case

El dolor torácico es un motivo frecuente de consulta en los servicios de urgencias, sin embargo, el hematoma esofágico es una causa muy poco frecuente. Se manifiesta más frecuentemente en mujeres de edad media y avanzada, con una triada de dolor torácico súbito, disfagia u odinofagia y hematemesis. Presentamos un caso de una mujer de 89 años con antecedentes de hipertensión arterial en tratamiento, usuaria de antihipertensivos y aspirina, con una historia de dos días de evolución de dolor retroesternal, sensación febril, disnea y tos productiva secundario a un hematoma esofágico.

Thoracic pain is a frequent reason for consultation in the emergency department, however, esophageal hematoma is a very rare cause. It manifests more commonly in women of middle and advanced age, with a triad of sudden chest pain, dysphagia or odynophagia and hematemesis. We present a case of a 89 years old female patient, with a history of arterial hypertension in treatment, user of antihypertensive drugs and aspirin with a two day history of retrosternal pain, febrile sensation, dyspnea and productive cough due to a esophageal hematoma.

The role of intragestational ghrelin on postnatal development and reproductive programming in mice

The purpose of this study was to evaluate the intragestational role of ghrelin in offspring development and reproductive programming in a mouse model of ghrelin imbalance during pregnancy. Female mice were injected with ghrelin (supraphysiological levels: 4 nmol/animal/day), antagonist (endogenous ghrelin inhibition with (D-Lys3)GHRP-6, 6 nmol/animal/day) or vehicle (control = normal ghrelin levels) throughout the pregnancy. Parameters evaluated in litters were growth, physical, neurobiological and sexual development and, at adulthood, reproductive function. Litter size and initial weight did not vary between treatments. Male pups from dams treated with ghrelin showed higher body weight increase until adulthood (31.7 ± 0.8 vs control = 29.7 ± 0.7, n = 11­14 litters/treatment; P < 0.05). Postnatal physical and neurobiological development was not modified by treatments. The antagonist accelerated male puberty onset, evidenced as earlier testis descent and increased relative testicular weight (antagonist = 0.5 ± 0.0% vs ghrelin = 0.4 ± 0.0% and control = 0.4 ± 0.0%, n = 5­10 litters/treatment; P < 0.05). At adulthood, these males exhibited lower relative testicular weight and reduced sperm motility (63.9 ± 3.6% vs control = 70.9 ± 3.3 and ghrelin = 75.6 ± 3.0, n = 13­15 animals; P < 0.05), without changes in plasma testosterone or fertility. Female pups intragestationally exposed to the antagonist showed earlier vaginal opening (statistically significant only at Day 25) and higher ovarian volume (antagonist = 1085.7 ± 64.0 mm3 vs ghrelin = 663.3 ± 102.8 mm3 and control = 512.3 ± 116.4 mm3; n = 4­6 animals/treatment; P < 0.05), indicating earlier sexual maturation. At adulthood, these females and those exposed to ghrelin showed a tendency to higher percentages of embryo loss and/or foetal atrophy. In conclusion, ghrelin participates in reproductive foetal programming: alterations in ghrelin activity during pregnancy modified body weight increase and anticipated puberty onset, exerting (or tending to) negative effects on adult reproductive function.

Esterasa leucocitaria como prueba diagnóstica eficaz, económica y rápida ante un proceso infeccioso articular de rodilla / Leucocyte esterase as a reliable diagnostic, cost-effective and fast in knee infections

