Psoriasis Severity, Health-Related Quality of Life, Work Productivity, and Activity Impairments Among Patients With Moderate to Severe Psoriasis Receiving Systemic Treatment: Real-World Data From Clinical Practice in Spain. / [Artículo traducido] Gravedad de la psoriasis, calidad de vida relacionada con la salud, productividad laboral y deterioro de la actividad en pacientes con psoriasis moderada a grave que reciben tratamiento sistémico: datos de la vida real de la práctica clínica en España.

BACKGROUND AND OBJECTIVE: The treatment of psoriasis should not only focus on skin affectations but also weigh the parameters for health-related quality of life (HRQoL), thereby tackling the concept of cumulative life course impairment (CLCI) and treating the patient from a holistic perspective. The CRYSTAL study aimed to characterize psoriasis with real-word data from Spanish clinical practice in patients with moderate to severe disease who received continuous systemic treatment for at least 24 weeks by using the absolute Psoriasis Area and Severity Index (PASI) score and its correlation to HRQoL. MATERIAL AND METHODS: This was a non-interventional, cross-sectional study conducted in 30 centers in Spain, with 301 patients between the ages of 18 and 75 years. The study collected data regarding current treatment and absolute PASI and their relationship to HRQoL using the Dermatology Life Quality Index (DLQI), to activity impairment using the Work Productivity and Activity Impairment (WPAI) questionnaire, and to treatment satisfaction. RESULTS: The mean (SD) age was 50.5 (12.5) years, with a duration of disease of 14 (14.1) years. The mean (SD) absolute PASI reported was 2.3 (3.5), with 28.7% of patients presenting with PASI from >1 to ≤3 and 22.6% with PASI>3. Higher PASI scores were associated with higher DLQI (p<0.001) and WPAI scores and lower levels of treatment satisfaction (p<0.001). CONCLUSIONS: These data indicate that achieving lower absolute PASI values may correlate not only with better HRQoL but also with better work productivity and treatment satisfaction.

Psoriasis Severity, Health-Related Quality of Life, Work Productivity, and Activity Impairments Among Patients With Moderate to Severe Psoriasis Receiving Systemic Treatment: Real-World Data From Clinical Practice in Spain.

BACKGROUND AND OBJECTIVE: The treatment of psoriasis should not only focus on skin affectations but also weigh the parameters for health-related quality of life (HRQoL), thereby tackling the concept of cumulative life course impairment (CLCI) and treating the patient from a holistic perspective. The CRYSTAL study aimed to characterize psoriasis with real-word data from Spanish clinical practice in patients with moderate to severe disease who received continuous systemic treatment for at least 24 weeks by using the absolute Psoriasis Area and Severity Index (PASI) score and its correlation to HRQoL. MATERIAL AND METHODS: This was a non-interventional, cross-sectional study conducted in 30 centers in Spain, with 301 patients between the ages of 18 and 75 years. The study collected data regarding current treatment and absolute PASI and their relationship to HRQoL using the Dermatology Life Quality Index (DLQI), to activity impairment using the Work Productivity and Activity Impairment (WPAI) questionnaire, and to treatment satisfaction. RESULTS: The mean (SD) age was 50.5 (12.5) years, with a duration of disease of 14 (14.1) years. The mean (SD) absolute PASI reported was 2.3 (3.5), with 28.7% of patients presenting with PASI from >1 to ≤3 and 22.6% with PASI>3. Higher PASI scores were associated with higher DLQI (p<0.001) and WPAI scores and lower levels of treatment satisfaction (p<0.001). CONCLUSIONS: These data indicate that achieving lower absolute PASI values may correlate not only with better HRQoL but also with better work productivity and treatment satisfaction.

Peach extract induces systemic and local immune responses in an experimental food allergy model.

Peach allergy is among the most frequent food allergies in the Mediterranean area, often eliciting severe anaphylactic reactions in patients. Due to the risk of severe symptoms, studies in humans are limited, leading to a lack of therapeutic options. This study aimed to develop a peach allergy mouse model as a tool to better understand the pathomechanism and to allow preclinical investigations on the development of optimized strategies for immunotherapy. CBA/J mice were sensitized intraperitoneally with peach extract or PBS, using alum as adjuvant. Afterwards, extract was administered intragastrically to involve the intestinal tract. Allergen provocation was performed via intraperitoneal injection of extract, measuring drop of body temperature as main read out of anaphylaxis. The model induced allergy-related symptoms in mice, including decrease of body temperature. Antibody levels in serum and intestinal homogenates revealed a Th2 response with increased levels of mMCPT-1, peach- and Pru p 3-specific IgE, IgG1 and IgG2a as well as increased levels of IL-4 and IL-13. FACS analysis of small intestine lamina propria revealed increased amounts of T cells, neutrophils and DCs in peach allergic mice. These data suggest the successful establishment of a peach allergy mouse model, inducing systemic as well as local gastrointestinal reactions.

Critically-timed sleep+light interventions differentially improve mood in pregnancy vs. postpartum depression by shifting melatonin rhythms.

