[Depression in patients with epilepsy. Pathophysiological and clinical concepts and therapeutic strategies]. / Depresión en pacientes con epilepsia. Conceptos fisiopatológicos, clínicos y estrategias terapéuticas.

INTRODUCTION: Depression and epilepsy are highly prevalent diseases and represent a worldwide public health problem. DEVELOPMENT: A non-systematic search was performed in PubMed (MEDLINE) considering current topics in pathophysiological, clinical concepts and treatment strategies in people with epilepsy and depression. RESULTS AND CONCLUSIONS: Depression and epilepsy have a bidirectional relationship and share some pathophysiological substrates. Depression is the most common neuropsychiatric manifestation in epilepsy; screening and diagnosis are important to start a timely treatment. Antidepressant drugs does not increase the frequency of seizures, on the contrary, it is believed that antidepressants may help reducing the frequency of seizures. In addition, other antidepressant therapies such as Cognitive Behavioral Therapy and neuromodulation may be also effective for reducing the frequency of seizures. However the evidence regarding antidepressant treatment(s) in epilepsy is limited and further prospective studies are needed to better characterize the possible therapeutic strategies and develop standarized treatment guidelines.

TITLE: Depresión en pacientes con epilepsia. Conceptos fisiopatológicos, clínicos y estrategias terapéuticas.Introducción. La depresión y la epilepsia son entidades altamente prevalentes y representan un problema de salud pública a nivel mundial. Desarrollo. Realizamos una búsqueda no sistemática en PubMed (MEDLINE) acerca de los conceptos fisiopatológicos y clínicos y las estrategias terapéuticas en pacientes con epilepsia y depresión. Resultados y conclusiones. La depresión y la epilepsia tienen una relación bidireccional y comparten algunos sustratos fisiopatológicos. La depresión es la manifestación neuropsiquiátrica más frecuente en la epilepsia; es importante el cribado y el diagnóstico para el manejo oportuno. El tratamiento con la mayoría de los medicamentos antidepresivos no incrementa la frecuencia de crisis, al contrario, se cree que puede incluso ayudar a disminuir el número de crisis de epilepsia. Además, existen otras terapias antidepresivas, como la terapia cognitivo-conductual y terapias con neuromodulación, que también llegan a ser eficaces en la reducción de la frecuencia de las crisis de epilepsia. Sin embargo, la evidencia respecto al tratamiento es limitada y se requiere un mayor número de estudios prospectivos para la caracterización de las estrategias terapéuticas y la creación de guías estandarizadas.

Depresión en pacientes con epilepsia. Conceptos fisiopatológicos, clínicos y estrategias terapéuticas / Depression in patients with epilepsy. Pathophysiological and clinical concepts and therapeutic strategies

Introducción: La depresión y la epilepsia son entidades altamente prevalentes y representan un problema de salud pública a nivel mundial. Desarrollo: Realizamos una búsqueda no sistemática en PubMed (MEDLINE) acerca de los conceptos fisiopatológicos y clínicos y las estrategias terapéuticas en pacientes con epilepsia y depresión. Resultados y conclusiones. La depresión y la epilepsia tienen una relación bidireccional y comparten algunos sustratos fisiopatológicos. La depresión es la manifestación neuropsiquiátrica más frecuente en la epilepsia; es importante el cribado y el diagnóstico para el manejo oportuno. El tratamiento con la mayoría de los medicamentos antidepresivos no incrementa la frecuencia de crisis, al contrario, se cree que puede incluso ayudar a disminuir el número de crisis de epilepsia. Además, existen otras terapias antidepresivas, como la terapia cognitivo-conductual y terapias con neuromodulación, que también llegan a ser eficaces en la reducción de la frecuencia de las crisis de epilepsia. Sin embargo, la evidencia respecto al tratamiento es limitada y se requiere un mayor número de estudios prospectivos para la caracterización de las estrategias terapéuticas y la creación de guías estandarizadas.(AU)

