Enhancement of Subjective Quality of Life Following Surgical Intervention in Patients With Drug-Resistant Epilepsy: A Depressive Symptom-Independent Outcome.

PURPOSE: To evaluate the impact of depressive symptoms on the subjective perception of quality of life in patients with drug-resistant epilepsy (DRE) after surgical treatment for seizures.  Methods: A case-control study with DRE patients who received surgical treatment (n=19) and matched non-operated patients (n=23). We assessed the quality of life using the Subjective Handicap of Epilepsy (SHE) scale, alongside measuring depressive symptoms using the Beck Depression Inventory (BDI). RESULTS: The mean age of the participants was 45 years, with females constituting 52.4% of the patients. A majority (73.8%) had been diagnosed with temporal lobe epilepsy. Those who had undergone surgical intervention showed significantly enhanced performance across all quality-of-life domains on the SHE scale independently of depressive symptoms. The domains of "Work and Activity," "Physical Health," and "Self-Perception" displayed the greatest improvements, with the surgical group's averages outperforming the control group by factors of 1.87, 2.53, and 2.81, respectively. Influential differences impacting the quality-of-life scores included seizure frequency, the quantity of antiepileptic drugs utilized, and the incidence of convulsive seizures. CONCLUSION: The findings suggest that surgical control of seizures in drug-resistant focal epilepsy is associated with improvement in quality of life across various domains, independently of the depressive symptoms of the patients.

Immunoglobulin free light chains in severe asthma patient: Could they be a new biomarker?

BACKGROUND: Increasing evidence is available about the presence of increased serum concentration of immunoglobulin (Ig) free light chains (FLCs) in both atopic and non-atopic inflammatory diseases, including severe asthma, providing a possible new biomarker of disease. METHODS: We analyzed clinical and laboratory data, including FLCs, obtained from a cohort of 79 asthmatic subjects, clinically classified into different GINA steps. A control group of 40 age-matched healthy donors (HD) was considered. Particularly, HD have been selected according to the absence of monoclonal components (in order to exclude paraproteinemias), were tested for total IgE (that were in the normal ranges) and were negative for aeroallergens specific IgE. Moreover, no abnormality of common inflammatory markers (i.e., erythrocyte sedimentation rate and C-reactive protein) was detectable. RESULTS: FLC-k levels were significantly increased in the asthmatic population, compared to the control group. Despite the absence of statistically significant differences in FLC-λ levels, the FLC-k/FLC-λ ratio displayed remarkable differences between the two groups. A positive correlation between FLC-κ and FLC-λ levels was found. FLC- λ level displayed a significant negative correlation with the FEV1 value. Moreover, the FLC-κ /FLC- λ ratio was negatively correlated with the SNOT-22 score and a positive correlation was observed between FLCs and Staphylococcus Aureus IgE enterotoxins sensitization. CONCLUSIONS: Our findings confirmed the role of FLCs in asthma as a potential biomarker in an inflammatory disease characterized by different endotypes and phenotypes. In particular, FLC-κ and FLC-k/FLC-λ ratio could be a qualitative indicator for asthma, while FLC-λ levels could be a quantitative indicator for clinical severity parameters.

Unraveling the parahormetic mechanism underlying the health-protecting effects of grapeseed procyanidins.

Proanthocyanidins (PACs), the predominant constituents within Grape Seed Extract (GSE), are intricate compounds composed of interconnected flavan-3-ol units. Renowned for their health-affirming properties, PACs offer a shield against a spectrum of inflammation associated diseases, such as diabetes, obesity, degenerations and possibly cancer. While monomeric and dimeric PACs undergo some absorption within the gastrointestinal tract, their larger oligomeric and polymeric counterparts are not bioavailable. However, higher molecular weight PACs engage with the colonic microbiota, fostering the production of bioavailable metabolites that undergo metabolic processes, culminating in the emergence of bioactive agents capable of modulating physiological processes. Within this investigation, a GSE enriched with polymeric PACs was employed to explore in detail their impact. Through comprehensive analysis, the present study unequivocally verified the gastrointestinal-mediated transformation of medium to high molecular weight polymeric PACs, thereby establishing the bioaccessibility of a principal catabolite termed 5-(3',4'-dihydroxyphenyl)-γ-valerolactone (VL). Notably, our findings, encompassing cell biology, chemistry and proteomics, converge to the proposal of the notion of the capacity of VL to activate, upon oxidation to the corresponding quinone, the nuclear factor E2-related factor 2 (Nrf2) pathway-an intricate process that incites cellular defenses and mitigates stress-induced responses, such as a challenge brought by TNFα. This mechanistic paradigm seamlessly aligns with the concept of para-hormesis, ultimately orchestrating the resilience to stress and the preservation of cellular redox equilibrium and homeostasis as benchmarks of health.

