The impact of butyrate on group B Streptococcus-induced intestinal barrier disruption.

Group B Streptococcus (Streptococcus agalactiae; GBS) is a leading cause of neonatal sepsis worldwide. As a pathobiont of the intestinal tract, it is capable of translocating across barriers leading to invasive disease. Neonatal susceptibility to invasive disease stems from immature intestinal barriers. GBS intestinal colonization induces major transcriptomic changes in the intestinal epithelium related to barrier function. Butyrate, a microbial metabolite produced by fermentation of dietary fiber, bolsters intestinal barrier function against enteric pathogens, and these effects can be transferred in utero via the placenta to the developing fetus. Our aim was to determine if butyrate mitigates GBS disruption of intestinal barriers. We used human intestinal epithelial cell (IEC) lines to evaluate the impact of butyrate on GBS-induced cell death and GBS adhesion and invasion. IECs and human fetal tissue-derived enteroids were used to evaluate monolayer permeability. We evaluated the impact of maternal butyrate treatment (mButyrate) using our established mouse model of neonatal GBS intestinal colonization and late-onset sepsis. We found that butyrate reduces GBS-induced cell death, GBS invasion, monolayer permeability, and translocation in vitro. In mice, mButyrate decreases GBS intestinal burden in offspring. Our results demonstrate the importance of bacterial metabolites, such as butyrate, in their potential to bolster epithelial barrier function and mitigate neonatal sepsis risk.IMPORTANCEGroup B Streptococcus (GBS) is a leading cause of neonatal morbidity and mortality. It is a commensal of the intestines that can translocate across barriers leading to sepsis in vulnerable newborns. With the rise in antibiotic-resistant strains and no licensed vaccine, there is an urgent need for preventative strategies. Butyrate, a short-chain fatty acid metabolized in the gut, enhances barrier function against pathogens. Importantly, butyrate is transferred in utero, conferring these benefits to infants. Here, we demonstrate that butyrate reduces GBS colonization and epithelial invasion. These effects were not microbiome-driven, suggesting butyrate directly impacts epithelial barrier function. Our results highlight the potential impact of maternal dietary metabolites, like butyrate, as a strategy to mitigate neonatal sepsis risk.

Going Viral: A Systematic Review of Google Trends in Plastic Surgery and a Recommended Framework for Its Use.

As the leading global search engine with billions of daily queries, Google and its open-source Google Trends (Google, Mountain View, CA) represent an emerging and powerful tool for epidemiological and medical research. Within the field of plastic surgery, Google Trends has yielded insights into online interest for facial feminization surgery, gender-affirmation surgery, cosmetic body procedures, and breast reconstruction, among other common procedures. The existing literature of Google Trends in plastic surgery was systematically reviewed following established Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Google Trends' 4 input variables-keyword, region, period, and category-were assessed. Seventeen plastic surgery studies employing Google Trends were reviewed. There was strong inter-rater reliability (Cohen's kappa = 0.68). Analyzing keyword syntax, only 3 of 17 studies (17.6%) used the "+" function to combine terms, which can significantly improve sensitivity. For the region variable, 12 of 16 studies (75%) conducted worldwide searches; yet, none of the studies used any non-English keywords, introducing significant bias. For the period, 88.2% of studies utilized a timespan of greater than 5 years, resulting in monthly intervals between data points in Google Trends. For the "category" variable, none of the studies appear to have employed the "surgery," "cosmetic surgery" or "health" categories to improve specificity. Google Trends is presented as an emerging methodology in plastic surgery research. The strengths and limitations of Google Trends as a resource for plastic surgeons and medical professionals are discussed, and a recommended step-by-step guide for conducting and interpreting Google Trends research is outlined.

Spanish Guidelines for Diagnosis, Management, Treatment, and Prevention of DRESS Syndrome.

