Longitudinal study of the newborn small for gestational age. Growth recovery and conditioning factors / Estudio longitudinal del recién nacido pequeño para la edad gestacional. Crecimiento recuperador y factores condicionantes

Background: small-for-gestational-age (SGA) newborns present a higher morbidity and mortality rate when compared to infants born appropriate for gestational age (AGA), as well as insufficient growth, with height far from their target and in some cases a low final height (< -2 SDs). Objective: the aim of this study was to determine when catch-up growth (CUG) in height occurs in these children, and which factors are associated with lack of CUG. Material and methods: this is a retrospective study of SGAs born between 2011 and 2015 in a secondary hospital. Anthropometric measurements were taken consecutively until CUG was reached, and fetal, placental, parental, newborn, and postnatal variables were studied. Results: a total of 358 SGAs were included from a total of 5,585 live newborns. At 6 and 48 months of life, 93.6 % and 96.4 % of SGAs achieved CUG, respectively. By subgroups, symmetric SGAs performed worse than asymmetric SGAs with CUG in 84 % and 92 % at 6 and 48 months of life, respectively. The same occurred in the subgroup of preterm SGAs with respect to term SGAs, with worse CUGs of 88.2 % and 91.2 % at 6 and 48 months of life, respectively. Prematurity, symmetrical SGA, intrauterine growth retardation (IUGR), preeclampsia, previous child SGA, perinatal morbidity, and comorbidity during follow-up were associated with absence of CUG. Conclusions: the majority of SGAs had CUG in the first months of life. The worst outcomes were for preterm and symmetric SGAs (AU)

Antecedentes: el recién nacido pequeño para la edad gestacional (PEG) presenta mayor morbimortalidad que el recién nacido con peso adecuado (PAEG), así como un crecimiento insuficiente con talla alejada de la talla diana y, en algunos casos, talla final baja (< -2 DE). Objetivo: el objetivo de este estudio fue determinar en qué momento se produce el crecimiento compensador (CUG) de la talla en estos niños y conocer qué factores se asocian a la falta de dicho crecimiento compensador. Material y métodos: estudio retrospectivo de los recién nacidos PEG entre los años 2011 y 2015 en un hospital secundario. Se tomaron medidas antropométricas de forma consecutiva hasta alcanzar el CUG y se estudiaron las variables fetales, placentarias, parentales, neonatales y posnatales. Resultados: se incluyeron 358 PEG de un total de 5585 recién nacidos vivos. A los 6 y 48 meses de vida alcanzaron el CUG el 93,6 % y 96,4 % de los PEG, respectivamente. Por subgrupos, los PEG simétricos obtuvieron peores resultados que los PEG asimétricos, con CUG del 84 % y 92 % a los 6 y 48 meses de vida, respectivamente. Lo mismo ocurrió en el subgrupo de PEG prematuros respecto de los PEG a término, con CUG peores del 88,2 % y 91,2 % a los 6 y 48 meses de vida, respectivamente. La prematuridad, el PEG simétrico, la restricción del crecimiento intrauterino, la preeclampsia, tener un hijo previo PEG, la morbilidad perinatal y la comorbilidad durante el seguimiento se asociaron a la ausencia de CUG. Conclusiones: la mayoría de los PEG alcanzaron el CUG en los primeros meses de vida. Los peores resultados fueron para los PEG prematuros y simétricos (AU)

Rotura del tendón distal del bíceps: potencia diagnóstica de la ecografía y la resonancia magnética / Distal biceps tendon rupture: diagnostic strength of ultrasonography and magnetic resonance

OBJETIVO: El objetivo fundamental de este estudio es determinar la concordancia entre dos pruebas radiológicas, la ecografía y la resonancia magnética, para el diagnóstico de rotura del tendón distal del bíceps braquial. MATERIAL Y MÉTODO: Se realizó un estudio retrospectivo de pacientes a lo largo de 3 años a los que se realizó cirugía abierta de reanclaje de tendón distal de bíceps y cuyo diagnóstico preoperatorio se complementó con ecografía, con resonancia magnética o bien con ambas. Se calculó la concordancia mediante el coeficiente kappa de Cohen (k). RESULTADOS: Se analizaron datos de 79 pacientes. La concordancia fue excelente entre resonancia y hallazgos quirúrgicos (k=0,950), y se obtuvo un índice de concordancia bueno tanto entre ecografía y cirugía (k=0,706) como entre ecografía y resonancia magnética (k=0,667). CONCLUSIONES: Tanto resonancia como ecografía se podrían considerar técnicas diagnósticas fiables para la determinación preoperatoria de rotura aguda del tendón distal del bíceps braquial en pacientes con mecanismo y clínica congruentes

