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The anti-Müllerian hormone triggers the regression of uterus and fallopian tubes in male embryos; if there are problems in the synthesis or action of this protein, Müllerian structures persist in an otherwise phenotypic male. The most frequent clinical presentation of Persistent Mullerian Duct syndrome is cryptorchidism and inguinal hernia. The few cases reported in adults are incidental findings or inguinal hernias. However, we present an adult male with history of bilateral cryptorchidism with unsuccessful orchidopexy, who presents with a large abdominal mass with the finding of a seminomatous tumor and persistence of Müllerian structures, in whom the variant c.916delC (p.Leu306Cysfs*29) in the AMHR2 gene not previously reported was documented.

Background Overcrowding of the Emergency Department is rapidly becoming a global challenge and a major source of concern for emergency physicians. The desire to improve Emergency Department throughput requires novel approaches to patient flow. Materials and methods We conducted a prospective and cluster-randomized study, to evaluate the impact in patient outcomes of a new patient flow based on Point-of-Care Testing (POCT). A total of 380 Emergency Severity Level-3 patients were enrolled and studied in two different groups, interventional arm (laboratory analyses performed on POCT analyzers implemented in the Emergency Department) or control arm (central laboratory). The primary outcome was the Emergency Department length of stay. Secondary outcome included the time to first medical intervention, the laboratory turnaround time and the time to disposition decision. Readmission within the 7 days after discharge was also calculated. Results Length of stay significantly decreased by 88.50 min (from 247.00 to 158.50), time to disposition decision by 89.00 min (from 192.00 to 103.00) and laboratory turnaround time by 67.11 min (from 89.84 to 22.73) in the POCT group. No increase in readmission was found. Conclusion Our strategy based on POCT represents a good approach to optimize patient flow in the Emergency Department and it should be seen as a starting point for further studies focusing on improving throughput.

International audience; Efforts to maintain and enhance reservoir permeability in geothermal systems can contribute to sourcing more sustainable energy, and hence to lowering CO 2 emissions. The evolution of permeability in geothermal reservoirs is strongly affected by interactions between the host rock and the fluids flowing through the rock's permeable pathways. Precipitation of secondary mineral phases, the products of fluidrock interactions, within the fracture network can significantly reduce the permeability of the overall system, whereas mineral dissolution can enhance reservoir permeability. The coupling between these two competing processes dictates the long-term productivity and lifetime of geothermal reservoirs. In this study, we simulate the conditions within a geothermal system from induced fracturing to the final precipitation stage. We performed batch and flow-through experiments on cores of the Carnmenellis granite, a target unit for geothermal energy recovery in Cornwall (UK), to understand the role of mineral dissolution and precipitation in controlling the permeability evolution of the system. The physico-chemical properties of the cores were monitored after each reaction-phase using ICP-OES, SEM, hydrostatic permeability measurements, and X-ray Computed Tomography. Results show that permeability evolution is strongly dependent on fluid chemistry. Undersaturated alkaline fluids dissolve the most abundant mineral phases in granite (quartz and feldspars), creating cavities along the main fractures and generating pressure-independent permeability in the core. Conversely, supersaturated alkaline fluids, resulting from extended periods of fluid-rock interactions, promote the precipitation of clay minerals, and decrease the permeability of the system. These results suggest that chemical dissolution during geothermal operations could generate permeable pathways that are less sensitive to effective stress and will remain open at higher pressures. Similarly, maintaining the circulation of undersaturated fluids through these granitic reservoirs can prevent the precipitation of pore-clogging mineral phases and preserve reservoir permeability in granite-hosted geothermal systems.

Introduction The midregional fragment of proadrenomedullin (MR-proADM) is known to provide accurate short-, mid- and long term prognostic information in the triage and multi-dimensional risk assessment of patients in the emergency department (ED). In two independent observational cohorts MR-proADM values identified low disease severity patients without risk of disease progression in the ED with no 28 days mortality that wouldn´t require hospitalization. In this interventional study we want to show that the combination of an MR-proADM algorithm with clinical assessment is able to identify low risk patients not requiring hospitalization to safely reduce the number of hospital admissions. Methods A randomized-controlled interventional multicenter study in 4 EDs in Spain. The study protocol was approved by Ethics Committees. Control arm patients received Standard Care. MR-proADM guided arm patients with low MR-proADM value (≤0.87 nmol/L) were treated as out-patients, with high MR-proADM value (>0.87 nmol/L) were hospitalized. The hospitalization rate was compared between the study arms. Results Two hundred patients with suspicion of infection were enrolled. In the MR-proADM guided arm the hospital admission rate in the intention-to-treat (ITT) population was 17% lower than in the control arm (40.6% vs. 57.6%, p=0.024) and 20% lower in the per protocol (PP) population (37.2% vs. 57.6%, p=0.009). No deaths of out-patients and no significant difference for the safety endpoints readmission and representation rates were observed. The readmission rate was only slightly higher in the MR-proADM guided arm compared to the control arm (PP population: at 14 days 9.3% vs. 7.1%, difference 2.1% (95% CI: -11.0% to 15.2%); and at 28 days 11.1% vs. 9.5%, difference 1.6% (95% CI: -12.2% to 15.4%)). The rate of 28 days representation was slightly lower in the MR-proADM guided arm compared to the control arm (20.4% vs. 26.2%, difference -5.8% (95% CI: -25.0% to 13.4%); PP population). Conclusions Implementing a MR-proADM algorithm optimizes ED workflows efficiently and sustainably. Hospitals can highly benefit from a reduced rate of hospitalizations by 20% using MR-proADM. The safety in the MR-proADM guided study arm was similar to the Standard Care arm. Trial registration ClinicalTrials.gov Identifier NCT03770533