Introduction. Depression and epilepsy are highly prevalent diseases and represent a worldwide public health problem. Development: A non-systematic search was performed in PubMed (MEDLINE) considering current topics in pathophysiological, clinical concepts and treatment strategies in people with epilepsy and depression. Results and conclusions: Depression and epilepsy have a bidirectional relationship and share some pathophysiological substrates. Depression is the most common neuropsychiatric manifestation in epilepsy; screening and diagnosis are important to start a timely treatment. Antidepressant drugs does not increase the frequency of seizures, on the contrary, it is believed that antidepressants may help reducing the frequency of seizures. In addition, other antidepressant therapies such as Cognitive Behavioral Therapy and neuromodulation may be also effective for reducing the frequency of seizures. However the evidence regarding antidepressant treatment(s) in epilepsy is limited and further prospective studies are needed to better characterize the possible therapeutic strategies and develop standarized treatment guidelines.(AU)

Mortalidad a 30 días en pacientes con fractura de fémur proximal durante la pandemia COVID-19 en Vizcaya (País Vasco) / Thirty-day mortality in patients with a proximal femur fracture during the COVID-19 pandemic in Biscay (Basque Country)

Objetivos: Comparar la tasa de mortalidad a 30 días en pacientes con fractura de fémur proximal (FFP) y coinfección por SARS-CoV-2 vs. FFP sin coinfección. Diseño: Estudio retrospectivo comparativo. Escenario: Tres hospitales universitarios en Vizcaya (País Vasco, España). Pacientes: Setenta y siete pacientes mayores de 65 años con FFP (AO 31-A y 31-B). Intervención: Entre el 9 de marzo y el 15 de abril de 2020. El grupo COVID-19 incluía pacientes con infección confirmada mediante el test PCR-RT. Medidas de resultados principales: Tasa de mortalidad a 30 días y factores de riesgo de mortalidad. Resultados: Diez de los 77 pacientes presentaron coinfección por SARS-CoV-2. La edad media fue de 85 años. Los pacientes infectados presentaban un IMC mayor (29,53 kg/m2) frente a los no infectados (24,09 kg/m2) (p = 0,001). No hubo diferencias significativas en el índice de comorbilidad de Charlson, la puntuación ASA, el uso de anticoagulantes o el deterioro cognitivo. Siete pacientes del grupo COVID-19 (7/10) desarrollaron neumonía (vírica), frente a un solo caso(1/67) de neumonía (bacteriana) en el grupo control (p < 0,001). La mortalidad a 30 días fue mayor (p = 0,03) en los pacientes con COVID-19 (40%) que en el grupo control (11,9%). La edad ≥ 91 años, la clase IV ASA y el IMC > 25 kg/m2 fueron predictores significativos de mortalidad a 30 días. Todas las muertes en el grupo COVID-19 ocurrieron intrahospitalariamente. Conclusiones: La infección por SARS-CoV-2 en pacientes con PFF resultó en tasas más altas de mortalidad temprana, siendo la neumonía por COVID-19 la principal causa directa de mortalidad. Nivel de evidencia: Estudio nivel III.(AU)

Objectives: Compare 30-day mortality rate following a proximal femur fracture (PFF) and SARS-CoV-2 infection versus a PFF and no SARS-CoV-2 infection. Design: Retrospective comparative study. Setting: Three university hospitals in Biscay province (Basque Country, Spain). Patients: 77 patients over 65 years-old with PFF (AO 31-A and 31-B). Intervention: Study conducted between 9 March and 15 April 2020. The COVID-19 group included only patients with SARS-CoV-2 infection, confirmed by a positive RT-PCR test. Main outcome measurements: 30-Day mortality rate and risk factors for mortality. Results: Of a total 77 patients, 10 were diagnosed with SARS-CoV-2 infection. Mean age was 85 years. Patients with SARS-CoV-2 infection had higher BMI (29.53 kg/m2) compared to patients without infection (24.09 kg/m2) (p = 0.001). No significant differences were found between both groups in terms of the Charlson Comorbidity Index, ASA score, use of oral anticoagulants or presence of cognitive impairment. Seven of the 10 patients in the COVID-19 group developed (viral) pneumonia, as compared to one single case (1/67) of (bacterial) pneumonia in the control group (p < 0.001). Thirty-days mortality was higher (p = 0.03) in COVID-19 patients (40%) than in those in the control group (11.9%). In the multivariate analysis, age ≥ 91 years-old, ASA class IV and BMI > 25 kg/m2 were significant predictors of 30-day mortality. All deaths in the COVID-19 group occurred while the patients were hospitalized. Conclusions: SARS-CoV-2 infection in patients with a PFF was seen to result in higher rates of early mortality, with COVID-19-related pneumonia being the leading direct cause of mortality. Level of evidence: Level III study.(AU)

