Analysis of the order-implantation relationship for musculoskeletal tissue transplantation. / Análisis de la relación solicitud-implante de injerto para trasplante osteomuscular.

OBJECTIVE: To analyze orders requested from a musculoskeletal tissue bank and to evaluate the percentage of tissue implantation. MATERIAL AND METHODS: Two hundred and sixty-five orders for musculoskeletal tissue were analyzed over the course of a year. EXCLUSIONS: 5 duplications and 5 orders for which there was no availability to cover the need. We analyzed the number of surgeries in which the graft was finally used. RESULTS: Of a total of 255 orders, the graft was used in 178 (70%), and the graft was not used in 77 (30%). Of the 178 used, there was a partial refund in 23 (10%). Of the 77 orders not used, surgery was performed in 32 (13%) without the use of bank tissue, while surgery was discontinued in the remaining 45 (17%). DISCUSSION: A non-utilization rate of 30% was identified, of which 17% was from surgery that was not performed and 13% from surgery that was performed, but the tissue was returned to the tissue bank, because it was not required. In a further 10% there was partial return of the tissue. Based on this analysis, we consider that it is important to have direct confirmation of the surgery to avoid sending tissue for discontinued surgeries, since in addition to the economic impact, the bank must ensure adequate temperature maintenance during transportation and storage in the transplantation centre, to avoid discarding said tissue if it is returned.

[Prevalence of mental disorders in the general population of Catalonia. Team of the Health Survey of Catalonia]. / Prevalencia de trastornos mentales en la población general de Catalunya. Equipo de la Encuesta de Salud de Catalunya.

OBJECTIVE: The objective of the study is to estimate the prevalence of mental disorders in the general population of Catalonia. METHODS: Data comes from the Health Interview Survey of Catalonia (Enquesta de Salut de Catalunya, ESCA) and from an epidemiological study of Tres Cantos (Madrid). The General Health Questionnaire (GHQ-12) was administered to all the individuals older than 14 years (n: 12,455). The prevalence was estimated according to the GHQ score obtained and its correspondence to the probabilities score of the Madrid study. This study determined the probability of being a psychiatric case in a logistic regression using the Present State Examination (PSE) as gold standard. Morbidity Comparative Index (MCI) was used to compare the prevalences between health regions. The population of reference was the population of Catalonia. RESULTS: The 17.42% (CI 95%: 17.02-17.82) of the population of Catalonia older than 14 years suffered a probable mental disorder, the 18.66% (CI 95%: 18.07-19.25) in women and the 15.77% (CI 95%: 15.26-16.28) in men. The prevalence was higher in women with regard to men in all age groups. The MCI was lower in the Health Regions of Lleida and Girona and it was higher in the Health Regions of Tarragona and Tortosa, both in men and women. CONCLUSIONS: The figures are at intermediate level with respect others Spanish and Anglo-Saxon published studies based on population data and lower than the obtained for primary care users in Spain and in other international settings.

Prevalencia de desesperanza y factores sociodemográficos de migrantes mexicanos repatriados / Prevalence of despair and social-demographic factors related of repatriated mexican migrants / Prevalência de desesperança e fatores sociodemográficos de migrantes mexicanos repatriados

