[On-line pornography and minors. Diagnosis, challenges and proposals]. / Pornografía on-line y menores. Diagnóstico, desafíos y propuestas.

The consumption of pornography over the Internet by minors has been increasing exponentially in recent years. The use of digital technologies and the ease of access to these contents are causes that explain this event. Simultaneously, there is concern about the increase in sexual violence, associated with discriminatory behavior, despite the efforts of laws and programs that promote sexual reproductive health (SRH) and the principle of equality. From a bioethical point of view, it is urgent to address this issue, which affects the physical and psychological health of minors and their affective-sexual education. The study addresses whether it is possible to relate the consumption of online pornography by minors and sexual violence. To do this, legal sources, reports from associations, audiovisual councils and scientific studies are consulted. In all of them, the relationship between the consumption of online pornography by adolescents and risky behavior in emotional-sexual matters and gender inequality is evident. In the legal and fiscal sphere, it is alerted to the damage that is occurring and points out the need to propose lines of action that reverse this situation. We propose measures to technically regulate access to content. These measures are based on the precautionary principle, a tool that has been applied in fields such as health and the environment. More studies and political actions are needed to make the Internet a safe place for minors.

Oral Pyogenic Granuloma: A Narrative Review.

Pyogenic granuloma (PG) is a benign vascular lesion found predominantly in the oral cavity. Characterized by rapid growth and propensity to bleed, PG presents diagnostic challenges due to its similarity and alarming proliferation. This narrative review synthesizes current knowledge on the epidemiology, etiopathogenesis, clinical manifestations, and management of oral PG, with emphasis on recent advances in diagnostic and therapeutic approaches. The epidemiology of the injury is meticulously analyzed, revealing a higher incidence in women and a wide range of ages of onset. It delves into the etiopathogenesis, highlighting the uncertainty surrounding the exact causal factors, although historical attributions suggest an infectious origin. It exhaustively analyzes the clinical and histopathological aspects of oral PG, offering information on its various presentations and the importance of an accurate diagnosis to guide effective treatment. It details treatment strategies, emphasizing the personalized approach based on individual patient characteristics. This comprehensive review consolidates current knowledge on oral PG, highlighting the need for further research to clarify its pathogenesis and optimize treatment protocols.

A Randomized Controlled Trial to Evaluate the Impact of an Exercise Therapy Program Based on Sports in People with Acquired Brain Injury: Discover Study Protocol.

INTRODUCTION: Acquired brain injury (ABI) constitutes a significant and growing global public health concern. People with ABI often face a range of physical and psychosocial challenges that span the domains of "body structure and function", "activity", and "participation", as defined by the International Classification of Functioning, Disability, and Health. Multidisciplinary approaches based on exercise therapy with social leisure activities are essential to improve physical recovery and health-related quality of life after injury. METHODS: Adults with ABI, aged > 18 years, in the subacute or chronic stage (within more than one month after the injury) will be recruited through a rehabilitation center. Adults will be randomized to receive either a racket sports-based exercise therapy program combined with usual care (sET) or usual care alone (UC) using a random number sequence with a 1:1 allocation ratio. sET intervention consists of an 8-week exercise therapy program focusing on different racket sports skills, 1 h in duration, 2 days/week. It will be delivered by a physiotherapist in tailored, face-to-face, group-based sessions. Primary outcomes will be the health-related quality of life (SF-36) and upper extremity motor function (Fugl-Meyer Assessment-Upper Extremity Scale). DISCUSSION: The study proposes an intervention that combines sports-based exercise therapy with usual care. It aims to determine whether this intervention improves the health-related quality of life and upper limb motor function in adults with ABI compared with usual care alone. The results of this study may have clinical implications for the rehabilitation of this population.

Clinical impact using low-dose mycophenolate mofetil with tacrolimus on infectious, noninfectious complications and acute rejection, in renal transplant: A single hospital experience in Mexico.

