Neurological toxicity after phenytoin infusion in a pediatric patient with epilepsy: influence of CYP2C9, CYP2C19 and ABCB1 genetic polymorphisms.

Pharmacogenetic studies have shown that genetic defects in drug-metabolizing enzymes encoded by CYP2C9, CYP2C19 genes and by the transporter ABCB1 gene can influence phenytoin (PTH) plasma levels and toxicity. The patient reported here is a 2-year-old girl with a medical history of cryptogenic (probably symptomatic) epilepsy, who had her first focal seizure with secondary generalization at 13 months of age. She initially received oral valproate treatment and three months later, she was prescribed an oral oxcarbazepine treatment. At 20 months of age, she was admitted to the Emergency Department because of generalized convulsive Status Epilepticus needing to be immediately treated with rectal diazepam (0.5 mg kg(-1)), intravenous diazepam (0.3 mg kg(-1)), and intravenous phenytoin with an initial-loading dose of 15 mg kg(-1). However, two hours after the initial-loading dose of PTH, the patient developed dizziness, nystagmus, ataxia and excessive sedation. Other potential causes of PTH toxicity were excluded such as drug interactions, decreased albumin or lab error. Therefore, to explain the neurological toxicity, PTH plasma levels and CYP2C9, CYP2C19 and ABCB1 genetic polymorphisms were analyzed. Initial plasma PTH levels were higher than expected (69 mg l(-1); normal range: 10-20 mg l(-1)), and the patient was homozygous for the CYP2C9*2 allele, heterozygous for the CYP2C19*4 allele and homozygous for the 3435C and 1236C ABCB1 alleles. Present findings support the previously established relationship between CYP2C9 and CYP2C19 genetic polymorphisms and the increased risk to develop PTH toxicity owing to high plasma concentrations. Nevertheless, although the association of these genes with PTH-induced adverse effects has been well-documented in adult populations, this is the first report examining the influence of these genetic polymorphisms on PTH plasma levels and toxicity in a pediatric patient.

MAGIC-5: an Italian mammographic database of digitised images for research.

The implementation of a database of digitised mammograms is discussed. The digitised images were collected beginning in 1999 by a community of physicists in collaboration with radiologists in several Italian hospitals as a first step in developing and implementing a computer-aided detection (CAD) system. All 3,369 mammograms were collected from 967 patients and classified according to lesion type and morphology, breast tissue and pathology type. A dedicated graphical user interface was developed to visualise and process mammograms to support the medical diagnosis directly on a high-resolution screen. The database has been the starting point for developing other medical imaging applications, such as a breast CAD, currently being upgraded and optimised for use in a distributed environment with grid services, in the framework of the Instituto Nazionale di Fisicia Nucleare (INFN)-funded Medical Applications on a Grid Infrastructure Connection (MAGIC)-5 project.

Neumonía adquirida en la comunidad durante el embarazo. Evaluación clínica del tratamiento y la profilaxis / Community-acquired pneumonia in pregnancy. Clinical evaluation of treatment and prophylaxis

Objetivo: La neumonía durante el embarazo se ha asociado con un incremento de la mortalidad y morbilidad maternas en relación con las mujeres no embarazadas. El propósito de este artículo es realizar una revisión bibliográfica sobre la neumonía adquirida en la comunidad (NAC) de la embarazada. Resultados: La enfermedad de base materna, como la anemia o el asma bronquial, incrementa el riesgo de NAC en la gestación. Los efectos adversos neonatales de la NAC incluyen bajo peso al nacer y riesgo aumentado de partos pretérminos. En el tratamiento de la NAC los betalactámicos y macrólidos son seguros y efectivos. La vacunación antigripal puede reducir la prevalencia de ingresos hospitalarios por enfermedad respiratoria en mujeres embarazadas durante la temporada de gripe. Conclusiones: Un diagnóstico precoz y un tratamiento antibiótico empírico apropiado reducen la morbimortalidad materna por NAC. La profilaxis mediante vacunación en gestantes de riesgo puede reducir la prevalencia y severidad de la NAC (AU)

Objective: Pneumonia during pregnancy has been associated with increased morbidity and mortality compared with that occurring in nonpregnant women. The present article reviews the current literature describing community-acquired pneumonia in pregnancy. Results: Coexisting maternal disease, including asthma and anemia, increase the risk of contracting community-acquired pneumonia in pregnancy. The neonatal effects of pneumonia in pregnancy include low birth weight and an increased risk of preterm birth. Beta-lactam and macrolide antibiotics are considered safe and effective in pregnancy. Influenza vaccination can reduce the prevalence of hospitalizations for respiratory illness among pregnant women during the influenza season. Conclusions: Prompt diagnosis and appropriate empirical antimicrobial therapy reduces maternal morbidity and mortality due to community-acquired pneumonia in pregnancy. Prevention with vaccination in at-risk populations may reduce the prevalence and severity of pneumonia in pregnant women (AU)

Evaluación clínica de los ácidos grasos omega-3 en la gestación, la lactancia y el desarrollo infantil / Clinical evaluation of omega-3 fatty acids on pregnancy, breast feeding and infant development

