Atmospheric drying and soil drying: Differential effects on grass community composition.

Global surface temperatures are projected to increase in the future; this will modify regional precipitation regimes and increase global atmospheric drying. Despite many drought studies examining the consequences of reduced precipitation, there are few experimental studies exploring plant responses to atmospheric drying via relative humidity and vapor pressure deficit (VPD). We examined eight native California perennial grass species grown in pots in a greenhouse in Los Angeles, California for 34 weeks. All pots were well-watered for 21 weeks, at which point we reduced watering to zero and recorded daily growth and dormancy for 3 weeks. We used this information to better understand the drought tolerance of our species in a larger soil drying × atmospheric drying experiment. In this larger experiment, we grew all eight species together in outdoor mesocosms and measured changes in community composition after 4 years of growth. Soil drying in our small pot experiment mirrored compositional shifts in the larger experiment. Namely, our most drought-tolerant species in our pot experiment was Poa secunda, due to a summer dormancy strategy. Similarly, the grass community shifted toward P. secunda in the driest soils as P. secunda was mostly unaffected by either soil drying or atmospheric drying. We found that some species responded strongly to soil drying (Elymus glaucus, Festuca idahoensis, and Hordeum b. californicum), while others responded strongly to atmospheric drying (Bromus carinatus and Stipa cernua). As result, community composition shifted in different and interacting ways in response to soil drying, atmospheric drying, and their combination. Further study of community responses to increasing atmospheric aridity is an essential next step to predicting the future consequences of climate change.

Simulating atmospheric drought: Silica gel packets dehumidify mesocosm microclimates.

1. As global temperatures rise, droughts are becoming more frequent and severe. To predict how drought might affect plant communities, ecologists have traditionally designed experiments with controlled watering regimes and rainout shelters. Both treatments have proven effective for simulating soil drought. However, neither are designed to directly modify atmospheric drought. 2. Here, we detail the efficacy of a silica gel atmospheric drought treatment in outdoor mesocosms with and without a cooccurring soil drought treatment. At California State University, Los Angeles, we monitored relative humidity (RH), temperature, and vapor pressure deficit (VPD) every 10 minutes for five months in a bare-ground experiment featuring mesocosms treated with soil drought (reduced watering) and/or atmospheric drought (silica packets suspended 12 cm above soil). 3. We found that silica packets dehumidified these microclimates most effectively (-5% RH) when combined with reduced soil water, regardless of the ambient humidity levels of the surrounding air. Further, packets increased microclimate VPD most effectively (+0.4 kPa) when combined with reduced soil water and ambient air temperatures above 20°C. Finally, packets simulated atmospheric drought most consistently when replaced within three days of deployment. 4. Our results demonstrate the use of silica packets as effective dehumidification agents in outdoor drought experiments. We emphasize that incorporating atmospheric drought in existing soil drought experiments can improve our understandings of the ecological impacts of drought.

Longitudinal Association between Late-Life Depression (LLD) and Frailty: Findings from a Prospective Cohort Study (MiMiCS-FRAIL).

OBJECTIVES: The aim of the present study was to investigate whether late-life depression (LLD) is associated with incident frailty over time. DESIGN: Prospective cohort study, one-year follow-up. SETTING: Geriatric outpatient clinic, Southwestern of Brazil. PARTICIPANTS: 181 follow-up participants aged 60 years or over. MEASUREMENTS: Depressive disorders were classified as Major Depressive disorder (MDD) or Subthreshold Depression (STD) according to DSM-5 criteria. Depressive symptoms were assessed with validated versions of 15-item Geriatric Depression Scale (GDS-15) and 9-item Patient Health Questionnaire (PHQ-9). We performed binary logistic regressions to estimate the odds ratio (OR) for frailty in LLD adjusting for multiple confounders. Participants who were frail at baseline were excluded from the analyses according to measures of frailty (FRAIL questionnaire and 36-item Frailty Index, FI-36). We also estimated the risk ratio or relative risk (RR) and the risk difference (RD) for incident frailty. RESULTS: We observed a 2 to 4-fold increased risk for incident frailty among participants with LLD. The presence of a depressive disorder was significantly associated with the onset of frailty (adjusted OR for FRAIL and FI-36: 3.07 [95% CI = 1.03 - 9.17] and 3.76 [95% CI = 1.09 - 12.97], respectively. Notably, the risk for frailty due to LLD was significantly higher with the FI-36 compared to the FRAIL (RR: 3.03 versus 2.23). RD was of 17.3% and 12.7% with the FRAIL and the FI-36, respectively. CONCLUSION: Our data support the association between LLD and incident frailty over one year among geriatric outpatients, reinforcing longitudinal evidence from population-based studies.

