Graves' disease induced by Alemtuzumab in relapsing-remitting multiple sclerosis patients: an observational study in a reference center.

OBJECTIVES: Graves' disease induced by Alemtuzumab (GD-IA) is one of the most frequently observed adverse events in patients with multiple sclerosis (MS) treated with this drug. The aim of this study is the sequencing and description of these events, along with the identification of the risk factors leading to their development. MATERIALS AND METHODS: We conducted a retrospective observational study identifying patients with relapsing-remitting multiple sclerosis (RRMS) and GD-IA, studying their baseline clinical features and variables related to the natural history of the disease. RESULTS: A total of 121 participants treated with Alemtuzumab were included, of whom 41 developed GD-IA (33.9%). A higher percentage of first-degree relatives with autoimmune thyroid disease was documented in the subgroup who developed the abovementioned event (14.6% vs 1.5%; p < 0.01). A total of 70.7% of patients diagnosed with GD-IA (n = 29/41) had fluctuations in thyroid function during follow-up, and 24.4% (n = 10/41) required total thyroidectomy for resolution of the condition. In 54.8% of participants diagnosed with GD-IA, a pattern of significant TSH decline was identified in the month prior to diagnosis of the event, with high predictive ability and associated with a more favorable clinical course (fewer weeks to normalization of thyroid function, HR = 8.99; 95% CI [2.11-38.44]; p = 0.0003). CONCLUSION: GD-IA has an atypical course compared to classical forms of the disease. The identification of risk factors for the development of the disease before starting treatment with Alemtuzumab and early monitoring of thyroid function once this treatment is initiated prove to be useful strategies in the diagnosis and clinical management of this condition.

An approach to evaluating and benchmarking the mechanical behavior of a surgical mesh prototype designed for the repair of abdominal wall defects.

Ventral hernia repair is a common surgical procedure in abdominal surgery in which surgical mesh has become an essential tool to improve outcomes. To avoid recurrences the mesh needs to mimic the mechanical behavior of the abdominal wall. In this scenario the mechanical properties at the interface between the mesh and its surrounding tissue is critical for the performance of the device and, therefore, the success after surgery. We aimed to characterize and compare the mechanical behavior of the patented prototype mesh Spider and four commercial meshes at the mesh-tissue interface. The prototype mesh was designed based on the hypothesis that the best performance for a large-sized defect in a ventral hernia is obtained when the mesh presents an isotropic behavior. In contrast, commercial meshes presented significant anisotropic behavior. Mechanical properties of the meshes were characterized through uniaxial tensile tests. Longitudinal and transverse axes were defined for each mesh, and samples were cut in each axis orientation. Samples underwent uniaxial tensile testing, from which the elastic modulus in each axis was determined. The degree of anisotropy was calculated as the ratio between the elastic modulus in each axis. An in silico model of the ventral hernia defect was designed to simulate the mesh-tissue interface behavior via finite element method. Meshes were modeled by an hyperelastic orthotropic constitutive model, which allowed isotropic symmetry as particular case for the prototype mesh. Abdominal wall was modeled using a Neo-Hookean model. Once the simulations were launched, mesh-tissue interface behavior was evaluated through the difference between Von Mises stress values on either size of the interface, both on the external and the internal face of the mesh and abdominal wall. Mechanical response was anisotropic for all commercial meshes and isotropic for the Spider prototype. Among commercial, Ultrapro® was highly anisotropic. Tests revealed Gore-Tex® to be the stiffest, followed by Repol Angimesh®, Spider and Ultrapro®; Duramesh™  was found to be the most compliant. Concerning mesh-tissue behavior, simulation results revealed the Spider prototype and Duramesh™  to be the best; Spider due to its uniformity and lower stress difference thanks to its nearly isotropic behavior, and Duramesh™  due to its compliant behavior. Our results suggest that the compromise between stiffness and anisotropy must be considered in order to improve the mechanical performance of the meshes, bearing in mind that for large-sized ventral defects, nearly isotropic mesh ensures better performance.

