Chronic obstructive pulmonary disease in severe mental illness: A timely diagnosis to advance the process of quitting smoking.

BACKGROUND: This study has two main objectives: to describe the prevalence of undetected chronic obstructive pulmonary disease (COPD) in a clinical sample of smokers with severe mental illness (SMI), and to assess the value of the Tobacco Intensive Motivational Estimated Risk tool, which informs smokers of their respiratory risk and uses brief text messages to reinforce intervention. METHOD: A multicenter, randomized, open-label, and active-controlled clinical trial, with a 12-month follow-up. Outpatients with schizophrenia (SZ) and bipolar disorder were randomized either to the experimental group-studied by spirometry and informed of their calculated lung age and degree of obstruction (if any)-or to the active control group, who followed the 5 A's intervention. RESULTS: The study sample consisted of 160 patients (71.9% SZ), 78.1% of whom completed the 12-month follow-up. Of the patients who completed the spirometry test, 23.9% showed evidence of COPD (77.8% in moderate or severe stages). TIMER was associated with a significant reduction in tobacco use at week 12 and in the long term, 21.9% of patients reduced consumption and 14.6% at least halved it. At week 48, six patients (7.3%) allocated to the experimental group achieved the seven-day smoking abstinence confirmed by CO (primary outcome in terms of efficacy), compared to three (3.8%) in the control group. CONCLUSION: In this clinical pilot trial, one in four outpatients with an SMI who smoked had undiagnosed COPD. An intensive intervention tool favors the early detection of COPD and maintains its efficacy to quit smoking, compared with the standard 5 A's intervention.

Reduced late urinary toxicity with high-dose intensity-modulated radiotherapy using intra-prostate fiducial markers for localized prostate cancer

Background/purpose. To evaluate the impact of intensity-modulated radiotherapy (IMRT) with intra-prostate fiducial markers image-guided radiotherapy (IGRT) on the incidence of late urinary toxicity compared to 3D conformal radiotherapy (3DCRT) for patients with prostate cancer (PC). Methods and materials. We selected 733 consecutive patients with localized PC treated with dose-escalation radiotherapy between 2001 and 2014. Eligibility criteria were radiation dose >72.0 Gy, no pelvic RT and minimum follow-up 24 months. 438 patients were treated with 3DCRT and 295 with IMRT. Acute and late urinary complications were assessed using the EORTC/RTOG and CTCAEs v3.0 definition. The Cox regression model was used to compare grade ≥2 urinary toxicity between both techniques. The median follow-up was 75 months (range 24-204). Results. The median isocenter radiation dose was 78.7 Gy for 3DCRT and 80.7 Gy for IMRT/IGRT (p < 0.001). The 5-year incidence of late grade ≥2 urinary toxicity was 6.4% for IMRT and 10.8% for 3DCRT [hazard ratio (HR) 0.575, p = 0.056]. The corresponding 5-year estimates of late grade ≥2 hematuria were 2% for IMRT and 5.3% for 3DCRT (HR 0.296, p = 0.024). On multivariate analysis, the antecedent of prior transurethral resection of the prostate was also a strong predictor of a higher risk of urinary complications (HR 2.464, p = 0.002) and of hematuria (HR 5.196, p < 0.001). Conclusion. Compared with 3DCRT, high-dose IMRT/IGRT is associated with a lower rate of late urinary complications in spite of higher radiation dose (AU)

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Reduced late urinary toxicity with high-dose intensity-modulated radiotherapy using intra-prostate fiducial markers for localized prostate cancer.

