RNA biogenesis and RNA metabolism factors as R-loop suppressors: a hidden role in genome integrity.

Genome integrity relies on the accuracy of DNA metabolism, but as appreciated for more than four decades, transcription enhances mutation and recombination frequencies. More recent research provided evidence for a previously unforeseen link between RNA and DNA metabolism, which is often related to the accumulation of DNA-RNA hybrids and R-loops. In addition to physiological roles, R-loops interfere with DNA replication and repair, providing a molecular scenario for the origin of genome instability. Here, we review current knowledge on the multiple RNA factors that prevent or resolve R-loops and consequent transcription-replication conflicts and thus act as modulators of genome dynamics.

Sleep disturbance in clinical and preclinical scrapie-infected sheep measured by polysomnography.

Neurodegenerative diseases are characterised by neuronal loss and abnormal deposition of pathological proteins in the nervous system. Among the most common neurodegenerative diseases are Alzheimer's disease (AD), Parkinson's disease (PD), Huntington's disease and transmissible spongiform encephalopathies (TSEs). Sleep and circadian rhythm disturbances are one of the most common symptoms in patients with neurodegenerative diseases. Currently, one of the main objectives in the study of TSEs is to try to establish an early diagnosis, as clinical signs do not appear until the damage to the central nervous system is very advanced, which prevents any therapeutic approach. In this paper, we provide the first description of sleep disturbance caused by classical scrapie in clinical and preclinical sheep using polysomnography compared to healthy controls. Fifteen sheep classified into three groups, clinical, preclinical and negative control, were analysed. The results show a decrease in total sleep time as the disease progresses, with significant changes between control, clinical and pre-clinical animals. The results also show an increase in sleep fragmentation in clinical animals compared to preclinical and control animals. In addition, sheep with clinical scrapie show a total loss of Rapid Eye Movement sleep (REM) and alterations in Non Rapid Eyes Movement sleep (NREM) compared to control sheep, demonstrating more shallow sleep. Although further research is needed, these results suggest that prion diseases also produce sleep disturbances in animals and that polysomnography could be a diagnostic tool of interest in clinical and preclinical cases of prion diseases.

Human DNA topoisomerase I poisoning causes R loop-mediated genome instability attenuated by transcription factor IIS.

DNA topoisomerase I can contribute to cancer genome instability. During catalytic activity, topoisomerase I forms a transient intermediate, topoisomerase I-DNA cleavage complex (Top1cc) to allow strand rotation and duplex relaxation, which can lead to elevated levels of DNA-RNA hybrids and micronuclei. To comprehend the underlying mechanisms, we have integrated genomic data of Top1cc-triggered hybrids and DNA double-strand breaks (DSBs) shortly after Top1cc induction, revealing that Top1ccs increase hybrid levels with different mechanisms. DSBs are at highly transcribed genes in early replicating initiation zones and overlap with hybrids downstream of accumulated RNA polymerase II (RNAPII) at gene 5'-ends. A transcription factor IIS mutant impairing transcription elongation further increased RNAPII accumulation likely due to backtracking. Moreover, Top1ccs can trigger micronuclei when occurring during late G1 or early/mid S, but not during late S. As micronuclei and transcription-replication conflicts are attenuated by transcription factor IIS, our results support a role of RNAPII arrest in Top1cc-induced transcription-replication conflicts leading to DSBs and micronuclei.

