Adaptación transcultural al español de la Signs of Depression Scale (SODS) para la evaluación precoz del estado de ánimo en pacientes ingresados en una unidad de ictus / Cross-cultural adaptation to Spanish of the Signs of Depression Scale (SODS) to the early assessment of mood in patients admitted to a Stroke Unit

Introducción: La hospitalización por ictus afecta negativamente al estado de ánimo. Las guías clínicas recomiendan evaluar precozmente el estado de ánimo. Sin embargo, no existe consenso sobre la escala más apropiada en idioma español. Objetivo: El objetivo del estudio es realizar una adaptación transcultural de la Signs of Depression Scale en pacientes ingresados en la unidad de ictus. Materiales y métodos: El esquema de trabajo de la adaptación transcultural al español fue: a) traducción directa; b) conciliación y síntesis de las traducciones; c) traducción inversa al inglés; d) consenso de la versión retrotraducida; e) interrogatorio cognitivo; f) revisión y versión consensuada en español; g) prueba de lectura, revisión ortográfica y gramatical, y h) versión final. Se realizó un análisis y un resumen descriptivo del proceso de adaptación transcultural. Resultados: Las versiones de traducción directa no presentaron diferencias. La versión de la traducción inversa fue aceptada por la autora del cuestionario original. Para el interrogatorio cognitivo se incluyó una muestra por conveniencia de 22 pacientes con/sin afasia a partir de la cual no se identificaron problemas en la aplicación del cuestionario. Se utilizó un lenguaje inclusivo en la versión final. Conclusiones: La versión española es equivalente al instrumento original. La adaptación transcultural de la escala permite, de forma sencilla y precoz, la evaluación del estado de ánimo en pacientes con ictus. Esta adaptación se puede incorporar en los cuidados en la unidad de ictus y es extrapolable a otros centros de habla hispana.(AU)

Introduction: Stroke hospitalization negatively affects mood. Clinical guidelines recommend early evaluation of mood disorders. However, there is no consensus on the most appropriate scale in Spanish language. Aim: The objective of the study is the cross-cultural adaptation of the Signs of Depression Scale (SODS) in patients admitted to the stroke unit of the Hospital del Mar. Materials and methods: The work scheme for transcultural adaptation into Spanish was: a) direct translation; b) reconciliation and synthesis of translations; c) reverse translation into English; d) consensus of the back-translated version with original author; e) cognitive interrogation; f) revision and consensus version in Spanish; g) reading test, spelling, and grammar check; h) final version. Analysis and descriptive summary of the adaptation process was performed. Results:. There were no differences between direct translation versions. The back-translation version was accepted by the author of the original questionnaire. A convenience sample of patients with/without aphasia (n = 22) was included for cognitive interview from which no major problems were identified in the implementation of the questionnaire. Inclusive language was used in the final version. Conclusion: The transcultural adaptation of the scale allows in a simple and early way the evaluation mood in patients admitted to the stroke unit. The Spanish version is equivalent to the original instrument. This adaptation can be incorporated into care in the Stroke Unit and is extrapolated to other Spanish-speaking centres.(AU)

[Cross-cultural adaptation to Spanish of the Signs of Depression Scale (SODS) to the early assessment of mood in patients admitted to a Stroke Unit]. / Adaptación transcultural al español de la Signs of Depression Scale (SODS) para la evaluación precoz del estado de ánimo en pacientes ingresados en una unidad de ictus.

