La hidroxiapatita asociada al sulfato cálcico como material de substitución ósea. Aspectos biológicos.

La cirugía ortopédica y máxilo-facial necesitan realizar en muchas ocasiones resecciones masivas de tejido óseo. Esto ha hecho que se haya propuesto la utilización de materiales inertes como substitutos óseos, gracias a la habilidad que tienen de permitir la regeneración del hueso, tanto en el campo de la medicina como en el de la odontología. Nuestro trabajo tiene por objetivo estudiar un biomaterial compuesto de hidroxiapatita y sulfato cálcico como material de substitución ósea en forma de cilindros. Se han intervenido 75 animales de experimentación (conejo Albino de Nueva Zelanda), divididos en tres grupos, cada uno de ellos compuesto por 25 animales. En el grupo I o control, los animales fueron intervenidos quirúrgicamente realizándoseles una cavidad a nivel metafisodiafisario en el fémur sin realizar implantes. A los animales del grupo II y III se les realizó la misma intervención, pero se les implantó un cilindro de hidroxiapatita (HA) y sulfato cálcico a dos concentraciones diferentes, 50% - 50% y 70% - 30% respectivamente. El estudio ha demostrado una regeneración ósea de la cavidad rellenada a expensas de la rápida reabsorción del yeso, y de una lenta reabsorción de la hidroxiapatita.Peer Reviewe

Estudio experimental del relleno de cavidades óseas con hidroxiapatita asociada a colágeno

La cirugía ortopédica y maxilo-facial necesita realizar en muchas ocasiones resecciones masivas de tejido óseo. Esto ha hecho que se hayan propuesta la utilización de materiales inertes como sustitutos óseos, gracias a la habilidad que tienen de permitir la regeneración del hueso, tanto en el campo de la medicina como de la odontología. Nuestro trabajo tiene por objetivo estudiar un biomaterial compuesto de hidroxiapatita asociado a colágeno como material de sustitución ósea (Collapat de OSTEO AG) en forma de esponjas, con un peso de 500 mg y de un tamaño de 35x30x6 mm. Se han intervenido 50 animales de experimentación (conejo Albino de Nueva Zelanda), divididos por 16 animales. Los animales de este grupo fueron intervenidos quirúrgicamente realizándose una cavidad a nivel metafisodiafisario en el fémur y otra en la tibia, pero en ninguna de las cavidades se realizaron implantes. Los animales del grupo II o grupo estudio estaban comprendidos por 34 animales, a los que se les realizó la misma intervención, pero se le implantó una esponja de hidroxiapatita-colágeno de las dimensiones antes descritas, en cada una de las cavidades. El estudio ha demostrado una regeneración ósea de la cavidad rellenada a expensas de la rápida reabsorbción del colágeno, y de una lenta reabsorbción de la hidroxiapatita

Estudio de un cemento bioactivo de hidroxiapatita como material de substitución ósea

La cirugía ortopédica y máxilo-facial necesita realizar en muchas ocasiones resecciones masivas de tejido óseo. Esto ha hecho que se haya propuesto la utilización de materiales inertes como substitutos óseos, gracias a la habilidad que tienen de permitir la regeneración del hueso, tanto en el campo de la medicina como en el de la odontología. Nuestro trabajo tiene por objetivo estudiar un biomaterial compuesto de hidroxiapatita y dicalcio-fosfato (hidroxiapatita deficiente en calcio) como material de substitución ósea, en forma de cemento bioactivo. Se han intervenido 75 animales de experimentación (conejo Albino de Nueva Zelanda), divididos en dos grupos, cada uno de ellos compuesto por 25 animales. En el grupo I o control, los animales fueron intervenidos quirúrgicamente realizándoseles una cavidad a nivel metáfisodiafisario en el fémur sin realizar implantes. A los animales del grupo II se les realizó la misma intervención, pero se les implantó un cilindro fraguado de hidroxiapatita deficiente en calcio.Peer Reviewe

Assessment of elemental composition in commercial fish of the Bay of Cádiz, Southern Iberian Peninsula

