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The emergence of algorithmic tools and Artificial Intelligence and their use in criminal justice has raised a relevant theoretical and political debate. This article unpacks and synthesizes the debate on the role of causality for the scientific method to analyze predictive decision support systems, their practical value and epistemic problems. As a result of this discussion, it is argued that the measured usage of theory and causation-based algorithms is preferable over correlational (i.e., causally opaque) algorithms as support tools in the penal system. At the same time, the usage of the latter is supported when it is critically accompanied by abductive reasoning. Finally, the arguments put forth in this article suggest that the field of criminology needs a deeper epistemological understanding of the scientific value of data-driven tools in order to entertain a serious debate on their use.

This clinical quandary details a Mexican man, aged 77 years, who presented to the oncology clinic with a sternal mass. Based on the results, the patient fulfilled the 2016 American College of Rheumatology/European League Against Rheumatism classification criteria for Sjögren syndrome, thus the diagnosis triggered by immune checkpoint inhibitors was definitively established.

A previously healthy woman, aged 32 years, presented to the oncology clinic with a 6-month history of left-breast tumor, mastalgia, and swollen axillary nodes. Physical examination was relevant for a 6-cm palpable mass in the upper outer quadrant of the left breast and an ipsilateral 2-cm, nonfixed axillary lymph node. Mammography showed a 1-cm mass in the upper outer quadrant, a 5.2-cm mass in the lower outer quadrant, and enlarged pathologic lymph nodes (BI-RADS category 5 disease). Breast ultrasound revealed 3 axillary lymph nodes with cortical thickening and loss of normal morphology (the largest with a 2.6-cm length in the long axis) (Figure 1A-B). The breast's core biopsy revealed a grade 3 apocrine invasive carcinoma with lymphovascular invasion; immunohistochemistry testing showed HER2-negative, hormone receptor-negative disease (estrogen receptor, 0%; progesterone receptor, 0%; HER2-negative, Ki67, 50%) (Figure 2A-B). A fine-needle aspiration biopsy of the axillary lymph nodes showed invasive breast carcinoma as well. Bone scintigraphy and a chest/abdomen CT scan ruled out metastatic disease. Upon initial diagnosis, clinical stage was deemed as cT3N1M0 (American Joint Committee on Cancer 8th edition: anatomic stage IIIA, clinical prognostic stage IIIC). After a multidisciplinary tumor board discussion, the patient underwent neoadjuvant chemotherapy with weekly paclitaxel, followed by 4 cycles of dosedense doxorubicin plus cyclophosphamide. After completing neoadjuvant treatment, clinical examination was relevant for a residual 1-cm palpable left breast mass and no palpable axillary nodes. Mammography and breast ultrasound showed a 77% partial response in the primary tumors, and axillary nodes with normal morphology and size (Figure 1C-D). Due to multicentric tumor disease, breast-conserving surgery would not confer satisfactory cosmetic results on her, and a modifi ed radical mastectomy with intraoperative sentinel lymph node biopsy (and second-stage breast reconstruction) was planned. However, during surgery, the surgeons failed to identify the mapped lymph node, and level I-III axillary lymph node dissection was performed. The pathology report described complete pathological response: Miller and Payne criteria grade 5 response with the absence of malignant cells within the mastectomy specimen and in 24 lymph nodes (Figure 2C-E). Pathological staging after neoadjuvant treatment concluded ypT0N0M0 disease. Subsequent treatment for this patient was discussed in another tumor board.

En este artículo se presenta un método educativo que permite unir funciones elementales. Se propone graficar funciones tipo piecewise por medio de una función graficadora que utiliza ventanas. En este caso, la ventaja es que tanto docentes y alumnos que no dispongan de conocimientos de programación o de comandos especializados de graficación podrán visualizarlas en el salón de clases mediante un software matemático educativo. Igualmente, se presentan tres casos de estudio en donde se han obtenido buenos resultados.

