Onset of Nut Allergy in a Pediatric Cohort: Clinical and Molecular Patterns in the AFRUSEN Study.

BACKGROUND AND OBJECTIVE: Nut allergy is a growing problem, yet little is known about its onset in children. Objective: To characterize the onset of nut allergy in children in southern Europe. METHODS: The study population comprised consecutive patients up to 14 years of age who visited allergy departments with an initial allergic reaction to peanut, tree nut, or seed. The allergy work-up included a clinical history, food challenge, skin prick testing, determination of whole-extract sIgE, and ImmunoCAP ISAC-112 assay. RESULTS: Of the 271 children included, 260 were first diagnosed with nut allergy at a mean age of 6.5 years and at a mean (SD) of 11.8 (21.2) months after the index reaction. The most common culprit nuts at onset were walnut (36.5%), peanut (28.5%), cashew (10.4%), hazelnut (8.5%), pistachio (5.4%), and almond (5%). Onset of peanut allergy was more frequent in children ≤6 years and walnut in those aged >6 years (P=.032). In 65% of cases, the allergic reaction occurred the first time the patient consumed the nut, and 35% of reactions were anaphylactic. Overall, polysensitization to nuts was detected by skin prick testing in 64.9% of patients, although this rate was lower among walnut-allergic children (54.7%) and peanut-allergic children (54.1%) (P<.0001). Sensitization to 2S albumins was predominant (75%), especially Jug r 1 (52.8%), whereas sensitization to lipid transfer proteins was less relevant (37%). CONCLUSION: In the population we assessed, the onset of nut allergy occurred around 6 years of age, slightly later than that reported in English-speaking countries. Walnut was the main trigger, followed by peanut. 2S albumin storage proteins, especially Jug r 1, were the most relevant allergens. This study will help guide management and may contribute to preventive strategies in pediatric nut allergy.

Simulation Study for Designing a Dedicated Cardiac TOF-PET System.

The development of dedicated positron emission tomography scanners is an active area of research, especially aiming at the improvement of lesion detection and in support of cancer treatment and management. Recently, dedicated Positron Emission Tomography (PET) systems with different configurations for specific organs have been developed for improving detection effectiveness. Open geometries are always subject to distortion and artifacts in the reconstructed images. Therefore, the aim of this work is to determine the optimal geometry for a novel cardiac PET system that will be developed by our team, and determine the time resolution needed to achieve reasonable image quality for the chosen geometry. The proposed geometries consist of 36 modules. These modules are arranged in two sets of two plates, each one with different configurations. We performed Monte Carlo simulations with different TOF resolutions, in order to test the image quality improvement in each case. Our results show, as expected, that increasing TOF resolution reduces distortion and artifact effects. We can conclude that a TOF resolution of the order of 200 ps is needed to reduce the artifacts, to acceptable levels, generated in the simulated cardiac-PET open geometries.

Validation of Recipes for Double-Blind Placebo-Controlled Challenges With Milk, Egg White, and Hazelnut.

BACKGROUND: The double-blind, placebo-controlled food challenge (DBPCFC) is considered the definitive diagnostic test for food allergy. Nevertheless, validated recipes for masking the foods are scarce, have not been standardized, and differ between centers. Sensory evaluation techniques such as the triangle test are necessary to validate the recipes used for DBPCFC. METHODS: We developed 3 recipes for use in DBPCFC with milk, egg white, and hazelnut and used the triangle test to validate them in a 2-phase study in which 197 volunteers participated. In each phase, participants tried 3 samples (2 active-1 placebo or 2 placebo-1 active) and had to identify the odd one. In phase 1, the 3 samples were given simultaneously, whereas in phase 2, the 3 samples of foods that failed validation in phase 1 were given sequentially. A visual analog scale (VAS) ranging from 1 to 10 was used to evaluate how much participants liked the recipes. RESULTS: In phase 1, the egg white recipe was validated (n=89 volunteers, 38.9% found the odd sample, P=.16). Milk and hazelnut recipes were validated in phase 2 (for both foods, n=30 participants, 36.7% found the odd sample, P=.36). Median VAS scores for the 3 recipes ranged from 6.6 to 9.7. CONCLUSIONS: We used sensory testing to validate milk, egg white, and hazelnut recipes for use in DBPCFC. The validated recipes are easy to prepare in a clinical setting, provide the equivalent of 1 serving dose, and were liked by most participants.