BACKGROUND/PURPOSE: To evaluate the impact of intensity-modulated radiotherapy (IMRT) with intra-prostate fiducial markers image-guided radiotherapy (IGRT) on the incidence of late urinary toxicity compared to 3D conformal radiotherapy (3DCRT) for patients with prostate cancer (PC). METHODS AND MATERIALS: We selected 733 consecutive patients with localized PC treated with dose-escalation radiotherapy between 2001 and 2014. Eligibility criteria were radiation dose >72.0 Gy, no pelvic RT and minimum follow-up 24 months. 438 patients were treated with 3DCRT and 295 with IMRT. Acute and late urinary complications were assessed using the EORTC/RTOG and CTCAEs v3.0 definition. The Cox regression model was used to compare grade ≥2 urinary toxicity between both techniques. The median follow-up was 75 months (range 24-204). RESULTS: The median isocenter radiation dose was 78.7 Gy for 3DCRT and 80.7 Gy for IMRT/IGRT (p < 0.001). The 5-year incidence of late grade ≥2 urinary toxicity was 6.4% for IMRT and 10.8% for 3DCRT [hazard ratio (HR) 0.575, p = 0.056]. The corresponding 5-year estimates of late grade ≥2 hematuria were 2% for IMRT and 5.3% for 3DCRT (HR 0.296, p = 0.024). On multivariate analysis, the antecedent of prior transurethral resection of the prostate was also a strong predictor of a higher risk of urinary complications (HR 2.464, p = 0.002) and of hematuria (HR 5.196, p < 0.001). CONCLUSION: Compared with 3DCRT, high-dose IMRT/IGRT is associated with a lower rate of late urinary complications in spite of higher radiation dose.

Immediate effects of thoracic spinal mobilisation on erector spinae muscle activity and pain in patients with thoracic spine pain: a preliminary randomised controlled trial.

OBJECTIVES: To investigate the activity of the thoracic erector spinae muscles and perceived pain intensity immediately after central postero-anterior (PA) mobilisation of the thoracic spine. DESIGN: Randomised, placebo-controlled, experimental design. PARTICIPANTS AND INTERVENTIONS: Thirty-four participants with non-specific thoracic pain were randomised to the experimental group [grade III central PA mobilisation performed for 3minutes at the level of the seventh thoracic vertebra (T7)] or the placebo group (less than grade I central PA mobilisation performed for 3minutes at T7). MAIN OUTCOME MEASURES: Before and immediately after PA mobilisation, surface electromyography (EMG) was recorded from the thoracic erector spinae muscles as the participants performed 10° spine extension from a prone position for 10seconds. Each participant rated their pain intensity as an investigator performed grade III central PA over the most symptomatic thoracic segment, and the pressure pain threshold (PPT) was evaluated bilaterally over the erector spinae muscles. RESULTS: The EMG amplitude of thoracic erector spinae activity was reduced significantly after the intervention in the experimental group (P<0.05), but not in the placebo group. The difference between the groups was significant {pre-post change: placebo -14 [standard deviation (SD) 50]mV, experimental 28 (SD 48)mV; mean difference -42mV; 95% confidence interval of the difference -76 to 7; P<0.05} albeit small (Grissom=0.44). However, both groups showed a significant reduction in pain immediately after the intervention, and both groups showed a similar pre-post change in PPT. CONCLUSION: These preliminary findings indicate that grade III central mobilisation over the most symptomatic thoracic segment reduces thoracic erector spinae activity during extension of the trunk in people with non-specific thoracic spine pain. CLINICAL TRIAL REGISTRATION NUMBER: ISRCTN47601528.

Duplicación de arteria femoral superficial en paciente con claudicación intermitente / Duplication of superficial femoral artery in a patient with intermittent claudication

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Hemorragia recidivante por fístula carótido-faríngea tras tratamiento endovascular / Recurrent haemorrhage due to a carotid-pharyngeal fistula after endovascular treatment

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Circulating CD4+CD28null and extra-thymic CD4+CD8+ double positive T cells are independently associated with disease damage in systemic lupus erythematosus patients.