BACKGROUND: Testing the hypothesis that combined wake + light therapy improves mood in pregnant vs. postpartum depressed participants (DP) by differentially altering melatonin and sleep timing. METHODS: Initially 89 women, 37 pregnant (21 normal controls-NC; 16 DP) and 52 postpartum (27 NCs; 25 DP), were randomized to a parallel trial of a phase-delay intervention (PDI): 1-night of early-night wake therapy (sleep 3-7 am) + 6-weeks of evening bright white light (Litebook Advantage) for 60 min starting 90 min before bedtime, vs. a Phase-advance intervention (PAI): 1-night of late-night wake therapy (sleep 9 pm-1 am) + 6-weeks of morning bright white light for 60 min within 30 min of wake time. Blinded clinicians assessed mood weekly by structured interview, and participants completed subjective ratings, a Morningness-Eveningness questionnaire, actigraphy, and collected 2 overnight urine samples for 6-sulphatoxy melatonin (6-SMT). RESULTS: In pregnant DP, mood improved more after the PDI vs. PAI (p = .016), whereas in postpartum DP, mood improved more after the PAI vs. PDI (p = .019). After wake therapy, 2 weeks of light treatment was as efficacious as 6 weeks (p > .05). In postpartum DP, PAI phase-advanced 6-SMT offset and acrophase (p < .05), which correlated positively with mood improvement magnitude (p = .003). LIMITATIONS: Small N. CONCLUSIONS: Mood improved more after 2 weeks of the PDI in pregnant DP, but more after 2 weeks of PAI in postpartum DP in which improvement magnitude correlated with 6-SMT phase-advance. Thus, critically-timed Sleep + Light Interventions provide safe, efficacious, rapid-acting, well-tolerated, at-home, non-pharmaceutical treatments for peripartum DP.

Deficit of ß-endorphin neurons in the hypothalamus and high expression of MOR in mesolimbic structures are related to high alcohol consumption in outbred rats.

Clinical studies have postulated that ß-endorphin deficiency generates excessive alcohol consumption, and it has been shown that the reduction of ß-endorphin neurons increases alcohol intake in animal models. The ß-endorphin produce their rewarding effect when they act mainly on the µ-opioid receptors (MOR) located in mesolimbic structures. Thus, it is possible that individual differences in these components of the endogenous opioid system are related to different levels of alcohol consumption. The present study thus examines the relation between two levels of alcohol consumption and intrinsic characteristics of the components of the opioid system in outbred Wistar rats that were not genetically selected. We analyzed the number of ß-endorphin-positive neurons in the arcuate nucleus (ArN) and the expression of µ-opioid receptors (MOR) in regions of the reward system, such as the nucleus accumbens (NAc), amygdala (Amy), and ventral tegmental area (VTA) in outbred rats with low (LC) or high (HC) voluntary alcohol consumption. Findings showed that the HC rats had a lower number of ß-endorphin-positive neurons in the hypothalamic ArN and a higher expression of MOR in the NAc and VTA, compared to the LC rats. No changes in the expression of MOR in the Amy were observed between the two groups. Results suggest that intrinsic variability in the number of ß-endorphin neurons and in the expression of MOR in the LC and HC rats could explain their different patterns for alcohol intake.

[Hydrostatic enema outcome in patients with long history of ileocolic intussusception]. / Resultados del enema hidrostático en pacientes con clínica prolongada de invaginación ileocólica.

PURPOSE: Hydrostatic enema is the gold standard treatment for ileocolic intussusception in stable patients without radiologic complication. There is no consensus about the influence of long history of symptoms in the outcome of this treatment. The aim of this study is to determine whether hydrostatic enema is effective and safe in patients with history of ileocolic intussusception of over 24 hours. MATERIAL AND METHODS: Retrospective review of all patients with ileocolic intussusception admitted to our hospital between 2014 and 2017. We divided the patients in whom enema was attempted on into two groups according to the length of history: over or under 24 hours. Statistical analysis was done by using the Fisher's exact test. RESULTS: In this study period 59 children presented with ileocolic intussusception. Duration of symptoms was variable (range 2 hours-7 days). Of the total of patients, initial hydrostatic enema was attempted on 49, with a success rate of 91.8% (45 patients). In the group of history <24 hours (33 patients, 67.3%) we observed a 93.9% effectiveness and in the group >24 hours (16 patients, 32.7%) effectiveness was 87.5%. Success rate showed no significant difference when comparing both groups (p=0.588). No complications were seen after enema reduction. CONCLUSIONS: The use of hydrostatic enema in patients with long history of intussusception is successful and safe. We consider it to be the first-line treatment in stable patients with no radiologic complication, regardless the duration of symptoms.

OBJETIVOS: El gold standard para el tratamiento de la invaginación ileocólica en el paciente estable sin complicación radiológica es el enema hidrostático. No hay unanimidad sobre si la sintomatología prolongada de invaginación influye en los resultados de dicho tratamiento. El objetivo de este estudio es determinar si el enema hidrostático es efectivo y seguro en pacientes con clínica de invaginación ileocólica mayor de 24 horas. MATERIAL Y METODOS: Estudio retrospectivo de los pacientes diagnosticados de invaginación ileocólica en nuestro hospital entre 2014 y 2017. Hemos dividido en 2 grupos a los pacientes a los que se realizó enema en función del tiempo de clínica, mayor o menor de 24 horas. El análisis estadístico se realizó mediante el test exacto de Fisher. RESULTADOS: En este periodo se atendieron 59 niños con invaginación ileocólica con duración variable de los síntomas (2 horas a 7 días). Del total de pacientes, en 49 se realizó enema hidrostático inicial con una efectividad del 91,8% (45 pacientes). En el grupo de clínica <24 horas (33 pacientes, 67,3%) se objetivó una efectividad del 93,9% y en el grupo de clínica >24 horas (16 pacientes, 32,7%) se objetivó una efectividad del 87,5%. No hubo diferencias significativas al comparar la efectividad entre ambos grupos (p=0,588). En ningún paciente hubo complicaciones tras el enema. CONCLUSIONES: El empleo del enema hidrostático en pacientes con clínica prolongada de invaginación es efectivo y seguro. Consideramos que debería ser la primera herramienta terapéutica en el paciente estable sin complicación radiológica, independientemente del tiempo de evolución.

