Mexican radiationdermatitis management consensus.

Background: Radiotherapy (RT) is an essential element in cancer treatment: 50-70% of cancer patients receive RT at some time of the course of their disease. Of these, almost 95% experience some grade of radiation dermatitis (RD). RD can affect patient's quality of life during and after treatment. Consequently, the management of RD is important. There are few randomized controlled clinical trials on interventions used to prevent and treat RD and no standardized consensus on RD management. A panel of opinion leaders of the Mexican Society of Radiotherapy (SOMERA) took part in a study of oncologic practice in Mexico. The following clinical guide is referenced both by the national practice reality and international evidence. Materials and methods: This RD management guide is based on input provided by 25 Mexican radiation oncologists, whose criteria were gathered using the Delphi Method and article review. Results: Twenty-one questions about experience in RD treatment were voted. More than 80% of the panel agreed with: the use of dermocosmetics/medical device in prevention and in treatment of RD grades 1-2. As for grade 3, they recommend individualizing each case and dermatologist evaluation. Topical steroids should be used when there is skin itching or pain. Consider the use of natural soaking elements. Skin care must be continued to avoid or reduce severity of late radiation skin lesions. Conclusion: This consensus was developed as a supportive educational tool that can be adapted to individual clinical needs, useful for professionals involved in the treatment of RT patients.

Strong Modulation of Optical Properties in Black Phosphorus through Strain-Engineered Rippling.

Controlling the bandgap through local-strain engineering is an exciting avenue for tailoring optoelectronic materials. Two-dimensional crystals are particularly suited for this purpose because they can withstand unprecedented nonhomogeneous deformations before rupture; one can literally bend them and fold them up almost like a piece of paper. Here, we study multilayer black phosphorus sheets subjected to periodic stress to modulate their optoelectronic properties. We find a remarkable shift of the optical absorption band-edge of up to ∼0.7 eV between the regions under tensile and compressive stress, greatly exceeding the strain tunability reported for transition metal dichalcogenides. This observation is supported by theoretical models that also predict that this periodic stress modulation can yield to quantum confinement of carriers at low temperatures. The possibility of generating large strain-induced variations in the local density of charge carriers opens the door for a variety of applications including photovoltaics, quantum optics, and two-dimensional optoelectronic devices.

On the relationships between auditory and visual factors in a residential environment context: A SEM approach.

To understand the effects of specific elements that may enhance or detract residents' well-being, it is important to explore the relationships between auditory and visual factors, based on people's sensory experiences. Although residential environments provide natural experimental conditions to observe these relationships, the complexity of measuring sensory perceptions and their subsequent interpretation constitutes a challenge. This study aims to identify the influence of socio-demographics and residential location characteristics on three latent variables: noise-Sensitivity, sound-Pleasantness, and visual-Liveability in a Latin American city. The methodology is replicable and relies on a digital survey that displays environments in 360-format video and uses sound immersion techniques; it was applied to a sample of household heads in Quito, Ecuador. Based on an efficient experimental design, we selected different residential environments according to acoustic-visual attributes and the proximity to residential, commercial, and recreational land uses. Structural Equation Models (SEM) were estimated using mediating variables. Our results reveal the influence of noise-Sensitivity on sound-Pleasantness and, indirectly, on visual-Liveability. Further analysis shows that the impact of sound and visual perception changes with different socio-demographics and residential location characteristics.

Thermo-Mechanical and Fungi Treatment as an Alternative Lignin Degradation Method for Bambusa oldhamii and Guadua angustifolia Fibers.

Different strategies have been used to degrade the molecular structure of lignins in natural fibers. Both chemical and biological processes can obtain different types of lignins for industrial use. In this study, a variation of the spectral intensity of the thermo-mechanical and fungi-modified Bambusa oldhamii (giant bamboo) and Guadua angustifolia Kunt fibers were examined via Fouriertransform infrared spectroscopy. The giant bamboo and Guadua angustifolia Kunt specimens were modified using a non-chemical alternative steam pressure method for degrading lignins, followed by mechanical sieving to obtain fibers of different lengths. The obtained fibers were treated with the Fusarium incarnatum-equiseti MF18MH45591 strain in a 21 d degradation process. The samples were subjected to Fouriertransform infrared spectroscopy before and after the strain treatment. The intensity variation was found to be in the spectral range of 1200 cm-1 to 1800 cm-1, in which lignin components are commonly found in most plant species. A multivariate analysis of the principal components of the treated and untreated control samples confirmed the changes in the spectral region of interest, which were associated with the thermo-mechanical and fungal treatment.