OBJECTIVE: To determine whether circulating CD4+CD28null and extra-thymic CD4+CD8+ double positive (DP) T cells are independently associated with damage accrual in systemic lupus erythematosus (SLE) patients. METHODS: This cross-sectional study was conducted between September 2013 and April 2014 in consecutive SLE patients from our Rheumatology Department. CD4+CD28null and CD4+CD8+ DP T-cell frequencies were analyzed by flow-cytometry. The association of damage (SLICC/ACR Damage Index, SDI) and CD4+CD28null and CD4+CD8+ DP T cells was examined by univariable and multivariable Poisson regression models, adjusting for possible confounders. All analyses were performed using SPSS 21.0. RESULTS: Patients' (n = 133) mean (SD) age at diagnosis was 35.5 (16.8) years, 124 (93.2%) were female; all were mestizo (mixed Caucasian and Amerindian ancestry). Disease duration was 7.4 (6.8) years. The SLE Disease Activity Index was 5.5 (4.2), and the SDI 0.9 (1.2). The percentages of CD4+CD28null and CD4+CD8+ DP T cells were 17.1 (14.4) and 0.4 (1.4), respectively. The percentage of CD4+CD28null and CD4+CD8+ DP T cells were positively associated with a higher SDI in both univariable (rate ratio (RR) 1.02, 95% confidence interval (CI): 1.01-1.03 and 1.17, 95% CI: 1.07-1.27, respectively; p < 0.001 for both) and multivariable analyses RR 1.02, 95% CI: 1.01-1.03, p = 0.001 for CD4+CD28null T cells and 1.28, 95% CI: 1.13-1.44, p < 0.001 for CD4+CD8+ DP T cells). Only the renal domain remained associated with CD4+CD28null in multivariable analyses (RR 1.023 (1.002-1.045); p = 0.034). CONCLUSIONS: In SLE patients, CD4+CD28null and CD4+CD8+ DP T cells are independently associated with disease damage. Longitudinal studies are warranted to determine the predictive value of these associations.

Post-operative hyponatraemic encephalopathy: a successful outcome despite hypoxia.

Hyponatraemia is the most common electrolyte disorder encountered in clinical practice. Symptomatic hyponatraemia reflects brain damage because of cerebral swelling. Some coexisting factors such as extreme ages, hypoxia and female sex are associated with poor prognosis. In this report, we describe the case of a 75-year-old patient who suffered from hyponatraemic encephalopathy after elective vaginal hysterectomy under spinal anaesthesia. After being transferred to the ward, she developed nausea, vomiting, hypertensive crisis and intense anxiety. These symptoms were followed by grand mal seizure. Serum sodium level was 108 mmol/l. She also presented hypoxia, considered an aggravating factor, which was probably caused by the combination of benzodiazepine intake and cerebral oedema. However, fast raise of serum sodium level was achieved by immediate treatment with hypertonic saline, and she was discharged home without any sequelae.

Effect of organic load and nutrient ratio on the operation stability of the moving bed bioreactor for kraft mill wastewater treatment and the incidence of polyhydroxyalkanoate biosynthesis.

This paper studies the effect of organic load rate (OLR) and nutrient ratio on operation stability of the moving bed bioreactor (MBBR) for kraft mill wastewater treatment, analyzing the incidence of polyhydroxyalkanoate (PHA) production. The MBBR operating strategy was to increase OLR from 0.25 ± 0.05 to 2.41 ± 0.19 kg COD m(-3) d(-1) between phases I and IV. The BOD(5):N:P ratio (100:5:1 and 100:1:0.2) was evaluated as an operation strategy for phases IV to V. A stable MBBR operation was found when the OLR was increased during 225 days in five phases. The maximum absolute fluorescence against the proportion of cells accumulating PHA was obtained for an OLR of 2.41 ± 0.19 kg COD m(-3)d(-1) and a BOD(5):N:P relationship of 100:1:0.2. The increase of PHA biosynthesis is due to the increased OLR and is not attributable to the increased cell concentration, which is maintained constant in stationary status during bioreactor biosynthesis.

Polyhydroxyalkanoates (PHA) biosynthesis from kraft mill wastewaters: biomass origin and C:N relationship influence.

