ApTOLL: A new therapeutic aptamer for cytoprotection and (re)myelination after multiple sclerosis.

BACKGROUND AND PURPOSE: ApTOLL is an aptamer selected to antagonize toll-like receptor 4 (TLR4), a relevant actor for innate immunity involved in inflammatory responses in multiple sclerosis (MS) and other diseases. The currently available therapeutic arsenal to treat MS is composed of immunomodulators but, to date, there are no (re)myelinating drugs available in clinics. In our present study, we studied the effect of ApTOLL on different animal models of MS. EXPERIMENTAL APPROACH: The experimental autoimmune encephalomyelitis (EAE) model was used to evaluate the effect of ApTOLL on reducing the inflammatory component. A more direct effect on oligodendroglia was studied with the cuprizone model and purified primary cultures of murine and human oligodendrocyte precursor cells (OPCs) isolated through magnetic-activated cell sorting (MACS) from samples of brain cortex. Also, we tested these effects in an ex vivo model of organotypic cultures demyelinated with lysolecithin (LPC). KEY RESULTS: ApTOLL treatment positively impacted the clinical symptomatology of mice in the EAE and cuprizone models, which was associated with better preservation plus restoration of myelin and oligodendrocytes in the demyelinated lesions of animals. Restoration was corroborated on purified cultures of rodent and human OPCs. CONCLUSION AND IMPLICATIONS: Our findings reveal a new therapeutic approach for the treatment of inflammatory and demyelinating diseases such as MS. The molecular nature of the aptamer exerts not only an anti-inflammatory effect but also neuroprotective and remyelinating effects. The excellent safety profile demonstrated by ApTOLL in animals and humans opens the door to future clinical trials in MS patients.

Adult intestinal malrotation: imaging findings.

Intestinal malrotation is the most common congenital anomaly of the small intestine. However, it is associated with delayed diagnosis due to the lack of specificity of its symptoms, which can lead to devastating consequences such as intestinal volvulus or massive intestinal necrosis. We present a clinical case in which we highlight the importance of abdominal computed tomography and the detection of its characteristic signs for the early identification of this pathology.

Diazoxide and moderate-intensity exercise improve skeletal muscle function by decreasing oxidants and enhancing antioxidant defenses in hypertensive male rats.

High sodium intake is decisive in the incidence increase and prevalence of hypertension, which has an impact on skeletal muscle functionality. Diazoxide is an antihypertensive agent that inhibits insulin secretion and is an opener of KATP channels (adosine triphosphate sensitive potasium channels). For this reason, it is hypothesized that moderate-intensity exercise and diazoxide improve skeletal muscle function by reducing the oxidants in hypertensive rats. Male Wistar rats were assigned into eight groups: control (CTRL), diazoxide (DZX), exercise (EX), exercise + diazoxide (EX + DZX), hypertension (HTN), hypertension + diazoxide (HTN + DZX), hypertension + exercise (HTN + EX), and hypertension + exercise + diazoxide (HTN + EX + DZX). To induce hypertension, the rats received 8% NaCl dissolved in water orally for 30 days; in the following 8 weeks, 4% NaCl was supplied to maintain the pathology. The treatment with physical exercise of moderate intensity lasted 8 weeks. The administration dose of diazoxide was 35 mg/kg intraperitoneally for 14 days. Tension recording was performed on the extensor digitorum longus and the soleus muscle. Muscle homogenates were used to measure oxidants using fluorescent probe and the activity of antioxidant systems. Diazoxide and moderate-intensity exercise reduced oxidants and increased antioxidant defenses.

Revealing the 1H-NMR Profiling of Six Edible Mushrooms Consumed in the Northeastern Highlands of Puebla, Mexico.

The 1H-NMR metabolomics profiling of six edible mushrooms consumed in the northeastern highlands of Puebla, Mexico is presented. These fungi were morpho- and molecularly identified as Infundibulicybe squamulosa, Amanita jacksonii, Lepista nuda, Russula delica, Russula brevipes, and Lactarius indigo. The chemical profiling confirmed the presence of eight essential amino acids and their derivatives, six organic acids, six nucleosides, low amounts of reducing sugars, and valuable nutraceuticals such as betaine, carnitine, glycero-3-phosphocholine and O-acetylcarnitine which were differentially determined and quantified in the six mushrooms by qNMR. Principal component analysis (PCA) and orthogonal projections to latent structures discriminant analysis (OPLS-DA) generated four different groups. Two of these groups were constituted by fungal species with phylogenic relationships whereas non-phylogenetic related species were separated from each other. The potential use of 1H-NMR metabolomics and chemometrics to group macromycetes and determine the nutritional and nutraceutical potential of these local foods is demonstrated.