Factors influencing safe glucose-lowering in older adults with type 2 diabetes: A PeRsOn-centred ApproaCh To IndiVidualisEd (PROACTIVE) Glycemic Goals for older people: A position statement of Primary Care Diabetes Europe.

Diabetes in later life is associated with a range of factors increasing the complexity of glycaemic management. This position statement, developed from an extensive literature review of the subject area, represents a consensus opinion of primary care clinicians and diabetes specialists. It highlights many challenges facing older people living with type 2 diabetes and aims to support primary care clinicians in advocating a comprehensive, holistic approach. It emphasises the importance of the wishes of the individual and their carers when determining glycaemic goals, as well as the need to balance intended benefits of treatment against the risk of adverse treatment effects. Its ultimate aim is to promote consistent high-quality care for older people with diabetes.

[Intranodal lymphangiography in pediatric chylothorax, a diagnostic and therapeutic tool]. / Linfangiografía intranodal en quilotórax pediátrico, una herramienta diagnóstica y terapéutica.

INTRODUCTION: High morbidity has been described in secondary chylothorax. Thoracic duct embolization (TDE) after intranodal lymphangiography (IL) is one of the treatments in adults but there is poor experience in children. We aim to describe our experience with this technique for refractory pediatric chylothorax. METHODS: A retrospective study of patients with refractory chylothorax treated with thoracic duct embolization at our Institution in the last 4 years was performed. Lymphatic vessels visualization was obtained by intranodal lymphangiography with ethiodized oil. Demographic and clinical data as well as imaging findings were collected. RESULTS: A total of 4 patients were treated during the study period with a median of age and weight of 2.5 months (1-16) and 4.25 kg (2.8-10) respectively. Chylothorax was secondary to cardiothoracic surgery in 3 patients and to venous thrombosis in the other one. Medical treatment was provided during a median of 47 days (13-56) without benefit in thoracic output [median: 46 ml/kg/day (19-64)]. After IL, thoracic duct catheterization was achieved in one patient however embolization was not possible. Chylothorax stopped in the 3 post-surgical patients regardless of how much lymphatic visualization was achieved in IL. In the venous thrombosis patient surgical treatment was performed 6 days after the study. CONCLUSION: IL can be a diagnostic and therapeutic tool in children. Ethiodized oil seems to seal lymphatic leak in postsurgical chylothorax. IL could be an option for chylothorax in patients too sick for surgical treatment or in whom thoracic duct embolization is not feasible.

INTRODUCCION: El quilotórax secundario es una entidad rara con una alta morbilidad. La embolización del conducto torácico (CT) mediante linfangiografía intranodal (LI) con aceite etiodizado (AE) forma parte del arsenal terapéutico del quilotórax en el adulto. Presentamos nuestra experiencia con esta técnica en pacientes pediátricos con quilotórax refractario al tratamiento médico. METODOS: Estudio retrospectivo de los pacientes tratados en nuestro centro por quilotórax refractario con LI en los últimos 4 años. Se recogieron los datos epidemiológicos, clínicos, terapéuticos y linfangiográficos. RESULTADOS: Se identificaron 4 pacientes, con unas medianas de edad y peso de 2,5 meses (1-16) y 4,25 kg (2,8-10) respectivamente. En 3 de los pacientes el quilotórax fue secundario a cirugía cardiaca y en el restante a trombosis extensa de vena cava superior. La mediana de débito fue de 46 ml/kg/día (19-64) y la de tiempo de tratamiento médico de 47 días (13-56). En todos ellos se realizó LI, opacificándose el CT solo en un paciente, sin lograrse la embolización. A pesar de ello, tras la LI, el quilotórax cesó en el grupo postquirúrgico independientemente del nivel de opacificación del árbol linfático. En el paciente secundario a trombosis, se realizó ligadura quirúrgica del CT 6 días después del estudio. CONCLUSIONES: La LI es una técnica diagnóstica e incluso terapéutica en casos de quilotórax refractario, que comienza a ser necesaria y realizable en centros con experiencia. El AE parece sellar la fuga linfática por un mecanismo embolizante en casos postquirúrgicos, eliminando la necesidad del cierre quirúrgico.

The beneficial effect of probiotics as a supplementary treatment in drug-resistant epilepsy: a pilot study.

Epilepsy is a neurological disease with high global prevalence. Despite the range of drug-based treatments currently available to control the condition, one in 3 patients experiences epileptic seizures. Therapeutic alternatives for these patients include the ketogenic diet, surgery or the cerebral implantation of neurostimulators; however these are benefits with limits. The target of this study is to find a new complementary treatment for these patients, studying the effectiveness of probiotics for controlling epileptic seizures in patients with drug-resistant epilepsy. A prospective study was designed in which a group of patients with drug-resistant epilepsy was administered a probiotic mixture for 4 months. Patients were assessed before and after taking the probiotics; among other variables, number of seizures and patients' quality of life (QOLIE-10) were monitored. Levels of cD-14, interleukin 6, and γ-aminobutyric acid were also analysed throughout the study. 45 patients were included in the study. In an intention-to-treat analysis, 28.9% of all patients displayed a greater than 50% reduction in the number of seizures (the parameter required in clinical trials). A significant improvement was also observed in patients' quality of life. We found that probiotics may be an option for supplementary therapy. Since the use of probiotics is safe, they may contribute to improving seizure control, and therefore quality of life, in patients with drug-resistant epilepsy. The study has been registered in https://clinicaltrials.gov with number NCT03403907.

