Strategic discussion on funding and access to therapies targeting rare diseases in Spain: an expert consensus paper.

BACKGROUND: In recent years, significant advances have been made in the field of rare diseases (RDs). However, there is a large number of RDs without specific treatment and half of these treatments have public funding in Spain. The aim of the FINEERR project was to carry out a multidisciplinary strategic discussion on the challenge of funding and access to RD-targeted drugs in Spain, in order to agree on specific proposals for medium-term improvement and hence support decision-making in the Spanish National Healthcare System (SNHS). RESULTS: The FINEERR Project was organized around a CORE Advisory Committee, which provided an overview, agreed on the design and scope of the project, and selected the members within each of four working groups (WG). Overall, 40 experts discussed and reached a consensus on different relevant aspects, such as conditioning factors for initial funding and access, evaluation and access to RD-targeted therapies, funding of these therapies, and implementation of a new funding and access model. From these meetings, 50 proposals were defined and classified by their level of relevance according to the experts. A descriptive analysis of responses was performed for each proposal. Thereafter, experts completed another questionnaire where they ranked the 25 most relevant proposals according to their level of feasibility of being implemented in the SNHS. The most relevant and feasible proposals were to improve: process of referral of patients with RDs, control over monitoring mechanisms, and communication between healthcare professionals and patients. CONCLUSIONS: The FINEERR project may provide a starting point for stakeholders involved in the process of funding and access to RD-targeted therapies in Spain to provide the necessary resources and implement measures to improve both the quality of life and life expectancy of patients with RDs.

Dynamic testing in columns for soil heavy metal removal for a car park SUDS.

The increase in urban runoff brought about by a rise in impermeable surfaces has triggered the alteration and pollution of many aquatic systems. The overall goal of this research was to design a 'Sustainable Urban Drainage System' (SUDS) for the retention of heavy metals from a car park consisting of mixing autochthonous soil (70%) with sand (30%) to improve the hydrological conductivity and adsorption capacity. To quantify the retention of metals we characterize the adsorption kinetics and isotherms of the soil mixture and perform dynamic experiments. The proposed methodology allowed us to work out the amount of heavy metal retention by the adsorbent and the retention mechanisms. The retention capacity of the adsorbent mixture was as follows: Cr3+ ≈ Cu2+ ≫ Zn2+ > Ni2+ > Cd2+. Chromium and copper ions were mainly retained by precipitation, whereas zinc, nickel and cadmium were retained by ionic exchange with calcium ions that saturate the soil colloids. The soil mixture buffered pH was found to change when fed with an acid solution of metallic ions.

Thermal diffusivity measurement in thin metallic filaments using the mirage method with multiple probe beams and a digital camera.

Photothermal beam deflection is a well-established technique for measuring thermal diffusivity. In this technique, a pump laser beam generates temperature variations on the surface of the sample to be studied. These variations transfer heat to the surrounding medium, which may be air or any other fluid. The medium in turn experiences a change in the refractive index, which will be proportional to the temperature field on the sample surface when the distance to this surface is small. A probe laser beam will suffer a deflection due to the refractive index periodical changes, which is usually monitored by means of a quadrant photodetector or a similar device aided by lock-in amplification. A linear relationship that arises in this technique is that given by the phase lag of the thermal wave as a function of the distance to a punctual heat source when unidimensional heat diffusion can be guaranteed. This relationship is useful in the calculation of the sample's thermal diffusivity, which can be obtained straightforwardly by the so-called slope method, if the pump beam modulation frequency is well-known. The measurement procedure requires the experimenter to displace the probe beam at a given distance from the heat source, measure the phase lag at that offset, and repeat this for as many points as desired. This process can be quite lengthy in dependence of the number points. In this paper, we propose a detection scheme, which overcomes this limitation and simplifies the experimental setup using a digital camera that substitutes all detection hardware utilizing motion detection techniques and software digital signal lock-in post-processing. In this work, the method is demonstrated using thin metallic filaments as samples.