Tuning the local frictional and electrostatic responses of nanostructured SrTiO(3)-surfaces by self-assembled molecular monolayers.

Exploiting the capability of preparing nanostructured bifunctional terminated SrTiO(3) substrates (SrO and TiO(2)), the surface properties have been locally tuned by employing a double bottom-up strategy which combines the use of chemically nanopatterned substrates with molecular self-assembly. The dynamics of surface diffusion that allows SrO and TiO(2) chemical-termination nano-patterning of the SrTiO(3) is first addressed. Second, termination-dependent heterogeneous nucleation is used to demonstrate that stearic acid selectively grows on the TiO(2) terminated terraces. This adsorption improves the frictional properties and modifies the surface contact potential. The possibility of simultaneously tailoring at the nanoscale different surface properties of widely employed oxide substrates is promising for building up new devices useful for emerging applications.

Acute myocardial infarction with ST-segment elevation. / Infarto agudo al miocardio con elevación del segmento ST en época de COVID-19.

Coronavirus disease 19 (COVID-19) is the infection caused by the SARS-CoV-2 virus and it has become a global emergency. The disease has a hughe impact on cardiopaths. Under regular conditions, patients entering the emergency room with a ST-segment elevation myocardial infarction (STEMI) must be urgently treated with reperfusion strategy. However, due to the scarce knowledge about COVID-19, there have not being yet established the guidelines for management of patients with STEMI and COVID-19. In this review we expose the main conclusions of relevant articles published about STEMI management during this pandemic. We aim to provide a review to guide the decisions about the management of STEMI during the COVID-19 emergency.

La infección por coronavirus SARS-CoV-2 es una emergencia sanitaria global que puede afectar gravemente a las personas cardiópatas. En condiciones normales, los pacientes que se presentan en las unidades médicas con diagnóstico de infarto agudo al miocardio con elevación del segmento ST (IAM-CEST) deben ser atendidos con estrategia de reperfusión coronaria de manera urgente. Sin embargo, no existen lineamientos bien establecidos sobre el tratamiento de los pacientes con IAM-CEST y COVID-19 debido a la aún escasa información al respecto, dada la súbita aparición de la enfermedad. En este artículo se exponen los principales aspectos de los artículos más relevantes sobre el manejo del IAM-CEST en el contexto de esta pandemia. El objetivo de esta publicación es apoyar en la toma de decisiones para el manejo del IAM-CEST en el contexto de la emergencia por COVID-19.

Layer-by-layer electropeeling of organic conducting material imaged in real time.

Soft materials comprising low-molecular-weight organic molecules are attracting increasing interest because of their importance in the development of a number of emerging areas in nanoscience and technology, including molecular electronics, nanosystems for energy conversion, and devices in the widest sense. Their interaction with electrodes and their behavior under electric fields is a topic of vital significance for these areas, and about which very little is known. Here unprecedented evidence is presented for the controlled peeling of organic molecular material when a voltage is applied between the conducting system and the conducting probe of a scanning force microscope. The rate of removal of the material from the surface of the bulk conducting supramolecular material can be tuned. It depends on the potential applied and is initiated only above a threshold value of 200 mV. The results indicate the importance of electric fields on the stability and performance of conducting organic systems at the nanoscale.

Anisotropic buckling of few-layer black phosphorus.

When a two-dimensional material, adhered onto a compliant substrate, is subjected to compression it can undergo a buckling instability yielding to a periodic rippling. Interestingly, when black phosphorus (bP) flakes are compressed along the zig-zag crystal direction, the flake buckles forming ripples with a 40% longer period than that obtained when the compression is applied along the armchair direction. This anisotropic buckling stems from the puckered honeycomb crystal structure of bP and a quantitative analysis of the ripple period allows the determination of the Youngs's modulus of few-layer bP along the armchair direction (EbP_AC = 35.1 ± 6.3 GPa) and the zig-zag direction (EbP_ZZ = 93.3 ± 21.8 GPa).

