Tratamiento de Artritis reumatoide con antagonistas del factor de necrosis tumoral alfa y su asociación con el desarrollo de melanoma cutáneo: revisión sistemática de la literatura y meta-análisis.

Introducción: El tratamiento con antagonistas del factor de necrosis tumoral alfa (anti TNF) ha impactado el pronóstico y la calidad de vida de los pacientes con artritis reumatoide (AR) positivamente, sin embargo, se interroga un incremento en el riesgo de desarrollar melanoma. Objetivo: Conocer la asociación entre el uso de anti TNF y el desarrollo de melanoma maligno en pacientes con AR. Metodología: Se realizó una búsqueda sistemática en MEDLINE, EMBASE, COCHRANE LIBRARY y LILACS para ensayos clínicos, estudios observacionales, revisiones y meta-análisis en pacientes adultos con diagnóstico de AR y manejo con anti TNF (Certolizumab pegol, Adalimumab, Etanercept, Infliximab y Golimumab). Resultados: 37 estudios clínicos cumplieron los criterios de inclusión para el meta-análisis, con una población de 16567 pacientes. El análisis de heterogeneidad no fue significativo (p=1), no se encontró diferencia en el riesgo entre los grupos comparados DR -0.00 (IC 95% -0.001; -0.001). Un análisis adicional de los estudios en los que se reportó al menos 1 caso de melanoma (4222 pacientes) tampoco mostró diferencia en el riesgo DR -0.00 (IC 95% -0.004 ; -0.003). Conclusión: En la evidencia disponible a la fecha no encontramos asociación significativa entre el tratamiento con anti TNF en pacientes con diagnóstico de AR y el desarrollo de melanoma cutáneo.

Percepción del riesgo biológico en el personal asistencial en un hospital de alta complejidad de la ciudad de Bogotá.

OBJETIVOS: Identificar la percepción del riesgo biológico de los trabajadores asistenciales del Hospital Central de la Policía Nacional en la ciudad de Bogotá. METODOS: se realizó un estudio analítico de corte transversal para describir la percepción acerca del riesgo biológico en 159 trabajadores asistenciales de un hospital de alta complejidad en la ciudad de Bogotá (Colombia), la información se recolectó por medio de la utilización de la encuesta validada nota técnica 578 (Portell M, Solé M, 2001). Se realizó la caracterización de la población por variables de sexo, edad, tiempo de experiencia y servicio al cual pertenece y se promediaron las respuestas obtenidas para cada ítem encuestado, obteniendo una clasificación para cada dimensión de percepción de riesgo baja (1 a 3), media (4 a 5) o alta (6 a 7). Resultados: De los 159 trabajadores asistenciales encuestados el 80.4% eran de género femenino, el 22.2% pertenecían al servicio de urgencias, el 16,5% al servicio de medicina interna y el 9.5% al servicio de pediatría, de los encuestados el 62.9% fueron auxiliares de enfermería, el 21,4% enfermeras jefes y el 6.9% médicos. Se obtuvo una percepción de riesgo alta (media aritmética mayor de 5) para todas las variables incluidas en la encuesta, demostrando conocimiento de todo el personal acerca de la alta exposición a accidentes de tipo biológico. No se encontró asociación entre la labor desempeñada y la percepción del riesgo biológico, sin embargo, se encontró una asociación entre el tiempo de experiencia del trabajador y una disminución en la magnitud del riesgo percibido (Chi cuadrado de asociación, p=0.042). Conclusiones: Los trabajadores asistenciales identifican la magnitud del riesgo biológico al que se encuentran expuestos en sus labores del día a día, sin embargo, es necesaria una mayor participación por parte del personal directivo y de los responsables de la prevención en temas de reacción ante accidentes y en la valoración del riesgo, especialmente en personas que llevan mucho tiempo desempeñando la labor.

Caracterización de los hábitos alimentarios en población pediátrica de cuatro instituciones escolares

Introducción: La obesidad infantil ha venido en aumento en los últimos años y Colombia no es ajena a esta problemática. Uno de los lugares para intervención son los planteles educativos, en los cuales los escolares son quienes escogen sus alimentos. En el presente estudio se pretendió caracterizar los hábitos alimentarios de una población pediátrica en cuatro instituciones educativas, con el fin de conocer las prioridades infantiles en cuanto a la escogencia de los alimentos, y por ende generar recomendaciones. Metodología: Se realizó un estudio descriptivo multicéntrico que presenta los resultados de encuestas dirigidas a escolares entre 8 y 18 años, usuarios de tiendas escolares. Se realizó un análisis descriptivo de acuerdo a las preferencias de alimentación por institución, por género y por edad entre otros. Resultados: Se incluyeron un total de 512 escolares. La distribución por género y edad fue similar en las cuatro instituciones educativas. Entre los alimentos de preferencia predominaron los alimentos empaquetados, pizza, helados y en menor proporción las frutas. En cuanto a las bebidas predominó la gaseosa y té en botella. Entre las razones para escoger los alimentos predominó “el sabor” seguido de la “facilidad y rapidez” para su consumo; y la principal razón para no escoger los alimentos fue el precio. Discusión: Es necesario hacer intervención desde una temprana edad para generar hábitos de alimentación saludable y equilibrada, al igual que se debería tener un programa de detección de hábitos alimentarios inadecuados en las instituciones escolares para así poder combatirlos.

