RESUMEN
OBJECTIVE: Intestinal dysbiosis has been associated with coeliac disease (CD), but whether the alterations are cause or consequence of the disease is unknown. This study investigated whether the human leukocyte antigen (HLA)-DQ2 genotype is an independent factor influencing the early gut microbiota composition of healthy infants at family risk of CD. DESIGN: As part of a larger prospective study, a subset (n=22) of exclusively breastfed and vaginally delivered infants with either high genetic risk (HLA-DQ2 carriers) or low genetic risk (non-HLA-DQ2/8 carriers) of developing CD were selected from a cohort of healthy infants with at least one first-degree relative with CD. Infant faecal microbiota was analysed by 16S rRNA gene pyrosequencing and real time quantitative PCR. RESULTS: Infants with a high genetic risk had significantly higher proportions of Firmicutes and Proteobacteria and lower proportions of Actinobacteria compared with low-risk infants. At genus level, high-risk infants had significantly less Bifidobacterium and unclassified Bifidobacteriaceae proportions and more Corynebacterium, Gemella, Clostridium sensu stricto, unclassified Clostridiaceae, unclassified Enterobacteriaceae and Raoultella proportions. Quantitative real time PCR also revealed lower numbers of Bifidobacterium species in infants with high genetic risk than in those with low genetic risk. In high-risk infants negative correlations were identified between Bifidobacterium species and several genera of Proteobacteria (Escherichia/Shigella) and Firmicutes (Clostridium). CONCLUSIONS: The genotype of infants at family risk of developing CD, carrying the HLA-DQ2 haplotypes, influences the early gut microbiota composition. This finding suggests that a specific disease-biased host genotype may also select for the first gut colonisers and could contribute to determining disease risk.
Asunto(s)
Enfermedad Celíaca/genética , Antígenos HLA-DQ/genética , Intestinos/microbiología , Microbiota/genética , Enfermedad Celíaca/microbiología , Clostridium/genética , Heces/microbiología , Femenino , Marcadores Genéticos/genética , Genotipo , Haplotipos/genética , Humanos , Lactante , Masculino , Estudios Prospectivos , Reacción en Cadena en Tiempo Real de la Polimerasa , Factores de RiesgoRESUMEN
Four patients with long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency are presented. Clinical onset in the form of acute encephalopathy occurred between the ages of 9 months and 3 years. The clinical course included recurrent metabolic crises in 4 patients, cardiac involvement and retinopathy in 3, and myopathy in 2. None had signs of peripheral neuropathy. Three patients died and one is currently well. Hypoketotic hypoglycemia with C6-C14 3-hydroxy-dicarboxylic aciduria during metabolic crises associated with decreased plasma carnitine levels was the main biochemical finding. Enzymologic studies disclosed long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency in all patients. Homozygosity for a G to C mutation at position 1528 in the encoding region of the enzyme was found in 2 patients. Histologic and electron microscopic studies of liver biopsy specimens revealed steatosis in 3 patients and mitochondrial abnormalities in 2. Skeletal muscle biopsies disclosed nonspecific degenerative changes in 2 patients and were normal in the remaining 2. Ultrastructural abnormalities in mitochondria were found in 3 patients. A review of the literature combined with the data from our series (total 22 patients) disclosed acute clinical onset in 77% of cases and subacute in 23%. In the combined series, the average age at onset was 11 months, family history was positive in 32% of patients and overall mortality was 50%. We describe the clinical spectrum of this disease and emphasize that, among patients with suspected beta-oxidation defects the finding of pigmentary retinopathy should lead to the suspicion of long-chain 3-hydroxyacyl-coenzyme A-dehydrogenase deficiency.
Asunto(s)
3-Hidroxiacil-CoA Deshidrogenasas/deficiencia , 3-Hidroxiacil-CoA Deshidrogenasas/genética , Encefalopatías/etiología , Preescolar , Humanos , Lactante , Hígado/patología , Enfermedades Metabólicas/etiología , Mitocondrias/ultraestructura , Músculo Esquelético/patología , MutaciónRESUMEN
We have studied four patients (three male, one female, age range 15-25 years) with epilepsy, bilateral occipital calcifications and latent coeliac disease (CD). The epilepsy started at mean age 7 years, in three cases there were partial seizures and in one case generalized seizure. Three cases had symptoms suggesting malabsorptive syndrome during infancy and one case was diagnosed CD before the onset of seizures. In all cases serologic markers of CD were found, especially antiendomisium antibody, and intestinal biopsy indicated several grades of atrophy. The electroencephalograph (EEG) findings pointed to focal abnormalities in three patients and generalized abnormalities in one patient. In all cases computer tomography (CT) showed bilateral, almost symmetrical occipital calcifications in the cortical subcortical layers. The enhanced CT were unremarkable and magnetic resonance images (MRI) were normal. After diagnosis of CD, all patients followed a gluten-free diet and in three patients a significant reduction in seizure frequency was observed. CD should be ruled out in all cases of epilepsy, cerebral calcifications of unexplained origin and malabsorption syndrome in infancy.