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

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

Programas de optimización de uso de antimicrobianos (PROA) en hospitales españoles: documento de consenso GEIH-SEIMC, SEFH y SEMPSPH / Programs for optimizing the use of antibiotics (PROA) in Spanish hospitals: GEIH-SEIMC, SEFH and SEMPSPH consensus document

Los antimicrobianos son fármacos distintos al resto. Su eficacia en la reducción de la morbilidad y la mortalidad es muy superior a la de otros grupos de medicamentos. Por otra parte, son los únicos fármacos con efectos ecológicos, de manera que su administración puede contribuir a la aparición y diseminación de resistencias microbianas. Finalmente, son utilizados por médicos de prácticamente todas las especialidades. La actual complejidad en el manejo de las enfermedades infecciosas y del aumento de las resistencias hace imprescindible el establecimiento de programas de optimización del uso de antimicrobianos en los hospitales (PROA).Este documento de consenso define los objetivos de los PROA (mejorar los resultados clínicos de los pacientes con infecciones, minimizar los efectos adversos asociados a la utilización de antimicrobianos, incluyendo aquí las resistencias, y garantizar la utilización de tratamientos coste-eficaces) y establece recomendaciones para su implantación en los hospitales españoles. Las líneas maestras de las recomendaciones son: la constitución de un equipo multidisciplinario de antibióticos, dependiente de la Comisión de Infecciones. Los PROA necesitan ser considerados programas institucionales de los hospitales donde se desarrollen. Deben incluir objetivos específicos y resultados cuantificables en función de indicadores, y basarse en la realización de actividades encaminadas a mejorar el uso de antimicrobianos, principalmente mediante actividades formativas y medidas no impositivas de ayuda a la prescripción (AU)

The antimicrobial agents are unique drugs for several reasons. First, their efficacy is higher than other drugs in terms of reduction of morbidity and mortality. Also, antibiotics are the only group of drugs associated with ecological effects, because their administration may contribute to the emergence and spread of microbial resistance. Finally, they are used by almost all medical specialties. Appropriate use of antimicrobials is very complex because of the important advances in the management of infectious diseases and the spread of antibiotic resistance. Thus, the implementation of programs for optimizing the use of antibiotics in hospitals (called PROA in this document) is necessary. This consensus document defines the objectives of the PROA (namely, to improve the clinical results of patients with infections, to minimise the adverse events associated to the use of antimicrobials including the emergence and spread of antibiotic resistance, and to ensure the use of the most cost-efficacious treatments), and provides recommendations for the implementation of these programs in Spanish hospitals. The key aspects of the recommendations are as follows. Multidisciplinary antibiotic teams should be formed, under the auspices of the Infection Committees. The PROA need to be considered as part of institutional programs and the strategic objectives of the hospital. The PROA should include specific objectives based on measurable indicators, and activities aimed at improving the use of antimicrobials, mainly through educational activities and interventions based more on training activities directed to prescribers than just on restrictive measures (AU)

[Programs for optimizing the use of antibiotics (PROA) in Spanish hospitals: GEIH-SEIMC, SEFH and SEMPSPH consensus document]. / Programas de optimización de uso de antimicrobianos (PROA) en hospitales españoles: documento de consenso GEIH-SEIMC, SEFH y SEMPSPH.

The antimicrobial agents are unique drugs for several reasons. First, their efficacy is higher than other drugs in terms of reduction of morbidity and mortality. Also, antibiotics are the only group of drugs associated with ecological effects, because their administration may contribute to the emergence and spread of microbial resistance. Finally, they are used by almost all medical specialties. Appropriate use of antimicrobials is very complex because of the important advances in the management of infectious diseases and the spread of antibiotic resistance. Thus, the implementation of programs for optimizing the use of antibiotics in hospitals (called PROA in this document) is necessary. This consensus document defines the objectives of the PROA (namely, to improve the clinical results of patients with infections, to minimise the adverse events associated to the use of antimicrobials including the emergence and spread of antibiotic resistance, and to ensure the use of the most cost-efficacious treatments), and provides recommendations for the implementation of these programs in Spanish hospitals. The key aspects of the recommendations are as follows. Multidisciplinary antibiotic teams should be formed, under the auspices of the Infection Committees. The PROA need to be considered as part of institutional programs and the strategic objectives of the hospital. The PROA should include specific objectives based on measurable indicators, and activities aimed at improving the use of antimicrobials, mainly through educational activities and interventions based more on training activities directed to prescribers than just on restrictive measures.

