Computer Vision for Parkinson's Disease Evaluation: A Survey on Finger Tapping.

Parkinson's disease (PD) is a progressive neurodegenerative disorder whose prevalence has steadily been rising over the years. Specialist neurologists across the world assess and diagnose patients with PD, although the diagnostic process is time-consuming and various symptoms take years to appear, which means that the diagnosis is prone to human error. The partial automatization of PD assessment and diagnosis through computational processes has therefore been considered for some time. One well-known tool for PD assessment is finger tapping (FT), which can now be assessed through computer vision (CV). Artificial intelligence and related advances over recent decades, more specifically in the area of CV, have made it possible to develop computer systems that can help specialists assess and diagnose PD. The aim of this study is to review some advances related to CV techniques and FT so as to offer insight into future research lines that technological advances are now opening up.

Involvement of Microbiota in Insect Physiology: Focus on B Vitamins.

Insects are highly successful in colonizing a wide spectrum of ecological niches and in feeding on a wide diversity of diets. This is notably linked to their capacity to get from their microbiota any essential component lacking in the diet such as vitamins and amino acids. Over a century of research based on dietary analysis, antimicrobial treatment, gnotobiotic rearing, and culture-independent microbe detection progressively generated a wealth of information about the role of the microbiota in specific aspects of insect fitness. Thanks to the recent increase in sequencing capacities, whole-genome sequencing of a number of symbionts has facilitated tracing of biosynthesis pathways, validation of experimental data and evolutionary analyses. This field of research has generated a considerable set of data in a diversity of hosts harboring specific symbionts or nonspecific microbiota members. Here, we review the current knowledge on the involvement of the microbiota in insect and tick nutrition, with a particular focus on B vitamin provision. We specifically question if there is any specificity of B vitamin provision by symbionts compared to the redundant yet essential contribution of nonspecific microbes. We successively highlight the known aspects of microbial vitamin provision during three main life stages of invertebrates: postembryonic development, adulthood, and reproduction.

Prevalencia por áreas sanitarias de enfermedad renal crónica en la población diabética de Extremadura durante los años 2012, 2013 y 2014. Un estudio observacional / Prevalence by health areas of chronic kidney disease in diabetic population of Extremadura during the years 2012, 2013 and 2014. An observational study

Antecedentes y objetivo: La diabetes mellitus es la principal causa de enfermedad renal crónica (ERC) en nuestro país. El objetivo fue estimar la prevalencia global y por áreas sanitarias de ERC en la población diabética de Extremadura. Pacientes y métodos: Estudio observacional, longitudinal, retrospectivo en la población diabética atendida en el Sistema Extremeño de Salud durante el periodo 2012-2014. Se incluyeron 90.709 pacientes ≥ 18 años. El cálculo del filtrado glomerular estimado (FGe) se realizó mediante la ecuación CKD-EPI (derivada de la ecuación desarrollada por la Chronic Kidney Disease Epidemiology Collaboration) y se calculó el cociente albúmina/creatinina en orina (CAC). Se consideró paciente con ERC a todo aquel que en su última analítica tenía un FGe<60 mL/min/1,73 m2 y/o un CAC ≥ 30 mg/g, confirmados en una determinación previa separada al menos por tres meses. Resultados: La prevalencia global de ERC fue del 15,6% (17,5% en mujeres y 13,7% en varones) y fue mayor en la provincia de Cáceres (17%) que en la de Badajoz (14,8%, p<0,001), encontrándose la menor prevalencia en el área sanitaria de Navalmoral de la Mata (13%) y la mayor en la de Plasencia (17,8%, p < 0,001). La prevalencia de ERC definida sin necesidad de confirmación de la sostenibilidad del daño renal o del FGe disminuido fue del 26,1% (29,3% en mujeres y 22,9% en varones), lo que supone una sobreestimación de la prevalencia del 67%. Conclusiones: La prevalencia de ERC en población diabética extremeña es menor a la referida habitualmente y difiere significativamente entre sus áreas sanitarias. (AU)

