Oncological monitoring after transanal total mesorectal excision (TaTME) for rectal neoplasia.

BACKGROUND: The surgical treatment of choice for rectal neoplasia is total mesorectal excision (TME). The transanal approach enables a better approach in male and obese patients and/or those with a narrow pelvis and in patients with small tumors. Short-term results are comparable with those for laparoscopy or the open approach, but the medium- and long-term oncological data are sparse. The aim of the present study was to evaluate our early experience with transanal TME (TaTME). METHODS: This was a retrospective study conducted on patients who underwent TaTME at our center between August 2013 and April 2017 with a follow-up ≥ 3 years. Histopathology, complications, mortality, neoplastic recurrence and disease-free survival were analyzed. RESULTS: One hundred patients (68 men and 32 women,, median age 66.8 years [range 29.6-91.2 years]) were included. There were 67 T3 cases (67%) with 74 N0 cases (74%), the mesorectal quality was graded optimal for 87.6% and only 2 cases of radial margin involvement were detected (2%). The median follow-up period was 47.6 months (range 11.8-78.9 months). Eighteen cases of recurrence were diagnosed, of which 3 (3%) recurred locally with an average disease-free period of 43.1 months. Overall survival was 80% and mortality due to progression of disease was 13%. CONCLUSIONS: TaTME is a safe surgical procedure with surgical, anatomopathological and oncological results at 3 years (medium-term) comparable with those for the laparoscopic and open approaches. Better monitoring is required with studies of the long-term functional and quality of life outcomes, i.e., at 5 or 10 years.

Eficacia de la magnetoterapia en artrosis erosiva de manos. Un ensayo clínico / Efficacy of magnetotherapy in hand erosive osteoarthritis. A clinical trial

Introducción La artrosis erosiva es una patología infrecuente con tratamiento de escasa eficacia. A pesar de tratarse con magnetoterapia, no existe evidencia para su uso. Los objetivos son evaluar la eficacia de la magnetoterapia en pacientes con artrosis erosiva de manos en cuanto a dolor, comparándola con placebo, y determinar su seguridad. Método Estudio experimental prospectivo, aleatorizado, doble ciego formado por grupo experimental (GI: tratamiento con magnetoterapia, 15 sesiones de 20min 5días/semana consecutivos) y grupo control (GC: placebo). Previo al tratamiento, al final y a los 3meses se evaluó el dolor con Escala Visual Analógica (EVA). Secundariamente, funcionalidad (escala Disabilities of the arm, shoulder and hand [DASH]), rigidez (Índice Kapandji modificado), fuerza de prensión (dinamometría) y calidad de vida (cuestionario SF-36). Resultados De 29 pacientes valorados se excluyeron 10, quedando 19, todas mujeres con una edad media de 59años. Se aleatorizaron 10 al GI y 9 al GC, siendo comparables. Se observó un mayor porcentaje de pacientes en el GI en relación con el GC con control del dolor (EVA<6) postratamiento y a los 3meses (77,8% vs. 33,3%, p=0,1 y 83,3% vs. 33,3%, p=0,2, respectivamente) y una tendencia a disminuir el dolor en el GI a los 3meses (coeficiente de regresión: −2,1 (IC 95%: −5,7-1,5; p=0,2). No hubo más diferencias excepto mayor fuerza de prensión en GI tanto en mano dominante como no dominante (p=0,01 y p<0,05, respectivamente). No se presentaron eventos adversos ni efectos secundarios. Conclusión El tratamiento con magnetoterapia en pacientes con artrosis erosiva de manos es seguro y parece contribuir a una mejora clínica (AU)

