Immunologic responses to the major allergen of Olea europaea in local and systemic allergic rhinitis subjects.

OBJECTIVE: To evaluate the in vivo and in vitro responses to nOle e 1 in allergic rhinitis (AR) and local allergic rhinitis (LAR) patients sensitized to olive tree pollen (OL) confirmed by nasal allergen provocation test (NAPT). METHODS: Twelve subjects with AR, 12 with LAR and 12 subjects as control group (CG) were selected. Skin testing and NAPT with nOle e 1 were performed. Eosinophilic cationic protein (ECP) and tryptase were measured in nasal lavages before and after NAPT. Serum IgE to OL allergens was measured by ELISA. Basophil activation tests (BAT) with OL and nOle e 1 and dendritic cell maturation/proliferation studies were carried out. RESULTS: All AR (12/12) and 10/12 (83%) of LAR had a +NAPT to nOle e 1. ECP levels in nasal lavages were significantly increased after NAPT in both AR and LAR compared with CG at 15 min (P < 0.05). Serum IgE was positive only in AR. All AR had +BAT responses to OL and 10/12 to nOle e 1 (83%); 8/12 LAR (66.6%) had a +BAT to OL and 4/12 (33%) to nOle e 1, with only one subject of the CG with a +BAT to both OL and nOle e 1 (8%). Dendritic cell proliferation to nOle e 1 was increased in AR compared to LAR and CG (P = 0.019 and P = 0.001, respectively). CONCLUSION: Both AR and LAR had a similar in vivo response to nOle e 1 with release of inflammatory mediators. Specific basophil activation with OL and nOle e 1 was observed in LAR confirming previous data obtained with dust mites.

Consenso experto sobre el uso clínico de los tratamientos por vía tópica en el manejo del dolor neuropático periférico / No disponible

Objetivo: Proponer a partir del consenso de un panel de expertos de ambito estatal que integre la experiencia clinica y la evidencia disponible mas actual, recomendaciones sobre el uso clinico de los tratamientos por via topica para el manejo del dolor neuropatico periferico (DNP). Métodos: Se proponen, a partir de una revision bibliografica sobre las distintas opciones terapeuticas topicas en DNP, una serie de criterios profesionales y recomendaciones clinicas para la mejora del uso de dichos agentes topicos. Se empleo el metodo Delphi modificado en dos rondas para contrastar las opiniones de un panel nacional de 52 reconocidos expertos, seleccionados mediante una estrategia en “bola de nieve” de entre el colectivo de anestesiologos de unidades del dolor (94 %) y otros especialistas (neurologos y traumatologos). Se evaluaron 61 recomendaciones clinicas agrupadas en 6 areas tematicas: a) DNP: tratamiento topico versus sistemico (11 items); b) dolor neuropatico postquirurgico, postraumatico y munones dolorosos (12 items); c) neuralgia posherpetica, intercostal y del trigemino (9 items); d) DNP por atrapamiento (8 items); e) sindrome de dolor regional complejo (11 items); y f) neuropatia diabetica (ND) y otras polineuropatias (por VIH, alcohol, toxicidad, etc.) (10 items). Se empleo una escala ordinal de tipo Likert de 9 puntos (desacuerdo/ acuerdo) para evaluar cada recomendacion. Tras la primera ronda de encuesta, se facilito al panel informacion del resultado (resultados estadisticos y opiniones libres de los panelistas) y se solicito la reconsideracion del voto sobre los items no consensuados. Resultados: Tras la primera ronda del panel se logró consenso en 37 de las 61 cuestiones planteadas. Al final de la segunda ronda el acuerdo ascendió hasta 46 ítems (75 %). En general, se aprecia consenso entre los expertos sobre la conveniencia de introducir los tratamientos tópicos en primera línea de tratamiento del DNP y sobre su mejor aceptación por los pacientes frente a los sistémicos. Asimismo, fue criterio compartido que la combinación de estos fármacos tópicos con los tratamientos sistémicos es una opción a considerar en el manejo de varios tipos de DNP. También se alcanzó un alto grado de acuerdo en aceptar, desde un punto de vista fisiopatológico, la indicación del tratamiento con parche de capsaicina al 8 % para varios tipos de DNP. Conclusión: Los expertos en el manejo clínico del DNP muestran un elevado nivel de acuerdo profesional con diversas recomendaciones terapéuticas analizadas en el estudio. La difusión de tales recomendaciones puede ayudar a la mejora del manejo rutinario de fármacos tópicos para el dolor neuropático en nuestro sistema sanitario (AU)

