Andalusian Health e-Library

The Andalusian Health e-Library (Biblioteca Virtual del Sistema Sanitario Público de Andalucía, BV-SSPA) set up in June 2006 allows health professionals to access the most prestigious resources to facilitate decisiontaking, healthcare, teaching and research activities. It is considered the undisputed medium for health research and clinical healthcare in Andalusia, being consolidated as the Health Knowledge Manager in the region.

De Tàrraco a Bàrcino : Factors econòmics, polítics i socials decisius pel canvi de capitalitat a la futura Catalunya

Anàlisi de les causes per les quals la magnífica Tàrraco romana, capital de la província Tarraconense, va entrar en un procés de decadència que va permetre l'auge de Bàrcino, una petita ciutat que va esdevenir en el futur la capital de Catalunya. L'anàlisi abarca des de la fundació de les dues ciutats romanes fins a l'entrada i domini dels visigots.

Algoritmo para el diagnóstico precoz de la deficiencia de vitamina b12 en ancianos

BACKGROUND: The elderly population is particularly at risk for developing vitamin B12-deficiency. Serum cobalamin does not necessarily reflect a normal B12 status. The determination of methylmalonic acid is not available in all laboratories. Issues of sensitivity for holotranscobalamin and the low specificity of total homocysteine limit their utility. The aim of the present study is to establish a diagnostic algorithm by using a combination of these markers in place of a single measurement. METHODS: We compared the diagnostic efficiency of these markers for detection of vitamin B12 deficiency in a population (n = 218) of institutionalized elderly (median age 80 years). Biochemical, haematological and morphological data were used to categorize people with or without vitamin B12 deficiency. RESULTS: In receiver operating curves characteristics for detection on vitamin B12 deficiency using single measurements, serum folate has the greatest area under the curve (0.87) and homocysteine the lowest (0.67). The best specificity was observed for erythrocyte folate and methylmalonic acid (100% for both) but their sensitivity was very low (17% and 53%, respectively). The highest sensitivity was observed for homocysteine (81%) and serum folate (74%). When we combined these markers, starting with serum and erythrocyte folate, followed by holotranscobalamin and ending by methylmalonic acid measurements, the overall sensitivity and specificity of the algorithm were 100% and 90%, respectively. CONCLUSION: The proposed algorithm, which combines erythrocyte folate, serum folate, holotranscobalamin and methylmalonic acid, but eliminate B12 and tHcy measurements, is a useful alternative for vitamin B12 deficiency screening in an elderly institutionalized cohort.

Clinicopathologic analysis of acute myeloid leukemia arising from chronic myelomonocytic leukemia.

Acute myeloid leukemia arising from chronic myelomonocytic leukemia is currently classified as acute myeloid leukemia with myelodysplasia-related changes, a high-risk subtype. However, the specific features of these cases have not been well described. We studied 38 patients with chronic myelomonocytic leukemia who progressed to acute myeloid leukemia. We compared the clinicopathologic and genetic features of these cases with 180 patients with de novo acute myeloid leukemia and 34 patients with acute myeloid leukemia following myelodysplastic syndromes. We also examined features associated with progression from chronic myelomonocytic leukemia to acute myeloid leukemia by comparing the progressed chronic myelomonocytic leukemia cases with a cohort of chronic myelomonocytic leukemia cases that did not transform to acute myeloid leukemia. Higher white blood cell count, marrow cellularity, karyotype risk score, and Revised International Prognostic Scoring System score were associated with more rapid progression from chronic myelomonocytic leukemia to acute myeloid leukemia. Patients with acute myeloid leukemia ex chronic myelomonocytic leukemia were older (P<0.01) and less likely to receive aggressive treatment (P=0.02) than de novo acute myeloid leukemia patients. Most cases showed monocytic differentiation and fell into the intermediate acute myeloid leukemia karyotype risk group; 55% had normal karyotype and 17% had NPM1 mutation. Median overall survival was 6 months, which was inferior to de novo acute myeloid leukemia (17 months, P=0.002) but similar to post myelodysplastic syndrome acute myeloid leukemia. On multivariate analysis of all acute myeloid leukemia patients, only age and karyotype were independent prognostic variables for overall survival. Our findings indicate that acute myeloid leukemia following chronic myelomonocytic leukemia displays aggressive behavior and support placement of these cases within the category of acute myeloid leukemia with myelodysplasia-related changes. The poor prognosis of these patients may be related to an older population and lack of favorable-prognosis karyotypes that characterize many de novo acute myeloid leukemia cases.

