Validez y fiabilidad del cuestionario DASH en mujeres con linfedema secundario a tratamiento de cáncer de mama / Validity and reliability of DASH questionnaire in women who suffer from lymphedema as a side effect of a breast cancer treatment

Introducción: El cuestionario DASH está diseñado para la valoración funcional del miembro superior en enfermedad musculoesquelética. El objetivo de este trabajo es verificar las principales propiedades instrumentales (validez y fiabilidad) del cuestionario para su aplicación en mujeres españolas con linfedema secundario a tratamiento de cáncer de mama. Métodos: Cohorte prospectiva de 65 mujeres con linfedema secundario a tratamiento de cáncer de mama, en las que se estudió la fiabilidad de la puntuación del DASH mediante la consistencia interna (coeficiente alfa de Cronbach) y test-retest en un intervalo de 15 días (coeficiente de correlación intraclase), y la validez mediante la correlación con las puntuaciones del SF-36v2 y de la FACT-B+4 (r o τ b de Kendall). Resultados: La consistencia interna y fiabilidad test-retest fueron alfa de Cronbach 0,969 y coeficiente de correlación intraclase 0,861, respectivamente. Existía correlación entre las puntuaciones del DASH y las del SF-36v2, sobre todo con los dominios de función física, dolor corporal y rol físico (r de 0,800, 0,738 y 0,682, respectivamente; p<0,001), y menos con el rol emocional y social. Se correlacionaba con la puntuación FACT-B+4 (r=0,836; p<0,001) y la subescala miembro superior (r=0,816; p<0,001) y no existe correlación con la subescala social/familiar (r=0,193; p=0,216). Conclusión: El cuestionario DASH es una herramienta fiable y válida para ser utilizada en la valoración funcional de miembro superior de mujeres españolas con linfedema secundario a tratamiento de cáncer de mama.(AU)

Introduction: DASH questionnaire was designed to assess upper limb function in musculoskeletal pathologies. The aim of this manuscript is to study the reliability and validity of this questionnaire, to determine if is adequate to use in women with lymphedema due to breast cancer treatment. Methods: Prospective study in 65 women with lymphedema due to breast cancer treatment was done, in which the reliability of DASH score with internal consistency (Cronbach's alpha) and test–retest reproducibility 15 days’ interval (interclass correlation coefficient) and validity by correlation with SF-36v2 and FACT-B+4 (r or Kendall's τ b) scores was investigated. Results: The internal consistency and the test–retest were Cronbach's alpha 0.969 and interclass correlation coefficient 0.861, respectively. There was correlation between the DASH score with the SF-36v2 score, mainly in the areas of physical function, body pain and physical role (r 0.800, 0.738, and 0.682, respectively; p<0.001), and lowest with the emotional and social wellbeing. The DASH score had correlation with FACT-B+4 (0.836; p<0.001) and the subscales the upper limb score (r=0.816; p<0.001), and there was no correlation with the social/familiar subscale (r=0.193; p=0.216). Conclusion: The DASH questionnaire is a reliable and valid tool to assess upper limb functionality in Spanish women with breast cancer related lymphedema.(AU)

Improving echographic monitoring of hemodynamics in critically ill patients: Validation of right cardiac output measurements through the modified subcostal window / Mejorando la monitorización hemodinámica ecográfica en el paciente crítico: validación de la medición del gasto cardíaco derecho a través de la ventana subcostal modificada

Objective We aimed to assess the usefulness of using the right ventricle outflow tract (RVOT) velocity-time integral (VTI) for echocardiographic monitoring of cardiac output compared to the gold standard, the VTI along the left ventricle outflow tract (LVOT). Design Prospective observational study. Setting A tertiary intensive care unit. Patients 100 consecutive patients. Interventions: echocardiographic monitoring in critically ill patients. Main variables of interest We used intraclass correlation coefficients (ICC) to compare echocardiographic measurements of LVOT VTI through apical window with RVOT VTI through the parasternal and modified subcostal windows and to assess interobserver reproducibility. Preplanned post hoc analyses compared the ICC between ventilated and nonventilated patients. Results At the time of echocardiography, 44 (44%) patients were mechanically ventilated and 28 (28%) were receiving vasoactive drugs. Good-quality measurements were obtained through the parasternal short-axis and/or apical views in 81 (81%) patients and in 100 (100%) patients through the subcostal window. Consistency with LVOT VTI was moderate for RVOT VTI measured from the modified subcostal view (ICC 0.727; 95%CI: 0.62–0.808) and for RVOT VTI measured from the transthoracic view (0.715; 95%CI: 0.59–0.807). Conclusions Measurements of RVOT VTI are moderately consistent with measurements of LVOT VTI. Adding the modified subcostal window allows monitoring RVOT VTI in all the patients of this selected cohort, even those under mechanical ventilation (AU)

