Identification of extraocular extension in uveal melanoma by ophthalmological ultrasound.

BACKGROUND AND PURPOSE: Uveal melanoma is the most common primary malignant intraocular tumour in the adult population, with a survival rate of 50% despite advances in treatment and knowledge of this disease. The presence of extraocular extension (EE) worsens the prognosis of these patients, so its proper identification can ensure its management and early intervention. Ophthalmological ultrasound is the technique of choice for the diagnosis and follow-up of these patients, both of the anterior EE using ultrasonic biomicroscopy (UBM), and the posterior EE using A and B ultrasound. The aim of this study is to describe the ultrasound characteristics of the BMU and the A and B ultrasound. MATERIAL AND METHODS: A descriptive and retrospective study is carried out on patients diagnosed with uveal melanoma (UM) and EE from 2003 to 2019. The ultrasound characteristics of the local disease and the follow-up after treatment were recorded completely and at each visit. In the case of anterior EE, photographs of the anterior segment and UBM were taken, while those involving the posterior segment were explored under A and B mode ultrasound. All enucleated eyes were sent for anatomopathological study. RESULTS: Ten patients with an average age of 72.3 years were included. The largest proportion of them were medium-sized tumours, followed by large and small ones. The most frequent morphology of the primary tumour was cupuliform. All the EE presented lower internal reflectivity compared to the primary tumour. No trans-scleral connection bridges were found between the primary tumour and the EE in the ultrasound studies. 50% of patients underwent primary enucleation at the time of diagnosis of intraocular MU due to the presence of the EE, and the remaining 50% presented the EE after initial treatment of the primary tumour with I125 brachytherapy. Sixty percent of the patients presented with posterior EE, and were therefore diagnosed with ultrasound A and B. The most frequent histopathological pattern with 87.5% of patients was the epithelioid pattern. DISCUSSION: Ultrasound scanning in patients with MU is mandatory for diagnosis and follow-up of EE. BMU and A and B ultrasound are the test of choice for anterior and posterior EE, respectively. EE have particular ultrasound characteristics such as low internal reflectivity, regularity of their contour and their location usually adjacent to the base of the primary intraocular tumor.

Identificación de extensión extraocular en el melanoma uveal mediante ecografía oftalmológica / Identification of Extraocular Extension in Uveal Melanoma by Ophthalmological Ultrasound

Antecedentes y objetivoEl melanoma uveal es el tumor primario maligno intraocular más frecuente en la población adulta, con una tasa de supervivencia del 50% a pesar de los avances en el tratamiento y conocimiento de esta enfermedad. La presencia de extensión extraocular (EE) empeora el pronóstico de estos pacientes, por lo que su correcta identificación puede asegurar su manejo e intervención temprana. La ecografía oftalmológica es la técnica de elección para el diagnóstico y seguimiento de estos pacientes, tanto de la EE anterior mediante biomicroscopía ultrasónica (UBM), como de la EE posterior mediante ecografía A y B. El objetivo de este estudio es describir las características ecográficas de la UBM y de la ecografía A y B.Material y métodosSe realiza un estudio descriptivo y retrospectivo de los pacientes diagnosticados de melanoma uveal (UM) y EE desde 2003 hasta 2019. Las características ecográficas de la enfermedad local y el seguimiento luego del tratamiento se registraron de maneracompleta y en cada visita. En caso de EE anteriores se realizaron fotografías de segmento anterior y BMU, por el contrario las que involucran el segmento posterior se exploraron bajo ecografía modo A y B. Todos los ojos enucleados se enviaron para su estudio anatomopatológico.

Background and purposeUveal melanoma is the most common primary malignant intraocular tumour in the adult population, with a survival rate of 50% despite advances in treatment and knowledge of this disease. The presence of extraocular extension (EE) worsens the prognosis of these patients, so its proper identification can ensure its management and early intervention. Ophthalmological ultrasound is the technique of choice for the diagnosis and follow-up of these patients, both of the anterior EE using ultrasonic biomicroscopy (UBM), and the posterior EE using A and B ultrasound. The aim of this study is to describe the ultrasound characteristics of the BMU and the A and B ultrasound.Material and methodsA descriptive and retrospective study is carried out on patients diagnosed with uveal melanoma (UM) and EE from 2003 to 2019. The ultrasound characteristics of the local disease and the follow-up after treatment were recorded completely and at each visit. In the case of anterior EE, photographs of the anterior segment and UBM were taken, while those involving the posterior segment were explored under A and B mode ultrasound. All enucleated eyes were sent for anatomopathological study.