La Reforma Catòlica a la muntanya catalana a través de les visites pastorals: els bisbats de Girona i Vic (1587-1800)

La present tesi vol explicar la implantació de la Reforma Catòlica en una sèrie de parròquies rurals dels bisbats de Girona (valls de Ridaura, Bas, Hostoles i Amer) i Vic (El Collsacabra i les valls de Susqueda i Sau), entre 1587 i 1800, des dels bisbes posttrentins Jaume Caçador i Pedro Jaime als il·lustrats Tomàs de Lorenzana i Francisco de Veyan. La documentació principal són les sèries de les visites pastorals conservades a l'Arxiu Diocesà de Girona i l'Arxiu Episcopal de Vic; paral·lelament, s'ha reforçat amb documentació parroquial (llibres sagramentals, consuetes, llibres d'obra i confraries), protocols notarials (notaries de Rupit, Sant Feliu de Pallerols, El Mallol i Amer) i impresos episcopals. Els manaments de les visites pastorals s'han contrastat, amb semblances i diferències, amb els decrets del concili de Trento, de les constitucions provincials tarraconenses i les sinodals gironines i vigatanes, i amb les evidències artístiques, arquitectòniques i arqueològiques. Tots ells han servit per demostrar la lentitud en la implantació del programa tridentí, que s'assoleix, de fet, amb força retard (ben entrat el segle XVIII).

A predictive model for early-warning of Septoria leaf blotch on winter wheat

Disease-weather relationships influencing Septoria leaf blotch (SLB) preceding growth stage (GS) 31 were identified using data from 12 sites in the UK covering 8 years. Based on these relationships, an early-warning predictive model for SLB on winter wheat was formulated to predict the occurrence of a damaging epidemic (defined as disease severity of 5% or > 5% on the top three leaf layers). The final model was based on accumulated rain > 3 mm in the 80-day period preceding GS 31 (roughly from early-February to the end of April) and accumulated minimum temperature with a 0A degrees C base in the 50-day period starting from 120 days preceding GS 31 (approximately January and February). The model was validated on an independent data set on which the prediction accuracy was influenced by cultivar resistance. Over all observations, the model had a true positive proportion of 0.61, a true negative proportion of 0.73, a sensitivity of 0.83, and a specificity of 0.18. True negative proportion increased to 0.85 for resistant cultivars and decreased to 0.50 for susceptible cultivars. Potential fungicide savings are most likely to be made with resistant cultivars, but such benefits would need to be identified with an in-depth evaluation.

A simple two-stage design for quantitative responses with application to a study in diabetic neuropathic pain

Two-stage designs offer substantial advantages for early phase II studies. The interim analysis following the first stage allows the study to he stopped for futility, or more positively, it might lead to early progression to the trials needed for late phase H and phase III. If the study is to continue to its second stage, then there is an opportunity for a revision of the total sample size. Two-stage designs have been implemented widely in oncology studies in which there is a single treatment arm and patient responses are binary. In this paper the case of two-arm comparative studies in which responses are quantitative is considered. This setting is common in therapeutic areas other than oncology. It will be assumed that observations are normally distributed, but that there is some doubt concerning their standard deviation, motivating the need for sample size review. The work reported has been motivated by a study in diabetic neuropathic pain, and the development of the design for that trial is described in detail. Copyright (C) 2008 John Wiley & Sons, Ltd.

Herbal medicine: the science of the art

In the last 50 years science has provided new perspectives on the ancient art of herbal medicine. The present article discusses ways in which the evidence base for the professional use of 'Western' herbal medicine, as therapy to treat disease, known as phytotherapy, can be strengthened and developed. The evidence base for phytotherapy is small and lags behind that for the nutritional sciences, mainly because phytochemicals are ingested as complex mixtures that are incompletely characterised and have only relatively recently been subject to scientific scrutiny. While some methodologies developed for the nutritional sciences can inform phytotherapy research, opportunities for observational studies are more limited, although greater use could be made of patient case notes. Randomised clinical trials of single-herb interventions are relatively easy to undertake and increasing numbers of such studies are being published. Indeed, enough data are available on three herbs (ginkgo (Ginkgo biloba), St John's wort (Hypericum perforatum) and saw palmetto (Serenoa repens)) for meta-analyses to have been undertaken. However, phytotherapy is holistic therapy, using lifestyle advice, nutrition and individually-prescribed mixtures of herbs aimed at reinstating homeostasis. While clinical experience shows that this approach is applicable to a wide range of conditions, including chronic disease, evidence of its efficacy is scarce. Strategies for investigating the full holistic approach of phytotherapy and its main elements are discussed and illustrated through the author's studies at the University of Reading.

