Comparison of the use of blood pressure telemonitoring versus standard medical care in the achievement of short-term therapeutic goals in blood pressure in patients with uncontrolled hypertension: An open-label clinical trial.

Background: In Mexico less than half of the treated hypertensive patients reach blood pressure (BP) targets. Most hypertensive individuals rely on the standard medical care (SMC) to achieve the BP control goals; however, the efficacy of BP telemonitoring (BPT) to achieve BP targets has been poorly studied. Aim: To compare the efficacy of BPT versus SMC to achieve BP goals in patients with uncontrolled hypertension. Methods: A two-arm, open-label clinical trial was conducted in patients ≥18 years with uncontrolled hypertension. The participants were randomized to 2 arms (BPT vs SMC) and followed for 12 weeks. For the statistical analysis, the chi-squared test and covariance were used. Results: One hundred and seventy-eight participants were included, BPT (n = 94) and SMC (n = 84), after 12 weeks of follow up, we observed a baseline-adjusted reduction in systolic BP with both BPT (-13.5 [1.3] mmHg) and the SMC (-5.9 [1.4] mmHg; p < 0.001) but a greater decrease with BPT (p < 0.001). Likewise, we found a baseline-adjusted reduction of diastolic BP with BPT (-6.9 [0.9] mmHg) and SMC (-2.7 [0.9] mmHg) (p = 0.007) with a more significant percentage change from baseline with BPT (-6.8% [1.0] vs 2.5% [1.1]; p = 0.007). In the BPT arm, a larger proportion of patients achieved the BP target versus SMC (30.5% vs 12.8%; p = 0.005). Conclusion: BPT showed a greater proportion of patients achieving office BP control goals (<140/90 mmHg), compared to standard medical care.

Una aproximación actualizada hacia el tratamiento de la esclerosis múltiple / An updated approach to the treatment of multiple sclerosis

La presente es una revisión bibliográfica actualizada sobre el manejo de la Esclerosis Múltiple (EM), enfermedad neurológica progresiva de tipo desmielinizante más frecuente a nivel mundial. En Chile, su presentación remitente-recurrente (RRMS) es patología GES, por lo que se vuelve relevante para el médico general y estudiantes del área de la salud reconocer e identificar las terapias disponibles para el control de esta patología. Si bien la EM no es un cuadro frecuente, su sintomatología es alarmante e incapacitante, por lo que, con frecuencia, el primer acercamiento del paciente es a los servicios de urgencia, tornándose necesario contar con nociones básicas sobre el tratamiento y manejo. La presente revisión recopiló artículos publicados entre 2019 y 2023 de distintos motores de búsqueda con énfasis en el tratamiento farmacológico y no farmacológico de esta enfermedad. Además de describir el tratamiento convencional como la inmunomodulación, las terapias biológicas, el soporte con glucocorticoides y los fármacos remielinizantes, se abordan nuevas líneas de investigación prometedoras, como el rol inmunogénico de la microbiota intestinal, la capacidad epigenética de la dieta, estrategias de rehabilitación cognitiva y el potencial uso de cannabinoides para el manejo paliativo del dolor. Se concluye que un tratamiento oportuno con fármacos modificadores de la enfermedad, tanto de primera línea como de segunda, son imprescindibles para el manejo de la EM, sin embargo, la calidad de vida puede verse significativamente acrecentada por la incorporación de estrategias que se encuentran al alcance del médico general y que no requieren de derivación a nivel secundario.

This is an updated bibliographical review on the management of Multiple Sclerosis (MS), the most common progressive neurological disease of demyelinating disorders worldwide. In Chile, its relapsing-remitting presentation (RRMS) is a state-covered illness pathology, so it becomes relevant for the general practitioner and med students to recognize and identify therapies available for the control of this desease. Although MS is not a frequent condition, its symptoms are alarming and disabling, which is why, frequently, the first approach of the patient is to the emergency services, making it necessary to have basic knowledge about treatment and management. The present review compiled articles published between 2019 and 2023 from different search engines with an emphasis on the pharmacological and non-pharmacological treatment of the MS. In addition to describing conventional treatment such as immunomodulation, biological therapies, glucocorticoid support and remyelinating drugs, new promising lines of research are addressed, such as the immunogenic role of the intestinal microbiota, the epigenetic capacity of the diet, strategies on cognition rehabilitation and the potential use of cannabinoids for the palliative management of pain. It is concluded that the classic treatment with disease-modifying drugs, both first-line and second-line, are essential for the management of MS; however, quality of life can be significantly increased by incorporating strategies found at the reach of the general practitioner and do not require referral at a greater complexity center.

Use of antihyperglycaemic therapy with cardiovascular benefit in patients with type 2 diabetes who require hospitalisation: A cross-sectional study.