Validation of recipes for double-blind placebo-controlled challenges with milk, egg white, and hazelnut

Background: The double-blind, placebo-controlled food challenge (DBPCFC) is considered the definitive diagnostic test for food allergy. Nevertheless, validated recipes for masking the foods are scarce, have not been standardized, and differ between centers. Sensory evaluation techniques such as the triangle test are necessary to validate the recipes used for DBPCFC. Methods: We developed 3 recipes for use in DBPCFC with milk, egg white, and hazelnut and used the triangle test to validate them in a 2-phase study in which 197 volunteers participated. In each phase, participants tried 3 samples (2 active-1 placebo or 2 placebo-1 active) and had to identify the odd one. In phase 1, the 3 samples were given simultaneously, whereas in phase 2, the 3 samples of foods that failed validation in phase 1 were given sequentially. A visual analog scale (VAS) ranging from 1 to 10 was used to evaluate how much participants liked the recipes. Results: In phase 1, the egg white recipe was validated (n=89 volunteers, 38.9% found the odd sample, P=.16). Milk and hazelnut recipes were validated in phase 2 (for both foods, n=30 participants, 36.7% found the odd sample, P=.36). Median VAS scores for the 3 recipes ranged from 6.6 to 9.7. Conclusions: We used sensory testing to validate milk, egg white, and hazelnut recipes for use in DBPCFC. The validated recipes are easy to prepare in a clinical setting, provide the equivalent of 1 serving dose, and were liked by most participants (AU)

Introducción: La provocación oral doble ciego controlada con placebo (PODCCP) es la prueba diagnóstica definitiva en alergia a alimentos. A pesar de ello hay pocas recetas validadas, que además no están estandarizadas y difieren entre centros. Para poder validar recetas para PODCCP es necesario utilizar pruebas sensoriales como el test del triángulo. Métodos: Se han desarrollado tres recetas para PODCCP con leche, clara de huevo y avellana, que se han validado mediante el test del triángulo en un estudio en dos fases con 197 voluntarios. En cada fase los participantes probaban 3 muestras (2 activo-1 placebo o 2 placebo-1 activo) y debían identificar la diferente. En la fase 1 las 3 muestras se presentaban simultáneamente, mientras que en la fase 2 las muestras de las recetas no validadas en la fase 1 eran presentadas secuencialmente a los voluntarios. Los participantes evaluaron de 1 a 10 su apreciación de las recetas en una escala visual analógica (EVA). Resultados: En la fase 1 la receta de clara de huevo fue validada (n=90 sujetos, 38,9% identificaron la muestra diferente, p=0,16). Las recetas de leche y avellana fueron validadas en la fase 2 (cada receta fue probada por 30 sujetos, y en cada una el 36,7% identificaron la muestra diferente, p=0,36). La mediana de la puntuación en la EVA de las 3 recetas osciló entre 6,6 y 9,7. Conclusiones: Hemos validado mediante pruebas sensoriales recetas para PODCCP con leche, clara de huevo y avellana. Las recetas validadas son fáciles de realizar en el entorno asistencial, proporcionan una cantidad equivalente a una ración y fueron apreciadas por la mayoría de los participantes (AU)

Increased incidence of admissions for anaphylaxis in Spain 1998-2011.

We report on trends in anaphylaxis admissions in the Spanish hospital system during the period 1998-2011. Data on admissions for anaphylaxis were obtained from the Spanish Information System for Hospital Data for the period 1998-2011. Patients were selected using the codes for anaphylaxis in the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Poisson regression models were used to estimate incidence rate ratios. We recorded a 1.89-fold increase in admissions for anaphylaxis in Spanish hospitals during the study period, particularly in patients aged 0-14 years (1.65- to 3.22-fold until 2009 and 4.09- to 12.59-fold until 2011) and in food anaphylaxis in all age groups (2.78-fold until 2009 and 8.74-fold until 2011). The incidence of anaphylaxis is perceived as having increased in recent years, especially anaphylaxis caused by food and anaphylaxis affecting the pediatric population.