[Intestinal failure and transplantation in microvillous inclusion disease]. / Fracaso intestinal y trasplante en la enfermedad por inclusiones microvellositarias.

INTRODUCTION: Microvillous inclusion disease is a rare autosomal recessive condition, characterized by severe secretory diarrhea that produces a permanent intestinal failure and dependency on parenteral nutrition. It usually begins in the neonatal period, and the only treatment at present is intestinal transplantation. PATIENTS AND METHODS: A retrospective review was conducted on 6 patients (three males and three females) diagnosed with microvillous inclusion disease between 1998 and 2013. RESULTS: All debuted in the first month of life, with a median age of three days (range, 3-30 days), and had secretory diarrhea dependent on parenteral nutrition, with fasting fecal volume of 150-200ml/kg/day. Light microscopy of duodenal biopsy samples showed varying degrees of villous atrophy without cryptic hyperplasia, accumulation of PAS positive material in the cytoplasm of enterocytes brush border, and anti-CD10 immunostaining was suggestive of intracytoplasmic inclusions. Diagnostic confirmation was performed with electron microscopy. Two of them had a genetic study, and showed mutations in MYO5B gene. Three died and three are alive; two of them with an intestinal transplantation and the third waiting for a multivisceral transplantation.

Development of an autoimmune syndrome affecting the skin and internal organs in P-selectin glycoprotein ligand 1 leukocyte receptor-deficient mice.

OBJECTIVE: To define and characterize the progression of the spontaneous autoimmune disease that develops in mice in the absence of the leukocyte adhesion receptor P-selectin glycoprotein ligand 1 (PSGL-1). METHODS: Skin-resident immune cells from PSGL-1-deficient mice and C57BL/6 control mice of different ages were isolated and analyzed by flow cytometry. Biochemical parameters were analyzed in mouse serum and urine, and the presence of serum autoantibodies was investigated. Skin and internal organs were extracted, and their structure was analyzed histologically. RESULTS: Skin-resident innate and adaptive immune cells from PSGL-1(-/-) mice had a proinflammatory phenotype with an imbalanced T effector cell:Treg cell ratio. Sera from PSGL-1(-/-) mice had circulating autoantibodies commonly detected in connective tissue-related human autoimmune diseases. Biochemical and histologic analysis of skin and internal organs revealed skin fibrosis and structural and functional abnormalities in the lungs and kidneys. Furthermore, PSGL-1(-/-) mice exhibited vascular alterations, showing loss of dermal vessels, small vessel medial layer remodeling in the lungs and kidneys, and ischemic processes in the kidney that promote renal infarcts. CONCLUSION: Our study demonstrates that immune system overactivation due to PSGL-1 deficiency triggers an autoimmune syndrome with characteristics similar to systemic sclerosis, including skin fibrosis, vascular alterations, and systemic organ involvement. These results suggest that PSGL-1 expression contributes to the maintenance of the homeostasis of the immune system and could act as a barrier for autoimmunity in mice.

[Takayasu arteritis and cerebral venous thrombosis: report of a case]. / Arteritis de Takayasu y trombosis venosa cerebral: a propósito de un caso.

Palpitations, paresthesias and anxiety are very common reasons of consultation in primary care. We report the case of a 40 year-old Caucasian woman who came to the clinic due to these symptoms, and was finally diagnosed with Takayasu arteritis. Later, she had an episode of headache, as the initial manifestation of cerebral venous thrombosis. Takayasu arteritis is a systemic vasculitis affecting medium and large arteries, mainly leacausing stenosis of the aorta and its branches. It most frequently affects Asian women, being much rarer in Europe. The primary care doctor plays a key role in the initial diagnosis and monitoring of patients with rare diseases, such as Takayasu arteritis, and must be a basic support for the patient and family, providing information and advice, and contributing with his work to reduce the vulnerability of this group.

Long-term effect of salinity on plant quality, water relations, photosynthetic parameters and ion distribution in Callistemon citrinus.

