Adequacy and prognostic impact of treatment for severe exacerbation of chronic obstructive pulmonary disease. / Adecuación e impacto pronóstico del tratamiento de las exacerbaciones graves de la enfermedad pulmonar obstructiva crónica.

OBJECTIVE: To define the clinical characteristics of patients hospitalised in pneumology and internal medicine departments for chronic obstructive pulmonary disease (COPD) exacerbation, to assess the compliance with the recommendations of the clinical practice guidelines and to determine the impact on the patients' prognosis. METHODOLOGY: We conducted a retrospective longitudinal study that randomly included patients hospitalised for COPD exacerbation in a tertiary hospital. We collected demographic and clinical variables (degree of dyspnoea and obstruction, previous exacerbations, comorbidities), readmission and mortality data and criteria for compliance with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines and the Spanish COPD guidelines (GesEPOC). We performed a univariate, multivariate and survival analysis. RESULTS: The study included 108 patients, and the mean age was 71.48±11.65 years. The readmission rate was 26.4% at 3 months and 43.4% at 1 year. The hospital mortality rate was 3.9%, the mortality rate at 3 months was 21.9%, and the mortality rate at 1 year was 27.4%. The patients hospitalised in the internal medicine department had higher mortality during hospitalisation (p=.043), at 3 months (p=.028) and at 1 year (p=.007) compared with the rates for the pneumology department. Overall compliance with the clinical guidelines was 63% for the clinical evaluation (less for the patients in internal medicine: 56.1% vs. 73.8%, p=.063). For the treatment, the compliance was 26.9% for GOLD and 28.7% for GesEPOC. Compliance with the GOLD guidelines in the use of corticosteroids was associated with a lower rate of long-term readmissions (p=.041) and hospital mortality (p=.007) and 3-month mortality (p=.05). CONCLUSIONS: The clinical profile of the patients is currently similar to that previously reported, but their clinical progression was poorer. Overall compliance with the clinical guidelines for drug treatment was low, and only appropriate use of systemic steroids was associated with a reduction in early mortality and in medium-term readmissions.

Expression of glyceraldehyde 3-phosphate dehydrogenase is enhanced in Leishmania spp naturally resistant to nitric oxide.

Leishmania spp are the causative agents of a spectrum of diseases termed leishmaniasis that affect mammals, including humans and dogs. Although reactive nitrogen species are employed in the control of parasitism by the immune system, it is known that Leishmania can withstand this oxidative stress. As the mechanism by which these species are resistant to nitric oxide (NO) is poorly understood, the main objective of this study was to evaluate the expression of glyceraldehyde 3-phosphate dehydrogenase (GAPDH) in Leishmania amazonensis and Leishmania chagasi promastigotes showing natural resistance to NO. GAPDH transcript levels were quantified by real-time polymerase chain reaction amplification, and GAPDH activity (assessed by levels of NADH oxidation) was measured by spectrophotometry. The level of nitration in total protein was assessed by immunoblotting. The results demonstrated an increase in GAPDH expression in resistant isolates of both species compared to susceptible isolates. The increase in GAPDH expression led to an increase in the activity of GAPDH in L. amazonensis human isolates resistant to NO. The pattern of protein nitration did not differ between sensitive and resistant isolates. Our results suggest that changes in expression of GAPDH may be responsible, at least in part, to natural resistance to NO found in human and canine Leishmania spp.

Morphological and morphometric changes in rat optic nerve microvessels in a glaucoma experimental model.

AIM: To study the morphological and morphometric changes produced in the capillaries of the optic nerve (ON) head and initial portion after the experimental increase in intraocular pressure (IOP). MATERIAL AND METHODS: Wistar rats underwent cauterization of three episcleral veins, which produced an immediate increase in the IOP, and was maintained for 3 months. Sagittal sections of the eyeball were studied with immunohistochemical techniques, using a primary antibody to GLUT-1. The GLUT-1 positive capillaries were counted, and measurements were made of the area, perimeter and mean diameter. RESULTS: Microscopic examination of sections of the ON of control rats revealed a lower density and larger caliber of capillaries in the prelaminar region as compared with the other regions of the ON (P<.05). Comparison between the control and the experimental groups showed a reduction in capillary density (except in the prelaminar region) and a smaller size in all the areas of the ON studied, but less evident in the initial portion (P<.05). CONCLUSIONS: The increase in IOP was associated with significant qualitative and quantitative changes in the capillaries of the laminar and poslaminar regions of the ON head. These changes appear to return towards parameters compatible with normality in the initial portion of the ON, an area where the vascular collapse was less evident. These findings might explain the significant reduction in ocular blood flow seen in patients with primary open-angle glaucoma.