Background and objective: Diabetes mellitus is the leading cause of chronic kidney disease (CKD) in our country. The objective was to estimate the global prevalence and by health areas of CKD in the diabetic population of Extremadura. Patients and methods: Observational, longitudinal retrospective study in the diabetic population attended in the Extremadura Health System in 2012–2014. A total of 90,709 patients ≥ 18 years old were studied. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI). The presence of CKD was defined as follows: an eGFR<60 mL/min/1.73 m2 in a time period of greater than three months or the presence of renal damage, as evaluated by an urine albumin-creatinine ratio (UACR) ≥ 30 mg/g, with or without reduced eGFR, also in a time period of greater than three months. Results: The overall prevalence of CKD was 15.6% (17.5% in women and 13.7% in men) and it was higher in the province of Cáceres (17%) than in Badajoz (14.8%, p<0.001), with the lowest prevalence in the Navalmoral de la Mata health area (13%) and the highest in Plasencia (17.8%, p<0.001). The prevalence of CKD defined without the need for confirmation of the sustainability of kidney damage or decreased eGFR was 26.1% (29.3% in women and 22.9% in men), which represents an overestimation of the prevalence of 67%. Conclusions: The prevalence of CKD in Extremadura's diabetic population is lower than usually referred to and differs significantly between its health areas. (AU)

Prevalence by health areas of chronic kidney disease in the diabetic population of Extremadura in 2012, 2013 and 2014. An observational study.

BACKGROUND AND OBJECTIVE: Diabetes mellitus is the leading cause of chronic kidney disease (CKD) in our country. The objective was to estimate the global prevalence and by health areas of CKD in the diabetic population of Extremadura. METHODS: Observational, longitudinal retrospective study in the diabetic population attended in the Extremadura Health System in 2012-2014. A total of 90,709 patients ≥18 years old were studied. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI). The presence of CKD was was defined as follows: an eGFR <60ml/min/1.73m2 in a time period≥of three months or the presence of renal damage, as evaluated by an urine albumin-creatinine ratio (UACR) ≥30mg/g, with or without reduced eGFR, also in a time period ≥ of three months. RESULTS: The overall prevalence of CKD was 15.6% (17.5% in women and 13.7% in men) and it was higher in the province of Cáceres (17.0%) than in Badajoz (14.8%, p<0.001), with the lowest prevalence in the Navalmoral de la Mata health area (13.0%) and the highest in Plasencia (17.8%, p<0.001). The prevalence of CKD defined without the need for confirmation of the sustainability of kidney damage or decreased eGFR was 26.1% (29.3% in women and 22.9% in men), which represents an overestimation of the prevalence of 67%. CONCLUSIONS: The prevalence of CKD in Extremadura's diabetic population is lower than usually referred to and differs significantly between its health areas.

Actitud terapéutica frente a una reabsorción interna perforante / Therapeutic attitude against a perforating internal resorption

Atendiendo a la localización de la reabsorción radicular, ésta puede ser clasificada en externa o interna. La reabsorción interna es relativamente poco frecuente, y su etiología y patogénesis no está todavía del todo clara. Este artículo muestra la complejidad de un incisivo central superior con una reabsorción interna inflamatoria perforante. El diagnóstico definitivo lo hallamos a través del examen tridimensional, que confirmó la extensión y comunicación con la superficie externa radicular. Aunque como podremos ver a lo largo de la exposición del caso clínico, la ayuda del microscopio nos permitió abordar el caso con mayor seguridad. En todo momento pudimos eliminar el tejido inflamatorio y preparar el conducto de manera adecuada. La obturación en este tipo de casos supone un reto para el endodoncista, siendo éste, mayor cuando se realiza únicamente de manera ortógrada. Para la obturación realizamos una técnica descrita en la literatura, sellando la zona apical a la reabsorción con gutapercha adaptada mediante condensación vertical; la zona reabsortiva con material biocerámico y, por último, la zona coronal con guta-percha inyectada. Se realizó un 3D a los 26 meses para una nueva evaluación de la zona reabsortiva, y así evaluar el estado óseo alrededor de la misma. La paciente se presenta totalmente asintomática sin signos clínicos y con buena salud de los tejidos periapicales

