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Background Despite major advances, multiple myeloma remains an incurable disease. Epidemiological data from high-quality population-based registries are needed to understand the heterogeneous landscape of the disease. Methods Incidence, mortality and survival in multiple myeloma were comprehensively analyzed in the Girona and Granada population-based cancer registries, over a 23-year study (19942016), divided into three periods (19942001, 20022009 and 20102016). Joinpoint regression analysis was used to estimate the annual percentage change in incidence and mortality. Age-standardized net survival was calculated with the PoharPerme method. Results 1957 myeloma patients were included in the study, with a median age of 72 years. Age-standardized incidence and mortality rates decreased over time in both sexes and both rates were higher in males. Five-year age-standardized net survival by period was 27.4% (19942001), 38.8% (20022009), and 47.4% (20102016). Survival improved for all age groups: 32.4%, 74.1% and 78.5% for patients aged 1549; 27.5%, 44.6%, and 58.5% for those aged 5069; finally, 24.8%, 25.5%, and 26.3% for the older group. Conclusion Incidence remained overall stable throughout the study, with only a small increase for men. Mortality was progressively decreasing in both sexes. Both incidence and mortality were higher in men. Age plays a critical role in survival, with impressive improvement in patients younger than 70 years, but only a minor benefit in those older than 70 (AU)
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Humanos , Masculino , Femenino , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Mieloma Múltiple/mortalidad , Tasa de Supervivencia , Factores de Tiempo , España/epidemiología , IncidenciaRESUMEN
BACKGROUND: Despite major advances, multiple myeloma remains an incurable disease. Epidemiological data from high-quality population-based registries are needed to understand the heterogeneous landscape of the disease. METHODS: Incidence, mortality and survival in multiple myeloma were comprehensively analyzed in the Girona and Granada population-based cancer registries, over a 23-year study (1994-2016), divided into three periods (1994-2001, 2002-2009 and 2010-2016). Joinpoint regression analysis was used to estimate the annual percentage change in incidence and mortality. Age-standardized net survival was calculated with the Pohar-Perme method. RESULTS: 1957 myeloma patients were included in the study, with a median age of 72 years. Age-standardized incidence and mortality rates decreased over time in both sexes and both rates were higher in males. Five-year age-standardized net survival by period was 27.4% (1994-2001), 38.8% (2002-2009), and 47.4% (2010-2016). Survival improved for all age groups: 32.4%, 74.1% and 78.5% for patients aged 15-49; 27.5%, 44.6%, and 58.5% for those aged 50-69; finally, 24.8%, 25.5%, and 26.3% for the older group. CONCLUSION: Incidence remained overall stable throughout the study, with only a small increase for men. Mortality was progressively decreasing in both sexes. Both incidence and mortality were higher in men. Age plays a critical role in survival, with impressive improvement in patients younger than 70 years, but only a minor benefit in those older than 70.
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Mieloma Múltiple/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Mieloma Múltiple/mortalidad , España/epidemiología , Tasa de Supervivencia/tendencias , Factores de Tiempo , Adulto JovenRESUMEN
BACKGROUND: The prevalence of arterial hypertension (AHT), a well-known risk factor for cardiovascular disease, has considerably increased over last decades. Non-persistent environmental pollutants (npEPs) are a group of ubiquitous chemicals, widely used in consumer products such as food packaging and cosmetics, which have been identified as endocrine disrupting chemicals and obesogens. The aim of this study was to assess the potential associations of serum levels of three groups of npEPs with the risk of incident AHT. METHODS: Cohort study within a sub-cohort of Granada EPIC-Spain center (n = 670). We quantified serum concentrations of three groups of npEPs, i.e., bisphenol A (BPA), four parabens: methylparaben (MP), ethylparaben (EP), propylparaben (PP) and butylparaben (BP), and two benzophenones: benzophenone 1 (BP1), benzophenone 3 (BP3), in samples collected at recruitment. Statistical analyses were performed by means of Cox Proportional Hazard Models. RESULTS: Median follow-up time was 23 years. BPA and MP were found in >80% of the study population. Individuals within the 4th PP quartile (0.53-9.24 ng/ml) showed a statistically significant increased risk of AHT (HR = 1.40, p = 0.015). No associations were found for the rest of pollutants. CONCLUSIONS: Overall, we evidenced no associations of most npEPs with AHT risk, with the exception of an increased risk in the highest PP percentiles. Considering the limitations of using one spot serum sample for exposure characterization, further research on the potential contribution of npEPs on the development of AHT risk is warranted.
