Phenotypic and Molecular Characterization of an Enterobacter ludwigii Clinical Isolate Carrying a Plasmid-Mediated blaIMI-6 Gene.

We report a plasmid-encoded IMI-6 carbapenemase in a clinical isolate of Enterobacter ludwigii from Spain. The isolate belongs to ST641 and was susceptible to expanded-spectrum cephalosporins and resistant to carbapenems. The modified carbapenem inactivation method (mCIM) test was positive, but ß-Carba was negative. Whole-genome sequencing identified the blaIMI-6 gene located in a conjugative IncFIIY plasmid and associated with the LysR-like regulator imiR. Both genes were bracketed by an ISEclI-like insertion sequence and a putatively defective ISEc36 insertion sequence. IMPORTANCE IMI carbapenemases confer an unusual resistance pattern of susceptibility to broad-spectrum cephalosporins and piperacillin-tazobactam but decreased susceptibility to carbapenems, which may make them difficult to detect in routine practice. Commercially available molecular methods for the detection of carbapenemases in clinical laboratories do not usually include blaIMI genes, which could contribute to the hidden dissemination of bacteria producing these enzymes. Techniques should be implemented to detect minor carbapenemases that are not very frequent in our environment and control their dissemination.

Importancia del diagnóstico precoz en policitemia vera y trombocitemia esencial. Experiencia de un centro / Relevance of early diagnosis in polycythemia vera and essential thrombocythemia: a single center's experience

Objetivos: Describir la proporción de pacientes con policitemia vera (PV) o trombocitemia esencial (TE) y trombosis previa al diagnóstico que presentaban eritrocitosis o trombocitosis antes de la trombosis. Pacientes y métodos: Revisión retrospectiva de 63 pacientes con PV y 130 con TE. Resultados: En PV, encontramos eritrocitosis previa en 7 (11,1%) de los 17 casos (27%) con trombosis previa al diagnóstico. En TE, encontramos trombocitosis previa en 10 (7,7%) de los 25 casos (19,2%) con trombosis previa al diagnóstico. La mediana de tiempo entre el hallazgo analítico y la trombosis fue de 8,2 meses y 11,8 meses para PV y TE, respectivamente. En ambas entidades, los pacientes con trombosis previa al diagnóstico tenían una supervivencia significativamente menor. Conclusión: Una proporción significativa de pacientes con trombosis previa al diagnóstico de PV y TE presenta eritrocitosis o trombocitosis previa al episodio de trombosis, lo que permitiría anticipar el diagnóstico y el tratamiento (AU)

Objectives: This work aims to describe the proportion of patients with polycythemia vera (PV) or essential thrombocythemia (ET) and thrombosis prior to the diagnosis who had erythrocytosis or thrombocytosis prior to thrombosis. Patients and methods: This is a retrospective review of 63 patients with PV and 130 with ET. Results: In regard to PV, we found prior erythrocytosis in 7 (11.1%) of the 17 cases (27%) with thrombosis prior to diagnosis. In ET, we found prior thrombocytosis in 10 (7.7%) of the 25 cases (19.2%) with thrombosis prior to diagnosis. The median time between the laboratory finding and thrombosis was 8.2 months and 11.8 months for PV and TE, respectively. In both entities, patients with thrombosis prior to diagnosis had significantly lower survival. Conclusion: A significant proportion of patients with thrombosis prior to the diagnosis of PV and ET present erythrocytosis or thrombocytosis prior to the episode of thrombosis. This could allow for anticipating diagnosis and treatment (AU)

Relevance of early diagnosis in polycythemia vera and essential thrombocythemia: A single center's experience.

OBJECTIVES: This work aims to describe the proportion of patients with polycythemia vera (PV) or essential thrombocythemia (ET) and thrombosis prior to the diagnosis who had erythrocytosis or thrombocytosis prior to the thrombosis. PATIENTS AND METHODS: This is a retrospective review of 63 patients with PV and 130 with ET. RESULTS: In regard to PV, we found prior erythrocytosis in 7 (11.1%) of the 17 cases (27%) with thrombosis prior to diagnosis. In ET, we found prior thrombocytosis in 10 (7.7%) of the 25 cases (19.2%) with thrombosis prior to diagnosis. The median time between the laboratory finding and thrombosis was 8.2 months and 11.8 months for PV and TE, respectively. In both entities, patients with thrombosis prior to diagnosis had significantly lower survival. CONCLUSION: A significant proportion of patients with thrombosis prior to the diagnosis of PV and ET present with erythrocytosis or thrombocytosis prior to the episode of thrombosis. This could allow for anticipating diagnosis and treatment.