Efficacy of a benzothiazole-based LRRK2 inhibitor in oligodendrocyte precursor cells and in a murine model of multiple sclerosis.

AIMS: Multiple sclerosis (MS) is a chronic neurological disease that currently lacks effective curative treatments. There is a need to find effective therapies, especially to reverse the progressive demyelination and neuronal damage. Oligodendrocytes form the myelin sheath around axons in the central nervous system (CNS) and oligodendrocyte precursor cells (OPCs) undergo mechanisms that enable spontaneously the partial repair of damaged lesions. The aim of this study was to discover small molecules with potential effects in demyelinating diseases, including (re)myelinating properties. METHODS: Recently, it has been shown how LRRK2 inhibition promotes oligodendrogliogenesis and therefore an efficient repair or myelin damaged lesions. Here we explored small molecules inhibiting LRRK2 as potential enhancers of primary OPCs proliferation and differentiation, and their potential impact on the clinical score of experimental autoimmune encephalomyelitys (EAE) mice, a validated model of the most frequent clinical form of MS, relapsing-remitting MS. RESULTS: One of the LRRK2 inhibitors presented in this study promoted the proliferation and differentiation of OPC primary cultures. When tested in the EAE murine model of MS, it exerted a statistically significant reduction of the clinical burden of the animals, and histological evidence revealed how the treated animals presented a reduced lesion area in the spinal cord. CONCLUSIONS: For the first time, a small molecule with LRRK2 inhibition properties presented (re)myelinating properties in primary OPCs cultures and potentially in the in vivo murine model. This study provides an in vivo proof of concept for a LRRK2 inhibitor, confirming its potential for the treatment of MS.

Podiatric Skin and Nail Involvement and Biomechanical Pathology in Renal Transplant Recipients: Assessment of the Foot as a Contributing Factor to Their Health.

Although several studies show the prevalence of podiatric conditions in people with end-stage renal disease or renal replacement therapy with hemodialysis, there is little scientific literature on this when subjects are undergoing kidney transplantation. The aim of this study is to determine the prevalence of podiatric skin and nail pathology in renal transplant recipients. A descriptive, observational, prevalence study was conducted at the Nephrology Department of the University Hospital of A Coruña. A total of 371 subjects were studied. The variables studied were sociodemographic (age, sex), anthropometric (Body Mass Index), comorbidity (Charlson Comorbidity Index), and podological (skin and nail alterations). A high presence of skin (83.1%) and nail pathology (85.4%) was observed, with hyperkeratosis (68.8%), onychogryphosis (39.4%), and onychocryptosis (36.9%) being the most predominant alterations. Although it was not significant, patients with a higher risk of presenting podiatric pathology were of female sex and had a high BMI, and both age and the Charlson comorbidity index were significantly associated with this risk. There was an increased risk of both skin and nail pathology at older age and in the presence of diabetes mellitus.

Segundos tumores primarios y sus factores de riesgo en pacientes con tumores índice de cabeza y cuello / Second primary tumors and their risk factors in patients with primary head and neck tumors

Introducción y objetivo: El término de segundo tumor primario (STP) es utilizado para designar un nuevo cáncer primario que se presenta en una persona a la que se le ha diagnosticado un cáncer previamente. Se considera que los STP se producen de forma independiente y no como resultado de un resurgimiento o metástasis del tumor índice o primer tumor primario (PTP). El objetivo de este estudio es investigar la prevalencia, factores de riesgo, localización y tratamiento de los STP, así como el tiempo transcurrido entre la aparición de los tumores. Método: Se realiza un estudio retrospectivo descriptivo con pacientes con diagnóstico de STP entre enero del 2004 y diciembre de 2021 en el Hospital Universitario de Fuenlabrada. Se analizó la prevalencia y localización de los STP, los factores de riesgo relacionados, el tiempo entre la aparición del PTP y el STP, el tratamiento del PTP y STP y su resultado. Resultados: Del total de 360 casos del registro de tumores, 73 pacientes (20,2%) fueron incluidos en el estudio por padecer un STP. De los participantes, el 75% eran fumadores y el 46,6% bebedores. La mayor parte de estos pacientes fueron tratados quirúrgicamente. Se observó que el PTP con mayor desarrollo de STP fue el de cáncer de laringe, siendo la supraglotis la sublocalización más frecuente. El STP más frecuente fue el carcinoma epidermoide de pulmón. Conclusiones: En nuestra serie los STP aparecen en el 20% de los pacientes con tumores índice de cabeza y cuello. Son más frecuentes tras el cáncer de laringe, siendo la localización más frecuente el pulmón. Tanto el tabaco como el alcohol juegan un papel importante en su desarrollo, acortando el tiempo entre la aparición de los tumores, además de poder aparecer recidivas, persistencias y metástasis. (AU)