Variaciones en la incidencia de bronquiolitis tras la aparición del SARS-CoV-2 / Variations in the incidence of bronchiolitis after the onset of SARS-CoV-2

Introducción. Durante la temporada 2020-2021 se ha asistido a una disminución de la incidencia de hospitalizaciones por bronquiolitis. Los cambios en la evolución de la pandemia de SARS-CoV-2 y en la aplicación de medidas preventivas podrían relacionarse con un aumento de la incidencia de bronquiolitis grave durante la temporada 2021-2022. Objetivo. Determinar la incidencia de hospitalizaciones por bronquiolitis en un hospital terciario durante la temporada 2021-2022 y compararla con temporadas previas. Método. Estudio epidemiológico de tipo observacional, descriptivo y ambispectivo. A través de la base de datos de un hospital terciario, se compararon la incidencia, la etiología y los indicadores de gravedad de las hospitalizaciones por bronquiolitis. Se analizaron 3 cohortes en época epidémica: la temporada 2020-2021 y la 2021-2022 (prospectivas); y la temporada 2018-2019 (retrospectiva). También se analizó una cohorte prospectiva entre los meses de abril y octubre de 2021. Resultados. La incidencia acumulada de hospitalizaciones fue de 113,6/10.000 niños menores de 2 años en la temporada pre-covídica; de 3,6/10.000 en la temporada 2020-2021; y de 65,7/10.000 en la temporada 2021-2022. El porcentaje de ingresos en UCIP fue de 36,6%, 0 % y 30,8%, respectivamente. La incidencia acumulada de hospitalizaciones en el periodo no epidémico fue de 60,8/10.000, precisando ingreso en UCIP el 19%. El microorganismo más frecuente fue el virus respiratorio sincitial en todas las cohortes. Conclusiones. La incidencia durante los meses típicamente epidémicos de bronquiolitis bajó drásticamente la temporada en la que apareció el SARS-CoV-2, aumentando notablemente el año posterior, aunque sin alcanzar la incidencia previa a la pandemia. Se ha observado una incidencia alta de casos de bronquiolitis entre abril y octubre de 2021 (AU)

Introduction. A decrease has been observed during the 2020-2021 season in the incidence of hospitalizations for bronchiolitis. Changes in the evolution of the SARS-CoV-2 pandemic and in the application of preventive measures could be related to an increase in the incidence of severe bronchiolitis during the 2021-2022 season. Objective. To determine the incidence of bronchiolitis hospitalizations in a tertiary hospital during the 2021-2022 season and to compare it with previous seasons. Method. An observational, descriptive and ambispective epidemiological study. A tertiary hospital database was used to compare the incidence, etiology, and severity indicators of bronchiolitis hospitalizations. 3 cohorts were analyzed in epidemic times: the 2020-2021 season and the 2021-2022 season (prospective); and the 2018-2019 season (retrospective). A prospective cohort between the months of April and October 2021 was also analyzed. Results. The cumulative incidence of hospitalizations was 113.6/10,000 children under 2 years of age in the pre-covid season; 3.6/10,000 in the 2020-2021 season; and 65.7/10,000 in the 2021-2022 season. The percentage of admissions in PICU was 36.6%, 0% and 30.8%, respectively. The cumulative incidence of hospitalizations in the non-epidemic period was 60.8/10,000, with 19% requiring admission to the PICU. The most frequent microorganism was the respiratory syncytial virus in all cohorts. Conclusions. The incidence during the typically epidemic months of bronchiolitis drastically decreased the season in which SARS-CoV-2 appeared, noticeably increasing the next year, although without reaching the pre-pandemic incidence. A high incidence of bronchiolitis cases was observed between April and October 2021 (AU)

Metabolizing profile of the cytochrome pathway CYP2D6, CYP3A4 and the ABCB 1 transporter in Spanish patients affected by Gaucher disease.

