Standard headache and neuralgia treatments and SARS-CoV-2: opinion of the Spanish Society of Neurology's Headache Study Group. / Tratamientos habituales utilizados en cefaleas, neuralgias y SARS-CoV-2. Posicionamiento del grupo de estudio de cefaleas de la Sociedad Española de Neurología.

INTRODUCTION: In recent months, doubts have arisen among patients, general practitioners, and neurologists as to whether some drugs commonly used in patients with headaches and neuralgia may favour or complicate the disease caused by SARS-CoV-2. MATERIAL AND METHODS: We collected information on the opinions of scientific societies and medicines agencies (American, European, and Spanish) to clarify doubts regarding the use of drugs such as lisinopril, candesartan, ibuprofen, corticosteroids, carbamazepine, and monoclonal antibodies targeting the calcitonin gene-related peptide in the context of the COVID-19 pandemic. RESULTS: We make recommendations about the use of standard headache treatments in the context of the COVID-19 pandemic, based on the current scientific evidence. CONCLUSIONS: At present, there is no robust scientific argument to formally contraindicate any of the standard treatments employed for headaches and neuralgias.

[Standard headache and neuralgia treatments and SARS-CoV-2: opinion of the Spanish Society of Neurology's Headache Study Group]. / Tratamientos habituales utilizados en cefaleas, neuralgias y SARS-CoV-2. Posicionamiento del grupo de estudio de cefaleas de la Sociedad Española de Neurología.

Introduction: In recent months, doubts have arisen among patients, general practitioners, and neurologists as to whether some drugs commonly used in patients with headaches and neuralgia may favour or complicate the disease caused by SARS-CoV-2. Material and methods: We collected information on the opinions of scientific societies and medicines agencies (American, European, and Spanish) to clarify doubts regarding the use of drugs such as lisinopril, candesartan, ibuprofen, corticosteroids, carbamazepine, and monoclonal antibodies targeting the calcitonin gene-related peptide in the context of the COVID-19 pandemic. Results: We make recommendations about the use of standard headache treatments in the context of the COVID-19 pandemic, based on the current scientific evidence. Conclusions: At present, there is no robust scientific argument to formally contraindicate any of the standard treatments employed for headaches and neuralgias.

Association of the tumor necrosis factor-alpha -308G>A polymorphism with breast cancer in Mexican women.

The tumor necrosis factor-alpha (TNF-α) gene plays an important role in cell proliferation, differentiation, apoptosis, lipid metabolism, coagulation, insulin resistance, and endothelial function. Polymorphisms of TNF-α have been associated with cancer. We examined the role of the -308G>A polymorphism in this gene by comparing the genotypes of 294 healthy Mexican women with those of 465 Mexican women with breast cancer. The observed genotype frequencies for controls and breast cancer patients were 1 and 14% for AA, 13 and 21% for GA, and 86 and 65% for GG, respectively. We found that the odds ratio (OR) for AA genotype was 2.4, with a 95% confidence interval (95%CI) of 5.9-101.1 (P = 0.0001). The association was also evident when comparing the distribution of the AA-GA genotype in patients in the following categories: 1) premenopause and obesity I (OR = 3.5, 95%CI = 1.3-9.3, P = 0.008), 2) Her-2 neu and tumor stage I-II (OR = 2.5, 95%CI = 1.31-4.8, P = 0.004), 3) premenopause and tumor stage III-IV (OR = 1.7, 95%CI = 1.0-2.9, P = 0.034), 4) chemotherapy non-response and abnormal hematocrit (OR = 2.4, 95%CI = 1.2-4.8, P = 0.015), 5) body mass index and Her-2 neu and III-IV tumor stage (OR = 2.8, 95%CI = 1.2- 6.6, P = 0.016), and 6) nodule metastasis and K-I67 (OR = 4.0, 95%CI = 1.01-15.7, P = 0.038). We concluded that the genotypes AA-GA of the -308G>A polymorphism in TNF-α significantly contribute to breast cancer susceptibility in the analyzed sample from the Mexican population.

[An analysis of the causes, characteristics, and consequences of reexposure to a drug or compound responsible for a hepatotoxicity event]. / Análisis de las causas, características y consecuencias de la reexposición al fármaco o compuesto responsable de un episodio de hepatotoxidad.