Telemedicina en el control de la hipertensión arterial

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Introduction: Arterial hypertension is the great challenge of health policies in the world. Its high prevalence, the lack of control (linked to poor adherence to antihypertensive treatment) and its high "burden" (as a non-communicable disease) are responsible for the increase in cardiovascular morbidity and mortality. Objetive: To evaluate, as a pilot test, the benefit of real-time telemonitoring applied to blood pressure (BP) control. Metodology: Inclusion criteria: Diagnosed hypertensives, under pharmacological treatment, assisted in the Maciel Hospital polyclinic in the period June-October 2019. Exclusion criteria: pregnancy and upper arm circumference less than 22 cm or greater than 42 cm. Home blood pressure monitoring was implemented, using a validated electronic blood pressure monitor and a smart cell phone connected to a private web platform in real time. Analytical, experimental, prospective study. Qualitative variables were expressed in absolute frequency and percentage relative frequency. Quantitative variables were expressed as mean and standard deviation. The normality of the distribution was verified using the Kolmogorov Smirnov test. Results: Of a total of 57 patients, the mean age was 59 ± 12.8 years, female sex 64.9%. Presenting 22.8% poor knowledge of the disease. Regarding the control of BP figures, 31.6% reported not checking regularly. Adherence to pharmacological treatment at the beginning of the monitoring was 33.3%. Figures lower than those described by RENATA-2, where half of the treated hypertensives complied with the treatment. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were analyzed at the beginning and end of the study. Pre-monitoring measurements were mean SBP: 138.6 ± 17.8 mmHg and mean DBP: 85.4 ± 14.8 mmHg. The records at the end of the immediate monitoring were 131.5 ± 19.9 mmHg and 81.5 ± 14.2 mmHg for PAS and PAD, respectively. Finding a significant difference between the means of the PAS (p 0.019), but not between the means of the DBP (p 0.06). Discussion: Although the percentage of patients achieving good BP control was significant, these results may be closely related to a subtype of observed performance bias, rather than the outcome of the intervention. The mean days of telemonitoring were 8, 85, number of shots was 34.12, and number of interventions performed by the observer (medication change) was 0.30. User satisfaction with the method used was 96.4%, and 100% considered it Easy or very easy to use. 87.5% would use it for long periods of time, including older adults. Conclusions: The studied method shows potential benefits for the control of BP figures, with a wide acceptance by users, facilitating access to the health system, and quality medical care.

Introdução: A hipertensão arterial é o grande desafio das políticas de saúde no mundo. Sua alta prevalência, o descontrole (ligado à baixa adesão ao tratamento anti-hipertensivo) e sua alta "carga" (como doença não transmissível) são responsáveis ​​pelo aumento da morbimortalidade cardiovascular. Objetivo: foi avaliar como teste piloto, o benefício do telemonitoramento em tempo real, aplicado ao controle da pressão arterial (PA). Metodologia: Critérios de inclusão: Hipertensos diagnosticados, em tratamento farmacológico, atendidos na policlínica do Hospital Maciel no período de junho a outubro de 2019. Critérios de exclusão: gravidez e circunferência do braço menor que 22 cm ou maior que 42 cm. Foi implementado o monitoramento domiciliar da pressão arterial, utilizando um monitor eletrônico de pressão arterial validado e um telefone celular inteligente conectado a uma plataforma web privada em tempo real. Estudo analítico, experimental, prospectivo.As variáveis ​​qualitativas foram expressas em frequência absoluta e frequência relativa percentual. As variáveis ​​quantitativas foram expressas como média e desvio padrão. A normalidade da distribuição foi verificada por meio do teste de Kolmogorov Smirnov. Resultados: De um total de 57 pacientes, a média de idade foi de 59 ± 12,8 anos, sexo feminino 64,9%. Apresentando 22,8% conhecimento ruim sobre a doença. Em relação ao controle dos valores da PA, 31,6% relataram não verificar regularmente. A adesão ao tratamento farmacológico no início do acompanhamento foi de 33,3%, valores inferiores aos descritos pelo RENATA-2, onde metade dos hipertensos tratados aderiu ao tratamento. A pressão arterial sistólica (PAS) e a pressão arterial diastólica (PAD) foram analisadas no início e no final do estudo. As medições de pré-monitoramento foram PAS média: 138,6 ± 17,8 mmHg e PAD média: 85,4 ± 14,8 mmHg. Os registros ao final do monitoramento imediato foram de 131,5 ± 19,9 mmHg e 81,5 ± 14,2 mmHg para PAS e PAD, respectivamente. Encontrando diferença significativa entre as médias do PAS (p 0,019), mas não entre as médias do DBP (p 0,06). Discussão: Embora a porcentagem de pacientes que alcançaram um bom controle da PA tenha sido significativa, esses resultados podem estar intimamente relacionados a um subtipo de viés de desempenho observado, e não ao resultado da intervenção. A média de dias de telemonitoramento foi 8, 85, o número de disparos foi 34,12, e o número de intervenções realizadas pelo observador (mudança de medicação) foi de 0,30. A satisfação dos usuários com o método utilizado foi de 96,4%, sendo que 100% consideraram fácil ou muito fácil de usar. 87,5% usariam por longos períodos de tempo, inclusive idosos adultos. Conclusões: O método estudado apresenta potenciais benefícios para o controle dos valores da PA, com ampla aceitação pelos usuários, facilitando o acesso ao sistema de saúde e assistência médica de qualidade.

