El clavo gamma en las fracturas proximales de fémur

El clavo Gamma constituye una alternativa a los clavos condilocefálicos de Ender y al clavo-placa o tornillo deslizante en las fracturas de cadera. Hemos revisado retrospectivamente las 50 primeras fracturas del extremo proximal de fémur en el anciano tratadas por nosotros con esta técnica. En 45 casos se trataba de fracturas inestables. El 68% de los pacientes dados de alta hospitalaria han sido revisados durante 6 meses. La mortalidad intrahospitalaria ha sido del 18%. Hemos permitido en todos los casos con independencia del tipo de fractura la deambulación en carga en el postoperatorio inmediato, no habiéndose producido ninguna movilización de la fractura ni fracaso del material. La consolidación se ha producido en todos los casos con una media de 10 semanas. El clavo Gamma concede una buena estabilidad en las fracturas inestables del extremo proximal del fémur, permite la carga precoz sin fracasos mecánicos. La calidad de vida postfractura de los pacientes mejora sensiblemente.The Gamma nail seems to be an alternative to the endomedullar flexible Ender's nail and the sliding screw-plate for trochanteric fractures of the hip. We have retrospectively reviewed the first 50 fractures of the proximal femur in the elderly treated in our hands by this technique. There were 45 unstable fractures. At 6 months after surgery, only 68% of the patients discharged from the hospital were assessed. Intrahospitalary mortality reached 18%. Weight-bearing was allowed from the early postoperative period independently of the type of fracture. No mechanical failures were observed. Fracture repair was achieved in an average period of 10 months. The Gamma nail provides a good stability in unstable fractures of the proximal femur, allowining an early weight-bearing without mechanical failures. The patient's quality of life after fracture is therefore improved by using this method of internal fixation

New insights for diagnosis of Pineapple Fusariosis by MALDI-TOF MS technique

Fusarium is one of the most economically important fungal genus, since it includes many pathogenic species which cause a wide range of plant diseases. Morphological or molecular biology identification of Fusarium species is a limiting step in the fast diagnosis and treatment of plant disease caused by these fungi. Mass spectrometry by matrix-assisted laser/desorption ionisation-time-of-flight (MALDI-TOF)-based fingerprinting approach was applied to the fungal growth monitoring and direct detection of strain Fusarium guttiforme E-480 inoculated in both pineapple cultivars Pérola and Imperial side shoots, that are susceptible and resistant, respectively, to this fungal strain. MALDI-TOF MS technique was capable to detect fungal molecular mass peaks in the susceptible pineapple stem side shoot tissue. It is assumed that these molecular masses are mainly constituted by ribosomal proteins. MALDI-TOF-based fingerprinting approach has herein been demonstrated to be sensitive and accurate for the direct detection of F. guttiforme E-480 molecular masses on both susceptible and resistant pineapple side stem free of any pre-treatment. According to the results obtained, the changing on molecular mass peaks of infected susceptible pineapple tissue together with the possibility of fungal molecular masses analysis into this pineapple tissue can be a good indication for an early diagnosis by MALDI-TOF MS of pineapple fusariosis

Multicenter double blind trial of autologous bone marrow mononuclear cell transplantation through intracoronary injection post acute myocardium infarction – MiHeart/AMI study

Background: Myocardial infarction remains as a major cause of mortality worldwide and a high rate of survivors develop heart failure as a sequel, resulting in a high morbidity and elevated expenditures for health system resources. We have designed a multicenter trial to test for the efficacy of autologous bone marrow (ABM) mononuclear cell (MC) transplantation in this subgroup of patients. The main hypothesis to be tested is that treated patients will have a significantly higher ejection fraction (EF) improvement after 6 months than controls. Methods: A sample of 300 patients admitted with ST elevation acute myocardial infarction (STEMI) and left ventricle (LV) systolic dysfunction, and submitted to successful mechanical or chemical recanalization of the infarct-related coronary artery will be selected for inclusion and randomized to either treated or control group in a double blind manner. The former group will receive 100 x 106 MC suspended in saline with 5% autologous serum in the culprit vessel, while the latter will receive placebo (saline with 5% autologous serum). Implications: Many phase I/II clinical trials using cell therapy for STEMI have been reported, demonstrating that cell transplantation is safe and may lead to better preserved LV function. Patients with high risk to develop systolic dysfunction have the potential to benefit more. Larger randomized, double blind and controlled trials to test for the efficacy of cell therapies in patients with high risk for developing heart failure are required.Brazilian Ministry of Science and Technology (MCT)/The Financing Agency for Studies and Projects (FINEP

