Spanish version of the Satisfaction with Epilepsy Care questionnaire: Adaptation and psychometric properties.

OBJECTIVE: The objective of this study was to perform a cross-cultural adaption and psychometric evaluation of the Spanish version of the Satisfaction with Epilepsy Care (SEC) questionnaire and analyze patient satisfaction with epilepsy care. METHODS: Transcultural adaptation and validation of the SEC were carried out using translation and back-translation with pilot testing and an expert panel. The SEC-E (Spanish) was analyzed in 213 patients with epilepsy to examine construct and criterion validity and internal consistency. RESULTS: The SEC-E achieved conceptual, semantic, and content equivalence with the original version. For content validity, one question was eliminated from the original questionnaire as it has little relevance in our cultural setting. Positive correlations for criterion validity were obtained using the gold standard measure (Satisfaction in Hospitalized Patients scale). Construct validity replicated the three dimensions of the original questionnaire. The scale showed adequate reliability through internal consistency (Cronbach's α of 0.94) and temporal stability on retest (n = 85). Patients scored (0 to 100) 77.5 [standard deviation (SD): 19.9] for satisfaction with communication, 76.9 (SD: 17) for organization, and 67.2 (SD: 22.1) for information. SIGNIFICANCE: The SEC-E is a valid and reliable tool for the assessment of educational interventions aiming to improve the quality of care in patients with epilepsy in Spanish clinical practice. The results showed a good level of patient satisfaction with epilepsy care.

MVA E2 therapeutic vaccine for marked reduction in likelihood of recurrence of respiratory papillomatosis.

BACKGROUND: Recurrent respiratory papillomatosis (RRP) or laryngeal papillomatosis is a disease caused by papillomavirus infection. METHODS: In this phase I/II clinical trial, we evaluated the efficacy of the modified vaccinia Ankara (MVA) E2 virus in the treatment of RRP. Twenty-nine patients (18 female and 11 male) underwent injection of MVA E2 directly into the borders of the vocal cords where lesions were seen and were monitored by direct laryngoscopy. The immune response was assessed by the determination of CD3+ , CD4+ , and CD8+ lymphocytes counts. The presence of papillomavirus was determined by polymerase chain reaction analysis. RESULTS: Lesions were completely eliminated in 13 patients (44.8%). In 16 patients (55.2%), lesions recurred between 6 and 18 months after treatment; these patients received a second round of treatment with MVA E2, and they are not seen with new recurrences. CONCLUSION: The MVA E2 vaccine has excellent potential for generating complete regression of RRP lesions.

Técnica de Horsley para la reconstrucción del nervio laríngeo / Reconstruction of the laryngeal nerve by yhe Horsley technique

Introducción. La temida complicación de la tiroidectomía es la parálisis de las cuerdas vocales secundaria a lesiones del nervio laríngeo recurrente. En este estudio se analiza una técnica de reconstrucción para estas lesiones neurales. Objetivo. Describir los resultados funcionales de la reconstrucción inmediata de las lesiones del nervio laríngeo recurrente con la técnica de Horsley. Material y métodos. Se llevó a cabo un estudio prospectivo entre enero del 2000 y diciembre del 2015, en pacientes con sección del nervio laríngeo recurrente y reconstrucción de Horsley, en el cual se evalúan: a) los índices del análisis acústico de voz [tiempo máximo de fonación, perturbación involuntaria de la frecuencia (jitter), perturbación de la amplitud (shimmer) y frecuencia fundamental], b) los hallazgos estroboscópicos, y c) el índice de discapacidad vocal. El análisis estadístico se hizo con la prueba exacta de Fisher y con el programa SPSS™. Resultados. Se practicaron 1.547 tiroidectomías y se produjeron 10 secciones del nervio laríngeo recurrente (0,64 %): dos (0,12 %) inadvertidas (p=0,0001) y 8 (0,51 %) advertidas por infiltración tumoral. En los exámenes de la calidad de voz, se encontraron: frecuencias fundamentales bajas con medias de 104,79 ± 0,29 Hz en hombres (valor de referencia, VR=141,74) y de 208,12 ± 22,72 Hz en mujeres (VR=241,08), que se correlaciona con un jitter de 1,39 ± 0,99 % (VR=1,04); y también, disminución del tiempo máximo de fonación (media=10,9 ± 3,07 s). El índice de percepción de calidad de la voz fue de discapacidad leve de la voz (22,7 ± 11,8). La estroboscopia mostró cierre completo de la glotis en nueve pacientes (90 %) (p=0,005), con una posición adecuada de los cartílagos aritenoides, en siete. Conclusiones. La tasa de lesión inadvertida del nervio laríngeo recurrente en el Hospital Militar Central es de 0,12 %. La técnica de Horsley tiene unos resultados funcionales satisfactorios en el 90 % de los casos