INTRODUCTION: Stroke hospitalization negatively affects mood. Clinical guidelines recommend early evaluation of mood disorders. However, there is no consensus on the most appropriate scale in Spanish language. AIM: The objective of the study is the cross-cultural adaptation of the Signs of Depression Scale (SODS) in patients admitted to the stroke unit of the Hospital del Mar. MATERIALS AND METHODS: The work scheme for transcultural adaptation into Spanish was: a) direct translation; b) reconciliation and synthesis of translations; c) reverse translation into English; d) consensus of the back-translated version with original author; e) cognitive interrogation; f) revision and consensus version in Spanish; g) reading test, spelling, and grammar check; h) final version. Analysis and descriptive summary of the adaptation process was performed. RESULTS: There were no differences between direct translation versions. The back-translation version was accepted by the author of the original questionnaire. A convenience sample of patients with/without aphasia (n = 22) was included for cognitive interview from which no major problems were identified in the implementation of the questionnaire. Inclusive language was used in the final version. CONCLUSION: The transcultural adaptation of the scale allows in a simple and early way the evaluation mood in patients admitted to the stroke unit. The Spanish version is equivalent to the original instrument. This adaptation can be incorporated into care in the Stroke Unit and is extrapolated to other Spanish-speaking centres.

TITLE: Adaptación transcultural al español de la Signs of Depression Scale (SODS) para la evaluación precoz del estado de ánimo en pacientes ingresados en una unidad de ictus.Introducción. La hospitalización por ictus afecta negativamente al estado de ánimo. Las guías clínicas recomiendan evaluar precozmente el estado de ánimo. Sin embargo, no existe consenso sobre la escala más apropiada en idioma español. Objetivo. El objetivo del estudio es realizar una adaptación transcultural de la Signs of Depression Scale en pacientes ingresados en la unidad de ictus. Materiales y métodos. El esquema de trabajo de la adaptación transcultural al español fue: a) traducción directa; b) conciliación y síntesis de las traducciones; c) traducción inversa al inglés; d) consenso de la versión retrotraducida; e) interrogatorio cognitivo; f) revisión y versión consensuada en español; g) prueba de lectura, revisión ortográfica y gramatical, y h) versión final. Se realizó un análisis y un resumen descriptivo del proceso de adaptación transcultural. Resultados. Las versiones de traducción directa no presentaron diferencias. La versión de la traducción inversa fue aceptada por la autora del cuestionario original. Para el interrogatorio cognitivo se incluyó una muestra por conveniencia de 22 pacientes con/sin afasia a partir de la cual no se identificaron problemas en la aplicación del cuestionario. Se utilizó un lenguaje inclusivo en la versión final. Conclusiones. La versión española es equivalente al instrumento original. La adaptación transcultural de la escala permite, de forma sencilla y precoz, la evaluación del estado de ánimo en pacientes con ictus. Esta adaptación se puede incorporar en los cuidados en la unidad de ictus y es extrapolable a otros centros de habla hispana.

Primary, secondary, and tertiary stress responses of juvenile seahorse Hippocampus reidi exposed to acute acid stress in brackish and seawater.

Seahorse Hippocampus reidi is a vulnerable species, inhabiting estuarine and coastal waters. The safety of acidic environments for fish has been considered in terms of ocean acidification in nature and decreasing pH in intensive aquaculture systems. This study aimed to investigate the effects of acute exposition (96 h) of juvenile seahorses to different pH (5, 6, 7, and 8) in brackish (BW - salinity 11) or seawater (SW - salinity 33). For that, we studied the responses of cortisol, oxidative stress, and survival, thus covering primary, secondary, and tertiary stress responses. In SW, cortisol levels were not altered for fish maintained at pH 5 and 8. However, in BW, cortisol was higher for fish kept at pH 5. Regarding secondary stress responses, only GST activity increased with acidification in SW. However, acidification in BW caused biochemical alterations at enzymatic level (SOD, GST, GPx) and glutathione metabolism, accompanied by reduction of antioxidant capacity (TEAC) and increased lipid peroxidation (TBARS). Survival was always above 90% and it did not differ significantly among pH levels. Our results suggest that H. reidi juveniles are more vulnerable to acidic exposure in BW than in SW.

Regulation of Polyhydroxybutyrate Synthesis in the Soil Bacterium Bradyrhizobium diazoefficiens.

