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Background and aim The use of amendments to immobilize metals in polluted soils is a widely accepted remediation approach, and in the framework of the circular economy, amendments produced from mining and/or biomass waste have gained relevance. However, the application of such amendments can also mobilize metalloids. Here we propose the combination of nanoscale zero-valent iron nanoparticles (nZVI) with dunite (mining waste) and compost for the remediation and restoration of soil affected by high concentrations of As and metals. Methods To this end, we treated pots containing the polluted soil with combinations of dunite, compost, and nZVI for 75 days. In addition, Sinapis alba was used to evaluate the effects of the amendments on pollutant accumulation in the plant. The mobility of the pollutants was monitored through TCLP extraction and by sampling pore water. Furthermore, pH, available P, and cation exchange capacity (CEC) were also determined. Results Dunite application led to the immobilization of metals, and supplied Mg, thus improving CEC. On the other hand, compost increased nutrient content, and also promoted plant growth. However, this amendment caused a dramatic increase in As accumulation in the plants. Finally, the application of nZVI in combination with the other two amendments was found to be the most appropriate strategy since it not only prevented As mobilization and accumulation but also added nutrients to the soil, thus promoting plant growth. Conclusion The combination of nZVI with dunite mining waste and compost proved effective for the remediation of soil simultaneously polluted by As and metals.

There is an extending use of percutaneous closure of patent foramen ovale (PFO) as therapy for PFO-associated cryptogenic strokes. The aim of our study was to investigate the clinical practice of percutaneous closure of PFO and to analyse the variables for decision-making on the selection of patients for this procedure.A prospective observational multicentric survey was conducted using all the cases of cryptogenic stroke/transient ischaemic attack associated with PFO recorded in the NORDICTUS hospital registry during the period 2018-2021. Clinical data, radiological patterns, echocardiogram data and factors related to PFO-associated stroke (thromboembolic disease and paradoxical embolism criteria) were recorded. The indication for closure was analysed according to age (≤/60 years) and the characteristics of the PFO.In the group ≤ 60 years (n = 488), 143 patients (29.3%) underwent PFO closure. The most influential variables for this therapy were detection of a high-risk PFO (OR 4.11; IC 2.6-6.5, P .001), criteria for paradoxical embolism (OR 2.61; IC 1.28-5.28; P = .008) and previous use of antithrombotics (OR 2.67; IC 1.38-5.18; P = .009). In the60 years group (n = 124), 24 patients had PFO closure (19%). The variables related to this option were history of pulmonary thromboembolism, predisposition to thromboembolic disease, paradoxical embolism criteria, and high-risk PFO.The detection of a high-risk PFO (large shunt, shunt with associated aneurysm) is the main criterion for a percutaneous closure-based therapy. Other conditions to consider in the eligibility of patients are the history of thromboembolic disease, paradoxical embolism criteria or the previous use of antithrombotics.

Resumen Introduccion La trombosis venosa cerebral (TVC) es una causa poco comun de ictus que afecta principalmente a adultos jovenes. Un diagnostico precoz y preciso puede reducir la tasa y gravedad de las complicaciones. Objetivo Analizar las caracteristicas clinicas, manejo y tratamiento de la TVC en diferentes centros de nuestro pais. Metodos Estudio descriptivo retrospectivo multicentrico de pacientes hospitalizados por TVC entre 2008 y 2017 en 11 centros sanitarios en nuestro pais. Resultados Se incluyeron 256 pacientes, edad media 49,8 ± 18,7 anos y el 51% fueron mujeres. Los sintomas mas frecuentes fueron: cefalea (73%), deficits focales (50%), crisis epilepticas (33%) y encefalopatia (21%). Las localizaciones mas frecuentes fueron: seno longitudinal superior (12,5%), transverso (10,9%) y afectacion de dos o mas senos o venas (66,4%). La etiologia conocida mas frecuente fue la trombofilia (24%), siendo la mutacion de la protrombina G20210A la mas comun (19%). El 46% fue tratado con antitromboticos durante 3-6 meses, el 21% durante un ano y un 22,6% de los pacientes requirieron anticoagulacion indefinida. En un 5% de los sujetos fue preciso terapia endovascular y un 33% requirio neurocirugia. En relacion al pronostico, el 75% fueron independientes a los 3 meses con una puntuacion en la escala de Rankin modificada (mRS) ≤ 2 y la presencia de papiledema (p = 0,03), deficit focal (p = 0,001) y encefalopatia (p 3). La tasa de mortalidad intrahospitalaria fue del 4,3% y el 6,3% de los pacientes fallecieron a los 3 meses. Conclusion La diversidad de factores de riesgo y la presentacion variable suponen un desafio en el diagnostico y tratamiento de la TVC. Para mejorar el pronostico y reducir la mortalidad es fundamental la instauracion de protocolos en el manejo de esta patologia.

Plant SYT1 transports lipids between endoplasmic reticulum and plasma membrane in response to stress. The protein flexibility and lipid-binding specificity determine SYT1 function at molecular level., Non-vesicular lipid transfer at ER and plasma membrane (PM) contact sites (CS) is crucial for the maintenance of membrane lipid homeostasis. Extended synaptotagmins (E-Syts) play a central role in this process as they act as molecular tethers of ER and PM and as lipid transfer proteins between these organelles. E-Syts are proteins constitutively anchored to the ER through an N-terminal hydrophobic segment and bind the PM via a variable number of C-terminal C2 domains. Synaptotagmins (SYTs) are the plant orthologous of E-Syts and regulate the ER–PM communication in response to abiotic stress. Combining different structural and biochemical techniques, we demonstrate that the binding of SYT1 to lipids occurs through a Ca2+-dependent lipid-binding site and by a site for phosphorylated forms of phosphatidylinositol, thus integrating two different molecular signals in response to stress. In addition, we show that SYT1 displays three highly flexible hinge points that provide conformational freedom to facilitate lipid extraction, protein loading, and subsequent transfer between PM and ER.