The assessment of trace metal content in our fish diet is important due to the adverse effect on human health. Despite the increasing interest about the fish quality, little information is available for Southern Spain, a region characterized by high seafood intake. Nine species from the Bay of Cádiz with high commercial value were selected. Similar values were measured in the nine studied species for most of the elements, except for the macroelements Ca and S, and the microelements Fe, Mn and As, which showed significant differences among species. Metal Pollution Index (MPI) did not differ among species, and it was similar to those obtained for other Atlantic and Mediterranean locations. The values measured for the nine species were below the health limits provided by World, European and Spanish legislations, indicating that, in general terms, consumption of these species is safe in the study area.We are very grateful to Dr. P. Burgos for chemical analysis conducted in IRNAS-CSIC (Instituto de Recursos Naturales y Agrobiología, Consejo Superior de Investigaciones Científicas, Sevilla). During the study, ID-A enjoyed a grant "Margarita Salas" financed by the European Union (Next Generation EU) and the Ministerio de Universidades of Spain

HIV and HCV screening by non-infectious diseases physicians: can we improve testing and hidden infection rates?

BackgroundMissed opportunities for Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV) testing remain high. We aimed to ascertain the knowledge of screening guidelines and attitudes of non-infectious disease (ID) hospital physicians and assess the impact of a 1-h session on screening rates and diagnoses.MethodsThis interventional study consisted of a 1-h training session on HIV and HCV epidemiology and testing guidelines for non-ID physicians. Pre-and post-session questionnaires compared the knowledge of the guidelines and attitudes toward screening before and after the session. Rates of screening and diagnoses were compared in three 6 months periods: before, immediately after, and 24 months ±4 after the session.ResultsA total of 345 physicians from 31 departments participated in these sessions. Before the session, 19.9% (28% medical, 8% surgical) and 17.9% (30% medical, 2.7% surgical) were aware of HIV and HCV testing guidelines, respectively. The willingness to routinely test increased from 5.6 to 22%, whereas not ordering tests decreased from 34.1 to 2.4%. HIV screening rates significantly increased by 20% after the session (7.7 vs. 9.3 tests per 103 patients; p < 0.001), and the effect persisted until the long-term period. The HIV diagnosis rate increased globally (3.6 vs. 5.2 HIV diagnoses per 105 patients; p = 0.157), mainly because of medical services (4.7 vs. 7.7 per 105 patients; p = 0.082). The HCV screening rate increased significantly immediately and in the long term only in medical services (15.7 and 13.6%, respectively). The new active HCV infection rates increased immediately and declined steeply thereafter.ConclusionA short session for non-ID physicians can improve HIV/HCV screening, increase diagnosis, and contribute to disease elimination

Base de datos de preguntas y actualización del software. Herramientas para la generación de exámenes presenciales u online

Depto. de Farmacología y ToxicologíaFac. de MedicinaFALSEsubmitte

Predictive Power of the "Trigger Tool" for the detection of adverse events in general surgery: a multicenter observational validation study

Background In spite of the global implementation of standardized surgical safety checklists and evidence-based practices, general surgery remains associated with a high residual risk of preventable perioperative complications and adverse events. This study was designed to validate the hypothesis that a new “Trigger Tool” represents a sensitive predictor of adverse events in general surgery. Methods An observational multicenter validation study was performed among 31 hospitals in Spain. The previously described “Trigger Tool” based on 40 specific triggers was applied to validate the predictive power of predicting adverse events in the perioperative care of surgical patients. A prediction model was used by means of a binary logistic regression analysis. Results The prevalence of adverse events among a total of 1,132 surgical cases included in this study was 31.53%. The “Trigger Tool” had a sensitivity and specificity of 86.27% and 79.55% respectively for predicting these adverse events. A total of 12 selected triggers of overall 40 triggers were identified for optimizing the predictive power of the “Trigger Tool”. Conclusions The “Trigger Tool” has a high predictive capacity for predicting adverse events in surgical procedures. We recommend a revision of the original 40 triggers to 12 selected triggers to optimize the predictive power of this tool, which will have to be validated in future studies

Effectiveness of Fosfomycin for the Treatment of Multidrug-Resistant Escherichia coli Bacteremic Urinary Tract Infections

