Projections of wildfire weather danger in the Canary Islands.

Climate change is expected to enhance weather conditions prone to wildfires. Climate regionalized projections for the Canary Islands were performed, using as boundary conditions some of the results provided by the Coupled Model Intercomparison Project (CMIP5) initiative, and covering the recent past (1980-2009) and future (2070-2099) periods, under two Representative Concentration Pathways, 4.5 and 8.5. All fire risk indicators derived from the Canadian Forest Fire Weather Index (FWI) are foreseen to worsen by the end of the century. The fire season could increase its length up to 75 days per year, being more noticeable as altitude increases. The extreme risk days (FWI > 60) show an average increase of 58%, reaching 12 days a year, and the area with high risk could increase by 44%. Analyzing the contribution of the different meteorological variables, it is observed that the main parameter in the fire danger index result is the temperature (currently weights 46%). However, in the future, the importance of precipitation will increase, since the rainfall reduction in some areas could reach 41%. The high dependence of the expected changes on land height, and the small size of the islands, demonstrates the necessity of using high-resolution climate regionalizations.

Herbarium macroalgae specimens reveal a rapid reduction of thallus size and reproductive effort related with climate change.

Understanding and forecasting the effects of climate changes on vulnerable species are leading concerns for ecologists and conservation biologists. Herbaria are invaluable for use in long-term data series, and one of the few available methods for quantifying biodiversity changes over large periods of time. Gelidium canariense is an endemic and habitat-forming macroalga of the Canary Islands that coexists with two other habitat-forming Gelidiales: G. arbuscula and Pterocladiella capillacea. This study assesses long-term changes in thallus size and reproductive effort of all specimens deposited in the Herbarium of Universidad de La Laguna of these three Gelidiales species. Also assessed were the effects of seawater temperature and increased incident light on net primary production (NPP), and the effects of extreme desiccation conditions on the relative water content and NPP of the three Gelidiales species. The length of the thallus of the endemic species G. canariense was halved during the past 40 years. The shortening of the thallus coincided with a significant decrease in the number of reproductive structures in both Gelidium species. These morphological changes coincide with a significant increase of the sea surface temperature, air temperature above sea surface and ultraviolet radiation in the studied area. The experiments have revealed the deleterious effects of extreme desiccation and extreme irradiance on all three species. Hence, these results suggest that air temperature and irradiance are related with these morphological changes over time in the habitat-forming Gelidium species and that are most likely compromising the survival of their populations which are already declining.

Un falso positivo para Beta2-transferrina en rinorrea. Traumatismo ocular / False positive for Beta2-transferrin in rhinorrhoea. Ocular trauma

Las perforaciones oculares precisan de una actuación acorde a la severidad de los hallazgos. Adicionalmente, la vecindad de la órbita a la cavidad nasal y a la fosa cerebral anterior obliga al menos a descartar daño asociado en estos espacios. La coexistencia de una herida ocular penetrante con secreción nasal homolateral, en la que se detecta β2-transferrina -marcador de alta especificidad y sensibilidad para presencia de líquido cefalorraquídeo- obliga a sospechar y localizar una fístula del mismo. Presentamos un caso en el que la detección de esta proteína desializada en una rinorrea postraumática tenía su origen en el propio globo ocular, y convirtió el diagnóstico de fístula de líquido cefalorraquídeo en un falso positivo

Ocular perforations require an action depending on the findings observed. Additionally, the closeness of the orbit to the nasal cavity and the anterior cranial fossa requires any collateral damage in these spaces to be ruled out. The presence of a penetrating ocular injury associated with ipsilateral rhinorrhoea in which the presence of β2-transferrin -a highly specific and sensitive marker to identify cerebrospinal fluid- is detected, obliges to suspect and locate any possible leakage. A case is presented in which this unbound protein is detected in post-traumatic rhinorrhoea with an origin in the eyeball, making the diagnosis of a CSF leak into a false positive

False positive for ß2-transferrin in rhinorrhoea. Ocular trauma. / Un falso positivo para ß2-transferrina en rinorrea. Traumatismo ocular.

Ocular perforations require an action depending on the findings observed. Additionally, the closeness of the orbit to the nasal cavity and the anterior cranial fossa requires any collateral damage in these spaces to be ruled out. The presence of a penetrating ocular injury associated with ipsilateral rhinorrhoea in which the presence of ß2-transferrin -a highly specific and sensitive marker to identify cerebrospinal fluid- is detected, obliges to suspect and locate any possible leakage. A case is presented in which this unbound protein is detected in post-traumatic rhinorrhoea with an origin in the eyeball, making the diagnosis of a CSF leak into a false positive.