Resumen: Antecedentes: La infección articular es un reto ortopédico por la complejidad diagnóstica y sus efectos devastadores al no tratarse oportunamente. Se cuenta con diversos estudios de diagnóstico: cultivo, VSG, PCR, conteo de leucocitos, entre otros, pero ninguno es preciso, tardan más de 30 minutos en realizarse y requieren una infraestructura compleja. En este estudio se determina la sensibilidad y especificidad de la esterasa leucocitaria para la detección de un proceso infeccioso articular en población mexicana. Material y métodos: de Noviembre de 2015 a Abril de 2016 se obtuvo líquido sinovial de pacientes con diagnóstico de infección articular con o sin implante y sin infección con patología degenerativa de rodilla. Se evaluó la muestra mediante el test de esterasa leucocitaria COMBI-SCREEN 11SYS con lectura colorimétrica a los dos minutos, determinando positivo para infección: dos cruces, el resto de la muestra fue enviado a cultivo. Resultados: Se aplicó el test a 64 muestras de líquido sinovial de rodilla, 19 diagnosticadas con infección articular y 45 sin infección. Se obtuvo una sensibilidad 100%, especificidad 88.24% VPP 68.42% y VPN 100%, índice de concordancia kappa 0.753 mediante el programa IBM SPSS Statistics 22, Python versión 2.7. Conclusiones: La esterasa leucocitaria es una prueba rápida, económica y eficaz para detectar un proceso infeccioso contra un proceso inflamatorio con alta probabilidad de acierto. Este estudio presentó un índice de concordancia kappa de 0.753, demostrando ser reproducible, por lo que se recomienda implementarse en los servicios de urgencias a nivel nacional.

Abstract: Background: The articular infection represents a challenge due to its complexity and its devastating effect when not treated promptly. We have various diagnostic studies: cultures, ESR, CRP, count of leukocytes, among others but none is specific, it takes more than 30 minutes to complete and require complex infrastructure. In this study we determine the sensitivity and specificity of the leukocyte esterase for detection of an infectious process joint in Mexican population. Material and methods: From November 2015 to April 2016 was obtained synovial fluid from patients with diagnosis of knee infection with or without implant and without infection with degenerative pathology of the knee. It assessed the sample through the COMBI-SCREEN 11SYS leukocyte esterase with reading colorimetric test at two minutes determining positive for infection: two crosses, the remainder of the sample was sent to culture. Results: We perform the test in 64 samples of synovial fluid of knee joint 19 diagnosed with infection and 45 without infection. Was obtained a sensitivity 100%, specificity of 88.24%, PPV 68.42% and PNV 100%, kappa index 0.753 using the program IBM SPSS Statistics 22, Python ver. 2.7. Conclusions: Leukocyte esterase is a fast, economical and effective to detect an infectious process against one inflammatory with high probability of success. This study showed an index of concordance 0.753 Kappa, proving to be reproducible so recommend be implemented in the emergency department at the national level.

Utilidad de la artrografía en la decisión terapéutica en niños con displasia del desarrollo de cadera de tres meses a tres años de edad / Usefulness of the arthrogram in the decision therapy in children with developmental dysplasia of the hip from 3 months to 3 years of age

Resumen: Objetivo: Evaluar la utilidad de la artrografía como herramienta en la decisión terapéutica de pacientes con displasia del desarrollo de cadera (DDC). Material y métodos: 19 niños con diagnóstico de DDC habitual de edad entre tres meses y tres años, sin antecedentes quirúrgicos, Tonis II o III y expediente radiográfico completo. Para cada caso se registró la decisión terapéutica radiográfica y artrográfica por tres observadores independientemente, en el análisis estadístico el estándar fue la cirugía realizada necesaria para lograr una reducción concéntrica y cobertura acetabular adecuada. Resultados: 20 casos, 19 pacientes, de los cuales 18 fueron unilateral y uno bilateral. Fueron 17 niñas (89%) y dos niños (11%). Edad promedio: un año tres meses (de cuatro meses a dos años 11 meses), 11 Tonis II (55%) y nueve Tonis III (45%). El coeficiente de correlación intraclase (CCI) en relación con la decisión terapéutica radiográfica fue de 0.8933 y para la artrografía fue de 0.7205. El CCI de la decisión terapéutica radiográfica en relación con el estándar fue de 0.7933 y para la artrográfica fue de 0.6219. Se confirmó que en los 20 casos revisados la utilidad de la artrografía (CCI 0.6219) es menor que la de las radiografías (CCI 0.7933). La utilidad de la artrografía fue mayor en los pacientes con Tonis II con una edad entre nueve meses y dos años.