Introduction and objective: The term second primary tumor (SPT) is used to designate a new primary cancer that occurs in a person previously diagnosed with cancer. SPT are considered to occur independently and not as a result of a resurgence or metastasis of the index tumor or first primary tumor (FPT). The aim of this study is to investigate the prevalence, risk factors, location and treatment of STP, as well as time elapsed between tumor occurrence. Method: A retrospective descriptive study was performed including patients diagnosed with SPT between January 2004 and December 2021 at Hospital Universitario de Fuenlabrada. The prevalence and location of SPT, related risk factors, time between the onset of FPT and SPT, treatment of FPT and SPT and their outcome were analyzed. Results: From a total of 360 cases, 73 patients were included in the study because of SPT. 75% were smokers and 46.6% were drinkers. Most of these patients were treated surgically. It was observed that the FPT with the highest development of SPT was the larynx, with supraglottis being the most frequent sublocalization. The most frequent SPT was epidermoid carcinoma of the lung. Conclusions: In our series SPT appear in 20% of head and neck tumors. They are more frequent after laryngeal cancer, the most frequent location being the lung. Both tobacco and alcohol play an important role in their development, shortening the time between the appearance of tumors, in addition to the possibility of recurrence, persistence and metastasis. (AU)

Infiltración temprana en la parálisis laríngea: evolución y factores pronósticos / Early infiltration in laryngeal paralysis: course and prognostic factors

Introducción y objetivo: La parálisis de las cuerdas vocales (CCVV) es una patología prevalente e incapacitante. El objetivo principal de este estudio es comparar la recuperación de la movilidad y funcionalidad de las CCVV, así como el requerimiento de tiroplastia en dos grupos de pacientes, los que se trataron con infiltración temprana con ácido hialurónico (GIT) y los no infiltrados (GNI). Método: Estudio retrospectivo observacional. Para formar el GNI se filtró la base de datos de 715 exploraciones de parálisis laríngeas y se seleccionaron 33 pacientes que cumplieran los criterios de inclusión. Para el GIT se incluyeron a los pacientes infiltrados por parálisis laríngea en los últimos 3 años (n=22). En el GNI se analizó como medida de resultado: la recuperación de la movilidad y funcionalidad de la cuerda y la necesidad de tiroplastia. En el GIT se midió, adicionalmente, la fecha de la infiltración. Resultados: Los resultados del GIT son significativamente mejores (p=0.001) en la recuperación de la movilidad de las CCVV. Se observa una reducción no significativa (p=0.14) en la necesidad de tiroplastia en los pacientes infiltrados. Existen diferencias significativas entre los pacientes con parálisis unilateral del GNI vs GIT (p=0.009), mientras que los grupos con parálisis bilaterales no son comparables entre sí, debido al compromiso de la vía aérea que sufren los pacientes con la cuerda en posición medial. Discusión: La infiltración con ácido hialurónico proporciona el tratamiento temporal del defecto de cierre glótico con baja tasa de complicaciones, prolongando el tiempo máximo de fonación y la funcionalidad de la cuerda vocal parética, pudiendo reducir tratamientos posteriores. Se ha propuesto como un tratamiento que puede mejorar la calidad de vida del paciente. Sin embargo, es importante seleccionar adecuadamente los pacientes, ya que no todos pueden ser candidatos... (AU)

Introduction and objective: Vocal cord paralysis is a prevalent and disabling pathology. The main objective is to compare the recovery of movility and functionality of vocal cords, as well as the requirement of definitive surgery in two groups of patients: non-infiltrated group (NIG) versus early infiltration group with hyaluronic acid (EIG). Method: Retrospective observational study. To set up the NIG, we sorted the database of 715 videos labeled as “laryngeal paralysis” and selected n=33 patients who met the inclusion criteria of the study. To create the EIG, we selected patients injected with hyaluronic acid in the last 3 years (n=22). In the NIG, the following were analyzed as outcome measures: recovery of mobility and functionality of the cord and the need for thyroplasty. In the EIG, the date of infiltration was also measured. Results: The results of the EIG are significantly better (p=0,001) in terms of vocal cord mobility recovery. A non-significant reduction (p=0.14) was observed in the need for thyroplasty in injected patients. There are significant differences between patients with unilateral paralysis of the NIG vs EIG (p=0.009), while the bilateral groups are not comparable, due to the compromise of the airway suffered by patients with the cord in a medial position. Discussion: Early infiltration with hyaluronic acid provides temporary treatment of the glottic closure defect with a low rate of complications, prolonging the maximum phonation time and improving the vocal movement, which may reduce the need for subsequent treatments. It has been proposed as a treatment that can improve the patient’s quality of life. However, it is important to properly select patients, since not all may be candidates... (AU)

