Management of Mechanical Nasal Obstruction Isolated or Associated to Upper Airway Inflammatory Diseases in Real Life: Use of both Subjective and Objective Criteria.

PURPOSE OF REVIEW: Mechanical nasal obstruction (MNO) is a prevalent condition with a high impact on patient's quality-of-life (QoL) and socio-economic burden. The aim of this study was to determine the usefulness of both subjective and objective criteria in the appropriate management of MNO, either alone or associated to upper airway inflammatory diseases such as allergic rhinitis (AR) or chronic rhinosinusitis with nasal polyps (CRSwNP). RECENT FINDINGS: A long debate persists about the usefulness of subjective and objective methods for making decisions on the management of patients with nasal obstruction. Establishing standards and ranges of symptom scales and questionnaires is essential to measure the success of an intervention and its impact on QoL. To our knowledge this is the first real-life study to describe the management of MNO using both subjective and objective criteria in MNO isolated or associated to upper airway inflammatory diseases (AR or CRSwNP). Medical treatment (intranasal corticosteroids) has a minor but significant improvement in MNO subjective outcomes (NO, NOSE, and CQ7) with no changes in loss of smell and objective outcomes. After surgery, all MNO patients reported a significant improvement in both subjective and objective outcomes, this improvement being higher in CRSwNP. We concluded that in daily clinical practice, the therapeutic recommendation for MNO should be based on both subjective and objective outcomes, nasal corrective surgery being the treatment of choice in MNO, either isolated or associated to upper airway inflammatory diseases, AR or CRSwNP.

A Versatile Approach to Access Trimetallic Complexes Based on Trisphosphinite Ligands.

A straightforward method for the preparation of trisphosphinite ligands in one step, using only commercially available reagents (1,1,1-tris(4-hydroxyphenyl)ethane and chlorophosphines) is described. We have made use of this approach to prepare a small family of four trisphosphinite ligands of formula [CH3C{(C6H4OR2)3], where R stands for Ph (1a), Xyl (1b, Xyl = 2,6-Me2-C6H3), iPr (1c), and Cy (1d). These polyfunctional phosphinites allowed us to investigate their coordination chemistry towards a range of late transition metal precursors. As such, we report here the isolation and full characterization of a number of Au(I), Ag(I), Cu(I), Ir(III), Rh(III) and Ru(II) homotrimetallic complexes, including the structural characterization by X-ray diffraction studies of six of these compounds. We have observed that the flexibility of these trisphosphinites enables a variety of conformations for the different trimetallic species.

Fining with purified grape pomace. Effect of dose, contact time and varietal origin on the final wine phenolic composition.

Fining, which involves the addition of adsorptive material in order to reduce or eliminate certain unwanted components, is a common winemaking practice. Fining agents affect the wine phenolic compounds, some of which may be reduced. When this reduction is experimented by the tannins, a positive effect may result by decreasing astringency in the wine, although a decrease in the wine color may also take place when the anthocyanins are involved, affecting its quality. Recently, grape cell wall material has been tested as a potential fining agent in wines, since it shows a high affinity for tannins so that its use could reduce wine astringency. In this work, the use of purified grape pomace as fining agent is proposed and the effect of different doses and contact times on wine chromatic characteristics was investigated as well as how differences in the composition of the purified pomace could alter the phenolic composition of a red wine. The results showed that a Monastrell purified grape pomace dose of 6 mg/ml and a contact time of 5 days could be suitable for decreasing the wine tannin content without producing great changes in the wine chromatic characteristics. When comparing the effect of purified pomaces from four grape varieties, some differences in their capacity to interact with the wine tannins and anthocyanins were found, however, the results confirm that the purified grape pomace, a byproduct of the enology industry could be a new interesting fining material.

PARP inhibition attenuates histopathological lesion in ischemia/reperfusion renal mouse model after cold prolonged ischemia.

