Hg and As pollution in the soil-plant system evaluated by combining multispectral UAV-RS, geochemical survey and machine learning.

The combination of a low-density geochemical survey, multispectral data obtained with Unmanned Aerial Vehicle-Remote Sensing (UAV-RS), and a machine learning technique was tested in the search for a statistically robust prediction of contaminant distribution in soil and vegetation, for zones with a highly variable pollutant load. To this end, a novel methodology was devised by means of a limited geochemical study of topsoil and vegetation combined with multispectral data obtained by UAV-RS. The methodology was verified in an area affected by Hg and As contamination that typifies abandoned mining-metallurgy sites in recent decades. A broad selection of spectral indices were calculated to evaluate soil-plant system response, and four machine learning techniques (Multiple Linear Regression, Random Forest, Generalized Boosted Models, and Multivariate Adaptive Regression Spline) were tested to obtain robust statistical models. Random Forest (RF) provided the best non-biased models for As and Hg concentration in soil and vegetation, with R2 and rRMSE (%) ranging from 0.501 to 0.630 and from 180.72 to 46.31, respectively, and with acceptable values for RPD and RPIQ statistics. The prediction and mapping of contaminant content and distribution in the study area were well enough adjusted to the geochemical data and revealed superior accuracy for As than Hg, and for vegetation than topsoil. The results were more precise than those obtained in comparable studies that applied satellite or spectrometry data. In conclusion, the methodology presented emerges as a powerful tool for studies addressing soil and vegetation pollution and an alternative approach to classical geochemical studies, which are time-consuming and expensive.

Situación de los cuidados intensivos en España / Intensive care in Spain

No disponible

Use of micafungin as antifungal prophylaxis in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) in Spain (GETH-MIC).

OBJECTIVE: The fungal infections remain an important problem in the allogeneic stem cell trasnsplantation (allo-SCT) setting and thus, anti-fungal prophylaxis is commonly used. The antifungal drug should offer activity, at least against Candida and Aspergillus spp., a good safety profile and low probability interactions. Micafungin could theoretically fulfill these requisites. The aim of the study was to describe the experience with micafungin as primary prophylaxis in patients undergoing allo-SCT in a cohort of Spanish centres, and to evaluate its efficacy and tolerability in this population. METHODS: Retrospective multicentre observational study including all consecutive adult patients admitted for allo-SCT in participating centres of the Grupo Español de Trasplante Hematopoyético (GETH), from January 2010 to December 2013, who received micafungin as primary prophylaxis during the neutropenic period. RESULTS: A total of 240 patients from 13 centres were identified and 159 patients were included for the analysis. Most patients (95.6%) received 50 mg/day of micafungin. During the follow-up, 7 (4.4%) patients developed breakthrough invasive fungal disease, 1 proven and 6 probable; one patient discontinued the drug because of serious drug interactions. Prophylaxis with micafungin was considered effective in 151 (94.9%) patients. CONCLUSIONS: According to our experience, micafungin is an appropriate alternative for antifungal prophylaxis in patients undergoing an allo-HSCT, because its efficacy, its low profile of drug interactions and side-effects.

Pápulas hipopigmentadas en niña sana / Hypopigmented Papules in a Healthy Girl

No disponible

Oxigenación unilobar con fibroscopio durante cirugía de resección pulmonar / Single-lung ventilation with bronchofibroscopy during lung resection surgery

El aislamiento pulmonar mediante ventilación unipulmonar es frecuente en procedimientos de cirugía torácica, ya que permite una mejor visualización y manipulación del pulmón a intervenir. El bloqueo lobar selectivo está descrito en pacientes que no toleran la ventilación unipulmonar y se suele realizar por medio del bloqueador bronquial. Sin embargo, su realización está condicionada por la necesidad de disponer de dicho bloqueador, por la complejidad para su correcta colocación y la necesidad de vigilancia intensiva para asegurar la adecuada colocación del sellado bronquial. En el caso que presentamos hemos aplicado una técnica novedosa para aumentar la superficie de intercambio de oxígeno. Se ha logrado mediante la administración directa de este por el canal del fibrobroncoscopio a uno de los lóbulos no ventilados no objeto de la cirugía. Mediante esta técnica, el cirujano se benefició de un campo quirúrgico óptimo, se mejoró la hipoxemia de la ventilación unipulmonar y no se observó ninguna complicación perioperatoria