Tratamiento quirúrgico de la patología tumoral de la glándula parótida. Estudio descriptivo de 263 parotidectomías / Surgical treatment of tumor pathology of the parotid gland. Descriptive study of 263 parotidectomies

Introducción y objetivo: Los tumores salivales representan el 3-10% de los tumores de cabeza y cuello, siendo el 75-80% de origen parotídeo y en su mayoría benignos. La parotidectomía es una técnica quirúrgica que consiste en la exéresis de la glándula parótida. Existen diversos tipos; parotidectomía superficial (PS), parotidectomía superficial parcial (PSP) y parotidectomía total (PT). En esta última, al no respetarse el nervio facial (NF), las complicaciones son más frecuentes. Nuestro objetivo es analizar el resultado (tasa de recidiva y complicaciones) de la parotidectomía como técnica quirúrgica empleada en el manejo de la patología parotídea, así como evaluar qué prueba complementaria es la más eficaz en el diagnostico prequirúrgico de la patología parotídea tumoral. Material y método: Se realiza un estudio retrospectivo incluyendo 263 pacientes tratados mediante PS o PT entre enero de 2004 y diciembre de 2020 en el Hospital Universitario de Fuenlabrada. Se registraron datos demográficos, tiempo de evolución de la lesión, pruebas complementarias, protocolo quirúrgico y complicaciones postoperatorias. Se analiza principalmente la correlación positiva entre las pruebas realizadas prequirúrgicas (PAAF, ecografía, TC y RMN), con el diagnóstico definitivo anatomopatológico obtenido tras examinar la pieza quirúrgica. También se describe la tasa de paresia y parálisis facial y otras complicaciones habidas. Resultados: Se incluyeron 263 pacientes tratados mediante parotidectomía. El tiempo de evolución medio de las lesiones parotídeas fue de 15 meses (DE 19.88). La sensibilidad de la PAAF en nuestro estudio fue de 68.7%. Se realizó ecografía en un 44.10% de los pacientes, TC en un 77.94% y RMN en un 15.20%, mostrando una sensibilidad de 18.05%, 31.21% y 45%, respectivamente. (AU)

Introduction and objetive: Salivary tumors account for 3-10% of head and neck tumors, 75-80% being of parotid origin and mostly benign. Parotidectomy is a surgical technique that consists of exeresis of the parotid gland. There are various types; Superficial parotidectomy (PS), partial superficial parotidectomy (PSP), and total parotidectomy (PT). In the latter, since the facial nerve (FN) is not spared, complications are more frequent. Our objective is to analyze the outcome (recurrence rate and complications) of parotidectomy as a surgical technique used in the management of parotid pathology, as well as to evaluate which complementary test is the most effective in the pre-surgical diagnosis of tumorous parotid pathology. Material and methods: We performed a retrospective study including 263 patients treated by SP or TP between January 2004 and December 2020 at the Fuenlabrada University Hospital. Demographic data, time of lesion evolution, complementary tests, surgical protocol and postoperative complications were recorded. The positive correlation between the pre-surgical tests performed (Fine needle aspiration (FNA), ultrasound, CT and MRI) and the definitive anatomopathological diagnosis obtained after examining the surgical specimen is analyzed. The rate of paresis/facial paralysis and other complications is also described. Results: We included 263 patients treated by parotidectomy. (AU)

Comparación de los test Aptima MG y Cobas TV/MG para la detección de Mycoplasma genitalium en muestras urogenitales y extragenitales / Comparison of the Aptima MG and Cobas TV/MG tests for the detection of Mycoplasma genitalium in urogenital and extragenital samples

Introducción: Mycoplasma genitalium (M. genitalium) es un patógeno de transmisión sexual emergente de importancia creciente. El objetivo de este estudio fue comparar dos test para la detección de M. genitalium; el test de Aptima® MG (Hologic® Inc., San Diego, CA, EE. UU.) y el test Cobas® TV/MG (Roche® Diagnostics, Mannheim, Alemania). Métodos: Se trata de un estudio descriptivo prospectivo donde se analizaron en paralelo y en orden aleatorio por ambos sistemas un total de 489 muestras genitales y extragenitales de pacientes procedentes del Centro de Infecciones de Transmisión Sexual en Sevilla y de las Consultas de Enfermedades Infecciosas del Hospital Virgen de Valme. Resultados: La concordancia global entre ambos ensayos fue muy buena (k >0,91). La sensibilidad y la especificidad del test Aptima® MG fueron del 100 y el 98,7% respectivamente, y del 100 y del 99,8%, respectivamente, para el test Cobas® TV/MG. Conclusión: Ambos sistemas mostraron un rendimiento excelente para la detección de M. genitalium.(AU)