Introduction Erosive arthritis is an unusual pathology. Despite using magnetotherapy as a treatment, there is no evidence supporting its use. The aim of the study is to evaluate magnetotherapy efficacy in patients suffering from hand erosive arthritis, compared to placebo, in terms of pain. Treatment safety will be also evaluated. Method Prospective experimental double-blind randomized study consisting of an intervention group (IG: treatment with magnetotherapy: 15 20-minute-sesions 5 consecutive days per week) and a control group (CG: placebo). Treatment efficacy was evaluated at the end and 3 months after. We used Visual Analog Scale (VAS) for assess pain. Secondarily, functionality (The Disabilities of the Arm, Shoulder and Hand (DASH) score), rigidity (Modified Kapandji Index), grip strength (dynamometry) and quality of life (SF-36 questionnaire) were assessed. Results 29 patients were evaluated. Due to exclusion criteria, there were 19 patients left, all women with an average age of 59. After randomization, 10 were awarded to IG and 9 to CG, being both comparable groups. A higher percentage of patients with pain controlled (VAS<6) was found in IG post treatment and after 3-months (77.8% vs 33.3%, p=0.1 y 83.3% vs 33.3%, p=0.2; respectively). A tendency to decrease VAS for IG at 3-months (regression coefficient: −2.1 (95% CI: −5.7-1.5; p=0.2) was showed. There were no other statistically significant differences, except a higher dynamometry results in IG, in both hands (p<0.01 and p<0.04 respectively). There were neither adverse effects nor secondary effects. Conclusion Magnetotherapy treatment for hand erosive arthritis patients is safe and probably leads to clinical improvement (AU)

Vertebral fractures are increased in rheumatoid arthritis despite recent therapeutic advances: a case-control study.

Prevalence and risk factors of vertebral fractures in postmenopausal RA women were assessed in 323 patients and compared with 660 age-matched women. Of patients, 24.15% had at least one vertebral fracture vs.16.06% of controls. Age, glucocorticoids and falls were the main fracture risks. Vertebral fractures were associated with disease severity. INTRODUCTION: There is little quality data on the updated prevalence of fractures in rheumatoid arthritis (RA) that may have changed due to advances in the therapeutic strategy in recent years. This study was aimed at analysing the prevalence and risk factors of vertebral fractures in postmenopausal women with RA and comparing it with that of the general population. METHODS: We included 323 postmenopausal women diagnosed with RA from 19 Spanish Rheumatology Departments, randomly selected and recruited in 2018. Lateral radiographs of the thoracic and lumbar spine were obtained to evaluate morphometric vertebral fractures and the spinal deformity index. We analysed subject characteristics, factors related to RA, and fracture risk factors. The control group consisted of 660 age-matched Spanish postmenopausal women from the population-based Camargo cohort. RESULTS: Seventy-eight (24.15%) RA patients had at least one vertebral fracture. RA patients had increased fracture risk compared with controls (106 of 660, 16.06%) (p = 0.02). Logistic regression analysis showed that age (OR 2.17; 95% CI 1.27-4.00), glucocorticoids (OR 3.83; 95% CI 1.32-14.09) and falls (OR 3.57; 95% CI 1.91-6.86) were the independent predictors of vertebral fractures in RA patients. The subgroup with vertebral fractures had higher disease activity (DAS28: 3.15 vs. 2.78, p = 0.038) and disability (HAQ: 0.96 vs. 0.63, p = 0.049), as compared with those without vertebral fractures. CONCLUSION: The risk of vertebral fracture in RA is still high in recent years, when compared with the general population. The key determinants of fracture risk are age, glucocorticoids and falls. Patients with vertebral fractures have a more severe RA.

[Efficacy of magnetotherapy in hand erosive osteoarthritis. A clinical trial]. / Eficacia de la magnetoterapia en artrosis erosiva de manos. Un ensayo clínico.

INTRODUCTION: Erosive arthritis is an unusual pathology. Despite using magnetotherapy as a treatment, there is no evidence supporting its use. The aim of the study is to evaluate magnetotherapy efficacy in patients suffering from hand erosive arthritis, compared to placebo, in terms of pain. Treatment safety will be also evaluated. METHOD: Prospective experimental double-blind randomized study consisting of an intervention group (IG: treatment with magnetotherapy: 15 20-minute-sesions 5 consecutive days per week) and a control group (CG: placebo). Treatment efficacy was evaluated at the end and 3 months after. We used Visual Analog Scale (VAS) for assess pain. Secondarily, functionality (The Disabilities of the Arm, Shoulder and Hand (DASH) score), rigidity (Modified Kapandji Index), grip strength (dynamometry) and quality of life (SF-36 questionnaire) were assessed. RESULTS: 29 patients were evaluated. Due to exclusion criteria, there were 19 patients left, all women with an average age of 59. After randomization, 10 were awarded to IG and 9 to CG, being both comparable groups. A higher percentage of patients with pain controlled (VAS<6) was found in IG post treatment and after 3-months (77.8% vs 33.3%, p=0.1 y 83.3% vs 33.3%, p=0.2; respectively). A tendency to decrease VAS for IG at 3-months (regression coefficient: -2.1 (95% CI: -5.7-1.5; p=0.2) was showed. There were no other statistically significant differences, except a higher dynamometry results in IG, in both hands (p<0.01 and p<0.04 respectively). There were neither adverse effects nor secondary effects. CONCLUSION: Magnetotherapy treatment for hand erosive arthritis patients is safe and probably leads to clinical improvement.