Introducción La obesidad afecta diversos aspectos físicos, psicológicos y sociales. Recientemente se ha comenzado a estudiar su relación con la función sexual y el efecto de las intervenciones dirigidas a reducir el peso. Objetivo Describir los cambios inducidos por la cirugía bariátrica en la función sexual en un grupo de pacientes obesos. Métodos Estudio observacional prospectivo de pacientes con obesidad mórbida, intervenidos con cirugía bariátrica. Se evaluó la función sexual en hombres con el cuestionario abreviado de función sexual (SHIM) y la encuesta de autoestima y relaciones (SEAR), y en mujeres con el Índice de función sexual femenina (IFSF). La calidad de vida se evaluó con el cuestionario SF-12. Se utilizaron pruebas estadísticas no paramétricas. Resultados Se incluyeron 19 pacientes, 13 mujeres con un promedio de edad de 45,3 años (22–59) y 6 hombres con un promedio de 41 años (36–54). El seguimiento promedio fue de 19 meses (13,1–25,9). Para el IFSF, todos los dominios demostraron mejoría, aunque la variable deseo fue la única en la que se obtuvo una diferencia estadísticamente significativa (p = 0.027). Los puntajes obtenidos con la escala SHIM, demuestran disminución en la severidad de la disfunción eréctil de 16,8 (8–21) a 22,16 (18–25) (p = 0,059). En calidad de vida, tanto mujeres como hombres reportaron un incremento estadísticamente significativo (p = 0.036 y p = 0.002, respectivamente). Conclusiones La cirugía bariátrica tiene un impacto altamente favorable en la calidad de vida y cambios positivos en todos los dominios de la función sexual de hombres y mujeres. Es posible que esos cambios se vean influidos por variables físicas y psicosociales que deben medirse con investigaciones futuras.

Resumen Introduccion La prevalencia de la infeccion por Helicobacter pylori afecta casi al 50% de la poblacion mundial, siendo un factor de riesgo para enfermedades benignas y malignas gastrointestinales. El aumento de la resistencia al tratamiento antibiotico contra esta infeccion ha presentado un dilema en el abordaje de otras alternativas en la terapeutica. Objetivo Determinar la eficacia del suplemento de vitaminas C y E anadido al tratamiento antibiotico en la erradicacion de la infeccion por H. pylori . Metodos Se realizo una revision sistematica en las bases de datos de MedLine, Embase y Cochrane Central Register of Clinical Trials (CENTRAL), para estudios que evaluaran la eficacia del suplemento de vitaminas C y/o E en el tratamiento antibiotico de infeccion por H. pylori . El resultado principal fue erradicacion de la infeccion y el secundario fueron efectos adversos. El metaanalisis fue elaborado mediante el metodo de efectos aleatorios. Resultados Se incluyeron 10 estudios y se hicieron 2 grupos. El primero comparo el uso de suplemento de vitaminas C y E incluyendo 973 pacientes, en el cual sin discriminar el numero de antibioticos no se obtuvo una relacion con la erradicacion de la infeccion (OR: 1,98 [IC95%: 0,92-4,29], p = 0,08). La terapia triple o cuadruple antibiotica no tuvo un efecto sobre la erradicacion (OR: 1,80 [IC95%: 0,64-5,08], p = 0,26, y OR: 2,84 [IC95%: 0,51-15,56], p = 0,22, respectivamente). En el grupo en que solo se evaluo el uso de vitamina C se incluyeron 702 pacientes, pero no se obtuvo un efecto sobre la erradicacion (OR: 1,17 [IC95%: 0,58-2,31], p = 0,65). Los efectos adversos solo fueron reportados en 4 estudios, siendo el mas frecuente las nauseas. Conclusiones El suplemento de vitaminas C y E en la terapia antibiotica contra H. pylori no tuvo ningun efecto. Sin embargo, los estudios presentaron bastantes sesgos y diferencias en la posologia de los suplementos y antibioticos.