Several therapeutic options are available for type 1 Gaucher disease (GD1), including enzymatic replacement therapy (ERT) and substrate reduction therapy (SRT). Eliglustat is a selective inhibitor of glucosylceramide synthase that is extensively metabolized by CYP2D6 and, to a lesser extent by CYP3A4; it is also an inhibitor of the P-gp transporter. The aim of this study is to evaluate the metabolizer profile of these cytochrome isoforms in 61 GD1 patients, and to analyze interferences with concomitant therapies. Patients were selected from the Spanish Gaucher Disease Registry considering clinical data, GBA genotype, severity score index, comorbidities, concomitant drugs, type and response to therapy and adverse effects. The polymorphisms of CYP2D6, CYP3A4 and three ABCB1 transporter variants were analyzed by Polymerase Chain Reaction (PCR). The most frequent metabolizer profile was extensive or intermediate for CYP2D6, extensive for CYP3A4*1B and CYP3A4*22 and normal activity for ABCB1. Correlations between metabolizer profile and other variables were analyzed by multiple regression study. Twenty-eight patients received ERT, 17 eliglustat and seven miglustat. Forty-two patients (68.8%) had associated diseases and 54.5% were taking daily concomitant medication. Nine patients under eliglustat therapy received concomitant drugs that interact with the CYPs and/or ABCB1, five of these did not reach therapeutic goals and three presented mild or moderate adverse effects (headache and gastrointestinal disorders). Detailed analysis in four patients with TTT haplotype, corresponding to lack of activity of the transporter, was performed. In order to apply personalized medicine and avoid interferences and adverse effects, the individual CYP metabolizer profile and transporter must be considered when choosing the concomitant medication and/or making dose adjustments.

Growth differentiation factor-15 is a predictive biomarker in primary ventricular fibrillation: The RUTI-STEMI-PVF study.

BACKGROUND: Primary ventricular fibrillation is an ominous complication of ST-segment elevation myocardial infarction, and proper biomarkers for risk prediction are lacking. Growth differentiation factor-15 is a marker of inflammation, oxidative stress and hypoxia with well-established prognostic value in ST-segment elevation myocardial infarction patients. We explored the predictive value of growth differentiation factor-15 in a subgroup of ST-segment elevation myocardial infarction patients with primary ventricular fibrillation. METHODS: Prospective registry of ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention from February 2011-August 2015. Growth differentiation factor-15 concentrations were measured on admission. Logistic regression and Cox proportional regression analyses were used. RESULTS: A total of 1165 ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention (men 78.5%, age 62.3±13.1 years) and 72 patients with primary ventricular fibrillation (6.2%) were included. Compared to patients without primary ventricular fibrillation, median growth differentiation factor-15 concentration was two-fold higher in ST-segment elevation myocardial infarction patients with primary ventricular fibrillation (2655 vs 1367 pg/ml, p<0.001). At 30 days, mortality was 13.9% and 3.6% in patients with and without primary ventricular fibrillation, respectively (p<0.001), and median growth differentiation factor-15 concentration in patients with primary ventricular fibrillation was five-fold higher among those who died vs survivors (13,098 vs 2415 pg/ml, p<0.001). In a comprehensive multivariable analysis including age, sex, clinical variables, reperfusion time, left ventricular ejection fraction, N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin T, growth differentiation factor-15 remained an independent predictor of 30-day mortality, with odds ratios of 3.92 (95% confidence interval 1.35-11.39) in patients with primary ventricular fibrillation (p=0.012) and 1.72 (95% confidence interval 1.23-2.40) in patients without primary ventricular fibrillation (p=0.001). CONCLUSIONS: Growth differentiation factor-15 is a robust independent predictor of 30-day mortality in ST-segment elevation myocardial infarction patients with primary ventricular fibrillation.

Calcinosis cutis facial en una paciente con dermatomiositis paraneoplásica / Facial Calcinosis Cutis in a Woman with Paraneoplastic Dermatomyositis

No disponible

Visión moderna sobre una técnica antigua: revisión narrativa de técnicas de localización del espacio epidural / Modern approach to an old technique: narrative revision of techniques used to locate the epidural space

Desde la primera descripción de la técnica epidural en los años 1920, el progreso continuo en el conocimiento de la anatomía y de la fisiología del espacio epidural ha permitido desarrollar diferentes técnicas de localización de este espacio para aumentar tanto la seguridad como la eficacia del procedimiento. Las técnicas más utilizadas hoy en día se basan en las 2 principales propiedades descritas del espacio epidural: la diferencia de distensibilidad entre el ligamento amarillo y el espacio epidural y la existencia de una presión negativa en el espacio epidural. Sin embargo, en los últimos años, la evolución tecnológica ha permitido desarrollar nuevas técnicas de localización basadas en otras propiedades físicas de los tejidos. Algunas de ellas están todavía en una fase experimental, pero otras como las técnicas con ultrasonidos han alcanzado una fase clínica y se está expandiendo su uso en la práctica diaria (AU)