BACKGROUND AND OBJECTIVE: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a complex multisystemic severe drug hypersensitivity reaction whose diagnosis and management are troublesome. DRESS syndrome requires management by various specialists. The correct identification of the culprit drug is essential to ensure safe future therapeutic options for the patient. There are no previous Spanish guidelines or consensus statements on DRESS syndrome. Objective: To draft a review and guidelines on the clinical diagnosis, allergy work-up, management, treatment, and prevention of DRESS syndrome in light of currently available scientific evidence and the experience of experts from multiple disciplines. METHODS: These guidelines were drafted by a panel of allergy specialists from the Drug Allergy Committee of the Spanish Society of Allergy and Clinical Immunology (SEAIC), together with other medical specialists involved in the management of DRESS syndrome and researchers from the PIELenRed consortium. A review was conducted of scientific papers on DRESS syndrome, and the expert panel evaluated the quality of the evidence of the literature and provided grades of recommendation. Whenever evidence was lacking, a consensus was reached among the experts. RESULTS: The first Spanish guidelines on DRESS syndrome are now being published. Important aspects have been addressed, including practical recommendations about clinical diagnosis, identification of the culprit drug through the Spanish pharmacovigilance system algorithm, and the allergy work-up. Recommendations are provided on management, treatment, and prevention. Algorithms for the management of DRESS in the acute and recovery phases have been drawn up. Expert consensus-based stepwise guidelines for the management and treatment of DRESS syndrome are provided.

[Monitoring of COVID-19 patients by telemedicine with telemonitoring]. / Telemedicina con telemonitorización en el seguimiento de pacientes con COVID-19.

AIM: To asses if telemedicine with telemonitoring is a clinically useful and secure tool in the tracking of patients with COVID-19. METHODS: A prospective observational study of patients with COVID-19 diagnosis by positive PCR considered high-risk tracked with telemedicine and telemonitoring was conducted in the sanitary area of Lugo between March 17th and April 17th, 2020. Two groups of patients were included: Outpatient Tracing from the beginning and after discharge. Every patient sent a daily clinical questionnaire with temperature and oxygen saturation 3 times a day. Proactive monitoring was done by getting in touch with every patient at least 11 a day. RESULTS: 313 patients (52.4% female) with a total average age of 60.9 (DE 15.9) years were included. Additionally, 2 patients refused to join the program. Since the beginning, 224 were traced outpatient and 89 after being discharged. Among the first category, 38 (16.90%) were referred to Emergency department on 43 occasions; 18 were hospitalized (8.03%), and 2 deceased. Neither deaths nor a matter of vital emergency occurred at home. When including patients after admissions monitoring was done in 304 cases. One patient re-entered (0.32%) to the hospital, and another one left the program (0.32%). The average time of monitoring was 11.64 (SD 3.58) days, and 224 (73.68%) patients were discharged during the 30 days of study. CONCLUSIONS: Our study suggests that telemedicine with home telemonitoring, used proactively, allows for monitoring high-risk patients with COVID-19 in a clinically useful and secure way.

Prevention of silica health effects in Italy: current challenges for the Occupational Health and Safety Unit of the Italian National Health Service.

BACKGROUND: Since its foundation in 2002, the Italian Silica Network (NIS), a collaborative network of professionals and public authorities, has been engaged in several aspects of research, control, and prevention of silica exposure and effects, and also in support for compensation claims for silica-related occupational health effects in Italy. METHODS: We start with a report on the NIS point of view concerning the recent scientific results (from epidemiology and laboratory studies), including those carried out by NIS in cooperation with Italian universities and other public agencies. This is followed by a description of the data on silica exposure in different Italian workplaces and guidelines for the management of occupational exposure to silica, as developed by two model regional programmes for the ceramics industry, metal foundries and tunnel excavation. RESULTS: The NIS initiatives highlighted the persistence of workplace conditions posing a significant risk for silica-related health effects, particularly in small industries and workshops. Experimental work has also shown that a number of physical and chemical factors affect the bioreactivity of silica particles. CONCLUSION: Based on NIS experience, it appears clear that currently conditions exist in Italy so as to positively contribute to the WHO Programme for the eradication of silicosis and the other diseases related to silica exposure. In order to achieve this goal, a coordinated and wide-ranging effort is required to reduce the wide gap in specific prevention activities, particularly in small industries and workshops, where high levels of silica exposure sometimes occur.