INTRODUCTION: reexposure to a causal agent represents a potentially serious event in hepatotoxicity. OBJECTIVES: to assess the characteristics and outcome of cases with positive reexposure. MATERIAL AND METHODS: a retrospective study of cases with evidence of positive reexposure included in Registro Español de Hepatopatías Asociadas a Medicamentos, and an analysis of their relation to demographic and clinical variables, causality, course, and consequences. RESULTS: of a total of 520 cases 31 (6%) met reexposure criteria. Fatal outcomes, needs for admission, and mean recovery time were all higher for hepatocellular-type toxic injury. The most commonly identified drug class was antibiotics. On most occasions (73%) reexposure to the causal compound escaped notice because of: absence of index case diagnosis, lack of information to patients and their physicians, and (12%) development of cross reactions between structurally similar drugs. CONCLUSIONS: accidental reexposure to a drug or a structurally-related compound after an initial hepatotoxicity event is common and may have serious consequences, particularly in hepatocellular-type toxicity. Careful history taking and reflecting diagnostic suspicion in the initial episode s record may reduce the incidence of this iatrogenic event.

Análisis de las causas, características y consecuencias de la reexposición al fármaco o compuesto responsable de un episodio de hepatotoxicidad / No disponible

Introducción: la reexposición al agente causal constituye unincidente potencialmente grave en hepatotoxicidad.Objetivos: evaluar las características y la evolución de los casoscon reexposición positiva.Material y métodos: estudio retrospectivo de una serie decasos con evidencia de reexposición positiva incluidos en el RegistroEspañol de Hepatopatías Asociadas a Medicamentos, analizandosu relación con variables demográficas y clínicas, causalidad,evolución y consecuencias.Resultados: de un total de 520 casos, 31 (6%) cumplían loscriterios de reexposición. La evolución fatal, la necesidad de hospitalizacióny el tiempo medio de recuperación fueron mayores enla lesión tóxica de tipo hepatocelular. El grupo farmacológicoidentificado con mayor frecuencia fue el de los antibióticos. En lamayoría de los casos la reexposición con el compuesto responsablefue inadvertida (73%) debido a: la ausencia de diagnóstico delcaso índice, la carencia de información al paciente o a su médicoy también (12%) por el desarrollo de una reacción cruzada entrefármacos estructuralmente similares.Conclusiones: la reexposición accidental a un mismo fármacoo a otro estructuralmente relacionado tras un primer episodiode hepatotoxicidad no es infrecuente y sus consecuencias puedenser graves, especialmente en el tipo de lesión hepatocelular. Unaminuciosa historia clínica y la sospecha diagnóstica reflejada en elinforme del primer episodio podrían disminuir la incidencia deeste evento iatrogénico

Introduction: reexposure to a causal agent represents a potentiallyserious event in hepatotoxicity.Objectives: to assess the characteristics and outcome of caseswith positive reexposure.Material and methods: a retrospective study of cases withevidence of positive reexposure included in Registro Español deHepatopatías Asociadas a Medicamentos, and an analysis of theirrelation to demographic and clinical variables, causality, course,and consequences.Results: of a total of 520 cases 31 (6%) met reexposure criteria.Fatal outcomes, needs for admission, and mean recovery timewere all higher for hepatocellular-type toxic injury. The most commonlyidentified drug class was antibiotics. On most occasions(73%) reexposure to the causal compound escaped notice becauseof: absence of index case diagnosis, lack of information topatients and their physicians, and (12%) development of cross reactionsbetween structurally similar drugs.Conclusions: accidental reexposure to a drug or a structurally-related compound after an initial hepatotoxicity event is commonand may have serious consequences, particularly in hepatocellular-type toxicity. Careful history taking and reflectingdiagnostic suspicion in the initial episode’s record may reduce the incidence of this iatrogenic event (AU)

[Informed consent at a primary care area]. / Consentimiento informado en un área de atención primaria.