Background. The most feared complication of thyroidectomy is the vocal cord palsy secondary to injury of the recurrent laryngeal nerve. In this study we analize the Horsley technique for reconstruction for this surgical injury. Objective. The aim of this study was to describe the functional outcomes of the reconstruction of the recurrent laryngeal nerve by the Horsley technique. Materials and methods. A prospective study including patients with section of the recurrent laryngeal nerve and the use of the of the Horsley technique for reconstruction was carried out in the period January 2000 to December 2015. The outcomes evaluated were: a) acoustic voice analysis indexes (maximum phonation time, involuntary disturbance of frequency (jitter), disturbance of amplitude (shimmer), and fundamental frequency); b) stroboscopic findings; and c) vocal disability index. The Fisher's exact test and the SPSS™ program were used for the statistical analysis. Results.The study included 1,547 thyroidectomies with 10 complete sections of the recurrent laringeal nerve (0.64%), 2 unnoticed injuries (0.12%) (p=0,0001), and 8 injuries identified intraoperatively in patients with tumor infiltration. In the voice quality test we found: low fundamental frequencies with median values of 104.79 ± 0, Hz in the male population (reference value, RV=141,74) and 208,12 ± 22,72 Hz in the female population (RV=241,08), wich correlates with a jitter of 1,39 ± 0,99% (RV=1,04) and with a decrease in maximum phonation time (median=10,9 ±3,07s). Index of perception of voice quality was mild voice disability (22,7 ± 11,8). Stroboscopy showed complete clossure of glottis in 9 patients (90%) (p=0,005), with an adequate position of the arytenoid cartilages in 7 patients. Conclusions. The rate of unnoticed injuries of recurrent laringeal nerve at Central Military Hospital in Bogotá, Colombia, is 0.12%. The Horsley reconstruction technique demonstrated satisfactory functional results in 90% of cases

New structural features of Acacia tortuosa gum exudate.

Acacia tortuosa produces a clear gum, very soluble in water. Previous reports showed that it was constituted by four fractions, one of them an arabinogalactan-protein complex. The elucidation of the A. tortuosa gum structure by the combination of classical chemical methods, size exclusion chromatography and NMR spectroscopy, was the objective of this investigation. The data obtained show that the heteropolysaccharide is an arabinogalactan type II, highly ramified, with lateral chains at C-2 as well as at C-6 of the galactose 3-O residues; mono-O-substituted galactoses were not detected. There are residues of mannose, the arabinose, pyranose predominantly, is terminal and 2-O-linked. The abundance of the 4-O-methyl-α-d-glucuronic acid was not previously reported. The proteic fraction is probably represented by an arabinogalactan-protein complex that binds poorly with ß-glucosyl Yariv reagent, and two glycoproteins. The NMR spectra suggest that the carbohydrate links to hydroxyproline through the galactose (galactosylation).

Intra- and inter-rater reliability of endonasal activity estimation in granulomatosis with polyangiitis (Wegener´s).

