Análisis ecológico de las comunidades liquénicas de la Catedral de León (España)

Ecological analysis of Leon Cathedral lichen communities (Spain).A study of the lichen communities present on Leon Cathedral showed there to be 39 species present, mainly crustose forms of the Teloschistaceae and Lecanoraceae. Two lichen communities were found on calcareous stonework and on highly nitrified habitats. Species distribution depends mainly on nitrophytism, hygrophytism, photophytism and pH indexes, and to a lesser extent on angle of inclination, exposure and substrate type.     

Queratomicosis en un centro de atención oftalmológica en la Ciudad de México

BackgroundSome of the most common precipitating events for keratomycoses (fungal keratitis), include surgical trauma (after cornea transplantation), the use of contaminated contact lenses or alterations in lacrimal secretions. Diagnosis and treatment (to avoid loss of vision) for these type of infections are challenging.ObjectiveRetrospective review of the diagnosis, epidemiology, etiology and response to treatment in 219 patients with fungal keratitis in Mexico.MethodsWe have studied the diagnosis, epidemiology, etiology and response to treatment in 219 patients from different states in the Mexican Republic in the Cornea Department at an Ophthalmology Hospital in Mexico D.F.ResultsTrauma was the precipitating event in 77 patients (36%), of which 12 (5.4%) were due to surgical trauma; 152 patients (64.8%) did not report any prior trauma. There were 165 male (75.3%) and 54 female (24.6%) patients, with an average age of 46 years old. For clinical and visual treatment patients were treated with topical and oral antifungals and surgery. One or more surgeries were performed on a total of 81 patients (36.9%). A total of 62 patients (28.3%) received a corneal transplant, and 19 patients (8.7%) were subjected to conjunctival flap or scleral-conjunctival surgery.ConclusionsIn Mexico, keratomycoses affect mostly male patients in a 4:1 ratio over females. Fusarium solani was the most frequent agent of fungal keratitis in our study (37.2%), and the highest number of corneal ulcers and eviscerations (26%) was present in patients infected by Aspergillus. The best therapeutic responses were with combination of topical antifungals against dematiaceous fungi.     

Análisis de la utilización de anfotericina B liposomal

BackgroundThe increase in immunosuppressed patients and in the use of cytotoxic and immunosuppressive agents in the last few years has led to a rise in the incidence of invasive fungal infections.AimsThe objective of this study is to evaluate the use of liposomal amphotericin B according to its indication, dosage, effectiveness and nephrotoxicity.MethodsThis is a retrospective study over a 8 year-period. Indications and dosage described in the Summary of Product Characteristics were taken as reference. Effectiveness was measured in terms of resolution of infection, no recurrence or emergence, survival at 7th day, no discontinuation and no addition of another antifungal. Effectiveness was also analysed in relation to indication, dosage, treatment duration, cumulative dose and comorbidity. Nephrotoxicity was defined as a doubled serum creatinine when compared with basal values.ResultsA total of 47 episodes were analysed, with 91.5% of treatments being adequate for the indications. Effectiveness was achieved in 44.7% of cases: 33% in neutropenic patients, 50% of aspergillosis, 60% of candidiasis, and 100% of the leishmaniasis. Response rates in patients treated for 15 days or less and those for more than 15 days were 25 and 56.5% (P = .039), respectively. The main causes of failure were death (23%) and lack of effectiveness (17%), with 9% of patients suffering from nephrotoxicity.ConclusionsThe effectiveness and nephrotoxicity data agree with those obtained in other studies. Liposomal amphotericin B is a safe drug with a moderate effectiveness that is associated with the duration of the treatment.     

Análisis cladístico del género Pachycereus (Cactaceae) con caracteres morfológicos

El géneroPachycereus incluye 13 especies de acuerdo con las clasificaciones más recientes, y se distribuye en Guatemala, México y SW de los Estados Unidos, Se presenta un análisis filogenético con el propósito de fundamentar la monofilia del género, respecto a los otros géneros de la subtribu Pachycereinae. Se creó una matriz utilizando 44 caracteres estructurales (morfología y anatomía) y 29 taxones, incluyendo nueve especies de Pachycereinae. Los resultados indican que la subtribu Pachycereinae sólo puede ser monofilética si se incluyen dos especies deStenocereus: S. aragonii y.S. eichlamii, con base en dos caracteres de la semilla (paredes periclinales planas y microrrelieve finamente rugoso). El géneroPachycereus no es monofilético de acuerdo con la clasificación más reciente;Pachycereus hollianus yP. lepidanthus carecen de zona fértil diferenciada y representan el grupo hermano de las restantes especies de la subtribu Pachycereinae;P. fulviceps está relacionado con los génerosCephalocereus yNeobuxbaumia por el tipo de zona nectarial, el color de la pulpa del fruto y los cristales prismáticos de oxalato de calcio en células epidérmicas;P. grandis, P. pecten-aboriginum, P. pringlei, P. tepamo yP. weberi se resuelven como grupo monofilético por presentar un surco angosto y una flor con constricción en la base del tubo. Este grupo de cinco especies debe representar al géneroPachycereus sensu stricto.     

