Treatment of Patients with Recently Exacerbated Schizophrenia with Paliperidone Palmitate: A Pilot Study of Efficacy and Tolerability.

BACKGROUND: Paliperidone palmitate is a long-acting, second-generation antipsychotic (SGA) indicated for the treatment of acute exacerbations and maintenance treatment of adults with schizophrenia. This study addressed the response to paliperidone palmitate in Latin American patients with acute symptoms and recently diagnosed schizophrenia. OBJECTIVE: Explore the efficacy and tolerability of paliperidone palmitate administered once a month for 4 months in patients with acute phase and recent diagnosis (within 1-6 years) of schizophrenia in 3 Latin American countries. METHODS: This was a non-randomized, open-label, multicenter study with paliperidone palmitate injected intramuscularly in the deltoid muscle at an initial loading dose of 150 mg eq. (234 mg) on day 1 and 100 mg eq. (156 mg) on day 8 (± 4 days). The recommended maintenance dose was 75 mg eq. (117 mg) from day 36 to day 92. Efficacy was evaluated with PANSS and CGI-S. The last observation carried forward (LOCF) was used for efficacy analysis for imputation of missing data; no adjustments were made for multiplicity. Adverse events were evaluated during treatment. RESULTS: The patient retention rate was 84.0% (144 patients received study drug; 121 finished the study). The percentage of patients with a reduction of at least 30% in PANSS total score compared to baseline gradually increased during the study, and at the end, 78.4% of patients showed response. The PANSS total score and CGI-S scores decreased significantly from baseline to LOCF endpoint (P <0.0001 for both); significant reduction in PANSS total score was observed at day 8 and persisted to the end of the study. Most common adverse events were muscle rigidity (11.8%), akathisia (11.1%), injection-site pain (7.6%), weight gain (7.6%), and insomnia (7.6%). CONCLUSION: Paliperidone palmitate was efficacious in Latin American patients studied with an acute exacerbation and recent diagnosis of schizophrenia, and no new safety signals were identified.

Effectiveness of water-saving technologies during early stages of restoration of endemic Opuntia cacti in the Galápagos Islands, Ecuador.

Restoration of keystone species is a primary strategy used to combat biodiversity loss and recover ecological services. This is particularly true for oceanic islands, which despite their small land mass, host a large fraction of the planet's imperiled species. The endemic Opuntia spp. cacti are one example and a major focus for restoration in the Galápagos archipelago, Ecuador. These cacti are keystone species that support much of the unique vertebrate animal community in arid zones, yet human activities have substantially reduced Opuntia populations. Extreme aridity poses an obstacle for quickly restoring Opuntia populations though water-saving technologies may provide a solution. The aim of this study was to evaluate current restoration efforts and the utility of two water-saving technologies as tools for the early stages of restoring Opuntia populations in the Galápagos archipelago. We planted 1,425 seedlings between 2013 and 2018, of which 66% had survived by the end of 2018. Compared with no-technology controls, seedlings planted with Groasis Waterboxx® water-saving technology (polypropylene trays with water reservoir and protective refuge for germinants) had a greater rate of survival in their first two-years of growth on one island (Plaza Sur) and greater growth rate on four islands whereas the "Cocoon" water-saving technology (similar technology but made of biodegradable fiber) did not affect growth and actually reduced seedling survival. Survival and growth rate were also influenced by vegetation zone, elevation, and precipitation in ways largely contingent on island. Overall, our findings suggest that water-saving technologies are not always universally applicable but can substantially increase the survival and growth rate of seedlings in certain conditions, providing in some circumstances a useful tool for improving restoration outcomes for rare plants of arid ecosystems.

