Disability Improvement Is Associated with Less Brain Atrophy Development in Multiple Sclerosis.

BACKGROUND AND PURPOSE: It is unknown whether deceleration of brain atrophy is associated with disability improvement in patients with MS. Our aim was to investigate whether patients with MS with disability improvement develop less brain atrophy compared with those who progress in disability or remain stable. MATERIALS AND METHODS: We followed 980 patients with MS for a mean of 4.8 ± 2.4 years. Subjects were divided into 3 groups: progress in disability (n = 241, 24.6%), disability improvement (n = 101, 10.3%), and stable (n = 638, 65.1%) at follow-up. Disability improvement and progress in disability were defined on the basis of the Expanded Disability Status Scale score change using standardized guidelines. Stable was defined as nonoccurrence of progress in disability or disability improvement. Normalized whole-brain volume was calculated using SIENAX on 3D T1WI, whereas the lateral ventricle was measured using NeuroSTREAM on 2D-T2-FLAIR images. The percentage brain volume change and percentage lateral ventricle volume change were calculated using SIENA and NeuroSTREAM, respectively. Differences among groups were investigated using ANCOVA, adjusted for age at first MR imaging, race, T2 lesion volume, and corresponding baseline structural volume and the Expanded Disability Status Scale. RESULTS: At first MR imaging, there were no differences among progress in disability, disability improvement, and the stable groups in whole-brain volume (P = .71) or lateral ventricle volume (P = .74). During follow-up, patients with disability improvement had the lowest annualized percentage lateral ventricle volume change (1.6% ± 2.7%) followed by patients who were stable (2.1% ± 3.7%) and had progress in disability (4.1% ± 5.5%), respectively (P < .001). The annualized percentage brain volume change values were -0.7% ± 0.7% for disability improvement, -0.8% ± 0.7% for stable, and -1.1% ± 1.1% for progress in disability (P = .001). CONCLUSIONS: Patients with MS who improve in their clinical disability develop less brain atrophy across time compared with those who progress.

Utilization of vinasses as soil amendment: consequences and perspectives.

Vinasses are a residual liquid generated after the production of beverages, such as mezcal and tequila, from agave (Agave L.), sugarcane (Saccharum officinarum L.) or sugar beet (Beta vulgaris L.). These effluents have specific characteristics such as an acidic pH (from 3.9 to 5.1), a high chemical oxygen demand (50,000-95,000 mg L(-1)) and biological oxygen demand content (18,900-78,300 mg L(-1)), a high total solids content (79,000 and 37,500 mg L(-1)), high total volatile solids 79,000 and 82,222 mg L(-1), and K(+) (10-345 g L(-1)) content. Vinasses are most commonly discarded onto soil. Irrigation of soil with vinasses, however, may induce physical, chemical and biochemical changes and affect crop yields. Emission of greenhouse gases (GHG), such as carbon dioxide, nitrous oxide and methane, might increase from soils irrigated with vinasses. An estimation of GHG emission from soil irrigated with vinasses is given and discussed in this review.

Concordancia de los nuevos criterios ACR/EULAR y los ACR 1980 para la clasificación de la esclerosis sistémica / Concordance of the new ACR/EULAR criteria and the ACR 1980 for the classification of systemic sclerosis

Objetivo: Evaluar cumplimiento, y así mismo concordancia y discordancia de los criterios de clasificación de Esclerosis Sistémica (ES) ACR/EULAR 2013 y ACR 1980 en pacientes con diagnóstico clínico de la enfermedad. Método: Se incluyeron 169 pacientes con diagnóstico de Esclerosis Sistémica. Resultados: El 72,2 por ciento cumplía los criterios ACR 1980, y el 99,4 por ciento (168 pacientes) cumplía los criterios ACR/EULAR 2013. La concordancia absoluta de toda la muestra fue 72,7 por ciento, para el subtipo limitado 35,2 por ciento, y 100 por ciento el difuso. Se subanalizaron los pacientes con limitada que sólo cumplían criterios ACR/EULAR 2013, y se comparó con el resto de las limitadas. Los primeros presentaron en forma estadísticamente significativa menor esclerodactilia distal a MCF, menor presencia de úlceras digitales y pitting scars, menor afectación intersticial pulmonar, y mayor daño microvascular en la capilaroscopia. Conclusión: Los nuevos criterios de clasificación de Esclerosis Sistémica serían más adecuados para detectar esclerodermias limitadas, siendo dicho hallazgo estadísticamente significativo.