espanolIntroduccion: en los ultimos anos, el aumento de cepas resistentes a los antimicrobianos puede deberse a su uso indiscriminado y excesivo. La Organizacion Mundial de la Salud (OMS) ha promovido la vigilancia mundial de la resistencia a los antimicrobianos; sin embargo, la mayor limitante es la falta de datos confiables en algunos paises. Estudios como el Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR), de 2009 y 2013, y el Tracking Resistance in the United States Today (TRUST) refieren que el microorganismo mas prevalente en infecciones en el mundo es el Staphylococcus aureus y un alto porcentaje son Staphylococcus aureus meticilino resistente (SAMR), que son de gran importancia para la salud publica por su alta resistencia a los antimicrobianos. Objetivo: identificar los principales perfiles de resistencia antimicrobiana de bacterias aisladas de infecciones o de la microbiota ocular. Metodos: revision sistematica de la literatura en las bases de datos EBSCOhost: Academic Search, Medline, ScienceDirect, Web of Science, Springer, PubMed y Google Academic, con las palabras clave ocular, antimicrobial y resistance, entre 2010 y 2017. Resultados: se analizaron 30 articulos de los ultimos siete anos sobre resistencia antimicrobiana. En la mayoria de paises predomino el genero Staphylococcus (S. aureus, 45 %; ECN, 37 %), Pseudomona (8 %) y Streptococcus (7 %). Los porcentajes mas bajos fueron de Corynebacterium (2 %) y Klebsiella (1 %). Conclusiones: la mayoria de los aislados del globo ocular reportados en el contexto mundial presentan resistencia a los betalactamicos. El incremento en la resistencia a estos antibioticos implica un grave problema terapeutico en el ambito hospitalario. EnglishIntroduction: the increase in strains resistant to antimicrobials in recent years may be due to their indiscriminate and excessive use. The World Health Organization (WHO) has promoted global surveillance of antimicrobial resistance; however, the biggest limitation is a lack of reliable data in some countries. Studies such as the Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR) (2009 and 2013) and the Tracking Resistance in the United States Today (TRUST) report that the most prevalent microorganism in infections worldwide is Staphylococcus aureus, with a high percentage of Methicillin-resistant Staphylococcus aureus (MRSA), which are of great importance for public health due to their high resistance to antimicrobials. Objetive: To identify the main antimicrobial resistance profiles of bacteria isolated from infections or from ocular microbiota. Methods: A systematic review of literature in EBSCOhost databases: Academic Search, Medline, ScienceDirect, Web of Science, Springer, PubMed, and Google Academics, with keywords such as ocular, antimicrobial, and resistance, between 2010 and 2017. Results: 30 articles on antimicrobial resistance from the last seven years were analyzed. In most countries, the genus Staphylococcus (S. aureus, 45%, NEC, 37%), Pseudomonas (8%) and Streptococcus (7%) were predominant. The lowest percentages were Corynebacterium (2%) and Klebsiella (1%). Conclusions: Most of the ocular isolates reported in the global context show resistance to beta-lactams. Increased resistance to these antibiotics implies a serious therapeutic problem in the hospital setting.

La porencefalia como lesión cerebral es una entidad que por el gran compromiso encefálico genera déficits motores y conductuales afectando el normal desarrollo de niños, siendo este el grupo poblacional principalmente afectado; quienes desde muy temprana edad presentan manifestaciones clínicas, sin embargo en algunos casos excepcionales tienden a cursan asintomáticos o con mínimas secuelas motoras que pueden retrasar su diagnóstico; campo en que las técnicas de imagen llegan a ser fundamentales. Se presenta aquí el primer caso de porencefalia reportado en Boyacá a la edad adulta sin antecedentes que sugieran su diagnóstico o algún manejo instaurado a la misma, la cual termina complicándose dejando varias secuelas.