An x-ray penumbral imager for measurements of electron-temperature profiles in inertial confinement fusion implosions at OMEGA.

Hot-spot shape and electron temperature (Te) are key performance metrics used to assess the efficiency of converting shell kinetic energy into hot-spot thermal energy in inertial confinement fusion implosions. X-ray penumbral imaging offers a means to diagnose hot-spot shape and Te, where the latter can be used as a surrogate measure of the ion temperature (Ti) in sufficiently equilibrated hot spots. We have implemented a new x-ray penumbral imager on OMEGA. We demonstrate minimal line-of-sight variations in the inferred Te for a set of implosions. Furthermore, we demonstrate spatially resolved Te measurements with an average uncertainty of 10% with 6 µm spatial resolution.

A multi-channel x-ray temporal diagnostic for measurement of time-resolved electron temperature in cryogenic deuterium-tritium implosions at OMEGA.

Electron-temperature (Te) measurements in implosions provide valuable diagnostic information, as Te is unaffected by residual flows and other non-thermal effects unlike ion temperature inferred from a fusion product spectrum. In OMEGA cryogenic implosions, measurement of Te(t) can be used to investigate effects related to time-resolved hot-spot energy balance. The proposed diagnostic utilizes five fast-rise (∼15 ps) scintillator channels with distinct x-ray filtering. Titanium and stepped aluminum filtering were chosen to maximize detector sensitivity in the 10 keV-20 keV range, as it has been shown that these x rays have similar density and temperature weighting to the emitted deuterium-tritium fusion neutrons. Initial data collected using a prototype nosecone on the existing neutron temporal diagnostic demonstrate the validity of this diagnostic technique. The proposed system will be capable of measuring spatially integrated Te(t) with 20 ps time resolution and <10% uncertainty at peak emission in cryogenic DT implosions.

Using millimeter-sized carbon-deuterium foils for high-precision deuterium-tritium neutron spectrum measurements in direct-drive inertial confinement fusion at the OMEGA laser facility.

Millimeter-sized CD foils fielded close (order mm) to inertial confinement fusion (ICF) implosions have been proposed as a game-changer for improving energy resolution and allowing time-resolution in neutron spectrum measurements using the magnetic recoil technique. This paper presents results from initial experiments testing this concept for direct drive ICF at the OMEGA Laser Facility. While the foils are shown to produce reasonable signals, inferred spectral broadening is seen to be high (∼5 keV) and signal levels are low (by ∼20%) compared to expectation. Before this type of foil is used for precision experiments, the foil mount must be improved, oxygen uptake in the foils must be better characterized, and impact of uncontrolled foil motion prior to detection must be investigated.

Gynecological-endocrinological aspects in women carriers of BRCA1/2 gene mutations.

Women carriers of mutations in the genes BRCA1 and BRCA2 coding for tumor suppressor proteins are at high risk of developing breast and ovarian cancers. Hereditary breast and ovarian cancers due to BRCA pathogenic mutations occur at earlier ages: mean age 43 years at diagnosis of breast cancer for BRCA1 mutations; onset of ovarian cancer up to 10-21% by age 50 years. Preventive strategies are then defined in the reproductive years. The National Comprehensive Cancer Network (NCCN) guidelines define that BRCA1/2 genetic testing should begin with the affected cancer individual (BRCA1/2 full sequencing); then, family members should be tested for the specific gene mutation found. A woman known to be a carrier needs a strict specific surveillance strategy to achieve early diagnosis. The NCCN proposes breast imageneological surveillance beginning at age 25 years; ovarian surveillance beginning at age 30-35 years. Concomitantly, risk-reducing strategies should be analyzed: surgical or pharmacological. When prophylactic bilateral salpingo-oophorectomy is performed before menopause, estrogen replacement therapy could be required. For BRCA, we review the risks of cancer in mutations carriers, criteria for genetic testing, surveillance and risk-reduction strategies, and the safety of prescribing hormone therapy when needed.