Objetivo Valorar la utilidad de la integral velocidad-tiempo (IVT) del tracto de salida del ventrículo derecho (TSVD) para la monitorización del gasto cardíaco comparado con el gold standard, el IVT del tracto de salida del ventrículo izquierdo (TSVI). Diseño Estudio prospectivo observacional. Ámbito UCI de un hospital terciario. Paciente Cien pacientes consecutivos. Intervenciones Ecocardiografías realizadas para monitorización hemodinámica. Variables de interés principales Usamos el coeficiente de correlación intraclase (CCI) para comparar las mediciones de IVT TSVI a través de la ventana apical con el IVT TSVD a través de la ventana paraesternal y subcostal modificada y la reproducibilidad interobservador. Se planeó un análisis post hoc para comparar los resultados en pacientes ventilados con no ventilados. Resultados En el momento de la ecografía, 44 (44%) pacientes estaban en ventilación mecánica y 28 (28%) recibían fármacos vasoactivos. Mediciones de buena calidad se obtuvieron a través de la ventana paraesternal o apical en 81 (81%) pacientes, y en 100 (100%) con la ventana subcostal modificada. La consistencia del IVT TSVI fue moderada con el IVT TSVD medido con la ventana subcostal modificada (CCI 0,727; IC 95%: 0,62-0,808) y la transtorácica (0,715; IC 95%: 0,59-0,807). Conclusiones El IVT TSVD presenta una consistencia moderada cuando se compara con el IVT TSVI. Añadir la ventana subcostal modificada permite monitorizar el IVT TSVD en todos los pacientes de esta cohorte, incluso aquellos con ventilación mecánica (AU)

[Validity and reliability of DASH questionnaire in women who suffer from lymphedema as a side effect of a breast cancer treatment]. / Validez y fiabilidad del cuestionario DASH en mujeres con linfedema secundario a tratamiento de cáncer de mama.

INTRODUCTION: DASH questionnaire was designed to assess upper limb function in musculoskeletal pathologies. The aim of this manuscript is to study the reliability and validity of this questionnaire, to determine if is adequate to use in women with lymphedema due to breast cancer treatment. METHODS: Prospective study in 65 women with lymphedema due to breast cancer treatment was done, in which the reliability of DASH score with internal consistency (Cronbach's alpha) and test-retest reproducibility 15 days' interval (interclass correlation coefficient) and validity by correlation with SF-36v2 and FACT-B+4 (r or Kendall's τ b) scores was investigated. RESULTS: The internal consistency and the test-retest were Cronbach's alpha 0.969 and interclass correlation coefficient 0.861, respectively. There was correlation between the DASH score with the SF-36v2 score, mainly in the areas of physical function, body pain and physical role (r 0.800, 0.738, and 0.682, respectively; p<0.001), and lowest with the emotional and social wellbeing. The DASH score had correlation with FACT-B+4 (0.836; p<0.001) and the subscales the upper limb score (r=0.816; p<0.001), and there was no correlation with the social/familiar subscale (r=0.193; p=0.216). CONCLUSION: The DASH questionnaire is a reliable and valid tool to assess upper limb functionality in Spanish women with breast cancer related lymphedema.

Improving echographic monitoring of hemodynamics in critically ill patients: Validation of right cardiac output measurements through the modified subcostal window.

OBJECTIVE: We aimed to assess the usefulness of using the right ventricle outflow tract (RVOT) velocity-time integral (VTI) for echocardiographic monitoring of cardiac output compared to the gold standard, the VTI along the left ventricle outflow tract (LVOT). DESIGN: Prospective observational study. SETTING: A tertiary intensive care unit. PATIENTS: 100 consecutive patients. INTERVENTIONS: echocardiographic monitoring in critically ill patients. MAIN VARIABLES OF INTEREST: We used intraclass correlation coefficients (ICC) to compare echocardiographic measurements of LVOT VTI through apical window with RVOT VTI through the parasternal and modified subcostal windows and to assess interobserver reproducibility. Preplanned post hoc analyses compared the ICC between ventilated and nonventilated patients. RESULTS: At the time of echocardiography, 44 (44%) patients were mechanically ventilated and 28 (28%) were receiving vasoactive drugs. Good-quality measurements were obtained through the parasternal short-axis and/or apical views in 81 (81%) patients and in 100 (100%) patients through the subcostal window. Consistency with LVOT VTI was moderate for RVOT VTI measured from the modified subcostal view (ICC 0.727; 95%CI: 0.62-0.808) and for RVOT VTI measured from the transthoracic view (0.715; 95%CI: 0.59-0.807). CONCLUSIONS: Measurements of RVOT VTI are moderately consistent with measurements of LVOT VTI. Adding the modified subcostal window allows monitoring RVOT VTI in all the patients of this selected cohort, even those under mechanical ventilation.