Background: Mycoplasma genitalium (M. genitalium) is an emerging sexually transmitted pathogen of increasing importance. The objective of this study was to compare twotests for the detection of M. genitalium; the Aptima® MG test (Hologic® Inc., San Diego, CA) and the Cobas® TV/MG test (Roche® Diagnostics, Mannheim, Germany). Methods: This is a prospective descriptive study where a total of 489 genital and extragenital samples were analyzed in parallel and in random order by both systems. The samples were collected from patients attending the Sexually Transmitted Infections Center in Seville and the Infectious Diseases consultation of the Virgen de Valme Hospital. Results: The overall agreement between both trials was very good (k>0.91). The sensitivity and specificity of the Aptima® MG test were 100% and 98.7% respectively for the Cobas® TV/MG test. Conclusion: Both systems showed excellent performance for the detection of M. genitalium.(AU)

Comparison of the Aptima MG and Cobas TV/MG tests for the detection of Mycoplasma genitalium in urogenital and extragenital samples.

BACKGROUND: Mycoplasma genitalium (M. genitalium) is an emerging sexually transmitted pathogen of increasing importance. The objective of this study was to compare two tests for the detection of M. genitalium; the Aptima® MG test (Hologic® Inc., San Diego, CA) and the Cobas® TV/MG test (Roche® Diagnostics, Mannheim, Germany). METHODS: This is a prospective descriptive study where a total of 489 genital and extragenital samples were analyzed in parallel and in random order by both systems. The samples were collected from patients attending the Sexually Transmitted Infections Center in Seville and the Infectious Diseases consultation of the Virgen de Valme Hospital. RESULTS: The overall agreement between both trials was very good (k > 0.91). The sensitivity and specificity of the Aptima® MG test were 100% and 98.7% respectively for the Cobas® TV/MG test. CONCLUSION: Both systems showed excellent performance for the detection of M. genitalium.

Atypical ocular Chlamydia trachomatis infections in two patients attending in a second-level hospital: a case report.

AIM: To report two atypical inclusion conjunctivitis cases due to Chlamydia trachomatis in young adults. METHOD: Transcription mediated amplification for C. trachomatis was performed using Aptima Combo 2 Assay (Hologic, Spain). RESULTS: The first patient was managed as an orbital disorder because he had unilateral location, and ptosis was observed. Orbital nuclear magnetic resonance revealed normal results, and conjunctival biopsy did not indicate significant results. For the second patient, thyroid eye disease was suspected, but the orbital nuclear magnetic resonance revealed normal results. Conjunctival exudate samples were collected and sent to the Microbiology Laboratory where C. trachomatis was confirmed. Both patients demonstrated a great improvement with oral azithromycin 1 g. CONCLUSION: Inclusion conjunctivitis could present as unspecified unilateral or bilateral chronic conjunctivitis. Thus, suspecting it would be important in order to prevent spread and wasting diagnostic resources.

Fístula traumática de líquido cefalorraquídeo tras realización de test PCR mediante hisopo nasal para el diagnóstico de COVID-19. Revisión sistemática / Traumatic cerebrospinal fluid leak after performing PCR test using a nasal swab for the detection of COVID-19 disease. A Systematic review

Introducción y objetivo: Las fístulas de líquido cefalorraquídeo (LCR) pueden producirse tras un traumatismo, esto conlleva una disrupción entre la aracnoides y la duramadre, frecuentemente asociado a un defecto óseo. La epidemia mundial producida por la COVID-19 ha generado la necesidad de disponer de test rápidos para la detección del virus en mucosa nasal y orofaríngea. Los hisopos nasales (HN) han demostrado ser útiles a la hora de recoger muestras nasofaríngeas y por lo tanto se ha generalizado su uso. Este método diagnostico se considera seguro, pero existen una serie de posibles complicaciones entre las que se encuentra una de las más temidas; la fístula de LCR. El objetivo de este artículo es realizar una revisión bibliográfica exhaustiva de artículos disponibles que describan esta complicación, investigando los factores predisponentes y a su vez describir una técnica segura para evitarla.Método: Se realizaron búsquedas en las bases de datos de PubMed, Web of Science y Scopus de acuerdo con las pautas de PRISMA desde marzo de 2020 hasta noviembre de 2021. Se revisaron los estudios que informaron datos clínicos de pacientes con fistulas de LCR tras ser sometidos a frotis nasales mediante hisopos. Nos centramos en los síntomas de alarma presentados, las estrategias diagnosticas y el manejo terapéutico. Resultados: Hasta la fecha se han reportado once casos publicados de pacientes con diagnostico de fistula de LCR segundaria a la realización de test PCR mediante HN. En esta revisión sistemática se incluyen estos artículos. (AU)