Relación y grado de contribución del estado neurológico y motor con el grado de autonomía y la calidad de vida del paciente con ictus cerebral agudo / Correlations and contribution of neurological and motor variables with degree of autonomy and quality of life in acute stroke patients

Introducción. La creciente demanda de tratamiento fisioterápico del ictus agudo requiere una predicción pronóstica temprana que facilite su gestión. Objetivos: 1) evaluar cómo se asocian las variables clínicas y autoinformadas del estado del paciente; 2) identificar el poder predictivo de las variables clínicas sobre el resultado autoinformado de autonomía y calidad de vida. Material y métodos. Estudio observacional transversal analítico. Se seleccionaron un total de 50 pacientes hospitalizados con ictus agudo, realizándose una medición basal de las variables de resultado clínicas (Escala Neurológica Canadiense [ENC], Test de Control de Tronco [TCT] e índice motor [IM] de miembro inferior [MI] y miembro superior [MS]) y autoinformadas (índice de Barthel [IB], Escala de Impacto del Ictus-16, Escala de Rankin Modificada, Escala Multidimensional de Apoyo Social Percibido y Escala de Calidad de Vida para el Ictus-38 [ECVI-38]). Resultados. Todas las variables clínicas se correlacionaron de forma estadísticamente significativa entre sí; la mayoría de las variables autoinformadas también correlacionaron entre ellas, y las variables clínicas, con algunas autoinformadas (oscilando entre r=-0,676 [p<0,01] y r=0,286 [p<0,05]). Se obtuvieron 2 modelos de predicción mediante análisis multivariante: 1) TCT y ENC explicaban un 61% de la varianza del IB, contribuyendo más el TCT (β=0,440) y menos la ENC (β=0,260). 2) TCT e IM de MI explicaban un 73% de la varianza de la ECVI-38 en su dimensión «estado de salud general», contribuyendo más el IM-MI (β=-0,479) y menos el TCT (β=-0,352). Conclusiones. TCT, ENC e IM-MI pueden ser útiles para predecir el estado de salud y la autonomía en el ictus agudo (AU)

Introduction. Because of the increasing demand for physical therapy for acute stroke patients, early prognostic prediction is needed to facilitate clinical management. Objectives: 1) To assess the relationship between clinical and self-reported variables regarding the patient's clinical status. 2) To identify the predictive power of clinical variables on self-reported outcome in terms of autonomy and quality of life. Material and methods. Analytic cross-sectional study of 50 patients hospitalised with acute stroke. Baseline measurements consisted of clinical variables (Canadian Neurological Scale [CNS], Trunk Control Test [TCT], Motricity Index [MI] of lower limb [MI-LL] and upper limb [MI-UL]) and self-reported outcome variables (Barthel Index [BI], Stroke Impact Scale 16 [SIS-16], Modified Rankin Scale, Multidimensional Scale of Perceived Social Support and Stroke-Specific Quality of Life Scale-38 [ECVI-38, Spanish initials]). Results. All the clinical variables were significantly correlated with each other, as were most of the self-reported variables. The clinical variables were significantly correlated with some of the self-reported variables (ranging from r=-.676 [P<.01] to r=.286 [P<.05]). Multivariate analysis provided two prediction models: 1) TCT and CNS accounted for 61% of the variance in the BI, with a greater contribution being made by TCT (β=.440) than CNS (β=.260). 2) TCT and MI-LL accounted for 73% of the variance of ECVI-38 in the General Health Status domain, with MI contributing more (β=-.479) than TCT (β=-.352). Conclusions. CNS, TCT and MI-LL may be useful to predict health status and autonomy in acute stroke patients (AU)

Efectividad de un tratamiento fisioterápico asociado a un programa educativo en el ictus cerebral agudo / Effectiveness of physiotherapy associated with a health education programme for patients with acute cerebral stroke

