Chronic diarrhea secondary to canine leishmaniosis: Case series.

Chronic diarrhea is a clinical sign associated with canine leishmaniosis, varying from 3 % to 30 % of prevalence. However, its occurrence in dogs has been mostly associated with chronic kidney or liver disease. Leishmania organisms can cause inflammation of the digestive tract with chronic diarrhea as the only clinical manifestation, although it has been poorly documented in dogs. The aim of this retrospective observational study was to describe dogs with chronic diarrhea as the main clinical sign associated with leishmaniosis. All cases had a complete blood count, biochemistry, urinalyses, and diagnostic tests for leishmaniosis. Exclusion criteria included renal or hepatic disease and/or previous diagnosis of gastrointestinal disease. Twenty-three dogs were included. Small bowel diarrhea was present in 7/23 (30.4 %), large bowel diarrhea in 9/23 (39.2 %) and mixed diarrhea in 7/23 (30.4 %). Gastrointestinal biopsies were performed in 8/23 dogs and Leishmania amastigotes were found in all of them. In the others, leishmaniosis was diagnosed by serology in 10/15 dogs (66.7 %), serology plus blood PCR in 3/15 (20.0 %), lymph node cytology in 1/15 (6.7 %), and blood PCR in 1/15 (6.7 %). All dogs treated had a complete resolution of diarrhea with specific treatment for leishmaniosis alone, based on meglumine antimoniate (75-100 mg/kg SID SC for 1 month) plus allopurinol (10 mg/kg BID PO ≥ 6 months). This study suggests that leishmaniosis should be also included in the differential diagnosis of dogs from endemic areas presenting with the primary problem of large-bowel, small-bowel, or mixed-bowel chronic diarrhea.

Cambios en el tratamiento y disminución de la mortalidad del síndrome aórtico agudo. Lecciones del Registro Español del Síndrome Aórtico Agudo (RESA) / Spanish Registry of Acute Aortic Syndrome (RESA). Changes in therapeutic management and lower mortality in acute aortic syndrome

Introducción y objetivos El Registro Español del Síndrome Aórtico Agudo (RESA) se inició en 2005 para valorar las características del síndrome aórtico agudo (SAA) en nuestro país. El objetivo es analizar las diferencias en las características, el abordaje y el tratamiento y la mortalidad observadas entre las 3 ediciones del RESA. Métodos Se analizaron los datos de los pacientes con SAA incluidos prospectivamente por 24-30 hospitales terciarios en las 3 ediciones: RESA I (2005-2006), RESA II (2012-2013) y RESA III (2018-2019). Resultados Se incluyó a 1.902 pacientes (el 74% varones; media de edad, 60,7± 12,5 años), 1.329 (69,9%) tipo A y 573 (30,1%) tipo B. Comparando los RESAS, la tomografía computarizada aumentó como técnica diagnóstica (el 77,1, el 77,9 y el 84,2% respectivamente; p=0,001). El tratamiento quirúrgico del SAA tipo A aumentó (el 79,6, el 78,7 y el 84,5%; p=0,045) y la mortalidad total disminuyó (el 41,2, el 34,5 y el 31,2%; p=0,002), coincidiendo con una reducción de la mortalidad quirúrgica (el 33,4, el 25,1 y el 23,9%; p=0,003). En el tipo B, el tratamiento endovascular aumentó (el 22,8, el 32,8 y el 38,7%; p=0,006). La mortalidad total del SAA tipo B disminuyó (el 21,6, el 16,1 y el 12,0%; p=0,005) como consecuencia de la reducción de la mortalidad de los tratamientos médico (el 16,8, el 13,8 y el 8,8%; p=0,030) y endovascular (el 27,0, el 18,0 y el 9,2%; p=0,009). Conclusiones El RESA evidencia una disminución de la mortalidad del SAA tipo A coincidiendo con un incremento del tratamiento quirúrgico y una reducción de su mortalidad. En el SAA tipo B, el tratamiento endovascular se asocia con un aumento de la supervivencia, ya que permite una mejor estrategia terapéutica para los pacientes con complicaciones (AU)

Introduction and objectives The Spanish Registry of Acute Aortic Syndrome (RESA) was launched in 2005 to identify the characteristics of acute aortic syndrome (AAS) in Spain. The aim of this study was to analyze the differences in management and mortality in the 3 RESA iterations. Method We analyzed data from patients with AAS prospectively included by 24 to 30 tertiary centers during the 3 iterations of the registry: RESA I (2005-2006), RESA-II (2012-2013), and RESA III (2018-2019). Result AAS was diagnosed in 1902 patients (74% men; age, 60.7±12.5 years): 1329 (69.9%) type A and 573 (30.1%) type B. Comparison of the 3 periods revealed that the use of computed tomography increased as the first diagnostic technique (77.1%, 77.9%, and 84.2%, respectively; P=.001). In type A, surgical management increased (79.6%, 78.7%, and 84.5%; P=.045) and overall mortality decreased (41.2%, 34.5%, and 31.2%; P=.002), due to a reduction in surgical mortality (33.4%, 25.1%, and 23.9%; P=.003). In type B, endovascular treatment increased (22.8%, 32.8%, and 38.7%; P=.006), while medical and surgical treatment decreased. Overall type B mortality also decreased (21.6%, 16.1%, and 12.0%; P=.005) in line with a reduction in mortality with medical (16.8%, 13.8%, and 8.8%, P=.030) and endovascular (27.0%, 18.0%, and 9.2%; P=.009) treatments. Conclusion The iterations of RESA show a decrease in mortality from type A AAS, coinciding with an increase in surgical treatment and a reduction in surgical mortality. In type B, the use of endovascular treatment was associated with improved survival, allowing better management in patients with complications (AU)

