West Indian Punctate Keratopathy and "Puerto Rican (PR) Spots".

This study describes the clinical characteristics of a cohort of Hispanic patients living in Puerto Rico who were found to have West Indian punctate keratopathy (WIPK). This case also introduces the term "PR (Puerto Rican) spots" to describe the dots observed in the eyes of individuals with WIPK who have a documented history of residing in Puerto Rico. The methods of the study consist of a retrospective chart review of patients presenting with WIPK. The patient data were entered retrospectively into a new database and analyzed. Eighteen patients who had WIPK were identified. The median age at presentation was 60.5 years (range: 49-72); 61.1% were female. At presentation, only one patient had both eyes affected. The median number of PR spots on examination was 1 (range: 1-4). All the patients had a history of ocular disease, most frequently glaucoma (55.5%), and had lived in Puerto Rico for more than 40 years. A total of 33.3% of the patients were retired or unemployed at the time of their presentation. While the origin of these dots remains unclear, ongoing efforts to document and characterize WIPK and PR spots will persist, with the aim of enhancing our understanding of this clinical entity.

Influencia de la obesidad en la severidad de la infección por SARS-CoV-2

La obesidad es una enfermedad metabólica crónica asociada a un incremento de la morbimortalidad cuya prevalencia se ha incrementado a niveles pandémicos lo que la constituye como un factor de riesgo clínico típico de peor pronóstico en pacientes con COVID-19. El propósito de esta revisión fue categorizar los principales factores fisiopatológicos que influyen en la gravedad de COVID-19 en pacientes con obesidad, mediante la búsqueda sistemática de artículos publicados hasta el 11 de marzo de 2022 usando diferentes bases de datos (Scopus, Cochrane, PubMed, Web of Science y Medline). Los resultados indican que la presencia de angiotensina II permite el ingreso del virus SARS-CoV-2 en las células del tejido adiposo convirtiéndolo en un depósito importante del virus lo que causa una diseminación más rápida a órganos vecinos. Estos valores incrementados de angiotensina II en el pulmón pueden inducir a vasoconstricción que a su vez conduce a un desajuste de ventilación/perfusión e hipoxemia, así como a inflamación y daño oxidativo. El incremento de la angiotensina II en pacientes con obesidad puede exacerbar el aumento del nivel de angiotensina II inducido por COVID-19, lo que lleva a una lesión pulmonar más grave, además de la formación de microcoágulos que colapsan la irrigación a nivel capilar, sobre todo la del alveolo, causando fallo a este nivel con extravasación de líquidos y neumonía fulminante. Además, la obesidad produce una alteración del sistema inmune comprometiendo así su capacidad de respuesta ante la infección respiratoria y propiciando un empeoramiento de la enfermedad.

Obesity is a chronic metabolic disease associated with increased morbidity and mortality whose prevalence has increased to pandemic levels, making it a typical clinical risk factor for worse prognosis in patients with COVID-19. The purpose of this review was to categorize the main pathophysiological factors that influence the severity of COVID-19 in patients with obesity, through a systematic search for articles published up to March 11, 2022 using different databases (Scopus, Cochrane, PubMed, Web of Science and Medline). The results indicate that the presence of angiotensin II allows the SARS-CoV-2 virus to enter the adipose tissue cells, making it an important reservoir for the virus, which causes faster dissemination to neighboring organs. These increased values of angiotensin II in the lung can induce vasoconstriction which in turn leads to ventilation/perfusion mismatch and hypoxemia, as well as inflammation and oxidative damage. The increase in angiotensin II in the obese can exacerbate the increase in the level of angiotensin II induced by COVID-19, leading to more severe lung injury, in addition to the formation of microclots that collapse the irrigation at the capillary level, especially in the alveolus, causing failure at this level with fluid extravasation and fulminant pneumonia. In addition, obesity produces an alteration of the immune system, thus compromising its ability to respond to respiratory infection and leading to a worsening of the disease.

Effects of cranioplasty in cerebral blood perfusion using quantification with 99m-Tc HMPAO SPECT-CT.