The goal of this study is to evaluate the feasibility of PHA biosynthesis from kraft mill effluent using the batch system evaluating the biomass origin and C:N relationship influence. To evaluate feasibility, batch assays were carried out. Also, two levels of the BOD5:N:P relationship (100:5:1 and 100:1:0.2) and three different sludge origins were considered. Inocula were obtained from activated sludge treatment plants for a) sewage (SAS), b) paper mill (PAS) and c) kraft (KAS). The results show that the maximum Biological Oxygen Demand (BOD5) and Chemical Oxygen Demand (COD) removal was 80.5% and 59.7% respectively using KAS as inoculum. In these assays, kinetics constants were 17.9±3.2 mg L(-1) and 46.5±1.2 d(-1) for (KCOD) and (rmax), respectively under a BOD5:N:P relationship of 100:5:1. The maximum PHA accumulation was obtained under a BOD5:N:P relationship of 100:1:0.2 on the third day of batch assays using PAS sludge with 25.72% of the cells accumulating PHA and on the fifth day in batch using SAS and KAS sludge with 25.85% and 30.40% of cells accumulating PHA, respectively. Yields obtained for the 100:1:0.2 relationships ranged from 0.10-0.14 mg PHA mg(-1) COD.

Monitoring endocrine activity in kraft mill effluent treated by aerobic moving bed bioreactor system.

A Moving Bed Bioreactor (MBBR) was operated at three different hydraulic retention times for a period of 414 days. The fate of the extractive compounds and the estrogenic activity of the Pinus radiata kraft mill effluents were evaluated using Yeast Estrogen Screen (YES) and gas chromatography - mass spectrometry (GC-MS) detection. Results show that the MBBR reactor is able to remove between 80-83% of estrogenic activity present in the kraft mill Pinus radiata influent, where the values of the effluent's estrogenic activity ranged between 0.123-0.411 ng L(-1), expressed as estrogenic equivalent (EEqs) of 17-a-ethynylestradiol (EE2 eq.). Additionally, the biomass of the MBBR reactor accumulated estrogenic activity ranging between 0.29-0.37 ng EEqs EE2 during the different Hydraulic Retention Time (HRT) operations. The main groups present in pulp mills effluents, corresponding to fatty acids, hydrocarbons, phenols, sterols and triterpenes, were detected by solid phase extraction (SPE) and gas chromatography - mass spectrometry (GC-MS). The results suggest that the sterols produce the estrogenic activity in the evaluated effluent.

Metrorragia masiva en una paciente anticoagulada con warfarina. Reversión rápida con concentrado de complejo protrombínico (Prothromplex Immuno TIM 4 600 UI) / Massive metrorrhagia in a patient under warfarin anticoagulation. Rapid reversal with a concentrated prothrombin complex (Prothromplex Immuno TIM 4 600 IU)

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Intussusception: the accuracy of ultrasound-guided saline enema and the usefulness of a delayed attempt at reduction.

BACKGROUND/PURPOSE: The aim of this study was to evaluate the therapeutic value of ultrasound (US)-guided saline enema for intussusception and the usefulness of a delayed attempt after at least 30 minutes when reduction has not been complete. METHODS: One hundred ninety-five cases of intussusception were diagnosed with ultrasonography. US-guided saline hydrostatic reduction was performed in 194 with an additional attempt after at least 30 minutes in those cases in which only partial resolution had been achieved. The method was changed (the volume of the reservoir bag and the caliber of the catheter were increased) so we analyze two different periods; 85 cases are included in the first period and 110 in the second. RESULTS: The global rate of successful reduction was 81.9% (159 of 194 cases), and it raised to 88.2% (97 of 110 cases) in the second period. In 15.5% cases (30 of 194) reduction was achieved in a delayed attempt at least 30 minutes after the initial partial resolution. The rate of recurrence was 9.7%. No perforation was seen. CONCLUSIONS: The accuracy of US-guided saline enema in achieving intussusception reduction is high, similar to other methods, avoiding radiation exposure. A delayed attempt after a period of rest increases the rate of reductions.