Objectives In this study we aim to compare UX2000 (Sysmex Corp, Japan) and SediMAX/AutionMax (Arkray Factory Inc., Japan), totally automatized analyzers, against Fuchs-Rosenthal counting chamber, the gold standard technique for sediment analysis. Design and methods Urine samples of 1454 patients from three Spanish hospitals were assessed for red and white blood cells (RBC; WBC) using three different techniques: flow cytometry, image-based method and Fuchs-Rosenthal counting chamber. Test strip results were subjected to concordance evaluation. Agreement was assessed by Cohen's weighted kappa for multinomial results. Sensitivity (SE) and specificity (SP) were calculated. Results The categorization of the results showed that UX-2000 had higher concordance over SediMAX for WBC (0.819 vs. 0.546) and similar for RBC (0.573 vs. 0.630). For RBC, UX-2000 had higher SE (92.7% vs. 80.3%) but lower SP (77.1% vs. 87.4%), and showed higher both SE (94.3% vs. 76.7%) and SP (94.7% vs. 88.2%) for WBC. Inter-devices test strip agreement was substantial (kappa > 0.600) for all variables except for bilirubin (kappa: 0.598). Intra-device test strip agreement was similar for UX2000 and SediMAX with regard to RBC (kappa: 0.553 vs. 0.482) but better for UX2000 with regard to WBC (0.688 vs. 0.465). Conclusions Both analyzers studied are acceptable for daily routine lab work, even though SediMAX is easier to use in laboratories thanks to its lower maintenance procedure. UX-2000 has shown to have better concordance with the gold standard method. However, it needs some improvements such as an image module in order to decrease manual microscopy review for urine samples.

The purpose of this study was to evaluate early changes in myocardial function in overweight and obese children without hypertension.This was a cross-sectional study involving 150 participants of both sexes between 6 and 15 years old. Anthropometric and biochemical evaluations were performed. Ventricular function was assessed by conventional echocardiographic methods and myocardial deformation analysis by two-dimensional speckle tracking echocardiography. One-way analysis of variance was employed for the global comparison of study variables between groups (children with normal weight, overweight, and obesity), and post hoc analysis with Bonferroni correction was used for multiple comparisons, considering normal weight children as the reference category.Overall, 142 participants were included, 50 (35%) with normal weight, 39 (28%) overweight, and 53 (37%) obesity. The diastolic diameter of the left ventricular and interventricular septum, and diameter of the left atrium and LV mass were significantly higher in children with obesity compared to those with normal weight. No significant differences in the conventional indicators of LV systolic and diastolic function were found between groups. Significant differences in the regional myocardial deformation between the three groups were observed. Mean global longitudinal myocardial deformation was smaller in patients with obesity (-20.9% vs. -23.5%, p0.05) compared to children with normal weight.The childhood obesity was associated with altered myocardial deformation, even in the presence of normal ejection fraction. Myocardial deformation evaluation is relevant in the assessment of pediatric patients with obesity.El propósito de este estudio fue evaluar los cambios tempranos en la función miocárdica en niños con sobrepeso y obesidad, sin hipertensión arterial.Estudio transversal en el que se incluyeron 150 participantes de ambos sexos entre 6 y 15 años. Se realizaron evaluaciones antropométricas, bioquímicas y de función ventricular mediante métodos ecocardiográficos convencionales y análisis de deformación miocárdica con ecocardiografía bidimensional speckle tracking. La comparación global entre los grupos de estudio (niños con peso normal, sobrepeso y obesidad) se llevó a cabo con la prueba de análisis de varianza (ANOVA) de una vía y análisis post hoc con corrección de Bonferroni para las comparaciones múltiples, y se consideró a los niños con peso normal como grupo de referencia.La muestra final fue de 142 participantes, 50 (35%) con peso normal, 39 (28%) con sobrepeso y 53 (37%) con obesidad. El diámetro diastólico del ventrículo izquierdo (VI) y el septum interventricular, y el diámetro de la aurícula izquierda (AI) y la masa del VI fueron significativamente más altos en el grupo con obesidad en comparación con el grupo con peso normal. No se observaron diferencias significativas en los indicadores convencionales de la función sistólica y diastólica ventricular izquierda. Se observaron diferencias significativas en la deformación miocárdica regional entre los tres grupos. La media de deformación miocárdica longitudinal global fue más baja en los pacientes con obesidad (−20.9% vs. −23.5%; p0.05) en comparación con los niños con peso normal.La obesidad infantil se asoció a alteraciones en la deformación miocárdica, incluso en presencia de fracción de expulsión normal. La evaluación de la deformación miocárdica es relevante en los pacientes pediátricos con obesidad.

