Characterization of Hearing Loss in Adult Patients With Nondialysis Chronic Kidney Disease.

OBJECTIVE: To confirm the association between chronic kidney disease and sensorineural hearing loss in non-dialysis non-diabetic patients and to establish the audiological profile of these patients indicating the possible location of the auditory damage. STUDY DESIGN: Cross-sectional study. SETTING: Tertiary referral center. PATIENTS: Patients between 18 and 60 years old with chronic kidney disease, without diabetes mellitus and without personal history of otology disease, were compared with a healthy control group pared by sex and age to establish differences between their audiological profile. INTERVENTIONS: Pure tone audiometry (PTA), transient evoked otoacoustic emissions (TEOAEs), distortion products otoacoustic emissions (DPOAEs), and auditory brainstem responses (ABR) were performed in both groups. MAIN OUTCOME MEASURES: Mean and standard deviation of PTA auditory thresholds, TEOAEs reproducibility, DPOAEs level/noise, and ABR absolute latency and interwave latency were measured, and compared using linear mixed models. RESULTS: Fifty one cases were included and compared with 51 healthy volunteers. The audiometric profile found in patients with chronic kidney disease was a sensorineural hearing loss in 4 to 8 kHz frequencies in the PTA, a decrease in the TEOAEs reproducibility and a decrease in the DPOAEs level. An enlargement in the V wave absolute latency and III to V and I to V interwave latency in the ABR were also found but within normal range. CONCLUSIONS: There is an association between chronic kidney disease in non-dialysis non diabetic adults patients and sensorineural hearing loss, affecting high frequencies and having the cochlea as the main site of auditory damage.

On the Shoulders of Giants: Benefits of Participating in a Dialogic Professional Development Program for In-Service Teachers.

This study explores the impact of a seminar on self-efficacy and argumentative skills on teachers' professional development. In this seminar, called "On the Shoulders of Giants," a group of teachers meet once a month. They debate scientific readings to critically discuss educational theory, which transforms their everyday practices in the school. A survey using a questionnaire was conducted to collect the data. The results show that teachers' involvement in dialogic-based training positively impacts their ability to address current school problems and that the teachers transfer their new knowledge to their work. The effectiveness of the teachers' practices increases and, consequently, their students' learning also improves.

Relevance of minor discrepancies at second pathology review in gynaecological cancer.

AIM: To determine the incidence of discrepancy rate between the initial pathology diagnosis and referral diagnosis in women with gynaecological cancer. METHODS: A retrospective observational study was performed including all consecutive patients with gynaecological cancer referred and who underwent pathologic review between January 2013 and May 2017. Discrepancies were minor when future treatment was not altered or major when the treatment was modified. RESULTS: A total of 259 patients were included. The original diagnosis was ovarian cancer (n = 126, 48.6%), endometrial cancer (n = 84, 32.4%), cervical cancer (n = 43, 16.6%) and vulvar cancer (n = 6, 2.3%). Eighteen women (6.9%) had major discrepancies and 69 patients (26.6%) had minor discrepancies. The main reason for the minor discrepancy was tumour grade or histology subtype. Regarding ovarian cancer, 13 out of 16 patients had minor discrepancies at histology subtype among serous, endometrioid, mucinous or undifferentiated tumours. The main issue for the minor discrepancy in patients with cervical cancer was among different subtype of cervical adenocarcinoma. Minor discrepancies due to tumour grade were also observed in 14, 19, 8 and 3 patients with endometrial, ovarian, cervical and vulvar cancer, respectively. CONCLUSIONS: A second pathology review also adds valid information in those cases with minor discrepancies leading to a difference in patients´ counselling regarding follow-up and prognosis.

Presence of acute and chronic renal failure in patients with paroxysmal nocturnal hemoglobinuria: results of a retrospective analysis from the Spanish PNH Registry.