OBJECTIVE: To evaluate the use of therapy with cardiovascular benefit in patients with type 2 diabetes mellitus admitted to internal medicine departments. METHODS: One day, cross-sectional study of patients with type 2 diabetes mellitus hospitalised in internal medicine departments. We recorded demographic and anthropometric variables, laboratory data and use of antihyperglycaemic drugs. The endpoint was the proportion and determinants of the use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1-RA). RESULTS: We included 928 patients belonging to 74 hospitals, with a mean age of 78.9 years (SD, 10.86 years), 50% of whom were men. A total of 557 (60%) patients had ischaemic heart disease, 189 (20.4%) had cerebrovascular disease, 293 (31.6%) had heart failure, 274 (29.5%) had chronic kidney disease, and 129 (13.9%) had peripheral arterial disease. Prior to their hospital admission, the patients were taking sulfonylureas (5.7%), biguanides (49.1%), alpha-glucosidase inhibitors (0.2%), pioglitazone (0%), dipeptidyl peptidase 4 inhibitors (39%), SGLT2i (5.8%), GLP1-RA (2.6%) and basal insulin analogues (24%). An age over 75 years was the main determinant for not taking SGLT2i (adjusted OR, 0.28; 95% CI 0.10-0.74; p = .039) or GLP1-RA (adjusted OR, 0.09; 95% CI 0.02-0.46; p = .006). DISCUSSION: A large proportion of elderly patients with type 2 diabetes mellitus at very high cardiovascular risk are not treated with antihyperglycemic drugs with proven cardiovascular benefit. The most commonly used drugs were metformin and DPP4i. There is room for improvement in the treatment of this very high-risk population.

Uso de terapia antihiperglucemiante con beneficio cardiovascular en pacientes con diabetes tipo 2 que requieren hospitalización: un estudio transversal / Use of antihyperglycaemic therapy with cardiovascular benefit in patients with type 2 diabetes who require hospitalisation: A cross-sectional study

Objetivo Evaluar el uso de la terapia con beneficio cardiovascular en pacientes con DM tipo 2 previo al ingreso en servicios de medicina interna. Métodos Estudio transversal en un día de los pacientes con DM tipo 2 hospitalizados en servicios de medicina interna. Se recogieron variables demográficas y antropométricas, datos de laboratorio y utilización de fármacos antihiperglucemiantes. La variable desenlace fue la proporción y los determinantes de uso de inhibidores del cotransportador sodio-glucosa 2 (iSGLT2) y de agonistas del receptor del péptido similar al glucagón tipo 1 (AR-GLP1). Resultados Se incluyeron 928 pacientes pertenecientes a 74 hospitales. La edad media fue 78,9 años (DE: 10,86), un 50% varones. Un total de 557 (60%) presentaba cardiopatía isquémica, 189 (20,4%) enfermedad cerebrovascular, 293 (31,6%) insuficiencia cardiaca, 274 (29,5%) enfermedad renal crónica y 129 (13,9%) enfermedad arterial periférica. Los antihiperglucemiantes utilizados previo al ingreso fueron: sulfonilureas (5.7%), biguanidas (49.1%), inhibidores de la alfa-glucosidasa (0,2%), pioglitazona (0%), iDPP4 (39%), iSGLT2 (5,8%), AR-GLP1 (2,6%) y análogos de insulina basal (24%). La edad mayor de 75 años fue el factor determinante principal para no utilizar iSGLT2 (OR ajustada 0,28; intervalo de confianza al 95%: 0,10-0,74; p=0,039) o AR-GLP1 (OR ajustada 0,09; intervalo de confianza al 95%: 0,02-0,46; p=0,006). Discusión Una gran proporción de pacientes ancianos con DM tipo 2 de muy alto riesgo cardiovascular no recibe terapia antihiperglucemiante con fármacos de probado beneficio cardiovascular. El tratamiento más frecuentemente utilizado fue metformina e iDPP4. Existe un margen de mejora en el tratamiento en esta población de muy alto riesgo (AU)

Objective To evaluate the use of therapy with cardiovascular benefit in patients with type 2 diabetes mellitus admitted to internal medicine departments. Methods One day, cross-sectional study of patients with type 2 diabetes mellitus hospitalised in internal medicine departments. We recorded demographic and anthropometric variables, laboratory data and use of antihyperglycaemic drugs. The endpoint was the proportion and determinants of the use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1-RA). Results We included 928 patients belonging to 74 hospitals, with a mean age of 78.9 years (SD, 10.86 years), 50% of whom were men. A total of 557 (60%) patients had ischaemic heart disease, 189 (20.4%) had cerebrovascular disease, 293 (31.6%) had heart failure, 274 (29.5%) had chronic kidney disease, and 129 (13.9%) had peripheral arterial disease. Prior to their hospital admission, the patients were taking sulfonylureas (5.7%), biguanides (49.1%), alpha-glucosidase inhibitors (0.2%), pioglitazone (0%), dipeptidyl peptidase 4 inhibitors (39%), SGLT2i (5.8%), GLP1-RA (2.6%) and basal insulin analogues (24%). An age over 75 years was the main determinant for not taking SGLT2i (adjusted OR, 0.28; 95% CI 0.10-0.74; P=.039) or GLP1-RA (adjusted OR, 0.09; 95% CI 0.02-0.46; P=.006). Discussion A large proportion of elderly patients with type 2 diabetes mellitus at very high cardiovascular risk are not treated with antihyperglycemic drugs with proven cardiovascular benefit. The most commonly used drugs were metformin and DPP4i. There is room for improvement in the treatment of this very high-risk population (AU)

Use of antihyperglycaemic therapy with cardiovascular benefit in patients with type 2 diabetes who require hospitalisation: A cross-sectional study. / Uso de terapia antihiperglucemiante con beneficio cardiovascular en pacientes con diabetes tipo 2 que requieren hospitalización: un estudio transversal.