Abstract: Objective: To evaluate the utility of arthrography as a tool in therapeutic decision in developmental dysplasia of hip (DDH). Material and methods: 19 children with true DDH with age between three months and three years, without previous surgical treatment, with Tonis II or III, and complete X-rays. For each case; therapeutic decision was registered for X-rays and arthrography by three independent observers, we took like standard, surgery in each patient necessary to obtain a concentric reduction and good acetabular coverage. Results: 20 cases, 19 patients. 18 unilateral, 1 bilateral. They were 17 girls (89%) and 2 children (11%). Average Age: 1 year 3 months (4 months to 2 years 11 months). 11 Tonis II (55%) and 9 Tonis III (45%). The intraclass coefficient of correlation (ICC) in relation to the decision therapeutic radiographic was of 0.8933 and for the arthrography of 0.7205. And ICC of the decision therapeutic radiographic in connection with the standard was of 0.7933 and for the arthrography it was of 0.6219. We confirm that in our 20 cases, the utility of the arthrography (ICC 0.6219), is smaller to the X-rays (ICC 0.7933). The utility of the arthrography was bigger in the patients with Tonis II, and an age between nine months and two years.

Evaluación sicológica en pacientes tratados con fijador externo / Psychological evaluation in patients treated with external fixator

Resumen: Objetivos: Establecer si las complicaciones en el tratamiento, reingresos y reintervenciones están relacionadas con alteraciones sicológicas. Determinar si el tipo, la edad y el tiempo de uso se relacionan con los aspectos sicológicos. Material y métodos: Estudio retrospectivo, observacional y transversal en pacientes tratados con fijador externo en el período comprendido de 2005 a 2010. Se utilizaron expedientes clínicos, pruebas estadísticas χ2 y t de Student con el programa IBM SPSS Statistics versión 24. Resultados: Fijador circular: se observó una p significativa de 0.024 en la relación entre la edad y las alteraciones sicológicas. En cuanto a las complicaciones en relación con las alteraciones sicológicas, se obtuvo una p significativa de 0.048. Fijador monoplanar: la p fue significativa de 0.038 en la relación de reingresos y las alteraciones sicológicas. Discusión: Hay alteraciones sicológicas en los pacientes y familiares que pueden interferir con el apego y las complicaciones. En la literatura se observó que si en el cuestionario inicial hay alteraciones, éstas continuarán igual y generarán mayor agresividad; si no hubo alteraciones iniciales, no habrá cambios. Se identificaron menos efectos sicológicos en pacientes de mayor edad (13-16 años) y mayor ansiedad en pacientes del grupo medio (10-12 años), así como en aquéllos con deformidades residuales. Conclusiones: Es importante la intervención de sicología pre-, trans- y postquirúrgica. Los pacientes de edad media, lo cual corresponde a preadolescencia, presentarán más alteraciones sicológicas, por lo que se recomienda evitar el uso de fijadores en este rango de edad.

Abstract: Objective: To establish whether complications in treatment, readmissions and reinterventions are related to psychological disturbances. To determine if the type, age and time of use are related to psychological aspects. Material and methods: Retrospective, observational and transversal study in patients treated with external fixator in the period from 2005 to 2010. We used clinical records, χ2 statistical tests and Student's t-test with the IBM SPSS Statistics program, version 24. Results: Circular fixator: we observed a significant p of 0.024 in the relations between age and psychological alterations. Regarding the complications and the psychological alterations, we obtained a significant p 0.048. Monoplanar fixator: the difference was significant of 0.038 on the relation between readmissions and psychological alterations. Discussion: There are psychological disturbances in patients and families that may interfere with the treatment and complications. The literature showed that if there are alterations in the initial questionnaire, they will remain equal and generate increased aggressiveness; if there were no initial alterations, there will be no changes. We observed less psychological effects in older patients (13-16 years) and greater anxiety in patients in the medium range (10-12 years), as well as in patients with residual deformities. Conclusions: The psychological intervention is important in the pre-, trans- and postsurgical time. Patients of medium age, which corresponds to preteens, presented more psychological disturbances; therefore, it is recommended to avoid the use of external fixators in this age range.

