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Aim Adult umbilical hernia accounts for between 3% and 14% of abdominal wall hernias, second only to inguinal hernias in frequency. The current prevalence of umbilical hernias in Africa is currently unknown, but it is estimated that about 50,000 patients die each year in Africa as a result of umbilical hernias. We describe below the number of interventions performed in 2022 by European aid workers in a third level Hospital in Tanzania using local anesthesia and the available material. Material and Methods We performed a retrospective observational study of the number of umbilical hernias operated in a Third level Hospital in Tanzania Results Throughout 2022, 2818 surgical interventions were performed in men and women by european aid workers: 114 interventions (4.04%) were umbilical hernia repairs. The age range of the operated patients was 12–18 years. No mesh was used in any case. The techniques used consisted of edge-to-edge closure. Patients were discharged after 24–48 hours without complications and no follow-up was obtained due to the fact that it was a rural hospital. Conclusions Umbilical hernia repair with mesh is the gold standard of treatment in our environment, however its practice in collaborative projects of this type requires a thorough knowledge of non-prosthetic repair options due to the scarcity of material.

Objectives In rural África, hernia and caesarean section are the most common elective procedures with a very high burden of morbidity and mortality in inguinal hernias. We present the interventions carried out during 2022 by European aid workers in a referral and third level hospital in Tanzania and the techniques performed from the scarce material available. Material and Methods A retrospective observational study of the number of inguinal hernias operated in a Hospital in Tanzania by European aid workers. Results Throughout 2022 the hospital performed 2818 surgical interventions (1445 men and 1373 women) of which 155 were inguinal hernias (5.5% of total interventions). Of this total, only 5 were repaired with mesh using the Lietchenstein technique (3% of operations). The remaining cases were repaired by herniorrhaphy using the Shouldice technique. The postoperative period was between 24 and 48 hours. Follow-up is carried out in less than 5% due to the fact that this is a rural hospital, with 17 reoperations. Conclusions Treatment of inguinal hernia in cooperative projects are challenging to the surgeon's skills and require a thorough understanding of the anatomy of the inguinal region and nonprosthetic repair options.

Management of negative pressure therapy with fascial traction mediated by inlay mesh, in the context of a patient with multiple organ failure (MOF) secondary to sepsis of abdominal origin in treatment with extracorporeal membrane oxygenation therapy (ECMO) We present the case of a 15-year-old female patient, referred to a hospital after continuous consultations in a primary care center. She refers abdominal pain located in the right iliac fossa of 72 hours of evolution. Blood analysis with high infectious parameters, abdomen on a table and scanner compatible with acute appendicitis complicated by perforation. Urgent surgical intervention, where purulent peritonitis was observed in the four quadrants, the abdomen was kept open with NPT. In a situation of MOF, the need for high-dose noradrenaline and acute respiratory failure. During intubation, 2nd pneumothorax due to barotrauma. Given early deterioration, ECMO therapy was started. After completion of treatment, decreased intra-abdominal pressure and no restrictive respiratory compromise. Progressive fascial traction, using inlay mesh for 18 days until complete closure, using 2/0 monofilament suture, small bites technique, 4:1 ratio and placement of wide-pore, onlay polypropylene mesh. Partial dehiscence of the surgical wound as the only complication, NPT at 80mm Hg with definitive closure was prescribed. Satisfactory evolution one year after the intervention. After our experience with this case, we can conclude that NTP in the open abdomen with the help of facial traction mesh, in patients with ECMO therapy in a situation of septic shock, may be an adequate alternative for definitive closure of the abdominal wall.

Aim We present the case of an advanced ovarian cancer spread to the abdominal wall and iliac vessels where a complete resection was performed with immediatly reconstruction of the abdominal wall to achieve a complete R0 resection. Material and Methods A 66-year-old woman with history of hysterectomy, double adnexectomy and adjuvant chemotherapy for ovarian cancer 36 years ago. The CT scan showed an 8×7 cm lesion involving the anterior rectus muscle with compression of the ipsilateral iliac vessels. A biopsy was positive for adenocarcinoma with gynecological origin. She received neoadjuvant treatment with chemotherapy. In the control CT scan persisted a mass the abdominal wall mass with slight reduction in size and compressing the iliac vessels. Results Following a karakousys incision, an anterior abdominal wall tumor intimately attached to the pubic symphysis was observed. The tumor measured 6 cm, it infiltrated the femoral vein but there was not invasion of the artery. A completed resection of the anterior abdominal wall musculature up to the pubic symphysis was performed, disconnecting the inguinal ligament and leaving a 10×10 cm wall defect. This defect was repaired with the placement of a preperitoneal biological mesh to provide a reinforcement plane and a polypropylene mesh above the previous one. Conclusions Wide abdominal wall resections may be necessary to obtain R0 resections. Numerous studies have shown that morbidity rates associated with these procedures are not high. In fact, in our case, an immediate abdominal wall reconstruction achieved good functional and aesthetic results in a single surgical procedure.

Toda actividad antrópica implica peligros, por lo cual siempre es necesario antes de emprender una actividad, considerar los riesgos potenciales a los que los individuos deberán enfrentarse al realizar sus actividades, pudiendo así establecer las acciones pertinentes que tiendan a minimizar la ocurrencia y las consecuencias de los mismos. Un sector que es particularmente vulnerable es el infantil, aunque no es un sector que se le permita realizar labores productivas, se encuentran expuestos cuando acuden a las instituciones educativas a realizar sus estudios. Al ser menores de edad, los riesgos pueden incrementarse tanto en frecuencia como en la gravedad de sus consecuencias, siendo indispensable que las instituciones educativas realicen un análisis que permita visualizar todos los factores y así establecer estrategias para proteger tanto a los infantes, como a los docentes y al personal administrativo que labora en las escuelas. En esta investigación se realizó una evaluacion de riesgos en la escuela primaria “Constituyentes de 1857 a 1917” con el objetivo de establecer una prueba piloto para determinar que tan delicada podría ser la situacion de los individuos dentro de las instalaciones educativas y que acciones podrían ser las pertinentes a contemplar en un plan estratégico que coadyuve a mitigar los riesgos y sus efectos.

This chapter explores how customer's attributes, shopping behavior, and preferences affect the retail choice in fiercely competitive retail environments of megacities from developing countries. We study how small, family-owned retailers (i.e., nanostores) compete against organized chains from the modern channel (i.e., convenience stores and supermarkets) at different socioeconomic levels in 9 out of 16 boroughs from Mexico City. Primary data were collected using a combination of instruments (i.e., observation, interviews, and surveys) that were applied to relevant stakeholders of the retail footprint where nanostores develop their operations. We analyze the data via statistical tools such as descriptive statistics and independent nonparametric tests to understand the significant factors of the competitive landscape in which nanostores are immersed. We supplement our research methodology by using causal loop diagrams to identify opportunities in the way suppliers, shopkeepers, competitors, and customers interact with each other and new business models for the nanostore supply chains. By breaking down our result analysis into low-, middle-, and high-income areas, we provide insightful recommendations to increase nanostores' survival, improve their operations, and grow them in Mexico City by addressing issues from the supply, store management, and customer service.