Lung isolation using one-lung ventilation is common during thoracic surgery procedures, as it allows proper visualisation and manipulation of the lung to be operated on. Selective lobar blockade has been described in patients that do not tolerate one-lung ventilation, and is usually achieved using endobronchial blockers. However, it depends on endobronchial blocker availability, its complexity regarding proper positioning, and the need for constant monitoring to ensure the correct placement of the bronchial seal. In the clinical case to be described, a new method was used to increase the available surface for oxygen exchange. This was accomplished by means of direct supply of oxygen through the bronchoscope's working channel to one of the not-to-be operated-on, non-ventilated lung lobes. With this technique, the surgeon had an optimal operating field, oxygenation from one-lung ventilation improved and no perioperative complications were found

Single-lung ventilation with bronchofibroscopy during lung resection surgery. / Oxigenación unilobar con fibroscopio durante cirugía de resección pulmonar.

Lung isolation using one-lung ventilation is common during thoracic surgery procedures, as it allows proper visualisation and manipulation of the lung to be operated on. Selective lobar blockade has been described in patients that do not tolerate one-lung ventilation, and is usually achieved using endobronchial blockers. However, it depends on endobronchial blocker availability, its complexity regarding proper positioning, and the need for constant monitoring to ensure the correct placement of the bronchial seal. In the clinical case to be described, a new method was used to increase the available surface for oxygen exchange. This was accomplished by means of direct supply of oxygen through the bronchoscope's working channel to one of the not-to-be operated-on, non-ventilated lung lobes. With this technique, the surgeon had an optimal operating field, oxygenation from one-lung ventilation improved and no perioperative complications were found.

Infectious encephalitis: utility of a rational approach to aetiological diagnosis in daily clinical practice.

In this study we attempt to assess the utility of a simplified step-wise diagnostic algorithm to determinate the aetiology of encephalitis in daily clinical practice and to describe the main causes in our setting. This was a prospective cohort study of all consecutive cases of encephalitis in adult patients diagnosed between January 2010 and March 2015 at the University Hospital Vall d'Hebron in Barcelona, Spain. The aetiological study was carried out following the proposed step-wise algorithm. The proportion of aetiological diagnoses achieved in each step was analysed. Data from 97 patients with encephalitis were assessed. Following a simplified step-wise algorithm, a definite diagnosis was made in the first step in 53 patients (55 %) and in 12 additional cases (12 %) in the second step. Overall, a definite or probable aetiological diagnosis was achieved in 78 % of the cases. Herpes virus, L. monocytogenes and M. tuberculosis were the leading causative agents demonstrated, whereas less frequent aetiologies were observed, mainly in immunosuppressed patients. The overall related mortality was 13.4 %. According to our experience, the leading and treatable causes of encephalitis can be identified in a first diagnostic step with limited microbiological studies. L. monocytogenes treatment should be considered on arrival in some patients. Additional diagnostic effort should be made in immunosuppressed patients.

High expression of cytochrome b 5 reductase isoform 3/cytochrome b 5 system in the cerebellum and pyramidal neurons of adult rat brain.

