Analysis of deep brain stimulation of the subthalamic nucleus (STN-DBS) in patients with monogenic PRKN and LRRK2 forms of Parkinson's disease.

INTRODUCTION: Deep brain stimulation of the subthalamic nucleus (STN-DBS) is the most common surgical treatment for Parkinson's disease (PD). Patient selection and genetic background can modify the response to this treatment. The objective of this study was to compare both clinical and pharmacologic response of STN-DBS between patients with monogenic forms of PD and non-mutation carriers with idiopathic PD. METHODS: A retrospective analysis among 23 carriers of genetic mutations (8 PRKN and 15 LRRK2) and 74 patients with idiopathic PD was performed. The study included comparisons of Unified Parkinson's Disease Rating Scale (UPDRS) II and III scores, Schwab and England (S&E) scale values, Hoehn & Yahr (H&Y) stage scores, and equivalent doses of levodopa before and after the surgery (at 6 and 12 months) between both groups. RESULTS: The mean age at the time in which STN-DBS was performed was 59.5 ± 8.6. Linear mixed models showed the absence of statistically significant differences between mutation and non-mutation carriers regarding levodopa doses (p = 0.576), UPDRS II (p = 0.956) and III (p = 0.512) scores, and S&E scale scores (0.758). The only difference between the two groups was observed with respect to H&Y stage in OFF medication/ON stimulation status being lower in genetic PD at 6 months after surgery (p = 0.030). CONCLUSION: Clinical and pharmacological benefit of bilateral STN-DBS is similar in PRKN and LRRK2 mutation carriers and patients with idiopathic PD.

Indicaciones y resultados de la biopsia del ganglio centinela en el cáncer de mama: cambios observados en el año 2018 respecto al año 2012 / Indications and results of Sentinel Lymph Node Biopsy in breast cancer: changes observed in 2018 compared to 2012

Antecedentes y objetivo Durante los últimos 15 años se han sucedido múltiples cambios en el tratamiento del cáncer de mama (CM) y, en especial, en las indicaciones de la biopsia del ganglio centinela (BGC) y las actitudes ante su resultado. Valorando estos avances, nuestro objetivo es comparar los resultados de las BGC realizadas en nuestro centro en 2012, año a partir del cual se dejó de practicar linfadenectomía axilar (LA) ante el hallazgo de micrometástasis en la BGC, con aquellas llevadas a cabo en 2018, cuando empezaron a aplicarse los criterios Z0011. Material y métodos Hemos desarrollado un estudio retrospectivo observacional comparativo entre la población de pacientes con CM cN0 a las que se les hizo una BGC en el año 2012 y aquellas a las que se les practicó este procedimiento en 2018. Resultados Al analizar los 2 grupos, 174 pacientes de 2012 y 165 de 2018, se hallaron algunas diferencias significativas: en 2018 hubo mayor tasa de BGC, menor número de cánceres lobulillares (14/28; p<0,05), el tamaño medio anatomopatológico fue menor (p<0,001), la representación de tumores Her2 y triple negativos fue mayor (28/49; p<0,01), así como la proporción de tratamiento neoadyuvante (6,6 vs. 42,5%; p<0,001). Al valorar los resultados del estudio axilar, en 2018 hubo un descenso tanto en la positividad de la BGC, que descendió a casi la mitad que en 2012 (42,4 vs. 24,1%; p<0,0001), como en el porcentaje de LA (21,2 vs. 12,6%; p<0,05), así como el de LA con resultado negativo (74,3 vs. 59,1%; p=ns). Conclusión En el grupo de estudio de 2018 se halló una mayor tasa de BGC, con menor tasa de resultado positivo y de LA en blanco, pese a tratarse de una población con tumores más agresivos. Este hecho podría justificarse con la mejora en el filtro radiológico mediante ecografía al diagnóstico, así como con el aumento en el uso de la terapia neoadyuvante (AU)