espanolIntroduccion: La prevalencia de complicaciones cronicas y comorbilidades en pacientes con diabetes tipo 2 (DT2) se han incrementado en el mundo. Objetivo: Comparar la prevalencia de complicaciones y comorbilidades cronicas en pacientes con DT2 en 36 unidades de medicina familiar de cinco delegaciones del Instituto Mexicano del Seguro Social (IMSS). Metodos: Conforme los codigos de la Decima Revision de la Clasificacion Internacional de Enfermedades se identificaron las complicaciones (hipoglucemia, pie diabetico, enfermedad renal, retinopatia, enfermedad cardiaca isquemica, enfermedad cerebrovascular y falla cardiaca) y comorbilidades (enfermedad hepatica, cancer, anemia) de DT2. Se compararon por delegacion, edad, sexo y tiempo de evolucion. Resultados: Las complicaciones y comorbilidades fueron mas comunes en personas ≥ 62 anos. De 297 100 pacientes, 34.9 % presento cualquier complicacion; microvasculares en el norte industrial (32 %), macrovasculares en el este rural (12.3 %) y comorbilidades (5 %) en el sur de la Ciudad de Mexico; estas complicaciones predominaron en los hombres (cualquier complicacion 30.2 %). La falla cardiaca y las comorbilidades fueron mas comunes en mujeres (5.6 y 4.9 %). Conclusiones: Las complicaciones y comorbilidades de DT2 mostraron diferencias geograficas y de sexo y fueron mayores con la edad y el tiempo de evolucion. Urge reforzar estrategias para la prevencion de las complicaciones y comorbilidades en los pacientes con DT2. EnglishIntroduction: The prevalence of chronic complications and comorbidities in patients with type 2 diabetes (T2D) has increased worldwide. Objective: To compare the prevalence of complications and chronic comorbidities in patients with T2D at 36 family medicine units of five chapters of the Mexican Institute of Social Security (IMSS). Method: Complications (hypoglycemia, diabetic foot, kidney disease, retinopathy, ischemic heart disease, cerebrovascular disease and heart failure) and comorbidities (liver disease, cancer and anemia) were identified according to codes of the International Classification of Diseases, 10th Revision. Comparisons were made by chapter, age, gender and evolution time. Results: Complications and comorbidities were more common in subjects aged ≥ 62 years. Out of 297 100 patients, 34.9 % had any complication; microvascular complications (32 %) prevailed in the industrial North, whereas macrovascular complications (12.3 %) did in the rural East, and comorbidities (5 %) in southern Mexico City. Complications predominated in men (any complication, 30.2 %). Heart failure and comorbidities were more common in women (5.6 % and 4.9 %, respectively). Conclusions: T2D complications and comorbidities showed geographic and gender differences, and were greater with older age and longer evolution time. It is urgent for strategies for the prevention of complications and comorbidities to be reinforced in patients with T2D.

La enfermedad de Kawasaki (EK) es una vasculitis sistemica cuya complicacion mas grave es la formacion de lesiones coronarias, las cuales pueden llevar a infarto del miocardio y muerte subita. El estudio ecocardiografico es parte del seguimiento obligado de los pacientes con EK. La deformacion sistolica longitudinal (DSL) medida mediante speckle tracking es una herramienta precisa para evaluar la funcion de la fibra miocardica (longitudinal) del ventriculo izquierdo. No se ha establecido la utilidad en la practica clinica de la DSL en ninos con antecedente de EK. El objetivo de este estudio fue analizar si la presencia de lesiones coronarias condiciona alteraciones en la DSL segmentaria y su correspondencia con el territorio coronario en donde se encuentra la lesion. Metodo Serie de casos. Se realizo un estudio ecocardiografico completo y la evaluacion de la DSL a ninos con antecedente de EK al menos 6 meses despues de la fase aguda. Resultados Se estudiaron 9 pacientes. La mediana de edad fue de 6 anos (minimo 2 y maximo 17). El 56% era de sexo masculino. El 77% presento aneurismas coronarios. La DSL resulto alterada en el 56% de la muestra estudiada. Dentro de los pacientes que presentaron una DSL anormal, todos mostraron aneurismas coronarios y lesiones estenoticas u oclusivas demostradas mediante cateterismo de arterias coronarias, ademas de alteraciones de la perfusion miocardica en estudio de Medicina Nuclear. Conclusiones En la muestra estudiada, los pacientes en quienes se encontro una DSL anormal, resultaron tener lesiones coronarias que condicionaban isquemia o infarto

The aim of this study was to evaluate the association between glycemic control (hemoglobin (Hb) A1c7%) and the dietary patterns identified in Mexican patients with type 2 diabetes mellitus (T2DM).This was a secondary analysis conducted with 4838 patients with T2DM in Mexico. Biochemical blood profiles, socioeconomic level, anthropometric measurements, and dietary data were obtained. Dietary data from a food frequency questionnaire were used to derive dietary patterns. Factor analysis was conducted to ascertain dietary patterns, and multivariate analysis was fitted to assess the relationship between glycemic control and consumption of dietary patterns.Three dietary patterns were identified. After control for potential cofounders (age, sex, duration of T2DM, body mass index, pharmacologic treatment, intensity of physical activity, socioeconomic level, and kcal/kg ideal weight), we found that consuming a Western-style diet (odds ratio [OR], 1.533, 95% confidence interval [CI], 1.253-1.875; P0.000), and the sweets and dairy diet (fats and sugars; OR, 1.444; 95% CI, 1.133-1.841; P = 0.003) patterns were associated with HbA1c ≥7%, whereas consuming a healthy dietary patter (OR, 0.800; 95% CI, 0.642-0.998; P = 0.048) was associated with HbA1c7%.Consuming a healthy diet was associated with glycemic control; whereas the Western-style or sweets and dairy patterns promoted a lack of metabolic control. These results support the promotion of a healthy pattern in the Mexican population with T2DM.