Cytochrome b 5 reductase (Cb 5R) and cytochrome b 5 (Cb 5) form an enzymatic redox system that plays many roles in mammalian cells. In the last 15 years, it has been proposed that this system is involved in the recycling of ascorbate, a vital antioxidant molecule in the brain and that its deregulation can lead to the production of reactive oxygen species that play a major role in oxidative-induced neuronal death. In this work, we have performed a regional and cellular distribution study of the expression of this redox system in adult rat brain by anti-Cb 5R isoform 3 and anti-Cb 5 antibodies. We found high expression levels in cerebellar cortex, labeling heavily granule neurons and Purkinje cells, and in structures such as the fastigial, interposed and dentate cerebellar nuclei. A large part of Cb 5R isoform 3 in the cerebellum cortex was regionalized in close proximity to the lipid raft-like nanodomains, labeled with cholera toxin B, as we have shown by fluorescence resonance energy transfer imaging. In addition, vestibular, reticular and motor nuclei located at the brain stem level and pyramidal neurons of somatomotor areas of the brain cortex and of the hippocampus have been also found to display high expression levels of these proteins. All these results point out the enrichment of Cb 5R isoform 3/Cb 5 system in neuronal cells and structures of the cerebellum and brain stem whose functional impairment can account for neurological deficits reported in type II congenital methemoglobinemia, as well as in brain areas highly prone to undergo oxidative stress-induced neurodegeneration.

El mesiodens: una patología odontológica que debe tenerse en cuenta / Mesiodens: a dental pathology to consider

Se denomina mesiodens a un diente supernumerario localizado entre los dos incisivos medios superiores o, más raramente, entre los incisivos medios inferiores. Puede producirse en los dos tipos de dentición, pero es mucho más frecuente en la dentición permanente. Clínicamente, se manifiesta por una alteración de la posición o erupción de los incisivos; sólo se manifiesta mediante la erupción del propio mesiodens en un 20-25% de los casos. Su tratamiento suele mejorar el pronóstico de las complicaciones que puede causar, por lo que es conveniente el conocimiento por parte de los pediatras de esta patología para su detección precoz(AU)

A tooth temporary located between the two central superior incisors higher or, more rarely, between the central lower incisors is called mesiodens. It can occur in the two types of teething, but it is much more frequent in the permanent dentition. Clinically it is manifested by an alteration of the position or rash incisors, only manifested through the eruption of mesiodens itself in a 20%-25% of the cases. The treatment may improve the prognosis of the complications that it can cause; the knowledge of the pediatricians of this pathology is appropriate for its early detection(AU)

Neuroprotective actions of flavonoids.

The experimental evidences accumulated during last years point out a relevant role of oxidative stress in neurodegeneration. As anti-cellular oxidative stress agents flavonoids can act either as direct chemical antioxidants, the classic view of flavonoids as antioxidants, or as modulators of enzymes and metabolic and signaling pathways leading to an overshot of reactive oxygen species (ROS) formation, a more recently emerging concept. Flavonoids, a large family of natural antioxidants, undergo a significant hepatic metabolism leading to flavonoid-derived metabolites that are also bioactive as antioxidant agents. The development of more efficient flavonoid's based anti-oxidative stress therapies should also take into account their bioavailability in the brain using alternate administration protocols, and also that the major ROS triggering the cellular oxidative stress are not the same for all neurodegenerative insults and diseases. On these grounds, we have reviewed the reports on neuroprotection by different classes of flavonoids on cellular cultures and model animals. In addition, as they are now becoming valuable pharmacological drugs, due to their low toxicity, the reported adverse effects of flavonoids in model experimental animals and humans are briefly discussed.

Low frequency electromagnetic radiation and hearing.

