Search

Abstract A successful strategy for improving the safety issues of new‐generation lithium‐ion batteries is to replace liquid electrolytes with solid or quasi‐solid membranes, a procedure that ensures adequate ionic conductions and are mechanical strengths.

La otalgia o dolor de oídos, puede ser consecuencia de una enfermedad otológica (otalgia primaria u otogénica) o generarse a partir de un proceso patológico y estructuras alejadas del oído (otalgia secundaria o referida). La historia clínica detallada y el examen físico completo de la cabeza y el cuello son suficientes para diagnosticar la causa de la otalgia. A través del examen de la oreja, conducto auditivo externo y la membrana timpánica se confirman casi todas las otalgias primarias. Sin embargo, cuando el examen del oído es normal debemos buscar exhaustivamente en áreas de inervación sensitiva compartida que tiene el oído a través del V, VII, IX y X par craneal y las ramas cervicales C2 y C3. En los niños, las enfermedades de los oídos son la causa más frecuente de otalgia, siendo la otitis media aguda la más importante; en adultos la otalgia referida es más común.

La diversidad de dispositivos conectados a Internet ha conllevado en la actualidad a un cambio en la concepción del diseño Web. La navegación, utilizando dispositivos de diferentes resoluciones y tamaños de pantalla, ha modificado de manera radical la experiencia del usuario. El sitio Web del Centro de Histoterapia Placentaria de Cuba creado en el año 2000 y modificado en varias ocasiones, según las tendencias del diseño no está ajeno a esta realidad. El objetivo general de este trabajo es crear e implementar un nuevo diseño del sitio, aplicando la filosofía de Responsive Web Design. Su empleo garantiza la visibilidad del sitio en cualquier dispositivo; ya sea, Smartphone, tableta, computadoras o smart TV. El diseño estuvo basado en el patrón Modelo-Vista-Controlador; en la Vista se concibieron dos interfaces, una para el usuario y otra para el administrador del sitio. El nuevo diseño soluciona el problema de la visibilidad en la gama de dispositivos móviles, permite un mejor posicionamiento del sitio en los buscadores y crea las bases para incorporar nuevos servicios como el Comercio Electrónico. Palabras claves: diseño web responsive, modelo-vista-controlador, hojas de estilo.

El desarrollo de la tecnología de la computación ha permitido la introducción, en la práctica docente, de nuevos medios de enseñanza que han revolucionado la docencia médica. La utilización del software educativo como medio que facilite el proceso de enseñanza aprendizaje en las diferentes carreras de las Ciencias Médicas es hoy una realidad en nuestras universidades. Este trabajo consiste en un software educativo como material complementario para la enseñanza de la oftalmología en Cuba, tanto para pregrado como para postgrado e incluye materiales audiovisuales para el aprendizaje no solo de la oftalmología clínica sino también quirúrgica. Se utilizó la herramienta de Crheasoft para la realización del producto final, con una combinación de elementos visuales y auditivos. Teniendo en cuenta el antiguo proverbio “más vale ver una vez que oír cien veces”, se confeccionó este atlas interactivo que tiene como finalidad proporcionar un material educativo didáctico de consulta y de apoyo a la docencia, útil para el desarrollo de una metodología de enseñanza más adaptable a las características individuales de cada usuario. El software cuenta con una interfaz que permite la fácil navegación, posibilitando la interacción y el intercambio de información entre el usuario y la aplicación.PALABRAS CLAVE:Atlas, oftalmología, software.

En este artículo se aborda la implementación de los Lineamientos Generales para el Expendio o Distribución de Alimentos y Bebidas en los Establecimientos de Consumo Escolar de los Planteles Educativos de Educación Básica de México. El análisis se basa en un estudio exploratorio de orientación cualitativa, apoyado en conceptos del análisis de políticas y del análisis político de discurso. El referente empírico se compone de testimonios de directivos, estudiantes, docentes y responsables de las tiendas de dos telesecundarias, vertidos a través de entrevistas. El artículo muestra: una endeble estrategia oficial para la implementación de los lineamientos, una respuesta afirmativa de los sujetos al sentido general de la propuesta, diversos ámbitos de resistencia, el peso de las prácticas de consumo arraigadas y la problemática interacción entre escuela y entorno. Todo esto resultó en que los lineamientos tuvieron un bajo impacto durante los primeros meses de su implementación. Abstract This paper addresses the implementation of the Lineamientos Generales para el Expendio o Distribución de Alimentos y Bebidas en los Establecimientos de Consumo Escolar de los Planteles Educativos de Educación Básica, a policy initiative oriented to regulate the preparation and selling of food in Mexican schools. The discussion is based on a qualitative exploratory study and uses conceptual notions from policy analysis and discursive policy analysis approaches. The empirical referent includes testimonies of principals, students, teachers and the managers of food establishments of two secondary schools. The results show, among other things, that the school agents agree with the general sense of the policy initiative, that there are struggles to change the patterns of food purchase and eating among the school community and an absence of articulation between school and parents. All this indicates a low effectiveness of the policy initiative. Recibido: 21 de junio de 2013 Aceptado: 04 de diciembre de 2013