Non-dipping blood pressure pattern in pediatricians during on-duty / Patrón no-dipper en la presión arterial de médicos pediatras durante las guardias presenciales

Introduction: People with a reduced nighttime dip in blood pressure have an increased cardiovascular risk. Our objective was to describe the different patterns in blood pressure (BP) among pediatricians who work in long on-duty shifts in relation with sex, medical rank and sleeping time. Methods: Descriptive, cross-sectional, two-center study. On duty pediatric Resident physicians and pediatric Consultants were recruited between January 2018 and December 2021. Results: Fifty-one physicians were included in the study (78.4% female, 66.7% Resident physicians). Resident physicians had a higher night/day ratio (0.91 vs 0.85; p<0.001) and a shorter nighttime period (3.87 vs 5.41, p<0.001) than Consultants. Physicians sleeping less than 5h had a higher night/day ratio (0.91 vs 0.87, p=0.014). Being a Resident showed a ∼4.5-fold increased risk of having a non-dipping BP pattern compared to Consultants. Conclusion: We found a potential link between both being a Resident and, probably, having shorter sleeping time, and the non-dipping BP pattern in physicians during prolonged shifts. (AU)

Introducción: Las personas con un descenso nocturno reducido de la presión arterial tienen mayor riesgo cardiovascular. Nuestro objetivo fue describir los diferentes patrones de presión arterial en los pediatras que trabajan de guardia con presencia física, en relación con el sexo, la categoría profesional y el tiempo de sueño. Métodos: Se realizó un estudio descriptivo, transversal, bicéntrico. Se reclutó a médicos residentes y adjuntos de pediatría, de guardia con presencia física, entre enero de 2018 y diciembre de 2021. Resultados: Fueron incluidos en el estudio 51 médicos (78,4% mujeres; 66,7% médicos residentes). Los médicos residentes presentaron un cociente de presión arterial noche/día mayor (0,91 vs. 0,85; p<0,001) y un tiempo de sueño menor (3,87 vs. 5,41; p<0,001) que los adjuntos. Los participantes que durmieron menos de 5horas presentaron un cociente de presión arterial noche/día mayor (0,91 vs. 0,87; p=0,014). Ser médico residente demostró tener aumentado el riesgo de presentar un patrón no dipper en más de 4,5 veces respecto a los médicos adjuntos. Conclusiones: Encontramos un vínculo potencial entre ser médico residente y, probablemente, tener menos horas de sueño, y el patrón de no descenso nocturno de la presión arterial en los médicos durante las guardias de presencia física. (AU)

Agenesia de la arteria y vena pulmonar izquierdas / Agenesis of the Left Pulmonary Vein and Artery

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Differential effects of two fontemplative practice-based programs for health care professionals / Los efectos diferenciales de dos programas basados en prácticas contemplativas para los profesionales de la salud

The aim of the study was testing the differential effectiveness of two interventions to improve Majorcan primary care professionals' quality of life: Mindful-Based Stress Reduction Training (MBSRT) and Compassion Cultivation Training (CCT). 50 professionals participated in the study; 81% were women. We evaluated mindfulness, empathy, self-compassion, and professional quality of life. Results showed statistically significant effects of the programs on the improvement of mindfulness, self-compassion, and professional quality of life, and differential effects on two dimensions of mindfulness, acting with awareness and non-reacting to inner experience, and on the dimension of burnout of the professional quality of life, in all the cases favoring the MBSRT group. The study concludes that this type of interventions is adequate to improve the aforementioned variables, with better efficacy of the MBSRT for this type of participants