Since the first description of the epidural technique during the 1920s, the continuous progress of knowledge of the anatomy and physiology of the epidural space has allowed the development of different techniques to locate this space while increasing both the safety and efficacy of the procedure. The most common techniques used today are based on the two main characteristics of the epidural space: the difference in distensibility between the ligamentum flavum and the epidural space, and the existence of negative pressure within the epidural space. However, over recent years, technological advances have allowed the development of new techniques to locate the epidural space based on other physical properties of tissues. Some are still in the experimental phase, but others, like ultrasound-location have reached a clinical phase and are being used increasingly in daily practice (AU)

In-hospital prognosis and long-term mortality of STEMI in a reperfusion network. "Head to head" analisys: invasive reperfusion vs optimal medical therapy.

BACKGROUND: ST Segment Elevation Acute myocardial infarction (STEMI) preferred treatment is culprit artery reperfusion with primary percutaneous coronary intervention (PPCI). We ought to analyze the benefit of early reperfusion vs. optimal medical therapy in STEMI before and after the set-up of a regional STEMI network that prioritizes PPCI. METHODS: Between January 2002 and December 2013, 1268 STEMI patients were consecutively admitted in a University Hospital. Patients were classified in two groups: pre-STEMI Network (January 2002-June 2009; n = 670) and post-STEMI network (July 2009-December 2013; n = 598). Vital status was available at 2-year follow-up. RESULTS: The STEMI network increased reperfusion (89.2% vs 64.4%, p < 0.001) mainly using PCI (99.0% vs 43.9%, p < 0.001). In univariate analysis, in-hospital mortality was significantly lower in the post-STEMI network period (2.51% vs. 7.16%, p < 0.001). After multivariate adjustment, including age, sex, comorbidities, severity and reperfusion therapy, a trend to a lower in-hospital mortality was observed (post-Network OR: 0.50, 95% CI:0.16-1.59, p = 0.24); this trend disappeared when optimal medical therapy was included in the model (post-Network OR: 1.14, 95% CI:0.32-4.08, p = 0.840). No differences in 2-year mortality were observed (post-Network HR: 0.83; CI 95%: 0.55-1.25, p = 0.37). CONCLUSION: A STEMI network with PPCI 24/7 improved reperfusion therapy, resulting in an increase on PPCI. Despite in-hospital mortality decreased with a STEMI network, 2-year mortality remained similar in both periods, pre- and post-Network. Optimal medical therapy could be as important as reperfusion therapy in a STEMI reperfusion network.

Modern approach to an old technique: Narrative revision of techniques used to locate the epidural space. / Visión moderna sobre una técnica antigua: revisión narrativa de técnicas de localización del espacio epidural.

Since the first description of the epidural technique during the 1920s, the continuous progress of knowledge of the anatomy and physiology of the epidural space has allowed the development of different techniques to locate this space while increasing both the safety and efficacy of the procedure. The most common techniques used today are based on the two main characteristics of the epidural space: the difference in distensibility between the ligamentum flavum and the epidural space, and the existence of negative pressure within the epidural space. However, over recent years, technological advances have allowed the development of new techniques to locate the epidural space based on other physical properties of tissues. Some are still in the experimental phase, but others, like ultrasound-location have reached a clinical phase and are being used increasingly in daily practice.

Autoantibodies against TIF-1-γ and CADM-140 in Spanish patients with clinically amyopathic dermatomyositis (CADM): clinical significance and diagnostic utility.