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, life-threatening blood disease. With the advent of eculizumab treatment, renal function has substantially improved, although no data from real-world clinical practice are available. An observational, retrospective, multicenter study was conducted in Spain on clinical data obtained from outpatient visits of patients with PNH (Spanish PNH Registry) who had experienced acute (ARF) or chronic (CRF) renal failure. Of the 128 patients registered (April 2014), 60 were diagnosed with classic PNH. Twenty-seven (45.0%) patients with a mean age of 48.5 (±16.2) years had renal failure, ARF or CRF, and were included in this study. Near half of the patients (n = 13; 48.1%) presented with ARF alone, 33.3% (n = 9) had CRF with episodes of ARF, while 18.5% (n = 5) were diagnosed with CRF alone. For patients with diagnosis of PNH and renal failure (n = 27), the median time to the first ARF episode was 6.5 (CI 95%; 2.2, 14.9) years, whereas the median to the diagnosis of CRF was 14.5 (CI 95%; 3.8, 19.2) years after the diagnosis of PNH. Patients with ARF (n = 22) were treated with eculizumab and did not experience new episodes of ARF, except for one patient with sepsis. Of the patients with CRF, two received treatment without experiencing further episodes of ARF. Sixteen patients who completed treatment (11 with ARF and 5 with ARF + CRF) recovered from the episode of ARF or from CRF. Of the remaining patients treated with eculizumab, one patient improved from stages III to II, three patients stabilized without showing disease progression, and one patient progressed from stages III to IV. Treatment with eculizumab in PNH patients has beneficial effects on renal function, preventing ARF and progression to CRF.

Malignant Bowel Obstruction in Relapsed Ovarian Cancer With Peritoneal Carcinomatosis: An Occlusive State.

OBJECTIVE: The aim of this study was to describe the clinical and oncological outcomes of women with malignant bowel obstruction (MBO) for relapsed ovarian cancer and peritoneal carcinomatosis. METHODS: A retrospective cohort study was performed in all consecutive patients admitted at Instituto Valenciano de Oncología, Valencia, Spain, between July 2013 and July 2016 with MBO for relapsed ovarian cancer and peritoneal carcinomatosis. All patients underwent the same protocol of conservative management. Surgical treatment was indicated only in selected cases. RESULTS: There were a total of 22 patients presenting 59 episodes of MBO; 17 (77.2%) of those patients presented more than 1 episode of MBO. All patients had serous epithelial ovarian cancer; 18 (81.8%) were high grade, and 4 (18.2%) low-grade tumors. The median (range) number of episodes per patient was 3 (range, 1-7) with a mean length of hospitalization of 13 (SD, 13.6) days. The median time interval between episodes of MBO (54 episodes in 17 patients) was 17 days (range, 1-727 days). Twenty of 22 patients died with a median overall survival time from the first episode of MBO of 95 days (95% confidence interval, 49-124 days). CONCLUSIONS: Patients with MBO due to relapsed epithelial ovarian cancer in the peritoneal carcinomatosis setting have a short life expectancy, presenting a median of 3 episodes of MBO until death, with a short time interval between episodes. These findings show that bowel obstruction can represent a constant status over time until death.

Diez años de vacunación frente al virus del papiloma: nuevos retos y oportunidades / Ten years of papillomavirus vaccination: new challenges and opportunities

No disponible

Efecto pronóstico de una estrategia terapéutica guiada por los valores del antígeno carbohidrato 125 (CHANCE-HF). Diseño del estudio / Prognostic effect of carbohydrate antigen 125-guided therapy in patients recently discharged for acute heart failure (CHANCE-HF). Study design