Identification of novel peptide biomarkers to predict safety and efficacy of cow's milk oral immunotherapy by peptide microarray.

BACKGROUND: Cow's milk oral immunotherapy (CM-OIT) is still an experimental treatment. The development of novel biomarkers to predict the safety and efficacy of CM-OIT is crucial to translate this treatment to common clinical practice. OBJECTIVE: To analyse long-term changes in IgE and IgG4 epitope binding profile induced by CM-OIT to identify safety and efficacy biomarkers. METHODS: We studied 25 CM-allergic children who underwent CM-OIT and seven non-treated CM-allergic children as controls. CM-OIT patients were classified as low, moderate, and high risk according to the number of allergic reactions (safety), time required to achieve desensitization (efficacy) and need of premedication. IgE and IgG4 peptide microarray immunoassay was performed using a library of overlapping peptides of CM proteins at baseline, after oral desensitization, and 6, 12, and 24 months of follow-up. RESULTS: Cow's milk oral immunotherapy induced a rapid increase of IgG4-binding epitopes and a slow decrease in IgE-binding epitopes. High-risk patients recognized a statistically significant higher number of IgE peptides in caseins at all the times studied. Similar but less pronounced changes were observed for IgG4-positive peptides. Clustering analysis grouped together the high-risk patients, and we identified 13 regions of caseins significantly differed between groups of patients. Bioinformatics analysis selected two sets of 16 IgE-binding peptides at baseline that predicted safety (R(2)  = 0.858) and efficacy (R(2)  = 0.732), respectively, of CM-OIT. CONCLUSION AND CLINICAL RELEVANCE: We found two sets of IgE-binding peptides that can be used as novel biomarkers to predict the safety and efficacy of CM-OIT before starting treatment.

ALBIRA: a small animal PET∕SPECT∕CT imaging system.

PURPOSE: The authors have developed a trimodal PET∕SPECT∕CT scanner for small animal imaging. The gamma ray subsystems are based on monolithic crystals coupled to multianode photomultiplier tubes (MA-PMTs), while computed tomography (CT) comprises a commercially available microfocus x-ray tube and a CsI scintillator 2D pixelated flat panel x-ray detector. In this study the authors will report on the design and performance evaluation of the multimodal system. METHODS: X-ray transmission measurements are performed based on cone-beam geometry. Individual projections were acquired by rotating the x-ray tube and the 2D flat panel detector, thus making possible a transaxial field of view (FOV) of roughly 80 mm in diameter and an axial FOV of 65 mm for the CT system. The single photon emission computed tomography (SPECT) component has a dual head detector geometry mounted on a rotating gantry. The distance between the SPECT module detectors can be varied in order to optimize specific user requirements, including variable FOV. The positron emission tomography (PET) system is made up of eight compact modules forming an octagon with an axial FOV of 40 mm and a transaxial FOV of 80 mm in diameter. The main CT image quality parameters (spatial resolution and uniformity) have been determined. In the case of the SPECT, the tomographic spatial resolution and system sensitivity have been evaluated with a (99m)Tc solution using single-pinhole and multi-pinhole collimators. PET and SPECT images were reconstructed using three-dimensional (3D) maximum likelihood and ordered subset expectation maximization (MLEM and OSEM) algorithms developed by the authors, whereas the CT images were obtained using a 3D based FBP algorithm. RESULTS: CT spatial resolution was 85 µm while a uniformity of 2.7% was obtained for a water filled phantom at 45 kV. The SPECT spatial resolution was better than 0.8 mm measured with a Derenzo-like phantom for a FOV of 20 mm using a 1-mm pinhole aperture collimator. The full width at half-maximum PET radial spatial resolution at the center of the field of view was 1.55 mm. The SPECT system sensitivity for a FOV of 20 mm and 15% energy window was 700 cps∕MBq (7.8 × 10(-2)%) using a multi-pinhole equipped with five apertures 1 mm in diameter, whereas the PET absolute sensitivity was 2% for a 350-650 keV energy window and a 5 ns timing window. Several animal images are also presented. CONCLUSIONS: The new small animal PET∕SPECT∕CT proposed here exhibits high performance, producing high-quality images suitable for studies with small animals. Monolithic design for PET and SPECT scintillator crystals reduces cost and complexity without significant performance degradation.

