Eficacia y seguridad del aripiprazol en trastornos del espectro autista en población infanto-juvenil: revisión sistemática de la literatura

Aunque han pasado cinco años desde su aprobación en Estados Unidos para el manejo de los Trastornos del Espectro Autista (TEA), en Colombia el uso de aripiprazol para esta indicación continúa siendo off-label. En este contexto, se ha propuesto la ejecución de una revisión sistemática de la literatura con el fin de conocer la eficacia y seguridad de esta estrategia terapéutica a la luz de la evidencia disponible en el manejo de niños y adolescentes con TEA

Osteomielitis esternal: utilidad de las pruebas de diagnóstico por imágenes con enfoque en medicina nuclear

Introducción: El diagnóstico de osteomielitis esternal post-esternotomía resulta difícil empleando síntomas clínicos o de laboratorio y las imágenes morfológicas orientan a sospecha más que al diagnóstico. Un diagnóstico precoz ofrece calidad de vida y el mejor tratamiento para reducir una mortalidad que oscila entre 14% y 47%. La gammagrafía con leucocitos marcados ofrece el mejor rendimiento diagnóstico para infecciones y se destaca como el patrón de oro diagnóstico. Objetivo: Identificar el desempeño y utilidad de la gammagrafía con leucocitos autólogos marcados con 99mTc-HMPAO en los estudios realizados para la evaluación de osteomielitis esternal. Materiales y métodos: Se realizó un estudio descriptivo, retrospectivo de prueba diagnóstica en la Fundación Cardioinfantil de Bogotá entre enero/2010 y mayo/2015 evaluando gammagrafías con leucocitos marcados ante la sospecha de osteomielitis posterior a esternotomía. Resultados: Se evaluaron 52 pacientes, en los que la gammagrafía con leucocitos mostró 23 pacientes (44,2%) con osteomielitis esternal, logrando una sensibilidad y especificidad del 88,46% y 100% respectivamente. El valor predictivo positivo fue de 100%, y el valor predictivo negativo fue de 89,66%. El impacto de una prueba negativa no modificó el manejo médico inicial en el 93% de los casos mientras que una prueba positiva lo modificó en el 83%. Conclusiones: La gammagrafía con leucocitos autólogos radiomarcados con 99mTc-HMPAO continúa siendo el patrón de oro de referencia no invasiva para el diagnóstico de osteomielitis, y en el caso de osteomielitis esternal se convierte en la prueba de elección pertinente en la selección de pacientes que ameritan una re-intervención quirúrgica.

Eficacia y seguridad de la melatonina para el manejo de los trastornos del sueño en el autismo: meta-análisis

INTRODUCCIÓN: El 80% de los niños y adolescentes con trastornos del espectro autista (TEA) presenta algún trastorno del sueño, en cuya génesis al parecer intervienen alteraciones en la regulación de la melatonina. El objetivo de este metaanálisis fue determinar la eficacia y seguridad de la melatonina para el manejo de ciertos trastornos del sueño en niños con TEA. MÉTODOS: Tres revisores extrajeron los datos relevantes de los ensayos clínicos aleatorizados doble ciego de alta calidad publicados en bases de datos primarias, de ensayos clínicos, de revisiones sistemáticas y de literatura gris; además se realizó búsqueda en bola de nieve. Se analizaron los datos con RevMan 5.3. Se realizó un análisis del inverso de la varianza por un modelo de efectos aleatorios para las diferencias de medias de los desenlaces propuestos: duración del tiempo total, latencia de sueño y número de despertares nocturnos. Se evaluó la heterogeneidad interestudios con el parámetro I2 RESULTADOS: La búsqueda inicial arrojó 355 resultados, de los cuales tres cumplieron los criterios de selección. La melatonina resultó ser un medicamento seguro y eficaz para aumentar la duración total del sueño y disminuir la latencia de sueño en niños y adolescentes con TEA; hasta el momento la evidencia sobre el número de despertares nocturnos no es estadísticamente significativa. DISCUSIÓN: A la luz de la evidencia disponible, la melatonina es una elección segura y eficaz para el manejo de ciertos problemas del sueño en niños y adolescentes con TEA. Es necesario realizar estudios con mayores tamaños muestrales y comparados con otros medicamentos disponibles en el mercado.