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Disruptores Endocrinos , Contaminantes Ambientales , Hipertensión , Estudios de Cohortes , Disruptores Endocrinos/toxicidad , Contaminantes Ambientales/toxicidad , Humanos , Parabenos/análisis , España/epidemiologíaRESUMEN
BACKGROUND: Environmental factors are believed to account for a substantial burden of type 2 diabetes mellitus (T2DM). Non-persistent environmental pollutants (npEPs) are a group of widely-used chemicals identified as endocrine/metabolic disrupting chemicals and obesogens. The aim of this study was to analyse the potential associations of serum levels of three groups of npEPs with the risk of incident T2DM. METHODS: This is a longitudinal study within a sub-sample of Granada EPIC-Spain cohort (n = 670). We quantified serum concentrations of 7 npEPs: four parabens (Methylparaben (MP) ethylparaben (EP), propylparaben (PP) and butilparaben (BP); two benzophenones: Benzophenone 1 (BP1), Benzophenone 3 (BP3); and Bisphenol A (BPA). Exposure was assessed by means of chemical analyses of serum samples collected at recruitment, and information on potential confounders was gathered by using validated questionnaires at baseline. Follow-up was performed by review of patients' clinical records. Cox Proportional Hazards Models were used for the statistical analyses. RESULTS: Median follow-up time was 23 years. There were 182 (27%) incident T2DM diagnoses in our sub-cohort. MP was the most frequently detected npEP, 88.42% samples above the limit of detection, and BP showed the lowest percentage of detection (19.21%). Those individuals within the fourth PP quartile (0.53-9.24 ng/ml) showed a statistically significant increased risk of T2DM (HR = 1.668 p = 0.012), while BP1 concentrations showed an inverse non-significant trend with the risk. CONCLUSIONS: We evidenced a potential contribution of npEP exposure on T2DM, but no clear trend was observed. However, limitations in relation to exposure estimation might influence our findings and further research is warranted to confirm our results.
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Diabetes Mellitus Tipo 2 , Contaminantes Ambientales , Neoplasias , Diabetes Mellitus Tipo 2/inducido químicamente , Diabetes Mellitus Tipo 2/epidemiología , Exposición a Riesgos Ambientales/análisis , Humanos , Estudios Longitudinales , Parabenos/análisis , Estudios Prospectivos , España/epidemiologíaRESUMEN
The relaxation of photoexcited nanosystems is a fundamental process of light-matter interaction. Depending on the couplings of the internal degrees of freedom, relaxation can be ultrafast, converting electronic energy in a few fs, or slow, if the energy is trapped in a metastable state that decouples from its environment. Here, we study helium nanodroplets excited resonantly by femtosecond extreme-ultraviolet (XUV) pulses from a seeded free-electron laser. Despite their superfluid nature, we find that helium nanodroplets in the lowest electronically excited states undergo ultrafast relaxation. By comparing experimental photoelectron spectra with time-dependent density functional theory simulations, we unravel the full relaxation pathway: Following an ultrafast interband transition, a void nanometer-sized bubble forms around the localized excitation (He[Formula: see text]) within 1 ps. Subsequently, the bubble collapses and releases metastable He[Formula: see text] at the droplet surface. This study highlights the high level of detail achievable in probing the photodynamics of nanosystems using tunable XUV pulses.
