Recomendaciones nacionales sobre donaci?n pedi?trica

Despite being an international reference in donation and transplantation, Spain needs to improve pediatric donation, including donation after the circulatory determination of death. The present article, a summary of the consensus report prepared by the Organizacion Nacional de Trasplantes and the Spanish Pediatrics Association, intends the facilitation of donation procedures in newborns and children and the analysis of associated ethical dilemma. The ethical basis for donation in children, the principles of clinical assessment of possible donors, the criteria for the determination of death in children, intensive care management of donors, basic concepts of donation after the circulatory determination of death and the procedures for donation in newborns with severe nervous system's malformation incompatible with life, as well as in children receiving palliative care are commented. Systematically considering the donation of organs and tissues when a child dies in conditions consistent with donation is an ethical imperative and must become an ethical standard, not only because of the need of organs for transplantation, but also to ensure family centered care.A pesar de ser una referencia internacional en donaci?n y trasplante, Espa?a precisa mejorar los procesos de donaci?n en ni?os, en particular la donaci?n tras la determinaci?n de la muerte por criterios circulatorios (donaci?n en asistolia). El presente art?culo, resumen del documento de consenso elaborado por la Organizaci?n Nacional de Trasplantes y la Asociaci?n Espa?ola de Pediatr?a, pretende facilitar los procesos de donaci?n en ni?os y neonatos y analizar los conflictos ?ticos que plantea. Se comentan los fundamentos ?ticos de la donaci?n pedi?trica, los principios de la evaluaci?n cl?nica de los posibles donantes, los criterios diagn?sticos de muerte encef?lica en ni?os, los cuidados intensivos para el mantenimiento de los donantes, los conceptos b?sicos de la donaci?n en asistolia y los procesos de donaci?n en neonatos con malformaciones muy graves del sistema nervioso incompatibles con la vida y en ni?os en cuidados paliativos. Considerar sistem?ticamente la donaci?n de ?rganos y tejidos cuando un ni?o fallece en condiciones de ser donante es un imperativo ?tico y ha de constituir un est?ndar profesional, tanto por la necesidad de ?rganos para trasplante, como por asegurar un cuidado integral centrado en la familia

NS5806 Induces Electromechanically Discordant Alternans and Arrhythmogenic Voltage-Calcium Dynamics in the Isolated Intact Rabbit Heart

Background: NS5806 activates the transient outward potassium current I to, and has been claimed to reproduce Brugada Syndrome (BrS) in ventricular wedge preparations. I to modulates excitation-contraction coupling, which is critical in alternans dynamics. We explored NS5806-arrhythmogenic effects in the intact whole heart and its impact on alternans. Methods: Langendorff-perfused rabbit hearts (n = 20) underwent optical AP and Ca mapping during pacing at decremental cycle lengths (CL). Spontaneous arrhythmias and pacing-induced alternans was characterized at baseline (BL), after perfusing with NS5806, before and after adding verapamil (VP), and SEA0400 (SEA, n = 5 each), to modulate Ca-current and Na-Ca exchange, the main AP-Ca coupling mechanisms. Results: NS5806 induced BrS-like ECG features in 6 out of 20 hearts. NS5806 prolonged steady-state (3 Hz) action potential duration (APD) by 16.8%, Ca decay constant by 34%, and decreased conduction velocity (CV) by 52.6%. After NS5806 infusion, spontaneous ventricular ectopy (VE) and AP/Ca alternans occurred. Pacing-induced alternans during NS5806 infusion occurred at longer CL and were AP/Ca discordant from its onset. Spatially discordant alternans after NS5806 infusion had non-propagation-driven nodal line distribution. No spontaneous phase-2 reentry occurred. Under NS5806 + VP, alternans became AP/Ca concordant and only induced in two out of five; NS5806 + SEA did not affect alternans but suppressed spontaneous ectopy. Conclusions: NS5806 disrupts AP-Ca coupling and leads to Ca-driven, AP/Ca-discordant alternans and VE. Despite BrS-like ECG features, no spontaneous sustained arrhythmias or phase-2 reentry occurred. NS5806 does not fully reproduce BrS in the intact rabbit heart