Introducción y objetivos La morbilidad y la mortalidad después de un ingreso por insuficiencia cardiaca aguda siguen siendo extremadamente elevadas. En este contexto, se ha demostrado que las concentraciones plasmáticas del antígeno carbohidrato 125 muestran correlación con la gravedad de la sobrecarga hídrica y el riesgo de muerte y reingreso. Los datos preliminares indican un posible papel del antígeno carbohidrato 125 como guía para el tratamiento. El objetivo de este estudio es evaluar el efecto pronóstico de una estrategia de tratamiento guiada por el antígeno carbohidrato 125 comparada con el tratamiento estándar en pacientes dados de alta recientemente tras un ingreso por insuficiencia cardiaca aguda. Métodos Ensayo clínico multicéntrico, aleatorizado y a ciego simple, de evaluación de la eficacia en pacientes recientemente dados de alta tras una insuficiencia cardiaca aguda (< 180 días), en clase funcional II-IV de la New York Heart Association y con antígeno carbohidrato 125 > 35 U/ml. Se utilizó un esquema de aleatorización para asignar a los participantes (en relación 1:1) a tratamiento guiado por el antígeno carbohidrato 125 (destinado a mantener valores normales) o tratamiento estándar. El tratamiento guiado se centra principalmente en la frecuencia de monitorización y ajuste de dosis de los tratamientos descongestivos y las estatinas. Hasta el 10 de diciembre de 2013, se había incluido en el estudio a 383 pacientes. El objetivo principal era la combinación de mortalidad por cualquier causa o rehospitalización por insuficiencia cardiaca aguda a 1 año. Se planificó el análisis según el criterio de intención de tratar. Conclusiones: El descubrimiento de estrategias terapéuticas novedosas o mejores formas de optimizar los tratamientos establecidos ha pasado a ser una prioridad de la asistencia sanitaria en la insuficiencia cardiaca. Este estudio aporta nuevos conocimientos importantes acerca del potencial del antígeno carbohidrato 125 como instrumento útil para la monitorización y ajuste de la posología de los tratamientos en los casos en que la utilización óptima no está bien definida, como ocurre con los diuréticos y las estatinas

Introduction and objectives Morbidity and mortality after admission for acute heart failure remain prohibitively high. In that setting, plasma levels of antigen carbohydrate 125 have shown to correlate with the severity of fluid overload and the risk of mortality and readmission. Preliminary data suggests a potential role of antigen carbohydrate 125 to guide therapy. The objective of this study is to evaluate the prognostic effect of an antigen carbohydrate 125-guided management strategy vs standard therapy in patients recently discharged for acute heart failure. Methods This is a multicenter, randomized, single-blind, efficacy trial study of patients recently discharged from acute heart failure (< 180 days), New York Heart Association functional class II-IV and antigen carbohydrate 125 > 35 U/ml. A randomization scheme was used to allocate participants (in a 1:1 ratio) to receive therapy guided by antigen carbohydrate 125 (aiming to keep normal values) or standard treatment. Mainly, antigen carbohydrate 125-guided therapy is focused on the frequency of monitoring and titration of decongestive therapies and statins. As of December 10, 2013, there were 383 patients enrolled. The primary outcome was the composite of 1-year all-cause mortality or rehospitalization for acute heart failure. Analysis was planned to be intention-to-treat. Conclusions Discovering novel therapeutic strategies or finding better ways of optimizing established treatments have become a health care priority in heart failure. This study will add important knowledge about the potential of antigen carbohydrate 125 as a management tool for monitoring and titration of therapies where optimal utilization has not been well defined, such as diuretics and statins (AU)

Guía de cribado del cáncer de cuello de útero en España, 2014 / No disponible

No disponible

Guía de cribado del cáncer de cuello de útero en España, 2014 / No disponible

No disponible

Persistent polyclonal B-cell lymphocytosis with splenomegaly: histologic description of 2 cases.

Persistent polyclonal B-cell lymphocytosis is a rare, benign lymphoproliferative disorder characterized by a stable, polyclonal CD19-positive CD5-negative lymphocytosis, the presence of binucleated lymphocytes in peripheral blood, and a polyclonal increase in serum immunoglobulin-M that may occasionally be accompanied by splenomegaly. Histopathologic diagnosis of these splenectomy specimens is difficult because of the massive spleen infiltration and the rarity of the descriptions of this condition. We describe the histopathologic findings from 2 splenectomy specimens. These included a partially preserved architecture with infiltration of the red pulp by small lymphocytes and partial replacement of the white pulp. Suggestions for identifying the disorder are made.