Resumen: Introducción: La hemorragia intracraneal (HIC) en pacientes tratados con anticoagulantes orales antagonistas de la vitamina K (AVK) es una complicación grave y frecuentemente letal; en este trabajo estudiamos las características clínicas y los factores que se relacionan con la mortalidad en este grupo de pacientes. Métodos: Realizamos un estudio observacional, multicéntrico y retrospectivo, de ámbito nacional, basado en registros prospectivos de pacientes con ictus. Se incluyó a los pacientes ingresados en servicios de Neurología durante un período de un año y que cumplieran los criterios de inclusión: pacientes mayores de 18 años con HIC que estuvieran en tratamiento con AVK y que ingresaron durante el periodo de estudio. Se analizaron las variables clínicas y radiológicas y su evolución a 3 meses. Resultados: Incluimos a 235 pacientes provenientes de 21 hospitales. La mortalidad a los 90 días fue del 42,6%. En el modelo bivariante los factores asociados con defunción fueron: mediana en la puntuación de la escala NIHSS al ingreso (5 [RIQ = 9] vs. 17 [RIQ = 14] puntos, p

Introduction: Intracranial haemorrhages (ICHs) represent a severe and frequently lethal complication in patients treated with vitamin K antagonists (VKA). The purpose of our study is to describe the factors and clinical features associated with mortality in these patients. Methods: We conducted an observational, retrospective, multi-centre study based on prospective stroke registries in Spain. We included all patients admitted to neurology departments during a 1-year period who met the following inclusion criteria: being 18 or older, having a diagnosis of ICH, and receiving VKA. Clinical and radiological parameters and 3-month outcomes were analysed. Results: A total of 235 patients from 21 hospitals were included. Mortality rate at 90 days was 42.6%. Bivariate analysis showed a significant association between death and the following factors: median NIHSS score at admission (5 [IQR = 9] vs 17 [IQR = 14] points, P

The role of hormonal factors in the etiology of lymphoid neoplasms remains unclear. Previous studies have yielded conflicting results, have lacked sufficient statistical power to assess many lymphoma subtypes, or have lacked detailed information on relevant exposures. Within the European Prospective Investigation Into Cancer and Nutrition cohort, we analyzed comprehensive data on reproductive factors and exogenous hormone use collected at baseline (1992-2000) among 343,458 women, including data on 1,427 incident cases of B-cell non-Hodgkin lymphoma (NHL) and its major subtypes identified after a mean follow-up period of 14 years (through 2015). We estimated hazard ratios and 95% confidence intervals using multivariable proportional hazards modeling. Overall, we observed no statistically significant associations between parity, age at first birth, breastfeeding, oral contraceptive use, or ever use of postmenopausal hormone therapy and risk of B-cell NHL or its subtypes. Women who had undergone surgical menopause had a 51% higher risk of B-cell NHL (based on 67 cases) than women with natural menopause (hazard ratio = 1.51, 95% confidence interval: 1.17, 1.94). Given that this result may have been due to chance, our results provide little support for the hypothesis that sex hormones play a role in lymphomagenesis. © The Author(s) 2018.

espanolObjetivo: conocer la evolucion de los pacientes ingresados y tratados en la Unidad de Ictus (UI) de un hospital de tercer nivel siguiendo el modelo actual de tratamiento, en comparacion con los que fueron ingresados y tratados anteriormente en una planta convencional de neurologia. Metodo: estudio observacional retrospectivo, de pacientes atendidos en el Hospital Universitario Central de Asturias tras sufrir un ictus, en dos periodos: antes de la creacion de la unidad de ictus (1 al 31 de enero de 2009) y despues de la implementacion de la unidad (1 al 31 de enero de 2014). Se diseno un cuaderno de recogida de datos. Se uso el sistema de clasificacion TOAST y las escalas NIHSS (gravedad del ictus) y la Rankin modificada (grado de discapacidad fisica tras un ictus). Revision de historias clinicas electronicas a traves de Cerner Millenium. Analisis mediante paquete estadistico SPPS version 22. Resultados: 152 pacientes en 2009 y 132 en 2014. Edad media 73,92 anos, con predominio de varones (62,9%). Los dias de hospitalizacion y la mortalidad durante el ingreso disminuyen entre 2009 y 2014. El numero de activaciones del protocolo de Codigo Ictus se duplico. La aplicacion de tratamientos recanalizadores paso del 16,1% al 20,4%. El inicio de la rehabilitacion precoz desde la instauracion de la UI se incremento del 7% al 33%. Los pacientes que no precisaron rehabilitacion pasaron del 42% al 80%. Conclusiones: la puesta en marcha de la UI y la activacion del Codigo Ictus han contribuido a mejorar los resultados de identificacion, clasificacion, tratamiento, seguimiento y resultados al alta de los pacientes ingresados por ictus en el hospital. EnglishObjective: to learn about the evolution of patients hospitalized and treated at the Stroke Unit of a third-level hospital following the current model of treatment, compared with those patients previously hospitalized and treated in a conventional Neurology ward. Method: an observational retrospective study, on patients managed at the Hospital Universitario Central de Asturias after suffering a stroke, conducted in two stages: before the Stroke Unit was set up (January, 1st to 31st, 2009), and after implementing the unit (January, 1st to 31st, 2014). A notebook for data collection was designed. The TOAST classification system was used, as well as the NIHSS scale (for stroke severity) and the modified Rankin scale (level of physical disability after a stroke). A review of electronic clinical records was conducted through Cerner Millenium. Analysis was conducted with the SPPS statistical package, version 22. Results: the study included 152 patients in 2009 and 132 patients in 2014; their mean age was 73.92 years, and the majority were male (62.9%). There was a reduction in hospitalization days and mortality during admission between 2009 and 2014. There was a twofold increase in the number of activations of the Stroke Code protocol. The application of recanalization treatments increased from 16.1% to 20.4%. The early initiation in physical therapy increased from 7% to 33% since the creation of the Stroke Unit; those patients who did not require physical therapy increased from 42% to 80%. Conclusions: the implementation of the Stroke Unit and the activation of the Stroke Code have contributed to improve the results in identification, classification, treatment, follow-up and results at discharge, in patients hospitalized for stroke.