An artificial-vision- and statistical-learning-based method for studying the biodegradation of type I collagen scaffolds in bone regeneration systems.

This work proposes a method based on image analysis and machine and statistical learning to model and estimate osteocyte growth (in type I collagen scaffolds for bone regeneration systems) and the collagen degradation degree due to cellular growth. To achieve these aims, the mass of collagen -subjected to the action of osteocyte growth and differentiation from stem cells- was measured on 3 days during each of 2 months, under conditions simulating a tissue in the human body. In addition, optical microscopy was applied to obtain information about cellular growth, cellular differentiation, and collagen degradation. Our first contribution consists of the application of a supervised classification random forest algorithm to image texture features (the structure tensor and entropy) for estimating the different regions of interest in an image obtained by optical microscopy: the extracellular matrix, collagen, and image background, and nuclei. Then, extracellular-matrix and collagen regions of interest were determined by the extraction of features related to the progression of the cellular growth and collagen degradation (e.g., mean area of objects and the mode of an intensity histogram). Finally, these critical features were statistically modeled depending on time via nonparametric and parametric linear and nonlinear models such as those based on logistic functions. Namely, the parametric logistic mixture models provided a way to identify and model the degradation due to biological activity by estimating the corresponding proportion of mass loss. The relation between osteocyte growth and differentiation from stem cells, on the one hand, and collagen degradation, on the other hand, was determined too and modeled through analysis of image objects' circularity and area, in addition to collagen mass loss. This set of imaging techniques, machine learning procedures, and statistical tools allowed us to characterize and parameterize type I collagen biodegradation when collagen acts as a scaffold in bone regeneration tasks. Namely, the parametric logistic mixture models provided a way to identify and model the degradation due to biological activity and thus to estimate the corresponding proportion of mass loss. Moreover, the proposed methodology can help to estimate the degradation degree of scaffolds from the information obtained by optical microscopy.

Revision Using Distal Inflow for the Treatment of Dialysis Access Steal Syndrome: A Systematic Review.

The aim of this systematic review is to establish the efficacy of revision using distal inflow (RUDI) on the primary endpoints of complete dialysis access steal syndrome (DASS) resolution and arteriovenous fistula (AVF) longevity. An electronic search of literature from 1966 to 2017 in CINAHL, Medline, Embase and the Cochrane library according to PRISMA standards was conducted. Quality evaluations and recommendations for practice were examined. Data on power, age, gender, comorbidities, arterial inflow, conduit material, fistulae type, follow-up, failure incidence, ischaemia grade, modality of diagnosis, morbidity and mortality were subjected to pooled analysis of prevalence at a 95% confidence interval (CI). Eleven studies involving 130 individuals with a median age of 57 [interquartile ranges (IQR), 54-65] and equal gender distribution were conducted. Of the patients with diabetes mellitus (67.3%), the most common type of AVF with DASS was brachiocephalic AVF (73.7%). Overall, the prevalence of success was 82.0% (95%CI, 74.4%-89.6%) over 12 months (IQR, 1-40 months). Grade 3 ischaemia was the most common type of DASS (49.2%). Grade 4 had the worst outcomes compared with grades 2 and 3. The overall morbidity was 3% with no mortality. Overall, RUDI is an effective treatment for various grades of DASS and their longevity.

Leak and Scattering Assessment by Optically Stimulated Luminescence Dosimetry in a Helical Linear Accelerator / Valoración de Fuga y Dispersión por medio de Dosimetría de Luminiscencia Estimulada Ópticamente (OSL) en un Acelerador Lineal Helicoidal

Radiation absorbed doses to organs outside the radiation therapy treatment beam can be significant and therefore of clinical interest. Two sets of out-of-beam measurements were performed measuring the leak dose and the scattered dose, at 5 points within the accelerator components (accelerator tube and collimator) and at 21 points on the equipment and surroundings based on a positioning scheme. For this purpose, 52 Optically Stimulated Luminescence (OSL) dosimeters were used in a latest generation helical linear accelerator. Of the 200 cGy fired at a cheese-like phantom, 0.332% of the out-of-beam dose contribution was found to come from the leak and 0.784% was transformed into scattering. For these dose values, estimates of the risk of second tumors in long-term survivors indicate a reduced probability of acquiring a second secondary radiation malignancy, based on information from the 1990 BEIR Committee report.