[Psychological evaluation in patients treated with external fixator]. / Evaluación sicológica en pacientes tratados con fijador externo.

OBJECTIVE: To establish whether complications in treatment, readmissions and reinterventions are related to psychological disturbances. To determine if the type, age and time of use are related to psychological aspects. MATERIAL AND METHODS: Retrospective, observational and transversal study in patients treated with external fixator in the period from 2005 to 2010. We used clinical records, 2 statistical tests and Students t-test with the IBM SPSS Statistics program, version 24. RESULTS: Circular fixator: we observed a significant p of 0.024 in the relations between age and psychological alterations. Regarding the complications and the psychological alterations, we obtained a significant p 0.048. Monoplanar fixator: the difference was significant of 0.038 on the relation between readmissions and psychological alterations. DISCUSSION: There are psychological disturbances in patients and families that may interfere with the treatment and complications. The literature showed that if there are alterations in the initial questionnaire, they will remain equal and generate increased aggressiveness; if there were no initial alterations, there will be no changes. We observed less psychological effects in older patients (13-16 years) and greater anxiety in patients in the medium range (10-12 years), as well as in patients with residual deformities. CONCLUSIONS: The psychological intervention is important in the pre-, trans- and postsurgical time. Patients of medium age, which corresponds to preteens, presented more psychological disturbances; therefore, it is recommended to avoid the use of external fixators in this age range.

OBJETIVOS: Establecer si las complicaciones en el tratamiento, reingresos y reintervenciones están relacionadas con alteraciones sicológicas. Determinar si el tipo, la edad y el tiempo de uso se relacionan con los aspectos sicológicos. MATERIAL Y MÉTODOS: Estudio retrospectivo, observacional y transversal en pacientes tratados con fijador externo en el período comprendido de 2005 a 2010. Se utilizaron expedientes clínicos, pruebas estadísticas 2 y t de Student con el programa IBM SPSS Statistics versión 24. RESULTADOS: Fijador circular: se observó una p significativa de 0.024 en la relación entre la edad y las alteraciones sicológicas. En cuanto a las complicaciones en relación con las alteraciones sicológicas, se obtuvo una p significativa de 0.048. Fijador monoplanar: la p fue significativa de 0.038 en la relación de reingresos y las alteraciones sicológicas. DISCUSIÓN: Hay alteraciones sicológicas en los pacientes y familiares que pueden interferir con el apego y las complicaciones. En la literatura se observó que si en el cuestionario inicial hay alteraciones, éstas continuarán igual y generarán mayor agresividad; si no hubo alteraciones iniciales, no habrá cambios. Se identificaron menos efectos sicológicos en pacientes de mayor edad (13-16 años) y mayor ansiedad en pacientes del grupo medio (10-12 años), así como en aquéllos con deformidades residuales. CONCLUSIONES: Es importante la intervención de sicología pre-, trans- y postquirúrgica. Los pacientes de edad media, lo cual corresponde a preadolescencia, presentarán más alteraciones sicológicas, por lo que se recomienda evitar el uso de fijadores en este rango de edad.

Esterasa leucocitaria como prueba diagnóstica ante un proceso infeccioso articular de rodilla / Leukocyte esterase as a diagnostic tool for an infectious disease of the knee

Resumen: Antecedentes: La infección articular es un reto ortopédico por su complejidad diagnóstica y efectos devastadores al no tratarse oportunamente. Contamos con diversos estudios de diagnóstico: cultivo, VSG, PCR, conteo de leucocitos, entre otros, pero ninguno es preciso, tardan más de 30 minutos en realizarse y requieren de infraestructura compleja. En este estudio determinamos la sensibilidad y especificidad de la esterasa leucocitaria para la detección de un proceso infeccioso articular en población mexicana. Material y métodos: Durante Noviembre de 2015 a Abril de 2016, se obtuvo líquido sinovial de pacientes con diagnóstico de infección articular con o sin implante, y de otros sin infección, con patología degenerativa de rodilla. Se evaluó la muestra mediante el test de esterasa leucocitaria COMBI-SCREEN 11SYS con lectura colorimétrica a los dos minutos; se determinó positivo para infección con dos cruces; el resto de la muestra fue enviado a cultivo. Resultados: Realizamos el test en 64 muestras de líquido sinovial de rodilla, 19 diagnosticadas con infección articular y 45 sin infección. Se obtuvo una sensibilidad de 100%, especificidad de 88.24%, VPP de 68.42% y VPN de 100%; índice de Kappa de .753. Conclusiones: La esterasa leucocitaria es una prueba eficaz para detectar un proceso infeccioso contra uno inflamatorio con alta probabilidad de acierto. Este estudio presentó un índice de concordancia Kappa de 0.753, con lo que demostró ser reproducible, por lo que recomendamos implementarlo en los servicios de urgencias a nivel nacional.

