Descriptive study of sensitization to methylchloroisothiazolinone and methylisothiazolinone in a skin allergy unit.

BACKGROUND: Methylchloroisothiazolinone (MCI) and methylisothiazolinone (MI) are heterocyclic compounds used as preservatives in cosmetic and industrial products. They continue to be common allergens, causing positive patch test reactions in 2% to 4% of patients tested. MATERIAL AND METHODS: We searched the database at our skin allergy unit for all cases of sensitization to MCI/MI and MI diagnosed between January 1980 and March 2013. RESULTS: Patch tests were performed with MCI/MI in 8705 patients and with MI in 404 patients. In total, 222 patients (2.55%) were sensitized to MCI/MI and 21 (5.19%) were sensitized to MI. The incidence of MCI/MI cases peaked between 1998 and 2005 and again between 2009 and 2013. Of the 222 patients with MCI/MI sensitization, 142 were women (64%) and 49 were men (36%); the mean age was 43 years. The most frequently affected areas were the hands (54% of cases), the arms (36%), and the face (35%); 75.67% of cases were due to cosmetics and 2.25% were due to paint. Of the 21 patients with MI sensitization (mean age, 50 years), 12 were women (57%) and 9 were men (43%). The most common site of involvement in this group was the face (71% of cases), followed by the arms (38%) and the hands (29%). All the cases were due to cosmetics. CONCLUSIONS: Our data show that sensitization to the combination of MCI and MI and MI alone has increased in recent years. It would appear to be necessary to add MI to the baseline patch test series, although the test concentration has yet to be determined.

[Early statin therapy in acute myocardial infarction]. / Tratamiento precoz con estatinas en el infarto agudo de miocardio.

OBJECTIVES: To evaluate the effects of the early administration of statins during acute myocardial infarction (MI). DESIGN: A retrospective cohort study was carried out. SETTING: National (Spain). PATIENTS OR PARTICIPANTS: Patients included in the ARIAM registry from January 1999 to December 2008 with a diagnosis of MI. INTERVENTIONS: None. MAIN VARIABLES: We used logistic regression analysis and propensity scoring to determine whether the administration of statins during the first 24h of MI acts as a protective factor against: 1) mortality, 2) the incidence of lethal arrhythmias, or 3) cardiogenic shock. RESULTS: A total of 36 842 patients were included in the study. Statins were administered early in 50.2% of the patients. Statin administration was associated with younger patients with known previous dyslipidemia, obesity, a history of ischemic heart disease, heart failure, presence of sinus tachycardia, use of beta-blockers, angiotensin-converting enzyme inhibitors, thrombolysis and percutaneous coronary intervention. Mortality was 8.2% (13.2% without statin versus 3% with statin, P<.001). Multivariate analysis demonstrated that statin administration acted as a protective factor against mortality (adjusted OR 0.518, 95%CI 0.447 to 0.601). Continued use of statins was associated with a reduction in mortality (adjusted OR 0.597, 95%CI 0.449 to 0.798), and the start of treatment was a protective factor against mortality (adjusted OR 0.642, 95%CI 0.544 -0.757). Statin therapy also exerted a protective effect against the incidence of lethal arrhythmias and cardiogenic shock. CONCLUSIONS: These results suggest that early treatment with statins in patients with MI is associated with reduced mortality.

Dissecting x-ray-emitting gas around the center of our galaxy.

Most supermassive black holes (SMBHs) are accreting at very low levels and are difficult to distinguish from the galaxy centers where they reside. Our own Galaxy's SMBH provides an instructive exception, and we present a close-up view of its quiescent x-ray emission based on 3 megaseconds of Chandra observations. Although the x-ray emission is elongated and aligns well with a surrounding disk of massive stars, we can rule out a concentration of low-mass coronally active stars as the origin of the emission on the basis of the lack of predicted iron (Fe) Kα emission. The extremely weak hydrogen (H)-like Fe Kα line further suggests the presence of an outflow from the accretion flow onto the SMBH. These results provide important constraints for models of the prevalent radiatively inefficient accretion state.