[Application of joint analysis to ongoing training of pharmacy personnel]. / Aplicación del análisis conjunto en la formacion continua de un servicio de farmacia.

INTRODUCTION: Ongoing training by means of clinical sessions constitutes an essential activity for a pharmacy department, being joint analysis useful to adapt the clinical sessions' characteristics to the preferences of the professionals involved. By means of this study we hope to optimize clinical sessions for their better use and efficiency. METHODS: A least squares model was used to assess the usefulness of different clinical session profiles. Data was collected from 14 individual interviews (7 specialists and 7 residents); these interviews consisted in ordering the clinical session profiles by order of preference. RESULTS: The most valued attributes were duration of sessions (29.9%) and the structure of teaching content (27.8%) in both groups studied; although the duration of the sessions was assigned greater value by the group of residents (31.1% vs. 27.2%). The availability of bibliographical references was the third attribute most valued (17.9%), and the two last attributes by order of importance were availability of a copy in files for storage (13.8%) and multimedia content (10.5%). DISCUSSION: The adaptation of clinical sessions as an integral part of ongoing training leads us to see that we can modify the duration, content structure and availability of bibliographical references so as to adapt them to the preferences of the professionals involved. However, according to the population surveyed, other attributes are of little importance.

[Analytical quality in biological monitoring of workers exposed to chemicals: experience of the Prevention and Safety at the Workplace Service in Modena]. / Qualità del dato analitico nel monitoraggio biologico dei lavoratori esposti a sostanze chimiche: esperienza del Servizio Prevenzione e Sicurezza Ambienti di Lavoro della Azienda USL di Modena.

BACKGROUND: The quality of laboratory data is one of the main factors in guaranteeing efficacy of biological monitoring. OBJECTIVES: To analyze the quality of laboratory data used for biological monitoring of exposed workers. METHODS: A survey involving 18 companies employing 945 workers in the area of Modena, Italy, was carried out in 2008. RESULTS: Most of the 9 private laboratories receiving biological samples did not perform directly part or all of the laboratory assessments requested, but this was not indicated in the final report. Major problems were observed in the application of internal quality control, and only one laboratory participated in external quality assessment for blood lead measurements. CONCLUSIONS: Our results raise major concerns on the traceability and reliability of laboratory assessments performed for biomonitoring of exposed workers. Systematic evaluation of the quality of analytical data would be highly recommendable.

Transfusional optimization in liver transplant using viscoelastic test guided therapy. / Optimización transfusional en el trasplante de hígado usando terapia guiada por pruebas viscoelásticas.

BACKGROUND: Assess the reduction of packed red blood cells (PRBCs) transfusion in liver transplantation (LT) after the introduction of the thromboelastometry as intraoperative coagulation monitor. METHODS: We conducted a retrospective cohort study (n=92), randomized into two groups: groupA (control), in whom transfusion therapy was based on conventional laboratory tests (CLT), and groupB (ROTEM), whose blood transfusion was performed as protocolized algorithms, guided by thromboelastometry (ROTEM). We analyzed packed red blood cells (PRBCs) units, transfused units of fresh frozen plasma (FFP), platelets units, fibrinogen and tranexamic acid. We used the chi square test for the comparison of proportions and Student's t test to compare means when the distribution was normal. Otherwise, Mann-Whitney U test was performed. RESULTS: In groupA 84.8% of patients required transfusion of PRBCs, with a median (IQR) of 4 (1.5-6), compared with 67.4% in groupB with a median (IQR) of 2 (0-4) (P<.05). We also found differences in the following variables: FFP transfusion rate was 84.8% with a median (IQR) of 5 (2-12) IU in groupA and 56.5% (median (IQR) of 1 (0-4.5) in B (P<.001) and in the fibrinogen administration, that was 6.5% in groupA and 34.8% in groupB (P<.01). Backward stepwise logistic regression model showed associations between the clamping time, the preoperative hemoglobin, the portal hypertension (PHT) and being or not in the treatment group and the need for perioperative transfusion. We didn't find significant differences in the incidence of complication during the early postoperative period between the two groups. CONCLUSIONS: The introduction of thromboelastometry (ROTEM) measurements in hemostatic therapy algorithms reduces the transfusion rate of FFP and PRBCs during liver transplantation. The using of ROTEM derived thresholds leads to detecting higher requirements of fibrinogen compared to conventional laboratory tests.

