Effects of intensity, attention and medication on auditory-evoked potentials in patients with fibromyalgia.

Fibromyalgia (FM) has been associated to an increased processing of somatosensory stimuli, but its generalization to other sensory modalities is under discussion. To clarify this, we studied auditory event-related potentials (AEPs) to stimuli of different intensity in patients with FM and healthy controls (HCs), considering the effects of attention mechanisms and medication. We performed two experiments: In study 1 (n = 50 FM, 60 HCs), the stimuli were presented randomly within the sequence; in study 2 (n = 28 FM, 30 HCs), they were presented in blocks of the same intensity. We analyzed intensity and group effects on N1-P2 amplitude and, only for the FM group, the effect of medication and the correlation between AEPs and clinical variables. Contrary to the expectation, the patients showed a trend of reduced AEPs to the loudest tones (study 1) or no significant differences with the HCs (study 2). Medication with central effects significantly reduced AEPs, while no significant relationships between the N1-P2 amplitude/intensity function and patients' symptoms were observed. The findings do not provide evidence of augmented auditory processing in FM. Nevertheless, given the observed effect of medication, the role of sensory amplification as an underlying pathophysiological mechanism in fibromyalgia cannot be discarded.

Spanish experience on the design of radon surveys based on the use of geogenic information.

One of the requirements of the recently approved EU-BSS (European Basic Safety Standards Directive, EURATOM, 2013) is the design and implementation of national radon action plans in the member states (Annex XVIII). Such plans require radon surveys. The analysis of indoor radon data is supported by the existing knowledge about geogenic radiation. With this aim, we used the terrestrial gamma dose rate data from the MARNA project. In addition, we considered other criterion regarding the surface of Spain, population, permeability of rocks, uranium and radium contain in soils because currently no data are available related to soil radon gas concentration and permeability in Spain. Given that, a Spanish radon map was produced which will be part of the European Indoor Radon Map and a component of the European Atlas of Natural Radiation. The map indicates geographical areas with high probability of finding high indoor radon concentrations. This information will support legislation regarding prevention of radon entry both in dwellings and workplaces. In addition, the map will serve as a tool for the development of strategies at all levels: individual dwellings, local, regional and national administration.

Inyección ecoguiada del músculo piriforme. Un nuevo abordaje / Ultrasound-guided piriformis muscle injection. A new approach

El síndrome piriforme es una causa poco frecuente de dolor de espalda y miembros inferiores. Algunas de las opciones de tratamiento incluyen la inyección del músculo piriforme con anestésicos locales y corticoides. Se han descrito varias técnicas de inyección. Las técnicas ecoguiadas permiten la visualización directa del músculo y la inyección en tiempo real. Se presenta una serie de 5 pacientes cuya clínica es compatible con síndrome piriforme, que no han mejorado tras tratamiento farmacológico. Se optó por la inyección del músculo piriforme con anestésicos locales y corticoides mediante un nuevo abordaje ecoguiado más sencillo técnicamente, basado en la técnica estándar. En los 5 pacientes se apreció una mejoría del dolor medido por la escala verbal numérica tras la inyección. Solo en un caso se presentó como complicación una ciatalgia que mejoró espontáneamente en 10 días. En los demás pacientes no se observaron complicaciones tras la inyección. Se describe una variante de la técnica ecoguiada recomendada en la inyección del músculo piriforme, más sencilla de realizar, con un buen perfil de seguridad y con buenos resultados clínicos (AU)

Piriformis syndrome is an uncommon cause of buttock and leg pain. Some treatment options include the injection of piriformis muscle with local anesthetic and steroids. Various techniques for piriformis muscle injection have been described. Ultrasound allows direct visualization and real time injection of the piriformis muscle. We describe 5 consecutive patients, diagnosed of piriformis syndrome with no improvement after pharmacological treatment. Piriformis muscle injection with local anesthetics and steroids was performed using an ultrasound technique based on a standard technique. All 5 patients have improved their pain measured by numeric verbal scale. One patient had a sciatic after injection that improved in 10 days spontaneously. We describe an ultrasound-guided piriformis muscle injection that has the advantages of being effective, simple, and safe (AU)

Filtering out repetitive auditory stimuli in fibromyalgia: a study of P50 sensory gating.