Lepra lepromatosa no erradicada en el perú / Leprosy lepromatosa not eradicated in peru

RESUMEN En este estudio del caso, los autores discuten la presentación de un varón de 56 años, con lepra lepromatosa multibacilar, localizado en un hospital del distrito de Trujillo. La biopsia de una de las lesiones, demostró infiltraciones difusas por macrófagos espumosos en toda su extensión; con la tinción de Ziehl - Neelsen se encuentran: bacilos ácido-alcohol resistentes sueltos o empaquetados en grupos, con índice bacilar: 6. La condición se manejó inicialmente en la comunidad como un "pénfigo ampolloso", sugiriendo que las barreras locales actualmente impiden la detección de la lepra en este sistema de atención primaria, en desarrollo. La lepra es una enfermedad multisistémica y el paciente demostró alteraciones neurológicas periféricas evidentes. Promover el conocimiento de estas manifestaciones sistémicas, evitará un retraso en el diagnóstico, a su vez disminuirá las complicaciones y eludirá la morbilidad a largo plazo. Los esfuerzos para optimizar los sistemas de detección, gestión, educación pública y profesional son esenciales, para impulsar la erradicación en estas poblaciones en riesgo.

SUMMARY In this case study, the authors discuss the presentation of a 56-year-old male in a hospital in the Trujillo district with lepromatous multibacillary leprosy. The biopsy of one of the lesions showed diffuse infiltrations by foamy macrophages in all its extension, with the stain of Ziehl - Neelsen bacilli acid resistant alcohol loose or packaged in groups, the bacilar index: 6. The condition was initially managed in the community as a "bullous pemphigus" that suggests that local barriers currently prevent the detection of leprosy in this developing primary care system. Leprosy is a multisystem disease and the patient demonstrated evident peripheral neurological alterations. Promoting the knowledge of these systemic manifestations will avoid a delay in the diagnosis, in turn will reduce complications and avoid long-term morbidity. Efforts to optimize detection systems, management and public and professional education are essential to promote eradication in these populations at risk.

Adaptación inicial de un cuestionario de autopercepción de calidad de vida en pacientes con disfagia / Initial adaptation of a questionnaire on selfperception of quality of life in patients with dysphagia

El propósito de este estudio fue realizar una adaptación inicial a la población chilena del Swallowing Quality of Life Questionnaire (SWAL-QOL), instrumento diseñado para conocer la autopercepción de la calidad de vida que informan las personas con disfagia orofaríngea.La adaptación se realizó mediante el proceso de traducción y retrotraducción y se obtuvo una versión final del cuestionario a través del consenso de expertos.Posteriormente, el cuestionario se aplicó a diez personas con disfagia a consecuencia de un accidente cerebrovascular. Los resultados evidenciaron que la adaptación del instrumento puede ser considerada adecuada. Los valores de consistencia interna para todas las escalas son buenos, con coeficientes de α de Cronbach entre 0.71 y 0.90. Los pacientes con disfagia reportaron una percepción disminuida de su calidad de vida, los puntajes más bajos se presentaron en duración de la alimentación (47.00 ± 9.90) y salud mental (48.00 ± 17.78). La versión adaptada del SWAL-QOL que se presenta es de fácil aplicación en la práctica clínica y entrega información valiosa acerca de la autopercepción de la calidad de vida de las personas con disfagia

The purpose of this study was to carry out an initial adaptation to the Chilean population of the Swallowing Quality of Life Questionnaire (SWAL-QOL) instrument designed to know the perception of quality of life in persons with oropharyngeal dysphagia.The adaptation of the instrument was carried out via translation and back-translations, which resulted in a final version of the questionnaire through consensus of experts. It was applied to ten people with dysphagia due to stroke.The adaptation of the instrument was considered appropriate and values of internal consistency for all scales were adequate, with coefficients α Cronbach ranging between 0.71 and 0.90. Dysphagia patients reported a decrease in their perception of quality of life, with the lowest scores observed for feeding duration (47.00 ± 9.90) and mental health (48.00 ± 17.78).The present study presents an adapted version of the SWAL-QOL, which is easy to apply in clinical practice