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BACKGROUND: Colorectal cancer (CRC) is the second cause of tumour mortality in Spain and Europe. To date, no studies have been conducted in Spain to evaluate the spatial and temporal distribution of the excess risk of death during hospitalisation for CRC. METHODS: A cohort was constructed of all episodes of hospitalisation in Spain due to CRC (codes 153 and 154 of the International Classification of Diseases, 9th edition, Clinical Modification) during the period 2008-2014, based on the minimum basic data set published by the Ministry of Health. Mortality ratios were calculated per region for each of the years analyzed (spatial or cross-sectional analysis) and during the overall study period, for each region independently (temporal or longitudinal analysis). In the first of these analyses, particular note was taken of the regions and years in which the limits of two and three standard deviations were exceeded. RESULTS: Two hundred and fifty eight thousand, nine hundred and twenty seven episodes of CRC were analysed. The patients were predominantly male (60.6%), with an average hospital stay of 13.16 days. Half underwent surgery during admission and on average presented more than six diagnoses at discharge. The spatial analysis revealed mortality ratios that deviated by at least three standard deviations in the following regions: Islas Canarias, Asturias, Valencia, Extremadura, País Vasco and Andalucía. The longitudinal analysis showed that most regions presented one or more years when CRC mortality was at least 15% higher than expected during the period; outstanding in this respect were Asturias, Navarra and La Rioja, where this excess risk was detected in at least 2 years. CONCLUSIONS: Geographic and temporal patterns of the distribution of the excess risk of mortality from CRC in Spain are described using SMRs. We conclude that during the study period, the geographic pattern of mortality in Spain did not coincide with the excess risk of mortality calculated using the SMR method described by Jarman and Foster. This method of risk estimation can be a useful tool for the study of mortality risk and its spatial variations.
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Neoplasias Colorrectales/mortalidad , Mortalidad Hospitalaria , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Tiempo de Internación , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Mortalidad , España/epidemiología , Análisis Espacio-TemporalRESUMEN
PURPOSE: The third most frequently diagnosed cancer in Europe in 2018 was lung cancer; it is also the leading cause of cancer death in Europe. We studied patient and tumor characteristics, and patterns of healthcare provision explaining regional variability in lung cancer survival in southern Spain. METHODS: A population-based cohort study included all 1196 incident first invasive primary lung cancer (C33-C34 according to ICD-10) cases diagnosed between 2010 and 2011 with follow-up until April 2015. Data were drawn from local population-based cancer registries and patients' hospital medical records from all public and private hospitals from two regions in southern Spain. RESULTS: There was evidence of regional differences in lung cancer late diagnosis (58% stage IV in Granada vs. 65% in Huelva, p value < 0.001). Among patients with stage I, only 67% received surgery compared with 0.6% of patients with stage IV. Patients treated with a combination of radiotherapy, chemotherapy, and surgery had a 2-year mortality risk reduction of 94% compared with patients who did not receive any treatment (excess mortality risk 0.06; 95% CI 0.02-0.16). Geographical differences in survival were observed between the two regions: 35% vs. 26% at 1-year since diagnosis. CONCLUSIONS: The observed geographic differences in survival between regions are due in part to the late cancer diagnosis which determines the use of less effective therapeutic options. Results from our study justify the need for promoting lung cancer early detection strategies and the harmonization of the best practice in lung cancer management and treatment.
