Trauma abdominal penetrante: Revision sistematica de la literatura

Introducción El manejo de las heridas abdominales penetrantes ha variado en los últimos 30 años, la laparotomía mandatoria es la conducta más usada en el Hospital Occidente De Kennedy a pesar presentar complicaciones y aumentar las tasas de morbimortalidad. Existen diferentes conductas selectivas del trauma abdominal penetrante como son: valoraciones físicas seriadas, ultrasonografía, laparoscopia, TAC de triple contraste y lavado peritoneal; sin embargo no se ha definido cuál de estos métodos es el más eficiente para el diagnóstico. El objetivo es determinar cual es el método diagnostico más efectivo para evaluar el trauma abdominal penetrante dependiendo del sitio topográfico de la lesión. Métodos: Revisión sistemática de la literatura en revistas indexadas a nivel mundial y literatura gris colombiana. Se escogieron artículos entre 1990 y 2010 que suministraran la mejor evidencia. Se evaluó su calidad metodológica de acuerdo a las recomendaciones desarrolladas por la Asociación Médica Americana en JAMA 1993. Adicionalmente se utilizó el SCORE de calidad metodológico publicado en la revista Chilena de Cirugía 2003. Los estudios incluidos fueron organizados en una tabla de evidencia donde se tuvo en cuenta los siguientes puntos: fecha de publicación, revista, autor, nivel de evidencia y desenlace principal. Resultados: En total se encontraron 98 artículos, según los criterios de elegibilidad se seleccionaron 57 y se adiciono 2 guías de manejo clínico. A pesar de la heterogeneidad de los estudios se encontró concordancia en 17 artículos en cuanto la disminución de complicaciones, tiempo de estancia hospitalaria y disminución de laparotomías negativas con el uso de la TAC de triple contraste y la laparoscopia diagnostica. Conclusión: No existe un juicio para determinar que metodología diagnóstica es la más eficiente en el manejo conservador, pero resulta evidente que la tendencia actual del manejo del trauma abdominal está dirigida a seleccionar y a enfocar al paciente de forma individual. Las alternativas más efectivas hasta el momento ha considerar son la TAC de triple contraste y la laparoscopia diagnostica en las heridas en flancos, dorso y región toracoabdominal respectivamente.

Uso de Dienogest para el tratamiento de la endometriosis: revision sistematica de la literatura.

La endometriosis es una entidad frecuente en ginecología para la que desafortunadamente aun no se tiene un tratamiento del todo efectivo. En los últimos años se ha propuesto el uso de Dienogest, una progestina selectiva, con buenos resultados. Objetivo: Realizar una revisión sistemática de la literatura para determinar la efectividad del Dienogest para el tratamiento de la endometriosis. Materiales y métodos: Se realizó una búsqueda sistemática y ampliada de ensayos clínicos acerca de la efectividad del Dienogest en el manejo de la endometriosis. Resultados: La efectividad del dienogest para el tratamiento de la endometriosis es equiparable al de los análogos de GnRH, tiene un perfil de seguridad adecuado y su uso prolongado no está limitado por la presentación de eventos adversos.

Estimulacion magnetica trascraneal en el desempeno motor en enfermedades del sistema nervioso central: Revision Sistematica

Introducción: El uso de la estimulación cerebral no invasiva en procesos de rehabilitación es de gran interés, por cuanto con mediación tecnológica se generan nuevas posibilidades de recuperación motora, a partir de la activación de la corteza cerebral. El objetivo del estudio es establecer la evidencia del uso terapéutico de la EMT, relacionado con el desempeño motor de pacientes con enfermedades del sistema nervioso central. Metodología: Se realizó una revisión sistemática de la literatura. Se incluyeron 10 estudios en el análisis cualitativo que incluyó la evaluación de calidad con la escala de Jadad y del riesgo de sesgo con la herramienta Cochrane. Fueron excluidos 1613 estudios. Se aplicó el protocolo del estudio para la extracción, revisión y validez de los estudios incluidos. Resultados: La evidencia disponible muestra resultados positivos del uso terapéutico de la EMT en el desempeño motor en aspectos como la aceleración, la fuerza de pinza y de agarre, la estabilidad y la fuerza muscular, así como una mejor velocidad de la marcha y una disminución en la frecuencia y severidad de los espasmos. Discusión: La EMT puede constituir una estrategia terapéutica para mejorar el desempeño motor en pacientes con ECV, Lesión Medular y enfermedad de Parkinson, que requiere más investigación por la heterogeneidad de los diseños y medidas de descenlace utilizados, así como por la alta variabilidad interindividual que hace complejo estandarizar los protocolos de su uso terapéutico.