Build up of off-diagonal long-range order in microcavity exciton-polaritons across the parametric threshold.

We report an experimental study of the spontaneous spatial and temporal coherence of polariton condensates generated in the optical parametric oscillator configuration, below and at the parametric threshold, and as a function of condensate area. Above the threshold we obtain very long coherence times (up to 3 ns) and a spatial coherence extending over the entire condensate (40 µm). The very long coherence time and its dependence on condensate area and pump power reflect the suppression of polariton-polariton interactions by an effect equivalent to motional narrowing.

A gas cloud on its way towards the supermassive black hole at the Galactic Centre.

Measurements of stellar orbits provide compelling evidence that the compact radio source Sagittarius A* at the Galactic Centre is a black hole four million times the mass of the Sun. With the exception of modest X-ray and infrared flares, Sgr A* is surprisingly faint, suggesting that the accretion rate and radiation efficiency near the event horizon are currently very low. Here we report the presence of a dense gas cloud approximately three times the mass of Earth that is falling into the accretion zone of Sgr A*. Our observations tightly constrain the cloud's orbit to be highly eccentric, with an innermost radius of approach of only ∼3,100 times the event horizon that will be reached in 2013. Over the past three years the cloud has begun to disrupt, probably mainly through tidal shearing arising from the black hole's gravitational force. The cloud's dynamic evolution and radiation in the next few years will probe the properties of the accretion flow and the feeding processes of the supermassive black hole. The kilo-electronvolt X-ray emission of Sgr A* may brighten significantly when the cloud reaches pericentre. There may also be a giant radiation flare several years from now if the cloud breaks up and its fragments feed gas into the central accretion zone.

[Protein contact dermatitis: review of 27 cases]. / Dermatitis de contacto por proteínas. Revisión de 27 casos.

BACKGROUND: Protein contact dermatitis (PCD) is a rare and underdiagnosed condition that many dermatologists fail to recognize. Nevertheless, increasing awareness of the condition and the substances responsible has led to a rise in the number of published cases in recent years. OBJECTIVE: To determine the clinical characteristics and allergens implicated in PCD in our setting. MATERIAL AND METHODS: A retrospective observational study of all patients diagnosed with PCD in the last 10 years was undertaken in the Skin Allergies Unit of the Department of Dermatology at Hospital General Universitario in Valencia, Spain. All patients were assessed by skin-prick test with the standard GEIDAC allergen panel and by prick-by-prick test with foods or other products that were linked to immediate skin symptoms following handling. RESULTS: Twenty-seven patients (8 men and 19 women) were diagnosed with PCD, and 26 of the cases were occupational in origin. The mean age of the patients was 32.3 years and 51.8% had a history of atopy. The latency period varied from 2 months to 27 years. The most commonly affected areas were the backs of the hands and the forearms. Four patients had an oral allergy syndrome. In order of frequency, the substances responsible for PCD were fish (9 patients, 33.3%), latex (8 patients, 29.6%), potato (4 patients, 14.8%), chicken (3 patients, 11.1%), flour (3 patients, 11.1%), alpha amylase (2 patients, 7.4%), aubergine (2 patients, 7.4%), pork (1 patient, 3.7%), garlic (1 patient, 3.7%), and Anisakis (1 patient, 3.7%). CONCLUSIONS: PCD is a clinically relevant condition that dermatologists should include in the differential diagnosis of chronic dermatitis affecting the hands or forearms in patients at high occupational risk, particular those in the food preparation industry.

Human neuroblastoma cultures for biorobotics.

This paper introduces a new biorobotic system using human neuroblastoma cultures and centre of area learning for basic robotic guidance. Multielectrode Arrays Setups have been designed for direct culturing neural cells over silicon or glass substrates, providing the capability to stimulate and record simultaneously populations of neural cells. The main objective of this work will be to control a robot using this biological neuroprocessor and a new simple centre of area learning scheme. The final system could be applied for testing how chemicals affect the behaviour of the robot or to establish the basis for new hybrid optogenetic neuroprostheses based on stimulating optically genetic-modified neurons.