Mucopolysaccharidosis type II: identification of 30 novel mutations among Latin American patients.

In this study, 103 unrelated South-American patients with mucopolysaccharidosis type II (MPS II) were investigated aiming at the identification of iduronate-2-sulfatase (IDS) disease causing mutations and the possibility of some insights on the genotype-phenotype correlation The strategy used for genotyping involved the identification of the previously reported inversion/disruption of the IDS gene by PCR and screening for other mutations by PCR/SSCP. The exons with altered mobility on SSCP were sequenced, as well as all the exons of patients with no SSCP alteration. By using this strategy, we were able to find the pathogenic mutation in all patients. Alterations such as inversion/disruption and partial/total deletions of the IDS gene were found in 20/103 (19%) patients. Small insertions/deletions/indels (<22 bp) and point mutations were identified in 83/103 (88%) patients, including 30 novel mutations; except for a higher frequency of small duplications in relation to small deletions, the frequencies of major and minor alterations found in our sample are in accordance with those described in the literature.

Intervenciones para mejorar el manejo de la neumonía adquirida en la comunidad desde el servicio de urgencias / Interventions to improve emergency-department management of community-acquired pneumonia

OBJETIVOS: Determinar el impacto de distintas intervenciones consistentes en la implantación de una guía de práctica clínica (GPC) en el proceso asistencial de la neumonía adquirida en la comunidad (NAC) en un servicio de urgencias (SU), analizar y comparar las decisiones de manejo (alta o ingreso, adecuación y precocidad de la antibioterapia, solicitud de estudios complementarios), los resultados de evolución (tiempo de estabilización clínica, tiempo de estancia hospitalaria, reconsultas en el SU) y la mortalidad, antes y después de las intervenciones y a lo largo de 5 años. MÉTODOS: Estudio prospectivo pre y postintervención realizado desdel 1 enero de 2008 al 31 julio de 2012 en cuatro fases (se evaluaron dos periodos pre-implantación y dos periodos post-implantación de las GPC). RESULTADOS: En los grupos tras la implantación de las GPC y al final del estudio se logró reducir el tiempo hasta la estabilización clínica (0,54 días, p < 0,001), la estancia hospitalaria (2,25 días, p < 0,001) y la mortalidad intrahospitalaria (de 20% a 4,3%, p < 0,001) y la global a los 30 días (de 15% a 5,5%, p = 0,003), con un aumento de la administración adecuada y precoz del antibiótico (p < 0,001) y una disminución del tiempo de tratamiento antibiótico total (2,25 días, p < 0,001) e intravenoso (1,96 días, p < 0,001). El uso del Pneumonia Severity Index (PSI) y los biomarcadores ayudaron a mejorar la adecuación de la decisión alta o ingreso (p < 0,001). CONCLUSIONES: Tras cada implementación de una GPC con el uso del PSI y los biomarcadores se mejoró de forma significativa todo el proceso asistencial en urgencias de la NAC

OBJECTIVES: To determine the impact of emergency-department interventions based on clinical practice guidelines for treating community-acquired pneumonia by analyzing and comparing management decisions (discharge vs admission; adequacy and timing of antibiotic treatment; additional tests ordered), results over time (until patient's condition stabilized, duration of hospital stay, emergency department revisits), and mortality (before and after interventions and up to 5 years). METHODS: Prospective, pre and postintervention study of cases between January 1, 2008, and July 31, 2012, in 4 phases (2 periods before introduction of interventions and 2 periods afterwards). RESULTS: In the patient groups just after introduction of the guidelines-based interventions and at the end of the study, time until the patient was stabilized decreased (by 0.54 days, P<.001), and hospital stay was shorter (by 2.25 days, P < .001). Mortality also fell: in-hospital mortality decreased from 20% to 4.3% (P<.001), and 30-day mortality decreased from 15% to 5.5%, P=.003). Early, adequate use of antibiotics increased, and the total time on antibiotics decreased (by 2.25 days); time on intravenous antibiotics also decreased (by 1.96 days) (all comparisons, P<.001). The pneumonia severity index (PSI) and biomarkers were helpful for making decisions to admit or discharge patients (P<.001). CONCLUSION: After implementation of clinical practice guidelines and use of the PSI, the emergency care of patients with community-acquired pneumonia improved