Introduction and objective: Cerebrospinal fluid leaks (CSF) can occur after trauma, this leads to a disruption between the arachnoid and the dura, frequently associated with a bone defect. The global epidemic produced by COVID-19 has generated the need for rapid tests to detect the virus in the nasal and oropharyngeal mucosa. Nasal swabs (NS) have proven to be useful in collecting nasopharyngeal specimens and therefore their use has become widespread. This diagnostic method is considered safe, but there are a number of possible complications, including one of the most feared; CSF leak. The objective of this article is to carry out an exhaustive bibliographic review of available articles that describe this compli-cation, investigating the predisposing factors and describe a safe technique to avoid it. Method: PubMed, Web of Science and Scopus databases were searched according to PRISMA guidelines, from March 2020 to November 2021. Studies reporting clinical data of patients with CSF leak after being subjected to NS were reviewed. We focus on the alarm symptoms presented, diagnostic strategies and therapeutic management. Results: To date, eleven published cases have been reported of patients with a diagnosis of CSF leaks caused by performig a PCR test using a nasal swab. All the articles were included in this systematic review. Each article described this complication in one patient, so we have a total of eleven patients. The average age at diagnosis was 45 years, with 8 women and 3 men. The cribriform plate is the most frequently affected anatomical location. In five patients, 45,5%, the preexistance of malformation at the level of the skull base was known, which corresponds to a risk factor when suffering a CSF leaks after NS. (AU)

Fístula de líquido cefalorraquídeo traumática tras realización de test PCR mediante hisopo nasal para la detección de COVID-19. Descripción de un caso / Traumatic cerebrospinal fluid leak after performing PCR test using a nasal swab for the detection of COVID-19 disease. A case report

Introducción y objetivo: Las fístulas de líquido cefalorraquídeo (LCR) pueden producirse tras un traumatismo, esto conlleva una disrupción entre la aracnoides y la duramadre, frecuentemente asociado a un defecto óseo. La epidemia mundial producida por la COVID-19 ha generado la necesidad de disponer de test rápidos para la detección del virus en mucosa nasal y orofaríngea. Los hisopos nasales (HN) han demostrado ser útiles a la hora de recoger muestras nasofaríngeas y por lo tanto se ha generalizado su uso. El objetivo de este artículo recae en describir una potencial complicación del test PCR mediante HN, como es la fístula de LCR, mediante el reporte de un caso clínico. Método: Se expone el caso de una paciente que sufre una fístula de LCR tras realización de test PCR mediante HN, se explica el diagnostico y manejo detallando las pruebas complementarias y el tratamiento final. Discusión: La fístula de LCR es una complicación poco frecuente de los test con HN. A pesar de esto, existen y hay que pensar en ella ante una rinorrea unilateral persistente tras realizar este test. En la actualidad tan sólo hay escasos casos en la publicados literatura que describan esta complicación. Conclusiones: Aunque la prueba de HN para diagnostico de la COVID-19 se considera segura, en ocasiones puede conllevar complicaciones. La aparición de rinorrea clara unilateral o goteo post nasal de sabor salado o metálico tras la realización de un HN nos debe poner en alerta a la hora de diagnosticar una posible fístula de LCR. Es de suma importancia instruir adecuadamente al personal sanitario que realiza el test, indicando la dirección y orientación correcta del hisopo. Además, se debe informar al paciente sobre los síntomas y signos de alarma. En pacientes con alteraciones previas de la base del cráneo, distorsión de la anatomía nasal o cirugías previas nasosinusales puede ser recomendable utilizar en ellos otro tipo de pruebas disponibles para diagnosticar la COVID-19. (AU)