Childhood hypertrophic cardiomyopathy; Outcomes; Phenotype Miocardiopatía hipertrófica infantil; Resultados; Fenotipo Miocardiopatia hipertròfica infantil; Resultats; Fenotip Background Up to one-half of childhood sarcomeric hypertrophic cardiomyopathy (HCM) presents before the age of 12 years, but this patient group has not been systematically characterized. Objectives The aim of this study was to describe the clinical presentation and natural history of patients presenting with nonsyndromic HCM before the age of 12 years. Methods Data from the International Paediatric Hypertrophic Cardiomyopathy Consortium on 639 children diagnosed with HCM younger than 12 years were collected and compared with those from 568 children diagnosed between 12 and 16 years. Results At baseline, 339 patients (53.6%) had family histories of HCM, 132 (20.9%) had heart failure symptoms, and 250 (39.2%) were prescribed cardiac medications. The median maximal left ventricular wall thickness z-score was 8.7 (IQR: 5.3-14.4), and 145 patients (27.2%) had left ventricular outflow tract obstruction. Over a median follow-up period of 5.6 years (IQR: 2.3-10.0 years), 42 patients (6.6%) died, 21 (3.3%) underwent cardiac transplantation, and 69 (10.8%) had life-threatening arrhythmic events. Compared with those presenting after 12 years, a higher proportion of younger patients underwent myectomy (10.5% vs 7.2%; P = 0.045), but fewer received primary prevention implantable cardioverter-defibrillators (18.9% vs 30.1%; P = 0.041). The incidence of mortality or life-threatening arrhythmic events did not differ, but events occurred at a younger age. Conclusions Early-onset childhood HCM is associated with a comparable symptom burden and cardiac phenotype as in patients presenting later in childhood. Long-term outcomes including mortality did not differ by age of presentation, but patients presenting at younger than 12 years experienced adverse events at younger ages. This work was supported by the British Heart Foundation (grant FS/16/72/32270) to Drs Norrish and Kaski. This work is (partly) funded by the National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre. Dr Norrish is supported by Great Ormond Street Hospital Children’s Charity. Drs Field and Kaski are supported by Max’s Foundation and Great Ormond Street Hospital Children’s Charity. Dr Kaski is supported by a Medical Research Council–National Institute for Health Research Clinical Academic Research Partnership award. This work was financially supported by the Foundation for Paediatric Research of Finland (Dr Ojala). Dr Fernandez has received speaker fees from Sanofi-Genzyme. Dr Kubus is supported by MH CZ – DRO, Motol University Hospital (00064203). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Resumen: Se presenta un caso clínico de ALCAPA neonatal con disfunción ventricular izquierda grave e insuficiencia mitral moderada. El paciente tuvo una buena evolución postoperatoria. A pesar de necesitar soporte en oxigenación por membrana extracorpórea los primeros días del postoperatorio, el paciente recuperó la función ventricular con persistencia de insuficiencia mitral leve al décimo mes postoperatorio. A propósito del caso, se realiza una revisión del síndrome centrándonos en su tratamiento quirúrgico. El síndrome consiste en el nacimiento de la arteria coronaria izquierda desde el tronco de la arteria pulmonar. Una vez que la presión pulmonar del recién nacido comienza a descender de forma fisiológica, se producen fenómenos de isquemia por robo desde el tronco de la arteria pulmonar. Dependiendo del grado de circulación colateral desarrollado desde la coronaria derecha, el paciente presentará isquemia e insuficiencia cardiaca en la infancia o puede pasar desapercibido hasta la edad adulta. Hoy día el tratamiento de elección, especialmente en su presentación infantil, es el reimplante en la aorta. En la gran mayoría de los pacientes se produce la recuperación de la función ventricular izquierda y mejoría o resolución de la insuficiencia mitral preoperatoria en el primer año tras la cirugía. Abstract: The case is presented of neonatal ALCAPA with severe left ventricular dysfunction and moderate mitral regurgitation. The patient had good postoperative course. Despite needing extracorporeal membrane oxigenation support in the first postoperative days, the patient recovered ventricular function with persistence of mild mitral regurgitation 10 months after the surgery. Along with this case, a review is carried out on the syndrome, mainly focusing on the surgical treatment. The syndrome consists of the origin of the left coronary artery from the pulmonary trunk. Once the physiological pulmonary pressure of the newborn falls, ischemia phenomena occur due to steal from the pulmonary trunk. Depending on the level of collateral circulation developed from the right coronary artery, the patient will present with ischaemia and heart failure in childhood, or can go unnoticed until adulthood. The treatment of choice, especially in infantile form, is currently aortic reimplantation. In the vast majority of patients, recovery of left ventricular function and improvement or resolution of preoperative mitral regurgitation occur in the first year after surgery.

