RESUMEN

OBJECTIVE: To assess the level of agreement on various prevention and management strategies for irritation caused by topical retinoids in facial and trunk acne in an attempt to alleviate it and minimize treatment discontinuations as much as possible. METHOD: After reviewing the scientific medical literatura currently available, 4 different areas of uncertainty in the management of irritation caused by topical retinoids in acne were identified. A questionnaire with 34 recommendations was created and evaluated by a group of 133 dermatologists (Delphi methodology). RESULTS: In 82.3% of the recommendations (28 out of 34), some level of agreement was reached (≥85% agreement in 22 recommendations and≥70% agreement in 6). The results with the highest level of agreement focused on specific patient education strategies (explaining that irritation is an expected reaction at the beginning of treatment and tends to decrease over time), gradual and/or spaced application of topical retinoids (at night time to prevent and/or reduce skin irritation), and the importance of using adjuvant products, specific for acne-prone skin, hydration, photoprotection, and skin cleansing. These recommendations reflect a comprehensive approach to managing irritation associated with topical retinoids and promoting long-term adherence. CONCLUSIONS: Skin irritation caused by topical retinoids in facial and trunk acne is an expected, mild, and controllable reaction if proper prevention and management guidelines are followed, meaning that it should not be a reason for treatment discontinuation.

Asunto(s)

RESUMEN

Introducción: El tratamiento adecuado del dolor, la disminución del estrés preoperatorio, la rehabilitación y la nutrición precoz, disminuyen la morbimortalidad postoperatoria y son la base actual del manejo del paciente quirúrgico. A pesar de haber mejorado los conocimientos sobre fisiopatología del dolor postoperatorio y de disponer de fármacos para su tratamiento, la mitad de los pacientes refieren dolor moderado o intenso. Objetivos: 1. Conocer la incidencia e intensidad del dolor agudo postoperatorio en una la unidad de cirugía gastrointestinal. 2. Evaluar el valor predictivo de la escala visual analógica a las dos horas de la intervención, en relación al grado de dolor postoperatorio durante las primeras 24 horas. 3. Evaluar el grado de satisfacción de los pacientes respecto al control del dolor postoperatorio. Material y métodos: Estudio observacional descriptivo y prospectivo, realizado en el Servicio de Cirugía Gastrointestinal del Hospital Clínico de Barcelona. Se realizó la valoración del dolor en los siguientes momentos: a) al final de la intervención, inmediatamente tras ser extubado el paciente; b) a las dos horas post-intervención; c) a las 24 horas en reposo y en movimiento; d) se recoge el máximo valor de dolor, así como el mínimo dolor referido por el paciente en las últimas 24 horas desde el final de la intervención; e) se valoró la satisfacción del paciente en relación al tratamiento del dolor recibido por parte de los profesionales, y en comparación con las expectativas que él tenía antes de la intervención. Si ha tenido más o menos dolor del que él esperaba tener; f) se registra si el paciente ha podido dormir la primer noche después de la intervención. El estudio fue aprobado por el Comité Ético de Investigación Clínica del Hospital (CEIC). Se solicitó el consentimiento informado de todos los participantes. Resultados: Se incluyeron 51 pacientes (54,9 % hombres y 45,1 % mujeres). La edad media fue de 55,9 ( DE: ± 16,32), 45 pacientes (88,2 %) refirieron haber experimentado dolor en algún momento durante las primeras 24 horas; el 11,8 % no tuvo dolor. En el momento de la entrevista a las 24 horas postintervención, 41 pacientes (80,4 %) refirieron dolor leve (EVA de 0 a 3); el resto de pacientes 15 (19,6 %) refirieron tener dolor moderado (EVA de 4 a 6). El 88,2 % de los pacientes pudo dormir durante la primera noche después de la intervención. Se encontró correlación entre el valor del EVA a las dos horas post-intervención ,y la intensidad del dolor valorada a las 24 horas, tanto en reposo como en movimiento (p = 0,049 y p = 0,03). Presentaron mucho más dolor de lo que ellos esperaban un 2 %, algo más de lo que esperaba un 21,6 %, mucho menos de lo esperado un 29,4 %, lo que esperaban un 33,3 %. Conclusiones: La incidencia de dolor agudo postoperatorio (DAP) es de un 88,2 % a las 24 horas, siendo la intensidad leve en el 80,4 % de los pacientes y moderada en el 19,6 %. La EVA a las dos horas post intervención tiene un alto poder predictivo de los pacientes que presentarán dolor durante las primeras 24 horas. El grado de satisfacción de los pacientes en relación al tratamiento del dolor fue elevado (AU)