Impacto de la densidad mamaria mamográfica en el funcionamiento de un sistema de detección asistido por ordenador en una unidad de patología mamaria / Impact of mammographic breast density on computer-assisted detection (CAD) in a breast imaging department

Objetivo. Evaluar si la densidad mamaria influye en la sensibilidad (global y por marcas) para la detección del cáncer de mama de un sistema de detección asistido por ordenador (CAD). Materiales y métodos. Estudio prospectivo de 8.750 mamografías digitales con un sistema CAD asociado. Se clasificaron las densidades mamarias según los criterios BI-RADS. Calculamos la sensibilidad global del radiólogo y del CAD, la sensibilidad por proyección, por hallazgo, en relación con la densidad mamográfica y analizamos los carcinomas de intervalo. Para el análisis estadístico utilizamos el programa SPSS vs 11. Resultados. Sensibilidad global del CAD 88,5% IC del 95% (IC95% 83,2-92,7%), sensibilidad del radiólogo 93,5% IC95% (84,4-95,5%), sensibilidad de la proyección craneocaudal 81,6% IC95% (76,5-90,7%) vs 76,5% IC95% (69,3-89,3%) para oblicuomediolateral, sensibilidad para microcalcificaciones 98,6% IC95% (96,5-99,7%), sensibilidad de marca masa 83,4% IC95% (81,2-91,7%). Detectamos discrepancias menores del 20% tanto para las microcalcificaciones presentes en los 4 tipos de densidades como para las masas con densidades 1 y 2; mientras en las masas con densidad 3 la discrepancia fue 20,8% y en la 4 fue 55%. El CAD solo dejó de marcar el 9,1% (9/94) de los cánceres diagnosticados como masas propiamente dichas. El 50% de los carcinomas de intervalo se produjo en densidad tipo 4 y el 75% se manifestaron como masas, asimetrías y distorsiones. El 35,7% de los carcinomas de intervalo fueron marcados previamente por el CAD. Conclusiones. La sensibilidad fue mayor en la proyección craneocaudal pero no significativamente. La sensibilidad del CAD fue alta para microcalcificaciones presentes en los 4 tipos de densidades, sin embargo, para la marca masa fue baja en densidades 3 y 4. El CAD sólo dejó de marcar el 9,1% de los cánceres diagnosticados como masas propiamente dichas pero fue muy poco sensible para los otros 2 hallazgos radiológicos incluidos en esta marca. El 50% de los carcinomas de intervalo se produjeron en densidades tipo 4 y el 35,7% fueron marcados previamente por el sistema de detección asistido por ordenador (AU)

Objective. To evaluate whether breast density influences the sensitivity of a computer-assisted detection (CAD) system for the detection of breast cancer. Material and methods. We prospectively studied 8750 digital mammograms with an associated CAD system. We used BI-RADS criteria to classify breast density. We calculated the overall sensitivity of the radiologist and of the CAD system, as well as the sensitivity for each projection and type of finding in relation to the mammographic density of the breast. Finally, we analyzed the interval carcinomas. We used SPSS 11 for all statistical analyses. Results. The overall sensitivity of the CAD system was 88.5% (95% CI: 83.2-92.7%), and the overall sensitivity of the radiologist was 93.5% (95% CI: 84.4%-95.5%). The sensitivity of the craniocaudal view was 81.6% (95% CI: 76.5-90.7%) vs 76.5% (95% CI: 69.3-89.3%) for the mediolateral oblique view. The sensitivity for microcalcifications was 98.6% (95% CI: 96.5-99.7%), and the sensitivity for masses 83.4% (95% CI: 81.2-91.7%). We detected discrepancies smaller than 20% both for microcalcifications present in the four types of densities and for masses with densities 1 and 2. In masses with density 3 the discrepancy was 20.8% and in those with density 4 it was 55%. The CAD system failed to mark only 9.1% (9/94) of the cancers presenting as masses. Half of the interval carcinomas were found in type 4 density and 75% manifested as masses, asymmetries, and distortions. The CAD system had marked 35.7% of the carcinomas. Conclusions. The craniocaudal view was more sensitive, although this difference was not statistically significant. The sensitivity of CAD was high for microcalcifications in all four density types; however, CAD's sensitivity for masses was low in density types 3 and 4. The CAD system only failed to mark 9.1% of the cancers presenting as masses but was not sensitive for the other two radiological findings included in this marking. Half of the interval carcinomas occurred in type 4 densities and 35.7% had been marked by the CAD sysem (AU)