Toxic effects of two essential oils and their constituents on the mealworm beetle, Tenebrio molitor.

The study identified insecticidal effects from the cinnamon and clove essential oils in Tenebrio molitor L. (Coleoptera: Tenebrionidae). The lethal concentrations (LC50 and LC90), lethal time, and repellent effect on larvae, pupae, and adults of T. molitor after exposure to six concentrations of each essential oil and toxic compounds were evaluated. The chemical composition of the cinnamon oil was also determined and primary compounds were eugenol (10.19%), trans-3-caren-2-ol (9.92%), benzyl benzoate (9.68%), caryophyllene (9.05%), eugenyl acetate (7.47%), α-phellandrene (7.18%), and α-pinene (6.92%). In clove essential oil, the primary compounds were eugenol (26.64%), caryophyllene (23.73%), caryophyllene oxide (17.74%), 2-propenoic acid (11.84%), α-humulene (10.48%), γ-cadinene (4.85%), and humulene oxide (4.69%). Cinnamon and clove essential oils were toxic to T. molitor. In toxic chemical compounds, eugenol have stronger contact toxicity in larvae, pupae, and adult than caryophyllene oxide, followed by α-pinene, α-phellandrene, and α-humulene. In general, the two essential oils were toxic and repellent to adult T. molitor. Cinnamon and clove essential oils and their compounds caused higher mortality and repellency on T. molitor and, therefore, have the potential for integrated management programs of this insect.

Dolor lumbar somático tratado con terapia neural y ozono paravertebral / Somatic low back pain treated with neural therapy and paravertebral ozone

La presente investigación tuvo como objetivo general evaluar el efecto de la terapia neural e infiltración paravertebral segmentaria con ozono en el dolor lumbar somático de los pacientes que asistieron a la consulta de terapia del dolor en el Hospital Dr. Pedro García Clara, Ciudad Ojeda Estado Zulia-Venezuela, en el periodo comprendido del 01 de abril al 31 de mayo del 2016. Fue un estudio prospectivo, explicativo-comparativo y el diseño fue cuasi-experimental. Se seleccionaron 60 pacientes de ambos sexos entre edades comprendidas de 18 a 60 años, se dividieron en dos grupos de 30 pacientes, al primer grupo denominado A, se le realizó terapia neural segmentaria lumbar utilizando procaína al 1% y consecutivamente se le aplicó infiltración paravertebral con ozono a una concentración de 15ug; y al grupo B, se le realizó terapia neural con lidocaína al 1% y posteriormente se le aplicó la infiltración paravertebral con ozono a una concentración de 15ug, ambos grupos con un volumen de 10mL. Para el análisis de los datos se utilizó estadística descriptiva e inferencial, específicamente la prueba t de Student para las muestras relacionadas. Resultados: indicaron que en ambas terapias, al evaluar el dolor con la escala visual análoga, se encontraron diferencias estadísticamente significativas (p<0,05), en ambos grupos. Conclusiones: no hubo diferencias estadísticamente significativas con respecto a los cambios hemodinámicos y la disminución del dolor fue significativa en ambos grupos, pero más notable en el grupo A(AU)

The present study was aimed at evaluating the overall effect of neural therapy and segmental paravertebral ozone infiltration in lumbar somatic pain patients attending the consultation of pain therapy Dr. Pedro Garcia Clara Hospital of Ciudad Ojeda Estado Zulia-Venezuela, in the period from 01 April to 31 May 2016. It was a comparative-explanatory, prospective study design was quasi-experimental, 60 patients of either sex between aged from 18 to 60 years were selected, they were divided into two groups of 30 patients, the first group called A, underwent neural therapy lumbar segmental using procaine 1% and consecutively was applied paravertebral infiltration with ozone at a concentration of 15ug; and group B, underwent neural therapy with lidocaine 1% and was subsequently applied the paravertebral infiltration with ozone at a concentration of 15ug, both groups with a volume of 10mL. For data analysis the mean, standard deviation, and inferential statistics, specifically the Student t test for related samples was used. Results: indicated that both therapies, to assess pain with visual analogue scale, statistically significant differences (p<0.05) in both groups. Conclusions: There were no statistically significant differences with respect to hemodynamic changes and pain reduction was significant in both groups, but more remarkable in group A(AU)

Invaginación intestinal: ¿alta precoz o ingreso por riesgo de recidiva? / Intussusception: hospital admission for risk of recurrence or early discharge?