OBJECTIVE: To evaluate the use of therapy with cardiovascular benefit in patients with type 2 diabetes mellitus admitted to internal medicine departments. METHODS: One day, cross-sectional study of patients with type 2 diabetes mellitus hospitalised in internal medicine departments. We recorded demographic and anthropometric variables, laboratory data and use of antihyperglycaemic drugs. The endpoint was the proportion and determinants of the use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1-RA). RESULTS: We included 928 patients belonging to 74 hospitals, with a mean age of 78.9 years (SD, 10.86 years), 50% of whom were men. A total of 557 (60%) patients had ischaemic heart disease, 189 (20.4%) had cerebrovascular disease, 293 (31.6%) had heart failure, 274 (29.5%) had chronic kidney disease, and 129 (13.9%) had peripheral arterial disease. Prior to their hospital admission, the patients were taking sulfonylureas (5.7%), biguanides (49.1%), alpha-glucosidase inhibitors (0.2%), pioglitazone (0%), dipeptidyl peptidase 4 inhibitors (39%), SGLT2i (5.8%), GLP1-RA (2.6%) and basal insulin analogues (24%). An age over 75 years was the main determinant for not taking SGLT2i (adjusted OR, 0.28; 95% CI 0.10-0.74; P=.039) or GLP1-RA (adjusted OR, 0.09; 95% CI 0.02-0.46; P=.006). DISCUSSION: A large proportion of elderly patients with type 2 diabetes mellitus at very high cardiovascular risk are not treated with antihyperglycemic drugs with proven cardiovascular benefit. The most commonly used drugs were metformin and DPP4i. There is room for improvement in the treatment of this very high-risk population.

PINK1 Silencing Modifies Dendritic Spine Dynamics of Mouse Hippocampal Neurons.

PTEN-induced kinase 1 (PINK1) mutations can cause early-onset Parkinson's disease and patients are likely to develop cognitive decline, depression, and dementia. Several neurophysiological studies have demonstrated PINK1 deficiency impairs striatal and hippocampal presynaptic plasticity. Dendritic spine postsynaptic abnormalities are common in neurological diseases; however, whether PINK1 silencing modifies dendritic spine dynamics of hippocampal neurons is unclear. To address this question, confocal images of mouse cultured hippocampal neurons transfected with plasmids to silence PINK1 were analyzed. These studies revealed that PINK1 silencing increased density of thin spines and reduced head size of stubby spines. Immunoblotting analysis uncovered that PINK1 silencing decreased expression of postsynaptic density proteins (PSD95 and Shank) and glutamate receptors (NR2B and mGluR5). We also found PINK1 silencing regulated dendritic spine morphology by actin regulatory proteins (RhoGAP29 and ROCK2) and regulated neuronal survival by decreased Akt activation. These results suggest PINK1 may regulate postsynaptic plasticity in hippocampal neurons generating presymptomatic alterations in dendritic spines that eventually could lead to the neurodegeneration and cognitive decline often seen in Parkinson's disease.

Diferenciación genética de las poblaciones de Felis catus en los municipios de Restrepo y Darién del Valle del Cauca, Colombia / Genetic differentiation of Felis catus populations in the municipalities Restrepo and Darién of Valle del Cauca, Colombia

Los genes implicados en los rasgos del pelaje de los gatos son útiles para el análisis de la estructura genética que presentan sus poblaciones. El objetivo de este trabajo fue determinar si existe diferenciación genética entre las poblaciones de gato doméstico de los municipios de Restrepo y Darién, los cuales se encuentran separados por el "Lago Calima". Para esto se estimaron las frecuencias alélicas de diversos marcadores del pelaje y se determinó si estas poblaciones presentaban diferencias significativas en su estructura génica o si se encontraban en equilibrio Hardy­Weinberg, además, se realizó una comparación con otras poblaciones inventariadas en el Valle del Cauca. Posteriormente, se llevó a cabo un análisis de componentes principales (ACP-Biplot), para conocer la correlación entre las frecuencias alélicas y los aportes de cada una de ellas a la variabilidad. También se realizó una prueba de Mantel para estimar si existía correlación entre los índices de fijación (FST) y las distancias geográficas. La prueba de Mantel mostró que el gen Orange es el único que muestra una correlación positiva entre los índices de diferenciación FST y las distancias geográficas. La comparación de las poblaciones de interés con las del Valle del Cauca, evidenció que los genes que aportaron más a la variabilidad fueron Dilution (19,08%), Long hair (16,09%), Agouti (16,06%) e Inhibitor (14,04%). Sin embargo, se encontró que las poblaciones de Restrepo y Darién tienen perfiles genéticos similiares y se comportan como una sola según los valores del equilibrio Hardy-Weinberg y los FST. Debido a que no hay diferencias significativas entre las poblaciones estudiadas, se concluye que, aunque el Lago Calima sea una barrera geográfica, no tiene un efecto significativo en la diferenciación genética entre las poblaciones de gatos de Restrepo y Darién.