[Impact of mammographic breast density on computer-assisted detection (CAD) in a breast imaging department]. / Impacto de la densidad mamaria mamográfica en el funcionamiento de un sistema de detección asistido por ordenador en una unidad de patología mamaria.

OBJECTIVE: To evaluate whether breast density influences the sensitivity of a computer-assisted detection (CAD) system for the detection of breast cancer. MATERIAL AND METHODS: We prospectively studied 8750 digital mammograms with an associated CAD system. We used BI-RADS criteria to classify breast density. We calculated the overall sensitivity of the radiologist and of the CAD system, as well as the sensitivity for each projection and type of finding in relation to the mammographic density of the breast. Finally, we analyzed the interval carcinomas. We used SPSS 11 for all statistical analyses. RESULTS: The overall sensitivity of the CAD system was 88.5% (95% CI: 83.2-92.7%), and the overall sensitivity of the radiologist was 93.5% (95% CI: 84.4%-95.5%). The sensitivity of the craniocaudal view was 81.6% (95% CI: 76.5-90.7%) vs 76.5% (95% CI: 69.3-89.3%) for the mediolateral oblique view. The sensitivity for microcalcifications was 98.6% (95% CI: 96.5-99.7%), and the sensitivity for masses 83.4% (95% CI: 81.2-91.7%). We detected discrepancies smaller than 20% both for microcalcifications present in the four types of densities and for masses with densities 1 and 2. In masses with density 3 the discrepancy was 20.8% and in those with density 4 it was 55%. The CAD system failed to mark only 9.1% (9/94) of the cancers presenting as masses. Half of the interval carcinomas were found in type 4 density and 75% manifested as masses, asymmetries, and distortions. The CAD system had marked 35.7% of the carcinomas. CONCLUSIONS: The craniocaudal view was more sensitive, although this difference was not statistically significant. The sensitivity of CAD was high for microcalcifications in all four density types; however, CAD's sensitivity for masses was low in density types 3 and 4. The CAD system only failed to mark 9.1% of the cancers presenting as masses but was not sensitive for the other two radiological findings included in this marking. Half of the interval carcinomas occurred in type 4 densities and 35.7% had been marked by the CAD system.

Clinical and biochemical studies in mucopolysaccharidosis type II carriers.

The aim of the study was to characterize clinically and biochemically mucopolysaccharidosis type II (MPS II) heterozygotes. Fifty-two women at risk to be a carrier, with a mean age of 34.1 years (range 16-57 years), were evaluated through pedigree analysis, medical history, physical examination, measurement of iduronate sulfatase (IDS) activities in plasma and in leukocytes, quantification of glycosaminoglycans (GAGs) in urine, and analysis of the IDS gene. Eligibility criteria for the study also included being 16 years of age or older and being enrolled in a genetic counselling programme. The pedigree and DNA analyses allowed the identification of 40/52 carriers and 12/52 non-carriers. All women evaluated were clinically healthy, and their levels of urinary GAGs were within normal limits. Median plasma and leukocyte IDS activities found among carriers were significantly lower than the values found for non-carriers; there was, however, an overlap between carriers' and non-carriers' values. Our data suggests that MPS II carriers show lower plasma and leukocyte IDS activities but that this reduction is generally associated neither with changes in levels of urinary GAGs nor with the occurrence of clinical manifestations.

[Effect of Helicobacter pylori eradication on patients with functional dyspepsia]. / Efecto del tratamiento erradicador para Helicobacter pylori en pacientes con dispepsia funcional.