Antropometría nutricional en la España de mediados del siglo XX. Medidas comparadas de estudiantes y reclutas / Nutritional anthropometry in mid-20th century Spain. Comparativemeasurements of students and recruits

Introducción: La talla y el perímetro torácico son indica-dores del estado de salud y bienestar de una población.Dichas medidas antropométricas dependen de agentes socio-económicos, nutricionales y ambientales. Objetivos: Analizar la estatura y el perímetro del tórax delos reclutas de diferentes provincias españolas en la décadade los 50 del pasado siglo. Asimismo, comparar dichas medi-das corporales con las de los estudiantes del mismo períodode tiempo. Material y Métodos: Se parte de dos muestras, una de2421 sujetos de los reclutamientos de 1950 a 1953 de dife-rentes provincias españolas y la otra, de 957 estudiantes va-rones de 23 a 33 años. Se confrontaron talla y perímetro to-rácico de los reclutas de las diferentes regiones. Secompararon dichas medidas entre soldados y estudiantes uni-versitarios. Resultados: Las estaturas más elevadas de reclutas seencontraban en las zonas catalana y vasco-navarra y la me-nor correspondía a la castellano-leonesa. Los soldados galle-gos y vasco-navarros poseían un perímetro torácico estadísti-camente mayor que el de los andaluces y castellano-leoneses.Los estudiantes tienen un promedio de talla superior a la delos reclutas, tanto a nivel general como en la mayoría de lasregiones geográficas comparadas. Igualmente, el perímetrotorácico medio del alumnado universitario es mayor que el delos soldados, a nivel del conjunto de España y de todas las re-giones analizadas. Conclusiones: Los reclutas más altos eran los del norestey los de mayor tórax, los de la zona septentrional de España.Las medidas de estudiantes fueron mayores que las de los dereclutas.(AU)

Introduction: Stature and thoracic perimeter are indica-tors of health and wellbeing status of a population. These an-thropometric measures are affected by socioeconomic, nutri-tional and environmental factors. Objectives: To analyze the stature and thoracic perime-ter of the recruits of different Spanish provinces in the decadeof the ‘50s of the last century. Also to compare these bodymeasurements with those of the students of the same period. Methods: This study was based on two samples, one com-posed of 2421 recruits conscripted between 1950 and 1953from different Spanish provinces. The second one featured956 male students aged 23-33. We collected the stature andthoracic perimeter of the recruits from different regions. Wecompared said measures between recruits and students. Results: The tallest recruits were found in the Catalan andBasque-Navarre areas and the shortest in the Castilian-Leonese area. Galician and Basque-Navarrese soldiers had astatistically greater thoracic perimeter than Andalusian andCastilian-Leonese soldiers. The students have a higher aver-age stature than the recruits, both overall and in most of thegeographical regions compared. Likewise, the average tho-racic perimeter of university students is greater than that ofsoldiers, at the level of Spain as a whole and of all the regionsanalyzed. Conclusion: The tallest recruits belonged to the northeastwhilst those with the largest thoracic perimeters were fromnorthern Spain. The measurements from students werehigher than those from the recruits.(AU)

Antioxidant activity of hydrated carboxylated nanodiamonds and its influence on water γ-radiolysis.

Water radiolysis involves chemical decomposition of the water molecule into free radicals after exposure to ionizing radiation. These free radicals have deleterious effects on normal cell physiology. Carboxylated nanodiamonds (cNDs) appear to modulate the deleterious effects of γ-irradiation on the pathophysiology of red blood cells (RBCs). In the present work, the antioxidant activity of hydrated cNDs (h-cNDs) on limiting oxidative damage (the water radiolysis effect) by γ-irradiation was confirmed. Our results show that h-cNDs have remarkable free radical scavenging ability and preserve the enzymatic activity of catalase after γ-irradiation. The underlying mechanism through which nanodiamonds exhibit antioxidant activity appears to depend on their colloidal stability. This property of detonation synthesized nanodiamonds is improved after carboxylation, which in turn influences changes in the hydrogen bond strength in water. The observed stability of h-cNDs in water and their antioxidant activity correlates with their protective effect on RBCs against γ-irradiation.