Objetivo: Describir las características sociodemográficas generales, así como algunas vinculadas con el proceso de migración y evaluar el nivel de desesperanza de los mexicanos que son deportados de los Estados Unidos de América (EE.UU) al Aeropuerto Internacional de la Ciudad de México (AICM), a través del Programa de Repatriación al Interior de México (PRIM). Métodos: Estudio descriptivo de tipo transversal en el periodo de julio a diciembre de 2015. Se aplicó en forma aleatoria, confidencial y previo consentimiento un cuestionario estructurado a migrantes mexicanos deportados a su arribo a México y provenientes de los EE.UU, se incluyó una sección de datos sociodemográficos generales; de aspectos relacionados con la migración y, se evaluó el nivel de desesperanza por medio de la Escala de Desesperanza de Beck. Resultados: Se encuestó a 367 migrantes mexicanos deportados, sólo siete fueron mujeres, la mayoría en un rango de edad de 18 a 35 años, el 23% reporta enfermedades pre-existentes, sólo el 45% tuvo un buen acceso a servicios de salud en EE.UU, el 56% ya había sido repatriado en dos o más ocasiones, el 75% había vivido más de cinco años en ese país, sólo el 13% utilizó una Ventanilla de Salud de algún consulado mexicano durante su estancia. La prevalencia de desesperanza fue del 6% en esta población. Conclusiones: El abordaje de la salud mental en poblaciones de migrantes mexicanos carece de políticas públicas. La caracterización de la población migrante repatriada debe ser el punto de partida para incidir en políticas públicas que mejoren la calidad de vida de los migrantes de retorno.

Objective: To describe some general social-demographic characteristics associated with the phenomenon of migration and assess the level of despair among Mexicans who are deported from USA to the City of Mexico International Airport through the Program of Repatriation. Methods: This is a descriptive and transversal study carried out from July to December 2015. A confidential questionnaire was randomly given, provided the previous informed consent, to Mexican migrants who had been deported from USA. Data sections on general social-demographic characteristics and migration-related issues were included. The level of despair was estimated using Beck's Despair Scale. Results: 367 deported Mexican migrants were studied. Only 7 were women. The majority were in the range of 18 to 35 years old. 23% reported having had preexisting illnesses and only 45% had access to health services in USA. 56% had previously been deported in two or more occasions. 75% had been living in USA for more than 5 years. Only 13% used the Health Window at any Mexican Consulate during their stay. The prevalence of despair was 6%. Conclusions: Addressing the condition of mental health among these populations requires further public policies and the precise identification of their characteristics should be the starting point to improve their quality of life upon return.

Objetivo: Descrever as características sociodemográficas gerais, assim como algumas associadas ao processo de migração e avaliar o nível de desesperança dos mexicanos que são deportados dos Estados Unidos da América (EE.UU) ao Aeroporto Internacional da Cidade do México (AICM), através do Programa de Repatriação ao Interior do México (PRIM). Métodos: Estudo descritivo de tipo transversal no período de julho a dezembro de 2015. Aplicou-se em forma aleatória, confidencial e com consentimento prévio, um questionário estruturado a migrantes mexicanos deportados a seu arribo ao México e provindos dos EE.UU. Incluiu-se uma secção de dados sociodemográficos gerais; de aspectos relacionados com a migração e, avaliou-se o nível de desesperança por médio da Escala de Desesperança de Beck. Resultados: Foram questionados 367 migrantes mexicanos deportados, só sete foram mulheres, a maioria em uma faixa etária de 18 a 35 anos, o 23% informa doenças pré-existentes, só o 45% teve um bom acesso a serviços de saúde nos EE.UU, o 56% já tinha sido repatriado em dois ou mais ocasiões, o 75% tinha vivido mais de cinco anos nesse país, só o 13% utilizou um guiché de Saúde de algum consulado mexicano durante sua permanência. A prevalência de desesperança foi do 6% nesta população. Conclusões: A abordagem da saúde mental em populações de migrantes mexicanos carece de políticas públicas. A caracterização da população migrante repatriada deve ser o ponto de partida para promover políticas públicas que melhorem a qualidade de vida dos migrantes de retorno.