Background and objective Over the last 15 years, breast cancer (BC) treatment has undergone numerous changes, which have also affected the indications for sentinel lymph node biopsy (SLNB) as well as the procedures depending on its outcome. The aim of this study is to compare the results of the SLNB carried out at our center during 2012, when we stopped performing an axillary lymph node dissection (ALND) after the finding of a micrometastasis, with those conducted in 2018, when we started applying Z011 criteria. Materials and methods We have performed a comparative retrospective observational study, including cN0 BC patients that underwent a SLNB in 2012 versus those that underwent this procedure in 2018. Results A total of 174 patients from 2012 and 165 from 2018 were studied. We found significant differences between the 2groups: in 2018 there were fewer lobular invasive cancers (14 vs. 28) (P<0.05), a smaller mean pathological size(P<0.001), a higher proportion of HER2 and triple negative tumors (28 vs. 49; P<0.01) and, finally, an increase in use of neoadjuvant treatments (42.0 vs. 6.7%). Regarding axillary involvement, we observed a decrease in both the presence of a positive sentinel node (24.1% in 2018 vs. 42.4% in 2012; P<0.0001) as well as in the proportion of ALND performed (12.6% in 2018 vs. 21.2% in 2012) and the presence of positive non sentinel nodes after a ALND (59.1% vs. 74.3%; P=ns). Conclusion Although the 2018 cohort that underwent SLNB had more aggressive tumors, there were fewer positive SN and ALND performed. This is probably due to a more accurate radiological diagnosis with ultrasound, that enables to detect cN1 cases before surgery, and to the increasing use of neoadjuvant treatments that may downstage the axilla (AU)

Indications and results of sentinel lymph node biopsy in breast cancer: Changes observed in 2018 compared to 2012.

BACKGROUND AND OBJECTIVE: Over the last 15 years, breast cancer (BC) treatment has undergone numerous changes, which have also affected the indications for Sentinel Lymph Node Biopsy (SLNB) as well as the procedures depending on its outcome. The aim of this study is to compare the results of the SLNB carried out at our Center during 2012, when we stopped performing an axillary lymph node dissection (ALND) after the finding of a micrometastasis, with those conducted in 2018, when we started applying Z011 criteria. MATERIALS AND METHODS: We have performed a comparative retrospective observational study, including cN0 BC patients that underwent a SLNB in 2012 versus those that underwent this procedure in 2018. RESULTS: 174 patients from 2012 and 165 from 2018 were studied. We found significant differences between the two groups: in 2018 there were fewer lobular invasive cancers (14 vs 28) (P < .05), a smaller mean pathological size (P < .001), a higher proportion of HER2 and triple negative tumors (28 vs 49) (P < .01) and, finally, an increase in use of neoadjuvant treatments (42.0% vs 6.7%). Regarding axillary involvement, we observed a decrease in both the presence of a positive sentinel node (24.1% in 2018 vs 42.4% in 2012) (P < .0001) as well as in the proportion of ALND performed (12.6% in 2018 vs 21.2% in 2012) and the presence of positive non sentinel nodes after a ALND (59.1% vs74.3%) (ns) CONCLUSION: Although the 2018 cohort that underwent SLNB had more aggressive tumors, there were fewer positive SN and ALND performed. This is probably due to a more accurate radiological diagnosis with ultrasound, that enables to detect cN1 cases before surgery, and to the increasing use of neoadjuvant treatments that may downstage the axilla.

Edema cerebral idiopático de inicio tardío asociado a estimulación cerebral profunda / Idiopathic delayed-onset edema associated with deep brain stimulation

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Angiopatía amiloide como causa de "hemorragia intracraneal remota" en paciente tratado mediante fibrinólisis / Amyloid angiopathy as a cause of "intracranial remote hemorrhage" in a patient treated with fibrinolysis

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Composición corporal y somatotipo de rugbistas chilenos y su relación con la posición de juego / Body composition and somatotype of chilean rugby players and their relationship with the game position