Objetivo: Evaluar el efecto de un tratamiento de fisioterapia más un complemento educativo al primer mes de evolución del paciente con ictus cerebral agudo, mediante escalas neurológicas, motoras, funcionales y sociales. Material y método: Estudio pragmático cuasiexperimental. Cincuenta pacientes hospitalizados con ictus agudo fueron seleccionados aplicando un tratamiento fisioterápico en hospitalización más un programa educativo y registrando al inicio y tras el tratamiento al mes de evolución las variables de resultado funcionales (escala neurológica canadiense [CNS], test de control de tronco [TCT] e índice motor [MI]) y clínicas (índice de Barthel [BI], escala de impacto del ictus-16 [SIS-16], escala Rankin modificada [MRS] y escala multidimensional de apoyo social percibido [MSPSS]). Resultados: Se encontraron diferencias estadísticamente significativas para todas las variables funcionales y clínicas a excepción de la MSPSS (p<0,0001 para la CNS [t=5,945], TCT [t=7,701], MI de extremidad inferior [t=5,676], BI [t=5,360] y SIS-16 [t=4,809]; p=0,001 para la MRS [t=-3,503]; p=0,01 para el MI de extremidad superior [t=3,767]). El tamaño de efecto medido con la d de Cohen fue grande para la CNS (1,26), TCT (1,20), BI (1,06) y SIS-16 (0,95), moderado para el MI de extremidad inferior (0,67), pequeño para el MI de extremidad superior (0,47) y nulo (0) para la MRS. Conclusiones: El tratamiento de fisioterapia más un programa educativo resultaron efectivos en la mejoría del paciente con ictus agudo al primer mes de evolución, alcanzándose cambios superiores a un 20% en la CNS que confirman la hipótesis planteada (AU)

Objective: To evaluate the effect of physiotherapy associated with a health education programme for patients with acute cerebral stroke, during the first follow-up month of the condition. The evaluation is based on neurological, motor, functional and social scales. Material and method: Pragmatic quasi-experimental study of fifty patients hospitalised with acute stroke and given physiotherapy in hospital, in association with a health education programme. Subjects were evaluated at baseline and after one month of treatment, with respect to functional outcome variables, according to the Canadian Neurological Scale (CNS), the Trunk Control Test (TCT) and the Motricity Index (MI), and with respect to clinical variables, according to the Barthel Index (BI), the Stroke Impact Scale-16 (SIS-16), the Modified Rankin Scale (MRS) and the Multidimensional Scale of Perceived Social Support (MSPSS). Results: Statistically significant differences were found for all functional and clinical variables except MSPSS (P<.0001 for CNS (t=5.945), TCT (t=7.701), lower-limb MI (t=5.676), BI (t=5.360) and SIS-16 (t=4.809); p=0.001 for MRS (t=-3.503); P=.01 for upper-limb MI (t=3.767)). The size effect measured by Cohen's d was large for CNS (1.26), TCT (1.20), BI (1.06) and SIS-16 (0.95), moderate for lower-limb MI (0.67), small for upper-limb MI (0.47) and zero (0) for MRS. Conclusions: After one month, physiotherapy associated with a health education programme achieved improvements in the condition of patients with acute stroke, raising outcome scores by 20% according to CNS, thus confirming our hypothesis in this respect (AU)

Changing trends in the epidemiology of hip fracture in Spain.

UNLABELLED: Temporal trends in hip fracture incidence have recently been reported in some developed countries. Such data in Spain has previously been incomplete; this study reports the stratified incidence of hip fractures in people over 65 in Spain during the last 14 years. INTRODUCTION: The main objective is to establish whether temporal trends in hip fracture incidence in Spain exist. METHODS: Ecological study with data from hospital discharges nationwide. The study includes patients aged ≥ 65 years during a 14-year period (1997-2010). The analysis compares two periods of four years: 1997-2000 (P1) and 2007-2010 (P2). RESULTS: There were 119,857 fractures in men and 415,421 in women. Comparing periods (P1 vs P2) over 10 years, the crude incidence rate/100,000 inhabitant/year increased an average of 2.3%/year in men and 1.4% in women. After adjustment, the rate increased an average of 0.4%/year in men (p < 0.0001), but decreased 0.2%/year in women (p < 0.0001). In men, younger than 85, the decrease was not significant except in 70-74 years, and from 80 years, the adjusted rate increases significantly (p < 0.0001). In women under 80 years of age, the decrease in adjusted rate was significant; there was no change in 80-84 years, and the adjusted rate increased significantly in individuals 85 years and older (p < 0.0001). Mortality rates declined by 22% in both sexes, and the index of overaging population rises 30.1 % in men and 25.2% in women. CONCLUSIONS: This study supports other international studies by showing changes in the incidence of hip fractures after age-population adjustment, which denotes a decrease in the younger age groups and among women and shows an increase in both groups over 85 years. The increase in the crude incidence rate of hip fracture in Spain reflects changes in population structure.

