Chytrid infections exhibit historical spread and contemporary seasonality in a declining stream-breeding frog.

Species with extensive geographical ranges pose special challenges to assessing drivers of wildlife disease, necessitating collaborative and large-scale analyses. The imperilled foothill yellow-legged frog (Rana boylii) inhabits a wide geographical range and variable conditions in rivers of California and Oregon (USA), and is considered threatened by the pathogen Batrachochytrium dendrobatidis (Bd). To assess drivers of Bd infections over time and space, we compiled over 2000 datapoints from R. boylii museum specimens (collected 1897-2005) and field samples (2005-2021) spanning 9° of latitude. We observed a south-to-north spread of Bd detections beginning in the 1940s and increase in prevalence from the 1940s to 1970s, coinciding with extirpation from southern latitudes. We detected eight high-prevalence geographical clusters through time that span the species' geographical range. Field-sampled male R. boylii exhibited the highest prevalence, and juveniles sampled in autumn exhibited the highest loads. Bd infection risk was highest in lower elevation rain-dominated watersheds, and with cool temperatures and low stream-flow conditions at the end of the dry season. Through a holistic assessment of relationships between infection risk, geographical context and time, we identify the locations and time periods where Bd mitigation and monitoring will be critical for conservation of this imperilled species.

Technical position on milk and its derivatives in adult health and disease from the Asociación Mexicana de Gastroenterología and the Asociación Mexicana de Gerontología y Geriatría. / Posición técnica sobre la leche y derivados lácteos en la salud y en la enfermedad del adulto de la Asociación Mexicana de Gastroenterología y la Asociación Mexicana de Gerontología y Geriatría.

Milk is a liquid food that possesses an important quantity of highly bioavailable macronutrients. In addition, it is readily accessible, as well as relatively inexpensive. Given that the knowledge of physicians about nutrition and food composition is deficient, in general, many of the dietary interventions recommended in diverse clinical settings lack a scientific basis. The aim of the present review was to produce a technical opinion that serves as a frame of reference to best sustain recommendations for consuming milk and dairy products as daily nutrition in the adult and older adult. The effects of milk and dairy products during the pediatric stage are not addressed in the present work. The Asociación Mexicana de Gastroenterología and the Asociación Mexicana de Gerontología y Geriatría jointly discussed and analyzed topics dealing with the legal designation of milk, the classification and nutritional profile of cow's milk, its nutritional characteristics, its consumption in the adult, intolerance to cow's milk, and associations of milk consumption with digestive tract alterations and other conditions. Finally, certain aspects of milk consumption in the older adult and its relation to overall health are briefly discussed.

Qat Chewing and Risk of Potentially Malignant and Malignant Oral Disorders: A Systematic Review.

BACKGROUND: Qat (also known as Khat, Kat and Miraa) is a green-leaved plant (Catha edulis). It is a shrub indigenous to Yemen and certain parts of eastern Africa. Chewing the leaves, which have sympathomimetic and euphoric effects, has been documented in many countries and increased with worldwide migration. The effect of long-term chewing Qat on the oral cavity is unknown. OBJECTIVE: A systematic review was performed to identify any associations between Qat chewing and the occurrence of potentially malignant and malignant oral disorders. METHODS: Medline and the Web of Science were searched for articles published before May 2014 without limits with regard to publication date and language. RESULTS: From a total of 890 papers identified, 17 English papers reported potentially malignant or malignant oral disorders and Qat chewing. One additional paper in Arabic language was identified from reviewing the list of references of eligible papers. It was found that exposure to Qat may be associated with potentially malignant and malignant oral disorders, but methodological issues, such as inadequate study design, sample size, selection of study subjects, clinical evaluations of outcome and limited adjustment for confounders, limit the strength of the evidence base in this area. CONCLUSION: The association between Qat chewing and potentially malignant and malignant oral disorders remains debatable and requires further investigations.

HLA-DQ genetic risk gradient for type 1 diabetes and celiac disease in northwestern Mexico.