La aparición de las técnicas de carga inmediata en implantología revolucionó la concepción de los planes de tratamiento convencionales. La supervivencia de estas rehabilitaciones en el período de osteointegración se puede ver amenazado por factores que pueden influir, tanto en etapas diagnósticas como terapéuticas. Objetivo: Establecer posibles relaciones entre la supervivencia de la rehabilitación implantosoportada de carga inmediata durante el período de osteointegración y algunos aspectos diagnósticos y terapéuticos. Se realizó un estudio descriptivo donde la muestra estuvo formada por 90 pacientes implantados en mayo del 2005 en el Hospital “Arnaldo Milián Castro” de Villa Clara, con un total de 120 rehabilitaciones implantosoportadas. Hubo casi iguales porcentajes de supervivencia favorable y medianamente favorable (44,2 % y 45,0 %, respectivamente). Ni el sexo, la edad, la naturaleza de los dientes antagonistas, el tipo de cirugía, ni los tipos de rehabilitaciones influyeron en la supervivencia, mientras que otras variables, como los aspectos oclusales y biomecánicos, la higiene bucal, la dieta y la ansiedad, sí estuvieron asociadas a la supervivencia de las rehabilitaciones implantosoportadas. Las variables más asociadas a la supervivencia, en orden decreciente de importancia, fueron los aspectos oclusales, la higiene bucal, los elementos biomecánicos, la dieta y la ansiedad.

El feocromocitoma es un tumor del sistema cromafín, que casi siempre se localiza en la médula suprarrenal; aunque también puede hacerlo fuera de ella, y a merced de una excesiva secreción de adrenalina y noradrenalina ocasiona un cuadro clínico de hipertensión arterial paroxística o permanente. Fue descrito por primera vez en 1922, en una mujer de 28 años, como el síndrome de la hipertensión paroxística intermitente; dicha paciente falleció de un edema agudo de pulmón, y en la autopsia se encontró un tumor de la glándula suprarrenal izquierda, con estructura del sistema cromafín1.

Se realizó un estudio de 740 pacientes con fractura de cadera, los cuales fueron operados en nuestro centro durante el período comprendido entre diciembre de 1991 y agosto de 1994, para conocer los grupos etarios, sexo, clasificación anatómica y procedimientos quirúrgicos empleados. Las fracturas más frecuentes fueron las intertrocantéricas, el sexo más afectado fue el femenino, y las reducciones y osteosíntesis, el procedimiento quirúrgico más utilizado.

Background: Outside of clinical trials, real-world data of advanced gastric cancers (AGCs) managed with perioperative or adjuvant chemotherapy with a backbone of D2 lymphadenectomy is limited., Patients and Methods: Curative resections for gastric adenocarcinoma between January 2003 and January 2020 at the Tata Memorial Centre were analyzed, comparing three time periods marking major increments in annual gastric resections (GRs)., Results: 1657 radical gastric resections were performed with a morbidity and mortality rate of 34.9% and 1.4%, respectively. Over three consecutive periods, the number of annual GRs increased from 56/year to 97/year to 156/year (P < 0.001) with a significant escalation in surgical magnitude and complexity. Improvement in surgical quality indicators (median lymph node yield from 15 to 25, P < 0.001 and margin negativity from 8.2 to 5.5%, P = 0.002) was observed with no corresponding increase in severe complications (6.9%) or mortality (1.4%). The proportion of distal and signet ring cancers was found to decrease over time, with an increase in proximal cancers and younger age at presentation. Overall, 90% of GRs were for AGCs with a median overall survival (OS) of 4.4 years (± 6 months), and 5-year OS rate of 47.6% (± 1.9%)., Conclusions: Change in pattern of tumor characteristics was observed. Aggressive treatment options for AGC were employed progressively with excellent survival. With increase in volumes, improvements in surgical quality indicators, and a relative improvement in postoperative mortality was observed. These results provide a roadmap for developing dedicated gastric cancer centers., (© 2024. Society of Surgical Oncology.)