BACKGROUND: Patients with clinically amyopathic dermatomyositis (CADM) appear to be at risk for developing cancer and interstitial lung diseases, but population data to confirm this hypothesis are limited. Moreover, CADM presents cutaneous and histological findings that may overlap with subacute cutaneous lupus erythematosus (SCLE). OBJECTIVES: To determine the association between myositis-specific autoantibodies, myositis-associated autoantibodies and CADM in Spanish patients. In addition, to study the usefulness of these autoantibodies in the differential diagnosis between CADM and SCLE. METHODS: Serum samples were tested for myositis-specific autoantibodies and myositis-associated autoantibodies through immunoprecipitation and other standardized methods. RESULTS: Anti-CADM-p140 and anti-p155 antibodies were the only myositis-specific autoantibodies found and were associated with interstitial lung diseases and cancer respectively. No myositis-associated autoantibodies were found in CADM. Moreover, clinical subsets and proportions seemed to differ from Asian cohorts, where anti-CADM-p140 is considered a CADM hallmark antibody and a risk factor for the development of interstitial lung disease. Interestingly, anti-SSA was highly associated with SCLE, whereas no myositis-specific autoantibodies were found in this entity. LIMITATIONS OF THE STUDY: Association between CADM and myositis-specific autoantibodies and differences between CADM and SCLE were tested on a relatively small cohort of patients. CONCLUSION: There is an association between cancer-associated myositis and interstitial lung diseases and their hallmark autoantibodies in our cohort. In addition, the combined determination of myositis-specific autoantibodies and SSA autoantibodies may help to accurately discriminate SCLE from CADM.

Lupus eritematoso subagudo inducido por terbinafina en un paciente con lupus eritematoso sistémico / Lupus erythematosus induced by terbinafine in a patient with systemic lupus erythematosus

No disponible

Development of an autoimmune syndrome affecting the skin and internal organs in P-selectin glycoprotein ligand 1 leukocyte receptor-deficient mice.

OBJECTIVE: To define and characterize the progression of the spontaneous autoimmune disease that develops in mice in the absence of the leukocyte adhesion receptor P-selectin glycoprotein ligand 1 (PSGL-1). METHODS: Skin-resident immune cells from PSGL-1-deficient mice and C57BL/6 control mice of different ages were isolated and analyzed by flow cytometry. Biochemical parameters were analyzed in mouse serum and urine, and the presence of serum autoantibodies was investigated. Skin and internal organs were extracted, and their structure was analyzed histologically. RESULTS: Skin-resident innate and adaptive immune cells from PSGL-1(-/-) mice had a proinflammatory phenotype with an imbalanced T effector cell:Treg cell ratio. Sera from PSGL-1(-/-) mice had circulating autoantibodies commonly detected in connective tissue-related human autoimmune diseases. Biochemical and histologic analysis of skin and internal organs revealed skin fibrosis and structural and functional abnormalities in the lungs and kidneys. Furthermore, PSGL-1(-/-) mice exhibited vascular alterations, showing loss of dermal vessels, small vessel medial layer remodeling in the lungs and kidneys, and ischemic processes in the kidney that promote renal infarcts. CONCLUSION: Our study demonstrates that immune system overactivation due to PSGL-1 deficiency triggers an autoimmune syndrome with characteristics similar to systemic sclerosis, including skin fibrosis, vascular alterations, and systemic organ involvement. These results suggest that PSGL-1 expression contributes to the maintenance of the homeostasis of the immune system and could act as a barrier for autoimmunity in mice.

Prevalencia de anticuerpos antifosfolípido en pacientes con lupus eritematoso cutáneo subagudo y crónico / Prevalence of Antiphospholipid Antibodies in Patients with Subacute and Chronic Cutaneous Lupus Erythematosus

Introducción y objetivos: La prevalencia de anticuerpos antifosfolípido (AcAF) en pacientes con lupus eritematoso sistémico (LES) ha sido muy estudiada, pero no en pacientes con lupus eritematoso cutáneo (LEC). Determinamos la prevalencia de AcAF entre nuestros pacientes con LEC, y analizamos sus características clínicas y serológicas. Material y métodos: Estudio retrospectivo de 182 pacientes con LEC subagudo (LECS) o crónico (LECC) que se hallaban en seguimiento en los últimos 5 años. Seleccionamos aquellos que presentaban uno o varios de los siguientes AcAF: anticoagulante lúpico (AL), anticuerpos anticardiolipina (ACA) y anticuerpos anti β2-glucoproteína i (anti-β2-GPI), en 2 determinaciones, distanciadas al menos en 12 semanas. En el caso de los ACA y los anti-β2-GPI solo se incluyeron pacientes con titulaciones iguales o superiores a 40 unidades por ml. Resultados: Obtuvimos una serie de 13 pacientes: 4 fueron clasificados como LECS y 9 como LECC. Siete cumplían criterios de LES y solo uno cumplía criterios de SAF. La prevalencia de AcAF fue del 38% entre los que cumplían criterios de LES, y del 3,65% entre los que no los cumplían. El AcAF más prevalente fue el AL, presente en 10 pacientes. Se detectaron Ac ANA en 12 pacientes y anti-dsADN en 11. Conclusiones: La prevalencia de AcAF entre nuestros pacientes con LEC que no cumplían criterios de LES fue similar a la referida para la población general. Esto, junto a la fuerte asociación de la presencia de ANA y AcAF, cuestionaría la rentabilidad de determinar los AcAF en aquellos pacientes con LEC y ANA negativo. Además destaca que entre nuestros pacientes con LEC y AcAF existe una alta prevalencia de lesiones discoides y el desarrollo de SAF es poco frecuente (AU)