Evidence supporting a starting dose of 2 g/day of mycophenolate mofetil (MMF) in combination with tacrolimus (TAC) for renal transplantation (RT) is still limited, but maintaining a dose of <2 g could result in worse clinical outcomes in terms of acute rejection (AR). This study aimed to determine the association between AR and infectious and noninfectious complications after RT with a dose of 1.5 g vs 2 g of MMF. A prospective cohort study was performed with a 12-month follow-up of recipients of RT from living donors with low (1.5 g/day) or standard (2 g/day) doses of MMF. The association between adverse effects and complications and doses of MMF was examined using Cox proportional hazard models, and survival free of AR, infectious diseases, and noninfectious complications was evaluated using the Kaplan-Meier test. At the end of the follow-up, the incidence of infectious diseases was 52% versus 50% (P = .71) and AR was 5% versus 5% (P = .86), respectively. The survival rate free of gastrointestinal (GI) complications requiring medical attention was higher in the low-dose group than in the standard-dose dose (88% vs 45%, respectively; P < .001). The use of 1.5 g/day of MMF confers a reduction in GI complications without an increase in infectious diseases or the risk of AR.

Oral Manifestations Associated with HIV/AIDS Patients.

Oral manifestations are early and important clinical indicators of Human Immunodeficiency Virus (HIV) infection since they can occur in up to 50% of HIV-infected patients and in up to 80% of patients at the AIDS stage (<200 CD4+ T lymphocytes). Oral health is related to physical and mental well-being because the presence of some lesions can compromise dental aesthetics, and alter speech, chewing, and swallowing, thus impacting the quality of life of patients. For this reason, it is necessary to integrate, as part of the medical treatment of HIV-positive patients, the prevention, diagnosis, and control of oral health. It is essential that health professionals have the power to identify, diagnose, and treat oral pathologies through clinical characteristics, etiological agents, and risk factors, both local and systemic. A diagnosis at an early stage of injury allows optimizing and prioritizing oral treatments, especially in acute pathologies, such as gingivitis and necrotizing periodontitis. In this group of patients, the development of strategies for the prevention, control, and reduction of these pathologies must be prioritized in order to reduce morbidity and mortality in this group of patients.

Oral Antiseptics against SARS-CoV-2: A Literature Review.

Dentists are health care workers with the highest risk of exposure to COVID-19, because the oral cavity is considered to be a reservoir for SARS-CoV-2 transmission. The identification of SARS-CoV-2 in saliva, the generation of aerosols, and the proximity to patients during dental procedures are conditions that have led to these health care workers implementing additional disinfection strategies for their protection. Oral antiseptics are widely used chemical substances due to their ability to reduce the number of microorganisms. Although there is still no evidence that they can prevent the transmission of SARS-CoV-2, some preoperative oral antiseptics have been recommended as control measures, by different health institutions worldwide, to reduce the number of microorganisms in aerosols and droplets during dental procedures. Therefore, this review presents the current recommendations for the use of oral antiseptics against SARS-CoV-2 and analyzes the different oral antiseptic options used in dentistry.

In vitro Azole antifungals susceptibility of Candida spp. isolates from HIV-infected patients with periodontitis.

OBJECTIVE: The objective of the present study was to determine the in vitro Azole antifungals susceptibility of Candida spp. strains isolated from HIV-positive patients with periodontitis. METHODS: Oral examination was performed in 500 HIV-positive patients, of which 228 were included in the study for having periodontitis which and separated in two groups based on their TCD4+ T-cells: (A) n = 110 (≤200 CD4+); (B) n = 118 (>200 CD4+). Candida spp. were isolated from the subgingival biofilm and crevicular fluid by seeding on CHROMagar plates and confirmed by endpoint PCR and MALDI-TOF. The susceptibility test in vitro for five antifungals was performed using the disc diffusion method. RESULTS: From the 228 HIV-positive patients with periodontitis, 174 were positive to Candida spp., and 204 isolations were obtained. 138 (67.64%) were C. albicans, and 66 (32.35%) were Candida non-albicans species. The most frequent Candida non-albicans species in order of frequency were C. glabrata with 48 (23.52%), C. tropicalis with 10 (4.9%), C. krusei with 7 (3.43%), and C. dubliniensis with 1 (0.49%). All species presented resistance to any antifungal: 149 to 5-fluorocytosine (73.0%), 149 to fluconazole (73.0%), and 144 to voriconazole (70.7%). Miconazole and econazole presented the highest susceptibility rates with 129 (63.2%) and 130 (63.7%) isolations, respectively. CONCLUSION: The Candida spp. involved in periodontitis of HIV-positive patients have a multi-resistant feature. It is necessary to implement recurrent research regarding the antifungal resistance of the Candida spp. that take part in periodontitis pathogenesis to promote an effective treatment in HIV patients.