Monitoring of COVID-19 patients by telemedicine with telemonitoring. / Telemedicina con telemonitorización en el seguimiento de pacientes con COVID-19.

AIM: To asses if telemedicine with telemonitoring is a clinically useful and secure tool in the tracking of patients with COVID-19. METHODS: A prospective observational study of patients with COVID-19 diagnosis by positive PCR considered high-risk tracked with telemedicine and telemonitoring was conducted in the sanitary area of Lugo between March 17th and April 17th, 2020. Two groups of patients were included: Outpatient Tracing from the beginning and after discharge. Every patient sent a daily clinical questionnaire with temperature and oxygen saturation 3 times a day. Proactive monitoring was done by getting in touch with every patient at least 11a day. RESULTS: 313 patients (52.4% female) with a total average age of 60.9 (DE 15.9) years were included. Additionally, 2 patients refused to join the program. Since the beginning, 224 were traced outpatient and 89 after being discharged. Among the first category, 38 (16.90%) were referred to Emergency department on 43 occasions; 18 were hospitalized (8.03%), and 2 deceased. Neither deaths nor a matter of vital emergency occurred at home. When including patients after admissions monitoring was done in 304 cases. One patient re-entered (0.32%) to the hospital, and another one left the program (0.32%). The average time of monitoring was 11.64 (SD 3.58) days, and 224 (73.68%) patients were discharged during the 30 days of study. CONCLUSIONS: Our study suggests that telemedicine with home telemonitoring, used proactively, allows for monitoring high-risk patients with COVID-19 in a clinically useful and secure way.

Characterization of Vibrio harveyi strains recovered from diseased farmed Senegalese sole (Solea senegalensis).

AIM: To characterize 16 Vibrio harveyi strains isolated from different epizootic outbreaks affecting farmed Senegalese sole. MATERIALS AND RESULTS: The Vibrio harveyi strains tested have broad phenotypic diversity based on their biochemical and exoenzymatic patterns, outer membrane proteins (OMP), extracellular product (ECP) patterns and presence of prophages. Lethal dose 50 (LD(50)) of the strains and in vitro antagonism tests with two probiotic strains were also determined. The OMP analysis revealed three different patterns (A, M and V). The electrophoretic analysis of the ECP showed two different groups. All strains considered virulent based on their LD(50) exhibited the same protein pattern in their ECP (pattern I), while all nonvirulent strains showed a different profile (pattern II). About 32% of the tested strains were positive for prophages, although a clear relationship between virulence and the presence of prophages has not been established. CONCLUSIONS: The results obtained have shown differences between virulent and avirulent strains isolated from diseased farmed Senegalese sole based on the protein patterns of their ECP. However, a clear relationship between virulence and presence of prophages has not been established. SIGNIFICANCE AND IMPACT OF THE STUDY: The differences observed between virulent and nonvirulent strains could be used to design prophylactic strategies against diseases caused by V. harveyi in farmed Senegalese sole.