BACKGROUND AND PURPOSE: Syndrome of the trephined or sinking skin flap syndrome is an underdiagnosed condition of craniectomized patients that usually improves after cranioplasty. Among the pathophysiological theories proposed, the changes of cerebral blood perfusion (CBP) caused by cranial defects might have a role in the neurological deficiencies observed. We aim to assess the regional cortex changes in CBP after cranioplasty with Technetium 99m hexamethylpropylene-amine oxime (99mTc-HMPAO) SPECT-CT. METHODS: Twenty-eight craniectomized patients subject to cranioplasty were studied with 99mTc-HMPAO SPECT-CT in three different times, before cranioplasty, a week, and 3 months after. The images were processed with quantification software comparing CBP of 24 cortical areas with a reference area, and with a database of controls. A mixed effects model and T-Student were used. RESULTS: CBP increased significantly in both hemispheres after cranioplasty, either using ratio (ß = .019, p-value = .030 first postsurgical SPECT-CT and ß = .021, p-value = .015 in the second study, vs. presurgical) or Z-score (ß = .220, p-value = .026 and ß = .279, p-value = .005, respectively). Nine areas of the damaged side had a significant lower CBP ratio and Z-score than the undamaged. Posterior cingulate showed an increased CBP ratio (p-value = .034) and Z-score (p-value = .028) in the first postsurgical SPECT-CT. These posterior cingulate changes represent a 4.83% increase in ratio and 91.04% in Z-Score (p-value = .035 and .040, respectively). CONCLUSION: CBP changes significantly in specific cortical areas after cranioplasty. Posterior cingulate changes might explain some improvements in attention impairments. SPECT-CT could be a useful tool to assess CBP changes in these patients and might be helpful in their clinical management.

Prioritization preferences for COVID-19 vaccination are consistent across five countries.

Vaccination against COVID-19 is making progress globally, but vaccine doses remain a rare commodity in many parts of the world. New virus variants require vaccines to be updated, hampering the availability of effective vaccines. Policymakers have defined criteria to regulate who gets priority access to the vaccination, such as age, health complications, or those who hold system-relevant jobs. But how does the public think about vaccine allocation? To explore those preferences, we surveyed respondents in Brazil, Germany, Italy, Poland, and the United States from September to December of 2020 using ranking and forced-choice tasks. We find that public preferences are consistent with expert guidelines prioritizing health-care workers and people with medical preconditions. However, the public also considers those signing up early for vaccination and citizens of the country to be more deserving than later-comers and non-citizens. These results hold across measures, countries, and socio-demographic subgroups.

Intravenous lidocaine infusion for the treatment of acute pain in the pediatric intensive care unit: case series / Infusión de lidocaína endovenosa para el tratamiento de dolor agudo en la unidad de cuidado intensivo pediátrico: serie de casos

Abstract Introduction: The use of intravenous lidocaine infusion has increased over the past decade as part of a multimodal approach to analgesia in adults; however, information about its safety and tolerability in the pediatric population is limited. Methods: Acute pain management using lidocaine infusion in eleven patients treated in the pediatric intensive care unit. Results: Five cases of postoperative abdominal pain and six cases of non-operative abdominal pain. Two cases were cancer patients affected by neutropenic colitis. Analgesic control achieved was good. Conclusion: Lidocaine infusions are apparently a safe option for the management of acute pain, either post-operative or not, in the pediatric population.

Resumen Introducción: El uso de la infusión de lidocaína endovenosa ha aumentado en la última década como parte de un enfoque analgésico multimodal en los adultos; sin embargo, se dispone de información limitada sobre su seguridad y tolerabilidad en la población pediátrica. Métodos: Se presentan once casos de manejo de dolor agudo con lidocaína en infusión tratados en unidad de cuidado intensivo pediátrico. Resultados: Cinco casos fueron postoperatorio abdominal y seis casos tenían dolor abdominal no postoperatorio. Dos pacientes tenían cáncer y cursaban con colitis neutropénica. El control analgésico alcanzado fue bueno. Conclusión: Las infusiones de lidocaína parecen ser una opción segura para el manejo del dolor agudo ya sea posquirúrgico o no en la población pediátrica.

Excess mortality in patients with schizophrenia spectrum disorders in Malaga (Spain): A cohort study.

