Chronic larval and adult honey bee laboratory testing: Which dietary additive should be considered when a test substance is not solubilized in acetone?

Chronic toxicity tests on adult and larval honey bees (Apis mellifera) can require the use of dietary additives (solvents, emulsifiers, adjuvants and viscosifier agents) when the active ingredient of plant protection products cannot be dissolved or does not remain stable and homogeneous within the test diets. Acetone is the widely used and accepted solvent allowed within the international regulatory guidelines, but it can be ineffective in keeping certain compounds in solution and can cause toxicity to adults and larvae. In this publication, we present an evaluation of alternative additives in adult and larval diets. Six dietary additives including five solvents (ethanol, isopropanol, n-propanol, propylene glycol and triethylene glycol) and a viscosifier agent (xanthan gum) at five concentrations along with a negative control and a solvent control (acetone) were investigated at seven laboratories. The safe levels for bees were determined for each of the additives used in the 10-day chronic adult and 22-day chronic larval tests. In the 10-day chronic adult study, ethanol and isopropanol were found to be safe at concentrations ≤ 5.0 %, while xanthan gum can be reliably used at concentrations ≤ 0.1 %. Greater variability across laboratories was observed for N-propanol, propylene glycol, and triethylene glycol and these agents may cause mortality when added to diets at concentrations above 0.25-0.5 %. The safe levels of additives to larval diet in the 22-day chronic larval test had a greater variability and were generally lower than what were observed for adult diet. Our results do not recommend the inclusion of ethanol or n-propanol into the larval diet, and isopropanol, propylene glycol, and triethylene glycol may cause mortality at concentrations above 0.25-0.5 %. Safe levels for xanthan gum were more variable than what was observed for adults, but it can be used reliably at concentrations ≤ 0.05 %. Our analyses conclude that several additives can be integrated successfully in honey bee laboratory bioassays at levels that cause low mortality to adults and larvae.

[Evidence-Based Psychological Treatments for Adults: A Selective Review]

Evidence-Based Psychological Treatments for Adults: A Selective Review. BACKGROUND: Psychological treatments have shown their efficacy, effectiveness, and efficiency in dealing with mental disorders. However, considering the scientific knowledge generated in recent years, in the Spanish context, there are no updating studies about empirically supported psychological treatments. The main goal was to carry out a selective review of the main empirically supported psychological treatments for mental disorders in adults. METHOD: Levels of evidence and degrees of recommendation were collected based on the criteria proposed by the Spanish National Health System (Clinical Practice Guidelines) for different psychological disorders. RESULTS: The results indicate that psychological treatments have empirical support for the approach to a wide range of psychological disorders. These levels of empirical evidence gathered range from low to high depending on the psychological disorder analysed. The review indicates the existence of certain fields of intervention that need further investigation. CONCLUSIONS: Based on this selective review, psychology professionals will be able to have rigorous, up-to-date information that allows them to make informed decisions when implementing empirically based psychotherapeutic procedures based on the characteristics of the people who require help.

Cervical cystic lymphangioma in a patient with blue rubber bleb nevus syndrome: clinical case report and review of the literature.

We present the case of a 9-year-old boy diagnosed with blue rubber bleb nevus syndrome, who showed a very large left cervical cystic lymphangioma. He was previously subjected to various treatments for lesions in the intestinal tract including blood transfusions for anemia, sclerosis, enterotomies or resections. The tumor was resected without any complications and the anatomopathologic report confirmed this diagnosis. The blue cavernous hemangioma syndrome (or blue rubber bleb nevus syndrome) is a rare disease characterized by cavernous angiomas involving the skin and gastrointestinal tract. Several cases of cystic lymphangiomas associated with this syndrome have been published recently and lymphomatous differentiation has been identified in the cells of cutaneous lesions. Given their common embryological origin, we underscore the importance of bearing in mind that it is possible for different types of vascular malformations to coexist in the same patient.