Intensive dietary intervention promoting the Mediterranean diet in people with high cardiometabolic risk: a non-randomized study.

AIMS: Mediterranean diet (MD) is acknowledged to exert a number of beneficial health effects. We assessed the efficacy and the durability of a 3-month intensive dietary intervention aimed at implementing the MD on body weight and cardiometabolic risk factors in subjects at high risk. METHODS: One hundred and sixteen subjects participated in the study (71 assigned to the intensive intervention and 45 to the conventional intervention). The intensive intervention consisted of 12 weekly group educational meetings and a free-of-charge supply of meals prepared according to the MD model. The conventional intervention consisted of an individual education session along with monthly reinforcements of nutritional messages by the general practitioner. All participants were followed up for 9 months. RESULTS: The two groups had similar pre-intervention characteristics. After the intervention, mean body weight decreased significantly in both groups (p < 0.001). However, the intervention group lost more weight (6.8 ± 4.0 vs. 0.7 ± 1.3, p < 0.0001) and showed a greater reduction in plasma glucose, triglycerides, blood pressure and an increase in HDL cholesterol than the control group (p < 0.01-p < 0.002). In the subgroup of participants with type 2 diabetes, there was a significant reduction in HbA1c level following the intensive (p < 0.0001) but not the conventional intervention. At follow-up, weight loss still persisted in the intervention group (p < 0.0001), while it was lost in the control group. Both interventions significantly reduced blood pressure in the long term (p < 0.001). A significant reduction in daily total energy intake was observed in both groups with a greater reduction in saturated fat and a higher increase in fibre intake in the intervention than in the control group (p < 0.009 and p < 0.001, respectively). CONCLUSIONS: A 3-month intensive dietary intervention inspired to the traditional MD produced greater and more durable weight loss and improvement in cardiometabolic risk profile than the conventional intervention.

Manejo de la vía aérea a través de faringostoma cervical por radionecrosis / Management of the airway through cervical faringostoma by radionecrosis

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Efecto de las bacterias uropatógenas y de los factores solubles de su metabolismo sobre la calidad espermática: Escherichia coli y Enterococcus faecalis / Effect of uropathogenic bacteria and soluble factors produced by their metabolism on sperm quality: Escherichia coli and Enterococcus faecalis

Objetivo: El contacto de los espermatozoides con algunas especies bacterianas y sus factores solubles tiene un efecto negativo en la calidad seminal, alterando la función reproductiva del hombre. El objetivo de este trabajo fue determinar el efecto de 2 bacterias enteropatógenas (Escherichia coli [E. coli] y Enterococcus faecalis [E. faecalis]) y sus factores solubles sobre la calidad espermática. Metodología: Las cepas bacterianas de E. coli sensible y resistente a ampicilina/sulbactam y piperacilina/tazobactam, las cepas de E. faecalis sensible y resistente a gentamicina y estreptomicina de alto nivel, además de los factores solubles producto del metabolismo bacteriano de cada cepa, se incubaron con las muestras de semen de voluntarios. Posteriormente, se cuantificó la movilidad por microscopia y los parámetros funcionales espermáticos (potencial de membrana mitocondrial, integridad de la membrana, detección de especies reactivas del oxígeno e índice de fragmentación del ADN) por citometría de flujo. Resultados: Las cepas de E. coli, E. faecalis y los factores solubles de su metabolismo alteran la movilidad espermática y algunos de los parámetros funcionales evaluados luego de 3 h de incubación con los espermatozoides humanos, sin que estos cambios sean estadísticamente significativos. Conclusión: La interacción de las bacterias E. coli y E. faecalis o los factores solubles producto de su metabolismo con los espermatozoides humanos alteran la calidad seminal, por lo que se debe evaluar el impacto de las infecciones urogenitales por estos microorganismos en la fertilidad masculina