Validation of an IGF1 Screening Method for Retinopathy of Pre-maturity

Retinopathy of pre-maturity (ROP) is a retinal disease that causes arrest of vascularization of the retina and can result in retinal detachment and blindness. Current screening protocols may not be sufficiently accurate to identify all at-risk patients. The aim of this study is to validate a method for improved identification of newborns at risk of ROP. We conducted a prospective clinical trial of pre-term newborns <32 weeks of gestation and/or <1,500 g birth weight during a 6-year period in a tertiary care hospital. We applied our new method based on measurement of insulin-like growth factor 1 (IGF1) levels at 3 weeks of age and the presence of sepsis during the first 3 weeks of life. Our screening protocol allowed exclusion of 121 (79.1%) patients for whom American Academy of Pediatrics (AAP) guidelines recommended screening, had a negative predictive value of 100%, and correctly identified all patients with ROP. Following retrospective assessment of our data based on these findings, we propose further restriction of the current AAP indications for screening to <1,100 g and <28 weeks of gestation in order to improve diagnostic efficacy while ensuring optimal use of restriction of human and material resources

Improved personalized survival prediction of patients with diffuse large B-cell Lymphoma using gene expression profiling

BACKGROUND: Thirty to forty percent of patients with Diffuse Large B-cell Lymphoma (DLBCL) have an adverse clinical evolution. The increased understanding of DLBCL biology has shed light on the clinical evolution of this pathology, leading to the discovery of prognostic factors based on gene expression data, genomic rearrangements and mutational subgroups. Nevertheless, additional efforts are needed in order to enable survival predictions at the patient level. In this study we investigated new machine learning-based models of survival using transcriptomic and clinical data. METHODS: Gene expression profiling (GEP) of in 2 different publicly available retrospective DLBCL cohorts were analyzed. Cox regression and unsupervised clustering were performed in order to identify probes associated with overall survival on the largest cohort. Random forests were created to model survival using combinations of GEP data, COO classification and clinical information. Cross-validation was used to compare model results in the training set, and Harrel's concordance index (c-index) was used to assess model's predictability. Results were validated in an independent test set. RESULTS: Two hundred thirty-three and sixty-four patients were included in the training and test set, respectively. Initially we derived and validated a 4-gene expression clusterization that was independently associated with lower survival in 20% of patients. This pattern included the following genes: TNFRSF9, BIRC3, BCL2L1 and G3BP2. Thereafter, we applied machine-learning models to predict survival. A set of 102 genes was highly predictive of disease outcome, outperforming available clinical information and COO classification. The final best model integrated clinical information, COO classification, 4-gene-based clusterization and the expression levels of 50 individual genes (training set c-index, 0.8404, test set c-index, 0.7942). CONCLUSION: Our results indicate that DLBCL survival models based on the application of machine learning algorithms to gene expression and clinical data can largely outperform other important prognostic variables such as disease stage and COO. Head-to-head comparisons with other risk stratification models are needed to compare its usefulness

Liver-related events and mortality among elderly patients with advanced chronic hepatitis C treated with direct-acting antivirals

BACKGROUND: Direct-acting antivirals (DAAs) are effective in patients aged >/=65 years. However, little is known about the effects of DAAs on survival, liver decompensation and development of hepatocellular carcinoma (HCC). OBJECTIVE: To compare the incidence of liver-related events and mortality between patients aged >/=65 and /=65 and /=65 and 380 aged /=65 years treated with DAAs seems to be secondary to non-liver-related causes. These results support the utilization of DAAs in patients aged >/=65 years

Effect of antiseptic gels in the microbiologic colonization of the suture threads after oral surgery