Expectation maximization (EM) algorithms using polar symmetries for computed tomography (CT) image reconstruction.

We suggest a symmetric-polar pixellation scheme which makes possible a reduction of the computational cost for expectation maximization (EM) iterative algorithms. The proposed symmetric-polar pixellation allows us to deal with 3D images as a whole problem without dividing the 3D problem into 2D slices approach. Performance evaluation of each approach in terms of stability and image quality is presented. Exhaustive comparisons between all approaches were conducted in a 2D based image reconstruction model. From these 2D approaches, that showing the best performances were finally implemented and evaluated in a 3D based image reconstruction model. Comparison to 3D images reconstructed with FBP is also presented. Although the algorithm is presented in the context of computed tomography (CT) image reconstruction, it can be applied to any other tomographic technique as well, due to the fact that the only requirement is a scanning geometry involving measurements of an object under different projection angles. Real data have been acquired with a small animal (CT) scanner to verify the proposed mathematical description of the CT system.

Strategy to estimate risk progression of chronic kidney disease, cardiovascular risk, and referral to nephrology: the EPIRCE Study

Background: Although the prevalence of chronic kidney disease (CKD) is 10-14%, several prospective studies note a low rate of progression to end-stage renal disease (ESRD) in stages 3 and 4. A correct classification of risk of progression, based on demonstrated predictive factors, would allow better management of CKD. Recent studies have demonstrated the high predictive value of a classification that combines estimated (e) glomerular filtration rate (GFR) and urine albumin-creatinine ratio (ACR). We estimated the clinical risk of progression to ESRD and cardiovascular mortality predicted by the combined variable of eGFR and ACR in the Spanish general population. Materials and Methods: This study was a cross-sectional evaluation in the Epirce sample, representative of Spanish population older than 20 years. GFR was estimated using MDRD and CKD-EPI formulas; microalbuminuria was considered to be an ACR 20-200 mg/g (men) or 30-300 mg/g (women) and macroalbuminuria was indicated beyond these limits. Population-weighted prevalence of risk (..) (AU)

Antecedentes: Si bien la prevalencia de la enfermedad renal crónica (ERC) es del 10-14 %, diversos estudios prospectivos indican que en las fases 3 y 4 existe una tasa baja de progresión hacia enfermedad renal terminal (ERT). Una clasificación correcta del riesgo de progresión basada en factores predictivos demostrados permitiría un mejor manejo de la ERC. Estudios recientes han demostrado el elevado valor predictivo de la clasificación que combina el valor estimado (e) de la tasa de filtrado glomerular (FG) con la ratio albúmina-creatinina (RAC) en orina. Realizamos una estimación del riesgo clínico de una progresión hacia una ERT y de mortalidad cardiovascular existente en la población general española basando la predicción en el uso combinado de las variables tasa (e) de FG y RAC. Materiales y métodos: Evaluación cruzada en la muestra Epirce, que era representativa de la población española mayor de 20 años. Para la estimación del FG se emplearon las fórmulas MDRD y CKD-EPI; se consideraba la existencia de microalbuminuria cuando los valores de RAC oscilaban entre 20-200 mg/g (hombres) o entre 30-300 mg/g (mujeres) y de macroalbuminuria cuando los valores superaban dichos límites. Se realizó una estimación de la prevalencia ponderada poblacionalmente del riesgo de progresión de ERC hacia ERT. Resultados: Con MDRD, el 1,4 % de la población (..) (AU)

Strategy to estimate risk progression of chronic kidney disease, cardiovascular risk, and referral to nephrology: the EPIRCE Study.

