Infecciones orofaciales de origen odontogénico

La naturaleza polimicrobiana de las infecciones odontógenas así como la heterogeneidad de los cuadros clínicos asociados son consecuencia de la diversidad de la microbiota bucal y de la complejidad anatómica y funcional de la cavidad oral. Así mismo, estos procesos pueden dar lugar a múltiples complicaciones que pueden limitarse a afecciones locales o derivar hasta compromisos sistémicos. En el tratamiento farmacológico de estas infecciones es crucial la elección del antibiótico y la pauta posológica más eficaces. La farmacodinamia proporciona los parámetros que hacen posible valorar como varía la actividad de los antibióticos en función del tiempo. Como norma general, en el manejo inicial de las infecciones orofaciales en el adulto, incluidas las infecciones odontógenas, se utilizará amoxicilina/ac. Clavulánico en dosis de 875 mg de amoxicilina y 125 mg de ac. clavulánico pautado cada 8 horas. El cumplimiento terapéutico es clave para evitar la aparición de resistencias, por lo que se ha de maximizar la aceptación por parte de los pacientes. En este sentido se ha demostrado que la nueva presentación de 2000/125 mg de Augmentine Plus pautado cada 12 horas tanto en profilaxis como tratamiento disminuye significativamente la tasa de complicaciones infecciosas derivada de la extracción del tercer molar.The polymicrobial nature of the odontogenic infections as well as the variety of associated conditions are a consequence of the diversity of the buccal microbiota and the anatomical and functional complexity of the oral cavity. In addition to this, all these processes can give way to multiple complications which range from the local to the systemic level. The appropriate choice of antibiotic and posology is crucial in the successful management of these infections. Pharmacodynamics provides those parameters that make it possible to assess how antibiotics activity varies in time. As a general rule, the first step in the initial management of orofacial infections in adults, included odontogenic infections, will be the administration of 875 mg of amoxicillin and 125 mg of clavulanic every 8 hours. Therapeutic compliance is paramount to avoid resistance, therefore patient's acceptance must be sought. In this sense, it has been proved that Augmentine Plus (2000/125) every twelve hours both as profylaxis and as treatment significantly decreases the rate of infective complications associated to extraction of the third molar

Limitations and usefulness of maximum daily shrinkage (MDS) and trunk growth rate (TGR) indicators in the irrigation scheduling of table olive trees

8 páginas.-- 7 figuras.-- 2 tablas.-- 32 referenciasMaximum daily trunk shrinkage (MDS) is the most popular indicator derived from trunk diameter fluctuations in most fruit trees and has been reported to be one of the earliest signs in the detection of water stress. However, in some species such as olive trees (. Olea europaea L.), MDS does not usually change in water stress conditions and trunk growth rate (TGR) has been suggested as better indicator. Most of this lack of sensitivity to drought conditions has been related to the relationship between the MDS and the water potential. This curvilinear relationship produces an uncertain zone were great variations of water potential do not imply any changes of MDS. The MDS signal, the ratio between measured MDS and estimated MDS with full irrigation, has been thought to be a better indicator than MDS, as it reduces the effect of the environment. On the other hand, though literature results suggest an effect of environment in TGR values, there are not clear relationship between this indicator and meteorological data. The aims of this work are, on one hand, to study the improvements of the baseline approach in the MDS signal and, on the other, study the influence of several meteorological variables in TGR. Three years' data from an irrigation experiment were used in to carry out the MDS analysis and six years' data for full irrigated trees during pit hardening period were used for TGR study. The comparison between MDS vs. water potential and MDS signal vs. water potential presented a great scattering in both relationships. Values of MDS signal between 1.1 and 1.4 were always identified with moderate water stress conditions (-1.4 to -2. MPa of water potential). However, since this MDS signal values are around the maximum in the curvilineal relationship with water potential, greater values of MDS signal (in the range of 1.1-1.4) were not necessary lower values of water potential. In addition, during low fruit load seasons MDS signal was not an accurate indicator. On the other hand, absolute values of several climatological measurements were not significantly related with TGR. Only daily increments explain part of the variations of TGR in full irrigated trees. In all the data analysed, the daily increment of average vapour pressure deficit was the best indicator related with TGR. The increase of this indicator decreased TGR values. In addition, the agreement between this indicator and TGR was affected for fruit load. Great yield seasons decrease the influence of VPD increment in TGR.This research was supported by the Spanish Ministerio de Ciencia e Innovación (MICINN), (AGL2010-19201-CO4-03). Thanks are due to J. Rodriguez and A. Montero for help with field measurements.Peer reviewe