Thirty-day mortality in patients with a proximal femur fracture during the COVID-19 pandemic in Biscay (Basque Country) / Mortalidad a 30 días en pacientes con fractura de fémur proximal durante la pandemia COVID-19 en Vizcaya (País Vasco)

Objectives: Compare 30-day mortality rate following a proximal femur fracture (PFF) and SARS-CoV-2 infection versus a PFF and no SARS-CoV-2 infection. Design: Retrospective comparative study. Setting: Three university hospitals in Biscay province (Basque Country, Spain). Patients: 77 patients over 65 years-old with PFF (AO 31-A and 31-B). Intervention: Study conducted between 9 March and 15 April 2020. The COVID-19 group included only patients with SARS-CoV-2 infection, confirmed by a positive RT-PCR test. Main outcome measurements: 30-Day mortality rate and risk factors for mortality. Results: Of a total 77 patients, 10 were diagnosed with SARS-CoV-2 infection. Mean age was 85 years. Patients with SARS-CoV-2 infection had higher BMI (29.53 kg/m2) compared to patients without infection (24.09 kg/m2) (p = 0.001). No significant differences were found between both groups in terms of the Charlson Comorbidity Index, ASA score, use of oral anticoagulants or presence of cognitive impairment. Seven of the 10 patients in the COVID-19 group developed (viral) pneumonia, as compared to one single case (1/67) of (bacterial) pneumonia in the control group (p < 0.001). Thirty-days mortality was higher (p = 0.03) in COVID-19 patients (40%) than in those in the control group (11.9%). In the multivariate analysis, age ≥ 91 years-old, ASA class IV and BMI > 25 kg/m2 were significant predictors of 30-day mortality. All deaths in the COVID-19 group occurred while the patients were hospitalized. Conclusions: SARS-CoV-2 infection in patients with a PFF was seen to result in higher rates of early mortality, with COVID-19-related pneumonia being the leading direct cause of mortality.(AU)

Objetivos: Comparar la tasa de mortalidad a 30 días en pacientes con fractura de fémur proximal (FFP) y coinfección por SARS-CoV-2 vs. FFP sin coinfección. Diseño: Estudio retrospectivo comparativo. Escenario: Tres hospitales universitarios en Vizcaya (País Vasco, España). Pacientes: Setenta y siete pacientes mayores de 65 años con FFP (AO 31-A y 31-B). Intervención: Entre el 9 de marzo y el 15 de abril de 2020. El grupo COVID-19 incluía pacientes con infección confirmada mediante el test PCR-RT. Medidas de resultados principales: Tasa de mortalidad a 30 días y factores de riesgo de mortalidad. Resultados: Diez de los 77 pacientes presentaron coinfección por SARS-CoV-2. La edad media fue de 85 años. Los pacientes infectados presentaban un IMC mayor (29,53 kg/m2) frente a los no infectados (24,09 kg/m2) (p = 0,001). No hubo diferencias significativas en el índice de comorbilidad de Charlson, la puntuación ASA, el uso de anticoagulantes o el deterioro cognitivo. Siete pacientes del grupo COVID-19 (7/10) desarrollaron neumonía (vírica), frente a un solo caso(1/67) de neumonía (bacteriana) en el grupo control (p < 0,001). La mortalidad a 30 días fue mayor (p = 0,03) en los pacientes con COVID-19 (40%) que en el grupo control (11,9%). La edad ≥ 91 años, la clase IV ASA y el IMC > 25 kg/m2 fueron predictores significativos de mortalidad a 30 días. Todas las muertes en el grupo COVID-19 ocurrieron intrahospitalariamente. Conclusiones: La infección por SARS-CoV-2 en pacientes con PFF resultó en tasas más altas de mortalidad temprana, siendo la neumonía por COVID-19 la principal causa directa de mortalidad. Nivel de evidencia: Estudio nivel III.(AU)

Thirty-day mortality in patients with a proximal femur fracture during the COVID-19 pandemic in Biscay (Basque Country). / [Artículo traducido] Mortalidad a 30 días en pacientes con fractura de fémur proximal durante la pandemia COVID-19 en Vizcaya (País Vasco).