AIMS: There is evidence that patients with schizophrenia spectrum disorders present higher mortality in comparison with the general population. The aim of this study was to analyse the causes of mortality and sociodemographic factors associated with mortality, standardised mortality ratios (SMRs), life expectancy and potential years of life lost (YLL) in patients with schizophrenia spectrum disorders in Spain. METHODS: The study included a cohort of patients from the Malaga Schizophrenia Case Register (1418 patients; 907 males; average age 42.31 years) who were followed up for a minimum of 10 years (median = 13.43). The factors associated with mortality were analysed with a survival analysis using Cox's proportional hazards regression model. RESULTS: The main causes of mortality in the cohort were circulatory disease (21.45%), cancer (17.09%) and suicide (13.09%). The SMR of the cohort was more than threefold that of the population of Malaga (3.19). The life expectancy at birth was 67.11 years old, which is more than 13 years shorter than that of the population of Malaga. The YLL was 20.74. The variables associated with a higher risk of mortality were age [adjusted hazard ratio (AHR) = 1.069, p < 0.001], male gender (AHR = 1.751, p < 0.001) and type of area of residence (p = 0.028; deprived urban zone v. non-deprived urban area, AHR = 1.460, p = 0.028). In addition, receiving welfare benefit status in comparison with employed status (AHR = 1.940, p = 0.008) was associated with increased mortality. CONCLUSIONS: There is excess mortality in patients with schizophrenia spectrum disorders and also an association with age, gender, socioeconomic inequalities and receiving welfare benefits. Efforts directed towards improved living conditions could have a positive effect on reducing mortality.

Antimicrobial Films Based on Nanocomposites of Chitosan/Poly(vinyl alcohol)/Graphene Oxide for Biomedical Applications.

Today, tissue regeneration is one of the greatest challenges in the field of medicine, since it represents hope after accidents or illnesses. Tissue engineering is the science based on improving or restoring tissues and organs. In this work, five formulations of chitosan/poly(vinyl alcohol)/graphene oxide (CS/PVA/GO) nanocomposites were studied for the development of biodegradable films with potential biomedical applications. The characterization of the films consisted of Fourier-transform infrared (FTIR) spectroscopy, scanning electron microscopy (SEM) and energy dispersive spectroscopy (EDS). The antibacterial activity was evaluated in vitro against Gram-positive bacteria Bacillus cereus and Staphylococcus aureus and Gram-negative Salmonella spp. and Escherichia coli, by contact of the film above inoculum bacterial in Müeller⁻Hinton agar. On the other hand, in vivo tests in which the material implanted in the subcutaneous tissue of Wistar rats demonstrated that the formulation CS/PVA/GO (14.25:85:0.75) was the best antibacterial film with adequate degradation in vivo. All together, these results indicate the potential of the films using nanocomposites of CS/PVA/GO in tissue engineering and cell regeneration.

Late diagnosis of pseudohypoparathyroidism in adulthood. Case series / Pseudohipoparatiroidismo diagnosticado tardíamente en la adultez, una serie de casos

Abstract Introduction: Pseudohypoparathyroidism (PHP) is a rare hereditary disease, characterized by hypocalcemia/hyperphosphatemia secondary to peripheral resistance to parathyroid hormone (PTH). PHP diagnosis is usually precluded since hypocalcemia is considered as the primary diagnosis, thus delaying further diagnostic studies and preventing an adequate management of this clinical condition. Materials and methods: Retrospective review of the databases of the Endocrinology departments of two tertiary care centers of Medellin, Colombia from January 2012 to December 2016. Patients diagnosed with PHP based on clinical presentation and confirmatory laboratory values were included. Results: Four patients met the inclusion criteria. All PHP cases were diagnosed in adulthood despite strong early clinical and laboratory evidence of the disease. Three patients were diagnosed with Fahr's syndrome and two with Albright's hereditary osteodystrophy. The mean values obtained were PTH of 376.8 pg/mL, calcium of 6.17 mg/dL and phosphorus of 6.55 mg/dL. Conclusions: PHP is a rare disorder. This paper describes four PHP cases diagnosed during adulthood. Emphasis should be placed on the judicious approach to the patient with hypocalcemia and hyperphosphatemia with increased PTH and normal renal function, since these symptoms strongly suggest a diagnosis of PHP.

