Estudi dels mecanismos fisiopatológics de la incontinència fecal

Hemos realizado un estudio descriptivo de una cohorte de 135 pacientes con incontinencia fecal, recogiendo la información necesaria para clasificarlos según dos clasificaciones publicadas anteriormente en la literatura, ambas basadas en la etiología de la incontinencia fecal. Al analizar los datos, observamos que una clasificación basada sólo en la etiología de la incontinencia puede no ser adecuada a la hora de establecer grupos de pacientes homogéneos, por ello pensamos proponer un nuevo modelo de clasificación basada en los mecanismos fisiopatológicos de la incontinencia, lo que nos permitirá obtener grupos más homogéneos, con problemas similares, y a los que podamos ofrecer líneas de tratamiento similares.

Transformació de dades pel comerç electrònic de Tous

Aquest projecte es tracta de la creació d'una aplicació que ens ajudarà a establir comunicació entre la web de comerç on-line de l'empresa “Joieria Tous”, que estarà administrat per “GSI Commerce” i el sistema informàtic de la nostra central logística. Observarem que el sistema actual és totalment propietari i fet a mida, llavors per poder tenir una comunicació amb les noves botigues on-line s'ha de crear una plataforma que transformi les dades d'entrada al sistema informàtic de la nostra empresa i les dades de sortida al sistema informàtic de la empresa externa que gestionarà el comerç on-line: “GSI Commerce”.

Il Discorso dell'amore verso la patria (1631) di Ludovico Zuccolo

Scopo di questo studio è la disamina e la divulgazione dei pregi letterari e del valore concettualmente innovativo del Discorso dell 'amore verso la patria di Ludovico Zuccolo. L'analisi dei contenuti dell'opera, unitamente alla puntualizzazione delle sue caratteristiche formali e stilistiche, permette di vedere come questo scrittore proponga, utilizzando la forma letteraria del discorso politico, una riuscita codificazione della tematica dei diritti e dei doveri dei cittadini verso la patria; operazione in cui si sostanzia, a mio avviso, l'apporto innovativo dello Zuccolo. Dopo l'iniziale riscoperta, da parte di Benedetto Croce, del capitolo delle Considerazioni sulla Ragion di Stato, l`opera dello Zuccolo ha generato un certo interesse critico fra gli studiosi di letteratura politica del "900" senza tuttavia divenire oggetto di contributi esaustivi malgrado, a nostro parere, la presenza di elementi di originalità di pensiero nel Discorso dell 'amore verso la patria. Inoltre, l'opinione degli specialisti non è mai stata unanime riguardo al valore e ai contenuti delle opere di questo autore. Se per il Croce, ne << La Critica >> del 1926, egli appare come colui che ha prodotto, «Lo scritto più acuto e originale sull'argomento [della Ragion di Stato], composto in quel seco1o.>> (p. 301), per altri egli si presenta come un dotto estensore di trattati politici nei quali sfoggia abilmente la sua erudizione classica e Luigi Firpo arriva a suggerire addirittura che lo Zuccolo sia colpevole di plagio proprio laddove tratta il tema della Ragion di Stato : Al punto in cui siamo, una cosa è certa, e cioè che i conti non tornano : non riesco a credere che uno scrittore inzeppi centinaia e centinaia di pagine di luoghi comuni, di erudizione d"accatto, di oziosità accademiche, e poi un bel mattino, morso dalla tarantola o baciato in fronte da Minerva, metta in carta il piccolo capolavoro, le pagine meditate e profonde, e perciò lungamente soffeite, che pure gli appartengono per una paternità incontestata e certa. Dico questo, perché in un caso del genere, non al miracolo s"avrebbe da credere, ma, semmai, al plagio. (1). Catherine Pitiot, nel suo saggio La retorica politica nell 'opera utopica di Ludovico Zuccolo, coglie invece in questo autore unicamente l"utopista che << lntende allontanarsi dalla realtà contemporanea per modificarla, correggerla e presentare un'in1magine che sia fondamentalmente diversa, a livello strutturale. >> (2). Di parere diametralmente opposto Rodolfo de Mattei, che attribuisce allo Zuccolo lo status di anti-utopista per eccellenza, tipico di uno scrittore che, Non ha voluto usufruire della facile libertà della fantasia per sovvertire l'ordine storico e per alterare arbitrariamente la natura umana, cioé per proporre un ordinamento mirante ad una radicale trasformazione della società e quindi di assai dubbia realizzazione. (3). Altri studiosi, fra cui Bruno Nediani, si sono dedicati alla descrizione della personalità dello Zuccolo, attingendo alle sue lettere - che lo stesso Nediani ha riscoperto - oltre che ai brevi accermi che di sé fa lo Zuccolo negli scritti. Dal saggio del Nediani, La personalità di Ludovico Zuccolo (1969), emerge la figura di un uomo tormentato e insoddisfatto, ossessionato dal sospetto dell"autorità ecclesiastica, costretto a procacciarsi impieghi inadeguati presso i potenti, all'inseguimento dell'obiettivo di una carriera che, comunque, finisce con il risultargli sempre, prima o poi, insopportabile. Più recentemente, Sergio Bertelli, nel suo contributo alla Storia della letteratura di Cecchi e Sapegno, ha aperto una nuova prospettiva sullo Zuccolo proponendolo come colui che, Spezza finalmente il cerchio moralistico costruito dal Botero attorno al pensiero machiavelliano e la ragion di stato cessa di essere giudicata vera o falsa, buona o malvagia, interessando in sé e per sé, cioé nei suoi presupposti e nei suoi fini esclusivamente politici. (4).