La dosis absorbida de radiación a órganos fuera del haz de tratamiento de radioterapia puede ser significativa y, por lo tanto, de interés clínico. Se realizaron dos sets de mediciones fuera del haz para determinar la dosis de fuga y la dosis dispersa, en 5 puntos dentro de los componentes del acelerador (tubo de aceleración y colimador) y 21 puntos en el equipo y alrededores basado en un esquema de posicionamiento. Para este fin se utilizaron 52 dosímetros de luminiscencia estimulada ópticamente (OSL, Optically Stimulated Luminescence), en un acelerador lineal helicoidal de última generación. De los 200 cGy disparados a un maniquí tipo queso, se encontró que el 0.332% de la contribución de dosis fuera del haz provenía de la fuga y 0.784% se transforma en dispersión. Para estos valores de dosis, las estimaciones del riesgo de segundos tumores en los supervivientes a largo plazo indican una reducida probabilidad de contraer una segunda malignidad por radiación secundaria, según la información del informe del Comité BEIR de 1990.

Engineering the optoelectronic properties of MoS2 photodetectors through reversible noncovalent functionalization.

We present an easy noncovalent functionalization of MoS2-based photodetectors that results in an enhancement of the photoresponse by about four orders of magnitude, reaching responsivities up to 100 A W-1. The functionalization is technologically trivial, air-stable, fully reversible and reproducible, and opens the door to the combination of 2D-materials with molecular dyes for the development of high performance photodetectors.

Anti-JC virus seroprevalence in a Spanish multiple sclerosis cohort: JC virus seroprevalence in Spain.

OBJECTIVE: To estimate the seroprevalence of anti-JCV antibodies, seroconverting rates and evolution of antibody levels in a multiple sclerosis (MS) Spanish cohort. METHODS: Multicenter, retrospective cross-sectional and longitudinal study. The JCV seroprevalence was analyzed in 711 MS patients by using 1st (STRATIFY-1) and 2nd generation (STRATIFY-2) two-step ELISA over 2.65 (±0.97) years. Seroconversion rate was obtained over 2 samples from 314 patients, and index stability from 301 patients with 3 or more samples available. The effect of each ELISA generation, demographics, clinical characteristics and therapy on seroprevalence was assessed by logistic regression. RESULTS: The overall anti-JCV seroprevalence was 55.3% (51.6-58.9), similar across regions (p=0.073). It increased with age (p<0.000) and when STRATIFY-2 was used (60.5%, p=0.001). Neither sex nor immunosuppressive therapy had any influence. Yearly seroconversion rate was 7% (considering only STRATIFY-2). Serological changes were observed in 24/301 patients, 5.7% initially seropositive reverted to seronegative and 7% initially seronegative changed to seropositive and again to seronegative, all these cases had initial index values around the assay's cut-off. CONCLUSIONS: JCV seroprevalence in Spanish MS patients was similar to that reported in other European populations. Changes in serostatus are not infrequent and should be considered in clinical decisions.

La investigación y la prueba de contexto como elementos de política criminal para la persecución del crimen organizado / Investigation and evidence of context as elements of criminal policy for the prosecution of the organized crime / A investigação e a prova de contexto como elementos de política criminal para a persecução ao crime organizado

Resumen El problema que aborda el artículo está directamente relacionado con la reflexión sobre cuál es la incidencia de la investigación y la prueba de contexto como elementos de política criminal para la persecución del crimen organizado. Se trazó como primer objetivo realizar una aproximación reflexiva a los conceptos de crimen organizado, investigación de contexto, prueba de contexto y política criminal, para luego desarrollar, como segundo objetivo, su interrelación desde su aplicación en la Corte Interamericana de Derechos Humanos y, en el caso colombiano, desde el estudio de la modalidad investigativa de contexto y su prueba derivada. Como tercer objetivo se buscó establecer la viabilidad desde el ámbito legal y constitucional y con enfoque de política criminal de la aplicación de esta metodología y prueba de contexto para la persecución de la criminalidad organizada como estrategia de respuesta estatal. El enfoque investigativo es cualitativo, que comprende investigación exploratoria, descriptiva, analítica y propositiva. Como resultado principal se establece la necesidad de que la política criminal del Estado colombiano consolide la aplicación de la investigación de contexto y en especial que defina la forma en que sus productos serán incorporados en el acervo probatorio, esto es, si los resultados obtenidos en la construcción de contextos investigativos pueden recibir el tratamiento como medio de prueba autónomo con caracterización y denominación de prueba de contexto.