Importancia de las alteraciones genéticas del mieloma múltiple / Importance of the genetic alterations of multiple myeloma

Introducción: El mieloma múltiple (MM) es una enfermedad que va precedida por una fase previa conocida como gammapatía monoclonal de significado incierto (GMSI); en esta última existen varias anormalidades citogenéticas, que permiten la progresión a MM, entre estas encontramos reordenamientos primarios del gen de la cadena pesada de la inmunoglobina (IGH), además de células hiperdiploides. Desarrollo: Las alteraciones cromosómicas en el MM se pueden clasificar en dos grupos principales: las que involucran las translocaciones del locus IGH ubicado en el cromosoma 14q32 y cuyos principales reordenamientos se dan entre las regiones cromosómicas 11q13, 16q23, 4p16.3, 6p21 y, un segundo grupo caracterizado por los desequilibrios genómicos. Los pacientes con translocaciones de la IGH, muestran un pronóstico diferente en dependencia del tipo de reordenamiento cromosómico. La t(4;14)(p16;q32) y t(14;16)(q32;q23) se asocian a un mal pronóstico, mientras que los pacientes con t(11;14) (q13;q32) tiene un buen pronóstico de la enfermedad en ausencia de otras anormalidades genéticas. En el grupo con desequilibrio genómico se encuentran deleciones, amplificaciones, y células con números anormales de cromosomas (hiperdiploidas y no hiperdiploides); casi siempre asociadas a mal pronóstico ya que muchas de estas alteraciones involucran perdida de material genómico relacionado con el control de ciclo celular y progresión de la enfermedad, como son las deleciones de los cromosomas 1,13 y 17. Los pacientes con trisomías de los cromosomas impares 1, 3, 5, 7, 9, 11, 15, 19,21 suelen tener un mejor pronóstico y una tasa mayor de sobrevivencia(AU)

Introduction: Multiple myeloma (MM) is a disease that is preceded by a previous phase known as monoclonal gammopathy of uncertain significance (MGUS); in this latter there are several cytogenetic abnormalities, which allow the progression to MM, among these we find primary rearrangements of the heavy chain gene of the immunoglobin (IGH), in addition to hyperdiploid cells. Development: Chromosomal alterations in MM can be classified into two main groups, those involving the translocations of the IGH locus located on chromosome 14q32 and whose main rearrangements occur between the chromosomal regions 11q13, 16q23, 4p16.3, 6p21, and a second group which is characterized by genomic imbalances. Patients with translocations of the IGH, show a different prognosis depending on the type of chromosomal rearrangement, the t(4; 14)(p16; q32) and t(14; 16)(q32; q23) are associated with a poor prognosis while patients with t(11; 14)(q13; q32) have a good prognosis of the disease in the absence of other genetic abnormalities. Within the genomic imbalances we find deletions, amplifications, and cells with abnormal numbers of chromosomes (hyperdiploids and not hyperdiploid), these almost always associated with poor prognosis since many of these alterations involve loss of genomic material related to cell cycle control and progression of the disease, such as deletions of chromosomes 1,13 and 17. Patients with trisomies of odd chromosomes 1, 3, 5, 7, 9, 11, 15, 19,21 usually have a better prognosis and a higher survival rate(AU)

Impacto de un modelo de gestión de enfermedad en una población con tratamiento de diálisis en Colombia / Impact of a disease management model on a population undergoing dialysis in Colombia

Resumen Introducción. La implementación de modelos de gestión de enfermedad (MGE) ha demostrado mejores desenlaces en salud. Objetivo. Describir la tasa de hospitalización y mortalidad en una cohorte de pacientes con tratamiento de diálisis en la que se implementó un MGE. Materiales y métodos. Estudio de cohorte prospectivo en el que se incluyeron pacientes prevalentes en diálisis, mayores de 18 años, pertenecientes a la entidad promotora de salud del régimen contributivo Nueva EPS y con al menos tres meses de intervención con MGE en la red Renal Therapy Services (RTS) entre el 1 de enero y el 31 de diciembre de 2014. Para el análisis se usaron modelos multivariables de supervivencia y estadística descriptiva. Resultados. Se evaluaron 2 525 pacientes; la mediana de edad fue 64.5 años (RIC=19), el 56.9% (n=1 437) estaban en hemodiálisis, el 59.5% (n=1 503) fueron hombres y se encontró una tasa de hospitalización de 1.15 eventos por paciente/año (IC95%: 1.10-1.19) con 9.6 días hospitalarios paciente/año. La tasa de mortalidad fue de 146 muertes por 1 000 pacientes/año (IC95%: 130.3-163.6). Conclusión. A pesar de la alta comorbilidad observada en esta población en diálisis intervenida con un MGE, se encontraron desenlaces clínicos favorables.