Comportamiento Clínico-Epidemiológico de las neumonías adquiridas Estado de Amazona Venezuela 2008 / Clinical-epidemiological behavior of acquired pneumonias State of Amazona Venezuela 2008

Se realizó un estudio descriptivo de corte transversal con 93 niños de cero a seis años de edad, que ingresaron con el diagnóstico de Neumonía Adquirida en la Comunidad (NAC), o que resultó detectada en las 48 horas posteriores al ingreso hospitalario, en el período desde el 1ro de enero hasta el 30 de junio de 2006, en la Sala de Emergencias de Pediatría del Hospital II José Gregorio Hernández, de la ciudad de Puerto Ayacucho, en el Estado Amazonas de la República Bolivariana de Venezuela. El objetivo era determinar las características clínico epidemiológicas de las neumonías adquiridas en la comunidad e identificar los principales factores de riesgo de las mismas en una población con diversas características culturales, como la Amazonía Venezolana. Se comprobó que la desnutrición constituyó el principal factor de riesgo, estando muy vinculado con la elevada letalidad reportada, y fue identificado que la Sepsis constituyó la complicación más frecuente y que la Ampicilina combinada con el Sulbactam, fue el antimicrobiano más utilizado(AU)

A descriptive, transversal study was carried out with 39 children from 0 to 6 years of age that were admitted with the diagnosis of acquired pneumonia in the community (APC) that was detected in the 48 hours after the admission to hospital, in the period from January 1rst to June 30th, 2006 in the Pediatric Emergency ward of José Gregorio Hernández hospital in the city of Puerto Ayacucho of the state of Amazonas, of the Bolivarian Republic of Venezuela. The aim of the study was to determine the clinical- epidemiological characteristics of the pneumonia acquired in the community and to identify their main risk factors in the population with varied cultural characteristics as is the Venezuela Amazonas. It was confirmed that malnutrition constituted the main risk factor closely related to the high lethality reported and the fact that sepsis constituted the most frequent complication was also identified. Ampicillin combined with Sulbactan was the antimicrobial treatment more used(AU)

Síndrome de Stevens Johnson a propósito de un caso / Stevens Johnson Syndrome about a case report

Se presenta un caso de una niña de cuatro años con antecedentes alérgicos, que comienza con manifestaciones catarrales y fiebre elevada de 39 y 40 grado Celsius, por lo que es llevada al cuerpo de guardia del hospital pediátrico docente Raymundo Castro de la Ciudad de Puerto Padre en Las Tunas, Cuba; donde se diagnostica Amigdalitis Aguda Exudativa, para lo que se le impone tratamiento ambulatorio con Cefalexina en cápsulas. Pero después de la segunda dosis comienza con lesiones eritematosas, que rápidamente se tornan vesiculares y ampollosas, tomando las mucosas oral, conjuntival y vulvar, además de acompañarse de gran sintomatología general, que hace girar el diagnóstico hacia un Eritema Multiforme Mayor, Necrólisis Epidérmica Tóxica o Síndrome de Stevens-Johnson. Se inicia entonces terapéutica con corticoides, antibióticos y medidas de apoyo vital en la Unidad de Terapia del mencionado hospital. Tiene una evolución muy favorable, sin complicaciones significativas o secuelas grave (AU)