Visibility and proximity on triangulated surfaces

En aquesta tesi es solucionen problemes de visibilitat i proximitat sobre superfícies triangulades considerant elements generalitzats. Com a elements generalitzats considerem: punts, segments, poligonals i polígons. Les estrategies que proposem utilitzen algoritmes de geometria computacional i hardware gràfic. Comencem tractant els problemes de visibilitat sobre models de terrenys triangulats considerant un conjunt d'elements de visió generalitzats. Es presenten dos mètodes per obtenir, de forma aproximada, mapes de multi-visibilitat. Un mapa de multi-visibilitat és la subdivisió del domini del terreny que codifica la visibilitat d'acord amb diferents criteris. El primer mètode, de difícil implementació, utilitza informació de visibilitat exacte per reconstruir de forma aproximada el mapa de multi-visibilitat. El segon, que va acompanyat de resultats d'implementació, obté informació de visibilitat aproximada per calcular i visualitzar mapes de multi-visibilitat discrets mitjançant hardware gràfic. Com a aplicacions es resolen problemes de multi-visibilitat entre regions i es responen preguntes sobre la multi-visibilitat d'un punt o d'una regió. A continuació tractem els problemes de proximitat sobre superfícies polièdriques triangulades considerant seus generalitzades. Es presenten dos mètodes, amb resultats d'implementació, per calcular distàncies des de seus generalitzades sobre superfícies polièdriques on hi poden haver obstacles generalitzats. El primer mètode calcula, de forma exacte, les distàncies definides pels camins més curts des de les seus als punts del poliedre. El segon mètode calcula, de forma aproximada, distàncies considerant els camins més curts sobre superfícies polièdriques amb pesos. Com a aplicacions, es calculen diagrames de Voronoi d'ordre k, i es resolen, de forma aproximada, alguns problemes de localització de serveis. També es proporciona un estudi teòric sobre la complexitat dels diagrames de Voronoi d'ordre k d'un conjunt de seus generalitzades en un poliedre sense pesos.

Isomerism and C-H, C-C, O-O, C-O bond activation studies by transition metals

Aquesta tesi és el reflex que de la cooperació entre grups experimentals i grups teòrics s'aconsegueix l'assoliment d'objectius inassolibles de forma individual. A partir de la DFT s'expliquen processos inorgànics i organometàl·lics de gran valor biològic i/o industrial. La tesi està enfocada especialment a l'estudi de complexos mononuclears i binuclears de coure, on té lloc l'activació d'enllaços C-H, C-C, i O-O. L'estudi de complexos octaèdrics de ruteni ha permès dur a terme extensos estudis isomèrics i racionalitzar les propietats espectroscòpiques dels mateixos. A més a més, estudis més puntuals respecte clusters de coure, l'estudi de la reacció de Pawson-Khand, l'estudi d'enllaços Pt-Pt en complexos trimèrics de platí, a més a més de l'estudi de la isomeria de complexos de Ni i Pt.

Grau de procura da acupunctura como opção terapêutica numa amostra da população de Lisboa

Este é um estudo exploratório e correlacional, com um número inicial de 150 participantes, utilizando uma amostra de conveniência constituída por cinco clínicas médicas e cinco casas de medicina tradicional chinesa, em Lisboa, onde os indivíduos foram autorizados a responder voluntariamente a questionários. Apresenta uma taxa de resposta de 74% (N=111). A adesão à acupunctura é maior no sexo feminino e na faixa etária de 31 a 50 anos (40% homens e 48% mulheres). A procura de tratamento de problemas musculares e articulares e para problemas do foro psicológico são as mais descritas, apesar de ser referida como eficaz noutro tipo de queixas, e não ser o primeiro tipo de tratamento que a população procura. É reconhecido que os resultados podem ocorrer a médio e longo prazo, após várias sessões terapêuticas, o que não parece afetar a perceção da população em estudo que se diz satisfeita (53%) com uma muita boa e / ou boa relação benefício-custo. Em geral, a maioria da população (93%) confia na terapia pelo resultado bom ou muito bom (79%) ou razoável (16%) obtido, e deposita confiança (88%) nas competências do profissional de saúde que executa a acupunctura.