Programas de optimización de uso de antimicrobianos (PROA) en hospitales españoles: documento de consenso GEIH-SEIMC, SEFH y SEMPSPH / No disponible

Los antimicrobianos son fármacos distintos al resto. Su eficacia en términos de curación y reducción de mortalidad es muy superior a la de otros grupos de medicamentos,habiéndose demostrado que la indicación de antimicrobianosinadecuados en determinadas situaciones clínicas es un factorindependiente de aumento del riesgo de mortalidad. Por otra parte, son los únicos fármacos con efectos ecológicos, de manera que su administación afecta tanto al paciente que los recibe como al resto, dado que pueden contribuir a la aparicióny diseminación de resistencias microbianas. Finalmente, sonutilizados por médicos de prácticamente todas las especialidades.La complejidad actual motivada por los avances en el conocimiento del manejo de las nfermedades infecciosas y del aumento de las resistencias hace imprescindible el establecimiento de programas de optimización del uso de antimicrobianos en los hospitales (PROA). Este documento de consenso define los objetivos de losPROA (por este orden: mejorar los resultados clínicos de los pacientes con infecciones, minimizar los efectosadversos asociados a la utilización de antimicrobianos, incluyendo aquí la aparición y diseminación deresistencias, y garantizar la utilización de tratamientos coste-eficaces) y establece recomendaciones para suimplantación en los hospitales españoles. Las líneas maestras de las recomendaciones son las siguientes: eldiseño y desarrollo de los PROA debe basarse en la constituciónde un equipo multidisciplinar de antibióticos, dependiente de la Comisión de Infecciones. Para posibilitar su éxito, estos programas necesitan ser considerados comoparte de la propia institución sanitaria y formar parte de los objetivos de los centros donde se desarrollen (AU)

No disponible

Modificaciones del flujo sanguíneo de las arterias uterina, umbilical y cerebral media fetal en preeclámpticas tratadas con parches de nitroglicerina / Blood flow modifications of uterine, umbilical and fetal middle cerebral arteries in preeclamptic patients treated with nitroglycerin patches

Objetivo Identificar las modificaciones del flujo sanguíneo de las arterias uterinas, umbilical y cerebral media fetal en preeclámpticas tratadas con parches de nitroglicerina. Método La muestra fue de 31 embarazadas preeclámpticas nulíparas con embarazos de más de 25 semanas que acudieron a la emergencia obstétrica del Hospital Central “Dr. Urquinaona”. Se midieron el índice de pulsatilidad, el índice de resistencia y la relación del flujo sanguíneo sistólico/diastólico de las arterias uterinas, umbilical y cerebral media fetal antes del tratamiento, a las 24 y a las 48h después de éste. El tratamiento fue con parches transdérmicos de nitroglicerina de 5mg, aplicado en la región torácica anterior o lumbar de las pacientes por un período de 12h, por un tiempo total de 48h.Resultados Se observó que el índice de pulsatilidad, el índice de resistencia y la relación de flujo sistólico/diastólico presentaron disminuciones significativas posteriores al uso de los parches de nitroglicerina (p<0,05). Con respecto a la arteria umbilical y cerebral media fetal, no se observaron modificaciones significativas a las 24 y 48 h al compararlo con los valores iniciales (p=ns). No se reportaron efectos adversos. Conclusión Existe disminución en la resistencia al flujo sanguíneo en las arterias uterinas de las preeclámpticas tratadas con parches de nitroglicerina sin producir modificaciones significativas en la arteria umbilical y cerebral media fetal (AU)