Valoración del cerebelo fetal mediante resonancia magnética / Evaluation of the fetal cerebellum by magnetic resonance imaging

La valoración del cerebelo fetal debe realizarse siempre por protocolo en las ecografías realizadas durante la gestación. Diferentes motivos como limitaciones técnicas o hallazgos ecográficos poco concluyentes han convertido la sospecha de patología del cerebelo fetal en una de las indicaciones más frecuentes de resonancia magnética (RM) prenatal. Aunque la ecografía fetal es la técnica de imagen de elección para su valoración, la RM muestra con mayor detalle la anatomía de la fosa posterior y las anomalías del desarrollo del cerebelo fetal, lo que permite un diagnóstico prenatal más preciso. Describimos la anatomía normal del cerebelo fetal mediante RM, así como las diferentes patologías que afectan a su normal desarrollo, y revisamos la terminología más apropiada para definirla, su diagnóstico diferencial y el papel de la RM en la evaluación prenatal de la fosa posterior (AU)

Obstetric protocols dictate that the fetal cerebellum should always be assessed during sonograms during pregnancy. For various reasons, including technical limitations or inconclusive sonographic findings, suspicion of cerebellar abnormalities is one of the most common indications for prenatal magnetic resonance imaging (MRI). Although sonography is the imaging technique of choice to assess the cerebellum, MRI shows the anatomy of the posterior fossa and abnormalities in the development of the fetal cerebellum in greater detail and thus enables a more accurate prenatal diagnosis. We describe and illustrate the normal anatomy of the fetal cerebellum on MRI as well as the different diseases that can affect its development. Moreover, we review the most appropriate terminology to define developmental abnormalities, their differential diagnoses, and the role of MRI in the prenatal evaluation of the posterior fossa (AU)

Evaluation of the fetal cerebellum by magnetic resonance imaging. / Valoración del cerebelo fetal mediante resonancia magnética.

Obstetric protocols dictate that the fetal cerebellum should always be assessed during sonograms during pregnancy. For various reasons, including technical limitations or inconclusive sonographic findings, suspicion of cerebellar abnormalities is one of the most common indications for prenatal magnetic resonance imaging (MRI). Although sonography is the imaging technique of choice to assess the cerebellum, MRI shows the anatomy of the posterior fossa and abnormalities in the development of the fetal cerebellum in greater detail and thus enables a more accurate prenatal diagnosis. We describe and illustrate the normal anatomy of the fetal cerebellum on MRI as well as the different diseases that can affect its development. Moreover, we review the most appropriate terminology to define developmental abnormalities, their differential diagnoses, and the role of MRI in the prenatal evaluation of the posterior fossa.

[Response to treatment with interferon beta in patients with multiple sclerosis. Validation of the Rio Score]. / Respuesta al tratamiento con interferon beta en pacientes con esclerosis multiple. Validacion del Rio Score.

INTRODUCTION: Different criteria have been proposed for the response to treatment with interferon beta, and the Rio Score is one of the most widely used. The aim of this study was to validate the usefulness of the Rio Score in an independent cohort. PATIENTS AND METHODS: A multi-centre, prospective, longitudinal study was conducted on patients with relapsing-remitting multiple sclerosis treated with interferon beta. The patients were classified according to the presence of attacks, active lesions (new in T2 or gadolinium enhancing lesions) in magnetic resonance imaging, a confirmed increase in disability or combinations of these variables (attacks, increase on the Expanded Disability Status Scale and active lesions) after one year's treatment. Regression analysis was used in order to identify the response-predicting variables after a three-year follow-up. RESULTS: The sample consisted of 249 patients with relapsing-remitting multiple sclerosis. The logistic model confirmed that the presence of two (odds ratio = 6.6; CI 95% = 2.7-16.1; p < 0.0001) or three (odds ratio = 8.5; CI 95% = 1.6-46; p < 0.01) positive variables during the first year of treatment were indicative of a significant risk of activity (attacks or progression) in the next two years. CONCLUSIONS: The usefulness of the Rio Score is confirmed, in an independent cohort, as a means of identifying patients with a higher risk of developing clinical activity or progression of disability during treatment with interferon beta.

TITLE: Respuesta al tratamiento con interferon beta en pacientes con esclerosis multiple. Validacion del Rio Score.Introduccion. Se han propuesto diferentes criterios de respuesta al tratamiento con interferon beta, y el Rio Score es uno de los mas utilizados. El objetivo de este estudio fue validar la utilidad del Rio Score en una cohorte independiente. Pacientes y metodos. Estudio multicentrico, prospectivo y longitudinal de pacientes con esclerosis multiple remitente recurrente tratados con interferon beta. Los pacientes fueron clasificados basandose en la presencia de brotes, lesiones activas (nuevas en T2 o lesiones que captaban gadolinio) en la resonancia magnetica, incremento confirmado de la discapacidad o combinaciones de estas variables (brotes, incremento en la Expanded Disability Status Scale y lesiones activas) tras un año de tratamiento. Se utilizo un analisis de regresion con el fin de identificar las variables de prediccion de respuesta despues de un seguimiento de tres años. Resultados. Se incluyo a 249 pacientes con esclerosis multiple remitente recurrente. El modelo logistico confirmo que la presencia de dos (odds ratio = 6,6; IC 95% = 2,7-16,1; p < 0,0001) o tres (odds ratio = 8,5; IC 95% = 1,6-46; p < 0,01) variables positivas durante el primer año de tratamiento conferia un riesgo significativo de actividad (brotes o progresion) en los siguientes dos años. Conclusiones. Se confirma, en una cohorte independiente, la utilidad del Rio Score para identificar a pacientes con un mayor riesgo de desarrollar actividad clinica o progresion de la discapacidad durante el tratamiento con interferon beta.