New Directions for Preventing Dating Violence in Adolescence: The Study of Gender Models.

Dating violence is a huge transcultural and alarming phenomenon, directly linked with endless discrimination against women. The latest research on dating violence in adolescence shows how dating violence is persistent and common in the adolescent period as well and pinpoints the origin of gender violence from first adolescent relationships. This element takes us to considerate how recent gender violence studies and policies, increased also thanks to international efforts on this issue, are not bringing expected results, especially among young people. This mini-review aims to analyze the main characteristics of current gender studies and policies on dating violence, focusing on percentages with a woman-centered approach, which stresses the consequences of gender violence. Other gender studies, that consider gender as a relational product, stress the importance of integrating the analysis of gender models as a key instrument to understand the main causes of dating violence, providing new elements to develop effective policies against dating violence. Indeed, gender models of femininity and masculinity are based on a binary system, which is also a reciprocal recognition and identity system: gender models define female and male characteristics, roles, stereotypes, and expectation, being complementary and foreclosing at the same time. Recent studies on gender relationships, especially among the youth, allows us to propose a new dialog between dating violence studies and gender model studies, underling the need of a complete and complex understanding of gender structure, and of its tensions and contradictions, to put an end to gender and dating violence, through effective programs.

[Hypovitaminosis D associated to low sun exposure in the population over 64 years old]. / Hipovitaminosis D asociada a exposición solar insuficiente en la población mayor de 64 años.

BACKGROUND AND OBJECTIVE: To identify the factors related to hypovitaminosis D in the population over 64 years of age without known risk factors of hypovitaminosis D. SUBJECTS AND METHOD: It was a cross-sectional population study in individuals over 64 year-old attending basic healthcare areas in our hospital's area of reference. A survey was conducted to assess various items (functional capacity, exposure to sun, walks, eating habits). Blood samples taken from each participant were analyzed. RESULTS: A total of 239 individuals -mean age (standard deviation): 72 (5.4) years- were evaluated. 95% of the participants scored > 90 on the Barthel index. Mean serum 25-hydroxyvitamin D3 -25(OH)D3- concentration was 17 (7.5) ng/ml and intact parathormone was 60 (26 pg/ml). The prevalence of hypovitaminosis D was 87%, including 70.3% with insufficiency (25(OH)D3 between 11 and 25 ng/ml) and 16.7% with deficiency (25(OH)D3 < or = 10 ng/ml). The intake of vitamin D and calcium were below recommended levels. The principal source of vitamin D was oily fish. Participants with deficiency scored lower on the Barthel index, had a higher mean age, lived in flats, had less exposure to sun, and used to walk less in sun-hours. Higher levels of alkaline phosphatase and intact parathormone were found in participants with deficiency. The variables independently and significantly associated with vitamin D deficiency were a Barthel score < or = 90, scant exposure to sun and living in a flat. CONCLUSIONS: There is a high prevalence of hypovitaminosis D in the population aged over 64 years in our area, which is associated with lower functional capacity, scant exposure to sun and living in flats.

Treatment of Comorbid Alcohol Dependence and Anxiety Disorder: Review of the Scientific Evidence and Recommendations for Treatment.

Patients with alcohol-use disorders (AUDs) have a high prevalence of anxiety disorders (AnxDs). "Co-occurring disorders" refers to the coexistence of an AUD and/or drug related disorders with another non-addictive psychiatric disorder. The aim of this study was to assess the effectiveness of psychopharmacological treatments and psychotherapy in patients with AUD and AnxD and to propose recommendations for the treatment of patients with comorbid AnxDs and AUDs. Randomized clinical trials, meta-analyses, and clinical guidelines were retrieved from PubMed, Embase, and Cochrane databases. Paroxetine was found to be effective in social anxiety patients with alcohol dependence. Selective serotonin reuptake inhibitors (SSRIs), especially sertraline, showed effective results in posttraumatic stress disorder and in comorbid AnxD-AUD. However, SSRIs should be used with caution when patients are actively drinking because they may increase alcohol consumption. Buspirone, gabapentin, and pregabalin were found to be effective in comorbid AnxD-AUD. The treatment of dual AnxDs should start as early as possible. Since AUDs and AnxDs can reinforce each other, treatments targeting both pathologies can be effective. Women suffer from higher levels of stress and AnxDs than men, and they are also more vulnerable to maintaining alcohol consumption levels. Further research is needed in this comorbid patient population, including the study of different types of patients and gender perspectives.