Objective: To evaluate the performance, and likewise concordance and discordance of the classification criteria of Systemic Sclerosis ACR/EULAR 2013 and ACR 1980 in a group of patients with clinical diagnosis of SSc. Methods: We enrolled 169 patients with diagnosis of Systemic Sclerosis. Results: 72.2 percent met the 1980 ACR criteria, and 99.4 percent met the ACR/EULAR 2013 criteria. The absolute agreement of the entire sample was 72.7 percent, 35.2 percent for the limited subtype, and 100 percent for the diffuse. Those patients with limited subtype who only met the ACR/EULAR 2013 criteria were compared with the rest of limited patients. The first group had statistically significantly lower sclerodactyly distal to MCF, lower presence of digital ulcers and pitting scars, less interstitial lung involvement, and greater abnormal nail fold capillaries. Conclusion: The new classification criteria for systemic sclerosis seem to be more suitable for detecting limited scleroderma. In the present study, statistically significant discrepancy was found in the limited subtype.

Trombosis venosa profunda en un caso de osteomielitis aguda estafilocócica / Deep venous thrombosis in a case of acute staphylococcal osteomyelitis

No disponible

Atrophy of the intestinal villi in a post-gastrectomy patient with severe iron deficiency anemia.

BACKGROUND & AIMS: Iron deficiency anemia is a common complication of gastric surgery that in certain patients can be refractory to treatment with oral iron and needs to be treated parenterally. METHODS: A 48-year woman underwent gastric surgery for a gastric ulcer. She was referred to the nutrition unit for the study and treatment of a 3-year iron deficiency anemia refractory to oral iron supplementation. Blood tests, endoscopy and jejunal biopsy were made to study the case. RESULTS: Intestinal villi atrophy in the absence of celiac disease was the result. She was treated with intravenous iron, resolving the villous atrophy and thus oral iron supplementation could be effective. CONCLUSION: This case illustrates that iron deficiency may cause villous atrophy. In this setting, parenteral iron administration is necessary to correct the haematological and non-hematological alterations associated with this deficiency.

Atrophy of the intestinal villi in a post-gastrectomy patient with severe iron deficiency anemia / Atrofia de las vellosidades intestinales en un paciente postgastrectomizado con anemia ferropénica grave

Background & aims: Iron deficiency anemia is a common complication of gastric surgery that in certain patients can be refractory to treatment with oral iron and needs to be treated parenterally. Methods: A 48-year woman underwent gastric surgery for a gastric ulcer. She was referred to the nutrition unit for the study and treatment of a 3-year iron deficiency anemia refractory to oral iron supplementation. Blood tests, endoscopy and jejunal biopsy were made to study the case. Results: Intestinal villi atrophy in the absence of celiac disease was the result. She was treated with intravenous iron, resolving the villous atrophy and thus oral iron supplementation could be effective. Conclusion: This case illustrates that iron deficiency may cause villous atrophy. In this setting, parenteral iron administration is necessary to correct the haematological and non-hematological alterations associated with this deficiency (AU)