Effectiveness of olive oil for the prevention of pressure ulcers caused in immobilized patients within the scope of primary health care: study protocol for a randomized controlled trial.

BACKGROUND Pressure ulcers are considered an important issue, mainly affecting immobilized older patients. These pressure ulcers increase the care burden for the professional health service staff as well as pharmaceutical expenditure. There are a number of studies on the effectiveness of different products used for the prevention of pressure ulcers; however, most of these studies were carried out at a hospital level, basically using hyperoxygenated fatty acids (HOFA). There are no studies focused specifically on the use of olive-oil-based products and therefore this research is intended to find the most cost-effective treatment and achieve an alternative treatment. METHODS/DESIGN The main objective is to assess the effectiveness of olive oil, comparing it with HOFA, to treat immobilized patients at home who are at risk of pressure ulcers. As a secondary objective, the cost-effectiveness balance of this new application with regard to the HOFA will be assessed. The study is designed as a noninferiority, triple-blinded, parallel, multi-center, randomized clinical trial. The scope of the study is the population attending primary health centers in Andalucía (Spain) in the regional areas of Malaga, Granada, Seville, and Cadiz. Immobilized patients at risk of pressure ulcers will be targeted. The target group will be treated by application of an olive-oil-based formula whereas the control group will be treated by application of HOFA to the control group. The follow-up period will be 16 weeks. The main variable will be the presence of pressure ulcers in the patient. Secondary variables include sociodemographic and clinical information, caregiver information, and whether technical support exists. Statistical analysis will include the Kolmogorov-Smirnov test, symmetry and kurtosis analysis, bivariate analysis using the Student's t and chi-squared tests as well as the Wilcoxon and the Man-Whitney U tests, ANOVA and multivariate logistic regression analysis. DISCUSSION The regular use of olive-oil-based formulas should be effective in preventing pressure ulcers in immobilized patients, thus leading to a more cost-effective product and an alternative treatment. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT01595347.

Molecular testing for fragile X: analysis of 5062 tests from 1105 fragile X families--performed in 12 clinical laboratories in Spain.