We test the hypothesis that PARP inhibition can decrease acute tubular necrosis (ATN) and other renal lesions related to prolonged cold ischemia/reperfusion (IR) in kidneys preserved at 4°C in University of Wisconsin (UW) solution. Material and Methods. We used 30 male Parp1(+/+) wild-type and 15 male Parp1(0/0) knockout C57BL/6 mice. Fifteen of these wild-type mice were pretreated with 3,4-dihydro-5-[4-(1-piperidinyl)butoxyl]-1(2H)-isoquinolinone (DPQ) at a concentration of 15 mg/kg body weight, used as PARP inhibitor. Subgroups of mice were established (A: IR 45 min/6 h; B: IR + 48 h in UW solution; and C: IR + 48 h in UW solution plus DPQ). We processed samples for morphological, immunohistochemical, ultrastructural, and western-blotting studies. Results. Prolonged cold ischemia time in UW solution increased PARP-1 expression and kidney injury. Preconditioning with PARP inhibitor DPQ plus DPQ supplementation in UW solution decreased PARP-1 nuclear expression in renal tubules and renal damage. Parp1(0/0) knockout mice were more resistant to IR-induced renal lesion. In conclusion, PARP inhibition attenuates ATN and other IR-related renal lesions in mouse kidneys under prolonged cold storage in UW solution. If confirmed, these data suggest that pharmacological manipulation of PARP activity may have salutary effects in cold-stored organs at transplantation.

[Eligibility of schizophrenia inpatients to participate in clinical trials]. / Elegibilidad de pacientes con esquizofrenia ingresados en una unidad de hospitalización psiquiátrica para participar en ensayos clínicos.

INTRODUCTION: This study assesses the potential eligibility of patients admitted to a psychiatric hospitalisation unit to take part in the major clinical trials based on schizophrenia treatment in clinical practice (CATIE, CUtLASS and EUFEST). MATERIAL AND METHODS: A retrospective evaluation by consulting the medical records of 241 subjects (59.8% males and 40.2% females, mean age 39.7±13.0 years), admitted consecutively over one year to psychiatric hospitalisation unit with a diagnosis of schizophrenia or another psychosis. The influence of the factors involved in the non-eligibility in each of the clinical trials is analysed using logistic regression analysis. RESULTS: Only 20.7%, 22.3%, and 22.5% of patients with schizophrenia or another psychosis would be eligible to participate in the CATIE, CUtLASS and EUFEST studies, respectively. The main factors involved in the non-eligibility were polytherapy with anti-psychotics (2 or more) (Odds Ratio (OR): 7.64, 95% confidence interval (CI): 3.06-19.06, P<.001), mental retardation (OR: 16.67, 95% CI: 1.75-166.67, P=.014), and resistance, intolerance or contraindication to any of the anti-psychotics of the study (OR: 3.68, 95% CI: 1.13-11.99, P=.030). CONCLUSIONS: Three out of every four patients with schizophrenia or another psychosis admitted to a psychiatric hospitalisation unit are not represented in the major clinical trials on schizophrenia treatment.

Normas básicas de seguridad durante el manejo de equipos de radiaciones no ionizantes / Safety basic rules when handling non-ionizing radiation equipment