Background We examined whether long-term use of selective digestive tract decontamination (SDD) was effective in reducing intensive care unit (ICU)-acquired infection and antibiotic consumption while decreasing colistin-, tobramycin-, and most of the antibiotic-resistant colonization rates in a mixed ICU with a high endemic level of multidrug-resistant bacteria (MDRB). Methods In this cohort study, which was conducted in a 30-bed medical-surgical ICU, clinical outcomes before (1 year, non-SDD group) and after (4 years) implementation of SDD were compared. ICU patients who were expected to require tracheal intubation for > 48 hours were given a standard prophylactic SDD regimen. Oropharyngeal and rectal swabs were obtained on admission and once weekly thereafter. Results ICU-acquired infections occurred in 110 patients in the non-SDD group and in 258 in the SDD group. A significant (P

The albumin-creatinine ratio is considered an indicator of microalbuminuria, precursor to chronic kidney disease, while HbA1c is used to measure glycemic control. Given the prevalence of diabetes-related nephropathy, spot testing of albumin has long been recommended as a preventative measure, for the timely detection of microalbuminuria. However, many countries do not have this testing available in primary care, and sometimes not even in second- and third-level care. The objective of this study was to compare agreement of the microalbuminuria and HbA1c results obtained in the laboratory with 'gold standard' techniques, with those obtained on site with a 'Point of Care' DCA Vantage™ device by Siemens. Results for the albumin-creatinine ratio and HbA1c from the Siemens DCA Vantage™ point of care device were compared with those from standard laboratory tests in 25 family medicine units in Mexico City and Toluca, State of Mexico, in patients diagnosed with type-2 diabetes. Agreement between the albumin values of the 2 tests was 0.745 (CI 95% 0.655-0.812). Agreement between the two measurement techniques for HbA1c was 0.970 (CI 95% 0.966-0.973). The results obtained were sufficiently comparative (R

Introduction Helicobacter pylori infections affect almost 50% of the world population, constituting a risk factor for benign and malignant gastrointestinal diseases. The increased resistance to antibiotic treatment against this infection represents a dilemma in the search of other therapeutic alternatives. Objective To determine the efficacy of the use of vitamin C and E supplements concomitantly to antibiotic treatment against H. pylori infections. Methods We performed a systematic review on the MedLine (PubMed), Embase and Cochrane Central Register of Clinical Trials (CENTRAL) databases, searching for studies evaluating the efficacy of vitamin C and/or E supplements in the antibiotic treatment of H. pylori infections. The primary outcome was eradication of the infection. The secondary outcome was the adverse effects. The meta-analysis was conducted using the random effects method. Results Ten studies were included and analyzed in two groups. The first group, which was comprised by 973 patients, compared the use of supplementation with vitamin C and E, showing that, without discriminating the number of antibiotics used, there was no relationship with the eradication of the infection (OR: 1.98 [95% CI: 0.92–4.29], p = 0.08). The triple or quadruple antibiotic therapy had no effect on eradication rates either (OR 1.80 [95% CI: 0.64–5.08], p = 0.26 and OR: 2.84 [95% CI: 0.51–15.56], p = 0.22, respectively). No effect on the eradication rates was observed either in the group that only assessed the use of vitamin C, comprised by 702 patients (OR: 1.17 [95% CI: 0.58–2.31], p = 0.65). Only four studies reported adverse effects, the most common one being nausea. Conclusions Supplementation with vitamin C and E in the antibiotic treatment against H. pylori has no effect. However, the reviewed studies had several biases and differences in the dosage of the supplements and antibiotics administered.