Global Acceleration and Dispossesion: Regression in the Right to Life and Public Health during Ecuador’s Neoliberal Decades

The present essay’s central argument or hypothesis is, consequently, that the mechanisms accelerating a wealth concentrating and exclusionary economy centred on the benefit and overprotection of big business—with a corresponding plundering of resources that are vital for life—generated forms of loss and regression in the right to healthcare and the dismantling of institutional protections. These are all expressed in indicators from 1990-2005, which point not only to the deterioration of healthcare programs and services but also to the undermining of the general conditions of life (social reproduction) and, in contrast to the reports and predictions of the era’s governments, a stagnation or deterioration in health indicators, especially for those most sensitive to the crisis. The present study’s argument is linked together across distinct chapters. First, we undertake the necessary clarification of the categories central to the understanding of a complex issue; clarifying the concept of health itself and its determinants, emphasizing the necessity of taking on an integral understanding as a fundamental prerequisite to unravelling what documents and reports from this era either leave unsaid or distort. Based on that analysis, we will explain the harmful effects of global economic acceleration, the monopolization and pillaging of strategic healthcare goods; not only those which directly place obstacles on the access to health services, but also those like the destructuration of small economies, linked to the impoverishment and worsening of living modes. Thinking epidemiologically, we intend to show signs of the deterioration of broad collectivities’ ways of life as a result of the mechanisms of acceleration and pillage. We will then collect disparate evidence of the deterioration of human health and ecosystems to, finally, establish the most urgent conclusions about this unfortunate period of our social and medical history.

On the development of horizontal CEN standards supporting the implementation of EU directives on sludge, soil and biowaste - Project HORIZONTAL

We give an overview on the development of "horizontal" European Committee for Standardisation (CEN) standards for characterising soils, sludges and biowaste in the context of environmental legislation in the European Union (EU). We discuss the various steps in the development of a horizontal standard (i.e. assessment of the possibility of such a standard, review of existing normative documents, pre-normative testing and validation) and related problems. We also provide a synopsis of European and international standards covered by the so-called Project HORIZONTAL. (C) 2004 Elsevier Ltd. All rights reserved.

Assessing the discourses and practices of urban regeneration in a growing region

Most research on the discourses and practices of urban regeneration in-the UK has examined case studies located in areas of relative socio-economic distress. Less research has been undertaken on regeneration projects and agendas in areas characterise by strong economic growth. Yet, it is in such places that some of the best examples of the discourses, practices and impacts of contemporary urban regeneration can be. found. In some areas of high demand regeneration projects have used inner urban brownfield sites as locations for new investment. With the New Labour government's urban policy agendas targeting similar forms of regeneration, an examination of completed or on-going schemes is timely and relevant to debates over the direction that policy should take. This paper, drawing on a study of urban regeneration in one of England's, fastest growing towns, Reading in Berkshire, examines the discourses, practices and impacts of redevelopment schemes during the 1990s and 2000s. Reading's experiences have received national attention and have been hailed as a model for other urban areas to follow. The research documents the discursive and concrete aspects of local regeneration and examines the ways in which specific priorities and defined problems have come to dominate agendas. Collectively, the study argues that market-driven objectives come to dominate regeneration agendas, even in areas of strong demand where development agencies wield a relatively high degree of influence. Such regeneration plays a symbolic and practical role in creating new forms of exclusion and interpretations of place. (C) 2003 Elsevier Science Ltd. All rights reserved.