El objetivo de este trabajo fue evaluar la eficacia diferencial de dos intervenciones para mejorar la calidad de vida de profesionales de atención primaria de Mallorca: un programa de reducción del estrés basado en mindfulness (MBSRt) y un entrenamiento en cultivo de la compasión (CCT). Participaron 50 profesionales, el 81% de los cuales eran mujeres. Se evaluó mindfulness, empatía, auto-compasión y calidad de vida profesional. Los resultados mostraron efectos estadísticamente significativos de los programas para la mejora del mindfulness, la empatía, la auto-compasión y la calidad de vida profesional, con un efecto diferencial sobre dos dimensiones del mindfulness, actuar con autoconciencia y no reaccionar a la experiencia interna y la dimensión de burnout de la calidad de vida profesional, en todos los casos a favor del entrenamiento MBSR. El estudio concluye que este tipo de intervenciones es adecuado para la mejora de las variables señaladas, con mayor eficacia de los programas MBSR en este tipo de participantes

Consenso nacional sobre diagnóstico, tratamiento y seguimiento cardiológico de la enfermedad de Kawasaki / National consensus on the diagnosis, cardiological treatment, and follow-up of Kawasaki disease

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Epilepsia dependiente de piridoxina por deficiencia en el gen PNPO / Pyridoxine-dependent epilepsy due to deficiency in the PNPO gene

No disponible

Afectación hepática de paciente portadora en heterocigosis de una mutación en el gen PHKA / Hepatic involvement in a female carrier heterozygous for a mutation in the PHKA2 gene

No disponible

Análisis de casos positivos de cribado neonatal de errores congénitos del metabolismo en la Comunidad de Madrid / Newborn Screening Program in the Community of Madrid: evaluation of positive cases

OBJETIVO: La tecnología de espectrometría de masas en tándem (MS/MS) en los programas de cribado neonatal ha permitido la detección de gran número de errores congénitos del metabolismo (ECM). En la comunidad de Madrid se implementó en marzo de 2011 incluyendo 13 aminoacidopatías, defectos de la beta-oxidación de ácidos grasos y acidemias orgánicas. El objetivo de este estudio fue describir nuestra experiencia y analizar los casos positivos de cribado en un periodo de 9 años (2011-2019). MÉTODOS: Durante el periodo de estudio se realizó el cribado mediante MS/MS a 592822 recién nacidos en la Comunidad de Madrid. Se cuantificaron aminoácidos, acilcarnitinas y succinilacetona en todas las muestras que cumplieron los criterios de calidad. Se calcularon medias, medianas, percentiles y desviación típica de los analitos y ratios de interés. RESULTADOS: Se derivaron a las unidades clínicas de seguimiento por sospecha de una ECM un total de 901 (0,15 %) casos. Se confirmaron 230 casos de 30 ECM diferentes (prevalencia 1:2577), 11 de los cuales no eran inicialmente objetivo de detección del programa. El valor predictivo positivo global fue de 25,6 %. Durante este periodo se detectaron dos falsos negativos. Las enfermedades con mayor prevalencia fueron fenilcetonuria/hiperfenilalaninemia y deficiencia de acil-CoA deshidrogenasa de cadena media (1:6444 y 1: 13174 respectivamente). 93 % de los casos fueron detectados en fase presintomática. CONCLUSIONES: En estos 9 años de experiencia se han detectado numerosos casos de ECM con un valor predictivo positivo global aceptable. Estos resultados confirman la utilidad del cribado neonatal de ECM como programa de salud pública

OBJECTIVE: Tandem mass spectrometry (MS/MS) is being used for newborn screening since this laboratory testing technology increases the number of metabolic disorders that can be detected from dried blood-spot specimens. In the Community of Madrid, it was implemented in March 2011 and it includes 13 aminoacidopathies, fatty acid oxidation disorders and organic acidemias. The aim of this study was to describe our experience and evaluate the screening positive cases in a period of 9 years (2011-2019). METHODS: During the period of the study, a total of 592.822 neonates were screened with this expanded program by MS/MS in the Community of Madrid. Amino acids, acylcarnitines, and succinylacetone were quantified in all samples that met the quality criteria. Means, medians, percentiles and standard deviation of the analytes and ratios of interest were calculated. RESULTS: 901 patients (0,15 %) with a positive screening test were referred to clinical evaluation. 230 patients were diagnosed of 30 different inborn errors of metabolism (prevalence 1:2577), 11 of which were not included as a target in the Community of Madrid newborn screening program. The global positive predictive value was 25,6 %. During this period of time, two false negative cases were detected. The most prevalent disorders were phenylketonuria/hyperphenylalaninemia and medium chain acyl-CoA dehydrogenase deficiency (1:6444 and 1:13174 respectively). 93 % of the patients were detected in the presymptomatic stage. CONCLUSIONS: During the last 9 years a large number of cases of IEM have been detected with an acceptable global positive predictive value. These results confirm the utility of inborn errors of metabolism newborn screening as a public health program