Objective: Interactions between sperm and bacteria or soluble factors have a negative effect on semen quality and male fertility. The aim of this study was to determine the effect of 2 enteropathogenic bacteria (Escherichia coli [E. coli] and Enterococcus faecalis [E. faecalis]) and their soluble factors on sperm quality. Methodology: E. coli-sensitive and -resistant strains to ampicillin/sulbactam and piperacillin/tazobactam, E. faecalis-sensitive and -resistant strains to gentamicin and high level streptomycin and soluble factors produced by bacterial metabolism of each strain were incubated with semen samples from volunteers. Subsequently, motility was quantified by light microscopy and sperm function parameters (mitochondrial membrane potential, membrane integrity, reactive oxygen species, and chromatin integrity) by flow cytometry. Results: E. coli and E. faecalis strains and their soluble factors altered sperm motility and some of the sperm function parameters evaluated after 3h of incubation with human sperm but these changes were not statistically significant. Conclusion: Semen quality is affected by the interaction between E. coli and E. faecalis or their soluble factors. Therefore, there is a need to assess the impact of urogenital infections by these microorganisms on male fertility

Derrame pleural maligno como debut de neoplasia no conocida / No disponible

Objetivo: Conocer el origen de la neoplasia en los pacientes con derrame pleural maligno (DPM) como primera manifestación de enfermedad tumoral. Diseño: Estudio retrospectivo y multicéntrico, desarrollado en 11 hospitales públicos de la Comunidad de Madrid, en el que se incluyeron todos los pacientes consecutivos con DPM, sin antecedentes de neoplasia conocida entre el 1 de abril de 2008 y el 1 de abril de 2013. Resultados: El diagnóstico del tumor primario se realizó mediante muestras citohistológicas en 339 pacientes (84%). El cáncer de pulmón destacó como el origen más frecuente del DPM tanto en hombres (59%) como en mujeres (46%), siendo el adenocarcinoma la estirpe histológica más frecuente. Los tumores pleurales primarios ocuparon el segundo lugar en frecuencia (20%), de los que el 92% fueron mesoteliomas. En tercer lugar se situaron en igual proporción (5,5%), las neoplasias hematológicas y los tumores ováricos. El cáncer mamario, junto con los tumores digestivos, renales y urológicos fueron muy infrecuentes (<2%). En 39 pacientes (9,7%) no fue posible determinar el origen neoplásico. Se hallaron otras metástasis a distancia en 187 pacientes (47%). Conclusión: El pulmón es el órgano que con mayor frecuencia produce DPM como primera manifestación de enfermedad neoplásica, seguido por las neoplasias pleurales. En ausencia de otros síntomas, el clínico debe dirigir sus esfuerzos iniciales a descartar uno de estos órganos como el origen tumoral. En mujeres, nuestro estudio obliga a cambiar la sospecha y enfoque clínico, ya que en esta situación el carcinoma mamario es muy infrecuente

Objective: To determine the origin of neoplasms in patients with malignant pleural effusion (MPE) as the initial manifestation of tumor disease. Material and methods: This is a retrospective, multicenter study. It was developed at 11 public hospitals in the Community of Madrid, and included all consecutive patients with MPE and no history of previously detected neoplasm between April 1, 2008 and April 1, 2013. Results: We studied 402 patients with MPE. We obtained a cytohistological diagnosis of the primary tumor in 339 of them (84%). Lung cancer was the most frequent origin of the MPE in both men (59%) and in women (46%), while adenocarcinoma was the most frequent histological type. Primary pleural tumors were the second most frequent (20%), 92% of which were mesotheliomas. Third were both hematological cancers and ovarian tumors (5,5%). Breast cancer, along with gastrointestinal, renal and urological tumors, were very rare (<2%). It was not possible to determine the origin of the neoplasm in 39 patients (9,7%). Other distant metastases were found in 187 patients (47%). Conclusion: The lungs are the organs that most frequently produce MPE as the initial manifestation of neoplastic disease, which is followed in frequency by pleural neoplasms. Therefore, in the absence of other symptoms, clinicians should aim their initial efforts at ruling out one of these organs as the tumor origin. Our study shows that the clinical suspicion and focus should be changed when diagnosing women, because MPE is uncommon as the first manifestation of breast cancer

Induction Immunosuppressive Therapy Use in Deceased Donor Kidney Transplantation: 11-Year Experience in Veracruz, Mexico.

