[Experience with continuous levodopa enteral infusion (Duodopa(®)) in patients with advanced Parkinson's disease in a secondary level hospital]. / Experiencia con la infusión continua de levodopa intraduodenal (Duodopa(®)) en pacientes con enfermedad de Parkinson avanzada en un hospital de segundo nivel asistencial.

INTRODUCTION: Continuous levodopa delivery by enteral infusion (Duodopa(®)) is an alternative to deep brain stimulation and subcutaneous apomorphine to control motor fluctuations and dyskinesias in advanced Parkinson's disease (PD). We report our experience with Duodopa(®) therapy in 11 patients with advanced PD. METHODS: We retrospectively assessed clinical and quality of life changes in all patients with PD with severe motor fluctuations and dyskinesias who started continuous daily levodopa duodenal infusion through percutaneous endoscopic gastrostomy from September 2006 (Duodopa(®) was approved for advanced PD treatment in Spain at that date) until April 2010 at the A. Marcide Hospital of Spain. RESULTS: Nine patients received Duodopa(®) [62.7±10.6 (44-74) years, 63.6% male)]. Pre-Duodopa(®) clinical characteristics of patients were: disease duration 14.5±8.9 (3-34) years, oral levodopa dose 918.2±277.7 (450-1300) mg/day, and Hoehn and Yahr staging 3.7±0.5 (3-4). Nine patients are still receiving Duodopa(®). Patients improved motor fluctuations (72.7% significant improvement), dyskinesia (55.5% significant improvement), daily off-time (90.9%) and daily duration dyskinesia (66.6%) after total infusion time of 170.5 months (3-31). The improvement in Parkinson's Disease Quality of Life Questionnaire-39 (PDQ-39) and Schwab&England Capacity for Daily Living Scale were 38.5±19.8 and 24±12.5 respectively (P<0.05). Equivalent daily dose of levodopa (April 2010) was 1683.4±295.8 (1234-2216) mg/day. CONCLUSIONS: Intraduodenal infusion of levodopa offers an important alternative in treating patients with advanced Parkinson disease.

Acute effects of coffee on endothelial function in healthy subjects.

BACKGROUND/OBJECTIVES: Coffee is the most widely consumed beverage in the world, but its effect on the cardiovascular system has not been fully understood. Coffee contains caffeine and antioxidants, which may influence endothelial function, both of which have not yet been investigated. The objective of this study was to investigate the acute effects of coffee on endothelial function measured by brachial artery flow-mediated dilation (FMD). SUBJECTS/METHODS: A total of 20 (10 males and 10 females) healthy non-obese subjects underwent a double-blind, crossover study. Subjects ingested one cup of caffeinated (CC) and one cup of decaffeinated (DC) Italian espresso coffee in random order at 5- to 7-day intervals. RESULTS: Following CC ingestion, FMD decreased progressively and significantly (mean+/-s.e.m.: 0 min, 7.7+/-0.6; 30 min, 6.3+/-0.7; 60 min, 6.0+/-0.8%; ANOVA (analysis of variance), P<0.05), but it did not significantly increase after DC ingestion (0 min, 6.9+/-0.6; 30 min, 8.1+/-0.9; 60 min, 8.5+/-0.9%; P=0.115). Similarly, CC significantly increased both systolic and diastolic blood pressure; this effect was not observed after DC ingestion. Blood glucose concentrations remained unchanged after ingestion of both CC and DC, but insulin (0 min, 15.8+/-0.9; 60 min, 15.0+/-0.8 muU/ml; P<0.05) and C-peptide (0 min, 1.25+/-0.09; 60 min, 1.18+/-0.09 ng/ml; P<0.01) blood concentrations decreased significantly only after CC ingestion. CONCLUSIONS: CC acutely induced unfavorable cardiovascular effects, especially on endothelial function. In the fasting state, insulin secretion is also likely reduced after CC ingestion. Future studies will determine whether CC has detrimental clinically relevant effects, especially in unhealthy subjects.

Dose-dependent effects of decaffeinated coffee on endothelial function in healthy subjects.