Objective To identify modifications in blood flow in uterine, umbilical and fetal middle cerebral arteries in preeclamptic patients treated with nitroglycerin patches.Method The sample consisted of 31 preeclamptic nulliparous patients with pregnancies of more than 25 weeks who attended the obstetric emergency service at the Dr. Urquinaona Central Hospital. The pulsatility index, resistance index and systolic/diastolic blood flow ratio of uterine, umbilical and fetal middle cerebral arteries were measured before treatment and after 24 and 48h of treatment administration. Treatment consisted of 5mg transdermal nitroglycerin patches, applied in the anterior thoracic and lumbar region of patients for 12h (total time of 48h).ResultsThe pulsatility index, resistance index and systolic/diastolic blood flow ratio significantly decreased after the use of nitroglycerin patches (p<0.05). There were no significant modifications in the umbilical and fetal middle cerebral arteries at 24 and 48 h when compared with initial values (p=ns). There were no adverse effects. Conclusion Nitroglycerin patches decreased resistance to blood flow in the uterine arteries of preeclamptic patients without producing significant modifications in the umbilical and fetal middle cerebral arteries (AU)

Quiste ovárico fetal. Reporte de caso / Fetal ovarian cyst. A case report

Los quistes ováricos fetales son la tercera causa de quistes intraabdominales, después de los de sistemas renal y gastrointestinal. Se puede sospechar su presencia en la ecografía cuando se observa una tumoración de aspecto quístico de estructura regular localizado en la parte inferior y lateral del abdomen, del tracto intestinal o urinario en un feto femenino sin anomalías. Se presenta el caso de una paciente de 18 años primigesta, a la que durante la evaluación ecográfica se le observó la presencia de una tumoración de apariencia blanda en la parte inferior derecha del abdomen correspondiente a un quiste ovárico fetal claramente identificado y separado de la vejiga fetal. La paciente fue sometida a cesárea obteniéndose una recién nacida femenina que fue dada de alta al tercer día sin complicaciones. A los 3 meses se observó la desaparición espontánea del quiste (AU)

Fetal ovarian cysts are the third cause of intra-abdominal cyst after renal and gastrointestinalcyst. The presence of these cysts can be suspected on ultrasound examination whena mass with a regular cystic structure is found in the inferior lateral region of the abdomen of afemale fetus without urinary or intestinal tract anomalies. We report the case of an 18-year-oldprimigravida in whom ultrasound examination revealed an apparently soft tumor in the inferior,right region of the abdomen, corresponding to a fetal ovarian cyst clearly identified and separatedfrom the bladder. A female newborn was delivered by cesarean section and was dischargedon the third day of life without complications. At 3 months, spontaneous disappearance of thecyst was observed (AU)

Edema agudo de pulmón secundario a preeclampsia severa / Acute pulmonary edema secondary to severe preeclampsia

El edema agudo de pulmón es una complicación rara y potencialmente fatal durante el embarazo. Se ha reportado que complica del 0,08 al 0,5% de los embarazos. Se presenta un caso de 28 años y embarazo de 35 semanas, quien presentó dificultad respiratoria, cefalea y epigastralgia. Se realizó el diagnóstico de edema agudo de pulmón secundario a preeclampsia severa (AU)

Acute pulmonary edema is a rare and potentially fatal complication during pregnancythat has been reported to affect 0.08 to 0.5% of pregnancies. We report the case of a 28-yearoldpatient with a 35-week pregnancy who presented with shortness of breath, headache andepigastralgia. A diagnosis of acute pulmonary edema secondary to severe preeclampsia wasmade (AU)

Lípidos y lipoproteína (a) en menopáusicas tratadas con tibolona / Lipids and lipoprotein (a) in postmenopausal women treated with tibolone

Objetivo Determinar las modificaciones en los lípidos y la lipoproteína (a) (Lp(a)) en menopáusicas que utilizan tibolona. Materiales y métodos Una muestra de 45 menopáusicas que fueron tratadas con una dosis diaria de 2,5mg de tibolona por 6 meses. Se midieron las concentraciones séricas de colesterol, triglicéridos (TG), lipoproteína de alta densidad (HDL-C), lipoproteína de baja densidad (LDL-C), Lp(a), la relación colesterol/HDL-C y la relación TG/HDL-C. Resultados Se observaron disminuciones significativas en las concentraciones de colesterol, TG, LDL-C y Lp(a) cuando se compararon las concentraciones después de 6 meses de uso de la tibolona con las concentraciones iniciales (p<0,05). Se observó una disminución estadísticamente significativa en las concentraciones de la HDL-C (p<0,05). En cuanto a la relación TG/HDL-C, ésta presentó una diminución estadísticamente significativa de más del 30% (p<0,05). Con respecto a la relación colesterol/HDL-C, no se encontraron diferencias estadísticamente significativas en los valores promedio antes y después del tratamiento (p=ns).Conclusión La tibolona produjo disminuciones significativas en las concentraciones plasmáticas de colesterol, TG, HDL-C, LDL-C y Lp(a), y modificaciones significativas en la relación TG/HDL-C-C luego de seis meses de uso (AU)