Background Accurate diagnosis of malaria and reduced reliance on presumptive treatment are crucial components of quality case management. From 2008 to 2012, the Improving Malaria Diagnostics project, in collaboration with the Zambia National Malaria Control Centre, implemented an external quality assurance scheme partially comprised of outreach training and supportive supervision (OTSS) in an effort to improve malaria case management across a spectrum of health facilities performing laboratory-based malaria diagnostics. OTSS assessments were conducted by project-trained laboratory and clinical supervisors on a regular basis and measured changes in health facility staff performance over time. Standardized supervision tools were used for data collection and guided OTSS teams to assess health facility infrastructure, record keeping practices, stores of supplies and consumables, good laboratory practices, and staff adherence to guidelines for the case management and diagnosis of suspected malaria cases via direct observations or record reviews. The structure of OTSS also allowed supervisors to provide ongoing support to clinicians and laboratory staff through regular mentoring and on-the-job training. Results This analysis included 88 laboratories and 64 clinics each with four repeated supervisory assessments. Over the course of the project there were significant declines in the number of laboratories experiencing stock-outs of microscopy reagents/consumables (p

Objectives Lupus systemic erythematosus is characterised by an increasing risk of premature cardiovascular disease (CVD). CVD is one of the most common causes of death in SLE. Subclinical atherosclerosis in comparison to general population is also more prevalent, especially the presence of plaques at the carotid level, as well as thickening of the carotid intima. The aetiology of atherosclerotic disease is completely unknown. It involves: traditional risk factors (age, male gender, smoking, diabetes, hypertension, dyslipidemia, obesity) as well as risk factors related to the disease itself and the treatments used. Methods A cross-sectional study was carried out from March to November 2015. 119 patients (94,1% women) were recruited from consultation at the Systemic Autoimmune Diseases Unit for a routine medical check. Clinical data on the disease (from diagnosis to the time of inclusion in the study) were obtained by reviewing the medical history. Data were collected about: Traditional vascular risk factors. Risk factors related to the disease: Age at diagnosis, time of disease progression, SLEDAI. Treatment performed. Lipid profile. Results View table 1. Hypertension is one of the classic risk factors attributed to the disease. In our study the prevalence is 25%, similar to the one found in other studies in literature. Likewise, the percentage of patients receiving antihypertensive therapy is higher than that of hypertensive patients. This can be explained by the use of antihypertensives for antiproteinuric purposes in patients with nephropathy. Unless contraindicated, most patients received antimalarials and the use of corticosteroids is still important. Conclusions Once the vascular risk factors have been identified, strict control of these factors is important. The realisation of cardiosaludable diet and regular aerobic exercise, since this constitutes the most effective form for its control. In addition, a rapid and long-term remission of the inflammatory activity of the disease should be achieved, avoiding high doses of oral glucocorticoids, thus avoiding its side effects. The decrease in the activity of the disease allows to do physical exercise, which would have beneficial consequences controlling the body mass index and hypertension.

Lupus systemic erythematosus is characterised by an increasing risk of premature cardiovascular disease (CVD). CVD is one of the most common causes of death in SLE. Subclinical atherosclerosis in comparison to general population is also more prevalent. Methods A cross-sectional study was carried out from March to November 2015. Patients (119; 94.1% women) were recruited from consultation at the Systemic Autoimmune Diseases Unit for a routine medical check. The population was divided into three groups: patients with lupus free cardiovascular disease (free CVD), lupus with subclinic cardiovascular disease (sub CVD) (with endothelial dysfunction in ultrasonography but no clinic events) and people with clinical cardiovascular disease. Patients with subclinical disease have higher cholesterol levels when compared to patients with established cardiovascular disease (p value=0.008) and to patients with SLE without vascular disease (p value=0.043). This is due to the lack of knowledge of subclinical damage by the clinician and, in addition to the absence of visible vascular damage, strict control of cholesterol levels is not performed in this group. Likewise, LDL cholesterol levels are elevated in the same context as triglycerides (differences between SLE free and SLE with subclinical SLE). There were no differences in the activity index, what is likely to be in relation to the low activity they had at the time of inclusion in the study. We do have indeed detected differences in the time of evolution of those who present vascular damage (longer evolution time, 22.88 years) compared to patients without vascular involvement (12.32 years) suggesting that at the same time as more years of disease are accumulated vascular damage accumulates. Likewise patients with vascular damage and subclinical vascular damage were older (55.12 and 54.29, respectively), compared to those with no involvement (42.94 years). No differences were detected between the use of antimalarials or the deleterious effect of corticosteroids and immunosuppressants (traditionally associated with increasing vascular risk) in the presence of clinical, subclinical or absence of vascular damage. It is important to know the lupic population with a higher tendences to have vascular damage for the purpose of greater control.