BACKGROUND: Although the prevalence of chronic kidney disease (CKD) is 10­14%, several prospective studies note a low rate of progression to end-stage renal disease (ESRD) in stages 3 and 4. A correct classification of risk of progression, based on demonstrated predictive factors, would allow better management of CKD. Recent studies have demonstrated the high predictive value of a classification that combines estimated (e) glomerular filtration rate (GFR) and urine albumin­creatinine ratio (ACR). We estimated the clinical risk of progression to ESRD and cardiovascular mortality predicted by the combined variable of eGFR and ACR in the Spanish general population. MATERIALS AND METHODS: This study was a cross-sectional evaluation in the Epirce sample, representative of Spanish population older than 20 years. GFR was estimated using MDRD and CKD-EPI formulas; microalbuminuria was considered to be an ACR 20­200 mg/g (men) or 30­300 mg/g (women) and macroalbuminuria was indicated beyond these limits. Population-weighted prevalence of risk of progression of CKD to ESRD was estimated. RESULTS: With MDRD, 1.4% of the adult Spanish population was at moderate risk of progression to ESRD, 0.1% at high risk, and 12.3% at low risk. With CKD-EPI, the moderate risk ratio rose to 1.7% and low risk to 12.6%, but high risk remained stable. CONCLUSIONS: The addition of ACR to eGFR best classifies the population at risk for renal impairment relative to Kidney/Disease Outcomes Quality Initiative grades 3 and 4. Estimating GFR with CKD-EPI modifies the distribution of low and moderate risk.

Trends of asthma mortality in Galicia from 1993 to 2007.

INTRODUCTION: In the past few years, deaths due to asthma appear to decrease at least in Western countries; but there are significant variations between populations. The aim of this study is to describe the trends in deaths due to asthma between 1993 and 2007 in our community and to analyze any factors associated with this. METHODS: All cases, which had asthma as a cause of death, were included in the study. The mortality data were obtained from the official death certificate from the Deaths Register. Mortality relative risk, based on the calendar year, sociodemographic variables (age and gender), seasons, and days of the week, were estimated using a Poisson generalized linear model with a log-link. RESULTS: In the 15 years of the study period, a total of 1180 people had died due to asthma, mainly in winter (34.5%), women (64.5%), and advanced age (65 years or above; 84.6%). A tendency of decreased mortality in all age groups was observed during the period of the study, which was significant in both the sexes in the 35- to 64-year-old age group, and in males above 65 years. CONCLUSION: Death due to asthma is changing favorably in our community, with a tendency to decrease in the past few years. Advanced age, being female, and the winter period are associated with a higher mortality rate due to asthma.

Small animal PET scanner based on monolithic LYSO crystals: performance evaluation.

PURPOSE: The authors have developed a small animal Positron emission tomography (PET) scanner based on monolithic LYSO crystals coupled to multi-anode photomultiplier tubes (MA-PMTs). In this study, the authors report on the design, calibration procedure, and performance evaluation of a PET system that the authors have developed using this innovative nonpixelated detector design. METHODS: The scanner is made up of eight compact modules forming an octagon with an axial field of view (FOV) of 40 mm and a transaxial FOV of 80 mm diameter. In order to fully determine its performance, a recently issued National Electrical Manufacturers Association (NEMA) NU-4 protocol, specifically developed for small animal PET scanners, has been followed. By measuring the width of light distribution collected in the MA-PMT the authors are able to determine depth of interaction (DOI), thus making the proper identification of lines of response (LORs) with large incidence angles possible. PET performances are compared with those obtained with currently commercially available small animal PET scanners. RESULTS: At axial center when the point-like source is located at 5 mm from the radial center, the spatial resolution measured was 1.65, 1.80, and 1.86 mm full width at half maximum (FWHM) for radial, tangential, and axial image profiles, respectively. A system scatter fraction of 7.5% (mouse-like phantom) and 13% (rat-like phantom) was obtained, while the maximum noise equivalent count rate (NECR) was 16.9 kcps at 12.7 MBq (0.37 MBq/ml) for mouse-like phantom and 12.8 kcps at 12.4 MBq (0.042 MBq/ml) for rat-like phantom The peak absolute sensitivity in the center of the FOV is 2% for a 30% peak energy window. Several animal images are also presented. CONCLUSIONS: The overall performance of our small animal PET is comparable to that obtained with much more complex crystal pixelated PET systems. Moreover, the new proposed PET produces high-quality images suitable for studies with small animals.