Objective To determine modifications in lipids and lipoprotein (a) in postmenopausal women receiving tibolone. Materials and methods A sample of 45 postmenopausal women who were treated with a dose of 2.5mg of tibolone daily for 6 months was selected. Serum concentrations of cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), lipoprotein (a) and the cholesterol/HDL and triglyceride/HDL ratios were measured. Results Cholesterol, triglyceride, LDL-C and lipoprotein (a) concentrations were significantly reduced after 6 months of tibolone use compared with initial concentrations (p<0.05). A statistically significant decrease in HDL-C was observed (p<0.05). The triglyceride/HDL ratio showed a significant reduction of more than 30% (p<0.05). No significant differences in mean cholesterol/HDL ratio values before and after treatment (p=ns) were found. Conclusions Tibolone significantly reduced cholesterol, triglyceride, HDL-C, LDL-C and lipoprotein (a) concentrations and significant modifications in the triglyceride/HDL-C ratio after 6 months of use (AU)

Production, purification and characterization of serraticin A, a novel cold-active antimicrobial produced by Serratia proteamaculans 136.

AIM: This study focuses on the production, purification and characterization of serraticin A, a novel cold-active antimicrobial produced by Serratia proteamaculans 136. METHODS AND RESULTS: A Ser. proteamaculans strain producing a novel cold-active antimicrobial was isolated from Isla de los Estados, Argentina. Antimicrobial production was optimized in a BIOFLO 101 bioreactor under batch culture mode, with temperature, pH and dissolved oxygen controlled conditions. A purification protocol was developed including activated charcoal adsorption, solid-phase C18 extraction (SPE) and semi-preparative HPLC. The molecular weight was determined by LC/QTOF/MS/MS mass analysis. CONCLUSIONS: Serratia proteamaculans 136 produces a cold-active low molecular bacteriocin-like compound named serraticin A. In this work, it has been laboratory-scale produced, purified and partially characterized. Cross-immunity test revealed that serraticin A is very different from other well-known microcins assayed, with a wide inhibitory spectrum, showing an interesting biotechnology potential to be applied as a control agent against pathogenic bacteria. SIGNIFICANCE AND IMPACT OF THE STUDY: The present study is the first report of a cold-active compound with antimicrobial activity from Ser. proteamaculans. The work also highlights that cold environments could be a suitable source of micro-organisms with ability to produce cold-active biomolecules of biotechnological interest.

Lípidos y lipoproteínas en pacientes menopáusicas tratadas con diosgenina / Lipid and lipoprotein levels in postmenopausal women treated with diosgenin

El objetivo de la investigación fue evaluar los cambios en las concentraciones de lípidos y lipoproteínas en pacientes menopáusicas tratadas con diosgenina, como tratamiento hormonal sustitutivo después de 6 meses de tratamiento. Se seleccionó a 49 pacientes menopáusicas, que asistieron a la consulta de Menopausia del Hospital Central Dr. Urquinaona y a las que se trató con diosgenina. Se midieron las concentraciones séricas de colesterol, triglicéridos, colesterol unido a lipoproteínas de baja densidad (cLDL) y colesterol unido a lipoproteínas de alta densidad (cHDL). Las concentraciones de colesterol y triglicéridos presentaron aumentos después de 6 meses de tratamiento con diosgenina, comparado con las concentraciones iniciales, pero estos aumentos se consideraron estadísticamente no significativos (NS) (p=NS). Al analizar las concentraciones de cLDL y cHDL, no se encontraron diferencias estadísticamente significativas en las concentraciones después de 6 meses de tratamiento al compararla con las concentraciones iniciales (p=NS). Se concluye que la diosgenina no produce modificaciones significativas en los valores promedio en los lípidos y lipoproteínas estudiados después de 6 meses de tratamiento en pacientes menopáusicas que la utilizan como tratamiento hormonal sustitutivo (AU)