OBJECTIVE: The main purpose of this study is to determine the agreement between two radiological tests, ultrasonography and magnetic resonance, in the diagnosis of distal brachial biceps tendon injury. MATERIAL AND METHOD: A retrospective study was made of patients over 3 years who underwent distal brachial biceps tendon reattachment open surgery, and whose preoperative diagnosis was complemented either by ultrasonography, by magnetic resonance or both. The agreement was calculated by Cohen's kappa coefficient (k). RESULTS: Information of 79 patients was analyzed. The concordance was excellent between resonance and surgical findings (k=.950), and a good Cohen's kappa coefficient was also achieved between both ultrasonography and surgery (k=.706) and between information of sonography and magnetic resonance (k=.667). CONCLUSIONS: Resonance and ultrasonography could be considered reliable diagnostic tests to determine the acute rupture of the distal brachial biceps tendon in patients with consistent aetiology and physical examination

Distal biceps tendon rupture: diagnostic strength of ultrasonography and magnetic resonance. / Rotura del tendón distal del bíceps: potencia diagnóstica de la ecografía y la resonancia magnética.

OBJECTIVE: The main purpose of this study is to determine the agreement between two radiological tests, ultrasonography and magnetic resonance, in the diagnosis of distal brachial biceps tendon injury. MATERIAL AND METHOD: A retrospective study was made of patients over 3 years who underwent distal brachial biceps tendon reattachment open surgery, and whose preoperative diagnosis was complemented either by ultrasonography, by magnetic resonance or both. The agreement was calculated by Cohen's kappa coefficient (k). RESULTS: Information of 79 patients was analyzed. The concordance was excellent between resonance and surgical findings (k=.950), and a good Cohen's kappa coefficient was also achieved between both ultrasonography and surgery (k=.706) and between information of sonography and magnetic resonance (k=.667). CONCLUSIONS: Resonance and ultrasonography could be considered reliable diagnostic tests to determine the acute rupture of the distal brachial biceps tendon in patients with consistent aetiology and physical examination.

The Calcium-Sensing Receptor in Health and Disease.

The extracellular calcium-sensing receptor (CaSR) is a unique G protein-coupled receptor (GPCR) activated by extracellular Ca2+ and by other physiological cations including Mg2+, amino acids, and polyamines. CaSR is the most important master controller of the extracellular Ca2+ homeostatic system being expressed at high levels in the parathyroid gland, kidney, gut and bone, where it regulates parathyroid hormone (PTH) secretion, vitamin D synthesis, and Ca2+ absorption and resorption, respectively. Gain and loss of function mutations in the CaSR are responsible for severe disturbances in extracellular Ca2+ metabolism. CaSR agonists (calcimimetics) and antagonists (calcilytics) are in use or under intense research for treatment of hyperparathyroidism secondary to kidney failure and hypocalcemia with hypercalciuria, respectively. Expression of the CaSR extends to other tissues and systems beyond the extracellular Ca2+ homeostatic system including the cardiovascular system, the airways, and the nervous system where it may play physiological functions yet to be fully understood. As a consequence, CaSR has been recently involved in different pathologies including uncontrolled blood pressure, vascular calcification, asthma, and Alzheimer's disease. Finally, the CaSR has been shown to play a critical role in cancer either contributing to bone metastasis and/or acting as a tumor suppressor in some forms of cancer (parathyroid cancer, colon cancer, and neuroblastoma) and as oncogene in others (breast and prostate cancers). Here we review the role of CaSR in health and disease in calciotropic tissues and others beyond the extracellular calcium homeostatic system.

Síndrome de Kounis, urgencia diagnóstica / Kounis syndrome: a diagnostic urgency

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Seasonal Local Allergic Rhinitis in Areas With High Concentrations of Grass Pollen.