RESUMEN: El objetivo del estudio fue describir las características morfoestructurales, por posición de juego, en rugbistas de la región de Valparaíso, Chile. La estatura, peso, índice de masa corporal (IMC) y otros 25 parámetros antropométricos fueron obtenidos desde 121 rugbistas competitivos (24,2 ± 4,9 años), siguiendo los estándares de medición de la Sociedad Internacional para el Avance de la Kinantropometría (ISAK). La composición corporal fue descrita en 5 componentes a través del método propuesto por Kerr, estos son masa muscular, adiposa, residual, ósea y piel. El uso del somatotipo descrito por Carter y Heath, permitió describir los componentes de endomorfía, mesomorfía y ectomorfía. Para comparar las características morfoestructurales de los rugbistas por posición de juego, estos fueron separados en forwards y backs. El peso corporal, la estatura sentado y de pie, el IMC y la sumatoria de 8 pliegues fueron mayores en los forwards que los backs (p<0,0001). En relación a las masas corporales, el tejido adiposo y muscular absoluto fueron mayores en los forwards que en los backs (P< 0,01), no así el relativo. El somatotipo evidenció mayor endomorfía y mesomorfía, y menor ectomorfía, en los forwards 4,8-6,9-0,7 (1,8-1,3-0,8) que los backs 3,7-6,1-1,2 (1,8-1,1-0,8) con P<0,01. En conclusión, la posición de juego en el rugby es determinante en la definición de características físicas básicas y morfológicas. El mayor peso corporal de los forwards respecto a los backs se encuentra influenciado por la presencia de más tejido muscular y adiposo. Esto último se relacionó con un mayor componente mesomórfico y endomórfico del somatotipo, y menor del ectomórfico, en los forwards. A pesar de estas diferencias ambos grupos se encuentran en una clasificación de endo-mesomorfo.

SUMMARY: The objective of the study was to describe the morpho-structural characteristics according to playing position, in rugby players from the region of Valparaíso, Chile. Height, weight, body mass index (BMI) and other 25 anthropometric parameters were obtained from 121 competitive rugby players (24.2 ± 4.9 years), following the recommendations of the International Society for the advancement of Kinanthropometry. The body composition was described in 5 components through the method proposed by Kerr, they are muscle, fat, residual, bone and skin. The somatotype described by Carter and Heath, allowed to describe the components of endomorphy, mesomorphy and ectomorphy. To compare the morphostructural characteristics of the rugby players by playing position, these were separated into forwards and backs. Body weight, sitting and standing height, BMI and S 8-fold were higher in the forwards than the backs (p <0.0001). In relation to body mass, adipose tissue and absolute muscle were higher in the forwards than in the backs (P <0.01), but not in the relative. The somatotype showed significant differences in the averages of the three components between forwards 4.8-6.9-0.7 (1.8-1.3-0.8) and backs 3.7-6.1-1, 2 (1.8-1.1-0.8) with P <0.01. In conclusion, the playing position in rugby is decisive in the definition of basic physical and morphological characteristics. A higher body weight of the forwards versus backs is influenced by a greater muscle and adipose tissues. Latter was related to a greater mesomorphic and endomorphic component of the somatotype, and lower ectomorphic in the forwards. Despite these differences, both groups are classified as endo-mesomorph.

Influence of expiratory positive airway pressure on cardiac autonomic modulation at rest and in submaximal exercise in COPD patients.