Ecological determinants of the occurrence and dynamics of Vibrio parahaemolyticus in offshore areas.

The life cycle of Vibrio parahaemolyticus has been conventionally associated with estuarine areas characterized by moderate salinity and warm seawater temperatures. Recent evidence suggests that the distribution and population dynamics of V. parahaemolyticus may be shaped by the existence of an oceanic transport of communities of this organism mediated by zooplankton. To evaluate this possibility, the presence of V. parahaemolyticus in the water column of offshore areas of Galicia was investigated by PCR monthly over an 18-month period. Analysis of zooplankton and seawater showed that the occurrence of V. parahaemolyticus in offshore areas was almost exclusively associated with zooplankton and was present in 80% of the samples. The influence of environmental factors assessed by generalized additive models revealed that the abundance and seasonality of V. parahaemolyticus in zooplankton was favoured by the concurrence of downwelling periods that promoted the zooplankton patchiness. These results confirm that offshore waters may be common habitats for V. parahaemolyticus, including strains with virulent traits. Additionally, genetically related populations were found in offshore zooplankton and in estuaries dispersed along 1500 km. This finding suggests that zooplankton may operate as a vehicle for oceanic dispersal of V. parahaemolyticus populations, connecting distant regions and habitats, and thereby producing impacts on the local community demography and the spread of Vibrio-related diseases.

Clinical diagnosis of toenail onychomycosis is possible in some patients: cross-sectional diagnostic study and development of a diagnostic rule.

BACKGROUND: Suspected toenail onychomycosis is a frequent problem. Clinical diagnosis has been considered inadequate. OBJECTIVES: To assess the diagnostic accuracy of clinical findings for detecting fungi in toenails, and to develop and validate a clinical diagnostic rule aimed at improving dermatologists' diagnosis of onychomycosis. METHODS: A cross-sectional diagnostic study was performed including a total of 277 patients seen by 12 dermatologists. The gold standard was the presence of dermatophytes on culture or a positive nail plate biopsy. For each sign we described prevalence, sensitivity, specificity, positive and negative predictive values, and likelihood ratios for positive and negative results. We developed a diagnostic clinical rule and validated it in a subsample. RESULTS: Helpful findings to predict the presence of fungi are: previous diagnosis of fungal disease; abnormal plantar desquamation (affecting > 25% of the sole); onychomycosis considered the most probable diagnosis by a dermatologist; and presence of interdigital tinea. When dermatologists considered onychomycosis the most probable diagnosis and plantar desquamation was present (13% of patients), the positive predictive value for presence of fungi was 81%. When both signs were absent (34% of patients), the positive predictive value for absence of fungi was 71%. In other situations, clinical diagnosis might not give enough information to decide on therapy. CONCLUSIONS: In 13% of the patients (a large number in absolute terms), when dermatologists consider onychomycosis the most probable diagnosis and plantar desquamation is present, therapy should be started without any further test, as clinical diagnosis is at least as accurate as laboratory tests. In other situations, an optimal management strategy should be defined.

Immunotherapy with a Phleum pratense allergen extract induces an immune response to a grass-mix allergen extract.