IgG4 serum levels in Graves' orbitopathy.

OBJECTIVE: IgG4-related disease (IgG4-RD) can involve many organs, including thyroid and orbital tissues. A link between IgG4, Graves' disease (GD) and Graves' orbitopathy (GO) has been proposed, but results are conflicting. Here we investigated the possible association between IgG4 and GO. METHODS: Retrospective investigation in 297 patients with Graves' disease (GD), 152 with GO. PRIMARY OUTCOME: prevalence of IgG4 ≥ 135 mg/dL (cut-off for IgG4-RD). SECONDARY OBJECTIVES: (1) serum IgG4 concentrations; (2) IgG4/IgG ratio; (3) prevalence of IgG4/IgG ratio ≥ 8.0%; (4) relationship between IgG4 and eye features; (5) relationship between IgG4 and anti-TSH receptor antibodies (TRAbs). RESULTS: Because GO patients had lower FT3 concentrations, we evaluated the main objectives in the second and third FT3 quartiles subpopulation, in which there were no relevant differences between patients with (n = 81) or without GO (n = 67) for baseline parameters. Within this population, the prevalence of IgG4 levels ≥ 135 mg/dL did not differ between patients without and with GO (17.9% vs 17.3%). No difference was observed concerning IgG4 concentrations, prevalence of IgG4/IgG ≥ 8.0%, and IgG4/IgG ratio. There was no relationship between IgG4 and eye features and no correlation between IgG4 levels and TRAb was found. CONCLUSIONS: Our results suggest that, within GD, there is no relationship between serum IgG4 and GO.

Tratamiento endovascular percutáneo de un síndrome de vena cava superior en el postoperatorio inmediato de recambio valvular mitroaórtico / Percutaneous endovascular treatment of an iatrogenic superior cava vein syndrome during the immediate post-operative period after mitral-aortic valve replacement

El síndrome de vena cava superior (SVCS) resulta de la obstrucción de la vena cava superior, que origina una disminución del retorno venoso procedente de cabeza, cuello y extremidades superiores. Aunque la causa más frecuente siguen siendo procesos tumorales malignos, en los últimos años hemos visto un aumento de causas no tumorales, como trombosis de dispositivos intravasculares permanentes o causas iatrogénicas durante la cirugía cardiaca. Presentamos un caso de SVCS tras cirugía cardiaca tratado de forma satisfactoria mediante técnica endovascular y anticoagulación sistémica

Superior vena cava syndrome (SVCS) results from superior vena cava obstruction, causing a decrease in venous return from the head, neck, and upper extremities. Although the most frequent cause is still malignant tumour processes, in recent years an increase has been observed in non-tumour causes, such as thrombosis of intravascular devices or iatrogenic causes during cardiac surgery. A case is presented of SVCS after cardiac surgery treated satisfactorily by an endovascular technique and systemic anticoagulation

Synchronous triple thymoma and true thymic hyperplasia simultaneously detected by 18F FDG PET-CT / Timoma triple sincrónico e hiperplasia tímica verdadera detectada mediante PET/TAC con 18F-FDG

No disponible

Inicio de un síndrome de Guillain-Barré durante la gestación / Onset of Guillain-Barré syndrome during pregnancy