BACKGROUND: Local allergic rhinitis (LAR) is a phenotype of allergic rhinitis characterized by the presence of a localized immune response in the nasal mucosa of patients with negative skin prick test (SPT) results and undetectable serum specific IgE (sIgE). It unknown whether LAR is limited to areas with low or moderate aeroallergen exposure. OBJECTIVE: To explore the presence of LAR and the clinical and immunological characteristics of this entity in geographic areas with high grass pollen loads. METHODS: A cross-sectional observational study was carried out in 2 hospitals in central Spain (Madrid and Ciudad Real). Sixty-one patients with seasonal rhinitis and negative SPT results and undetectable serum sIgE were evaluated using a clinical questionnaire, determination of serum total IgE, and a nasal allergen provocation test (NAPT) with Phleum species. The response to NAPT was monitored using assessment of nasal symptoms, acoustic rhinometry, and determination of sIgE, tryptase, and eosinophil cationic protein in the nasal cavity. RESULTS: Seasonal LAR was detected in 37 patients (61%) using the techniques described above. Eleven percent of patients with LAR were adolescents or children, and 14% reported onset of rhinitis in childhood. Most patients reported persistent-moderate seasonal nasal symptoms, and 41% reported worsening of the disease during the last 2 years. Conjunctivitis was the most common comorbidity, affecting 95% of cases. CONCLUSIONS: LAR to grass pollen is relevant in patients with seasonal symptoms indicative of allergic rhinitis but with a negative skin test result who live in areas with high allergenic pollen loads. This entity should be included the differential diagnosis of rhinitis.

Exudative erythema multiforme due to cyclobenzaprine

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Seasonal local allergic rhinitis in areas with high concentrations of grass pollen

Background: Local allergic rhinitis (LAR) is a phenotype of allergic rhinitis characterized by the presence of a localized immune response in the nasal mucosa of patients with negative skin prick test (SPT) results and undetectable serum specific IgE (sIgE). It unknown whether LAR is limited to areas with low or moderate aeroallergen exposure. Objective: To explore the presence of LAR and the clinical and immunological characteristics of this entity in geographic areas with high grass pollen loads. Methods: A cross-sectional observational study was carried out in 2 hospitals in central Spain (Madrid and Ciudad Real). Sixty-one patients with seasonal rhinitis and negative SPT results and undetectable serum sIgE were evaluated using a clinical questionnaire, determination of serum total IgE, and a nasal allergen provocation test (NAPT) with Phleum species. The response to NAPT was monitored using assessment of nasal symptoms, acoustic rhinometry, and determination of sIgE, tryptase, and eosinophil cationic protein in the nasal cavity. Results: Seasonal LAR was detected in 37 patients (61%) using the techniques described above. Eleven percent of patients with LAR were adolescents or children, and 14% reported onset of rhinitis in childhood. Most patients reported persistent-moderate seasonal nasal symptoms, and 41% reported worsening of the disease during the last 2 years. Conjunctivitis was the most common comorbidity, affecting 95% of cases. Conclusions: LAR to grass pollen is relevant in patients with seasonal symptoms indicative of allergic rhinitis but with a negative skin test result who live in areas with high allergenic pollen loads. This entity should be included the differential diagnosis of rhinitis (AU)

Introducción: La rinitis alérgica local (RAL) es un fenotipo de rinitis alérgica (RA) caracterizado por la presencia de una respuesta inmunológica localizada en la mucosa nasal de pacientes con pruebas cutáneas (PC) negativas e IgE específica (sIgE) sérica no detectable. Se desconoce si la RAL es una entidad limitada a áreas con baja o moderada exposición a aeroalérgenos. Objetivos: Explorar la presencia y características clínico-inmunológicas de la RAL en áreas geográficas con alta concentración atmosférica de polen de gramíneas. Métodos: Estudio observacional-transversal realizado en dos hospitales de la zona centro de España (Madrid y Ciudad Real). Sesenta y un pacientes con rinitis estacional, PC negativas y sIgE sérica no detectable fueron evaluados mediante cuestionario clínico, IgE total sérica, y test de provocación nasal con Phleum (TPN-Phleum). La respuesta al TPN se monitorizó mediante síntomas, rinometría acústica, y determinación de sIgE, triptasa y proteína catiónica de eosinófilos en secreciones nasales. Resultados: Se detectó RAL estacional en 37 pacientes (61%) mediante TPN-Phleum. El 11% de los pacientes eran adolescentes o niños, y el 14% habían comenzado con los síntomas en la infancia. La mayoría presentaban rinitis estacional persistente-moderada, y el 41% refirió empeoramiento en los 2 últimos años. La conjuntivitis fue la enfermedad asociada más frecuente, afectando al 95% de los sujetos con RAL. Conclusiones: La RAL por polen de gramíneas es una enfermedad frecuente en pacientes con síntomas indicativos de RA estacional y PC negativas que viven en áreas con alta concentración atmosférica de pólenes, y debe ser incluida en el diagnostico diferencial de la rinitis (AU)