Abstract Introduction: The implementation of disease management models (DMM) has shown better health outcomes. Objective: To describe hospitalization and mortality rates in a cohort of patients on dialysis in which a DMM was implemented. Materials and methods: Prospective cohort study in which prevalent dialysis patients, older than 18 years of age, belonging to the health promoter of the contributory scheme (Nueva EPS), and with at least three months of intervention with DMM, were included in the Renal Therapy Services Network (RTS) between January 1 and December 31, 2014.To conduct the multivariate analysis, survival models and descriptive statistics were used. Results: 2 525 patients were evaluated; median age was 64.5 years (IR=19); 56.9% (n=1 437) were on hemodialysis; 59.5% (n=1,503) were male, and a hospitalization rate of 1.15 events per patient/year was found (95% CI: 1.10-1.19) with 9.6 hospital patient days/year. The mortality rate was 146 deaths per 1 000 patients/year (95% CI: 130.3-163.6). Conclusion: Despite the high comorbidity observed in the population undergoing dialysis managed with DMM, favorable clinical outcomes were found.

Galápagos land iguana (Conolophus subcristatus) as a seed disperser.

The role of the most common land iguana (Conolophus subcristatus) in the Galápagos Islands as an effective seed disperser is explored in this study. A total of 5705 seeds of 32 plant species were identified from 160 scats, 4545 of which (80%) appeared visually undamaged. Germination trials of 849 seeds from 29 species revealed that at least 10 species remained viable after passing through the iguana's gut, although only a small proportion of those seeds (4%) germinated. In any case, we argue that C. subcristatus exerts an important role on the 7 Galapagos islands where it occurs because of its abundance and capacity to ingest and disperse seeds at long distances. Our results strongly suggest that the Galápagos C. subcristatus plays an important role as a seed disperser of not only of native species but also some introduced plants in the Galápagos Islands.

Inicio de diálisis y mortalidad en una población con enfermedad renal crónica en Colombia / Dialysis initiation and mortality in a program for chronic kidney disease prevention in Colombia

Antecedentes. La enfermedad renal crónica (ERC) se asocia con una alta morbimortalidad. En todo el mundo, se han desarrollado programas preventivos con el fin de afrontar tal enfermedad, que han resultado eficaces para lograr mejores desenlaces clínicos. En Colombia, una red de centros clínicos renales comenzó un programa preventivo secundario donde los pacientes de ERC reciben cuidado multidisciplinario con el objetivo de controlar la mortalidad y retrasar el inicio de diálisis. Objetivo. Determinar la frecuencia de inicio de diálisis y mortalidad en un grupo de adultos con ERC avanzada y evaluar qué variables clínicas y demográficas se asocian con estos desenlaces. Materiales y métodos. Estudio de cohorte retrospectiva en el que se evaluaron 511 pacientes con ERC en estadios 3 a 5, admitidos en un programa de prevención entre abril 2010 y mayo 2013. Se calcularon tasas de densidad de incidencia. La asociación entre los factores clínicos y demográficos con los desenlaces se evaluó usando regresión de Cox. Resultados. Los 551 pacientes evaluados contribuyeron con 1199 años-riesgo; tuvieron una mediana de 6 visitas durante el seguimiento. Del total de pacientes, 301 (54.6%) fueron mujeres; la media de edad fue de 75.8 años; las principales causas de ERC fueron hipertensión en 431 pacientes (78.2%) y diabetes en 101 (18.3%). En el momento de ingreso al estudio, la mediana de tasa de filtración glomerular (TFG) fue de 40.9 ml/min/1.73m² y la de índice de masa corporal (IMC) fue de 22.9 kg/m². La tasa de inicio de diálisis fue 2.1 por 100 pacientes-año; se observó que otras causas de ERC (diferentes a hipertensión) y la diabetes predicen mayor riesgo de dicho desenlace; por el contrario, una mayor TFG y una mayor edad, menor riesgo. La tasa de mortalidad fue 2.9 por 100 pacientes-año, los mejores predictores encontrados para este desenlace fueron TFG, IMC y sexo masculino; la elevación de la TFG y del IMC están asociadas con menor riesgo.La tasa de mortalidad fue mayor que la tasa de inicio de diálisis. Conclusión. Una mayor TFG disminuye el riesgo para ambos desenlaces; a diferencia de otros estudios, la edad avanzada parece ser predictor de bajo riesgo de mortalidad y no fue un buen predictor de inicio de diálisis.