BACKGROUND AND PURPOSE The aim of this study was to describe the clinical and epidemiological characteristics of acute ischaemic stroke (AIS) in patients with atrial fibrillation (AF) previously treated with oral anticoagulants (OACs) according to the type of OAC prescribed. Also, to analyze the outcomes of the patients and the therapeutic approach adopted by the neurologist in the acute phase and for secondary prevention. METHODS We performed a multicenter, observational study based on prospective registries. We included patients with AF treated with OACs admitted for AIS over a 1-year period. Detailed clinical data and functional outcome at 3 months (modified Rankin Scale score) were collected. Patients were divided into two groups according to their pre-AIS anticoagulant therapy: vitamin K antagonists (AIS-VKA) and direct-acting OACs (AIS-DOAC). RESULTS We recruited 1240 patients (80.4% AIS-VKA and 19.6% AIS-DOAC). In the AIS-DOAC group, transient ischaemic attack was more frequent (18.1% vs. 10.8%; P = 0.001), symptomatic hemorrhagic transformation was less frequent (1.6% vs. 4.6%; P = 0.035) and hospital stay was shorter (median 6 vs. 7 days; P = 0.03). Intravenous thrombolysis was more commonly used in AIS-VKA (9.2% vs. 1.6%; P

Intracranial haemorrhages (ICH) represent a severe and frequently lethal complication in patients treated with vitamin K antagonists (VKA). The purpose of our study is to describe the factors and clinical features associated with mortality in these patients.We conducted an observational, retrospective, multi-centre study based on prospective stroke registries in Spain. We included all patients admitted to neurology departments during a one-year period who met the following inclusion criteria: being 18 or older, having a diagnosis of ICH, and receiving VKA. Clinical and radiological parameters and 3-month outcomes were analysed.A total of 235 patients from 21 hospitals were included. Mortality rate at 90 days was 42.6%. Bivariate analysis showed a significant association between death and the following factors: median NIHSS score at admission (5 [IQR = 9] vs 17 [IQR = 14] points, P.01) and presence of an extensive hemispheric haemorrhage (4.9% vs 35%, P .01; χICH in patients treated with VKA is associated with high mortality rates; mortality in these patients is mainly and independently associated with the clinical situation at stroke onset.

Prehospital code stroke (CS) systems have been proved effective for improving access to specialised medical care in acute stroke cases. They also improve the prognosis of this disease, which is one of the leading causes of death and disability in our setting. The aim of this study is to analyse results one year after implementation of the new code stroke protocol at one hospital in Asturias.We prospectively included patients who were admitted to our tertiary care centre as per the code stroke protocol for the period of one year.We analysed 363 patients. Mean age was 69 years and 54% of the cases were men. During the same period in the previous year, there were 236 non-hospital CS activations. One hundred forty-seven recanalisation treatments were performed (66 fibrinolysis and 81 mechanical thrombectomies or combined treatments), representing a 25% increase with regard to the previous year.Recent advances in the management of acute stroke call for coordinated code stroke protocols that are adapted to the needs of each specific region. This may result in an increased number of patients receiving early care, as well as revascularisation treatments.

Background and purpose: The study is aimed to report neurologic manifestations in a population of patients with inflammatory bowel disease in order to address its clinical characteristics. Methods: We conducted a retrospective study based on a computer-guided search, of patients with Crohn′s disease or ulcerative colitis diagnosed at three hospitals in Spain spanning from 2000 through 2008. Patients were classified into different clinical groups based on the type of neurologic involvement. Only patients without iatrogenic complications, vitamin deficiencies, or known cerebrovascular risk factors were included. Results: We identified and reviewed the records of eighty-four inflammatory bowel disease patients with neurologic symptoms: thirteen patients with ulcerative colitis and twelve patients with Crohn′s disease associated with neurologic complications were identified. Their ages ranged from 17 to 74 years. There was a slight predominance of women. Only four of them have another extra-intestinal manifestation. Most of the patients developed neurologic manifestations coincidental or after digestive symptoms appeared. Demyelinating disease was the most frequent manifestation observed (8 patients). Cerebrovascular, peripheral nerve, and epilepsy disorders were diagnosed in 6, 5, and 3 patients, respectively. One patient with myoclonus, one with amyotrophic lateral sclerosis, and one with sensorineural hearing loss were found. Conclusions: Although an incidence could not be obtained, this population of patients with inflammatory bowel disease have a low frequency of severe neurologic disorders. Neurologic diseases, such as cerebrovascular disease, demyelinating disease, and peripheral neuropathy, could be associated with Crohn′s disease and ulcerative colitis.