The aim of this study was to evaluate the changes in lipid and lipoprotein concentrations in postmenopausal women after 6 months of treatment with diosgenin as hormone replacement therapy. Forty-nine postmenopausal women attending the menopause unit at the Dr. Urquinaona central hospital who were treated with diosgenin were selected. Serum concentrations of cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) were measured. Cholesterol and triglyceride concentrations rose after 6 months of treatment with diosgenin compared with initial values, but these increases were not statistically significant (p=ns).When LDL-C and HDL-C concentrations were analyzed, no statistically significant differences were found in plasma concentrations after 6 months of treatment compared with initial concentrations (p=ns). We conclude that diosgenin produces no significant modifications in mean lipid and lipoprotein values after 6 months of treatment in postmenopausal women administered this drug as hormone replacement therapy (AU)

Carcinoma neuroendocrino de células pequeñas del endometrio. Reporte de caso / Small cell neuroendocrine carcinoma of the endometrium. A case report

El carcinoma neuroendocrino de células pequeñas del endometrio es un tumor muy raro y agresivo; el endometrio es el sitio menos común para su aparición. Se presenta el caso de una mujer de 41 años de edad que refería hemorragia genital anormal desde aproximadamente un año antes de asistir a la consulta. La biopsia de endometrio evidenció carcinoma de células pequeñas (CCP) del endometrio. Se realizó histerectomía total radical con linfadenectomía pélvica y paraaórtica. El estadio quirúrgico de la mujer fue II. El reporte de anatomía patológica evidenció la presencia de CCP del endometrio, redondeadas, con escaso citoplasma y núcleos hipercromáticos, ordenadas en un patrón trabecular sólido con disposición perivascular; las técnicas inmunohistoquímicas especiales demostraron el origen neuroendocrino del tumor (AU)

Small cell neuroendocrine carcinoma is a very rare tumor and the endometrium is the least common site of occurrence. We present the case of a 41-year-old woman who reported abnormal genital bleeding for approximately 1 year before consulting. Endometrial biopsy revealed small cell carcinoma. The patient underwent a total radical hysterectomy with pelvic and para-aortic lymphadenectomy. The carcinoma was surgical stage II.The histopathological report showed the presence of rounded small cell carcinoma of the endometrium with scanty cytoplasm and hyperchromatic nuclei, ordered in a solid-trabecular pattern with perivascular arrangement. Special immunohistochemical study showed the neuroendocrine origin of the tumor (AU)

Concentraciones de ácido úrico en pacientes con preeclampsia y eclampsia / Uric acid concentrations in patients with preeclampsia and eclampsia

Objetivo: Establecer las concentraciones de ácido úrico en pacientes con preeclampsia y eclampsia. Material y métodos: Se incluyó a 30 pacientes con preeclampsia leve (grupo A), 30 pacientes con preeclampsia grave (grupo B) y 30 pacientes con eclampsia (grupo C). El grupo control fue seleccionado por tener una edad y un índice de masa corporal similares a los de los grupos en estudio y consistió en 35 embarazadas sanas (grupo D). Las muestras de sangre para la determinación de ácido úrico se recolectaron en todas las pacientes antes del parto e inmediatamente después del diagnóstico en los grupos de estudio. Resultados: Se observaron diferencias significativas en la edad gestacional en el momento del parto entre los grupos B y C comparado con el grupo control, y en los promedios de presión arterial sistólica y diastólica entre los 3 grupos de pacientes en estudio y los controles (p<0,05). Las concentraciones de ácido úrico plasmáticas mostraron diferencias estadísticamente significativas en las pacientes del grupo A, B y C, comparado con las controles normotensas (p<0,05). Se observó una correlación positiva significativa con la proteinuria en 24h, alanina-aminotransferasa, aspartato-aminotransferasa y lactato deshidrogenasa (p<0,05). También se observó una correlación negativa significativa con las plaquetas (p<0,05). Conclusiones: Existe un incremento en las concentraciones de ácido úrico en pacientes con preeclampsia y eclampsia comparado con embarazadas normotensas controles (AU)