On-therapy HBsAg kinetics can predict HBsAg loss after nucleos(t)ide analogues interruption in HBeAg-negative patients. The cup is half full and half empty.

BACKGROUND: Nucleos(t)ide analogues withdrawal may improve HBsAg loss rates. However, conditions to select patients are not well established. AIMS: to evaluate the impact of HBsAg kinetics before treatment interruption on post-treatment response. METHODS: Longitudinal, ambispective study in non-cirrhotic chronic hepatitis B HBeAg-negative patients, analysing on-treatment and post-treatment HBsAg kinetics. On-treatment HBsAg kinetics diagnostic accuracy (AUROC) to identify HBsAg loss was evaluated. RESULTS: 52 HBeAg-negative patients stopped treatment after 8.2 years, and 6 (11.5%) achieved HBsAg loss one year after withdrawal. Multivariate analysis showed that on-treatment HBsAg kinetics was related to HBsAg loss (OR=0.10; 95%CI=0.016-0.632; p = 0.014) with a high diagnostic accuracy (AUROC=0.935). A significant HBsAg decline ≥1 log10 IU/mL showed a positive and negative predictive value of 50% and of 97.6%, respectively. After treatment interruption, HBsAg decline speed (log10 IU/mL/year) accelerated in patients treated >6 years (from -0.06 to -0.20, p<0.05) and remained stable in treated <6 years (from -0.12 to -0.12 p=ns). CONCLUSIONS: On-treatment HBsAg kinetics can predict post-treatment HBsAg loss rate. Half of patients with a significant HBsAg decline can eliminate HBsAg the first year after withdrawal. Post-treatment HBsAg decline is faster not only in patients who lost the HBsAg but also in those who remain HBsAg-positive.

Alimentación, comportamiento de oviposición, ciclo de vida y enemigos naturales de Hamadryas feronia (Nymphalidae) en la Amazonía del Perú / Feeding, oviposition behavior, life cycle, and natural enemies of Hamadryas Feronia (Nymphalidae) in the Peruvian Amazon