Three different bioadhesive gels were evaluated in a double-blind randomized clinical trial in which microbial growth in the suture thread was assessed following post-surgical application of the aforementioned gels. Also assessed in this trial were, the intensity of post-surgical pain as well as the degree of healing of the patients' surgical wounds. A total of 21 patients (with 42 wisdom teeth) participated in this trial. Chlorhexidine gel, chlorhexidine-chitosan gel, and hyaluronic acid gel were evaluated, with a neutral water-based gel serving as the control agent. The aerobic and facultative anaerobic bacterial recovery on blood agar was lower in the placebo group than in the experimental groups. The most significant difference (p = 0.04) was observed in the chlorhexidine-chitosan group. in which the growth of Blood Agar and Mitis Salivarius Agar was significantly higher than in the placebo group. The intensity of post-surgical pain was very similar among all the groups. Significantly better healing rates were observed in the patients treated with chlorhexidine-chitosan gel when compared with those who used the placebo gel (p = 0.03), and in particular when compared with those patients who used hyaluronic acid gel (p = 0.01). Through our microbiological analyses, we were able to conclude that none of the bioadhesive gels tested resulted in beneficial reductions in the bacterial/fungal populations. However, the healing rates of patients who were treated with chlorhexidine-chitosan were better than those of the patients who used either the placebo gel or the hyaluronic acid gel

LipoDDx: a mobile application for identification of rare lipodystrophy syndromes

BACKGROUND: Lipodystrophy syndromes are a group of disorders characterized by a loss of adipose tissue once other situations of nutritional deprivation or exacerbated catabolism have been ruled out. With the exception of the HIV-associated lipodystrophy, they have a very low prevalence, which together with their large phenotypic heterogeneity makes their identification difficult, even for endocrinologists and pediatricians. This leads to significant delays in diagnosis or even to misdiagnosis. Our group has developed an algorithm that identifies the more than 40 rare lipodystrophy subtypes described to date. This algorithm has been implemented in a free mobile application, LipoDDx(R). Our aim was to establish the effectiveness of LipoDDx(R). Forty clinical records of patients with a diagnosis of certainty of most lipodystrophy subtypes were analyzed, including subjects without lipodystrophy. The medical records, blinded for diagnosis, were evaluated by 13 physicians, 1 biochemist and 1 dentist. Each evaluator first gave his/her results based on his/her own criteria. Then, a second diagnosis was given using LipoDDx(R). The results were analysed based on a score table according to the complexity of each case and the prevalence of the disease. RESULTS: LipoDDx(R) provides a user-friendly environment, based on usually dichotomous questions or choice of clinical signs from drop-down menus. The final result provided by this app for a particular case can be a low/high probability of suffering a particular lipodystrophy subtype. Without using LipoDDx(R) the success rate was 17 +/- 20%, while with LipoDDx(R) the success rate was 79 +/- 20% (p < 0.01). CONCLUSIONS: LipoDDx(R) is a free app that enables the identification of subtypes of rare lipodystrophies, which in this small cohort has around 80% effectiveness, which will be of help to doctors who are not experts in this field. However, it will be necessary to analyze more cases in order to obtain a more accurate efficiency value

Morphological characterization of Anastrepha obliqua and Anastrepha suspensa larvae in Cuba

3 ilus. 4 tab. 14 ref.El objetivo de este trabajo fue la diferenciaci?n morfom?trica de Anastrepha obliqua (Macquart) y Anastrepha suspensa (Loew), partiendo de los caracteres taxon?micos de mayor importancia en el diagn?stico de larvas del tercer estadio. Se realizaron montajes de los espir?culos anteriores y posteriores, as? como del esqueleto cefalofar?ngeo, y se midieron las estructuras que los conforman. El gancho bucal y el n?mero de carinas orales no mostraron diferencias significativas sin embargo, la longitud del esqueleto cefalofar?ngeo evidenci? diferencias entre ambas especies. El n?mero de t?bulos de los espir?culos anteriores present? rangos de 10-17 y 9-15 para A. obliqua y A. suspensa, respectivamente. Adem?s, se determin? que el di?metro de la base de los espir?culos anteriores fue de 117,0-150,8 micrometros y 91,0-137,8 micrometros para ambas especies, respectivamente. A. obliqua presenta un menor n?mero de pelos en los espir?culos posteriores, m?s largos y ramificados que en A. suspensa. This paper describes morphometric differences between Anastrepha obliqua (Macquart) and Anastrepha suspensa (Loew), taking into consideration the most important taxonomic characters for the diagnosis of third instar larvae. Slide mounts of anterior and posterior spiracles and the cephalopharyngeal skeleton were carried out. The more relevant structures were measured. Neither the mouthhook nor the oral ridges showed significant differences between the two species, while the length of the cephalopharyngeal skeleton did show differences between both species. Values for the number of tubules in anterior spiracles ranged from 10 to 17 and from 9 to 15 for A. obliqua and A. suspensa, respectively. The base diameter of the anterior spiracles ranged from 117.0 to 150.8 micrometers and 91.0 to 137.8 micrometers for A. obliqua and A. suspensa, respectively. A. obliqua has less spiracular hairs, which are longer and more split that in A. suspens