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Detección Precoz del Cáncer/mortalidad , Servicios de Salud , Disparidades en Atención de Salud , Neoplasias Pulmonares/mortalidad , Sistema de Registros/estadística & datos numéricos , Adolescente , Adulto , Anciano , Estudios de Cohortes , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Pulmonares/epidemiología , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/terapia , Masculino , Persona de Mediana Edad , Pronóstico , Factores de Riesgo , España/epidemiología , Tasa de Supervivencia , Adulto JovenRESUMEN
It has been hypothesized that circadian disruption is related to higher cancer risk. Since the International Agency for Research on Cancer classified shift work involving circadian disruption as probably carcinogenic to humans (Group 2A), multiple studies have been conducted to test this hypothesis. The aim of this systematic review was to summarize the findings and evaluate the quality of existing epidemiological studies (case-control and cohort studies) on the relationship between night-shift work and breast and prostate cancer risk. Thirty-three epidemiological studies investigating the relationship between night-shift work and breast (n = 26) or prostate (n = 8) cancer risk were included (one paper included both sites). The Newcastle-Ottawa Scale for the quality of non-randomized studies was used to assess the risk of bias of the publications. The studies included were heterogeneous regarding population (general population, nurses working in rotating shifts, and other) and measurement of exposure to night-shift work (ever vs. never exposure, short vs. long-term, rotating vs. permanent) and, thus, a diversity of outcomes were observed even within the same type of cancer. In summary, 62.5% works found some type of association between night-shift work and increased risk of cancer, for both breast and prostate. The risk of bias scored an average of 7.5 over 9 stars. Due to the limitations inherent in these studies, the evidence of a possible association between night-shift work and breast or prostate cancer risk remains uncertain and more studies providing greater control of exposure and confounding factors are required. Despite the lack of conclusive evidence, application of the precautionary principle seems advisable.
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Neoplasias de la Mama/epidemiología , Neoplasias de la Próstata/epidemiología , Horario de Trabajo por Turnos , Neoplasias de la Mama/etiología , Estudios de Casos y Controles , Estudios de Cohortes , Femenino , Humanos , Masculino , Neoplasias de la Próstata/etiología , Medición de Riesgo , Horario de Trabajo por Turnos/efectos adversosRESUMEN
INTRODUCTION: Pertussis is a communicable disease that primarily affects infants. Vaccination has led to an important reduction in the incidence of the disease, however, resurgence of the disease has been observed. This study aimed to analyze the incidence of pertussis and assess the vaccination effectiveness (VE) of different schedules of acellular pertussis vaccination in the community of Madrid. METHODS: Pertussis cases notified to the Mandatory Disease Reporting System from 1998 to 2015 were analyzed. Five comparison periods were created: 1998-2001 (reference), 2002-2005, 2006-2009, 2010-2012 and 2013-2015. The incidence ratio (IR) between inter-epidemic periods was analyzed using a Poisson regression. VE was calculated using the screening method. Vaccine status data were collected from the vaccine registry. RESULTS: In total, 3855 cases were notified. Inter-epidemic periods were observed every 3-4â¯years. The incidence increased (IR: 5.99, pâ¯<â¯0.05) in the 2013-2015 period, particularly among infants younger than 1â¯month (IR: 32.41, pâ¯<â¯0.05). Vaccination data were available in 89% of cases. For those receiving the last dose at ≤6-month VE was 89.9% (95% confidence interval (CI): 87.3-92.0) after one year of follow-up, and 85.5% (95% CI: 82.4-88.1) after 11â¯years of follow-up. For those receiving the last dose at 18-months VE decreased from 98.8% (95% CI: 98.3-99.1) to 85.1% (95% CI: 81.9-87.7) in the same period, and for those receiving the last dose at 4-year VE decreased from 99.6% (95% CI: 99.3-99.7) to 79.3% (95% CI: 74.6-83.1). CONCLUSIONS: B. pertussis is circulating in our population, as shown by the epidemic peaks and increased incidence of pertussis in recent years. VE increased with the number of doses and decreased with the follow-up period. The effect of this and other vaccination strategies must be monitored to control the disease.