BACKGROUND: Induction therapy reduces the frequency of acute rejection and delayed graft function in renal transplantation. Basiliximab and Thymoglobulin are most commonly used agents for induction. METHODS: A retrospective study of two transplant centers in Veracruz, Mexico compared induction therapy in deceased donor renal transplantation from 2003 to 2014. Efficacy and safety outcomes evaluated were primary graft nonfunction, delayed graft function, acute rejection episodes and hospitalizations during first year, and patient and graft survival. P < .05 was considered statistically significant. RESULTS: Seventy deceased kidney donors (40 male) were studied. Mean donor age was 32.9 ± 14.3 years, mean donor BMI 25.6 ± 4.3 kg/m(2), and mean donor creatinine 1.13 ± 0.58 mg/dL. Main cause of death was trauma (62.9%). In total, 125 kidney transplantations were performed, with female predominance (53.6%) and mean age 33.8 ± 11.8 years. Of these, 66.4% used basiliximab and 33.6% Thymoglobulin. Thymoglobulin patients were significantly older, with lower weight and BMI, and were on dialysis longer than basiliximab patients. DGF was present in 19.3% of basiliximab patients vs 16.7% in Thymoglobulin patients, acute rejection occurred in 16.9% of basiliximab patients vs 19% Thymoglobulin patients. A total of 33.7% basiliximab patients were hospitalized during the first year vs 47.6% Thymoglobulin-induced patients (P > .05). Mean graft survival was 84.2 ± 5.3 months (73.8-94.7) basiliximab vs 32.4 ± 28.7 months (28.7-36.1) Thymoglobulin, Kaplan-Meier survival did not show statistically significant differences between groups (P = .276; CI 95%). CONCLUSION: Similar transplant outcomes were obtained using basiliximab or Thymoglobulin induction in our population.

Labioplastía genital, experiencia y resultados en 500 casos consecutivos / Genital labiaplasty, experience and results in 500 consecutive cases

ANTECEDENTES: La cosmetoginecología se ha instalado, no exenta de controversia, en la práctica ginecológica durante la última década. OBJETIVO: Presentar los resultados obtenidos en una serie de 500 labioplas-tías de labios menores realizadas por dos cirujanos en el curso de 10 años. MÉTODO: Estudio descriptivo del universo de labiobioplastías practicadas por dos cirujanos entre octubre de 2003 y abril de 2014. La decisión de intervención quirúrgica se basó en razones estéticas, funcionales y psicológicas, y no por una clasificación de hipertrofia de labios menores. RESULTADOS: Aproximadamente la mitad se realizó utilizando láser y la otra mitad electrobisturí, sin ventajas de alguna técnica sobre la otra, en cuanto a complicaciones, grado de satisfacción y resultado final estético. Las indicaciones fueron: estética en 95,4% de las intervenciones, funcional en 37,2% y psicológicas en 17,4%. Los resultados fueron satisfactorios en el 99% de las pacientes, según un autoreporte. No hubo complicaciones importantes y sólo en dos casos se presentó hemorragia post operatoria que requirió una sutura. El procedimiento, cuando fue único, fue ambulatorio, requiriendo no más de 8 horas de hospitalización. En esta experiencia, el 46% se asoció a otra cirugía ginecológica. CONCLUSIÓN: A nuestro parecer, la hipertrofia de labios menores, aún cuando pueda considerarse subjetiva, es una condición que merece ser corregida cuando es requerido por la paciente y que las técnicas actuales ofrecen resultados seguros y satisfactorios.

BACKGROUND: Cosmetogynecology is installed, not without controversy, in gynecological practice in the last decade. Aims: We present a descriptive study of 500 labia minora labiaplasty performed by two surgeons in the course of 10 years. METHOD: A descriptive study of the universe of labiobioplastys performed by two surgeons between October 2003 and April 2014. The decision for surgery was based on aesthetic, functional and psychological reasons and not on a classification of labia minora hypertrophy. RESULTS: Approximately, half was performed using laser, and electrocautery the other half, without any technical advantages over the other, in terms of complications, satisfaction and aesthetic final outcome. Indications for surgery were: in 95.4% of interventions, functional in 37.2% and 17.4% psychological. The results were satisfactory in 99% of patients, according to a self-report. There were no major complications and only two cases presented postoperative bleeding that required stitches. The procedure was ambulatory when it was unique, requiring no more than 8 hours of hospitalization. In this experience, 46% was associated with another gynecological surgery. CONCLUSION: In our view, the labia minora hypertrophy, even though it may be considered subjective, is a condition that should be corrected as required by the patient and the current techniques provide safe and satisfactory results.