La mediació penal en l’àmbit del menor i la seva incidència a Catalunya

La mediació en l‘àmbit penal del menor és un mitjà innovador de resolució de conflictes, que s’ha de promoure per les seves innegables avantatges envers el model de punició tradicional. Permet que tots el agents afectats puguin intervenir i apropa la justícia a la societat, tot donant un paper fonamental a la víctima i afavorint-hi les possibilitats resocialitzadores i educatives del menor infractor. L’objectiu principal ha de ser facilitar al menor, que tot just comença la seva carrera criminal, les eines necessàries per evitar-ne l’evolució com a adult delinqüent, amb el consegüent benefici per a tota la societat. Igualment, la víctima, gran oblidada del procés penal, adquireix un nou protagonisme per decidir l‘abast de la seva reparació i, alhora, la societat reforça els mecanismes per obtenir la pau social. Aquestes finalitats tan loables mereixen l’esforç de les institucions per invertir en mitjans personals i materials que garanteixin l’eficàcia i la viabilitat dels programes de mediació i reparació. L’experiència a Catalunya, comunitat pionera en aquest àmbit, ve avalada per uns resultats excel·lents en el camp de la jurisdicció dels menors, segons reconeixen els mateixos protagonistes. Els resultats favorables de la mediació en l’àmbit del menor han permès, fins i tot, iniciar la primera experiència a l’Estat pel que fa a la mediació en la justícia penal d’adults. S’obren, doncs, noves possibilitats dins la filosofia del dret penal que ens permetran assolir en el futur solucions innovadores, proposades per les persones directament afectades. Aquest ha estat l’objectiu del nostre estudi, tot mirant d’aprofundir els avantatges de la mediació envers al sistema punitiu tradicional i els resultats de la seva implantació a Catalunya, així com cercar solucions que alleugeressin la sempre sobrecarregada Administració de justícia.

Dummy run and conformity indices in the ongoing EORTC low-grade glioma trial 22033-26033: First evaluation of quality of radiotherapy planning.

PURPOSE: Early assessment of radiotherapy (RT) quality in the ongoing EORTC trial comparing primary temozolomide versus RT in low-grade gliomas. MATERIALS AND METHODS: RT plans provided for dummy cases were evaluated and compared against expert plans. We analysed: (1) tumour and organs-at-risk delineation, (2) geometric and dosimetric characteristics, (3) planning parameters, compliance with dose prescription and Dmax for OAR (4) indices: RTOG conformity index (CI), coverage factor (CF), tissue protection factor (PF); conformity number (CN = PF x CF); dose homogeneity in PTV (U). RESULTS: Forty-one RT plans were evaluated. Only two (5%) centres were requested to repeat CTV-PTV delineations. Three (7%) plans had a significant under-dosage and dose homogeneity in one deviated > 10%. Dose distribution was good with mean values of 1.5, 1, 0.68, and 0.68 (ideal values = 1) for CI, CF, PF, and CN, respectively. CI and CN strongly correlated with PF and they correlated with PTV. Planning with more beams seems to increase PTV(Dmin), improving CF. U correlated with PTV(Dmax). CONCLUSION: Preliminary results of the dummy run procedure indicate that most centres conformed to protocol requirements. To quantify plan quality we recommend systematic calculation of U and either CI or CN, both of which measure the amount of irradiated normal brain tissue.

Occurrence, risk factors, diagnosis and treatment of syphilis in the prospective observational Swiss HIV Cohort Study.