Abstract: Background: Articular infection is an orthopedic challenge due to its difficult diagnosis and devastating results. Various diagnostic studies exist: culture, ESR, CRP, count of leukocytes, among others, but none is specific, they all take more than 30 minutes to complete, and require complex infrastructure. In this study, we determine the sensitivity and specificity of the leukocyte esterase for detection of an infectious process joint in Mexican population. Material and methods: During November 2015 to April 2016, we obtained synovial fluid from two groups of patients: one with a diagnosis of synovial joint infection with or without implant, and the control group, without infection but with degenerative pathology of the knee. We evaluated the sample using the leukocyte esterase test COMBI-SCREEN 11SYS with colorimetric reading at two minutes; two crosses determined positive for infection; the remainder of the sample was sent for culture. Results: We performed the test in 64 samples of synovial fluid, 19 diagnosed with articular infection and 45 without it. We obtained a sensitivity of 100%, specificity of 88.24%, PPV of 68.42%, and NPV of 100%; Kappa index of .753. Conclusions: Leukocyte esterase is an effective test to detect an infectious process against an inflammatory one with a high probability of success. This study presented an index of agreement Kappa of 0.753, proving to be reproducible.

[Leukocyte esterase as a diagnostic tool for an infectious disease of the knee]. / Esterasa leucocitaria como prueba diagnóstica ante un proceso infeccioso articular de rodilla.

BACKGROUND: Articular infection is an orthopedic challenge due to its difficult diagnosis and devastating results. Various diagnostic studies exist: culture, ESR, CRP, count of leukocytes, among others, but none is specific, they all take more than 30 minutes to complete, and require complex infrastructure. In this study, we determine the sensitivity and specificity of the leukocyte esterase for detection of an infectious process joint in Mexican population. MATERIAL AND METHODS: During November 2015 to April 2016, we obtained synovial fluid from two groups of patients: one with a diagnosis of synovial joint infection with or without implant, and the control group, without infection but with degenerative pathology of the knee. We evaluated the sample using the leukocyte esterase test COMBI-SCREEN 11SYS with colorimetric reading at two minutes; two crosses determined positive for infection; the remainder of the sample was sent for culture. RESULTS: We performed the test in 64 samples of synovial fluid, 19 diagnosed with articular infection and 45 without it. We obtained a sensitivity of 100%, specificity of 88.24%, PPV of 68.42%, and NPV of 100%; Kappa index of .753. CONCLUSIONS: Leukocyte esterase is an effective test to detect an infectious process against an inflammatory one with a high probability of success. This study presented an index of agreement Kappa of 0.753, proving to be reproducible.