Background: Maximal left ventricular wall thickness (MLVWT) is a risk factor for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). In adults, the severity of left ventricular hypertrophy has a nonlinear relationship with SCD, but it is not known whether the same complex relationship is seen in childhood. The aim of this study was to describe the relationship between left ventricular hypertrophy and SCD risk in a large international pediatric HCM cohort. Methods: The study cohort comprised 1075 children (mean age, 10.2 years [±4.4]) diagnosed with HCM (1–16 years) from the International Paediatric Hypertrophic Cardiomyopathy Consortium. Anonymized, noninvasive clinical data were collected from baseline evaluation and follow-up, and 5-year estimated SCD risk was calculated (HCM Risk-Kids). Results: MLVWT Z score was Z scores were associated with heart failure symptoms, unexplained syncope, left ventricular outflow tract obstruction, left atrial dilatation, and nonsustained ventricular tachycardia. One hundred twenty-two patients (71.3%) with MLVWT Z score ≥20 had coexisting risk factors for SCD. Over a median follow-up of 4.9 years (interquartile range, 2.3–9.3), 115 (10.7%) had an SCD event. Freedom from SCD event at 5 years for those with MLVWT Z scores Z score, peaking at Z score +23. The presence of coexisting risk factors had a summative effect on risk. Conclusions: In children with HCM, an inverted U-shaped relationship exists between left ventricular hypertrophy and estimated SCD risk. The presence of additional risk factors has a summative effect on risk. While MLVWT is important for risk stratification, it should not be used either as a binary variable or in isolation to guide implantable cardioverter defibrillator implantation decisions in children with HCM.

Resumen: Introducción y objetivos: El cierre quirúrgico del ductus arterioso persistente (DAP) en prematuros provoca un cambio en el sistema circulatorio que afecta al miocardio inmaduro de estos pacientes. El objetivo del estudio fue analizar la respuesta del ventrículo izquierdo al cierre del DAP, basándonos en parametros ecocardiográficos pre- y postoperatorios. Método: Análisis retrospectivo de los pacientes intervenidos de DAP menores de 1.500 g en nuestro hospital durante un periodo de 5 años. Se recogieron datos de características clínicas, de manejo médico preoperatorio, ecocardiográficos y quirúrgicos, así como de estancia en UCI neonatal y hospitalización. La valoración del riesgo operatorio fue calculada según la escala completa Aristóteles de complejidad (ACCS). Los datos ecocardiográficos preoperatorios fueron obtenidos 24 horas antes de la intervención y los postoperatorios 24 horas después. Se recogieron características del DAP, fracción de eyección de ventrículo izquierdo (FEVI) y diámetro telediastólico de ventriculo izquierdo (DdVI). Resultados: La media de edad gestacional fue de 26,1 ± 1,8 semanas y el peso medio al nacimiento de 823,5 ± 191,9 g, mientras que la mediana de edad en el momento de la cirugía fue de 15,5 días (IQR, 11-21). El ACCS medio fue de 14,02 ± 2,48 (rango 9-20). Diecinueve pacientes (19%) fallecieron intrahospitalariamente. La correlación pre-posquirúrgica para los valores ecocardiográficos presentó una disminución significativa de los valores postintervención para la FEVI (p = 0,0001) y el DdVI (p = 0,001). El análisis por subgrupos según peso en el momento de la intervención mostró diferencias significativas para DdVI en los pacientes con más de 820 g (p = 0,002) pero no en los de peso igual o menor de 820 g (p = 0,311). Conclusiones: Los recién nacidos prematuros tienen un peor manejo de la sobrecarga de volumen producida por el DAP a causa de la inmadurez miocárdica. El cierre quirúrgico del DAP provoca un descenso en la precarga, que en estos pacientes se refleja en una peor adaptación a los cambios de volumen tras la cirugía en relación directa con el peso en el momento de la intervención. Abstract: Introduction and objectives: Patent ductus arteriosus (PDA) ligation in premature infants causes changes in the circulatory system that affects the immature myocardium of the patients. The objective of the study was to analyse the response of left ventricle to PDA ligation, according to pre-operative and post-operative echocardiograph parameters. Method: A retrospective analysis was performed on all patients (n = 100) with less than 1500 g birth weight undergoing PDA surgical ligation in this hospital during a five year period.Data were collected on the clinical characteristics, pre-operative medical management, echocardiography, surgical intervention, and in-hospital stay and Neonatal Intensive Care Unit (NICU) stay. The assessment of operative risk was made by calculating the Aristotle comprehensive complexity score (ACCS). The preoperative echocardiography data were obtained 24 hours before the intervention and 24 hours after surgery. Characteristics of the patent ductus arteriosus, left ventricular ejection fraction (LVEF), and left ventricular end-diastolic dimension (LVEDD) were assessed. Results: The mean gestational age and birth weight was 26.1 ± 1.8 weeks and 823.5 ± 191.9 g, respectively. The mean ACCS was 14.02 ± 2.48 (range, 9 to 20). The median age at surgery was 15.5 days (IQR, 11 to 21). Nineteen patients (19%) died during admission. No echocardiography variable was significant in the univariate analysis for mortality.The pre-postoperative correlation for echocardiography values showed a significant decrease in post-intervention values for LVEF (P = .0001) and LVEDD (P = .001). The analysis by subgroups according to weight at the time of the intervention showed significant differences for LVEDD in patients with more than 820 g (P = .002), but not in those of equal or less than 820 g (P = .311). Conclusions: Preterm infants have a worse management of the volume overload produced by the DAP because of myocardial immaturity. The surgical closure of the DAP causes a decrease in the preload that in these patients is reflected in a worse adaptation to volume changes after surgery in direct relation with the weight at the time of the intervention. Patients with less weight at PDA surgical ligation were more likely to have a worse management to load changes after operation. Palabras clave: Ductus arterioso persistente, Recién nacido prematuro, Función ventricular, Keywords: Patent ductus arteriosus, Preterm infants, Ventricular function