Asunto(s)
Encefalopatías Metabólicas/diagnóstico , Calcinosis/diagnóstico , Enfermedad Celíaca/diagnóstico , Epilepsias Parciales/diagnóstico , Epilepsia Generalizada/diagnóstico , Glútenes/administración & dosificación , Lóbulo Occipital , Adolescente , Adulto , Biopsia , Encefalopatías Metabólicas/dietoterapia , Calcinosis/dietoterapia , Enfermedad Celíaca/dietoterapia , Diagnóstico Diferencial , Diagnóstico por Imagen , Dominancia Cerebral/fisiología , Electroencefalografía , Epilepsias Parciales/dietoterapia , Epilepsia Generalizada/dietoterapia , Femenino , Estudios de Seguimiento , Glútenes/efectos adversos , Humanos , Mucosa Intestinal/patología , Masculino , Examen NeurológicoRESUMEN
This study looked at the incidence of infection complications, in relation to central vein catheterisation as a provisional HD access, by means of the establishment of a nursing protocol for the handling of these catheters. Central vein catheterisation is a classical technique in Nephrology.
Asunto(s)
Cateterismo Venoso Central/enfermería , Control de Infecciones/métodos , Evaluación en Enfermería/normas , Diálisis Renal/instrumentación , Adulto , Anciano , Anciano de 80 o más Años , Vendajes , Cateterismo Venoso Central/efectos adversos , Infección Hospitalaria/etiología , Infección Hospitalaria/prevención & control , Femenino , Humanos , Incidencia , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Cuidados de la Piel/métodos , Cuidados de la Piel/enfermeríaAsunto(s)
Enfermedad Celíaca/diagnóstico , Enfermedad Celíaca/inmunología , Fenómenos Fisiológicos Nutricionales Infantiles , Gastroenterología/normas , Enfermedad Celíaca/dietoterapia , Enfermedad Celíaca/genética , Niño , Trastornos de la Nutrición del Niño/prevención & control , Fenómenos Fisiológicos Nutricionales Infantiles/genética , Fenómenos Fisiológicos Nutricionales Infantiles/inmunología , Fenómenos Fisiológicos Nutricionales Infantiles/fisiología , Países en Desarrollo , Humanos , Cooperación Internacional , América del Norte , Sociedades MédicasRESUMEN
A case study of a female patient in which most of the fingernails and toenails and terminal phalanges of hands and feed were absent, together with retarded psychomotor development, minor mental retardation and seizures due to simple cerebral cyst, with bilateral deafness is presented. This association, similar to Coffin-Siris syndrome, is not found in the literature.
Asunto(s)
Anomalías Múltiples/diagnóstico , Sordera/diagnóstico , Articulaciones de los Dedos/anomalías , Uñas Malformadas , Articulación del Dedo del Pie/anomalías , Anomalías Múltiples/tratamiento farmacológico , Animales , Encefalopatías/diagnóstico , Encefalopatías/tratamiento farmacológico , Carbamazepina/uso terapéutico , Gatos , Preescolar , Quistes/diagnóstico , Quistes/tratamiento farmacológico , Diagnóstico Diferencial , Femenino , Humanos , Fenobarbital/uso terapéutico , SíndromeRESUMEN
BACKGROUND: ELISA methods for the measurement of IgA antigliadin antibodies (AGA), both home-made and commercial systems, routinely employ wheat gliadin fractions as coating antigens. We investigate the sensitivity and specificity for CD diagnosis of a new ELISA method using a highly immunoreactive beta-turn rich gamma3-avenin peptide as an alternative coating antigen. METHODS: The assay was standardized with antihuman IgA peroxidase-conjugated as the second antibody. Alternatively, an ELISA based on the use of protein A-peroxidase was assayed to measure both IgG plus IgA antibodies. Sixty-three sera from healthy controls were analyzed to establish the system's cut-off point. Sera from 103 coeliac and from 65 noncoeliac children were tested; for diagnosis purposes, a small intestinal biopsy had been performed in all of them. RESULTS: For the IgA class antibodies assay a high sensitivity and specificity of 90.3% and 98.5%, respectively, was obtained, comparable to those achieved for IgA antiendomysium antibodies (EmA) with the same sera. CONCLUSIONS: In view of the high sensitivity and specificity obtained together with water solubility of the peptide and easiness for large-scale reproducible synthesis, the new AGA IgA avenin peptide ELISA represents a significant improvement in CD diagnosis in comparison with conventional established AGA IgA ELISA using crude gliadins as coating antigens.