Polyhydroxybutyrate (PHB) is a carbon and energy reserve polymer in various prokaryotic species. We determined that, when grown with mannitol as the sole carbon source, Bradyrhizobium diazoefficiens produces a homopolymer composed only of 3-hydroxybutyrate units (PHB). Conditions of oxygen limitation (such as microoxia, oxic stationary phase, and bacteroids inside legume nodules) were permissive for the synthesis of PHB, which was observed as cytoplasmic granules. To study the regulation of PHB synthesis, we generated mutations in the regulator gene phaR and the phasin genes phaP1 and phaP4 Under permissive conditions, mutation of phaR impaired PHB accumulation, and a phaP1 phaP4 double mutant produced more PHB than the wild type, which was accumulated in a single, large cytoplasmic granule. Moreover, PhaR negatively regulated the expression of phaP1 and phaP4 as well as the expression of phaA1 and phaA2 (encoding a 3-ketoacyl coenzyme A [CoA] thiolases), phaC1 and phaC2 (encoding PHB synthases), and fixK2 (encoding a cyclic AMP receptor protein [CRP]/fumarate and nitrate reductase regulator [FNR]-type transcription factor of genes for microoxic lifestyle). In addition to the depressed PHB cycling, phaR mutants accumulated more extracellular polysaccharides and promoted higher plant shoot dry weight and competitiveness for nodulation than the wild type, in contrast to the phaC1 mutant strain, which is defective in PHB synthesis. These results suggest that phaR not only regulates PHB granule formation by controlling the expression of phasins and biosynthetic enzymes but also acts as a global regulator of excess carbon allocation and symbiosis by controlling fixK2 IMPORTANCE: In this work, we investigated the regulation of polyhydroxybutyrate synthesis in the soybean-nodulating bacterium Bradyrhizobium diazoefficiens and its influence in bacterial free-living and symbiotic lifestyles. We uncovered a new interplay between the synthesis of this carbon reserve polymer and the network responsible for microoxic metabolism through the interaction between the gene regulators phaR and fixK2 These results contribute to the understanding of the physiological conditions required for polyhydroxybutyrate biosynthesis. The interaction between these two main metabolic pathways is also reflected in the symbiotic phenotypes of soybeans inoculated with phaR mutants, which were more competitive for nodulation and enhanced dry matter production by the plants. Therefore, this knowledge may be applied to the development of superior strains to be used as improved inoculants for soybean crops.

A practical introduction to the hemodynamic analysis of the cardiovascular system with 4D Flow MRI.

The 4D Flow MRI technique provides a three-dimensional representation of blood flow over time, making it possible to evaluate the hemodynamics of the cardiovascular system both qualitatively and quantitatively. In this article, we describe the application of the 4D Flow technique in a 3T scanner; in addition to the technical parameters, we discuss the advantages and limitations of the technique and its possible clinical applications. We used 4D Flow MRI to study different body areas (chest, abdomen, neck, and head) in 10 volunteers. We obtained 3D representations of the patterns of flow and quantitative hemodynamic measurements. The technique makes it possible to evaluate the pattern of blood flow in large and midsize vessels without the need for exogenous contrast agents.

Introducción práctica al análisis hemodinámico del sistema cardiovascular mediante la técnica «4D Flow» / A practical introduction to the hemodynamic analysis of the cardiovascular system with 4 D Flow MRI

La técnica de resonancia magnética 4 D Flow permite evaluar cualitativa y cuantitativamente la hemodinámica del sistema cardiovascular representando en tres dimensiones los patrones de flujo sanguíneo en el tiempo y cuantificando variables hemodinámicas. En este trabajo describimos la técnica 4 D Flow en un equipo de resonancia de 3 T y adicionalmente se exponen, además de los parámetros técnicos, las ventajas, las limitaciones y las posibles aplicaciones clínicas. Para esto estudiamos a diez voluntarios con la técnica 4 D Flow en diferentes áreas corporales (tórax, abdomen, cuello y cráneo) con la que obtuvimos representaciones tridimensionales de los patrones del flujo y medidas cuantitativas hemodinámicas. La técnica permite evaluar los patrones de flujo sanguíneo en vasos grandes y medianos sin la necesidad de contrastes exógenos (AU)