A man, age 45 years, was diagnosed with intermediate-risk stage IV clear cell renal carcinoma (lung and lymph node metastases). He was prescribed first-line systemic treatment with sunitinib (Sutent) 50 mg per day (each cycle: 4 weeks on, 2 weeks off). Upon day 22 of his second sunitinib cycle, he came to the oncology clinic complaining of difficulty walking due to bilateral sole pain. He described initial tingling sensations, which then became burning and painful, with symmetrical erythema and edema of the soles, without blisters. These turned into painful plaques with yellowish discoloration and hyperkeratosis on pressure-bearing areas. He denied fever or other symptoms. The pain limited his instrumental activities of daily living, but not his self-care activities of daily living. Total body skin examination disclosed hyperkeratotic plaques on the undersurface of the great toes and heels of both feet, predominantly at sites of pressure; no blisters, crusts, ulcers, or fissures were found. No relevant findings were found upon physical examination of his hands, mucosae, and scalp. A diagnosis of grade 2 hand-foot skin reaction (HFSR) was made.

European Union (EU) research is based on the commitment to embed ethics from the first conceptual stage of the proposal through the implementation of the project. Given this background, and while the concern for ethics in crime research has been widely covered by the European Commission, few contributions have yet shifted their interest on this issue with respect to the growing research on cybercrime. Hence, the purpose of the study is threefold: first, to identify the main European Commission research ethics guidelines and their applicability to cybercrime research; second, to conceptually introduce internet research ethics as a potential ethical framework that can serve as a complement to existing European reference documents; and third, to provide support on identifying some of its main challenges through practical key questions applied to cybercrime research.

Self-reports and questionnaires have been the preferred research methods in the criminological field of “fear of crime” (FOC) since its rise in the 1960s. Our study had two main goals: (1) to measure the physiological indicators of fear in real time and (2) to compare these data with those obtained through self-reports, designed also to measure the emotion of fear. An experimental study was conducted over the course of a week during late February 2016 in Aarhus (Denmark), in which the focus was on traditional environmental variables in the field of FOC (i.e., poor lighting conditions). Our results support the ideas that: (1) the absence of good luminosity in an open public space in an urban setting elicits physiological reactions of arousal that can be taken as indicators of experiences of fear and (2) heart rate appears to capture aspects of the emotion of fear that are not reflected in data obtained through self-report questionnaires. This study, introducing a pioneering approach to the study of FOC, presents great potentials in complementing traditional methods in the crime sciences. The many challenges we faced are significant and reported with the hope that subsequent literature will build upon. We propose that traditional methods and new measurements could be combined to advance research in the field by allowing researchers to more unambiguously constrain the interpretation of their data. This becomes particularly relevant in a field like FOC, which has long suffered from irreconcilable results stemming from different investigations.