Resumen Introducción. El pseudohipoparatiroidismo (PHP) es una condición rara caracterizada por hipocalcemia e hiperfosfatemia secundarias a resistencia periférica a la hormona paratiroidea (PTH). Es frecuente que la hipocalcemia sea establecida de forma equivocada como diagnóstico primario y que el diagnóstico definitivo de PHP sea tardío, difiriendo los estudios y el manejo específico que exigen estos pacientes. Materiales y métodos. Se revisaron de forma retrospectiva las bases de datos de endocrinología de dos centros terciarios de Medellín, Colombia, desde enero de 2012 a diciembre de 2016. Se incluyeron pacientes con diagnóstico de PHP por presentación clínica y valores confirmatorios de laboratorio. Resultados. Cuatro pacientes cumplieron los criterios de inclusión. Todos los casos fueron diagnosticados en la adultez a pesar de tener evidencia temprana, clínica y bioquímica de la enfermedad. Tres pacientes tenían síndrome de Fahr y dos tenían osteodistrofia hereditaria de Albright. Los valores medios registrados fueron PTH de 376.8 pg/mL, calcio de 6.17 mg/dL y fósforo de 6.55 mg/dL. Conclusiones. El PHP es un trastorno raro; se describen cuatro casos diagnosticados de forma tardía en la adultez. Se enfatiza en el enfoque juicioso del paciente con hipocalcemia, la cual, en presencia de hiperfosfatemia con PTH elevada y función renal normal, debe hacer sospechar el diagnóstico de PHP.

Future time perspective in female prison inmates convicted for the crime of terrorism in Lima, Peru / Perspectiva temporal futura en mujeres sentenciadas por el delito de terrorismo en un establecimiento penitenciario de lima (perú)

RESUMEN La perspectiva temporal futura plantea un espectro de motivaciones ubicadas cognitivamente en el futuro. Este estudio la describe veinticuatro mujeres sentenciadas por el delito de terrorismo en un establecimiento penitenciario de Lima. Para ello, se utilizó el método de inducción motivacional que usando frecuencias porcentuales categoriza y jerarquiza las metas de las participantes. La conclusión principal es que la distribución general y la extensión de las metas muestran proporciones similares con la población no penitenciaria estudiada en nuestro medio. Esto contradice la opinión pública, cuya imagen de las participantes es que su único interés corresponde a los fines del partido en el cual han militado.

ABSTRACT Future Time Perspective (PTF) formulates a spectrum of goals, cognitively located in the future. This study describes the PTF of 24 female prison inmates convicted for the crime of terrorism in Lima. To do so, we used the Motivational Induction Method, which categorizes and hierarchizes the goals of the participants using percentage frequencies. Our main conclusion is that proportions regarding the general distribution and the extension of the goals are similar to the non-prisoned society groups studied by Martínez (2004c). This is opposite to the public's opinion of the participants, according to which their only interest corresponds with the goals of the party they have been ascribed to.

Caracterización de compuestos fenólicos presentes en el extracto etanólico de hojas de Alternanthera lanceolata (Benth) Schinz, "lancetilla" / Characterization of phenolic compounds present in the ethanolic extract of leaves of Alternanthera lanceolata (Benth.) Schinz, "lancetilla"

Objetivos: Caracterizar compuestos fenólicos presentes en el extracto etanólico de las hojas de Alternanthera lanceolata (Benth.) Schinz "lancetilla". Materiales y métodos: Se preparó un extracto etanólico de las hojas de Alternanthera lanceolata (Benth.) Schinz "lancetilla". Se evaluó la solubilidad del extracto en solventes de polaridad creciente. Se detectaron los componentes químicos del extracto etanólico mediante un tamizaje fitoquímico empleando gelatina, tricloruro férrico, reacción de Shinoda, entre otros. Se realizó cromatografía en capa fina, desorción y propuesta de estructuras químicas para los metabolitos tipo flavonoides presentes en el extracto etanólico de hojas de Alternanthera lanceolata (Benth.) Schinz "lancetilla" mediante espectroscopía UV-Vis. Resultados: El extracto etanólico presentó mejor solubilidad en solventes de mediana polaridad. El tamizaje fitoquímico dio resultados positivos para presencia de compuestos fenólicos, flavonoides y glicósidos. Se propuso la estructura química de siete flavonas en el extracto investigado. Conclusiones: Se caracterizó y propuso las estructuras de compuestos fenólicos tipo flavonas en el extracto etanólico de las hojas de Alternanthera lanceolata (Benth.) Schinz "lancetilla".