Prevalencia de prescripción-indicación de protectores gástricos en pacientes hospitalizados / A survey of gastroprotective drugs: prescription-indication in hospitalized patients

La prescripción de fármacos antiulcerosos en medio hospitalario, y su influencia posterior en atención primaria, se incrementó en los últimos años y con ello el gasto farmacéutico. El objetivo del presente estudio es analizar la prevalencia de prescripción de antiulcerosos en nuestro centro hospitalario y la adecuación a las indicaciones establecidas. Se realizó un estudio observacional de prescripción-indicación con 2 cortes transversales separados en 6 meses para evitar sesgos de selección. Se constata el uso elevado de gastroprotectores, principalmente inhibidores de bomba de protones, sobre todo en profilaxis de gastropatía por antiinflamatorios no esteroideos (AINE) (17,1%), con una tasa de prescripciones incorrectas del 77,6% a pesar de la existencia de un protocolo específico elaborado por el comité de farmacia y terapéutica de nuestro centro. Destaca el número elevado de prescripciones en pacientes con corticoterapia sin asociación con AINE (25,7%). Se requieren nuevas herramientas que impliquen al facultativo y a los gestores clínicos en el uso racional de medicamentos

Prescription rates of anti-ulcer drugs in hospitals and their spill-over to general practice have risen over the last few years, increasing pharmaceutical expenses. The aim of this study was to analyze gastroprotective drug prescription habits in our hospital by assessing both prevalence and adherence to approved indications. An observational study of prescription-indication was performed with 2 cross sections separated by 6 months to avoid selection bias. We found overprescription of gastroprotective drugs, mainly proton pump inhibitors for the prevention of non-steroidal antiinflammatory drug-induced ulcer (17.1%). Overall, 77.6% of prescriptions had no acceptable indication, despite the availability of a specific protocol produced by the Pharmacy and Therapeutics Committee in our center. There was a high prevalence of prescriptions for non-approved indications such as prophylaxis in patients administered corticosteroids without non-steroidal anti-inflammatory agents (25.7%). New programs to train clinicians and clinical managers in rational drug use are required

Repercusión de la implantación de laley de dependencia sobre los profesionalesde enfermería / Impact and repercussion resulting from the implantation of the Dependency Law on nursing professionals

Objetivos: detectar la sobrecarga de trabajo que sobre los profesionales deEnfermería ha podido producir la puesta en marcha de la Ley 39/2006, identificarproblemas relacionados con la implantación del Baremo de Valoraciónde Dependencia (BVD) y conocer las necesidades específicas de formaciónen los profesionales enfermeros como valoradores de la dependenciaen los pacientes inmovilizados.Material y métodos: se realiza un estudio trasversal descriptivo duranteabril de 2009 de la opinión de los profesionales de Enfermería de los Equiposde Atención Primaria (EAP) del área de Palencia. Se realiza a través deencuestas personales y anónimas, mediante un cuestionario de elaboraciónpropia, que recogía datos demográficos, laborales, aspectos relativos a la cumplimentacióndel BVD, trámites administrativos y necesidades formativas.Resultados: población diana son 151 enfermeros, de los cuales contestan un64,23% (97). El tiempo medio de realización del BVD es de 77,55 minutos;un 40,4% (38) cree que es complicado de completar, 8,5% (8) fácil yun 51,1% depende de los casos; el 69,1% (65) demanda más formación yun 58,5% (55) opina que se deberían crear equipos de valoración enfermerosindependientes. Un 63,8% (60) piensan que no han sido cubiertas las necesidadesde los pacientes, el 23,4% (22) que sus pacientes fallecen antesde recibirlas y un 12,8% (12) que las ayudas han sido eficaces.Conclusiones: la cumplimentación del baremo de valoración de dependenciaha supuesto una sobrecarga de trabajo enfermero. El BVD es difícilde rellenar, denso y en algunas ocasiones no recoge la situación real del paciente.La creación de grupos de profesionales enfermeros entrenados e independientesdel EAP hubiera salvado obstáculos como la valoración subjetivay presiones por parte de las familias (AU)