Access to the frontal sinus and zygomatico frontal suture through the supratarsal fold

Precise repositioning of a fractured zygoma is difficult. The traditional approach is through an eyebrow incision, but it can produce a scar that causes aesthetic and psychological problems for the patient. We describe the supratarsal fold approach to expose the frontozygomatic suture and to reduce small displacements of frontal sinus anterior wall; it gives good access and excellent aesthetic results. (C) 2007 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Forebrain projections to brainstem nuclei involved in the control of mandibular movements in rats

Mandibular movements occur through the triggering of trigeminal motoneurons. Aberrant movements by orofacial muscles are characteristic of orofacial motor disorders, such as nocturnal bruxism (clenching or grinding of the dentition during sleep). Previous studies have suggested that autonomic changes occur during bruxism episodes. Although it is known that emotional responses increase jaw movement, the brain pathways linking forebrain limbic nuclei and the trigeminal motor nucleus remain unclear. Here we show that neurons in the lateral hypothalamic area, in the central nucleus of the amygdala, and in the parasubthalamic nucleus, project to the trigeminal motor nucleus or to reticular regions around the motor nucleus (Regio h) and in the mesencephalic trigeminal nucleus. We observed orexin co-expression in neurons projecting from the lateral hypothalamic area to the trigeminal motor nucleus. In the central nucleus of the amygdala, neurons projecting to the trigeminal motor nucleus are innervated by corticotrophin-releasing factor immunoreactive fibers. We also observed that the mesencephalic trigeminal nucleus receives dense innervation from orexin and corticotrophin-releasing factor immunoreactive fibers. Therefore, forebrain nuclei related to autonomic control and stress responses might influence the activity of trigeminal motor neurons and consequently play a role in the physiopathology of nocturnal bruxism.

Immune response to cytolethal distending toxin of Aggregatibacter actinomycetemcomitans in periodontitis patients

Background and Objective: Cytolethal distending toxin (CDT) is a genotoxin produced by Aggregatibacter actinomycetemcomitans. In spite of its association with pathogenesis, little is known about the humoral immune response against the CDT. This study aimed to test whether subgingival colonization and humoral response to A. actinomycetemcomitans would lead to a response against CDT. Material and Methods: Sera from periodontally healthy, localized and generalized aggressive periodontitis and chronic periodontitis subjects (n = 80) were assessed for immunoglobulin G titers to A. actinomycetemcomitans serotypes a/b/c and to each CDT subunit (CdtA, CdtB and CdtC) by ELISA. A. actinomycetemcomitans subgingival levels and neutralization of CDT activity were also analyzed. Results: Sera from 75.0% localized and 81.8% generalized aggressive periodontitis patients reacted to A. actinomycetemcomitans. A response to serotype b was detected in localized (66.7%) and generalized aggressive periodontitis (54.5%). Reactivity to A. actinomycetemcomitans correlated with subgingival colonization (R = 0.75, p < 0.05). There was no correlation between A. actinomycetemcomitans colonization or response to serotypes and the immunoglobulin G response to CDT subunits. Titers of immunoglobulin G to CdtA and CdtB did not differ among groups; however, sera of all generalized aggressive periodontitis patients reacted to CdtC. Neutralization of CDT was not correlated with levels of antibodies to CDT subunits. Conclusion: Response to CdtA and CdtB did not correlate with the periodontal status of the subject in the context of an A. actinomycetemcomitans infection. However, a response to CdtC was found in sera of generalized but not of localized aggressive periodontitis subjects. Differences in response to CdtC between generalized and localized aggressive periodontitis subjects indicate that CDT could be expressed differently by the infecting strains. Alternatively, the antibody response to CdtC could require the colonization of multiple sites.

Monotone positive solutions for a fourth order equation with nonlinear boundary conditions

This work is concerned with the existence of monotone positive solutions for a class of beam equations with nonlinear boundary conditions. The results are obtained by using the monotone iteration method and they extend early works on beams with null boundary conditions. Numerical simulations are also presented. (C) 2009 Elsevier Ltd. All rights reserved.