[Allergic contact dermatitis to cosmetics]. / Dermatitis alérgica de contacto por cosméticos.

INTRODUCTION: Contact dermatitis to cosmetics is a common problem in the general population, although its prevalence appears to be underestimated. We reviewed cases of allergic contact dermatitis to cosmetics diagnosed in our dermatology department over a 7-year period with a view to identifying the allergens responsible, the frequency of occurrence of these allergens, and the cosmetic products implicated. METHODS: Using the database of the skin allergy department, we undertook a search of all cases of allergic contact dermatitis to cosmetics diagnosed in our department from January 2000 through October 2007. RESULTS: In this period, patch tests were carried out on 2,485 patients, of whom 740 were diagnosed with allergic contact dermatitis and the cause was cosmetics in 202 of these patients (170 women and 32 men), who accounted for 27.3 % of all cases. A total of 315 positive results were found for 46 different allergens. Allergens most often responsible for contact dermatitis in a cosmetics user were methylisothiazolinone (19 %), paraphenylenediamine (15.2 %), and fragrance mixtures (7.8 %). Acrylates were the most common allergens in cases of occupational disease. Half of the positive results were obtained with the standard battery of the Spanish Group for Research Into Dermatitis and Skin Allergies (GEIDAC). The cosmetic products most often implicated among cosmetics users were hair dyes (18.5 %), gels/soaps (15.7 %), and moisturizers (12.7 %). CONCLUSION: Most patients affected were women. Preservatives, paraphenylenediamine, and fragrances were the most frequently detected cosmetic allergens, in line with previous reports in the literature. Finally, in order to detect new cosmetic allergens, cooperation between physicians and cosmetics producers is needed.

[Sensitization to acrylates caused by artificial acrylic nails: review of 15 cases]. / Sensibilización a acrilatos por uñas artificiales acrílicas. Revisión de 15 casos.

BACKGROUND: Allergic contact dermatitis due to acrylates present in the workplace is a disease frequently reported among dentists, printers, and fiberglass workers. Recently, the number of cases of contact allergic dermatitis among beauticians specialized in sculpting artificial nails has increased. OBJECTIVE: Our objective was to study the clinical characteristics and allergens implicated in allergic contact dermatitis due to acrylates in beauticians and users of sculpted nails. MATERIAL AND METHODS: This was an observational, retrospective study of patients diagnosed with allergic contact dermatitis due to acrylates used in sculpting artificial nails over the last 26 years in the Hospital General Universitario, Valencia, Spain. RESULTS: In total, 15 patients were diagnosed: 14 beauticians and 1 client. Most cases were diagnosed in the past 2 years. All were women, their mean age was 32.2 years, and 26.7 % had a personal or family history of atopy. The sensitization time varied between 1 month and 15 years. The most frequently affected areas were the fleshy parts of the fingers and hands. Three patients - 2 beauticians and 1 client - presented allergic asthma due to acrylates. All patients underwent patch testing with a standard battery of allergens and a battery of acrylates. The most frequent allergens were ethylene glycol dimethacrylate (13/15, 86.7 %), hydroxyethyl methacrylate (13/15, 86.7 %), triethylene glycol dimethacrylate (7/15, 46.7 %), 2-hydroxypropyl methacrylate (5/15, 33.3 %), and methyl methacrylate (5/15, 33.3 %). CONCLUSIONS: Acrylate monomers used for sculpting artificial nails are important sensitizers for contact and occupational dermatitis. The most important consideration is primary and secondary prevention.

[Sensitization to gallates: review of 46 cases]. / Sensibilización por galatos. Revisión de 46 casos.