[Evaluation assessment of the cut-off point of vitamin D in the population older than 64 years old]. / Valoración del umbral óptimo de vitamina D en la población mayor de 64 años.

BACKGROUND AND OBJECTIVE: Serum 25(OH)D(3) is the best indicator of vitamin D status, although some controversy remains regarding "normal" and "abnormal" values. The objective was to identify the 25(OH)D(3) serum concentration threshold which allows to know the 25(OH)D(3) serum levels correlated to PTH(i) increase and to describe the prevalence of hypovitaminosis D. PATIENTS AND METHOD: Cross-sectional population study in subjects over 64 years of age residing in the basic healthcare areas in our hospital's area of reference. RESULTS: A total of 239 persons -mean age (standard deviation) 72 (5.4) years- were evaluated. Mean serum concentrations of 25(OH)D(3) and PTH(i) were 17 (7.5) ng/ml and 60.5 (26.1) pg/ml, respectively. 32% of the subjects showed an increase in the serum concentration of PTH(i) > 65 pg/ml. 96% of the cases with an increase in PTH(i) had serum concentrations of 25(OH)D(3) < or = 25.5 ng/ml. In 70% of the subjects, the serum concentration levels of 25(OH)D(3) ranged between 11 and 25 ng/ml and in 17% the levels of 25(OH)D(3) were lower than 10 ng/ml. CONCLUSIONS: The normal ranges for our population could correspond to levels of 25(OH)D3 > or = 25 ng/ml, with a 95% of sensibility to detect secondary hyperparathyroidism.

Survival study of opioid addicts in relation to its adherence to methadone maintenance treatment.

OBJECTIVES: To study the putative role of methadone maintenance treatment in the improvement of life expectancy of opioid addicts. DESIGN: Retrospective longitudinal study. PARTICIPANTS: All 1487 patients receiving methadone maintenance treatment in Alicante between June 1990 and December 1997. STATISTICAL ANALYSIS: Mortality rates were studied using Kaplan-Meier survival curves. Protection or risk factors were analyzed using Cox's proportional hazards model. RESULTS: Mortality rates decreased from 87/1000 in 1991 to 17/1000 in 1997. The following factors influenced mortality: HIV infection [Hazard Ratio (HR)=7, 95% confidence interval (CI)=4-12]; current methadone status (HR=3.2, 95%CI=1.5-7.1) and MMT retention (retained vs. drop-out, HR=0.5, 95%CI=0.2-1.1; re-enrolled vs. drop-out, HR=0.3, 95%CI=0.2-0.5). CONCLUSION: Expediting entry and re-enrolling in methadone maintenance treatment improves survival.

Detection of clinical interactions between methadone and anti-retroviral compounds using an enantioselective capillary electrophoresis for methadone analysis.

A capillary electrophoresis method was developed to detect interactions between methadone and anti-retroviral compounds. Eight subjects, who underwent methadone maintenance treatment in the Province of Alicante (Spain), consented to participate in the present study. Of those, one subject was followed up for 123 days to detect drug-drug interactions. The enantiomers of methadone and those of its main metabolite were conveniently resolved within 4 min using a chiral electrophoresis buffer mixture which consisted of phosphate buffer, pH 5, plus 0.2% highly sulphated-(beta)-cyclodextrin. The effective mobility of the analytes was in the 0.061-0.140 cm(2)/(kV s) range at pH 5. The R-methadone plasma concentration range for seven patients was 91-318 ng/mL, it decreased from 186 to 46 ng/mL in a patient followed-up on commencement of the anti-retroviral therapy, returning to the previous higher levels after progressive dose increases. We conclude that monitoring R-methadone plasma levels can be a useful tool for the dose adjustment of methadone.