OBJECTIVES: Compare 30-day mortality rate following a proximal femur fracture (PFF) and SARS-CoV-2 infection versus a PFF and no SARS-CoV-2 infection. DESIGN: Retrospective comparative study. SETTING: Three university hospitals in Biscay province (Basque Country, Spain). PATIENTS: 77 patients over 65 years-old with PFF (AO 31-A and 31-B). INTERVENTION: Study conducted between 9 March and 15 April 2020. The COVID-19 group included only patients with SARS-CoV-2 infection, confirmed by a positive RT-PCR test. MAIN OUTCOME MEASUREMENTS: 30-Day mortality rate and risk factors for mortality. RESULTS: Of a total 77 patients, 10 were diagnosed with SARS-CoV-2 infection. Mean age was 85 years. Patients with SARS-CoV-2 infection had higher BMI (29.53 kg/m2) compared to patients without infection (24.09 kg/m2) (p = 0.001). No significant differences were found between both groups in terms of the Charlson Comorbidity Index, ASA score, use of oral anticoagulants or presence of cognitive impairment. Seven of the 10 patients in the COVID-19 group developed (viral) pneumonia, as compared to one single case (1/67) of (bacterial) pneumonia in the control group (p < 0.001). Thirty-days mortality was higher (p = 0.03) in COVID-19 patients (40%) than in those in the control group (11.9%). In the multivariate analysis, age ≥ 91 years-old, ASA class IV and BMI > 25 kg/m2 were significant predictors of 30-day mortality. All deaths in the COVID-19 group occurred while the patients were hospitalized. CONCLUSIONS: SARS-CoV-2 infection in patients with a PFF was seen to result in higher rates of early mortality, with COVID-19-related pneumonia being the leading direct cause of mortality. LEVEL OF EVIDENCE: Level III study.

Thirty-day mortality in patients with a proximal femur fracture during the COVID-19 pandemic in Biscay (Basque Country).

Objectives: Compare 30-day mortality rate following a proximal femur fracture (PFF) and SARS-CoV-2 infection versus a PFF and no SARS-CoV-2 infection. Design: Retrospective comparative study. Setting: Three university hospitals in Biscay province (Basque Country, Spain). Patients: 77 patients over 65 years-old with PFF (AO 31-A and 31-B). Intervention: Study conducted between 9 March and 15 April 2020. The COVID-19 group included only patients with SARS-CoV-2 infection, confirmed by a positive RT-PCR test. Main outcome measurements: 30-day mortality rate and risk factors for mortality. Results: Of a total 77 patients, 10 were diagnosed with SARS CoV-2 infection. Mean age was 85 years. Patients with SARS-Cov-2 infection had higher BMI (29.53 kg/m2) compared to patients without infection (24.09 kg/m2) (p = 0.001). No significant differences were found between both groups in terms of the Charlson Comorbidity Index, ASA score, use of oral anticoagulants or presence of cognitive impairment. Seven of the 10 patients in the COVID-19 group developed (viral) pneumonia, as compared to one single case (1/67) of (bacterial) pneumonia in the control group (p < 0.001). Thirty-days mortality was higher (p = 0.03) in COVID-19 patients (40%) than in those in the control group (11.9%). In the multivariate analysis, age ≥91 years-old, ASA class IV and BMI >25 kg/m2 were significant predictors of 30-day mortality. All deaths in the COVID-19 group occurred while the patients were hospitalized. Conclusions: SARS CoV-2 infection in patients with a PFF was seen to result in higher rates of early mortality, with COVID-19-related pneumonia being the leading direct cause of mortality.