Aportación de los nuevos broncodilatadores en el tratamiento de la EPOC / No disponible

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Rejection is a strong graft survival predictor in live donor pediatric renal transplantation using cyclosporine, mycophenolate mofetil, and steroids: 5-year outcomes in a single Mexican center.

Long-term graft function and survival are of particular importance in children assuming that they have a longer transplantation life span than most adults. Because acute rejection episodes (ARE) continue to have a serious impact on graft loss, we analyzed the effects of ARE on 5-year survival and function in our population. Fifty-seven living donor kidney transplant recipients (34 males) younger than 18 years of age (13.5 ± 2.6 years; range, 5-17) were follow up for at feast 12 months using cyclosporine, mycophenolate mofetil, and steroid therapy with or without induction treatment between February 2003 and December 2010. ARE incidence during the first 12 months following transplantation was 14%. One-, 3- and 5-year serum creatinine values were 1.24 ± 0.39, 2.16 ± 2.39, and 1.76 ± 0.9 mg/dL, respectively. Mean calculated creatinine clearances (Schwartz) at 1, 3, and 5 years were 82.5 ± 24.8, 64.7 ± 24.1, and 67 ± 27.5 mL/min*1.73 m(2), respectively. Patient/graft survival rates were 96/85%, 90/72%, and 88/65% at 1, 3, and 5 years, respectively. Patients who experienced an ARE within 12 months following transplantation displayed a reduced 5-year graft survival rate (37.5%) versus those who did not (78%; P = .005). Patients who did not have an ARE during 60 months had a higher graft survival rate (76%) than those who had ARE (33%; P = .001). Patient without basiliximab induction showed a lower 5-year graft survival rate (61% vs 100%; P = not significant [NS]). ARE is an important risk factor for graft loss in the pediatric kidney transplant population.

Malformación arterio-venosa cerebral causante de insuficiencia cardiaca congestiva en un neonato / Cerebral arteriovenous malformation as a cause of congestive heart failure in a newborn

La malformación arterio-venosa de la vena de Galeno representa una anomalía congénita vascular muy infrecuente. Esta patología se presenta de forma preferente en el periodo neonatal pudiendo causar una importante morbi-mortalidad. La forma de presentación clínica es muy variable, siendo la asociación de soplo craneal e insuficiencia cardiaca la forma de presentación más frecuente en el periodo neonatal. El grado de insuficiencia cardiaca asociada constituye el principal factor pronóstico y condicionante del tratamiento, que consistirá, en primer lugar en el tratamiento sintomático de la misma, y en segundo lugar, en el tratamiento de la lesión vascular, bien mediante cirugía, o mediante acceso intravascular, método que ha mejorado los resultados en los últimos años. Se presenta el caso de un neonato varón con diagnóstico prenatal de malformación aneurismática de la vena de Galeno que se confirmó en el periodo postnatal, y que desarrolló insuficiencia cardiaca congestiva refractaria al tratamiento instaurado, siendo éxitus a los cuatro días de vida (AU)

Arteriovenous malformation of the vein of Galen represents a very uncommon congenital vascular anomaly. This patology occurs preferably in neonatal period, and can cause severe morbi-mortality. Clinical presentation is variable. Association of cranial murmur and heart failure are frequent presentations in neonatal period. The degree of heart failure associated represents the main prognostic factor and determinant of the treatment, which consists, first, in the symptomatic treatment of the same, and secondly, in the treatment of the vascular lesion, either by surgery, or by intravascular access, method that has improved results in recent years. We report the case of a male neonate with prenatal diagnosis of aneurysmal dilatation of the vein of Galen, that was confirmed in the postnatal period and developed congestive heart failure that does not respond to treatment initiated, and died at four days old (AU)

Intoxicación por cafeína en un recién nacido prematuro / Caffeine intoxication in a premature newborn

El citrato de cafeína se usa en Neonatología como tratamiento de primera línea para tratar o prevenir la apnea de la prematuridad. Describimos un caso de intoxicación accidental por cafeína (140mg/kg) en un prematuro de 36 horas de vida. El paciente presentó alteraciones neurológicas y cardiacas, con hiperglucemia, elevación de la creatininfosfo-quinasa y de la troponina T. En sangre la cifra máxima de cafeína fue de 127 µg/ml. La evolución fue favorable con tratamiento conservador. El análisis de los errores en la seguridad de los pacientes debe ser un punto esencial en la educación pediátrica (AU)