The genes involved in cat coat traits are useful for the analysis of genetic structure within a population. The objective of this paper was to determine if any genetic differences exist among domestic cat populations from the municipalities of Restrepo and Darien, which are separated by Calima Lake. To analyze population structure, we estimated allelic frequencies of several coat markers, tested for alignment with the Hardy-Weinberg equilibrium, and compared our populations of interest to others from the Valle del Cauca region. Subsequently, we performed a principal components analysis (PCA-Biplot) to determine the correlation between allelic frequencies and their contributions to variability. A Mantel test was also used to estimate possible correlation among differentiation indexes (FST) and geographic distances. We performed the Mantel test on the Orange gene and identified a positive correlation among differentiation indexes (FST) and geographical distances. After comparing our populations of interest to others in the Valle del Cauca, we observed that the genes with the greatest contribution to variability were Dilution (19,08%), Long hair (16,09%), Agouti (16,06%) and Inhibitor (14,04%). However, we also found that the Restrepo and Darien populations of interest had similar genetic profiles, and aligned with the Hardy-Weinberg equilibrium, and the FST. Due to the absence of significant differentiation between the populations studied, we conclude that Calima Lake does not have a significant effect on any differentiation between the cat populations of Restrepo and Darien.

Liver X Receptor Agonist GW3965 Regulates Synaptic Function upon Amyloid Beta Exposure in Hippocampal Neurons.

Alzheimer's disease (AD) is a devastating neurodegenerative disease characterized by beta-amyloid (Aß) accumulation and neurofibrillary tangles formation in the brain which are associated to synaptic deficits and dementia. Liver X receptor (LXR) agonists have been demonstrated to revert of pathologic and cognitive defects in murine models of AD through the regulation of Apolipoprotein E, ATP-Binding Cassette A1 (ABCA1), by dampening neuroinflammation and also by reducing the levels of amyloid-ß (Aß) accumulation in the brain. However, the role of LXR with regard to the regulation of synaptic function remains relatively understudied. In the present paper, we analyzed the in-vitro effect of the LXR agonist GW3965 on synaptic function upon exposure of primary hippocampal cultures to oligomeric amyloid-ß (oAß(1-42)). We showed that oAß(1-42) exposure significantly decreased the density of mature (mushroom shaped) dendritic spines density and synaptic contacts number. oAß(1-42) also modulates the expression of pre- (VGlut1, SYT1, SV2A) and post-synaptic (SHANK2, NMDA) proteins, it decreases the expression of PINK1, and increases ROCKII, and activates of caspase-3; these changes were prevented by the pre-treating neuronal cultures with GW3965. These results show further support the role of the LXR agonist GW3965 in synaptic physiology and highlight its potential as an alternative pharmacological strategy for AD.

Effect of everolimus on the pharmacokinetics of octreotide long-acting repeatable in patients with advanced neuroendocrine tumors: An analysis of the randomized phase III RADIANT-2 trial.

In the RADIANT-2 trial, addition of everolimus to octreotide long-acting repeatable (LAR) exhibited a clinically meaningful 5.1-month improvement in progression-free survival (PFS) in patients with advanced functional neuroendocrine tumors. In this study, we characterized the effects of everolimus co-administration on octreotide LAR pharmacokinetics and its relationship with efficacy and safety. At least one evaluable blood everolimus and plasma octreotide predose minimum concentration (Cmin ) was available for 182 patients and 294 patients, respectively. Concomitant everolimus administration increased octreotide Cmin with a geometric mean ratio (everolimus/placebo) of 1.47 (90% confidence interval [CI] = 1.32-1.64). Risk for progression was consistently reduced when everolimus Cmin was increased twofold, regardless of octreotide exposure (hazard ratio [HR] = 0.74; 95% CI = 0.46-1.18; HR = 0.54; 95% CI = 0.32-0.92 for 6 ng/mL and 4 ng/mL octreotide, respectively). Risk for pulmonary or metabolic events was associated with increased everolimus Cmin . Co-administration of everolimus plus octreotide LAR increased octreotide Cmin , which did not impact efficacy.