Impacto de la trombosis venosa cerebral durante embarazo y puerperio: revision sistematica

Introducción: La trombosis venosa cerebral es una entidad que se presenta más a menudo en gestantes especialmente durante el puerperio debido a que tanto el embarazo como el puerperio se consideran estados procoagulantes. Desafortunadamente al ser la cefalea el síntoma más común, hace que el diagnóstico sea difícil por ser un síntoma común e inespecífico, tan solo en el 40% de los casos hay déficit neurológico focal. Metodología: Se realizó una revisión sistemática de literatura, evaluando la incidencia, curso clínico, factores de riesgo, principales complicaciones de esta patología con el fin de medir el impacto en lasgestantes. Los artículos fueron clasificados por nivel de evidencia y se calculó un componente meta-analítico. Resultados: Se encontraron un total de 40 artículos que cumplieron criterios de inclusión, el 27.5% fueron evidencia III y 72.5% fueron evidencia IV. Su cuadro clínico fue más común durante el puerperio, estando la cefalea presente en el 90% de los casos. El impacto es alto debido al riesgo de complicarse (OR 13.9, IC95% 2.8 – 69.3) y presentar secuelas neurológicas a largo plazo e incluso muerte materno fetal. Resultados significativos. Discusión: La gran variedad de signos y síntomas en la presentación clínica de la trombosis cerebral sumado a la baja frecuencia y poca conciencia de esta patología en la comunidad médica, hacen que la TVSC tenga un nivel bajo de sospecha clínica, con un alto impacto tanto en la morbilidad como la mortalidad materna.

A revision of the Upper Jurassic-Lower Cretaceous dragonfly family Tarsophlebiidae, with a discussion on the phylogenetic positions of the Tarsophlebiidae and Sieblosiidae (Insecta, Odonatoptera, Panodonata)

The Upper Jurassic-Lower Cretaceous dragonfly family Tarsophlebiidae is revised. The type species of the type genus Tarsophlebia Hagen, 1866, T eximia (Hagen, 1862) from the Upper Jurassic Solnhofen Limestones, is redescribed, including important new information on its head, legs, wings, anal appendages and male secondary genital apparatus. The type specimen of Tarsophlebiopsis mayi Tillyard, 1923 is regarded as an aberrant or unusually preserved Tarsophlebia eximia. One new species of Tarsophlebia and three new species of Turanophlebia are described, i.e. Tarsophlebia minor n. sp., Turanophlebia anglicana n. sp., T mongolica n. sp., and T. vitimensis n. sp. A new combination is proposed for Turanophlebia neckini (Martynov, 1927) n. comb. The phylogenetic relationships of the Mesozoic Tarsophlebiidae are discussed on the basis of new body and wing venation characters. The present analysis supports a rather derived position for the Tarsophlebiidae, as sister group of the the Epiproctophora rather than of (Zygoptera + Epiproctophora). Also, through the present discussion, the Oligo-Miocene family Sieblosiidae seems to be more closely related to the Epiproctophora than to the Zygoptera. But the present study and previous analyses suffer of the lack of informations concerning the more inclusive groups of Odonatoptera, viz. Protozygoptera, Triadophlebiomorpha, Protanisoptera, etc. The significance of the tarsophlebiid secondary male genital apparatus for the reconstruction of the evolution of odonate copulation is discussed.

Grasshoppers and crickets (Insecta : Orthoptera) from the lower cretaceous of southern England