Objective: To propose consensus from a panel of state level that integrates clinical experience and the most current evidence, recommendations on the clinical use of topical treatments for the management of peripheral neuropathic pain (PNP). Methods: We propose, based on a literature review on topical therapeutic options in PNP, a series of professional standards and clinical recommendations for improving the use of these topical agents. We used the modified Delphi method in two rounds to contrast the views of a national panel of 52 renowned experts, selected by a “snowball” strategy among the group of anesthesiologists pain units (94 %) and other specialists (neurologist and trauma). We evaluated 61 clinical recommendations grouped into 6 areas: a) PNP systemic versus topical treatment (11 items); b) postsurgical neuropathic pain, post-traumatic and painful stumps (12 items); c) post-herpetic neuralgia, intercostal and trigeminal (9 items); d) PNP entrapment (8 items); e) CRPS (11 items); and f) diabetic neuropathy (DN) and other polyneuropathy (HIV, alcohol, toxicity, etc.) (10 items). We used a Likert- type ordinal scale of 9 points (disagree/agree) to evaluate each recommendation. After the first round of the survey, information was provided requested to reconsider the vote on itemsnot agree. Results: After the first round the panel consensus was achieved in 37 of the 61 issues raised. At the end of the second round of the agreement amounted to 46 (75 %). In general, there was consensus among experts on whether to introduce topical treatment in first line treatment of PNP and its greater acceptance by patients compared with systemic. He was also a shared view consider in the management of various types of PNP. Also reached a high level of agreement to accept, from a physiological point of view, the indication for treatment with capsaicin patch 8 % for various types of PNP. Conclusions: Experts in the clinical management of PNP show a high level of professional agreement with various therapeutic recommendations for study. The dissemination of such recommendations can help improving the routine management of topical drugs for neuropathic pain in our health system (AU)

[Therapeutic effectiveness of psoralen-UV-A bath therapy in psoriasis]. / Eficacia terapéutica del baño-PUVA en psoriasis.

INTRODUCTION: The use of psoralen baths with long-wave UV radiation, known as PUVA bath therapy, is useful in the treatment of psoriasis. The therapy is not associated with systemic adverse effects and the dose of UV-A radiation administered is lower. The objectives of this study aimed to identify the variables that influence the effectiveness of PUVA bath therapy and the duration of remission, as well as to determine factors that predict relapse. It also aimed to assess the effectiveness of a protocol using the minimal phototoxic dose and to compare two concentrations of 8-methoxypsoralen. PATIENTS AND METHODS: Two hundred nine patients with moderate-severe plaque psoriasis attended between 1994 and 2000 were included in the study. The characteristics and therapeutic outcomes of the sample were recorded. Survival curves were plotted for the disease-free interval after a good response to treatment. A proportional hazard model was used to assess the factors that influence the duration of remission. RESULTS: Therapeutic outcomes were better in patients with greater photosensitivity (p = 0.03). Application of the minimal phototoxic dose protocol was not associated with greater phototoxicity during treatment. The median duration of remission was 7 months. Those patients who had previously undergone oral PUVA therapy and those who did not achieve a substantial reduction in the psoriasis area and severity index (PASI) score were at greater risk of relapse. CONCLUSIONS: A lower final PASI extended the lesion-free period.

