Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial

Background Results of small trials indicate that fluoxetine might improve functional outcomes after stroke. The FOCUS trial aimed to provide a precise estimate of these effects. Methods FOCUS was a pragmatic, multicentre, parallel group, double-blind, randomised, placebo-controlled trial done at 103 hospitals in the UK. Patients were eligible if they were aged 18 years or older, had a clinical stroke diagnosis, were enrolled and randomly assigned between 2 days and 15 days after onset, and had focal neurological deficits. Patients were randomly allocated fluoxetine 20 mg or matching placebo orally once daily for 6 months via a web-based system by use of a minimisation algorithm. The primary outcome was functional status, measured with the modified Rankin Scale (mRS), at 6 months. Patients, carers, health-care staff, and the trial team were masked to treatment allocation. Functional status was assessed at 6 months and 12 months after randomisation. Patients were analysed according to their treatment allocation. This trial is registered with the ISRCTN registry, number ISRCTN83290762. Findings Between Sept 10, 2012, and March 31, 2017, 3127 patients were recruited. 1564 patients were allocated fluoxetine and 1563 allocated placebo. mRS data at 6 months were available for 1553 (99·3%) patients in each treatment group. The distribution across mRS categories at 6 months was similar in the fluoxetine and placebo groups (common odds ratio adjusted for minimisation variables 0·951 [95% CI 0·839–1·079]; p=0·439). Patients allocated fluoxetine were less likely than those allocated placebo to develop new depression by 6 months (210 [13·43%] patients vs 269 [17·21%]; difference 3·78% [95% CI 1·26–6·30]; p=0·0033), but they had more bone fractures (45 [2·88%] vs 23 [1·47%]; difference 1·41% [95% CI 0·38–2·43]; p=0·0070). There were no significant differences in any other event at 6 or 12 months. Interpretation Fluoxetine 20 mg given daily for 6 months after acute stroke does not seem to improve functional outcomes. Although the treatment reduced the occurrence of depression, it increased the frequency of bone fractures. These results do not support the routine use of fluoxetine either for the prevention of post-stroke depression or to promote recovery of function. Funding UK Stroke Association and NIHR Health Technology Assessment Programme

Fluor en las aguas de consumo y caries dental, Cuenca - Shiquir - Tarqui

Doctor en OdontologíaCuenc

Granulomatous Hepatitis Secondary to Histoplasma Infection after Treatment with Infliximab

Classical presentation of Histoplasma infection includes fever and respiratory symptoms. Opportunistic microorganisms must be suspected on immunocompromised patients who develop bizarre symptoms. We present a case of a female patient with rheumatoid arthritis who received treatment with Infliximab during one and a half year; she developed granulomatous hepatitis secondary to Histoplasma infection. The patient was admitted with acute hepatitis and thrombocytopenic coagulopathy. A liver biopsy was performed revealing granulomatous hepatitis, microvesicular steatosis, isolated apoptotic cells, and parenchyma microabscesses. PAS and Gömöri stains revealed areas with mycotic microorganisms morphologically compatible with Histoplasma spp. and confirmed by culture

Estudio de frecuencias de comportamiento de tuberculosis osea datos obtenidos del H.V.C.M. de Cuenca Y H.H.C. de Azogues 1979-1983

Doctor en Medicina y CirugíaCuenc

Proyecto de mejora de la eficiencia en la nacionalización de la mercadería de la importadora de llantas abc en la ciudad de Guayaquil, aplicando la metodología idef0 y transformación de empresas

El objetivo principal del modelo de IDEF0, es identificar y explicar los procesos que intervienen en las actividades diarias dentro de una compañía, ya sean estas administrativas u operativas. El modelo consiste en diagramar todos los procesos de la empresa, previo a una investigación interna del funcionamiento de la misma en todas sus áreas. La identificación de los procesos es de gran ayuda a la hora de encontrar donde se están creando atrasos o problemas en la búsqueda de la eficiencia dentro de la empresa. En el presente proyecto se tomo en consideración a la empresa importadora de neumáticos ABC, a la cual, una vez modelada e identificado el área problema, se procedió a planificar las estrategias que darán solución al problema de ABC. El proyecto se encuentra dividido en cinco capítulos, empezando por una descripción de la empresa ABC y el mercado donde compite. A continuación se detalla el modelo de IDEF0 y su respectiva implementación en la empresa. Como tercer punto se identifica el área problema dentro de ABC y a continuación se elabora el plan de eliminación de desperdicios. El quinto capítulo consiste en el análisis financiero que permite constatar la real utilidad del plan de mejoras. Finalmente se realizarán las conclusiones del proyecto, así como recomendaciones dirigidas a la gerencia para alcanzar la meta trazada por ABC