OBJECTIVE: Assessment of the understanding and performance of informed consent by primary care doctors and people attending clinics (PAC) in Madrid Area 3. DESIGN: Descriptive cross-sectional study. SETTING: The 20 health centres in Madrid Area 3. PARTICIPANTS: Doctors and PAC in Area 3. MEASUREMENTS AND MAIN RESULTS: It was a structured survey, validated by a pilot study. 98.7% of doctors stated that they informed their patients about illnesses; 91.8% on the risks and benefits. 90.6% and 78.6%, respectively, of the PAC said they were informed. Although 86.8% (CI 83.7-89.9) of the PAC thought they understood the information transmitted well, only 61% (CI 53.4-68.6) of the doctors thought so. 60.4% of the doctors and 54.6% of the PAC thought that the doctors' decisions took into account the patient's view. This was also the preferred option of both groups (46.5% and 59.3%). 29% of the doctors preferred greater power of decision for the patients, and only 16.06% of the PAC. 91.6% (CI 89.1-94.1) of the PAC were satisfied with the information received. CONCLUSIONS: Doctors think they give information better than PAC think. Patients' understanding of the information is given a higher rating by the PAC than by the doctors. Decisions are habitually taken by the doctor, with the patient's views borne in mind. However, doctors would prefer patients to have greater decision-making power.

Consentimiento informado en un área de atención primaria / Informed consent in a primary care area

Objetivo. Valoración del conocimiento y realización del consentimiento informado (CI) por los médicos de atención primaria y las personas que acuden a consultas (PAC) del Área 3 de Madrid. Diseño. Estudio transversal descriptivo. Emplazamiento. Los 20 centros de salud del Área 3 de Madrid. Participantes. Médicos y PAC del Área 3. Mediciones y resultados principales. Encuesta estructurada y validada mediante un estudio piloto. Resultados: un 98,7 por ciento de los médicos afirma informar a sus pacientes sobre las enfermedades, el 91,8 por ciento sobre los riesgos y beneficios. Sólo refieren ser informados en esos aspectos un 90,6 y 78,6 por ciento de las PAC, respectivamente. A pesar de que el 86,8 por ciento (IC, 83,7-89,9) de las PAC considera que comprende bien la información transmitida, únicamente un 61 por ciento (IC, 53,4-68,6) de los médicos lo perciben así. Respecto a la toma de decisiones, el 60,4 por ciento de los médicos y el 54,6 por ciento de las PAC consideran que la realiza el médico contando con la opinión del paciente. También es la opción preferida por ambos grupos (46,5 y 59,3 por ciento). Un 29 por ciento de los médicos prefiere mayor poder de decisión de los pacientes y sólo el 16,06 por ciento de las PAC. El 91,6 por ciento (IC, 89,1-94,1) de las PAC se encuentran satisfechas con la información recibida. Conclusiones. Los médicos consideran que informan mejor de lo que las PAC perciben. La comprensión de la información es mejor valorada por las PAC que por los médicos. La toma de decisiones habitualmente la realiza el médico considerando la opinión del paciente, aunque los médicos prefieren mayor poder del paciente (AU)

Decreased health care quality associated with emergency department overcrowding.

The objective of this study was to assess the influence of overcrowding on health care quality provided by emergency departments (ED). The study was carried out in an urban, university tertiary care hospital. All patients seen at the internal medicine unit (IMU) of the ED who returned during the following 72 hours, and those who died in the ED rooms were included in the study. During a consecutive period of 2 years (104 weeks), we prospectively quantified the number of weekly visits, revisits and deaths. We calculated revisit and mortality rates (in respect of percentage of all visited patients) for each week. Correlation between the number of weekly visits, and revisit and mortality rates was assessed using a simple linear regression model. We consigned 81,301 visits, 1137 revisits and 648 deaths; mean (+/- SD) number of weekly visits, revisits and deaths were 782 (68), 10.93 (3.97) and 6.23 (3.04) respectively; weekly revisit rate was 1.40% (0.48%) and weekly mortality rate was 0.79% (0.36%). We observed a significant, positive correlation between mortality rates and weekly number of visits (p = 0.01). Although a similar trend was also found for revisit rates, such an increase did not reach statistical significance (p = 0.06). It is concluded that since revisit and mortality rates constitute good health care quality markers, present data demonstrate that ED overcrowding implies a decrease in the health care quality provided by it.