BACKGROUND: Since 1947, the cosmetics, pharmaceutical, and food industries have used gallates as antioxidants to prevent the oxidation of unsaturated fats in their products. The aim of this study was to review the cases of sensitization to gallates diagnosed in our department between 1985 and 2006. METHODS: All suspected cases of allergic contact dermatitis with patch tests positive for propyl gallate, octyl gallate, and/or dodecyl gallate were retrieved from the database of the allergy section of our dermatology department. RESULTS: Forty-six patients had positive patch tests for 1 or more gallates (36 women and 10 men, with a mean age of 42.8 years). The most common presenting complaint was cheilitis (63% of the cases) followed by dermatitis of the hands (28.26%). The most common sensitizing agent was lipstick (54.3%) followed by bakery products (15.2%). The test result was considered clinically relevant in 73.9% of the cases whereas the relevance was unknown in 23.9 %. CONCLUSIONS: In our case series, most patients sensitized to gallates attended the clinic due to cheilitis. The main allergen was propyl gallate and the most common mechanism of sensitization was use of lipstick. The most common gallate among bakers was octyl gallate. This agent was considered to be clinically relevant in all cases studied.

[Anesthesia for electroconvulsive therapy: clinical experience]. / Anestesia en terapia electroconvulsiva. Experiencia clínica.

OBJECTIVE: To assess the utility of propofol and succinylcholine in obtaining optimal convulsions and assuring patient safety during electroconvulsive therapy. PATIENTS AND METHODS: This was a prospective observational study of patients undergoing electroconvulsive therapy under general anesthesia with propofol and succinylcholine. We recorded patient characteristics, doses of propofol and succinylcholine, electroencephalographically-recorded duration of convulsions, and complications. Descriptive statistics were compiled and the data were subjected to analysis of correlations, comparison with the Student t test for independent samples, the Mann-Whitney U test, and analysis of variance. RESULTS: We studied 108 patients, 62% women and 38% men, 80% classified as ASA 1 and 20% as ASA 2. The patients underwent 844 sessions of electroconvulsive therapy; their mean (SD) age was 39.95 (18.09) years. The doses of propofol and succinylcholine were 1.34 (0.32) mgxkg(-1) and 1.35 (0.26) mgxkg(-1), respectively. The mean recorded duration of the first convulsion (29.87 [22.42] seconds) was negatively correlated with age (r = -0.12) and unrelated to propofol dose (r = 0.06) or body weight (r = 0.02). Male and schizophrenic patients had longer-lasting convulsions (P < .01). Cardiovascular complications occurred in 2.4% and psychomotor agitation in 1.4%; there were no respiratory complications, musculoskeletal injuries, nausea, or vomiting. CONCLUSIONS: Electroconvulsive therapy can be safely applied in an operating room or similar space undergeneral anesthesia and with a neuromuscular blockade in order to prevent psychological or musculoskeletal trauma. Propofol did not affect the convulsions at the dosages administered.

[Patients and quality of primary health care services. Survey of practitioners at the Bahía de Cádiz and La Janda health centers]. / Los pacientes y la calidad de los servicios de atención primaria de salud. Opinión de los profesionales de los centros de salud de la Bahía de Cádiz y La Janda.

AIM: To report the opinions of practitioners at health centers on dimensions of quality that affect user satisfaction. DESIGN: Cross-sectional study of focus groups (FG). SETTING: Bahía de Cádiz and La Janda health centers in southwestern Spain. PARTICIPANTS: We studied 4 FG whose participants were staff members of the two health centers: FG1, physicians; FG2, user satisfaction service staff; FG3, social workers; FG4, nurses. The groups were based on the different functions of staff at the two centers. METHOD: The analysis was based on variables in the SERCAL model (an adaptation of the SERVQUAL model for the Spanish health care system) of opinions regarding service quality: access, comfort (tangibles), personalized service (courtesy), competence, and loyalty. The data were analyzed with version N-Vivo of the NUDIST program. RESULTS: All dimensions of the theoretical model were identified by practitioners as constructs of users' perceptions of service quality. Users' and practitioners' views contrasted with and complemented each other to generate a model that could be validated. Access, personalized service and problem-solving (responsiveness) were key variables. CONCLUSIONS: Practitioners' opinions provided information of use in improving the quality model. Differences in opinion between users and practitioners merit further study based on an understanding of these groups' values and interests, and on the care provision context. Practitioners identified access, personalized service and problem-solving as features that influenced users' opinions of the quality of the health center.

Thrombolysis during cardiopulmonary resuscitation in fulminant pulmonary embolism: a review.