Se presenta en este trabajo la implementación de un algoritmo en el lenguaje Python orientado a la reconstrucción tridimensional de entornos y objetos utilizando dos imágenes capturadas por medio de dos cámaras idénticas con eje óptico paralelo y haciendo uso de la tarjeta Raspberry-PI 3. Se explica el principio de funcionamiento que se utilizó en este trabajo, así como también las características esenciales que se deben de cumplir para obtener resultados válidos. Se describe cada una de las partes del código programado, explicando de manera precisa los parámetros modificables que ayudan a obtener una reconstrucción adecuada. Se muestra la estructura empleada para la colocación de las cámaras y, finalmente, se presentan los resultados obtenidos en las diferentes pruebas, especificando las características aplicadas para la generación de los mapas de disparidad. De esta manera, se demuestra que mediante dos cámaras idénticas de cualquier tipo y una tarjeta Raspberry-PI 3 se puede lograr una reconstrucción 3D. &nbsp

In many petroleum-producing regions, there are not adequate controls to prevent pipeline breaks and spills, and thus soil is frequently contaminated with petroleum hydrocarbons. Different petroleum oil compounds may produce negative impacts on soil fertility. In this study, four fresh crudes, a weathered petroleum, and oils from bioremediated and burned sites were investigated (specific gravities 0.83–1.27). Fourier transform infrared spectroscopy revealed three predominant polar functional groups to be more plentiful in the heavier crudes. The relative abundance of these groups was used to calculate an index that was directly correlated with specific gravity (R 2 = 0.9960) and the percent of asphaltene plus (polars + resins) fractions in the oil (R 2 = 0.9643). This index correlated exponentially to the water repellency caused by petroleum in an alluvial soil (R 2 = 0.9928). Furthermore, extra-heavy oil at a concentration of 10,000 ppm, the maximum allowable oil concentration in the soil that is within regulatory norms in many US states and other countries, and with a specific gravity >1.002, showed severe water repellency. This study presents an alternative for determining soil remediation criteria based on the API gravity of the oil rather than the C-range of the hydrocarbon mixtures, simplifying analytical methods and systematically studying the interaction between the kinds of petroleum mixtures and potential impacts to soil fertility.

Tussilago farfara L. (“coltsfoot”, Asteraceae) is indigenous to Eurasia, including Turkey, but has been classified as a Class A noxious weed in North America. Plant pathogens are being sought as potential candidates for biological control of coltsfoot. A rust fungus, Coleosporium tussilaginis (Pers) Lev. has been reported to cause disease on T. farfara from Europe, Russia, and Japan (2). During August of 2001 and 2002, rust pustules were observed on coltsfoot leaves in Kizilcahamam, Ankara, Turkey. Diseased plant specimens with rust pustules were collected, examined microscopically, and compared with published descriptions (1) and specimens in the U.S. National Fungus Collections in Beltsville, MD. The causal agent was subsequently identified as the fungus Coleosporium tussilaginis (Pers.) Lév. on the basis of symptomatology and morphology of uredinial and telial stages such as: clustered, golden-orange, sub-epidermal, erumpent, uredinia approximately 1.0 × 2.0 mm in diameter on the abaxial surface, and corresponding achlorotic areas on the adaxial leaf surfaces; thick-walled (3.0 to 4.0 μm), pale orange, coarsely verrucose, variously shaped (mostly broadly ellipsoid or angular) urediniospores measuring 23.5 to 33.0 × 20.0 to 25.7 μm (average = 27.3 × 23.3 μm), with obscure and scattered germ pores; and orange-red telia on the abaxial leaf surfaces covered by a gelatinous apical layer enclosing orange-red, cylindrical to clavate teliospores measuring 50.0 to 80.0 × 18.0 to 28.0 μm. A voucher specimen of this material has been deposited in the U.S. National Fungus Collections (BPI 863516). To the best of our knowledge, this is the first report of C. tussilaginis rust on coltsfoot in Turkey. References: (1) G. Deml et al. Phytopathol. Z 104:39, 1982. (2) D. F. Farr et al. Fungal Databases. USDA-ARS Systematic Botany and Mycology Laboratory, Online publication. ARS, USDA, 2005.

Asian soybean rust, caused by Phakopsora pachyrhizi Sydow, has been known to occur in the eastern hemisphere for nearly a century. More recently, it was reported from Hawaii in 1994, eastern and southern Africa from 1996-1998, Nigeria in 2001, and Brazil and Paraguay in 2002. Aerobiological models suggested that urediniospores of the pathogen would be disseminated on wind currents to the continental United States in association with tropical storms if the disease became established north of the equator during hurricane season (U.S. Soybean Rust Detection and Aerobiological Modeling online publication at www.aphis.usda.gov/ppq/ ep/soybean_rust/ ). Since soybean rust was observed at approximately 5°N latitude in South America before several hurricanes impacted the continental United States in September 2004, it seems likely that the introduction was associated with at least one of these tropical storms, especially hurricane Ivan. Symptoms of the disease were first observed on soybean (Glycine max (L.) Merr.) in the continental United States on November 6, 2004 in a field near Baton Rouge, LA. Typical pustules and urediniospores on infected leaves were readily apparent when viewed with a dissecting microscope. Urediniospores were obovoid to broadly ellipsoidal, hyaline to pale yellowish brown with a minutely echinulate thin wall, and measured 18 to 37 × 15 to 24 μm. Paraphyses were cylindric to clavate and slightly thickened at the apex, colorless to pale yellowish brown, and 25–50 × 6–14 μm in size. This morphology is typical of Phakopsora pachyrhizi and P. meibomiae, a less aggressive, western hemisphere species (2). DNA was extracted from leaves containing sori using the Qiagen DNeasy Plant Mini kit. P. pachyrhizi was detected using a real-time polymerase chain reaction (PCR) protocol (1) that differentiates between P. pachyrhizi and P. meibomiae performed in a Cepheid thermocycler with appropriate positive and negative controls. The PCR master mix was modified to include OmniMix beads (Cepheid). The field diagnosis of P. pachyrhizi was confirmed officially by the USDA/APHIS on November 10, 2004, and this was followed on November 11, 2004 by a wide-ranging survey of soybean and kudzu (Pueraria sp.) in soybean production areas in southern and central Louisiana. Collections from this survey also were assayed as described above, and six soybean specimens from five sites were confirmed positive. The disease was not found on kudzu samples. To our knowledge, this is the first report of P. pachyrhizi in the continental United States. Voucher specimens have been placed in the USDA National Fungus Collection. References: (1) R. D. Frederick et al. Phytopathology 92:217, 2002. (2) Y. Ono et al. Mycol. Res. 96:825, 1992.

Leaves of Ipomoea carnea Jacq. subsp. fistulosa (Mart. ex Choisy) D. Austin (Convolvulaceae) with conspicuous, round, yellowish orange leaf spots measuring up to 8 mm in diameter were collected from a garden plant in Cabo Rojo, Miradero, Puerto Rico on 8 December 2004. Uredinia and telia were observed in the symptomatic areas. The uredinia were aecioid, amphigenous but mainly hypophyllous, cupulate, and grouped in the round chlorotic leaf spots. The peridial cells measured 24 to 36 × 18 to 25 μm with walls 4 to 6 μm thick, the outer wall was striate to verrucose and the inner wall was verrucose. Urediniospores were catenulate, globoid to ellipsoid, sometimes narrow at the apex, and measured 28 to 36 × 20 to 30 μm. The urediniospore walls were colorless to yellowish, verrucose, 2 to 3 μm at the sides, and as much as 15 μm at the apex. Telia were epiphyllous, in the same spots as the uredinia, rounded, chestnut brown, and subepidermal, becoming erumpent. Teliospores measured 42 to 57 × 28 to 36 μm and were pale to cinnamon brown when young, becoming chestnut brown at maturity. The teliospores were ellipsoid or oblong, rounded at the top and bottom, with no constriction at the septum, and with walls verrucose, 3 to 4 μm at the sides and 5 to 7 μm at the septum and apex. Each teliospore had a pedicel that was colorless except close to the spore it was pale brown. Pedicels measured as much as 70 μm long and 10 μm thick and were easily broken. The rust was identified as Puccinia puta H.S. Jacks. & Holw. ex F. Kern, Thurst. & Whetzel (2), as compared macroscopically and microscopically with specimens in the U.S. National Fungus Collection (BPI) and also with published descriptions. P. puta has been reported from South America and Mexico on species of Ipomoea (1). I. carnea subsp. fistulosa is cultivated as an ornamental plant and widely distributed mainly in wet areas in the Americas from Argentina to Florida and Texas. To my knowledge this is the first report of P. puta in Puerto Rico. It has not been reported in the continental United States. The voucher specimen has been deposited in the U.S. National Fungus Collection as BPI 872006. References: (1) D. F. Farr et al. Fungal Databases. Systematic Botany and Mycology Laboratory. On-line publication. ARS, USDA, 2005. (2). F. D. Kern et al. Mycologia 25:448, 1933.