We present the case of a patient with an acute obstruction in the origin of the internal carotid artery that was associated with occlusion of segment one of the ipsilateral medial cerebral artery and severe neurologic deterioration. We describe the neuroimaging findings (unenhanced cranial computed tomography [CT], CT angiography, CT perfusion studies, and cerebral angiography) and the intravascular treatment (mechanical and pharmacological intra-arterial fibrinolysis). Treatment yielded good morphological and clinical results; we also analyze the follow-up of the patient.

The Bioko Island Malaria Control Project (BIMCP) has carried out intensive interventions since early 2004 to reduce malaria transmission through indoor residual spraying (IRS) and case management. Annual parasite prevalence surveys have been carried out to monitor the effectiveness of the program. Significant overall reductions in prevalence of infection have been observed, with 42% fewer infections occurring in 2006 compared with baseline. Nevertheless, there is evidence of considerable heterogeneity in impact of the intervention. Prevalence of infection was significantly associated with spray status of the child’s house, spray coverage with effective insecticide of the neighborhood of the house, bed net use, and time elapsed since last spray. Careful scheduling of spray coverage is therefore essential to maximize the effectiveness of IRS and to ensure consistent reductions in parasite prevalence. This can only be achieved if comprehensive monitoring systems are in place for both the management and evaluation of the intervention.

Entre los meses de setiembre y noviembre de 1989, se realizó un estudio transversal en 1322 escolares supuestos sanos, del distrito de San Juan de Lurigancho, sin antecedente de inmunización contra fiebre tifoidea, seleccionado mediante muestreo por conglomerados, con el objetivo de estimar las prevalencias de serología positiva para antígeno O y H de Salmonella typhi y su distribución según sexo, grupo etáreo y tipo de colegio. La determinación de los títulos se hizo con la técnica de microaglutinación en placa, que tiene una sensibilidad del 84% y una especificidad del 87% para el punto de corte > 1:160 para eldiagnóstico de fiebre tifoidea. Las prevalencias de serología O positiva para los diferentes puntos de corte (> 1:20, > 1:40 y > 1:80), fue significativamente mayor en mujeres (41.6%, 12.4% y 3.9%) que en hombres (41.1%, 9.1% y 1.1%) (p0.05). Ambas prevalencias positivas O y H fueron estadísticamente diferentes según grupo etáreo; pero, similares según tipo de colegio. Las altas proporciones de prevalencia encontradas, sugieren frecuenteinfección subclínica lo cual perpetúa la endemicidad de esta enfermedad.

INTRODUCTION. Cocaine is an independent cerebrovascular risk factor both for ischaemic and haemorrhagic events, above all among persons under 55 years of age. CASE REPORT. A case report of stroke due to the consumption of cocaine is used to review its pathophysiology and the complexity involved in the management and diagnosis of the associated complications. One of these complications reported in relation to the consumption of cocaine is vasospasm. This condition shares findings observed in ultrasound imaging studies with other conditions, such as early-onset post ischaemic hyperperfusion. Yet, there are important differences between the two as regards their treatment and prognosis. CONCLUSIONS. The consumption of cocaine is associated with cerebrovascular disease through a number of different mechanisms, which each give rise to different complications. By identifying these complications, correct management can be implemented.Diagnostico del ictus por cocaina y sus complicaciones.Introduccion. La cocaina es un factor de riesgo cerebrovascular independiente, tanto para eventos isquemicos como hemorragicos, sobre todo entre los menores de 55 años. Caso clinico. A traves de un caso clinico de ictus por consumo de cocaina, se revisa su fisiopatologia y la complejidad en el manejo y diagnostico de las complicaciones asociadas. Una de estas complicaciones descritas en relacion con el consumo de cocaina es el vasoespasmo. Esta entidad comparte con otras entidades, como la hiperperfusion postisquemica precoz, los hallazgos en estudios ecograficos. Sin embargo, ambas presentan importantes diferencias en cuanto a tratamiento y pronostico se refiere. Conclusiones. El consumo de cocaina se asocia con la enfermedad cerebrovascular a traves de multiples mecanismos, de los que se derivan diferentes complicaciones. Identificar estas complicaciones permite su correcto abordaje.