BACKGROUND: Type 1 diabetes (T1D) and celiac disease (CD) are the 2 most common autoimmune childhood diseases that share their HLA-DQ2 and DQ8 genetic origin. There has currently been an increase in both diseases worldwide. In children from the low-population State of Sonora (15 inhabitants/km(2)) in north-western Mexico, there is no information on their genetic risk or the distribution of the related alleles in the general population. AIMS: To compare the HLA-DQ allele frequency in a representative sample of newborns from Sonora with that of T1D and CD patients to determine the risk gradient, and to identify the presence of celiac autoimmunity in the T1D group. METHODS: The study included 397 Sonoran newborns, with 44 cases of T1D, and 25 CD cases. The CD and T1D cases were clinically diagnosed by specialists at the Hospital Infantil del Estado de Sonora, and the autoantibodies were determined by ELISA. Whole blood was collected, gDNA was extracted, and HLA-DQ2 and DQ8 were typed by PCR-SSP. The risk gradient was calculated by comparing the allele frequencies of the cases with those of the newborns. RESULTS: The Sonoran HLA-DQ risk heterodimer proportion was 16.1% for HLA-DQ2 and 13.6% for HLA-DQ8, with an HLA-DQ2:HLA-DQ8 ratio of 1.2:1. The DQ8/DQ2 genotype represented a 1:14 risk for T1D, whereas the DQ8/DQB1*0201 combination showed a 1:6 risk for CD. The prevalence of CD autoimmunity in T1D children was 7%. CONCLUSION: The Sonoran population has a distinctive HLA-DQ allele distribution due to its ancestry. The HLA-DQ8 combinations with DQ2 or one of its alleles conferred the highest risk for both diseases, and T1D and CD frequently appear together.

COPD-related morbidity and mortality after smoking cessation: status of the evidence.

The evidence base for the benefit of quitting smoking as regards morbidity and mortality outcomes in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) is limited. The present article is a review of the existing literature. A systematic literature search in medical databases was performed until March 2006, and subsequently until September 1, 2007. The outcomes examined were COPD-related morbidity and mortality (including all-cause mortality) in COPD patients in connection with smoking cessation. A total of 21 and 27 published articles on morbidity and mortality, respectively, were identified and reviewed. For both outcomes, only a few of the studies included patients with severe COPD. Most of the studies reported a beneficial effect of smoking cessation compared with continued smoking, whereas a few found no improvement. Methodological problems, including small study sizes, poor data quality, possibility of reverse causality and incomplete ascertainment of cause of death, limit interpretation of some of the studies. The evidence as a whole supports the conclusion that, even in severe chronic obstructive pulmonary disease, smoking cessation slows the accelerated rate of lung function decline and improves survival compared with continued smoking.

Comparación de la eficacia analgésica de codeína más paracetamol vs tramadol en el tratamiento del dolor por cáncer / Comparison of the analgesic effectiveness of codeine plus paracetamol vs tramadol in the treatment of cáncer pain

Pain is the principal symptom in 70% of patients with severe cáncer. Analgesics therapy with a proper management controls pain in 80-90% of patients. Objective. Compare the analgesic efficacy and tolerability of codeine plus acetaminophen (CA) and tramadol clorhydrate (T) in the relief of cáncer pain. Method. A double blind, randomize controlled clinical trial was perform in patients with modérate to severe pain intensity. Randomly patients were assigned in a group for receiving codeine plus acetaminophen and in other group for receiving tramadol chlorhydrate for a three weeks period. Pain intensity was measure using a numeric scale from zero to ten in which modérate pain goes from 5-7, and severe pain goes from 8-10. Analgesic treatment was considered to be effective when pain disappear or become mild, 1-4 in the numeric scale. Results. One hundred fifteen patients participated, 59 receive CA and 56 T. In the group of patients that receive CA, 58% achieved pain relief with the initial dose of 150 mg/d and 8% responded to the double dose; 34% didn't experience pain relief. In the group patients treated with T pain relief occurred in 62% of patients with the initial dose of 200mg/d and 11% with the double dose; 27% didn't experienced pain relief. Differences between both groups were not significant in the analgesic efficacy. The tramadol group experienced in a significant way a higher incidence of adverse events of mild intensity: nausea (p: 0.05, RR: 0.62; IC95%: 0.38-1.01), dizziness (p: 0.04; RR: 0.58; IC95%: 0.33-1.01) and lost of appetite (p: 0.001; RR: 0.08; IC95%: 0.01-0.59). Conclusion. Efficacy of C and T during a treatment of 23 days was similar, no statistical differences were found. There were no differences in the analgesic effectiveness between CA and T in the management of cáncer pain. With the use of T a higher incidence of adverse events of mild intensity were reported (AU)