Asian soybean rust, caused by Phakopsora pachyrhizi Sydow, has been known to occur in the eastern hemisphere for nearly a century. More recently, it was reported from South America in 2002 and the continental United States in Louisiana in November 2004 (1,2). Subsequently, P. pachyrhizi was confirmed in Alabama, Arkansas, Georgia, Florida, Missouri, Mississippi, South Carolina, and Tennessee in 2004. Surveys conducted in North Carolina in late November 2004 failed to detect this pathogen. Symptoms of the disease were first observed on soybean (Glycine max (L.) Merr.) in North Carolina on 25 October 2005 in farmers' fields in the counties of Brunswick, Columbus, and Robeson. Typical pustules and urediniospores were readily apparent on infected leaves when viewed with a dissecting microscope. Urediniospores were obovoid to broadly ellipsoidal, hyaline to pale yellowish brown with a minutely echinulate thin wall, and measured 18 to 37 × 15 to 24 μm. This morphology is typical of soybean rust caused by P. pachyrhizi or P. meibomiae, the latter is a less aggressive species causing soybean rust in the western hemisphere (1). DNA was extracted from leaves containing sori using the Qiagen DNeasy Plant Mini kit (Valencia, CA). P. pachyrhizi was detected using a real-time polymerase chain reaction (PCR) protocol that differentiates between P. pachyrhizi and P. meibomiae in a Cepheid thermocycler (Sunnyvale, CA) with appropriate positive and negative controls. The PCR master mix was modified to include OmniMix beads (Cepheid). Field diagnosis of P. pachyrhizi was confirmed by the USDA/APHIS on 28 October 2005. Soybean rust was identified in subsequent surveys of soybean fields and leaf samples submitted by North Carolina Cooperative Extension Agents in an additional 15 counties. These samples also were assayed using a traditional PCR protocol and by the enzyme-linked immunosorbent assay protocol included in the EnviroLogix QualiPlate kit (Portland, ME) for soybean rust. Ten soybean specimens from 10 sites were confirmed positive by these methods. Disease was not found on three kudzu samples, although one kudzu sample was adjacent to a soybean field that was positive for P. pachyrhizi. Although soybean rust was eventually detected in 18 North Carolina counties in 2005, no soybean yield loss occurred since the pathogen was detected when more than 80% of the soybean crop was mature. To our knowledge, this is the first report of P. pachyrhizi in North Carolina and the northern most find on soybean in the continental United States in 2005. References: (1) R. D. Frederick et al. Phytopathology 92:217, 2002. (2) R. W. Schneider et al. Plant Dis. 89:774 2005.

Phakopsora pachyrhizi Syd. & P. Syd., the cause of soybean rust, was first observed on soybean (Glycine max (L.) Merr.) in South America in the district of Itapúa in Paraguay during March, 2001 (2). The disease is now widespread in soybean-production areas in South America on soybean and kudzu (Pueraria lobata (Willd.) Ohwi). On 15 March 2006, leaves of the perennial legume Neonotonia wightii (Graham ex Wight & Arn.) Lackey with lesions and rust sori were observed in the Reserva Biológica de Itabó, Departamento Alto Paraná. Lesions were scattered, most contained a single uredinium, mostly hypophyllous, and appeared to be new infections. Lesions with several uredinia, which are indicative of older infections on soybean, were also observed. Sori (Malupa-type) contained hyaline, peripheral, cylindric to clavate paraphyses measuring 24 to 45 × 6 to 13 μm and urediniospores that were hyaline, ovoid to globose, and measuring 20 to 40 × 14 to 25 μm with an echinulate spore wall, characteristics typical of a Phakopsora sp. DNA extracted from sori from leaves of N. wightii was amplified in a real-time fluorescent polymerase chain reaction with the P. pachyrhizi-specific primers Ppm1 and Ppa2 (1). Sequence alignment of the internal transcribed spacer region 2 further confirmed the identification as P. pachyrhizi (1). The host identification was confirmed by J. Kirkbride, USDA/ARS/SBML, using the Smithsonian Institution Department of Botany, U.S. National Herbarium. To our knowledge, this is the first confirmed report of natural infection of P. pachyrhizi on a host other than soybean or kudzu in South America. Voucher specimens were deposited in the herbarium of the Facultad Ciencias Químicas of the Universidad Nacional de Asunción of Paraguay (FCQ) and the National Fungus Collection (Accession No. BPI 875340). References: (1) R. D. Frederick et al. Phytopathology 92:217, 2002. (2) W. Morel and J. Yorinori. Bol. Divulg. No. 44. Ministerio de Agricultura y Ganadería, Centro Regional de Investigación Agrícola, Capitán Miranda, Paraguay, 2002.

Leaves, young branches, and fruits of Acacia farnesiana (L.) Willd. (Fabaceae) that were distorted because of hypertrophy causing witches' brooms and other abnormal growth were collected in the area surrounding the Panteón da Liberdade e da Democracia, Brasilia, Brazil, during August 2005. Uredinia and telia were observed in the symptomatic areas. The uredinia were small on leaflets and rachis and on pods in confluent groups as much as 1 cm in diameter, subcuticular becoming erumpent, and cinnamon-brown; paraphyses were mostly clavate and colorless. Urediniospores were 17 to 28 × 12 to 16 μm, ellipsoid to obovoid, with a wall 1.5 to 2 μm thick at the sides and 2 to 3 μm at the apex, cinnamon-brown, with hub and spoke pattern of ornamentation, and pores in two bands of four each above and below the equator. Telia were small, erumpent, on rachis and small branches, and dark cinnamon-brown. Teliospores were 84 to 100 × 65 to 90 μm in diameter, chestnut-brown, (4) 5 to 6 probasidial cells across, and smooth; cysts were globoid, same number as peripheral probasidial cells; pedicels were colorless, multihyphal, and deciduous. The rust was identified as Ravenelia spegazziniana J.C. Lindq, on the basis of the comparison with specimens deposited at the Instituto Spegazzini (LPS) and U.S. National Fungus Collection (BPI), as well as with published descriptions (2). R. spegazziniana has been reported on species of Acacia from Central, North, and South America, and Hawaii (1). A. farnesiana is probably native to tropical America, but it is naturalized and cultivated all over the world where it has become invasive in disturbed areas in some Pacific islands. This species is economically important for fuel wood, flowers used in the perfume industry, and bark and fruits used for tannin production. In Federal District (DF), Brasilia, Brazil, A. farnesiana is commonly used in urban forestation as an ornamental and shade tree. To our knowledge, this is the first report of R. spegazziniana in Brazil. The voucher specimen has been deposited in the herbarium of the Faculty of Biology of Porto Alegre from the Universidade Federal do Rio Grande do Sul as ICN 139085. References: (1) D. F. Farr et al. Fungal Databases. Systematic Botany and Mycology Laboratory. On-line publication. ARS, USDA, 2006. (2) J. R. Hernandez and J. F. Hennen. Mycol. Res. 106:972. 2002.

espanolRESUMEN Objetivo: Presentar el caso de una paciente femenina de 32 anos con diagnostico de sindrome de persona rigida, con multiples tratamientos para el dolor y espasticidad sin respuesta a los mismos, con una prueba por via intratecal de baclofeno con respuesta positiva, por lo que se coloco un dispositivo implantable definitivo para administracion de medicamento intratecal (baclofeno), realizada en el Centro Medico Nacional 20 de noviembre del ISSSTE con una mejora de mas de 80 % en cuanto al dolor, disminucion de la espasticidad. Metodologia: Presentacion de caso clinico, estudio descriptivo y observacional realizado en el Centro Medico Nacional 20 de Noviembre, de la Ciudad de Mexico, con seguimiento a la paciente y su evolucion por un periodo de 12 meses entre los anos 2017 y 2018. Resultados: Posterior a la prueba con dosis unica de baclofeno intratecal se realiza colocacion del dispositivo permanente para administracion de baclofeno intratecal, en la ultima consulta con dosis de 300 microgramos al dia, con una mejora del dolor de mas del 80 % y con mejora de 100 % en la espasticidad y mejora en general de la sintomatologia y con la reincorporacion a su vida habitual. Conclusiones: El uso de baclofeno intratecal se debe considerar una alternativa optima y real para el tratamiento del sindrome de persona rigida mediante la administracion por via intratecal en Mexico. EnglishABSTRACT Objective: To present the case of a 32-year-old female patient with a diagnosis of stiff person syndrome, with multiple treatments for pain and spasticity without response, with an intrathecal baclofen test with a positive response, so a definitive implantable device was placed for administration of intrathecal medication (baclofen), performed at the National Medical Center November 20 of the ISSSTE with an improvement of more than 80 % in terms of pain, decreased spasticity. Methodology: Presentation of clinical case, descriptive and observational study carried out in the National Medical Center November 20, of Mexico City, with follow-up of the patient and its evolution for a period of 12 months between 2017 and 2018. Results: After the trial with a single dose of intrathecal baclofen, the permanent device was placed for administration of intrathecal baclofen, in the last consultation with a dose of 300 micrograms a day, with an improvement of pain of more than 80 % and with improvement of 100 % in spasticity and overall improvement of the symptoms and with the reincorporation to his habitual life. Conclusions: The use of intrathecal baclofen should be considered an optimal and real alternative for the treatment of rigid person syndrome through intrathecal administration in Mexico.