Congenital Harlequin syndrome as an isolated phenomenon: A case report and review of the literature.

UNLABELLED: Harlequin syndrome (HS) is a rare autonomic disorder due to a hemifacial cutaneous sympathetic denervation. It is characterized by unilateral diminished sweating and flushing of the face even though after heat or prolonged exercise. It is typically acquired. Congenital cases only represent a 6% of all individuals with HS. All congenital HS cases reported so far showed a concomitant Horner syndrome, probably due to a stellate ganglion involvement. HS represents an uncommon autonomic disorder due to a hemifacial cutaneous sympathetic denervation. It is clinically characterized by a dramatic alteration in facial appearance: ipsilateral denervated pale and dry half from the other intact red and moist half. CONCLUSION: We present, to the best of our knowledge, the first case of a patient with a congenital HS as an isolated phenomenon.

Effects of doxycycline on haematology, blood chemistry and peripheral blood lymphocyte subsets of healthy dogs and dogs naturally infected with Ehrlichia canis.

Canine monocytic ehrlichiosis (CME), caused by Ehrlichia canis, is a vector-borne disease with a worldwide distribution. It has been proposed that the pathogenesis, clinical severity and outcome of disease caused by Ehrlichia spp. can be attributed to the immune response rather than to any direct rickettsial effect. Moreover, doxycycline, the antimicrobial of choice for the treatment of CME, has immunomodulatory and anti-inflammatory properties associated with blood leukocyte proliferation function, cytokine synthesis, and matrix metalloproteinase activity. In order to assess the potential effects of doxycycline, dependent and independent of its antimicrobial activity, the present study compared changes in haematology, blood chemistry and circulating lymphocyte subpopulations in 12 healthy dogs and 20 dogs with CME after doxycycline therapy. Some changes were recorded only in the CME affected dogs, probably due to the antimicrobial effect of doxycycline. However, increases in mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration, platelet count and α2-globulins, and decreased plasma creatinine were observed in both healthy and CME affected dogs. The absolute count of B lymphocytes (CD21(+)) increased initially, but then decreased until the end of the study period in both groups. A potential effect of doxycycline unrelated to its antimicrobial activity against E. canis is suggested, taking into account the results observed both in healthy dogs and in dogs with CME.

Clinical characteristics and long-term outcomes of patients undergoing combined heart-kidney transplantation: a single-center experience.

BACKGROUND: The purpose of the study was to describe clinical characteristics and long-term survival of patients undergoing combined heart-kidney transplant in a single center. METHODS: We conducted a retrospective analysis of 22 consecutive patients who underwent combined heart-kidney transplant at our institution between 1995 and 2013. Long-term outcomes were analyzed by means of the Kaplan-Meier method. RESULTS: Four patients underwent re-do transplant (2 cardiac re-transplants, 1 kidney re-transplant, and 1 combined heart-kidney re-transplant). Most frequent underlying cardiac conditions were coronary artery disease (54%), dilated cardiomyopathy (23%), and chronic rejection of a previous heart graft (18%). Known causes of chronic renal dysfunction were nephroangioesclerosis (23%), drug-related toxicity (14%), and Wegener granulomatosis (5%). Non-specified chronic renal dysfunction was present in 50% patients. In-hospital postoperative mortality rate was 5 of 22 (23%). Causes of early death were directly related to kidney transplant surgery in 4 of 5 (80%) patients. Among the remaining 17 patients who surmounted the postoperative period, long-term survival rates 1 year, 5 years, and 10 years after HKT were 88%, 82%, and 65%, respectively. Over a mean follow-up of 6.7 ± 6.4 years, cumulative incidences of cytomegalovirus infection, coronary allograft vasculopathy, malignancy, and acute cardiac graft rejection were 41%, 6%, 24%, and 41%, respectively. There was no episode of acute renal graft rejection. At the end of follow-up, all survivors (n = 11) were in functional New York Heart Association class I. Mean creatinine serum level was 1.68 mg/dL. CONCLUSIONS: In our experience, combined heart-kidney transplant is a feasible therapeutic option that yielded favorable long-term outcomes, with a low cumulative incidence of cardiac graft dysfunction. These results were obtained at the expense of a significant risk of early postoperative mortality, which was mainly related to complications of kidney transplant surgery.