Intussusception in children: current concepts in diagnosis and enema reduction.

Intussusception cannot be reliably ruled out with clinical examination and plain radiography. However, a contrast material enema study and ultrasonography (US) allow definitive diagnosis of intussusception. The components of an intussusception produce characteristic appearances on US scans. These appearances include the multiple concentric ring sign and crescent-in-doughnut sign on axial scans and the sandwich sign and hayfork sign on longitudinal scans. Indicators of ischemia and irreducibility are trapped fluid at US and absence of blood flow at Doppler imaging. The aim of enema therapy is to reduce the greatest number of intussusceptions without producing perforation. Barium, water-soluble contrast media, water, electrolyte solutions, or air may be used with radiographic or US guidance. The differences in reduction and perforation rates between the various types of enemas are probably due more to perforations that occurred before enema therapy and the pressure exerted within the colon than to the contrast material used. The pressure within the colon is more constant with hydrostatic reduction than with air reduction; this fact may explain the lower risk of perforation with hydrostatic reduction. Radiation exposure is lower with air enema therapy than with barium enema therapy and is absent in US-guided enema therapy.

Intussusception: trapped peritoneal fluid detected with US--relationship to reducibility and ischemia.

PURPOSE: To determine the frequency and meaning of fluid inside the intussusception at ultrasound (US) and its relationship to irreducibility and ischemia. MATERIALS AND METHODS: US enabled the diagnosis of intussusception in 145 cases. Shape and axial diameters of the area of fluid were determined. US-guided hydrostatic reduction was attempted in 144 cases. RESULTS: Fluid was present in the intussusception in 20 cases (14%) and appeared on axial images as an anechoic crescent between both serosal layers of the enfolded and everted intussusceptum. No cystic structural anomaly was detected at surgery. Rates of reduction were 89% (111 of 125) in cases without fluid and 26% (five of 19) in cases with fluid (P < .001). At surgery, ischemia was absent in all 14 cases without fluid and present in 10 of 20 cases with fluid; necrosis was present in two cases with fluid. Areas of fluid greater than 14 x 5 mm, especially if associated with fluid in the dilated apex of the intussusception, were strongly related to irreducibility and ischemia (odds-likelihood ratio, 67.5). CONCLUSION: Fluid seen inside the intussusception represented trapped peritoneal fluid. Substantial amounts of fluid were associated with irreducibility and ischemia.

Intussusception: US findings with pathologic correlation--the crescent-in-doughnut sign.

PURPOSE: To determine the characteristic ultrasound (US) findings of intussusception and to explain its different components. MATERIALS AND METHODS: Three intussusceptions were surgically induced in pigs, and in vitro US scans were compared with the corresponding pathologic slices. US findings in 44 cases of pediatric intussusception confirmed by means of saline enema examination were analyzed. RESULTS: Axial images of intussusception showed a doughnut pattern. The hypoechoic external ring was formed by the everted returning limb of intussusceptum and, to a lesser degree, by the intussuscipiens. The doughnut's center varied according to the scan level. Scans obtained at the middle or at the base of the intussusception showed a characteristic hyperechoic crescent in all cases. This crescent was formed by the mesentery enclosing the entering limb of the intussusceptum, which the authors have termed the "crescent-in-doughnut sign". On scans obtained at the apex of the intussusception, the center was hypoechoic owing to the entering limb of the intussusceptum and the absence of the mesentery. CONCLUSION: The crescent-in-doughnut sign appears to be a characteristic feature of intussusception.

Manejo nutricional en el infante prematuro

Siendo el prematuro por su inmadurez orgáncia un niño con necesidades especiales de nutrición, en el presente artículo se revisan las diversas técnicas de alimentación que se deben implementar en relación con los problemas que estos niños presentan, y los requerimientos nutricionales que ellos necesitan para conseguir un normal crecimiento y desarrollo, similar al que hubiesen tenido dentro del útero materno.