El dolor es el síntoma más importante en 70% de pacientes que padecen cáncer avanzado. La terapia con analgésicos utilizada en forma adecuada, controla el dolor en 80-90% de los pacientes. Objetivos. Comparar la eficacia analgésica y seguridad de la codeína más acetaminofén (CA) y Clorhidrato de Tramadol (T) en el alivio del dolor por cáncer. Método. Se realizó un ensayo clínico controlado doble ciego, en pacientes con dolor por cáncer de intensidad moderada o severa. En forma aleatoria se asignó un grupo de pacientes para ser tratados con la combinación de Codeína más paracetamol, mientras que el otro grupo recibió Clorhidrato de Tramadol por un periodo de tres semanas. La intensidad del dolor fue medida con una escala numérica de cero a diez, considerándose como dolor de intensidad moderada el marcado en la escala entre 5-7 y de intensidad severa de 8-10. El tratamiento analgésico se consideró eficaz cuando el dolor desapareció o disminuyó a una intensidad leve, comprendida entre 1-4. Resultados. Se incluyeron 115 pacientes: 59 recibieron CA y 56 recibieron T. En el grupo de pacientes que recibió CA 58% aliviaron con una dosis inicial de codeína de 150 mg/día y 8% con la dosis doblada; 34% no aliviaron. En el grupo de pacientes tratado con T el dolor alivió en 62% de los pacientes con la dosis inicial de 200mg/día y 11% con la dosis doblada, mientras que 27% no experimentó alivio. Las diferencias entre los dos grupos no fueron significativas en cuanto a su eficacia analgésica. El grupo que recibió Tramadol presentó en forma significativa, mayor incidencia de efectos colaterales de intensidad leve: náusea (p: 0.05, RR: 0.62; IC95%: 0.38-1.01), mareo (p: 0.04; RR: 0.58; IC95%: 0.33-1.01) y pérdida de apetito (p: 0.001; RR: 0.08; IC95%: 0.01-0.59). Conclusión. No existen diferencias en cuanto a la eficacia analgésica de CA y T en el tratamiento del dolor por cáncer. Con el uso de T se presentó una mayor incidencia de efectos colaterales de intensidad leve

Cancer control in women. Update 2003.

The global cancer burden in women appeared to be increasing quickly at the end of the twentieth century with notable increases in the absolute numbers of cases of breast, cervix, lung and colorectal cancer of concern. However, prospects for cancer control in women appear to be good within our current knowledge and deserve close attention. Rates of lung cancer in women are increasing substantially in many countries and seem set to overtake breast cancer as the commonest form of cancer death in women in many parts of the world. These changes are due to the effects of cigarette smoking, a habit which women widely embraced during the second half of the last century. The high levels of smoking current in young women, which have yet to have their full inpact on death rates, constitute an important hazard not only for future cancer risks but for several other important causes of death. Although the breast is the commonest form of cancer in women in most western countries, the etiology of this disease remains elusive and preventable causes remain to be identified. Endogenous hormones also appear to have a role in cancer risk in women: oral contraceptives seem to increase slightly the risk of breast cancer in users in the use, and in the immediate post-use, period, but ten years after cessation the risk returns to that of never users. Oral contraceptive usage also appears to be protective against ovarian and endometrial cancer. The use of Hormonal Replacement Therapy (HRT) appears to increase the risk of endometrial cancer and a positive association with breast cancer risk appears to exist. Within the current knowledge of the epidemiology of cancer in women, the most important Cancer Control strategy is the prevention of cigarette smoking and the increase in the prevalence of adult women quitting smoking. Screening has also shown to be effective in reducing incidence and mortality of cervix cancer and mortality from breast and colorectal cancer. Although more work is needed, it is becoming clear that there could be an important role of HPV testing to further enhance cervix cancer screening.

Fluoro-deoxi-glucose uptake and angiogenesis are independent biological features in lung metastases.

Neoangiogenesis and enhanced glucose metabolism in neoplasms are likely to be activated by the same biochemical stimulus; hypoxia. A correlation between these two parameters has been postulated. The objective of this study was to evaluate the relationship between Fluoro-desoxi-glucose uptake at positron emission tomography scan and angiogenesis in lung metastasis. Fluoro-desoxi-glucose activity, expressed as a standard uptake value, and microvessel intratumoural density, were retrospectively calculated in a series of 43 lung metastasis resected in 19 patients. Primary sites were colorectal cancer in 16 metastases, sarcoma in eight, gynaecological in four and other sites in 15. The correlation between the two parameters was tested by logistic regression and multivariate analysis. Positron emission tomography scan was positive in 17 patients (sensitivity 89%). No correlation was observed between standard uptake value and microvessel intratumoural density in this series of lung metastasis. Positron emission tomography negative and positive nodules presented comparable value of microvessel intratumoural density (12.9 vs 11.3). Standard uptake value was significantly correlated with nodules size and was higher in colon cancer metastasis than in sarcoma ones. Microvessel intratumoural density was independent from nodule size but significantly higher in sarcoma than in colon cancer metastasis. The lack of correlation was confirmed by multivariate analysis after adjustment for tumour type and nodules size. The present study demonstrated that positron emission tomography scan is positive in a high proportion of patients regardless of microvessel density. Glucose uptake and angiogenesis appear to be independent biological features in lung metastasis. This observation may have implications for future antiangiogenic therapies.