Use of EMG biofeedback for basic activities of daily living training in stroke patients. Pilot randomized clinical trial / Uso de biofeedback electromiográfico durante el entrenamiento de las actividades básicas de la vida diaria en pacientes con accidente cerebrovascular. Ensayo clínico aleatorizado piloto

Abstract Introduction: Sequels in stroke patients include hemiparesis and dependency for performing basic activities of daily living (BADL). EMG biofeedback has yielded some benefits but has been limited to repetitive movement, therefore, it is insufficient for current task-oriented neurorehabilitation paradigms. Objective: To assess whether the application of EMG biofeedback in upper limbs during BADL training improves motor, occupational and satisfaction performances compared to BADL training without this feedback. Materials and methods: A pilot randomized clinical trial was conducted with stroke patients of more than six months of evolution, who showed hemiparesis and no cognitive deterioration. These patients were randomly classified into two groups: control group, who underwent conventional occupational therapy (COT), and experimental group, who underwent COT+EMG-BF. Patients were given 10 therapy sessions. Entry, evaluation and data analysis were masked. Results: Seven patients were included in each group, showing the same initial clinical and demographic characteristics (p>0.05). The group that underwent COT+EMG-BF showed a significantly better performance in all assessments. For example, the Barthel scale obtained a median of 100 points [85-100] for the COT+EMG-BF group versus 85 [80-90] for the control group (p<0.05), whereas ARAT score was 42 [40-47] points versus 20 [15-38] (p=0.03), respectively. Conclusion: The combination of COT+EMG-BF for BADL may be considered as an alternative for treatment of stroke patients.

Resumen Introducción. Las principales secuelas del accidente cerebrovascular (ACV) son la hemiparesia y la dependencia en actividades básicas de la vida diaria (ABVD). El biofeedback electromiográfico (BF-EMG) ha mostrado beneficios, pero su uso se ha centrado en el entrenamiento de movimientos aislados, lo que difiere del paradigma actual en rehabilitación. Objetivo. Evaluar si la aplicación de BF-EMG durante el entrenamiento de ABVD mejora el nivel de independencia, el funcionamiento motor y la satisfacción en el desempeño comparado con entrenamiento de ABVD sin esta técnica. Materiales y métodos. Ensayo clínico piloto en pacientes de 18 a 70 años con hemiparesia secundaria a ACV isquémico crónico. Los pacientes fueron aleatorizados en dos grupos: un grupo control con terapia ocupacional convencional (TOC) o un grupo experimental con TOC + BF-EMG. Se enmascaró el enrolamiento, la evaluación y el análisis de datos. Resultados. Se reclutaron siete pacientes en cada grupo, control y experimental, con las mismas características demográficas y clínicas iniciales (p>0.05). El grupo TOC+BF -EMG mostró mejor rendimiento en todas las evaluaciones. En el índice de Barthel se obtuvo una mediana de 100 puntos (85-100) para el grupo TOC + BF-EMG en comparación a 85 (80-90) del grupo control (p<0.05), mientras que en el test de Arat fueron 42 (40-47) puntos frente a 20 (15-38) (p=0.03), respectivamente. Conclusión. La combinación de TOC + BF-EMG en ABVD podría considerarse una alternativa en el tratamiento de personas con ACV.

Frecuencia de acoso y ciber-acoso, y sus formas de presentación en estudiantes de secundaria de colegios públicos de la ciudad de Manizales, 2013 / Frequency of bullying and cyberbullying, and its ways of presentation in public high school students in the city of Manizales. 2013