We attempted to assess whether microalbuminuria conferred the same cardiovascular risk as overt CVD in type 2 diabetic patients.A prospective cohort study including 436 type 2 diabetic patients (64.8+/-9.2 years old) without proteinuria, with follow-up until any cardiovascular event occurred, was performed. Patients were classified into four groups: group 0, non baseline CVD and normoalbuminuria; group 1, non baseline CVD and microalbuminuria; group 2, baseline CVD and normoalbuminuria; group 3, baseline CVD and microalbuminuria. Cox's multivariate regression models were used to assess the risk ratio (RR) associated with each variable.The median follow-up time was 7.6 years. Incidence rates of cardiovascular events per 1000 patient-years increased from groups 0 to 3 (23.8, 63.4, 74.1, 85.6; p0.0001). Multivariate RR for incident CVD in groups 1, 2 and 3 in relation to group 0 were 2.8 (95% confidence interval (CI) 1.7-4.6; p0.0001), 2.7 (95% CI 1.6-4.6; p0.0001) and 2.9 (95% CI 1.6-5.4; p=0.001), respectively. No significant differences were seen between groups 1 and 2.We suggest that patients with microalbuminuria are at very high vascular risk and should share the same objectives of a vascular risk-factor control as patients with overt CVD.

Fundamento y objetivo Evaluar la contribucion independiente de la retinopatia diabetica a la mortalidad de los pacientes con diabetes tipo 2. Pacientes y metodo Estudio de cohortes prospectivo. Se incluyo a los pacientes con diabetes tipo 2 y fondo de ojo visualizable. Como variable dependiente, se evaluo la mortalidad total. La variable independiente principal fue la presencia de retinopatia simple o proliferativa, con ajuste para edad, sexo, tiempo de evolucion de la diabetes, factores de riesgo clasicos y presencia de otras complicaciones cronicas (nefropatia y macroangiopatia). Se realizaron curvas de supervivencia y regresion de Cox multivariable, con calculo de cocientes de riesgo (CR). Resultados Se incluyo a 458 pacientes (181 varones y 277 mujeres), con seguimiento mediano de 8 anos (intervalo intercuartil, 6,7-9). Hubo 125 (27,3%) pacientes con retinopatia simple y 46 (10%) con proliferativa. Las tasas de incidencia de mortalidad fueron 20/1.000 pacientes-ano (ausencia de retinopatia), 36,8/1.000 pacientes-ano (retinopatia simple) y 45,9/1.000 pacientes-ano (retinopatia proliferativa); p = 0,0021. En el analisis multivariable, la presencia de retinopatia simple (CR = 1,87; intervalo de confianza [IC] del 95%, 1,1-3,1; p = 0,019) y de retinopatia proliferativa (CR = 2,6; IC del 95%, 1,3-5,1; p = 0,0048) predijeron de modo independiente la mortalidad. Otros predictores independientes fueron la edad (CR [1 ano] = 1,13; IC del 95%, 1,1-1,17; p = 0,76; IC del 95%, 0,6-0,97; p = 0,026), el tratamiento con insulina (CR = 1,9; IC del 95%, 1,1-3,2; p = 0,017) y la proteinuria (CR = 4,1; IC del 95%, 2-8,5; p = 0,0001). Conclusiones La presencia de retinopatia diabetica se relaciona con un incremento de mortalidad en los pacientes con diabetes tipo 2.

Streptococcus agalactiae, or group B streptococcus (GBS), has been traditionally considered an infrequent etiologic agent of disease in adults except for urinary tract infection in pregnant women. Attention has recently been drawn to other adult infections caused by GBS such as skin and soft tissue infections, bacteriemias, pneumonia, meningitis, endocarditis, peritonitis, and bone and joint infections. We present two adult patients with GBS spondylodiscitis and review 30 cases of GBS spinal infection previously reported in the literature. This series clearly illustrates that GBS has recently been recognized as an emerging cause of vertebral infections in adults, particularly in those with chronic underlying diseases, although it can also affect immunocompetent patients without debilitating conditions. Although uncommon, GBS should be considered in the differential diagnosis of infective spondylodiscitis in nonpregnant adults, whatever the patient's immunological status.