Objectives: to detect the work overload that the coming into effect of Law39/2006 might have had on nursing professionals, to identify problems relatingto the implantation of the Dependency Law Assessment Rating Scale andto determine the specific training needs of nursing professionals as evaluatorsof the dependency level of immobilised patients.Material and methods: a cross-sectional descriptive study was conducted inApril 2009 on the opinion of the nursing professionals that comprise primarycare teams in the area of Palencia. Anonymous personal polls were carriedout using a self-elaborated questionnaire which gathered information on demographicdata, work-related data, aspects relating to the completion of thedependency law assessment rating scale, administrative- red tape proceduresand training needs.Results: the target population was composed of 151 nurses, of which 64,23%(97) responded. Mean time for the completion of the assessment rating scalewas 77,55 minutes; 40,4% (38) thought it was hard to complete, 8,5%(8) easy to complete and 51,1% said complexity was case-dependent;69,1%(65) requested more information and 58,5% (55) were of the opinionthat independent assessment nursing teams should be created. 63,8% (60)thought that patient needs had not been covered, 23,4% (22) stated thattheir patients died before they could be assessed and 12,8% (12) that the aidshad been effective.Conclusions: the completion of the dependency assessment rating scale hasrepresented an increase in the work load of nurses. The dependency assessmentrating scale is hard to fill in, it is long and in some instances does notreflect the real situation of the patients. The creation of trained groups of nursingprofessionals that work independently from the primary care centreswould have solved these obstacles such as subjective assessment and the pressureon the part of the families (AU)

Insuficiencia mitral aguda severa resuelta mediante angioplastia / No disponible

No disponible

Importancia pronóstica de la frecuencia cardiaca en la población general y en pacientes con enfermedad arterial coronaria e hipertensión arterial. Posibles mecanismos / Prognostic significance of heart rate in the general population and in patients with coronary artery disease and hypertension. Possible mechanisms

Numerosos estudios epidemiológicos han demostrado que hay relación entre el aumento de la frecuencia cardiaca y el incremento de la mortalidad total y cardiovascular tras ajustar por otros factores de riesgo cardiovascular. La mayoría de los estudios ha analizado poblaciones generales, mientras que sólo unos pocos han considerado poblaciones de pacientes hipertensos o con enfermedad coronaria estable. Esta relación entre aumento de la frecuencia cardiaca y morbimortalidad es más evidente en los varones que en las mujeres. Aunque el aumento de la frecuencia cardiaca puede ser un marcador de alguna enfermedad subyacente, lo que podría explicar la asociación con incremento de la mortalidad, lo cierto es que ésta no parece ser la causa. Hay evidencias de que el aumento de la frecuencia cardiaca se asocia con aumento de la actividad del sistema simpático, con aumento de la presión arterial, con obesidad y síndrome metabólico y con progresión de la aterosclerosis. De igual forma, se ha observado asociación entre el incremento de la frecuencia cardiaca y la rotura de la placa aterosclerótica coronaria. Dada esta información, parece razonable que los clínicos comencemos a valorar la importancia de la frecuencia cardiaca como un factor de riesgo independiente. Futuros estudios nos indicarán si la reducción selectiva de la frecuencia cardiaca mejora el pronóstico de los pacientes con frecuencia cardiaca elevada (AU)