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe"). Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799 Publisher PDF

Resumen Introduccion y objetivos La neuromodulacion de raices sacras (NMS) es un procedimiento empleado para el manejo de trastornos del funcionamiento urinario, intestinal y sexual. Hablando de trastornos sexuales, hay algunos datos que sugieren beneficios en disfuncion erectil y muy poca evidencia en trastornos de la eyaculacion. El reporte de este caso tiene como objetivo revisar la teoria acerca del funcionamiento y las indicaciones de la NMS con el fin de plantear una hipotesis acerca del mecanismo por el cual respondio este paciente, y sugerir la NMS como una alternativa en el manejo de la aneyaculacion refractaria al tratamiento farmacologico. Materiales y metodos Recoleccion de la historia clinica desde el ingreso en el Hospital Universitario San Ignacio. Se realizo una busqueda bibliografica en Medline y Ovid, sin limites de idioma ni diseno, en los ultimos 10 anos. Los terminos MESH usados fueron: “sacral plexus”, “sacral region”, “ejaculation”, “neurobiology”, “spinal cord stimulation”, “transcutaneous electric nerve stimulation”; tambien se utilizo un termino no MESH: “neuromodulation”. Resultados Se trata del primer reporte de un caso de aneyaculacion secundaria a manipulacion del area pelvica durante la reseccion de neurogangliomas en un paciente joven con vida sexual previa normal, tratado exitosamente con NMS. La NMS es un procedimiento cuyo mecanismo de accion se desconoce; es posible que la estimulacion electrica de las aferencias permita la modulacion de los reflejos medulares restaurando el equilibrio entre la inhibicion y la activacion a nivel central. Ha sido usado en el manejo de alteraciones urinarias, intestinales, sexuales y nerviosas. Basada en esta respuesta positiva, nuestra hipotesis consiste en que el procedimiento quirurgico altero la transmision de senales eferentes de los nervios pelvicos. Con la terapia neuromoduladora en las raices sacras, se logro la regulacion de los reflejos medulares al facilitar la transmision de senales eyaculatorias mediadas por serotonina y noradrenalina trasportadas por los nervios pelvicos y pudendos. Conclusiones La NMS se presenta como una alternativa en el manejo de la aneyaculacion a pesar de que falta evidencia que soporte la estandarizacion del procedimiento. © 2012 Sociedad Colombiana de Urologia. Publicado por Elsevier Espana, S.L. Todos los derechos reservados.

Objectives A better glycemic monitoring of diabetic patients and avoiding complications of poorly controlled diabetes could be possible with point-of-care testing technology (POCT) for HbA1c determination. B-Analyst® was studied to check whether it complied with the quality requirements for this purpose. Design and methods We evaluated the B-Analyst® (Menarini Diagnostics), which is based in the principle of latex agglutination immunoturbidimetry, to assess the validity of the technique of HbA1c. We carried out the method comparison with the HA-8180® (Menarini Diagnostics) as a reference method [High Performance Liquid Chromatography (HPLC)]. We assessed the analytical quality of the B-Analyst® studying the accuracy: inter-assay variability and intra-assay study. Furthermore, possible interferences by hemoglobinopathies were studied. Results Regression analysis of the data for the method comparison between HA-8180® and B-Analyst® showed a slope of 1.0085 and an intercept of 0.1208. The Pearson's correlation coefficient was 0.9958 (p Bias study showed a mean difference from B-Analyst® with respect to HA-8180® of 0.1872 with a 95% confidence interval. The standard error of the estimate (S yx ) was 0.2091. The concordance correlation coefficient to assess accuracy was 0.9922 (0.9891–0.9945). The CV for the inter-assay study was 1.4%. For the intra-assay study we analyzed 3 samples with different HbA1c % whose CV were 1.03% [4.7% HbA1c (28 mmol/mol)], 0.46% [6.4% HbA1c (46 mmol/mol)] and 0.78% [8.1% HbA1c (65 mmol/mol)]. Conclusion The B-Analyst® evaluated not only showed good correlation with HA-8180®, but also it presented a great accuracy both in the inter-assay and in the intra-assay studies. The B-Analyst® complies with quality specifications required for monitoring of diabetic patients.