Sección de Gastroenterología Infantil del Hospital Universitario Gregorio Marañón / Pediatric Gastroenterology section of the Hospital Universitario Gregorio Marañón

La Sección de Gastroenterología, Hepatología y Nutrición Infantil del Hospital Materno Infantil del HGU Gregorio Marañón se dedica a la atención integral del paciente pediátrico con patología digestiva y con especial dedicación a la nutrición del niño enfermo en diferentes situaciones especiales (enfermedades oncohematológicas, niños con cardiopatías congénitas, enfermedades neuromusculares, postoperatorio de diferentes patologías quirúrgicas, enfermedades del riñón, enfermedades metabólicas, etc.). Dentro de las actividades asistenciales de la sección cabe destacar el seguimiento de diferentes patologías digestivas crónicas, como la enfermedad celíaca, la dedicación especial con novedosos proyectos asistenciales y de investigación en la enfermedad inflamatoria intestinal, así como la asistencia en enfermedades crónicas del hígado y páncreas, entre otras. En esta Sección se han desarrollado nuevas técnicas diagnósticas y se han fortalecido la aplicación de otras exploraciones complementarias complejas en el estudio de enfermedades digestivas, convirtiéndose en centro de referencia de algunas de ellas como sucede en el caso de trastornos de motilidad digestiva o el estudio de la microbiota intestinal. En este artículo se refleja la estructura de la unidad junto con una revisión de su actividad asistencial en patologías digestivas cada vez más complejas, la elaboración de las tareas docentes realizadas en nuestro centro y para otras entidades con gran difusión de las mismas, así como la importante labor de investigación clínica con participación en diferentes líneas de investigación (AU)

The Paediatric Gastroenterology, Hepatology and Nutrition Section of Maternal and Child Hospital HGU Gregorio Maranon is dedicated to comprehensive care of pediatric patients with digestive diseases with special attention to the nutrition of the sick child in different special situations (oncohaemathologic diseases, complex heart diseases, neuropaediatric diseases, postoperative of different surgical diseases, kidney diseases, metabolíc diseases…). Within the humanitarian assistance activities of the Section include monitoring of different chronic digestive diseases, such as celiac disease, special dedication to innovative care projects and research in inflammatory bowel disease, and such as assistance in chronic diseases of the liver and pancreas, among others. On the other hand, in our section we have developed new diagnostic techniques and strengthened the implementation of other complex complementary examinations in the study of digestive diseases, becoming a reference center for some of them as happens in the case of motility disorders and research of microbiome. In this article, the structure of the Section is reflected along with a review of their daily work in increasingly complex digestive diseases, as well as educational activities in our center and to other entities with widely distributed thereof, as well as the important work of clinical research with participation in different lines of research (AU)

Role of calcifying nanoparticle in the development of hyperplasia and vascular calcification in an animal model.

OBJECTIVE: Calcifying nanoparticles (NPs) have been detected recently in calcified human arterial specimens and are involved in the process of calcification. This study was designed to test the hypothesis that human-derived NPs could worsen the response to arterial endothelial injury and induce vascular calcification. METHODS: The right carotid artery of 24 New Zealand rabbits was injured with an angioplasty balloon. Animals were perfused intravenously with saline (100 mL) during the experiment and divided into three groups: group-A, control; group-B, exposed to NPs (2 mL) obtained from calcified aortic valves; and group-C, exposed to NPs (2 mL) and treated postoperatively with atorvastatin (2.5 mg/kg/24 h). At 30 days, both carotid arteries were removed and examined histologically. Blood measurements were monitored during the study. RESULTS: The intimal hyperplasia area was significantly larger in the injured right carotid artery compared with the left unoperated carotid artery in all groups. There was no significant variation in medial area between groups. Morphometrically, the intima/media ratio (IMR) was significantly higher in damaged carotids compared with controls. A significant increase of IMR was found in group-B (1.81 ± 0.41) compared with group-A (0.38 ± 0.59; p = .004) or group-C (0.89 ± 0.79; p = .035). Differences between groups C and A were not significant (p = .064). Calcifications were observed in six animals, all of which had been exposed to NPs (4 in group-B, 2 in group-C, p = .027). Plasma levels of cholesterol and triglycerides remained stable. CONCLUSIONS: This research confirms the ability of systemic inoculation of human-derived NPs to accelerate hyperplasia and stimulate calcification in localized areas of arteries previously submitted to endothelial damage, while it was harmless in healthy arteries. Atorvastatin was demonstrated to slow down this process.