Bioavailability and plant accumulation of heavy metals and phosphorus in agricultural soils amended by long-term application of sewage sludge.

Amendment of agricultural soils with municipal sewage sludges provides a valuable source of plant nutrients and organic matter. Nevertheless, addition of heavy metals and risks of eutrophication continue to be of concern. Metal behaviour in soils and plant uptake are dependent on the nature of the metal, sludge/soil physico-chemical properties and plant species. A pot experiment was carried out to evaluate plant production and heavy metal uptake, soil heavy metal pools and bioavailability, and soil P pools and possible leaching losses, in agricultural soils amended with sewage sludge for at least 10 years (F20) compared to non-amended soils (control). Sewage sludge application increased soil pH, N, Olsen-extractable-P, DOC and exchangeable Ca, Mg and K concentrations. Total and EDTA-extractable soil concentrations of Cu and Zn were also significantly greater in F20, and soil metal (Cu, Mn and Zn) and P fractionation altered. Compared to the control, in F20 relative amounts of acid-extractable (Mn, Zn), reducible (Mn, Zn) and oxidisable (Cu, Zn) metal fractions were greater, and a dominance of inorganic P forms was observed. Analyses of F20 soil solutions highlighted risks of PO4 and Cu leaching. However, despite the observed increases in metal bioavailability sewage sludge applications did not lead to an increase in plant shoot concentrations (in wild plants or crop species). On the contrary, depending on the plant species, Mn and Zn tissue concentrations were within the deficiency level for most plants.

Valoración de la actitud terapéutica ante el paciente con dolor crónico en las Unidades de Dolor en España. Estudio STEP / Survey of therapeutic attitudes for the treatment of chronic pain in Spanish Pain Units. The STEP study

En el año 1986, la Organización Mundial de la Salud puso enmarcha un proyecto encaminado a ordenar el tratamiento deldolor crónico de origen oncológico de una forma eficaz, simpley con un costo económico bajo. De esta forma nació laEscalera Analgésica.Posteriormente, y de una forma gradual, se ha ido aplicandola Escalera en el tratamiento de otros tipos de dolor, entreellos el de origen no oncológico.Hoy, pasados 20 años de la puesta en marcha de la EscaleraAnalgésica nos encontramos con que, desde una serie de mediosautorizados, se está cuestionando su efectividad. Por ello,desde la Sociedad Española del Dolor se tomó la iniciativa, através del Estudio STEP, de actualizar cuál es el grado de cumplimientode las recomendaciones de la Escalera Analgésicade la O.M.S. en los pacientes con dolor crónico no oncológicotratados en las Unidades del Dolor españolas

In 1986, the World Health Organization (WHO) started up a project aimed to improve the treatment of chronic cancer pain in a simple, effective and low-cost manner. The Analgesic Ladder was so born. The Analgesic Ladder has progressively been used for the treatment of other types of pain, including non-cancer cases. Nowadays, after 20 years of its introduction, a number of authorized opinions question its effectiveness. Therefore, the Spanish Pain Society promoted the STEP study to survey the degree of compliance with the WHO Analgesic Ladder recommendations for the treatment of chronic non-cancer pain in patients attending Spanish Pain Units (AU)

Manejo anestésico de 20 pacientes programados para peritonectomía y quimioterapia intraperitoneal caliente / Anesthetic management for scheduled peritonectomy and hyperthermic intraperitoneal chemotherapy in 20 patients