Rabdomiólisis, insuficiencia renal aguda (ira) y empleo combinado de cerivastatina con gemfibrozil. Una nueva evidencia

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Low morbidity of bronchoplastic procedures after chemotherapy for lung cancer.

OBJECTIVE: To evaluate if induction chemotherapy, with or without irradiation, represents an additional risk factor for early and late morbidity and perioperative mortality in bronchoplastic procedures for lung cancers. METHODS: From January 1998 to January 2001, 27 patients underwent a bronchial sleeve resection after induction treatment at the European Institute of Oncology in Milan. They represent 7% of lung cancer resections (387) and 27% of those performed after neoadjuvant treatment (100 cases). Histology was: 17 epidermoid carcinoma, 8 adenocarcinoma and 2 SCLC. Twenty-four patients (89%) received a preoperative cisplatin based polichemotherapy, and three cases (11%) a chemo-radiation therapy. A right sleeve lobectomy or bilobectomy was undertaken in 21 patients (78%) and a left lobectomy in 6 (22%). A resection of tracheal carina was associated in three cases and a vascular resection in 10 (five vena cava and five pulmonary artery). Twelve patients (44%) received adjuvant mediastinal irradiation. Perioperative morbidity of the study group (group 1) was compared with that of patients submitted to sleeve resection without neoadjuvant treatment (group 2), or standard pneumonectomy after induction treatment (group 3). RESULTS: There were no postoperative deaths. A major perioperative complication occurred in two patients (7%) of group 1, one patient of group 2 (3.5%), and four in group 3 (17%). Among patients of the study group, no anastomotic dehiscence or pleural empyema were observed. Only one late anastomotic stricture occurred after postoperative radiation treatment. No significant difference in early and late complication rate was found between the three groups of patients. High rate of complete resection was achieved (93%) in patients of the study group and extent of nodal dissection was similar between sleeve resections and pneumonectomy patients. CONCLUSIONS: Preoperative chemotherapy or combination of chemo-radio therapy is not associated with an additional risk of anastomotic complications in bronco and angioplastic procedures. Parenchyma sparing resection is a valid option for selected patients with locally advanced lung cancer after induction treatment. A longer follow up is necessary to evaluate efficacy of the procedure in term of survival and local control.

El diagnóstico de alcoholismo en estudiantes de medicina un enfoque transhispanoamericano: México, Colombia, Perú (Lima y Cuzco) y Ecuador / Diagnosis of alcoholismo in students of medicine: A transhispanic-american approach: México, Colombia, Perú (Lima and Cuzco) and Ecuador

Mediante el inventario de evaluación sussmilch (IES), previamente validado y confiabilizado, se estableció una diferencia significativa entre la teoría y la realidad de la calidad de la información publicada (1967-1999). Esto señala que esos resultados no pueden generalizarse ni dentro ni fuera de las muestras de estudiantes, también de medicina. En contraste, con base en el principio de que resultados negativos también son resultados, en este ejercicio de demostró empíricamente que los resultados obtenidos representan bien a las muestras de estudiantes que fueron admitidos a cinco facultades de medicina hispanoamericana (FMH). Se desarrolló el indice de alcoholismo de pregrado (IAPG) integrado por cuatro (ó cinco) reactivos con respuestas dicotómicas, capaces de discernir, con error conocido, entre estudiantes de medicina no-alcohólicos (NOH), sospechosos (SOH) y alcohólicos (OH). El perfil psicométrico del IAPG exhibió una equivalente entre las Facultades de Medicina de la Universidad Nacional Autónoma de México (UNAM), Universidad Nacional de Colombia (UNC), Universidad Peruana Cayetano Heredia(UPCH), universidad Nacional de San Antonio Abad del Cuzco (UNSAAC) y Universidad de Cuenca(UC).

Anatomy of the central nervous system.

OBJECTIVES: To provide an overview of central nervous system anatomy. DATA SOURCES: Published books and articles. CONCLUSIONS: Classification of tumors, location of primary and metastatic tumors, and initial and progressive symptoms are best understood within a solid knowledge base of neuroanatomy. IMPLICATIONS FOR NURSING PRACTICE: It is essential for nurses caring for neuro-oncology patients to be familiar with normal central nervous system anatomy. This knowledge will enable them to anticipate symptoms, response to treatment, and prognosis for recovery. Understanding of the effects of central nervous system tumors on the function of the central nervous system will help nurses provide holistic care to both patients and significant others.