Fragile X syndrome is the most common inherited form of intellectual disability. Here we report on a study based on a collaborative registry, involving 12 Spanish centres, of molecular diagnostic tests in 1105 fragile X families comprising 5062 individuals, of whom, 1655 carried a full mutation or were mosaic, three cases had deletions, 1840 had a premutation, and 102 had intermediate alleles. Two patients with the full mutation also had Klinefelter syndrome. We have used this registry to assess the risk of expansion from parents to children. From mothers with premutation, the overall rate of allele expansion to full mutation is 52.5%, and we found that this rate is higher for male than female offspring (63.6% versus 45.6%; P < 0.001). Furthermore, in mothers with intermediate alleles (45-54 repeats), there were 10 cases of expansion to a premutation allele, and for the smallest premutation alleles (55-59 repeats), there was a 6.4% risk of expansion to a full mutation, with 56 repeats being the smallest allele that expanded to a full mutation allele in a single meiosis. Hence, in our series the risk for alleles of <59 repeats is somewhat higher than in other published series. These findings are important for genetic counselling.

Long-term effects of varying consumption of ω3 fatty acids in ear, nose and throat cancer patients: assessment 1 year after radiotherapy.

Abstract A prospective 1-year follow-up study in ear, nose, and throat (ENT) cancer patients was carried out one year after radiotherapy to assess the effect of varying consumption of ω3 fatty acid according to whether they consumed more or less than the 50th percentile of ω3 fatty acids. Clinical, analytical, inflammatory (CRP and IL-6), and oxidative variables (TAC, GPx, GST, and SOD) were evaluated. The study comprised 31 patients (87.1% men), with a mean age of 61.3 ± 9.1 years. Hematological variables showed significant differences in the patients with a lower consumption of ω3 fatty acids. A lower mortality and longer survival were found in the group with ω3 fatty acid consumption ≥50th percentile but the differences were not significant. No significant difference was reached in toxicity, inflammation, and oxidative stress markers. The group with ω3 fatty acid consumption <50th percentile significantly experienced more hematological and immune changes.

Study of protein haptenation by amoxicillin through the use of a biotinylated antibiotic.

Allergic reactions towards β-lactam antibiotics pose an important clinical problem. The ability of small molecules, such as a β-lactams, to bind covalently to proteins, in a process known as haptenation, is considered necessary for induction of a specific immunological response. Identification of the proteins modified by β-lactams and elucidation of the relevance of this process in allergic reactions requires sensitive tools. Here we describe the preparation and characterization of a biotinylated amoxicillin analog (AX-B) as a tool for the study of protein haptenation by amoxicillin (AX). AX-B, obtained by the inclusion of a biotin moiety at the lateral chain of AX, showed a chemical reactivity identical to AX. Covalent modification of proteins by AX-B was reduced by excess AX and vice versa, suggesting competition for binding to the same targets. From an immunological point of view, AX and AX-B behaved similarly in RAST inhibition studies with sera of patients with non-selective allergy towards β-lactams, whereas, as expected, competition by AX-B was poorer with sera of AX-selective patients, which recognize AX lateral chain. Use of AX-B followed by biotin detection allowed the observation of human serum albumin (HSA) modification by concentrations 100-fold lower that when using AX followed by immunological detection. Incubation of human serum with AX-B led to the haptenation of all of the previously identified major AX targets. In addition, some new targets could be detected. Interestingly, AX-B allowed the detection of intracellular protein adducts, which showed a cell type-specific pattern. This opens the possibility of following the formation and fate of AX-B adducts in cells. Thus, AX-B may constitute a valuable tool for the identification of AX targets with high sensitivity as well as for the elucidation of the mechanisms involved in allergy towards β-lactams.

Participación social en salud: conceptos de usuarios, líderes comunitarios, gestores y formuladores de políticas en Colombia. Una mirada cualitativa.

BACKGROUND Health sector reforms taking place in Colombia during the Nineties included policies to promote social participation in the health system, which is considered essential to its functioning. The aim of this article is to analyse the meaning and the significance of participation in health for the different social actors involved in implementing policies in Colombia. METHODS A qualitative, descriptive, exploratory study was carried out using focal groups (FG) and semi-structured individual interviews (I) of the different social actors: 210 users (FG), 40 community leaders (FG), 3 policy makers (E) and 36 healthcare professionals (E). A carried out analysis was content up of the contents. The study area corresponded to the municipalities of Tulua and Palmira in Colombia. RESULTS The concept of participation was interpreted differently depending on the actor studied: for users and leaders the concept referred to contributing ideas, presence in social spaces, solidarity and frequently, and use of the health services. Healthcare professionals considered the activities carried out by institutions together with the community as social participation, the use of services and affiliation to the health system. Policy markers considered participation to concern evaluation and control of the health services by the community, to improve its quality. CONCLUSIONS The different concepts of participation reveal dif ferences between the content of the policy and how it is understood and interpreted by the different social actors in their interaction with the health services. These different perspectives must be taken into account to develop a link between society and the health services.