Análisis temático de la disciplina Fisioterapia en la Web of Science / Thematic analysis of the discipline of physiotherapy in the Web of Science

La disciplina Fisioterapia, pese a su juventud, viene desarrollando todo su potencial de investigación en los últimos años. El objetivo de este estudio es analizar los temas de investigación que se están desarrollando en esta disciplina según la base de datos «Web of Science». Se realiza un estudio de corte bibliométrico descriptivo longitudinal retrospectivo desde 1945 hasta el 2005, realizando un análisis temático por el análisis de coocurrencia de las palabras. Existen 15 temas principales en esta disciplina, siendo los principales calidad de vida, ejercicio, lumbalgia y mortalidad. La estructura de la disciplina es homogénea y tiene una buena dinámica, si bien en futuros proyectos sería necesario ampliar el estudio mediante otras bases de datos y sistemas de búsqueda en aras de mejorar la discusión y la objetivación de los resultados (AU)

In spite of its youth, the area of physiotherapy has been developing all of its potential in recent years. This study has aimed to analyze those subjects of research that are being developed in this discipline according to the Web of Science database. A retrospective, longitudinal, descriptive and bibliometric study was done including the years 1945 to 2005. A thematic analysis was done through subject co-word analysis. There are 15 principal subjects in this area, the main ones being: Quality of life, Exercise, Low back pain, Mortality. The structure of the area is consistent and has good dynamics, although future project are needed to extend the study using other database and search engines in the interest of optimizing the discussion and the results (AU)

Exploración y tratamiento fisioterapéutico de la hiperhidrosis palmar / Exploration and physiotherapy treatment of palm hyperhidrosis

En este artículo, se estudian las técnicas de valoración más utilizadas en la exploración de la hiperhidrosis palmar. Así mismo se describe detalladamente la técnica fisioterapéutica aplicada en la citada afección, mediante iontoforesis por agua corriente (del grifo), con distintas guías terapéuticas, lo que permite una mayor versatilidad en relación a la idiosincrasia de los pacientes. (AU)

Functional implications of circulating muscarinic cholinergic receptor autoantibodies in chagasic patients with achalasia.

BACKGROUND & AIMS: Autoantibodies against M(2)-muscarinic acetylcholine receptors (M(2) mAChR) have been reported in patients with chronic Chagas' disease who have cardiac dysautonomia. The aim of this study was to investigate the presence of such antibodies in chronic chagasic and non-chagasic patients with esophageal achalasia and their ability to activate M(2) mAChR in the isolated esophagus. METHODS: Enzyme-linked immunosorbent assay was used to detect serum immunoglobulin (Ig) G antibodies against a synthetic 24-mer peptide corresponding to the second extracellular loop of human M(2) mAChR. The effects of both total serum IgG and affinity-purified antipeptide antibodies on the contractile activity and adenosine 3', 5'-cyclic monophosphate (cAMP) production in rat esophageal strips were also tested. RESULTS: Circulating IgG antibodies from chagasic achalasia patients recognized the M(2)-peptide more often than those from non-chagasic achalasia patients (P < 0.0005) and normal subjects (P < 0.0001). A strong association between the existence of circulating anti-M(2) mAChR antibodies and the presence of achalasia in chagasic patients was found (P < 0.01). Both the total IgG fraction and anti-M(2)-peptide antibodies increased the basal tone, reduced the relaxant effect of isoproterenol, and decreased cAMP accumulation in esophageal strips, displaying a muscarinic agonist-like activity on M(2) mAChR. CONCLUSIONS: Patients with chronic Chagas' disease have circulating autoantibodies against M(2) mAChR. These antibodies could be involved in the pathophysiological mechanism of chagasic achalasia.

[Serologic study of vertically transmitted infections in pregnant women attending 3 health centers in Jaén]. / Estudio serológico de las infecciones de transmisión vertical en las mujeres embarazadas controladas en tres centros de salud de Jaén.