The aim of this study was to evaluate the effect of expiratory positive airway pressure (EPAP) on heart rate variability (HRV) indices at rest and during 6-min walk test (6MWT) in chronic obstructive pulmonary disease (COPD) patients. Fifteen moderate to severe COPD patients were randomized and evaluated with and without (Non-EPAP) a 5 cmH2O EPAP device. Respiratory rate (RR) was collected at rest (5 min), during the 6MWT (5 min), and at recovery (5 min). Indices of HRV were computed in the time domain, in the frequency domain, and nonlinear analysis. For EPAP and Non-EPAP during the 6MWT, we found an increased mean heart rate (HR) (P=0.001; P=0.001) while mean RR (P=0.001; P=0.015) and RR tri index decreased (P=0.006; P=0.028). Peripheral oxygen saturation (P=0.019) increased at rest only in the EPAP group. In EPAP, correlations were found between forced expiratory volume in 1 s (FEV1) and low frequency (LF) sympathetic tonus (P=0.05; r=-0.49), FEV1 and high frequency (HF) parasympathetic tonus at rest (P=0.05; r=0.49), lactate at rest and LF during the 6MWT (P=0.02; r=-0.57), and lactate at rest and HF during 6MWT (P=0.02; r=0.56). Through a linear regression model, we found that lactate at rest explained 27% of the alterations of LF during 6MWT. The use of 5 cmH2O EPAP improved autonomic cardiac modulation and its complexity at rest in COPD patients. Although it did not influence the performance of the 6MWT, the EPAP device caused alterations in resting lactate concentration with an effect on sympatho-vagal control during the test.

Microbiota of high-pressure-processed Serrano ham investigated by culture-dependent and culture-independent methods.

The microbiota of Serrano dry-cured ham of different chemical composition, subjected or not to high-pressure processing (HPP), was investigated using culture-dependent and culture-independent methods. Microbial counts were submitted to analysis of variance with physicochemical parameters (aw, NaCl concentration, salt-in-lean ratio and intramuscular fat content) or HPP as main effects. In untreated hams, physicochemical parameters significantly affected counts of aerobic mesophiles, psychrotrophs, and moulds and yeasts. NaCl concentration and fat content influenced the levels of four and three of the five studied microbial groups, respectively, whereas no influence of aw was stated. The HPP treatment had a significant effect on counts of all investigated microbial groups. Culture-independent methods showed the presence of bacteria such as Staphylococcus equorum, Staphylococcus succinus, Bacillus subtilis and Cellulosimicrobium sp., moulds like Penicillium commune, Aspergillus fumigatus, Sclerotinia sclerotiorum, Eurotium athecium and Moniliella mellis, and yeasts like Debaryomyces hansenii and Candida glucosophila. Absence of B. subtilis bands and weaker bands of E. athecium were recorded for HPP-treated hams. The higher microbial levels found in lean ham might result in a quicker deterioration. HPP treatment confirmed its suitability as a procedure to control spoilage microorganisms. DGGE did not seem to be sensitive enough to highlight changes caused by HPP treatment in the microbiota of ham, but contributed to the detection of microbial species not previously found in ham.

CTX-M-15-non-ST131 Escherichia coli isolates are mainly responsible of faecal carriage with ESBL-producing Enterobacteriaceae in travellers, immigrants and those visiting friends and relatives.

Prevalence of extended-spectrum ß-lactamases (ESBL) and/or carbapenemase-producing Enterobacteriaceae (EPE and CPE) in stool samples from 75 travellers, 8 people visiting friends and relatives and 3 immigrants who had travelled or came from tropical or subtropical areas was determined. Thirty-one per cent (27/86) of the subjects were faecal carriers of EPE, and 37 EPE isolates were recovered (36 Escherichia coli, 1 Klebsiella pneumoniae). CTX-M-15 was the most prevalent enzyme (64.8%) mainly associated with E. coli belonging to phylogroup A and sequence type complex 10. Most of the ESBL-positive travellers (50%) had visited countries from Asia.

Dosificación de cidofovir en un paciente crítico en hemodiafiltración continua venovenosa / Cidofovir dosage in a critically ill patient undergoing continuous veno-venous hemodiafiltration

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Dosificación de antibióticos antipseudomónicos en pacientes con disfunción renal aguda sometidos a técnicas continuas de depuración extrarenal / Dosage of antipseudomonal antibiotics in patients with acute kidney injury subjected to continuous renal replacement therapies