Presentamos el caso de una gestante de tercer trimestre en la que se inicia un síndrome de Guillain-Barré muy florido, llegando a tal punto en que precisa ingreso en la UCI del hospital de referencia por sospecha de progresión de la enfermedad. En el mismo centro, al no observar mejora clínica y sospechar un inicio de parálisis diafragmática, junto con una presentación fetal podálica, se realizó una cesárea urgente. Revisamos esta entidad tan poco frecuente como cuadro de comienzo en el embarazo para mejorar nuestros conocimientos sobre el manejo materno y fetal (AU)

We present the case of a pregnant woman who developed severe Guillain-Barré syndrome in the third trimester and who required admission to the intensive care unit of the referral hospital for suspected disease progression. No clinical improvement was observed. Because the onset of diaphragm paralysis was suspected and the fetus was in the podalic position, emergency cesarean was performed. Given the rarity of onset of Guillain-Barré syndrome in pregnancy, were view this entity to improve knowledge of maternal and fetal management (AU)

Asociación de enfermedad celiaca y pancolitis ulcerosa: a propósito de un caso y revisión de la bibliografía / Association between celiac disease and ulcerative pancolitis: a case report and review of the literature

Presentamos el caso de una niña de 7 años y 6 meses de edad, diagnosticada de una enfermedad celiaca por presentar clínica, analítica y biopsia yeyunal compatibles, que mejoró tras instaurar una dieta exenta de gluten. Un año después presentó un cuadro de deposiciones con sangre, con analítica y estudio de colonoscopia sugestivo de pancolitis ulcerosa. Dado que la asociación de celiaquía y enfermedad inflamatoria intestinalapenas ha sido descrita en niños, nos parece interesante presentar el caso y llevar a cabo una revisión de la bibliografía disponible (AU)

We report the case of a 7 and a half-year-old girl who was diagnosed as having celiac disease on the basis of compatible clinical features, serological tests and jejunal biopsy. The course was favourable after a gluten-free diet. One year later, she presented bloody stools, with laboratory tests and colonoscopic findings that suggested ulcerative pancolitis. As the association between celiac disease and inflammatory bowel disease has rarely been reported in children, we consider it to be of great interest to present our case and review the available literature (AU)

Enfermedad severa de inclusiones citomegálicas en un feto de una mujer inmunizada antes de la gestación / Severe cytomegalic inclusion disease in the fetus of a woman with preconceptional immunity

El descubrimiento de una microfelalia durante la gestación nos ha incitado a practicar una punción de líquido amniótico para análisis cromosómico y la búsqueda viral por reacción en cadena de la polimerasa (PCR). El análisis realizado ha confirmado una infección fetal por citomegalovirus (CMV) en una madre inmunizada antes de la concepción. El feto presentaba una clásica enfermedad de inclusiones citomegálicas. Se han publicado observaciones similares. Publicaciones recientes explican tales observaciones por la variabilidad de las cepas virales. Estos hechos incitan a estar atentos con los signos ecográficos evocadores de una infección viral en una mujer encinta ya inmunizada: se puede tratar de una reinfección por CMV

Due to detection of fetal microcephaly at 24 weeks' gestation, we performed an amniocentesis at 29 weeks with chromosomal analysis and polymerase chain reaction (PCR) to investigate the presence of viral contamination. Cytomegalovirus (CMV) infection was confirmed by PCR, although the mother had preconceptional CMV immunity. The fetus showed classical CMV inclusion disease. Recent publications explain similar observations by the variability of viral strains. These findings highlight the importance of being alert to ultrasonographic signs of CMV reinfection in pregnant women with preconceptual immunity

Intoxicación aguda por monóxido de carbono durante la gestación / Acute carbon monoxide poisoning during pregnancy

Documentamos dos intoxicaciones agudasmoderadas al monóxido de carbono en el cursodel tercer trimestre de la gestación. Las dos pacientesse beneficiaron de una oxigenación hiperbáricaa 2.5 atmósferas durante 90 minutosy han parido a término. Uno de los niños hapresentado una lesión cerebral de origen isquémicode constitución antenatal, posiblementedebida a la hipoxia secundaria a la intoxicaciónpor monóxido de carbono. La fisiopatología y eltratamiento de este tipo de accidente son discutidos