ResumenObjetivoDescribir la incidencia de neumonía por Pneumocystis (PCP) en pacientes con síndrome de inmunodeficiencia adquirida hospitalizados en el Hospital La María de Medellín durante 2008–2009.IntroducciónEl Pneumocystis jirovecii (P. jirovecii) es un hongo oportunista que produce enfermedad pulmonar en personas inmunosuprimidas, principalmente por el virus de la inmunodeficiencia humana (VIH). Es la segunda enfermedad definitoria del síndrome de inmunodeficiencia adquirida en países desarrollados, luego de la candidiasis esofágica, y la principal causa de ingreso a la unidad de cuidado intensivo en esta población. Su incidencia varía según la población estudiada y el método diagnóstico utilizado.Materiales y métodosSe realizó un estudio observacional, descriptivo, retrospectivo, mediante la revisión manual de 218 historias clínicas de todos los pacientes hospitalizados en el Hospital La María de Medellín con diagnóstico de infección por VIH desde enero de 2008 hasta diciembre de 2009. Se incluyeron pacientes VIH positivos con diagnóstico confirmado de PCP por tinción de plata metenamina en muestra de lavado broncoalveolar.ResultadosSe encontró una incidencia de PCP de 11,9% (26 pacientes); el 61,5% fueron hombres y el 38,5% mujeres, la edad promedio fue 33,1 años (21–49), fue la enfermedad definitoria de síndrome de inmunodeficiencia adquirida en 5 pacientes (19,2%), el 15,2% era desconocedor de su condición de infección por VIH, el 92,3% no se encontraban recibiendo profilaxis contra PCP y el 76,9% no recibían terapia antirretroviral altamente efectiva. Ingresaron a la unidad de cuidado intensivo 6 pacientes (23,1%), de los cuales, 3 fallecieron. La mortalidad general fue del 11,5%. El recuento promedio de linfocitos T CD4 fue de 60 células/μL. En el 47,88% de los pacientes, la presentación clínica fue de curso subagudo, con 2 semanas de evolución de la sintomatología. Entre los síntomas más frecuentes al ingreso fueron tos (96,2%), disnea (96,2%) y taquipnea (96,2%) con hipoxemia (presión arterial de oxígeno < 70mmHg) en el 49,5%. Can-didiasis orofaríngea se presentó concomitantemente en 18 pacientes (69,2%), y tuberculosis en 19,2%. El 77% de los pacientes recibió trimetoprim/sulfametoxazol como terapia, acompañada de corticosteroides en el 46,2%.ConclusionesLa PCP es una de las principales infecciones oportunistas en pacientes con VIH en nuestro medio y asociada al diagnóstico tardío de infección por VIH.AbstractObjectivesTo describe the incidence of Pneumocystis pneumonia (PCP) in patients with AIDS, hospitalized in the Hospital La María in Medellín, Colombia during 2008–2009. Pneumocystis jirovecii (P. jirovecii) is an opportunistic fungus that compromises the pulmonary tract mainly in immunosuppressed individuals infected with the human immunodeficiency virus (HIV). It is one of the principal defining illnesses for Acquired Immune Deficiency Syndrome (AIDS) in developed countries after esophageal candidiasis, and the main cause of admission to the intensive care unit (ICU) in this population. Its incidence varies based on the population stud-ied and diagnostic method used.MethodsWe performed an observational, descriptive, retrospective study that involved manual analysis of 218 medical records of all the patients admitted with AIDS between January 2008 and December 2009. All patients had a confirmed diagnosis of PCP using a lung sample taken with bronchoalveolar lavage (BAL), stained with methenamine silverResultsThis study found a PCP incidence of 11.9% (26 patients), 61.5% were men and 38,5% women, the mean age was 33.1 years (21–49). It was the AIDS-defining illness in 5 patients (19.2%), and 15.2% of the population did not know they were HIV-infected, 92.3% had not received prophylaxis for PCP, and 76.9% were not receiving HAART. Six patients were admitted to the ICU (23.1%), and three of them died. The overall mortality was 11.4% (3 patients). The mean CD4 T lymphocyte count was 60 cells/μL. According to the clinical presentation, 47.88% of the patients presented with a subacute course (2 weeks of symptoms). The most frequent symptoms of admission were cough (96.2%), dyspnea (96.2%) and tachypnea (96.2%), with hypoxemia (PaO2

Objectives: To define which variables upon ICU admission could be related to the presence of coinfection using CHAID (Chi-squared Automatic Interaction Detection) analysis. Methods: A secondary analysis from a prospective, multicentre, observational study (2009 -2014) in ICU patients with confirmed A(H1N1)pdm09 infection. We assessed the potential of biomarkers and clinical variables upon admission to the ICU for coinfection diagnosis using CHAID analysis. Performance of cut-off points obtained was determined on the basis of the bi-nominal distributions of the true (+) and true (-) results. Results: Of the 972 patients included, 196 (20.3%) had coinfection. Procalcitonin (PCT; ng/mL 2.4 vs. 0.5, p < 0.001), but not C-reactive protein (CRP; mg/dL 25 vs. 38.5; p = 0.62) was higher in patients with coinfection. In CHAID analyses, PCT was the most important variable for coinfection. PCT < 0.29 ng/mL showed high sensitivity (Se = 88.2%), low Sp (33.2%) and high negative predictive value (NPV = 91.9%). The absence of shock improved classification capacity. Thus, for PCT < 0.29 ng/mL, the Se was 84%, the Sp 43% and an NPV of 94% with a post-test probability of coinfection of only 6%. Conclusion: PCT has a high negative predictive value (94%) and lower PCT levels seems to be a good tool for excluding coinfection, particularly for patients without shock. (C) 2015 The British Infection Association. Published by Elsevier Ltd. All rights reserved.