[Study of mortality in a medical unit of emergency department: incidence, causes and consequences]. / Estudio de la mortalidad en un servicio de urgencias de medicina hospitalario: incidencia, causas y consecuencias.

OBJECTIVES: To define the mortality pattern in a medical unit of emergency department (ED) and to know the satisfaction of relatives with ED provided care. PATIENTS AND METHODS: We computed the number of patients visited and dead from 1989 to 1996. From all patients dying during 1996, we recorded clinical and epidemiological data and we interviewed the patients' family to know their satisfaction with ED provided care. RESULTS: Whole mortality rate was 0.71 (0.15)% X (SD) with an annual increase of 10.4% (r = 0.78, p < 0.05). The clinical profile of patient dying at ED is an individual of advanced age, with a poor quality of life, and in whom the death was expected when arrived to ED. From the family interview, 61% of cases preferred that their relative was dying in the hospital, and 88% were satisfied with ED provided care. CONCLUSIONS: Although the annual mortality rate has progressively increased in ED, family satisfaction with the received care is good.

Preoperative management of congestive heart failure in neonates: the closed hood.

In this study we report the results of the use of a closed hood with no external administration of CO2 to increase pulmonary vascular resistance by lowering the inspired fraction of oxygen (FiO2) and raising the inspired fraction of carbon dioxide (FiCO2) in patients with congenital heart disease and increased pulmonary blood flow. Between December 1995 and May 1996, 9 neonates (F:5, M:4) were admitted. Each study patient was assigned to clinical classes using a 1 to 4 classification. Ages ranged between 2 and 30 days (mean 18), weight between 2.25 and 3.65 kg (mean 2.89). A plastic hood, closed on the top with a plastic membrane and with the gas entrance open to room air was placed over the head of the patients. Patients increase pCO2 by rebreathing their own expired CO2. After 24 h of the onset of the treatment the media of points of congestive heart failure 1 to 4 classification decrease from a mean of 4 to a mean of 2.28+/-0.44 (p=0.001). A statistically significant improvement in symptoms and lowering of PO2 and pH while raising pCO2 has been demonstrated in this study.

[Sexual dysfunction secondary to SSRIs. A comparative analysis in 308 patients]. / Disfunción sexual secundaria a ISRS. Análisis comparativo en 308 pacientes.

UNLABELLED: The authors analyze the incidence of sexual dysfunction (SD) with different SSRIs (Fluoxetine, Fluvoxamine, Paroxetine and Sertraline) and hence the qualitative and quantitative changes in SD throughout time 308 outpatients (169 women, 139 men; mean +/- SD age = 41 +/- 7) under treatment with SSRIs were interviewed with an SD questionnaire designed for this purpose by the authors including questions about the following items decreased libido, delayed orgasm or anorgasmia, delayed ejaculation inability to ejaculation, impotence and general sexual satisfaction. Patients with the following criteria were included: normal sexual function before SSRIs intake, exclusive treatment with SSRIs or associated with benzodiazepines, previous heterosexual or self-orone current sexual practices. We excluded patients with previous sexual dysfunction, association of SSRIs with neuroleptics, recently hormone intake and significant medical illnesses. RESULTS: There is a significant increase in the incidence of SD when the physicians ask the patients direct questions (55.29%) versus spontaneous SD reported (14.2%). There are some significant differences among different SSRIs paroxetine provoked more delay of orgasm/ejaculation and more impotence than fluvoxamine, fluoxetine and sertraline (Chi square p < 0.05). Only 22.6% of the patients had a good tolerance about their sexual dysfunction. SD has positive correlation with the dose. The patients experienced substantial improvement in sexual function when the dose was diminished or the drug was withdrawn. Men showed more incidence of sexual dysfunction than women but women's sexual dysfunction was more intense than men. Seven of nine patients (77.7%) experienced total improvement when the treatment was changed to Moclobemide (450 mg/day) and two of four patients (50%) improved when treatment was changed to Amineptine.

Recent progress in understanding chemical shifts.

In the past three or four years computer hardware and software developments have reached the stage where the nuclear magnetic resonance (NMR) spectra of many molecular systems can now be accurately evaluated. Detailed analysis of chemical shifts may soon become a routine part of solid (and liquid) state NMR structure prediction in chemistry and biology, and this Article covers the development of the topic from its earliest beginnings.