Efecto de una intervención sobre indicadores de calidad para mejorar el tratamiento de la hiperglucemia en pacientes hospitalizados en áreas no críticas / Effect of an intervention on quality indicators for improving the treatment of hyperglycemia in patients hospitalized in noncritical areas

Objetivos. Evaluamos el efecto de una intervención sobre determinados indicadores de calidad utilizados para mejorar el tratamiento de la hiperglucemia hospitalaria. Material y métodos. Estudio transversal multicéntrico de pacientes con hiperglucemia ingresados en servicios de Medicina Interna de 44 hospitales evaluados en 2 periodos: 2014 (periodo basal) y 2015 (periodo postintervención). La intervención consistió en la difusión de los indicadores obtenidos en el año 2014 y de los objetivos de mejora. Como indicadores se evaluó la frecuencia de monitorización de la glucosa adaptada a la ingesta o la medicación del paciente, el uso de insulina en régimen basal-bolo o basal-bolo-corrección como método de control de la hiperglucemia y la disponibilidad reciente de HbA1c previa al alta hospitalaria. Resultados. En el año 2014 se evaluó a 506 pacientes y en el 2015 a 562. Los resultados de los indicadores en el periodo basal y postintervención fueron los siguientes: monitorización de la glucemia adaptada a la ingesta o la medicación (71,5 frente a 74,1%; p=0,33), uso de insulina en régimen basal-corrección (32 frente a 32,6%; p=0,61) o basal-bolo-corrección (20,7 frente a 24%; p=0,20) y valor reciente de HbA1c (54,1 frente a 66,3%; p<0,001). Los valores medios de glucosa en las 24h previos al estudio fueron similares en los 2 periodos. El porcentaje de hipoglucemias también fue similar en ambos periodos (3,3 vs. 2,3%; p=0,31). Conclusiones. Es necesario implementar intervenciones multimodales para mejorar el tratamiento de la hiperglucemia en pacientes hospitalizados en áreas no críticas (AU)

Objectives. We evaluated the effect of an intervention on certain quality indicators employed for improving the treatment of hospital hyperglycemia. Material and methods. A multicenter cross-sectional study was conducted on patients with hyperglycemia hospitalized in the internal medicine departments of 44 hospitals evaluated in 2 time periods: 2014 (baseline period) and 2015 (postintervention period). The intervention consisted of the dissemination of the indicators obtained in 2014 and the objectives for improvement. As indicators, we assessed the frequency of glucose monitoring adapted to the patient's dietary intake or medication, the use of basal-bolus or basal-bolus-correction insulin therapy as the preferred control method of hyperglycemia and the recent availability of HbA1c prior to hospital discharge. Results. A total of 506 and 562 patients were assessed in 2014 and 2015, respectively. The results of the indicators in the baseline and postintervention periods were as follows: blood glucose monitoring adapted to the dietary intake or the medication (71.5 vs. 74.1%, P=.33), use of insulin in basal-correction regimen (32 vs. 32.6%, P=.61) or basal-bolo-correction (20.7 vs. 24, P=.20) and recent HbA1c value (54.1 vs. 66.3%, P<.001). The mean glucose values in the 24h prior to the study were similar in the 2 periods. The rate of hypoglycemia was also similar in both periods (3.3 vs. 2.3%, P=.31). Conclusions. There is a need to implement multimodal interventions to improve the treatment of hyperglycemia in patients hospitalized in noncritical areas (AU)

Drenaje lumbar externo de líquido cefalorraquídeo en pacientes con hemorragia subaracnoidea aneurismática: revisión sistemática y metaanálisis de estudios controlados / External lumbar cerebrospinal fluid drainage in patients with aneurysmal subarachnoid hemorrhage: A systematic review and meta-analysis of controlled trials

Introducción: El drenaje lumbar externo de líquido cefalorraquídeo es una medida promisoria para la prevención de las complicaciones de la isquemia cerebral tardía asociada a la hemorragia subaracnoidea espontánea de origen aneurismático. Métodos: Se incluyeron los estudios controlados que evaluaran los efectos del drenaje lumbar externo en pacientes con hemorragia subaracnoidea aneurismática. Los desenlaces primarios fueron: nuevos infartos cerebrales y discapacidad grave. Los desenlaces secundarios fueron: deterioro clínico causado por isquemia cerebral tardía, mortalidad y necesidad de derivación ventricular definitiva. Los resultados se presentaron en riesgos relativos combinados, con un intervalo de confianza del 95% (IC 95%). Resultados: Fueron incluidos un total de 6 estudios controlados. Los riesgos relativos combinados fueron: nuevos infartos cerebrales, 0,48 (IC 95%: 0,32-0,72); discapacidad grave, 0,5 (IC 95%: 0,29-0,85); deterioro clínico causado por isquemia cerebral tardía, 0,46 (IC 95%: 0,34-0,63); mortalidad, 0,71 (IC 95%: 0,24-2,06) y necesidad de derivación ventricular definitiva, 0,80 (IC 95%: 0,51-1,24). La evaluación de la heterogeneidad demostró índices estadísticamente significativos únicamente en el análisis de discapacidad grave (I2 = 70% y p = 0,01). Conclusión: El drenaje lumbar externo se asoció con una reducción estadísticamente significativa del riesgo de complicaciones causadas por la isquemia cerebral tardía (infartos cerebrales y deterioro clínico), así como del riesgo de discapacidad grave; sin embargo, esto no se tradujo en una menor mortalidad. No obstante, no es prudente emitir recomendaciones definitivas debido a la heterogeneidad cualitativa y cuantitativa entre los estudios. Son necesarios más ensayos clínicos con definiciones homogéneas de sus desenlaces para aclarar sus efectos en los pacientes con hemorragia subaracnoidea aneurismática