Numerous epidemiological studies have shown that a raised heart rate is associated with higher overall and cardiovascular mortality, once other cardiovascular risk factors have been adjusted for. Most of these studies have involved the general population; only a few concerned hypertensives and patients with stable coronary artery disease. The association between a raised heart rate and increased morbidity and mortality is more marked in men than women. Although an increase in heart rate could be a marker of underlying disease, which would explain the association with increased mortality, it is clear that this does not appear to be the case. On the contrary, there is evidence that a raised heart rate is linked to increased sympathetic activity, high blood pressure, obesity, metabolic syndrome, and atherosclerosis progression. Similarly, it has been shown that a raised heart rate is also associated with the disruption of coronary atherosclerotic plaque. Given these findings, it is reasonable that clinicians should now recognize heart rate as a useful independent cardiovascular risk factor. Future studies will tell us whether targeted reductions in heart rate improve prognosis in patients in whom it is raised (AU)

Recidivas locorregionales tras el tratamiento conservador del cáncer de mama en estadios I y II / Locoregional recurrences after conservative treatment of breast cancer stage I-II

FUNDAMENTO: Desde 1992 el tratamiento conservador del cáncer de mama (estadios I y II, TNM clínico) se establece en nuestro hospital como la alternativa a la mastectomía. La finalidad de este estudio retrospectivo fue analizar las características de estos casos de recidiva locorregional y comparar el pronóstico en relación con la localización de las recidivas. MÉTODO: Entre 1987 y 1993 en el Hospital de la Santa Creu i Sant Pau de Barcelona se trataron 489 pacientes afectadas de carcinoma de mama en estadios I y II con cirugía conservadora y radioterapia. La mediana de seguimiento fue de 58,8 meses (extremos, 12 y 144). Presentaron recidiva locorregional 35 pacientes. La recidiva locorregional se clasificó en dos grupos: recidiva local, en mama únicamente; recidiva locorregional, como la presentada en ganglios regionales con recidiva simultánea en mama o sin ella. El diagnóstico se confirmó con estudio anatomopatológico y en todos los casos se efectuó estudio de extensión para descartar metástasis. La última revisión fue en diciembre de 1999. RESULTADOS: La tasa de recidiva locorregional después del tratamiento conservador fue de un 7,5 por ciento y la de recidiva local del 3,06 por ciento. La recidiva fue diagnosticada en el 80 por ciento de los casos en la exploración física y sólo en el 20 por ciento fue detectada por la misma paciente. Los tumores con grado histológico III presentaron mayor número de recidivas locorregionales que locales (p = 0,030). Las recidivas locorregionales se asociaron a una tasa de supervivencia global (p = 0,0005), una supervivencia libre de enfermedad (p = 0,0012) y un intervalo libre de metástasis (p < 0,0005) inferiores a los observados en la recidiva local. CONCLUSIONES: La mayor parte de las recidivas locorregionales fueron diagnosticadas en el control clínico durante el seguimiento. El grado histológico III se relacionó con las recidivas locorregionales. La recidiva local tuvo mejor pronóstico que la recidiva locorregional. (AU)

Aislamiento y elucidación estructural de polisacáridos del alga gigartina glomerata howe, fases esporofítica y gametofítica / Isolation and structural elucidation of plysaccharides of alga gigartina glomerata howe, sporophitic phases and gametophitic

Los carragenanos son galactanos sulfatados que se encuentran en diversos géneros de las algas rojas, como son chondrus, gigartina, euchema e hypneo entre otros del género gigartina se han registrado cuatro especies en nuestro litoral. Las muestras biológicas utilizadas fueron las fases esporofítica y gamerofítica femenina del alga roja gigartina glomerata howe, recolectadas en julio de 1991 en la playa Homillos (Huacho-Lima) los polisacáridos totales se obtuvieron mediante extracción acuosa caliente (cada fase por separado), luego se filtraron, purificaron y se concentraron por evaporación, posteriormente se precipitaron con ETOH, redisolviendo con agua destilada y desecando en las estufas a 60ºC. Estos se sometieron a hidrólisis ácida y la cromatografía en papel reveló que la D-galactosa era el úrico monosacárido presente en las estructuras de los extractos obtenidos. Los polisacáridos totales se fraccionaron con soluciones de cloruro de potasio luego se separaron, dializaron, purificaron y desecaron a baja Taº, obteniéndose en la fase esporofítica mayor porcentaje de fracción insoluble, fueron analizados mediantes métodos químicos y espectrofotométricos.