Based on the location of the root resorption, it can be classified as external or internal. Internal resorption is relatively rare, and its etiology and pathogenesis is not yet entirely clear. This article shows the complexity of a superior central incisor with a perforating inflammatory internal resorption. The definitive diagnosis is found through the three-dimensional examination, which confirmed the extension and communication with the external root surface. Although as we can see throughout the presentation of the clinical case, the help of the microscope allowed us to address the case with greater certainty. At all times we were able to remove the inflammatory tissue and prepare the duct properly. The obturation in this type of cases supposes a challenge for the endodontist, being this one, greater when it is done only in an ortograde way. For the filling, we performed a technique described in the literature, filling the apical area with resorption with gutta-percha adapted by vertical condensation; the resorptive zone with bioceramic material and finally the coronal zone with injected gutta-percha. A 3D was performed at 26 months for a new evaluation of the resorptive zone, and thus evaluate the bone state around it. The patient presents totally asymptomatic without clinical signs and with good health of the periapical tissues

Regeneración pulpar: una segunda oportunidad al diente inmaduro. A propósito de un caso / Regenerative endodontics: at second chance to immature apex. A case report

Desde la introducción del término revascularización en 1971, muchos han sido los protocolos descritos para el tratamiento de un diente inmaduro con necrosis pulpar y periodontitis apical. La complejidad que supone la realización de técnicas de apicoformación en dientes con raíces cortas, paredes frágiles, ápices no formados y divergentes, permiten que el tratamiento de endodoncia regenerativa esté indicado. El caso que presentamos a continuación se trata de un paciente de corta edad que acude a la consulta por presentar dolor en el cuarto cuadrante. Tras la anamnesis y pruebas complementarias, llegamos al diagnóstico de necrosis pulpar con periodontitis apical sintomática del diente 44. En la radiografía podemos apreciar la presencia de una raíz corta, con paredes frágiles y ápice no formado. Tras hablar con los padres del paciente decidimos optar por el tratamiento de endodoncia regenerativa. Discutiremos a lo largo del caso la técnica empleada durante la realización de este caso clínico, centrándonos en la desinfección del interior del sistema de conductos, y la posterior creación de una matriz de andamiaje necesaria para poder colocar nuestro material biocerámico. En el apartado de discusión acercaremos al clínico las distintas opciones presentes en la literatura para afrontar la desinfección, medicación intraconducto y material de sellado, pilares fundamentales para el éxito del tratamiento de endodoncia regenerativa. En el seguimiento del caso, el paciente se presenta totalmente asintomático, con un desarrollo radicular completo y una formación de las paredes que devuelven la integridad al diente inmaduro

Since the introduction of the term revascularization in 1971, there have been many specific protocols for the treatment of an immature tooth with pulp necrosis and apical periodontitis. The complexity of performing apexification techniques on teeth with short roots, fragile walls, and non-formed and divergent apices, allows regenerative endodontic treatment to be indicated. The case presented below is about a young patient who comes to the office for presenting pain in the fourth quadrant. After the anamnesis and complementary tests, we arrived at the diagnosis of pulp necrosis with symptomatic apical periodontitis of tooth 44. On radiography, we can detect the presence of a short root, with fragile walls and an unformed apex. After talking with the patient's parents, we decided to opt for regenerative endodontic treatment. We will discuss throughout the case the technique used during the realization of this clinical case, focusing on the disinfection of the interior of the duct system, and the subsequent creation of a scaffolding matrix necessary to be able to place our bioceramic material. In the discussion section we will approach the clinician the different options present in the literature to deal with disinfection, intra-conduction medication and sealing material, fundamental pillars for the success of regenerative endodontic treatment. In the follow-up of the case, the patient appears totally asymptomatic, with a complete root development and a formation of the walls that restore integrity to the immature tooth

The effect of cryotherapy on fibromyalgia: a randomised clinical trial carried out in a cryosauna cabin.