Background and objectives: The prevalence of antiphospholipid antibodies (APLAs) has been extensively studied in patients with systemic lupus erythematosus (SLE) but not in those with cutaneous lupus erythematosus (CLE). We determined the prevalence of APLAs among our patients with CLE, and analyzed their clinical and serologic characteristics. Materials and methods: This retrospective study analyzed 182 patients with subacute or chronic CLE who had been in follow-up for 5 years. We selected those positive for 1 or more of the following APLAs in 2 measurements at least 12 weeks apart: lupus anticoagulant (LA), anticardiolipin antibodies (ACAs), and anti-β2-glycoprotein I (anti-β2-GPI) antibodies. In the case of ACAs and anti-β2-GPI antibodies, only patients with titers greater than or equal to 40 U/mL were selected. Results: We obtained a series of 13 patients (4 with subacute disease and 9 with chronic disease). Seven met the diagnostic criteria for SLE and only 1 met the diagnostic criteria for antiphospholipid syndrome (APS). The prevalence of APLAs was 38% among patients with SLE and 3.65% among those without SLE. The most prevalent APLA was LA, present in 10 patients. Antinuclear antibodies (ANAs) were detected in 12 patients and anti-double-stranded DNA antibodies in 11. Conclusions: The prevalence of APLAs among our patients with CLE who did not meet the diagnostic criteria for SLE was similar to that reported in the general population. This, along with the strong assocation between the presence of ANAs and the presence of APLAs, would bring into question the value of determining APLAs in patients with CLE who are negative for ANAs. We also note that there was a high prevalence of discoid lesions but a low prevalence of APS among our patients with CLE who were positive for APLAs (AU)

Estudio observacional sobre las técnicas de punción del bloqueo axilar para cirugía de mano en pacientes ambulantes en un hospital universitario: Aportes a la ecografía / No disponible

Objetivos: Valorar el aporte de la ecografía para la realización de bloqueos axilares en cirugía mayor ambulatoria con tres tipos de técnicas. Material y métodos: Estudio observacional, prospectivo en pacientes programados para cirugía de manos. Se construyó una base con datos demográficos, el tipo y eficacia de la técnica en cuanto al bloqueo motor y sensitivo, dolor posoperatorio, el grado de satisfacción y complicaciones asociadas. Las tres técnicas estudiadas fueron el uso de neuroestimulador, el uso de la ecografía y la combinación de ambas. Resultados: Se recogieron 151 casos. 77(51 %) se realizaron con NS solo, 36 (24 %) combinando la técnica de NS con Eco, y 38 (25 %) con Eco solo. 15 (20 %) pacientes puncionados con NS requerían un refuerzo de anestesia local versus 14 (38,9 %) en el grupo NS + Eco y 1 (2,6 %) en el grupo Eco solo (p < 0,001). La técnica combinada NS + Eco ha permitido bajar más el volumen de anestésico local comparado con la técnica Eco sola (NS + Eco: 26,2 ± 7,3; Eco solo: 31,4 ± 5,6; p = 0,001). En las 24 primeras horas posoperatorias, no hubo diferencias significativas en el consumo de analgésicos (p = 0,59). El índice de satisfacción era alto y comparable entre los tres grupos (NS: 8,4 ± 1,7/10; NS + Eco: 8,5 ± 1,9/10; Eco: 9,0 ± 1/10; p = 0,17). No hubo complicaciones ni reingresos a las 24 horas de la realización del bloqueo. Conclusión: La técnica ecográfica es segura y permite aumentar la seguridad del bloqueo con una eficacia equivalente o mejor a la técnica neuroestimulada. En cambio, la combinación de las 2 técnicas, da peores resultados, por lo que no recomendamos su uso (AU)