La preocupación creciente de los trabajadores hacia los posibles efectos nocivos de la exposición a campos electromagnéticos, está suponiendo una percepción desproporcionada de los riesgos derivados de la exposición. En la actualidad, no existe evidencia científica sobre dichos efectos nocivos, siendo aconsejable la vigilancia sobre las exposiciones que están fuera de los límites de seguridad. Desde este Servicio de Prevención y en colaboración con el Servicio de Física Médica, hemos elaborado un procedimiento que garantice, mediante criterios preventivos básicos, la seguridad y salud de los trabajadores que manejan equipos emisores de radiaciones no ionizantes, en nuestro hospital y centros de especialidades. Para la elaboración de este procedimiento hemos revisado la literatura científica relativa a los efectos de los campos electromagnéticos sobre la salud, reuniones periódicas de trabajo entre ambos servicios, identificación y ubicación de los equipos de radiaciones no ionizantes, y asesoramiento por expertos en la materia. El procedimiento establece medidas de control para los trabajadores, y medidas de control para los equipos. Con la finalidad de conseguir una buena difusión e implantación de dicho procedimiento, hemos elaborado dípticos y carteles, donde reflejamos las medidas de control para trabajadores y equipos: Onda Corta, Microondas, Magnetoterapia, Resonancia Magnética Nuclear, Láser y Ultravioleta El procedimiento con sus carteles explicativos ha sido distribuido específicamente por servicios, realizando formación e información de los trabajadores que maneja dichos equipos (AU)

Employee increasing concern about possible dangerous effects of the exposure to electromagnetic fields is meaning a distorted perception of the exposure related risks. Currently, there is no scientific evidence of the dangerous effects mentioned although surveillance over the exposures out of the safety limits is recommended. Within this Prevention Department in cooperation with The Medical Physics Department a procedure based on basic preventive criteria has been elaborated to guarantee health and safety of the employees who handle non-ionizing radiation emitting equipment in our hospital and specialized centers. To draw the procedure: scientific literature related to the electromagnetic fields effects over health has been checked, periodical working meetings have been held between both above mentioned departments; non-ionizing radiation equipment have been identified as well as the places they are based or used; and expert people advice has been used. The procedure sets control and follow-up measurements both for people and equipment such as follows: Shortwave, microwave and magnetic therapy, Nuclear magnetic resonance, Laser, Ultraviolet radiation. The procedure and illustrative posters have been deployed to the linked departments, the information and training having been given to the employees who work with kind of equipment (AU)

Indoor air pollution from gas cooking and infant neurodevelopment.

BACKGROUND: Gas cooking is a main source of indoor air pollutants, including nitrogen dioxide and particles. Because concerns are emerging for neurodevelopmental effects of air pollutants, we examined the relationship between indoor gas cooking during pregnancy and infant neurodevelopment. METHODS: Pregnant mothers were recruited between 2004 and 2008 to a prospective birth cohort study (INfancia y Medio Ambiente) in Spain during the first trimester of pregnancy. Third-trimester questionnaires collected information about the use of gas appliances at home. At age 11 to 22 months, children were assessed for mental development using the Bayley Scales of Infant Development. Linear regression models examined the association of gas cooking and standardized mental development scores (n = 1887 mother-child pairs). RESULTS: Gas cookers were present in 44% of homes. Gas cooking was related to a small decrease in the mental development score compared with use of other cookers (-2.5 points [95% confidence interval = -4.0 to -0.9]) independent of social class, maternal education, and other measured potential confounders. This decrease was strongest in children tested after the age of 14 months (-3.1 points [-5.1 to -1.1]) and when gas cooking was combined with less frequent use of an extractor fan. The negative association with gas cooking was relatively consistent across strata defined by social class, education, and other covariates. CONCLUSIONS: This study suggests a small adverse effect of indoor air pollution from gas cookers on the mental development of young children.

Historia de la raquianestesia y de la anestesia epidural en España / History of rachianesthesia and epidural anesthesia in Spain

Objetivo: Conocer como se desarrollaron en nuestro país las técnicas de la raquianestesia y la anestesia epidural, y cuales fueron las aportaciones de los urólogos españoles. Métodos: Hemos revisado los libros de Historia de la Medicina, de la Urología y de Anestesia, las publicaciones periódicas y las Tesis Doctorales que sobre este tema se realizaron en la época. Resultados: En buena parte del siglo XX aquellos que se dedicaban a la cirugía administraban también la anestesia. Es a partir del año 1900 cuando comienzan a desarrollarse la raquianestesia y la anestesia epidural siendo numerosas y fundamentales las aportaciones de los urólogos españoles como F. Rusca Doménech, J.M. Batrina, M. Barragán Bonet, R. Lozano Monzón, L. Guedea Calvo, Gil Vernet, Fidel Pagés Miravé, V. Sagarra Lascuraín, Gómez Ulla, etc. realizando publicaciones en revistas de prestigio, comunicaciones en congresos y tesis doctorales sobre la anestesia raquídea y epidural (AU)