OBJECTIVES: Granulomatosis with polyangiitis (GPA) frequently starts with an affection of the nasal and paranasal mucosa. Localised GPA of the nasal mucosa or persistent disease activity ('grumbling disease') is often encountered even under immunosuppressive therapy. Necessity for reconstructive surgery is common and careful scheduling to prevent failure and minimise revision rates is crucial. Therefore, reliable estimation of GPA activity in the upper airways using a score is mandatory for diagnosis, follow-up and scheduling reconstructive surgery. METHODS: Fifty endoscopic, endonasal images of 45 patients with GPA were used. Twelve (4 German, 8 Mexican) experienced (n=7) and inexperienced (n=5) physicians assessed GPA-activity at two times (T1/T2) in dichotomy and in a grading approach (none, mild, moderate and high activity) using the novel ENT Activity Score (ENTAS). All documents were written in English. RESULTS: Estimation of activity in dichotomy (none vs. mild/moderate/high): Cohen's Kappa (κ) for intra-rater reliability T1/T2 in inexperienced and experienced physicians was κ=0.58 (agreement 85%) and κ=0.72 (agreement 91%). The inter-rater reliability (Fleiss's κ) T1/T2 for inexperienced and experienced physicians was κ=0.62/κ=0.59 and κ=0.50/κ=0.58 respectively. Estimation of activity in grading approach (none, mild, moderate, high): for inexperienced physicians the intra-rater reliability T1/T2 was κ=0.67 (agreement 56%) and the inter-rater reliability at T1/T2 was κ=0.29 (intraclass correlation coefficient, ICC=0.69) and κ=0.27 (ICC=0.59). For experienced physicians the intra-rater reliability T1/T2 was κ=0.80 (agreement 67%) and the inter-rater reliability at T1 and T2 was κ=0.41 (ICC=0.77) and κ=0.39 (ICC=0.75) respectively. CONCLUSIONS: Intra-rater reliability is high in decision in dichotomy and even in grading activity. There is no difference for experienced or inexperienced physicians. Inter-rater reliability is high in dichotomy, but low for activity grading. Thus, the ENTAS provides a reliable instrument for assessing, documenting and following GPA-related disease activity in the upper respiratory tract. The relationship of activity and following damage needs to be investigated in further studies.

Comparación de las pruebas de dilución en Agar y PCR para determinación de susceptibilidad antimicrobiana de Helicobacter pylori. Revisión sistemática de la literatura / Comparation of Agar dilution test with Polymerase Chain Reaction (PCR) to determinate antimicrobial susceptiblility of Helicobacter Pylori. A systematic literature review

Objetivo: determinar las características operativas de la prueba RFLP-PCR frente a la prueba dilución en agar para evaluar la susceptibilidad antimicrobiana a claritromicina en aislamientos clínicos de H. pylori. Metodología: la búsqueda de estudios de pruebas diagnósticas sobre resistencia antimicrobiana de H. pylori a claritromicina con técnicas de dilución en agar y RFLP-PCR se realizó en Medline, Science direct, Ovid y Cochrane. Se elaboraron tablas de contingencia para calcular las características operativas, en el programa RevMan 5. La heterogeneidad fue evaluada por la gráfica Forest Plot y el estadístico de Q. La presencia de sesgos de publicación se evaluó con Funnel Plot. Resultados: doce artículos cumplieron con los criterios de inclusión. El overall de especificidad fue 100% (IC 95% 91-100), demostrando baja probabilidad de falsos positivos. Para sensibilidad el valor fue de 91% (IC 95% 88-94) indicando una mayor probabilidad de resultados falsamente negativos. En la gráfica de “Funnel Plot” se observó asimetría para ambas características demostrando sesgo de publicación. Conclusiones: la técnica RFLP-PCR no presentó características operativas iguales o superiores al 95%, comparada con el estándar de referencia dilución en agar. Por lo anterior esta técnica de se debe considerar la prueba de elección cuando se estudie la susceptibilidad antimicrobiana de H. pylori.

