A proposal for using the ratio of attempted to completed suicides across several countries worldwide.

Completed suicide (CS) is a leading cause of death worldwide and its rates are available for most developed countries. On the other hand, attempted suicide (AS) is a risk factor for CS but there are limited data on its rates in various countries. In constructing a ratio for AS/CS rates, most would agree that for CS, the denominator should be the annual suicide rate (per 100 000). As for the ratio's numerator (AS) per 100 000, there are three possible calculations: (1) annual prevalence from population surveys, (2) annual prevalence from national clinical registers or (3) lifetime prevalence from population surveys. We think that the first possibility would probably be the best choice but, unfortunately, surveys providing the annual prevalence of AS are lacking for most countries. Annual prevalence from national registers is also lacking for most countries and is contaminated by under-reporting. Therefore, in this editorial, we are left with only the last option, a ratio for lifetime prevalence of AS (per 100 000) divided by annual rate of CS (per 100 000). This ratio for AS/CS rates appears to differ substantially across countries worldwide but presents no big regional differences other than two remarkable exceptions, one per continent. In Europe, Spain and France had greater ratios (174.4 and 152.5, respectively) than Italy (64.1). In Asia/Pacific, New Zealand has a higher ratio (345.9) compared with China (75.8) and Japan (76.9). The ratio for AS/CS rates could be a good index for implementing evidence-informed decision-making regarding suicidal behaviour (SB) among health service managers, and for helping them in the allocation of health resources for the prevention of SB.

Immobilization of lipases in hydrophobic chitosan for selective hydrolysis of fish oil: The impact of support functionalization on lipase activity, selectivity and stability.

The objective of this paper was to carry out an integral study of the use of hydrophobic chitosan as a low-cost support for immobilizing lipases and their further application in the selective hydrolysis of fish oil. Chitosan functionalized with different alkyl chains (C4, C8, C12) were characterized by FTIR, TGA, SEM, and Rose Bengal adsorption. Lipase B from Candida antarctica (CalB) and lipase from Rhizomucor miehei (RML) were immobilized obtaining a higher expressed activity at a longer alkyl chain length of support. Biocatalyst thermal stability showed that the impact of the alkyl chain length on enzyme stabilization varied according to the lipase source. The biocatalysts were applied in menhaden oil hydrolysis. Total polyunsaturated fatty acids released after 30 h of reaction with lipases immobilized in butyl, octyl and dodecyl-chitosan was 60, 107, and 90 mM for CalB biocatalysts, and 560, 392, and 50 mM for RML biocatalysts, respectively. Selectivity of CalB was not affected by the alkyl chain, while in the case of RML, a higher selectivity to cis-4,7,10,13,16,19-docohexaenoic acid release was obtained with dodecyl-chitosan. In conclusion, the adequate functionalization of chitosan varied according to lipase source, affecting their activity, stability and performance in the hydrolysis of fish oil.

Evaluation of traction stirrup distraction technique to increase the joint space of the shoulder joint in the dog: A cadaveric study.

The objective of this study was to evaluate technical feasibility and efficacy of a joint distraction technique by traction stirrup to facilitate shoulder arthroscopy and assess potential soft tissue damage. Twenty shoulders were evaluated radiographically before distraction. Distraction was applied with loads from 40 N up to 200 N, in 40 N increments, and the joint space was recorded at each step by radiographic images. The effects of joint flexion and intra-articular air injection at maximum load were evaluated. Radiographic evaluation was performed after distraction to evaluate ensuing joint laxity. Joint distraction by traction stirrup technique produces a significant increase in the joint space; an increase in joint laxity could not be inferred by standard and stress radiographs. However, further clinical studies are required to evaluate potential neurovascular complications. A wider joint space may be useful to facilitate arthroscopy, reducing the likelihood for iatrogenic damage to intra-articular structures.

Evaluation of a distractor to increase joint space of the stifle joint in dogs: a cadaveric study.

OBJECTIVE: To evaluate the technical feasibility and efficacy of a joint distraction technique to increase the stifle joint space and assess potential soft tissue damage due to the distraction. METHODS: Twenty stifle joints of twelve canine cadavers without evidence of disease were radiographically evaluated by medio-lateral, cranio-caudal and varus-valgus stressed projections. Joint distraction was applied with loads from 40 N up to 200 N, and the joint space achieved was measured on radiographic images. Distraction plus distension with saline was subsequently applied and measured. Varus-valgus stressed projections were repeated after distraction to evaluate a potential increase in joint laxity. RESULTS: Distraction produced a significant increase of the joint space for most of the evaluated loads. Distraction plus distension produced a significant increase for most of the loads compared to the distraction alone. No ensuing joint laxity could be inferred from the post-distraction radiographic evaluation. CLINICAL SIGNIFICANCE: Stifle distraction produces an increase of the joint space, which is wider when intra-articular saline is injected. This may be potentially useful for improving joint structure visualization and facilitating arthroscopic procedures, thus reducing the potential for iatrogenic damage to intra-articular structures. No soft tissue damage could be inferred by radiographic pre- and post-procedure comparison. Further clinical studies are required to evaluate potential neurovascular complications.