BACKGROUND: Studying serological tests into syphilis, German measles, toxoplasma and hepatitis B requested as part of the monitoring of pregnant women and analysing the different activities in the face of the findings. METHODS: A descriptive study. A systematic random process was used to select (1/3) 299 cases of women whose pregnancy had been monitored between 1991 and 1993 in three health centres in Jaen (capital of the province of the same name), which have a catchment population of 66,423 inhabitants. We analyse the differences between the centres using the Chi squared test. RESULTS: A serology of syphilis (R.P.R.) was conducted on 269 pregnant women (90% Standard Error (S.E.): 1.7) all of which proved negative; German measles (ELISA Immunoglobulin (Ig) G, toxoplasm (FIAX IgG and IgM) and (HBsAg in 92% (S.E.: 1.6) German measles antibodies being found in 98% (S.E.: 0.8), the HBsAg proving negative in 99% (S.E.: 0.6) and immunity to toxoplasm existing in 13% (S.E.:2). When the data were analysed, being broken down into the different health centres, notable differences were observed (p > 0.04) in the case of German measles. In the five cases were German measles proved negative, the serology was not repeated once, and on two occasions it was the second pregnancy. They do not appear in the history of preventive medicine. Treatment with spiromycine was initiated for toxoplasmosis, and it lasted for 10 to 21 days for five of the cases, but the infection was not confirmed once, and for two of these it was only determined serologically. CONCLUSIONS: Both the percentage of requests for the first serology and the prevalence are consistent with literature on the subject, with the exception of toxoplasm, whose immunity prevalence was much lower than in other zones. The actions taken in the face of certain results were rather inadequate.

A distinct variant of intermediate maple syrup urine disease.

Branched chain alpha-ketoacid dehydrogenase (BCKAD) deficiency, or maple syrup urine disease (MSUD), can be categorized as classical, intermediate, intermittent or thiamine responsive, based on generally concordant in vitro BCKAD activity and severity of phenotype. We present clinical and enzymatic data on a boy with intermediate maple syrup urine disease, and suggest that he represents a novel category of mutation. He presented at age 10 months in ketoacidotic coma, with a history of irritability, poor feeding and growth and developmental delay. Branched chain amino acid restriction effected normal growth and developmental parameters by age 42 months. In contrast to previous patients with intermediate MSUD, his fibroblasts and fibroblast extracts failed to decarboxylate [1-14C]-alpha-ketoisovalerate (KIV). The defect is not in mitochondrial transport of substrate, but rather in the catalytic activity of the E1 component of the BCKAD. Disrupted cells of the proband exhibited negligible BCKAD activity over a wide range of keto acid substrate concentrations, irrespective of the presence of added thiamine pyrophosphate (TPP). These results differ from the sigmoidal kinetics observed using classical MSUD extracts, and the hyperbolic kinetics with control preparations under the same assay conditions. We propose that the structurally altered enzyme possesses reduced but not negligible activity in vivo, and exists as an unstable complex in vitro under assay conditions used, even in the presence of added TPP.

Acetyl CoA carboxylase in cultured fibroblasts: differential biotin dependence in the two types of biotin-responsive multiple carboxylase deficiency.

In biotin-responsive multiple carboxylase deficiency, a characteristic organic aciduria reflects in vivo deficiency of mitochondrial propionyl CoA carboxylase, 3-methylcrotonyl CoA carboxylase, and pyruvate carboxylase. A possible primary or secondary defect in biotin absorption leads to an infantile-onset syndrome, while abnormal holocarboxylase synthetase activity has been identified in the neonatal-onset form. While distinct mitochondrial and cytosolic holocarboxylase synthetase biotinylation systems may exist in avian tissues, the system has not been characterized in humans. Toward this objective, we studied the biotin dependence of a cytosolic carboxylase, acetyl CoA carboxylase (ACC), in cultured skin fibroblasts of both types of multiple carboxylase deficiency. ACC specific activities in control and infantile-onset cells were not distinguishable at all biotin concentrations: with decreasing biotin availability (+ avidin), there were only modest decrements in ACC activity in both these cell types. In contrast, there were pronounced declines of ACC activity in neonatal-onset (holocarboxylase synthetase-deficient) cells after growth in low biotin concentrations, and activity was undetectable in + avidin. ACC activity was rapidly restored with biotin repletion to biotin-starved holocarboxylase synthetase-deficient cells, and this restoration was largely independent of protein synthesis. The behavior of the cytosolic carboxylase, ACC, is in all these respects identical to that of the mitochondrial carboxylases, an observation consistent with the existence of similar biotinylation mechanisms in the two cell compartments. Further, the data support the notion that at least some components of the holocarboxylase synthetase system are shared by mitochondria and cytosol in humans, and are consistent with the suggestion that restoration of activity in biotin-depleted cells represents biotinylation of preexisting enzyme protein. The modest decrements in ACC activity in normal and infantile-onset cells may be related to the compromised epidermal integrity observed in that form of multiple carboxylase deficiency. Finally, ACC and mitochondrial carboxylase activities were compared in cells from mutants representing a spectrum of clinical severity. Cells from later-onset patients of intermediate clinical severity were ultimately classifiable as putative holocarboxylase synthetase-deficient cells on chemical criteria. Accurate etiologic classification cannot be based on clinical presentation alone, and biochemical studies should be performed on all patients. Accordingly, we propose a classification of multiple carboxylase deficiency based on biochemical criteria.