Sistema robótico guía para la inserción de tornillos en cirugía de fijación de columna / Robotic Guide System for Insertion of Screws in Spinal Fixation Surgery

El presente artículo muestra el diseño y operación de un primer prototipo de robot para la guía en la inserción de tornillos en cirugía de fijación de columna. Este tipo de cirugía, realizada normalmente de forma manual, puede producir muchas lesiones debido a errores humanos al momento de introducir los tornillos en las vértebras del paciente. Para evitar dichos errores se puede utilizar la tomografía computarizada, pero los resultados son mucho mejores si un robot asistente proporciona al cirujano el camino para la inserción del tornillo, según la imagen del tomógrafo. Este artículo muestra como utilizando un robot comercial de bajo costo se puede implementar un sistema que provee una solución funcional a este problema. Se implementó un software que permite definir la posición inicial y final del tornillo a ser introducido, sobre la imagen Dicom del paciente. Con esta información el sistema mueve el robot el cual posee un anillo que guiará al cirujano en la inserción final. Los resultados muestran un sistema bastante preciso ofreciendo al cirujano un camino seguro de inserción.

This article presents the design and operation of the first prototype of a robot, designed to guide the insertion of screws in spinal fixation surgery. This type of surgery, usually done manually, could cause many injuries due to human error at the moment of inserting the screws into the patient’s vertebrae. Computed tomography can be used to avoid such errors, but the results are much better if a robot assists and indicates the surgeon the path for the insertion of the screw, according to the image scanner. This article shows how using a commercial low-cost robot can be implemented in a system that provides a practical solution to this problem. A software that allows you to define the start and the end positions of the screw to be introduced on the Dicom image of the patient, was implemented. With this information the system moves the robot which has a ring that will guide the surgeon in the final insertion. The results show a fairly accurate system, giving the surgeon a safe path of insertion.

Gangliosides noncovalently bound to DEAE-Sephadex: application to purification of anti-ganglioside antibodies.

A simple, rapid, effective, and inexpensive method for the purification of ligands having high affinity for gangliosides has been developed. DEAE-Sephadex has a high capacity for binding gangliosides (approx 1/1.6, w/w). The gangliosides, bound to the support by electrostatic and hydrophobic interactions, showed a high resistance, in an aqueous environment, to being detached by eluants commonly employed to desorb ligands (i.e., low or high pH or chaotropic agent solutions) or by nonionic detergent solutions as well as by organic solvents. The DEAE-Sephadex-ganglioside complex was assayed as an immunoadsorbent for purifying anti-GM1 ganglioside antibodies from serum of an immunized rabbit. The specific activity of the purified antibodies was 200- to 400-fold higher, and the recovery of the anti-ganglioside activity was above 50%, with respect to the untreated antiserum. The preparation of the complex and the purification of the antibodies can be done in less than 5 h. The glycolipids from the complex can be recovered by elution with organic solvents containing salt or volatile base solutions, and reused. In principle, this method can be adapted for other anionic amphipathic receptor molecules to purify ligands which bind to them.

Glycolipids noncovalently bound to DEAE-Sephadex. Use of the complexes for purification of IgM and IgG anti-(Gal beta 1-->3 GalNAc-) antibodies.

A method for the purification by affinity of antibodies of the IgM and IgG classes against the (Gal beta 1-->3 GalNAc-) epitope has been developed. The immunoadsorbent is based on the property of DEAE-Sephadex to bind acid glycolipids bearing this epitope, by electrostatic and hydrophobic interactions in a stable form in an aqueous medium. The acid glycolipid employed was asialo-GM1 ganglioside (GA1) derivatized to produce a carboxyl function on the olefinic bond of the sphingosine moiety (GA1 acid). The DEAE-Sephadex-GA1 acid complex was used to purify the antibodies of the IgG class from serum of an immunized rabbit and of the IgM class from a human serum. The specific activities of the purified antibodies were 1,200- to 2,400-fold higher, and the antibody activities were quantitatively recovered respect to the untreated sera, in both cases. The sequential use of two immunoadsorbents: DEAE-Sephadex-ganglioside and DEAE-Sephadex-GA1 acid, allows the separation of the two classes of immunoglobulins that recognize the same sugar residues in glycolipids.

Acid and enzymatic hydrolysis of the internal sialic acid residue in native and chemically modified ganglioside GM1.