espanolIntroduccion: Los sistemas de estimulacion medular espinal pueden utilizar electrodos percutaneos (EP) o paletas percutaneas, a diferencia de los electrodos quirurgicos que se requiere un abordaje quirurgico para su implantacion mediante laminotomia o laminectomia. Hasta la fecha no existen reportes en la literatura mundial acerca del retiro percutaneo de EP disfuncional. Materiales y metodos: Es un reporte de caso, descriptivo y retrospectivo, que ha requerido de colocacion de Neuroestimulador Medular Implantable (NEMI) con EP por dolor neuropatico cronico refractario, que curso con disfuncion y posteriormente candidato para recambio del EP con tecnica percutanea. Realizado en el servicio de Clinica del Dolor del Centro Medico Nacional "20 de Noviembre" en el mes de septiembre de 2016. Resultados: Paciente de sexo femenino de 54 anos con diagnostico de schwannoma de raiz L2 izquierda, que presento disfuncion del EP del NEMI durante accidente automovilistico. Se realizo abordaje percutaneo en sala de fluoroscopia mediante el uso del EpiducerTM de ST. Jude Medical como "puente" para el retiro del EP disfuncional y recolocacion del nuevo EP sin realizar abordaje por laminotomia o laminectomia. Conclusiones: El abordaje percutaneo para recambio de EP es una tecnica efectiva minimamente invasiva, con menor probabilidad de complicaciones y sin necesidad de realizar laminectomia o laminotomia. EnglishIntroduction: Spinal cord stimulation systems can use percutaneous electrodes or percutaneous (PP) paddles, unlike surgical paddles that require a surgical approach for implantation by laminotomy or laminectomy. To date, there are no reports in the world literature regarding percutaneous withdrawal of dysfunctional (PP). Materials and methods: It is a case report, descriptive and retrospective. Who required implantation of implanted medullary neurostimulator (NEMI) with (PP) for refractory chronic neuropathic pain, who attended with dysfunction and later candidate for replacement of the (PP) with percutaneous technique. Performed in service of Pain Clinic of the National Medical Center "November 20" in September 2016. Results: A 54-year-old female with a diagnosis of Schwannoma of the left L2 root who presented dysfunction of the (PP) of the (NEMI) during an automobile accident. A percutaneous approach is performed in a fluoroscopy room using the Epiducer TM of ST. Jude Medical as a "bridge" for the removal of the dysfunctional (PP) and replacement of the new (PP) without conducting a laminotomy or laminectomy approach. Conclusions: The percutaneous approach to replacement of (PP) is an effective minimally invasive technique, with a lower probability of complications and without the need for laminectomy or laminotomy.

Introducción: La estimulación eléctrica medular (EEM) definitiva es un procedimiento para pacientes con dolor crónico de predominio neuropático. El objetivo fue analizar la respuesta a la EEM en el dolor y los índices de calidad de vida. Material y métodos: Se trata de un estudio de serie de pacientes retrospectiva, longitudinal y descriptiva, en el que se incluyó a 40 pacientes de ambos sexos, con edades entre los 18 y los 85 años, a los que se implantó un sistema de EEM. Se evaluó la intensidad del dolor mediante la escala visual analógica (EVA) previamente, al mes y a los 6 meses de implantado. Se aplicó el índice de discapacidad de Oswestry y el Fast-Espiditest previo a la implantación y a los 6 meses. Se utilizó estadística descriptiva, con prueba de ANOVA, para lo que se consideró como significativo un valor de p < 0,05. Resultados: El 88% de los pacientes tenía dolor neuropático, con diagnóstico etiológico de síndrome poslaminectomía (67,5%). La medición de la EVA basal fue 8,8 ± 1,1, al mes 3,5 ± 2,3 y a los 6 meses 3,9 ± 2,0 (p < 0,001). El índice de Oswestry inicial fue de 65,5 ± 8,5 y el final, de 43,8 ± 11,4 (p < 0,001). Con el Fast-Espiditest basal encontramos dentro de dolor moderado al 10% de los pacientes y con dolor intenso, al 90%, y a los 6 meses dentro de dolor leve, al 45%; dolor moderado, al 37,5%, y con dolor intenso, al 17,5%. (p < 0,001). Conclusiones: La EEM es una alternativa analgésica en el tratamiento del dolor crónico intenso de tipo neuropático, siendo una técnica segura y satisfactoria, la cual mejora la discapacidad y la calidad de vida, con complicaciones mínimas.

A significant inoculum-size effect has been observed with piperacillin-tazobactam, and has been associated with β-lactamase production in extended-spectrum β-lactamase (ESBL) producers. This association has not been previously studied in the case of amoxycillin-clavulanate. Piperacillin-tazobactam and amoxycillin-clavulanate were compared, using high inocula of susceptible strains either harbouring ESBLs or not. Two non-ESBL-producing and 15 amoxycillin-clavulanate-susceptible and piperacillin-tazobactam-susceptible ESBL-producing Escherichia coli isolates, and their respective transconjugants, were tested in dilution susceptibility tests using standard and 100-fold higher inocula. Three ESBL-producing strains and E. coli ATCC 25922 were selected for time-kill studies using standard and high initial inocula. At high inocula, MICs of piperacillin increased >eight-fold for non-ESBL-producing strains, and MICs of piperacillin-tazobactam (8 : 1 ratio or with tazobactam fixed at 4 mg/L) increased>eight-fold for all ESBL-producing strains. However, amoxycillin MICs were not affected by a high inoculum with non-ESBL-producing strains, whereas the MICs of amoxycillin-clavulanate (2 : 1 and 4 : 1) increased ≤four-fold for ESBL producers, using the broth and agar dilution methods. In kinetic studies at a high inoculum, amoxycillin and amoxycillin-clavulanate were bactericidal against E. coli ATCC 25922, whereas piperacillin and piperacillin-tazobactam yielded decreases of

Background There is little clinical information about community-onset bloodstream infections (COBSIs) caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (ESBLEC). We investigated the prevalence and risk factors for COBSI due to ESBLEC, and described their clinical features and the impact of COBSI caused by ESBLEC on 14-day mortality. Methods Risk factors were assessed using a multicenter case-control-control study. Influence of ESBL production on mortality was studied in all patients with COBSI due to E. coli. Isolates and ESBLs were microbiologically characterized. Statistical analysis was performed using multivariate logistic regression. Thirteen tertiary care Spanish hospitals participated in the study. Results We included 95 case patients with COBSI due to ESBLEC, which accounted for 7.3% of all COBSI due to E. coli. The ESBL in 83 of these (87%) belonged to the CTX-M family of ESBL, and most were clonally unrelated. Comparison with both control groups disclosed association with health care (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.2-3.8), urinary catheter use (OR, 3.1; 95% CI, 1.5-6.5), and previous antimicrobial use (OR, 2.7; 95% CI, 1.5-4.9) as independent risk factors for COBSI due to ESBLEC. Mortality among patients with COBSI due to ESBLEC was lower among patients who received empirical therapy with beta-lactam/beta-lactam inhibitor combinations or carbapenems (8%-12%) than among those receiving cephalosporins or fluoroquinolones (24% and 29%, respectively). Mortality among patients with COBSI due to E. coli was associated with inappropriate empirical therapy irrespective of ESBL production. Conclusions ESBLEC is an important cause of COBSI due to E. coli. Clinicians should consider adequate empirical therapy with coverage of these pathogens for patients with risk factors.