A combination of ascorbic acid and α-tocopherol to test the effectiveness and safety in the fragile X syndrome: study protocol for a phase II, randomized, placebo-controlled trial.

BACKGROUND Fragile X syndrome (FXS) is an inherited neurodevelopmental condition characterised by behavioural, learning disabilities, physical and neurological symptoms. In addition, an important degree of comorbidity with autism is also present. Considered a rare disorder affecting both genders, it first becomes apparent during childhood with displays of language delay and behavioural symptoms.Main aim: To show whether the combination of 10 mg/kg/day of ascorbic acid (vitamin C) and 10 mg/kg/day of α-tocopherol (vitamin E) reduces FXS symptoms among male patients ages 6 to 18 years compared to placebo treatment, as measured on the standardized rating scales at baseline, and after 12 and 24 weeks of treatment.Secondary aims: To assess the safety of the treatment. To describe behavioural and cognitive changes revealed by the Developmental Behaviour Checklist Short Form (DBC-P24) and the Wechsler Intelligence Scale for Children-Revised. To describe metabolic changes revealed by blood analysis. To measure treatment impact at home and in an academic environment. METHODS/DESIGN A phase II randomized, double-blind pilot clinical trial. SCOPE male children and adolescents diagnosed with FXS, in accordance with a standardized molecular biology test, who met all the inclusion criteria and none of the exclusion criteria. INSTRUMENTATION clinical data, blood analysis, Wechsler Intelligence Scale for Children-Revised, Conners parent and teacher rating scale scores and the DBC-P24 results will be obtained at the baseline (t0). Follow up examinations will take place at 12 weeks (t1) and 24 weeks (t2) of treatment. DISCUSSION A limited number of clinical trials have been carried out on children with FXS, but more are necessary as current treatment possibilities are insufficient and often provoke side effects. In the present study, we sought to overcome possible methodological problems by conducting a phase II pilot study in order to calculate the relevant statistical parameters and determine the safety of the proposed treatment. The results will provide evidence to improve hyperactivity control and reduce behavioural and learning problems using ascorbic acid (vitamin C) and α-tocopherol (vitamin E). The study protocol was approved by the Regional Government Committee for Clinical Trials in Andalusia and the Spanish agency for drugs and health products. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01329770 (29 March 2011).

Immediate Effects of Neurodynamic Sliding versus Muscle Stretching on Hamstring Flexibility in Subjects with Short Hamstring Syndrome.

Background. Hamstring injuries continue to affect active individuals and although inadequate muscle extensibility remains a commonly accepted factor, little is known about the most effective method to improve flexibility. Purpose. To determine if an isolated neurodynamic sciatic sliding technique would improve hamstring flexibility to a greater degree than stretching or a placebo intervention in asymptomatic subjects with short hamstring syndrome (SHS). Study Design. Randomized double-blinded controlled trial. Methods. One hundred and twenty subjects with SHS were randomized to 1 of 3 groups: neurodynamic sliding, hamstring stretching, and placebo control. Each subject's dominant leg was measured for straight leg raise (SLR) range of motion (ROM) before and after interventions. Data were analyzed with a 3 × 2 mixed model ANOVA followed by simple main effects analyses. Results. At the end of the study, more ROM was observed in the Neurodynamic and Stretching groups compared to the Control group and more ROM in the Neurodynamic group compared to Stretching group. Conclusion. Findings suggest that a neurodynamic sliding technique will increase hamstring flexibility to a greater degree than static hamstring stretching in healthy subjects with SHS. Clinical Relevance. The use of neurodynamic sliding techniques to improve hamstring flexibility in sports may lead to a decreased incidence in injuries; however, this needs to be formally tested.