Introducción y objetivos: La anemia ferropénica es una complicación frecuente tras la cirugía gástrica que en algunos pacientes puede ser refractaria al tratamiento con hierro oral, siendo necesaria su administración por vía parenteral. Métodos: Presentamos el caso de una mujer de 48 años intervenida de gastrectomía para tratamiento de una úlcera gástrica. Fue remitida a la unidad de nutrición para estudio y tratamiento de una anemia ferropénica de 3 años de evolución refractaria al tratamiento con hierro oral. Para el estudio del caso se realizó analítica y endoscopia digestiva alta con biopsia yeyunal. Resultados: En el estudio realizado la paciente presentaba atrofia de la mucosa yeyunal en ausencia de enfermedad celíaca. Fue tratada con hierro intravenoso desapareciendo la atrofia intestinal, tras lo cual continuamos con suplementos de hierro por vía oral. Conclusión: Este caso ilustra que la deficiencia de hierro puede producir atrofia intestinal. Si esto ocurre, es necesario la suplementación de este metal por vía parenteral para corregir las alteraciones hematológicas y no hematológicas asociadas a esta deficiencia (AU)

Evaluación de resultados en programas sanitarios: marco conceptual e instrumental oerativo aplicaados en el ámbito del Ministerio de Salud de la Ciudad de Buenos Aires / Evaluation of reults in sanitary programs

Evaluation of results in sanitary programs: conceptual mark and operative instrumentable, applied in the concern of the Ministery of Health from the city of Buenos Aires.

Epidemiología y medicamentos: esenciales, genéricos y el programa Remediar / Epidemiology and pharmaceutical drugs: essential and generics

This report describes the epidemiology and pharmaceutical drugs: essentials and generics.

La salud de los niños adoptados en el extranjero por familias del País Vasco y Navarra (1997-2004) / No disponible

Objetivo: estudiar el estado físico, el desarrollo psicomotor y la adaptación de niñosadoptados internacionalmente entre 1997 y 2004 en el País Vasco y Navarra al llegar y un añodespués.Material y métodos: doble encuesta médica y psicológica bilingüe anónima a todas las familiasadoptantes.Resultados: se enviaron 1.647 encuestas y se recibieron 420 (25,5%). Los niños proveníande China, Latinoamérica y Europa del Este. Media y mediana de edad: 2 años.Malnutrición: 9% índice de masa corporal (IMC) < 2 DE (desviaciones estándar); los valoresdel Z score para el peso, la talla y el IMC evolucionaron de –1 DE al llegar a casi 0 DE un añodespués.Parasitosis intestinal: 18,5%; infección tuberculosa latente: 5,5%; serología de hepatitis Balterada: 4%; una lúes tratada; anemia: 12,2%; alteraciones visuales: 11,4%; y déficit auditivo:1%.Trastorno psicomotor global: 2,5%, retraso área motora: 8%, comportamiento retraído18,2%, conducta hiperactiva 18,6%. Un año después 1,6%, 5%, 7,1% y 13,2% respectivamente.Ninguna alteración espectro autista. Control esfínteres, sueño y alimentación similares anuestra población.Conclusiones: en general, alteraciones físicas poco graves con satisfactoria evolución. Desarrollopsicomotor adecuado para la mayoría. Al año buena evolución excepto los 7 casos graves (4 con información preadoptiva al respecto). Se debe investigar sobre el excesivo númerode niños con comportamiento hiperactivo y sobre el posible retraso del lenguaje.Con respecto a otras publicaciones, encontramos iguales patologías pero con incidenciamenor tanto en datos objetivos (auxología, vacunaciones y estudios complementarios) comoen el lenguaje, la adaptación social o el desarrollo psicomotor. El grado de satisfacción de lospadres es altísimo.Los gobiernos deberían exigir informes preadoptivos fidedignos y completos ya que la patologíaes, sin duda, mayor en estos niños.Los pediatras de Atención Primaria son los indicados para el diagnóstico y el seguimientocoordinado siempre que se mejore la difusión de los protocolos de adopción internacional