Pseudomonas es un patógeno frecuente en las unidades de pacientes críticos y puede ser causa de shock séptico y de fallo renal. Es fundamental en estos pacientes instaurar un tratamiento antibiótico precoz y a dosis adecuadas. La disfunción renal aguda es también habitual en pacientes críticos. En aquellos que necesitan depuración extrarenal, las técnicas continuas de depuración extrarenal (TCDE) son una alternativa a la hemodiálisis intermitente y es necesario tener en cuenta que muchos antibióticos se eliminan de forma sustancial por las TCDE. El objetivo de esta revisión es analizar la evidencia clínica disponible sobre el comportamiento farmacocinético y las recomendaciones posológicas de los principales grupos de antibióticos empleados en el tratamiento de infecciones por Pseudomonas spp. en pacientes críticos sometidos a técnicas continuas de depuración extrarenal (AU)

Critically ill patients are often affected by infections produced by Pseudomonas, which can be a cause of sepsis and renal failure. Early and adequate antibiotic treatment at correct dosage levels is crucial. Acute kidney injury is also frequent in critically ill patients. In those patients who require renal replacement therapy, continuous techniques are gaining relevance as filtering alternatives to intermittent hemodialysis. It must be taken into account that many antibiotics are largely cleared by continuous renal replacement therapies (CRRT).The aim of this review is to assess the clinical evidence on the pharmacokinetics and dosage recommendations of the main antibiotic groups used to treat Pseudomonas spp. infections in critically ill patients subjected to CRRT (AU)

[Dosage of antipseudomonal antibiotics in patients with acute kidney injury subjected to continuous renal replacement therapies]. / Dosificación de antibióticos antipseudomónicos en pacientes con disfunción renal aguda sometidos a técnicas continuas de depuración extrarenal.

Critically ill patients are often affected by infections produced by Pseudomonas, which can be a cause of sepsis and renal failure. Early and adequate antibiotic treatment at correct dosage levels is crucial. Acute kidney injury is also frequent in critically ill patients. In those patients who require renal replacement therapy, continuous techniques are gaining relevance as filtering alternatives to intermittent hemodialysis. It must be taken into account that many antibiotics are largely cleared by continuous renal replacement therapies (CRRT). The aim of this review is to assess the clinical evidence on the pharmacokinetics and dosage recommendations of the main antibiotic groups used to treat Pseudomonas spp. infections in critically ill patients subjected to CRRT.

Autonomic control of heart rate after exercise in trained wrestlers.

The objective of this study was to establish differences in vagal reactivation, through heart rate recovery and heart rate variability post exercise, in Brazilian jiu-jitsu wrestlers (BJJW). A total of 18 male athletes were evaluated, ten highly trained (HT) and eight moderately trained (MT), who performed a maximum incremental test. At the end of the exercise, the R-R intervals were recorded during the first minute of recovery. We calculated heart rate recovery (HRR60s), and performed linear and non-linear (standard deviation of instantaneous beat-to-beat R-R interval variability - SD1) analysis of heart rate variability (HRV), using the tachogram of the first minute of recovery divided into four segments of 15 s each (0-15 s, 15-30 s, 30-45 s, 45-60 s). Between HT and MT individuals, there were statistically significant differences in HRR60s (p <0.05) and in the non linear analysis of HRV from SD130-45s (p <0.05) and SD145-60s (p <0.05). The results of this research suggest that heart rate kinetics during the first minute after exercise are related to training level and can be used as an index for autonomic cardiovascular control in BJJW.

Demencia frontotemporal asociada al cromosoma 17 y otros síndromes parkinsonianos asociados a demencia / Frontotemporal dementia associated to chromosome 17 and other Parkinsonian syndromes linked to dementia