Background. Chronic kidney disease (CKD) has been associated with high mortality rate. Preventive programs have been developed to face the burden of this disease worldwide. These programs have proved efficient at achieving better outcomes. In Colombia, a renal facilities network began a secondary preventive program where CKD patients receive multidisciplinary care aimed at controlling mortality and delaying initiation of dialysis. Objective. To determine the frequency of dialysis initiation and mortality in a group of patients older than 18 with advanced CKD, and to evaluate demographic and clinical factors associated with these outcomes. Materials and Methods. In a retrospective cohort study, we evaluated 511 patients with advanced CKD stages 3 to 5, admitted in a preventive program between April 2010 and May 2013. Incidence density rates were calculated. Associations between clinical and demographic factors and outcomes were tested using Cox regression. Results. A total of 551 patients contributed with 1199 years-in-risk; they had a median of 6 visits during follow-up. Out of the total of patients, 301(54.6%) were female; mean age was 75.8 years; main causes of CKD were hypertension for 431 patients (78.2%) and diabetes for 101 (18.3%). Baseline median of glomerular filtration rate (GFR) was 40.9 ml/min/1.73m² and body mass index (BMI) was 22.9 kg/m². Rate of initiation of dialysis was 2.1 per 100 patient-years; other causes of CKD (different to hypertension) and diabetes were better predictors for this outcome; higher GFR and older age were associated with low risk of dialysis initiation. The mortality rate was 2.9 per 100 patient-years; high GFR and high BMI were predictors of low risk for this outcome. The mortality rate was higher than the rate of dialysis initiation. Conclusions. This data confirms that higher GFR results in lower risk for both outcomes, unlike other reports, older age seems to indicate a low risk of mortality, and was not a good predictor for dialysis initiation.

Bird-flower visitation networks in the Galápagos unveil a widespread interaction release.

Owing to food scarcity and to the high densities that vertebrates often reach on islands, typical insect- and seed-eaters widen their feeding niche and interact with a greater fraction of species than their mainland counterparts. This phenomenon, coined here 'interaction release', has been previously reported for single species but never for an entire community. During 4 years, we gathered data on bird-flower visitation on 12 Galápagos islands. We show that all sampled land birds exploit floral resources and act as potential pollinators across the entire archipelago, in all major habitats and all year round. Although species and link composition varies among islands, strong interaction release takes place on all islands, making their bird-flower network highly generalized. Interaction release is crucial to the survival of native birds but simultaneously threatens the unique biodiversity of this archipelago, as the birds also visit invading plants, likely facilitating their integration into pristine native communities.

Caracterización de factores pronósticos en pacientes con linfoma B difuso de células grandes / Characterization of prognostic factors to diagnosis of patients with diffuse large B cell lymphoma

Objetivo: describir los factores pronósticos demográficos, clínicos, hematológicos, inmunohistoquímicos y bioquímicos al diagnóstico de pacientes con linfoma B difuso de células grandes y su asociacióncon la severidad según el Índice Pronóstico Internacional en un Hospital Universitario, 2009-2012. Métodos: se realizó un estudio descriptivo en 40 pacientes con dicho linfoma. Se comparó laconcentración de β2 microglobulina con los factores pronósticos que componen el IPI y otros que nohacen parte; se determinó la asociación entre el IPI e IPI revisado y la concentración de β2 microglobulina,infiltración medular, masa voluminosa y expresión de BCL-2 y Ki-67. La información se analizó en SPSS. Resultados: 40% de los pacientes pertenecían al grupo de riesgo alto según el IPI y 55% al grupocon pronóstico pobre según el IPI revisado; 82.5% expresaron BCL-2 y 61.5% tenían un Ki-67>70%.Se observó asociación entre la β2 microglobulina y el Ann Arbor (p=0.036), la β2 microglobulina y lainfiltración medular (p=0.003), y la β2 microglobulina y el IPI revisado (p=0.037). Conclusiones: es probable que el tiempo transcurrido entre la aparición de los síntomas y eldiagnóstico haya favorecido que los pacientes se presentaran en estados avanzados de la enfermedady como consecuencia, con un pronóstico pobre. Así mismo, el estudio de la infiltración medular, elporcentaje de expresión de Ki-67 y la concentración de β2 microglobulina favorece a la identificaciónde pacientes con un pronóstico adverso. (Acta Med Colomb 2014: 39: 137-147).