Introduction: The effect of porin loss and inoculum size on the comparative activity of ertapenem against either extended-spectrum beta lactamase-producing (ESBL) or plasmid-mediated AmpC beta lactamaseproducing (pACBL) Klebsiella pneumoniae strains was evaluated. Methods: Microdilution using 2 different bacterial inocula. Results: Imipenem, amikacin, ertapenem, and cefepime were the most active agents under standard conditions. Ertapenem was more highly affected by porin loss than imipenem. Conclusions: Ertapenem showed high activity against K. pneumoniae strains expressing ESBL, pACBL or both. Strains deficient in porins showed decreased susceptibility to beta lactams. The inoculum effect had a greater impact on imipenem than on ertapenem.

Antecedentes: Aproximadamente 6,35 millones de nuevos casos de cáncer se diagnostican anualmente. El 90% de los pacientes con cáncer avanzado presentan dolor. El objetivo en el tratamiento del dolor oncológico es aliviar el dolor, interrumpiendo la transmisión o modulándolo a nivel cerebral o espinal. La Organización Mundial de la Salud (OMS) desarrolló una escala de tres escalones para manejar el dolor oncológico. En el escalón I se incluyen analgésicos no opiáceos + coadyuvantes; en el escalón II se incluyen opiáceos leves + coadyuvantes y en el escalón III se incluyen opiáceos potentes + coadyuvantes. Material y métodos: Se revisaron 72 expedientes, en un total de 4 años, de todos los pacientes con dolor crónico oncológico que hayan estado en tratamiento con hidromorfona. En este trabajo obtuvimos la dosis promedio en la que se logró un buen control del dolor (escala analógica visual [EVA]

espanolRESUMEN Antecedentes: La neurofibromatosis tipo 1 (NF1) es una enfermedad genetica con una incidencia de 1 entre 2.500-3.000 habitantes. La presencia de neurofibromas (NF) en diferentes estructuras del sistema nervioso central puede desencadenar cuadros severos de dolor, entre otros sintomas neurologicos. Es importante mencionar que tambien el dolor puede ser postquirurgico, ya que el tratamiento de los NF es fundamentalmente quirurgico. Objetivo: Presentar un reporte de caso de un paciente portador de NF1 con dolor neuropatico secundario a NF, el cual fue tratado mediante estimulacion electrica medular (EEM). Metodos: Varon de 41 anos de edad con dolor neuropatico en region lumbar con irradiacion a extremidades inferiores secundario a NF a nivel de raices L2-L3-L4-L5, con poca respuesta y tolerancia al manejo farmacologico. Fue sometido en forma inicial a implante de electrodo de prueba de EEM e implante subsecuente de equipo definitivo. La Escala Visual Analogica (EVA) fue empleada para valorar la intensidad de dolor. Resultados: El paciente reporto mejoria en el control del dolor neuropatico. El EVA inicial reportado fue de 8/10, y el EVA posterior a la colocacion definitiva de EEM fue 1/10, logrando una reduccion total de tratamiento analgesico farmacologico. Conclusiones: La EEM puede representar una opcion en el manejo del dolor neuropatico secundario a NF1. EnglishABSTRACT Background: Neurofibromatosis type 1 (NF1) is a genetic disease with an incidence of 1 per 2.500-3.000 inhabitants. The presence of neurofibroma (NF) in different structures of the Central Nervous System can trigger severe pain, among other neurological symptoms. It is important to mention that the pain can also be post-surgical, since the NF is treated mainly using surgical proceedings. Objective: To present a case report of a patient with NF1 with neuropathic pain secondary to NF, who was treated by electrical stimulation of spinal cord (ESSC). Methods: A 41-year-old male patient suffering from neuropathic pain in the lumbar region, which irradiated to the lower extremities secondary to NF at the L2-L3-L4-L5 level. He had a poor response and tolerance to pharmacological management. He initially underwent an implantation of a trial ESSC electrode and subsequently an implantation of definitive equipment. The Visual Analogue Scale (EVA) was used to assess pain intensity. Results: The patient reported improvement in the control of neuropathic pain. The baseline EVA reported was 8/10, and the EVA after the definitive placement of the ESSC was 2/10, achieving a total reduction of the pharmacological analgesic treatment. Conclusions: ESSC may represent an option in the management of neuropathic pain secondary to NF1.

espanolObjetivo: Determinar el efecto del plasma rico en plaquetas y factores de crecimiento sobre la regeneracion y la reduccion del dolor en discopatia degenerativa. Material y metodo: Revision sistematica de la literatura. Se siguio las recomendaciones de la colaboracion Cochrane expuestas en el Cochrane Hand book for Systematic Reviews of interventions. Se incluyeron ensayos clinicos aleatorizados fases preclinicas y clinicas donde evaluaban el efecto del plasma rico en plaquetas o factores de crecimiento sobre la discopatia degenerativa entre el 1 de septiembre de 2013 y el 30 de septiembre de 2014, publicados en PubMed, MEDLINE y LILACS. Resultados: En la busqueda inicial se identificaron 11 articulos, de los cuales 3 cumplieron los criterios de seleccion determinados para esta revision. Se realizo estrategia de busqueda donde se revisaron las citas relacionadas de los tres articulos principales. De estos, solo 6 cumplieron los criterios de seleccion. Se incluyeron dos articulos mas que arrojo la busqueda en google academico, quedando un total de 10 estudios para el analisis final. En esta revision, nosotros incluimos en la busqueda de no solo aquellos estudios realizados in vitro, sino ademas aquellos estudios en modelos murinos y estudio realizado en humanos. De estos estudios, la mayor parte de ellos fueron realizados in vitro (6), en modelos animales (2) y en humanos (2). En este estudio se seleccionaron solo aquellos estudios donde fue evaluado el PRP y/o los factores de crecimiento sobre las celulas o tejidos del disco intervertebral. Para poder conocer el efecto que estas sustancias, tienen que ser evaluadas en estudios tanto preclinicos como clinicos. Todos los estudios analizados coincidieron sobre el efecto antiinflamatorio, reparador, proliferador e incluso en la mejoria del dolor de la discopatia vertebral. Conclusiones: Los resultados de los estudios muestra el efecto antiinflamatorio, reparador, proliferador e incluso en la mejoria del dolor de la discopatia vertebral. En ninguno de ellos se menciono si este aumento de la sintesis de la matriz conllevaria a una mayor fibrosis del tejido y mayor deterioro, por lo que los estudios en animales o en humanos deberian enfocarse a evaluar un seguimiento mayor para poder evaluar los efectos tardios de la terapia. Por lo tanto, podemos concluir que los puntos de enfoque de la investigacion actual debe apuntar hacia entender mas el mecanismo de la degeneracion discal conjuntamente con los beneficios del PRP en tratarla. EnglishObjective: To determine the effect of platelet-rich plasma and growth factors on regeneration and reduction of pain in degenerative disc disease. Methods: Systematic review of the literature. The recommendations of the Cochrane Collaboration Cochrane outlined in the Handbook for Systematic Reviews of interventions was followed; randomized clinical trials preclinical and clinical phases which evaluated the effect of platelet-rich plasma or growth factors for degenerative disc disease between september 1/2013 to september 30/2014, published in PubMed, MEDLINE and LILACS were included. Results: The initial search 11 items of which 3 met the selection criteria determined for this review were identified. Search strategy where citations related to the three main articles were reviewed was conducted. Of these only 6 met the selection criteria. Threw two articles in academic google search, leaving a total of 10 studies were included in the final analysis. In this review we include in the search not only those studies in vitro but also those studies in murine models and human study. From these studies, most of them were done in vitro (6), in animal models (2) and in humans (2). In those studies where this study was evaluated PRP and growth factors on cells or tissues of the intervertebral disc is selected alone. To know the effect these substances have to be evaluated in both preclinical and clinical studies. All studies reviewed agreed on the anti-inflammatory effect, repair, and even proliferator improvement in pain, vertebral discopathy. Conclusions: The results of studies showing the anti-inflammatory effect, repair, and even proliferator improvement in pain, vertebral discopathy. None of them mention whether this increased matrix synthesis would lead to greater tissue fibrosis and further deterioration, so that studies in animals or humans should focus on evaluating increased monitoring, to assess late effects of therapy. Therefore we can conclude that the focus points of the present investigation should point to more understand the mechanism of disc degeneration together with the benefits of PRP to treat it.

