Síndrome de Guillain-Barré tras infección por SARS-CoV-2. Comentarios tras la publicación de 16 nuevos casos / Guillain-Barré syndrome associated with SARS-CoV-2 infection. Comments after 16 published cases

No disponible

Acute visceral cysticercosis by Taenia hydatigena in lambs and treatment with praziquantel.

An acute outbreak of Taenia hydatigena cysticercosis, causing mortality in 5 of 21 (23.8%) female lambs, is reported. Gross post-mortem examinations and histology showed Cysticercus tenuicollis as the cause of death. Biochemical parameters in infected lambs confirmed severe hepatitis. Praziquantel, given once at 15 mg/kg body weight (bw), was administered and a dramatic improvement in the clinical condition and biochemical parameters was observed up to 30 days following treatment.

Trichinella britovi from domestic to wild animals of Sardinia, Italy.

The zoonotic nematode Trichinella britovi has been documented in animals and/or humans of the Mediterranean islands of Corsica and Sardinia since 2004. From 2005 to 2007 in the Sardinia island, several surveys had shown that T. britovi was circulating among backyard and free-ranging pigs reared in the Orgosolo municipality but all attempts had failed to detect this parasite in wild susceptible animals. The aim of the present work was to investigate the circulation of T. britovi in pigs and wildlife of the Orgosolo municipality, and of surrounding municipalities and provinces in the 2010-2014 slaughtering/hunting seasons. The results show that the T. britovi circulation was still restricted to the Orgosolo municipality with a prevalence of 2.6% in free-ranging pigs and 0.2% in backyard pigs but, for the first time, this parasite was detected also in 0.4% of wild boar, and 27.6% of red foxes. No infection was detected in backyard pigs, wild boar, and red foxes of the other municipalities and provinces. Since 1978, African swine fever is endemic in Sardinia and foci of this virus are still active in the investigated areas favoring cannibalism and, consequently, the T. britovi transmission, due to the high mortality rate caused by this virus. This is the first documented report on the transmission of T. britovi between the domestic and the sylvatic cycle. The health authority of the island must provide a service to dispose animal carcasses and offal, stamping out illegal free-ranging pigs, and train hunters and pig owners to manage waste and by-products according to the EU regulations.

Factors associated with a rapid normalization of HbA1c in newly diagnosed type 2 diabetes patients seen in a specialist setting.

The time to achieve good metabolic control after diagnosis is essential for type 2 diabetes patients because it can influence long-term prognosis. This study aimed to elucidate the predictive role of several clinical and organization factors in normalizing metabolism within 6 months. A multi-centered, retrospective, observational study on 960 patients, with diabetes duration of 12 months or less, consecutively seen in 123 Italian clinics, was undertaken. Information about clinic's organization, along with data abstracted from medical records at enrollment (first visit) and after 6 months (follow-up visit), was collected. At 6 months, HbA1c dropped by -3.1 ± 2.2 points in those who achieved HbA1c <7 % (responders), whereas in non-responders (HbA1c ≥7 %), the mean reduction was -1.8 ± 1.9. The intervention markedly reduced lipids, blood pressure, BMI, and waist circumference, especially in responders. The presence of a diabetes team correlated with a likelihood of HbA1c normalization (OR 1.94, 1.17-3.22). By contrast, indicators of advanced disease such as previous retinopathy (0.53, 0.29-0.98), use of secretagogues (0.40, 0.25-0.64), high levels of HbA1c at first visit and related insulin use emerged as adverse factors. Early detection of diabetes, along with human resources and organization, was found to play a crucial role in rapidly attaining good metabolic control.

Nitrate estimation in the denitrifying post-filtration unit of a municipal wastewater treatment plant: the Viikinmäki case.

In this work we present and discuss the design of an array of soft-sensors to estimate the nitrate concentration in the denitrifying post-filtration unit at the Viikinmäki wastewater treatment plant in Helsinki (Finland). The developed sensors aim at supporting the existing hardware analyzers by providing a reliable back-up system in case of malfunction of the instruments. In the attempt to design easy to implement and interpretable sensors, computationally light linear models have been considered. However, due to the intrinsic nonlinearity of the process, also nonlinear but still computationally affordable models have been considered for comparison. The experimental results demonstrate the potential of the developed soft-sensors and the possibility for an on-line implementation in the plant's control system as alternative monitoring devices.

Cholesterol esters as growth regulators of lymphocytic leukaemia cells.

OBJECTIVE: Alterations in plasma lipid profile and in intracellular cholesterol homoeostasis have been described in various malignancies; however, significance of these alterations, if any, in cancer biology is not clear. The aim of the present study was to investigate a possible correlation between alterations in cholesterol metabolism and expansion of leukaemia cell numbers. MATERIALS AND METHODS: Lipid profiles in plasma and in primary leukaemia cells isolated from patients with acute or chronic lymphocytic leukaemia (ALL and CLL) were studied. RESULTS AND CONCLUSIONS: Decreased levels of HDL-C were observed in plasma of leukaemic patients, levels of total cholesterol, LDL-C, triglycerides and phospholipids were unchanged or only slightly increased. As compared to normal lymphocytes, freshly isolated leukaemic cells showed increased levels of cholesterol esters and reduction in free cholesterol. Growth stimulation of ALL and CLL cells with phytohemagglutinin led to further increase in levels of cholesterol esters. Conversely, treatment with an inhibitor of cell proliferation such as the mTOR inhibitor, RAD, caused decline in population growth rate of leukaemia cells, which was preceded by sharp reduction in rate of cholesterol esterification. On the other hand, exposure of leukaemic cells to two inhibitors of cholesterol esterification, progesterone and SaH 58-035, caused 60% reduction in their proliferation rate. In addition to demonstrating tight correlation between cell number expansion and cholesterol esterification in leukaemic cells, these results suggest that pathways that control cholesterol esterification might represent a promising targets for novel anticancer strategies.