Caffeine citrate is used as first-line therapy in neonates to treat or prevent apnea of prematurity. We describe a caffeine intoxication (140 mg/kg) in a 36 hours-old preterm neonate. Patient showed neurological and cardiac alterations, with hyperglycemia, elevated creatine kinase and troponin and peak caffeine plasma level of 127 µg/ml. Clinical evolution was favorable with conservative support. Analysis of patient safety errors must be essential point in paediatric education (AU)

EVALUACIÓN DEL POLICULTIVO DE BOCACHICO Prochilodus magdalenae Y TILAPIA Oreochromis niloticus UTILIZANDO SUPERFICIES FIJADORAS DE PERIFITON: EVALUATION OF THE POLYCULTURE OF BOCAChICO Prochilodus magdalenae AND TILAPIA Oreochromis niloticus USING PERIPHYTON FIXING SURFACES

La piscicultura es una actividad importante para satisfacer la demanda alimenticia de una población en crecimiento y en su práctica es necesario desarrollar tecnologías responsables con el ambiente. El policultivo de tilapia-bocachico es relevante por la importancia de estas especies a nivel nacional; tilapia por sus características zootécnicas, y bocachico por su hábito alimentario detritívoro-iliófago, recientemente visto como un pez ecológico. El cultivo basado en perifiton permitiría un sistema altamente eficiente y más limpio, pues aporta alimento natural a los peces y mejora la calidad del agua. Para evaluar el efecto del perifiton sobre el desempeño del policultivo tilapia-bocachico, se ejecutó un experimento durante ocho meses en 18 estanques de 90 m², con 2,6 tilapias/m² y 0,7 bocachicos/m², sin fertilización; como sustrato para perifiton se instalaron de forma vertical tubos plásticos (3,3 tubos/m²), que se constituyeron en una variable por evaluar. Adicionalmente, tres estrategias alimentarias fueron evaluadas: 0 (sin alimento), alimentación con ración del 20% de proteína bruta (PB) y alimentación con ración del 25% de PB. Se utilizó un diseño factorial 2x3 en bloques completos al azar con tres repeticiones por tratamiento y se analizaron datos productivos mediante ANOVA con un modelo lineal general (P < 0,05). No fueron encontrados efectos del sustrato sobre los parámetros estudiados. Hubo efectos simples de la estrategia alimentaria sobre el desempeño de los peces. Por lo pronto, puede ser concluido que la producción basada en perifiton no genera problemas en el sistema ni en los peces y que se requiere más investigación para consolidar la tecnología.

Fishculture is very important to satisfy human food demand. However, the ignorance in more efficient and environment-friendly systems is a big problem for fish farming activities. Tilapia-Bocachico polyculture is of great interest; tilapia, for the excellent productive characteristics, and bocachico for being a bottom-feeder specie, beside of the great socio-cultural value in this region. An alternative approach is the adoption of periphyton-based pond systems; periphyton can: be a food source for fish and improve water quality, thus becoming into a highly efficient and cleaner system. With the aim to evaluate the periphyton effects on performance of Tilapia-Bocachico polyculture, a trial was carried out for 8 months. Eighteen 90 m² earthen ponds were used under polyculture conditions at low stocking density (2.6 tilapia/m², 0.7 bocachico/m²). These ponds were not fertilized during the experimental period. Plastic tubes of 1.2 m and 6 cm in diameter were used vertically as periphyton substrate at 3.3 tubes/m² rate. Three alimentary strategies were used: 0 (without food), fish feed (20% protein) and fish feed (25% protein); thereby constituting a factorial experiment 2x3 in a randomized complete block with three replications per treatment. They were analyzed using ANOVA with a general linear model (GLM) (p < 0.05). There were no effects of substrates on the study variables, but simple effects of alimentary strategies on the productive parameters. Other parameters are being analyzed and it is still premature to conclude.