Analysis of sedentariness in women from a gender and equity perspective.

ABSTRACTThis cross-sectional study aimed to analyse the social and gender-related factors influencing sedentariness in women, including occupation and family size (FS). We included women aged 45-70 years participating in the Breast Cancer Screening Programme of the Valencia Region (BCSP-VR) between November 2018 and October 2019 (n = 121,988). The response variable was sedentariness measured by sitting time in hours/day (h/day) (<3 h/day and ≥3 h/day). The explanatory variables were age, educational level, country of origin, living alone, childcare responsibilities, FS, disability, body mass index (BMI) and smoking status. Logistic regression models were adjusted for the whole sample and were stratified by occupation and FS. The variables that increased the odds of sedentariness were age ≥65 years (OR = 1.28; CI = 1.20-1.36), high educational level (OR = 1.39; CI = 1.31-1.47), non-manual occupation (OR = 2.38; CI = 2.27-2.48), living alone (OR = 1.11; CI = 1.05-1.17), disability (OR = 1.37; CI = 1.20-1.56) and BMI ≥ 30 (OR = 1.33; CI = 1.28-1.38). The variables decreasing the odds were large (OR = 0.90; CI = 0.87-0.96) and medium FS (OR = 0.93; CI = 0.90-0.97). Older age, high educational level and high BMI conferred a higher odd of sedentary lifestyle, independently of occupation and FS with statistical differences. Protective factors were childcare responsibilities in non-working women (OR = 0.86; CI = 0.74-0.99), large FS in women with manual occupations (OR = 0.88; CI = 0.80-0.97) and medium FS in housewives (OR = 0.91; CI = 0.86-0.97). This study identified social and gender-related inequalities in the factors influencing sedentariness, which were related to the type of occupation and FS.Highlights There are social and gender inequalities in the factors influencing sedentarinessNon-manual occupation increases the risk of sedentary lifestyleBelonging to a medium or large family decreases the risk of sedentary behaviourChildcare responsibilities are related to lower sitting time throughout the day.

Primer consenso cubano sobre el uso de terapia convencional y biológica en pacientes con artritis reumatoide / First Cuban consensus on the use of conventional and biological therapy in patients with rheumatoid arthritis

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Introduction: The development of recommendations for the treatment of rheumatoid arthritis (RA) in the Cuban context may be one of the ways to achieve better control of this disease. Objective: To reach a consensus and update relevant aspects of conventional and biological RA modifier therapy in Cuba. Methods: 18 specialists from 8 Cuban provinces, experts in RA care, were summoned, according to the years of dedication to the specialty, the conferences on this topic and their publications. The first meeting took place in March 2016 in the provincial hospital of Villa Clara, Cuba, with the participation of all the experts. A review of the literature on conventional and biological therapy previously collected by the participants was developed, and two teams were formed: the first would address everything related to conventional therapy in RA (HRCT) and the other, biological therapy in RA (TBAR). Three questionnaires related to the use of corticosteroids, HRCT and TBAR, were prepared, answered by the participants via email. In a second meeting, held in October 2016 in Havana, the analysis of all the responses provided was carried out. Questions with a response of 90% or more votes were considered as recommendations. Results: The questionnaires were answered by 95% of the participants. 9 recommendations and 1 algorithm were established. The recommendations are as follows: methotrexate is the drug of choice in the treatment of RA after diagnosis; The administration of another conventional drug (DMARDc) (azathioprine, salazosulfapyridine, antimalarials and leflunomide) is recommended in patients with a diagnosis of active RA in whom methotrexate is contraindicated or there is a failure in response - consider the administration of low doses of prednisone or equivalent (<7.5 mg/d) associated with DMARDc in patients with active moderate to severe RA, for the shortest possible time; perform serological control including tests for hepatitis B and C viruses and screening for HIV in all patients diagnosed with RA before starting treatment with DMARDc and biologics; in patients in remission or, at least, with a DAS-28 below 3.2, consideration should be given to withdrawing one of the DMARDs or reducing, to the minimum possible expression, the dose of both disease modifiers; if methotrexate fails, tocilizumab in combination with methotrexate or as monotherapy will be indicated. Conclusions: Aspects related to conventional therapy with methotrexate, azathioprine, salazosulfapyridine, antimalarials and leflunomide were agreed. The value of early diagnosis and immediate initiation of DMARDc therapy and the use of glucocorticoids was analyzed. Treatment with tocilizumab, the only biological available in Cuba against RA, will be administered when there is a failure in the response to conventional therapy and combinations between these drugs. It is recommended to hold educational conferences through the mass media aimed at patientshttp(AU)