Deficit irrigation and emerging fruit crops as a strategy to save water in Mediterranean semiarid agrosystems

Water scarcity in Mediterranean climate areas will be progressively aggravated by climate change, population increase and urban, tourism and industrial activities. To protect water resources and their integrity for future use and to improve biodiversity, besides following advanced deficit irrigation strategies in fruit cultivation, attention could well be directed towards what are at present underused plant materials able to withstand deficit irrigation with minimum impact on yield and fruit quality. To this end, the state of the art as regards deficit irrigation strategies and the response of some very interesting emerging fruit crops [jujube (Zizyphus jujuba Mill.), loquat (Eriobotrya japonica Lindl.), pistachio (Pistacia vera L.) and pomegranate (Punica granatum L.)] are reviewed. The strengths and weaknesses of deficit irrigation strategies and the mechanisms developed by these emerging fruit crops in the face of water stress are discussed. The response of these crops to deficit irrigation, with special attention paid to the effect on yield but also on fruit quality and health-related chemical compounds, was analysed in order to assess their suitability for saving water in Mediterranean semiarid agrosystems and to analyze their potential role as alternatives to currently cultivated fruit crops with higher water requirements. Finally, the factors involved in establishing an identity brand (hydroSOS) to protect fruits obtained under specific DI conditions are discussed

Capecitabine and bevacizumab as first-line treatment in elderly patients with metastatic colorectal cancer

BACKGROUND: The efficacy and safety of capecitabine and bevacizumab in elderly patients with metastatic colorectal cancer (mCRC) considered unsuitable for receiving first-line chemotherapy with an irinotecan or oxaliplatin-based combination were assessed in a phase II, open, multicentre, uncontrolled study. METHODS: Treatment consisted of capecitabine 1250 mgm 2 (or 950 mgm 2 for patients with a creatinine clearance of 30–50ml min 1) twice daily on days 1–14 and bevacizumab (7.5 mg kg 1) on day 1 every 3 weeks. RESULTS: A total of 59 patients aged X70 years with mCRC were enrolled. In an intention-to-treat analysis, the overall response rate was 34%, with 71% of patients achieving disease control. Median progression-free survival and overall survival were 10.8 months and 18 months, respectively. In all, 32 patients (54%) had grade 3/4 adverse events (AEs), the most common being hand–foot syndrome (19%), diarrhoea (9%) and deep venous thrombosis (7%). Four patients died because of treatment-related AEs. A relationship was detected between creatinine clearance p50 ml min 1 and the development of non-bevacizumab-related grade 3/4 AEs. The incidence of bevacizumab-associated AEs (hypertension, thromboembolic events and proteinuria) was consistent with that of previous reports in elderly patients. CONCLUSION: Bevacizumab combined with capecitabine represents a valid therapeutic alternative in elderly patients considered to be unsuitable for receiving polychemotherapy.This study was supported by Hoffmann-La Roche, Nutley, NJ, USA

Cannabinoid agonists showing BuChE inhibition as potential therapeutic agents for Alzheimer's disease

Designing drugs with a specific multi-target profile is a promising approach against multifactorial illnesses as Alzheimer's disease. In this work, new indazole ethers that possess dual activity as both cannabinoid agonists CB2 and inhibitors of BuChE have been designed by computational methods. On the basis of this knowledge, the synthesis, pharmacological evaluation and docking studies of a new class of indazoles has been performed. Pharmacological evaluation includes radioligand binding assays with [3H]-CP55940 for CB1R and CB2R and functional activity for cannabinoid receptors on isolated tissue. Additionally, in vitro inhibitory assays of AChE/BuChE and the corresponding competition studies have been carried out. The results of pharmacological tests have revealed that three of these derivatives behave as CB2 cannabinoid agonists and simultaneously show BuChE inhibition. In particular, compounds 3 and 24 have emerged as promising candidates as novel cannabinoids that inhibit BuChE by a non-competitive or mixed mechanism, respectively. On the other hand, both molecules show antioxidant properties. © 2013 Elsevier Masson SAS. All rights reserved.Peer Reviewe

Bedside Sublingual Video Imaging of Microcirculation in Assessing Bacterial Infection in Cirrhosis

