Influence of oral health on mucositis in patients undergoing hematopoietic progenitor cell transplantation (HPCT).

AIMS: To establish whether or not the state of patient oral health can influence the occurrence and/or severity of oral mucositis during hematopoietic progenitor cell transplantation (HPCT). MATERIALS AND METHODS: The study included 72 patients awaiting HPCT. Prior to transplantation, clinical exploration and radiology were carried out and oral photographs were taken. This evaluated the extent of caries present, the number of missing teeth and the number of dental fillings in each patient; CAO (Caries and Obturations Index) DMFS (Decayed, Missing, and Filled Surfaces) and Restoration Indices were calculated. Gingival pathology was also examined by means of the Ainamo and Bay Gingival Bleeding Index. O'Leary's Plaque Index was used to evaluate the level of patient oral hygiene. This data was analyzed to see if it exercised any influence on the mucositis grade suffered during HPCT. RESULTS: 96,87% of patients suffered some degree of mucositis during their treatment by the Transplant Unit. The grade of mucositis was seen to be influenced by the number of missing teeth (ANOVA p<0.016) and by the DMFS Index (ANOVA p< 0.038). Although this was not one of the aims of this study, patient age and the administration of colony-stimulating factors were also seen to influence these clinical manifestations. CONCLUSIONS: The state of prior oral health can influence decisively the mucositis suffered during transplantation.

Fisiopatología de las tormentas eléctricas en el encéfalo del paciente con una lesión cerebral aguda. Resultados preliminares de un estudio piloto / Pathophysiology of electrical storms in the brain of patients with acute brain injury. Preliminary results of a pilot study

Los fenómenos de despolarización cortical propagada (CSD y CSD-like) son despolarizaciones celulares que se extienden en forma de onda y están implicados en la progresión de las lesiones en pacientes con ictus y traumatismo craneoencefálico (TCE). Son detectables en el registro de electrocorticografía (ECoG). Experimentalmente inducen hipoxia cerebral e incrementa la permeabilidad de la barrera hematoencefálica. Objetivos: Determinar la frecuencia y duración de estos episodios en pacientes con TCE o infarto maligno de la arteria cerebral media (IMACM) que requieran craniectomía. Material y métodos: 20 pacientes a los que se les colocó, en el córtex perilesional, una tira de seis electrodos. Análisis del número y la duración de los episodios de CSD registrados. Resultados: En cuatro, de los ocho registros de ECoG analizados, se identificaron episodios de CSD o CSD-like de duración y frecuencia variable. Conclusiones: Se detectan frecuentemente episodios de CSD y CSD-like en pacientes con IMACM y TCE (AU)

The phenomena of cortical spreading depolarization (CSD and CSD-like phenomena) are cellular depolarization waves involved in the progression of lesions in patients with stroke and traumatic brain injury (TBI). Which are detected by an electrocorticographic (ECoG) recording. Experimentally, CSD induces cerebral hypoxia and increases the permeability of the blood-brain barrier. Objectives: To determine the frequency and duration of CSD episodes in patients with TBI and malignant middle cerebral artery infarction (MMCAI) requiring craniectomy. Material and methods: 20 patients were included. A strip of 6 electrodes was placed in the perilesional cortex. Analysis of the number and duration of CSD episodes in the ECoG recording was performed. Results: In four, of the eight ECoG recordings that was fully analyzed, CSD or CSD-like phenomena were identified with a variable frequency and duration. Conclusions: Episodes of CSD and CSD-like phenomena are frequently detected in patients with MMCAI and TBI (AU)

¿Es el lactato un buen indicador de hipoxia tisular? Resultados de un estudio pilotoen 21 pacientes con un traumatismo craneoencefálico / Is lactate a good indicator of brain tissue hypoxia in the acute phase of traumatic brain injury? Results of a pilot study in 21 patients

El lactato y el índice lactato-piruvato (LP) son dosmarcadores utilizados para la detección de la hipoxiacerebral en pacientes que han sufrido un traumatismocraneoencefálico (TCE). Estos dos marcadores presentanun comportamiento más complejo de lo que seesperaría debido a que pueden estar anormalmenteelevados en circunstancias que no cursan con hipoxiatisular detectable. Este comportamiento debe ser consideradoen el diagnóstico diferencial puesto que reflejatambién una alteración del metabolismo energéticocerebral.Objetivos. 1. Describir las características del metabolismoenergético cerebral que se observa en la faseaguda de los pacientes que han sufrido un TCE en basea los dos indicadores tradicionales del metabolismoanaeróbico: lactato e índice LP, 2. Determinar la concordanciaentre ambos indicadores para clasificar laincidencia del metabolismo anaeróbico y 3. Clasificarlos diferentes tipos de alteración metabólica que seobserva en los pacientes con un TCE moderado o graveen base a estos dos indicadores.Material y métodos. Se seleccionaron aleatoriamenteveintiún pacientes de una cohorte de pacientes con TCEmoderado o grave admitidos en la unidad de cuidadosintensivos y monitorizados mediante microdiálisis(MD) cerebral y presión tisular de oxígeno (PtiO2). Seanalizaron los niveles de lactato e índice LP de cadamicrovial generado en las primeras 96 horas tras elTCE. Estos datos fueron correlacionados con los valoresde PtiO2.Resultados. El lactato y el índice LP estuvieronelevados el 49,5% y el 38,4% del tiempo totalmonitorizado respectivamente (..) (AU)