Contenido en Lisina y Arginina en soluciones de aminoácidos comercializadas en España / Comparison of Lysine and Arginine content in amino acid parenteral formulas approved in Spain

Introducción: La terapia basada en péptidos con radionúclidos representa una estrategia terapéutica eficaz frente a tumores neuroendocrinos pero no está exenta de efectos adversos como la nefrotoxicidad. Para prevenir esta nefrotoxicidad se emplean soluciones de aminoácidos de Lisina y Arginina. El objetivo de este artículo es conocer el contenido de L-Lisina, L-Arginina y la osmolaridad en las soluciones de aminoácidos autorizadas en España hasta marzo de 2021 y comparar la composición de éstas con las características de las soluciones nefroprotectoras indicadas en la ficha técnica de Lutecio. Métodos: Revisión de las fichas técnicas de todas aquellas soluciones de aminoácidos comercializadas en España. Las presentaciones comerciales con otros macronutrientes o electrolitos que no tengan una función de estabilidad o conservación de la solución fueron excluidas. Resultados: De las 23.658 presentaciones a marzo de 2021, fueron seleccionadas 90 soluciones. Tras esta primera selección, 18 presentaciones comerciales cumplían los criterios de inclusión. De las soluciones incluidas, al extrapolar el contenido a un volumen máximo de 2000 ml, cumplían con los objetivos de L-Lisina y L-Arginina. El contenido difería entre presentaciones pero contenían más L-Arginina y presentaban una alta osmolaridad. Discusión: Empleando un volumen máximo de 2000 ml, la mayoría de las soluciones incluidas en el estudio cumplían con los requisitos de L-Lisina y L-Arginina indicadas en la ficha técnica, si bien pueden existir problemas de administración por vía periférica por su osmolaridad. El hecho de que incluyan otros aminoácidos podría dar lugar a otro tipo de efectos adversos como toxicidad gastrointestinal. (AU)

Introduction: Peptide Receptor Radionuclide Therapy represents an effective therapeutic strategy against neuroendocrine tumors, but it is not without serious adverse effects such as nephrotoxicity. In order to prevent this nephrotoxicity, Lysine and Arginine amino acid solutions are used. The objectives of this article are to to know the content of L-Lysine, L-Arginine and the osmolarity in commercial amino acid solutions authorized in Spain until march 2021 and to compare their composition with the characteristics of the nephroprotective solutions indicated in the Lutetium technical data sheet. Methods: Review of all the technical sheets of all those amino acid solutions that were marketed in Spain. Commercial presentations with other macronutrients or electrolytes that do not have a stability or solution conservation function were excluded. Results: From the 23,658 commercial presentations as of march 2021, 90 parenteral nutrition solutions were selected. After this first selection, 18 commercial presentations met the inclusion criteria. Of the included solutions, when the content was extrapolated to a maximum volume of 2000 ml, they met the objectives of L-Lysine and L-Arginine. The content varied between solutions and was mostly the highest content in L-Arginine. The solutions studied had a high osmolarity. Discussion: Using a maximum volume of 2000 ml, most of the solutions included in the study fulfilled the requirements of the content of L-Lysine and L-Arginine indicated in the technical data sheet, although there may be problems of administration by peripheral route to the have a high osmolarity. The fact that they include other amino acids could lead to other types of adverse effects such as gastrointestinal toxicity. (AU)

[Sacral root neuromodulation as treatment for fecal incontinence. Preliminary results]. / Neuromodulación de raíces sacras como tratamiento de la incontinencia fecal. Resultados preliminares.

We present our initial experience in the treatment of fecal incontinence (FI) with sacral root neuromodulation (SRN) by reporting the results of a prospective study with 26 patients where baseline Wexner-Cleveland scale scores and ability to delay defecation were compared to results after one year with SRN. The initial study of patients included history taking, general examination, anal ultrasonography, and manometry, and a three-week diary of continence and quality of life specific for FI was used. Before SRN the mean baseline Wexner-Cleveland score was 15.00 +/- 1.81, and 62.50% of patients could only delay defecation for less than a minute. After a year with NRS the mean Wexner-Cleveland score was 4.87 +/- 2.54 (p = 0.0031), and 75.01% of patients could delay defecation above fifteen minutes (p = 0.0018). We also describe the surgical technique and its indications, and finally review the various therapeutical options for FI and show our algorithm for this condition. SRN is an effective technique for the treatment of FI in properly selected patients with no response to medical therapies (including biofeedback) or anatomic correction (sphincteroplasty), with efficacy, little morbidity, and a short hospital stay.