The effect of saline stress on physiological and morphological parameters in Callistemon citrinus plants was studied to evaluate their adaptability to irrigation with saline water. C. citrinus plants, grown under greenhouse conditions, were subjected to two irrigation treatments lasting 56 weeks: control (0.8 dS·m(-1)) and saline (4 dS·m(-1)). The use of saline water in C. citrinus plants decreased aerial growth, increased the root/shoot ratio and improved the root system (increased root diameter and root density), but flowering and leaf colour were not affected. Salinity caused a decrease in stomatal conductance and evapotranspiration, which may prevent toxic levels being reached in the shoot. Net photosynthesis was reduced in plants subjected to salinity, although this response was evident much later than the decrease in stomatal conductance. Stem water potential was a good indicator of salt stress in C. citrinus. The relative salt tolerance of Callistemon was related to storage of higher levels of Na+ and Cl- in the roots compared with the leaves, especially in the case of Na+, which could have helped to maintain the quality of plants. The results show that saline water (around 4 dS·m(-1)) could be used for growing C. citrinus commercially. However, the cumulative effect of irrigating with saline water for 11 months was a decrease in photosynthesis and intrinsic water use efficiency, meaning that the interaction of the salinity level and the time of exposure to the salt stress should be considered important in this species.

[Contents, positioning and quality analysis in Spanish websites related to nutrition and eating behavior disorders]. / Análisis del contenido, posicionamiento y calidad de páginas web en español relacionadas con la nutrición y los trastornos de la conducta alimentaria.

INTRODUCTION: Eating disorders are serious psychological disorders with an increased incidence in last years. One of the factors that determine the high prevalence of eating disorders in our society is the lack of knowledge about nutrition. One of the reasons of this lack of knowledge could be the presence of online resources without scientific validity. OBJECTIVE AND SCOPE: The aim of this study was to analyze the scientific quality and positioning of websites in Spanish that have information on nutrition, eating disorders and obesity. MATERIALS AND METHODS: For this purpose, a web search was conducted in the Google Chrome browser using the key words: diet, anorexia, bulimia, obesity and nutrition, and selecting the first 20 results of each search at the rates offered by SeoQuake positioning (Page Rank, Alexa Rank y SEMrush Rank). The variables used for the analysis were: information related to eating habits and diets, information on healthy eating, information about eating disorders and their diagnostics, and formative information about general health topics with professional criteria. RESULTS: Only the 50% of the webpages accomplished the inclusion criteria for this study. Most of them did not follow the guidelines established by e- Europe assessment for quality. The median of the Webpage's PageRank was 2, except those associated with health institutions. CONCLUSIONS: Given the scarcity of healthcare websites with scientific rigor is essential to review the existing one and to create new online spaces whose supervision must be carried out by specialists in health and nutrition.

Introducción: Los trastornos del comportamiento alimentario (TCA) son las patologías psicológicas que más se han incrementado en los últimos años. Uno de los factores que determina la elevada prevalencia de TCA en nuestra sociedad es el gran desconocimiento sobre alimentación. Este desconocimiento puede deberse a la consulta de recursos online sin validez científica. Objetivo y ámbito: El objetivo de este trabajo ha sido analizar la calidad científica y el posicionamiento de los sitios web en español con información sobre nutrición, TCA y obesidad. Material y métodos: Se realizó una búsqueda de páginas web en el navegador Google Chrome con las palabras clave: dieta, anorexia, bulimia, nutrición y obesidad, seleccionándose los 20 primeros resultados de cada búsqueda según los índices de posicionamiento ofrecidos por SEOquake (Page Rank, Alexa Rank y SEMrush Rank). Las variables de análisis fueron: información relacionada con dietas y hábitos alimentarios, información sobre alimentación saludable, información sobre TCA y sus criterios diagnósticos e información de carácter formativo acerca de temas profesionales de salud general. Resultados: Sólo el 50% de las web encontradas cumplían los criterios de inclusión en el estudio. La mayoría no seguían las pautas establecidas por e-Europa sobre calidad. La mediana de Page Rank fue de 2, excepto en aquellas asociadas a instituciones sanitarias de prestigio. Conclusiones: Dada la escasez de webs sanitarias con rigor científico, es imprescindible la revisión de las existentes y la creación de nuevos espacios on-line cuya supervisión sea realizada por profesionales especialistas en salud y nutrición.