BACKGROUND/OBJECTIVES: Coffee is known to contain antioxidant substances whose effects may be blunted because of caffeine that may unfavorably affect the cardiovascular system. This study was designed to investigate the acute dose-dependent effects of decaffeinated coffee (DC) on endothelial function measured by the brachial artery flow-mediated dilation (FMD). SUBJECTS/METHODS: A total of 15 (8 men and 7 women) healthy nonobese subjects underwent a single-blind, crossover study. Subjects ingested one and two cups of decaffeinated Italian espresso coffee in random order at 5- to 7-day intervals. RESULTS: In the hour following the ingestion of two cups of DC, FMD increased (mean+/-s.e.m.): 0 min, 7.4+/-0.7%; 30 min, 8.0+/-0.6%; 60 min, 10.8+/-0.8%; P<0.001) as compared to consumption of one cup of DC (0 min, 6.9+/-0.7%; 30 min, 8.4+/-1.2%; 60 min, 8.5+/-1.1%; 3 x 2 repeated-measures analysis of variance: P=0.037 for time x treatment effect). Blood pressure did not differ between groups, and basal heart rate was lower in the two-cup group at baseline and 60 min. CONCLUSIONS: The present study demonstrated a significant acute favorable dose-dependent effect of decaffeinated espresso coffee on endothelial function. Further studies are needed to investigate the effects of chronic use of DC especially with respect to caffeinated coffee and in subjects with cardiovascular diseases.

Reconocimiento y soporte nutricional precoz en pacientes hospitalizados desnutridos / Identification and early nutritional support in hospitalized malnourished patients

Introducción: La desnutrición en pacientes hospitalizados tiene una prevalencia en nuestro medio del 53%. El enfoque terapéutico genera opiniones controvertidas. Objetivos: Determinar si una intervención nutricional precoz en los pacientes hospitalizados desnutridos mediante un suplemento nutricional oral mejora el pronóstico de los mismos en términos de disminución de la morbi-mortalidad y estadía hospitalaria. Material y métodos: Estudio prospectivo randomizado integrado por grupo tratado-grupo control de pacientes hospitalizados desnutridos en áreas de medicina y neumología. El diagnóstico nutricional se realizó mediante Valoración Global Subjetiva. Los B y C se asignaron a recibir la dieta hospitalaria acorde a sus necesidades y patología (grupo Control) y al grupo tratado se lo instó además a ingerir un suplemento nutricional estándar. Se controló la aparición de infecciones, úlceras de presión, días de hospitalización, mortalidad y peso. Resultados: Se realizaron más de 1.700 Valoraciones Globales Subjetivas. Se controlaron hasta el alta hospitalaria o el fallecimiento a 537 pacientes, 264 tratados y 273 controles. No se encontraron diferencias estadísticamente significativas en la mortalidad, estadía hospitalaria, o aparición de complicaciones entre el grupo tratado y el control. El grupo Tratado presentó un aumento de peso con respecto al Control estadísticamente significativo. Conclusiones: No pudieron demostrarse beneficios con el suplemento nutricional oral utilizado en términos de mortalidad, estadía hospitalaria o complicaciones infecciosas ni úlceras de presión. El aumento significativo en el peso, en el grupo Tratado permite concluir que el suplemento trató efectivamente la desnutrición en este grupo. Esta nueva situación clínica significa un mejor pronóstico, como ya ha sido demostrado El mismo sin embargo no pudo objetivarse mediante los parámetros planteados. Estudios a más largo plazo se requieren para valorar cuánto esta mejoría nutricional se puede mantener en el tiempo, y signifique una mejoría en el pronóstico a largo plazo