Objetivos: Comparar la tasa de mortalidad a 30 días en los pacientes con fractura de fémur proximal (FFP) y coinfección por SARS-CoV-2 frente a FFP sin coinfección. Diseño: Estudio retrospectivo comparativo. Escenario: Tres hospitales universitarios en Vizcaya (País Vasco, España). Pacientes: Setenta y siete pacientes mayores de 65 años con FFP (AO 31-A y 31-B). Intervención: Entre el 9 de marzo y el 15 de abril de 2020. El grupo COVID-19 incluía pacientes con infección confirmada mediante el test PCR-RT. Medidas de resultados principales: Tasa de mortalidad a 30 días y factores de riesgo de mortalidad. Resultados: Diez de los 77 pacientes presentaron coinfección por SARS-CoV-2. La edad media fue de 85 años. Los pacientes infectados presentaban un IMC mayor (29,53 kg/m2) frente a los no infectados (24,09 kg/m2) (p = 0,001). No hubo diferencias significativas en el índice de comorbilidad de Charlson, la puntuación ASA, el uso de anticoagulantes o el deterioro cognitivo. Siete pacientes del grupo COVID-19 (7/10) desarrollaron neumonía (vírica), frente a un solo caso (1/67) de neumonía (bacteriana) en el grupo control (p < 0,001). La mortalidad a 30 días fue mayor (p = 0,03) en los pacientes con COVID-19 (40%) que en el grupo control (11,9%). La edad ≥ 91 años, la clase IV ASA y el IMC > 25 kg/m2 fueron predictores significativos de mortalidad a 30 días. Todas las muertes en el grupo COVID-19 ocurrieron intrahospitalariamente. Conclusiones: La infección por SARS-CoV-2 en pacientes con PFF resultó en tasas más altas de mortalidad temprana, siendo la neumonía por COVID-19 la principal causa directa de mortalidad.Nivel de evidencia: Estudio nivel III.

Numerical Estimation and Mathematical Learning Methodology in Preschoolers.

One of the means for representing quantities/magnitudes is the mental number line. It is still a nonsolved question as to whether the method of learning mathematics in the early years could improve this type of estimating. A total of 233 students, aged four and five years, who learned mathematics with a new method called Open Algorithm Based on Number or the more traditional Closed Based on Ciphers approach, were evaluated with a reliable estimation on the number line test. Results revealed significant differences in participants' estimation functions based on the learning method used. Students who learned mathematics through the Open Algorithm Based on Number method used a linear representation more efficiently than those who were taught with the Closed Based on Ciphers methodology. This group exhibited a logarithmic function in their approach. We discussed whether these differences can be attributed to a recurrent practice in estimation tasks at school, characterized by the Open Algorithm Based on Number methodology.

Long-term outcomes with multi-targeted immunosuppressive protocol in children with severe proliferative lupus nephritis.

We have previously reported the one-year outcomes of 16 children with severe proliferative lupus nephritis (LN) who were treated using a multi-targeted induction protocol based on intravenous (IV) pulse methylprednisolone (MP), mycophenolate mofetil (MMF) and cyclosporine (CSA). This study examined the long-term renal outcomes of these 16 children, followed up for a median duration of 9.2 years (range 5.8-14.2 years). Primary treatment outcome was complete renal remission. Secondary outcomes included patient and renal survival as well as relapse-free and event-free survival. All patients achieved complete renal remission within 24 months (median 8.7 months, range 4.0-24.0 months). Comparing clinical and laboratory parameters at induction and last follow-up, respectively, Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score (25.4 ± 8.7 vs. 0.4 ± 0.8), serum complement C3 (47 ± 21 vs. 107 ± 27 mg/dL), estimated glomerular filtration rate (eGFR) (72 ± 57 vs. 109.7 ± 43 ml/min/1.73 m2) and urine protein (6.97 ± 7.09 vs. 0.2 ± 0.02 g/day/1.73 m2) improved significantly (p < 0.05). Kaplan-Meier survival analysis showed a cumulative ten-year renal relapse-free survival of 73.3% when considering relapses with severe proteinuria >1 g/day/1.73 m2. Cumulative probability that hospitalization would not be required was 93.8% at one year, and 71.4% at ten years. Our multi-targeted protocol for induction and maintenance therapy in Asian children with severe proliferative LN resulted in good long-term patient survival and renal preservation, with a good safety profile.