Glaucomas asociados a patología coriorretiniana / Glaucomas associated with disorders of the retina and choroid

La patología retiniana puede cursar a lo largo de su evolución con una gran multitud de glaucomas de diversa índole. El glaucoma neovascular es el cuadro que con mayor frecuencia se asocia a dicha patología. No obstante, existen otros cuadros menos conocidos pero igual de importante puesto que pueden comprometer la función visual de nuestros pacientes (AU)

Several types of glaucoma are associated with diseases of the retina. The most common of these is neovascular glaucoma, although some cases are associated with other less common forms of glaucoma. All are important because they can cause loss of visual acuity (AU)

Altered pharmacology of native rodent spinal cord TRPV1 after phosphorylation.

BACKGROUND AND PURPOSE: Evidence suggests that phosphorylation of TRPV1 is an important component underlying its aberrant activation in pathological pain states. To date, the detailed pharmacology of diverse TRPV1 receptor agonists and antagonists has yet to be reported for native TRPV1 under phosphorylating conditions. Our goal was to optimize a relatively high-throughput methodology to allow pharmacological characterization of the native TRPV1 receptor using a spinal cord neuropeptide release assay under naive and phosphorylating states. EXPERIMENTAL APPROACH: Herein, we describe characterization of rodent TRPV1 by measurement of CGRP release from acutely isolated lumbar (L1-L6) spinal cord using a 96-well technique that combines use of native, adult tissue with quantitation of CGRP release by ELISA. KEY RESULTS: We have studied a diverse panel of TRPV1 agonists and antagonists under basal and phosphorylating conditions. We show that TRPV1-mediated CGRP release is evoked, in a temperature-dependent manner, by a PKC activator, phorbol 12,13-dibutyrate (PDBu); and that treatment with PDBu increases the potency and efficacy of known TRPV1 chemical agonists, in an agonist-specific manner. We also show that the pharmacological profile of diverse TRPV1 antagonists is dependent on whether the stimulus is PDBu or capsaicin. Of note, HPPB was identified as an antagonist of capsaicin-evoked, but a potentiator of PDBu-evoked, CGRP release. CONCLUSIONS AND IMPLICATIONS: Our findings indicate that both TRPV1 agonist and antagonist profiles can be differentially altered by PKC activation. These findings may offer new insights for targeting TRPV1 in pain states.

Propranolol: tratamiento del hemangioma capilar con afectación orbitaria / Propranolol: Treatment of capillary hemangioma with orbital involvement

Caso clínico: Lactante de 2 meses con un hemangioma de crecimiento rápido en la hemicara izquierda, que afecta al párpado superior y la porción superoexterna de la órbita, obstaculizando el eje visual y desplazando medialmente el recto lateral y el globo ocular. Se administra propranolol oral y se observa una rápida y sostenida disminución del hemangioma, con regresión del componente órbito-palpebral. Discusión: Según estudios previos el propranolol parece ser un fármaco seguro y efectivo en el tratamiento del hemangioma infantil. En nuestro caso, la respuesta al propranolol fue satisfactoria y no se presentaron efectos adversos. Este tratamiento debe ser considerado como una alternativa promisoria(AU)

Clinical case: A 2-months-old girl had a fast growth hemangioma in the left side of the face, that involved upper eyelid and superior and external portion of the orbit, covering her visual axis and pushing the eye and lateral rectus muscle. We gave oral propranolol as treatment and we noticed a fast and constant hemangioma reduction and resolution of orbital and palpebral component. Discussion: According to previous researches, propranolol seems to be an effective and safe drug to treat capillary hemangioma. In our case, response to propranolol was satisfactory and with no side effects. This treatment should be considered as a promising alternative(AU)

[Propranolol: Treatment of capillary hemangioma with orbital involvement]. / Propranolol: tratamiento del hemangioma capilar con afectación orbitaria.

CLINICAL CASE: A 2-months-old girl had a fast growth hemangioma in the left side of the face, that involved upper eyelid and superior and external portion of the orbit, covering her visual axis and pushing the eye and lateral rectus muscle. We gave oral propranolol as treatment and we noticed a fast and constant hemangioma reduction and resolution of orbital and palpebral component. DISCUSSION: According to previous researches, propranolol seems to be an effective and safe drug to treat capillary hemangioma. In our case, response to propranolol was satisfactory and with no side effects. This treatment should be considered as a promising alternative.

The submarine volcano eruption at the island of El Hierro: physical-chemical perturbation and biological response.