Protein phosphatase inhibition assays for okadaic acid detection in shellfish: matrix effects, applicability and comparison with LC-MS/MS analysis

The applicability of the protein phosphatase inhibition assay (PPIA) to the determination of okadaic acid (OA) and its acyl derivatives in shellfish samples has been investigated, using a recombinant PP2A and a commercial one. Mediterranean mussel, wedge clam, Pacific oyster and flat oyster have been chosen as model species. Shellfish matrix loading limits for the PPIA have been established, according to the shellfish species and the enzyme source. A synergistic inhibitory effect has been observed in the presence of OA and shellfish matrix, which has been overcome by the application of a correction factor (0.48). Finally, Mediterranean mussel samples obtained from Rı´a de Arousa during a DSP closure associated to Dinophysis acuminata, determined as positive by the mouse bioassay, have been analysed with the PPIAs. The OA equivalent contents provided by the PPIAs correlate satisfactorily with those obtained by liquid chromatography–tandem mass spectrometry (LC–MS/MS).

Implantació d'un sistema ERP per a gestionar una empresa dedicada a la producció i distribució de material odontològic

Aquest projecte tracta sobre la implantació d'un sistema ERP per tal de gestionar una empresa dedicada a la producció i distribució de material odontològic. El que durem a terme en aquesta aplicació serà importar les dades de l'aplicació VolkSoft a la nova aplicació. La idea principal es buscar una aplicació que satisfaci les necessitats de l'aplicació VolkSoft i a continuació, importar les dades d'una aplicació a l'altra.

Sistema de classificaçao de pacientes: aplicaçao de um instrumento validado

As autoras aplicaram um instrumento de classificação de pacientes na Ala B2 do Hospital de Clínicas de Marília, em doisperíodos distintos, no ano de 1999, com o intuito de conhecer o grau de dependência dos pacientes em relaçãoàequipe de enfermagem. A amostra foi constituída de 31 pacientes no primeiro período e 35 pacientes no segundo período. Osresultados mostraram que a maioria dos pacientes foi classificada como cuidados mínimos ou intermediários, sendopreocupante o número de pacientes classificados como cuidados semi-intensivos e intensivos nas unidades de internação.São sugeridas algumas modificações no instrumento utilizado.

Influència dels serotips dels Streptococcus pneumoniae en l’evolució clínica de les pneumònies.

Estudi retrospectiu en el que es descriuen les característiques clíniques de pacients adults amb pneumònia causada per Streptococcus pneumoniae aïllats en mostres invasives i la influència dels serotips amb elevada capacitat de causar malaltia invasiva en l'evolució clínica d’aquestes. Es divideixen en 2 grups: en el grup E s’inclouen pacients infectats amb serotips amb elevada capacitat invasiva i en el grup X s’engloba a la resta. Els pacients del grup E són més joves i la mortalitat d’aquest grup és significativament més baixa (p = 0,022). No es troben diferències entre els grups en relació a comorbiditats i evolució clínica.

Evaluación de la situación del Síndrome de Burnout, Reactividad al Estrés y Calidad de Vida Profesional de los residentes de Anestesiología, Reanimación y Terapéutica del Dolor en Cataluña

Tanto el estrés cómo el Síndrome de Burnout, condicionados por factores demográficos, económicos, sociales y profesionales, afectan especialmente al colectivo médico y sobretodo a residentes. Se recogieron 154 residentes de Anestesiología que cumplimentaron tres cuestionarios : Malasch Burnout Inventory, índice de Reactividad al Estrés y Calidad de Vida Profesional. El 49,3% presentó Agotamiento Emocional alto y el 53,3% alta Despersonalización, presentando Burnout el 66,4%. El 47,9% tenía un Probable Trastorno de Estrés, y su valoración global de Calidad de Vida Profesional fue del 6,17 en una escala del 1 al 10. La incidencia de Burnout entre los residentes de Anestesiología de Cataluña es elevada, y casi la mitad de ellos probablemente padecen un trastorno de estrés.