Introduction: Recent evidence supports the efficacy of surgical navigation (SN) in improving outcomes of sinonasal and craniofacial oncologic surgery. This study aims to demonstrate the utility of SN as a tool for integrating surgical, radiologic, and pathologic information. Additionally, a system for recording and mapping biopsy samples has been devised to facilitate sharing of spatial information., Materials and Methods: SN was utilized for biopsy mapping in 10 sinonasal/craniofacial oncologic procedures. Twenty-five raters with experience in anterior skull base oncology were interviewed to identify 15 anatomical structures in preoperative imaging, relying on topographical descriptions and surgical video clips. The difference in the localization of anatomical structures by raters was analyzed, using the SN-mapped coordinates as a reference (this difference was defined as spatial error)., Results: The analysis revealed an average spatial error of 9.0 mm (95 % confidence interval: 8.3-9.6 mm), with significant differences between surgeons and radiation oncologists (7.9 mm vs 12.5 mm, respectively, p < 0.0001). The proposed model for transferring SN-mapped coordinates can serve as a tool for consultation in multidisciplinary discussions and radiotherapy planning., Conclusions: The current standard method to evaluate disease extension and margin status is associated with a spatial error approaching 1 cm, which could affect treatment precision and outcomes. The study emphasizes the potential of SN in increasing spatial precision and information sharing. Further research is needed to incorporate this method into a multidisciplinary workflow and measure its impact on outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

This study aimed to evaluate the dose in different protocols of 18F-2-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (PET/CT) procedure. The retrospective study involves 207 patients with confirmed malignancies who underwent PET/CT. Effective dose (E) from PET was estimated based on injected activity and dose coefficient as per International Commission on Radiation Protection (ICRP) 128. Estimation of E from CT was done utilizing the dose length product (DLP) method and conversion factors as per ICRP 102. There was a significant statistical difference observed in E between different PET/CT protocols (P < .001). E of PET in the whole body (WB) was found to be 4.9 ± 0.9 mSv, whereas mean volume computed tomography dose indexvol, DLP, and E of CT in WB were 7.0 ± 0.2 mGy, 674.3 ± 80.7 mGy.cm, and 10.1 ± 1.2 mSv, respectively. No linear correlation was seen between the size-specific dose estimate and E of CT (r = -0.003; P = .978). The total mean E in WB PET/CT was 17.0 ± 1.7 mSv. CT dose was contributing more than PET dose in all protocols except brain PET/CT. Optimization strategies can be evaluated only if monitored periodically., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Background: India has the highest incidence worldwide of smokeless tobacco (SLT)-associated oral cancer, accounting for nearly 70% of all SLT users globally. Nicotine and tobacco-specific N -nitrosamines (TSNA) play critical roles in the addictive and carcinogenic potential, respectively, of SLT products. Our group has previously reported substantial variability in nicotine and TSNA levels across a small SLT product sample in India, calling for systematic surveillance. However, there is no information available on the current levels of these constituents in Indian SLT., Methods: We analysed 321 samples representing 57 brands of eight popular types of manufactured SLT products purchased from five local markets in Mumbai, India between August, and September 2019. The sampling locations were Mumbai Central, Kurla, Thane, Vashi, and Airoli. Product pH, moisture content, total and unprotonated (biologically available) nicotine, and TSNA levels were measured at the Advanced Centre for Treatment, Research, and Education in Cancer (ACTREC) in Mumbai., Findings: Total nicotine content ranged from 0.45 to 35.1 mg/g across products. The unprotonated nicotine fraction contributed 0.1-100% of the total nicotine content. The carcinogenic TSNA levels ranged 0.06-76 ug/g for N' -nitrosonornicotine (NNN), 0.02-19.2 ug/g for 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), and 0.01-6.51 ug/g for 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL). Consistent with our previous study, we observed substantial variations across different brands of the same product type., Interpretation: This is the most extensive and the first within-country study to report brand-specific nicotine and TSNA levels in SLT products marketed in Mumbai, India. Our results show that levels of these constituents remain extremely variable across Indian SLT and are strikingly high in many products. Enhanced public education and continued efforts to reduce SLT use prevalence in India are critical for reducing the global burden of SLT-associated morbidity and mortality. Regulation of nicotine and TSNA levels in SLT products should be considered., Funding: This work was supported by the National Institutes of Health (USA) grant R01-TW010651 and, in part, by grants R01-CA180880 and R50-CA211256. The LC-MS/MS analysis was supported in part by XII Plan project funding from the Department of Atomic Energy, Government of India., Competing Interests: S.K. provided an expert testimony, with the payment received institutionally by the University of Minnesota. J.S.A. received travel compensation for the 2021 and 2022 Annual Global Tobacco and Nicotine Forum and is a consultant and has equity in Qnovia, a start-up company developing a nicotine replacement product for U.S. Food and Drug Administration prescription product approval. We declare no other competing interests., (© 2024 The Author(s).)