On October 10 2011 an underwater eruption gave rise to a novel shallow submarine volcano south of the island of El Hierro, Canary Islands, Spain. During the eruption large quantities of mantle-derived gases, solutes and heat were released into the surrounding waters. In order to monitor the impact of the eruption on the marine ecosystem, periodic multidisciplinary cruises were carried out. Here, we present an initial report of the extreme physical-chemical perturbations caused by this event, comprising thermal changes, water acidification, deoxygenation and metal-enrichment, which resulted in significant alterations to the activity and composition of local plankton communities. Our findings highlight the potential role of this eruptive process as a natural ecosystem-scale experiment for the study of extreme effects of global change stressors on marine environments.

Estimation of the uncertainty associated with the results based on the validation of chromatographic analysis procedures: application to the determination of chlorides by high performance liquid chromatography and of fatty acids by high resolution gas chromatography.

This article presents a model to calculate the uncertainty associated with an analytical result based on the validation of the analysis procedure. This calculation model is proposed as an alternative to commonly used bottom-up and top-down methods. This proposal is very advantageous as the validation of the procedures and the estimation of the uncertainty of the measurement are part of the technical requirements needed in order to obtain the ISO 17025:2005 accreditation. This model has been applied to the determination of chloride by liquid chromatography in lixiviates and in the determination of palmitic acid and stearic acid by gas chromatography in magnesium stearate samples.

Violencia de género: detección precoz y abordaje integral desde los servicios extrahospitalarios de emergencias / No disponible

Introducción: la ciudad de Madrid dispone de un sistema integral de actuación contra la VG (Violencia de Género) en la que la petición de ayuda por parte de una víctima de violencia doméstica será codificada como 5.7, activándose una unidad de SAMUR-Protección Civil junto con otra de UAPF (Unidad de Atención y Protección a la Familia) e iniciándose la atención sanitaria y psicológica urgente y la protección a la víctima. El SAVD (Servicio de Atención de Violencia Doméstica) y el PMORVG (Punto Municipal del Observatorio Regional de Violencia de Género) serán los últimos eslabones para facilitar la reinserción al tejido social de la víctima. Según el 016, el 24,9% de las llamadas relacionadas con VG proceden deMadrid, el 80,2% las realiza la propia víctima. El perfil es el de una mujer casada en el 51% casos, con hijos en el 90,6% y su edad no supera los 40 años en el 59,3%. El nivel de estudios es primario y se dedican a las tareas del hogar mayoritariamente. Las lesiones presentes en las víctimas tienen el siguiente mecanismo lesional: arma blanca (46,8%), arma de fuego (16,1%), traumas contusos (13,6%), estrangulamiento (8,7%). Objetivos: obtener datos estadísticos de la actividad derivada del procedimiento de actuación (SAMURProtección Civil-UAPF-SAVD-PMORVG) ante la VG y estudio del perfil de las personas atendidas. Material y método: estudio observacional, descriptivo, transversal, retrospectivo de las asistencias realizadas por SAMUR-Protección Civil de código 5.7 VG desde diciembre de 2007-diciembre 2009, coincidiendo con la entrada en vigor de las medidas de prevención y protección integral contra VG en la Ley 13/2007. Consulta archivo de informes de asistencia, bases de datos del servicio, memoria de actividad y protocolo de SAVD, PMORVG, UAPF y 016. Resultados: SAMUR-Protección Civil realizó 2.102 intervenciones por VG, de las cuales 1.938 son resueltas en el lugar por una unidad SVA y derivadas al SAVD. De ellas 164 precisan traslado a centro sanitario, siendo los hospitales: 12 de Octubre (35), Gregorio Marañon (32), Clínico (26) los principales receptores. La demanda de asistencia sanitaria proviene de Policia Múnicipal (1.466), Policia Nacional (421) y Madrid 112 (166) y se realiza en la propia comisaría (1.140), vía pública (516) y en el domicilio o alrededores (446). Esta se produce los domingos (486), sábados (350) y viernes (269); en los meses de Diciembre (226), Junio (210), Mayo (207), Enero (197), Febrero (194) y Julio (178); en horario de tarde (916), mañana (597) y noche (589). La edad de las pacientes es de 31/40 años (873), 18/30 años (803) y de 41/50 años (277) y su distrito de residencia es: Villaverde (245), Tetúan (226), Puente Vallecas (184), Ciudad Lineal (168) y San Blas (153)...(AU)