espanolIntroduccion: La neuroestimulacion de las raices sacras bajo tecnica retrograda (NERSR) es eficaz para el tratamiento del dolor perineal cronico (DPC) refractario a tratamiento farmacologico. Este reporte busca demostrar la utilidad de la NERSR para el control del dolor y su impacto en la calidad de vida del paciente. Material y metodos: Se presentan tres casos con DPC por coxigodinia (caso 1 y 2) y neuralgia del nervio pudendo (caso 3) sin respuesta a tratamientos convencionales e intervencionistas, previamente seleccionados en el Servicio de Clinica del Dolor, Centro Medico Nacional "20 de Noviembre"- Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico D.F., desde junio 2006 a septiembre 2014. La neuroestimulacion sacra se realizo en dos etapas: primero con la colocacion de un electrodo de neuroestimulacion de prueba positiva (CENPP) y posteriormente implantacion del NERSR. Se evaluo al paciente a la primera y segunda semana, despues una vez al mes durante seis meses y, posteriormente, cada cuatro meses hasta el momento actual. Resultados: Se exponen tres casos clinicos, con edad promedio de 55,6 anos, dos de sexo femenino y uno de sexo masculino con DPC. Caso 1 y 2 con diagnostico de coxigodinia y caso 3 con neuralgia del nervio pudendo. Previo a la implantacion presentaban dolor severo (valorada con la Escala Verbal Analoga del dolor (EVA 8-10/10), un Oswestry con limitacion funcional discapacitante (32 puntos equivalente a un 64 % de discapacidad) y una entrevista psicologica con presencia de depresion moderada y ansiedad alta en promedio (Cuestionario Depresion de Beck y Salud de Goldberg). En la actualidad presentan un dolor leve (EVA 1-3/10), un Oswestry con limitacion funcional moderada (18 puntos equivalente a 35 % de discapacidad), depresion y ansiedad leve en promedio. Se reporto una complicacion menor, posterior a la implantacion, por fistula de liquido cefalorraquideo (LCR). Conclusion: En esta pequena serie de casos se demostro que una alternativa para el tratamiento del DPC es la estimulacion medular. Al controlar el dolor, mejora la calidad de vida del paciente y el estado psico-emocional que presentaba previo a la implantacion. EnglishIntroduction: Neurostimulation of the sacral nerves by Retrograde Technique (NESRT) is effective for the treatment of drug refractory Chronic Perineal Pain (CPP). This paper seeks to understand the usefulness of NERSR for pain control and its impact on the patients' quality of life. Materials and methods: Three cases are presented, previously selected from the Service of Pain Clinic, "20 de Noviembre" National Medical Center - Institute for Social Security and Services for State Workers (ISSSTE), Mexico D.F. from June 2006 to September 2014, with PPC: cases one and two caused by coccygodynia, and case three with pudendal nerve neuralgia, all unresponsive to conventional and interventional treatments. Sacral neuromodulation was performed in two stages: first with the placement of a Neurostimulation Positive Test Electrode (NPTP) and then by implementing NESRT. The patient was evaluated during the first and second week, then once a month for six months and finally every four months up to current time. Results: Three clinical cases with DPC, mean age 55.6 years, two female and one male, are exposed. Case one and two diagnosed with coccydynia and Case three with neuralgia of the pudendal nerve. Prior to implantation they showed severe pain (assessed with the Pain Verbal Analogue Scale (VAS 8-10 / 10), an Oswestry with disabling functional limitations (32 points equivalent to a 64 % disability) and a psychological interview with presence of average moderate depression and high anxiety (Beck Depression Questionnaire and Goldberg Health). Currently, they show mild pain (VAS 1-3/10), an Oswestry with moderate functional limitation (18 points equivalent to 35 % of disability) and average mild depression and anxiety. There was only one mild complication after implantation, due to fistula of cerebrospinal fluid (CSF). Conclusion: Spinal cord stimulation has proven to be and effective alternative treatment in dealing with DPC. By controlling pain, it improves the patients' quality of life and the psycho-emotional state shown prior to implantation.

Introduccion Las infecciones por enterobacterias productoras de betalactamasas de espectro extendido (BLEE) son un problema emergente en la comunidad y un alto porcentaje de estos aislamientos son causa de infeccion no complicada del tracto urinario (ITU). El perfil de multirresistencia que expresan estas cepas limita las alternativas para el tratamiento oral de las ITU comunitarias. Material y metodos Se determino la actividad de fosfomicina (FOS) frente a 428 cepas productoras de BLEE, 290 (68%) Escherichia coli y 138 (32%) Klebsiella pneumoniae, comparandola con la de amoxicilina-acido clavulanico (AMC), ciprofloxacino (CIP) y cotrimoxazol (SxT). Las concentraciones inhibitorias minimas (CIM) de AMC, CIP, SxT y la deteccion de BLEE se determinaron mediante tecnica de microdilucion y la CIM de fosfomicina mediante tecnica de dilucion en agar. Las BLEE fueron caracterizadas mediante isoelectroenfoque, reaccion en cadena de la polimerasa (PCR) y secuenciacion de los genes codificantes, y la relacion genetica de los aislamientos fue determinada mediante secuencias extragenicas palindromicas repetidas (REP)-PCR. Resultados Entre las 428 cepas estudiadas, 417 (97,4%) resultaron sensibles a fosfomicina (CIM ≤ 64 μg/ml). La tasa de resistencia de E. coli fue del 0,3%, muy inferior a la de AMC (11,7%); mientras que en K. pneumoniae la tasa de resistencia a FOS fue del 7,2%, igual que a AMC. Las tasas de resistencia a CIP y SxT fueron en ambos casos proximas al 50%. No se encontraron diferencias en la actividad de fosfomicina frente a cepas que expresaban diferentes familias y tipos de BLEE. Conclusion Fosfomicina mantiene su actividad frente a cepas productoras de BLEE y no presenta resistencia cruzada con otros grupos de antimicrobianos.

Major article BACKGROUND: Extended-spectrum beta-lactamase (ESBL)-producing members of the Enterobacteriaceae family are important nosocomial pathogens. Escherichia coli producing a specific family of ESBL (the CTX-M enzymes) are emerging worldwide. The epidemiology of these organisms as causes of nosocomial infection is poorly understood. The aims of this study were to investigate the clinical and molecular epidemiology of nosocomial infection or colonization due to ESBL-producing E. coli in hospitalized patients, consider the specific types of ESBLs produced, and identify the risk factors for infection and colonization with these organisms. METHODS: All patients with nosocomial colonization and/or infection due to ESBL-producing E. coli in 2 centers (a tertiary care hospital and a geriatric care center) identified between January 2001 and May 2002 were included. A double case-control study was performed. The clonal relatedness of the isolates was studied by repetitive extragenic palindromic-polymerase chain reaction and pulsed-field gel electrophoresis. ESBLs were characterized by isoelectric focusing, polymerase chain reaction, and sequencing. RESULTS: Forty-seven case patients were included. CTX-M-producing E. coli were clonally unrelated and more frequently susceptible to nonoxyimino-beta-lactams. Alternately, isolates producing SHV- and TEM-type ESBL were epidemic and multidrug resistant. Urinary catheterization was a risk factor for both CTX-M-producing and SHV-TEM-producing isolates. Previous oxyimino-beta-lactam use, diabetes, and ultimately fatal or nonfatal underlying diseases were independent risk factors for infection or colonization with CTX-M-producing isolates, whereas previous fluoroquinolone use was associated with infection or colonization with SHV-TEM-producing isolates. CONCLUSIONS: The epidemiology of ESBL-producing E. coli as a cause of nosocomial infection is complex. Sporadic CTX-M-producing isolates coexisted with epidemic multidrug-resistant SHV-TEM-producing isolates. These data should be taken into account for the design of control measures. Yes

In this work, the numerical simulation of in-situ combustion in a fracture-porous medium system at laboratory scale, was done. The simulations were developed in a commercial reservoir simulator designed to evaluate oil recovery by thermal methods. The simulator involves the mass, momentum (Darcy law) and energy balance equations for multiphase and multicomponent flows. The main aim of this work was to study the effect of the airflow rate and oil saturation on the in-situ combustion behaviour. In the first stage of this study, the in-situ combustion was simulated in a homogeneous porous medium and the simulation was validated using experimental data. In a second stage, such simulation was modified in order to incorporate fractures in the porous medium. It was found that the oxygen diffusion from fractures to porous medium controls the in-situ combustion in fractured systems. Moreover, it is necessary to restrict the injected air flow rate due to the breakthrough phenomenon and because the oil recovery is not substantially increased for larger flow rates.