We report two cases of moderate maternalpoisining during the third trimester. They underwentoxygen therapy at 2.5 atmospheres for90 minutes and werw delivered at term. In onecase the newborn presented an antenatal ischemiccerebral lesion probably due to monoxidepoisoning. Pathophysiology and treatment ofsuch accidents are discussed

Iniencefalia / Iniencephaly

La iniencefalia es una malformación rara de la charnela cervicooccipital, de pronóstico grave. Pertenece al espectro de anomalías del cierre del tubo neural. En la actualidad se han documentado 200 casos en la literatura científica. El diagnóstico, desde ahora posible mediante la ecografía morfológica, justifica proponer a la pareja la posible interrupción de la gestación. Aportamos tres nuevos casos, recogidos entre 1990 y 2000, y revisamos las publicaciones dedicadas a esta malformación. También se describe el caso de una paciente cuyo diagnóstico temprano de iniencefalia a las 13 semanas de amenorrea permitió realizar una interrupción voluntaria del embarazo al término de la semana 14 (AU)

Iniencephaly is a rare malformation of the base of the skull and prognosis is almost invariably lethal. This entity belongs to the group of neural tube closure defects. To date, 2000 reports have been published in the literature. Diagnosis can now be made using ultrasound morphology examination, allowing pregnancy termination to be proposed. We report 3 cases of iniencephaly diagnosed between 1990 and 2000 and review the literature on this malformation. We describe the case of a patient in whom early ultrasonographic diagnosis of iniencephaly at 13 weeks of gestation allowed induced abortion at 14 weeks (AU)

Cafeína y deporte: efectos derivados de su ingesta e implicaciones en el organismo / Caffeine and sport: effects and consequences of their consumption

La cafeína es un producto muy habitual en nuestrasdietas y su reciente eliminación de la listas desustancias prohibidas por la agencia mundial antidopaje(AMA) hacen de ella un producto de graninterés en el mundo deportivo. Existen numerosasevidencias científicas de sus efectos ergogénicos,variables dependiendo del tipo de actividad físicao las pautas de utilización de la misma. La cafeínaactúa sobre gran diversidad de tejidos acarreandomultitud de efectos secundarios, que en ciertasocasiones pueden no ir encaminados en la direccióndeseada y por ello es necesario su conocimiento.Las dosis empleadas, los mecanismos deactuación, las pautas de utilización o los efectosrelacionados con la actividad física son aspectosde gran relevancia a la hora de hablar sobre la cafeína

Caffeine is a common product in our diets andits recent disappearance from the forbidden substanceslist by the World Anti-doping Agency (WADA)has made it an interesting ergogenic aid forsports. Several researches show its ergogenic effects,depending on the kind of physical activity orhow often it is used. Caffeine acts over several tissuescausing plenty of secondary effects whichmight not go on the right way sometimes, so certainknowledge of it should be considered necessary.Amount of caffeine, action mode, how oftenyou take it or the effects related with physical activityare key topics when talking about caffeine

Carcinoma tubárico primitivo y polimiositis / Primary primitive fallopian tube carcinoma and polymiositis

Los autores aportan un caso de asociación de un carcinoma tubárico primitivo a una polimiositis. Se trata de una paciente de 53 años, que consultó por dolores pelvianos, metrorragias y leucorreas amarillentas, con una masa pelviana de difícil movilización y móvil a la exploración clínica, y una masa laterouterina derecha con hidrosálpinx en la ecografía pelviana. El diagnóstico definitivo lo aportó el examen ana tomoclínico de la pieza de anexectomía derecha. La histerectomía total sin conservación anexial no dejó residuo tumoral. La paciente perdió contacto con nosotros sin tratamiento complementario y reconsultó 3 años después por una impotencia funcional de los miembros superiores, seguida de los inferiores, mialgias, alteraciones de la deglución y aparición de una adenopatía supraclavicular izquierda. Los exámenes clínicos, paraclínicos y anatomopatológicos mostraron que se trataba de un adenocarcinoma tubárico derecho con recaída ganglionar pelviana y metastásica supraclavicular izquierda, con polimiositis paraneoplásica. La paciente se ha beneficiado de 6 sesiones de quimioterapia, después de radioterapia en el hueco subclavicular izquierdo, a la dosis de 45 Gy. La respuesta al tratamiento ha sido excelente, y la paciente está en remisión completa después de un margen de 50 meses tras el diagnóstico. La asociación de cáncer de la trompa con una polimiositis es excepcional, y es necesaria una terapia antineoplásica rápida para tratar el cáncer y la polimiositis paraneoplásica (AU)