Separation and Execution of graphical engine on a cross platform IDE to enhance performance

“Biosim” is a simulation software which works to simulate the harvesting system.This system is able to design a model for any logistic problem with the combination of several objects so that the artificial system can show the performance of an individual model. The system will also describe the efficiency, possibility to be chosen for real life application of that particular model. So, when any one wish to setup a logistic model like- harvesting system, in real life he/she may be noticed about the suitable prostitution for his plants and factories as well as he/she may get information about the least number of objects, total time to complete the task, total investment required for his model, total amount of noise produced for his establishment in advance. It will produce an advance over view for his model. But “Biosim” is quite slow .As it is an object based system, it takes long time to make its decision. Here the main task is to modify the system so that it can work faster than the previous. So, the main objective of this thesis is to reduce the load of “Biosim” by making some modification of the original system as well as to increase its efficiency. So that the whole system will be faster than the previous one and performs more efficiently when it will be applied in real life. Theconcept is to separate the execution part of ”Biosim” form its graphical engine and run this separated portion in a third generation language platform. C++ is chosenhere as this external platform. After completing the proposed system, results with different models have been observed. The results show that, for any type of plants of fields, for any number of trucks, the proposed system is faster than the original system. The proposed system takes at least 15% less time “Biosim”. The efficiency increase with the complexity of than the original the model. More complex the model, more efficient the proposed system is than original “Biosim”.Depending on the complexity of a model, the proposed system can be 56.53 % faster than the original “Biosim”.

La thématique de l’eau dans l’œuvre de Marguerite Duras

The aim of this thematic study is to examine how the water motif is used in Marguerite Duras’s literary work. The study shows that water has multiple functions in these texts: it is linked to major themes and creates an enigmatic atmosphere by its association with the unknown, the inexplicable and the unconscious. The strong presence of water in Duras’s texts is striking. References to the water element can be found in several titles throughout her career, from early works such as Un barrage contre le Pacifique (1950) to La mer écrite (1996), published just after her death. Almost all of her fiction take place near water – and the rain or the sound of waves serve as leitmotifs in specific novels. The water motif can play a metonymic as well as a metaphoric role in the texts and it sometimes takes on human or animalistic characteristics (Chapter 4). Several emblematic Durassian characters (e.g. the beggar-woman, Anne-Marie Stretter and Lol V. Stein) have a close relationship to water (Chapter 5). The water motif is linked to many major Durassian themes, and illustrates themes with positive connotations, for example, creation, fecundity, maternity, liberty and desire, as well as themes with negative connotations such as destruction and death (Chapter 6). A close reading of three novels, La vie tranquille (1944), L’après-midi de Monsieur Andesmas (1962) and La maladie de la mort (1982), shows that the realism of the first novel is replaced by intriguing evocations of the sea and the pond in the second text, motifs which resist straightforward interpretation. The enigmatic feeling persists in the last novel, in which the sea illustrates the overall sombre mood of the story (Chapter 7). Finally, the role of the water element in psychoanalytic theory is discussed (Chapter 8), and a parallel is drawn between the Jungian concept of the mother archetype and the water motif in Duras’s texts. The suggestion is made in this last chapter that water is used to illustrate an oriental influence (Taoist or Buddhist) of some of the female characters in Duras’s work.

Strategies which aim to positively impact on weight, physical activity, diet and sedentary behaviours in children from zero to five years. A systematic review of the literature

Preventing the development of obesity in children is an international health priority. To assess the effectiveness of interventions designed to prevent obesity, promote healthy eating and/or physical activity and/or to reduce sedentary behaviours in 0–5-year-old children, a systematic review of the literature was performed. Literature searches were limited to articles published between January 1995 and June 2006, printed in English and sampling children aged 0–5-years. Searches excluded literature concerned with breastfeeding, eating disorders, and interventions which were school-based or concerned with obesity treatment. Two reviewers independently extracted data and assessed study strengths and weaknesses. Nine included studies were grouped based on the settings in which they were delivered. Most studies involved multi-approach interventions, were conducted in the USA and varied in study designs and quality. All showed some level of effectiveness on at least one obesity-behaviour in young children. These studies support, at a range of levels, the premise that parents are receptive to and capable of some behavioural changes that may promote healthy weight in their young children. The small quantity of research heralds the need, particularly given the potential for early intervention to have long-lasting impacts on individual and population health, to build in a substantial way upon this evidence base.

What do we mean by the term "inflammation"? A contemporary basic science update for sports medicine

Most practicing sports medicine clinicians refer to the concept of "inflammation" many times a day when diagnosing and treating acute and overuse injuries. What is meant by this term? Is it a "good" or a "bad" process? The major advances in the understanding of inflammation in recent years are summarised, and some clinical implications of the contemporary model of inflammation are highlighted.