A critique of the official report on the evacuation of the World Trade Center: continued doubts.

This paper criticises the conclusions and the unanswered questions in the National Institute of Standards and Technology (NIST)'s official report on the evacuation of the World Trade Center in New York City, United States, on 11 September 2001. It reviews the extent to which the report disregards several conventional statistical methods and comments on the NIST's refusal to share the machine-readable data file with the scientific community for replication and further analysis. Problems lie in the sampling methods employed, the treatment of missing data, the use of ordinary least squares (OLS) with binary dependent variables, the failure to document the scalability of the scales used, the lack of tests to check for constant error variance, and the absence of overall fit tests of the model. There are also conceptual and theoretical issues, such as the absence in the report of considerations of the influence of group-level processes and their impact on the collective behaviour of evacuating collectivities.

Normative collective behavior in the Station building fire.

Objective. This article offers a test of the normative explanation of collective behavior by examining the fire at the Station nightclub in Rhode Island that killed 100 and injured nearly 200 persons.Methods. Information on all persons at the club comes from content analysis of documents from the Rhode Island Police Department, the Rhode Island Office of the Attorney General, and The Providence Journal. We use negative binomial regression to test hypotheses about the effects of group-level predictors of the counts of dead and injured in 179 groups at the nightclub.Results. Results indicate that group-level factors such as distance of group members at the start of the fire, the number of intimate relations among them, the extent to which they had visited the nightclub prior to the incident, and the average length of the evacuation route they used predict counts of injured and dead. The research also looks at what behavioral differences exist between survivors and victims, ascertains the existence of role extension among employees of the nightclub, and provides support for the affirmation that dangerous contexts negate the protective influence of intimate relations in groups.Conclusion. We argue for the abandonment of current emphasis on irrationality and herd-like imitative behavior in studies of evacuation from structural fires in buildings and for the inclusion of group-level processes in social psychological explanations of these incidents.

Carcinoma ductal in situ: correlación entre la histología y la resonancia magnética de mama / Breast MRI-histologic correlation for ductal carcinoma in situ

Objetivo: Evaluar la concordancia de la resonancia magnética (RM) de mama con la histología en la valoración del tamaño y extensión del carcinoma ductal in situ puro (CDIS), y compararla con la de las técnicas convencionales (mamografía y ecografía). Material y métodos: Estudio retrospectivo de pacientes consecutivas con biopsia percutánea con resultado de CDIS. Se estimó el coeficiente de concordancia de correlación de Lin para cada uno de las 3 técnicas de imagen con la histología. Además, se revisó la concordancia con gráficos de Bland-Altman. Se evaluaron los cambios de conducta quirúrgica generados por la RM. Resultados: El grupo estudiado fue de 32 pacientes. En cuanto al tamaño tumoral, la concordancia fue superior en la RM (0,78; intervalo de confianza [IC] de 95%, 0,62–0,87) que en la mamografía (0,43; IC del 95%, 0,19–0,62) o en la ecografía (0,27; IC del 95%, 0,09–0,43). La RM sobrestimó el tamaño con un promedio de 3mm, mientras que la mamografía y la ecografía lo subestimaron en 9 y 18mm, respectivamente. La RM fue superior para la detección del multifocalidad o multicentricidad (7 casos) frente a la mamografía (3 casos) y a la ecografía (0 casos). Hubo 6 cambios de conducta quirúrgica correctos basados en los hallazgos de la RM. Conclusión: La RM de mama es superior a las técnicas convencionales en la valoración del tamaño de los CDIS. Además, detecta más casos de multifocalidad y multicentricidad, por lo que aconsejamos su utilización prequirúrgica en pacientes diagnosticadas de CDIS, especialmente en mamas densas (AU)