This is a synoptic monograph of fossil Orthoptera from the English Lower Cretaceous (Purbeck and Wealden groups). The previously described taxa of these insects are revised on the basis of type specimens and examination of extensive new material. Eight new genera and 30 new species are proposed: Probaisselcana cretacea sp. nov., Minelcana membranacea gen. et sp. nov., Panorpidium proximum sp. nov., P. bimacillatum sp. nov., ?P. parvum sp. nov. (Elcanidae); ?Cyrtophyllites cretaceus sp. nov. (Haglidae); Aenigmodus minutus gen. et sp. nov., Pseudaboilus wealdensis gen. et sp. nov., P. purbeckensis sp. nov., Tettigoilus sonorus gen. et sp. nov., ?Agrionidium obscurum sp. nov. (Prophalangopsidae); Notocearagryllus britannicus sp. nov., N. grandispeculum sp. nov., N. cordispeculum sp. nov., Anglogryllus lyristes gen. et sp. nov., A. rotundispeculum sp. nov.. Speculogryllus acutispeculum gen. et sp. nov., Sharategia davisi sp. nov., S. batchelorae sp. nov., S. baldocki sp. nov. (Baissogryllidae); ?Araripegryllus orientalis sp. nov. (Gryllidae); Deinovitimia occidentalis sp. nov. (Ensifera: infraorder incertae sedis); Cretoxya rasnitsyni gen. et sp. nov. (Tridactylidae); Locustopsis posterior sp. nov., Zeunerella prior sp. nov., Zessinia borealis sp. nov., Mesolocustopsis anglica sp. nov., M. angusta sp. nov., M. problematica sp. nov., and Britannacrida distincta gen. et sp. nov (Locustopsidae). The subfamily Baisselcaninae is synonymized with Elcaninae, and a new subfamily (Archelcaninae subfam. nov.) is proposed for a segregate of Elcaninae. A preliminary comparison of the Purbeck/Wealden with other Early Cretaceous orthopteran faunas is given. (c) 2006 Published by Elsevier Ltd.

Host plant recognition by the root feeding clover weevil, Sitona lepidus (Coleoptera : Curculionidae)

This study investigated the ability of neonatal larvae of the root-feeding weevil, Sitona lepidus Gyllenhal, to locate white clover Trifolium repens L. (Fabaceae) roots growing in soil and to distinguish them from the roots of other species of clover and a co-occurring grass species. Choice experiments used a combination of invasive techniques and the novel technique of high resolution X-ray microtomography to non-invasively track larval movement in the soil towards plant roots. Burrowing distances towards roots of different plant species were also examined. Newly hatched S. lepidus recognized T. repens roots and moved preferentially towards them when given a choice of roots of subterranean clover, Trifolium subterraneum L. (Fabaceae), strawberry clover Trifolium fragiferum L. (Fabaceae), or perennial ryegrass Lolium perenne L. (Poaceae). Larvae recognized T. repens roots, whether released in groups of five or singly, when released 25 mm (meso-scale recognition) or 60 mm (macro-scale recognition) away from plant roots. There was no statistically significant difference in movement rates of larvae.

Effects of carbon dioxide on the searching behaviour of the root-feeding clover weevil Sitona lepidus (Coleoptera : Curculionidae)

The respiratory emission of CO2 from roots is frequently proposed as an attractant that allows soil-dwelling insects to locate host plant roots, but this role has recently become less certain. CO2 is emitted from many sources other than roots, so does not necessarily indicate the presence of host plants, and because of the high density of roots in the upper soil layers, spatial gradients may not always be perceptible by soil-dwelling insects. The role of CO2 in host location was investigated using the clover root weevil Sitona lepidus Gyllenhall and its host plant white clover (Trifolium repens L.) as a model system. Rhizochamber experiments showed that CO2 concentrations were approximately 1000 ppm around the roots of white clover, but significantly decreased with increasing distance from roots. In behavioural experiments, no evidence was found for any attraction by S. lepidus larvae to point emissions of CO2, regardless of emission rates. Fewer than 15% of larvae were attracted to point emissions of CO2, compared with a control response of 17%. However, fractal analysis of movement paths in constant CO2 concentrations demonstrated that searching by S. lepidus larvae significantly intensified when they experienced CO2 concentrations similar to those found around the roots of white clover (i.e. 1000 ppm). It is suggested that respiratory emissions of CO2 may act as a 'search trigger' for S. lepidus, whereby it induces larvae to search a smaller area more intensively, in order to detect location cues that are more specific to their host plant.

The role of flower inclination, depth, and height in the preferences of a pollinating beetle (Coleoptera : Glaphyridae)

Amphicoma ( Glaphyridae) beetles are important pollinators of red bowl-shaped flowers in the Mediterranean. The role of color and shape in flower choice is well studied but the roles of inclination, depth, and height have seldom been investigated. Under field conditions, models were used to experimentally manipulate these three characters and visitation rates of beetles were recorded. Models with red horizontal surfaces were visited significantly more often than models with red vertical surfaces. Shallow flower models were visited significantly more than deeper equivalents. Models below or at the height of natural flower populations elicited significantly more landings than models above the height of flowers. Inclination, depth, and height characteristics are all likely to be important components in the flower preferences exhibited by pollinating beetles.