The 4 D Flow MRI technique provides a three-dimensional representation of blood flow over time, making it possible to evaluate the hemodynamics of the cardiovascular system both qualitatively and quantitatively. In this article, we describe the application of the 4 D Flow technique in a 3 T scanner; in addition to the technical parameters, we discuss the advantages and limitations of the technique and its possible clinical applications. We used 4 D Flow MRI to study different body areas (chest, abdomen, neck, and head) in 10 volunteers. We obtained 3 D representations of the patterns of flow and quantitative hemodynamic measurements. The technique makes it possible to evaluate the pattern of blood flow in large and midsize vessels without the need for exogenous contrast agents (AU)

An overview of permeable reactive barriers for in situ sustainable groundwater remediation.

Permeable reactive barriers (PRBs) are one of the innovative technologies widely accepted as an alternative to the 'pump and treat' (P&T) for sustainable in situ remediation of contaminated groundwater. The concept of the technology involves the emplacement of a permeable barrier containing reactive materials across the flow path of the contaminated groundwater to intercept and treat the contaminants as the plume flows through it under the influence of the natural hydraulic gradient. Since the invention of PRBs in the early 1990s, a variety of materials has been employed to remove contaminants including heavy metals, chlorinated solvents, aromatic hydrocarbons, and pesticides. Contaminant removal is usually accomplished via processes such as adsorption, precipitation, denitrification and biodegradation. Despite wide acknowledgment, there are still unresolved issues about long term-performance of PRBs, which have somewhat affected their acceptability and full-scale implementation. The current paper presents an overview of the PRB technology, which includes the state of art, the merits and limitations, the reactive media used so far, and the mechanisms employed to transform or immobilize contaminants. The paper also looks at the design, construction and the long-term performance of PRBs.

Effect of sublethal concentrations of waterborne copper on lipid peroxidation and enzymatic antioxidant response in Gambusia holbrooki.

The aim of the current research was to assess the possible influence of copper sulphate contamination on the antioxidant enzymatic defenses and lipid peroxidation (LPO) in the mosquitofish (Gambusia holbrooki). Quadruplicated lots of this fish were exposed to three increasing sub-lethal concentrations of Cu (0.10; 0.17 and 0.25mgCu/L) and a control without Cu for 20 days. Previous to laboratory acclimation, 8 fish were taken to define the initial population. At the end of the trials, 12 fish/sex/treatment were sampled for the determination of levels of copper in gills, metallothioneins (MTs) content, total lipids, fatty acids profiles and antioxidant enzymatic activity, as well as lipid peroxidation. Most of the antioxidant enzymatic defenses assayed were not activated and lipid peroxidation decreased significantly in fish exposed to any concentration of copper applied. This leads us to presume the existence of a protective mechanism against peroxidation other than the enzymatic antioxidant defense, which could be related to the observed increase of copper content in the gills.

La adherencia al tratamiento nutricional y composición corporal: un estudio transversal en pacientes con obesidad o sobrepeso / Adherence to the nutritional treatment and body composition: a crooss-sectional study in patients with obesity or overweight

To assess nutritional adherence to treatment among obese or overweight patients and to examine the relationship between anthropometrical variables, 94 subjects between 20-50 years old randomly selected were recruited at two nutritional health centers in Medellin-Colombia. Nutritional adherence to treatment was evaluated using a questionnaire, with a total score above 24 considered as adherent to the treatment. In addition, socio-demographic information was obtained and anthropometrical variables were measured. We used descriptive statistical, Kolmogorov-Smirnov test, Chi-square for proportions comparison, and Student T test or U Mann Whitney for means comparison. A 68% of the patients were classified as no adherent to the nutritional treatment, with significant differences found according to physical activity (p= 0,013). Mean weight (p= 0,014), BMI (p= 0,026), waist circumference (p= 0,005) and waist-hip ratio (p= 0,022) differed according to adherence, being significantly higher in non adherent patients. Percent body fat did not change by degree of adherence. However when controls were separated by gender the results were significant for both men and women. Nutritional adherence to treatment in patients on a diet for weight reduction produces significant changes in body composition.