Introducción/Objetivo. En la literatura actual existe debate en cuanto a la necesidad de ingresar a los pacientes con invaginación intestinal (II) después de la reducción exitosa mediante enema. El propósito de este estudio es caracterizar la recidiva de las II en nuestro medio para valorar la posibilidad del tratamiento ambulatorio. Pacientes y métodos. Estudio retrospectivo de los niños atendidos por II entre 2009 y 2013 definiendo como recidiva temprana la que ocurre entre las 12-72 horas post-reducción, comparando los resultados con la literatura actual. Resultados. Se trataron 121 niños (77 varones - 44 mujeres), con edad de 18,9±2,7 meses y peso de 10,77±0,57 kg (IC 95%), por II. Se intentó reducción mediante enema en 90,7% (n= 88) de los casos, siendo efectivo en un 76,1% (n= 67). La tasa de recidiva temprana fue del 6% (n= 4), sin complicaciones asociadas, similar a lo referido en estudios de meta-análisis recientes (5,4%); tres precisaron tratamiento quirúrgico. La estancia hospitalaria media es de 2 días para las II tratadas conservadoramente, lo que supuso un gasto promedio de 2.076,67 euros por ingreso. Conclusión. Dada la baja tasa de recidiva temprana y escaso riesgo de complicaciones, la observación durante 8-12 horas es una alternativa al ingreso hospitalario, lo que conllevaría ventajas de bienestar socio-familiar y de gestión. Estos resultados sirven como punto de partida para estudios prospectivos randomizados entre ambas modalidades de tratamiento

Introduction/Purpose. There is current debate about the need of hospitalization of patients with enema-reduced intussusception. The purpose of this study is to describe intussusception recurrence in a tertiary care children’s hospital in order to evaluate the feasibility of ambulatory treatment. Patients and methods. Retrospective review of children diagnosed with intussusception from January 2009 to December 2013, identifying early recurrences as those that occurred between 12-72 hours after successful enema reduction and comparing the results with current literature. Results. A total of 121 children (77 male - 44 female), with a mean age of 18,9±2,7 months and weight of 10,77±0,57 kg (CI 95%) were treated for intussusception. Enema reduction was attempted in 90,7% (n= 88) of the cases, with a success rate of 76,1% (n= 67). Early recurrence rate was 6% (n= 4), without associated complications, which is similar to recent meta-analysis results (5,4%); however, three patients required surgical exploration. Mean length of stay was 2 days for enema-reduced intussusception, which resulted in a total cost of 2,076.67 euro per patient. Conclusion. The low recurrence rate and scarce risk of complications suggests that an 8 to 12 hour observation is a feasible alternative to hospital admission, which results in social advantages including family welfare as well as management costs. These results are a starting point for prospective randomized controlled trials comparing both treatment modalities

Dolor en la articulación sacroilíaca: estudio prospectivo, aleatorizado, experimental y comparativo de la radiofrecuencia térmica con el bloqueo de la articulación sacroilíaca / Sacroiliac joint pain: Prospective, randomised, experimental and comparative study of thermal radiofrequency with sacroiliac joint block

Objetivo. Comparar el bloqueo con la radiofrecuencia térmica bipolar para el dolor de la articulación sacroilíaca. Método. Estudio prospectivo, aleatorizado y experimental en 60 pacientes, seleccionados en 9 meses en 2 centros, con dolor intenso (escala visual analógica [EVA] > 6) de > 3 meses de duración. Fueron divididos en 3 grupos (n = 20). Grupo A: pacientes a los que se les realizaron 2 bloqueos intraarticulares, con control ecográfico en 7 días. Grupo B: radiofrecuencia bipolar «palisade» utilizando 6 agujas perpendiculares a la zona dorsal del sacro, a una distancia de 1 cm, para producir lesiones contiguas entre los forámenes S1-S2-S3 y la línea articular. Grupo C: radiofrecuencia bipolar «palisade» modificada (distancia entre agujas > 1 cm). Los pacientes fueron evaluados al mes, a los 3 y a los 12 meses del tratamiento. Se valoraron los datos demográficos (en la visita basal), la eficacia analgésica y los efectos secundarios (en el resto). Resultados. Al mes, la reducción del dolor en los 3 grupos fue > 50% (p ≤ 0,001). A los 3 y 12 meses el grupo A no refirió disminución significativa del dolor. El grupo B, a los 3 meses, alivio cercano al 50% (p = 0,03), y < 25% (23,8) a los 12 meses (p = 0,01). En el grupo C, alivio próximo al 50% a los 3 y 12 meses (p < 0,001) respecto al basal. Todos los pacientes finalizaron el estudio. Conclusiones. La radiofrecuencia bipolar «palisade», especialmente aumentando la distancia entre las agujas, ha sido eficaz, a más largo plazo, que el bloqueo con anestésicos y corticoides en el alivio del dolor de la articulación sacroilíaca (AU)

Objective. To compare the analgesic effects between the blockade and bipolar thermal radiofrequency in the treatment of sacroiliac joint pain. Method. Prospective, randomised and experimental study conducted on 60 patients selected in the two hospitals over a period of nine months, who had intense sacroiliac joint pain (Visual Analogue Scale [VAS] > 6) that lasted more than 3 months. Patients were randomised into three groups (n = 20): Group A (two intra-articular sacroiliac injections of local anaesthetic/corticosteroid guided by ultrasound in 7 days). Group B: conventional bipolar radiofrequency «palisade». Target points were the lateral branch nerves of S1, S2, and S3, distance needles 1 cm. Group C: modified bipolar radiofrequency «palisade» (needle distance > 1 cm). Patients were evaluated at one month, three months, and one year. Demographic data, VAS reduction, and side effects of the techniques were assessed. Results. One month after the treatment, pain reduction was > 50% in the three groups P < .001. Three and 12 months after the technique, the patients of the group A did not have a significant reduction in pain. At 3 months, almost 50% patients of the group B referred to improvement of the pain (P = .03), and < 25% at 12 months, and those results were statistically significant (P = .01) compared to the baseline. Group C showed an improvement of 50% at 3 and 12 months (P < .001). All patients completed the study. Conclusions. Bipolar radiofrequency «palisade», especially when the distance between the needles was increased, was more effective and lasted longer, compared to join block and steroids, in relieving pain sacroiliac joint (AU)

[Intussusception: hospital admission for risk of recurrence or early discharge?] / Invaginación intestinal: ¿alta precoz o ingreso por riesgo de recidiva?

