[Clinical profile and satisfaction with anticoagulated treatment in patients with non-valvular atrial fibrillation attended in Internal Medicine and Neurology departments of Spain]. / Perfil clinico y satisfaccion con el tratamiento anticoagulante en pacientes con fibrilacion auricular no valvular atendidos en consultas de medicina interna y neurologia de España.

AIM: To determine the clinical profile, management of anticoagulant treatment and satisfaction related to anticoagulation in outpatients with nonvalvular atrial fibrillation attended in Neurology or Internal Medicine departments of Spain. PATIENTS AND METHODS: Cross-sectional and multicenter study, in which 1,337 outpatients were included. Patients fulfilled ACTS, SAT-Q and EQ-5D questionnaires. RESULTS: 865 patients (64.7%) were recruited from Neurology department and 472 (35.3%) from Internal Medicine department. Those patients attended in Internal Medicine department were older and had more frequently hypertension, diabetes, heart failure, renal insufficiency and peripheral artery disease. Those patients attended in Neurology department had more commonly prior stroke. Overall, CHADS2 score was 3.2 ± 1.3, CHA2DS2-Vasc 4.8 ± 1.5 and HAS-BLED 2.0 ± 0.9. All scores were higher in those patients attended in Neurology department. Globally, 56.1% of patients were taking vitamin K antagonists, more commonly in Internal Medicine department. The adequate percent of time in therapeutic range was 47% (Rosendaal), without significant differences between groups. Satisfaction with oral anticoagulation was high in both groups, but higher in those attended in Neurology department, and higher in those individuals taking direct oral anticoagulants compared with vitamin K antagonists. CONCLUSIONS: Although there were some differences in the clinical profile of patients with atrial fibrillation attended in Neurology or Internal Medicine departments, all of them had many comorbidities and a high thromboembolic risk. Despite INR control was poor, the most common oral anticoagulant used were vitamin K antagonists. Satisfaction related to oral anticoagulation was high.

TITLE: Perfil clinico y satisfaccion con el tratamiento anticoagulante en pacientes con fibrilacion auricular no valvular atendidos en consultas de medicina interna y neurologia de España.Objetivo. Determinar el perfil clinico, el manejo del tratamiento anticoagulante y la satisfaccion relacionada con la anticoagulacion en pacientes con fibrilacion auricular no valvular atendidos en consultas de neurologia o medicina interna de España. Pacientes y metodos. Estudio prospectivo, transversal y multicentrico en el que se incluyo a 1.337 pacientes, que completaron los cuestionarios Anti-Clot Treatment Scale, Self-Assessment of Treatment Questionnaire y EuroQol-5 dimensions. Resultados. 865 pacientes (64,7%) provenian de consultas de neurologia, y 472 (35,3%), de medicina interna. Los atendidos en medicina interna eran mayores, tenian mas hipertension, diabetes, insuficiencia cardiaca, insuficiencia renal y arteriopatia periferica. Los pacientes atendidos en neurologia tenian mas antecedentes de ictus. Globalmente, la escala CHADS2 fue 3,2 ± 1,3; CHA2DS2Vasc, 4,8 ± 1,5, y HAS-BLED, 2,0 ± 0,9, y las puntuaciones mas altas fueron en neurologia. El 56,1% tomaba antagonistas de la vitamina K, lo que era mas comun en medicina interna. El porcentaje de tiempo en rango terapeutico adecuado fue del 47% (Rosendaal), sin diferencias entre los grupos. La satisfaccion con el tratamiento anticoagulante oral fue elevada en ambos grupos, aunque mayor en los sujetos atendidos en neurologia, y mayor con los anticoagulantes orales de accion directa que con los antagonistas de la vitamina K. Conclusiones. Aunque existieron ciertas diferencias en el perfil clinico de los pacientes con fibrilacion auricular atendidos en neurologia o medicina interna, todos presentaban multiples comorbilidades y un riesgo tromboembolico elevado. A pesar de que el control del indice internacional normalizado fue pobre, el anticoagulante oral mas empleado fueron los antagonistas de la vitamina K. La satisfaccion con el tratamiento anticoagulante oral fue alta.

Clinical characteristics of the patients with systemic amyloidosis in 2000-2010.