[Management of onychocryptosis in primary care: A clinical case]. / Manejo de la onicocriptosis en atención primaria. Caso clínico.

Onychocryptosis (ingrown toenail) is a condition commonly seen in Primary Care clinics. It is uncomfortable and restrictive for patients and has a high incidence in males between second and third decades of life. It is of unknown origin, with a number of predisposing triggering factors being involved. Treatment depends on the stage of the ingrown nail and the procedures may range from conservative to minor surgery that can be performed by the Primary Care physician in the health centre. We report the case of a 25-year onychocryptosis that did not respond to conservative management, and was extracted with partial matricectomy of the nail.

Manejo de la onicocriptosis en atención primaria. caso clínico / Management of onychocryptosis in primary care: a clinical case

La onicocriptosis (uña encarnada) es una enfermedad ungueal de gran demanda en el servicio de atención primaria, molesta y limitante para los pacientes, con gran incidencia en el sexo masculino y en edades comprendidas entre la segunda y tercera décadas de la vida, de etiología indeterminada en la que intervienen una serie de factores tanto desencadenantes como predisponentes. El tratamiento depende del estadio en que se encuentre la uña encarnada e incluye desde procedimientos conservadores hasta intervenciones de cirugía menor que pueden ser realizadas por el médico de atención primaria en el centro de salud. Presentamos el caso clínico de un hombre de 25 años con onicocriptosis que no respondió a un manejo conservador y se realizó una extracción del extremo ungueal con matricectomía parcial (AU)

Onychocryptosis (ingrown toenail) is a condition commonly seen in Primary Care clinics. It is uncomfortable and restrictive for patients and has a high incidence in males between second and third decades of life. It is of unknown origin, with a number of predisposing triggering factors being involved. Treatment depends on the stage of the ingrown nail and the procedures may range from conservative to minor surgery that can be performed by the Primary Care physician in the health centre. We report the case of a 25-year onychocryptosis that did not respond to conservative management, and was extracted with partial matricectomy of the nail (AU)

Determination of the risk of self-ignition of coals and biomass materials.

The safe storage, processing and handling of coals and biomass resources requires their tendency to self-ignite be understood; fires caused by self-ignition have occurred on many occasions in ports and at industrial plants. This work provides information on the tendency of several types of coal and four types of biomass to self-ignite. Data were obtained using the isothermal oven procedure and analyzed using the Frank-Kamenetskii method and a scaling procedure, both contemplated in standard EN15188. The results obtained throw light on the optimum volumes and storage times of the studied materials. The results also validate the methodology followed for determining the risk of self-ignition.

[Perineal endometriosis with anal external sphincter involvement: a case-report]. / Endometrioma perianal involucrando esfínter anal externo: reporte de un caso.

The presence of perianal endometriosis involving the anal sphincter is a rare presentation of this disease, most cases are diagnosed late and few are reported in the literature despite the number of episiotomies performed today. We present a case in a female with perianal symptoms after an episiotomy 15 years ago and visualized by endoanal ultrasound. We also review the literature of this condition. The treatment of choice is wide excision of the lesion involving the anal sphincter so the sphincter defect should be repaired by sphincteroplasty. According to the literature, early diagnosis by clinical suspicion and confirmation by endoanal ultrasound, with wide excision of endometrioma gives satisfactory results regarding anal continence.

Good outcomes with mycophenolate-cyclosporine-based induction protocol in children with severe proliferative lupus nephritis.