Thrombin-receptor antagonist vorapaxar in acute coronary syndromes

Background: Vorapaxar is a new oral protease-activated-receptor 1 (PAR-1) antagonist that inhibits thrombin-induced platelet activation. Methods: In this multinational, double-blind, randomized trial, we compared vorapaxar with placebo in 12,944 patients who had acute coronary syndromes without ST-segment elevation. The primary end point was a composite of death from cardiovascular causes, myocardial infarction, stroke, recurrent ischemia with rehospitalization, or urgent coronary revascularization. RESULTS: Follow-up in the trial was terminated early after a safety review. After a median follow-up of 502 days (interquartile range, 349 to 667), the primary end point occurred in 1031 of 6473 patients receiving vorapaxar versus 1102 of 6471 patients receiving placebo (Kaplan-Meier 2-year rate, 18.5% vs. 19.9%; hazard ratio, 0.92; 95% confidence interval [CI], 0.85 to 1.01; P = 0.07). A composite of death from cardiovascular causes, myocardial infarction, or stroke occurred in 822 patients in the vorapaxar group versus 910 in the placebo group (14.7% and 16.4%, respectively; hazard ratio, 0.89; 95% CI, 0.81 to 0.98; P = 0.02). Rates of moderate and severe bleeding were 7.2% in the vorapaxar group and 5.2% in the placebo group (hazard ratio, 1.35; 95% CI, 1.16 to 1.58; P<0.001). Intracranial hemorrhage rates were 1.1% and 0.2%, respectively (hazard ratio, 3.39; 95% CI, 1.78 to 6.45; P<0.001). Rates of nonhemorrhagic adverse events were similar in the two groups. Conclusions: In patients with acute coronary syndromes, the addition of vorapaxar to standard therapy did not significantly reduce the primary composite end point but significantly increased the risk of major bleeding, including intracranial hemorrhage. (Funded by Merck; TRACER ClinicalTrials.gov number, NCT00527943.

Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA)

Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients. The cornerstones in the management of complicated IAIs are timely effective source control with appropriate antimicrobial therapy. Empiric antimicrobial therapy is important in the management of intra-abdominal infections and must be broad enough to cover all likely organisms because inappropriate initial antimicrobial therapy is associated with poor patient outcomes and the development of bacterial resistance. The overuse of antimicrobials is widely accepted as a major driver of some emerging infections (such as C. difficile), the selection of resistant pathogens in individual patients, and for the continued development of antimicrobial resistance globally. The growing emergence of multi-drug resistant organisms and the limited development of new agents available to counteract them have caused an impending crisis with alarming implications, especially with regards to Gram-negative bacteria. An international task force from 79 different countries has joined this project by sharing a document on the rational use of antimicrobials for patients with IAIs. The project has been termed AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections). The authors hope that AGORA, involving many of the world's leading experts, can actively raise awareness in health workers and can improve prescribing behavior in treating IAIs

La organización y atención a la diversidad en centros de educación secundaria de Iberoamérica. Reflexiones y experiencias

La organización y atención a la diversidad en centros de educación secundaria de Iberoamérica. Reflexiones y experiencias" es el nuevo título de la Serie Informes de RedAGE. La misma recoge la visión de 41 especialistas de 13 países iberoamericanos sobre la realidad y perspectivas de la atencion a la diversidad en centros de educación secundaria. La focalización, en esta etapa educativa, tiene que ver con la consideración de que, actualmente, es el momento de la escolarización donde se producen más abandonos y donde se abren o limitan posibilidades para el posible acceso a estudios superiores de los más capacitados. La orientación de los escritos tiene que ver con las finalidades y objetivos de la Red de Apoyo a la Gestion Educativa (RedAGE); también con el convencimiento, por parte de los que escriben, de que el contexto organizativo actúa como un amplificador o limitador de las actuaciones dirigidas a la formación de los escolares

Relación de los centros educativos de enseñanza secundaria con el entorno en Iberoamérica

La presente aportación recoge la visión de 46 especialistas de trece países iberoamericanos sobre las formas de entender y promover la relación de los centros educativos con el entorno. Situados en la enseñanza secundaria (y en la franja de edad de 15 a 18 años), se trata de delimitar la manera cómo se conecta la vida interna y la vida externa del centro educativo, presentando los modelos que se utilizan, las estrategias de intervención y las experiencias más significativas en cada uno de los países. Las aportaciones no buscan tanto revisar la vinculación de los centros educativos entre sí como de analizar fundamentalmente las vinculaciones con la comunidad y las organizaciones que acoge (asociaciones, empresas, organizaciones gubernamentales o no gubernamentales significativas,…). Al respecto, una parte de los escritos recogen experiencias y estrategias que concretan la relación que estudiamos. Esperamos sea así un apoyo para los estudiosos de la temática, pero también aporte contenidos que ayuden a los directivos a mejorar su gestión de las relaciones externas. La orientación de los escritos al análisis organizativo y a la función de los directivos como promotores de las relación con la comunidad tiene que ver con las finalidades y objetivos de la RedAGE; también con el convencimiento por parte de los que escriben que la ordenación que se haga del contexto de intervención y la actuación de los directivos es fundamental para obtener y mantener las respuestas más idóneas a las exigencias del medio socio-cultural-económico. Su realización se vincula al encuentro de especialistas de la RedAGE realizado en el mes de marzo de 2013 en La Paz. Allí, los representantes de las organizaciones miembro presentaron y debatieron, durante el mismo, documentos sobre la temática de la vinculación escuela y entorno, en sus respectivos países, que constituyen la base sobre la que se han realizado las aportaciones definitivas que recoge el presente texto. Se cubre así y de nuevo un propósito fundamental de la Red AGE, como es el de fomentar el intercambio de experiencias, la promoción del conocimiento sobre administración y gestión educativa y la reflexión sobre la práctica de la gestión. La finalidad última es la de mejorar el funcionamiento de los centros educativos (y, a través de ellos, de los sistemas educativos), procurando sean de calidad y un instrumento para el cambio profesional y social