Objective: Asses the role of ultrasound guided axillary block in hand day case surgery with three different techniques. Materials and methods: we design a prospective, observational study in patients scheduled for day case hand surgery. Demographics data, type and efficiency of technique regarding sensitive and motor block, postoperative pain, satisfaction survey and complications were recorded. Block using neurostimulator (NS), ultrasound guide (US) and the combination of both was evaluated (NS+US). Results: 151 patients were included. 77 (51 %) were performed only by NS, 36 (24 %) using both techniques and 38 (25 %) with US solely. 15 (20 %) patients blocks by NS required an extra dose of local anesthetic in relation to 14 (38.9 %) in NS + US group and only 1 patient (2.6 %) block using US (p < 0.001). The combination technique allow to reduce total volume of local anesthetic used respect US guide block (NS + US: 26.2 ± 7.3; US: 31.4 ± 5.6; p = 0.001). In the first postoperative day, no different in analgesic consumption between three groups was found (p = 0.59).The satisfaction was high and comparable in all patients regardless of the technique used (NS: 8.4 ± 1.7/10; NS + US: 8.5 ± 1.9/10; US: 9.0 ± 1/10; p = 0.17). No complications and readmission was reported. Conclusion: US guided are a safe technique and make possible to increase block safety and efficiency. Nevertheless, the combination technique gives worse results and we should avoid their use (AU)

Prevalence of antiphospholipid antibodies in patients with subacute and chronic cutaneous lupus erythematosus.

BACKGROUND AND OBJECTIVES: The prevalence of antiphospholipid antibodies (APLAs) has been extensively studied in patients with systemic lupus erythematosus (SLE) but not in those with cutaneous lupus erythematosus (CLE). We determined the prevalence of APLAs among our patients with CLE, and analyzed their clinical and serologic characteristics. MATERIALS AND METHODS: This retrospective study analyzed 182 patients with subacute or chronic CLE who had been in follow-up for 5 years. We selected those positive for 1 or more of the following APLAs in 2 measurements at least 12 weeks apart: lupus anticoagulant (LA), anticardiolipin antibodies (ACAs), and anti-ß2-glycoprotein i (anti-ß2-GPI) antibodies. In the case of ACAs and anti-ß2-GPI antibodies, only patients with titers greater than or equal to 40 U/mL were selected. RESULTS: We obtained a series of 13 patients (4 with subacute disease and 9 with chronic disease). Seven met the diagnostic criteria for SLE and only 1 met the diagnostic criteria for antiphospholipid syndrome (APS). The prevalence of APLAs was 38% among patients with SLE and 3.65% among those without SLE. The most prevalent APLA was LA, present in 10 patients. Antinuclear antibodies (ANAs) were detected in 12 patients and anti-double-stranded DNA antibodies in 11. CONCLUSIONS: The prevalence of APLAs among our patients with CLE who did not meet the diagnostic criteria for SLE was similar to that reported in the general population. This, along with the strong assocation between the presence of ANAs and the presence of APLAs, would bring into question the value of determining APLAs in patients with CLE who are negative for ANAs. We also note that there was a high prevalence of discoid lesions but a low prevalence of APS among our patients with CLE who were positive for APLAs.

Prevalencia de EPOC entre la población fumadora de Colloto (Asturias) / Prevalence of COPD among the smoker population of Colloto (Asturias)