Negative reactions of men to the loss of power in gender relations: Lilith vs. Eve

This paper examines the reaction of the man when he sees he is losing power and authority over a woman and it relation with men’s sexist ideology. 83 men participated in the study and were led to believe they were interacting via computer with a woman, and answered a decision-making task about family relationships. All of them were assigned the role of someone with authority and power. In half the cases, the woman accepted the man's decisions, and, in the other half, she did not accept. The results showed that when woman did not accept the decisions of the man, she was perceived more negatively. Moreover, the more hostile sexist participants were, the more they rated negatively their female partner, especially when the woman did not accept their decisions. Hostile sexism acts as a corrective tool against those women who defy the traditionally higher status accorded to men. The valuation that woman receive in their interaction with man is determined by what man feel threatened. These results are of great interest in the field of gender violence, since it is one more step towards explaining why some men use violence to attempt to regain their threatened or lost power(AU)

Este artículo examina la reacción del hombre cuando ve que está perdiendo poder y autoridad sobre la mujer y su relación con la ideología sexista de los hombres. 83 hombres participaron en el estudio y se les hizo creer que estaban interactuando a través del ordenador con una mujer, y respondierona una tarea de toma de decisiones sobre las relaciones familiares. A todos ellos se les asignó el papel de alguien con autoridad y poder. En la mitad de los casos, la mujer aceptaba las decisiones del hombre y en la otra mitad ella no aceptaba. Los resultados mostraron que cuando la mujer no aceptaba las decisiones del hombre, ella era percibida de forma más negativa. Además, cuando más sexistas y hostiles eran los participantes, evaluaban más negativamente a su pareja, especialmente cuando la mujer no aceptaba sus decisiones. El sexismo hostil actúa como una herramienta correctiva hacia las mujeres que desafían el tradicionalmente más alto estatus otorgado a los hombres. La valoración que la mujer recibe en su interacción con el hombre está determinada porque el hombre se siente amenazado. Estos resultados son de gran interés en el campo de la violencia de género, ya que es un paso más hacia la violencia para tratar de recuperar su poder amenazado o perdido(AU)

[Mesenteric lymphangiomatosis. Case report]. / Linfangiomatosis mesenterica. Presentacion de un caso.

OBJECTIVE: Lymphangiomas are lesions usually presenting during childhood and are located mainly in the head and neck region; less than 5% are intraabdominal. Lymphangiomatosis is the term used for multifocal or diffuse lymphangiomas. METHODS AND RESULTS: We report the case of a mesenteric lymphangiomatosis presenting as an acute abdomen in a 19-year-old man, review the literature and discuss the clinical management of these patients. CONCLUSIONS: Prognosis and treatment of these lesions depends of its site of origin and extension, being complete surgical excision the optimal treatment.

Linfagiomatosis mesentérica. Presentación de un caso / Mesenteric lymphangiomatosis. Case report

OBJETIVO: El término linfangiomatosis se utiliza para definir los linfangiomas con afectación multifocal o difusa. Los linfangiomas son lesiones que se suelen presentar en la infancia y su localización más frecuente es cabeza y cuello, representando los linfangiomas intrabdominales menos de un 5%. MÉTODOS Y RESULTADOS: Presentamos un caso de linfangiomatosis mesentérica en un paciente de 19 años de edad que se presenta como cuadro de abdomen agudo, realizando revisión de la literatura y discusión del manejo de estos pacientes. CONCLUSIONES: El pronóstico y tratamiento de estas lesiones va a depender de su localización y extensión; siendo el tratamiento de elección la exéresis quirúrgica completa

OBJECTIVE: Lymphangiomas are lesions usually presenting during childhood and are located mainly in the head and neck region; less than 5% are intraabdominal. Lymphangiomatosis is the term used for multifocal or diffuse lymphangiomas. METHODS AND RESULTS: We report the case of a mesenteric lymphangiomatosis presenting as an acute abdomen in a 19-year-old man, review the literature and discuss the clinical management of these patients. CONCLUSIONS: Prognosis and treatment of these lesions depends of its site of origin and extension, being complete surgical excision the optimal treatment

Mujer de 42 años con masa torácica anterior / 42 year old woman with anterior thoracic mass

No disponible

[Prevalence of chronic renal failure in primary care]. / Prevalencia de insuficiencia renal crónica en atención primaria.