Objetivo: Determinar la incidencia y factores de riesgo para adquirir diarrea aguda en una comunidad rural localizada en la selva del departamento de San Martín, Perú. Material y métodos: Una cohorte de 119 personas fue seleccionada al azar entre la población de 446 habitantes y seguida diariamente por un mes entre enero y febrero de 1999, buscando casos de diarrea aguda, definida como tres ó más cámaras de deposiciones al día por no más de 3 días. Un estudio caso control pareado fue diseñado para determinar los factores de riesgo para adquirir diarrea. Resultados: Fueron observados 18 casos de diarrea aguda; la incidencia fue 15.1 casos por 100 personas-mes (IC 95%: 9.45-23.12). La edad media de los casos fue de 10.7 años (rango: 1-34 años) y 66% de los casos fueron niños menores de 10 años de edad. Los factores de riesgo para adquirir diarrea fueron: consumo de alimentos crudos, RR: 2.2 (IC 95%: 1.12-4.33), consumo de alimentos no lavados, RR: 4.47 (IC 95%: 1.56-12.82), falta de lavado de manos antes de alimentarse, RR: 9.61 (95% IC: 1.44-64.16), consumo de agua no hervida, RR: 4.52 (IC 95%: 1.23-16.65) y alimentación fuera de casa, RR: 2.2 (IC 95%: 1.51-3.20). La diferencia en el número promedio (DE) de personas que vivían por casa entre casos y controles fue de 4.38 (1.03) vs. 3.22 (0.54), p=0.0003, respectivamente. No hubo diferencia en el tiempo de residencia en la comunidad entre casos y controles, media de 5.61 ( 5.04) años vs. 8.83 (9.79), p=0.5747. Conclusiones: Diarrea aguda es un problema de salud pública en la selva de San Martín. Hacinamiento, carencia de saneamiento y pobres prácticas higiénicas son los responsables para adquirir diarrea aguda en esta comunidad de bajo nivel socioeconómico. Campañas educativas y mejora en las condiciones sanitarias son claramente necesarias para superar este problema. Objectives: Few data are available on the relevance of acute diarrhea as a health problem in rural peruvian communities. The objectives of the study were to determine the incidence and risk factors to acquire acute diarrhea in a rural community, Pamashto, located in the rain forest of the department of San Martin, Peru. Material and Methods: A cohort of 119 people was selected randomly among the population of 446 habitants, and followed daily for one month between january and february 1999, searching for the presence of acute diarrhea; defined as 3 or more loose stools per day for no more than 3 days. A matched case-control study was performed to determine the risk factors to acquire diarrhea. Results: Eighteen cases of acute diarrhea were observed; the incidence rate was 15.1 cases per 100 person-month (95% CI: 9.45-23.12). Median age of cases was 10.7 years (range: 1-34 years), 66% of cases were seen among people less than 10 years of age. Risk factors to acquire diarrhea were: eating raw food, RR: 2.2 (95% CI: 1.12-4.33), eating unwashed food, RR: 4.47 (95% CI: 1.56-12.82), lack of washing hands before eating, RR: 9.61 (95% CI: 1.44-64.16), drinking unboiled water, RR: 4.52 (95% CI: 1.23-16.65) and eating outside home, RR: 2.2 (95% CI: 1.51-3.20). Mean number (SD) of people living at home differed between cases and controls; 4.38 (1.03) vs. 3.22 (0.54), p=0.0003, respectively. No difference was observed in the length of staying in the community between cases and controls, mean of 5.61 (5.04) years vs. 8.83 (9.79), p=0.5747. Conclusions: Acute diarrhea is a public health problem in the rain forest of San Martin. Crowding, improper sanitation, and poor hygienic practices are responsible for acquiring acute diarrhea in this low socioeconomic community. Educational campaigns and good sanitation facilities are clearly necessary to overcome this problem.

A prospective study was conducted to better characterize the epidemiology of plasmid-bearing strains of Salmonella typhi in an endemic area of Lima, Peru, and to determine if plasmids were associated with specific manifestations of typhoid fever. Of 228 S. typhi isolated from patients at Cayetano Heredia University Hospital in Lima during 1987-1988, 76 (33%) contained plasmids. Ten different plasmid profiles were identified, with ten distinct plasmids present within these profiles. There was significant temporal clustering of isolates having common plasmid profiles. Two plasmids (both from the same isolate) carried antibiotic resistance genes. Two cryptic plasmids with approximate sizes of 55 and 65 kilobases (kb) appeared to be closely related, based on restriction endonuclease digestions and Southern blot analysis. An ampicillin resistance plasmid from a 1989 patient isolate differed by only a single restriction fragment from the cryptic 65-kb plasmid. No association was found between any plasmid or plasmid profile and severity or clinical manifestations of disease.

In malaria-endemic countries in Africa, a large proportion of child deaths are directly or indirectly attributable to infection with Plasmodium falciparum. Four years after high coverage, multiple malaria control interventions were introduced on Bioko Island, Equatorial Guinea, changes in infection with malarial parasites, anemia, and fever history in children were estimated and assessed in relation to changes in all-cause under-5 mortality. There were reductions in prevalence of infection (odds ratio [OR] = 0.31, 95% confidence interval [CI] = 0.2–0.46), anemia (OR = 0.11, 95% CI = 0.07–0.18), and reported fevers (OR = 0.41, 95% CI = 0.22–0.76) in children. Under-5 mortality fell from 152 per 1,000 births (95% CI = 122–186) to 55 per 1,000 (95% CI = 38–77; hazard ratio = 0.34 [95% CI = 0.23–0.49]). Effective malaria control measures can dramatically increase child survival and play a key role in achieving millennium development goals.

We present the case of a patient with an acute obstruction in the origin of the internal carotid artery that was associated with occlusion of segment one of the ipsilateral medial cerebral artery and severe neurologic deterioration. We describe the neuroimaging findings (unenhanced cranial computed tomography [CT], CT angiography, CT perfusion studies, and cerebral angiography) and the intravascular treatment (mechanical and pharmacological intra-arterial fibrinolysis). Treatment yielded good morphological and clinical results; we also analyze the follow-up of the patient.

Historically, basilar artery occlusive disease has been considered to convey a poor prognosis and a high mortality rate. In contrast, recently prospective studies have shown a better prognosis. The basilar artery is most commonly affected by atherosclerosis, but may also be affected by embolisms, dissections, aneurysms, and other conditions like fibromuscular dysplasia.The case of a 46 year-old male who was admitted after suffering a transient episode of ataxic gait and dysarthria is reported. Transcranial Doppler showed a stenotic flow in the basilar artery with distal embolic signals. Magnetic resonance (MR) angiography demonstrated an isolated fibromuscular dysplasia of the basilar artery that caused a50% stenosis without parenchymal lesions. Oral anticoagulation treatment was initiated. The control MR angiography performed ten months later, and although the patient was asymptomatic, showed a dissection which evolved into a complete occlusion of the basilar artery. Its distal portion was filled via a reverse flow from both posterior communicating arteries. Anticoagulation treatment was discontinued.Fibromuscular dysplasia of the basilar artery is a rare and usually asymptomatic disease. It may develop into a dissection, but the usual clinical presentation is stenosis-related ischemic stroke. Intracranial artery dissections may be further complicated by subarachnoid hemorrhage. Many authors have recommended anticoagulant therapy for fibromuscular dysplasia. Basilar artery occlusion, as this case shows, does not always convey a poor prognosis. This is determined, at least partially, by the presence of good collateral circulation.