The outcomes of children with severe proliferative lupus nephritis (LN) were examined using a new mycophenolate and cyclosporine-based (MMF-CSA) induction protocol. Sixteen children with LN (WHO class III and IV), 31.3% of whom required dialysis at induction, were retrospectively studied. Median MMF dose was 942 mg/m( 2)/day. Thirteen patients (81%) with persistent proteinuria received CSA. Clinical and laboratory parameters were compared at pre-induction, 6 and 12 months. Treatment outcome was defined by Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), renal function, haematuria, proteinuria and serological markers (complements C3, C4 and anti-dsDNA). Comparing these parameters at induction, 6 months and 12 months, respectively, SLEDAI (25.4 +/- 8.7 versus 3.2 +/- 2.9 versus 2.9 +/- 2.8), serum C3 (47 +/- 21 versus 107 +/- 27 versus 111 +/- 38 mg/dl), C4 (12 +/- 14 versus 23 +/- 14 versus 22 +/- 11 mg/dl) and urine protein (6.97 +/- 7.09 versus 0.98 +/- 1.56 versus 0.21 +/- 0.13 g/ day/1. 73 m(2)) improved significantly (p < 0.05). Anti-dsDNA titres decreased in 73% by 6 and 12 months (p < 0.05). Complete renal remission was achieved in 7/16 (43.8%) at 6 months and 12/16 (75%) at 12 months, the rest achieving partial remission with no treatment failures. In conclusion, a combination MMF-CSA protocol is an effective therapeutic alternative for induction of children with severe proliferative LN, resulting in significant clinical and serological improvement with minimal adverse effects.

NMR structural studies on human p190-A RhoGAPFF1 revealed that domain phosphorylation by the PDGF-receptor alpha requires its previous unfolding.

p190-A and -B Rho GAPs (guanosine triphosphatase activating proteins) are the only cytoplasmatic proteins containing FF domains. In p190-A Rho GAP, the region containing the FF domains has been implicated in binding to the transcription factor TFII-I. Moreover, phosphorylation of Tyr308 within the first FF domain inhibits this interaction. Because the structural determinants governing this mechanism remain unknown, we sought to solve the structure of the first FF domain of p190-A Rho GAP (RhoGAPFF1) and to study the potential impact of phosphorylation on the structure. We found that RhoGAPFF1 does not fold with the typical (alpha1-alpha2-3(10)-alpha 3) arrangement of other FF domains. Instead, the NMR data obtained at 285 K show an alpha1-alpha2-alpha 3-alpha 4 topology. In addition, we observed that specific contacts between residues in the first loop and the fourth helix are indispensable for the correct folding and stability of this domain. The structure also revealed that Tyr308 contributes to the domain hydrophobic core. Furthermore, the residues that compose the target motif of the platelet-derived growth factor receptor alpha kinase form part of the alpha 3 helix. We observed that the phosphorylation reaction requires a previous step including domain unfolding, a process that occurs at 310 K. In the absence of phosphorylation, the temperature-dependent RhoGAPFF1 folding/unfolding process is reversible. However, phosphorylation causes an irreversible destabilization of the RhoGAPFF1 structure, which probably accounts for the inhibitory effect that it exerts on the TFII-I interaction. Our results link the ability of a protein domain to be phosphorylated with conformational changes in its three-dimensional structure.

Oxcarbazepine monotherapy in carbamazepine-unresponsive trigeminal neuralgia.

The objective of this prospective open-label study was to evaluate the efficacy and tolerability of oxcarbazepine in trigeminal neuralgia (TN) unresponsive to treatment with the standard antiepileptic drug, carbamazepine. Thirty-five patients with idiopathic TN, who underwent treatment with oxcarbazepine monotherapy for at least 12 weeks, were studied. Pain was assessed using mean pain frequency, responder rate, pain-free patients and clinical global impression. The mean maintenance dose was 773.7 mg/day. There was a significant decrease in the mean of the main scores following 12 weeks of treatment (p<0.05) compared with baseline. Oxcarbazepine was effective from the first month of treatment. There was a significant reduction in pain frequency, leading to improvements in patient satisfaction. In general, oxcarbazepine was well tolerated. Oxcarbazepine appears to be an important alternative therapeutic approach for patients affected by TN. This study adds to the existing literature arriving at the same findings.

Tetraplejía espástica secundaria a intoxicación por arsénico inorgánico / Spastic quadriplegia secondary to intoxication with inorganic arsenic

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[Topiramate in comorbid disorders: epilepsy and migraine]. / Topiramato en enfermedades comórbidas: epilepsia y migraña.