ANTECEDENTES: La infección articular es un reto ortopédico por su complejidad diagnóstica y efectos devastadores al no tratarse oportunamente. Contamos con diversos estudios de diagnóstico: cultivo, VSG, PCR, conteo de leucocitos, entre otros, pero ninguno es preciso, tardan más de 30 minutos en realizarse y requieren de infraestructura compleja. En este estudio determinamos la sensibilidad y especificidad de la esterasa leucocitaria para la detección de un proceso infeccioso articular en población mexicana. MATERIAL Y MÉTODOS: Durante Noviembre de 2015 a Abril de 2016, se obtuvo líquido sinovial de pacientes con diagnóstico de infección articular con o sin implante, y de otros sin infección, con patología degenerativa de rodilla. Se evaluó la muestra mediante el test de esterasa leucocitaria COMBI-SCREEN 11SYS con lectura colorimétrica a los dos minutos; se determinó positivo para infección con dos cruces; el resto de la muestra fue enviado a cultivo. RESULTADOS: Realizamos el test en 64 muestras de líquido sinovial de rodilla, 19 diagnosticadas con infección articular y 45 sin infección. Se obtuvo una sensibilidad de 100%, especificidad de 88.24%, VPP de 68.42% y VPN de 100%; índice de Kappa de .753. CONCLUSIONES: La esterasa leucocitaria es una prueba eficaz para detectar un proceso infeccioso contra uno inflamatorio con alta probabilidad de acierto. Este estudio presentó un índice de concordancia Kappa de 0.753, con lo que demostró ser reproducible, por lo que recomendamos implementarlo en los servicios de urgencias a nivel nacional.

Influence of the number of daily pills and doses on adherence to antiretroviral treatment: a 7-year study.

WHAT IS KNOWN AND OBJECTIVE: Antiretroviral treatment (ART) is hampered by complicated regimens, high pill burden, drug-drug interactions, and frequent short- and long-term adverse effects, leading to decreased adherence. Over recent years, considerable effort has been directed at developing regimens that are less burdening. We undertook a 7-year retrospective study of the records of 264 HIV-infected subjects enrolled in a pharmaceutical care programme to document the progress made and to study the influence of the number of ART pills and doses on the level of treatment adherence. METHODS: Antiretroviral dispensing records were analysed for the number of pills and doses administered and the ART adherence rate estimated. RESULTS AND DISCUSSION: In 2005, the patients took a mean of 6·2 pills daily (CI 95%: 5·9-6·6), and 92·9% of them were on a twice-a-day (BID) dosage regimen. By 2012, the mean number of pills was reduced to 4·1 (CI 95%: 3·8-4·4), and only 50·9% were on a BID regimen. No statistically significant relation was observed between number of daily pills and doses and ART adherence reached by the patients in any of the analyses performed. WHAT IS NEW AND CONCLUSIONS: There has been a continuous reduction in the number of pills and doses of antiretrovirals taken by individual patients over the last 7 years due largely to the introduction of improved treatments and regimens. More daily pills or doses was not associated with worse ART adherence in our pharmaceutical care programme.

Actualización sobre los efectos de los estiramientos en la lumbalgia: una revisión sistemática / Update on the effects of stretching in low back pain: a systematic review

Objetivo: Analizar la literatura científica actual para conocer los efectos de los estiramientos en pacientes con lumbalgia. Estrategia de búsqueda: La búsqueda se llevó a cabo en enero de 2014 en Medline, CINAHL, Scopus, WOS, LILACS y PubMed. Selección de los estudios: Se obtuvieron un total de 350 artículos publicados entre 2009 y 2014, y aplicando los criterios de inclusión y exclusión, 12 fueron válidos para la revisión. Resultados: En muchos de los artículos seleccionados se realizaron estiramientos de la musculatura de la cadena posterior, en uno de ellos se hizo estiramiento del tejido nervioso, y otro comparó estiramientos musculares con movilización neural. Conclusiones: Los estiramientos, en general, obtienen resultados positivos. La calidad metodológica de los artículos analizados fue baja, por lo que serían necesarios más estudios de mejor calidad y con tamaños de muestra más amplios que verificasen los buenos resultados

Objective: To analyze the current scientific evidence to know the effects of stretching in patients with low back pain. Research strategy. The research was carried out in January 2014 using Medline, CINAHL, Scopus, WOS, LILACS and PubMed. Study selection: A total of 350 papers, published between 2009 and 2014, were review. Of these, 12 were finally selected for review after applying the inclusion and exclusion criteria. Results: Stretching of posterior muscle chain was done in many of the articles. In one article, the nervous tissue was stretched, and in another, muscle stretching was compared with neural mobilization. Conclusions: In general, stretching resulted in positives results. The methodological quality of the papers analyzed was low. Therefore, more studies with better quality and larger samples sizes are needed to verify the good results

Experimental and computational models of neurite extension at a choice point in response to controlled diffusive gradients.