OBJECTIVE: To analyse the possible impact of low and extremely low frequency electromagnetic fields on the outer hairs cells of the organ of Corti, in a guinea pig model. MATERIALS AND METHODS: Electromagnetic fields of 50, 500, 1000, 2000, 4000 and 5000 Hz frequencies and 1.5 microT intensity were generated using a transverse electromagnetic wave guide. Guinea pigs of both sexes, weighing 100-150 g, were used, with no abnormalities on general and otic examination. Total exposure times were: 360 hours for 50, 500 and 1000 Hz; 3300 hours for 2000 Hz; 4820 hours for 4000 Hz; and 6420 hours for 5000 Hz. One control animal was used in each frequency group. The parameters measured by electric response audiometer included: hearing level; waves I-IV latencies; wave I-III interpeak latency; and percentage appearance of waves I-III at 90 and 50 dB sound pressure level intensity. RESULTS: Values for the above parameters did not differ significantly, comparing the control animal and the rest of each group. In addition, no significant differences were found between our findings and those of previous studies of normal guinea pigs. CONCLUSION: Prolonged exposure to electromagnetic fields of 50 Hz to 5 KHz frequencies and 1.5 microT intensity, produced no functional or morphological alteration in the outer hair cells of the guinea pig organ of Corti.

The partial labyrinthectomy petrous apicectomy approach to petroclival meningiomas. A quantitative anatomic comparison with other approaches to the same region.

The partial labyrinthectomy petrous apicectomy (PLPA) approach is a transpetrous route that provides the advantages of the labyrinthine removal but with hearing preservation. Using seven temporal bone tissue blocks and three formaldehyde-fixed cadaveric heads we have made a morphometric and comparative study on this approach that summarizes the invasiveness, the optimal surgical exposure, the anatomic complexity of the skull base approaches and, on the other hand, the spirit of preservation that is the constant aim of modern neurosurgery. The morphometric analysis is designed to make the bony phase of the PLPA approach safer and to define the relationship between petrous landmarks. The comparative study is made between the PLPA and other neurosurgical routes enhancing the potentiality of the PLPA approach that permits a wider angle of incidence towards the brainstem than with the retrosigmoid routes.

The partial labyrinthectomy petrous apicectomy approach to petroclival meningiomas. A quantitative anatomic comparison with other approaches to the same region

La laberintectomía parcial con apicectomía petrosa (PLPA) es una vía de abordaje que proporciona las ventajas de la extirpación parcial del laberinto preservando la audición. Trabajando sobre 7 piezas anatómicas de hueso temporal y 3 cabezas de cadáver fijadas con formaldehido, hemos realizado un estudio morfométrico y comparativo de este abordaje interesándonos los aspectos de la invasividad del abordaje, óptima exposición quirúrgica obtenida, complejidad anatómica de la entrada a la base craneal, y por otra parte, la actitud conservadora de la moderna neurocirugía. El análisis morfométrico tiene como objetivo hacer la fase ósea de la PLPA más segura al definir la relación entre los puntos de referencia petrosos. El estudio comparativo entre la PLPA y otros abordajes neuroquirúrgicos exalta la posibilidades de la PLPA ya que proporciona un ángulo de incidencia hacia el tronco cerebral más amplio que el que proporcionan las vías retrosigmoideas

The partial labyrinthectomy petrous apicectomy (PLPA) approach is a transpetrous route that provides the advantages of the labyrinthine removal but with hearing preservation. Using seven temporal bone tissue blocks and three formaldehyde-fixed cadaveric heads we have made a morphometric and comparative study on this approach that summarizes the invasiveness, the optimal surgical exposure, the anatomic complexity of the skull base approaches and, on the other hand, the spirit of preservation that is the constant aim of modern neuro surgery. The morphometric analysis is designed to make the bony phase of the PLPA approach safer and to define the relationship between petrous landmarks. The comparative study is made between the PLPA and other neurosurgical routes enhancing the potentiality of the PLPA approach that permits a wider angle of incidence towards the brainstem than with the retro sigmoid routes

Doctor Agustín Encinoso de Abreu y Reyes Gavilán: innovador de la docencia médica en Cuba / Doctor Agustín Encinoso de Abreu y Reyes Gavilán: innovator of the medical teaching in Cuba