Asunto(s)
Anticuerpos/sangre , Avena/inmunología , Enfermedad Celíaca/diagnóstico , Ensayo de Inmunoadsorción Enzimática/métodos , Péptidos/inmunología , Proteínas de Plantas/inmunología , Adolescente , Adulto , Avena/química , Enfermedad Celíaca/inmunología , Niño , Preescolar , Femenino , Gliadina/inmunología , Humanos , Inmunoglobulina A/sangre , Inmunoglobulina G/sangre , Masculino , Péptidos/química , Proteínas de Plantas/química , Valor Predictivo de las Pruebas , Prolaminas , Estructura Secundaria de Proteína , Sensibilidad y EspecificidadRESUMEN
Two patients with anorexia nervosa were studied. One of them showed cerebral atrophy by computed tomography (CT) of the brain. This finding has been reported previously in three cases. No other reports have been found in Spanish literature. This data could be merely a CT finding. Etiopathogenic and therapeutic evolution is discussed. Behavior modification, based in experimental psychology was used in treatment. Hypercaloric and hyperproteic feeding was also used.
Asunto(s)
Anorexia Nerviosa/patología , Encéfalo/diagnóstico por imagen , Adolescente , Anorexia Nerviosa/psicología , Atrofia , Encéfalo/patología , Femenino , Humanos , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: To date, the most commonly accepted techniques for the screening of coeliac disease are indirect immunofluorescence and enzyme-linked immunosorbent assay (ELISA), which reveal antiendomysium and antigliadin antibodies respectively. We report the use of a simple visual system for coeliac disease screening based on the use of Staphylococcus aureus protein A, which binds to both IgG and IgA, thus avoiding the need for two parallel immunoassays. MATERIALS AND METHODS: Opaque polystyrene microwell strips coated with a wheat gliadin extract were incubated with sera followed by incubation with protein A-colloidal gold conjugate. The resulting colour was compared with that of positive and negative control sera. The procedure took less than an hour. RESULTS: One hundred and forty-five biopsy-proven sera, 94 from active coeliac patients and 51 from non-coeliac patients with diverse gastrointestinal pathologies or diabetes mellitus, were assayed. Ninety of the 94 sera from the active coeliac patients were positive, whereas only 3 of the 51 non-coeliac control subjects were positive. The technique has a sensitivity of 95.7% and a specificity of 94.1%. CONCLUSIONS: The sensitivity and specificity of the visual system are greater than those of most ELISA systems and are similar to those observed with IgA antiendomysium antibodies when tested in the same population. Moreover, it is inexpensive, quick, simple to perform and easy to interpret, i.e. it requires no qualified personnel. It is for these features, together with the outstanding sensitivity and specificity, that we propose this immunoassay as a new test for reliable coeliac disease screening.
Asunto(s)
Enfermedad Celíaca/diagnóstico , Inmunoensayo/métodos , Adolescente , Autoanticuerpos/análisis , Estudios de Casos y Controles , Enfermedad Celíaca/inmunología , Niño , Preescolar , Ensayo de Inmunoadsorción Enzimática , Gliadina/inmunología , Humanos , Inmunoensayo/estadística & datos numéricos , Inmunoglobulina A/análisis , Inmunoglobulina G/análisis , Fibras Musculares Esqueléticas/inmunología , Sensibilidad y Especificidad , Proteína Estafilocócica ARESUMEN
We present the genotype/phenotype correlation analysis for 16 cystic fibrosis (CF) patients who carry mutation R334W. Current age and age of diagnosis was significantly higher in the R334W/any-mutation group (P < 0.05 and P < 0.01), compared with the delta F508/delta F508 group. A slightly, but not significantly, worse lung function was found in the R334W/any-mutation group, when compared with the delta F508/delta F508 patients. The proportion of patients with lung colonization with bacterial pathogens was slightly, but not significantly, higher in the R334W/any-mutation group (71.4%), compared with the delta F508/delta F508 or R334W/delta F508 groups (55.5%). None of the R334W patients had meconium ileus but 60% were pancreatic insufficient (PI), a significantly lower proportion (P << 0.001) than delta F508/delta F508 patients. Two R334W/N1303K compound heterozygous sisters of three sibs with genotype R334W/delta F508 showed interfamilial discordant clinical data for lung and pancreatic function. The data provided here for mutation R334W demonstrate that this mutation is responsible for a less severe form of CF than delta F508. Interfamilial differences for PI and lung function suggest that other factors, viz. genetic, environmental and medical, contribute to the wide spectrum of clinical differences observed in CF patients with the same CF transmembrane conductance regulator genotypes.