Evidence of symptomatic treatment for fibromyalgia (FM) is very low. Whole body cryotherapy (WBC) modulates different neurotransmitters, which might have a role in pain alleviation and could exert an effect on FM. Our aim was to evaluate the efficacy of WBC for the control of pain and impact of disease in FM. For this we run an open, randomized, crossover trial of Cryosense TCT™ cabin vs rest. Patients with FM according to ACR criteria were recruited consecutively from general practices. Trial endpoints were change (∆) in pain after 2 and 4 weeks, measured by a visual analogue scale (VAS), ∆ burden of disease, evaluated by the Fibromyalgia Impact Questionnaire (FIQ), and severity of FM, measured by the Combined Index of Severity of Fibromyalgia (ICAF). Within group differences, sequence and period effects were tested with Student's t or Mann-Whitney U tests. Multiple linear regression models were used to adjust effect by baseline differences between groups. Sixty patients were included in the trial. A period effect was noted, with residual effect of WBC; therefore, only results from the first sequence were analysed. ∆VAS pain, ∆FIQ and ∆ICAF scores were significantly larger in the WBC group after the first period (3.0 vs 0.3 in ∆VAS pain; 32.1 vs 0.4 in ∆FIQ; 13.7 vs 0.07 in ∆ICAF; all p < 0.001), and were confirmed after adjustment. In conclusion, WBC with a Cryosense TCT cabin may be a useful adjuvant therapy for FM; further studies on long-term effect and compared to other physical therapies are warranted.Trial registration NCT03425903.

De Novo DNA Synthesis in Aedes aegypti Midgut Cells as a Complementary Strategy to Limit Dengue Viral Replication.

Aedes aegypti is the main vector of Dengue Virus, carrying the virus during the whole mosquito life post-infection. Few mosquito fitness costs have been associated to the virus infection, thereby allowing for a swift dissemination. In order to diminish the mosquito population, public health agency use persistent chemicals with environmental impact for disease control. Most countries barely use biological controls, if at all. With the purpose of developing novel Dengue control strategies, a detailed understanding of the unexplored virus-vector interactions is urgently needed. Damage induced (through tissue injury or bacterial invasion) DNA duplication (endoreplication) has been described in insects during epithelial cells renewal. Here, we delved into the mosquito midgut tissue ability to synthesize DNA de novo; postulating that Dengue virus infection could trigger a protective endoreplication mechanism in some mosquito cells. We hypothesized that the Aedes aegypti orthologue of the Drosophila melanogaster hindsight gene (not previously annotated in Aedes aegypti transcriptome/genome) is part of the Delta-Notch pathway. The activation of this transcriptional cascade leads to genomic DNA endoreplication. The amplification of the genomic copies of specific genes ultimately limits the viral spreading during infection. Conversely, inhibiting DNA synthesis capacity, hence endoreplication, leads to a higher viral replication.

Aedes aegypti antiviral adaptive response against DENV-2.