El propósito del estudio fue la revisión sistemática de la literatura médica con el fin de evaluar e identificar la influencia que los ácidos grasos (AG) omega-3 (o-3) ejercen sobre la salud infantil y materna. Se planteó como objetivo dar respuesta a una serie de preguntas acerca de la relevancia de la ingesta de AG o-3 en la duración de la gestación, incidencia de preeclampsia, eclampsia o hipertensión gestacional e incidencia de recién nacidos con bajo peso para su edad gestacional. También se revisó la influencia de los AG o-3 (suplementos o leche materna) en el crecimiento de los recién nacidos pretérmino y a término así como en el desarrollo neurocognitivo y visual. Como conclusiones señalar que los suplementos de AG o-3 podrían disminuir el riesgo de partos pretérmino e incrementar la duración del embarazo y el peso al nacer justificado por una alteración en la regulación de los eicosanoides, que se encuentran involucrados en la fisiología del trabajo de parto y en el crecimiento fetal, y que actúan favoreciendo el flujo sanguíneo placentario. La ingesta de AG o-3 durante el embarazo y la lactancia favorece el desarrollo cerebral en la infancia. También hay evidencia que podría justificar la prevención de la preeclampsia tras la administración de AG o-3 (AU)

The aim of this study was to conduct a systematic review of the scientific-medical literature to identify and appraise the evidence on the influence of omega-3 fatty acids on maternal and infant health. Evidence was sought to answer a series of questions about the effect of omega-3 fatty acid intake (supplemented during pregnancy) on pregnancy duration and the incidence of preeclampsia, eclampsia, gestational hypertension, and small for gestational age infants. The influence of omega-3 fatty acid intake (supplements or breast milk) on developmental outcomes in preterm and term infants, such as growth, neurocognitive development and visual function, were also investigated. Conclusions: Supplementation with omega-3 fatty acids during pregnancy lowers the risk of premature birth and can increase pregnancy duration and birth weight by altering the balance of eicosanoids. These molecules are involved in labor and also promote fetal growth by improving placental blood flow. Intake of omega-3 fatty acids during pregnancy and breast feed-ing may facilitate the infant's brain development. There is also some evidence that supplementation with omega-3 fatty acids may help to prevent preeclampsia (AU)

Poliomielitis en una gestante / Poliomyelitis during pregnancy

Actualmente, la poliomielitis está erradicada en países desarrollados por la acción preventiva de las vacunas, aunque debido al aumento de la inmigración que hay en los últimos años podría haber algún caso procedente de áreas donde todavía sufren esta enfermedad (AU)

Poliomyelitis has been eradicated in developed countries through vaccination. However, due to the increase in immigration in the last few years, Spanish physicians may have to deal with patients from areas where this disease is still prevalent (AU)

Síndrome neuroléptico maligno inducido por olanzapina. Descripción de un caso y respuesta favorable a risperidona / Olanzapine-associated neuroleptic malignant syndrome. A case report and favorable response to risperidone

No disponible

Hepatopatías en la gestación. Revisión bibliográfica / Liver diseases in pregnancy

No disponible

A completely automated CAD system for mass detection in a large mammographic database.

Mass localization plays a crucial role in computer-aided detection (CAD) systems for the classification of suspicious regions in mammograms. In this article we present a completely automated classification system for the detection of masses in digitized mammographic images. The tool system we discuss consists in three processing levels: (a) Image segmentation for the localization of regions of interest (ROIs). This step relies on an iterative dynamical threshold algorithm able to select iso-intensity closed contours around gray level maxima of the mammogram. (b) ROI characterization by means of textural features computed from the gray tone spatial dependence matrix (GTSDM), containing second-order spatial statistics information on the pixel gray level intensity. As the images under study were recorded in different centers and with different machine settings, eight GTSDM features were selected so as to be invariant under monotonic transformation. In this way, the images do not need to be normalized, as the adopted features depend on the texture only, rather than on the gray tone levels, too. (c) ROI classification by means of a neural network, with supervision provided by the radiologist's diagnosis. The CAD system was evaluated on a large database of 3369 mammographic images [2307 negative, 1062 pathological (or positive), containing at least one confirmed mass, as diagnosed by an expert radiologist]. To assess the performance of the system, receiver operating characteristic (ROC) and free-response ROC analysis were employed. The area under the ROC curve was found to be Az = 0.783 +/- 0.008 for the ROI-based classification. When evaluating the accuracy of the CAD against the radiologist-drawn boundaries, 4.23 false positives per image are found at 80% of mass sensitivity.

Early diagnosis of Alzheimer's disease using a grid implementation of statistical parametric mapping analysis.

A quantitative statistical analysis of perfusional medical images may provide powerful support to the early diagnosis for Alzheimer's Disease (AD). A Statistical Parametric Mapping algorithm (SPM), based on the comparison of the candidate with normal cases, has been validated by the neurological research community to quantify ipometabolic patterns in brain PET/SPECT studies. Since suitable "normal patient" PET/SPECT images are rare and usually sparse and scattered across hospitals and research institutions, the Data Grid distributed analysis paradigm ("move code rather than input data") is well suited for implementing a remote statistical analysis use case, described in the present paper. Different Grid environments (LCG, AliEn) and their services have been used to implement the above-described use case and tackle the challenging problems related to the SPM-based early AD diagnosis.