Objectives: To show the beginning of spinal and epidural anesthesia in our country and the contributions of Spanish urologists. Methods: We reviewed books and writings of History of Medicine, Urology and Anesthesia and Doctoral thesis about spinal and epidural anesthesia. Results: In the 20th century, surgeons also gave the anesthetic drugs to the patients. Spinal and epidural anesthesia were used for the first time in 1900. A lot of Spanish urologists like F. Rusca Doménech, J.M. Batrina, M. Barragán Bonet, R. Lozano Monzón, L. Guedea Calvo, Gil Vernet, Fidel Pagés Miravé, V. Sagarra Lascuraín, Gómez Ulla, etc, did research, writings in scientific journals and Doctoral thesis about anesthesia (AU)

La fenomenología de la comorbilidad del trauma y la psicosis / The phenomenology of the comorbidity of trauma and psychosis

A lo largo de este artículo queremos reflejar cómo la psicosis y el trastorno porestrés postraumático (TEPT) no son entidades tan distintas ni separadas, sino que confrecuencia confluyen y se solapan. Muchas investigaciones nos indican que la prevalenciavital de TEPT en pacientes mentales graves es muy superior a la de la poblacióngeneral. Algunos autores concluyen que algunas personas con sintomatología psicóticadesarrollan TEPT como resultado de la propia experiencia psicótica. Durante muchosaños los investigadores se han centrado preferentemente en la relación del trauma consíndromes no psicóticos. No obstante, en los últimos años se ha producido un gran interéssobre cómo el trauma puede precipitar o favorecer la aparición de cuadros psicóticos.Por otro lado, parece existir evidencia empírica que señala la existencia de un subtipoTEPT con síntomas psicóticos. Por último, Morrison, Frame y Larkin (2003) plantean,que tanto la psicosis como el TEPT, representan un continuo de respuestas del individuosometido a un evento traumático. Las similitudes entre ambos trastornos indican quepodrían formar parte del mismo espectro de respuestas ante un acontecimiento traumático.No obstante, es preciso indagar el por qué el trauma da lugar un tipo de síntomas uotros. Visto todo lo anterior, el objetivo de este artículo es examinar la naturaleza de lasdistintas relaciones entre la psicosis y el trauma. Así como, recomendar encarecidamenteque se introduzcan protocolos específicos y preguntas rutinarias para detectar y tratar elabuso sexual y físico en pacientes con trastornos psicóticos

Throughout this article we have attempted to show how psychotic disorders and posttraumatic stress disorder (PTSD) are not such distinct or apart entities, on the contrary they frequently come together and overlap. A lot of research has indicated that the vital prevalence of PTSD in severe mental illness is quite superior to that of the general population. Some authors has concluded that some people with psychotic symptoms develop PTSD due to their own psychotic experience. During many years researches have focused on the relation of trauma with non psychotic syndromes. Nonetheless, in recent years a great interest has been raised on how trauma might precipitate the onset of psychosis. Moreover, there is empirical evidence that points out to the existence of PTSD subtype with psychotic symptomatology. Finally, Morrison, Frame y Larkin (2003) proposed that psychosis as well as PTSD represent a continuum of responses of an individual exposed to a traumatic event. The similarities among both disorders indicate that they could form part of a spectrum of post-traumatic responses. However, it is necessary to ascertain why trauma produces a type of symptom or the other. Consequently, the aim of the article is to examine the nature of the different relations between psychosis and trauma. Additionally, it is to recommend earnestly the introduction of specific protocols and routine inquiries to detect and treat sexual and physical abuse for persons with psychotic disorders