Objetivo: Determinar la frecuencia y formas de presentación de acoso y ciber-acoso en estudiantes de secundaria de instituciones educativas de la ciudad de Manizales, Caldas, Colombia. Materiales y métodos: Estudio de corte transversal realizado en tres instituciones educativas públicas de Manizales. La población de estudiantes fue de 1 769, de los cuales se tomó una muestra de 574. Se tomaron variables demográficas, de acoso escolar empleando el instrumento para medir violencia escolar de la Fundación Paz Ciudadana, ciber-acoso, funcionalidad familiar, ansiedad, depresión y autoestima según cuestionarios empleados en estudios anteriores. Resultados: 50% de la población de género femenino, con promedio de edad de 14,3 años. El cuestionario empleado arrojó un 5% en el rango 3-5 de acoso, 2,4% en el rango 3-5 de acosadores, 1,6% en el mismo rango de la escala de ciber-acoso, y 0,9% en la de ciber-acosadores. Si bien es cierto que estas proporciones son bajas, se debe tener en cuenta que en el rango 2-3 de todos los cuestionarios podría haber tanto acoso o acosador Se encontró que la baja autoestima, los altos niveles de depresión y la disfuncionalidad familiar correlacionan con altos niveles tanto de acoso, como de acosador, y también sus contrapartes virtuales. El género femenino es tan acosado como el masculino pero son más los acosadores de género masculino que de femenino (p=0,000). Conclusiones: En esta población el “bullying” es un fenómeno de ocurrencia no despreciable. Se encontró igualmente que los efectos psicológicos del “bullyng” afectan tanto al acosado como al acosador…

Objective: Determine the frequency and the ways of presentation of bullying and cyberbullying in high school students from schools in Manizales, Caldas, Colombia,between January and June of 2013. Materials and methods: A cross-sectional study realized in three public schools of Manizales. The population of students was 1769,of which 574 were gotten as a sample. Many variables were taken from previous questionnaires’ studies: Demographic, bullying using the instrument for bullying of Fundación Paz Ciudadana, cyberbullying, family functioning, anxiety, depression andself-esteem. Results:50% of the sample was male and the rest was female with anaverage of 14.3 years old. The questionnaire showed a prevalence of 5% within the3-5 range in regards to the bullied, 2,4% in regards to the bully and 1,6% in regardto the cyber-bullies. It was found that low self-esteem, high levels of depression and family dysfunction are correlated to the high levels of bulling and cyber-bulling. Malesand females are being bullied equally, but males are more often the bully (p=0,000). Conclusions:In the population bullying is not of low occurrence. It was found as well that the psychological effects are present in the bullied as well as the bully.

Copper deficiency alters cell bioenergetics and induces mitochondrial fusion through up-regulation of MFN2 and OPA1 in erythropoietic cells.

Copper is essential in cell physiology, participating in numerous enzyme reactions. In mitochondria, copper is a cofactor for respiratory complex IV, the cytochrome c oxidase. Low copper content is associated with anemia and the appearance of enlarged mitochondria in erythropoietic cells. These findings suggest a connection between copper metabolism and bioenergetics, mitochondrial dynamics and erythropoiesis, which has not been explored so far. Here, we describe that bathocuproine disulfonate-induced copper deficiency does not alter erythropoietic cell proliferation nor induce apoptosis. However it does impair erythroid differentiation, which is associated with a metabolic switch between the two main energy-generating pathways. That is, from mitochondrial function to glycolysis. Switching off mitochondria implies a reduction in oxygen consumption and ROS generation along with an increase in mitochondrial membrane potential. Mitochondrial fusion proteins MFN2 and OPA1 were up-regulated along with the ability of mitochondria to fuse. Morphometric analysis of mitochondria did not show changes in total mitochondrial biomass but rather bigger mitochondria because of increased fusion. Similar results were also obtained with human CD34+, which were induced to differentiate into red blood cells. In all, we have shown that adequate copper levels are important for maintaining proper mitochondrial function and for erythroid differentiation where the energy metabolic switch plus the up-regulation of fusion proteins define an adaptive response to copper deprivation to keep cells alive.

Ethinylestradiol/Chlormadinone acetate for use in dermatological disorders.

The diagnosis and management of four cases of dermatological disorders, most of which are related to the endocrine disorder of androgen excess, are presented. Combined oral contraceptives (COCs) may be useful when well-tolerated hormonal therapy and/or when contraception is required. A female patient with androgenetic alopecia or female pattern balding, without underlying hyperandrogenism, was treated with ethinylestradiol/chlormadinone acetate (EE/CMA) 0.03 mg/2 mg for 6 months and experienced stabilization of hair loss (case report 1). A patient who had previously received a COC for an irregular menstrual pattern but again experienced irregular menses and also acne after stopping treatment was diagnosed with acne associated with polycystic ovary syndrome (PCOS) [case report 2]. After 6 month's treatment with EE/CMA 0.03 mg/2 mg, this patient had fewer acne lesions and became eumenorrheic. A third patient who had excess hair since childhood was diagnosed with idiopathic hirsutism (no underlying gynecological or endocrinological disorder was found) and was treated with EE/CMA 0.03 mg/2 mg (case report 3). Less hair growth was reported after 6 months' treatment. Case report 4 describes a patient who presented with oligomenorrhea and acne. She was diagnosed with PCOS with acne, seborrhea and mild hirsutism. Treatment with EE/CMA 0.03 mg/2 mg for 6 months resulted in improvements in her facial acne, seborrhea and hirsutism; she also became eumenorrheic. These four cases illustrate that EE/CMA may be a useful and well tolerated treatment option in the management of patients with dermatological disorders with or without hyperandrogenization.