"CLUPS": A New Culture Medium for the Axenic Growth of Entamoeba histolytica.

Amebiasis remains a major health problem in Mexico. Therefore, the search for better culture media and low-cost diagnostic and therapeutic tools is fundamental. We present a new culture medium for Entamoeba histolytica which allows the microbe to preserve its virulence factors and ability to induce hepatic abscesses in animal models. The novel CLUPS medium is an improved version of the PEHPS medium, previously designed in our laboratory. The main difference is the substitution of raw beef liver in PEHPS by raw beef lung in the CLUPS medium. To compare the performance of three-culture media (traditional TYI-S-33, PEHPS, and CLUPS), E. histolytica trophozoites were cultured in quintuplicate, followed by the evaluation of phospholipase activity and the induction of liver abscesses in golden hamsters. E. histolytica trophozoites grew significantly better in CLUPS medium than in TYI-S-33. Likewise, CLUPS-cultured trophozoites produced significantly more phospholipases than TYI-S-33-cultured trophozoites. Finally, trophozoites grown in any of the three tested media had similar potential to induce liver abscesses.

El cotidiano de la cuidadora primaria durante la hospitalización del niñ@ con enfermedad crónica / The daily life of the primary caregiver during the hospitalization of children with chronic disease

El presente estudio trata acerca de la cotidianidad de la cuidadora primaria durante la hospitalización del niño(a) con enfermedad crónica, considerando este un tema importante para el profesional de enfermería en el desarrollo del cuidado. Objetivo: Analizar el cotidiano de la cuidadora primaria durante la hospitalización del niño(a) con enfermedad crónica. Metodología: Estudio cualitativo, fenomenológico. Participaron 6 cuidadoras de niños/as hospitalizados/as con enfermedad crónica que se encontraban en el servicio de infectología de un hospital de tercer nivel de atención; se utilizó para la recogida de datos la observación participante y la entrevista semi-estructurada, fueron grabadas previo consentimiento informado, se realizó análisis temático. Hallazgos: Después de analizar los datos se desprendieron, cinco categorías con 2 subcategorías y la quinta categoría con 3 subcategorías; cuidados que dedica la madre al niño/a hospitalizado/a; el apego materno, una forma de fortalecer los lazos de afecto entre el hijo/a y la madre; tiempo y espacio en el entorno hospitalario; percepción de sí misma y repercusiones del proceso de la enfermedad. Conclusiones: Las cuidadoras primarias expresan su cotidiano como la repetición de las mismas actividades en el hospital, al participar en el cuidado lo asumen como su responsabilidad para contribuir en la pronta recuperación del niño/a.

The present study is intended to survey the daily life of a primary healthcare giver during the hospitalization of a child with chronic illness, taking into consideration that the crucial issue for the nursing professionals is the development of all the processes for adequate healthcare delivery. Objective: To analyze the daily routine of the primary healthcare giver throughout the hospitalization time of a chronically ill child. Methodology: A qualitative phenomenological study involving 6 healthcare givers for hospitalized children with chronic diseases assigned to the Infectology service of a third level hospital. For data collection, direct observation of the participants and application of semi-structured interview were used. The responses of the participating caregivers in the interview were recorded priorto informed consent and thematic analysis was performed. Findings: The analysis of data brought into evidence the existence of five categories and 2 subcategories. The five categories found were: 1. Mother-childward care provision, 2. mother-child attachment as bond-of-affection strengthening tool, 3. time and space in the hospital environment, 4. self-perception and 5. disease process repercussions. The fifth category has three subcategories. Conclusions: The daily lives of the primary healthcare givers are fraught with repetitive activities in the hospital wards. When participating in the healthcare delivery, the caregivers unalloyedly assume it as their responsibility to contribute to the early recovery of the child.