A 4 years old girl with antecedents of allergy, who started with cold manifestations and fever of 39 to 40 degrees, was brought to the Emergency room of Raymundo Castro Teaching Pediatric Hospital in Puerto Padre, Las Tunas, Cuba, where the doctors made the diagnosis of exudative tonsillitis. It was decided to prescribe ambulatory treatment with oral Cephalexin, but after second a dose the girl started with erythematous vesicular and ampullar lesions which progressed quickly and spread to the oral, conjuntival and vulvar mucosa, accompanied with great general symptomatology that made the doctors turn to the diagnoses of either major multifom erythema, toxic epidermal necrolysis or Stevens-Johnson Syndrome. Because of these, the girl started to undergo corticostherioid therapy, wide spectrum antibiotics, and advanced life support measures in the Intensive Care Unit of the hospital, where she did satisfactorily without complications or grave sequela(AU)

Conocimientos sobre sexualidad en la adolescencia / Knowledge about sexuality in adolescence

Se realizó un estudio descriptivo y transversal con los adolescentes de las Secundarias Básicas urbanas del área de Puerto Padre correspondiente al curso escolar 2005 2006, con el propósito de indagar acerca de sus conocimientos en la esfera sexual. El universo estuvo constituido por los 2997 adolescentes que cursan estudios en las tres Secundarias Básicas urbanas del área de salud de Puerto Padre. Para la muestra se seleccionaron 450 estudiantes. Los resultados obtenidos mostraron las mayores deficiencias en la esfera relacionada con el embarazo; se evidenciaron estereotipos sexistas, al asignarse ciertas actividades al varón y otras a la hembra. Prevaleció el criterio de que la masturbación es un acto normal, fundamentalmente en el sexo masculino(AU)

A descriptive and transversal study was carried out with adolescents of urban secondary schools in Puerto Padre during the 2005 2006 school year, with the goal of investigating about their knowledge of sexual matters. The universe was composed of 2997 adolescents, who study in the three urban junior high schools of the health area of Puerto Padre. 450 students were selected for the sample. The results obtained showed that the main problem was related to pregnancy. There were evident sexist stereotypes when assigning certain activities to the boys and others to the girls. The point of view that masturbation is a normal act prevailed, mainly in the male sex(AU)

Sexualidad y Adolescencia / Sexuality and Adolescente

Se realizó un estudio descriptivo y transversal con los adolescentes de las Secundarias Básicas urbanas del área de Puerto Padre correspondiente al curso escolar 2005 2006, con el propósito de indagar acerca de sus conocimientos en la esfera sexual. Los resultados obtenidos mostraron que los sexos y el grado escolar estuvieron igualmente representados, predominó el color de piel blanca, seguida de mestiza y negra, y de estado civil soltero. El nivel de conocimientos de forma general fue bueno; los padres, maestros y la televisión constituyeron la principal vía de obtención de la información(AU)

A transversal and descriptive study was carried out with adolescents of urban junior high schools in Puerto Padre City in the 2005 2006 school year, with the aim of investigating about their knowledge of sexual matters. The results obtained showed that both genders and the school grade were all represented, being the white skin color the most prevailing race, followed by mixed and black races, those with the marital status of single. The knowledege level, in general, is good; parents, teachers and the television constituted the main source of obtaining information(AU)

Vacunas frente al virus del papiloma humano / Vaccines against the human papilloma virus