Caracterización del accidente con riesgo biológico en estudiantes de pregrado en facultades de salud en una institución de educación superior de Bogotá 2009-2010 / Characterization of the accident with biohazard risk in undergraduate students in health schools and in institutions of higher education of Bogotá 2009-2010

Objetivo: caracterizar el accidente por exposición al riesgo biológico en los estudiantes de las facultades de enfermería, medicina y odontología de la Institución de Educación Superior (IES) 2009-2010. Metodología: estudio descriptivo mixto y retrospectivo. Para identificar estudiantes accidentados, se aplicó por conveniencia una encuesta cerrada y autodiligenciada a estudiantes de pregrado, matriculados en las facultades participantes entre junio de 2009 y junio de 2010. Para la descripción del accidente, se empleó una entrevista semiestructurada, de participación voluntaria, mediante búsqueda activa de casos, aplicada a los estudiantes identificados como siniestrados a través de la estadística reportada por la póliza estudiantil de accidentes. Resultados: en la caracterización de la accidentalidad con exposición al riesgo biológico en el estudiante de pregrado de las facultades de salud, se encontró un porcentaje de reporte del evento por debajo de lo encontrado en otros estudios (1, 2). De los estudiantes que refirieron haber sufrido algún accidente con exposición a riesgo biológico, entre el 50% y el 72% solicitó atención de urgencias mientras que entre el 56% y el 79% refirieron haber reportado el caso a Bienestar Universitario; en lo referente al mecanismo de transmisión, entre el 56% y el 94% de los eventos referidos fueron ocasionados con material cortopunzante afectando principalmente miembro superior; el segundo mecanismo de exposición reportado fue la exposición de mucosas oculares con sangre o fluidos corporales con un 44% de eventos referidos por los estudiantes de medicina, mientras que para los estudiantes de las facultades de enfermería y odontología fue alrededor del 5%. En cuanto al sitio de ubicación del evento, los estudiantes de las facultades de enfermería y odontología refirieron una mayor proporción de ocurrencia en los centros de práctica formativa extramurales a la IES, mientras que los estudiantes de odontología refirieron una mayor frecuencia de ocurrencia en las clínicas odontológicas, ubicadas en las instalaciones de la Universidad; lo anterior se explica en virtud de la distribución geográfica de los centros de práctica formativa para cada programa académico. En el abordaje cualitativo de la descripción del accidente con riesgo biológico, se establecieron como categorías de análisis: el acompañamiento, las técnicas de procedimiento, la solicitud de atención en urgencias, el seguimiento y las lecciones aprendidas. El estudio permitió identificar que la presencia del docente en el campo de práctica facilita la atención del estudiante en el momento del evento; así mismo que los estudiantes identifican que la falta de adherencia a las normas o estándares de bioseguridad es un factor que incide en la ocurrencia del evento. Los participantes manifestaron que para ser atendidos en el servicio de urgencias, debieron desplazarse con las muestras sanguíneas del individuo fuente desde el sitio de ocurrencia del evento al de atención; el transporte de las muestras fue realizado por el estudiante, sin el debido cumplimiento del protocolo de transporte de muestras sanguíneas y ya en el servicio de urgencias, la atención tardó en promedio tres horas. El seguimiento del caso por Bienestar Universitario no es claro para los participantes del estudio y el principal temor se relaciona con la posibilidad de desarrollar en el largo plazo una enfermedad por virus de transmisión hemática y fluidos corporales. Se resalta que los estudiantes identifican la necesidad de modificar la práctica de medidas de bioseguridad y comprometerse con la adherencia a las normas o estándares de bioseguridad como una estrategia efectiva para evitar el accidente con riesgo biológico. Conclusiones: la IES debe fortalecer las estrategias de prevención del accidente con riesgo biológico en el marco del los convenios docencia servicio, para promover el bienestar del estudiante de las facultades de salud en el desarrollo de las prácticas formativas, de manera que se minimice el riesgo inherente a estas. Debe establecer mecanismos para asegurar el reporte de los eventos y en la misma medida favorecer la calidad en la atención al estudiante de pregrado. Se deben reforzar las estrategias que permitan a los estudiantes ser responsables de su autocuidado y a la vez permitan su adherencia a las normas de bioseguridad; ampliar el conocimiento del uso de elementos de protección y los procedimientos a seguir de presentarse el accidente.

Successful renal transplantation from a deceased donor with pesticide intoxication: a case report.

The number of individuals awaiting organ transplantation exceeds the number of organs. Patients who die from intoxication are rarely accepted as potential organ donors. Herein we have presented the results of kidney transplantations performed from a deceased 20-year-old female donor with suicidal ingestion of a pesticide (carbamate). The procured kidneys were successfully transplanted. Patients and grafts are doing well at 4 months following transplantation. There are few reports of successful transplantation of organs obtained from patients who die from various intoxications. Poisoned patients represent another pool of organ donors for transplantation services.