Resumen Introducción: Hamadryas feronia feronia, se mimetiza sobre las cortezas de los árboles y suele emitir sonidos al volar que llaman la atención; posee un buen potencial para los bionegocios (exportación, elaboración de artesanías y centros turísticos de crianza). Sin embargo, aún se desconocen sus aspectos biológicos que obstaculizan su crianza en cautiverio. Objetivos: Determinar los aspectos biológicos de alimentación, comportamiento de oviposición, ciclo de vida y los enemigos naturales de Hamadryas feronia feronia L. en San Rafael-Indiana, Loreto, Perú. Métodos: Los muestreos fueron realizados desde enero 2018 a diciembre 2019 en la comunidad de San Rafael, río Amazonas. Los adultos fueron observados durante el día, se registraron sus plantas alimenticias, su comportamiento de oviposición, su ciclo biológico y sus enemigos naturales. El ciclo de vida fue evaluado en el laboratorio, utilizando 20 huevos recientemente depositados en las hojas de su planta hospedera. Resultados: Las larvas de H. feronia feronia se alimentan de las hojas de Dalechampia juruana y los adultos se alimentan de la savia de la corteza de los árboles de Cedrela odorata, Spondias mombin, Uncaria guianensis y de los frutos fermentados de Syzygium malaccense y Pouteria caimito. Los adultos vuelan en días soleados, los machos emiten un fuerte sonido al volar. Las hembras previo a la oviposición revolotean de forma irregular alrededor de su planta hospedera entre las 8.00 y las 14.00 h y depositan sus huevos en el haz y envés de las hojas de forma aislada con mayor frecuencia en el envés (N= 85). La duración del ciclo, desde huevo hasta adulto fue de 28.24 días. El periodo promedio del huevo fue 3.75 ± 0.40 días. La larva pasa por cinco estadíos larvales: el primero duró 3.21 ± 1.03 días, el segundo 2.78 ± 0.73 días, el tercero 2.67 ± 0.77 días, el cuarto 3.22 ± 0.81 días, y el quinto 4.61 ± 0.70 días. El periodo de la prepupa duró 1.33 ± 0.49 días y el de pupa 6.67 ± 0.80 días; los adultos nacieron entre las 10:00 y 11:00 h. Los machos adultos viven en promedio 31.80 ± 3.29 días, la hembra 42.00 ± 2.14 días y sus huevos son parasitados por un microhimenóptero (Scelionidae). Conclusiones: Este estudio permitió conocer los aspectos biológicos de H. feronia feronia identificando sus plantas alimenticias tanto de las larvas como de los adultos, su comportamiento de oviposición, así mismo se ha determinado que tiene un ciclo biológico relativamente corto con un periodo menor de un mes y sus huevos son consumidos por un pequeño Himenóptero que puede obstaculizar su producción. Este trabajo brinda información necesaria para desarrollar la crianza de H. feronia feronia, orientado a su conservación, la educación ambiental y los bionegocios (turismo y artesanía) en la Amazonia peruana.

Abstract Introduction: Hamadryas feronia feronia, which mimics the bark of trees and often makes attention-grabbing sounds when flying, has good potential for bio-business (export, handicrafts and tourist breeding centers). However, its biological aspects are still unknown, which hinder its captive breeding. Objectives: To determine the biological aspects of feeding, oviposition behavior, life cycle and natural enemies of Hamadryas feronia feronia L. in San Rafael-Indiana, Loreto, Peru. Methods: Sampling was conducted from January 2018 to December 2019 in the community of San Rafael, Amazon River. Adults were observed during the day, their food plants, oviposition behavior, biological cycle and natural enemies were recorded. The life cycle was evaluated in the laboratory, using 20 eggs recently deposited on the leaves of their host plant. Results: The larvae of H. feronia feronia feed on the leaves of Dalechampia juruana and the adults feed on the bark sap of Cedrela odorata, Spondias mombin, Uncaria guianensis and the fermented fruits of Syzygium malaccense and Pouteria caimito. Adults fly on sunny days, males emit a loud sound when flying. Females prior to oviposition flit irregularly around their host plant between 8.00 and 14.00 h and deposit their eggs on the upper and underside of leaves in isolation, most frequently on the underside. The duration of the cycle from egg to adult was 28.24 days. The average egg period was 3.75 ± 0.40 days. The larvae passed through five larval instars: the first instar 3.21 ± 1.03 days, the second 2.78 ± 0.73 days, the third 2.67 ± 0.77 days, the fourth 3.22 ± 0.81 days, and the fifth 4.61 ± 0.70 days. The prepupal period lasted 1.33 ± 0.49 days and the pupal period 6.67 ± 0.80 days; the adults hatched between 10:00 to 11:00 h. Adult males lived on average 31.80 ± 3.29 days, the female 42.00 ± 2.14 days and their eggs were parasitized by a microhymenopteran (Scelionidae). Conclusions: This study allowed to know the biological aspects of H. feronia feronia identifying its food plants of both larvae and adults, its oviposition behavior, as well as it has been determined that it has a relatively short biological cycle with a period of less than one month and its eggs are consumed by a small Hymenoptera that can hinder its production. This work provides necessary information to develop the breeding of H. feronia feronia, oriented to its conservation, environmental education and biotrade (tourism and handicrafts) in the Peruvian Amazon.

Cytomegalovirus in renal transplant recipients from living donors with and without valganciclovir prophylaxis and with immunosuppression based on anti-thymocyte globulin or basiliximab.