Actualización del cáncer de mama en atención primaria (IV/V) / Update of breast cancer in primary care (IV/V)

El cáncer de mama es una enfermedad prevalente con implicaciones en todas las esferas de la vida de las pacientes, por lo que el médico de familia debe conocer en profundidad esta patología para optimizar la atención con los mejores recursos disponibles. Los 5 artículos que componen esta revisión ofrecen un resumen de la literatura sobre el cáncer de mama publicada en los últimos 10 años. Este cuarto artículo aborda el tratamiento de la enfermedad, el papel del médico de atención primaria al respecto y el manejo de las principales complicaciones. Esta revisión pretende ofrecer una visión global, actualizada y práctica sobre esta enfermedad que permita resolver los interrogantes que se presentan en la consulta de atención primaria, facilitar respuestas a las mujeres que las soliciten y en definitiva, permanecer al lado de las pacientes a lo largo de su enfermedad con la tranquilidad del conocimiento (AU)

Breast cancer is a prevalent disease affecting all areas of patients’ lives. Therefore, family physicians must thoroughly understand this pathology in order to optimize the health care services and make the best use of available resources, for these patients. A series of 5 articles on breast cancer is presented below. It is based on a review of the scientific literature over the last 10 years. This fourth article deals with the treatment of the disease, the role of the primary care physician, and management of major complications. This summary report aims to provide a current and practical review about this problem, providing answers to family doctors and helping them to support their patients and care for them throughout their illness (AU)

[Update of breast cancer in primary care (IV/V)]. / Actualización del cáncer de mama en atención primaria (IV/V).

Breast cancer is a prevalent disease affecting all areas of patients' lives. Therefore, family physicians must thoroughly understand this pathology in order to optimize the health care services and make the best use of available resources, for these patients. A series of 5 articles on breast cancer is presented below. It is based on a review of the scientific literature over the last 10 years. This fourth article deals with the treatment of the disease, the role of the primary care physician, and management of major complications. This summary report aims to provide a current and practical review about this problem, providing answers to family doctors and helping them to support their patients and care for them throughout their illness.

SNP-based mapping arrays reveal high genomic complexity in monoclonal gammopathies, from MGUS to myeloma status.

Genetic events mediating transformation from premalignant monoclonal gammopathies (MG) to multiple myeloma (MM) are unknown. To obtain a comprehensive genomic profile of MG from the early to late stages, we performed high-resolution analysis of purified plasma cells from 20 MGUS, 20 smoldering MM (SMM) and 34 MM by high-density 6.0 SNP array. A progressive increase in the incidence of copy number abnormalities (CNA) from MGUS to SMM and to MM (median 5, 7.5 and 12 per case, respectively) was observed (P=0.006). Gains on 1q, 3p, 6p, 9p, 11q, 19p, 19q and 21q along with 1p, 16q and 22q deletions were significantly less frequent in MGUS than in MM. Although 11q and 21q gains together with 16q and 22q deletions were apparently exclusive of MM status, we observed that these abnormalities were also present in minor subclones in MGUS. Overall, a total of 65 copy number-neutral LOH (CNN-LOH) were detected. Their frequency was higher in active MM than in the asymptomatic entities (P=0.047). A strong association between genetic lesions and fragile sites was also detected. In summary, our study shows an increasing genomic complexity from MGUS to MM and identifies new chromosomal regions involved in CNA and CNN-LOH.

Progressive renal failure as the first manifestation of monoclonal light-chain deposition disease with rapid multiple organ involvement.