129Xe magic-angle spinning spectra of xenon in zeolite NaA. Direct observation of mixed clusters of co-adsorbed species.

We present the first demonstration that the individual 129Xe resonances corresponding to Xen (n = 1-8) clusters inside the alpha-cages of zeolite NaA can be narrowed under magic-angle spinning (MAS). Under these high-resolution conditions we also observe upon addition of Kr the individual peaks corresponding to mixed clusters, XenKrm, inside the alpha-cages, which will allow the first direct determination of the distribution of co-adsorbates in a microporous solid. Under MAS the chemical shifts of the Xen clusters are shown to be highly sensitive to "disorder" in the zeolite and provides new, quantitative information about the presence of alpha-cages of several types.

[The index of left and right diastolic ventricular filling with 2D Doppler echocardiography in normal children]. / Indice de llenado diastólico ventricular izquierdo y derecho con ecocardiografía 2-D Doppler en niños normales.

Cross-sectional echocardiographic and Doppler studies were performed to study early and late diastolic inflow velocities transmitral and transtricuspid. The study group consisted of 50 normal subjects. Age varied from 5 hours to 17 years (x: 22 m). The measurements made were E/A ratio, isovolumetric relaxation time of the left ventricle, acceleration and deceleration time. Transmitral E/A ratio is higher than 1 since newborn period, increasing with age (newborn: 1.25 +/- 0.27 over 2 years of age: 1.79 +/- 0.35), and related to increase of "E" wave velocity (newborn: 0.67 +/- 0.09.m/s and over 2 years of age: 0.98 +/- 0.21 m/s). There is also a higher acceleration time (newborn: 50 +/- 10 m/s) and over 6 years of age 130 +/- 30 m/sec; isovolumetric relaxation time of the left ventricle (newborn: 60 +/- 10 msec vs. over 6 years of age: 80 +/- 20 msec). The E/A transtricuspid ratio is lower than 1 in the newborn (0.71 +/- 0.08) and (0.97 +/- 0.32) in infants less than 6 months of age; it is higher than 1 between 6 months and 2 years (1.17 +/- 0.33) and increasing in the group of six years of age and older (1.5 +/- 0.28), due to the higher velocity of "E" (newborn 0.47 +/- 0.07 m/s in relation to 6 years and older group (0.77 +/- 0.08 m/s). There is also an increase of acceleration time with aging (newborn: 50 +/- 10 msec and over six: 70 +/- 10 msec) and deceleration time (newborn: 60 +/- 10 msec and over six: 120 +/- 40 msec). The "A" wave velocities have been similar in the tricuspid and transmitral inflow, with progressive increasing since newborn period up to 2 years of age and decreasing over 6 years of age.

NMR chemical shifts and structure refinement in proteins.

Computation of the 13C alpha chemical shifts (or shieldings) of glycine, alanine and valine residues in bovine and Drosophila calmodulins and Staphylococcal nuclease, and comparison with experimental values, is reported using a gauge-including atomic orbital quantum-chemical approach. The full approximately 24 ppm shielding range is reproduced (overall r.m.s.d. = 1.4 ppm) using 'optimized' protein structures, corrected for bond-length/bond-angle errors, and rovibrational effects.

Secondary and tertiary structural effects on protein NMR chemical shifts: an ab initio approach.

Recent theoretical developments permit the prediction of 1H, 13C, 15N, and 19F nuclear magnetic resonance chemical shifts in proteins and offer new ways of analyzing secondary and tertiary structure as well as for probing protein electrostatics. For 13C, phi, psi torsion angles dominate shielding for C alpha and C beta, but the addition of hydrogen bonding and electrostatics gives even better accord with experiment. For 15NH, side chain (chi 1) torsion angles are also important, as are nearest neighbor sequence effects, whereas for 1HN, hydrogen bonding is particularly significant. For 19F, weak or long-range electrostatic fields dominate 19F shielding nonequivalencies. The ability to predict chemical shifts in proteins from known or test structures opens new avenues to structure refinement or determination, especially for condensed systems.