Se determinó la adherencia al tratamiento nutricional en pacientes con obesidad o sobrepeso y se examinó la relación entre ésta y variables antropométricas, mediante un estudio transversal en 94 sujetos entre 20 y 50 años seleccionados de forma aleatoria en dos centros de atención nutricional de Medellín. La adherencia al tratamiento nutricional se evaluó aplicando un cuestionario, donde puntajes mayores o iguales a 24 se consideraron como adherentes. Además, se obtuvo información socio-demográfica y antropométrica, previa estandarización de los evaluadores. Se utilizaron medidas descriptivas, prueba de Kolmogorov-Smirnov, Chi-cuadrado para comparación de proporciones, T de Student o U Mann Whitney para comparación de promedios. El 68% de los pacientes fueron clasificados como no adherentes al tratamiento nutricional, encontrando diferencias según actividad física (p=0,013). El peso promedio (p=0,014), Indice de Masa Corporal (p=0,026), perímetro de cintura (p=0,005) y relación cintura cadera (p=0,022), difirieron de acuerdo a la clasificación de adherencia, siendo significativamente más altos en los no adherentes. No hubo diferencias en el porcentaje de masa grasa según adherencia (p=0,690), pero se hallaron al controlar por sexo, p=0,009 mujeres y p=0,026 hombres. La adherencia al tratamiento nutricional en pacientes en dieta para reducir de peso, produce cambios significativos en la composición corporal.

[Normal thyroid-stimulating hormone levels in screening for congenital hypothyroidism in newborn twins]. / Valores normales de TSH en el cribado neonatal del hipotiroidismo congénito en nacimientos gemelares.

INTRODUCTION: A large number of articles have been published since neonatal screening for congenital hypothyroidism (CH) started in the 1970s. Surprisingly, little information on false negative results in these screenings has been reported. PATIENTS AND METHODS: Thyroid-stimulating hormone (THS) levels were determined in 360,651 newborn infants in Malaga until March 2005. One hundred and fifty-six CH cases were detected, of which 86 % were permanent and 14 % were transient. In this study, we retrospectively analyzed a group of 13 CH dizygotic twins in which only one of the twins had CH. RESULTS: The first two patients were diagnosed late and data on whether they were included in neonatal screening were lacking. In seven of the 13 patients, TSH values were initially normal: five patients were diagnosed by a second test performed 14 days after birth and were treated before they were 1 month old, and two were diagnosed and treated late because a second test was not performed. In the remaining four patients, TSH values were initially elevated but were lower than confirmation test values. CONCLUSIONS: It is now widely accepted that thyroid function could be compensated between two dizygotic twins if only one of the twins has CH, leading to a false negative result. The results of the present study indicate the need to repeat the test for CH 14 days after birth in all dizygotic twins.

Valores normales de TSH en el cribado neonatal del hipotiroidismo congénito en nacimientos gemelares / Normal thyroid-stimulating hormone levels in screening