Evaluation of a joint distractor to facilitate arthroscopy of the hip joint in dogs.

OBJECTIVE: To evaluate the technical feasibility and efficacy of a hip joint distraction technique, any potential ligamentous damage linked to the procedure, and the effect of joint venting on the maximum distraction achieved. METHODS: Twenty hip joints from 11 canine cadavers were evaluated radiographically by standard and stressed projections. Joint distraction was applied with loads from 40 up to 200 N, in 40 N increments, and fluoroscopic images were obtained at each load. At 200 N, a needle was inserted into the joint to achieve a venting effect, and the space was measured again. Standard and stressed radiographs were performed to evaluate potential laxity changes. RESULTS: Distraction caused a significant increase in joint space at each load of distraction, although there were some variations. Joint venting produced a significant increase in joint space. A statistically significant difference in joint laxity evaluated radiographically before and after the procedure was recorded. CLINICAL SIGNIFICANCE: Use of the distraction apparatus resulted in an increase in joint space. This could be useful for clinical situations where a larger joint space is required such as for arthroscopic procedures. However, loads in excess of 200 N may induce significant increases in joint laxity.

Evaluation of a joint distractor to facilitate arthroscopy of the tibio-tarsal joint in dogs.

OBJECTIVE: To evaluate the technical feasibility, efficacy and potential soft tissue damage of a joint distraction technique to facilitate arthroscopy of the tibio-tarsal joint and to test the effect of joint venting on the maximum distraction achieved. METHODS: Twenty hocks were preliminarily evaluated radiographically by standard and stressed projections. Joint distraction was applied with loads from 40 N up to 200 N, in 40 N increments, and radiographic images were obtained at each load. The effect of joint venting by an intra-articular needle was evaluated at the maximum load. Standard and stressed radiographs were repeated to evaluate potential laxity changes. RESULTS: Joint distraction caused a significant increase in the joint space at each load of distraction except for the 40 to 80 N load increase. Joint venting produced a significant increase in the joint space. No increase of joint laxity could be inferred from the postdistraction radiographic evaluation. CLINICAL SIGNIFICANCE: Hock distraction can be useful to facilitate arthroscopic procedures, increasing the joint space available for intra-articular manoeuvres. Further clinical studies are required to evaluate potential neurovascular complications.

Effect of interfacial rheology on model emulsion coalescence II. Emulsion coalescence.

In Part I, surface pressure isotherms were measured for model interfaces between a dispersed water phase and a continuous phase of asphaltenes, toluene, and heptane. Here, the coalescence rate of model emulsions prepared from the same components is determined from measured drop size distributions at 23 degrees C. A correlation is found between the initial coalescence rate and the interfacial compressibility. It is shown that the change in coalescence rate as the emulsion ages and coalesces can be predicted from surface pressure isotherm data also obtained at 23 degrees C. The stability of the emulsions was further assessed in terms of free water resolved after a treatment of heating at 60 degrees C and centrifugation. The emulsions were aged up to 24 h prior to treatment. The free water resolution appears to correlate to the "capacity for coalescence" of the interfacial film; that is, to the product of the initial film compressibility and (1-CR), where CR is the film ratio at which the film crumples.

Effect of interfacial rheology on model emulsion coalescence I. Interfacial rheology.

Interfacial elasticity and "dynamic" surface pressure isotherms were measured for interfaces between a dispersed water phase and a continuous phase of asphaltenes, toluene, and heptane. The interfacial modulus is a function of asphaltene concentration and in all cases reached a maximum at an asphaltene concentration of approximately 1 kg/m(3). The modulus increased significantly as the interface aged and slightly as the heptane content increased to a practical limit of 50 vol%. The modulus was approximately the same at 23 and 60 degrees C. The modulus correlated with the inverse of the initial compressibility determined from surface pressure isotherms. The surface pressure isotherms also indicated that a phase transition occurred as the interface was compressed leading to the formation of low compressibility films. Crumpling was observed upon further compression. The phase transition shifted to a higher film ratio with an increase in heptane content and interface age. Asphaltene concentration and temperature (23 and 60 degrees C) has little effect on the surface pressure isotherms. The surface pressure and elasticity measurements are consistent with the gradual formation of a cross-linked asphaltene network on the interface.