When smoke gets in our eyes: The multiple impacts of atmospheric black carbon on climate, air quality and health

With both climate change and air quality on political and social agendas from local to global scale, the links between these hitherto separate fields are becoming more apparent. Black carbon, largely from combustion processes, scatters and absorbs incoming solar radiation, contributes to poor air quality and induces respiratory and cardiovascular problems. Uncertainties in the amount, location, size and shape of atmospheric black carbon cause large uncertainty in both climate change estimates and toxicology studies alike. Increased research has led to new effects and areas of uncertainty being uncovered. Here we draw together recent results and explore the increasing opportunities for synergistic research that will lead to improved confidence in the impact of black carbon on climate change, air quality and human health. Topics of mutual interest include better information on spatial distribution, size, mixing state and measuring and monitoring. (c) 2006 Elsevier Ltd. All rights reserved.

UK commercial property lease structures: Landlord and tenant mismatch

UK commercial property lease structures have come under considerable scrutiny during the past decade since the property crash of the early 1990s. In particular, tenants complained that the system was unfair and that it has blocked business change. Government is committed, through its 2001 election manifesto, to promote flexibility and choice in the commercial property lettings market and a new voluntary Commercial Leases Code of Practice was launched in April 2002. This paper investigates whether occupiers are being offered the leases they require or whether there is a mismatch between occupier requirements and actual leases in the market. It draws together the substantial data now available on the actual terms of leases in the UK and surveys of corporate occupiers' attitude to their occupation requirements. Although the data indicated that UK leases have become shorter and more diverse since 1990, this is still not sufficient to meet the current requirements of many corporate occupiers. It is clear that the inability to manage entry and exit strategies is a major concern to occupiers. Lease length is the primary concern of tenants and a number of respondents comment on the mismatch between lease length in the UK and business planning horizons. The right to break and other problems with alienation clauses also pose serious difficulties for occupiers, thus reinforcing the mismatch. Other issues include repairing and insuring clauses and the type of review clause. There are differences in opinion between types of occupier. In particular, international corporate occupiers are significantly more concerned about the length of lease and the incidence of break clauses than national occupiers and private-sector tenants are significantly more concerned about leasing in general than public-sector occupiers. Proposed solutions by tenants are predictable and include shorter leases, more frequent breaks and relaxation of restrictions concerning alienation and other clauses. A significant number specify that they would pay more for shorter leases and other improved terms. Short leases would make many of the other terms more acceptable and this is why they are the main concern of corporate occupiers. Overall, the evidence suggests that there continues to be a gap between occupiers' lease requirements and those currently offered by the market. There are underlying structural factors that act as an inertial force on landlords and inhibit the changes which occupiers appear to want. Nevertheless, the findings raise future research questions concerning whether UK lease structures are a constraining factor on UK competitiveness.

Force constants and dipole‐moment derivatives of molecules from perturbed Hartree–Fock calculations

General expressions for the force constants and dipole‐moment derivatives of molecules are derived, and the problems arising in their practical application are reviewed. Great emphasis is placed on the use of the Hartree–Fock function as an approximate wavefunction, and a number of its properties are discussed and re‐emphasised. The main content of this paper is the development of a perturbed Hartree–Fock theory that makes possible the direct calculation of force constants and dipole‐moment derivatives from SCF–MO wavefunctions. Essentially the theory yields ∂ϕi / ∂RJα, the derivative of an MO with respect to a nuclear coordinate.

Calibration and use of a cesium-iodide prism in the infrared

With a cesium-iodide prism the long wavelength range of an infrared spectrometer may be extended to 55µ The use of such a prism, the choice of optical system, and the problems of stray radiation are all discussed. Accurate data are assembled for calibration in this region, and sample calibration traces are shown. A simple gas absorption cell is described for use at long wavelengths.

Mining, grievance and conflict in rural Tanzania

This paper provides an extended analysis of the tensions that have surfaced between large-scale mine operators and artisanal miners in gold-rich areas of rural Tanzania. The literature on grievance is used to contextualise, these disputes, the underlying cause of which is artisanal miners' mounting frustration over not being able to secure viable concessions to work. Newly implemented legislation has, for the most part, empowered foreign large-scale mine operators, while simultaneously disempowering indigenous small-scale miners. In many cases, the former have addressed mounting security and community problems on their own. Until the country's major mine operators extend assistance to marginalised small-scale mining groups, the likelihood of violent conflict unfolding between these parties will increase.