Influence of temperature on the production and infectivity of entomopathogenic nematodes against larvae and pupae of vine weevil, Otiorhynchus sulcatus, (Coleoptera: Curculionidae)

Susceptibility of late instar vine weevil Otiorhynchus sulcatus larvae and pupae to four species entomopathogenic nematodes were tested. Bioassays on production and infectivity to larvae and pupae were compared for two steinernematids and two heterorhabditis such as Steinernema carpocapsae, S. feltiae, Heterorhabditis indica and H. bacteriophora. Nematodes production of all species was determined by the number infective juveniles (IJs) established in vine weevil larvae and pupae O. sulcatus using sand and filter paper bioassay. S. feltiae produced the maximum number in larvae and pupae at 20°C as compared to other nematodes but production of H. indica, was better at 25°C in larvae and pupae followed by H. bacteriophora, S. carpocapsae and Infectivity test of larvae and pupae was also done in sand media. Infective juveniles recovered from larvae and pupae when infected with S. feltiae produced maximum infective juveniles at 20°C temperatures than all other isolates. H. bacteriophora produced higher number of IJs in larvae and pupae than all other nematode isolates at 25°C. This paper indicates the application of nematodes with the knowledge of insect pest biology represents a possible new strategy for O. sulcatus larvae and pupae.

Biological control of black vine weevil (Otiorhynchus sulcatus, Coleoptera: Curculionidae) by entomopathogenic bacteria and their cell-free toxic metabolites

Biocontrol agents such as Xeiwrhabduf, nemalophilci and X. nematophila ssp. bovienii and their cell-free protein toxin complexes were lethal to larvae of O. sulcatus when applied to potting compost in the absence of plants. Similarly, strawberry plants infected with 0. sulcaitfi larvae were protected from damage by applications of both cell suspensions of the bacteria and solutions of their cell-free toxic metabolites, indicating that it is the protein toxins, which are responsible for the lethal effects observed. These toxic metabolites were found more effective against 0. sulccitus larvae when treated in soil microflora. Insect mortality is increased by increasing temperature and bacterial concentration. The toxins remained pathogenic for several months when stored in potting soil either at 15 or 20°C, however, bacterial cells were not as persistent as the toxins. It is therefore suggested that these bacteria and their toxic metabolites can he applied in soil for insect pest control.

Distribution and abundance of ladybirds (Coleoptera : Coccinellidae) in non-crop habitats

The abundance and distribution of coccinellids in non-crop habitats was studied using removal sampling and visual observation. Coccinellids were most frequently found on grassland habitats. Coccinellid abundance appeared to be most strongly correlated with the percentage ground cover of thistle, grasses and nettles. The most commonly collected coccinellids were Coccinella septempunctata and Adalia bipunctata comprising 60% and 35% of the catches respectively. Most coccinellids were found on Rubus spp. with nettles (Urtica dioica) and grasses being the next most favoured plant species. Adalia bipunctata was the most commonly found coccinellid species on nettles and birch (Betula spp.) whereas C. septempunctata was the most commonly found species on grasses, Rubus spp, and oak (Quercus spp.). These results are discussed in light of current thinking on the importance of "island" habitats as pali of an integrated pest management programme.

Prospects and challenges for sustainable management of the mango stone weevil, Sternochetus mangiferae (F.) (Coleoptera: Curculionidae) in West Africa: a review

Commercial mango production in Ghana is a relatively young industry faced with several pest problems including the mango stone weevil, Sternochetus mangiferae (F.). There is an urgent need to control this and other pests to facilitate access to the international export market for fresh mango fruits. A literature survey identifies stone weevil control tactics in the areas of host plant resistance, administrative and legislative controls, use of pesticides, biological control, cultural control and quarantine and phytosanitary measures that have been developed in other mango-producing areas. We assess these pest management approaches for their relevance to Ghana and West Africa, with emphasis on the research required for their appropriate, effective and sustainable use in the systems of mango production of the West African sub-region. The importance of processing and value addition technologies, as a means of circumventing the quarantine hurdles of S. mangiferae, is highlighted.