BACKGROUND: In our population, anti-thymocyte globulin (ATG) of 1 mg/Kg/day for 4 days is used; which permits not using valgancyclovir (VGC) prophylaxis in some renal transplant recipients (RTR) with moderate risk (R+), to reduce costs. This study aimed to determine the incidence and risk of developing cytomegalovirus (CMV), with or without prophylaxis, when exposed to low doses of ATG or basiliximab (BSL). PATIENTS AND METHODS: A retrospective cohort included 265 RTR with follow-up of 12 months. Prophylaxis was used in R-/D+ and some R+. Tacrolimus (TAC), mycophenolate mofetil, and prednisone were used in all patients. Logistic regression analysis was performed to estimate the risk of CMV in RTR with or without VGC. RESULTS: Cytomegalovirus was documented in 46 (17.3%) patients: 20 (43.5%) with CMV infection, and 26 (56.5%) with CMV disease. Anti-thymocyte globulin was used in 39 patients (85%): 32 R+, six D+/R-, and one D-/R-. ATG was used in 90% (27 of 30) of patients with CMV and without prophylaxis. The multivariate analysis showed an association of risk for CMV with the absence of prophylaxis (RR 2.29; 95% CI 1.08-4.86), ATG use (RR 3.7; 95% CI 1.50-9.13), TAC toxicity (RR 3.77; 95% CI 1.41-10.13), and lymphocytes at the sixth post-transplant month (RR 1.77; 95% CI 1.0-3.16). CONCLUSIONS: Low doses of ATG favored the development of CMV and a lower survival free of CMV compared with BSL. In scenarios where resources for employing VGC are limited, BSL could be an acceptable strategy.

Physical Activity and Sport for Acquired Brain Injury (PASABI): A Non-Randomized Controlled Trial.

Background and objectives: Acquired brain injury (ABI) is the first cause of disability and physical activity (PA) is a key element in functional recovery and health-related quality of life (HRQoL) during the subacute and chronic phases. However, it is necessary to develop PA programs that respond to the heterogeneity and needs of this population. The aim of this study was to assess the effectiveness of a PA program on the HRQoL in this population. Materials and Methods: With regard to recruitment, after baseline evaluations, participants were assigned to either the intervention group (IG, n = 38) or the control group (CG, n = 35). Functional capacity, mood, quality of life and depression were measured pre- and post-intervention. The IG underwent the "Physical Activity and Sport for Acquired Brain Injury" (PASABI) program, which was designed to improve HRQoL (1-h sessions, two to four sessions/week for 18 weeks). The CG underwent a standard rehabilitation program without PA. Results: Results for the IG indicated significant differences and large effect sizes for the physical and mental dimensions of quality of life, as well as mood and functional capacity, indicating an increase in HRQoL. No significant differences were found for the CG across any variables. Conclusions: The PASABI program was feasible and beneficial for improving physiological and functionality variables in the IG. The wide range of the activities of the PASABI program allow its application to a large number of people with ABI, promoting health through PA, especially in the chronic phase.

Hepatitis B surface antigen and hepatitis B core-related antigen kinetics after adding pegylated-interferon to nucleos(t)ids analogues in hepatitis B e antigen-negative patients.