Quantum nonlocality. Detecting nonlocality in many-body quantum states.

Intensive studies of entanglement properties have proven essential for our understanding of quantum many-body systems. In contrast, much less is known about the role of quantum nonlocality in these systems because the available multipartite Bell inequalities involve correlations among many particles, which are difficult to access experimentally. We constructed multipartite Bell inequalities that involve only two-body correlations and show how they reveal the nonlocality in many-body systems relevant for nuclear and atomic physics. Our inequalities are violated by any number of parties and can be tested by measuring total spin components, opening the way to the experimental detection of many-body nonlocality, for instance with atomic ensembles.

Local orthogonality as a multipartite principle for quantum correlations.

In recent years, the use of information principles to understand quantum correlations has been very successful. Unfortunately, all principles considered so far have a bipartite formulation, but intrinsically multipartite principles, yet to be discovered, are necessary for reproducing quantum correlations. Here we introduce local orthogonality, an intrinsically multipartite principle stating that events involving different outcomes of the same local measurement must be exclusive or orthogonal. We prove that it is equivalent to no-signalling in the bipartite scenario but more restrictive for more than two parties. By exploiting this non-equivalence, it is then demonstrated that some bipartite supra-quantum correlations do violate the local orthogonality when distributed among several parties. Finally, we show how its multipartite character allows revealing the non-quantumness of correlations for which any bipartite principle fails. We believe that local orthogonality is a crucial ingredient for understanding no-signalling and quantum correlations.

Utilidad de las retinografías en el diagnóstico del edema macular diabético / Use of retinal photography in the diagnosis of diabetic macular edema

Objetivo: Determinar la validez de las retinografías en el diagnóstico del edema macular diabético. Fijar el número y amplitud de las fotografías necesarias para su correcto diagnóstico. Métodos: Estudio observacional transversal constituido por 650 ojos de pacientes con retinopatía diabética, a los que se realizó una combinación de retinografías (simples, estereoscópicas y luz aneritra), previa dilatación, para determinar su validez, en el diagnóstico del edema macular diabético. Se calcularon sensibilidad, especificidad, valores predictivo positivo y negativo, así como la concordancia con la prueba de referencia (tomografía de coherencia óptica). Las fotografías fueron evaluadas por tres expertos y sus resultados analizados con el programa estadístico SPSS 15.0 Windows. Resultados: Se obtuvieron valores de sensibilidad inferiores al 80% en el caso de fotografías simples, superando el 80% las retinografías estereoscópicas o aquellas que asocian filtros verdes, siendo la fotografía estereoscópica verde a 30° la que alcanzó mayor sensibilidad, próxima al 94,3%. La especificidad fue del 95% en el caso de fotografías estereoscópicas en color y aneritra a 45 y 30°, respectivamente. El valor predictivo positivo superior al 95% y negativo del 90% con un coeficiente de acuerdo del 80% y un grado de concordancia con la prueba de referencia superior al 80%. Conclusiones: Las retinografías estereoscópicas ofrecen resultados suficientes, como para ser utilizadas en el cribado del edema macular diabético. La utilización de filtros verde (luz aneritra) y su combinación con la agudeza visual mejora los resultados en el diagnóstico de esta enfermedad (AU)

Objective: To determine the validity of retinal photography in the diagnosis of diabetic macular edema. Determine the number and size of the photographs for its correct diagnosis. Methods: Cross-sectional observational study consisting of 420 eyes of patients with diabetic retinopathy, using a combination of retinography (simple, stereoscopic, red-free light), after expansion, to determine its validity in the diagnosis of diabetic macular edema. Sensitivity, specificity, positive and negative predictive values and the correlation with the gold standard test (optical coherence tomography) were calculated. The retinographs were evaluated by three experts and their results analyzed by the statistical program SPSS 15.0 Windows. Results: Sensitivities were below 80% in simple photographs and above 80% in the stereoscopic retinography, whereas those associated with red-free filters, reaching the 30° green stereoscopic photography, showed a sensitivity of 94.3%. The specificity was 95% in color and red-free stereoscopic retinography of 45° and 30°. The positive predictive value was greater than 95% and the negative value greater than 90% with a coefficient of agreement of 80%, and a degree of consistency with the benchmark of over 80%. Conclusions: The results of the stereoscopic retinographs are sufficient to enable them to be used in screening for diabetic macular edema. The use of a green filter and its combination with visual acuity improves results in the diagnosis of this disease (AU)

[Use of retinal photography in the diagnosis of diabetic macular edema]. / Utilidad de las retinografías en el diagnóstico del edema macular diabético.