Objective: to describe demographic, clinical, hematological, and immunohistochemical and biochemical prognostic factors to the diagnosis of patients with diffuse large B cell lymphoma and itsassociation with the severity according to the International Prognostic Index in a University Hospital,2009-2012. Methods: a descriptive study was conducted in 40 patients with this lymphoma. β2 microglobulinconcentration was compared with prognostic factors that compose the IPI and others which are not part of it; the association between IPI and revised IPI and β2 microglobulin concentration, bone marrow infiltration, bulky mass and expression of BCL -2 and Ki p-67 was determined. Data was analyzed in SPSS. Results: 40% of the patients were in the high risk group according to IPI and 55% to the group with poor prognosis according to the revised IPI; 82.5% expressed BCL-2 and 61.5% had a Ki-67 > 70%. Association between β2 microglobulin and Ann Arbor (p = 0.036), the β2 microglobulin and bone marrow infiltration (p = 0.003), and β2 microglobulin and revised IPI (p = 0.037) was observed. Conclusions: it is likely that the time between onset of symptoms and diagnosis has favored tha patients presented in advanced stages of the disease and as a result, with a poor prognosis. Likewise, the study of bone marrow infiltration, the percentage of Ki-67 expression and the concentration of β2 microglobulin favors the identification of patients with an adverse prognosis. (Acta Med Colomb 2014: 39: 137-147).

Impacts of climate variability and human colonization on the vegetation of the Galápagos Islands.

A high-resolution (2-9 year sampling interval) fossil pollen record from the Galápagos Islands, which spans the last 2690 years, reveals considerable ecosystem stability. Vegetation changes associated with independently derived histories of El Niño Southern Oscillation variability provided evidence of shifts in the relative abundance of individual species rather than immigration or extinction. Droughts associated with the Medieval Climate Anomaly induced rapid ecological change that was followed by a reversion to the previous state. The paleoecological data suggested nonneutral responses to climatic forcing in this ecosystem prior to the period of human influence. Human impacts on the islands are evident in the record. A marked decline in long-term codominants of the pollen record, Alternanthera and Acalypha, produced a flora without modern analogue before 1930. Intensified animal husbandry after ca. 1930 may have induced the local extinction of Acalypha and Alternanthera. Reductions in populations of grazing animals in the 1970s and 1980s did not result in the return of the native flora, but in invasions by exotic species. After ca. 1970 the trajectory of habitat change accelerated, continuously moving the ecosystem away from the observed range of variability in the previous 2690 years toward a novel ecosystem. The last 40 years of the record also suggest unprecedented transport of lowland pollen to the uplands, consistent with intensified convection and warmer wet seasons.

Frugivory and seed dispersal in the Galápagos: what is the state of the art?

The Galápagos are considered a model oceanic archipelago, with unique flora and fauna currently threatened by alien invasive species. Seed dispersal is an important ecosystem function with consequences for plant population dynamics and vegetation structure. Hence, understanding the seed dispersal abilities of the assemblages of frugivores will inform scientists and managers of the dynamics of plant invasions and improve management planning. Here we provide the first comprehensive review of published information on frugivory and animal seed dispersal in the Galápagos. We collected data from a variety of sources, including notes of the first naturalist expeditions, gray literature available only in Galápagos collections, and peer-reviewed journal articles. Plant-animal frugivorous interactions were retrieved from 43 studies and compiled into an interaction matrix describing 366 unique interactions. Most studies focused on fruit consumption as a driving force for natural selection, but seed fate was seldom considered. Although most (71%) of the interactions involved native plants, more than one-quarter (28%) involved introduced species. Interactions involving birds are considerably more common than those of reptiles and mammals, probably reflecting a research bias towards birds. Despite the historical importance of the archipelago as the laboratory for evolutionary and ecological research, understanding of its seed dispersal systems is limited. We end the review by suggesting 3 priority areas of research on frugivory and seed dispersal in the Galápagos: (i) target research to close knowledge gaps; (ii) the use of a network approach to frame seed dispersal at the community level; and (iii) evaluation of the effect of seed dispersal as a selective pressure acting upon plants and frugivores. Finally, the output of this research has to be properly delivered to the Galápagos National Park Services to help increase management effectiveness.

t(8;21) (q22;q22) acute myelogenous leukemia in Mexico: a single institution experience.