Introducción A pesar del gran número de trabajos publicados desde que, en la década de 1970, se implantaron los programas de cribado neonatal para el diagnóstico del hipotiroidismo congénito, no hay demasiados datos sobre resultados paradójicos o casos que pudieran escapar del cribado. Pacientes y métodos Hasta marzo de 2005, en Málaga se ha estudiado la hormona tiroestimulante (TSH) en 360.651 recién nacidos detectándose 156 hipotiroidismos congénitos, de los que 86 % fueron permanentes y 14 % transitorios. En este trabajo se analiza, retrospectivamente, un grupo de 13 hipotiroidismos congénitos nacidos de parto gemelar, en los que solamente uno de los hermanos ha tenido la enfermedad. Resultados Los dos primeros fueron diagnosticados tarde y se desconoce si se estudiaron en el cribado. En 7 casos la TSH dio un valor normal: cinco, diagnosticados mediante una segunda muestra realizada a los 14 días, se trataron antes de un mes de vida; a dos no se repitió la prueba, iniciando tarde el tratamiento. Los cuatro restantes tuvieron desde la primera prueba un valor elevado de TSH, siendo significativamente inferior al obtenido para su confirmación. Conclusiones En la actualidad se acepta que la función tiroidea pueda estar compensada entre los dos gemelos, resultando un falso negativo en el caso de ser uno de ellos hipotiroideo congénito. De los datos que se presentan se deduce la necesidad de repetir la prueba a los 14 días en todos los nacimientos gemelares

Introduction A large number of articles have been published since neonatal screening for congenital hypothyroidism (CH) started in the 1970s. Surprisingly, little information on false negative results in these screenings has been reported. Patients and methods Thyroid-stimulating hormone (THS) levels were determined in 360,651 newborn infants in Malaga until March 2005. One hundred and fifty-six CH cases were detected, of which 86 % were permanent and 14 % were transient. In this study, we retrospectively analyzed a group of 13 CH dizygotic twins in which only one of the twins had CH. Results The first two patients were diagnosed late and data on whether they were included in neonatal screening were lacking. In seven of the 13 patients, TSH values were initially normal: five patients were diagnosed by a second test performed 14 days after birth and were treated before they were 1 month old, and two were diagnosed and treated late because a second test was not performed. In the remaining four patients, TSH values were initially elevated but were lower than confirmation test values. Conclusions It is now widely accepted that thyroid function could be compensated between two dizygotic twins if only one of the twins has CH, leading to a false negative result. The results of the present study indicate the need to repeat the test for CH 14 days after birth in all dizygotic twins

A multitude of CRP/FNR-like transcription proteins in Bradyrhizobium japonicum.

In Bradyrhizobium japonicum, the nitrogen-fixing soya bean endosymbiont and facultative denitrifier, three CRP (cAMP receptor protein)/FNR (fumarate and nitrate reductase regulatory protein)-type transcription factors [FixK(1), FixK(2) and NnrR (nitrite and nitric oxide reductase regulator)] have been studied previously in the context of the regulation of nitrogen fixation and denitrification. The gene expression of both fixK(1) and nnrR depends on FixK(2), which acts as a key distributor of the 'low-oxygen' signal perceived by the two-component regulatory system FixLJ. While the targets for FixK(1) are not known, NnrR transduces the nitrogen oxide signal to the level of denitrification gene expression. Besides these three regulators, the complete genome sequence of this organism has revealed the existence of 13 additional CRP/FNR-type proteins whose functions have not yet been studied. Based on sequence similarity and phylogenetic analysis, we discuss in this paper the peculiarities of these additional factors.

Characterization of the nirK gene encoding the respiratory, Cu-containing nitrite reductase of Bradyrhizobium japonicum.

The structural gene, nirK, for the respiratory Cu-containing nitrite reductase from Bradyrhizobium japonicum USDA110 has been isolated and sequenced. The deduced amino acid sequence exhibited a high degree of similarity to other Cu-containing nitrite reductases from various sources. The full-length protein included a signal peptide for protein export. Analysis of the sequence upstream from the structural nirK gene revealed the presence of an anaerobox located 83 base pairs from the putative translational start codon. Cells of strain GRK308, a nitrite reductase-deficient derivative of strain USDA110, were unable to grow when cultured under microaerobic conditions (1% O(2)) in the presence of either nitrate or nitrite. Maximal expression of a nirK-lacZ fusion in strain USDA110 required simultaneously both low level oxygen conditions and the presence of nitrate. Expression of beta-galactosidase activity was not detected in the B. japonicum fixL 7403, fixJ 7360 and fixK(2) 9043 mutants transformed with the nirK-lacZ fusion after incubation of the cells under oxygen-limiting conditions either with or without nitrate. Complementation of B. japonicum 9043 with the fixK(2) gene restored beta-galactosidase activity to levels similar to those found in the parental strain. These results suggest that nirK expression depends on the low-oxygen-responsive two-component regulatory system FixLJ and on the Fnr/FixK-like DNA binding protein FixK(2).