Abstract The problem addressed by the article is directly related to the reflection about what is the incidence of research and context evidence as elements of criminal policy to prosecute the organized crime. We drew as first objective to make a reflective approach to the concepts of organized crime, context investigation, context evidence and criminal policy, to then develop as a second objective, its correlation from its implementation in the Inter - American Court of Human Rights and, in the Colombian case, from the context investigation modality and its derived proof. As a third objective, we sought to establish the viability from the legal and constitutional scope and with a criminal policy approach to the application of this methodology and context evidence for the prosecution of the organized crime as State's response strategy. The research approach is qualitative, which contains exploratory, descriptive, analytic and propounding research. As main result is the need for the criminal policy of the Colombian State to consolidate the application of the context investigation and, in particular, to define the way in which its products will be incorporated into the body of evidence, that is, if the results obtained in the construction of research contexts can be treated as an autonomous means of evidence with characterization and designation of context evidence.

Resumo O problema que aborda o artigo está diretamente relacionado com a reflexão sobre qual é a incidência da investigação e a prova de contexto como elementos de política criminal para a persecução ao crime organizado. Foi traçado como primeiro objetivo realizar uma aproximação reflexiva aos conceitos de crime organizado, investigação de contexto, prova de contexto e política criminal, para logo desenvolver, como segundo objetivo, a sua interrelação desde a sua aplicação na Corte Interamericana de Direitos Humanos e, no caso colombiano, desde o estudo da modalidade investigativa de contexto e a sua prova derivada. Como terceiro objetivo buscou-se estabelecer a viabilidade desde o âmbito legal e constitucional e com enfoque de política criminal da aplicação desta metodología e prova de contexto para a persecução da criminalidade organizada como estratégia de resposta estatal. O enfoque investigativo é qualitativo, que compreende investigação exploratória, descritiva, analítica e propositiva. Como resultado principal se estabelece a necessidade de que a política criminal do Estado colombiano consolide a aplicação da investigação de contexto e em especial que defina a forma em que os seus produtos serão incorporados no acervo probatório, isto é, se os resultados obtidos na construção de contextos investigativos podem receber o tratamento como meio de prova autónomo com caracterização e denominação de prova de contexto.

Macroscopic evidence of nanoscale resistive switching in La2/3Sr1/3MnO3 micro-fabricated bridges.

In this work we report on a combined macro, micro and nanoscale investigation where electronic transport properties through La⅔Sr⅓MnO3 (LSMO) microfabricated bridges, in which nano-sized resistive states are induced by using a conducting scanning probe microscope (C-SPM), are analyzed. The strategy intentionally avoids the standard capacitor-like geometry, thus allowing the study of the electronic transport properties of the locally modified region, and approaches the integration of functional oxides in low dimensional devices while providing macroscopic evidence of nanoscale resistive switching (RS). The metallic and ferromagnetic LSMO is locally modified from its low resistance state (LRS) to a high resistance state (HRS) when a bias voltage is applied on its surface through the conducting tip, which acts as a mobile electrode. Starting from a metallic oxide the electroforming process is not required, thus avoiding one of the major drawbacks for the implementation of memory devices based on RS phenomena. The application of a bias voltage generates an electric field that promotes charge depletion, leading to a strong increase of the resistance, i.e. to the HRS. This effect is not only confined to the outermost surface layer, its spatial extension and final HRS condition can be modulated by the magnitude and duration of the potential applied, opening the door to the implementation of multilevel devices. In addition, the half-metallic character, i.e. total spin polarization, of LSMO might allow the implementation of memory elements and active spintronic devices in the very same material. The stability of the HRS and LRS as a function of temperature, magnetic field and compliance current is also analyzed, allowing the characterization of the nature of the switching process and the active material.