OBJECTIVE: To determine the validity of retinal photography in the diagnosis of diabetic macular edema. Determine the number and size of the photographs for its correct diagnosis. METHODS: Cross-sectional observational study consisting of 420 eyes of patients with diabetic retinopathy, using a combination of retinography (simple, stereoscopic, red-free light), after expansion, to determine its validity in the diagnosis of diabetic macular edema. Sensitivity, specificity, positive and negative predictive values and the correlation with the gold standard test (optical coherence tomography) were calculated. The retinographs were evaluated by three experts and their results analyzed by the statistical program SPSS 15.0 Windows. RESULTS: Sensitivities were below 80% in simple photographs and above 80% in the stereoscopic retinography, whereas those associated with red-free filters, reaching the 30° green stereoscopic photography, showed a sensitivity of 94.3%. The specificity was 95% in color and red-free stereoscopic retinography of 45° and 30°. The positive predictive value was greater than 95% and the negative value greater than 90% with a coefficient of agreement of 80%, and a degree of consistency with the benchmark of over 80%. CONCLUSIONS: The results of the stereoscopic retinographs are sufficient to enable them to be used in screening for diabetic macular edema. The use of a green filter and its combination with visual acuity improves results in the diagnosis of this disease.

Percutaneous coronary interventions and bypass surgery in patients with cardiac allograft vasculopathy: a single-center experience.

INTRODUCTION: Cardiac allograft vasculopathy (CAV) remains a major impediment to long-term survival after heart transplantation (HT). Limited data exist regarding the impact of coronary revascularization in these patients. OBJECTIVE: To evaluate the outcomes of revascularization procedures in patients with CAV compared with patients who did not undergo revascularization. METHODS: Retrospective analysis of 249 patients who underwent HT at our center between June 1998 and December 2009 and who were examined by coronary angiography after HT. We included patients with moderate or severe CAV according to the International Society for Heart and Lung Transplantation (ISHLT) nomenclature to evaluated outcomes after revascularization or diagnostic angiography. Major adverse cardiovascular events (MACE) comprised death, acute coronary syndrome, coronary revascularization, admission because of heart failure not due to an acute rejection episode, and cardiac retransplantation. RESULTS: Moderate or severe CAV was detected in 43 patients. Twelve (27.9%) underwent coronary revascularization: eight percutaneous interventions and four bypass surgeries. Indications for revascularization were symptomatic ischemia or noninvasive evidence of ischemia (n = 6, 14.0%) or high-risk asymptomatic CAV (n = 6; 14.0%), namely, lesions located in the left main or proximal anterior descending arteries or multivessel disease with left ventricular dysfunction. The remaining 31 (72.1%), who did not undergo revascularization showed an absence of ischemia during exercise echocardiography (n = 11; 25.6%) or diffuse disease not amenable to revascularization (n = 20; 46.5%). During a mean follow-up of 3.0 ± 2.4 years, MACE occurred in three revascularized patients (25.0%), in one with absence of stress-induced ischemia (9.1%) and in 13 with nonrevascularizable disease (65%; P = .012). CONCLUSIONS: Revascularization procedures were effective in HT patients with evidence of ischemia or high-risk CAV. Patients with absence of stress-induced ischemia have a good prognosis without revascularization. On the other hand, diffuse nonrevascularizable CAV is associated with a poor prognosis.

SPECT-CT in the localization of an ectopic retropharyngeal parathyroid adenoma as a cause for persistent primary hyperparathyroidism.

A common cause for surgical failure of primary hyperparathyroidism (pHPT) is the non-detection of an ectopic adenoma during the intervention. We present a case of a patient with pHPT in whom an ectopic gland was found in the right retropharyngeal space by means of a double phase (99m)Tc-methoxy-isobutyl-isonitrile ((99m)Tc-MIBI) scintigraphy and early SPECT-CT after several surgeries and imaging tests. The addition of a tomography to the planar scintigraphy increases its sensitivity and improves pathological parathyroid glands localization. The hybrid imaging is sometimes essential to obtain surgical success, as in the case of ectopic adenomas.

Valor de la SPECT-TAC en la localización de un adenoma de paratiroides ectópico retrofaríngeo como causa de hiperparatiroidismo primario persistente / SPECT-CT in the localization of an ectopic retropharyngeal parathyroid adenoma as a cause for persistent primary hyperparathyroidism

Una causa frecuente de fracaso de la cirugía del hiperparatiroidismo primario (HPTp) es la existencia de un adenoma ectópico no detectado en la intervención. Presentamos a una paciente con HPTp en la que, tras sucesivas intervenciones y pruebas de imagen, se encuentra una glándula ectópica en el espacio retrofaríngeo derecho mediante gammagrafía de doble fase con 99mTc-metoxi-isobutil-isonitrilo (99mTc-MIBI) y SPECT-TAC precoz. La adición de una tomografía al estudio gammagráfico planar, aumenta su sensibilidad y mejora la localización de las paratiroides patológicas. En ciertas ocasiones, como es el caso de adenomas ectópicos, la imagen híbrida será esencial para conseguir el éxito quirúrgico(AU)

A common cause for surgical failure of primary hyperparathyroidism (pHPT) is the non-detection of an ectopic adenoma during the intervention. We present a case of a patient with pHPT in whom an ectopic gland was found in the right retropharyngeal space by means of a double phase 99mTc-methoxy-isobutyl-isonitrile (99mTc-MIBI) scintigraphy and early SPECT-CT after several surgeries and imaging tests. The addition of a tomography to the planar scintigraphy increases its sensitivity and improves pathological parathyroid glands localization. The hybrid imaging is sometimes essential to obtain surgical success, as in the case of ectopic adenomas(AU)