We analyze the prevalence and clinical features of a group of patients with t(8;21) (q22;q22) acute myeloblastic leukemia, identified in a single institution in México over a 10-year period. Fifteen patients presented at the Centro de Hematología y Medicina Interna de Puebla from February 1995 to August 2005; only nine were treated and followed in the institution. Median age was 24 years, (range 7-49); there was only one male. According to the French-American-British (FAB) morphological classification of leukemia, the morphology was M2 in four cases, M4 in three cases, M3 in one case and M0 in one. In addition to the myeloid markers, lymphoid markers were identified in 6 patients. Patients were induced to remission with combined chemotherapy and three subsequently underwent bone marrow transplantation (BMT). The median overall and disease-free survival has not been reached, being above 3390 days, the probability of survival at this time was 73%. In this single-center experience in México, we found that the t(8;21) (q22;q22) variant of leukemia was more frequent than in Caucasian populations, that the co-expression of lymphoid markers in the blast cells is very frequent and that this malignancy is associated with a relatively good prognosis.

Analgesia obstétrica: ¿Una práctica deseable? / Obstetric analgesia: a desiderable practice

El propósito de la revisión es describir los mecanismo y efectos relacionados con el dolor durante el trabajo de parto, así como evaluar las ventajas y efectos secundarios de la analgesia peridural, como una de las primeras alternativas en el manejo del dolor en obstetricia

Trasplante simultaneo de rinon y pancreas en la Clinica San Pedro Claver del ISS / Simultaneous kidney and pancreas transplantation in Clinica San Pedro Claver del ISS

Se informa sobre los tres primeros casos de trasplante simultaneo de rinon-pancreas en la Clinica San Pedro Claver del ISS. Se presentan los criterios de seleccion de los pacientes y se discuten la valoracion pretrasplante del receptor, la tecnica quirurgica utilizada, las soluciones con las que se preservaron los organos, las complicaciones que se presentaron y los resultados obtenidos en cuanto a sobrevida del injerto y del paciente. Se concluye que el trasplante simultaneo de rinon-pancreas controla efectivamente los niveles de glicemia en los diabeticos insulinodependientes y que este procedimiento es una alternativa eficaz en el tratamiento de la diabetes mellitus tipo I con nefropatia a pesar de que aun es prematuro evaluar la evolucion de los danos previos al trasplante producidos por esta grave entidad nosologica

Trasplante renal en la Clinica San Pedro Claver / Renal transplantation in Clinica San Pedro Claver

Se presenta la experiencia de los primeros 40 trasplantes renales de la Clinica San Pedro Claver, que junto con otros 14 pacientes trasplantados en otros centros, han seguido siendo controlados por el mismo grupo de trabajo. Se muestran las principales pautas del protocolo de tratamiento de los pacientes y se analizan los resultados obtenidos desde el punto de vista de rechazo, necrosis tubular aguda, complicaciones y sobrevida del injerto y de los pacientes

Embarazos precoces en el Hospital de Constitución año 1982-1985 / Early pregnancies in the Hospital de Constitución: year 1982-1985

Se hizom un estudio retrospectivo de 4 años en 128 embarazadas precoces en el Hospital de Constituición que corresponde a un 4,2% de los partos, la edad más frecuente de embarazo está en los 15 y 16 años, con un 50, 4% de solteras y un 39,4% de casadas. Un 67% del grupo tienen educación básica cursado o en curso. De las 128 pacientes la mayoría estaba ccon buen estado nutricional al momento del parto y llegaron a su parto de término. Las complicaciones durante el embarazo son poco frecuente y al 100% de los R.N. llegarn en buenas condiciones de salud al término del embarazo