Análisis de la sedación paliativa en pacientes mayores hospitalizados: efectividad de un protocolo

ObjectiveTo measure changes in the practice of palliative sedation during agony in hospitalised elderly patients before and after the implementation of a palliative sedation protocol.Material and methodsA retrospective before-after study was performed in hospitalised patients over 65 years old who received midazolam during hospital admission and died in the hospital in two 3-month periods, before and after the implementation of the protocol. Non-sedative uses of midazolam and patients in intensive care were excluded. Patient and admission characteristics, the consent process, withdrawal of life-sustaining treatments, and the sedation process (refractory symptom treated, drug doses, assessment and use of other drugs) were recorded. Association was analysed using the Chi² and Student t tests.ResultsA total of 143 patients were included, with no significant differences between groups in demographic characteristics or symptoms. Do not resuscitate (DNR) orders were recorded in approximately 70% of the subjects of each group, and informed consent for sedation was recorded in 91% before vs. 84% after the protocol. Induction and maintenance doses of midazolam followed protocol recommendations in 1.3% before vs 10.4% after the protocol was implemented (P=.02) and adequate rescue doses were used in 1.3% vs 11.9% respectively (P=.01). Midazolam doses were significantly lower (9.86 mg vs 18.67 mg, P<.001) when the protocol was used than when it was not used. Ramsay sedation score was used in 8% vs. 12% and the Palliative Care Team was involved in 35.5% and 16.4% of the cases (P=.008) before and after the protocol, respectively.ConclusionsUse of midazolam slightly improved after the implementation of a hospital protocol on palliative sedation. The percentage of adequate sedations and the general process of sedation were mostly unchanged by the protocol. More education and further assessment is needed to gauge the effect of these measures in the future.     

Blastomicosis: presentación de un caso importado en México,con lesiones exclusivamente cutáneas

BackgroundBlastomycosis is a granulomatous infectious disease. It is caused by the dimorphus fungus Blastomyces dermatitidis. It predominates in the United States of America, but in Mexico two systemic imported cases have been reported. Cutaneous primary blastomycosis is a rare clinical presentation, which occurs after traumatic inoculation of the fungus.ObjectivesWe present a case of a 54 year old male, born in Guadalajara, Mexico, and living in Chicago, USA, who had two verrucous nodules (8 mm in diameter) on the forehead and right nasogenian fold, of 4 weeks progression.MethodsWe made a histopathological study (hematoxylin and eosin, Gomori Groccot and periodic acid-Schiff stains) and mycology studies (direct microscopic examination, Sabouraud and mycobiotic agar cultures). Multiple studies were made with no evidence of systemic spread.ResultsBiopsy showed a dermal inflammatory infiltrate made up of lymphocytes, neutrophils, histiocytes and multinucleated giant cells. A few large, haloed, broad-based budding yeasts were also observed. Direct examination with KOH revealed broad-based budding yeasts, 10 μm in diameter. Culture at 35 °C yielded a white, pleated colony, which changed into a yellowish cerebriform. Multiple studies were made with no evidence of systemic spread.Itraconazole 200 mg qd PO was given over a 2 month period, with a complete clinical and mycological response.ConclusionsThis is the first imported case in Mexico of blastomycosis with cutaneous lesions without systemic involvement.     

Primer registro del género Corytoplectus (Gesneriaceae: Episcieae) en México, con descripción de una nueva especie

Corytoplectus (Gesneriaceae) is a neotropical genus of 11 species from South America. Collections recently made in Oaxaca indicate, for the first time, the presence of the genus in Mexico, and a newly described endemic species, C. oaxacensis. This species is most closely resembles C. schlimii which is from Colombia and Venezuela. Geographical distribution of the genus is briefly discussed.     

Una nueva especie de Hypenia (Lamiaceae) de México

Hypenia violacea (Lamiaceae), a new species from Guerrero, Mexico, is described and illustrated. This species is characterized by glabrescent, coriaceous leaves, lax thyrsoid inflorescences with pedunculate and umbelliform cymules that have 3–6 violet flowers with corollas 0.8–1.6 cm long. The species is referred to the Southern American genus Hypenia.

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Resumen  Se describe e ilustra Hypenia violacea (Lamiaceae), una especie nueva de Guerrero, México. Presenta hojas coriáceas, glabrescentes, inflorescencia tirsoide, laxa, con címulas umbeliformes, pedunculadas, con 3–6 flores por címula, flores de color violeta, de 0.8–1.6 cm largo. Las características observadas corresponden, en su mayoría, a Hypenia, un género de distribución sudamericana, por lo que se incluye en el mismo.

     

Epidemiología de las candidiasis invasoras en población pediátrica y adulta

BackgroundInvasive candidiasis (IC) is the most frequent fungal disease in children and adults.AimsTo critically review and update the current epidemiology of Candida spp. disease in neonates, children and adults (critically ill patients and in oncohematologic patients and in solid organ transplant recipients).MethodsWe searched the PubMed/Medline, discussing the current data.Results and conclusionsIC is associated with high attributable morbimortality and increased healthcare costs. In the last decades the incidence of invasive Candida spp. disease has increased in critically ill patients, has decreased in oncohematologic patients, although currently the involvement of non-albicans Candida species in the etiology of this disease is increasing steadily.