Aim: Establish the available scientific evidence of the operational characteristics of PCR-RFLP test with Agar Dilution for the determination of antimicrobial susceptibility in clarithromycin clinical isolates of Helicobacter pylori. Methods: We have performed the search bibliography about diagnostic tests on antimicrobial resistance of H. pylori to clarithromycin by using Agar Dilution and PCR-RFLP techniques over Medline, Science direct, Ovid and Cochrane of studies. The information was validated by two observers who checked the inclusion criteria and quality. We obtained the operational characteristics of the studies on contingency tables; analysis was performed on the RevMan 5 program. Results: A total of 50 references were tested from those 12 has been chosen in accord with the inclusion criteria and analyzed as summary measures. The specificity “overall” was a 100 % (CI 95% 91-100) that demonstrate a low probability of positive false. The projected overall sensitivity was 91% (CI 95% 88-94%) which indicated a high probability of negative results. The test showed heterogeneity studies homogeneous in sensitivity and specificity (p = 0.78) (p = 0.99). The graphics of “Funnel Plot” revealed asymmetry for both of those characteristics that showed a publications bias. In the group analysis have not found antibiotics different from clarithromycin and was evident that the continent was more publications Europe, followed by Asia and Latin America. Conclusion: The sensitivity and specificity of PCR-RFLP technique for clarithromycin not have values equal to or higher than 95% compared proof Agar Dilution.

N-(2-Pyridylmeth-yl)phthalimide.

In the title compound, C(14)H(10)N(2)O(2), the phtalimide and 2-pyridylmethyl units are almost perpendicular, with an inter-planar angle of 85.74 (2)°. In the crystal, mol-ecules are linked by weak C-H⋯O inter-actions, forming chains running along the b axis. The packing is further stabilized by offset π-π inter-actions between adjacent pyridine rings, with a centroid-centroid distance of 3.855 (2) Å.

Funcionalidad de una mezcla de gomas de acasia glomerosa, Enterolobium cyclocarpum e Hymenaea courbaril en la preparación de helados de bajo contenido calórico / Functionality of a mixture of gums from acacia glomerosa, Enterolobium cyclocarpum and Hymenea courbaril in the low fat ice-cream preparation

Acacia glomerosa, Anterolobium cyclocarpum e Hymenaea courbaril, especies arbóreas ampliamente disemindas en Venezuela producen gomas con buen rendimiento. La mezcla de estas gomas se ensayó, como estabilizante en la preparación de helados de bajo contenido calórico. La viscosidad, el porcentaje de derretido y las propiedades sensoriales fueron determinados. Estas características físico-químicas se compararon con las exhibidas por los productos obtenidos con base en mezcla de gomas comerciales. La mezcla de gomas de las especies estudiadas incrementó la viscocidad del sistema, por lo tanto, favoreció una excelente incorporación y una distribución uniforme del aire; aportó textura y estabilidad durante el almacenamiento; mejoró la capacidad de expansión de la espuma y las propiedades de derretido. Por otra parte, aportó buenas características sensoriales, como la indica el alto puntaje alcanzado; apariencia (7.78), cremosidad (7.62), sabor (8.01) y bajo puntaje en presencia de cristales de hielo (3.06). Este trabajo evidenció la funcionalidad como estabilizante de la mezcla de gomas investigadas en la preparación de helados bajo en calorías.

Acacia glomerosa, Enterolobium cyclocarpum and Hymenaea courbaril, species widely disseminated in Venezuela, South America, produce gum with good yield. The mixture of these gums was tested as stabilizer in the low fat ice cream preparation. Viscosity, overrun, foam expansion, meltdown, shape factor and sensory properties were determined. These quality characteristics were compared with those exhibited by the product obtained with a mixture of commercial gums. The mixture tested provided the suitable viscosity for the ice cream mix with the corresponding overrun and texture. It gave better foaming properties and air incorporation. On the other hand, it was demonstrated the good sensory attributes by the highest score i.e. appearance (7.78), creaminess (7.62), flavor (8.01) and lowest score of iciness (3.06). This work showed good functionality as stabilizer of the mixture of gums investigated in the low fat ice cream preparation.