Introduction: Adequate pain treatment, together with items that reduce preoperative stress, introducing rehabilitation and nutrition at an early stage, decrease postoperative morbidity and mortality are the current basis of surgical patient management despite greatly improved knowledge of pathophysiology of postoperative pain and provide drug for treatment, half of the patients reported moderate to severe pain in the postoperative period. Objectives: 1. Know the incidence and intensity of acute postoperative pain in gastrointestinal surgery unit. 2. Assessing the predictive value of visual analogue scale at two hours after surgery. 3. To measure the degree of satisfaction of the patients operated on CGI respect to postoperative pain control. Material and methods: A prospective, descriptive, observational study, was conducted in the Department of Gastrointestinal Surgery Clinical Hospital of Barcelona. We performed a measurement of the degree of pain at different times: a) at the end of the intervention; b) at two hours post intervention; c) after 24 hours at rest and in motion immediately after extubation the patient; d) collect the maximum amount of pain and minimal pain reported by the expected patient in the last 24 hours from the end of the intervention is collected; e) patient satisfaction was assessed in relation to the treatment of pain received from professionals and compared to the expectations he had before surgery. If you have had more or less pain than he would have expected; f) the Clinical Research Ethics Committee of the Hospital (CEIC) approved in October 2011, and g) respondents were informed consent request. Results: The study included 51 patients one (54.9 %) males and (45.1 %) women the mean age was 55.90 (SD ± 16.32). A total of 45 patients (88.2 %) reported having experienced pain Sometime in the last 24 hours versus 11.8 % 6 patients who had no pain at the time of the interview 41 patients (80.4 %) mild pain VAS 0-3. The remaining 15 patients (19.6 %) reported having moderate pain VAS 4-6. However, 88.2 % of patients could not sleep during the first night after surgery. A correlation between the value of EVA at two hours post intervention and assessed pain intensity at 24 hours, both at rest and in motion p 0.049 and p 0.03 Despite suffering pain satisfaction was very good, presented much more pain than they expected 2 %, something more than expected by 21.6 %, much less than what they expected 29.4 % what they expected 33.3 %. Conclusions: 1. DAP incidence is 88.2 % at 24 hours after the IQ. With a mild pain intensity in 80.4 % of patients and moderate pain intensity in 19.6 %. 2. The Eva at two hours post-intervention, indicating that patients will require special attention and has a high predictive as it almost certainly will suffer pain 24 hours. 3. Although there is acute postoperative pain degree of patient satisfaction with physicians and nurses regarding their treatment was very satisfactory (AU)

Asunto(s)

RESUMEN

The results of a simultaneous (13)C and (15)N labelling experiment with two different durum wheat cultivars, Blanqueta (a traditional wheat) and Sula (modern), are presented. Plants were grown from the seedling stage in three fully controllable plant growth chambers for one growing season and at three different CO2 levels (i.e. 260, 400 and 700 ppm). Short-term isotopic labelling (ca. 3 days) was performed at the anthesis stage using (13)CO2 supplied with the chamber air and (15)NH4₋(15)NO3 applied with the nutrient solution, thereby making it possible to track the allocation and partitioning of (13)C and (15) N in the different plant organs. We found that photosynthesis was up-regulated at pre-industrial CO2 levels, whereas down-regulation occurred under future CO2 conditions. (13)C labelling revealed that at pre-industrial CO2 carbon investment by plants was higher in shoots, whereas at future CO2 levels more C was invested in roots. Furthermore, the modern genotype invested more C in spikes than did the traditional genotype, which in turn invested more in non-reproductive shoot tissue. (15)N labelling revealed that the modern genotype was better adapted to assimilating N at higher CO2 levels, whereas the traditional genotype was able to assimilate N more efficiently at lower CO2 levels.