Component-resolved diagnosis in vespid venom-allergic individuals

BACKGROUND: Hymenoptera venom-allergic patients frequently present multiple sensitisations. OBJECTIVES: To define the allergic profile by components in wasp allergic patients. To study the usefulness of specific IgE to components in cases of double sensitisation. MATERIALS AND METHODS: Wasp allergic patients who needed Polistes and/or Vespula venom immunotherapy were included. Before immunotherapy and after two years of treatment the following specific IgE (sIgE) levels were measured:Apis mellifera, Vespula spp. Polistes spp., rVes V 5, rPol d 5, nVes V 5, nPol d 5, nVes V 1, nPol d 1, nApi m 1, nApi m 2 and peroxidase. Skin tests with venoms were performed. Based on the sIgE and the skin test results, Polistes and/or Vespula immunotherapy was administered. RESULTS: Thirteen patients were included. Double sensitisation to Polistes/Vespula was detected in eight patients. Sensitisation to rVes V 5 and rPol d 5 was found in two of eight cases, to nVes V 1 and nPol d 1 in eight of 13 cases, and to nVes V 5 and nPol d 5 in 2 of 13 cases. Three patients received double immunotherapy with both wasps. One patient was treated with Vespula and nine with Polistes. sIgE levels decreased after two years of treatment. In patients who showed double sensitisation but were treated with only one venom, sIgE to both venoms decreased. CONCLUSIONS: Components analysis can be useful to study double positivity. In case of doubt, double immunotherapy should be administered. Phospholipase was found to be a major allergen in our population

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Thermomechanical transitions of egg-ceramide monolayers.

Ceramides have unique biophysical properties. Their high melting temperature and their ability to form lateral domains have converted ceramides into the paradigm of rigid lipids. Here, using shear surface rheology of egg-ceramide Langmuir monolayers, a solid to fluid transition was evidenced as a vanishing shear rigidity at lower temperatures than the lipid melting temperature. Such a mechanical transition, which depends on the lipid lateral pressure, was found in a broad range temperature (40-50 °C). The solid to fluid transition was correlated to a LC to LC+LE phase transition, as confirmed by BAM experiments. Interestingly, together with the softening transition, a supercooling process compatible with a glassy behavior was found upon freezing. A new phase scenario is then depicted that broadens the mechanical behavior of natural ceramides. The phase diversity of ceramides might have important implications in their physiological roles.

Component-resolved diagnosis in vespid venom-allergic individuals.

BACKGROUND: Hymenoptera venom-allergic patients frequently present multiple sensitisations. OBJECTIVES: To define the allergic profile by components in wasp allergic patients. To study the usefulness of specific IgE to components in cases of double sensitisation. MATERIALS AND METHODS: Wasp allergic patients who needed Polistes and/or Vespula venom immunotherapy were included. Before immunotherapy and after two years of treatment the following specific IgE (sIgE) levels were measured: Apis mellifera, Vespula spp. Polistes spp., rVes v 5, rPol d 5, nVes v 5, nPol d 5, nVes v 1, nPol d 1, nApi m 1, nApi m 2 and peroxidase. Skin tests with venoms were performed. Based on the sIgE and the skin test results, Polistes and/or Vespula immunotherapy was administered. RESULTS: Thirteen patients were included. Double sensitisation to Polistes/Vespula was detected in eight patients. Sensitisation to rVes v 5 and rPol d 5 was found in two of eight cases, to nVes v 1 and nPol d 1 in eight of 13 cases, and to nVes v 5 and nPol d 5 in 2 of 13 cases. Three patients received double immunotherapy with both wasps. One patient was treated with Vespula and nine with Polistes. sIgE levels decreased after two years of treatment. In patients who showed double sensitisation but were treated with only one venom, sIgE to both venoms decreased. CONCLUSIONS: Components analysis can be useful to study double positivity. In case of doubt, double immunotherapy should be administered. Phospholipase was found to be a major allergen in our population.

First case report of acute generalized exanthematous pustulosis due to labetalol

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Occupational asthma and eosinophilic esophagitis in a patient with egg-bird syndrome

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