Introducción. Dentro de los síndromes con deterioro cognitivo se hallan múltiples entidades que asocian parkinsonismo como síntoma acompañante a lo largo de su evolución. En ocasiones no se valoran los signos de patología extrapiramidal de forma adecuada, atribuyéndolos a efectos secundarios de la medicación o simplemente obviándolos si son leves y no causan incapacidad notable. Sin embargo, cuando aparecen es conveniente pensar en otras causas que los expliquen, replanteándose el diagnóstico inicial. Objetivo. Realizar un repaso breve de las entidades que presentan demencia como síntoma principal además de síndrome parkinsoniano en diferente medida. Desarrollo. Entre los síndromes con demencia y parkinsonismo asociado se encuentran numerosas patologías muy heterogéneas tanto en frecuencia como en etiología y pronóstico. Algunas son poco frecuentes, como las asociadas a mutaciones del cromosoma 17, y otras son tan comunes como la enfermedad de Alzheimer o la hidrocefalia normotensiva. También se incluyen procesos de diferente etiología: degenerativa, infecciosa, traumática, tóxica o metabólica, vascular, etc... que pueden, entre otros síntomas, presentar demencia y parkinsonismo. Conclusiones. Conocer dichas patologías nos puede ayudar a realizar un diagnóstico correcto, siempre deseable para tratar al paciente adecuadamente e informar de la forma más veraz a la familia sobre la evolución y pronóstico esperables (AU)

Introduction. Among the syndromes with cognitive impairment, there are a number of conditions that associate parkinsonism as an accompanying symptom throughout the whole of its development. On some occasions the signs of extrapyramidal pathology are not appraised properly and are attributed to secondary effects of the medication or are simply ignored if they are mild and do not cause any notable disability. When they do appear, however, it is wise to think about other causes that can explain them, reconsidering the initial diagnosis. Aims. To carry out a brief review of the conditions that present dementia as the main symptom, in addition to Parkinsonian syndrome, although to different extents. Development. Among the syndromes with dementia and parkinsonism associated to them, there are a number of pathologies that are very heterogeneous in terms of both their frequency and their causation and prognosis. Some of them are not very frequent, such as those associated to mutations of chromosome 17, and others are as common as Alzheimer's disease or normotensive hydrocephalus. They also include processes with different aetiologies (which can be degenerative, infectious, traumatic, toxic or metabolic, vascular, and so forth) that can present dementia and parkinsonism, among other symptoms. Conclusions. An understanding of such pathologies can help reach a correct diagnosis, which is fundamental to be able to treat the patient adequately and provide the family with information that is as accurate as possible about the expected development and prognosis (AU)

Intervención farmacéutica en pacientes quirúrgicos con alteraciones electrolíticas / Drug treatment in surgical patients with electrolyte imbalances

Objetivo Determinar cuali y cuantitativamente las alteraciones electrolíticas (relacionadas con potasio, fósforo, magnesio y calcio) en pacientes ingresados en áreas de cirugía general y gastrointestinal, el porcentaje de dichas alteraciones detectado por el equipo médico y el grado de aceptación de las recomendaciones realizadas desde el Servicio de Farmacia Hospitalaria. Método Estudio prospectivo de 7 meses. Toda alteración detectada se registró en una hoja de recogida de datos (datos personales, sala de hospitalización, tipo de alteración, detección por equipo médico, tipo de intervención farmacéutica, modo de notificación, aceptación de la intervención, fecha de corrección de la alteración, paciente en tratamiento con nutrición parenteral).Resultados Se detectaron 100 alteraciones en 66 pacientes (231 analíticas revisadas). Se realizaron un total de 78 intervenciones. La mayoría de alteraciones se debieron a hipokalemias e hipomagnesemias, siendo la hipofosfatemia la alteración más frecuente en pacientes portadores de nutrición parenteral. El grado de aceptación de la intervención farmacéutica por parte del equipo médico fue superior cuando la información fue oral (100 vs 35% escrita). Se consiguió el doble de analíticas de comprobación tras las intervenciones (RR 2,1; IC 95% 1,11-3,94, p=0,006). La aceptación de la intervención comportó una mayor proporción de resoluciones de la alteración respecto a los casos en los que no se aceptó (RR 1,5; IC 95% 1,01-2,24, p=0,04).Conclusiones Este estudio pone de manifiesto que las alteraciones electrolíticas en pacientes quirúrgicos son frecuentes y su grado de detección y seguimiento por parte del equipo médico es bajo. Por ello, el farmacéutico podría contribuir en la mejora de dichos aspectos participando en la atención a estos pacientes (AU)