Abstract The Bioko Island Malaria Control Project (BIMCP) is a collaborative effort of Marathon Oil, Atlantic Methanol (AMPCO) and partners, the government of Equatorial Guinea (EG), Medical Care Development International and other non-profit partners, and academic institutions. Its aim is to reduce malaria transmission and morbidity and mortality due to malaria in oil workers and in the general population though the use of indoor residual spraying (IRS) and other control measures. Methods: The BIMCP conducted five rounds of IRS between 2004 and 2006 on Bioko Island, Equatorial Guinea. It introduced artemisinin-based combination therapy in 2005 as first line treatment for uncomplicated malaria in health facilities. The BIMCP regularly monitors the mosquito population, the prevalence of malaria parasitemia, malaria incidence, and all-cause mortality in the human population. The BIMCP also monitors malaria incidence in three categories of AMPCO workers. A malaria case was defined as a worker with fever and parasitemia (according to a Rapid Diagnostic Test). Denominators consisted of the number of worker-hours of exposure. Results, Observations, and Conclusions: Malaria incidence among AMPCO's indigenous (EG) workers (particularly those residing in housing areas sprayed by the BIMCP IRS program) declined significantly from 8.23 cases/200,000 man-hours in 2003 to 3.07 in 2006. The corresponding decline in malaria incidence among AMPCO's non-western expatriate workers was from 2.9 to 0.92 for the same interval (overall p Significance: The BIMCP diminished the economic burden of malaria for AMPCO workers and their families, and promoted family and community well-being, as well as diminishing the impact of malaria on worker productivity. Marathon Oil, AMPCO, and the NGO and academic partners used BIMCP to strengthen the capacity of the local health system to contain any future resurgence of malaria. The elements required for a resurgence - the presence of malaria vectors, a persistent human reservoir of malaria infection, and susceptible individuals - are still present, albeit at significantly reduced levels relative to the pre-BIMCP period. This successful experience is being scaled up to the rest of EG with additional funding from other sources.

The Bioko Island Malaria Control Project was initiated in 2003 to substantially reduce malaria on the island of Bioko in Equatorial Guinea. The intervention consisted of generalized indoor residual spraying during the first year of the project. Case management and related measures were introduced during the second year. Two large household and parasitemia surveys of children 2 to < 15 years of age were carried out in 2004 and 2005, respectively, to assess the effect of the intervention after the first year. Patient records were collected retrospectively from one district hospital and analyzed for a comparison of pre-intervention and post-intervention periods. Overall mean prevalence of P. falciparum infection reduced from 46% (95% confidence interval [CI] = 40-51%) at baseline in 2004 to 31% (95% CI = 24-40%) in 2005 (P < 0.001). When the 12-month pre-intervention period was compared with the 12-month post-intervention period, there was a modest but statistically significant reduction in the number of malaria cases among hospital patients.

Although there is a consensus about the use of oral anticoagulants (OAC) to prevent stroke in patients with atrial fibrillation this treatment is underused in actual practice. Our aim was to determine the proportion of patients with previously known atrial fibrillation who were receiving OAC before stroke onset and their characteristics.We recruited 50 patients who were admitted with acute stroke and previously known atrial fibrillation over a period of one year. Patients were classified according to the type of antithrombotic treatment they were on. The clinical picture was evaluated by the NIHSS. Functional prognosis was estimated by modified-Rankin score at discharge.Of 50 patients, 16 (32%) were receiving OAC before stroke. Four variables were associated with prescription of OAC: treatment with digoxin, previous ischemic stroke or transient ischemic accident, congestive heart failure and the type of AF (chronic vs paroxysmal). Age and medical history of arterial hypertension, diabetes mellitus or ischemic cardiopathy did not influence the prescription. According to the NIHSS and modified-Rankin scales patients on OAC showed less serious strokes and presented a better functional situation at discharge than those who were not on that treatment.This study highlights the need to improve medical education about OAC in patients with atrial fibrillation because only 32% of patients received OAC before stroke although 90% of them should receive it according to current guidelines. Our results suggest that OAC treatment not only prevents stroke but may also contribute to the development of less serious strokes with a better functional prognosis.