INTRODUCTION: With relative frequency epilepsy and migraine are associated in a same patient. Some times it is difficult to distinguish an attack of others. Reason why it would be of utility to have a treatment effective in both pathologies. It is tried to study in patients with this comorbidity, how of effective it is a drug indicated in the two pathologies, as it is topiramate. PATIENTS AND METHODS: An observational, longitudinal and prospective study is made, where 15 patients are recruited with this association, and which they were treated with topiramate. They are revaluated at three and six months of treatment. RESULTS: Significant differences are obtained (p < 0.05) in all the studied variables (severity and duration of the migraine attacks and frequency of the migraine and epileptic attacks), with a medium dose of 100 mg/day of topiramate, at the end of the study. Not serious adverse effects were observed. CONCLUSIONS: Topiramate in monotherapy seems to be a suitable treatment in patients who undergo epileptic and migrainous attacks jointly.

Topiramato en enfermedades comórbidas: epilepsia y migraña / Topiramate in comorbid disorders: epilepsy and migraine

Introducción. Con relativa frecuencia la epilepsia y lamigraña se ven asociadas en un mismo paciente. Algunas veces esdifícil distinguir unas crisis de otras. Por tanto, sería de utilidadposeer un tratamiento que fuera eficaz en ambas patologías. Sepretende estudiar la eficacia del topiramato en el tratamiento delos pacientes que padecen epilepsia y migraña. Pacientes y métodos.Se realiza un estudio observacional, longitudinal y prospectivo,donde se recoge la frecuencia de las crisis, tanto de migrañacomo epilépticas, en una serie de 15 pacientes con dicha comorbilidad,tratados con topiramato. Se reevalúan a los tres y seis mesesde tratamiento. Resultados. Se obtienen diferencias significativas(p < 0,05) en todas las variables estudiadas (intensidad y duraciónde las crisis migrañosas y frecuencia de crisis migrañosas y epilépticas),con una dosis mediana de topiramato de 100 mg/día al finalizarel estudio. No se observaron efectos adversos graves. Conclusiones.El topiramato en monoterapia parece ser un tratamientoefectivo en pacientes que sufren conjuntamente crisis epilépticas ymigrañosas

Introduction. With relative frequency epilepsy and migraine are associated in a same patient. Some times it isdifficult to distinguish an attack of others. Reason why it would be of utility to have a treatment effective in both pathologies.It is tried to study in patients with this comorbidity, how of effective it is a drug indicated in the two pathologies, as it istopiramate. Patients and methods. An observational, longitudinal and prospective study is made, where 15 patients arerecruited with this association, and which they were treated with topiramate. They are revaluated at three and six months oftreatment. Results. Significant differences are obtained (p < 0.05) in all the studied variables (severity and duration of themigraine attacks and frequency of the migraine and epileptic attacks), with a medium dose of 100 mg/day of topiramate, at theend of the study. Not serious adverse effects were observed. Conclusions. Topiramate in monotherapy seems to be a suitabletreatment in patients who undergo epileptic and migrainous attacks jointly

In vitro assessment of the genotoxicity of ethyl paraoxon in newborns and adults.

This in vitro experiment measured the genotoxic effects of ethyl paraoxon, the active metabolite of ethyl parathion. To assess genotoxicity, we used the micronuclei (MN) technique by blocking cytokinesis, and the 'comet' assay. We cultured peripheral blood samples from healthy adults and umbilical cord blood samples from four clinically healthy newborns to identify the frequency of MN. After 48 hours, we added the following ethyl paraoxon concentrations to the cultures: 0.0, 0.075, 0.100, 0.160, and 0.200 microg/mL. For the comet assay, following Singh's technique, we treated the blood samples for 2 hours with similar doses of the metabolite. The comet assay results, at a concentration of 0.075 microg/mL, showed that ethyl paraoxon causes a greater DNA migration that followed a dose-response pattern, a greater intensity being observed in lymphocytes from newborns. A comparison of the treatment and control groups indicated that only the 0.200 microg/mL concentration produced a slight increase in MN. In conclusion, our study identified primary DNA damage due to ethyl paraoxon, with a major effect on newborn lymphocytes, as well as an effect on the frequency of MN in the study groups at high concentrations only.