Corticosteroides vs dosis bajas de adrenocorticotropina en el tratamiento de espasmos infantiles. Revisión sistemática de la literatura

Antecedentes: El tratamiento de los espasmos infantiles generalmente se realiza con ACTH a pesar de perfil de efectos secundarios y el alto costo financiero. Se ha propuesto el uso de los corticoides como primera línea de tratamiento para la enfermedad, no obstante no existe certeza sobre la eficacia de este esquema. Objetivos: Evaluar la eficacia del uso de los corticoides comparados con la ACTH como primera línea de tratamiento en el manejo de pacientes con espasmos infantiles. Metodología: Se realizó una revisión sistemática de la literatura. La búsqueda se efectuó en las bases de datos Pubmed, Embase, Ovid, LiLaCs y en el registro de ensayos clínicos de Estados Unidos. Se incluyeron estudios en portugués, ingles y español, no se fijo límite de tiempo para la publicación. Se realizó un análisis de riesgo de sesgo y de calidad de la evidencia utilizando el programa GRADEPRO. Se estimaron OR y sus respectivos intervalos de confianza al 95%. Resultados: Se incluyeron 4 estudios, un ensayo clínico y tres estudios de cohorte retrospectiva. Dos estudios aportaron evidencia de calidad moderada y alta. No se encontraron diferencias en la eficacia a corto plazo entre el uso de los corticoides y la ACTH sobre desenlaces clínicos o electroencefalográficos. No se encontraron estudios de seguridad a largo plazo. La seguridad a corto plazo no mostró diferencias. Conclusiones: Es muy probable que el uso de los corticoides como primera línea de tratamiento puedan reemplazar el uso de la ACTH, se requiere estudios de seguridad a largo plazo. La decisión de su uso rutinario debería estar basada en un análisis de costo efectividad y bajo la mirada del balance riesgo/beneficio.

Eficacia de la melatonina en insomnio primario en el adulto mayor: revisión sistemática de la literatura

Introducción: La melatonina, una sustancia cronobiótica endógena, es cada vez más empleada para el manejo de los problemas del sueño en adultos mayores por su aparente eficacia y buen perfil de eventos adversos. En este sentido, se intentó evaluar la eficacia de la melatonina en el tratamiento del insomnio primario en el adulto mayor (≥55 años) comparado con benzodiacepinas, zopiclona y placebo a la luz de la evidencia disponible en los últimos cinco años. Métodos: Revisión sistemática de la literatura. Resultados: En comparación con placebo, al parecer la melatonina mejora la calidad y los hábitos de sueño, no así la latencia de inicio de sueño en mediciones subjetivas ni objetivas (polisomnografía); a diferencia de otros medicamentos hipnóticos, no altera la arquitectura del sueño ni genera síntomas diurnos. Conclusiones: No se encontró evidencia que soporte el uso de melatonina en adultos mayores de 55 años para la reducción de la latencia de sueño, aumento del tiempo total de sueño, mejoría de la eficiencia del sueño, disminución de despertares nocturnos o mejoría de la calidad de sueño. Es necesario adelantar más estudios en comparación con placebo y otros medicamentos.

Percepción de calidad de vida relacionada con la salud en pacientes con síndrome de apnea e hipoapnea obstructiva del sueño

El objetivo de esta investigación es describir la calidad de vida y la calidad del sueño en los pacientes con diagnóstico de Síndrome de Apnea Hipoapnea del sueño, mediante el uso de un grupo de cuestionarios para obtener datos demográficos, la evaluación del grado de somnolencia diurna percibida, la percepción de la calidad del sueño y la percepción de la calidad de vida relacionada con la salud con encuestas en sus respectivas versiones validadas para Colombia.

Analysing Strategy Use in Terms of the Four Parameters of Strategic Competence : Contributions from a Numerosity Judgement Task.'Analizando el uso de estrategias en términos de cuatro parámetros de la competencia estratégica: contribuciones de una tarea de juicio de cantidad'.

Resumen tomado parcialmente de la revista.- El artículo forma parte de un monográfico de la revista dedicado a Psicología de las Matemáticas

The Role of Context-Related Parameters in Adults' Mental Computational Acts. 'El papel de los parámetros relacionados con el contexto en actos de cálculo mental en adultos'.