OBJECTIVE: To review current knowledge on thrombolysis in patients with fulminant pulmonary embolism (FPE) who need cardiopulmonary resuscitation (CPR). DATA SOURCES: The bibliography for the study was compiled through a search of different databases between 1966 and 2000. References cited in the articles selected were also reviewed. STUDY SELECTION: The selection criteria included all reports published on thrombolysis, pulmonary embolism, and CPR, from case reports and case series to controlled studies. DATA SYNTHESIS: Very few studies evaluated thrombolysis in cases of FPE that required CPR and most of these were clinical case reports and case series with a low level of scientific evidence. There has been no clinical trial to address this issue. CONCLUSIONS: FPE can frequently produce cardiac arrest, which has an extremely high mortality despite application of the usual CPR measures. The administration of thrombolytic therapy during CPR could help to reduce the mortality, although it has classically been contraindicated. There are no published clinical trials or other high-grade studies that evaluated the efficacy and safety of this approach. From the few existing studies, it can be inferred that thrombolysis may be efficacious and safe for patients with FPE who need CPR. However, a clinical trial is required to provide evidence of value for sound clinical decision-making.

Thrombolysis with recombinant tissue plasminogen activator during cardiopulmonary resuscitation in fulminant pulmonary embolism. A case series.

OBJECTIVE: To describe our outcomes using thrombolysis during the cardiopulmonary resuscitation (CPR) of patients in cardiorespiratory arrest (CA) caused by fulminant pulmonary embolism (FPE). DESIGN: A case series. SETTING: Intensive care units of a district hospital and a referral centre. PATIENTS: Six patients that suffered CA secondary to an FPE. INTERVENTIONS: Administration of recombinant tissue plasminogen activator during usual CPR manoeuvres when there was a strong suspicion of FPE. Permission for the thrombolytic therapy was sought from family members in all cases. RESULTS: Four out of the six patients survived and remain symptom-free. The thrombolysis was not associated with any fatal complications. CONCLUSIONS: Early thrombolysis during CPR manoeuvres for CA apparently caused by an FPE may reduce the mortality rate among these patients.

Efficacy of thrombolysis in patients with acute myocardial infarction requiring cardiopulmonary resuscitation.

OBJECTIVE: To evaluate the efficacy and safety of systemic thrombolysis administered to resuscitated patients after cardiac arrest (CA) due to an acute myocardial infarction (AMI), through a study of their mortality and haemorrhagic complications. DESIGN: We studied a retrospective cohort of patients with ischaemic heart disease gathered from the database of the Spanish multi-centre project "Analysis of Delay in AMI" (ARIAM). SETTING: Intensive care (ICU) and coronary care (CCU) units of 77 Spanish hospitals. PATIENTS AND PARTICIPANTS: The study period was from 1 January 1995 to 1 January 2000, when 22,922 patients were included in the ARIAM database register; 13,704 were diagnosed with AMI and we studied 303 of these AMI patients admitted after resuscitation for CA. MEASUREMENTS AND RESULTS: Of the 303 patients studied, 228 were male (75.25%); the mean age was 64.57 +/- 12.48 years. Systemic thrombolysis was administered to 67 patients (group I) and the remaining 236 patients were managed without this treatment (group II). The ICU/CCU mortality rate of the series was 39.93 % (121 patients); that of group I was 17.91% (12 patients) and that of group II 46.18% (109 patients) (P < 0.00001). Group I required less mechanical ventilation (group I, 42.85% vs group II, 80.76 %; P < 0.00001) and fewer cardiopulmonary resuscitation attempts (33.34% vs 60.98%, P < 0.0001). Group I also showed a lower incidence of cardiogenic shock (14.28% vs 39.01%, P < 0.0001) and anoxic encephalopathy (8.62% vs 39.89% P = 0.006). There were no fatal haemorrhagic complications in either group. Logistic regression analysis showed the administration of thrombolysis to be an independent variable that protected against mortality. CONCLUSIONS: The administration of thrombolysis to patients with AMI who require resuscitation may be efficacious in reducing mortality and is safe, with no increase in haemorrhagic complications.