BACKGROUND: Hepatitis B e antigen-negative chronic hepatitis B patients under nucleos(t)ids analogues (NAs) rarely achieve hepatitis B surface antigen (HBsAg) loss. AIM: To evaluate if the addition of pegylated interferon (Peg-IFN) could decrease HBsAg and hepatitis B core-related antigen (HBcrAg) levels and increase HBsAg loss rate in patients under NAs therapy. METHODS: Prospective, non-randomized, open-label trial evaluating the combination of Peg-IFN 180 µg/week plus NAs during forty-eight weeks vs NAs in monotherapy. Hepatitis B e antigen-negative non-cirrhotic chronic hepatitis B patients of a tertiary hospital, under NAs therapy for at least 2 years and with undetectable viral load, were eligible. Patients with hepatitis C virus, hepatitis D virus or human immunodeficiency virus co-infection and liver transplanted patients were excluded. HBsAg and HBcrAg levels (log10 U/mL) were measured at baseline and during ninety-six weeks. HBsAg loss rate was evaluated in both groups. Adverse events were recorded in both groups. The kinetic of HBsAg for each treatment group was evaluated from baseline to weeks 24 and 48 by the slope of the HBsAg decline (log10 IU/mL/week) using a linear regression model. RESULTS: Sixty-five patients were enrolled, 61% receiving tenofovir and 33% entecavir. Thirty-six (55%) were included in Peg-IFN-NA group and 29 (44%) in NA group. After matching by age and treatment duration, baseline HBsAg levels were comparable between groups (3.1 vs 3.2) (P = 0.25). HBsAg levels at weeks 24, 48 and 96 declined in Peg-IFN-NA group (-0.26, -0.40 and -0.44) and remained stable in NA group (-0.10, -0.10 and -0.10) (P < 0.05). The slope of HBsAg decline in Peg-IFN-NA group (-0.02) was higher than in NA group (-0.00) (P = 0.015). HBcrAg levels did not change. Eight (22%) patients discontinued Peg-IFN due to adverse events. The HBsAg loss was achieved in 3 (8.3%) patients of the Peg-IFN-NA group and 0 (0%) of the NA group. CONCLUSION: The addition of Peg-IFN to NAs caused a greater and faster decrease of HBsAg levels compared to NA therapy. Side effects of Peg-IFN can limit its use in clinical practice.

Evaluación endocrinológica del paciente con enfermedad nodular tiroidea / Endocrinologic approach to the patient with thyroid nodules

Llamamos nódulo tiroideo a aquella lesión concreta palpable o radiológicamente distinguible del parénquima tiroideo. La enfermedad nodular tiroidea tiene una prevalencia progresivamente creciente a medida que ha mejorado la calidad de las técnicas de imagen, principalmente la ecografía. El objetivo de la presente revisión es señalar cuales son los pasos en la evaluación endocrinológica del paciente con enfermedad nodular tiroidea. Más concretamente, cual es la mejor estrategia coste/efectiva para diagnosticar los nódulos tiroideos malignos. Tras una buena anamnesis y exploración clínica, el estudio se completa con una determinación de TSH y la realización de una ecografía tiroidea, que es la prueba diagnóstica que más criterios aporta para poder hacer la indicación de PAAF. La muestra obtenida se estudiará según el sistema Bethesda

Thyroid nodule is defined as a palpable lesion o radiologically distinguishable from thyroid parenchyma. Its prevalence is increasing with the improvement of the imagine techniques, mainly the ultrasonography. The aim of this review is to indicate the steps for the endocrinology evaluation of the patient with thyroid nodules, particularly to choose the best cost/effective strategy to diagnose the malignant thyroid nodules. After having the anamnesis and physical examination done, a TSH determination and an thyroid ultrasound are needed. The sample obtained will be studied according to the Bethesda system

Tratamiento médico del hipertiroidismo / Medical treatment of hyperthyroidism

El hipertiroidismo es una enfermedad común que afecta a un 0.2 % de la población en Europa. Aun siendo un síndrome, el tratamiento varía dependiendo de la causa. Los mecanismos patogénicos de cada una de las etiologías dictan la selección del tratamiento, siendo el hipertiroidismo un buen modelo de medicina de precisión, por cuanto una vez conocida la patogenia se personaliza el tratamiento. En este capítulo se considera el tratamiento de las causas más comunes como son la enfermedad de Graves-Basedow, el bocio multinodular y adenoma tóxico, causas menos frecuentes que incluyen diverso tipo de tiroiditis y causas raras como los tirotropinomas, e hipertiroidismo por patologías obstétricas y ginecológicas. Para el tratamiento médico de estas condiciones disponemos de un arsenal que incluye drogas antitiroideas, beta-bloqueadores, glucocorticoides, análogos de la somatostatina, agonistas dopaminérgicos, ácido iopanoico e, incluso, agentes antineoplásicos. El tratamiento con radioyodo es objeto de otro trabajo aparte