OBJETIVOS: El objetivo de este trabajo es comunicarnuestro protocolo de actuación y los resultados obtenidosen pacientes sometidos a peritonectomía y quimioterapiaintraperitoneal caliente.MÉTODOS: Se estudiaron pacientes ASA II-III diagnosticadosde carcinomatosis peritoneal. Realizamosmonitorización invasiva y colocamos catéter epiduraltorácico. Se valoró el tiempo quirúrgico, las alteracioneshemodinámicas y el uso de fármacos vasoconstrictores,la necesidad de líquidos intraoperatorios, la transfusiónde derivados hemáticos, la diuresis y el uso de diuréticos.RESULTADOS: Incluimos 20 pacientes. En 3 casos no sepudo realizar la peritonectomía, decidiéndose su exclusiónde los resultados del estudio con el fin de evitar sesgos.La duración media de la intervención fue de 543±98minutos. Se emplearon fármacos vasoconstrictores en 7de 17 pacientes (41%). En 10 de los 17 casos se utilizarondiuréticos (58%). La media de administración defluidos intraoperatorios fue de 7,9±2 litros de cristaloidesy 2,3±06 litros de coloides. En 9 casos se transfundieronconcentrados de hematíes y sólo 1 paciente requirióplasma fresco congelado. La temperatura aumentóde 1-1,5ºC durante la administración de la quimioterapiacaliente, se controló sin problemas con la infusión delíquidos fríos y la manta térmica a 32-34ºC. El 41% delos casos se extubó en quirófano. Dos pacientes desarrollaronproblemas respiratorios postoperatorios, unpaciente insuficiencia renal y otro fue reintervenido porsangrado.CONCLUSIONES: Con el protocolo empleado se consiguerealizar esta cirugía sin complicaciones reseñables, salvohipotensión que responde al uso de vasoconstrictores

OBJETIVE: The aim of this study was to describe ourprotocol for the anesthetic management for peritonectomyand hyperthermic intraperitoneal chemotherapyand to report the results from a series of 20 patients.METHODS: The patients were diagnosed with peritonealcarcinomatosis and classified ASA 1-3. A thoracicepidural catheter was inserted for invasive monitoring.We recorded duration of surgery, hemodynamic changesand the use of vasoconstrictors, requirement for intraoperativefluid replacement or blood product transfusion,diuresis, and use of diuretics.RESULTS: Twenty patients were studied. Peritonectomycould not be performed in 3 patients and their datawas excluded in order to avoid skewing. The mean (SD)duration of the intervention was 543 (98) minutes. Vasoconstrictorswere used in 7 out of 17 patients (41%).Diuretics were used in 10 out of 17 patients (58%).Fluids infused during surgery were a mean of 7.9 (2) Lof crystalloid solution and 2.3 (0.6) L of colloid solution.Packed red blood cells were transfused in 9 cases andonly 1 patient required fresh frozen plasma. The temperaturerose from 1-1.5ºC during administration of thehyperthermic chemotherapy and was controlled withoutcomplications with the infusion of cold liquids and aheating blanket set at 32-34ºC. Extubation inside theoperating room was possible in 41% of the cases. Twopatients developed postoperative respiratory problemsand 1 patient, renal failure. One patient was reoperatedfor bleeding.CONCLUSIONS: The described anesthetic managementprotocol allowed the intervention to be carried outwithout complications other than hypotension, whichresponded to vasoconstrictor therapy

[Anesthetic management for scheduled peritonectomy and hyperthermic intraperitoneal chemotherapy in 20 patients]. / Manejo anestésico de 20 pacientes programados para peritonectomía y quimioterapia intraperitoneal caliente.