INTRODUCTION/PURPOSE: There is current debate about the need of hospitalization of patients with enema-reduced intussusception. The purpose of this study is to describe intussusception recurrence in a tertiary care children's hospital in order to evaluate the feasibility of ambulatory treatment. PATIENTS AND METHODS: Retrospective review of children diagnosed with intussusception from January 2009 to December 2013, identifying early recurrences as those that occurred between 12-72 hours after successful enema reduction and comparing the results with current literature. RESULTS: A total of 121 children (77 male - 44 female), with a mean age of 18,9±2,7 months and weight of 10,77±0,57 kg (CI 95%) were treated for intussusception. Enema reduction was attempted in 90,7% (n= 88) of the cases, with a success rate of 76,1% (n= 67). Early recurrence rate was 6% (n= 4), without associated complications, which is similar to recent meta-analysis results (5,4%); however, three patients required surgical exploration. Mean length of stay was 2 days for enema-reduced intussusception, which resulted in a total cost of 2,076.67 euro per patient. CONCLUSION: The low recurrence rate and scarce risk of complications suggests that an 8 to 12 hour observation is a feasible alternative to hospital admission, which results in social advantages including family welfare as well as management costs. These results are a starting point for prospective randomized controlled trials comparing both treatment modalities.

INTRODUCCION/OBJETIVO: En la literatura actual existe debate en cuanto a la necesidad de ingresar a los pacientes con invaginación intestinal (II) después de la reducción exitosa mediante enema. El propósito de este estudio es caracterizar la recidiva de las II en nuestro medio para valorar la posibilidad del tratamiento ambulatorio. PACIENTES Y METODOS: Estudio retrospectivo de los niños atendidos por II entre 2009 y 2013 definiendo como recidiva temprana la que ocurre entre las 12-72 horas post-reducción, comparando los resultados con la literatura actual. RESULTADOS: Se trataron 121 niños (77 varones - 44 mujeres), con edad de 18,9±2,7 meses y peso de 10,77±0,57 kg (IC 95%), por II. Se intentó reducción mediante enema en 90,7% (n= 88) de los casos, siendo efectivo en un 76,1% (n= 67). La tasa de recidiva temprana fue del 6% (n= 4), sin complicaciones asociadas, similar a lo referido en estudios de meta-análisis recientes (5,4%); tres precisaron tratamiento quirúrgico. La estancia hospitalaria media es de 2 días para las II tratadas conservadoramente, lo que supuso un gasto promedio de 2.076,67 euros por ingreso. CONCLUSION: Dada la baja tasa de recidiva temprana y escaso riesgo de complicaciones, la observación durante 8-12 horas es una alternativa al ingreso hospitalario, lo que conllevaría ventajas de bienestar socio-familiar y de gestión. Estos resultados sirven como punto de partida para estudios prospectivos randomizados entre ambas modalidades de tratamiento.

Dispersion and Functionalization of Nanoparticles Synthesized by Gas Aggregation Source: Opening New Routes Toward the Fabrication of Nanoparticles for Biomedicine.

The need to find new nanoparticles for biomedical applications is pushing the limits of the fabrication methods. New techniques with versatilities beyond the extended chemical routes can provide new insight in the field. In particular, gas aggregation sources offer the possibility to fabricate nanoparticles with controlled size, composition, and structure out of thermodynamics. In this context, the milestone is the optimization of the dispersion and functionalization processes of nanoparticles once fabricated by these routes as they are generated in the gas phase and deposited on substrates in vacuum or ultra-high vacuum conditions. In the present work we propose a fabrication route in ultra-high vacuum that is compatible with the subsequent dispersion and functionalization of nanoparticles in aqueous media and, which is more remarkable, in one single step. In particular, we will present the fabrication of nanoparticles with a sputter gas aggregation source using a Fe50B50 target and their further dispersion and functionalization with polyethyleneglycol (PEG). Characterization of these nanoparticles is carried out before and after PEG functionalization. During functionalization, significant boron dissolution occurs, which facilitates nanoparticle dispersion in the aqueous solution. The use of different complementary techniques allows us to prove the PEG attachment onto the surface of the nanoparticles, creating a shell to make them biocompatible. The result is the formation of nanoparticles with a structure mainly composed by a metallic Fe core and an iron oxide shell, surrounded by a second PEG shell dispersed in aqueous solution. Relaxivity measurements of these PEG-functionalized nanoparticles assessed their effectiveness as contrast agents for magnetic resonance imaging (MRI) analysis. Therefore, this new fabrication route is a reliable alternative for the synthesis of nanoparticles for biomedicine.