Objective: To evaluate the concordance between the breast MRI findings and the histologic findings for the size and extension of pure ductal carcinoma in situ (DCIS) and to compare this concordance with that of conventional techniques (mammography and ultrasonography). Material and methods: This is a retrospective study of consecutive patients diagnosed with DCIS after percutaneous biopsy. We estimated Lin's coefficient of concordance for the histologic findings with each of the three techniques. We also assessed concordance using Bland-Altman graphs. Finally, we determined the impact of the MRI findings on the surgical management of patients with DCIS. Results: A total of 32 patients were included in the study. Concordance between imaging and histology on tumor size was higher for MRI (0.78; 95%CI, 0.62–0.87) than for mammography (0.43; 95%CI, 0.19–0.62) or for ultrasonography (0.27; 95%CI, 0.09–0.43). MRI overestimated the size of DCIS by a mean of 3mm, whereas mammography and ultrasonography underestimated it by 9mm and 18mm, respectively. MRI detected multifocality and multicentricity (7 cases) better than mammography (3) or ultrasonography (0). The MRI findings correctly changed the surgical management in six patients. Conclusion: Breast MRI is better than conventional techniques for the evaluation of the size of DCIS. Breast MRI also detects more cases of multifocality and multicentricity. We recommend that all patients diagnosed with DCIS (especially those with dense breasts) undergo breast MRI prior to surgery (AU)

[Breast MRI--histologic correlation for ductal carcinoma in situ]. / Carcinoma ductal in situ: correlación entre la histología y la resonancia magnética de mama.

OBJECTIVE: To evaluate the concordance between the breast MRI findings and the histologic findings for the size and extension of pure ductal carcinoma in situ (DCIS) and to compare this concordance with that of conventional techniques (mammography and ultrasonography). MATERIAL AND METHODS: This is a retrospective study of consecutive patients diagnosed with DCIS after percutaneous biopsy. We estimated Lin's coefficient of concordance for the histologic findings with each of the three techniques. We also assessed concordance using Bland-Altman graphs. Finally, we determined the impact of the MRI findings on the surgical management of patients with DCIS. RESULTS: A total of 32 patients were included in the study. Concordance between imaging and histology on tumor size was higher for MRI (0.78; 95%CI, 0.62-0.87) than for mammography (0.43; 95%CI, 0.19-0.62) or for ultrasonography (0.27; 95%CI, 0.09-0.43). MRI overestimated the size of DCIS by a mean of 3 mm, whereas mammography and ultrasonography underestimated it by 9 mm and 18 mm, respectively. MRI detected multifocality and multicentricity (7 cases) better than mammography (3) or ultrasonography (0). The MRI findings correctly changed the surgical management in six patients. CONCLUSION: Breast MRI is better than conventional techniques for the evaluation of the size of DCIS. Breast MRI also detects more cases of multifocality and multicentricity. We recommend that all patients diagnosed with DCIS (especially those with dense breasts) undergo breast MRI prior to surgery.

Taquicardia paroxística supraventricular en lactantes. A propósito de un caso / No disponible

La taquicardia paroxística supraventricular (TPSV) es la arritmia más frecuente en Pediatríay constituye una urgencia médica. Se presenta en un 0,1-0,4% de la población pediátrica,la mayoría de ocasiones como hallazgo casual o palpitaciones, siendo bien toleraday en ocasiones de resolución espontánea.No obstante, suele requerir ingreso hospitalario preferentemente en una unidad de cuidadosintensivos (UCI), ya que puede desencadenar arritmias malignas, insuficiencia cardiacay miocardiopatía dilatada, sobre todo en lactantes. La evolución a muerte oscila del 1%en pacientes con cardiopatía al 0,25% en los pacientes sin cardiopatía asociada.El tratamiento basado en la realización de maniobras vagales y la administración deadenosina suele ser efectivo aunque recientemente ha venido constatándose la escasa eficaciade las dosis bajas de ATP (50-100 μg/kg), imperando una revisión de los protocolosactuales.En ocasiones, la primera asistencia es prestada en centros de Atención Primaria, inclusocentros rurales con accesibilidad limitada a un centro hospitalario. A nuestro entenderes básico que el médico de Atención Primaria conozca el manejo de esta patología ytambién que Enfermería sea adecuadamente entrenada, sobre todo en la obtención devías venosas periféricas con el fin de prestar una adecuada asistencia al enfermo, más aúnsi no es posible organizar el traslado medicalizado del paciente en un lapso de tiempo razonable.Es nuestra intención llamar la atención sobre dicha patología y con ayuda de un casoclínico centrar los aspectos básicos de su diagnóstico y manejo terapéutico, especialmenteen lactantes pequeños(AU)