BACKGROUND: The epidemiology of systemic amyloidosis has been changing in the last decades. We aim to describe the clinical characteristics of the patients seen at our institution with systemic amyloidosis in 2000-2010 and compare them with previous Spanish series. PATIENTS AND METHODS: An observational, retrospective study was performed on all patients admitted to a tertiary hospital in Madrid, Spain who had been diagnosed of amyloidosis from January 2000 to December 2010. Patients without a proven diagnosis of amyloidosis, with dialysis-associated, senile, or localized forms of amyloidosis were excluded from the study. A systematic review was made of the clinical records, collecting the demographic, clinical and biochemical variables at diagnosis and patients' outcome. RESULTS: A total of 55 patients were studied, 24 (44%) of whom had AL amyloidosis, 30 (56%) AA amyloidosis, and 1 a familiar form. The most frequent underlying disorders were rheumatoid arthritis (9 patients, 30%) and ankylosing spondylitis (4 cases, 13%). The kidneys were the most frequently involved organ (36 patients, 67%) with nephrotic-range proteinuria at diagnosis (3.4 ± 3.7 g/24 h). Median time to diagnosis was 3 months (interquartile range [IQR]: 1-17). Median follow-up time was 24 months (IQR: 10-91). During follow-up 31 patients died; 18 of those deaths were related to amyloidosis. CONCLUSIONS: Renal dysfunction dominates the course of systemic amyloidosis, which does not seem to have changed in the last decades. We have observed an important delay in the diagnosis of these processes. Therefore, it is necessary to maintain a high degree of clinical suspicion regarding these conditions.

Reversed-phase ultra-high-performance liquid chromatography coupled to electrospray ionization-quadrupole-time-of-flight mass spectrometry as a powerful tool for metabolic profiling of vegetables: Lactuca sativa as an example of its application.

Lettuce (Lactuca sativa), a leafy vegetal widely consumed worldwide, fresh cut or minimally processed, constitutes a major dietary source of natural antioxidants and bioactive compounds. In this study, reversed-phase ultra-high-performance liquid chromatography (RP-UHPLC) coupled to electrospray ionization-quadrupole-time-of-flight mass spectrometry (ESI-QTOF-MS) was applied for the comprehensive profiling of polar and semi-polar metabolites from three lettuce cultivars (baby, romaine, and iceberg). The UHPLC systems allowed the use of a small-particle-size C18 column (1.8 µm), with very fine resolution for the separation of up to seven isomers, and the QTOF mass analyzer enabled sensitive detection with high mass resolution and accuracy in full scan. Thus, a total of 171 compounds were tentatively identified by matching their accurate mass signals and suggested molecular formula with those previously reported in family Asteraceae. Afterwards, their structures were also corroborated by the MS/MS data provided by the QTOF analyzer. Well-known amino acids, organic acids, sesquiterpene lactones, phenolic acids and flavonoids were characterized, e.g. lactucin, lactucopicrin, caftaric acid, chlorogenic acid, caffeoylmalic acid, chicoric acid, isochlorogenic acid A, luteolin, and quercetin glycosides. For this plant species, this is the first available report of several isomeric forms of the latter polyphenols and other types of components such as nucleosides, peptides, and tryptophan-derived alkaloids. Remarkably, 10 novel structures formed by the conjugation of known amino acids and sesquiterpene lactones were also proposed. Thus, the methodology applied is a useful option to develop an exhaustive metabolic profiling of plants that helps to explain their potential biological activities and folk uses.

Acute and repeated dose (4 weeks) oral toxicity studies of two antihypertensive peptides, RYLGY and AYFYPEL, that correspond to fragments (90-94) and (143-149) from alpha(s1)-casein.

The Lowpept is a powdered casein hydrolysate containing the antihypertensive peptides RYLGY and AYFYPEL, two sequences that correspond to alpha(s1)-casein f (90-94) (RYLGY) and alpha(s1)-casein f (143-149) (AYFYPEL). To support the safety, Lowpept has been examined in an acute and in a 4-week repeated dose oral toxicity studies in rats. Powdered casein hydrolysate administered in a single oral gavage dose of 2000 mg/kg resulted in no adverse events or mortality. Also, casein hydrolysate administered as a daily dose of 1000 mg/kg for 4 weeks by gavage resulted in no adverse events or mortality. No evidence or treatment-related toxicity was detected during both studies. Data analysis of body weight gain, food consumption, clinical observations, blood biochemical, haematology, organ weight ratios and histopathological findings did not show significant differences between control and treated groups. It is concluded that the casein hydrolysate containing the peptides RYLGY and AYFYPEL orally administered to rats was safe and that not treatment-related toxicity was detected even at the highest doses investigated in both acute (2000 mg/kg of body weight) and repeated dose (4 weeks) oral (1000 mg/kg of body weight) toxicity studies.