Lactate and the lactate-pyruvate index (LPI) aretwo hypoxia markers widely used to detect brain tissuehypoxia in patients with acute traumatic brain injury.These two markers have a more complex behavior thanexpected as they can be abnormally high in circumstances with no detectable brain hypoxia. This conditionmust be considered in the differential diagnosis becauseit also reflects an alteration of brain energy metabolism.Objectives. 1. To describe cerebral energy metabolismcharacteristics observed in the acute phase oftraumatic brain injury (TBI) based on two traditionalindicators of anaerobic metabolism: lactate and LPI,2. To determine the concordance between these twobiomarkers in order to classify the incidence of anaerobicmetabolism and 3. To classify the different types ofmetabolic abnormalities found in patients with moderateand severe TBI using both lactate and LPI.Materials and methods. Twenty-one patients wererandomly selected from a cohort of moderate orsevere TBI patients admitted to the neurotraumatologyintensive care unit. All of them who underwentboth cerebral microdialysis and brain tissue oxygenmonitoring (PtiO2). We analyzed the levels of lactateand the LPI for every microvial within the first 96hours after head trauma. These data were correlatedwith PtiO2 values.Results. Lactate levels and the LPI were respectivelyincreased during 49,5% and 38,4% of the monitoringtime. The incidence and behavior of high levels of bothmarkers were extremely heterogeneous. The concordancebetween these two biomarkers to determineepisodes of dysfucntional metabolism was very weak(Kappa Index=0,29; IC 95%: 0,24-0,34). Based on thelevels of lactate and the LPI, we defined four metabolicpatterns: I: L>2,5 mmol/L and LPR>25; II: L>2,5mmol/L and LPR≤ 25; III: L≤ 2,5 mmol/L and LPR≤25; IV: L≤ 2,5 mmol/L and LPR>25). In more than80% of cases in which lactate or LPI (..) (AU)

Microdiálisis de alta resolución. Aspectos metodológicos y aplicación al estudio de larespuesta inflamatoria cerebral / High Resolution Microdialysis. Methodological issues and application to the study of inflammatory brain response

La técnica de microdiálisis (MD) cerebral es un instrumentoque proporciona información relevante en lamonitorización del metabolismo cerebral en pacientesneurocríticos. La MD es una técnica especialmente efectivapara la detección y análisis de pequeñas moléculas,puesto que el tamaño de los poros de la membranadializante actúa como barrera restringiendo el paso deespecies mayores, tales como proteínas u otras macromoléculas.La reciente disponibilidad de catéteres demicrodiálisis con poros de mayor calibre, denominadosde “alta resolución”, permite ampliar el rango de moléculasdetectables en el dializado. Sin embargo, existencomplicaciones técnicas relacionadas con la utilizaciónde estos catéteres para estos propósitos, por lo que estacapacidad potencial para la recuperación de proteínasnecesita ser validada antes de su aplicación como herramientapara estudios de proteómica asociados a la lesióncerebral. En esta revisión se contemplan los principiosbásicos de la microdiálisis y los diferentes factores queintervienen en los procesos de recuperación de moléculasen el dializado, tales como las características físicasde la membrana dializante, así como de las moléculasque se desea investigar (AU)

Cerebral microdialysis is a tool that provides veryrelevant information in the metabolic monitoring ofbrain injured patients. It is a particularly effective technique for the detection and analysis of small molecules,given that the pores of the dialysis membrane actas a barrier to restrict the transport of larger species,such as proteins and other macromolecules. The recentavailability of microdialysis catheters with membranepores of larger size, termed “high resolution” catheters,would widen the spectrum of molecules detectablein the dialisate. However, there are technical complicationsrelated to the use of these catheters for suchpurposes, and therefore, this potential capacity for therecovery of proteins needs to be validated, in order tobegin its application as a tool in studies of proteomicsassociated with brain injuries. The following reviewdepicts the basic principles of microdialysis, and describessome of the issues involved in the recovery ofmolecules in the dialisate, including the physical propertiesof the dialysis membrane and of the moleculesof interest (AU)

Meteorological and agricultural effects on airborne Alternaria and Cladosporium spores and clinical aspects in Valladolid (Spain).

The aeropalynological monitoring was carried out from 1 February 2005-31 January 2007. The total number of spores collected during the main spore season (MSS) in 2005 was 4,500 for Alternaria and 93,744 in the case of Cladosporium, whereas in 2006 values were increased (8,385 for Alternaria and 150,144 for Cladosporium), reaching the maximum concentrations on 18 July and 17 June 2006 with 344 and 5,503 spores, respectively. The influence of the main meteorological parameters on spore concentrations was studied, resulting in a positive correlation with temperature. Rainfall, relative humidity and frequency of calms obtained negative correlations in the case of Alternaria, and positive for Cladosporium, the total daily hours of sunshine having an inverse influence on them. The intra-diurnal pattern was very similar for both genera, with a greater representation towards the central hours of the day and at night. Finally, some clinical aspects for the Alternaria spore type were analyzed, with a low percentage of sensitized patients though (9.5%). Only one patient showed positive skin test reaction to Cladosporium.