Objective To qualitatively and quantitatively determine electrolyte imbalances (potassium, phosphorus, magnesium and calcium) in patients admitted for general and gastrointestinal surgery, the degree of these imbalances in percentage detected by medical staff, and the acceptance of the recommendations made by the Hospital Pharmacy Department. Method Seven-month prospective study. Any alteration detected was recorded on a data collection form (personal data, hospital ward, type of alteration, detection by medical staff, type of pharmaceutical intervention, form of notification, acceptance of the intervention, date of imbalance correction, patient receiving parenteral nutrition).Results100 imbalances were detected in 66 patients (231 analytical tests revised). A total of 78 interventions were carried out. Most changes were due to hypokalaemia and hypomagnesaemia, hypophosphataemia being the most frequent abnormality in patients receiving parenteral nutrition. The acceptance of pharmaceutical intervention was higher if the information was oral (100% vs. 35% written). Twice the number of analytical tests were performed after interventions (RR: 2.1, 95% CI: 1.11 to 3.94, P=.006). When pharmaceutical intervention was accepted there was a greater number of imbalance resolutions in comparison with those cases which did not accept (RR: 1.5, 95% CI: 1.01 to 2.24, P=.04).Conclusions This study shows that electrolyte imbalances are common in surgical patients and the level of detection and monitoring by medical staff is low. Therefore, the pharmacist could help in improving this aspect (AU)

[Drug treatment in surgical patients with electrolyte imbalances]. / Intervención farmacéutica en pacientes quirúrgicos con alteraciones electrolíticas.

OBJECTIVE: To qualitatively and quantitatively determine electrolyte imbalances (potassium, phosphorus, magnesium and calcium) in patients admitted for general and gastrointestinal surgery, the degree of these imbalances in percentage detected by medical staff, and the acceptance of the recommendations made by the Hospital Pharmacy Department. METHOD: Seven-month prospective study. Any alteration detected was recorded on a data collection form (personal data, hospital ward, type of alteration, detection by medical staff, type of pharmaceutical intervention, form of notification, acceptance of the intervention, date of imbalance correction, patient receiving parenteral nutrition). RESULTS: 100 imbalances were detected in 66 patients (231 analytical tests revised). A total of 78 interventions were carried out. Most changes were due to hypokalaemia and hypomagnesaemia, hypophosphataemia being the most frequent abnormality in patients receiving parenteral nutrition.The acceptance of pharmaceutical intervention was higher if the information was oral (100% vs. 35% written). Twice the number of analytical tests were performed after interventions (RR: 2.1, 95% CI: 1.11 to 3.94, P=.006). When pharmaceutical intervention was accepted there was a greater number of imbalance resolutions in comparison with those cases which did not accept (RR: 1.5, 95% CI: 1.01 to 2.24, P=.04). CONCLUSIONS: This study shows that electrolyte imbalances are common in surgical patients and the level of detection and monitoring by medical staff is low. Therefore, the pharmacist could help in improving this aspect.

[The chronopathology of prion encephalopathies]. / Cronopatología de las encefalopatías priónicas.

INTRODUCTION: Prion encephalopathies are a group of diseases with a hereditary or acquired origin which, after a long asymptomatic period, give rise to rapidly progressing neurological disorders. This progression can only be explained by an exponential growth of the pathogenic protein load, which allows to keep the load in low levels for many years and then to grow swiftly in a few months. DEVELOPMENT: Bearing in mind the knowledge currently available about the pathogenesis of prion diseases and patients' clinical progression, it becomes possible to distinguish several different periods of progression, the length of which can be estimated for each disease by reviewing the series of cases published to date. In general, the infectious prion diseases have a shorter period of latency than the hereditary ones and those caused by insertion of genetic material are associated to shorter latencies and to longer periods of illness than those caused by sporadic mutations. CONCLUSIONS: The rate of growth of the prion load depends essentially on how fast the pathogenic prion protein replicates; nevertheless, this growth is also modulated by other factors, many of which are polymorphisms in certain positions on the gene coding for prion protein or in other genes.