Hyperthyroidism is a rather common disease that affects 0.2 % of general population in Europe. There are many causes as well as various pathogenic mechanisms inducing a hypersecretion of thyroid hormones. Therefore, treatments are selected for each cause to obtain the highest therapeutic benefit. Is this chapter we consider the treatment of common causes such as Graves-disease, toxic multinodular goiter, toxic adenoma and other more infrequent entities such as several subtypes of thyroiditis and, finally, we briefly comment on rare cases of thyroid hyperfunction

Seguimiento posterapéutico del paciente con carcinoma tiroideo / Post-therapeutic follow-up of thyroid carcinoma

El cáncer de tiroides es la neoplasia endocrina más frecuente. Su incidencia en los últimos años ha aumentado, requiriendo estrategias de vigilancia que garanticen un manejo individualizado y efectivo de los pacientes. El objetivo principal de la siguiente revisión es brindar pautas de seguimiento a corto y largo plazo, guiándonos por una adecuada estratificación de riesgo de los pacientes y reclasificación de su respuesta al tratamiento

Thyroid cancer is the most common endocrine neoplasia. Its incidence in recent years has increased, requiring surveillance strategies that guarantee individualized and effective patient management. The main objective of the following review is to provide short-term and long-term follow-up guidelines, guiding us through adequate stratification of patient risk and reclassification of their response to treatment

Tratamiento médico del hiperparatiroidismo primario / Medical treatment of primary hyperparathyroidism

El diagnóstico de hiperparatiroidismo primario en pacientes sin criterio quirúrgico es cada vez más frecuente. Aunque la evidencia de calidad es escasa en algunos casos, cada vez se dispone de más datos que nos permiten conocer el efecto de los distintos fármacos sobre la calcemia, la afectación ósea y renal en pacientes sometidos a ellos durante periodos prolongados de tiempo

The diagnosis of primary hyperparathyroidism in patients without surgical criteria is increasingly frequent. Although quality evidence is scarce in some cases, last years there are more data available that allow us to know the effect of different drugs on calcemia, bone and kidney involvement in patients undergoing them for prolonged periods of time

Speciation of chromium in waters using dispersive micro-solid phase extraction with magnetic ferrite and graphite furnace atomic absorption spectrometry.

The combination of a solid-phase microextraction process with graphite furnace atomic absorption spectrometry provides a very sensitive determination method for determining chromium in waters. Freshly prepared ferrite particles are used to retain the chromium species, and then separated by a magnet without the need for a centrifugation step. The solid phase is suspended in water and directly introduced into the graphite furnace to obtain the analytical signal. The complexation of Cr(III) with ethylenediaminetetraacetate allows the selective retention of Cr(VI), and thus the speciation of the metal. The procedure is sensitive (0.01 µg L-1 detection limit when using a 10 mL sample aliquot) and reproducible (5% relative standard deviation for five consecutive experiments at the 0.3 µg L-1 level). The reliability of the procedure is verified by analysing five certified water samples.

Thermal and Chemical Treatments To Reduce Salmonella on Alfalfa (Medicago sativa) and Broccoli (Brassica oleracea var. italica) Seeds before and during the Sprouting Process: A Hurdle Approach.

Sprouts are vehicles of foodborne diseases caused by pathogens such as Salmonella. The aim of this study was to evaluate thermal and chemical treatments applied as a hurdle approach to reduce Salmonella in alfalfa (Medicago sativa) and broccoli (Brassica oleracea var. italica) seeds before and during their germination. Seeds, inoculated and then dried at 55°C for 48 h, were subjected to a chemical treatment and a thermal shock with (i) 75 mM caprylic acid at 70°C for 5 s, (ii) 0.04% CaO at 70°C for 5 s, or (iii) 1% H2O2 at 70°C for 5 s. After each treatment, seeds were immersed in water at 3°C for 5 s. Next, the imbibition process was carried out with 0.016% H2O2 at pH 3.0. Finally, the seeds were transferred to a rotary drum-type germinator and were sprayed with the same chemical solution that was applied before the imbibition process, for 20 s at intervals of 5 min for 40 min at 3 rpm. All chemical treatments reduced Salmonella at least 5 log CFU/g on both seeds. Germination rates between 90 and 93% were obtained after application of thermal and chemical treatments. Salmonella was not detected after the imbibition stage when caprylic acid and H2O2 treatments were applied. However, during the germination process of both seeds, Salmonella counts of >6 log CFU/g were obtained despite all treatments being applied at different stages of the sprouting process. These results demonstrated that thermal and chemical treatments used as a hurdle approach to control Salmonella on alfalfa and broccoli seeds significantly reduced the pathogen concentration on seeds >5 log but were ineffective to eliminate Salmonella and to control its growth during the sprouting process. The production of safe sprouts continues to be a major challenge for industry.