Asunto(s)

RESUMEN

Cessation of traditional management threatens semi-natural grassland diversity through the colonisation or increase of competitive species adapted to nutrient-poor conditions. Regular mowing is one practice that controls their abundance. This study evaluated the ecophysiological mechanisms limiting short- and long-term recovery after mowing for Festuca paniculata, a competitive grass that takes over subalpine grasslands in the Alps following cessation of mowing. We quantified temporal variations in carbon (C) and nitrogen (N) content, starch, fructan and total soluble sugars in leaves, stem bases and roots of F. paniculata during one growth cycle in mown and unmown fields and related them to the dynamics of soil mineral N concentration and soil moisture. Short-term results suggest that the regrowth of F. paniculata following mowing might be N-limited, first because of N dilution by C increments in the plant tissue, and second, due to low soil mineral N and soil moisture at this time of year. However, despite short-term effects of mowing on plant growth, C and N content and concentration at the beginning of the following growing season were not affected. Nevertheless, total biomass accumulation at peak standing biomass was largely reduced compared to unmown fields. Moreover, lower C storage capacity at the end of the growing season impacted C allocation to vegetative reproduction during winter, thereby dramatically limiting the horizontal growth of F. paniculata tussocks in the long term. We conclude that mowing reduces the growth of F. paniculata tussocks through both C and N limitation. Such results will help understanding how plant responses to defoliation regulate competitive interactions within plant communities.

Asunto(s)

RESUMEN

Further knowledge of the processes conditioning nitrogen use efficiency (NUE) is of great relevance to crop productivity. The aim of this paper was characterise C and N partitioning during grain filling and their implications for NUE. Cereals such as bread wheat (Triticum aestivum L. cv Califa sur), triticale (× Triticosecale Wittmack cv. Imperioso) and tritordeum (× Tritordeum Asch. & Graebn line HT 621) were grown under low (LN, 5 mm NH(4) NO(3)) and high (HN, 15 mm NH(4)NO(3)) N conditions. We conducted simultaneous double labelling ((12)CO(2) and (15)NH(4) (15)NO(3)) in order to characterise C and N partitioning during grain filling. Although triticale plants showed the largest total and ear dry matter values in HN conditions, the large investment in shoot and root biomass negatively affected ear NUE. Tritordeum was the only genotype that increased NUE in both N treatments (NUE(total)), whereas in wheat, no significant effect was detected. N labelling revealed that N fertilisation during post-anthesis was more relevant for wheat and tritordeum grain filling than for triticale. The study also revealed that the investments of C and N in flag leaves and shoots, together with the 'waste' of photoassimilates in respiration, conditioned the NUE of plants, and especially under LN. These results suggest that C and N use by these plants needs to be improved in order to increase ear C and N sinks, especially under LN. It is also remarkable that even though tritordeum shows the largest increase in NUE, the low yield of this cereal limits its agronomic value.

Asunto(s)

Asunto(s)

RESUMEN

No disponible

Asunto(s)

RESUMEN

Effects of drought on water relations, whole-shoot gas-exchange characteristics, and pigment and zeatin concentrations were investigated in the Mediterranean shrubs rosemary (Rosmarinus officinalis L.) and lavender (Lavandula stoechas L.). Two-year-old, greenhouse-grown plants were placed in a whole-shoot gas-exchange measurement system and subjected to 10 days of drought, resulting in severe water stress, and then re-watered for 5 days in order to study their recovery. Water stress resulted in a significant decline in maximum whole-shoot net CO2 assimilation rates (An) for both species that was associated with reductions in leaf area and stomatal conductance. Because shoot dark respiration rate (Rd) was less sensitive to water stress than An, shoot Rd/An ratio increased from about 15 to 95% during water stress. No major changes in chlorophyll and carotenoid concentrations of rosemary leaves were observed during the experiments, but chlorophyll and carotenoid concentrations fell significantly in water-stressed lavender leaves. Zeatin concentrations were higher in rosemary leaves than in lavender leaves during water stress. After re-watering, whole-shoot An and Rd rapidly recovered to their pre-drought rates.