Gc globulin and prealbumin serum levels in patients with cancer and benign inflammatory diseases and in asymptomatic smokers.

Gc globulin and prealbumin serum levels were determined in a coded serum panel from the National Cancer Institute-Mayo Clinic. Serum samples came from 100 patients with cancer (lung, prostate gland, or gastrointestinal tract), from 50 patients with benign inflammatory diseases from the same organs as those of the cancer patients, and from 50 clinically healthy smokers. No differences were observed among groups in the Gc globulin (vitamin D carrier) serum concentrations; however, prealbumin (vitamin A carrier) serum levels were decreased for patients with benign inflammatory diseases and for cancer patients; the cancer group showed the greatest decrease.

Distinct glycosylation of serum proteins in patients with cancer: brief communication.

Concanavalin A and wheat germ agglutinin, lectins that interact with serum glycoprotein in a manner similar to the antigen--antibody reaction, were used as "antibodies" in a single radial immunodiffusion technique to test a coded serum panel (from the National Cancer Institute, Bethesda, Md., and the Mayo Clinic, Rochester, Minn.) containing a) 99 serum samples from patients with different types of malignant neoplasms of the gastrointestinal tract, prostate gland, and lung, b) 50 samples from patients with benign diseases of the same organs as those affected in the cancer patients, and c) 50 samples from apparently healthy smokers. The resulting precipitation rings were not correlated to serum protein concentration, and the differences (demonstrated by Student's t-test and with a generalization of the one-sided two-sample Kolmogorov-Smirnov statistic for evaluating diagnostic tests) established that serum glycoproteins are glycosylated differently in cancer patients than in people without cancer.

Telemedicina con telemonitorización en el seguimiento de pacientes con COVID-19 / Tracing of COVID-19 patients by telemedicine with telemonitoring

OBJETIVO: Evaluar si la telemedicina con telemonitorización es una herramienta clínicamente útil y segura para el seguimiento de pacientes con COVID-19. MÉTODOS: Estudio observacional prospectivo de los pacientes con diagnóstico de COVID-19 por PCR positiva y considerados de alto riesgo que se siguieron con telemedicina y telemonitorización en el Área Sanitaria de Lugo entre el 17 de marzo y el 17 de abril de 2020. Se incluyeron dos grupos de pacientes: seguimiento ambulatorio desde el inicio y tras el alta hospitalaria. Cada paciente remitió un cuestionario clínico al día con su temperatura y saturación de oxígeno 3 veces al día. El seguimiento fue proactivo contactando con todos los pacientes al menos una vez al día. RESULTADOS: Se incluyeron 313 pacientes (52,4% mujeres) con edad media 60,9 (DS 15,9) años. Otros 2 pacientes rehusaron entrar en el programa. Desde el inicio se siguieron ambulatoriamente 224 pacientes y 89 tras su alta hospitalaria. Entre los primeros, 38 (16,90%) se remitieron a Urgencias en 43 ocasiones con 18 (8,03%) ingresos y 2 fallecidos. En los domicilios no hubo fallecimientos ni urgencias vitales. Incluyendo a los pacientes tras hospitalización, el seguimiento se realizó en 304 casos. Un paciente reingresó (0,32%) y otro abandonó (0,32%). El tiempo medio de seguimiento fue 11,64 (SD 3,58) días y en los 30 días del estudio 224 (73,68%) pacientes fueron dados de alta. CONCLUSIONES: Nuestros datos sugieren que la telemedicina con telemonitorización domiciliaria, utilizada de forma proactiva, permite un seguimiento clínicamente útil y seguro en pacientes con COVID-19 de alto riesgo