OBJECTIVE: To determine the prevalence of chronic renal failure (CRF) without replacement treatment (RT), and to describe the primary renal diseases and associated risk factors that might favour its evolution to terminal renal failure. Design. Cross-sectional, descriptive study. SETTING: Population attended at a primary care centre (PCC). PARTICIPANTS: Over-14s with a clinical history opened at the Bon Pastor PCC. RESULTS: Between the 1st of January 1997 and the 1st of December 1997, 12241 clinical histories were reviewed. 64 patients were identified who satisfied criteria of CRF without RT, a prevalence of 5228 patients per million inhabitants (95% CI, 3,950-6,510). 71.9% were men, and mean age was 72 (SD, 13.5). The most recent plasma creatinine averaged 2 mg/dl (SD, 0.66). Frequency according to kind of nephropathy was: 3 (4.7%) glomerular, 5 (7.8%) diabetic, 3 (4.7%) interstitial, 41 (64.1%) vascular (hypertension), 2 (3.1%) indeterminate and 10 (15.6%) unclassifiable. Associated risk factors in these patients were: 47 (73.4%) with hypertension, 16 (25%) diabetic, 26 (40.6%) with hypercholesterolaemia, 20 (31.3%) chronic consumers of analgesics, and 10 (15.6%) smokers. 51.6% of the patients suffered other cardiovascular illnesses. CONCLUSIONS: The estimated prevalence in the population of CRF without RT is 5,228 per million inhabitants. Hypertension is the risk factor most closely associated with this pathology.

Prevalencia de insuficiencia renal crónica en atención primaria / Prevalence of chronic renal failure in primary care

Objetivo. Determinar la prevalencia de insuficiencia renal crónica (IRC) sin tratamiento sustitutivo (TSR), describir el tipo de enfermedades renales primarias y los factores de riesgo asociados que pueden favorecer su evolución hacia la insuficiencia renal terminal. Diseño. Estudio descriptivo, transversal. Emplazamiento. Población atendida por un centro de atención primaria. Participantes. Mayores de 14 años con historia clínica abierta en el CAP Bon Pastor. Resultados. Durante el período 1-I-1997 hasta 1-XII-1997 se revisaron 12.241 historias clínicas. Se identificaron 64 pacientes que cumplían criterios de IRC sin TSR; prevalencia, 5.228 pacientes por millón de habitantes (pmp) (IC del 95 por ciento, 3.950-6.510 pmp). Un 71,9 por ciento era varón, la edad media era de 72 años (DE, 13,5). La media de la última creatinina plasmática fue de 2 mg/dl (DE, 0,66). La frecuencia según tipo de nefropatía fue: glomerular, 3 (4,7 por ciento); diabética, 5 (7,8 por ciento); intersticial, 3 (4,7 por ciento); vascular (HTA), 41 (64,1 por ciento); indeterminada, 2 (3,1 por ciento), e inclasificable, 10 (15,6 por ciento). Los factores de riesgo asociados en estos pacientes fueron: hipertensos, 47 (73,4 por ciento); diabéticos, 16 (25 por ciento); hipercolesterémicos, 26 (40,6 por ciento); consumidores crónicos de analgésicos, 20 (31,3 por ciento), y 10 (15,6 por ciento), fumadores. Un 51,6 por ciento de los pacientes presentaba otras enfermedades cardiovasculares. Conclusiones. La prevalencia estimada de IRC sin TRS en la población es de 5.228 pmp, y la hipertensión es el factor de riesgo más frecuente asociado a esta patología (AU)

Beyond prejudice as simple antipathy: hostile and benevolent sexism across cultures.

The authors argue that complementary hostile and benevolent components of sexism exist across cultures. Male dominance creates hostile sexism (HS), but men's dependence on women fosters benevolent sexism (BS)--subjectively positive attitudes that put women on a pedestal but reinforce their subordination. Research with 15,000 men and women in 19 nations showed that (a) HS and BS are coherent constructs that correlate positively across nations, but (b) HS predicts the ascription of negative and BS the ascription of positive traits to women, (c) relative to men, women are more likely to reject HS than BS, especially when overall levels of sexism in a culture are high, and (d) national averages on BS and HS predict gender inequality across nations. These results challenge prevailing notions of prejudice as an antipathy in that BS (an affectionate, patronizing ideology) reflects inequality and is a cross-culturally pervasive complement to HS.