Light-chain deposition disease (LCDD) is an uncommon condition in which monoclonal light chains are deposited in different organs causing varying degrees of tissue damage. We report the case of a 56-year-old male with progressive renal failure as the first manifestation of LCDD without initial evidence of monoclonal immunoglobulin protein in either serum or urine. The patient later developed severe systemic disease with rapid multiple organ involvement. Finally, he died 2 months after diagnosis, despite steroid and cyclophosphamide therapy.

[Peritoneal tuberculosis as a complication in a case of unclassifiable myelodysplastic/myeloproliferative disease]. / Tuberculosis peritoneal como complicación en un caso de síndrome mielodisplásico/mieloproliferativo inclasificable.

We report the case of a 68-year-old male with a diagnosis of unclassifiable myelodysplatic/myeloproliferative disease (WHO classification), under prolonged steroid treatment and unsuccesful chemotherapy response, who developed progressive asthenia, thoracic pain, minimal efforts dyspnea, and abdominal distension, that initially was suspicious of splenic rupture. Exploratory laparotomy showed multiple peritoneal implants, and a diagnosis of peritoneal tuberculosis was obtained from local biopsy. Definitive diagnosis included a positive result to culture and PCR urine test, together with a possible pleural and splenic tuberculous affectation. Response to tuberculostatic treatment was successful. To the best of our knowledge, this is the first reported case with such characteristics.

Beneficios del ejercicio físico en los pacientes con diabetes / Benefits of exercise in patients with diabetes

El ejercicio físico tiene importantes beneficios sobre la salud. En efecto, mientras los hábitos de vida sedentarios se asocian con un mayor riesgo de enfermedades crónicas como la diabetes mellitus tipo 2, niveles moderados de ejercicio físico producen beneficios considerables en los pacientes con esta enfermedad. Al inicio, la modificación del estilo de vida, con cambios dietéticos y ejercicio, puede mejorar el control metabólico y obviar, por un tiempo, el tratamiento farmacológico. Cuando la enfermedad progresa y el control metabólico se deteriora a pesar del tratamiento con hipoglucemiantes orales, el ejercicio puede contribuir a la mejora del control glucémico. El ejercicio mejora la condición física y diversos parámetros antropométricos como el peso y la distribución de la grasa corporal, además de participar en la prevención de complicaciones crónicas. Existen evidencias claras acerca del beneficio de la actividad física sobre los factores de riesgo cardiovascular, reduciendo la incidencia de hipertensión arterial y de dislipemia, lo que se asocia globalmente a la reducción del riesgo de enfermedad cardiovascular. Además, el ejercicio presenta importantes beneficios psicológicos que pueden contribuir a mejorar la adherencia terapéutica y la calidad de vida del paciente con diabetes. Sin embargo, la adhesión a programas de ejercicio físico es muy baja en la población con esta enfermedad. Ello se debe, en parte, a las dificultades en la implementación de los cambios en el estilo de vida, a la escasa dedicación del personal sanitario a la promoción del ejercicio, y a la falta de formación y de tiempo para su adecuada prescripción. En consecuencia, debe incentivarse en la práctica clínica la necesidad de informar, aconsejar y prescribir el ejercicio físico de forma adecuada a los pacientes con diabetes

Physical exercise has important health benefi ts. Physical inactivity is associated with an increased risk of chronic diseases like type 2 diabetes mellitus. In contrast, moderate levels of physical exercise produce considerable benefi ts in diabetic patients, especially in those with type 2 diabetes mellitus. At the onset of the disease, modifi cation of lifestyle, with improvements in diet and exercise, may restore good metabolic control, postponing, for the time being, the need for pharmacological treatment. When the disease progresses and metabolic control deteriorates, despite treatment with oral hypoglycemic agents, exercise may also contribute to enhance glycemic control. Physical exercise improves fi tness status and a number of anthropometric parameters, such as weight and fat distribution, and contributes to the prevention of chronic complications. There is also evidence of the benefi ts of exercise in terms of cardiovascular risk factors, reducing the incidence of hypertension and dyslipidemia, which contributes overall to lowering the risk of cardiovascular disease. Moreover, regular exercise produces important psychological benefi ts, which can contribute to increase the adherence to treatment and improve the quality of life of people with diabetes. However, adherence to physical exercise programs among diabetic patients is very low. Factors that contribute to this circumstance include the diffi culties associated with the introduction of changes in lifestyle and the limited interest in the promotion and prescription of exercise on the part of health care professionals, who lack both the training and the time necessary for proper prescription. Therefore, the need to inform, recommend and prescribe the most appropriate physical exercise for people with diabetes should be promoted among clinicians