AIM: To asses if telemedicine with telemonitoring is a clinically useful and secure tool in the tracking of patients with COVID-19. METHODS: A prospective observational study of patients with COVID-19 diagnosis by positive PCR considered high-risk tracked with telemedicine and telemonitoring was conducted in the sanitary area of Lugo between March 17th and April 17th, 2020. Two groups of patients were included: Outpatient Tracing from the beginning and after discharge. Every patient sent a daily clinical questionnaire with temperature and oxygen saturation 3 times a day. Proactive monitoring was done by getting in touch with every patient at least once a day. RESULTS: 313 patients (52.4% female) with a total average age of 60.9 (DS 15.9) years were included. Additionally, 2 patients refused to join the program. Since the beginning, 224 were traced outpatient and 89 after being discharged. Among the first category, 38 (16.90%) were referred to Emergency department on 43 occasions; 18 were hospitalized (8.03%), and 2 deceased. Neither deaths nor a matter of vital emergency occurred at home. When including patients after admissions monitoring was done in 304 cases. One patient re-entered (0.32%) to the hospital, and another one left the program (0.32%). The average time of monitoring was 11.64 (SD 3.58) days, and 224 (73.68%) patients were discharged during the 30 days of study. CONCLUSIONS: Our study suggests that telemedicine with home telemonitoring, used proactively, allows for monitoring high-risk patients with COVID-19 in a clinically useful and secure way

Spanish guidelines for diagnosis, management, treatment, and prevention of DRESS syndrome

BACKGROUND: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a complex multisystemic severe drug hypersensitivity reaction whose diagnosis and management are troublesome. DRESS syndrome requires management by various specialists. The correct identification of the culprit drug is essential to ensure safe future therapeutic options for the patient. There are no previous Spanish guidelines or consensus statements on DRESS syndrome. OBJECTIVE: To draft a review and guidelines on the clinical diagnosis, allergy work-up, management, treatment, and prevention of DRESS syndrome in light of currently available scientific evidence and the experience of experts from multiple disciplines. METHODS: These guidelines were drafted by a panel of allergy specialists from the Drug Allergy Committee of the Spanish Society of Allergy and Clinical Immunology (SEAIC), together with other medical specialists involved in the management of DRESS syndrome and researchers from the PIELenRed consortium. A review was conducted of scientific papers on DRESS syndrome, and the expert panel evaluated the quality of the evidence of the literature and provided grades of recommendation. Whenever evidence was lacking, a consensus was reached among the experts. RESULTS: The first Spanish guidelines on DRESS syndrome are now being published. Important aspects have been addressed, including practical recommendations about clinical diagnosis, identification of the culprit drug through the Spanish pharmacovigilance system algorithm, and the allergy work-up. Recommendations are provided on management, treatment, and prevention. Algorithms for the management of DRESS in the acute and recovery phases have been drawn up. Expert consensus-based stepwise guidelines for the management and treatment of DRESS syndrome are provided