We report a case of a primitive fallopian tube carcinoma associated with polymyositis. A 53­year-old woman consulted for pelvic pain, metrorrhagia, and leukorrhea. Physical examination revealed a renitent and mobile mass in the pelvis. Ultrasonography showed a right lateral uterine mass with hydrosalpinx. Pathological examination of the right annexectomy specimen provided the definitive diagnosis. No residual tumor was found at total hysterectomy with bilateral annexectomy. The patient was lost to follow-up for 3 years without complementary treatment and then consulted again for functional disability first of the upper limbs and subsequently of the lower limbs with myalgia, swallowing disorders and left supraclavicular node enlargement resulting from pelvic relapse of the right fallopian tube adenocarcinoma and left supraclavicular metastasis with paraneoplastic polymyositis. The patient was given 6 courses of chemotherapy with radiotherapy (45 Gy) centered on the left clavicular region. The patient showed excellent response to treatment, and remains in complete remission 50 months after diagnosis. The association of fallopian tube carcinoma with polymyositis is exceptional, requiring rapid treatment effective against the cancer and paraneoplastic polymyositis (AU)

Síndrome de Munchausen y gestación / Syndrome of Munchausen and pregnancy

Las metrorragias en el tercer trimestre de la gestación que parecen un cuadro de placenta previa pueden corresponder a una llamada de atención del paciente hacia el médico. Esta situación clínica nace de alteraciones facticias que permiten al paciente adoptar el papel de enfermo. Ello puede conducir a una intervención quirúrgica inútil: cesárea por metrorragias, por ejemplo. La principal dificultad de la situación es diagnóstica. El tratamiento está basado en la psicoterapia, dirigida a mejorar la relación ulterior madre-hijo y puede prevenir actos de automutilación (AU)

Metrorrhagia during the third trimester of pregnancy, simulating placenta previa, may be a sign of the patient calling for help to the doctor. This clinical situation is one where the woman mimics an illness, in order to play the role of sick patient. The risk is that this may lead to unnecessary surgical procedures, in this case caesarean section. The main difficulty in caring for these patients is to make the diagnosis. Treatment is based on psychotherapy, which can contribute to an improved mother-infant relationship and perhaps prevent acts of self-mutilation (AU)

Memory tests are not good predictors of surgical outcome in patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis

One of the objectives of pre-surgical evaluation in mesial epilepsy associated to hippocampal sclerosis is the identification of patients with bad surgical prognosis for seizure ccontrol. At least theoretically, neuropsychological tests could be used in this venue. To evaluate whether verbal and visual memory tests can be used as isoleted predicotrs of the post-surgical sizure outcome in patients wit mesial temporal lobe epilepsy associated with hippocampal sclerosis refractory to pharmacological treatment. In a retrospective cohort study using the control of epileptic seizres as end-point, we evaluated 187 patients and calculated the correlation of clinical variables, cognitive evaluation, neuroimaging data, demographic data and electrophysiological findings with the result of seizure control after lobectomy in these patients. An unfavorable prognosis during the postoperative period was observed only in association with low visual reproduction scores (visual memory). However, afterBonferrroni corrections, which was necessary to reduce the chance of type I error this result was found to be spurious. We conclude that neuropsychological tests of verbal and visual memory such as those used in the routine presurgica evaluation of our patients with temporal lobe epilepsy are not good isolated predictors of surgical outcome