Fractura de clavícula en recién nacidos: factores de riesgo y morbilidad asociada / Clavicle fracture in newborns: risk factors and associated morbidities

Introducción: La fractura de clavícula es el traumatismo obstétrico óseo más frecuente en el recién nacido; se asocia a partos con distocia de hombros y a múltiples factores biomédicos relacionados. Objetivo: Analizar los factores de riesgo y morbilidad asociada con la fractura de clavícula en el recién nacido de parto normal. Pacientes y método: Estudio retrospectivo, tipo caso control, realizado en el Hospital Herminda Martín de Chillán (Chile), entre los meses de enero a junio de 2004. El grupo de estudio estuvo constituido por el total de recién nacidos con fractura de clavícula (44 casos), el grupo control se constituyó en razón de 1:2, que correspondió a los 2 partos vaginales siguientes al caso estudio (88 casos). Resultados: La incidencia fue del 4,1 por ciento; resultaron estadísticamente significativos con la presencia de fractura de clavícula el período de dilatación y expulsivo en primíparas, el peso y talla del recién nacido y la presencia de complicaciones durante el parto, como distocia de hombros (el 9,1 frente al 2,3 por ciento), el descontrol materno (el 6,8 frente al 1,1 por ciento) y laterocidencia de mano, que sólo se presentó en el grupo estudio (6,8 por ciento). Conclusiones: La fractura de clavícula en el recién nacido se asocia principalmente a factores del trabajo de parto y expulsivo

Introduction: Clavicle fractures are caused by injury during the birth process. It is associated to childbirth with difficulty in the exit of shoulders and to multiple related biomedical factors. Objective: To evaluate risk factors and associated morbidities the clavicle facture in newborn of normal childbirth. Patients and method: Retropective study, type case control in the Hospital Herminda Martín, Chillán (Chile), January to June of 2004. The group study was constituted by 44 cases of newborn with clavicle fracture, the group control constituted itself in regard to 1:2, both corresponded to following vaginal childbirths to the case study (88 cases). Results: The incidence was of 4.1 percents, were statistically significant with the time of dilatation and expulsive in primiparas, weight and size of the newborns and presence of complications in the attention of the childbirth, shoulder dystocia (9.1 percents versus 2.3 percents), maternal uncontrol (6.8 percents versus 1.1 percents) and hand-dystocia (6.8 percents). Conclusions: Clavicle fracture in newborn is associated to factors of the normal labor and delivery

Análisis de los factores de riesgo de infección del tracto urinario asociada con sonda vesical en la UCI / Risk factors of urinary tract infection associated with cathetersin ICU

Objetivo: Identificar factores de riesgo de infección del tracto urinario en pacientes de cuidado intensivo, con sonda vesical.Diseño: Estudio de casos y controles.Localización: Unidad de cuidados intensivos geneal de adultos, de una clínica no universitaria (Clínica Comfandi-Tequendama, Cali, Colombia).Métodos: Se empleó el registro del Comité de Vigilancia Epidemiológica para identificar los casos (individuos hospitalizados en la unidad de cuidados intensivos, con sonda vesical como parte de su manejo y en quienes se desarrolló infección del tracto urinario). Del mismo registro se seleccionaron al azar tres controles por cada caso, del grupo de pacientes manejados en la unidad de cuidados intensivos con sonda vesical y que no presentaron infección urinaria.Mediciones y resultados: Se analizaron 132 pacientes, 33 casos y 99 controles. Se registraron datos demográficos, características de los pacientes y variables del manejo de la sonda.La distribución por sexos y la severidad del compromiso sistémico, determinada por el APACHE II de las primeras 24 horas, fueron iguales en ambos grupos.La edad > 74 años, la inserción de la sonda vesical antes del ingreso a la unidad de cuidados intensivos, la duración del cateterismo por más de dos semanas, la coexistencia de peritonitis y el manejo con abdomen abierto se asociaron con mayor riesgo de infección del tracto urinarioEl género, la puntuación de APACHE II, la existencia de patología estructural del tracto urinario, los cambios de sonda, la medición de la presión intravesical, la existencia de infecciones diferentes a peritonitis y la administración previa de antibióticos no aumentaron el riesgo...

[Changes in ethical attitudes during medical studies]. / Cambios de actitudes éticas a lo largo de los estudios de medicina.

The aim of this work was to explore the attitude changes towards ethico-medical issues in medical students as they went through medical school. A personal standardized questionnaire containing 14 closed and direct questions was applied to 27 freshmen, 38 interns and 14 post graduates. The most outstanding differences in ethical attitudes occurred between first year students and the older groups. The younger students adhered to ethical principles, valued justice towards patients and moral integrity in physicians. The older students and post graduates emphasized the professional role of physicians and preferred institutional ethical regulations over public control. They also considered more valuable therapeutic efficiency and paternal attitudes towards patients as well as social prestige and economical rewards. We conclude that there is a progressive erosion of humanistic principles along the medical studies, that are substituted by a model of professional competence, social recognition and internal ethical control.

Sindrome de Weill-Marchesani: cuatro casos clinicos familiares. / Weill-Marchesani syndrome: 4 familial clinical cases

Se presenta el arbol genealogico de una familia originaria de Bucalemu, de la que se examino a 34 personas, encontrandose en 13 de ellos branquimorfismo solo, y en 4, braquimorfismo y microesferofaquia, que corresponden a las alteraciones musculoesqueleticas y oculares del sindrome de Weill-Marchesani. El objeto de esta presentacion es llamar la atencion sobre la escasa frecuencia de este sindrome y sobre la importancia de un diagnostico y tratamiento precoz para evitar las complicaciones y conservar la buena vision