OBJECTIVE: The aim of this study was to describe our protocol for the anesthetic management for peritonectomy and hyperthermic intraperitoneal chemotherapy and to report the results from a series of 20 patients. METHODS: The patients were diagnosed with peritoneal carcinomatosis and classified ASA 1-3. A thoracic epidural catheter was inserted for invasive monitoring. We recorded duration of surgery, hemodynamic changes and the use of vasoconstrictors, requirement for intraoperative fluid replacement or blood product transfusion, diuresis, and use of diuretics. RESULTS: Twenty patients were studied. Peritonectomy could not be performed in 3 patients and their data was excluded in order to avoid skewing. The mean (SD) duration of the intervention was 543 (98) minutes. Vasoconstrictors were used in 7 out of 17 patients (41%). Diuretics were used in 10 out of 17 patients (58%). Fluids infused during surgery were a mean of 7.9 (2) L of crystalloid solution and 2.3 (0.6) L of colloid solution. Packed red blood cells were transfused in 9 cases and only 1 patient required fresh frozen plasma. The temperature rose from 1-1.5 degrees C during administration of the hyperthermic chemotherapy and was controlled without complications with the infusion of cold liquids and a heating blanket set at 32-34 degrees C. Extubation inside the operating room was possible in 41% of the cases. Two patients developed postoperative respiratory problems and 1 patient, renal failure. One patient was reoperated for bleeding. CONCLUSIONS: The described anesthetic management protocol allowed the intervention to be carried out without complications other than hypotension, which responded to vasoconstrictor therapy.

Selenium distribution in topsoils and plants of a semi-arid Mediterranean environment.

Selenium was determined from 25 topsoils and 25 plants in the semi-arid Central Spain where large extents of soils are developed on evaporitic materials. Some species of vegetation associated with them are of the genera Astragalus, Salsola, Mercurialis, Phlomis, Thymus and Atriplex. Total selenium in soils was determined and its bioavailability assessed by chemical sequential fractionation. Se content in soils was adequate (in the range 0.17-0.39 mg kg(-1)) or large (in the range 0.50-4.38 mg kg(-1)) and appeared in highly and/or potentially available forms. Several plant species showed high Se levels (in the range 5-14.3 mg kg(-1)), which can be a potential risk of toxicity to animals. Data obtained from the study area can be used as a guide to the range of values in soils and plants of the European Mediterranean area that are relatively unpolluted from industrial sources, allowing comparison with more polluted areas.

[Treatment of allergy to mushrooms]. / Tratamiento de la alergia a hongos.

The treatment of patients with respiratory allergy is based on environmental control measures, pharmacological and immunotherapy treatment. The third cause of allergic respiratory disease in our environment is mushrooms, the most frequently involved being the Alternaria class. However, due to the great difficulties in their diagnosis and specific treatment, there are few controlled studies on immunotherapy with mushroom extracts. A clinical test was carried out with a suitable, biologically standardized extract for the diagnosis and treatment of patients allergic to Alternaria. A second phase determined the maximum tolerated dosage of this extract administered through immunotherapy, in depot preparation and in conventional dosage, which was 0.1 mg/ml of Alt a I. This dosage was established as the maintenance dosage in the following phase (double blind test controlled with placebo), in which the efficacy and safety of the immunotherapy with this extract was determined, administered in immunotherapy to the mentioned maintenance dosage, to 28 patients with rhinitis and/or asthma due to allergy to Alternaria. All the patients reached the pre-established maintenance dosage of 1670 BSU. The treatment proved efficient, producing an improvement in the symptoms, respiratory function, subjective evaluation of patient and doctor, and severity of the disease. The immunological response supported the clinical efficacy, with an increase in the IgG and a fall in the IgE over the course of the study. Tolerance to the treatment was excellent, with only two light systemic reactions registered in the 711 dosages administered (0.28% reactions/dosages administered).

A home telecare management system.

The increasing tendency to discharge chronic patients from hospital, as well as the growing expectation of improved quality of life for elderly and disabled people at home, was the original motivation for the development of a home telecare management system. The system allows a service centre to perform remote monitoring of biological signals and other data via the public telephone network, as well as to manage different emergency situations arising at home. The system is part of the FU-funded EPIC project (European Prototype for Integrated Care). It was tested in Belfast (Northern Ireland) and is currently being installed in Torre del Mar (Spain). This paper describes the system design and preliminary evaluation. The results indicate that the system operators find it highly acceptable in terms of efficiency, effectiveness, helpfulness, control and learnability. Integration of home telecare data with community-care information systems is essential if data captured at home are to be incorporated into the care process effectively.