OJECTIVE: Axons are guided toward desired targets through a series of choice points that they navigate by sensing cues in the cellular environment. A better understanding of how microenvironmental factors influence neurite growth during development can inform strategies to address nerve injury. Therefore, there is a need for biomimetic models to systematically investigate the influence of guidance cues at such choice points. APPROACH: We ran an adapted in silico biased turning axon growth model under the influence of nerve growth factor (NGF) and compared the results to corresponding in vitro experiments. We examined if growth simulations were predictive of neurite population behavior at a choice point. We used a biphasic micropatterned hydrogel system consisting of an outer cell restrictive mold that enclosed a bifurcated cell permissive region and placed a well near a bifurcating end to allow proteins to diffuse and form a gradient. Experimental diffusion profiles in these constructs were used to validate a diffusion computational model that utilized experimentally measured diffusion coefficients in hydrogels. The computational diffusion model was then used to establish defined soluble gradients within the permissive region of the hydrogels and maintain the profiles in physiological ranges for an extended period of time. Computational diffusion profiles informed the neurite growth model, which was compared with neurite growth experiments in the bifurcating hydrogel constructs. MAIN RESULTS: Results indicated that when applied to the constrained choice point geometry, the biased turning model predicted experimental behavior closely. Results for both simulated and in vitro neurite growth studies showed a significant chemoattractive response toward the bifurcated end containing an NGF gradient compared to the control, though some neurites were found in the end with no NGF gradient. SIGNIFICANCE: The integrated model of neurite growth we describe will allow comparison of experimental studies against growth cone guidance computational models applied to axon pathfinding at choice points.

Oxygen non-stoichiometry phenomena in Pr1-xZrxO2-y compounds (0.02 < x < 0.5).

New Pr1-xZrxO2-y oxides with x < 0.5 have been prepared by co-precipitation in basic medium and annealed under air at high temperatures (T≤ 1200 °C). Defined compositions with x = 0.02, 0.1, 0.2, 0.35, 0.40 and 0.5 have been characterized by XRD, Zr-K-edge EXAFS for the local structure, magnetic susceptibility measurements, and Pr LIII-edge XANES in order to identify the variation of the cell parameter and Zr local environment versus Zr content and Pr(n+) (4 < n < 3) oxidation states. The higher the Zr content, the lower the Pr valence state. The Zr amount stabilized in the distorted octahedral site is at the origin of the formation of defined compositions as discovered by Leroy Eyring et al. in the PrnO2n-2m series and the generation of oxygen vacancies stabilized in the fluorite-type network. TGA and TPR analyses help to follow the reduction properties under Ar/5% H2 and show high Pr reducible rates at low temperatures (T < 250 °C). The identification of the fluorite-type superstructure (SG: Ia3[combining macron]) of reduced compositions annealed at T = 900 °C under Ar/5% H2 shows the cationic and oxygen vacancy ordering. This feature plays a key role with Zr(4+) cations stabilized in flattened octahedral sites for the generation of oxygen vacancies and the stabilization of Pr(3+) in the reduced states.

Los abuelos de aa memoria en aguablanca (cali, olombia): entre una ciudad agreeste y un campo vueltouutopía / Granparents of mmemory aguablanca (cali, Colombia): etween a city aand a rugged back country utopia / Os avós da memoria em aguablanca (cali, Colômbia): entre uma cidae agreste e um campo que virou utopia

La exclusión social y cultural de las personas víctimas del desplazamiento forzado en Colombia obedece a la negación del conflicto por parte de la sociedad, que pareciera sentirse más cómoda con el ejercicio de una ética ciudadana indiferente ante el dolor. Una indiferencia que contribuye al irrespeto hacia los derechos humanos e impide la creación de escenarios sociales consensuados e incluyentes, como lo propone la bioética. La metodología utilizada se basó en el acompañamiento a un grupo focal, compuesto por doce abuelos afrocolombianos, habitantes del distrito de Aguablanca (Cali), desplazados del Pacífico colombiano. Esta metodología se complementó con entrevistas de profundidad. El objetivo de la investigación fue comprender cómo los desplazados recuerdan el campo desde la ciudad y, a su vez, contextualizar los relatos del desplazamiento del cual fueron víctimas. En las conclusiones se afirma que el uso de la memoria colectiva favorece la creación de una ética pluralista e incluyente, lo cual ayuda a restituir los derechos violados de la población víctima de desplazamiento forzado.