Paroxistical supraventricular tachycardia is the most frequent arrhythmia in Pediatrics and itis a medical emergency. It happens in 0.1-0.4% of the pediatric population, mostly as an accidentalfinding or palpitations, it is well tolerated and sometimes with a spontaneous resolution.Nevertheless, it frequently requires admission preferably in an intensive care unit(UCI), since it can be followed by malignant arrhythmias, cardiac insufficiency and dilatedmyocardiopathy, especially in infants. The evolution to death goes from 1% in patientswith cardiopathy to 0,25% in patients without cardiopathy.The treatment based on vagal stimulation manoeuvres and Adenosine (ATP) is usuallysuccessful, although recently has been communicated the low effectiveness of low doses ofATP (50-100 Ìg/kg), making necessary a review of current protocols.Occasionally, the first assistance is given at primary care centres, even at rural medicalcentres. So we think that it is basic that primary care doctors knew about this pathology andalso that nurses must be trained in periferical venous access, especially if the patient cannotbe moved to a reference centre in a brief time.We wish to draw the attention to this condition and with the help of a clinical case toshow the basics of its diagnosis and treatment, especially in infants(AU)

[Prevalence of microalbuminuria in a hypertensive population of northerm Navarre and its relation to other cardiovascular risk factors]. / Prevalencia de la microalbuminuria en una población hipertensa de Navarra septentrional y su relación con otros factores de riesgo cardiovascular.

AIM: To determine the prevalence of microalbuminuria in a hypertense population in northern Navarre and its relationship to other cardiovascular risk factors. PATIENTS AND METHODS: All the known hypertensive patients in our area of work were included, and a transversal study was designed that also evaluated the presence of other cardiovascular risk factors, including diabetes mellitus, hypercholesterolemia, obesity, smoking and alcohol drinking. RESULTS: A total of 106 hypertensive patients (54.7% women) were studied. The presence of microalbuminuria was found in 19 patients (18%), and a significant percentage showed other cardiovascular risk factors - diabetes mellitus (24.5%), hypercholesterolemia (61.3%), and obesity (49%). In 12.2% there was a concurrence of arterial hypertension, diabetes mellitus, hypercholesterolemia and obesity. Eighty-four percent of the diabetics were type 2. The highest percentage of cardiovascular risk factors corresponded to the group of hypertensive patients with positive microalbuminuria, and the most significant differences were found in the group of diabetics. CONCLUSIONS: The frequency of microalbuminuria in our hypertensive population was similar to that reported in other papers. A high prevalence of cardiovascular risk factors was found, especially in the group of hypertensive patients with positive microalbuminuria.

Prevalencia de la microalbuminuria en una población hipertensa de Navarra septentrional y su relación con otros factores de riesgo cardiovascular / Prevalence of microalbuminuria in a hypertensive population of northern Navarre and its relation to other cardiovascular risk factors