Introduction: The prevalence of hyponutrition in hospitalized patients in our setting is 53%. The therapeutic approach is controversial. Objectives: To determine whether an early nutritional intervention in hospitalized patients by means of oral nutritional support can improve their prognosis regarding decreased morbimortality and hospital stay. Material and methods: Randomized prospective study comprised by a treatment group and a control group of malnourished patients hospitalized at the Internal Medicine and Respiratory Medicine Departments. The nutritional diagnosis was made by using the Subjective Global Assessment. Groups B and C were assigned to receive the hospital diet according to their needs and pathology (control group) and the treatment group also received a standard nutritional supplement. We recorded the development of infections, pressure ulcers, hospitalization days, mortality, and weight. Results: We performed more than 1,700 Subjective Global Assessments. Five hundred and thirty seven patients (264 treated and 273 controls) were followed-up until hospital discharge or death. We did not find statistically significant differences immortality, hospital stay, or occurrence of complications between the treatment group and the control group. The treatment group presented statistically significant weight increase as compared with the control group. Conclusions: We could not demonstrate benefits when using the oral nutritional supplement in terms of mortality, hospital stay, infectious complications, or pressure ulcers. The significant weight increase in the treatment group allowed us concluding that the supplement effectively treated hypo nutrition in this group. This new clinical status implies a better prognosis, as it nutritional improvement can be sustained, implying a better prognosis in the long run has already been shown. However, this could not be observed by means of the study parameters. Long-term studies are required to determine for how long this

Embolias gaseosas y terapia por oxigenación hiperbárica durante la gestación / Uterine rupture secondary to dinoprostone in association with epidural analgesia

Aportamos el caso de una mujer embarazada que presentó una embolia paradójica gaseosa subsiguiente a la desconexión del catéter de una vía venosa central. La instalación secundaria de una hemiplejía derecha asociada con un síndrome confusional justificó el tratamiento de urgencia por oxigenoterapia hiperbárica, lo que permitió la remisión completa del cuadro neurológico inicial. La presentación de este caso clínico pone en primer plano la discusión de los riesgos de embolia gaseosa durante el embarazo y el posparto, las indicaciones y los efectos de la oxigenoterapia hiperbárica sobre el feto (AU)

Embolias gaseosas y terapia por oxigenación hiperbárica durante la gestación / Air embolism and hyperbaric oxygen therapy during pregnancy

Aportamos el caso de una mujer embarazada que presentó una embolia paradójica gaseosa subsiguiente a la desconexión del catéter de una vía venosa central. La instalación secundaria de una hemiplejía derecha asociada con un síndrome confusional justificó el tratamiento de urgencia por oxigenoterapia hiperbárica, lo que permitió la remisión completa del cuadro neurológico inicial. La presentación de este caso clínico pone en primer plano la discusión de los riesgos de embolia gaseosa durante el embarazo y el posparto, las indicaciones y los efectos de la oxigenoterapia hiperbárica sobre el feto (AU)

The sesquiterpene lactone dehydroleucodine (DhL) affects the growth of cultured epimastigotes of Trypanosoma cruzi.

Here, we report an inhibitory effect of a sesquiterpene lactone dehydroleucodine (DhL) on the growth of Trypanosoma cruzi in culture. At concentrations of the drug between 5 and 10 microg/ml in the medium,the parasites remained alive for at least 4 days. Higher concentrations of DhL were lethal for the parasites within a few hours. The effect of DhL is irreversible. Morphological changes induced by DhL were also observed in the parasites. The effect of DhL was blocked by the presence of reducing substrates such as glutathione or dithiothreitol, but these agents were not able to reverse the effect of DhL if added 2 days after the start of drug exposure.

[A case control study of the relationship between diet and breast cancer in a sample from 3 Spanish hospital populations. Effects of food, energy and nutrient intake]. / Estudio caso-control de la relación dieta y cáncer de mama en una muestra procedente de tres poblaciones hospitalarias españolas. Repercusión del consumo de alimentos, energía y nutrientes.

A case-control study was conducted to analyze the possible role of diet on the incidence of breast cancer in a group of 275 women (139 cases and 136 controls) recruited from three hospital populations (Madrid, Mérida, and Santiago de Compostela). The retrospective intake of foods was studied by a modified dietary history; from this the intake of energy, nutrients, fiber, and alcohol was derived. Intake of oils and fats was significantly higher among cases, which translates into a higher intake of lipids and vitamin E. In contrast, intake of vitamin D and legumes was significantly lower. No differences were observed regarding other foods and nutrients between cases and controls. The estimate of the odds ratio as a relative risk measure for breast cancer, adjusted and unadjusted for total energy, indicates that intake of cereals and legumes, proteins, carbohydrates and fiber is apparently a protective factor, whereas an excessive intake of meat, oils and fats and a lipid intake higher than 46% of the total caloric intake or poly-unsaturated fatty acids higher than 15 g would be a risk factor for this pathology.