To determine the extent of lung cancer in Alvila. Its incidence rates and significant epidemiological aspects of the year 2012 were recorded, and the results of each 5-year period (up to 20 years) were compared with those of known studies conducted using the same methodology.A prospective study was conducted on all patients diagnosed with lung cancer in the Province of Avila throughout the year 2012.A total of 81 patients were diagnosed, of whom 70 were males and 11 females, with a mean age of 72.1 years (range: 44-91), and was higher than that found in previous studies. This gave gross, and adjusted to the standard world population, incidence rates in 2012 of 80.99 and 31.23 per 100,000, respectively, in males, and 12.97 and 5.68 per 100,000, respectively in females. These rates are lower in both sexes than those found in Alvila in 2002. In 2012, 80.25% had been smokers (90% of males and 18.18% of the women), although, on diagnosis, 68.75% had quit smoking. A clinical-radiological diagnosis was made in 9 (11.1%), with a histocytological diagnosis in 72 (88.9%). The histological types were: adenocarcinomas in 37.5%; squamous in 33.3%; microcytic in 13.8%; undifferentiated non-small cell in 11.1%; large cell in 2.77%, and carcinoid in 1.38%. The most frequent treatments were chemotherapy (50.6%), symptomatic (23.4%), and surgery (12.3%).The incidence of lung cancer in Avila has decreased in both sexes in the last 10 years. In 2012, the patients have been older, the majority with adenocarcinoma histology, and receiving chemotherapy.

The true role of the age in the prognosis of patients admitted in the ICU is not known. This work analyzes the influence of age on the duration of the stay and mortality of patients who remain in an Intensive Care Unit (ICU) for a long period of time.A retrospective, observational study was performed with patients hospitalized ≥14 days in the ICU. Three age groups were established:50, 50-70 and70 years. The influence of different factors on the relationship existing between stay and age was studied. In addition, stay and survival in the ICU, hospital and at one year were analyzed based on the groups.A total of 707 patients were included. Significant differences in hospital stay (P=.183) were not found among the three groups. The older group, which showed greater severity on admission, was the group undergoing the most tracheostomies (74.7%) and extrarenal purification (HDF) (10.8%). When the influence of factors such as APACHE II, pre-ICU stay, origin, tracheostomy or hemodiafiltration (HDF) were analyzed, no relation was found between stay and age of patient. Survival decreased as age increased.No differences were found in stay based on age, although a difference was found in mortality.

Extended-spectrum β-lactamases (ESBL) of the CTX-M, SHV, and TEM families were recognized in 76 (67%), 31 (27%), and 6 (5%) isolates, respectively, among 162 ESBL-producing Klebsiella pneumoniae (ESBL-Kp) strains obtained in a multicenter study in Spain. Predisposing factors for ESBL-Kp acquisition included invasive procedures, mechanical ventilation, and previous antimicrobial use.

Hepatic encephalopathy (HE) is a common cause of hospital admission in patients with cirrhosis involving high costs of care.To evaluate the use of L-ornithine L-aspartate (LOLA) vs. lactulose is able to reduce the length of hospital stay and the timing of improvement of hepatic encephalopathy.Retrospective and comparative study of patients with HE admitted to the Medical Gastroenterology Unit of a tertiary referral center in Mexico City (Hospital General de México) in a period of three years. Patients were divided in two treatment groups: LOLA vs. oral lactulose. We compared time to remission of encephalopathy, days of hospital stay and costs of hospital care.We included 80 patients: 40 patients who received treatment with latulose had acumulative hospital stay of 443 days vs. 264 days for those who received LOLA (40% reduction in hospital stay). In the group treated with lactulose, mean hospital stay was 11.07 days vs. 6.47 days in the group treated with LOLA. Thus, a significantly greater number of patients treated with LOLA remained hospitalized less than a week compared with those treated with lactulose (65% vs. 20% respectively. OR 4.33, 95% CI 1.67- 11.23, p = 0.004). The mean recovery time of encephalopathy was less with LOLA treatment (4.32 vs. 10.15 days).Treatment with LOLA was more effective in improving HE and reducing the duration of hospital stay.

Extended-spectrum-β-lactamase (ESBL)-producing Escherichia coli (ESBLEC) is an increasing cause of community and nosocomial infections worldwide. However, there is scarce clinical information about nosocomial bloodstream infections (BSIs) caused by these pathogens. We performed a study to investigate the risk factors for and prognosis of nosocomial BSIs due to ESBLEC in 13 Spanish hospitals. Risk factors were assessed by using a case-control-control study; 96 cases (2 to 16% of all nosocomial BSIs due to E. coli in the participating centers) were included; the most frequent ESBL was CTX-M-14 (48% of the isolates). We found CTX-M-15 in 10% of the isolates, which means that this enzyme is emerging as a cause of invasive infections in Spain. By repetitive extragenic palindromic sequence-PCR, most isolates were found to be clonally unrelated. By multivariate analysis, the risk factors for nosocomial BSIs due to ESBLEC were found to be organ transplant (odds ratio [OR] = 4.8; 95% confidence interval [CI] = 1.4 to 15.7), the previous use of oxyimino-β-lactams (OR = 6.0; 95% CI = 3.0 to 11.8), and unknown BSI source (protective; OR = 0.4; 95% CI = 0.2 to 0.9), and duration of hospital stay (OR = 1.02; 95% CI = 1.00 to 1.03). The variables independently associated with mortality were a Pitt score of >1 (OR = 3.9; 95% CI = 1.2 to 12.9), a high-risk source (OR = 5.5; 95% CI = 1.4 to 21.9), and resistance to more than three antibiotics, apart from penicillins and cephalosporins (OR = 6.5; 95% CI = 1.4 to 30.0). Inappropriate empirical therapy was not associated with mortality. We conclude that ESBLEC is an important cause of nosocomial BSIs. The previous use of oxyimino-β-lactams was the only modifiable risk factor found. Resistance to drugs other than penicillins and cephalosporins was associated with increased mortality.

Resumen Introduccion La epidurografia es un recurso invasivo que evalua deformidades y eventual ocupacion del espacio epidural, ademas de ser un estudio facilmente realizable, confiable, economico y que forma parte del algoritmo de manejo del sindrome poslaminectomia. Objetivo Verificar si la localizacion y la extension de la fibrosis epidural se correlacionan con el cuadro clinico presente en los pacientes con sindrome poslaminectomia. Material y metodos Se incluyo a 30 pacientes con diagnostico de sindrome poslaminectomia lumbar divididos en dos grupos: grupo A (n=15) pacientes con lumbalgia y dolor neuropatico del miembro pelvico unilateral y grupo B (n=15) pacientes con lumbalgia con dolor neuropatico bilateral. En todos los pacientes se realizo el abordaje caudal bajo control fluoroscopico en decubito prono con aguja Tuohy ♯17. La epidurografia se realizo inyectando medio de contraste ioversol al 63%, acetato de metilprednisolona y lidocaina al 2%. Se relaciono la localizacion de la fibrosis con el cuadro clinico ademas de valorar la intensidad del dolor utilizando la escala visual analogica previa al procedimiento a las 2 y a las 4 semanas de realizado este. Resultados Del total de la poblacion, el 53,3% (16) tuvo correlacion clinicorradiografica, lo cual no se considera estadisticamente significativo (p=0,259). En relacion con la evaluacion de la escala visual analogica inicial se observo disminucion significativa a las 2 semanas de realizado el procedimiento (p=0,0001). Conclusion La epidurografia diagnostica no tiene utilidad al momento de intentar correlacionar el sitio de fibrosis epidural con la presentacion clinica en los pacientes con sindrome poslaminectomia.