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Bordetella pertussis/inmunología , Vacuna contra la Tos Ferina/inmunología , Tos Ferina/epidemiología , Tos Ferina/prevención & control , Adolescente , Adulto , Niño , Preescolar , Femenino , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Vigilancia de la Población , España/epidemiología , Vacunación , Cobertura de Vacunación , Tos Ferina/historia , Adulto JovenRESUMEN
INTRODUCTION: The heptavalent pneumococcal conjugate vaccine (PCV-7) was added to the childhood routine vaccination program in the Community of Madrid in November of 2006 with 3+1 recommended doses and a catch-up for those under 2years old. In June 2010, PCV-7 was replaced by 13-valent vaccine (PCV-13) with 2+1 recommended doses. In July of 2012, the PCV-13 was removed from the funded program and reintroduced again (2+1 recommended doses) in December 2014. In between, children were vaccinated privately with 3+1 recommended doses of PCV-13. The aim of this study was to evaluate the effectiveness of each vaccination schedule used in the Community of Madrid. METHODS: We included all cases of invasive pneumococcal disease (IPD) reported between 2007 and 2015 to the Notifiable Diseases Surveillance System. Vaccination information was obtained from the Immunization Registry. Vaccine effectiveness (VE) was estimated using the indirect cohort design for cases with serotype information. RESULTS: A total 779 cases were included in the study. Among them 47.6% of the cases were primo-vaccinated with booster, 20% primo-vaccinated, 15.9% incompletely primo-vaccinated and 16.5% not vaccinated. The VE for ≥1 doses of any PCV was 82% (CI 95%: 67.8-89.9%): 91.9% (CI 95%: 76.5-97.2%) for PCV-7 and 77.2% (48.6-89.9%) for PCV-13. VE in those receiving the full 2+1 or 3+1 schedules was 100% for both vaccines. CONCLUSIONS: A high number of vaccine failures were reported in children before they had the opportunity to receive the booster dose, especially due to PCV-13-non-PCV-7 serotypes. VE was higher for PCV-7 compared to PCV-13, except for those that received the complete schedule with booster that achieved 100% of VE, which shows the relevance of the vaccines and complying with all doses scheduled.
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Vacuna Neumocócica Conjugada Heptavalente/uso terapéutico , Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas/uso terapéutico , Femenino , Vacuna Neumocócica Conjugada Heptavalente/inmunología , Humanos , Esquemas de Inmunización , Masculino , Infecciones Neumocócicas/epidemiología , Infecciones Neumocócicas/inmunología , VacunaciónRESUMEN
We present a combined ion imaging and density functional theory study of the dynamics of the desorption process of rubidium and cesium atoms off the surface of helium nanodroplets upon excitation of the perturbed 6s and 7s states, respectively. Both experimental and theoretical results are well represented by the pseudodiatomic model for effective masses of the helium droplet in the desorption reaction of meff/mHe ≈ 10 (Rb) and 13 (Cs). Deviations from this model are found for Rb excited to the 6p state. Photoelectron spectra indicate that the dopant-droplet interaction induces relaxation into low-lying electronic states of the desorbed atoms in the course of the ejection process.
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Agricultural and residential use of organophosphate (OP) pesticides has increased in recent decades after banning some persistent pesticides. Although there is evidence of the effects of OPs on neurodevelopment and behaviour in adults, limited information is available about their effects in children, who might be more vulnerable to neurotoxic compounds. This paper was aimed at analysing the scientific evidence published to date on potential neurodevelopmental and behavioural effects of prenatal and postnatal exposure to OPs. A systematic review was undertaken to identify original articles published up to December 2012 evaluating prenatal or postnatal exposure to OPs in children and effects on neurodevelopment and/or behaviour. Articles were critically compared, focusing on the methodology used to assess exposure and adverse effects, as well as potential contributing factors that may modify both exposure and outcomes, such as genetic susceptibility to certain enzymes involved in OPs metabolisation (e.g. paraoxonase-1) and gender differences. Twenty articles met the inclusion criteria, 7 of which evaluated prenatal exposure to OPs, 8 postnatal exposure and 5 both pre- and postnatal exposure. Most of the studies evaluating prenatal exposure observed a negative effect on mental development and an increase in attention problems in preschool and school children. The evidence on postnatal exposure is less consistent, although 2 studies found an increase in reaction time in schoolchildren. Some paraoxonase-1 polymorphisms could enhance the association between OPs exposure and mental and psychomotor development. A large variability in epidemiological designs and methodologies used for assessing exposure and outcome was observed across the different studies, which made comparisons difficult. Prenatal and to a lesser extent postnatal exposure to OPs may contribute to neurodevelopmental and behavioural deficits in preschool and school children. Standardised methodologies are needed to allow results to be better compared and to perform a quantitative meta-analysis before drawing any final conclusions.