Introduction: External lumbar drainage is a promising measure for the prevention of delayed aneurysmal subarachnoid hemorrhage-related ischemic complications. Methods: Controlled studies evaluating the effects of external lumbar drainage in patients with aneurysmal subarachnoid hemorrhage were included. Primary outcomes were: new cerebral infarctions and severe disability. Secondary outcomes were: clinical deterioration due to delayed cerebral ischemia, mortality, and the need of definitive ventricular shunting. Results were presented as pooled relative risks, with their 95% confidence intervals (95% CI). Results: A total of 6 controlled studies were included. Pooled relative risks were: new cerebral infarctions, 0.48 (95% CI: 0.32-0.72); severe disability, 0.5 (95% CI: 0.29-0.85); delayed cerebral ischemia-related clinical deterioration, 0.46 (95% CI: 0.34-0.63); mortality, 0.71 (95% CI: 0.24-2.06), and need of definitive ventricular shunting, 0.80 (95% CI: 0.51-1.24). Assessment of heterogeneity only revealed statistically significant indexes for the analysis of severe disability (I2 = 70% and P = .01). Conclusion: External lumbar drainage was associated with a statistically significant decrease in the risk of delayed cerebral ischemia-related complications (cerebral infarctions and clinical deterioration), as well as the risk of severe disability; however, it was not translated in a lower mortality. Nevertheless, it is not prudent to provide definitive recommendations at this time because of the qualitative and quantitative heterogeneity among included studies. More randomized controlled trials with more homogeneous outcomes and definitions are needed to clarify its impact in patients with aneurysmal subarachnoid hemorrhage

Effect of an intervention on quality indicators for improving the treatment of hyperglycemia in patients hospitalized in noncritical areas. / Efecto de una intervención sobre indicadores de calidad para mejorar el tratamiento de la hiperglucemia en pacientes hospitalizados en áreas no críticas.

OBJECTIVES: We evaluated the effect of an intervention on certain quality indicators employed for improving the treatment of hospital hyperglycemia. MATERIAL AND METHODS: A multicenter cross-sectional study was conducted on patients with hyperglycemia hospitalized in the internal medicine departments of 44 hospitals evaluated in 2 time periods: 2014 (baseline period) and 2015 (postintervention period). The intervention consisted of the dissemination of the indicators obtained in 2014 and the objectives for improvement. As indicators, we assessed the frequency of glucose monitoring adapted to the patient's dietary intake or medication, the use of basal-bolus or basal-bolus-correction insulin therapy as the preferred control method of hyperglycemia and the recent availability of HbA1c prior to hospital discharge. RESULTS: A total of 506 and 562 patients were assessed in 2014 and 2015, respectively. The results of the indicators in the baseline and postintervention periods were as follows: blood glucose monitoring adapted to the dietary intake or the medication (71.5 vs. 74.1%, P=.33), use of insulin in basal-correction regimen (32 vs. 32.6%, P=.61) or basal-bolo-correction (20.7 vs. 24, P=.20) and recent HbA1c value (54.1 vs. 66.3%, P<.001). The mean glucose values in the 24h prior to the study were similar in the 2 periods. The rate of hypoglycemia was also similar in both periods (3.3 vs. 2.3%, P=.31). CONCLUSIONS: There is a need to implement multimodal interventions to improve the treatment of hyperglycemia in patients hospitalized in noncritical areas.

Thermal behavior in the magnetic phase diagram of the easy axis antiferromagnet Cs2FeCl5·H2O.

The specific heat at a constant applied field C(H)(T) and at fixed temperatures C(T)(H) of single crystals of the low anisotropy antiferromagnet Cs2FeCl5·H2O was measured across the different boundaries of its magnetic phase diagram, in magnetic fields up to 9 T applied parallel and perpendicular to the easy axis direction and to temperatures down to 0.3 K. The specific heat data indicate that the critical behavior along the antiferromagnetic to paramagnetic phase boundary and the spin-flop to paramagnetic phase boundary, are basically the same. We also measured the specific heat when the first order antiferromagnetic to spin-flop phase boundary is crossed at a fixed temperature. The entropy of the different magnetic phases is discussed.

Phlpp1 facilitates post-traumatic osteoarthritis and is induced by inflammation and promoter demethylation in human osteoarthritis.