OBJECTIVE: This study evaluated Helicobacter pylori eradication therapy in terms of symptomatic response in patients with functional dyspepsia. On the other hand, we analyzed the importance of histologic findings as a predictor of treatment response. In particular, we studied whether antral gastritis (which is associated with peptic ulcer) may predict a greater symptomatic response to Helicobacter pylori eradication in functional dyspepsia. PATIENTS AND METHODS: This prospective, randomized, single-center trial included 48 patients with functional dyspepsia and Helicobacter pylori infection (27 women and 21 men, mean age 37 +/- 13.5 years). Twenty-seven patients received a 10-day course of rabeprazole, amoxicillin, and clarithromycin (eradication group), followed by 20 mg of rabeprazole for 3 months. Twenty-one patients received 20 mg of rabeprazole for 3 months (control group). Patients were followed up over a 1-year period. All patients completed the Dyspepsia-Related Health Scale Questionnaire, which studies four dimensions: pain intensity, pain disability, non-pain symptoms, and satisfaction with dyspepsia-related health. RESULTS: There was significant symptomatic improvement (p < 0.002) after 6 and 12 months, which was similar with both treatments. In the multivariate analyses, eradication therapy and less severe symptoms before treatment were the only independent factors. The symptomatic response to Helicobacter pylori eradication after 6 months was significantly greater as compared to control therapy (p = 0.01) in patients with antral gastritis and in the non-pain symptoms dimension of the questionnaire. CONCLUSIONS: Both treatments proved to be clinically beneficial in patients with functional dyspepsia. We observed a tendency to greater symptomatic benefit with Helicobacter pylori eradication therapy when compared to control treatment in patients with functional dyspepsia and in a population with a high prevalence of this infection. There is a tendency to symptomatic benefit with Helicobacter pylori eradication therapy in patients with antral gastritis.

Efecto del tratamiento erradicador para Helicobacter pylori en pacientes con dispepsia funcional / No disponible

Objetivo: este estudio ha tenido un doble objetivo: por unlado, evaluar el efecto del tratamiento erradicador para Helicobacterpylori en la respuesta sintomática de pacientes diagnosticadosde dispepsia funcional y, por otro, determinar si los hallazgoshistológicos podían servir como predictor de la efectividad dela terapia. En particular, se trató de averiguar si la presencia degastritis antral (la que se asocia a la enfermedad ulcerosa péptica)podría predecir una mayor respuesta sintomática al tratamientoerradicador en los pacientes con dispepsia funcional e infecciónpor Helicobacter pylori.Pacientes y métodos: estudio prospectivo, monocéntrico yaleatorizado, que incluyó a 48 pacientes con dispepsia funcional einfección por Helicobacter pylori (27 mujeres y 21 hombres, conedad media de 37 ± 13,5 años). Veintisiete pacientes recibieronel tratamiento erradicador (rabeprazol, claritromicina y amoxicilinadurante 10 días, seguido de 20 mg/día de rabeprazol 3 meses)y 21 el tratamiento control (20 mg/día de rabeprazol 3 meses).Los pacientes fueron seguidos durante un año. Todos rellenaronel Cuestionario de calidad de vida asociada a dispepsia, queevalúa cuatro apartados: intensidad de los síntomas habituales, intensidaddel dolor de estómago, incapacidad debida al dolor y satisfaccióncon la salud.Resultados: existió una mejoría significativa (p < 0,002) enlos síntomas de los pacientes, tanto a los 6 como a los 12 mesestras el inicio del tratamiento, que además fue común a las dospautas de tratamiento. En el análisis de regresión lineal múltiple,los efectos del tratamiento erradicador y de tener una sintomatologíamenos intensa antes de recibir el tratamiento, fueron los dosúnicos factores independientes de forma significativa. La respuestaal tratamiento erradicador a los 6 meses fue significativamentemayor que con el tratamiento control (p = 0,01) en los pacientescon gastritis de predominio antral y en el apartado concreto de lossíntomas habituales. Conclusiones: ambos tratamientos producen una mejoríasintomática significativa en los pacientes con dispepsia funcional.Se observa una tendencia hacia un beneficio sintomático mayorcon el tratamiento erradicador respecto al control en pacientescon dispepsia funcional y en un medio con elevada prevalencia deinfección por Helicobacter pylori. Existe una tendencia hacia lamejoría sintomática con el tratamiento erradicador en los pacientesque tienen una gastritis de predominio antral