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Encéfalo/efectos de los fármacos , Desarrollo Infantil/efectos de los fármacos , Feto/efectos de los fármacos , Organofosfatos/toxicidad , Plaguicidas/toxicidad , Encéfalo/fisiología , Niño , Conducta Infantil/efectos de los fármacos , Exposición a Riesgos Ambientales , Femenino , Humanos , Masculino , EmbarazoRESUMEN
Introducción: La encefalomielitis aguda desmielinizante (EMAD) es una enfermedad inflamatoria mutifocal y monofásica del sistema nervioso central (SNC) que afecta a la sustancia blanca. La evolución suele ser favorable. Presentamos nuestra experiencia en el manejo de la EMAD de curso clínico hiperagudo. Pacientes y métodos: Revisión de 5 casos de EMAD que se encontraban en coma en el momento del ingreso en la Unidad de Cuidados Intensivos Pediátricos (UCIP). Se describen los resultados epidemiológicos, clínicos, microbiológicos y los hallazgos de resonancia magnética (RM), así como el tratamiento y la evolución de dichos pacientes. Resultados: La edad media fue de 5,2 años (100% varones). Ningún caso presentó criterios de leucoencefalitis aguda hemorrágica. Todos los pacientes ingresaron en coma y precisaron ventilación mecánica controlada. Todos presentaron fiebre previamente al ingreso. El intervalo entre el primer síntoma de afectación neurológica y el coma fue ≤ 24 h. En 3 casos se objetivó alteración bioquímica del LCR. El estudio inmunológico del LCR detectó bandas oligoclonales en un paciente. En la primera RM, la sustancia blanca supratentorial y núcleos basales se mostraron afectados en todos los casos y 3 presentaron afectación medular. Todos recibieron tratamiento con metilprednisolona a dosis altas. Cuatro recibieron tratamiento con inmunoglobulina G a dosis altas y uno, plasmaféresis. Dos pacientes fallecieron durante su estancia en UCIP. Las lesiones radiológicas de sustancia blanca persistieron al alta. A los 9 meses, los 3 supervivientes presentaban un Glasgow Outcome Scale de 5 puntos y no habían presentado recaídas. Conclusiones: Existen formas hiperagudas de EMAD que se acompañan de una mortalidad elevada. A corto plazo, la mejoría clínica no se acompaña de una regresión paralela de las lesiones detectables en la RM(AU)
Introduction: Acute disseminated encephalomyelitis (ADEM) is an inflammatory disease that damages the white matter of the central nervous system. Its clinical course is monophasic and multifocal. The outcome is usually favourable. We report our experience in the management of the hyperacute form of ADEM. Patients and methods: A retrospective chart review was performed on five patients admitted in coma with a diagnosis of ADEM in the Paediatric Intensive Care Unit (PICU). We describe their epidemiological, clinical, microbiological, magnetic resonance imaging features and their treatment and outcomes. Results: The mean age was 5.2 years and all were male. None of them fulfilled radiologic criteria for acute haemorrhagic leukoencephalitis. At admission all patients were in a coma, and all were on controlled mechanical ventilation support. Before their admission all patients had fever. In all cases the time between the first neurological symptom and coma was ≤ 24hours. The cerebrospinal fluid examination was abnormal in three patients, and in one case, oligoclonal bands were detected. The first brain magnetic resonance imaging (MRI) showed white matter and basal ganglia lesions in all patients, and in three cases the spinal medulla was affected by demyelination. All patients were treated with a course of high-dose methylprednisolone. Four patients were also treated with high-dose immunoglobulins, and one of them received plasmapheresis. Two patients died, and one patient had severe sequelae at discharge from the PICU. At discharge the lesions in the white matter were still present in the MRI. After nine months the three survivors had a Glasgow Outcome Scale score of five and no one relapsed. Conclusions: There is a hyperacute clinical form of ADEM which has a high mortality rate. In the short term, the clinical improvement of hyperacute ADEM is not accompanied by a decrease of severity of the brain MRI(AU)