Objective: to study physical status, psychomotor development, and social adaptation atarrival and a year after of 420 children (25.5%) adopted internationally in the Basque Countryand Navarra. Most children come from China, Latin America and East Europe. Median and mode:2 years of age.Method: medical and psychological survey administered to each of the adopting familiesto complete with their pediatrician.Results: 9% malnourished (BMI< 2 SD). Z score for weight, height and BMI increased from–1SD to almost 0 SD after one year.Psychomotor retardation from mild to serious 8%. Introspective behaviour 18.6%. Hyperactivebehaviour 18.2. After one year, 7% and 13% respectively.No autistic spectrum disorders. Sphincter control, sleep quality and nutrition behaviour similarto that of the local population.Conclusions: mild physical diseases, the majority of which disappeared or were improvedafter one year. Psychomotor development is good in general, especially after one year, exceptfor the seven severe cases, four of which had bad preadopting reports. There is a substantialpercentage of hyperactive behaviour and also a possible language delay.In respect to other publications, vaccinations, nutrition, height, weight, examinations, socialadaptation and psychomotor development showed better results.Preadopting reports present serious deficits but are not always false. Our governmentsshould struggle to obtain good preadopting reports.First line pediatricians are the appropriate ones to coordinate monitoring as long as the diffusionof the adoption protocols improves

Physiological adaptations to exercise in people with spinal cord injury.

The number of patients that suffer some type of spinal cord lesion in recent years are high and have increased because of factors such as traffic accidents. Although their life expectancy has increased, cardiovascular illnesses is one of the main causes of morbidity and mortality. Since the degree of physical fitness is an important factor regarding the risk of cardiovascular disease, the objective of the present study was to examine the global adaptation (cardiorespiratory, metabolic and thermoregulatory response) of the organism to exercise and the application of this data to the habitual practice of physical activity to improve state of health. A group of 42 patients with spinal injury, 85% of whom were paraplegic and the remaining 15% tetraplegic performed 42 exercise tests on a cycloergometer. Body temperature (tympanum, surface of the deltoids and surface of the back), metabolic parameters (plasma uric acid, glycemia, plasma lactate), cardiocirculatory adaptation (heart rate, blood pressure arm, blood pressure leg) and ventilatory adaptation (VO2, VCO2, fr Vt, VE) were monitored. Blood pressure in the arm, blood concentrations of lactate and ventilatory parameters showed an evolution statistically dependent on the work to which the subject was submitted. Heart rate showed a statistically significant correlation with the ventilatory parameters and work load. The proportional response of the cardioventilatory parameters to the increase in the work load allowed us to evaluate the repercussion of a given exercise and thus avoid exercise of an excessive intensity that could produce cardiocirculatory changes that might entail an added risk. Heart rate presents an excellent correlation, shown in this work, with the oxygen consumption and could therefore be used to quantify the cardiorespiratory and metabolic repercussion of the exercise carried out. Furthermore, this quantification may allow for the adaptation of exercise intensity to the patient thus improving the results obtained from the practice of exercise that has been proven so necessary in these patients.

[Thrombosis of the superior sagittal sinus in a breast fed infant: secondary to prolonged exposure to mesalazine?]. / Trombosis del seno longitudinal superior en un lactante: ¿secundaria a una exposición prolongada a mesalazina?

INTRODUCTION: Mesalazine or 5 aminosalicylic acid (5 ASA) is currently a first choice drug in the treatment of inflammatory bowel disease. It has been shown that it crosses the placenta and is excreted into breast milk in small quantities. CASE REPORT: We present the case of a four month old breast fed infant, with a thrombosis of the superior sagittal sinus secondary to a severe thrombocytosis (1,124,000/mm3). The only interesting antecedent we would draw attention to, is that breast feeding had been suddenly stopped the week before. The mother, suffering Crohn s disease, had been receiving treatment with oral mesalazine throughout her pregnancy and during lactation. CONCLUSIONS: Once other causes of the thrombocytosis had been eliminated, we based our approach on the hypothesis that it was due to prolonged intake of 5 ASA by the mother.

Trombosis del seno longitudinal superior en un lactante: ¿secundaria a una exposición prolongada a mesalazina? / Thrombosis of the superior sagittal sinus in a breast-fed infant: secondary to prolonged exposure to mesalazine?