The nir, nor, and nos denitrification genes are dispersed over the Bradyrhizobium japonicum chromosome.

Cleavage of genomic DNA from Bradyrhizobium japonicum strain 3I1b110 by the restriction enzymes PmeI, PacI, and SwaI has been used together with pulsed-field gel electrophoresis and Southern hybridization to locate the nirK, norCBQD, and nosRZDFYLX denitrification genes on the chromosomal map of B. japonicum strain 110spc4. Mutant strains GRK13, GRC131, and GRZ25 were obtained by insertion of plasmid pUC4-KIXX-aphII-PSP, which carries recognition sites for the enzymes PacI, PmeI and SwaI, into the B. japonicum 3I1b110 nirK, norC and nosZ genes, respectively. Restriction of strain 3I1b110 genomic DNA with PacI, PmeI and SwaI yielded three, five and nine fragments, respectively. Pulsed-field gel electrophoresis of restricted mutant DNAs resulted in an altered fragment pattern that allowed determination of the position of the selected genes. Complementary mapping data were obtained by hybridization using digoxigenin-labeled B. japonicum 3I1b110 nirK, norBQD and nosZD as gene probes. The nirK, norCBQD and nosRZDFYLX genes were located close to the groEL(2), cycH and cycVWX genes, respectively, on the strain 110spc4 genetic map. In contrast to other denitrifiers, B. japonicum 3I1b110 denitrification genes were dispersed over the entire chromosome.

[Serum TSH values during clinical controls of patients treated for congenital hypothyroidism]. / Valores elevados de TSH en los controles de tratamiento del hipotiroidismo congénito.

During the second half of 1995, an increased serum TSH level was found in about 50% of the patients that had been biochemically studied to check their treatment for hypothyroidism by the Laboratory of Molecular Endocrinology in the Regional Hospital of Malaga. A retrospective analysis was carried out to check if those results were erroneous. The biochemical data concerning the thyroid function were followed-up in patients requiring more studies, such as the ones suffering from congenital hypothyroidism (CH) and a random double assay of some samples was made with an alternative technique. Currently, the average TSH level is rated as 14.31 microU/ml in 54% of the subjects, even though levothyroxine doses were increased. Levothroid is the preparation prescribed in all cases. In 1994, the TSH average level was 1.68 microU/ml in the aforementioned group. Another 12% with increased TSH levels were readjusted by modifying the treatment. The T4F in CH subjects with increased TSH dropped significantly from 24.1 pmol/ml to 15.7 pmol/ml in the same period of time. We suggest that one possible etiological factor could be a mistake in the dosage of the commercial preparation.

[Long-term clinical course of patients with chronic autoimmune thrombocytopenic purpura]. / Evolución a largo plazo de los pacientes con púrpura trombocitopénica crónica autoinmune.

We studied 296 patients with thrombocytopenic purpura in our hospital from 1974 to 1985; 179 acute and 117 chronic forms. We identificated inherence forms (9.5%), of the last 106, 73 accepted to participate in the long time study. We found 69 patients with autoimmune chronic thrombocytopenic purpura, with the following response to the treatment with prednisone: 1. Long total remission for 8 to 100 months in 27 patients. 2. Total remission with relapse in 35 patients. 3. Partial remission in 5 patients. 4. No remission in 2 patients. We realized splenectomy in 16 patients of second group, in four of third group and one of fourth group. Everybody are in total remission althrough we had two with temporal relapse. We analyzed the factors with the excellent evolution, 5 of 69 patients with autoimmune forms (7.2%), their evolution to disseminated eritematous lupus. Nobody of the cases evolutioned to malignance.