OBJECTIVE: Osteoarthritis (OA) is the most common form of arthritis and a leading cause of disability. OA is characterized by articular chondrocyte deterioration, subchondral bone changes and debilitating pain. One strategy to promote cartilage regeneration and repair is to accelerate proliferation and matrix production of articular chondrocytes. We previously reported that the protein phosphatase Phlpp1 controls chondrocyte differentiation by regulating the activities of anabolic kinases. Here we examined the role of Phlpp1 in OA progression in a murine model. We also assessed PHLPP1 expression and promoter methylation. DESIGN: Knee joints of WT and Phlpp1(-/-) mice were surgically destabilized by transection of the medial meniscal ligament (DMM). Mice were assessed for signs of OA progression via radiographic and histological analyses, and pain assessment for mechanical hypersensitivity using the von Frey assay. Methylation of the PHLPP1 promoter and PHLPP1 expression were evaluated in human articular cartilage and chondrocyte cell lines. RESULTS: Following DMM surgeries, Phlpp1 deficient mice showed fewer signs of OA and cartilage degeneration. Mechanical allodynia associated with DMM surgeries was also attenuated in Phlpp1(-/-) mice. PHLPP1 was highly expressed in human articular cartilage from OA patients, but was undetectable in cartilage specimens from femoral neck fractures (FNFxs). Higher PHLPP1 levels correlated with less PHLPP1 promoter CpG methylation in cartilage from OA patients. Blocking cytosine methylation or treatment with inflammatory mediators enhanced PHLPP1 expression in human chondrocyte cell lines. CONCLUSION: Phlpp1 deficiency protects against OA progression while CpG demethylation and inflammatory cytokines promote PHLPP1 expression.

External lumbar cerebrospinal fluid drainage in patients with aneurysmal subarachnoid hemorrhage: A systematic review and meta-analysis of controlled trials. / Drenaje lumbar externo de líquido cefalorraquídeo en pacientes con hemorragia subaracnoidea aneurismática: revisión sistemática y metaanálisis de estudios controlados.

INTRODUCTION: External lumbar drainage is a promising measure for the prevention of delayed aneurysmal subarachnoid hemorrhage-related ischemic complications. METHODS: Controlled studies evaluating the effects of external lumbar drainage in patients with aneurysmal subarachnoid hemorrhage were included. Primary outcomes were: new cerebral infarctions and severe disability. Secondary outcomes were: clinical deterioration due to delayed cerebral ischemia, mortality, and the need of definitive ventricular shunting. Results were presented as pooled relative risks, with their 95% confidence intervals (95% CI). RESULTS: A total of 6 controlled studies were included. Pooled relative risks were: new cerebral infarctions, 0.48 (95% CI: 0.32-0.72); severe disability, 0.5 (95% CI: 0.29-0.85); delayed cerebral ischemia-related clinical deterioration, 0.46 (95% CI: 0.34-0.63); mortality, 0.71 (95% CI: 0.24-2.06), and need of definitive ventricular shunting, 0.80 (95% CI: 0.51-1.24). Assessment of heterogeneity only revealed statistically significant indexes for the analysis of severe disability (I(2)=70% and P=.01). CONCLUSION: External lumbar drainage was associated with a statistically significant decrease in the risk of delayed cerebral ischemia-related complications (cerebral infarctions and clinical deterioration), as well as the risk of severe disability; however, it was not translated in a lower mortality. Nevertheless, it is not prudent to provide definitive recommendations at this time because of the qualitative and quantitative heterogeneity among included studies. More randomized controlled trials with more homogeneous outcomes and definitions are needed to clarify its impact in patients with aneurysmal subarachnoid hemorrhage.

A functional microengineered model of the human splenon-on-a-chip.

The spleen is a secondary lymphoid organ specialized in the filtration of senescent, damaged, or infected red blood cells. This unique filtering capacity is largely due to blood microcirculation through filtration beds of the splenic red pulp in an open-slow microcirculation compartment where the hematocrit increases, facilitating the recognition and destruction of unhealthy red blood cells by specialized macrophages. Moreover, in sinusal spleens such as those of humans, blood in the open-slow microcirculation compartment has a unidirectional passage through interendothelial slits before reaching the venous system. This further physical constraint represents a second stringent test for erythrocytes ensuring elimination of those cells lacking deformability. With the aim of replicating the filtering function of the spleen on a chip, we have designed a novel microengineered device mimicking the hydrodynamic forces and the physical properties of the splenon, the minimal functional unit of the red pulp able to maintain filtering functions. In this biomimetic platform, we have evaluated the mechanical and physiological responses of the splenon using human red blood cells and malaria-infected cells. This novel device should facilitate future functional studies of the spleen in relation to malaria and other hematological disorders.

Validation of a methodology for inpatient pharmacotherapy follow-up / Validación de una metodología para el seguimiento farmacoterapéutico en paciente hospitalizado