ANTECEDENTES: El síndrome DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) es una reacción cutánea grave inducida por hipersensibilidad a fármacos, compleja y multisistémica. Su diagnóstico y manejo es difícil e implica a diferentes especialistas. Es muy importante una correcta identificación del fármaco responsable para que el paciente disponga de opciones terapéuticas seguras en el futuro. No hay guías ni documentos de consenso españoles previos sobre el síndrome DRESS. OBJETIVO: Realizar una revisión y guía sobre el diagnóstico clínico y alergológico, manejo, tratamiento y prevención del DRESS según la evidencia científica disponible y la experiencia de expertos de diferentes especialidades médicas. MÉTODOS: Esta guía ha sido elaborada por un grupo de alergólogos del Comité de Alergia a Fármacos de la SEAIC, junto a otros especialistas involucrados en el manejo del DRESS e investigadores del Consorcio PIELenRed. Se realizó una búsqueda de publicaciones científicas sobre DRESS y el grupo de expertos evaluó la evidencia científica de la literatura y aportaron grados de recomendación. Cuando no existía evidencia se alcanzó un consenso entre expertos. RESULTADOS: Se publica la guía española sobre DRESS. Incluye aspectos prácticos importantes sobre el diagnóstico clínico, la identificación de fármacos causales a través del algoritmo del Sistema Español de Farmacovigilancia y guía para el diagnóstico alergológico. Se realizan recomendaciones sobre el manejo, tratamiento y prevención del DRESS. Se aportan algoritmos sobre el manejo en la fase aguda y en la de recuperación. Se ha elaborado una guía terapéutica escalonada consensuada por expertos especialistas implicados en el tratamiento del DRESS

Gastroenteritis-associated Guillain-Barré syndrome on the Caribbean island Curaçao.

BACKGROUND: The number of patients with Guillain-Barré syndrome (GBS) who have been observed in Curaçao, the Netherlands Antilles, may be increasing. METHODS: Clinical and serologic data were obtained from records of patients admitted between 1987 and 1999 and fulfilling National Institute of Neurological and Communicative Disorders and Stroke criteria for GBS. When possible, serum and stool samples were collected. The results were compared with a large Dutch epidemiologic study. RESULTS: The authors identified 49 patients, an overall crude incidence rate (IR) in Curaçao of 2.53/100,000 inhabitants (95% CI 1.87 to 3.35) (Dutch study 1.18, rate ratio (RR) of 2.14, p < 0.001). The IR in Curaçao increased from 1.62 in 1987 to 1991 to 3.10 in 1992 to 1999, RR 5.22 (95% CI 2.48 to 10.2, p = 0.02). The IR showed a curvilinear shape within a year. In comparison with the Dutch group, patients from Curaçao had a more severe course of the disease, with a mortality rate of 23% (3.4% in the Dutch group, p < 0.001), a higher percentage of preceding gastroenteritis (p < 0.001), and less sensory involvement (p < 0.001). In 8 of 10 serum samples, evidence was found for a recent infection with Campylobacter jejuni. CONCLUSIONS: The authors found a steady increase in incidence of GBS over the years in association with a more pronounced seasonal preponderance and a more severe course. The clinical characteristics suggest a role for C jejuni.

Nimesulide in the treatment of menstrual migraine.

In a controlled double-blind clinical trial, 30 patients aged 18 to 45 years, with menstrual migraine, were randomly assigned to 2 parallel treatment groups of 15 patients each. One group received granular nimesulide 100mg 3 times daily and the other group received placebo. Each treatment was given for 10 days, starting from the onset of migraine symptoms, and was repeated for the 2 following menstrual cycles. The overall assessment of efficacy in the 2 groups was based on hourly self-evaluation of pain during each study day. In patients treated with nimesulide, pain intensity and duration were significantly reduced compared with placebo (p = 0.0001) during all the menstrual cycles in the study.

Study of pancreatic secretion after subtotal gastrectomy followed by different methods of reconstruction.

To study the effect subtotal gastrectomies have on exocrine pancreatic function, 12 dogs were prepared with gastric and duodenal cannulas using a modified technique of Thomas. In our study protocol, we collected pancreatic juice by selective ductal cannulation after having applied two types of stimulation [tryptophan intraduodenally together with secretin intravenously (i.v.) and cholecystokinin i.v. together with secretin i.v.]. Our results did not show a significant increase in pancreatic juice after performing the gastrectomies. In both cases the concentration of bicarbonate decreased significantly in contrast to that in the control group. After Billroth I anastomosis, however, a significant decrease in the first periods of stimulation in relation to the gastrojejunostomy was appreciated. In the case of proteins, a loss of the dose/effect relation in these parameters was seen only after Billroth II anastomosis.