[Preventive immunotherapy]. / Inmunoterapia preventiva.

Allergen specific immunotherapy has been shown to be effective in rigorous double-blind placebo-controlled clinical trials in both children and adults A recent WHO position paper stated that immunotherapy is an effective treatment for patients with allergic rhinitis/conjunctivitis, allergic asthma and allergic reactions from stinging insects and is thought to be more effective in children than in adults. When speaking about children there are several questions that are important regarding the natural course of the disease. One of the most important is whether immunotherapy can prevent asthma, either by preventing sensitisation to allergens related to the development of asthma or by preventing the inflammation in the lungs caused by allergen exposure. Another point could be to establish the differences in the long term outcome of those patients treated with immunotherapy and medication during childhood, compared to the long term outcome of those with comparable asthma features who received only antiasthmatic medication The PAT study is a European multi-center study. The end-point is to show in what capacity allergen specific subcutaneous immunotherapy can prevent the development of asthma in children who only have rhinoconjunctivitis secondary to grass or birch pollen sensitisation. Two hundred and ten children aged from 5 to 13 years were included in the study. Children were randomised to the active treatment group receiving allergen specific immunotherapy with birch and/or timothy pollen allergen extract or to the control group receiving only pharmacotherapy. It is important to highlight that the main criteria to be included was that the children should never have had any asthmatic symptom. Immunotherapy has been effective in terms of decreasing significantly the amount of symptoms in the active group compared to the control one. It was safe with no serious adverse reactions and reduced the risk of the onset of asthma. After two years of treatment more children in the control group developed clinical asthma than in the active group: p = 0.004. Des Roches et al reported the results of a prospective non randomised trial of immunotherapy with Dermatophagoides pteronyssinus in 44 asthmatic children younger than six years of age who were sensitive only to dust mites. The purpose of the study was to assess whether immunotherapy could reduce the development of new sensitisation during a period of three years of follow up. Specific immunotherapy was given with only D. Pteronyssinus extract. All 22 children in the control group developed new sensitivities as determined by skin testing and in vitro tests, while 10 (45%) of 22 children who received mite immunotherapy did not develop additional sensitivities. The findings of this study suggests that immunotherapy may alter the natural course of the allergic sensitisation reducing the risk of developing new sensitisation in mono sensitive children. A limited number of studies have examined the long terms effects of immunotherapy on the clinical presentation of asthma and rhinoconjunctivitis, and have shown a long lasting efficacy decreasing the amount of symptoms 6-10 years after termination. In a retrospective study of children treated with immunotherapy during childhood for at least three years, that were re-evaluated in early adulthood, the control patients who were treated with medication and no immunotherapy suffered almost 3.5 times more symptoms than the active group treated with immunotherapy. The current findings suggest that immunotherapy should be considered earlier in the course of allergic disease to prevent progression or to prevent the development of new sensitisation. Further studies with long term follow up particularly in children could address this possibility.