Association of HLA-DR3 and HLA-DR4 with sinonasal polyposis in Mexican Mestizos.

OBJECTIVE: The pathogenesis of sinonasal polyposis (SNP) is not clear; it has been suggested that it is polygenic and multifactorial. The major histocompatibility complex is a useful tool to predict genetic susceptibility to diseases, especially to autoimmune diseases. Since such susceptibility is influenced by ethnicity, it is necessary to have a wide knowledge of the structure of the population to which the patient belongs. The purpose of the study was to determine the association of HLA-DRB1 alleles with sinonasal polyposis in the Mexican Mestizo population. STUDY DESIGN: We studied the HLA-DR alleles in 34 adult Mexican Mestizo patients with SNP and compared them to those present in 99 healthy controls. METHODS: Genomic DNA from mononuclear cells was obtained by using the "salting out" technique and high-resolution DNA typing of the HLA-DRB1 alleles was performed after PCR amplification. RESULTS: We found a statistically significant increased frequency of the HLA-DRB1*03 allele (P = 0.03, odds ratio [OR] = 2.9, 95% confidence interval [CI]: 1.0-7.8) and of the HLA-DRB1*04 allele (P = 0.009, OR = 2.2, 95% CI: 1.2-4.2) in patients with SNP as compared to controls, and a statistically significant decreased frequency of the HLA-DRB1*08 allele (P = 0.01, OR = 0.2, 95% CI: 0.05-0.8). CONCLUSION: The HLA-DR locus seems to be associated with the genetic susceptibility to develop SNP in Mexicans. EBM RATING: B-2b.

Structural features of an arabinogalactan gum exudates from Spondias dulsis (Anacardiaceae).

The tree Spondias dulcis, located in Venezuela, exudes a light-brown gum. The polysaccharide, isolated from the original gum, contains galactose, arabinose, mannose, rhamnose, glucuronic acid, and its 4-O-methyl derivative. Application of chemical methods, in combination with 1D and 2D NMR spectroscopy afforded interesting structural features of the gum polysaccharide. The unequivocal presence of rhamnose in the polymer structure was confirmed by chemical and spectral data [1H (1.03 ppm); 13C (16.92 ppm)]. Also confirmed was the existence of 3-O- and 6-O-substitutes galactose residues by the spectral data correlations observed in Heteronuclear Multiple Quantum Coherence (HMQC) and Heteronuclear Multiple Bond Correlation (HMBC). Also observed were unequivocal resonances for beta-D-glucuronic acid and its 4-O-methyl derivative, and the presence of 3-O-alpha-L-arabinofuranose and 3-O-beta-L-arabinopyranose residues.

Caracterización de vesículas liposomales. 1. Efecto de la composición fosfolipídica sobre el volumen atrapado / Characterization of liposomes vesicles. 1.Effect of phospholipid composition on entrapped volume

La incidencia de la composición lipídica sobre el volumen atrapado de liposomas del tipo vesículas multilaminares grandes (MLV), almacenados durante 18 días bajo condiciones de refrigeración y en atmósfera libre de oxígeno ha sido examinada utilizando un nuevo método para la determinación del volumen de atrapamiento de solución acuosa de colorante amarillo FD&C No. 5 al 5 por ciento p/v, el método incluye centrifugación y espectrometría. Las MLVs fueron preparadas por el método clásico de evaporación de solvente descrito originalmente por Bangham y col. en 1965. Los resultados experimentales muestran que las vesículas con composición variable de colesterol poseen un volumen de atrapamiento de 4.9 a 15.7 µL/mg de lecitina