Resume Streptococcus agalactiae (streptocoque du groupe B) est classiquement considere comme un agent infectieux rarement implique dans les pathologies de l’adulte exception faite des infections du tractus urinaire chez les femmes enceintes. Recemment, l’attention a ete portee sur d’autres infections a Streptocoque du groupe B survenant chez l’adulte, notamment des infections de la peau et des tissus mous, des bacteriemies, des pneumopathies, des meningites, des endocardites, des peritonites et des infections osteo-articulaires. Nous presentons le cas de deux patients pour lesquels le diagnostic de spondylodiscite a Streptocoque B a ete porte ainsi qu’une revue de 30 cas d’infections rachidiennes a Streptocoque B prealablement rapportes dans la litterature. Cette serie montre, comme il a ete reconnu recemment dans la litterature, que le Streptocoque du groupe B peut etre, et cela de plus en plus frequemment, responsable d’infections rachidiennes chez l’adulte, sur un terrain debilite mais egalement chez des patients immuno-competents sans pathologie sous-jacente. Meme s’il est rarement en cause, il doit etre considere comme une etiologie possible de spondylodiscite chez l’adulte en dehors de la grossesse, quelle que soit l’immunocompetence du patient.

Aims/Hypothesis: The purpose of this study was to determine whether plasma glucose variability, irrespective of glycated hemoglobin (HbA1c), was able to predict the onset of retinopathy in Type 2 diabetic patients. Methods: The study was based on a cohort of 130 Type 2 diabetic patients without retinopathy recruited from June 1994 to June 1998. The fundus was reexamined between November 2000 and June 2001, with a mean follow-up period of 5.2 years. Fasting plasma glucose (FPG) variability was measured by its variation coefficient (VC). Stratified and multivariate models were used to estimate the effect of FPG variability and mean HbA1c during follow-up on cumulative incidence (IP) of retinopathy. Results: The IP of retinopathy was 36.2% and increased all along the quartiles of FPG variability ( P =.001). In multivariate analyses, only the last quartile of the distribution of VC (OR=3.68; 95% confidence interval (CI) 1.01–13.4; P =.049) was significant. The term of interaction between mean HbA1c and VC was not significant. Conclusions/Interpretation: FPG variability fulfills criteria to be considered a risk factor for retinopathy: A statistically significant association exists after adjustment for confounders, time sequence, dosage response gradient, and biological plausibility.

Stomatococcus mucilaginosus is a gram-positive coccus present in the normal flora of the mouth and upper respiratory tract of humans. Although traditionally believed to be an organism of low virulence, S. mucilaginosus has recently been recognized as an emerging opportunistic pathogen, especially in patients with chronic immunosuppressive diseases. This report describes the case of a patient with known mitral valve prolapse, who presented with a mycotic cerebral aneurysm revealing a non-nosocomial spontaneous S. mucilaginosus endocarditis. The spectrum of infections due to this opportunistic pathogen is reviewed, with particular focus on assessing the clinical characteristics and prognosis of S. mucilaginosus infective endocarditis.

We report a nine-year-old boy referred for evaluation of suspected coarctation of the aorta. He presented with hypertension and absent femoral pulses. A 50 mmHg gradient was detected in the abdominal aorta by color flow doppler echocardiography but the level of coarctation was impossible to locate. The diagnosis was made by magnetic resonance imaging and aortography, showing segmentary hypoplasia in the upper abdominal segment of the descending aorta, immediately below the celiac axis and above the renal arteries. Treatment consisted in placement of a stent Palmaz, which was effective in significantly decreasing the gradient. Some clinical aspects and different therapeutic strategies for this unusual case are discussed.