BACKGROUND: Annual syphilis testing was reintroduced in the Swiss HIV Cohort Study (SHCS) in 2004. We prospectively studied occurrence, risk factors, clinical manifestations, diagnostic approaches and treatment of syphilis. METHODS: Over a period of 33 months, participants with positive test results for Treponema pallidum hemagglutination assay were studied using the SHCS database and an additional structured case report form. RESULTS: Of 7244 cohort participants, 909 (12.5%) had positive syphilis serology. Among these, 633 had previously been treated and had no current signs or symptoms of syphilis at time of testing. Of 218 patients with newly detected untreated syphilis, 20% reported genitooral contacts as only risk behavior and 60% were asymptomatic. Newly detected syphilis was more frequent among men who have sex with men (MSM) [adjusted odds ratio (OR) 2.8, P < 0.001], in persons reporting casual sexual partners (adjusted OR 2.8, P < 0.001) and in MSM of younger age (P = 0.05). Only 35% of recommended cerebrospinal fluid (CFS) examinations were performed. Neurosyphilis was diagnosed in four neurologically asymptomatic patients; all of them had a Venereal Disease Research Laboratory (VDRL) titer of 1:>or=32. Ninety-one percent of the patients responded to treatment with at least a four-fold decline in VDRL titer. CONCLUSION: Syphilis remains an important coinfection in the SHCS justifying reintroduction of routine screening. Genitooral contact is a significant way of transmission and young MSM are at high risk for syphilis. Current guidelines to rule out neurosyphilis by CSF analysis are inconsistently followed in clinical practice. Serologic treatment response is above 90% in the era of combination antiretroviral therapy.

Acidentes do trabalho entre trabalhadores de enfermagem de um hospital universitário

Foi realizado um estudo descritivo com trabalhadores de enfermagem para avaliar determinados aspectos epidemiológicos dos acidentes de trabalho acontecidos. No período de 1² de janeiro a 30 de junho de 1995 foram estudados 100 acidentes do trabalho ocorridos, o que correspondem a 8,2% de incidência acumulada no período para uma população de 1.218 trabalhadores pesquisados. Como síntese o estudo reconstroi o acidente do trabalho acontecido e os múltiplos fatores de risco presentes nas condições de trabalho de trabalhadores de enfermagem de um hospital universitário.

Colour-polymorphic snake species are older

Many characteristics, for example life-history traits, physiological tolerance to heat and cold, and energy requirements, contribute to a population's ability to persist in the face of climatic variation. Recent studies have suggested that the presence of intraspecific colour polymorphism could be another potential contributor to population resilience (e.g. to climate change) in ectothermic vertebrates such as reptiles. In the present study, we tested for a relationship between the presence of intraspecific colour polymorphism and the age of snake species. Using phylogenetic comparative methods, we demonstrate that the presence of intraspecific colour polymorphism is correlated with the age of a species, with polymorphic snake species being significantly older than monomorphic species. Understanding how species have dealt with past environmental modifications, such as climate change, can provide important insights into how they are likely to respond in the future to ongoing climate warming.

Statines et insuffisance rénale chronique: un bon ménage? : revue Cochrane pour le praticien

Cet article présente les résultats de la revue systématique: Navaneethan SD, Pansini F, Perkovic V, Manno C, Pellegrini F, Johnson DW, Craig JC, Strippoli GF. HMG CoA reductase inhibitors (statins) for people with chronic kidney disease not requiring dialysis. Cochrane Database Syst Rev. 2009 Apr 15;(2):CD007784. PMID: 19370693

Vitae sanctorum.