Efectividad de la privaci?n de la libertad en centro de atenci?n especializada, como sanci?n pedag?gica en el sistema de responsabilidad penal para mujeres adolescentes en el municipio de Ibagu? en los a?os 2013-2014 y julio de 2015

98 p. Recurso Electr?nicoCon el nacimiento de la Convenci?n sobre los Derechos del Ni?o (1989) se produce un cambio radical en materia legislativa sobre la infancia, a partir de ella, el menor se constituye en un sujeto de derecho en cuanto a su responsabilidad penal, convirti?ndolo en ?ni?o-adolescente?; actualmente en Colombia est? vigente el Sistema de Responsabilidad Penal para Adolescentes, consagrado en el C?digo de la Infancia y la Adolescencia - Ley 1098 de 2006, que pone a Colombia al d?a con la legislaci?n internacional en materia de derechos al menor y en el que establece entre otros la privaci?n de libertad para delitos graves en adolescentes mayores de 14 a?os y menores de 18, afirmando que a esta edad tienen la madurez psicol?gica y por lo tanto ya tienen la capacidad de discernir sobre las conductas adecuadas o inadecuadas por lo que son considerados punibles ante la ley. Existen algunas fallas que presenta el sistema y que derivan no solo en situaciones de inconstitucionalidad con ocasi?n de la violaci?n de determinados derechos fundamentales a los menores sujetos de ese procedimiento, sino que permite distinguir la ausencia de la aplicaci?n material de los instrumentos internacionales que sobre aplicaci?n de justicia punitiva para menores de edad han sido reconocidos por la mayor?a de los Estados democr?ticos y las consecuencias de esa inaplicaci?n e inobservancia, si bien el sistema de responsabilidad penal para adolescentes (SRPA) recoge los principales instrumentos internacionales ordenadores de la privaci?n de la libertad para los menores de edad y se asienta sobre el tratamiento diferenciado y el modelo de protecci?n integral y corresponsabilidad, este no ha sido del todo eficiente porque lleva tras de s?, los problemas que durante mucho tiempo han evidenciado los estudios cr?ticos sobre el derecho penal, especialmente los problemas y las finalidades no declaradas que suscita el internamiento, la disciplina impuesta, la adecuaci?n para el sistema productivo y la victimizaci?n dentro de los centros cerrados, con consecuencias negativas para los derechos fundamentales de los adolescentes objeto de este sistema.With the birth of the Convention on the Rights of the Child (1989) A radical change in legislation on children from it, the less becomes a subject of law as to criminal responsibility, making it "child-teen"; Colombia currently in the Criminal Responsibility System for Adolescents, enshrined in the Code for Children and Adolescents-Law 1098 of 2006, which makes Colombia a day with international law regarding rights to smaller states and which is in effect including imprisonment for serious crimes in adolescents ages 14 and under 18, saying that at this age have the psychological maturity and therefore already have the ability to discern appropriate behavior or inappropriate for what are considered punishable under the law. There are some flaws that presents the system and derive not only in situations of unconstitutional during the violation of certain fundamental to the subject of this procedure under rights but to distinguish the absence of the Matters covered by the international instruments on the application of punitive justice for minors has been recognized by most democratic states and the consequences of that derogation and failure, although the system of criminal responsibility for adolescents (SRPA) includes the key international instruments computers imprisonment for minors and sits on the differential treatment and the model of comprehensive protection and responsibility, this has not been very efficient because it takes behind the problems that have demonstrated long critical studies on criminal law, especially the problems and objectives raises undeclared detention, the discipline imposed, the suitability for the production system and victimization within the closed centers, with negative consequences for the fundamental rights of adolescents This system object. Keywords: Criminal Responsibility, Adolescents, Law, Fundamental Rights, State, minors