BACKGROUND: It has been suggested that fibromyalgia (FM) patients show increased sensory processing of nociceptive and non-nociceptive stimuli and also reduced habituation. Although this pattern of increased reactivity has been established for the somatosensory modality, its generalization to other sensory modalities remains controversial. METHODS: Auditory evoked potentials were obtained using a paired-stimuli paradigm from a sample of 52 FM female patients and 55 healthy women matched for age and socio-economic status. Sensory gating of the P50 component, as indicated by P50 suppression rates to the second identical stimuli, was analysed in relation to clinical indices of FM, including algometry of tender points and a number of self-reported questionnaires. RESULTS: Sensory gating mechanisms in FM patients proved to be normal, robust and as efficient as those recorded in control subjects. There was no correlation between P50 suppression rates and indices of clinical or experimental (threshold or tolerance) pain. In addition, P50 sensory gating was not related to the other main symptoms of FM, including fatigue, sleep dysfunction or co-morbid depression, nor to hypersensitivity to noise or headache. CONCLUSIONS: The results indicate that FM patients do not present significant deficits in early sensory gating when processing auditory stimuli, and therefore challenge the 'generalized hypersensitivity' hypothesis of FM.

Algunas reflexiones sobre los medicamentos genéricos / No disponible

No disponible

Fallo renal agudo en varón joven con celulitis en extremidad inferior / Acute renal failure in a young male with cellulitis in the lower leg

La fascitis necrotizante producida por el Streptococo pyogenes presenta una mortalidad elevada. Habitualmente el reto supone detectar la infección antes de que el cuadro progrese al denominado síndrome de shock tóxico posestreptocócico, ya que entonces las medidas terapéuticas resultan frecuentemente ineficaces. En la secuencia de eventos en la progresion de la infección a shock es frecuente la presencia de insuficiencia renal previa a la hipotensión. Presentamos un caso clínico de un paciente de 38 años que desarrolló una fascitis necrotizante fulminante por Streptococo pyogenes cuya sintomatología al ingreso hospitalario fue la presencia de celulitis en extremidad inferior asociada a fallo renal

Necrotizing fascitiis due to Streptococcus Pyogenes has a high mortality rate. Detection of the infection before it developes to the streptococcal toxic shock syndrome is quite challenging and its one of the main goals of its management because at this final stage the treatment is inmost of the cases ineffective. In a secuence of events of the progression ofthe infection to shock, renal failure occurs before hipotension very often. We report the case of a 38-year-old patient affected by a fulminant necrotizing fascitiis by Streptococcus Pyogenes which presented at admission with lower leg cellulitis and acute renal failure

Neuroprotective effect of a ginseng (Panax ginseng) root extract on astrocytes primary culture.

A standardized aqueous extract of Panax ginseng radix was tested for its antioxidant effect on primary astrocytes culture on an oxidant stress model generated by H(2)O(2). The results indicated that this extract had a significant effect on the reduction of astrocytic death induced by H(2)O(2). Dose-response experiments revealed that this ginseng extract increased cell viability at a wide range of concentrations. Therefore, we investigated the effects of this extract on antioxidant enzymes such as catalase (CAT), superoxide dismutase (SOD), glutathione peroxidases (GPx) and glutathione reductase (GR), on glutathione content (reduced and oxidized forms and red/ox index) and on the intracellular reactive oxygen species (ROS) formation. Exposure of astrocytes to H(2)O(2) decreased the activities of antioxidant enzymes, and increased ROS formation. Ginseng root extract reversed the effect of almost all of these parameters in H(2)O(2)-injured primary cultures of rat astrocytes.

Current European practice in immune tolerance induction therapy in patients with haemophilia and inhibitors.