Background: Pharmacotherapy follow-up is a practice in which the pharmacist assumes responsibilityfor the patient’s drug-related Problems. Its goal is to achieve positive clinical outcomes. Methods toperform pharmacotherapy follow-up have centered principally on ambulatory patients. Objective: Thepurpose of this study is to propose and validate a methodology for inpatient pharmacotherapy follow-up.Methods: A systematic review was performed. This consisted in a comprehensive search of databasescontaining studies published in English or Spanish during 1998 - 2008, and that sought to improve thetransfer of accurate information about Pharmacotherapy follow-up in inpatients. The key terms used toconduct the search were identified in consultation with clinical experts and included: Pharmacotherapyfollow-up methods, pharmacotherapy follow-up, drug therapy problems, and validation. A comparativetable was elaborated to differentiate and evaluate the advantages of each of the proposed methodologies.The information gathered allowed to propose a sequence of general steps for inpatient Pharmacotherapyfollow-up. To validate the methodology, a descriptive study was carried out with 32 randomly selectedpatients and was independently followed up by two pharmacists to assess the reproducibility of the process.Results: Pharmaceutical Care Practice: The Clinician’s Guide, proposed by Cipolle & Strand. AppliedTherapeutics: The Clinical Use of Drugs, the DÁDER method, and the IASER program, were selected.79 drug therapy problems (DTPs) were identified and resolved, where errors in necessity of medicationhad the highest incidence (46.6%), followed by effectiveness (24.5%) and safety (28.9%). The degree ofagreement among researchers in the identification and resolution of DTPs was quantified using the kappacoefficient, showing a high concordance (90% CI)...

Functional analysis of Plasmodium vivax VIR proteins reveals different subcellular localizations and cytoadherence to the ICAM-1 endothelial receptor.

The subcellular localization and function of variant subtelomeric multigene families in Plasmodium vivax remain vastly unknown. Among them, the vir superfamily is putatively involved in antigenic variation and in mediating adherence to endothelial receptors. In the absence of a continuous in vitro culture system for P. vivax, we have generated P. falciparum transgenic lines expressing VIR proteins to infer location and function. We chose three proteins pertaining to subfamilies A (VIR17), C (VIR14) and D (VIR10), with domains and secondary structures that predictably traffic these proteins to different subcellular compartments. Here, we showed that VIR17 remained inside the parasite and around merozoites, whereas VIR14 and VIR10 were exported to the membrane of infected red blood cells (iRBCs) in an apparent independent pathway of Maurer's clefts. Remarkably, VIR14 was exposed at the surface of iRBCs and mediated adherence to different endothelial receptors expressed in CHO cells under static conditions. Under physiological flow conditions, however, cytoadherence was only observed to ICAM-1, which was the only receptor whose adherence was specifically and significantly inhibited by antibodies against conserved motifs of VIR proteins. Immunofluorescence studies using these antibodies also showed different subcellular localizations of VIR proteins in P. vivax-infected reticulocytes from natural infections. These data suggest that VIR proteins are trafficked to different cellular compartments and functionally demonstrates that VIR proteins can specifically mediate cytoadherence to the ICAM-1 endothelial receptor.

Reparación de la eventración mediante prótesis intraperitoneal composite (parietene composite®) de componente absorbible, encirugía mayor ambulatoria y corta estancia en un hospital de alta resolución / No disponible

Objetivo: La cirugía mayor ambulatoria (CMA) requiere procedimientos seguros, de corta duración y con resultados similares a los de la hospitalización convencional. El objetivo de nuestro estudio es valorar la factibilidad y calidad de la reparación de eventraciones mediante la inserción de una prótesis intraperitoneal en CMA. Material y método: A lo largo de 31 meses 74 pacientes fueron atendidos con el diagnóstico de eventración en nuestra unidad. De estos, 54 fueron operados mediante técnica de reparación con prótesis intraperitoneal (RPI) de Parietene o Parietex Composite® (Sofradim Production). La RPI se ha realizado en eventraciones con defecto músculo-aponeurótico mayor de 5 cm. Se valora el estado de salud postoperatorio al 5º día mediante escala analógico-visual y EuroQol-5D.Resultados: El índice de sustitución fue del 51% y la duración media de la intervención de 38 minutos. Se registraron cuatro infecciones y un hematoma de herida, una perforación puntiforme de intestino delgado y tres ingresos no programados. Cinco pacientes fueron programados para cirugía en régimen de corta estancia.A los 5 días los pacientes se ocupaban de su aseo personal y dos de los pacientes manifestaron dolor espontáneo leve. El seguimiento de 39 pacientes (15,7 meses) ha detectado 3 recidivas. Conclusiones: La RPI es una técnica rápida y segura, realizable en régimen de CMA (AU)

Objective: Ambulatory surgery requires safe procedures of short duration with results comparable to those of hospitalization. The aim of our study is to assess the feasibility and quality of the repair of incisional hernia by insertion of an intraperitoneal prosthesis(IPP) on an ambulatory basis. Method and material: Over 31 months we have operated on 74 patients with a diagnosis of incisional hernia. In 54, the IPP technique was used by insertion of a Parietene or Parietex Composite mesh (Sofradim Production). The IPP technique was chosen when the hernia defect was greater than 5 cm. The postoperative status was evaluated through a visual analogue scale and the test EuroQol-5D.Results: The substitution index was 51 %. The mean operative time was 38 minutes. Complications were: four wound infections, one hematoma, one pinpoint bowel perforation. Three patients had to be unexpectedly admitted to hospital and another five were scheduled as short stay surgery. On the fifth postoperative day, patients were able to self-care and two patients complained of mild pain. The follow-up of 39 patients (15.7 months) has detected three recurrences. Conclusion: The IPP technique is a rapid and safe method, feasible as day surgery (AU)