Objective: this study evaluated Helicobacter pylori eradicationtherapy in terms of symptomatic response in patients withfunctional dyspepsia. On the other hand, we analyzed the importanceof histologic findings as a predictor of treatment response.In particular, we studied whether antral gastritis (which is associatedwith peptic ulcer) may predict a greater symptomatic responseto Helicobacter pylori eradication in functional dyspepsia.Patients and methods: this prospective, randomized, single-center trial included 48 patients with functional dyspepsiaand Helicobacter pylori infection (27 women and 21 men,mean age 37 ± 13.5 years). Twenty-seven patients received a10-day course of rabeprazole, amoxicillin, and clarithromycin(eradication group), followed by 20 mg of rabeprazole for 3months. Twenty-one patients received 20 mg of rabeprazole for3 months (control group). Patients were followed up over a 1-year period. All patients completed the Dyspepsia-RelatedHealth Scale Questionnaire, which studies four dimensions:pain intensity, pain disability, non-pain symptoms, and satisfactionwith dyspepsia-related health.Results: there was significant symptomatic improvement (p <0.002) after 6 and 12 months, which was similar with both treatments.In the multivariate analyses, eradication therapy and lesssevere symptoms before treatment were the only independent factors.The symptomatic response to Helicobacter pylori eradicationafter 6 months was significantly greater as compared to controltherapy (p = 0.01) in patients with antral gastritis and in thenon-pain symptoms dimension of the questionnaire.Conclusions: both treatments proved to be clinically beneficialin patients with functional dyspepsia. We observed a tendencyto greater symptomatic benefit with Helicobacter pylori eradicationtherapy when compared to control treatment in patients withfunctional dyspepsia and in a population with a high prevalence of this infection. There is a tendency to symptomatic benefit withHelicobacter pylori eradication therapy in patients with antralgastritis

Clinical and biochemical study of 28 patients with mucopolysaccharidosis type VI.

This paper presents data collected by a Brazilian center in a multinational multicenter observational study of patients with mucopolysaccharidosis type VI (MPS VI), aiming at determining the epidemiological, clinical, and biochemical profile of these patients. Twenty-eight south-American patients with MPS VI were evaluated through medical interview, physical exam, echocardiogram, electrocardiogram, ophthalmologic evaluation, quantification of glycosaminoglycans (GAGs) in urine, and measurement of the activity of N-acetylgalactosamine-4-sulfatase (ARSB) in leukocytes. 92.9% of patients were Brazilian. Mean age at diagnosis and at evaluation was 48.4 months and 97.1 months, respectively. 88% of patients had onset of symptomatology before the age of 36 months. Consanguinity was reported by 27% of the families. Mean weight and height at birth were 3.481 kg and 51.3 cm, respectively. The most frequently reported clinical manifestations were short stature, corneal clouding, coarse facial features, joint contractures, and claw hands. All patients presented with echocardiogram changes as well as corneal clouding. Mean ARSB activity in leukocytes was 5.4 nmoles/h/mg protein (reference values: 72-174), and urinary excretion of GAGs was on average 7.9 times higher than normal. The number of clinical manifestations did not show a significant correlation with the levels of urinary GAGs nor with the ARSB activity. Also, no significant correlation was found between the levels of urinary GAGs and the ARSB activity. It was concluded that MPS VI has high morbidity and that, when compared with data published in the literature, patients in our study were diagnosed later and presented with a higher frequency of cardiological findings.

Digoxinemias obtenidas con dos métodos de dosificación desarrollados en ancianos / Digoxin plasma drug levels atained with two dosing methods developed in aged patients

Objetivo: Evaluar dos métodos de cálculo de la dosis de digoxina en ancianos. Métodos: Se calculan las digoxinencias que hubieran alcanzado 87 ancianos ajustando la dosis a la función renal por dos procedimientos diferentes. Resultados: Edad: 79,0 ± 6,3 años; aclaramiento de creatina (Clc): 0,70 ± 0,23 ml/kg de peso magro y minuto (AU)

Purpose: to evaluate two methods for digoxin dose adjustment in aged patients. Methods: We determined the plasma digoxin levels that would be atained in 87 old patients with doses adjusted to the kidney function by means of two separate procedures. Results: Age: 79,00 ± 6,3 years of age; Clc: 0,70 ± 0,23 ml/kg of lean body weight and minute (...) (AU)

[Best result of digoxin dosing in the aged by taking into account that both the elimination as well as the volume of distribution of the drug decrease when the kidney function deteriorates]. / Mejor resultado del ajuste de la dosis de digoxina en ancianos si se tiene en cuenta que tanto la eliminación como el volumen de distribución del fármaco disminuyen cuando se reduce la función renal.