Inmunoterapia preventiva / Preventive immunotherapy

La inmunoterapia específica representa la piedra angular del tratamiento de las enfermedades alérgicas y junto con la evitación del alergeno constituye, en la actualidad, el único tratamiento etiológico disponible. Bajo condiciones óptimas, que incluyen la demostración de la importancia etiológica del alergeno, la disponibilidad de extractos alergénicos de calidad y la correcta monitorización del paciente, la inmunoterapia con inyección subcutánea es un tratamiento seguro y eficaz. Al igual que cualquier otro tratamiento, la inmunoterapia subcutánea no está exenta de posibles reacciones adversas relacionadas con su administración, aunque cuando se siguen las directrices recomendadas, estas suelen ser predominantemente locales, de escasa intensidad y fácilmente controlables. Durante los últimos 15 años, especialmente en Europa, ha aumentado el interés por las vías locales, no inyectadas, de inmunoterapia, buscando sobre todo aumentar su seguridad y la aceptación por el paciente. Las vías alternativas a la inmunoterapia inyectada que han sido estudiadas y utilizadas hasta la actualidad son: oral, sublingual, nasal y bronquial. En los documentos de posición de la Organización Mundial de la Salud (OMS), de la Academia Europea de Alergia e Inmunología Clínica (EAACI) y de la Sociedad Europea de Inmunología Clínica y Alergia Pediátrica (ESPACI), la inmunoterapia bronquial no se recomienda, debido a que su eficacia no está suficientemente documentada y al riesgo de graves efectos secundarios de tipo asmático; la inmunoterapia nasal no se considera indicada para su uso clínico en niños y la inmunoterapia oral no se recomienda, excepto como parte de estudios controlados, debido al riesgo de efectos secundarios e insuficiente documentación que avale su eficacia. Actualmente, en la práctica clínica, parece detectarse un interés progresivo hacia la inmunoterapia sublingual y está siendo cada vez más utilizada en nuestro país, por lo que se hace necesario revisar el estado actual de nuestros conocimientos acerca de esta modalidad terapéutica. Para considerar a la inmunoterapia sublingual como una alternativa válida, partiendo de la base de su mecanismo de acción, habrá que comprobar una mayor seguridad en su administración, demostrar su eficacia clínica y que esta sea al menos equiparable a la obtenida con la inmunoterapia subcutánea. El mecanismo de acción de la inmunoterapia sublingual es desconocido. Los experimentos con extractos alergénicos marcados con isótopos radioactivos administrados por vía sublingual, no indican ninguna absorción a través de la mucosa oral, lo que tranquiliza en el sentido de no temer por reacciones adversas sistémicas, pero por otra parte nos plantea serias dudas acerca del fundamento de esta forma de administración de inmunoterapia. La inmunoterapia sublingual, sobre todo la exclusivamente sublingual (en la que la dosis es posteriormente escupida), es un tratamiento seguro según se desprende de los ensayos clínicos y de los estudios de farmacovigilancia publicados, aunque la forma de administración sublingual con posterior ingestión de la dosis puede dar lugar a reacciones adversas sistémicas, tales como urticaria y asma. En la experiencia de su utilización no hay referidas, hasta la actualidad, reacciones sistémicas graves que amenacen la vida. El análisis de los resultados de los ensayos clínicos controlados doble ciego publicados hasta la actualidad nos llevan a la misma conclusión que los documentos de posición de la OMS, de la EAACI y de la ESPACI, en el sentido de que no existe suficiente evidencia para recomendar el empleo de la inmunoterapia sublingual en niños, excepto dentro de un estudio controlado. Son necesarios más estudios controlados para que esta forma de inmunoterapia pueda ser recomendada en niños como alternativa a la inmunoterapia subcutánea y deben obtenerse más datos de estos estudios en niños para documentar el grado de eficacia, la pauta de tratamiento, las dosis máximas, su seguridad durante el tratamiento prolongado y su eficacia a largo plazo (AU)

Allergen specific immunotherapy has been shown to be effective in rigorous double-blind placebo-controlled clinical trials in both children and adults A recent WHO position paper stated that immunotherapy is an effective treatment for patients with allergic rhinitis/conjunctivitis, allergic asthma and allergic reactions from stinging insects and is thought to be more effective in children than in adults. When speaking about children there are several questions that are important regarding the natural course of the disease. One of the most important is whether immunotherapy can prevent asthma, either by preventing sensitisation to allergens related to the development of asthma or by preventing the inflammation in the lungs caused by allergen exposure. Another point could be to establish the differences in the long term outcome of those patients treated with immunotherapy and medication during childhood, compared to the long term outcome of those with comparable asthma features who received only antiasthmatic medication The PAT study is a European multi-center study. The end-point is to show in what capacity allergen specific subcutaneous immunotherapy can prevent the development of asthma in children who only have rhinoconjunctivitis secondary to grass or birch pollen sensitisation. Two hundred and ten children aged from 5 to 13 years were included in the study. Children were randomized to the active treatment group receiving allergen specific immunotherapy with birch and/or timothy pollen allergen extract or to the control group receiving only pharmacotherapy. It is important to highlight that the main criteria to be included was that the children should never have had any asthmatic symptom. Immunotherapy has been effective in terms of decreasing significantly the amount of symptoms in the active group compared to the control one. It was safe with no serious adverse reactions and reduced the risk of the onset of asthma. After two years of treatment more children in the control group developed clinical asthma than in the active group: p = 0.004. Des Roches et al reported the results of a prospective non randomized trial of immunotherapy with Dermatophagoides pteronyssinus in 44 asthmatic children younger than six years of age who were sensitive only to dust mites. The purpose of the study was to assess whether immunotherapy could reduce the development of new sensitisation during a period of three years of follow up. Specific immunotherapy was given with only D. Pteronyssinus extract. All 22 children in the control group developed new sensitivities as determined by skin testing and in vitro tests, while 10 (45%) of 22 children who received mite immunotherapy did not develop additional sensitivities. The findings of this study suggests that immunotherapy may alter the natural course of the allergic sensitisation reducing the risk of developing new sensitisation in mono sensitive children. A limited number of studies have examined the long terms effects of immunotherapy on the clinical presentation of asthma and rhinoconjunctivitis, and have shown a long lasting efficacy decreasing the amount of symptoms 6-10 years after termination. In a retrospective study of children treated with immunotherapy during childhood for at least three years, that were re-evaluated in early adulthood, the control patients who were treated with medication and no immunotherapy suffered almost 3.5 times more symptoms than the active group treated with immunotherapy. The current findings suggest that immunotherapy should be considered earlier in the course of allergic disease to prevent progression or to prevent the development of new sensitisation. Further studies with long term follow up particularly in children could address this possibility (AU)