The management of patients with inhibitors is an important challenge in haemophilia care. The lack of randomized controlled trials means that clinical decisions are generally based on subjective opinions, and purchasers' attention is likely to focus on the costs of treatment. In order to assess the current management of inhibitor patients and use of immune tolerance induction therapy (ITI) in Europe, we performed a survey within a European network of 21 comprehensive care centres from 14 countries (the European Haemophilia Therapy Standardisation Board). The survey identified a total of 381 patients with inhibitors attending the centres, 211 (55.4%) of whom had never been exposed to ITI. Between 1998 and 2003, the centres performed 233 procedures and 114 (48.9%) were successful. The survey demonstrated that dosing, which is the time to start and stop the ITI, the type of concentrate to use and the definition of success varied among the centres. Well-designed trials are warranted to guide decision-making, but in the absence of these studies we have developed consensus guidance for the management of inhibitor patients based on current clinical practice, as identified by the survey, and review of the literature.

Analysis and retention behaviour in high-performance liquid chromatography of terpenic plant constituents (Sideritis spp.) with pharmacological interest.

Terpenoids are natural products with an important pharmacological interest, which are present in a number of medicinal plants. The species of Sideritis genus are valuable due to their high content in those compounds and they have been used in the Mediterranean area in folk medicine as anti-inflammatory and anti-ulcer agents. The present study describes a gradient elution reversed-phase method that uses diode array detection to determine ten pharmacologically active diterpenoids occurring in 12 species of Sideritis. First, we studied the chromatographic behaviour of standard diterpenoids to analyse the variation on retention time and the chromatographic properties with the mobile phase. Standard calibration curves were generated by plotting the area of peaks against a concentration range of the compounds. Second, the validated method was applied to the analyses of hexanic and methanolic extracts from 12 species of Sideritis, which were collected from different areas of Spain. Finally, we established for this plant a relationship between their use in folk medicine and their diterpenoid content.

Neuropharmacological activity of Nigella sativa L. extracts.

Pharmacological studies have been conducted on the aqueous and methanol extracts of defatted Nigella sativa L. seeds to evaluate their effects on the central nervous system (CNS) and on analgesic activity. The observations suggest that the two extracts of Nigella sativa possesses a potent CNS and analgesic activity (depressant action especially in the case of the methanolic extract).

Doxorubicin in combination with fluorouracil and cyclophosphamide (i.v. FAC regimen, day 1, 21) versus methotrexate in combination with fluorouracil and cyclophosphamide (i.v. CMF regimen, day 1, 21) as adjuvant chemotherapy for operable breast cancer: a study by the GEICAM group.

BACKGROUND: The purpose of this study was to determine the relative efficacy of doxorubicin versus methotrexate in combination with intravenous cyclophosphamide and 5-fluorouracil (FAC versus CMF) as adjuvant chemotherapy for operable breast cancer. PATIENTS AND METHODS: Over a 4-year period, 985 women undergoing curative surgery for breast cancer (T1-3 N0-2 M0, stage I-IIIA, UICC) from nine hospitals were stratified with respect to axillary node involvement (node positive versus node negative) and randomized to receive either FAC (500/50/500/m(2)) every 3 weeks for six cycles or CMF (600/60/600/m(2)) every 3 weeks for six cycles. RESULTS: The relative dose intensities of FAC and CMF were 87% and 85% of planned doses, respectively. Unadjusted data indicated a non-significant trend towards better results with FAC. In the prospectively formed subset of node-negative patients, disease-free survival and overall survival were statistically superior in the FAC treatment arm (P = 0.041 and 0.034, respectively), but this advantage was not seen in the subset of node-positive patients, probably because of a difference in the percentage of patients with four or more positive nodes. Adjusting data for size of treatment effect and potential interactions (number of positive nodes, tumor size, treatment center), the overall relative risk (RR) of disease recurrence and death were significantly lower with FAC treatment (RR 1.2, P = 0.03, and RR 1.3, P = 0.05, respectively). This result was mainly due to the difference observed in the node-negative patient population. Toxicity was mild: FAC induced more alopecia, emesis, mucositis and cardiotoxicity; this last was of clinical concern, but was infrequent and manageable. CMF induced more conjunctivitis and weight gain. There were no toxic deaths. CONCLUSIONS: Doxorubicin in combination with day 1 i.v. cyclophosphamide and 5-fluorouracil is superior to methotrexate in combination with day 1 i.v. cyclophosphamide and 5-fluorouracil as adjuvant chemotherapy for operable breast cancer. A treatment effect is particularly evident in the node-negative patients. Although the clinical toxicity of FAC is greater than that of CMF, the levels were manageable and clinically acceptable.