[Prevalence of infection by HIV and hepatitis C virus in a cohort of patients on methadone treatment]. / Prevalencia de infección por virus de la inmunodeficiencia humana y hepatitis C en una cohorte de pacientes en tratamiento de mantenimiento con metadona.

BACKGROUND AND OBJECTIVES: Methadone maintenance treatment reduces drug-related-harm. The aims of the study were: a) to analyze the temporal tendencies of prevalence of infection by HIV and hepatitis C virus, and b) to evaluate if the adherence to methadone maintenance treatment protects against the infection by HIV and hepatitis C virus. PATIENTS AND METHOD: Retrospective longitudinal study with All the 1,487 patients receiving treatment in the Province of Alicante between June 1990 and December 1997. The prevalence of infection by HIV and hepatitis C virus were computed. The variables associated to the infection by HIV and hepatitis C virus were recognized though a model of logistic regression. RESULTS: The prevalence of infection by HIV decreased, and the prevalence of infection by hepatitis C virus increased along the studied period. The independent predictors with regard to the infection by HIV were the age of beginning in treatment (odds ratio [OR] = 0.95; 95% confident interval [95%CI], 0.93-0.97; p < 0.001), total time within treatment (OR = 0.99; 95%CI, 0.98-1.0; p = 0.01) and non-parenteral route of administration (OR = 0.25; 95%CI, 0.18-0.33; p < 0.001). CONCLUSIONS: To be admitted to methadone maintenance treatment for the first time after opiate dependence has been developed and to remain in treatment for long periods of time, all that decreases the risk of infection by HIV.

Increase of R-/S-methadone enantiomer concentration ratio in serum of patients treated with either nevirapine or efavirenz.

An increased methadone enantiomer ratio (R/S) was associated to both nevirapine (179%, n=5) and efavirenz (36%, n=9) treatments when compared with that of controls (n=52). Additionally, in four follow-up patients, both R- and S-methadone normalized concentrations decreased (19%-93%) while R/S increased (22%-314%) following nevirapine/efavirenz treatment. R/S decreased (42%) after non-compliance with efavirenz treatment. Therefore, the methadone-maintenance-treatment outcome should be evaluated when patients are treated with drugs which are supposed to induce CYP3A4 and CYP2B6 isoforms.

[Extraintestinal infection due to Aeromonas spp.: review of 38 cases]. / Infección extraintestinal por Aeromonas spp.: revisión de 38 casos.

INTRODUCTION: Aeromonas spp. typically cause gastroenteritis, but can occasionally produce extraintestinal infections. The aim of this study was to determine the clinical and microbiological characteristics of extraintestinal infections caused by Aeromonas spp. in our area. PATIENTS AND METHODS: The clinical histories of patients with extraintestinal infections by Aeromonas spp. diagnosed in Hospital Universitario de Guadalajara (Guadalajara, Spain) from January 1990 to December 2005 were reviewed. Identification and susceptibility testing of the strains were performed by the MicroScan WalkAway-40 automated method (DadeBerhing). RESULTS: Thirty-eight cases of extraintestinal infections were diagnosed: 18 abdominal infections, 11 skin and soft tissue infections, 3 urinary tract infections, and 3 episodes of bacteremia with no primary focus. The species most frequently found was A. hydrophila (16 cases). Infection occurred most often in patients with underlying diseases (76.3%), including malignancy (34.2%) and diabetes mellitus (21%). Polymicrobial infections were detected in 50% and the etiology was nosocomial in 21%. The mortality rate was 16.2%. Gentamicin, amikacin, cefotaxime and ciprofloxacin had the highest activity against the Aeromonas species isolated. CONCLUSIONS: Aeromonas spp. as the causative infectious agent should be kept in mind in patients with infections of the biliary system, surgical wounds in the abdomen and posttraumatic cellulitis. Extraintestinal infection is usually polymicrobial, appears most commonly in patients with underlying diseases, and generally has a good prognosis. The most active antibiotics in vitro were gentamicin, amikacin, cefotaxime and ciprofloxacin.