Objective: To establish uric acid concentrations in preeclamptic and eclamptic patients. Material and methods: This study included 30 patients with mild preeclampsia (group A), 30 patients with severe preeclampsia (group B) and 30 patients with eclampsia (group C). Controls were selected because they had a similar age and body mass index to patients in the study groups and consisted of 35 healthy pregnant women (group D). Blood samples for uric acid determination were collected from all patients before delivery and immediately after diagnosis in the study groups. Results: Statistically significant differences were found in gestational age at delivery in groups B and C with respect to the control group and in mean values of systolic and diastolic blood pressure between the three study groups and controls (P<.05). Plasma uric acid concentrations showed statistically significant differences in groups A, B and C compared with normotensive controls (P<.05). A significant positive correlation was found with 24-hour proteinuria, alanineaminotransferase, aspartate-aminotransferase and lactic dehydrogenase (P<.05). A significant negative correlation was found with platelets (P<.05). Conclusions: Uric acid concentrations are increased in patients with preeclampsia and eclampsia compared with those in normotensive pregnant controls (AU)

Efecto de diosgenina sobre la proteína C reactiva y homocisteína en pacientes menopáusicas / Effect of diosgenin on homocysteine and C-reactive protein concentrations in postmenopausal women

El objetivo fue investigar las concentraciones de homocisteína y proteína C reactiva en pacientes menopáusicas tratadas con diosgenina como alternativa a la terapia de reemplazo hormonal. Se realizó una investigación de tipo explicativa, prospectiva y longitudinal, con un diseño cuasi experimental y un muestreo no probabilístico de 49 pacientes que asistieron a la consulta de menopausia del Hospital Central Dr. Urquinaona. Se determinaron las concentraciones de homocisteína y proteína C reactiva antes y después de 6 meses de tratamiento con diosgenina. El promedio ± desviación estándar de las mujeres menopáusicas fue de 51,6 ± 2,9 años; la edad ± desviación estándar de aparición de la menopausia fue de 44,6 ± 2,1 años y el tiempo desde la menopausia fue de 45,7 ± 18,4 meses. Se encontró un incremento de más del 56% en la concentración de proteína C reactiva a los 6 meses de tratamiento en comparación con las concentraciones iniciales (p < 0,05). Las concentraciones de homocisteína plasmática presentaron una ligera disminución (aproximadamente mayor del 5%) comparadas con las concentraciones iniciales (p = NS). Se concluye que la diosgenina produce aumento significativo en la concentración de proteína C reactiva sin inducir modificaciones en las concentraciones plasmáticas de homocisteína luego de 6 meses de tratamiento (AU)

The aim of this study was to investigate homocysteine and C-reactive protein concentrations in postmenopausal women treated with diosgenin as an alternative to hormone replacement therapy. An explanatory, prospective and longitudinal study was performed with a quasi-experimental design and non-probabilistic sampling of 49 patients who attended the menopause clinic of the Dr. Urquinaona General Hospital. Homocysteine and C-reactive protein concentrations were determined before and after 6 months of treatment with diosgenin. The mean age of the postmenopausal women was 51.6 ± 2.9 years. Age at menopause onset was 44.6 ± 2.1 years and the time from m e n o p a use was 45.7 ± 18.4 months. C-reactive protein concentrations were increased by more than 56% at 6 months of treatment compared with initial concentrations (P<.05). Plasma homocysteine concentrations slightly decreased (by more than 5%, approximately) compared with initial concentrations (P=NS). We conclude that diosgenin significantly increases C -reactive concentrations, without modifying plasma homocysteine concentrations after 6 months of treatment (AU)

The effect of moisture regimes on the anaerobic degradation of municipal solid waste from Metepec (México).