Introduction: The city of Madrid has a comprehensive system of performance against VG in which the request for help from a victim of domestic violence will be coded as 5.7 SAMUR activating a unit, along with other Civil Protection of health care starting UAPF urgent psychological and protection to the victim. The PMORVG Savda and will be the final links in the social reintegration of the victim. According to 016, 24,9% of the calls regarding genderbased violence came from Madrid, 80,2% were phone calls the victim made and this average victim is married in the 51% of the cases and has children in the 90,6%, and her age was up to 40 y.o. in 59,3% of the cases. The victim’s studies level is Primary and they are mainly housewives. The violence was caused by: White weapons (46,8%), Guns (16,1%), Contusions (13,6%) or Strangulation (8,7%). Background: To obtain stadistic figures about act proceedure (SAMUR-Protección Civil-UAPF-SAVDPMORVG) and to study the patients that were attended. Methodology: Observation, description, transversal, retrospective from the assistances by SAMUR-Protección Civil 5.7 code (Domestic Violence) from December 2007 to December 2009, coinciding with the enforcement date of the prevention and fully protection measures against Domestic Violence that are part of the 13/2007 Spanish Law. Files seeking, memory and other sources (SAVD, PMORVG, UAPF and 016). Results: SAMUR-Protección Civil attended 2.102 situations caused by Domestic Violence, 1.938 were fixed in the place by a SVA unit and referred SAVD; regarding the other 164 cases, transfer to a medical center were needed, and the most frequently used Hospitals were: 12 de octubre (35), Gregorio Marañon(32), Clinico(26). The medical service requirement comes from Local Police (1466), National Police (421) and also from Madrid 112 Service (166) and this requirement is made from the Police Station (1140), from the street (516) or from a home address or nearby (446). The requirements are made on Sunday (486), Saturday (350) and Friday (269) during the months of December (226), June (210), May (207), January (197), February (194) and July (178), in the afternoon (916), morning (597) and evening/night (589). The patient’s average age is 31/40 y.o. (873), 18/30 y.o. (803) and 41/50 y.o. (277) and their neighborhood is: Villaverde (245), Tetúan (226), Puente Vallecas (184), Ciudad Lineal (168) and San Blas (153). They were Spanish in 1.352 of the situations and 750 were foreigners. The main reasons why assistance was needed were: injuries and minor contusions (1690), facial trauma (79), orthopedic trai,a (54), anxiety attack (53), (42) thoracic trauma (17) and neck trauma (12). Throughout the time the study took, 131 women were mortal victims by Domestic Violence: 21 of them died in Madrid region and 8 of them were in Madrid city. Half of these 8 victims were in Puente de Vallecas(AU)

Chronic antigenic stimuli as a possible explanation for the immunodepression caused by liver cirrhosis.

The objectives of this work were the analysis of the functional characteristics of circulating monocytes and T lymphocytes in patients with liver cirrhosis, and evaluation of the relationship with an increased exposure to antigens due to bacterial translocation. Forty patients with liver cirrhosis (20 with compensated cirrhosis and 20 with ascitic decompensation) and 20 healthy control subjects were studied. Bacterial translocation was evaluated by serum levels of lipopolysaccharide binding protein (LBP). Macrophage activation was studied by CD40 antigen expression. T lymphocytes were analysed for activation (CD25(+), CD122(+)), effector function (CD8(+)CD45RO(+)CD57(+)), apoptosis (CD95(+)) and regulatory abilities, either by analysis of the membrane expression of co-stimulatory molecules CD80, CD86 and CD28, or by quantification of regulatory T cells CD4(+)CD25(high)forkhead box P3 (FoxP3). The percentage of activated monocytes and T lymphocytes in patients was increased significantly. The proportions of effector senescent cells and of those near to apoptosis were also significantly higher. With respect to these proportions, there were no significant differences between patients in function of the presence or absence of decompensation or in function of the increased or normal values of LBP. Conversely, those patients with elevated levels of LBP presented a significantly higher frequency of regulatory T cells than those with normal levels. In conclusion, patients with liver cirrhosis showed an intensive activation state with a higher percentage of cells committed to activation-induced death, even in non-advanced stages. It is possible that bacterial permeability and endotoxaemia contribute to the expansion of those lymphocyte populations implicated in the prevention of a more severe antigen-induced immunopathology.

