The updated Charlson comorbidity index is a useful predictor of mortality in patients with Staphylococcus aureus bacteraemia.

The objective was to compare the performance of the updated Charlson comorbidity index (uCCI) and classical CCI (cCCI) in predicting 30-day mortality in patients with Staphylococcus aureus bacteraemia (SAB). All cases of SAB in patients aged ⩾14 years identified at the Microbiology Unit were included prospectively and followed. Comorbidity was evaluated using the cCCI and uCCI. Relevant variables associated with SAB-related mortality, along with cCCI or uCCI scores, were entered into multivariate logistic regression models. Global model fit, model calibration and predictive validity of each model were evaluated and compared. In total, 257 episodes of SAB in 239 patients were included (mean age 74 years; 65% were male). The mean cCCI and uCCI scores were 3.6 (standard deviation, 2.4) and 2.9 (2.3), respectively; 161 (63%) cases had cCCI score ⩾3 and 89 (35%) cases had uCCI score ⩾4. Sixty-five (25%) patients died within 30 days. The cCCI score was not related to mortality in any model, but uCCI score ⩾4 was an independent factor of 30-day mortality (odds ratio, 1.98; 95% confidence interval, 1.05-3.74). The uCCI is a more up-to-date, refined and parsimonious prognostic mortality score than the cCCI; it may thus serve better than the latter in the identification of patients with SAB with worse prognoses.

Detection and characterization of the ferric uptake regulator (fur) gene in Plesiomonas shigelloides.

Iron availability plays an important role in the virulence of micro-organisms, which develops different systems for iron acquisition. The expression of genes involved in iron uptake systems is usually regulated by Fur, a transcriptional regulator. Plesiomonas shigelloides is a Gram-negative food- and water-borne enteropathogen. Even though the mechanisms involved in the pathogenicity of P. shigelloides are not properly elucidated, iron seems to be implicated in the development of human infections and in the production of potential virulence factors; however, detection and characterization of fur gene has not been performed in this bacterium. In this work the presence of a conserved fur gene was determined in six strains of P. shigelloides. The expression of fur was studied under different culture conditions and it was demonstrated to be higher when the micro-organism was cultured under iron-restricted than under iron-abundance conditions. SIGNIFICANCE AND IMPACT OF THE STUDY: Significance and Impact of the Study: This study provides evidence of the presence of a conserved fur gene in strains of Plesiomonas shigelloides. Expression of this gene is higher when the micro-organism is cultured under iron-restricted conditions. The study provides clues to understand the role of iron in the regulation of important activities of P. shigelloides.

[Development of Lennox-Gastaut syndrome in adulthood]. / Evolucion del sindrome de Lennox-Gastaut en la edad adulta.

INTRODUCTION: Lennox-Gastaut syndrome (LGS) is an epileptic encephalopathy that starts in childhood and has an unknown pathophysiological mechanism. Studies on the progress of LGS reveal a poor prognosis. PATIENTS AND METHODS: A retrospective study of 1629 patients with epilepsy was conducted. Patients included in the study were those with an age of onset during childhood, tonic seizures and atypical absences (who might also suffer from other types of seizures); electroencephalogram (EEG) showing generalised slow spike-wave and generalised fast activity; mental retardation and a follow-up time of at least 10 years. RESULTS: The sample consisted of 12 patients, 9 of whom were males. Follow-up time: 20 years. Onset of seizures: 3 years. Cryptogenic LGS: 67%; symptomatic: 33%. Frequency of the seizures at onset: daily (83.3%) or weekly (16.7%). Types of seizures: tonic and atypical absences (100%); drop-attacks (83%); generalised tonic-clonic (75%); myoclonias (41.7%); partial (8.3%) and pseudo-epileptic (8.3%). EEG with slow background activity, generalised slow spike-wave and generalised fast activity: 100%. Fifty percent of the patients had at least one epileptic status. They used an average of 7.5 different antiepileptic drugs. At the end of the follow-up 33% were suffering from seizures on a daily basis; 17% were weekly and 42% monthly. A total of 8.3% were free from seizures. All of them were following combination therapy: 17% in bitherapy and 83% with an average of 3.8 drugs (range: 3-5). A total of 92% suffered from severe or very severe mental retardation. Fifty percent required neuroleptic drugs due to behavioural disorders. CONCLUSIONS: Despite the fact that the diagnosis of LGS is serious, we observed a decrease in the number of seizures after several years of development, although the antiepileptic combination therapy remains constant. The mental retardation and behavioural disorders lead to a poor functional prognosis.

[Adequacy of anticoagulant prevention in patients with atrial fibrillation]. / Adecuación de la profilaxis anticoagulante en pacientes con fibrilación auricular.