Resumen basado en el de la publicación

Application of modal interval analysis to the simulation of the behaviour of dynamic systems with uncertain parameters

Els models matemàtics quantitatius són simplificacions de la realitat i per tant el comportament obtingut per simulació d'aquests models difereix dels reals. L'ús de models quantitatius complexes no és una solució perquè en la majoria dels casos hi ha alguna incertesa en el sistema real que no pot ser representada amb aquests models. Una forma de representar aquesta incertesa és mitjançant models qualitatius o semiqualitatius. Un model d'aquest tipus de fet representa un conjunt de models. La simulació del comportament de models quantitatius genera una trajectòria en el temps per a cada variable de sortida. Aquest no pot ser el resultat de la simulació d'un conjunt de models. Una forma de representar el comportament en aquest cas és mitjançant envolupants. L'envolupant exacta és complete, és a dir, inclou tots els possibles comportaments del model, i correcta, és a dir, tots els punts dins de l'envolupant pertanyen a la sortida de, com a mínim, una instància del model. La generació d'una envolupant així normalment és una tasca molt dura que es pot abordar, per exemple, mitjançant algorismes d'optimització global o comprovació de consistència. Per aquesta raó, en molts casos s'obtenen aproximacions a l'envolupant exacta. Una aproximació completa però no correcta a l'envolupant exacta és una envolupant sobredimensionada, mentre que una envolupant correcta però no completa és subdimensionada. Aquestes propietats s'han estudiat per diferents simuladors per a sistemes incerts.

Single versus multiple occupancy - Effects on toxicity parameters measured on Eisenia fetida in lead nitrate-treated soil

The mortality (7 and 14 d), weight change (7 and 14 d), and metal uptake of Eisenia fetida (Savigny, 1826) kept in Pb(NO3)(2)-treated Kettering loam soil in single- and multiple-occupancy (10 earthworms) test containers were determined. The number of earthworms to dry mass (g) ratio of soil was 1:50 in both sets of test containers. Lead concentrations were in the nominal range of 0 to 10,000 mg Pb/kg soil (mg/kg hereafter). Levels of mortality at a given concentration were statistically identical between the single- and multiple-occupancy tests, except at 1,800 mg/kg, at which significantly (p less than or equal to 0.05) more mortality occurred in the multiple-occupancy tests. Death of individual earthworms in the multiple-occupancy tests did not trigger death of the other earthworms in that soil. The LC50 values (concentration statistically likely to kill 50% of the population) were identical between the multiple- and single-occupancy soils: 2,662 mg/kg (2,598-2,984, 7 d) and 2,589 mg/kg (2,251-3,013, 14 d) for the multiple-occupancy soils and 2,827 mg/kg (2,443-3,168, both 7 and 14 d) for the single-occupancy soils (values in brackets represent the 95% confidence intervals). Data were insufficient to calculate the concentration statistically likely to reduce individual earthworm mass by 50% (EC50), but after 14 d, the decrease in earthworm weight in the 1,800 and 3,000 mg/kg tests was significantly greater in the multiple- than in the single-occupancy soils. At 1,000, 1,800, and 3,000 mg/kg tests, earthworm Pb tissue concentration was significantly (p less than or equal to 0.05) greater in earthworms from the multiple-occupancy soils. The presence of earthworms increased the NH3 content of the soil; earthworm mortality increased NH3 concentrations further but not to toxic levels.

Identifying the critical parameters of a cyanobacterial growth and movement model by using generalised sensitivity analysis

Bloom-forming and toxin-producing cyanobacteria remain a persistent nuisance across the world. Modelling of cyanobacteria in freshwaters is an important tool for understanding their population dynamics and predicting the location and timing of the bloom events in lakes and rivers. A new deterministic-mathematical model was developed, which simulates the growth and movement of cyanobacterial blooms in river systems. The model focuses on the mathematical description of the bloom formation, vertical migration and lateral transport of colonies within river environments by taking into account the major factors that affect the cyanobacterial bloom formation in rivers including, light, nutrients and temperature. A technique called generalised sensitivity analysis was applied to the model to identify the critical parameter uncertainties in the model and investigates the interaction between the chosen parameters of the model. The result of the analysis suggested that 8 out of 12 parameters were significant in obtaining the observed cyanobacterial behaviour in a simulation. It was found that there was a high degree of correlation between the half-saturation rate constants used in the model.