Priming is the conceptual term defining memory phenomenon in innate immune response. Numerous examples of enhanced secondary immune response have been described in diverse taxa of invertebrates; which naturally lacks memory response. In mosquitoes, a previous non-lethal challenge with some specific pathogens modify their immune response against the same microorganism; developing an improved antimicrobial reaction. In this work, we explore the ability of Aedes aegypti to mount a higher antiviral response upon a second oral DENV challenge. When previously challenged with inactive virus, we observed that the posterior infection showed a diminished number of DENV infectious particles in midguts and carcasses. In challenged tissues, we detected higher de novo midgut DNA synthesis than control group, as determined by DNA incorporation of 5-bromo-2-deoxyuridine. We demonstrated that inactive DENV particle are capable to induce DNA synthesis levels comparable to infective DENV. We considered the Drosophila melanogaster hindsight and Delta-Notch mosquitoes orthologues as potential de novo DNA synthesis pathway components (as observed in fly oocyte development and midgut tissue renewal). We showed that Aedes aegypti hindsight transcript relative expression levels were higher than control during DENV infection and inactive DENV particle alimentation. Also, Aedes aegypti second challenge with active DENV induced higher hindsight, Delta and Notch transcriptions in the primed mosquitoes (compared with the primary infection levels). Considering that the mosquito de novo DNA synthesis is concomitant to viral particle reduction, this finding opens a new perspective on the mechanisms underlying the vector antiviral immune response and the effector molecules involved.

Incisivo lateral superior con doble reabsorción interna / A rare case of not perforating double internal root resorption

La reabsorción radicular podría ser clasificada en externa o interna dependiendo de la localización de la misma en relación con la superficie de la raíz afectada. La reabsorción interna es relativamente poco frecuente, y su etiología y patogénesis no esta todavía del todo clara. Este artículo muestra la complejidad de un incisivo lateral superior con una doble reabsorción radicular no perforante y la importancia de la CBCT para la confirmación tridimensional de la reabsorción dental, su diagnóstico y clasificación. Tiene gran importancia el examen de la radiografía preoperatoria y el de las realizadas durante el tratamiento. Desde una perspectiva de diagnóstico diferencial, la llegada de la CBCT ha mejorado considerablemente la capacidad clínica de diagnóstico de la reabsorción radicular interna. Sin embargo, hasta la fecha, el tratamiento de conductos sigue siendo el tratamiento de elección para este tipo de patologías pulpares. En el seguimiento del caso que se presenta, el diente muestra signos clínicos y radiográficos de salud a los 24 meses después del tratamiento

Root resorption might be broadly classified into external or internal resorption by the location of the resorption in relation to the root surface. Internal root resorption is a relatively rare occurrence, and its etiology and pathogenesis have not been completely elucidated. This article shows the complexity of upper lateral incisor with a double not perforating root resorption and the significance of CBCT imaging in the confirmation of the three-dimensional resorption of teeth. The importance of the preoperative radiographic examination as well as radiographs during treatment is necessary. From a differential diagnosis perspective, the advent of cone beam computed tomography has considerably enhanced the clinician’s capability of diagnosing internal root resorption. Nevertheless, root canal treatment remains the treatment of choice for this pathologic condition to date. The tooth was clinically and radiographically healthy at the 24-month follow-up

Diagnóstico y manejo de un incisivo lateral inferior con lesión laterorradicular / Diagnosis and management of a maxillary lateral incisor with a large peri-radicular lesion

El objetivo del tratamiento de conductos consiste en prevenir o curar la periodontitis apical, lo que se logra mediante una correcta preparación quimiomecánica, junto a un sellado tridimensional. Una imagen radiolúcida periapical de gran extensión, indicativa de una gran lesión inflamatoria periapical, supone un reto para el clínico. Un buen diagnóstico, un buen planteamiento y comunicación con el paciente, contribuirán, junto a la realización de un correcto tratamiento de conductos, a la consecución del éxito clínico. A continuación presentamos un caso clínico de un paciente joven, con antecedente traumático, que acude a la consulta para la realización de un tratamiento de conductos previo a la intervención quirúrgica que tiene programada. Tras establecerse el diagnóstico de necrosis pulpar de los dientes 31, 41 y 42 y periodontitis apical sintomática del diente 42 por reagudización de un proceso inflamatorio periapical crónico, se procede al tratamiento de conductos. A los 24 meses, el paciente se presenta asintomático, con ausencias de signos y síntomas, y con una clara disminución de la lesión en la radiografía de control