The methodology used was based in the accompaniment to a focal group, formed by twelve afro-Colombian grandparents, who live in Aguablanca district (Cali), displaced from the Colombian Pacific. This methodology was complemented with in-depth interviews. The objective of this investigation was to understand how internally displaced people remember the countryside from the city and, at the same time, contextualize the stories of the displacement that they suffered. In the conclusions is confirmed that the use of the collective memory benefits the creation of a pluralistic and inclusive ethics, which helps in the restitution of the violated rights of the internally displaced people.

A exclusão social e cultural das pessoas vítimas do deslocamento forçado na Colômbia é devido à negação do conflito por parte da sociedade, o que parece se sentir mais confortável com o exercício de uma ética cidadania indiferente perante a dor. Uma indiferença que contribui para desrespeitar os direitos humanos e impede a criação de cenários sociais consensuais e inclusivos, como a bioética propõe. A metodologia utilizada baseou-se no acompanhamento de um grupo de foco, composto por doze avós afro-americanos, moradores do distrito Aguablanca (Cali), deslocados do Pacífico colombiano. Esta metodologia foi complementada por entrevistas em profundidade. O objetivo da pesquisa foi compreender como os deslocados, desde a cidade, se lembram do campo e, por sua vez, conseguir contextualizar as histórias do deslocamento do qual foram vítimas. Nas conclusões afirmou-se que o uso da memória coletiva favorece a criação de uma ética pluralista e inclusiva, que ajuda a restaurar os direitos violados da população vítima do deslocamento forçado.

Aplicación de un modelo de acompañamiento docente para la instalación e implementación curricular (MADIIC) Facultad de Medicina de la Universidad de Chile / Applying a model of accompaniment for teaching Installation and curricular implementation (MADIIC) Faculty of Medicine University of Chile

Curricular innovation at the University of Chile Faculty of Medicine carries a considerable challenge to teaching practice and to all the “actors” involved in the educational process. It is essential to create the right conditions to perform the desired improvements; therefore, keeping this in mind, from the year 2012 we began to apply a model of Teachers’ Accompaniment, favouring their reflection capabilities through out a collaborative and participatory process for proper installation and implementation of the innovation process.

Pharmacogenetic analysis of SNPs in genes involved in the pharmacokinetics and response to lopinavir/ritonavir therapy.

Despite the known benefits and the experienced use of lopinavir/ritonavir (LPV/r) in the management of HIV infection, important interindividual variability in the pharmacokinetics (PKs) and the response to treatment with standard doses of this drug has been observed. Host genetic factors have been recently suggested as being responsible for part of this variability as they may affect the expression and functional activity of many proteins involved in the kinetic behavior, the immune recovery or the adverse effects related to LPV/r. Here, we present a genetic association study in 106 HIV-infected individuals collected over a period of 5 years with the aim of identifying and confirming single nucleotide polymorphisms (SNPs) with a significant influence on the PK parameters of LPV/r, the immunovirological response or toxicity derived from treatment with the studied drug. Genotyping was performed by MALDI-TOF and KASPar; LPV/r plasma concentrations were quantified using high-performance liquid chromatography with an ultraviolet detection system and the PK parameters were estimated using Bayesian algorithms. Genetic association analysis was performed with SPSS. The most significant associations were found between SNPs in the dopamine receptor D3 gene and the PK of LPV/r. Additionally, other suggestive relationships were established between genetic factors and the response during treatment with this drug. Thereby, identifying HIV-infected individuals who are at increased risk of achieve non-optimal LPV/r plasma concentrations with the emergence of toxicity, drug resistance or absence of clinical response could be helpful as a tool to optimize the LPV/r-based antiretroviral therapy.