Isquemia cerebral secundaria a una endocarditis trombótica no bacteriana como forma de presentación de un tumor ovárico / Cerebral ischaemia secondary to non-bacterial thrombotic endocarditis as the presenting symptom of an ovarian tumour

Introducción. En los pacientes con cáncer, los accidentes cerebrovasculares (ACV) son la complicación en sistema nervioso central más común después de las metástasis. Una de sus etiologías es la endocarditis trombótica no bacteriana (ETNB), que se presenta de forma excepcional como primera manifestación del tumor. Las manifestaciones clínicas de la ETNB son resultado del embolismo sistémico múltiple. Los émbolos se componen de plaquetas y hebras de fibrina que se depositan en las válvulas cardíacas, en el contexto de un estado de hipercoagulabilidad secundario al tumor. Los tumores más frecuentemente asociados a ETNB son los adenocarcinomas secretores de mucina. En las diferentes series publicadas, los casos de cáncer de ovario con ETNB son excepcionales. Caso clínico. Mujer de 58 años que, previamente asintomática, presentó de forma brusca disminución de nivel de conciencia, hemiplejía derecha y afasia motora. La tomografía axial computarizada a las 48 horas mostraba dos lesiones isquémicas agudas en el hemisferio izquierdo. La resonancia magnética cerebral con secuencia de difusión mostró múltiples lesiones isquémicas en diferentes territorios arteriales. El ecocardiograma transtorácico a las 24 horas mostraba una vegetación en el velo posterior de la válvula mitral. La paciente se trató con heparina sódica intravenosa y no volvió a presentar nuevos ACV. Las lesiones valvulares desaparecieron tras el tratamiento. En un estudio de búsqueda neoplasia oculta, se halló un tumor ovárico derecho. Conclusiones. La posibilidad de ETNB debe considerarse en casos de embolia cerebral de origen desconocido. La mayoría de pacientes muestran datos analíticos de coagulación intravascular diseminada crónica. Para el diagnóstico las pruebas más útiles son el ecocardiograma transesofágico y la resonancia magnética cerebral con secuencia de difusión. El tratamiento de elección es la heparina (AU)

Introduction. In cancer patients, cerebrovascular accidents (CVA) are the most common complication occurring in the central nervous system after metastasis. One of its causations is non-bacterial thrombotic endocarditis (NBTE), which appears on rare occasions as the first symptom of the tumour. The clinical manifestations of NBTE are the result of multiple systemic embolism. Emboli consist of platelets and strands of fibrin that are deposited in the valves of the heart, within a context of a state of hypercoagulability secondary to the tumour. The tumours that are most frequently associated to NBTE are mucin-secreting adenocarcinomas. Cases of ovarian cancer with NBTE are rare in the different series reported in the literature. Case report. We describe the case of a 58-year-old female, previously asymptomatic, who suddenly showed a lowered level of consciousness, hemiplegia on the right-hand side and motor aphasia. A computerised axial tomography scan taken at 48 hours showed two acute ischaemic lesions in the left hemisphere. Magnetic resonance imaging of the brain with diffusion sequences revealed multiple ischaemic lesions in different arterial territories. Transthoracic echocardiography at 24 hours showed a vegetation on the posterior leaflet of the mitral valve. The patient was treated with intravenous sodium heparin and no new CVA appeared. The valve injuries disappeared after treatment. In a study conducted to search for occult neoplasia, a tumour was found in the right ovary. Conclusions. NBTE must be taken into account in cases of cerebral embolism due to unknown causes. The results of the analyses of most patients reveal chronic disseminated intravascular coagulation. The most valuable diagnostic tests are the transesophageal echocardiogram and magnetic resonance imaging of the brain with diffusion sequences. Preferred treatment is with heparin (AU)

[Cerebral ischaemia secondary to non-bacterial thrombotic endocarditis as the presenting symptom of an ovarian tumour]. / Isquemia cerebral secundaria a una endocarditis trombótica no bacteriana como forma de presentación de un tumor ovárico.