Root canal treatment aims to prevent or cure apical periodontitis through a proper chemo-mechanical preparation and three-dimensional sealing. Wide periapical radiolucencies, indicative of a large periapical inflammatory lesion, are a challenge for the clinician. A proper diagnosis, a good approach and communication with the patient, together with an appropriate root canal treatment, provide the achievement of clinical success. A case of a young patient with a traumatic history, suffering pulp necrosis of teeth 31, 41 and 42 and symptomatic apical periodontitis of 42 tooth, is reported. After 24 months follow-up, patient is asymptomatic, with absence of signs and symptoms, and an evident reduction of the periapical lesion in x-ray control

Protocolo de weaning rápido en pacientes obesos mórbidos, con ventilación mecánica no invasiva posextubación / Rapid weaning protocol in morbid obese patients using noninvasive ventilation immediately after extubation

Introducción: La dificultad de completar un protocolo de weaning convencional, en el paciente obeso mórbido, establece una estadía prolongada en ventilación mecánica (VMI) y en UCI. Se propone el protocolo de weaning “Fast-Fat”, en pacientes obesos mórbidos, con insuficiencia respiratoria aguda (IRA), utilizando VMNI posextubación inmediata. Metodología: A fin de evaluar el protocolo de weaning en relación a: mortalidad a los 28 días, días de VMI, días UCI, necesidad de reintubación, número de traqueotomías (TQ) realizadas, y días de VMNI; y a la vez, comparar los días de VMI y días UCI en relación a protocolo de weaning convencional; se realizó un estudio de corte transversal con reclutamiento prospectivo, entre mayo de 2010 y julio de 2011, incluyendo en el protocolo, al total de pacientes que estaban en condiciones de iniciar un proceso de weaning con antecedentes de obesidad (IMC >35) e IRA. Si completan de manera exitosa la PVE de 1 hora en VMI, y cumplen criterios de extubación, pasan directamente VMNI. Se incluyeron 30 pacientes adultos, con edades de 59,1 +/- 12,7; 50 por ciento varones, con APACHE II 16,3 (rango 7 a 33), que fueron comparados con una cohorte retrospectiva de 18 pacientes similares características. Resultados: Nuestro estudio no presentó mortalidad a los 28 días, ningún paciente requirió reintubación, ni TQ; con 2,1 +/- 1,1 días en VMNI. Con estadía en VMI 5,7 +/- 2,4 días, versus el grupo comparativo sin aplicación de protocolo de 14,4 +/- 6 días (p<0,05). Con estadía en UCI de 21,4 +/- 5,6 días sin protocolo versus 7,6 +/- 2,48 días (p <0,05) con protocolo de weaning. Conclusión: Es posible disminuir de manera significativa, la estadía en VMI, en UCI, con la aplicación de este protocolo de weaning rápido utilizando VMNI posextubación en pacientes obesos mórbidos; de manera eficaz y segura.

Introduction: The difficulty of completing a standard weaning protocol in morbid obese patient, provides an extended stay on invasive mechanical ventilation (MV) and in ICU. Intends a protocol of weaning “Fat-Fast”, in morbidly obese patients and acute respiratory failure (ARF) using noninvasive ventilation (NIV) immediately after extubation. Methodology: to assess the weaning protocol in relation to: mortality at 28 days, days in IMV, ICU days, need for reintubation, n° of tracheotomies performed; and also, compare IMV days, and ICU days in relation to conventional weaning protocol. We conducted a cross sectional study with prospective recruitment between May 2010and July 2011, including all patients who were able to initiate a process of weaning, with clinical history obesity (BMI > 35) and ARF. If completed successfully the designed spontaneous ventilatory trial for 1 hour in the IMV, and meet extubation criteria, pass directly to the NIV. We included 30 adult patients, aged 59.1 +/- 12.7, 50 percent male, and with APACHE II 16.3 (range 7 to 33), were compared with a retrospective cohort of 18 patients with similar characteristics. Results: no mortality at 28 days, no patient requires reintubation or TQ; with an average of 2.1 +/- 1.1 days in the NIV. IMV stay was 5.7 +/- 2.4 days with Fast-Fat, versus conventional weaning protocol was 14.4 +/- 6 days (p < 0, 05). ICU stay with the conventional protocol was 21.4 +/- 5.6 versus 7.6 +/- 2.48 days (p<0, 05) with “Fast Fat”. Conclusion: With the application of this rapid weaning protocol, using postextubation NIV in morbidly obese patients, it is possible to decrease effectively and safely the IMV and ICU stay, significantly.