Introducción: El síndrome de dolor miofascial es uno de los principales problemas de dolor crónico en la práctica clínica, comúnmente asociado a un traumatismo o a microtraumatismos repetitivos. La toxina botulínica tipo A (Botox®) es una alternativa aceptada como opción terapéutica. Objetivo: Valorar la funcionalidad de las actividades diarias mejorando la intensidad del dolor con el uso de la toxina botulínica tipo A, infiltrada en puntos gatillo, en pacientes con síndrome de dolor miofascial crónico. Material y métodos: 30 pacientes con síndrome de dolor miofascial crónico con edad entre 25 y 50 años de ambos sexos. A todos se les realizó infiltración de puntos gatillo mediante equipo de electrosonomiografía para la aplicación de toxina botulínica tipo A a una dilución de las 100 Um de toxina en 1 ml de solución salina infiltrando de 200 a 400 Um totales, dependiendo del sitio del dolor. Se valoró la calidad analgésica mediante la escala visual analógica (EVA) y el índice de funcionalidad con el cuestionario de Oswestry durante 4 semanas. Resultados: La valoración de la EVA promedio inicial fue de 7,23 y la final de 3,13 (p < 0,01), y el índice de Oswestry promedio inicial de 67,7% y al finalizar el estudio de 35,5% (p < 0,0001). Conclusiones: La aplicación de toxina botulínica tipo A en pacientes con síndrome de dolor miofascial crónico es efectiva para disminuir la intensidad del dolor, mejorando así su funcionalidad y, por lo tanto, su calidad de vida.

Resumen Introduccion La analgesia intratecal surge como una opcion terapeutica para el alivio del dolor en pacientes con dolor cronico en quienes han fallado otras formas de tratamiento. El objetivo fue evaluar la discapacidad y la calidad de vida en pacientes con dolor cronico intratable. Material y metodos Investigacion retrospectiva, longitudinal y descriptiva, se incluyeron 27 pacientes, de ambos sexos, con edades entre 18 y 85 anos, a quienes se les implanto una bomba de infusion intratecal, con un tiempo minimo de 6 meses de colocacion. Se evaluo la intensidad del dolor mediante la escala visual analoga (EVA), el indice de discapacidad de Oswestry (OW) y la calidad de vida con el Fast-Espiditest previo a la implantacion y a los 6 meses. Resultados El 65,38% presentaban dolor mixto, siendo el sindrome postlaminectomia el diagnostico etiologico mas frecuente (51,8%). La EVA inicial fue 7,7±1 y la EVA final 2,07±1, lo cual fue estadisticamente significativa (p=0,00001). El OW inicial fue 61,2%±10,8 (discapacitado) y el OW final 20,2 %±8,7 (incapacidad minima), con una significancia estadistica de p=0,000006. El Fast-Espiditest inicial reporto dolor intenso en 4 pacientes, (14%), moderado en 21 pacientes (77%), leve en 2 pacientes (7,4%), y el Fast-Espiditest final, dolor intenso en 1 paciente (3,7%), moderado en 4 pacientes (14,8%), leve en 22 pacientes (81,4%). Conclusiones La bomba de infusion intratecal es un dispositivo seguro y eficaz, logrando adecuado alivio del dolor en los pacientes con dolor cronico intratable, mejorando su funcionalidad y por lo tanto su calidad de vida.

to assess the impact of a hand hygiene campaign on the rate of healthcare-associated infections in a teaching hospital in Las Palmas.Ecological design by hand hygiene frequency measurement at three high risk areas along with infection rates calculation over four periods of time: baseline (2005), phase 1 (2006), phase 2 (2007), and post-intervention (2008). Multi-modal intervention comprised the introduction of alcoholic solutions for rubbing hands, feedback on observed compliance, design and placement of posters, and healthcare workers training through all clinician areas. Variables measurement was carried out according to standardized criteria.an increase in hand hygiene compliance was achieved over the tree periods of compliance surveillance, from 19.6% at baseline to 40.0% (p0.001) at the last period. The increase was higher among those opportunities for hand hygiene considered as high risk for pathogen transmission (from 12.0% to 28.4%; p0.001), but only after phase 1, and for medium risk opportunities. Infection rates did not low in every area under surveillance, especially prevalence of infected patients, which increased from 8% in 2005 to 12.2% in 2008.Despite the increase in adherence to hand hygiene at the areas under surveillance, health-care associated infections were not lowered hospital-wide. A more comprehensive strategy should be implemented, increasing managers and directors support in every task related to infection control.

Major article Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli, particularly those producing CTX-M types of ESBL, are emerging pathogens. Bacteremia caused by these organisms represents a clinical challenge, because the organisms are frequently resistant to the antimicrobials recommended for treatment of patients with suspected E. coli sepsis. METHODS:A cohort study was performed that included all episodes of bloodstream infection due to ESBL-producing E. coli during the period from January 2001 through March 2005. Data on predisposing factors, clinical presentation, and outcome were collected. ESBLs were characterized using isoelectric focusing, polymerase chain reaction, and sequencing. RESULTS: Forty-three episodes (8.8% of cases of bacteremia due to E. coli) were included; 70% of the isolates produced a CTX-M type of ESBL. The most frequent origins of infection were the urinary (46%) and biliary tracts (21%). Acquisition was nosocomial in 21 cases (49%), health care associated in 14 cases (32%), and strictly community acquired in 8 cases (19%). Thirty-eight percent and 25% of patients had obstructive diseases of the urinary and biliary tracts, respectively, and 38% had recently received antimicrobials. Nine patients (21%) died. Compared with beta-lactam/beta-lactamase-inhibitor and carbapenem-based regimens, empirical therapy with cephalosporins or fluoroquinolones was associated with a higher mortality rate (9% vs. 35%; P=.05) and needed to be changed more frequently (24% vs. 78%; P=.001). CONCLUSIONS: ESBL-producing E. coli is a significant cause of bloodstream infection in hospitalized and nonhospitalized patients in the context of the emergence of CTX-M enzymes. Empirical treatment of sepsis potentially caused by E. coli may need to be reconsidered in areas where such ESBL-producing isolates are present. Yes

The in vitro activity of ertapenem was tested against extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae isolated in Spain. Ertapenem activity was similar to that of imipenem and meropenem and better than that of the other antimicrobials tested. No differences in activity were observed regarding the origin of the isolates or type of ESBL produced.

The agar dilution, broth microdilution, and disk diffusion methods were compared to determine the in vitro susceptibility of 428 extended-spectrum-β-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae to fosfomycin. Fosfomycin showed very high activity against all ESBL-producing strains. Excellent agreement between the three susceptibility methods was found for E. coli , whereas marked discrepancies were observed for K. pneumoniae .

Presentation of a comparative study of four ideal weight tables applied to the same population, in order to evaluate the differences or similarities between the same. Significant differences (p0.001) were found between the four tables studied (WHO, USA, Barcelona, Tenerife) when classifying a patient into one of the three groups defined (malnutrition, normal and obese). The maximum differences found were between the Barcelona and Tenerife tables, which classified 13,7% and 24.05% respectively as cases of malnutrition and 35.9% and 16.89% respectively as obese.

Presentation of a clinical study of 256 patients eligible for elective surgery, with the purpose of evaluating the immunological consequences of malnutrition. With this aim, retarded hypersensitivity skin tests were performed. The malnutrition criteria used included 10% normal weight loss and/or seric albumin levels of less than 3.5 g/dl. There were 99 patients in total (38.67%) with malnutrition criteria. Within this group 21.79% showed positive responses compared to 38.88% of control group (p less than 0.001). The "average papule" in the group suffering from malnutrition was 4.18 +/- 2.06 and in the control group, 3.64 +/- 2.20 (p less than 0.001), with a significant increase in tuberculine papule in the group with malnutrition.