La infección anogenital por el virus del papiloma humano(VPH) constituye una enfermedad de transmisión sexualmuy común en la población sexualmente activa. Aunque lamayoría de las infecciones siguen un curso benigno y seresuelven espontáneamente, la infección persistente porciertos genotipos del VPH está asociada causalmente conel desarrollo del cáncer de cuello uterino y de una fracción de otros cánceres anogenitales, de la cavidad oral y de la orofaringe.Los datos procedentes de los ensayos clínicos de las 2vacunas VPH disponibles hasta la fecha —una bivalentefrente a los tipos del VPH 16/18 y otra tetravalente frente a los tipos virales 6/11/16/18— demuestran que estas vacunas son seguras, inmunogénicas y altamente eficaces en la prevención no sólo de la infección persistente por los tipos virales incluidos en las vacunas, sino también en la prevención de las lesiones precursoras inmediatas al carcinoma invasivo de cuello de útero. Asimismo, los resultados de los ensayos de la vacuna tetravalente indican que esta vacuna es también altamente eficaz en la prevención de las verrugas genitales o condilomas, así como de las neoplasias avanzadas de la vulva y la vagina.Ambas vacunas presentan evidencias de proteccióncruzada contra la infección por tipos virales no incluidos en la vacuna, pero ninguna de las dos tiene efectos terapéuticos. La población diana de vacunación para alcanzar el máximo potencial preventivo son las niñas preadolescentes a partir de los 9 años de edad.La comunidad científica es optimista y se estima que enlos próximos 25-30 años se observará una reducción de lastasas de incidencia del cáncer de cuello uterino y otraslesiones asociadas al VPH, siempre que los programas devacunación frente al VPH alcancen una buena cobertura.Con anterioridad a esta reducción, podrá observarse unimpacto importante en las tasas de lesiones citológicascervicales con la consecuente reducción del número decolposcopias, biopsias y tratamientos quirúrgicos, asícomo una disminución de la carga de ansiedad queocasiona en la mujer el diagnóstico de enfermedadesasociadas al VPH

Anogenital infection due to human papilloma virus (HPV) is a highly common sexually transmitted disease in thesexually active population. Although most infections havea benign course and resolve spontaneously, persistentinfection by certain HPV genotypes is causally associatedwith the development of cervical cancer and of a fraction of some other cancers of the anogenital area, oral cavity, and oropharynx. The data available from clinical trials of two HPV vaccines – a bivalent vaccine against HPV 16/18 and a tetravalent vaccine against HPV 6/11/16/18 – show that these vaccines are safe, immunogenic, and highly effective in preventing not only of persistent infection by the viraltypes included in these vaccines but also in preventingimmediate precursor lesions of invasive cervical carcinoma.Likewise, the results of trials of the tetravalent vaccine indicate that this vaccine is also highly effective in preventing against genital warts or condylomas, as well as advanced neoploasias, as well advanced neoplasias, as well as advanced tumours of the vulva and vagina. There is evidence that both vaccines confer cross protection against infection by viral types not included in the vaccines, but neither of the two vaccines has therapeutical effects. The vaccination target population to achieve the maximum preventive potential consists of preadolescent girls aged 9 years old or above. The scientific community is optimistic and it is estimated that in the next 25 to 30 years there will be a reduction in the incidence rates of cervical cancer and other lesions associated with HPV, as long as vaccination programs against this virus achieve good coverage. Before this reduction occurs, there may be a substantial impact on the rates of cytological cervical lesions with a consequent reduction in the number of colposcopies, biopsies and surgical treatments, as well as a decrease in anxiety in women caused by the diagnosis of HPV-related diseases

Relación entre el estado nutricional y la morbilidad respiratoria infantil / Relation between nutritional status and infant respiratory morbidity

Se realizó un estudio de intervención, prospectivo y longitudinal con la finalidad de disminuir la relación desnutrición- enfermedad respiratoria en los niños desnutridos menores de 15 años y que presentan patologías respiratorias asociadas, pertenecientes al policlínico “Rafael Izquierdo” del municipio Puerto Padre provincia Las Tunas, durante el período del 1ro de septiembre del 2002 al 31 de diciembre del 2003. Los resultados se recogieron a través de tablas de contingencias y gráficos, se aplicó el método porcentual y la hipótesis de proporciones. Luego de la intervención terapéutica y educativa se compararon los estados iniciales con los logrados al finalizar la intervención, se concluyó que en la DPE la presencia de enfermedades respiratorias es común, los factores de riesgo socioeconómicos y la inmunodeficiencia los más representativos. Un plan de acción médica multifactorial es imprescindible para la recuperación de este grupo de pacientes, se logró revertir en la mayoría su estado de salud desfavorable(AU)