Cañada Real Galiana: intervención sanitaria urgente en las 'favelas españolas' / No disponible

Introducción: La Cañada Real Galiana es un antiguo camino de trashumancia, con más de 2.000 casas ilegales y 40.000 habitantes que se arremolinan a los lados de un camino de barro irregular, lleno de basura y ruedas de coches quemadas, de unos 15 kilómetros. Es el mayor asentamiento ilegal de España y similar, en menor magnitud, a las favelas de Brasil. Cerca de 1.500 niños viven entre ratas y culebras; más de 4.500 camiones transitan a diario el camino de la cercana incineradora de Valdemingómez. Aquí se concentra el 95% de la venta de droga de Madrid. Los sanitarios de SAMUR-Protección Civil deben actuar en el asentamiento bajo protección policial. Objetivos: Analizar si los factores y circunstancias de riesgo social a los que se ve sometida esta población (insalubridad, tráfico denso, incineradora, drogas) se correlacionan con el aumento de demanda sanitaria urgente (problemas digestivos, cutáneos, atropellos, enfermedades respiratorias, sobredosis estupefacientes). Material y método: Estudio descriptivo transversal retrospectivo de las asistencias realizadas por SAMUR-Protección Civil en Cañada Real Galiana durante 2008. Resultados: SAMUR-Protección Civil intervino en 244 ocasiones; en 136 ocasiones con SVA (soporte vital avanzado) y en 108 con SVB (soporte vital básico). Se realizaron 52 traslados ( 39 en SVB y 13 en SVA) a hospitales (Gregorio Marañón: 38, Clínico: 3, F. J. Díaz: 3, Infanta Leonor: 3, 12 de Octubre: 2, Princesa: 1 y Puerta Hierro: 1). SAMUR-Protección Civil actúa por petición del 112 en 144 ocasiones, Policía Municipal en 61, Policía Nacional en 19, Bomberos en 9, SUMMA-112 en 7 y Guardia Civil en 4. El motivo de asistencia fue: sobredosis/drogas en 55 actuaciones seguido de accidente de tráfico/atropello en 26, agresiones en 24, problemas respiratorios en 12. Por patología, las unidades SVA atendieron a 54 casos debidos a drogas abuso, 11 por trauma facial o TCE y 6 por traumatismo ortopédico. Las ambulancias SVB atendieron 46 heridas y contusiones menores, 10 traumatismos ortopédicos y 9 crisis nerviosas/trastorno de ansiedad. Los meses de mayor intervención fueron: junio –29–, mayo, julio y agosto con 24. Los domingos se dispara la demanda con 54 intervenciones, de manera más frecuente en la mañana –107– frente a la tarde –88–. Se atendieron a 200 hombres y 44 mujeres, de los cuales 139 eran personas de nacionalidad española. Por edades 89 se encuentran entre 31-40 años, 68 entre 19-30 años, 63 entre 41-50 años, 18 con más de 51 años y 6 son menores. Conclusiones: El perfil del paciente atendido en la Cañada corresponde a un varón de origen español con una edad de 31-40 años. Se interviene principalmente en fin de semana durante los meses de primavera y verano y en horario de mañana, a petición del 112. SAMUR-Protección Civil envió, prioritariamente unidades de SVA que tuvieron como hospital de traslado el Gregorio Marañon, aunque la mayor parte de las intervenciones se resolvieron en el lugar. La actividad de venta y 'trapicheo' de drogas y el tráfico denso condicionan la gran cantidad de intervenciones realizadas por SAMUR-Protección Civil. La sobredosis por drogas es el principal motivo de intervención, seguido de heridos en accidente tráfico y atropellos. El elevado número de agresiones que se generan en la zona hace de esta un terreno de difícil intervención por su inseguridad. No hay datos que permitan establecer relación entre las insuficiencias respiratorias atendidas, ni tampoco dato alguno que establezca un mayor índice de atención a menores por la cercanía a la incineradora. La población de La Cañada es de origen extranjero (rumano y africano); la mayor parte de atenciones se realizan con personas no residentes en el lugar(AU)