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Humanos , Masculino , Lactante , Preescolar , Niño , Adolescente , Encefalomielitis Aguda Diseminada/fisiopatología , Encefalitis/etiología , Espectroscopía de Resonancia Magnética , Índice de Severidad de la Enfermedad , Corticoesteroides/uso terapéuticoRESUMEN
INTRODUCTION: Acute disseminated encephalomyelitis (ADEM) is an inflammatory disease that damages the white matter of the central nervous system. Its clinical course is monophasic and multifocal. The outcome is usually favourable. We report our experience in the management of the hyperacute form of ADEM. PATIENTS AND METHODS: A retrospective chart review was performed on five patients admitted in coma with a diagnosis of ADEM in the Paediatric Intensive Care Unit (PICU). We describe their epidemiological, clinical, microbiological, magnetic resonance imaging features and their treatment and outcomes. RESULTS: The mean age was 5.2 years and all were male. None of them fulfilled radiologic criteria for acute haemorrhagic leukoencephalitis. At admission all patients were in a coma, and all were on controlled mechanical ventilation support. Before their admission all patients had fever. In all cases the time between the first neurological symptom and coma was ≤ 24hours. The cerebrospinal fluid examination was abnormal in three patients, and in one case, oligoclonal bands were detected. The first brain magnetic resonance imaging (MRI) showed white matter and basal ganglia lesions in all patients, and in three cases the spinal medulla was affected by demyelination. All patients were treated with a course of high-dose methylprednisolone. Four patients were also treated with high-dose immunoglobulins, and one of them received plasmapheresis. Two patients died, and one patient had severe sequelae at discharge from the PICU. At discharge the lesions in the white matter were still present in the MRI. After nine months the three survivors had a Glasgow Outcome Scale score of five and no one relapsed. CONCLUSIONS: There is a hyperacute clinical form of ADEM which has a high mortality rate. In the short term, the clinical improvement of hyperacute ADEM is not accompanied by a decrease of severity of the brain MRI.
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Encefalomielitis Aguda Diseminada , Niño , Preescolar , Encefalomielitis Aguda Diseminada/diagnóstico , Encefalomielitis Aguda Diseminada/terapia , Femenino , Humanos , Lactante , Masculino , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
There is a growing concern about the endocrine effects of long-term, low-level exposure to organophosphate (OP) compounds. Studies on experimental animals have found that OP pesticides have an impact on the endocrine system and a few clinical and epidemiological studies have also shown that OPs may affect the male hormone profile, although results are inconsistent. We have evaluated the effect of exposure to OP pesticides, measured through urinary levels of six dialkylphosphate (DAP) metabolites, on male hormone profile in 136 floriculture workers from the State of Mexico and Morelos during two agricultural periods with different degree of pesticide exposure. Generalized estimated equations (GEE) models were developed and adjusted for several potential confounders, including PON1 enzyme activity, as a biomarker of susceptibility, and serum levels of p,p'-DDE, a metabolite of the pesticide DDT widely used in Mexico until 1999 for control of agricultural pests and malaria. Exposure of male floriculture workers to OP pesticides was associated with increased serum levels of follicle-stimulating hormone (FSH) and prolactin and with decreased serum testosterone and inhibin B levels. Among all DAPs tested, only DETP was inversely associated with luteinizing hormone (LH). Estradiol showed a marginally significant positive trend with DEP and DETP derivatives. In conclusion, OP pesticides may have an impact on the endocrine function because of their potential to modify the male hormone profile as a function of the type of pesticide used as well as the magnitude of exposure.