Incidencia lesional en competición de atletismo de alto nivel de deportistas paralímpicos / Number of injuries in high athletics competition of paralympics sportsmen

El deporte paralímpico de alta competición, que tiene un desarrollo muy notable en cuanto al número de participantes y al nivel de dedicación y de competición, no ha generado amplias investigaciones respecto a su incidencia lesiona!. El presente trabajo analiza la incidencia lesional en el atletismo de deportistas paralímpicos de alta competición, concretamente en el Campeonato de Europa celebrado en Assen (Holanda) en año 2003 y en el que la Selección Española participó con un total de 34 atletas (28 varones) pertenecientes a las federaciones españolas de Deportes para Ciegos (FEDC) con 17 atletas, a la de Deportes de Minusválidos Físicos (FED MF), con 8 atletas y a la de Deportes de Paralíticos Cerebrales (FEDPC) con 9 atletas. Se describen los diagnósticos específicos, las clasificaciones de los deportistas y las pruebas en las que participaron. Se recogieron un total de 50 lesiones que afectaron a 24 de los 34 deportistas (70,58%). Todas fueron agudas ylas más frecuentes fueron las musculares (50% del total) con 6 sobrecargas de adductores, 4 sobrecargas en zona dorsolumbar, 4 en isquiotibiales y 3 en cintura escapular. Hubo 6 contracturas. Se observaron 2 roturas fibrilares y 3 tendinitis. Salvo una herida por compresión de la silla, no se encontraron lesiones específicas de los grandes discapacitados. Las lesiones afectaron preferentemente a las extremidades inferiores (64%), a las extremidades superiores (12%) yal tronco (8%). La incidencia lesional fue de 1,47 lesiones/deportista en el grupo de atletas ciegos, de 1,22 en los paralíticos cerebrales y de 0,75 en los discapacitados físicos

Paralympic sport of high competition has a very remarkable development as far as the number of participants and to the level of dedication and competition, however there are few investigations about the injuries that this kind of sport produces. The present work analyzes the number of injuries in athletics of paralympics sportsmen ofhigh competition, concretely in the Championship of Europe celebrated in Assen (Holland) in 2003, where the Spanish Selection participated with a total of 34 athletes (28 men) belongs to the Spanish federations of Sports for Blinds (FEDC) with 17 athletes, to the one of S ports of PhysicalDisabled (FED MF), with 8 athletes and to the one of Cerebral Palsy Brain (FEDPC) with 9 athletes. The specific diagnoses, the classifications of the sportsmen and the tests are described in which they participated. A total of 50 injuries took shelter that affected to 24 of the 34 sportsmen (70.58%). AlI the injuries were acute and the most frequent were the muscular ones (50% of the total) with 6 overuse of adducers, 4 overuse in back-Iumbar zone, 4 in hamstrings and 3 in shoulder joint complex. There were also 6 spasm muscle, 2 strains and 3 tendinitis. Except for a wound by compression of the chair there were not specific injuries ofhandicapped sportsmen. The injuries preferredly affected to the lower extremities (64%), upper extremities superior (12%) and trunk (8%). The injuries rate was of 1.47 injuries/sportsman in the group of blind athletes, 1.22 in cerebral palsy ones and 0.75 in the physical disabled ones

Heterophile antibodies produce spuriously elevated concentrations of cardiac Troponin I in patients with Legionella pneumophila.

We found an unusually high positive rate for cTnI in patients recently infected with Legionella pneumophila. The aim of this study was to examine the possible origin of increased cTnI levels and to test if it could be associated with the immune response to legionellosis. The cTnI was above the cut point in 46.7% of patients infected with legionellosis when measured with reagent lot number RF421A. A strong correlation between high cTnI measurements and positive serologic values for legionellosis was found. With a revised formulation of cTnI reagent, lot number RF421C, the positive rate decreased by over 10-fold to 3.3%. We conclude that the revised lot of cTnI reagent minimized interference by heterophilic antibodies produced in response to legionellosis.