GPCALMA: a Grid-based tool for mammographic screening.

OBJECTIVES: The next generation of high energy physics (HEP) experiments requires a GRID approach to a distributed computing system: the key concept is the Virtual ORGANISATION (VO), a group of distributed users with a common goal and the will to share their resources. METHODS: A similar approach, applied to a group of hospitals that joined the GPCALMA project (Grid Platform for Computer Assisted Library for MAmmography), will allow common screening programs for early diagnosis of breast and, in the future, lung cancer. The application code makes use of neural networks for the image analysis and is useful in improving the radiologists' diagnostic performance. GRID services allow remote image analysis and interactive online diagnosis, with a potential for a relevant reduction of the delays presently associated with screening programs. RESULTS AND CONCLUSIONS: A prototype of the system, based on AliEn GRID Services [1], is already available, with a central server running common services [2] and several clients connecting to it. Mammograms can be acquired in any location; the related information required to select and access them at any time is stored in a common service called Data Catalogue, which can be queried by any client. Thanks to the PROOF facility [3], the result of a query can be used as input for analysis algorithms, which are executed on the nodes where the input images are stored,. The selected approach avoids data transfers for all the images with a negative diagnosis and allows an almost real time diagnosis for the set of images with high cancer probability.

Síndrome de Sjögren y gestación. A propósito de un caso / Sjörgren syndrome and gestation. A case study

En este artículo hablamos del síndrome de Sjögren, enfermedad autoinmune de etiología desconocida que cursa con una clínica muy diversa y que no tiene tratamiento específico, sólo sintomático. Presentamos el caso de una paciente gestante con esta enfermedad que le fue diagnosticada en la infancia y que tuvo un embarazo que cursó sin mayores complicaciones. La clínica preexistente no se exacerbó en el curso del embarazo y la enfermedad no influyó en el desarrollo de la gestación (AU)

Uso de cocaína durante el embarazo / Cocaine usage during pregnancy

Vamos a hablar de la cocaína, de sus efectos farmacológicos y de cómo puede influir el consumo de esta droga durante el embarazo; asimismo, llevaremos a cabo una revisión bibliográfica del tema (AU)

Antiarrítmicos en el embarazo / Antiarrhythmic drugs during pregnancy

Vamos a repasar los fármacos antiarrítmicos y su uso durante el embarazo, veremos para qué patologías los utilizamos y haremos una revisión bibliográfica del tema (AU)

[Tetrabamate-induced hepatotoxicity. Report of seven cases and literature review]. / Hepatotoxicidad por tetrabamato. Presentación de 7 casos y revisión de la bibliografía.

OBJECTIVES: Analysis of all cases of tetrabamate (Atrium)-induced hepatotoxicity reported in the Andalusian Registry of drug-induced liver disorders and comparison with cases reported in the literature. MATERIAL AND METHOD: Information was gathered in a structured protocol. The causal role of tetrabamate was estimated in each case using the diagnostic scale of the Council for International Organizations of Medical Sciences (CIOMS). RESULTS: Of 327 cases of hepatotoxicity, 7 (2%) were due to tetrabamate. The mean age was 57 years (4 men). In 57% of the cases, the presenting symptom was tremor. The latency period was between 15 and 730 days. Liver damage was mainly cytolytic without signs of hypersensitivity. In all cases outcome was favorable with complete recovery between 60 and 120 days. The CIOMS diagnostic scale rated a causal role of tetrabamate as highly probable in six cases and as probable in one. CONCLUSION: Tetrabamate can induce hepatotoxicity, probably due to an idiosyncratic metabolic mechanism. Because of this finding and the existence of more appropriate therapeutic alternatives, tetrabamate should not be used in the treatment of alcohol withdrawal.

Trasplante hepático y gestación. Revisión bibliográfica / Liver transplant and pregnancy. A bibliographical review

Durante los ultimos 10 años el transplante hepático ha experimentado un avance terapéutico sustancial en la mejora del tiempo de supervivencia y la calidad de vida en los pacientes con enfermedades hepáticas terminales. Actualmente, la supervivencia en estos pacientes es del 90% y 75-80% a los 5 y 10 años respectivamente después del trasplante (AU)

Trastornos dermatológicos y gestación / Dermatological conditions and pregnancy

La dermatosis que pueden complicar a la gestación son un grupo extenso de enfermedades de diferente índole. Existen diferentes cambios de carácter fisiológico, que son frecuentes y hay que conocer, sobre todo por su ausencia de carácter patológico. Otro grupo, muy importante, son las dermopatías propias de la gestación, que si bien son menos frecuentes también resultan más graves y el obstetra debe tener un amplio conocimiento sobre ellas. Asimismo, describimos otras alteraciones cutáneas que, si bien son independientes del embarazo, cuando se asocian a éste pueden tener una visión diferente (AU)