INTRODUCTION: Although there is a consensus about the use of oral anticoagulants (OAC) to prevent stroke in patients with atrial fibrillation this treatment is underused in actual practice. Our aim was to determine the proportion of patients with previously known atrial fibrillation who were receiving OAC before stroke onset and their characteristics. PATIENTS AND METHODS: We recruited 50 patients who were admitted with acute stroke and previously known atrial fibrillation over a period of one year. Patients were classified according to the type of antithrombotic treatment they were on. The clinical picture was evaluated by the NIHSS. Functional prognosis was estimated by modified-Rankin score at discharge. RESULTS: Of 50 patients, 16 (32%) were receiving OAC before stroke. Four variables were associated with prescription of OAC: treatment with digoxin, previous ischemic stroke or transient ischemic accident, congestive heart failure and the type of AF (chronic vs paroxysmal). Age and medical history of arterial hypertension, diabetes mellitus or ischemic cardiopathy did not influence the prescription. According to the NIHSS and modified-Rankin scales patients on OAC showed less serious strokes and presented a better functional situation at discharge than those who were not on that treatment. CONCLUSIONS: This study highlights the need to improve medical education about OAC in patients with atrial fibrillation because only 32% of patients received OAC before stroke although 90% of them should receive it according to current guidelines. Our results suggest that OAC treatment not only prevents stroke but may also contribute to the development of less serious strokes with a better functional prognosis.

Sindrome de ovario refractario. Informe de tres casos. / Refractory ovarian syndrome. Report of 3 cases

El sindrome de ovario refractario esta caracterizado por: amenorrea primaria o secundaria, esterilidad, hipogonadismo hipergonadotropico y preesencia de foliculos primarios hasta fase antral. Se estudiaron tres pacientes de 26 a 30 anos, portadoras de este sindrome; todas con amenorrea secundaria y esterilidad, bien feminizadas.Las determinaciones hormonales en sangre por radioinmunoanalisis mostraron: hormona foliculoestimulante (FSH), hormona luteinizante (LH) y 17 B estradiol en niveles postmenopausicos; perfil tiroideo normal; prolactina normal. Las radiografias de silla turca sin alteraciones. La prueba de estimulacion con gonadotropina corionica en las tres pacientes fue negativa. Las determinaciones de anticuerpos anti-FSH y anti-LH fueron negativas. El estudio histologico de biopsias de ovario revelo foliculos primarios hasta fase antral. El diagnostico diferencial del ovario refractario es fundamentalmente con menopausia precoz; los limites entre estas entidades estan mal definidos y pudiera tratarse de grados diversos de una misma entidad nosologica. El tratamiento es a base de terapeutica sustitutiva con estrogenos-progestagenos

Valor de la determinacion de la subunidad beta de gonadotropina corionica en el diagnostico de neoplasias malignas no trofoblasticas. / Value of determination of beta subunit of chorionic gonadotrophin in the diagnosis of malignant non trophoblastic neoplasms

Con el proposito de establecer el valor de la determinacion de la gonadotropina corionica (HCG) como marcador tumoral, se estudiaron 100 pacientes con diagnostico de neoplasia maligna no trofoblastica, incluyendose 40 controles sanos; a todos se les realizo cuantificacion en suero de HCG por medio de la subunidad beta, por radioinmunoalisis (RIA) empleando la tecnica de doble anticuerpo. El 10 por ciento de los casos, presento niveles detectables de dicha hormona; el tipo de neoplasia y la frecuencia de positividad encontrados fueron los siguientes: dermatofibrosarcoma: 100 por ciento, seminoma y teratoma testicular 66.6 por ciento, hepatoma 25 por ciento, carcinoma renal 25 por ciento, carcinoma cervicouterino 14.8 por ciento, carcinoma de mama 14.2 por ciento; en el resto de pacientes como en los casos control, las determinaciones para beta HCG fueron negativas. Se concluye, que aunque la produccion de beta HCG por diversas neoplasias malignas no trofoblasticas, puede variar del 0 al 100 por ciento, la positividad para esta fraccion hormonal en ausencia de embarazo, es sugestiva de algun proceso tumoral

[Absence of the inhibitor factor of the Mullerian structures. Report of a case]. / Ausencia de factor inhibidor de estructuras de Müller. Informe de un caso.

A 30 year old patient with normal masculine phenotype, karyotype 46 XY with a congenital left inguinal hernia, was studied. This hernia contained (at surgery): uterus, tubes and a hypoplasic vagina, as well as testis. The Müllerian structures and the right testicle, were resected, and left orchidopexy was performed. FSH, LH, testosterone, prolactine, B-HCG in blood by radioimmunoanalysis, total estrogens, 17-ketosteroids and 17-hydroxicorticosteroids in urine, were all normal. Roentgenologic and endoscopic urologic studies were normal. A post-operative study of semen showed moderate oligospermia. The factors involved in masculine sexual differentiation, were reviewed, specially the inhibitory factor of Müllerian structures.