Entre los médicos ilustres que ejercieron en La Habana durante la primera mitad del siglo XIX, ocupa un lugar destacado el talentoso y laborioso doctor Agustín Encinoso de Abreu y Reyes Gavilán (1798-1854), una de las más eminentes personalidades de su tiempo por su vasta erudición y espíritu científico. Catedrático de Patología y Fisiología en la Real y Pontificia Universidad de La Habana, fue un verdadero innovador de la docencia médica, pues fue el primero que propuso sustituir al latín como lengua para la enseñanza por el idioma vernáculo, el español. De su actuación como profesor, el último de Prima (Fisiología) en la Universidad, ninguna calificación mejor que la del doctor Ramón Zambrana, quien afirmó que en sus materias, Patología y Fisiología, nunca poseyó La Habana ni voz más persuasiva ni inteligencia más clara y fecunda.1 Fue el profesor más elocuente de cuantos tuvo la Universidad Pontificia y el más audaz en la labor de incorporación de nuevas doctrinas médicas

Doctor Agustín Encinoso de Abreu y Reyes Gavilán: innovador de la docencia médica en Cuba / Doctor Agustín Encinoso de Abreu y Reyes Gavilán: innovator of the medical teaching in Cuba

Entre los médicos ilustres que ejercieron en La Habana durante la primera mitad del siglo XIX, ocupa un lugar destacado el talentoso y laborioso doctor Agustín Encinoso de Abreu y Reyes Gavilán (1798-1854), una de las más eminentes personalidades de su tiempo por su vasta erudición y espíritu científico. Catedrático de Patología y Fisiología en la Real y Pontificia Universidad de La Habana, fue un verdadero innovador de la docencia médica, pues fue el primero que propuso sustituir al latín como lengua para la enseñanza por el idioma vernáculo, el español. De su actuación como profesor, el último de Prima (Fisiología) en la Universidad, ninguna calificación mejor que la del doctor Ramón Zambrana, quien afirmó que en sus materias, Patología y Fisiología, nunca poseyó La Habana "ni voz más persuasiva ni inteligencia más clara y fecunda".1 Fue el profesor más elocuente de cuantos tuvo la Universidad Pontificia y el más audaz en la labor de incorporación de nuevas doctrinas médicas(AU)

Bronquiolitis en el primer mes de vida / Bronchiolitis in the first month of life

Objetivo: Analizar la hospitalización por bronquiolitis durante el primer mes de vida y sus características clínico epidemiológicas. Método: Estudio descriptivo y analítico de los casos de bronquiolitis con edad neonatal (0-30 días), ingresados en nuestro hospital desde 1997 a 2000. Se estudiaron las características epidemiológicas y clínicas, comparándose la necesidad de unidad de cuidados intensivos neonatales (UCIN) y la mortalidad con otra población de lactantes mayores con bronquiolitis. Resultados: Se hospitalizaron 108 niños (15,5 por ciento de las 695 bronquiolitis hospitalizadas). Nacieron intrahospitalarios 93 (8,5 por mil). El 10,1 por ciento del total presentaron bajo peso al nacimiento y el 9,2 por ciento fueron pretérminos. En el 87 por ciento se analizó la presencia de virus respiratorio sincitial (VRS) en moco nasal (positivo: 63,8 por ciento). Se consideraron graves el 21,2 por ciento, moderados: 58,3 por ciento y leves: 20,3 por ciento, precisaron UCIN el 19,4 por ciento, con diferencia significativa con los lactantes de más edad (9,8 por ciento). La estancia media fue de 10 días. No hubo diferencias en la mortalidad. La tasa de infección nosocomial, en la sala de Neonatología para los VRS positivos, fue del 4 por ciento. Conclusiones: La proporción de bronquiolitis para esta edad ha sido mayor que la publicada. Precisaron UCIN en mayor proporción que los lactantes mayores, si bien no se han producido fallecimientos. Su ingreso en la sala neonatal, no ha presentado complicaciones comial) 5. Estadísticamente las variables cuantitativas se han descrito con media y desviación estándar y las variables cualitativas con proporción y se han comparado por el test de Chi2. Significación estadística < 0,05. (AU)