PURPOSE: To evaluate three methods for digoxin dose adjustment in aged patients. METHODS: We determined the plasma digoxin levels that would be attained in 87 old patients with doses adjusted to the kidney function by means of three separate procedures. RESULTS: Age: 79.0 "6.3 years of age; creatinin clearance (Clc): 0.70" 0.23 ml/Kg of lean body weight and minute. Only the methods that adjust both the digoxin clearance and the volume of distribution to the Clc achieve the independence between the digoxinemia and the kidney function. The best of them, by calculating the elimination constant (K) and the volume of distribution (V) as linear functions of the Clc, so that K ranges between 0.173 and 0.462 days-1 and V between 4 and 10 l/Kg of lean body weight when the Clc varies from 0 to 110 ml/minute, achieve digoxinemia figures between 0.8 y 2.0 ng/ml and above 2.0 ng/ml in the 81.6% and 0.0% of the patients (95% confidence intervals (95% CI): 72.2% to 88.4 and 0.0% to 4.6%), respectively; with a precision and a bias of 0.43 and -0.06 ng/ml (95% CI: 0.38 to 0.48 and -0.16 to 0.03 ng/ml), respectively. CONCLUSION: The described method would lead to good results if digoxin has not been prescribed in order to control the cardiac frequency in the setting of auricular fibrilation.

Ranitidina-citrato bismuto frente a omeprazol más dos antibióticos durante 7 días para la erradicación del Helicobacter pylori: un ensayo clínico no concluyente / Ranitidine-bismuth citrate versus omeprazol plus two antibiotics during seven days for the eradication of Helicobacter pylori: a non-concluding clinical essay

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Premature ovarian failure and FMR1 premutation co-segregation in a large Brazilian family.

Fragile X syndrome is the most common form of inherited mental retardation in men. The molecular mechanism underlying the disease is an amplification of a polymorphic trinucleotide repeat (CGG)n located at 5' end of FMR1 which promotes transcriptional silencing of the gene. Four different classes of alleles could be distinguished in the population based on the size of the repeat, however only large amplifications over 200 CGG are associated with the disease. In the past decade several authors have associated premutated alleles, which harbor expansions from 61 to 200 repeats, with the occurrence of premature ovarian failure (POF). In this work we describe a large Brazilian family in which a POF/premutated woman has transmitted to five out of seven daughters a FMR1 premutated allele. From these five women with premutations, three have experienced premature ovarian failure. Our data clearly indicate a co-segregation pattern of inheritance between POF and fragile X premutation.

Mejor resultado del ajuste de la dosis de digoxina en ancianos si se tiene en cuenta que tanto la eliminación como el volumen de distribucion del fármaco disminuyen cuando se reduce la función renal / Best result of digoxin dosing in the aged by taking into account that both the elimination as well as the volume of distribution of the drug decrease when the kidney function deteriores

Objetivo: Evaluar tres métodos de cálculo de la dosis de digoxina en ancianos. Métodos: Se calculan las digoxinemias que hubieran alcanzado 87 ancianos ajustando la dosis a la función renal con tres procedimientos diferentes. Resultados: Edad: 79,0 ñ 6,3 años; aclaramiento de creatinina (Clc): 0,70 ñ 0,23 ml/Kg de peso magro y minuto. Sólo los métodos que ajustan el aclaramiento de digoxina y su volumen de distribución al Clc consiguen independizar la digoxinemia de la función renal. El mejor entre ellos, consistente en calcular la constante de eliminación (K) y el volumen de distribución (V) como funciones lineales del Clc, de forma que K oscile entre 0,173 y 0,462 días-1 y V entre 4 y 10 l/Kg de peso magro, respectivamente, cuando el Clc varía de 0 a 110 ml/minuto, obtendría digoxinemias entre 0,8 y 2,0 ng/ml y superiores a 2,0 ng/ml en el 81,6 por ciento y el 0,0 por ciento de los pacientes (intervalos de confianza al 95 por ciento (IC 95 por ciento): 72,2 por ciento a 88,4 y 0,0 por ciento a 4,6 por ciento), respectivamente; con una precisión y un sesgo de 0,43 y -0,06 ng/ml (IC 95 por ciento: 0,38 a 0,48 y -0,16 a 0,03 ng/ml), respectivamente. Conclusiones: El método descrito conseguiría un ajuste inicial de la dosis de digoxina adecuado cuando su indicación no es la reducción rápida de la frecuencia cardiaca en la fibrilación auricular (AU)

La medición de la corrección del tratamiento de la bacteriemia / The treatment adquation measurement in the bloodstream infections

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