Terpenoids: sources, structure elucidation and therapeutic potential in inflammation.

Natural products research has lately undergone exponential growth owing to advances in isolation techniques and in synthetic methods design, as well as for the identification of a wide range of biological properties exhibited by these compounds. In the present review, general remarks on the chemical features, biosynthetic pathways, isolation and structure elucidation of terpenoids are briefly discussed. In addition to this, recent work done on anti-inflammatory terpenoids (diterpenoids, triterpenoids and sesquiterpene lactones) with special emphasis on the last new molecular targets evaluated is presented.

New insights into the mechanism of action of the anti-inflammatory triterpene lupeol.

The pentacyclic triterpene lupeol has been studied for its inhibitory effects on murine models of inflammation and peritoneal macrophage functions in-vitro. Lupeol (0.5 and 1 mg/ear) administered topically suppressed the mouse ear oedema induced by 12-0-tetradecanoyl-phorbol acetate (TPA), being less effective on ear oedema induced by arachidonic acid. Quantitation of the neutrophil specific marker myeloperoxidase demonstrated that its topical activity was associated with reduction in cell infiltration into inflamed tissues. When tested in-vitro, lupeol significantly reduced prostaglandin E2 (PGE2) production from A23187-stimulated macrophages, but failed to affect leukotriene C4 release. It was a weak inhibitor of nitrite release, but dose-dependently suppressed PGE2. Cytokine production (tumour necrosis factor-alpha and interleukin-1beta) was inhibited in the range 10-100 microM in lipopolysaccharide-treated macrophages. This study demonstrated that lupeol possessed anti-inflammatory activity which was likely to depend on its ability to prevent the production of some pro-inflammatory mediators.

Post-synoviorthesis rehabilitation in haemophilia.

The efficacy of radiosynoviorthesis in the management of chronic haemophilic synovitis has been proven. Like replacement therapy, however, this procedure has no effect on muscle strength or endurance, range of movement, coordination, or the patient's physical condition in general. All the factors just enumerated are essential for the recovery and maintenance of the haemophiliac's quality of life. That is why rehabilitation and physiotherapy are so important, since no medical therapy or surgical procedure are by themselves capable of preventing disabilities.

Antiulcerogenic activity of Lippia alba (Mill.) N. E. Brown (Verbenaceae).

Lippia alba (Mill.) N. E. Brown Verbenaceae, known popularly as 'Juanilama' or 'Salvia Sija', is prized widely in folk medicine in Guatemala. Its leaves are employed as an infusion and decoction as a remedy for stomach problems, dysentery, colds and cough, febrifuge, as well as a sedative and in spasmolitic remedies. The present study reports the effects of the infusion of L. alba on the rat gastric mucosa. The following behavioural parameters were evaluated: (a) gastric irritancy test in Wistar rats; (b) antiulcer activity, short term and long term; (c) acid secretion; (d) measurement of total proteins; (e) estimation of total protein bound and nonprotein sulfhydryl groups. Ranitidine (100 mg/kg, p.o.) was used as the reference antiulcer drug. Oral treatment with the infusion (12.5 g dry plant/kg) did not cause gastric irritancy in the rats treated during five consecutive days. In addition, the oral administration of L. alba was found to be effective at preventing gastric ulceration induced by indomethacin (50 mg/kg, p.o.) in rats in the short term (1 day) and long term (5 days).

Preliminary screening of five ethnomedicinal plants of Guatemala.