Condiciones de transporte de medicamentos en misiones internacionales de las Fuerzas Armadas. Diseño de un estudio de estabilidad especifico para operaciones / Conditions of drugs transportation in international missions of the Armed Forces. Design of a specific stability study of operations

Introducción: El abastecimiento de los recursos sanitarios es una parte crítica del apoyo sanitario en las operaciones de nuestras Fuerzas Armadas. El transporte de medicamentos y productos sanitarios se realiza por vía aérea. La regulación del medicamento exige que las condiciones de almacenamiento y transporte se efectúen de modo que su calidad se mantenga íntegra durante el periodo de validez del mismo, por lo que un trasporte de calidad no debe generar riesgos sobre los medicamentos, derivados de exposiciones a elevados grados de calor, frío, humedad, otros factores negativos, microorganismos o plagas. Podremos caracterizar, por tanto, las condiciones ambientales asociadas a un transporte mediante la medición de la Temperatura y la Humedad Relativa. Objetivo: Cualificación del transporte de medicamentos. Diseño de un Estudio de Estabilidad específico para Operaciones (EEO). Material y métodos: Se efectúa una monitorización de los transportes efectuados al ROLE 2 E (Herat) durante un ciclo anual. Se utilizan Data logger: LOG 32 con rango de medición -40 a +70°C y 0 a 100% HR y programa para cálculo de los parámetros de cualificación de los envíos, para la cualificación y evaluación del transporte. Distintos aparatos de laboratorio y sus correspondientes métodos para el ensayo de estabilidad. Paquete estadístico SPSS versión 15 para el tratamiento de resultados Las temperaturas máximas y mínimas registradas en los 18 transportes monitorizados, a lo largo de 13 meses, muestran valores que no rebasan los límites establecidos en el ensayo de estabilidad propuesto. La HR media se mantuvo, de manera habitual, durante el periodo monitorizado, en valores inferiores al 50%. Los resultados analíticos de los medicamentos sometidos al ensayo de estabilidad, basado en la aplicación de oscilaciones térmicas en diferentes ciclos, arrojan valores que se sitúan dentro de las especificaciones del producto terminado, no apreciándose diferencias significativas entre los productos testigo y los sometidos a variaciones térmicas, demostrándose que las oscilaciones de temperatura entre 2ºC y 50ºC establecidas para el ensayo, durante un periodo de 7 días, no afectan a las características de los medicamentos seleccionados en este estudio. Conclusiones: Evaluadas las características ambientales del transporte durante un ciclo anual, no se aprecian diferencias estacionales destacables entre los diferentes envíos. Desde el punto de vista ambiental, el transporte de medicamentos a Role 2E (Herat), resulta cualificado, demostrándose la calidad del mismo. Todos los elaborados fabricados en el Centro Militar de Farmacia de la Defensa, seleccionados en este estudio y que han sido sometidos al nuevo ensayo de estabilidad, se mantienen dentro de las especificaciones, por lo que no se observa alteración en la calidad de los mismos. Para el control del transporte de medicamentos a las Misiones Internacionales, se considerarán condiciones seguras de transporte, oscilaciones térmicas comprendidas entre 2°C y 50°C durante al menos 7 días (AU)

Introduction: The supply of medical materiel and pharmaceuticals is a critical part of medical support in our military operations. The transport of medical materiel and drugs is provided by Air. The drug regulation requires performed storage and transportation conditions so that its quality are maintained during the whole period of drug validity, so a quality transportation should not generate risks to drugs derived from high temperature, cold, humidity or other negative factors, such as microorganisms or pests. We characterize, therefore, the environmental conditions associated to the transport with the measurement of the temperature and relative humidity. Objective: Qualification of drug transport. Design of a specific stability study to Operations (SSO). Materials and Methods: Monitoring is performed for the drugs transport ROLE 2 E (Herat) during an annual cycle. Data logger are used: LOG 32 with measurement range -40 to +70 °C and 0 to 100% RH and program for calculating the parameters of qualified shipments for the qualification and evaluation of transport. Different laboratory equipments and their corresponding methods for stability testing. SPSS version 15 for the treatment of results. Results: The maximum and minimum recorded temperatures in the 18 transports monitored, during 13 months, show values that not exceed the limits in the proposed test stability. Mean relative humidity was maintained on a regular basis during the period monitored, at values below 50%. The analytical results of the drugs tested against stability, based on the of fluctuations temperature application in different cycles, give values that are within the specifications of the finished product, without significant differences between control products and the products subjected to thermal variations, showing that the oscillations of 2 °C and 50 °C set for the trial, during a period of 7 days, do not affect the drugs characteristics selected in this study Conclusions: Have been evaluated environmental characteristics of transportation during an annual cycle, showing there are not remarkable seasonal differences between the various shipments. From the environmental standpoint, drugs transportation to Role 2(Herat) is qualified. All medicines produced by the Military Pharmacy Center of Defense, choosen in this study and which have been subjected on the new stability test, remain within specification, by what alteration is not observed in the quality of the same ones. In order to control the drugs transport to the International Mission, temperature fluctuations between 2 ºC and 50 °C during at least 7 days would be considered safe conditions (AU)

Defining the concept of 'tick repellency' in veterinary medicine.