The sialic acid of gangliosides not containing GalNAc (i.e., GM3, GD3) is readily hydrolyzed either enzymatically by sialidases or chemically in acid conditions. On the other hand, in gangliosides having the sialic acid on the internal galactose residue linked to GalNAc (i.e., GM1, GM2) the Neu5Ac is largely resistant to acid or enzymatic hydrolysis. In the present work GM1 (NH4+), GM1(H+), and several de-acetylated derivatives in the sialic acid and in both sialic acid and N-acetylgalactosamine moieties were prepared. Studies by counterion exchange with DEAE-Sephadex A-25 and Dowex 50WX8, acid-base titration, and acid or enzymatic hydrolysis with sialidases were performed on these derivatives. Our results provide cumulative evidence supporting that a hydrogen bonding interaction between the hydrogen atom of un-ionized carboxyl group in Neu5Ac and the oxygen atom of the carbonyl group in GalNAc reduces the dissociation of the Neu5Ac carboxyl group and impairs its enzymatic and acid hydrolysis. In addition, our results suggest that the enzymatic hydrolysis of the ionized form of sialic acid in GM1(Na+) and GM1(NH4+) is impaired by a second hydrogen bonding interaction between the proton of the acetamide group in GalNAc and the carbonyl moiety of the carboxyl group of the Neu5Ac.

Estudio preliminar dirigido a la construcción de un cuestionario de derivación de la atención primaria a los servicios de salud mental / Preliminary study aimed at the construction of a questionnaire for referral from primary care to mental health services

La alta prevalencia de morbilidad psiquiátrica en atención primaria, la mayor percepción de necesidad de ayuda de los casos más leves y que las derivaciones sean poco discriminadas, incrementa la presión asistencial en los servicios de salud mental. Todo ello hace necesario disponer de instrumentos que mejoren el reconocimiento de los casos más graves y que ayuden en la toma de decisión de la derivación. Con esta finalidad hemos elaborado una escala con criterios de derivación a salud mental (CDSM) que es multidimensional y hetero aplicada. En este trabajo se muestran los resultados preliminares de su aplicación por un grupo de médicos de atención primaria en un estudio piloto realizado sobre una muestra de 198 pacientes. Los datos obtenidos confirman la existencia de un alto porcentaje de posibles casos psiquiátricos (46,9%) y detecta un 4% de casos susceptibles de derivación. Los resultados también ponen de manifiesto una baja capacidad de detección de dicha patología por parte de los médicos de atención primaria. La CDSM presenta una moderada asociación con el General Health Questionnaire (GHQ) y con el reconocimiento de psicopatología por el médico de atención primaria. Otros factores diferentes de la gravedad clínica evaluada por el CDSM, posiblemente pertenecientes a la relación médico-paciente y que convendría estudiar, parecen estar influyendo en la decisión de derivación a salud mental. En un trabajo ulterior se publicará la validación de la escala para nuestro entorno asistencial (AU)

The high prevalence of psychiatric morbidity in primary care, the growing perception of the need for specialized help by the least severe patients and the lack of accuracy in referrals, contribute to the increasing overload in mental health services. So it seems necessary to design diagnostic tools in order to improve the detection of more severe patients and to help in the referral decision. With this purpose in mind, we have designed the multidimensional hetero-administrated Scale Referral Criteria for Mental Health (CRMH). This paper presents the preliminary results of a pilot study on its application in a sample of 198 patients by a group of Primary Care Physicians (PCP). The data show the detection of a high percentage of potential psychiatric patients (46.9%) and 4% of patients who having the possibility of being referred. The results also illustrate the low ability of PCP to detect these disorders. CRMH has a moderate correlation with the General Health Questionnaire (GHQ) and with detection of psychopathology by PCP. Other factors, apart from clinical severity evaluated through CRMH, possibly belonging to doctor-patient relationship, which should be analyzed, seem to influence the mental health referral. Ina future article, we will present the validation of this scale in our care setting (AU)