Recuperación nutricional de niños con desnutrición leve y moderada según dos modalidades de atención: seminternado y ambulatoria / Nutritional recovery of mild and moderately malnourished children under two different treatment approaches (ambulatory versus day-care)

This retrospective analysis was conducted between May 1997 and May 2000 at the Centro de Atención Nutricional Infantil de Antímano, CANIA, in Caracas, Venezuela to assess the efficacy of two treatments (ambulatory versus day-care) of mild and moderate malnourished children. Inclusion criteria were: children under 10 years old with mild and moderate malnourishment, who attended a minimum of 3 control visits during a period of 12 months. One hundred fourteen malnourished children were included: fifty seven in ambulatory treatment and fifty seven in day-care treatment paired per nutritional diagnosis, gender and age (thirty nine mild and eighteen moderate malnourished children). The nutritional recovery criterion was weight for height above tenth percentile. No relation was found between treatment approaches and nutritional recovery at 3 and 6 months of treatment. In the group of mild malnourished children, the percentage of recovered patients at 3 months of treatment, that kept their recovered condition at 6 months was 83 (15/18) in the ambulatory treatment and 82 per cent (18/22) in the day-care treatment Age of children, associated disease, acute morbidity, dietetic risk and mother's education and age were not associated with nutritional recovery at 6 months of treatment (p > 0.05). The day-care approach resulted as effective as ambulatory in mild malnourished children. In moderate malnourished new studies will need to be conducted with greater number of patients.

Intensidad de ejercicio como factor generador de estrés oxidativo / Exercise intensity as a generating factor of oxidative stress

Introducción: El ejercicio físico es una fuente de estrés oxidativo, perjudicial para la célula humana. El propósito del experimento es estudiar el efecto de intensidad y duración de ejercicio físico sobre el estrés oxidativo. Métodos: 20 sujetos no entrenados desarrollaron dos test ergoespirométicos, máximo y submáximo de mayor duración, para determinar cambios plasmáticos en vitaminas antioxidantes A, E y C, y marcadores de perioxidación lipídica: malondialdehido, mediante HPLC. Resultados : Hematocrito (M: 47.59 ñ 3.74 a 52.28* ñ 3.68 S: 47.97ñ2.45 a 51.41*ñ3.75, *p<0.001), Malondialdehido µM (M: 31.99ñ7.88 a 33.54*ñ8.44 S: 38.63ñ6.91 a 39.18ñ10.40, *p<0.05), Vitamina C µg/ml (M: 6.93ñ2.65 a 9.11*ñ3.16 S: 7.71ñ1.07 a 7.68ñ1.87, *p<0.05), Vitamina E µg/ml (M: 6.55ñ1.87 a 6.23*ñ1.51 S: 5.97ñ2.08 a 5.69*ñ1.09, *p<0.05), Vitamina A µg/ml (M:4.41ñ1.72 a 3.97*ñ1.65 S: 4.76ñ1.42 a 3.91*ñ1.50, *p<0.05) Discusión: El esfuerzo máximo generó mayor estrés oxidativo que el submáximo, sobre todo debido a la incapacidad de contrarrestar la perioxidación lipídica. Conclusión: La intensidad del ejercicio físico parece ser más decisiva que la duración en la generación de estrés oxidativo. Los datos deben ser corregidos con el hematocrito para evitar errores metodológicos (AU)

Reacciones adversas neurológicas asociadas a ciprofloxacino / Neurologic adverse reactions associated with ciprofloxacin

El ciprofloxacino es una fluoroquinolona con una amplia variedad de indicaciones terapéuticas. Las fluoroquinolonas pueden inducir reacciones adversas neurológicas en aproximadamente un 1 -4 per cent de los pacientes. Se describen dos pacientes con reacciones adversas sobre el sistema nervioso central asociadas a tratamiento con ciprofloxacino oral. Un paciente presentó un cuadro de agitación psicomotriz y otro un cuadro de temblor de reposo, que se resolvieron tras la suspensión del ciprofloxacino (AU)