Obesity is an ever more frequent health problem. An assessment of eating habits, attitudes towards the body and presence and degree of psychopathology in morbid obese subjects is presented.Eighty subjects with morbid obesity (BMI40), candidates for bariatric surgery, were systematically studied. A semistructured interview was carried out, including demographic and anthropometric data, eating habits, family history of obesity and family and personal background of psychiatric illness. The following tests were also administered: BITE, EDI and GHQ-28.Most of the subjects were women (90%), married (67.5%), with medium educational and professional levels. Mean age was 38 years, weight 131.3 kg, and BMI 50.17 kg/m2. A high frequency of familial history of obesity (82.5%) was observed, with fewer familial antecedents of depression (37.5%) and personal history of psychiatric illness (36.3%). A total of 27.5% admitted binge eating, 60% were nibblers and 46.3% sweet eaters. BITE results shows a medium level of bulimia (12.25), with 22.5% high scorers. A high level of body dissatisfaction (mean score of 21.5), with a significant drive for thinness stood out in the EDI. GHQ detects the existence of psychopathology in low degree (mean total score of 8.64), especially anxiety-insomnia, with a high proportion of possible psychopathologic disorders (46.2%).Morbid obese subjects have a significant frequency of binge eating, and show a high level of body dissatisfaction, an important drive for thinness and medium frequency of low degree psychopathology, mainly anxiety.

Prevalence of right to left shunt is estimated as 25% of the general population [1]. The prevalence of shunt has been shown to be increased in migraine with aura and one study has found a high prevalence of shunt in chronic migraine (CM) [2].

Seasonal variation in nutritional status among young children has been described in rural populations, but in few urban settings. We examined seasonality in 7 years of nutritional surveillance data from an urban shanty town near Lima, Peru, where children 0-35 months old were measured at intervals of 4-5 months. We compared nutritional status by month, using generalized estimating equations to account for the intercorrelations among measurements of the same person at different times. The periodicity of the seasonal variation was found to fit a model in which the month of the year was sine-transformed, and this sine-transformed model was used to examine possible interactions with age, sex and year of examination. A total of 38,626 measurements was available from 11,333 children. In late winter, mean weight-for-height was an estimated 0.38 Z score higher than in late summer. The seasonal effect occurred at all ages, in both sexes, and in each year of surveillance. The amplitude was greatest for children 6-23 months old. The summer trough in weight-for-height was lower in 1989 than in other years; children who experienced this summer low had lower mean height-for-age in subsequent years. The seasonal variation in nutritional status may be related to differences in dietary intake, or to the higher prevalence of bacterial diarrhoea in summer than in winter. The more marked drop in weight-for-height in 1989 and subsequent trough in height-for-age may be related to political and economic changes than adversely affected food access in Peru.

Results of two national surveys were used to study regional patterns of breast feeding and their relationship to birth spacing and infant mortality in Peru. Estimates of the duration of breast feeding were based on the 1984 National Survey of Nutrition and Health. The 1986 Demographic and Family Health Survey (DHS) was the basis for an analysis of factors associated with short durations of breast feeding and of the effect of breast feeding on birth spacing and infant mortality. Mothers who had ever used contraception were excluded from the segments based on the DHS data. Prevalence and life table methods were used to determine regional patterns of breast feeding. The study of risk factors for short duration of breast feeding used a retrospective cohort study comparing infants breast feeding for less than or more than 12 months using bivariate analysis. The effect on birth spacing was assessed using a life table methodology. The infant mortality rate was calculated for the 199 children born between 1980 and 1984 to mothers not using contraception. The duration of breast feeding was relatively short in Lima, perhaps because of the importance of the middle and upper socioeconomic strata. Breast feeding was prolonged in the sierra and of intermediate duration in the lowlands. The coastal area outside of Lima appeared to have an adequate duration of breast feeding. Birth order of 4 or under and urban residence were the only factors significantly related to breast feeding for less than one year. Prolonged lactation was associated with longer birth intervals in women who never used contraception. The median birth interval was increased by around five months according to the life table applied to children born between 1980 and 1984 to women interviewed in the DHS. Prolonged lactation was associated with lower mortality among infants of mothers not using contraception. Infants breast feeding for less than a year had a relative risk of mortality of 3.6 on the coast and 2.7 in the sierra or lowlands. Promotion of breast feeding, it would appear, offers a cost-effective response to the two serious problems of short birth intervals and high infant mortality.

The work described here sought to assess the merits of using an indirect hemagglutination test employing highly purified Vi antigen to screen a high-risk population for chronic S. typhi carriers in Lima, Peru. A total of 1,931 female food handlers over 30 years old were enrolled in the study. Indirect hemagglutination tests performed on these subjects' sera, taking a titer of 1:40 or more as positive, yielded 29 positive results. Subsequent bacteriologic testing performed on 26 of these 29 subjects identified four (15%) as S. typhi carriers. The procedure had a sensitivity of 79%, indicating that the prevalence of S. typhi carriers among the population studied was on the order of 262 per 100,000. It appears that Vi serology employing highly purified Vi antigen offers a practical and cost-effective way of screening for S. typhi carriers in both endemic and nonendemic typhoid fever areas.

Cultures were made from blood, bone marrow, stool and duodenal contents (obtained with string capsules) from 36 patients with bacteriologically proven typhoid fever on admission to hospital. Duodenal content cultures proved to be as sensitive in diagnosis (86%) as bone marrow (75%) and more effective than blood (42%) and stool (26%) cultures in recovery of Salmonella typhi. The sensitivity of duodenal content cultures was not modified by the duration of illness at admission or by previous antibacterial therapy. Even on the seventh day of effective treatment with chloramphenicol, the culture of duodenal contents remained positive in 8 of 17 patients, whereas salmonellae were isolated from stool cultures in only 2 of the same patients. The results obtained with the string capsule, together with the simplicity, economy and acceptability of the procedure, the fact that it can be performed with minimal facilities and the advantages of bacteriological recovery for antibiotic sensitivity testing, suggest that its adoption would be very helpful in efforts to control this disease.