Introduccion En los ultimos anos se han producido importantes progresos en el tratamiento de las cardiopatias congenitas. Estos cambios han afectado tanto al diagnostico como al manejo preoperatorio, tratamiento quirurgico y a los cuidados postoperatorios, todo lo cual ha contribuido a mejorar la evolucion de los ninos con cardiopatia congenita. Objetivos Pretendemos valorar la evolucion de las cardiopatias congenitas en un hospital de nivel terciario, comparando dos periodos distintos en cuanto al manejo diagnostico y terapeutico. Tambien pretendemos conocer la influencia que han tenido en la mortalidad factores como la presencia de anomalias extracardiacas asociadas y la realizacion o no de cirugia cardiaca. Pacientes y metodos Analizamos, de manera retrospectiva, la evolucion tanto global como por cardiopatias individualizadas, asi como los factores relacionados con esta, de 1.216 ninos con cardiopatia congenita, de un dia a 7 anos de edad, nacidos a lo largo de 13 anos y estudiados en la seccion de cardiologia pediatrica de un hospital de referencia para toda la Comunidad Autonoma de Murcia. El tiempo de estudio se dividio a su vez en dos periodos: 1978-1983 y 1984-1990, con diferencias en cuanto al diagnostico y al tratamiento. Resultados a) Se ha producido un descenso de la mortalidad en el periodo 1984-1990, con respecto al periodo 1978-1983, pasando del 28 al 21,7% (p Conclusion Los progresos en el manejo de las cardiopatias congenitas han conducido a un resultado mas favorable en los ultimos anos.

Introducción. El complejo respiratorio de los cerdos es uno de los principales síndromes que afectan a la industria porcina, debido al efecto negativo que tiene sobre los costos de producción por concepto de mortalidad, tratamientos, disminución en la ganancia diaria de peso y aumento en la conversión alimenticia. El objetivo de este estudio fue determinar la frecuencia de las lesiones macroscópicas en cornetes de cerdos finalizados obtenidos en el mercado municipal No. 32 de Mérida, Yucatán, México. Materiales y Métodos. Se inspeccionaron 101 hocicos de cerdos de engorda finalizados adquiridos en el mercado municipal No. 32 de Mérida, Yucatán, México, de abril a junio de 1997. Con un rinómetro se determinó el grado de rinitis. A los casos positivos a rinitis atrófica progresiva (RAP) se les realizó un análisis histopatológico y bacteriológico. Resultados. Cincuenta y cinco (54.5%) hocicos presentaron RAP. Treinta y tres (60.0%) cornetes nasales presentaron grado 2, 17 (30.9%) cornetes nasales con grado 3 y 5 (9.1%) cornetes nasales con grado 4. Se observó 1 (1.8 %) caso con cuerpos de inclusión y correspondió al grado 4 de RAP. Se aislaron Pasteurella multocida en 2 (3.6 %) casos positivos a RAP y correspondieron a los grados 2 y 4 y Bordetella bronchiseptica en 3 (5.5%) muestras y correspondieron a los grados 2, 3 y 4 de RAP. Discusión. Las diferencias encontradas entre la RAP de este estudio y las reportadas por los diferentes autores, probablemente se debieron a la técnica utilizada. La baja frecuencia de aislamientos probablemente se debió a que las muestras fueron tomaron de cerdos sacrificados en el rastro, lo cual pudo favorecer la contaminación de las muestras. La RAP probablemente se asocia a los agentes etiológicos B bronchiseptica, P multocida y Citomegalovirus. En el estado de Yucatán, México, este es el primer reporte de un caso de rinitis atrófica con cuerpos de inclusión. Esto permite demostrar que la RAP es un padecimiento que no necesariamente guarda relación con un solo agente etiológico.

It is important identify patients with very high cardiovascular risk to intensify their therapy. Our aim was to assess the association between retinopathy and incident cardiovascular events (cardiovascular disease [CVD]) in patients with type 2 diabetes mellitus (DM). Patients were included if they had type 2 DM and a visible fundus. Baseline clinical and biochemical variables, including urinary albumin excretion rate, were collected. Clinical end points were nonfatal or fatal cardiovascular events (unstable angina including revascularization, nonfatal or fatal myocardial infarction, transient ischemic attack, nonfatal or fatal stroke, lower-leg amputation, terminal chronic heart failure, sudden death). Cox multivariate regression models were used to evaluate the risk associated with each variable and the independent contribution of baseline retinopathy. A total of 458 patients were included, with mean follow-up time of 6.7 +/- 2.6 years. Incident CVD rates were 30.7 per 1,000 patient-years in patients with a normal fundus, 56.7 in patients with nonproliferative retinopathy, and 90.7 in patients with proliferative retinopathy (p0.0001). In multivariate analysis, nonproliferative retinopathy (hazard ratio 1.71, 95% confidence interval 1.1 to 2.66, p = 0.017) and proliferative retinopathy (hazard ratio 2, 95% confidence interval 1.1 to 3.56, p = 0.019) were significantly associated with incident CVD. In conclusion, retinopathy proved to be an independent risk marker for CVD in patients with type 2 DM.