Introduction and objective: Cerebrospinal fluid leaks can occur after trauma, this leads to a disruption between the arachnoid and the dura, frequently associated with a bone defect. The global epidemic produced by COVID-19 has generated the need for rapid tests to detect the virus in the nasal and oropharyngeal mucosa. Nasal swabs (NS) have proven to be useful in collecting nasopharyngeal specimens and therefore their use has become widespread. The objective of this article is to describe a potential compli-cation of the NS PCR test, such as cerebrospinal fluid (CSF) leaks, by reporting a clinical case. Method: The case of a patient who suffers a CSF leak after performing a PCR test using a NS is presented, the diagnosis and management are explained, detailing the complementary tests and the final treatment. Discussion: CSF leaks is a rare complication of NS tests. Despite this, persistent unilateral rhinorrhea does exist and should be considered first after performing this test. Currently, there are few cases published in the literature that describe this possible complication. Conclusions: Although the NS test for the diagnosis of COVID-19 is considered safe, it can sometimes lead to complications. The appearance of unilateral clear rhinorrhea or post-nasal drip with a salty or metallic taste after performing a NS should alert us when diagnosing a possible CSF leak. It is extremely important to adequately instruct the health workers to perform the test, indicating the correct direction and orientation of the swab. In addition, the patient should be informed of the warning signs and symptoms. In patients with previous skull base alterations, distortion of the nasal anatomy or previous sinus surgeries, it may be advisable to use other types of tests available to diagnose COVID-19. (AU)

Microorganisms and Antibiotic Resistance of Bacterial Keratitis at a Rural County Hospital in Seville.

PURPOSE: To review the incidence, resistance patterns, and management of bacterial keratitis during the past 4 years. METHODS: We retrospectively reviewed the clinical records of microbiological isolates from patients with a clinical diagnosis of bacterial keratitis. RESULTS: A total of 159 patients were analyzed, and 102 microorganisms were isolated from 129 cultures. In these cultures, 23.7% of the microorganisms were gram positive, 60.8% were gram negative, and 15.5% were fungi. Pseudomonas aeruginosa was the most common bacteria (9.2%), followed by Serratia marcescens (4.4%) and Staphylococcus aureus (4%). Resistance to fluoroquinolones and aminoglycosides was found to be 23.1% and 53.1% in gram-positive and 2.8% and 13.9% in gram-negative bacteria, respectively. Resistance to ceftazidime against gram-negative bacteria was 13.9%. No resistance to vancomycin was observed. CONCLUSIONS: A high resistance rate to aminoglycosides and fluoroquinolones was observed in gram-positive bacteria. We concluded that fluoroquinolones or aminoglycosides may not be suitable for initial monotherapy in patients with severe bacterial keratitis.

Enfermedad arterial periférica en pacientes trasplantados renales. Validez del cuestionario de Edimburgo para el diagnóstico de enfermedad / Peripheral arterial disease in renal transplant patients. Validity of the Edinburgh questionnaire for disease diagnosis

RESUMEN Objetivos: Determinar en pacientes trasplantados renales la prevalencia de enfermedad arterial periférica y la validez de las manifestaciones clínicas de claudicación intermitente para su diagnóstico. Material y métodos: Ámbito y período: Servicio de Nefrología del Complejo Hospitalario Universitario A Coruña, 2013-2017. Criterios inclusión: pacientes trasplantados renales con injerto funcionante que consientan participar en el estudio. Justificación del tamaño muestral: n=371 pacientes (seguridad= 95% y precisión= ± 4,25%). Mediciones: edad, edad al trasplante, sexo, dislipemia, índice de masa corporal, tabaquismo, diabetes, signo de Godet, edema perimaleolar, índice tobillo-brazo y cuestionario Edimburgo. El riesgo cardiovascular se midió mediante los scores Framingham-Wilson, Regicor, SCORE y Dorica. Resultados: La edad media al trasplante fue de 47,86 ± 12,62 años, 65,5% hombres. El 8,7% de los pacientes presentan un índice tobillo-brazo <0,90. El 16,2% de los pacientes manifiestan claudicación intermitente según el cuestionario Edimburgo. La concordancia entre ambas pruebas diagnósticas es débil (índice de Kappa=0,34). El cuestionario de Edimburgo mostró sensibilidad del 59,38% para predecir índice tobillo-brazo <0,90 y especificidad del 88,10%. Las variables asociadas a la presencia de arteriopatía son la edad al trasplante (OR=1,07) y el tabaquismo (OR=6,17), encontrándose la dislipemia en el límite de la significación estadística. Conclusiones: Una décima parte de los pacientes presentan arteriopatía periférica. La concordancia entre el cuestionario Edimburgo y el índice tobillo-brazo es débil. Por lo que debería usarse el índice tobillo-brazo como método diagnóstico. Las manifestaciones clínicas infraestiman la prevalencia de arteriopatía. La edad, el tabaquismo y la dislipemia incrementan su riesgo. Los pacientes con arteriopatía presentan riesgo cardiovascular más elevado.