We performed the Irwin test on some different extracts of the aerial parts of Tridax procumbens L., of the leaves of Neurolaena lobata (L.) R. Br., of the bark and leaves of Byrsonima crassifolia (L.) Kunth. and Gliricidia sepium Jacq. Walp. and of the root and leaves of Petiveria alliacea L. At a dosage of 1.25 g extract/100 g dried plant, the aqueous extracts of bark and leaves of Byrsonima crassifolia (L.) Kunth. and G. sepium Jacq. Walp. showed higher activity: decrease in motor activity, back tonus, reversible parpebral ptosis. catalepsy and strong hypothermia.

Lippia: traditional uses, chemistry and pharmacology: a review.

The chemical composition, pharmacological activity and traditional uses of 52 species attributed to the genus Lippia (Verbenaceae) as used in the South and Central America, and Tropical Africa, were revised and compared. A survey of the available literature shows that these species are used mostly for the treatment of gastrointestinal and respiratory disorders and as seasoning. Additionally, some of these Lippia species showed antimalarial, spasmolitic, sedative, hypotensive and, anti-inflammatory activities. Generally, the essential oil or the phenolic compounds (flavonoids) from these plant extracts are assumed to be the active principles.

Anti-inflammatory activity of abietic acid, a diterpene isolated from Pimenta racemosa var. grissea.

The anti-inflammatory activity of abietic acid, a diterpene isolated from Pimenta racemosa var. grissea (Myrtaceae), was evaluated in-vivo and in-vitro. This compound significantly inhibited rat paw oedema induced by carrageenan in a time- and dose-dependent manner, and mouse ear oedema induced by 12-O-tetradecanoylphorbol acetate, after oral or topical administration. The inhibition of myeloperoxidase enzyme showed that its topical activity was influenced by neutrophil infiltration into the inflamed tissues (ears). In addition, the effect of abietic acid on some macrophage functions was analysed in-vitro. Non-toxic concentrations of abietic acid inhibited prostaglandin E2 (PGE2) production in lipopolysaccharide-treated macrophages, whereas nitrite, tumour necrosis factor alpha and interleukin-1beta production were only weakly affected by this diterpene. PGE2 production from A23187-stimulated macrophages was only inhibited at high doses (100 microM) and it failed to modify leukotriene C4 production. These results indicate that abietic acid exerts in-vivo anti-inflammatory activity after oral or topical administration and has partial ability to prevent the production of some inflammatory mediators.

Anti-Inflammatory properties of a lipid fraction obtained from Sideritis javalambrensis.

A lipid fraction obtained by activity-guided fractionation from the hexane extract of Sideritis javalambrensis was evaluated for anti-inflammatory activity. This fraction significantly inhibited paw oedema induced by carrageenan as well as ear oedema induced by 12-O-tetradecanoylphorbol 13-acetate (TPA) in mice after oral or topical administration, respectively. Quantitation of the specific marker myeloperoxidase (MPO) demonstrated that its topical anti-inflammatory activity was associated with reduction in cell infiltration into inflamed tissues. The lipid fraction significantly decreased leukocyte granular enzyme release (beta-glucuronidase), but failed to inhibit superoxide generation. Histamine release from mast cells was also suppressed in a concentration-dependent manner. In addition, non-toxic concentrations of this fraction reduced nitric oxide (NO) generation in lipopolysaccharide (LPS)-treated J774 macrophages. Taken together, these results suggest that the lipid fraction exerts in vivo anti-inflammatory activity with the partial contribution of inhibitory actions on some inflammatory responses.

Suppression of croton oil-induced rabbit corneal edema by sideritis javalambrensis.

This investigation was designed to evaluate the anti-inflammatory activity of the aqueous and hexane extracts of Sideritis javalambrensis, to which pharmacological properties have been attributed in Spanish traditional medicine. The extracts were applied as eye drops in a croton oil-induced corneal edema model in rabbits. Corneal thickness was estimated before the induction of inflammation and 3, 6, 8, 12, 48, 72 and 96 h after induction. Significant inflammation inhibition percentages were shown during both the acute and chronic stages of inflammation by both extracts and by the reference drug dexamethasone, with most therapeutic effect shown during the chronic phase. However, the hexane extract exhibited potent anti-inflammatory activity from 6 to 24 h post-induction, achieving greater percentage inhibition values during this stage than those obtained for dexamethasone.