Infragenicular bypass graft for limb salvage using polytetrafluoroethylene and distal vein cuff as the first alternative in patients without ipsilateral greater saphenous vein.

The objectives of this study were to evaluate the results of polytetrafluoroethylene infragenicular bypass grafts with a distal interposition vein cuff in patients with critical limb ischemia in the absence of ipsilateral greater saphenous vein. From January 1997 to June 2002, 58 consecutive below-knee bypass grafts with PTFE and distal interposition vein cuff were performed in 57 patients with a median age of 70.8 years. The distal anastomosis was located at the infragenicular popliteal artery in 18 cases and at tibial vessels in 40. Primary patency, secondary patency, and limb salvage were analyzed using the Kaplan-Meier method. During a median follow-up of 14.4 months (range, 1-50) 26 cases of graft occlusion and 19 major amputations were registered. The primary and secondary patency rates at 12, 24, and 36 months were 57%, 54%, and 47% and 61%, 58%, and 50%, respectively. Limb salvage rates reached 69%, 69%, and 59% at 12, 24, and 36 months. When below-knee revasculanzation is required in patients with limb-threatening ischemia, in the absence ipsilateral greater saphenous vein, PTFE grafts with a distal vein cuff are a reasonable substitute with acceptable long-term patency and limb salvage rates.

Treatment of aberrant right subclavian artery aneurysm with endovascular exclusion and adjunctive surgical bypass.

Aberrant right subclavian arteries occur in as much as 2% of the population. Aneurysms in this vessel are rare but exhibit a marked propensity toward rupture; therefore, early elective treatment is indicated. Transluminally placed stent-grafts offer an alternative approach to the standard surgical treatment. This type of procedure is less invasive, with less attendant risk than operative repair. Because there was no proximal neck between the aneurysm and Kommerell diverticulum in the case described herein, it was decided to perform endovascular exclusion of the aneurysm by inserting an endoprosthesis to occlude the aortic exit of the aneurysm, combined with distal ligation. A bilateral carotid/subclavian bypass was also created to preserve the function of both subclavian arteries.

Infección extraintestinal por Aeromonas spp: revisión de 38 casos / Extraintestinal infection due to Aeromonas spp: review of 38 cases

Introducción. Aeromonas spp. es una causa habitual de gastroenteritis pero ocasionalmente puede producir infecciones extraintestinales. El objetivo de este estudio es conocer las características clínicas y microbiológicas de las infecciones extraintestinales producidas por este microorganismo en nuestro medio. Pacientes y métodos. Se revisaron retrospectivamente las historias clínicas de los enfermos con infecciones extraintestinales por Aeromonas spp., diagnosticadas en el Hospital Universitario de Guadalajara entre enero de 1990 y diciembre de 2005. La identificación microbiológica y la susceptibilidad antimicrobiana de las cepas aisladas se realizaron mediante el sistema automático MicroScan WalkAway-40 (DadeBerhing). Resultados. Se diagnosticaron 38 casos: 18 infecciones abdominales, 11 de piel y partes blandas, 3 del tracto urinario, 3 del aparato respiratorio y 3 bacteriemias sin foco primario. La especie más frecuente fue A. hydrophila (16 casos). El 76,3% de los enfermos presentaron patologías de base predisponentes, siendo las de naturaleza neoplásica las más frecuentes (34,2%), seguida de diabetes mellitus (21%). El 50% de las infecciones fueron polimicrobianas y el 21% de origen nosocomial. La mortalidad global fue del 16,2%. Los antibióticos con mayor porcentaje de sensibilidad fueron gentamicina, amikacina, cefotaxima y ciprofloxacino. Conclusiones. Aeromonas spp. debe ser tenida en cuenta en infecciones del sistema biliar, infecciones de heridas quirúrgicas abdominales y celulitis postraumáticas. La infección extraintestinal con frecuencia es polimicrobiana, suele aparecer en enfermos con patologías de base y en general el pronóstico es bueno. Los antibióticos más activos in vitro fueron gentamicina, amikacina, cefotaxima y ciprofloxacino (AU)