Although widely used, the term repellency needs to be employed with care when applied to ticks and other periodic or permanent ectoparasites. Repellency has classically been used to describe the effects of a substance that causes a flying arthropod to make oriented movements away from its source. However, for crawling arthropods such as ticks, the term commonly subsumes a range of effects that include arthropod irritation and consequent avoiding or leaving the host, failing to attach, to bite, or to feed. The objective of the present article is to highlight the need for clarity, to propose consensus descriptions and methods for the evaluation of various effects on ticks caused by chemical substances.

Gestión del riesgo en la transferencia de procesos productivos. Aplicación a la fabricación de comprimidosde oseltamivir en la pandemia de gripe A / Risk management in the transfer of manufacturing processes. Application to the manufacturing of oseltamivir tablets in the swine flu pandemic

Introducción: La gestión de riesgos aplicada a la industria farmacéutica, a través de su identificación, valoración y control, es una herramienta útil para garantizar la calidad del medicamento. La declaración por la Organización Mundial de la Salud en el año 2.009, de la pandemia provocada por el virus de la influenza H1N1, origina la necesidad de transformar en medicamento parte de las reservas estratégicas de fosfato de oseltamivir, pertenecientes al Ministerio de Sanidad y Política Social y a las Comunidades Autónomas. Debido a esta circunstancia, se dibuja, un nuevo escenario de actuación de los Servicios Farmacéuticos de la Defensa, bajo la tutela de la Agencia Española de Medicamentos y Productos Sanitarios. Objetivo: La aplicación de los principios de gestión del riesgo, posibilitará una rápida adaptación de la tecnología necesaria para la fabricación de comprimidos de fosfato de oseltamivir. Se realiza la evaluación del riesgo asociado a las diversas fases del proceso y se establecen determinados parámetros de control sobre la calidad final del medicamento producido. Material y Método: Se aplica el Análisis modal de fallos modales y efectos y su criticidad para establecer y evaluar los posibles riesgos del proceso productivo y se efectúan las correspondientes determinaciones analíticas referidas a la calidad del producto obtenido. Resultados: Los riesgos asociados al proceso son establecidos y evaluados. La media del contenido de los comprimidos y del porcentaje de disolución de los mismos a los 20 minutos es de 101,9 % y 102,5% respectivamente, cumpliendo todos los lotes fabricados el ensayo de evaluación de la contaminación microbiológica. Los resultados obtenidos para los lotes en las variables objeto de validación del proceso (peso de los comprimidos y porcentajes de principio activo, de homogeneidad de la mezcla y de disolución) cumplen las especificaciones establecidas y no se aprecian diferencias significativas entre los diferentes lotes (p>0,05). Conclusiones: Los resultados obtenidos corroboran el éxito de la transferencia del proceso productivo de comprimidos de fosfato de oseltamivir a las instalaciones y equipos disponibles, así como la consecución de un proceso robusto y repetitivo, que proporciona un medicamento ajustado a las especificaciones de calidad establecidas (AU)

Introduction: Risks management applied to the pharmaceutical industry, through their identification, evaluation and control, is a useful tool to guarantee drug quality. The declaration of swine flu H1N1 pandemic in 2009 by the World Health Organization, resulted in the need to transform into tablets part of the strategic reserves of oseltamivir phosphate of the Ministry of Health and Social Policy and the Autonomous Communities. This situation led to a change in the activity of the Defense Pharmaceutical Service under the auspices of the Spanish Agency for Medicines and Health Products. Objective: Applying the principles of risk management makes possible a fast adaptation of the technology to manufacture the oseltamivir phosphate tablets. We evaluated the risk associated to the different stages of the process and established particular control parameters of the final quality of the product. Materials and Methods: We applied the modal analysis of failures and effects and their criticality to establish and evaluate possible risks of the manufacturing process and carried out the necessary lab tests to check the quality of the product. Results: The risks associated to the process are established and evaluated. The average tablet content and the dissolution percentage at 20 minutes is 101.9% and 102.5%, respectively. All batches passed the microbiological contamination control. The results obtained for all batches in the validating variables of the process (weight of the tablets, percentages of active principle, homogeneity of the mix and dissolution) fulfill the required specifications and there are not significant differences among the different batches (p>0,05). Conclusions: The results confirm the successful transfer of the manufacturing process of the oseltamivir phosphate tablets to the facilities and equipment available, as well as the achievement of a robust and repetitive process that provides a drug fulfilling the required quality specifications(AU)