Salmonella, Listeria monocytogenes, and Indicator Microorganisms on Hass Avocados Sold at Retail Markets in Guadalajara, Mexico.

Hass avocados may become contaminated with Salmonella and Listeria monocytogenes at the farm and the packing facility or later during transportation and at retail. In Mexico, avocados are frequently sold in bulk at retail markets, where they are stored at room temperature for several hours or days and exposed to potential sources of microorganisms. These conditions may favor the entry, adhesion, survival, and biofilm formation of Salmonella and L. monocytogenes. The aim of this study was to determine the occurrence of Salmonella, L. monocytogenes, and other Listeria species and the levels of indicator microorganisms on the surface of avocados sold at retail markets. A total of 450 samples (Persea americana var. Hass) were acquired from retail markets located in Guadalajara, Mexico. One group of 225 samples was evaluated for the presence of Salmonella and for enumeration of aerobic plate counts, yeasts and molds, Enterobacteriaceae, coliforms, and Escherichia coli. The other 225 samples were processed for isolation of L. monocytogenes and other Listeria species. Microbial counts (log CFU per avocado) were 4.3 to 9.0 for aerobic plate counts, 3.3 to 7.1 for yeasts and molds, 3.3 to 8.2 for Enterobacteriaceae, 3.3 to 8.4 for coliforms, and 3.3 to 6.2 for E. coli. Eight samples (3.5%) were positive for Salmonella. Listeria spp. and L. monocytogenes were detected in 31 (13.8%) and 18 (8.0%) of 225 samples, respectively. Listeria innocua, Listeria welshimeri, and Listeria grayi were isolated from 7.6, 1.3, and 0.9% of samples. These results indicate that avocados may carry countable levels of microorganisms and could be a vehicle for transmission of Salmonella and L. monocytogenes.

Hospital productivity bias when not adjusting for cost heterogeneity: The case of Spain.

This research quantifies the bias caused in hospital productivity measurements when cost heterogeneity is not considered. A multi-output stochastic cost frontier under a normalised translog specification is used to approximate the structure of technology of a sample of public general hospitals in Spain during the period 2002-2009. To control for observable heterogeneity in costs, a set of variables related to hospital characteristics are included in the cost frontier specification (i.e., hospital complexity, degree of specialisation, availability of outpatient clinics, variety of high-technology equipment available, teaching activity and quality of care), whereas unobservable heterogeneity is accounted for by means of individual dummy variables. A measure of hospitals' cost efficiency is first obtained, and the analysis is then completed by measuring and decomposing the total factor productivity index (TFP-I) change. Findings reveal that controlling for heterogeneity decreases total productivity from an annual average rate of 0.028% to 1.330%, mainly driven by the negative contribution of the cost efficiency change component. Hence, a bias of 1.303 percentage points in the overall TFP-I is found as consequence of not controlling for heterogeneity. In addition to this, if heterogeneity factors are not accounted for, the mean cost efficiency index during the period analysed is 0.730, figure that increases up to 0.974 if heterogeneity is considered. Hence, the omission of heterogeneity leads to a bias of 24.4 percentage points in the mean cost efficiency. Therefore, not adjusting for heterogeneity in costs gives rise to distorted measurements of hospital productivity, as well as distortions in the contribution of each of its components, which may lead to the adoption of inadequate policies and decisions on resource allocation.