Objetivos. Conocer la prevalencia total y no conocida de EPOC en la población fumadora y ex-fumadora de 40 a 75 años en el área urbano-rural de Colloto, Asturias, y las diferencias según las distintas variables sociodemográficas. Pacientes y método. Estudio descriptivo transversal sobre 364 fumadores y ex-fumadores de ambos sexos de 40 a 75 años que acudían al consultorio de Colloto. Se realizó una historia clínica del hábito y examen físico detallados, y un estudio espirométrico completo para el diagnóstico y estadiaje. Resultados. La prevalencia de EPOC fue del 15,1% (IC 95% 11,7-19,4), sin diferencias entre sexos. Los factores asociados fueron la edad (pasando del 8,1 al 24,8% del primer al tercer terciles de edad) y el índice tabáquico (pasando del 8,4 al 24,8% del primer al tercer terciles del mismo), y como factor protector el índice de masa corporal. El hábito actual de consumo de tabaco no presentaba diferencias. El 48% de los diagnosticados por espirometría fueron nuevos diagnósticos. De los diagnosticados previamente de EPOC, en el 52% no se confirma el diagnóstico en la espirometría. El 14,8% de los EPOC se clasificaron como grave o muy grave. Conclusiones. La prevalencia obtenida es similar a la de otros estudios, siendo la mitad de los casos desconocidos. Deben estudiarse espirométricamente de rutina todos los fumadores, al menos desde 15 paquetesaño a partir de los 40 años, y en todos los pacientes que hayan sido fumadores a partir de los 65 años (AU)

Objectives. To know the total and unknown prevalence of COPD in the smoker and ex-smoker population of 40 to 75 years in the urban -rural area of Colloto, Asturias, and the differences according to the different sociodemographic variables. Patients and method. A descriptive cross-sectional study on 364 smokers and ex-smokers of both genders, 40 to 75 years old, who came to the medical facility of Colloto. A detailed clinical history on the habit and physical examination was obtained, as well as a complete spirometric study for the diagnosis and staging. Results. COPD prevalence was 15.1% (95% CI 11.7- 19.4), without differences between genders. Associated factors were age (going from 8.1 to 24.8% from its first to third terciles of age) and the smoking habit index (going from 8.4 to 24.8% from its first to the third terciles) and as protective factor, the body mass index. The current smoking consumption habit showed no differences. A total of 48% of those diagnosed by spirometry were new diagnoses. Of those previously diagnosed of COPD, the diagnosis was not confirmed in the spirometry in 52% and 14.8% of the COPD were classified as severe or very severe. Conclusions. The prevalence obtained is similar to that of other studies, half of the cases being unknown. All smokers should undergo routine spirometric studies, at least those smoking from 15 packs a year after the age of 40 and in all of those patients who have been smokers after the age of 65 (AU)

[Influence of family environment of the development of obesity and overweight in a population of school children in Granada (Spain)]. / Influencia del entorno familiar en el desarrollo del sobrepeso y la obesidad en una población de escolares de Granada (España).

According to recent research, eating behaviour should be understand as a cyclical and interactive process in which parental eating habits cause children to develop specific eating strategies as well as their own eating habits. Needless to say, this interactive process is reflected and has a direct impact on the nutritional indicators of the children in a family. The objectives of this study were the following: (i) to verify the existence of a significant association between the educational level of parents and the nutritional state of children in the same family; (ii) to discover if there is a direct relation between the nutritional state of children and the person that decides the menu and/or prepares family meals; (iii) to determine if there is a link between the nutritional state of children and the time that they spend on sedentary leisure activities. The sample population was composed of 718 school children and adolescents, 9-17 years of age, who A descriptive, transversal, and multicentric study was performed that evaluated the nutritional state of the entire sample by using anthropometric techniques to assess weight, height, and body mass index.

[Comparative study of the effectiveness of body mass index and the body-fat percentage as methods for the diagnosis of overweight and obesity in children]. / Estudio comparativo de la eficacia del índice de masa corporal y el porcentaje de grasa corporal como métodos para el diagnóstico de sobrepeso y obesidad en población pediátrica.

The World Health Organization (WHO) regards obesity as one of the most serious public health problems in the world that can affect young children and adolescents. Accordingly, a major priority is to find ways to more effectively study and analyze the various methods used to diagnose and evaluate the nutritional state of the pediatric and adolescent population. The nutritional indicators currently employed for this purpose are the body mass index and body-fat percentage. However, there is a certain controversy related to the body-fat percentage since it tends to overestimate overweight and obesity. The main objectives of this study were the following: (i) to determine the prevalence of overweight and obesity in a population of primary and secondary school children between 9-17 years of age at 13 educational centers in the city and province of Granada; (ii) to verify possible differences regarding the accuracy of the body mass index and the body-fat percentage in the diagnosis of overweight and obesity.