This study was intended to assess the independent contribution of retinopathy to mortality in type 2 diabetic patients.Prospective cohort study. Type 2 diabetic patients with available fundus were included. The clinical end-point was total mortality. The main independent variable was baseline presence of background or proliferative retinopathy. Cox regression models were adjusted for age, sex, duration of diabetes, classical risk factors and baseline presence of nephropathy and cardiovascular disease.458 patients were included (181 male, 277 females), with a median follow-up of 8 years (inter-quartile range, 6.7-9). There were 125 patients (27.3%) with background retinopathy and 46 (10%) with proliferative retinopathy. Mortality incidence rates per 1,000 patients-year were 20/1,000 (non retinopathy), 36.8/1,000 (background retinopathy) and 45.9/1,000 (proliferative retinopathy) with p = 0.0021. In the multivariate analysis, background retinopathy (HR = 1.87; 95% CI, 1.1-3.1; p = 0.019) and proliferative retinopathy (HR = 2.6; 95% CI, 1.3-5.1; p = 0.0048) were independent predictors of mortality. Other independent predictors were age (HR [1 year] = 1.13; 95% CI, 1.1-1.17; p0.0001), total cholesterol (HR [1 mmol/l] = 0.76; 95% CI, 0.6-0.97; p = 0.026), baseline insulin treatment (HR = 1.9; 95% CI, 1,1-3.2; p = 0.017) and baseline proteinuria (HR = 4.1; 95% CI, 2-8.5; p = 0.0001).The presence of retinopathy increases the mortality risk in type 2 diabetic patients.

We present the case of a 57-year-old patient who was visited in our ophthalmology department complaining of acute right ocular proptosis, fever and malaise. The clinical, ophthalmic and radiologic examination showed the presence of an extraconal orbital tumor as the cause of this exophthalmos.Further complementary studies revealed a small cell carcinoma of the lung metastatic to the right orbit. We report the excellent response to chemotherapy both of the primary lung neoplasm and the orbital metastasis.

The aim of this study was to compare the mortality rate of type 2 diabetic patients with the mortality rate of the background population. Also was assessed the impact of baseline variables on mortality.Prospective cohort study. Patients with type 2 diabetes were included from june 1994 to june 1998. The life status was ascertained on october 2001. Excess mortality, compared with the background population, was assessed in terms of standardised mortality ratio (SMR) for the whole group, for males and for females. The Cox's model was used to investigate the influence of baseline risk factors on mortality.463 patients were included. The mean follow-up was of 5 years. The life status was ascertained for the 99% of the cohort. The mortality rate of the whole group was 21.75 per 1000 (31.4 per 1000 males and 16.4 per 1000 females). The SMR of the whole group was 147% (IC 95%: 109-194; p0.05), the SMR of males 167% (IC 95%: 107-246; p0.05) and the SMR of females 147% (IC 95%: 95-217; p = ns). The independent predictors of early mortality on multivariate survival analysis were age (HR = 1.13; IC 95%: 1.08-1.18; p0.0001) and proteinuria (HR = 4.72; IC 95%: 2.15-10.35; p = 0.0001).Diabetic patients in our population have increased their mortality risk in 47%. The main risk factor of mortality was the presence of proteinuria.

We prove that if D D is a “strongly quasihomogeneous" free divisor in the Stein manifold X X , and U U is its complement, then the de Rham cohomology of U U can be computed as the cohomology of the complex of meromorphic differential forms on X X with logarithmic poles along D D , with exterior derivative. The class of strongly quasihomogeneous free divisors, introduced here, includes free hyperplane arrangements and the discriminants of stable mappings in Mather’s nice dimensions (and in particular the discriminants of Coxeter groups).