The State of México, situated in central México, has a population of about 14 million, distributed in approximately 125 counties. Solid waste management represents a serious and ongoing pressure to local authorities. The final disposal site ("El Socavón") does not comply with minimum environmental requirements as no liners or leachate management infrastructure are available. Consequently, leachate composition or the effects of rain water input on municipal solid waste degradation are largely unknown. The aim of this work was to monitor the anaerobic degradation of municipal solid waste (MSW), simulating the water addition due to rainfall, under two different moisture content regimes (70% and 80% humidity). The study was carried out using bioreactors in both laboratory and pilot scales. The variation of organic matter and pH was followed in the solid matrix of the MSW. The leachate produced was used to estimate the field capacity of the MSW and to determine the pH, COD, BOD and heavy metals. Some leachate parameters were found to be within permitted limits, but further research is needed in order to analyze the leachate from lower layers of the disposal site ("El Socavón").

Fluvastatin as co-medication in heart transplant recipients with elevated creatine-kinase.

BACKGROUND: Statins reduce the risk for transplant vasculopathy and mortality among heart transplant recipients. Interactions between commonly used statins (ie, simvastatin, atorvastatin) and immunosuppressant drugs lead to side effects or withdrawal of statin therapy. Fluvastatin shows fewer interactions with the immunosuppressant agents because it is not metabolized via the cytochrome P-450 3A4 pathway like most immunosuppressants, steroids, or other statins. This study investigated the impact of a switch from other statins to fluvastatin in heart transplant recipients who revealed elevated creatine-kinase levels. METHODS: A total of 23 heart transplant patients with elevated creatine-kinase levels were included in this study. Statins were replaced with an equal dosage of fluvastatin. We measured on the day of replacement as well as there after at 3, 6, 9, and 12 months creatine-kinase, lipid status, ALT, AST, and creatinine levels. RESULTS: After 6 months creatine-kinase showed a significant reduction of 25% (P < .05) and after 9 months of 38% (P < .05). The HDL-cholesterol levels were significantly reduced at 6 months (8%; P < .05) and 9 months (23%; P < .05). At 3 months, triglyceride levels were significantly elevated (18%; P < .05). No differences were observed in ALT, AST, creatinine, total, and LDL-cholesterol at any time. CONCLUSION: A conversion from commonly used statins to fluvastatin in heart transplant patients with elevated creatine-kinase was safe, leading to a significant reduction in creatine-kinase levels. Except for an initial raise in triglycerides and a lowering of HDL-cholesterol, no changes in lipid status were seen. This conversion might help to maintain lipid-lowering therapy in transplant recipients who show side effects using conventional statins.

La lectura en las tabaquerías en Cuba / Reading in the Cuban cigar factories

Se examina el fenómeno de la lectura en las tabaquerías en Cuba desde sus orígenes hasta la actualidad; se abordan los inicios de la actividad, la lectura de tabaquería y los tabaqueros en las luchas sociales del siglo XIX, los tabaqueros emigrados y José Martí en la Tribuna Avanzada de la Libertad, la lectura en las tabaquerías de la república, así como la lectura en las tabaquerías en el período posrevolucionario(AU)

The phenomenon of reading activity in cigar factories was studied from its origins to the present day; the starting of the reading activity at cigar factory; the involvement of workers in the 21ST century social struggle, the immigrant cigar factory workers and the work of José Martí in Tribuna Avanzada de la Libertad were addressed. An analysis was made of the reading activity at cigar factories at republican times and after the triumph of the revolution

La lectura en las tabaquerías en Cuba / Reading in the Cuban cigar factories

Se examina el fenómeno de la lectura en las tabaquerías en Cuba desde sus orígenes hasta la actualidad; se abordan los inicios de la actividad, la lectura de tabaquería y los tabaqueros en las luchas sociales del siglo XIX, los tabaqueros emigrados y José Martí en la Tribuna Avanzada de la Libertad, la lectura en las tabaquerías de la república, así como la lectura en las tabaquerías en el período posrevolucionario.

The phenomenon of reading activity in cigar factories was studied from its origins to the present day; the starting of the reading activity at cigar factory; the involvement of workers in the 21ST century social struggle, the immigrant cigar factory workers and the work of José Martí in Tribuna Avanzada de la Libertad were addressed. An analysis was made of the reading activity at cigar factories at republican times and after the triumph of the revolution.