IMPORTANCE The consumption of broad-spectrum drugs has increased as a consequence of the spread of multidrug-resistant (MDR) Escherichia coli. Finding alternatives for these infections is critical, for which some neglected drugs may be an option. OBJECTIVE To determine whether fosfomycin is noninferior to ceftriaxone or meropenem in the targeted treatment of bacteremic urinary tract infections (bUTIs) due to MDR E coli. DESIGN, SETTING, AND PARTICIPANTS This multicenter, randomized, pragmatic, open clinical trial was conducted at 22 Spanish hospitals from June 2014 to December 2018. Eligible participants were adult patients with bacteremic urinary tract infections due to MDR E coli; 161 of 1578 screened patients were randomized and followed up for 60 days. Data were analyzed in May 2021. INTERVENTIONS Patients were randomized 1 to 1 to receive intravenous fosfomycin disodium at 4 g every 6 hours (70 participants) or a comparator (ceftriaxone or meropenem if resistant; 73 participants) with the option to switch to oral fosfomycin trometamol for the fosfomycin group or an active oral drug or pa renteral ertapenem for the comparator group after 4 days. MAIN OUTCOMES AND MEASURES The primary outcome was clinical and microbiological cure (CMC) 5 to 7 days after finalization of treatment; a noninferiority margin of 7% was considered. RESULTS Among 143 patients in the modified intention-to-treat population (median [IQR] age, 72 [62-81] years; 73 [51.0%] women), 48 of 70 patients (68.6%) treated with fosfomycin and 57 of 73 patients (78.1%) treated with comparators reached CMC (risk difference, -9.4 percentage points; 1-sided 95% CI, -21.5 to infinity percentage points; P = .10). While clinical or microbiological failure occurred among 10 patients (14.3%) treated with fosfomycin and 14 patients (19.7%) treated with comparators (risk difference, -5.4 percentage points; 1-sided 95% CI. -infinity to 4.9; percentage points; P = .19), an increased rate of adverse event-related discontinuations occurred with fosfomycin vs comparators (6 discontinuations [8.5%] vs 0 discontinuations; P = .006). In an exploratory analysis among a subset of 38 patients who underwent rectal colonization studies, patients treated with fosfomycin acquired a new ceftriaxone-resistant or meropenem-resistant gram-negative bacteria at a decreased rate compared with patients treated with comparators (0 of 21 patients vs 4 of 17 patients [23.5%]; 1-sided P = .01). CONCLUSIONS AND RELEVANCE This study found that fosfomycin did not demonstrate noninferiority to comparators as targeted treatment of bUTI from MDR E coli; this was due to an increased rate of adverse event-related discontinuations. This finding suggests that fosfomycin may be considered for selected patients with these infections

IKZF1plus is a frequent biomarker of adverse prognosis in Mexican pediatric patients with B-acute lymphoblastic leukemia

BackgroundRecurrent genetic alterations contributing to leukemogenesis have been identified in pediatric B-cell Acute Lymphoblastic Leukemia (B-ALL), and some are useful for refining classification, prognosis, and treatment selection. IKZF1plus is a complex biomarker associated with a poor prognosis. It is characterized by IKZF1 deletion coexisting with PAX5, CDKN2A/2B, or PAR1 region deletions. The mutational spectrum and clinical impact of these alterations have scarcely been explored in Mexican pediatric patients with B-ALL. Here, we report the frequency of the IKZF1plus profile and the mutational spectrum of IKZF1, PAX5, CDKN2A/2B, and ERG genes and evaluate their impact on overall survival (OS) in a group of patients with B-ALL.MethodsA total of 206 pediatric patients with de novo B-ALL were included. DNA was obtained from bone marrow samples at diagnosis before treatment initiation. A custom-designed next-generation sequencing panel was used for mutational analysis. Kaplan-Meier analysis was used for OS estimation.ResultsWe identified the IKZF1plus profile in 21.8% of patients, which was higher than that previously reported in other studies. A significantly older age (p=0.04), a trend toward high-risk stratification (p=0.06), and a decrease in 5-year Overall Survival (OS) (p=0.009) were observed, although heterogeneous treatment protocols in our cohort would have impacted OS. A mutation frequency higher than that reported was found for IKZF1 (35.9%) and CDKN2A/2B (35.9%) but lower for PAX5 (26.6%). IKZF1MUT group was older at diagnosis (p=0.0002), and most of them were classified as high-risk (73.8%, p=0.02), while patients with CDKN2A/2BMUT had a higher leukocyte count (p=0.01) and a tendency toward a higher percentage of blasts (98.6%, >50% blasts, p=0.05) than the non-mutated patients. A decrease in OS was found in IKZF1MUT and CDKN2A/2BMUT patients, but the significance was lost after IKZF1plus was removed.DiscussionOur findings demonstrated that Mexican patients with B-ALL have a higher prevalence of genetic markers associated with poor outcomes. Incorporating genomic methodologies into the diagnostic process, a significant unmet need in low- and mid-income countries, will allow a comprehensive identification of relevant alterations, improving disease classification, treatment selection, and the general outcome