Psicosis epiléptica periictal, una causa de psicosis reversible / Epileptic peri-ictal psychosis, a reversible cause of psychosis

Introducción: Las psicosis epilépticas se dividen respecto de su relación con las crisis en periictales e interictales. Las psicosis periictales tienen una estrecha relación temporal con las crisis epilépticas y ocurren antes (preictales), durante (ictales) o después de las mismas (postictales). Generalmente, tienen un inicio y final agudo, corta duración y una remisión completa, con riesgo de recurrencia. Las psicosis interictales o crónicas no guardan relación temporal con las crisis epilépticas. Existe otro tipo de psicosis epilépticas que se relaciona con la respuesta al tratamiento de la epilepsia: psicosis epiléptica por fenómeno de normalización forzada (psicosis alternativa) y dentro de esta se encuentra la psicosis epiléptica secundaria a cirugía de la epilepsia. Aunque se ha generalizado la combinación de antiepilépticos y neurolépticos para su manejo, no existen unas pautas estandarizadas de tratamiento en las psicosis epilépticas. Casos clínicos: Presentamos 5 casos de psicosis epilépticas periictales y remarcamos la excelente respuesta al tratamiento con levetiracetam. Consiguiendo un buen control tanto de las crisis como de los episodios psicóticos. Este fármaco resultó inocuo al asociarlo con neurolépticos en nuestros pacientes y no se precisaron dosis elevadas de estos últimos. Conclusiones: La diferenciación de los estados psicóticos asociados con la epilepsia según la relación temporal con las crisis epilépticas tiene utilidad clínica y pronóstica, dado que aporta aspectos importantes respecto al tratamiento y a la evolución de la enfermedad. El tratamiento de los trastornos mentales periictales o agudos se basa en el control de las crisis epilépticas, mientras que el tratamiento de los interictales o crónicos guarda más similitud con el de los trastornos de origen puramente psiquiátrico. El control estricto de las crisis puede, además de mejorar la calidad de vida del paciente y su discapacidad, prevenir el desarrollo de una psicosis interictal, por lo que consideramos que sería necesario establecer un protocolo de tratamiento para estos casos (AU)

Introduction: Epileptic psychoses are categorised as peri-ictal and interictal according to their relationship with the occurrence of seizures. There is a close temporal relationship between peri-ictal psychosis and seizures, and psychosis may present before (preictal), during (ictal) or after seizures (postictal). Epileptic psychoses usually have acute initial and final phases, with a short symptom duration and complete remission with a risk of recurrence. There is no temporal relationship between interictal or chronic psychosis and epileptic seizures. Another type of epileptic psychosis is related to the response to epilepsy treatment: epileptic psychosis caused by the phenomenon of forced normalisation (alternative psychosis), which includes epileptic psychosis secondary to epilepsy surgery. Although combination treatment with antiepileptic and neuroleptic drugs is now widely used to manage this condition, there are no standard treatment guidelines for epileptic psychosis. Clinical cases: We present 5 cases of peri-ictal epileptic psychosis in which we observed an excellent response to treatment with levetiracetam. Good control was achieved over both seizures and psychotic episodes. Levetiracetam was used in association with neuroleptic drugs with no adverse effects, and our patients did not require high doses of the latter. Conclusions: Categorising psychotic states associated with epilepsy according to their temporal relationship with seizures is clinically and prognostically useful because it provides important information regarding disease treatment and progression. The treatment of peri-ictal or acute mental disorders is based on epileptic seizure control, while the treatment of interictal or chronic disorders has more in common with managing disorders which are purely psychiatric in origin. In addition to improving the patient’s quality of life and reducing disability, achieving strict control over seizures may also prevent the development of interictal psychosis. For this reason, we believe that establishing a treatment protocol for such cases is necessary (AU)

Reduced phase-advance of plasma melatonin after bright morning light in the luteal, but not follicular, menstrual cycle phase in premenstrual dysphoric disorder: an extended study.

The authors previously observed blunted phase-shift responses to morning bright light in women with premenstrual dysphoric disorder (PMDD). The aim of this study was to determine if these findings could be replicated using a higher-intensity, shorter-duration light pulse and to compare these results with the effects of an evening bright-light pulse. In 17 PMDD patients and 14 normal control (NC) subjects, the authors measured plasma melatonin at 30-min intervals from 18:00 to 10:00 h in dim (<30 lux) or dark conditions the night before (Night 1) and after (Night 3) a bright-light pulse (administered on Night 2) in both follicular and luteal menstrual cycle phases. The bright light (either 3000 lux for 6 h or 6000 lux for 3 h) was given either in the morning (AM light), 7 h after the dim light melatonin onset (DLMO) measured the previous month, or in the evening (PM light), 3 h after the DLMO. In the luteal, but not in the follicular, phase, AM light advanced melatonin offset between Night 1 and Night 3 significantly less in PMDD than in NC subjects. The effects of PM light were not significant, nor were there significant effects of the light pulse on melatonin measures of onset, duration, peak, or area under the curve. These findings replicated the authors' previous finding of a blunted phase-shift response to morning bright light in the luteal, but not the follicular, menstrual cycle phase in PMDD compared with NC women, using a brighter (6000 vs. 3000 lux) light pulse for a shorter duration (3 vs. 6 h). As the effect of PM bright light on melatonin phase-shift responses did not differ between groups or significantly alter other melatonin measures, these results suggest that in PMDD there is a luteal-phase subsensitivity or an increased resistance to morning bright-light cues that are critical in synchronizing human biological rhythms. The resulting circadian rhythm malsynchonization may contribute to the occurrence of luteal phase depressive symptoms in women with PMDD.