Asunto(s)

RESUMEN

The effects of drought on the photosynthetic characteristics of three Mediterranean plants (olive, Olea europea L.; rosemary, Rosmarinus officinalis L.; lavender, Lavandula stoechas L.) exposed to elevated UV-B irradiation in a glasshouse were investigated over a period of weeks. Drought conditions were imposed on 2-year-old plants by withholding water. During the onset of water stress, analyses of the response of net carbon assimilation of leaves to their intercellular CO2 concentration were used to examine the potential limitations imposed by stomata, carboxylation velocity and capacity for regeneration of ribulose 1,5-bisphosphate on photosynthesis. Measurements of chlorophyll fluorescence were used to determine changes in the efficiency of light utilization for electron transport, the occurrence of photoinhibition of photosystem II photochemistry and the possibility of stomatal patchiness across leaves. The first stages of water stress produced decreases in the light-saturated rate of CO2 assimilation which were accompanied by decreases in the maximum carboxylation velocity and the capacity for regeneration of ribulose 1,5-bisphosphate in the absence of any significant photodamage to photosystem II. Leaves of rosemary and lavender were more sensitive than those of olive during the first stages of the drought treatment and also exhibited increases in stomatal limitation. With increasing water stress, significant decreases in the maximum quantum efficiency of photosystem II photochemistry occurred in lavender and rosemary, and stomatal limitation was increased in olive. No indication of any heterogeneity of photosynthesis was found in any leaves. Drought treatment significantly decreased leaf area in all species, an important factor in drought-induced decreases in photosynthetic productivity. Exposure of plants to elevated UV-B radiation (0.47 W m(-2)) prior to and during the drought treatment had no significant effects on the growth or photosynthetic activities of the plants. Consequently, it is predicted that increasing UV-B due to future stratospheric ozone depletion is unlikely to have any significant impact on the photosynthetic productivity of olive, lavender and rosemary in the field.

Asunto(s)

RESUMEN

The effects of ultraviolet-B (UV-B) radiation on stomatal conductance (g(s)) in pea (Pisum sativum L.), commelina (Commelina communis L.), and oilseed rape (Brassica napus L.) plants were investigated. Plants were grown in a greenhouse either with three different high ratios of UV-B to photosynthetically active radiation or with no UV-B radiation. Pea plants grown in the highest UV-B radiation (0.63 W m(-2)) exhibited a substantial decrease of adaxial and abaxial g(s) (approximately 80% and 40%, respectively). With growth in 0.30 W m(-2) of UV-B adaxial g(s) was decreased by 23%, with no effect on abaxial g(s), and lower UV-B irradiance of 0.21 W m(-2) had no effect on either surface. Although abaxial g(s) increased when leaves were turned over in control plants, it did not in plants grown with the highest UV-B. Adaxial g(s) in commelina and oilseed rape also decreased on exposure to high UV-B (0.63 W m(-2)). For previously unexposed pea plants the time course of the effect of UV-B on g(s) was slow, with a lag of approximately 4 h, and a time constant of approximately 3 h. We conclude that there is a direct effect of UV-B on stomata in addition to that caused by changes in mesophyll photosynthesis.

RESUMEN

The effects of ultraviolet-B (UV-B) radiation on water relations, leaf development, and gas-exchange characteristics in pea (Pisum sativum L. cv Meteor) plants subjected to drought were investigated. Plants grown throughout their development under a high irradiance of UV-B radiation (0.63 W m-2) were compared with those grown without UV-B radiation, and after 12 d one-half of the plants were subjected to 24 d of drought that resulted in mild water stress. UV-B radiation resulted in a decrease of adaxial stomatal conductance by approximately 65%, increasing stomatal limitation of CO2 uptake by 10 to 15%. However, there was no loss of mesophyll light-saturated photosynthetic activity. Growth in UV-B radiation resulted in large reductions of leaf area and plant biomass, which were associated with a decline in leaf cell numbers and cell division. UV-B radiation also inhibited epidermal cell expansion of the exposed surface of leaves. There was an interaction between UV-B radiation and drought treatments: UV-B radiation both delayed and reduced the severity of drought stress through reductions in plant water-loss rates, stomatal conductance, and leaf area.

RESUMEN

BACKGROUND. Pneumocephalus developed in a 45-year-old woman after epidural anesthesia was performed to treat her low back pain. The cause was thought to be the loss of resistance to air technique. The clinical symptoms were immediate headache independent of posture, pallor, bradycardia, and hypotension. These symptoms disappeared during the first 24 hours with no neurologic sequelae. CONCLUSION. This case suggests that using the loss of resistance technique with saline versus air should prevent this complication, especially after unintentional dural puncture or when, in difficult placements, the technique is repeated frequently in the same patient.

Asunto(s)

Asunto(s)