BACKGROUND: Grass pollen allergy is one of the most common allergies worldwide, and patients often show sensitization to an array of phylogenetically related species. OBJECTIVE: To determine the effect of specific immunotherapy (SIT) with Phleum pratense extract on induction of the immune response to a mixture composed of 5 grass pollen extracts. METHODS: Forty-six adult patients suffering from rhinitis and sensitized to a mix of grass pollen allergen extracts were randomized 3:1 to receive a short course of SIT with P. pratense or to an open control group without SIT. At baseline and after 3-4 months, we evaluated levels of specific immunoglobulin (Ig) E and IgG4, as well as the immediate and delayed cutaneous responses to the grass mix and P. pratense. IgG4 to Lolium perenne was also determined. RESULTS: Levels of IgE and IgG4 to grass mix and P. pratense increased significantly during treatment (P<.001). However, this increase was only significantly higher in the SIT group than in the control group for IgG4 (P<.001). The levels of IgG4 to Phl p 5 and Lol p 5 were highly correlated (r=0.99, P<.001). The immediate and delayed cutaneous responses were significantly diminished to both extracts after SIT (P<.001). CONCLUSIONS: Patients with rhinoconjunctivitis diagnosed using skin prick testing with a grass mix allergen extract and treated with a short course of SIT based on a single species P. pratense allergen extract are able to develop an immune response that targets not only the immunizing species, but also the grass mix allergen extract.

[Neuropsychological performance in patients with human inmunodeficiency (HIV) and hepatitis C virus (HCV) coinfection]. / Rendimiento neuropsicológico en pacientes coinfectados por virus de la inmunodeficiencia humana (VIH) y de la hepatitis C (VHC).

INTRODUCTION: Few investigations have focused their attention on the study of neuropsychological deterioration associated to human inmunodeficiency virus (HIV) and hepatitis C virus (HCV) coinfection. This study has aimed to evaluate neuropsychological performance and neuropsychological impairment rates in HIV and HCV positive patients (HIV+/HCV+) of Spanish nationality of the region of Galicia. METHOD: Three groups of 122 subjects underwent neuropsychological evaluation: 55 HIV+, 29 HIV/HCV+ and 34 seronegative to both HIV/HCV. All subjects gave their written informed consent and underwent the same evaluation process. RESULTS: HIV+ and HIV/HCV+ patients showed significantly lower levels of neuropsychological performance in all neuropsychological domains evaluated in comparison with the control group. Nevertheless, only visual memory showed significantly differences between both groups. The rate of neuropsychological impairment of HIV+/HCV+ patients (62%) was significantly greater than that of HIV+ (38%). CONCLUSIONS: HIV and HIV/HCV infection are related to low levels of neuropsychological performance, HIV/HCV patients showing lower performance in visual memory tasks. HIV/HCV coinfection represents a neuropsychological impairment risk factor in HIV patients, because it influences the probability of having neuropsychological impairment. However, this may not only be related with HCV, but also with being in methadone-maintenance programs.

Rendimiento neuropsicológicoen pacientes coinfectadospor virus de la inmunodeficienciahumana (VIH) y de la hepatitis C (VHC) / No disponible

Introducción. Pocas investigaciones han centrado su atenciónen el estudio del deterioro neuropsicológico asociado a la coinfecciónpor los virus de la inmunodeficiencia humana (VIH) y de la hepatitisC (VHC). El objetivo de este estudio es evaluar el rendimientoneuropsicológico y las tasas de deterioro neuropsicológico en pacientesgallegos seropositivos coinfectados por VIH/VHC.Método. Se realizó una evaluación neuropsicológica a tres gruposde 122 sujetos, 59 infectados por VIH, 29 coinfectados porVIH/VHC y 34 seronegativos a ambos virus. Todos los sujetos dieronel consentimiento informado y fueron sometidos al mismo procesode evaluación.Resultados. Los pacientes monoinfectados por VIH y los coinfectadospor VIH/VHC mostraron niveles significativamente más bajosde rendimiento neuropsicológico que el grupo control en todaslas funciones estudiadas, apreciándose diferencias significativas entreel grupo de monoinfectados y coinfectados únicamente en elfactor que evalúa la memoria visual. En cuanto a las tasas de deterioroneuropsicológico, éstas fueron significativamente más elevadasen el grupo de pacientes coinfectados (62%) frente al de monoinfectados(38%).Conclusiones. La infección por VIH y la coinfección por VIH yVHC se asocia a niveles de rendimiento bajos, mostrando los pacientescoinfectados un rendimiento más bajo en tareas de memoria visual.La coinfección por VIH/VHC representa un factor de riesgo dedaño neuropsicológico en sujetos seropositivos al VIH, ya que influyede forma significativa en la probabilidad que tienen éstos de presentardeterioro neuropsicológico, si bien ésta pudiera estar relacionadano sólo con el VHC, sino también con la permanencia en programasde mantenimiento con metadona (AU)