Sangre y Cirugía. EStrategia de Ahorro en cirugía cardiaca / Blood and Surgery. Strategic saving in cardiac surgery

El incremento de intervenciones quirúrgicas y su mayor complejidad y agresividad, especialmente en cirugía cardiovascular y trasplantes, junto con el envejecimiento de la población ha supuesto un considerable aumento de la demanda de transfusión sanguínea y derivados hemáticos. Los riesgos médicos inherentes al uso de sangre homóloga, el rechazo por motivaciones personales, éticas o creencias religiosas y una insuficiente disponibilidad de hemoderivados consecuencia de la escasezde donaciones, ha condicionado la necesidad del desarrollo de procesos de ahorro de sangre en cirugía y la búsqueda de técnicas alternativas a la transfusión. Problemática que alcanza su máxima expresión en cirugía cardiaca bajo circulación extracorpórea, como consecuencia del alto consumo de sangre de los enfermos cardiológicos intervenidos. Con la experiencia que aporta un promedio de quinientas cirugías anuales de corazón se realiza una revisión sobre las diferentes medidas y procedimientos asociados al ahorro de sangre en cirugía, especialmente en cirugía cardiovascular (AU)

The increase in the number of operations and their greater complexity and aggressiveness, especially in cardiovascular surgery and transplants, together with the aging of the population, has entailed an increase in the demand for transfusion and haematological derivates. The inherent medical risks of homolog blood usage, rejection for personal motivations, ethical and religious beliefs and insufficient availability of haematological derivates as a consequence of the shortage of donations, have conditioned the necessity for the development of processes for saving blood during surgery and the search for alternative techniques to transfusion. This is a problem which has its highest repercussions in cardiac surgery with cardio-pulmonary by-pass because of the high consumption of blood of patients undergoing cardiac surgery. With the experience of approximately 500 operations per year a review of the different measures and procedures associated with saving blood in surgery has been carried out, especially with regard to cardiovascular surgery (AU)

Una base de datos relacional para consulta de litiasis urinaria. Evaluación inicial de resultados / Relational database for urinary stone ambulatory consultation. Assessment of initial outcomes

Objetivos: Crear una base de datos relacional orientada al seguimiento de la litiasis urinaria. Se presentan los detalles del diseño y los resultados iniciales de su explotación. Material y métodos: Se realiza base de datos desarrollada en el entorno de Microsoft Access® 2002, cuya información se ha distribuido en 4 tablas interrelacionadas: una tabla inicial donde se recogen los datos demográficos, una tabla de consulta, una tabla litiasis y una tabla procedimientos. Para la evaluación de la base de datos se realiza estudio observacional prospectivo desde mayo de 2004 hasta agosto de 2009 sobre 171 enfermos libres de litiasis tras tratamiento (médico, quirúrgico o LEOC), de un total de 511 introducidos en la base de datos. Se utilizó como variable indicadora la presencia o ausencia de recidiva litiasica. Se realizó análisis univariante para el estudio de la influencia de los factores demográficos (edad y sexo), aspectos relativos a la historia personal (antecedentes personales de litiasis o alteraciones de la vía urinaria) y características del cálculo (lateralidad, localización, tamaño y composición), mediante el test de la chi cuadrado, completándose con el cálculo de la probabilidad de recidiva litiásica en función del tiempo, mediante el método de Kaplan Meier. Posteriormente se realizó análisis multivariante mediante la regresión de Cox para estudiar la influencia cada una de las variables en presencia del resto de covariables. Resultados: Desde la puesta en marcha de la aplicación informática (septiembre de 2007), se han recogido datos de 702 consultas correspondientes a 511 enfermos. El análisis de los 171 enfermos disponibles para el análisis de supervivencia demostró una probabilidad de recidiva litiásica del 85,38% (146/171) con una mediana de tiempo a la recidiva de 608 días (rango 70–1.758). En el análisis univariante ningún factor estudiado resultó ser predictivo. El análisis multivariante tampoco confirmó ningún factor predictivo independiente para la recidiva litiásica. Conclusiones: La base de datos relacional es útil para el seguimiento de los enfermos con litiasis urinaria. Permite un control fácil y actualizado de los enfermos, así como un almacenamiento de datos para su posterior explotación. El estudio realizado para la evaluación de la misma no demostró influencia estadísticamente significativa de ninguno de los factores predictivos estudiados en la recidiva litiásica (AU)

Objectives: To create a relational database for monitoring lithiasic patients. We describe the architectural details and the initial results of the statistical analysis. Methods and materials: For a reliability analysis of the database the number of correctly stored data was gathered. To evaluate the performance of the database, a prospective analysis was conducted, from May 2004 to August 2009, on 171 stone free patients after treatment (EWSL, surgery or medical) from a total of 511 patients stored in the database. Lithiasic status (stone free or stone relapse) was used as primary end point, while demographic factors (age, gender), lithiasic history, upper urinary tract alterations and characteristics of the stone (side, location, composition and size) were considered as predictive factors. An univariate analysis was conducted initially by chi square test and supplemented by Kaplan Meier estimates for time to stone recurrence. A multiple Cox proportional hazards regression model was generated to jointly assess the prognostic value of the demographyc factors and the predictive value of stones characteristics. Results: For the reliability analysis 22,084 data were available corresponding to 702 consultations on 511 patients. Analysis of data showed a recurrence rate of 85.4% (146/171, median time to recurrence 608 days, range 70–1758). In the univariate and multivariate analysis, none of the factors under consideration had a significant effect on recurrence rate (p=ns). Conclusions: The relational database is useful for monitoring patients with urolithiasis. It allows easy control and update, as well as data storage for later use. The analysis conducted for its evaluation showed no influence of demographyc factors and stone features on stone recurrence (AU)