ABSTRACT Objectives: To assess the prevalence of peripheral artery disease in kidney transplant patients and the validity of intermittent claudication for its diagnosis. Methods: Setting and period: Nephrology Department of the University Hospital A. Coruña, 2013-2017. Inclusion criteria: transplant patients with functioning grafts who gave their consent to participate in the study. Sample size rationale: n=371 patients (confidence interval= 95%; precision= ± 4.25%). Measurements: age, age at the time of transplant, sex, dyslipemia, body mass index, smoking, diabetes, sign of Godet, perimalleolar edema, ankle-brachial index and the Edinburgh Questionnaire. Cardiovascular risk was measured with these scores: Framingham-Wilson, Regicore, SCORE and Dorica. Results: The mean age at the time of transplant was 47.86±12.62; 65.5% of patients were men and 8.7% of them had an ankle-brachial index of <0.90. When answering the Edinburgh Questionnaire, 16.2% of subjects reported suffering from intermittent claudication. Concordance between these two diagnostic tests is poor (kappa index= 0.34). The Edinburgh Questionnaire showed a sensitivity of 59.38% in predicting the ankle-brachial index (<0.90) and specificity (88.10%). The variables associated with the presence of artery disease are age at the time of transplant (OR=1.07) and smoking (OR=6.17), dyslipidemia being at the limit of statistical significance. Conclusions: A tenth part of the patients have peripheral artery disease. Concordance between the Edinburgh Questionnaire and the ankle-brachial index is poor; therefore, the latter should be used as diagnostic method. Clinical signs and symptoms underestimate the prevalence of artery disease. Age, smoking and dyslipidemia increase the risk of this disease. Artery disease patients have a higher cardiovascular risk.

Discordance of the Evaluation of the Plantar Footprint in Kidney Transplant.

BACKGROUND: The measures used for the diagnosis of biomechanical pathologic disorders are variable. The aim of this study was to determine the concordance between the Clarke angle and the Chippaux-Smirak and Staheli indices in evaluation of the footprints of kidney transplant patients. METHODS: An observational prevalence study was performed in kidney transplant patients in the University Hospital Complex A Coruña from 1981 through 2014. After obtaining patient informed consent and ethics committee approval, sociodemographic (age and sex) and anthropometric (body mass index) variables and comorbidity (Charlson Comorbidity Index score) were assessed for each patient, and a podiatric medical examination was performed of the footprint through a pedigree (Chippaux-Smirak index, Staheli index, and Clarke angle). A descriptive analysis of all of the variables was performed; for agreement, the kappa index and the Bland-Altman method were used. RESULTS: We found a predominance of male sex (65.6%) and a high level of overweight (43.3%) in the sample. The highest concordance between the indices studied is presented by the Chippaux-Smirak index, with a kappa index of 0.86 for the left foot and 0.76 for the right foot. CONCLUSIONS: High agreement was attained among observers in measurements of the footprints of kidney transplant patients.

Effects of Apocynin on Heart Muscle Oxidative Stress of Rats with Experimental Diabetes: Implications for Mitochondria.

Diabetes mellitus (DM) constitutes one of the public health problems today. It is characterized by hyperglycemia through a defect in the ß-cells function and/or decreased insulin sensitivity. Apocynin has been tasted acting directly as an NADPH oxidase inhibitor and reactive oxygen species (ROS) scavenger, exhibiting beneficial effects against diabetic complications. Hence, the present study's goal was to dissect the possible mechanisms by which apocynin could mediate its cardioprotective effect against DM-induced oxidative stress. Male Wistar rats were assigned into 4 groups: Control (C), control + apocynin (C+A), diabetes (D), diabetes + apocynin (D+A). DM was induced with streptozotocin. Apocynin treatment (3 mg/kg/day) was applied for 5 weeks. Treatment significantly decreased blood glucose levels and insulin resistance in diabetic rats. In cardiac tissue, ROS levels were higher, and catalase enzyme activity was reduced in the D group compared to the C group; the apocynin treatment significantly attenuated these responses. In heart mitochondria, Complexes I and II of the electron transport chain (ETC) were significantly enhanced in the D+A group. Total glutathione, the level of reduced glutathione (GSH) and the GSH/ oxidized glutathione (GSSG) ratio were increased in the D+A group. Superoxide dismutase (SOD) and the glutathione peroxidase (GSH-Px) activities were without change. Apocynin enhances glucose uptake and insulin sensitivity, preserving the antioxidant defense and mitochondrial function.