Introducción. La mesalazina o ácido 5-aminosalicílico (5-ASA) es actualmente un fármaco de primera elección en el tratamiento de la enfermedad inflamatoria intestinal. Se ha demostrado que atraviesa la placenta y que se excreta a la leche materna, aunque en pequeñas cantidades. Caso clínico. Presentamos el caso de una lactante de 4 meses de edad, afectada de una trombosis del seno venoso longitudinal superior, secundaria a una grave trombocitosis (1.124.000/mm3). Destacaremos como único antecedente de interés que la semana anterior se había suprimido bruscamente la lactancia materna. Su madre, afectada de la enfermedad de Crohn, se había tratado con mesalazina oral durante todo el embarazo y el período de lactancia. Conclusiones. Descartadas otras causas de trombocitosis, planteamos la hipótesis de que ésta se deba a la ingesta materna prolongada de 5-ASA (AU)

Influence of prolonged exercise on myocardial distribution of 123I-MIBG in long-distance runners.

BACKGROUND: A study was conducted to determine if prolonged exercise could provoke sympathetic neuronal alteration in an athlete's heart through assessment of myocardial distribution of 123I-metaiodobenzylguanidine (MIBG) in nine ultramarathon runners at baseline and after a 4-hour race. METHODS AND RESULTS: After injection of 370 MBq of 123I-MIBG, the athletes ran for 4 hours, covering 45 +/- 8 km. Planar and single-photon emission computed tomography (SPECT) images of the thorax were acquired at the end of the race. Two weeks later, studies at baseline were performed. A heart:mediastinum ratio (HMR) was calculated to quantify MIBG uptake. Basal MIBG studies showed normal myocardial tracer uptake, on both planar and SPECT images, and the HMR was 1.84 +/- 0.16. After the 4-hour race, MIBG studies showed decreased myocardial uptake in all athletes, and the HMR was 1.70 +/- 0.18 (p < 0.005). A positive correlation between the percentage of decrease of HMR after the race and the distance covered was observed (r = .910, p < 0.001). CONCLUSIONS: Myocardial MIBG activity is decreased by prolonged exercise in long-distance runners. The degree of reduction of myocardial MIBG activity is related to the distance covered. Prolonged exercise, as sustained sympathetic stimulus, may alter myocardial distribution of MIBG.

Hernia inguinal y ocupación laboral / Inguinal hernia and labor occupation

Se hace un estudio de 266 pacientes operados por hernia inguinal en nuestro hospital en el período de un año. Se investigan sexo y edades más frecuentes, relación de aparición de la hernia con esfuerzos físicos grandes, actividad laboral que desempeña, práctica de deportes, tipo de hernia que presenta, etc., encontrándose que es más frecuente en los hombres mayores de 65 años, y que en la mayoría se presentó después de un esfuerzo físico no habitual y en enfermos que realizan una actividad laboral que no requiere de dichos esfuerzos; también, en su inmensa mayoría, no practican deportes. La hernia inguinal indirecta fue la más frecuente en nuestro estudio (AU)

Absceso hepático amebiano. Diagnóstico y tratamiento médico / Amebic hepatic abscess. Medical diagnosis and treatment

Se hace un estudio del absceso hepático amebiano, y se presenta un total de 34 pacientes tratados en el Hospital Regional, de Arusha, Tanzania, Africa, a quienes se hizo el diagnóstico de absceso hepático amebiano basado en los síntomas y signos y corroborándose por la laparoscopía. Se explica la forma en la cual fue creado el servicio de laparoscopias en dicho hospital, utilizando citoscopios en desuso para realizar esta investigación. A los enfermos que presentaron abscesos grandes o medianos se les puncionó, evacuó e instiló una mezcla medicamentosa, bajo visión laparoscópica, que contribuyó a su pronta mejoría. Los pacientes que presentaban abscesos pequeños o múltiples recibieron tratamiento sistémico, al igual que los anteriores, y se comprobó su rápido restablecimiento (AU)