Introduction. Aeromonas spp. typically cause gastroenteritis, but can occasionally produce extraintestinal infections. The aim of this study was to determine the clinical and microbiological characteristics of extraintestinal infections caused by Aeromonas spp. in our area. Patients and methods. The clinical histories of patients with extraintestinal infections by Aeromonas spp. diagnosed in Hospital Universitario de Guadalajara (Guadalajara, Spain) from January 1990 to December 2005 were reviewed. Identification and susceptibility testing of the strains were performed by the MicroScan WalkAway-40 automated method (DadeBerhing). Results. Thirty-eight cases of extraintestinal infections were diagnosed: 18 abdominal infections, 11 skin and soft tissue infections, 3 urinary tract infections, and 3 episodes of bacteremia with no primary focus. The species most frequently found was A. hydrophila (16 cases). Infection occurred most often in patients with underlying diseases (76,3%), including malignancy (34,2%) and diabetes mellitus (21%). Polymicrobial infections were detected in 50% and the etiology was nosocomial in 21%. The mortality rate was 16,2%. Gentamicin, amikacin, cefotaxime and ciprofloxacin had the highest activity against the Aeromonas species isolated. Conclusions. Aeromonas spp. as the causative infectious agent should be kept in mind in patients with infections of the biliary system, surgical wounds in the abdomen and posttraumatic cellulitis. Extraintestinal infection is usually polymicrobial, appears most commonly in patients with underlying diseases, and generally has a good prognosis. The most active antibiotics in vitro were gentamicin, amikacin, cefotaxime and ciprofloxacin (AU)

Hipovitaminosis D asociada a exposición solar insuficiente en la población mayor de 64 años / Hypovitaminosis D associated to low sun exposure in the population over 64 years old

Fundamento y objetivo: Identificar los factores relacionados con la hipovitaminosis D en la población ambulatoria mayor de 64 años sin factores de riesgo conocidos de hipovitaminosis D. Sujetos y método: Se ha realizado un estudio transversal de ámbito poblacional en personas mayores de 64 años procedentes de las áreas básicas de salud del área de referencia del hospital. Se realizó una encuesta con varios ítems (capacidad funcional, exposición solar, paseos, alimentación) y se determinaron parámetros analíticos. Resultados: Se evaluó a 239 personas, cuya edad media (desviación estándar) era de 72 (5,4) años. El 95% presentaba un índice de Barthel mayor de 90. La concentración sérica media de 25-hidroxicolecalciferol ­25(OH)D3­ fue de 17 (7,5) ng/ml y la de paratirina intacta, de 60 (26) pg/ml. La prevalencia de hipovitaminosis D fue del 87%. El 70,3% presentó insuficiencia ­25(OH)D3 entre 11 y 25 ng/ml­ y el 16,7% deficiencia ­25(OH)D3 # 10 ng/ml­. La ingesta de vitamina D y calcio fue inferior a lo recomendado. La principal fuente de vitamina D fue el pescado azul. Las personas con deficiencia tenían un menor índice de Barthel, edad media superior, vivían en pisos, tenían una ingesta menor de calcio, menor exposición solar y menor hábito de pasear al sol. Los valores más elevados de fosfatasa alcalina y paratirina intacta se hallaron en las personas con deficiencia. Las variables asociadas independiente y significativamente con la situación de deficiencia fueron el índice de Barthel igual o menor de 90, no tomar el sol y vivir en un piso. Conclusiones: Se evidencia una elevada prevalencia de hipovitaminosis D durante los meses de invierno, que se asocia a un menor grado de autonomía funcional, a un escaso hábito de exposición solar y a vivir en un piso, en los mayores de 64 años residentes en nuestra comunidad