Ventilación mecánica no invasiva y falla respiratoria aguda, variables de éxito y fracaso / Noninvasive ventilation and acute respiratory failure: variables in the success or failure

Introducción: La VMNI se utiliza en una gran variedad de condiciones clínicas, siendo necesario, determinar las variables que condicionan el éxito o fracaso de la VMNI en insuficiencia respiratoria aguda (IRA) tipo I y II, y en falla postextubación (FPEXT). Material y método: A fin de analizar las variables responsables del éxito o fracaso de la VMNI en IRA, y desarrollar un modelo predictivo precoz, del éxito de la VMNI; se analizaron 102 pacientes (edad 56,5 +/- 17,2 años, 64 por ciento hombres, con APACHE II: 14,7 +/-6,5); que utilizaron VMNI, en modalidad Bilevel. Se registraron parámetros demográficos, clínicos y gasométricos, basales y a la hora de inicio de la VMNI. Los datos fueron analizados con regresión lineal, tablas de contigencia, pruebas de normalidad Shapiro Wilks, Cramer Von Mises, Durbin-Watson; razón de verosimilitud, Chi cuadrado y árbol de clasificación. Resultados: La aplicación de la VMNI fue exitosa en 82,4 por ciento de los casos. El éxito no está supeditado al tipo de IRA; puesto que tanto en IRA I y II es >80 por ciento de los casos, con una leve tendencia hacia mejores resultados con VMNI en IRA tipo II (p= 0,93). En FPEXT,y en IRA, se logra evitar la intubación, en el 78 por ciento y 87 por ciento respectivamente. Se observan 6 variables, que mediante un flujograma propuesto, permiten predecir con el 96 por ciento de exactitud, el éxito o fracaso de la VMNI, en ambos tipos de IRA y en FPEXT. Además se aporta con un modelo que permite calcular la FiO2 administrada en equipos de VMNI sin blender de O2 (p = 0.09). Conclusiones: La VMNI es una herramienta eficaz en el manejo precoz de ambos tipos de IRA y FPEXT, evitando la conexión a VMI.No se encontraron variables individuales, que logren predecir el éxito o fracaso de la VMNI de manera significativa en ambos tipos de IRA, como tampoco en FPEXT. Sin embargo, la combinación de 6 variables permite, a través del flujograma propuesto...

Noninvasive ventilation (NIV) is used in a variety of clinical conditions, it is important to determine the variables that decide the success or failure of NIV in Acute Respiratory Failure (ARF) type I and II, and also in failure after extubation (FAE). Material and Methods: The aims of this study were asses with the variables in the success or failure of NIV in ARF, and develop an early prediction model of success or failure in the NIV. We analyzed 102 patients (age 56, 5 +/- 17,2 years; 64 percent men; APACHE II 14,7 +/- 6,5) who used NIV in bilevel mode. We recorded demographic, clinical and blood gas prior and an hour later, to the initiation of the NIV. Data were analyzed whit linear regression, contingency tables, Shapiro Wilks normality tests, Cramer Von Mises, Durbin-Watson, like hood ratio, chi square and classification tree. Results: the application of NIV was successful in 82, 4 percent of cases. The success does not depend of the type of ARF, since both of ARF have a success in >80 percent of cases, with a slight trend towards better outcome whit NIV to treat ARF type II(p=0,93). In FAE and in both ARF, intubations were avoided in 78 percent and 87 percent respectively. Six variables are obtained, through a proposed flow chart, whit 96 percent of accuracy, allows predicting success of NIV, in both types of ARF and in FAE. In addition, we delivered a new model that calculates the FiO2administrated in ventilators without an O2 blender (p =0.09). Conclusion: The noninvasive ventilator assistant is an effective tool in early management of both types of ARF, avoiding the connection to invasive ventilation, or reintubation. There were no isolated variables that are able to predict the success or failure of NIV significantly in both types of ARF, nor in FAE. However, the combination of 6 variables can, through the proposed flow chart, anticipates the evolution of the patients in the NIV.