Desarrollo y conducta adaptativa en niños con insuficiencia renal crónica en DPCA / Development and adaptative behavior in children with chronic renal insuffiency on CAPD

Los niños con enfermedad renal crónica encuentran un riesgo aumentado de presentar compromiso de su neurodesarrollo. El objetivo de este trabajo fue la evaluación cognitiva y adaptativa de 15 niños con insuficiencia renal crónica en tratamiento de reemplazo con diálisis peritoneal ambulatoria. El desarrollo cognitivo fue normal o superior en 3 pacientes (20%) y retrasado en 12 (80%). La conducta adaptativa fue adecuada en 8 (53%) y baja o muy baja en 7 (47%). No hubo relación entre el desarrollo cognitivo y la escolaridad materna o el nivel socio económico, ni entre la conducta adaptativa y el nivel de escolaridad materna. La relación entre el NSE y la conducta adaptativa fue significativa (p 0.04). Esto sugeriría que si bien la enfermedad renal crónica compromete el desarrollo cognitivo, un nivel socioeconómico medio/alto puede proveer oportunidades para una mejor conducta adaptativa.

Children with chronic kidney disease are at increased riskof having impaired neurodevelopment. The objective of thepresent study was to perform a cognitive and adaptive eva-luation of 15 children with chronic renal insufficiency onoutpatient peritoneal dialysis. Cognitive development wasnormal or above normal in 3 patients (20%) and delayed in12 (80%). Adaptive behavior was adequate in 8 (53%) andlow or very low in 7 (47%). No correlation was found eitherbetween cognitive development and maternal education orsocio-economic level or between adaptive behavior andeducation of the mother. A significant correlation was foundbetween socio-economic level and adaptive behavior (p0.04). This would suggest that although chronic kidney dise-ase compromises cognitive development, middle or uppersocio-economic level may provide opportunities for impro-ved adaptive behavior.

Evolución neonatal y alejada de los recién nacidos pretermino de muy bajo peso de nacimiento / Long-term outcome of preterm newborns of very lowbirth weight

El presente trabajo analiza y compara las características y la evolución hasta los dos años de edad corregida del grupo de recién nacidos de pretérmino de muy bajo peso de nacimiento (PTMBPN) (EG<36 sem. PN<1500 g.) que ingresaron en la etapa inicial de funcionamiento del área (Período A: 1 de abril de 1988 al 31 de diciembrede 1989, n=90), y aquellos de iguales caracteristicas que lo hicieron en los últimos años de actividad del sector (Período B: 1 de enero de 1994 al 31 de diciembre de 1995, n=64) con el objeto de conocer si existieron variaciones en dichosaspectos entre estos dos periodos. Se estudiaron y compararon 1) Aspectos perinatales. 2) Morbilidad de los sobrevivientes durante la internación en la UCIN y 3) Evolución alejada. En ambos períodos hubo una alta frecuencia de madres que no controlaron nunca su embarazo (A=40 por ciento, B=46 por ciento) y una baja utilización de la inducción prenatal de maduración pulmonar fetal con corticoides (A=2 por ciento, B=12 por ciento). Los PTMBPN del período B presentaron PN y EGsignificativamente menores y se registro un descenso de la mortalidad de aquellos con PN <1000g. En los dos períodos existió una muy alta incidencia de niños fallecidos entre los que ingresaron en estado crítico (70 por ciento-76 por ciento). En el período B se observó una mayor utilización de ARM, y se registro un incremento significativo de niños con DBP. 3) Los pacientes del período A presentaron una X de peso y talla significativamente mayor a las 40 semanas de edad postconcepcional. La talla mantuvo esta diferencia al año y a los dos años. La frecuencia de casos con parálisis cerebral grave fue similar en ambos períodos: 16 por ciento y 15 por ciento. El análisis del desarrollo cognitivo mostró un incremento de niños normales en el período B: 64 por ciento Vs. 42 por ciento en el período A. El 25 por ciento del total de pacientes seguidos en ambos períodos presentó discapacidad grave, la que se relacionó significativamente con la presenciade HIC grave en el período neonatal.