Accidentes laborales en la provincia de Málaga. Participación del alcohol etílico y las drogas de abuso / Labor accidents in the province of Malaga. Participation of the ethyl alcohol and the drugs of abuse

El presente trabajo se corresponde con un estudio observacional descriptivo de los accidentes de trabajo ocurrido en la provincia de Málaga entre Octubre de 2003 y Diciembre de 2006, con resultado de muerte y que fueron autopsiados en el Instituto de Medicina Legal de Málaga. En él hemos analizado todas aquellas variables circunstanciales que, de una forma u otra, desempeñan algún papel en la etiopatogenia de este tipo de lesiones, haciendo hincapié en la participación del alcohol etílico y las drogas de abuso. Se describen 17 casos positivos a alcohol etílico, cannabis o cocaína y destácala ausencia de medidas de seguridad en el trabajador. Todo ello con la finalidad de establecer unas pautas de conducta que permitan, en la medida de lo posible, ayudar a prevenir e incluso a disminuir el número de estos accidentes que, por desgracia, en pleno siglo XXI se vienen cobrando todos los años un número no desechable de vidas humanas, con la tragedia que ello supone (AU)

This work corresponds to a descriptive observational study of work accidents occurred in the province of Malaga between October 2003 and December 2006, resulting in death and which were autopsied in the Institute of Legal Medicine of Malaga. We have analyzed all those circumstantial variables that, in one way or another, play a role in the pathogenesis of these lesions, emphasizing in the participation of ethyl alcohol and drug abuse. We described 17 cases positive to ethylic alcohol, cannabis or cocaine and the absence of safety measures in the worker. All this with the purpose of establishing a few behavior guidelines which as far as possible, may help to anticipate, and even to diminish the number of this type of accidents that, unfortunately, in full 21stcentury are still very high (AU)

Demandas inadecuadas en urgencias e identificación del uso inapropiado de la hospitalización en el Centro Piloto de Assbasalud ESE. en Manizales: año 2008 / Inappropriate demands in the emergency room and identification of the inappropriate use of hospitalization in Assbasalud ESE. in Manizales, Colombia

Introducción: Es evidente la congestión cotidiana que se genera en los servicios de urgencias, de allí el interés por indagar sobre la demanda adecuada de este servicio de urgencias en el Centro Piloto de ASSBASALUD, ESE (Manizales, Caldas, Colombia). Materiales y Métodos: Se tuvieron en cuenta diversas variables socio demográficas, y criterios de utilización correcta del servicio de urgencias, basados en protocolos de distintos estudios realizados en otros países y adaptados al medio colombiano. La investigación se llevó a cabo en el servicio de urgencias del Centro Piloto de Assbasalud E.S.E, a través de encuestas realizadas directamente a los pacientes, y de historias clínicas. Resultados: Son inadecuadas el 23.6 por ciento de las consultas a urgencias, el 16.6 por ciento de las estancias hospitalarias, ambas suficientes para saturar este servicio. Prevalece la consulta por patología aguda, 83.2 por ciento, en especial aquellas que afectan al sistema respiratorio, 24.1por ciento. La población de pacientes en los extremos de la vida consultan más frecuentemente a los servicios de urgencia, asociado a patologías respiratorias y gastrointestinales , se encuentra un 32.2 por ciento de varones y un 67.8 por ciento de mujeres, en su mayoría pertenecientes al estrato más bajo del SISBEN, el 1, con un 72.2 por ciento. Predomina el sexo femenino, 58.8 por ciento, y los rangos educativos más bajos, 58 por ciento; el 43.7 por ciento, 65.6 por ciento tienen vinculación laboral...