Microwave-assisted extraction in dry fruit of andean species Vaccinium meridionale: Experimental conditions on the recovery of total polyphenols / Extração assistida por microondas para frutos da espécie andina Vaccinium meridionale: Condições experimentais na remoção de polifenóis totais

ABSTRACT Due to their nutraceutical properties, the fruits of the species Vaccinium meridionale, which inhabit the Andean region, are of scientific interest. Microwave-assisted extraction has been applied to different vegetal matrices for to extract efficiently polyphenolic compounds. In this work we study in microwave assisted extraction processes, the effect on the extraction of total polyphenols in dried fruits of Vaccinium meridionale, using response surface methodology. The main objective of this research was to analyze the relationships between power, temperature, solid-liquid ratio, time and ethanol concentration in aqueous media on the effectiveness of total polyphenols recovery in dry fruits of Vaccinium meridionale. A central composite design face-centered with three levels for each variable was used: P = 300 - 900 W; T = 70 -110 °C; L:Srat. = 30:1 - 70:1 w/w; t = 5 - 15 min; [EtOH] = 0 - 80%. In this sense, the effect of the input variables on the recovery of total polyphenols, the optimization process for maximum extraction, and the comparison to other solid-liquid extractions in terms of quantity of total polyphenols, are reported. It was found that the significant variables in the extraction process were ethanol concentration, temperature and time; the best yields were obtained in the range [EtOH] = 44 - 49%, T = 110 °C, and t = 10 - 15 min. In terms of quantity, time and consumption of energy, microwave-assisted extraction technique is more efficient than other solid-liquid extraction processes for the extraction of total polyphenols.

RESUMO Devido a suas propriedades nutracêuticas em termos do conteúdo de polifenóis totais, os frutos da espécie andina Vaccinium meridionale tem associado um grande interesse cientifico. A extração assistida por microondas tem sido utilizada em diferentes matrizes vegetais para a remoção de forma eficiente de compostos polifenólicos que apresentam uma atividade biológica. Neste artigo são apresentados os principais resultados experimentais obtidos em diferentes processos de extração assistida por microondas, com respeito à quantia de polifenóis totais removidos em frutos secos de Vaccinium meridionale por meio da metodologia da superfície de resposta. O principal objetivo desta pesquisa foi analisar as relações entre as variáveis independentes da potência, a temperatura, a relação sólido-líquido, tempo e concentração de etanol com respeito à quantidade polifenóis totais extraídos de frutos secos de Vaccinium meridionale. Foi utilizado um desenho composto centrado nas caras com três diferentes níveis para cada variável: P = 300 - 900 W; T = 70 -110 °C; L:Srat. = 30:1 - 70:1 w/w; t = 5 - 15 min; [EtOH] = 0 - 80%. Foi utilizado o método de Folin-Ciocalteu para a quantificação de polifenóis totais com ácido gálico como molécula de referência. Neste sentido, foi reportado neste trabalho o efeito dos fatores de entrada com respeito a quantidade de polifenóis totais removidos, o processo de optimização para obter a máxima remoção possível, e também uma comparação dos resultados experimentais com outros processos de extração sólido-líquido. Foi achado que a concentração de etanol, a temperatura e o tempo foram a variáveis mais importantes no processo de extração. A máxima quantidade de recuperação achada neste trabalho foi obtida no intervalo [EtOH] = 44 - 49%, T = 110 °C e t = 10 - 15 min. Em termos de quantidade, tempo e gasto de energia, a extração assistida por microondas é uma técnica eficiente para a remoção de polifenóis totais em frutos secos de Vaccinium meridionale.

Aracnoiditis crónica / Chronic arachnoiditis

La aracnoiditis se refiere al compromiso inflamatorio de uno, varios o todos los segmentos de la capa media de las meninges, es decir la aracnoides. Se encuentra asociada con meningitis, neoplasias, hemorragia subaracnoidea, enfermedades infecciosas como tuberculosis, procedimientos invasivos por el uso de medios de contraste tecales, colocación de analgésicos y anestésicos a nivel del raquis, quimioterápicos intratecales, procesos autoinmunes, afecciones ginecológicas e incluso procesos no invasivos. Como en la actualidad esta entidad no se considera entre los primeros diagnósticos en pacientes con clínica de dolor tipo ardor en región lumbar irradiado a miembros inferiores, incontinencia urinaria y disestesias en artejos, queremos resaltar la importancia de tener en cuenta esta patología como diagnóstico diferencial...