Introduction: Cañada Real Galiana is an old way of transhumance, it has more than 2,000 illegal houses and 40,000 inhabitants that swirls on the sides of an irregular path of mud, full of rubbish and burnt car wheels, about 15 kilometers long, is the largest illegal settlement of Spain similar to the Brazilian favelas. About 1,500 children are living among rats and snakes, more than 4,500 trucks cross this road every day from the nearby incinerator Valdemingómez and it assembles 95% of drugs-sale in Madrid. The Health Protection Civil-SAMUR act in the settlement under police protection. Background: To analyze and quantify the pleas for emergency health care in a marginal settlement. Show whether there are correlated social (unhealthy, heavy traffic, incinerators, drugs) to health care urgently (digestive problems, skin attacks, respiratory diseases, drug overdose). Methodology: A retrospective cross-sectional descriptive study of visits made by SAMUR-Protección Civil in Cañada Real Galiana during 2008. Results: SAMUR-Protección Civil intervened on 244 occasions, 136 SVA (advanced life support) and 108 BLS (basic life support), there were 52 movements (39 and 13 SVA SVB) to hospital (Gregorio Marañon 38, Clínico 3, FJ Díaz 3, Infanta Leonor 3, 12 de Octubre 2, Princesa 1 and Pueta de Hierro 1). SAMUR-Protección Civil action at the request of 112 in 144 cases, 61 Municipal Police, Nacional Police 19, Fire 9, SUMMA-061 Guardia Civil 4 and 7. The reason for assistance is by overdose/drug, followed by 55 performances accident/26 hit, 24 attacks, respiratory disease 12. Pathology units attended SVA 54 (drugs abuse), 11 (facial trauma-TCE) and 6 (orthopedic trauma). BLS ambulances attended 46 (injuries/minor contusions), 10 (orthopedic trauma) and 9 (nervous disorder, anxiety). Greater intervention months were: June –29–, May, July and August (with 24). Sundays demand soars to 54 interventions mainly in the morning 107 in the afternoon and 88. The profile is 200 men and 44 women attended, of which 139 were Spanish. By age 89 are (31-40 years), 68 (19-30 years), 63 (41-50 years), 18 more than 51 years and 6 are minors. Conclusions: The patient’s profile attended at Cañada Real at the is a Spaniard man about 31/40 years, the interventions are mainly on weekends during the spring and summer months usually in the morning by 112, SAMUR Protección Civil SVA priority units demard, there were sent which were chose the 'Gregorio Marañon Hospital' although most of the interventions were resolved on site. There is a direct relation between sales and 'shady' and the drug traffic to y PC-SAMUR interventions, drug overdose was the main reason for intervention followed by traffic accidents and run overs. The high number of attacks certifies injunes by unsafety and difficulty of intervening in the area, there is no data to establish the relationship between respiratory failure nor any data served to establish a higher rate for children by the proximity to the incinerator. The Cañada’s population is foreign (African and Romanian), of the interventions are done to non-residents of this place(AU)

Novel splice donor site mutation in MERTK gene associated with retinitis pigmentosa.

BACKGROUND/AIM: Mutations in MERTK, a member of the MER/AXL/TYRO3 receptor kinase family, have been associated with disruption of the Retinal Pigment Epithelium (RPE) phagocytosis pathway and settling of autosomal recessive RP (arRP) in humans. This study reports a novel MERTK mutation (IVS16+1G>T) in a Spanish consanguineous family presenting arRP. METHODS: 21 genes were screened by high-throughput SNP multiplexing assay. Subsequent direct sequencing was performed in exons and intronic boundaries of the cosegregating gene. The effect of the mutation in mRNA splicing was confirmed by cDNA analysis. RESULTS: Haplotypic data revealed MERTK cosegregation with RP in affected individuals. MERTK sequencing showed a G-to-T substitution at the first nucleotide of intron 16. Finally, cDNA analysis confirmed the lack of exon 16 in the mRNA splicing process. CONCLUSIONS: IVS16+1G>T disrupts the splice donor site causing exon 16 skipping. Absence of exon 16 causes a frameshift and, subsequently, the introduction of a premature termination codon into exon 17 creating an altered mRNA transcript with a seriously affected tyrosine kinase domain.

[Vogt Koyanagi Harada syndrome]. / Síndrome de Vogt Koyanagi Harada.

CASE REPORTS: Case 1. A female patient with visual loss and migraine who was found to have an exudative, bilateral retinal detachment. Steroid therapy was commenced initially and then cyclosporin-A added. Nine months later, her vision was 10/10 in the right eye and 9/10 in the left eye. Case 2. A female patient with unclear vision who was found to have an exudative, bilateral retinal detachment. Systemic steroid therapy was given and ultimately her vision was 9/10 in the right eye and 8/10 in the left eye. DISCUSSION: Vogt Koyanagi Harada syndrome is a bilateral granulomatous panuveitis associated with neurologic and dermatologic disorders. When a patient has exudative multifocal and bilateral retinal detachment and systemic symptomatology, the possibility of this disease needs to be suspected. Good visual prognosis is possible if early treatment is given.