INTRODUCTION: In cancer patients, cerebrovascular accidents (CVA) are the most common complication occurring in the central nervous system after metastasis. One of its causations is non-bacterial thrombotic endocarditis (NBTE), which appears on rare occasions as the first symptom of the tumour. The clinical manifestations of NBTE are the result of multiple systemic embolism. Emboli consist of platelets and strands of fibrin that are deposited in the valves of the heart, within a context of a state of hypercoagulability secondary to the tumour. The tumours that are most frequently associated to NBTE are mucin-secreting adenocarcinomas. Cases of ovarian cancer with NBTE are rare in the different series reported in the literature. CASE REPORT: We describe the case of a 58-year-old female, previously asymptomatic, who suddenly showed a lowered level of consciousness, hemiplegia on the right-hand side and motor aphasia. A computerised axial tomography scan taken at 48 hours showed two acute ischaemic lesions in the left hemisphere. Magnetic resonance imaging of the brain with diffusion sequences revealed multiple ischaemic lesions in different arterial territories. Transthoracic echocardiography at 24 hours showed a vegetation on the posterior leaflet of the mitral valve. The patient was treated with intravenous sodium heparin and no new CVA appeared. The valve injuries disappeared after treatment. In a study conducted to search for occult neoplasia, a tumour was found in the right ovary. CONCLUSIONS: NBTE must be taken into account in cases of cerebral embolism due to unknown causes. The results of the analyses of most patients reveal chronic disseminated intravascular coagulation. The most valuable diagnostic tests are the transesophageal echocardiogram and magnetic resonance imaging of the brain with diffusion sequences. Preferred treatment is with heparin.

[Fibrillary and immunotactoid glomerulonephritis: report of a case and review of the literature]. / Glomerulonefritis fibrilar e inmunotactoide: descripción de un caso y revisión de la literatura.

We describe the case of a 67 year-old female with nephrotic syndrome and rapidly progressive renal failure. The nephropathy was characterized by deposits of randomly oriented fibrils with a diameter of about 18-20 nm on electron microscopy. Immunofluorescence microscopy was performed and there was no staining for immunoglobulins and complement. We diagnosed atypical fibrillary glomerulopathy with absence of immune deposits. The patient developed end-stage renal failure rapidly. We review in the literature new clinical and pathogenetic features related to fibrillary and immunotactoid glomerulopathy.

Contribution of beverages to the intake of lipophilic and hydrophilic antioxidants in the Spanish diet.

OBJECTIVE: To investigate the contribution of beverages to the intake of lipophilic and hydrophilic antioxidants in the Spanish diet. DESIGN: This includes the following (i) estimation of the daily intakes of beverages in Spain, from national food consumption data obtained from annual surveys of 5400 households, 700 hotels and restaurants and 200 institutions; (ii) determination of total antioxidant capacity in the selected beverages using two complementary procedures: ferric reducing ability of plasma (FRAP), which measures the ferric reduction capacity, and ABTS, which measures the radical scavenging capacity; (iii) determination of the antioxidant capacity in both lipophilic and hydrophilic extracts of the beverages; (iv) determination of the antioxidant efficiency of the lipophilic and hydrophilic phase of the beverages; and (v) estimation of the intake of dietary antioxidants from beverages in comparison with the daily requirements of antioxidant vitamins C and E. RESULTS: The contribution of beverages to the antioxidant intake in the Spanish diet is estimated at 1623 mg of vitamin E and 598 mg of vitamin C by FRAP, and 1521 mg of vitamin E and 556 mg of vitamin C by ABTS. Coffee is the main contributor (66 and 61% by FRAP and ABTS, respectively), followed by red wine (16 and 22%), fruit juices (6 and 5%), beer (4 and 5%), tea (3 and 5%) and milk (4 and 1%). CONCLUSIONS: Beverages account for a very high proportion of dietary antioxidant intake as compared to intake of antioxidant vitamins C and E. Although their metabolic effect must be affected by the bioavailability of the antioxidants, the significance of this intake for antioxidant status and health should be considered.