Background and objective: To identify the factors related to hypovitaminosis D in the population over 64 years of age without known risk factors of hypovitaminosis D. Subjects and method: It was a cross-sectional population study in individuals over 64 year-old attending basic healthcare areas in our hospital's area of reference. A survey was conducted to assess various items (functional capacity, exposure to sun, walks, eating habits). Blood samples taken from each participant were analyzed. Results: A total of 239 individuals ­mean age (standard deviation): 72 (5.4) years­ were evaluated. 95% of the participants scored > 90 on the Barthel index. Mean serum 25-hydroxyvitamin D3 ­25(OH)D3­ concentration was 17 (7.5) ng/ml and intact parathormone was 60 (26 pg/ml). The prevalence of hypovitaminosis D was 87%, including 70.3% with insufficiency (25(OH)D3 between 11 and 25 ng/ml) and 16.7% with deficiency (25(OH)D3 # 10 ng/ml). The intake of vitamin D and calcium were below recommended levels. The principal source of vitamin D was oily fish. Participants with deficiency scored lower on the Barthel index, had a higher mean age, lived in flats, had less exposure to sun, and used to walk less in sun-hours. Higher levels of alkaline phosphatase and intact parathormone were found in participants with deficiency. The variables independently and significantly associated with vitamin D deficiency were a Barthel score # 90, scant exposure to sun and living in a flat. Conclusions: There is a high prevalence of hypovitaminosis D in the population aged over 64 years in our area, which is associated with lower functional capacity, scant exposure to sun and living in flats

Valoración del umbral óptimo de vitamina D en la población mayor de 64 años / Evaluation assessment of the cut-off point of vitamin D in the population older than 64 years old

Fundamento y objetivo: El mejor indicador del estado de la vitamina D es la determinación en suero del 25-hidroxicolecalciferol [25(OH)D3], aunque cuáles son los valores normales es objeto de controversia. El objetivo del estudio ha sido conocer el umbral de 25(OH)D3 a partir del cual se produce la mayoría de los incrementos de los valores de parathormona intacta (PTHi) y describir la prevalencia de hipovitaminosis D en la población estudiada. Pacientes y método: Se ha realizado un estudio transversal de ámbito poblacional en personas mayores de 64 años procedentes de las áreas básicas de salud del área de referencia de un hospital. Resultados: Se evaluó a 239 personas, con una edad media (desviación estándar) de 72 (5,4) años. Los valores medios de 25(OH)D3 y de PTHi fueron 17 (7,5) ng/ml y 60,5 (26,1) pg/ml, respectivamente. El 32% presentó valores de PTHi superiores a 65 pg/ml. El 96% de los casos con PTHi elevada tenía valores de 25(OH)D3 iguales o inferiores a 25,5 ng/ml. El 70% de los participantes presentó valores de 25(OH)D3 entre 11 y 25 ng/ml y el 17%, valores inferiores a 10 ng/ml. Conclusiones: El umbral de normalidad para nuestra población podría corresponder a valores de 25(OH)D3 iguales o superiores a 25 ng/ml, con una sensibilidad del 95% para detectar hiperparatiroidismo secundario