Asunto(s)
Fibrosis Quística/genética , Fibrosis Quística/fisiopatología , Insuficiencia Pancreática Exocrina/genética , Edad de Inicio , Arginina/genética , Niño , Preescolar , Insuficiencia Pancreática Exocrina/fisiopatología , Femenino , Volumen Espiratorio Forzado , Genotipo , Humanos , Obstrucción Intestinal/genética , Pulmón/microbiología , Pulmón/fisiopatología , Masculino , Fenotipo , Mutación Puntual , Triptófano/genética , Capacidad VitalRESUMEN
Actualmente, el dolor crónico se contempla no como un fenómeno meramente físico sino como un trastorno claramente influenciado por factores psicológicos y sociales. Si queremos que el tratamiento del dolor se encuentre acorde con esta concepción, deberemos abordar diferentes aspectos tanto médicos, como psicológicos y sociales. Las técnicas a aplicar deberán ser interdisciplinares. En un trabajo realizado durante los años 2001 y 2002, pudimos comprobar la eficacia de un programa interdisciplinar en el tratamiento del dolor de espalda crónico. Con el objetivo de corroborar dicha eficacia mediante un diseño distinto, diseñamos la presente investigación. Material y métodos: Los sujetos fueron 14 pacientes con dolor de espalda crónico. Todos los pacientes asistieron a un programa educativo interdisciplinar en el que se abordaron multitud de aspectos biopsicosociales a través de sesiones impartidas por distintos profesionales (anestesistas, traumatólogos, psicólogos de la salud, sexólogos, trabajadores sociales y fisioterapeutas). La eficacia se evaluó a través de un diseño intrasujetos de medidas repetidas. Concretamente las evaluaciones que se llevaron a cabo fueron cuatro. Dos anteriores al programa, y dos una vez finalizado el mismo. Los periodos temporales entre las evaluaciones fueron de tres meses. En todas las evaluaciones, se midió: el dolor, la ansiedad y la depresión. En la segunda y tercera evaluación, se preguntó sobre la disminución de toma de medicación analgésica. Así mismo en la tercera evaluación, justo al finalizar el programa, se evaluó la opinión de los pacientes acerca del programa. Los resultados apoyan la eficacia del programa ya que se logró disminuir de forma estadísticamente significativa y, en muchos casos, también clínicamente significativa la depresión y la ansiedad. El 35,7 por ciento de los sujetos disminuyó la toma de analgésicos. Los cambios que se lograron a través del programa se mantuvieron transcurridos tres meses después del mismo. La opinión de todos los pacientes respecto a la técnica interdisciplinar fue claramente positiva. Conclusión: Nuestros resultados corroboraron la eficacia del programa demostrada en nuestro estudio anterior. Los resultados de ambas investigaciones apoyando la eficacia del programa, al provenir de diseños diferentes, adquieren mayor solidez (AU)
Asunto(s)
Adolescente , Adulto , Anciano , Femenino , Masculino , Persona de Mediana Edad , Humanos , Dolor de la Región Lumbar/rehabilitación , Clínicas de Dolor , Trastornos de Ansiedad/terapia , Trastorno Depresivo/terapia , Analgésicos/uso terapéutico , Estudios de Casos y ControlesRESUMEN
Las competencias del técnico en emergencias sanitariasquedan fijadas y unificadas con la nueva formación profesionalde grado medio. Un gran avance en nuestra profesióny una ampliación de nuestras competencias que haceque el trabajo conjunto con los diferentes profesionalessanitarios de la emergencia quede integrado e interrelacionadopara conseguir el objetivo final de salvar vidas.Sirva pues este artículo para situar al técnico en emergenciassanitarias dentro del equipo de soporte vital avanzadoy citar y enumerar sus funciones y los medios con losque ha de desarrollar su trabajo (AU)
The field of emergency medical technicians has beenestablished and unified by this new intermediate-gradevocational training. A great advance in our profession, andan extended field that both integrates and inter-relates jointwork with the various healthcare emergency professionalsto attain the ultimate goal of saving lives. May thus thispaper serve to place emergency medical technicians withinadvanced life support teams, and to cite and list both theirroles and the means to develop their work (AU)