Effects of metals on life cycle parameters of the earthworm Eisenia fetida exposed to field-contaminated, metal-polluted soils

Two control and eight field-contaminated, metal-polluted soils were inoculated with Eisenia fetida (Savigny, 1826). Three, 7, 14, 21, 28 and 42 days after inoculation, earthworm survival, body weight, cocoon production and hatching rate were measured. Seventeen metals were analysed in E.fetida tissue, bulk soil and soil solution. Soil organic carbon content, texture, pH and cation exchange capacity were also measured. Cocoon production and hatching rate were more sensitive to adverse conditions than survival or weight change. Soil properties other than metal concentration impacted toxicity. The most toxic soils were organic-poor (1-10 g C kg(-1)), sandy soils (c. 74% sand), with intermediate metal concentrations (e.g. 7150-13, 100 mg Ph kg(-1), 2970-53,400 mg Zn kg(-1)). Significant relationships between soil properties and the life cycle parameters were determined. The best coefficients of correlation were generally found for texture, pH, Ag, Cd, Mg, Pb, Tl, and Zn both singularly and in multivariate regressions. Studies that use metal-amended artificial soils are not useful to predict toxicity of field multi-contaminated soils. (c) 2007 Elsevier Ltd. All rights reserved.

An application of the GLUE methodology for estimating the parameters of the INCA-N model

The conceptual and parameter uncertainty of the semi-distributed INCA-N (Integrated Nutrients in Catchments-Nitrogen) model was studied using the GLUE (Generalized Likelihood Uncertainty Estimation) methodology combined with quantitative experimental knowledge, the concept known as 'soft data'. Cumulative inorganic N leaching, annual plant N uptake and annual mineralization proved to be useful soft data to constrain the parameter space. The INCA-N model was able to simulate the seasonal and inter-annual variations in the stream-water nitrate concentrations, although the lowest concentrations during the growing season were not reproduced. This suggested that there were some retention processes or losses either in peatland/wetland areas or in the river which were not included in the INCA-N model. The results of the study suggested that soft data was a way to reduce parameter equifinality, and that the calibration and testing of distributed hydrological and nutrient leaching models should be based both on runoff and/or nutrient concentration data and the qualitative knowledge of experimentalist. (c) 2006 Elsevier B.V. All rights reserved.

Robust dynamics of Amazon dieback to climate change with perturbed ecosystem model parameters

Climate change science is increasingly concerned with methods for managing and integrating sources of uncertainty from emission storylines, climate model projections, and ecosystem model parameterizations. In tropical ecosystems, regional climate projections and modeled ecosystem responses vary greatly, leading to a significant source of uncertainty in global biogeochemical accounting and possible future climate feedbacks. Here, we combine an ensemble of IPCC-AR4 climate change projections for the Amazon Basin (eight general circulation models) with alternative ecosystem parameter sets for the dynamic global vegetation model, LPJmL. We evaluate LPJmL simulations of carbon stocks and fluxes against flux tower and aboveground biomass datasets for individual sites and the entire basin. Variability in LPJmL model sensitivity to future climate change is primarily related to light and water limitations through biochemical and water-balance-related parameters. Temperature-dependent parameters related to plant respiration and photosynthesis appear to be less important than vegetation dynamics (and their parameters) for determining the magnitude of ecosystem response to climate change. Variance partitioning approaches reveal that relationships between uncertainty from ecosystem dynamics and climate projections are dependent on geographic location and the targeted ecosystem process. Parameter uncertainty from the LPJmL model does not affect the trajectory of ecosystem response for a given climate change scenario and the primary source of uncertainty for Amazon 'dieback' results from the uncertainty among climate projections. Our approach for describing uncertainty is applicable for informing and prioritizing policy options related to mitigation and adaptation where long-term investments are required.