Background and objective: Serum 25(OH)D3 is the best indicator of vitamin D status, although some controversy remains regarding «normal» and «abnormal» values. The objective was to identify the 25(OH)D3 serum concentration treshold which allows to know the 25(OH)D3 serum levels correlated to PTHi increase and to describe the prevalence of hypovitaminosis D. Patients and method: Cross-sectional population study in subjects over 64 years of age residing in the basic healthcare areas in our hospital's area of reference. Results: A total of 239 persons ­mean age (standard deviation) 72 (5.4) years­ were evaluated. Mean serum concentrations of 25(OH)D3 and PTHi were 17 (7.5) ng/ml and 60.5 (26.1) pg/ml, respectively. 32% of the subjects showed an increase in the serum concentration of PTHi > 65 pg/ml. 96% of the cases with an increase in PTHi had serum concentrations of 25(OH)D3 ¾ 25.5 ng/ml. In 70% of the subjects, the serum concentration levels of 25(OH)D3 ranged between 11 and 25 ng/ml and in 17% the levels of 25(OH)D3 were lower than 10 ng/ml. Conclusions: The normal ranges for our population could correspond to levels of 25(OH)D3 >= 25 ng/ml, with a 95% of sensibility to detect secondary hyperparathyroidism

Enfermedad de Ménétrier y edemas bilaterales en un paciente joven / Menetrier’s disease and bilateral oedemas in a young patient

Introducción. La enfermedad de Ménétrier es una gastropatía hiperplásica de aparición excepcional, que se caracteriza por un engrosamiento marcado de los pliegues gástricos, a expensas fundamentalmente de una hiperplasia foveolar. La presentación clínica más frecuente es dolor epigástrico, náuseas o vómitos. Se ha descrito una elevada prevalencia de infección por Helicobacter pylori (90%), y se ha comprobado una mejoría clínica, analítica e histológica tras la erradicación de éste. Caso clínico. Varón de 45 años que consultó por edemas de dos meses de evolución en los miembros inferiores. La ecografía Doppler de los miembros inferiores y la linfogammagrafía isotópica fueron normales. En la analítica se observó una marcada hipoproteinemia, y entre los estudios adicionales destacaba una serología positiva para H. pylori. Se le realizó un tránsito esofagogastroduodenal donde se observó un engrosamiento marcado de los pliegues gástricos, que se confirmó con gastroscopia y biopsia. El examen anatomopatológico objetivó la existencia de una gastritis crónica mixta con hiperplasia foveolar focal, junto con la presencia de H. pylori. Se instauró un tratamiento erradicador, y el paciente mostró una mejoría significativa de los edemas y una normalización de la cifra de proteínas. Conclusión. Presentamos un caso de enfermedad de Ménétrier, cuya principal manifestación clínica –a diferencia de lo habitual– son los edemas periféricos. Cabe reseñar la importancia de incluir las gastroenteropatías pierdeproteínas dentro del diagnóstico diferencial de edemas periféricos sin causa vascular

Introduction. Ménétrier’s disease is rare hyperplastic gastropathy that is characterised by a notable thickening of the gastric folds, mainly due to foveolar hyperplasia. The most frequent clinical presentation is epigastric pain, nausea or vomiting. A high rate of prevalence of infection by Helicobacter pylori (90%) has been reported and clinical, analytical and histological improvement is observed once this has been eradicated. Case report. A 45-year-old male who visited due to a two-month history of oedemas in the lower limbs. Results of Doppler ultrasound scans of the lower limbs and isotopic lymphoscintigraphy imaging were normal. Lab tests revealed a notable hypoproteinemia and one of the most significant findings in the additional studies was positive serology for H. pylori. The upper gastrointestinal series that was performed revealed a notable thickening of the gastric folds, which was confirmed by means of gastroscopic and biopsy tests. A pathological examination revealed the existence of a chronic non-specific gastritis with focal foveolar hyperplasia, together with the presence of H. pylori. Treatment was established to eradicate the infection and the patient showed significant improvement with regard to the oedemas and normalisation of the protein count. Conclusion. We report a case of Ménétrier’s disease in which, uncharacteristically, the main clinical feature is the presence of peripheral oedemas. It is important to include protein-losing gastroenteropathies within the differential diagnosis of peripheral oedemas that have no vascular causation