Objective: Craniopharyngioma (CP) is a benign neuroepithelial tumor generally treated with maximal safe resection and radiation therapy (RT) in incompletely resected CP or in recurrent tumors to achieve long-term control. We analyzed the clinical outcomes of patients with CPs treated with a multimodality approach., Patients and Methods: A retrospective clinical audit of histologically proven CPs registered between 2008 and 2019 at a specialized neuro-oncology center in India was performed. Time-to-event outcomes (overall survival [OS] and progression-free survival [PFS]) were analyzed., Results: One hundred and twenty-two patients with CP were analyzed. The median age of the population was 14 years (interquartile range [IQR], 8-26) with a significant male preponderance. Gross total resection was achieved in only 25% of patients. At a median follow-up of 57.1 months (IQR, 27.8-87.8), 5-year estimates of PFS and OS were 52% (95% confidence interval, 46%-63.4%) and 85.8% (95% confidence interval, 78.6%-93%), respectively. Recurrence or progression was observed in 48 of 122 patients (39.3%) at a median time of 84.4 months (IQR, 24.7-174.8). On multivariate analysis, the absence of residual disease (P = 0.004), near-total resection (P = 0.035), and use of up-front adjuvant RT (P < 0.001) significantly improved the 5-year PFS, whereas the absence of extracavernous extension (P = 0.058) and any use of postoperative RT (P = 0.026) significantly improved the 5-year OS., Conclusions: This study represents one of the largest single-institutional series of CPs, showing improved PFS with up-front adjuvant RT in most cases of CP. Deferring adjuvant RT should be considered only in patients with no evidence of residual disease (as shown on dedicated sellar imaging) after primary surgery., (Copyright © 2023 Elsevier Inc. All rights reserved.)

With increasing multidisciplinary management and emphasis on masterly inactivity for abdominal fibromatosis (AF), the indications for surgery are evolving. This retrospective analysis looked at outcomes following surgery. Two groups of patients who underwent surgery for AF between November 2011 and August 2021 were identified-intra-abdominal fibromatosis (IAF) and abdominal wall fibromatosis (AWF). All treatment-related details and follow-up data were gathered from a database and analyzed. Sixteen patients underwent surgery for IAF. R0 resection (wide margin) was achieved in 13 patients (81.2%). Over a median follow-up period of 51.7 (range 5-103) months, 5 patients developed recurrence (31.2%). The conditional probabilities of OS and DFS at 5 years were 80% (95% CI 58.7-100) and 42.2% (95% CI 20.3-87.8), respectively. Ten patients with AWF underwent surgery. R0 resection was achieved at 70% (7/10). Over a median follow-up period of 54.8 (range 12.9-96.7) months, 2 patients (20%) developed recurrence. The conditional probabilities of OS and DFS at 5 years were 88.9% (95% CI 70.6-100) and 77.8% (95% CI 54.9-87.8), respectively. Surgery has a vital role in the management of AF presenting with progressive/symptomatic lesions, especially when watchful waiting is not an option, and must be considered as one of the first-line active therapy. Timely curative surgery avoids disease progression and its morbidity with acceptable recurrence rates and provides durable remissions., Competing Interests: Conflict of InterestThe authors declare no competing interests., (© The Author(s), under exclusive licence to Indian Association of Surgical Oncology 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

In health systems with little public funding and decentralized procurement processes, the pricing and quality of anti-cancer medicines directly affects access to effective anti-cancer therapy. Factors such as differential pricing, volume-dependent negotiation and reliance on low-priced generics without any evaluation of their quality can lead to supply and demand lags, high out-of-pocket expenditures for patients and poor treatment outcomes. While pooled procurement of medicines can help address some of these challenges, monitoring of the procurement process requires considerable administrative investment. Group negotiation to fix prices, issuing of uniform contracts with standardized terms and conditions, and procurement by individual hospitals also reduce costs and improve quality without significant investment. The National Cancer Grid, a network of more than 250 cancer centres in India, piloted pooled procurement to improve negotiability of high-value oncology and supportive care medicines. A total of 40 drugs were included in this pilot. The pooled demand for the drugs from 23 centres was equivalent to 15.6 billion Indian rupees (197 million United States dollars (US$)) based on maximum retail prices. The process included technical and financial evaluation followed by contracts between individual centres and the selected vendors. Savings of 13.2 billion Indian Rupees (US$ 166.7million) were made compared to the maximum retail prices. The savings ranged from 23% to 99% (median: 82%) and were more with generics than innovator and newly patented medicines. This study reveals the advantages of group negotiation in pooled procurement for high-value medicines, an approach that can be applied to other health systems., ((c) 2023 The authors; licensee World Health Organization.)