The expression of GLP-1 receptor mRNA and protein allows the effect of GLP-1 on glucose metabolism in the human hypothalamus and brainstem.

In the present work, several experimental approaches were used to determine the presence of the glucagon-like peptide-1 receptor (GLP-1R) and the biological actions of its ligand in the human brain. In situ hybridization histochemistry revealed specific labelling for GLP-1 receptor mRNA in several brain areas. In addition, GLP-1R, glucose transporter isoform (GLUT-2) and glucokinase (GK) mRNAs were identified in the same cells, especially in areas of the hypothalamus involved in feeding behaviour. GLP-1R gene expression in the human brain gave rise to a protein of 56 kDa as determined by affinity cross-linking assays. Specific binding of 125I-GLP-1(7-36) amide to the GLP-1R was detected in several brain areas and was inhibited by unlabelled GLP-1(7-36) amide, exendin-4 and exendin (9-39). A further aim of this work was to evaluate cerebral-glucose metabolism in control subjects by positron emission tomography (PET), using 2-[F-18] deoxy-D-glucose (FDG). Statistical analysis of the PET studies revealed that the administration of GLP-1(7-36) amide significantly reduced (p < 0.001) cerebral glucose metabolism in hypothalamus and brainstem. Because FDG-6-phosphate is not a substrate for subsequent metabolic reactions, the lower activity observed in these areas after peptide administration may be due to reduction of the glucose transport and/or glucose phosphorylation, which should modulate the glucose sensing process in the GLUT-2- and GK-containing cells.

Autoevaluación del dolor en la colonoscopia / Patient-perceived pain during colonoscopy

Objetivo. Conocer el dolor percibido por los pacientes sometidos a una colonoscopia. Material y método. Se diseñó un estudio descriptivo. La muestra estuvo constituida por 79 pacientes de entre 18 y 90 años citados en la consulta de endoscopia del Hospital General Universitario de Elche para la realización de una colonoscopia. El instrumento utilizado para la evaluación del dolor fue el cuestionario del dolor en español. Resultados. La valoración media de intensidad del dolor total [VID(T)] en el grupo de mujeres fue de 6,07; desviación típica (dt.), 3,98 y en los varones, de 4,94; dt., 3,67, sin diferencias significativas. En cuanto a la valoración de la intensidad del dolor actual (VIA), la puntuación media en los varones fue de 2,21; dt., 1,17, y en las mujeres, de 2,83; dt., 1,39, con diferencias significativas. Respecto a la escala analógica visual (EVA), las mujeres percibieron significativamente mayor dolor (5,86; dt., 2,85) que los varones (3,73; dt., 2,63). La edad no parece influir en la percepción del dolor evaluada en VID(T) (p<= 0,772), en VIA (p<= 0,951) y en EVA (p<= 0,798).La relación entre el tramo explorado y la evaluación del dolor en EVA no fue significativa (p<= 0,400).Conclusiones. Existen diferencias significativas en cuanto a sexo; las mujeres informan percibir más dolor que los varones en la VIA y en las puntuaciones en la EVA. La edad no parece influir en las VIA ni en las puntuaciones en la EVA. La longitud del tramo explorado en la colonoscopia no se relaciona con el dolor percibido (AU)

Análisis de la demanda en el equipo de saludmental de Andújar: evolución y estudio comparativo a los 20 años de apertura / Analysis of demand of the group of mental health in Andújar: evolution and comparative analysis twenty years from its opening

Se presentan los resultados de un análisis de la evolución de la demanda asistencial en un ESMD para la población general desde su creación en 1981 hasta 2001, analizando variables sociodemográficas, clínicas y psicoterapéuticas de 200 historias clínicas (AU)