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Hormonas Gonadales/sangre , Exposición Profesional/efectos adversos , Intoxicación por Organofosfatos/complicaciones , Plaguicidas/efectos adversos , Adolescente , Adulto , Agricultura , Arildialquilfosfatasa/metabolismo , Diclorodifenil Dicloroetileno/sangre , Estradiol/sangre , Hormona Folículo Estimulante/sangre , Humanos , Inhibinas/sangre , Estudios Longitudinales , Hormona Luteinizante/sangre , Masculino , Persona de Mediana Edad , Intoxicación por Organofosfatos/sangre , Compuestos Organofosforados/efectos adversos , Compuestos Organofosforados/orina , Prolactina/sangre , Encuestas y Cuestionarios , Testosterona/sangre , Adulto JovenRESUMEN
Within the diffusion Monte Carlo approach, we have determined the structure of isotopically pure and mixed helium droplets doped with one magnesium atom. For pure (4)He clusters, our results confirm those of Mella et al. [J. Chem. Phys. 123, 054328 (2005)] that the impurity experiences a transition from a surface to a bulk location as the number of helium atoms in the droplet increases. Contrarily, for pure (3)He clusters Mg resides in the bulk of the droplet due to the smaller surface tension of this isotope. Results for mixed droplets are presented. We have also obtained the absorption spectrum of Mg around the 3s3p (1)P(1) â 3s(2) (1)S(0) transition.
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INTRODUCTION: Population ageing is a main concern under the biosanitary point of view. AIM: To assess the nutritional status of people 65 year-old and older in Cantabria (Spain) METHOD: A total of 1605 persons were studied by means of the MNA (Mini Nutritional Assessment); a) by primary care (59.9% in the unit, and 4.7% at home) and, b) in nursing homes (35.4%). RESULTS: Nutritional score (NS) was 23.4 ± 4.1 for women and 24.4 ± 4 in males (p < 0.001). We emphasize the fact that 22.3% of people studied in the nursing homes were malnourished or at risk of malnutrition, compared with 14.2% of those studied at the unit, and only 3.3% of the home visited elders. The correlation between the value of the NS and the subjective estimation of nutrition status showed a high value (0.65). We emphasize the negative correlation (-0.53) between BNI value and the incidence of skin lesions. CONCLUSION: Our results highlight the importance of identifying malnutrition or its risk in elders in order to prevent the negative consequences of this deficiency.
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Anciano/estadística & datos numéricos , Estado Nutricional , Factores de Edad , Anciano de 80 o más Años , Peso Corporal/fisiología , Femenino , Humanos , Masculino , Desnutrición/epidemiología , Casas de Salud , Evaluación Nutricional , Población , Atención Primaria de Salud , Factores Sexuales , España/epidemiologíaRESUMEN
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Humanos , Femenino , Niño , Necrobiosis Lipoidea/diagnóstico , Complicaciones de la Diabetes/diagnóstico , Eritema/etiologíaRESUMEN
A finite-temperature density functional approach to describe the properties of parahydrogen in the liquid-vapor coexistence region is presented. The first proposed functional is zero-range, where the density-gradient term is adjusted so as to reproduce the surface tension of the liquid-vapor interface at low temperature. The second functional is finite-range and, while it is fitted to reproduce bulk pH(2) properties only, it is shown to yield surface properties in good agreement with experiments. These functionals are used to study the surface thickness of the liquid-vapor interface, the wetting transition of parahydrogen on a planar Rb model surface, and homogeneous cavitation in bulk liquid pH(2).
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