[Prevalence of hepatitis C virus infection and cohabiting contacts]. / Estudio de la prevalencia de infección por el virus de la hepatitis C y estudio de contactos convivientes.

OBJECTIVES: Study of the prevalence of Hepatitis C infection and of cohabiting contacts. DESIGN: A descriptive crossover study. SETTING: Health District. PATIENTS: There were a total of 13,500 people with histories opened at our centre. The histories of patients attending for general medical consultations between January 1995 and December 1996 were reviewed for Ac+ to the Hepatitis C (HC) virus. RESULTS: 145 patients were found to be Ac positive for HC (1.07%; CI, 0.9-1.2). 135 were index cases and 10 contacts. The most important items of history were intravenous drug use in 33 carriers (23%), transfusion in 22 (15%), contact with non-disposable material in 97 (67%) and surgery in 119 (82%). 115 (79%) of those infected had Transaminase disorder (< x10). CONCLUSIONS: The 1.07% prevalence found was similar to other studies. Previous surgery stood out among the factors causing risk of infection. Prevalence among cohabitants was 7%, half through sexual contacts. Since there was a higher prevalence of HC+ among family members (50% sexual partners), we believe the study should be extended and followed up in the family environment.

[Study of the demand for home care by the Pamplona Extrahospital Emergency Services in 1995]. / Estudio de la demanda de atención domiciliaria en 1995 del Servicio de Urgencias Extrahospitalario de Pamplona.

The present paper is a retrospective descriptive study, carried out in the Special Casualty Service (Servicio Especial de Urgencias) of Pamplona. It evaluates 8,411 cases of calls from homes, extracted from an aleatory sample stratified by day of the week and season of the year, with a N=647. The diagnoses were codified according to the ICHPPC-2 of the WONCA and the statistical study with SPSS/PC+V 4.0. The monthly average was 701 calls from homes, with a daily average of 19 (from Monday to Friday), with 38 on Sundays and holidays. With respect to distribution by time, on working days 66.5% were distributed between 15.00 and 22.00 hours, while on Sundays and holidays 51% fell between 8.00 and 13.00 hours. The overall rate of use was situated at 32.71/1,000 inhabitants and year (with extreme rates in Mendillorri=7.42 and II Ensanche=57.35). In 74% of the cases a doctor or nurse visited the home. The most frequent cause for home care are illnesses of the respiratory apparatus with 23.5%. Some 40.9% of the patients attended were over 75 years of age. The conclusions are: 1. There is a low rate of home care. 2. Those requiring such visits are of an advanced age. 3. Illnesses of the respiratory apparatus are the most frequent cause of demand. 4. The zones of most demand are those where a Health Centre has not been set up as such.

Protección miocárdica durante la cirugía cardíaca / Myocardial protection during cardiac surgery

Durante el último siglo,los avances científicos permitieron estudiar los mecanismos responsables del daño celular producidos por isquemia.Gracias a ello,numerosas técnicas fueron propuestas,modificadas,aceptadas o rechazadas hasta nuestros días.Actualmente los cadiocirujanos disponen de un arsenal terapéutico muy variado que permite disminuir en un grado importante esta injuria.Sin embargo, todavía ésta no puede ser evitada totalmente.Las contínuas investigaciones en proceso y a realizar permitirán, tal vez, conocer mecanismos y las técnicas necesarias de protección miocárdica para impedirlo