Abdo et Sennes (262-263v) ; Acisclus et Victoria (163-165) ; Adrianus (72v-77) ; Affra (45v) ; Amancius (122-125v) ; Andochius (90v-92v) ; Andreas (186-194v) ; Antoninus (68v-70v, 221v) ; Apollinaris (1bis-1bis v); Audardus (254-259) ; Augustinus (231-232v) ; Bartholomeus (55v-59v) ; Bricius Turonensis (162v-163) ; Caprasius (107-108) ; Caprasius et Fides (218-219v) ; Cassianus (48v) ; Cecilia (168v-174v) ; Christina (12-16v) ; Christoforus (22-24) ; Ciricus et Julita (2v-6, 260v-262) ; Cirillus (2-2v) ; Ciprianus (47v-48v) ; Claudius, Asterius, Neo (54v-55v) ; Clemens (174v-176) ; Cosmas et Damianus (97v-98v) ; Crisantus et Daria (179-182v) ; Crucis exaltatio (83-84) ; Cucufas (24-25) ; Dalmacius Rutenae urbis (131-132v) ; Desiderius Caturcensis (207v-217v) ; Dionisius (105-106v) ; Donatus (263v-265v) ; Eleazarus (38-38v) ; Eptadius (59v-61v) ; Eufemia (84-86) ; Eugenia (78-83) ; Eulalia (195v-199) ; Eustachius (125v-129v) ; Fabius (34v-36v) ; Fausta (52-53v) ; Faustus, Januarius et Marcialis (106v-107) ; Felix (36v-38) ; Felix Nolensis ep. (25-27) ; Filibertus (227v-231) ; Genesius Arelatensis (61v-62v) ; Germanus Autissiodorensis (33-34) ; Gervasius et Protasius (259v-260v) ; Gregorius papa (222-224v) ; Grisogonus (176v-178) ; Jacobus major (20v-21v) ; Jeronimus (100-102) ; Johannis Baptistae decollatio (66v-68v) ; Johannes et Paulus (227-227v) ; Julia (11-12) ; Julianus (64-64v) ; Julianus, auct. Gregorio Turonense (265v-272) ; Julius (178-178v) ; Justa et Rufina (6v-7) ; Justina et Ciprianus (92v-97v) ; Justus et Pastor (44v-45) ; Laurianus (167v-168v) ; Leochadia (195-195v) ; Leodegarius (102-104v) ; Licerius (62v-64) ; Longinus (195) ; Lucia (199-200v) ; Machabei (34-34v) ; Mammes (45v-47v) ; Marcellinus et Petrus (259-259v) ; Marcellus (114) ; Marcellus Cavalonis (219v-220) ; Marcellus Kavilonensis (1v-1bis) ; Marcus (224v-225) ; Marciana (129v-131) ; Marcianus (206-206v) ; Margarita (7-11) ; Mariae assumptio (48v-51) ; Martinus, auct. Sulpicio Severo (133-160v) ; Matheus (86-89) ; Mauricius (89-90v) ; Mauricius, Exuperius, Candidus, Innocentius, Victor cum sociis eorum (272-272v) ; Maurinus (245-247v) ; Maximus (241-244v) ; Medardus (225-227) ; Mennas (160v-162v) ; Michael (98v-100) ; Mimius (39v-40) ; Nazarius et Celsus (27-31v) ; Omnes Sancti (118v-122) ; Pantaleo (31v-32v) ; Petri cathedra (220-221v, 249-250) ; Petrus, ep. Alexandriae (248-249) ; Procopius (39-39v) ; Quintinus (114-118v) ; Regina (70v-72v) ; Reparata (104v-105) ; Romanus (165-167) ; Sabina (64v-66v) ; Salvius (77-78) ; Saturninus et Sisinnius (178v) ; Saturninus Tolosanensis (182v-185v, 232v-239) ; Segolena (16v-20v) ; Servandus et Germanus (108-109) ; Sixtus, Laurentius et Ypolitus (40-44v); Symo et Judas (109-112v) ; Symphorianus (53v-54v) ; Teodota (38v-39) ; Terencianus (239-241) ; Theodardus Narbonensis (250-254) ; Thomas (200v-206) ; Valerianus (206v-207) ; Vamnes (51-52) ; Vincentius et Savina (112v-114). Le f. 220v contient un catalogue ancien de la bibliothèque de Moissac.