Bacterial infections are common in cirrhosis and can lead to life-threatening complications. Sidestream dark-field (SDF) imaging has recently emerged as a noninvasive tool for capturing real-time video images of sublingual microcirculation in critically ill patients with sepsis. The objective of this study was to assess the utility of SDF in determining underlying infection in patients with cirrhosis. Sublingual microcirculation was compared among patients with compensated cirrhosis (Group A, n = 13), cirrhosis without sepsis (Group B, n = 18), cirrhosis with sepsis (Group C, n = 14), and sepsis only (Group D, n = 10). The blood flow was semi-quantitatively evaluated in four equal quadrants in small (10–25 mm); medium (26–50 mm); and large (51–100 mm) sublingual capillaries. The blood flow was described as no flow (0), intermittent flow (1), sluggish flow (2), and continuous flow (3). The overall flow score or microvascular flow index (MFI) was measured for quantitative assessment of microcirculation and predicting power for concurrent infection in cirrhosis. Marked impairment was observed at all levels of microvasculature in Groups B and C when compared with Group A. This effect was restricted to small vessels only when Group B was compared with Group C. MFI < 1.5 was found to have highest sensitivity (100%) and specificity (100%) for infection in decompensated cirrhosis. SDF imaging of sublingual microcirculation can be a useful bedside diagnostic tool to assess bacterial infection in cirrhosis

Attitudes and burden in relatives of patients with schizophrenia in a middle income country

BACKGROUND: Most studies of family attitudes and burden have been conducted in developed countries. Thus it is important to test the generalizability of this research in other contexts where social conditions and extended family involvement may be different. The aim of this study was to assess the relationship between the attitudes of caregivers and the burden they experience in such a context, namely Arica, a town located in the northernmost region of Chile, close to the border with Peru and Bolivia. METHODS: We assessed attitudes towards schizophrenia (including affective, cognitive and behavioural components) and burden (including subjective distress, rejection and competence) in 41 main caregivers of patients with schizophrenia, all of whom were users of Public Mental Health Services in Arica. RESULTS: Attitude measures differed significantly according to socio-demographic variables, with parents (mainly mothers) exhibiting a more negative attitude towards the environment than the rest of the family (t = 4.04; p = 0.000).This was also the case for caregivers with a low educational level (t = 3.27; p < 0.003), for the oldest caregivers (r = 0.546; p = 0.000) and for those who had spent more time with the patient (r = 0.377; p = 0.015). Although attitudes had significant association with burden, their explanatory power was modest (R2 = .104, F = 4,55; p = .039). CONCLUSIONS: Similar to finding developed countries, the current study revealed a positive and significant relationship between the attitudes of caregivers and their burden. These findings emphasize the need to support the families of patients with schizophrenia in this social context

Effectiveness of a clinical practice guideline implementation strategy for patients with anxiety disorders in primary care: cluster randomized trial

<p>Abstract</p> <p>Background</p> <p>Anxiety is a common mental health problem seen in primary care. However, its management in clinical practice varies greatly. Clinical practice guidelines (CPGs) have the potential to reduce variations and improve the care received by patients by promoting interventions of proven benefit. However, uptake and adherence to their recommendations can be low.</p> <p>Method/design</p> <p>This study involves a community based on cluster randomized trial in primary healthcare centres in the Madrid Region (Spain). The project aims to determine whether the use of implementation strategy (including training session, information, opinion leader, reminders, audit, and feed-back) of CPG for patients with anxiety disorders in primary care is more effective than usual diffusion.</p> <p>The number of patients required is 296 (148 in each arm), all older than 18 years and diagnosed with generalized anxiety disorder, panic disorder, and panic attacks by the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). They are chosen by consecutive sampling.</p> <p>The main outcome variable is the change in two or more points into Goldberg anxiety scale at six and twelve months. Secondary outcome variables include quality of life (EuroQol 5D), and degree of compliance with the CPG recommendations on treatment, information, and referrals to mental health services. Main effectiveness will be analyzed by comparing the patients percentage improvement on the Goldberg scale between the intervention group and the control group. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in this analysis.</p> <p>Discussion</p> <p>There is a need to identify effective implementation strategies for CPG for the management of anxiety disorders present in primary care. Ensuring the appropriate uptake of guideline recommendations can reduce clinical variation and improve the care patients receive.</p> <p>Trial registration</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN83365316">ISRCTN83365316</a></p