Validation of the Spanish version of the Liverpool Adverse Events Profile in patients with epilepsy.

The objective of the study was to validate the Spanish version of the Liverpool Adverse Events Profile (LAEP). An observational, cross-sectional, multicenter study was carried out on patients with epilepsy treated with a stable dose of antiepileptic drugs. Patients completed the LAEP, Quality of Life in Epilepsy Inventory-31 (QOLIE-31), and Hospital Anxiety and Depression Scale (HADS). Two hundred sixty-six patients were recruited. The LAEP was completed in a short time, perceived as easy to complete, and there was no relevant information missing. Ceiling/floor effects were negligible. Internal consistency (Cronbach's alpha=0.84) and test-retest reliability (ICC=0.81) were satisfactory. LAEP scores consistently correlated with QOLIE-31 (r=0.71) and HADS (r=0.52-0.63) scores. When the LAEP was used to discriminate between patients with and without adverse events, the scores on the QOLIE and HADS corresponded. The Spanish version of the LAEP scale exhibits adequate psychometric properties, suggesting that it is an appropriate instrument to measure adverse events among Spanish-speaking patients with epilepsy.

Partial trisomy 13q22-qter associated to leukoencephalopathy and late onset generalised epilepsy.

The partial trisomy 13q.22 is an uncommon chromosomopathy. We present a case with a partial trisomic component 13q22 and a monosomic component 5p15 from paternal origin. This patient developed early menopause and major neurological disorders as leukoencephalopathy, late onset generalised epilepsy and stroke. She also had fatty acids disturbances and their potential relation to the neurological disorders and early menopause is discussed. The presented case illustrates the phenotype of 13q22-qter in adult age and reaffirms the importance of studying the karyotype of any patient with seizures or leukoencephalopathy particularly when there are associated other clinical features including stroke at a young age, fatty acids disturbances, microcephaly, hypotelorism, short neck, hemangiomata, short fingers or distal swell in thumbs.

Study of cerebral cavernous malformation in Spain and Portugal: high prevalence of a 14 bp deletion in exon 5 of MGC4607 (CCM2 gene).

OBJECTIVE: We aimed to study clinical, radiological and molecular genetic features of patients with cerebral cavernous malformations (CCMs) from the Iberian Peninsula. METHODS: We screened Krit1(CCM1), MGC4607(CCM2), and PDCD10(CCM3) by systematic SSCP and direct sequencing of coding exons in 48 nuclear families and 30 sporadic cases of CCM from Spain and Portugal. RESULTS: Screening of CCM patients detected nine different mutations in 19 families. We found four new mutations in Krit1. Three of them were caused by either a small insertion or deletion, which lead to frameshift and premature termination codons. We also found a missense L308H mutation located in a highly conserved sequence within the ankyrin domain of Krit1. In CCM2, we found a redundant 14 bp deletion in exon 5 of MGC4607 which predicts a truncated protein at residue 230. We did not find mutations in CCM3. CONCLUSIONS: Finding that the 14 bp deletion was present in eleven families from the Iberian Peninsula indicates a high prevalence of this mutation. This redundant CCM2 mutation is worth considering in molecular diagnosis and genetic counselling of cerebral cavernous malformations.