Introduction. Few investigations have focused their attentionon the study of neuropsychological deterioration associated tohuman inmunodeficiency virus (HIV) and hepatitis C virus (HCV)coinfection. This study has aimed to evaluate neuropsychologicalperformance and neuropsychological impairment rates in HIVand HCV positive patients (HIV+/HCV+) of Spanish nationality ofthe region of Galicia.Method. Three groups of 122 subjects underwent neuropsychologicalevaluation: 55 HIV+, 29 HIV/HCV+ and 34 seronegativeto both HIV/HCV. All subjects gave their written informedconsent and underwent the same evaluation process.Results. HIV+ and HIV/HCV+ patients showed significantlylower levels of neuropsychological performance in all neuropsychologicaldomains evaluated in comparison with the controlgroup. Nevertheless, only visual memory showed significantlydifferences between both groups. The rate of neuropsychologicalimpairment of HIV+/HCV+ patients (62%) was significantly greaterthan that of HIV+ (38%).Conclusions. HIV and HIV/HCV infection are related to low levelsof neuropsychological performance, HIV/HCV patients showinglower performance in visual memory tasks. HIV/HCV coinfectionrepresents a neuropsychological impairment risk factor in HIV patients,because it influences the probability of having neuropsychologicalimpairment. However, this may not only be related withHCV, but also with being in methadone-maintenance programs (AU)

Angiodisplasias. Un interensate caso / Angiodyslasias. An interesting case

Las Angiodisplasias son el resultado de trastornos en el desarrollo embriológico del sistema circulatorio, y en dependencia del momento en que esto ocurra, determinará afecciones venosas, linfáticas, arteriales o mixtas, lo que unido a su localización determinarán la mayor o menor complejidad del cuadro resultante y de su enfoque terapéutico, aspecto este, que en determinadas circunstancias constituyen un verdadero reto para los especialistas que tendrán que enfrentarla. Se presenta una mujer de 46 años de edad, mestiza, que sin antecedentes patológicos personales, ni familiares a excepción de padecer de una angiodisplasia compleja por sus características anátomo-fisiológicas, localizada en la región lumbosacra, tratada hace mas de 20 años con embolizaciones, sin resultados favorables y antecedentes de alergia al yodo durante estudios posteriores, presenta hemorragias recurrentes con serias implicaciones para la conservación su vida, lo que hicieron de ella uno de esos casos interesantes y particularmente difíciles, que a menudo nos ponen a prueba, y que deseamos compartira través de elocuentes imágenes gráficas (AU)

The Angiodysplasias are a result of a disturbance in the embriologic development of the circulatory system, and, dependingof the moment in which those occur, they will determine venous, linfatic, and arterial affections or a mixture of them, and also due to their location, there will determine more or less complications of the desease and its therapeutic approach, which can be a real challenge, in certain circumstances, for the specialists who should face them. A 46 years old, half-breed woman, without personal nor familiar patological antecedents, suffering from a complicated angiodysplasia due to her anatomo-fisiological caracteristics, localized in the lumbosacral region, treated with embolizations for more than 20 years, without any favorable results and having discovered iodine allergy during subsequent investigations, presents recurrent hemorrage with serious implicacions for his life; all that made us determine to be an interesting and particularly dificult case, that frequently can be a challenge for us, and that we wish to share through eloquent grafic images (AU)