Arachnoiditis is a broad term denoting inflammation of one, several or all segments of the middle layer of the meninges known as the arachnoid mater. It is related to meningitis, neoplasia, subarachnoid hemorrhage, infectious diseases such as tuberculosis, invasive procedures using intrathecal injection of contrast media, epidural injection of analgesics and anesthetic agents, intrathecal chemotherapy, autoimmune processes, gynecological disorders and even non invasive procedures. As this disorder is nowadays not considered within the main diagnostic possibilities in patients who manifest burning back pain irradiated to the lower limbs, bladder dysfunction and dysethesia of the toes, we wish to highlight the importance of also considering arachnoiditis as a differential diagnosis...

Anestesia: morbilidad y mortalidad perioperatorias Hospital de San José, octubre y noviembre de 2007 / Anesthesia morbidity and mortality in the perioperative period San José Hospital, October and November 2007

Antecedentes: el Hospital de San José no tiene registros sobre morbimortalidad relacionada con anestesia en las cirugías realizadas en esta institución. Objetivo: describir la morbilidad y mortalidad perioperatorias relacionadas con la anestesia en pacientes sometidos a cirugía electiva en el Hospital de San José durante octubre y noviembre de 2007. Métodos: estudio observacional descriptivo longitudinal, donde los desenlaces de interés fueron morbilidad y mortalidad perioperatorias relacionadas con anestesia. Resultados: se incluyeron 727 pacientes programados para cirugía electiva. La edad promedio fue 44.5 años (DE 16.0), se caracterizaron por ser clase funcional I (69,9%), clasificación ASA I en 51,1%, vía aérea fácil en 85% de los pacientes y sometidos a cirugía electiva categoría quirúrgica A (50,7%) y B (43%). No se presentó mortalidad y el evento adverso más frecuente fue arritmia (23 casos) 3,1%, la mayoría en pacientes en buenas condiciones clínicas. Conclusiones: las arritmias y demás eventos adversos observados en pacientes con buenas condiciones clínicas preanestésicas, sugieren profundizar estrategias como la mejor evaluación preanestésica, para disminuir la morbilidad relacionada con anestesia.

Antecedents: Hospital de San José has no records on anesthesia-related morbidity and mortality rates in surgical procedures conducted at this institution. Objective: to describe anesthesia-related morbidity and mortality rates in the perioperative period of patients who underwent elective surgical procedures at Hospital de San José during October and November 2007. Methods: a longitudinal obsevational descriptive study was conducted. Outcomes of interest were the anesthesia-related morbidity and mortality rates during the perioperative period. Results: a sample of 727 patients scheduled for elective surgical procedures was included. The mean age was 44.5 years (OF 16.0) and patients were categorized in, functional class I (69,9%), ASA classification I 51,1%, easy airway management 85% and those who underwent elective surgery category A (50,7%) and B (43%). No mortality occured and the main adverse event was arrythmia (23 cases) 3,1%, the majority in healthy patients. Conclusions: arrhytmias and other adverse events observed in patients in good preanesthetic medical condition suggest in-depth assessment strategies as the best preanesthetic evaluation in order to ameliorate anesthesia-related morbidity.

Efectos gastrointestinales del alendronato: relación entre los estudios clínicos y la práctica clínica

La osteoporosis es un problema de salud pública de alta incidencia en la población femenina. Afortunadamente en la actualidad se dispone en el mercado de medicamentos que corrigen este defecto previniendo así sus consecuencias por todos ya conocidas, obviamente junto con dieta y ejercicio. Uno de estos medicamentos es el alendronato sódico que ha demostrado gran eficacia en el tratamiento de esta entidad; en la literatura científica se han descrito efectos adversos gastrointestinales importantes los cuales se pueden prevenir con medidas como tomar el alendronato en ayunas acompañado de un vaso con agua completo, no recostarse inmediatamente se ingiera el medicamento y no tomarlo con café o leche. Para evaluar si estas medidas eran seguidas por poblaciones que no hicieran parte de un estudio clínico en donde se controlaran una serie de variables, se realizó el estudio ®Kaiser¼ a través de un cuestionario que se obtuvo de una base de datos en California (EUA) en 981 mujeres que habían tomado alendronato. En el presente artículo se revisan los resultados obtenidos en esta población sobre la adherencia al tratamiento