During the periodo of september 1 st 2002 and december 31 st 2003, a prospective and longitudinal study of intervention in order to diminish the relation of desnutrition respiratory disease in undernourished children lesser than 15 years old that had associated respiratory pathologies who belong to “Rafael Izquierdo” Policlinic in Puerto Padre municipality, Las Tunas province was done. The results were collected at tables of contingency and graphics. Percentage method and hypothesis of proportion were applied. After therapeutic and educative intervention, initial status and the one obtained were compared when the intervention finished, having concluded that in the DPE the respiratory disease are common, being the most representatives the socioeconomic risk factors and immunodeficiency it is essential a multifactorial medical plan of action to gain the recuperation of this group of patients reverting in most of them their unfavourable health status(AU)

Sjögren syndrome associated with hepatitis C virus: a multicenter analysis of 137 cases.

To define the clinical and immunologic pattern of expression of Sjögren syndrome (SS) associated with chronic hepatitis C virus (HCV) infection, we conducted a multicenter study aiming to collect a large number of patients with SS and HCV infection. Inclusion criteria were the fulfillment of at least 4 of the classification criteria for SS proposed by the European Community Study Group and repeated positive HCV serology, confirmed by recombinant immunoblot assay and/or detection of serum HCV-RNA by polymerase chain reaction. One hundred thirty-seven patients were included (104 female and 33 male; mean age, 65 yr). Seventy-nine (58%) patients presented a systemic process with diverse extraglandular manifestations, with articular involvement (44%), vasculitis (20%), and neuropathy (16%) being the most frequent features observed. The main immunologic features were antinuclear antibodies (65%), hypocomplementemia (51%), and cryoglobulinemia (50%). Cryoglobulins were associated with a higher frequency of cutaneous vasculitis, rheumatoid factor, and hypocomplementemia. Thirty-two (23%) patients had positive anti-Ro/SS-A and/or anti-La/SS-B antibodies; these patients were predominantly women and had a higher prevalence of some extraglandular features and a lower frequency of liver involvement. Nineteen (14%) patients developed neoplasia, with hematologic neoplasia (8 cases) and hepatocellular carcinoma (6 cases) being the most frequent types. Eighty-five percent of SS-HCV patients also fulfilled the recently proposed 2002 classification criteria for SS. In conclusion, HCV-associated SS is indistinguishable in most cases from the primary form using the most recent set of classification criteria. Chronic HCV infection should be considered an exclusion criterion for the classification of primary SS, not because it mimics primary SS, but because the virus may be implicated in the development of SS in a specific subset of patients. We propose the term "SS secondary to HCV" when these patients fulfill the 2002 classification criteria for SS.

[Usefulness of oral pilocarpin therapy in the treatment of xerostomia and xerophthalmia in patients with primary Sjögren's syndrome]. / Pilocarpina oral en el tratamientode la xerostomía y xeroftalmía en pacientes con síndrome de Sjögren primario.

BACKGROUND AND OBJECTIVE: We aimed to asses the efficacy of pilocarpine tablets as a symptomatic treatment for dry mouth and dry eyes in patients with primary Sjögren's syndrome (SS). PATIENTS AND METHOD: We included 40 patients with SS (38 women and 2 men), mean age 49.2 years (range, 35-68), with severe xerostomia and xerophthalmia. Objective tests (salivary scintigraphy, Schirmer's test, break-up time, Rose Bengal staining) and subjective tests (symptoms' questionnaire) were carried out before starting treatment and 6 months later to evaluate any glandular function improvement. RESULTS: All patients initially received 15 mg daily of pilocarpine. Twelve (30%) patients received 20 mg daily. Dry mouth-related symptoms improved in 57.5% of patients and dry eyes-related ones improved in 35%. Scintigraphic studies demonstrated an objective improvement of the glandular function in 35% patients. Ocular tests showed an improvement in 30% cases. CONCLUSIONS: Pilocarpine therapy is useful to improve xerostomia and xerophthalmia in SS patients with moderate and severe glandular involvement. However, we have not observed a good correlation between subjective improvement of symptoms and the objective test results.