Objetivo. Conocer la prevalencia de microalbuminuria en una población hipertensa de Navarra Septentrional y su relación con otros factores de riesgo cardiovascular. Pacientes y métodos. Se incluyó a todos los pacientes hipertensos conocidos de nuestro ámbito de trabajo y se diseñó un estudio transversal que valoró además la presencia de otros factores de riesgo cardiovascular, incluyendo la diabetes mellitus, la hipercolesterolemia, la obesidad, el consumo de tabaco y la ingesta de alcohol. Resultados. Se estudiaron un total de 106 hipertensos (54,7 por ciento mujeres). En 19 (18 por ciento) pacientes se descubrió presencia de microalbuminuria, y un porcentaje importante presentó otros factores de riesgo cardiovascular -diabetes mellitus (24,5 por ciento), hipercolesterolemia (61,3 por ciento), obesidad (49 por ciento)-. En el 12,2 por ciento concurrieron hipertensión arterial, diabetes mellitus, hipercolesterolemia y obesidad. El 84,6 por ciento de los diabéticos perteneció al tipo 2. El mayor porcentaje de factores de riesgo cardiovascular correspondió al grupo de hipertensos con microalbuminuria positiva y las diferencias más significativas se hallaron en el grupo de diabéticos. Conclusiones. La frecuencia de microalbuminuria en nuestra población hipertensa fue similar a la obtenida en otros trabajos. Se encontró una elevada prevalencia de factores de riesgo cardiovascular, especialmente en el grupo de hipertensos con microalbuminuria positiva (AU)

Hemocromatosis: revisión de la enfermedad y presentación de dos casos / Hemochromatosis: a review of the disease and report of two cases

La hemocromatosis es un trastorno hereditario del metabolismo del hierro muy común en América y norte de Europa, donde afecta del 0,3 al 0,8 por ciento de la población. Se caracteriza por un depósito progresivo de hierro en las células parenquimatosas del hígado, el corazón y otros órganos; finalmente, conduce a su alteración. Trousseau en el siglo XIX encontró una asociación entre cirrosis, diabetes y pigmentación. Recklinghausen, en 1989, identificó el pigmento como hierro y denominó a esta enfermedad hemocromatosis. Consideró que el origen del hierro era la sangre. En 1935, Sheldon revisó 311 casos previamente publicados de hemocromatosis y concluyó que la enfermedad era causada por una alteración en el metabolismo del hierro. Recientes desarrollos en medicina molecular han permitido la localización, a partir de estudios del HLA, del déficit genético de la hemocromatosis junto a los genes HLA en el brazo corto del cromosoma 6 4,5. Sin embargo, el gen no fue identificado hasta 1996 gracias a importantes esfuerzos en clonación posicional. A partir de ese momento, se establece un criterio más preciso para realizar el cribado y el diagnóstico de esta enfermedad (AU)

Déficit ornitintranscarbamilasa / Ornithine transcarbamylase deficency

El déficit de ornitintranscarbamilasa (OTC) es el trastorno enzimático más frecuente del ciclo de la urea. Se caracteriza por un bloqueo en la utilización de carbamilfosfato en el ciclo, con elevación de aminoácidos precursores en sangre y aumento de ácido orótico en la orina. Es de herencia ligada al cromosoma X. Los hombres hemocigotos generalmente manifiestan la enfermedad de forma grave desde el periodo neonatal, mientras que en las mujeres heterocigotas los síntomas son más tardíos y larvados, por la desigual inactivación de uno de los cromosomas X durante el desarrollo embriogénico, aunque siempre existe el riesgo de hiperamoniemia. El objetivo de este trabajo, con el estudio de un caso clínico de una niña de 14 meses, es conocer fundamentalmente las formas de presentación y las dificultades diagnósticas que pueden tener este grupo de portadoras, porque: a) no siempre se demuestra una importante elevación de aminoácidos y amoniaco en sangre; b) las cifras de ácido orótico en orina pueden ser basalmente normales; c) el déficit enzimático en enterocitos o hepatocitos puede no confirmarse por el mosaicismo celular, y d) el estudio genético nunca será una prueba confirmatoria urgente por la complejidad que entraña. En este caso, la elevación de glutamina y alanina en sangre fue discreta y la excreción de ácido orótico en orina fue normal; sin embargo, tras sobrecarga oral de alopurinol (100 mg), hubo una importante elevación de oroticoaciduria con pico máximo a las 12 horas de la prueba de 80 mmol/mol de creatinina, y permaneció la elevación a las 24 horas. Los controles sanos con la sobrecarga no sobrepasaron elevaciones de 10-20 mmol/mol de creatinina y a las 24 horas se volvieron a cifras presobrecarga. La conclusión es realizar el diagnóstico rápido en probables pacientes heterocigotos por déficit de OTC, con la determinación de aminoácidos en sangre junto con la prueba de sobrecarga de alopurinol (AU)