[Postoperative hyponatremia in pediatric patients]. / Hiponatremia postoperatoria en pacientes pediátricos.

Fluid replacement therapy for pediatric patients in the past 50 years has meant the infusion of hypotonic solutions in amounts calculated using the Holliday-Segar formula. Recent studies have focused attention on the incidence of postoperative hyponatremia and associated morbidity and mortality rates, generating debate on the advisability of perioperative fluid therapy and calling into question both the effectiveness of this strategy and the quantities used. We report 3 cases of hyponatremic encephalopathy in children following different types of minor surgery. Free water excretion by the kidneys is known to be a conditioning factor in this therapy, yet the ideal way to provide pediatric fluid therapy is still hotly debated. The question cannot be resolved until large randomized clinical trials are carried out to compare the use of hypotonic and isotonic solutions. Some general recommendations can be offered, however, in the interest of lowering the incidence of electrolyte disturbances and diminishing their repercussions.

Hiponatremia postoperatoria en pacientes pediátricos / Postoperative hyponatremia in pediatric patients

Durante los últimos 50 años la fluidoterapia de mantenimientopara pacientes pediátricos se ha realizadocon soluciones hipotónicas y se ha cuantificado mediantela fórmula de Holliday y Segar. Recientes publicacioneshan puesto de manifiesto tanto la incidencia como lamorbi-mortalidad asociadas a la hiponatremia postoperatoria,generando opiniones encontradas sobre la idoneidadde la fluidoterapia perioperatoria, tanto respectoa su cantidad como a su calidad.Describimos tres casos de encefalopatía hiponatrémicaen niños, tras intervenciones menores realizadas pordiferentes servicios quirúrgicos en nuestro centro.La disminución en la capacidad de excreción renal deagua libre perioperatoria condiciona de forma marcadala fluidoterapia a realizar durante este periodo; a pesardel reconocimiento de este hecho, existe gran controversiarespecto a la fluidoterapia pediátrica ideal que nopodrá resolverse hasta que no se realicen amplios ensayosclínicos, prospectivos y randomizados comparandola fluidoterapia de mantenimiento con soluciones hipotónicase isotónicas. Sin embargo, es posible realizar unasrecomendaciones generales para reducir la incidencia yconsecuencias de esta alteración electrolítica(AU)

Fluid replacement therapy for pediatric patients inthe past 50 years has meant the infusion of hypotonicsolutions in amounts calculated using the Holliday-Segarformula. Recent studies have focused attention on theincidence of postoperative hyponatremia and associatedmorbidity and mortality rates, generating debate on theadvisability of perioperative fluid therapy and callinginto question both the effectiveness of this strategy andthe quantities used. We report 3 cases of hyponatremicencephalopathy in children following different types ofminor surgery. Free water excretion by the kidneys isknown to be a conditioning factor in this therapy, yet theideal way to provide pediatric fluid therapy is still hotlydebated. The question cannot be resolved until largerandomized clinical trials are carried out to compare theuse of hypotonic and isotonic solutions. Some generalrecommendations can be offered, however, in theinterest of lowering the incidence of electrolytedisturbances and diminishing their repercussions(AU)

Wastewater treatment modelling in practice: a collaborative discussion of the state of the art.

Three consulting teams conducted independent modelling projects for three different wastewater treatment plants ranging in size from approximately 113,800 m(3)/d (30 mgd) to 530,000 m(3)/d (140 mgd), in different parts of the world (USA and Finland). The plants have different treatment objectives ranging from nitrification and partial denitrification (nitrate plus nitrite <8.7 mg/L) to enhanced nutrient removal (total nitrogen <3 mg/L, total phosphorus <0.3 mg/L). Commonly-used models were applied in the case studies, including ASM3 (using the GPS-X simulator), New General (using GPS-X), Dold (using BioWin), and a variation of the Dold model methanol degradation capabilities (NGmeth within GPS-X). The authors compare and contrast the modelling approaches taken, including calibration and validation approaches, sensitivity analyses, and the application of results to full-scale studies, designs and operations. Despite several differences between the approaches, there are many similarities which are discussed in light of the IWA draft uniform protocol for activated sludge modelling. The authors also discuss current modelling limitations and offer suggestions to improve the state of the art.

Analgesia del Trabajo de Parto con Remifentanilo por vía intravenosa mediante un Sistema de Analgesia Controlada por la Paciente (PCIA) / Labour analgesia with Remifentanil by PCIA

Objetivo: Valorar la eficacia analgésica y seguridad en el parto de Remifentanilo por vía intravenosa mediante un sistema deanalgesia controlada por la paciente.Material y MétodoEl grupo de estudio lo componen 25 gestantes sanas, primigestasa término, con parto eutócico instaurado, que solicitananalgesia durante el trabajo de parto.ResultadosSe produce un alivio significativo del dolor desde la primerahora de tratamiento en todos los casos. La analgesiase mantiene hasta el final en el 80% de los casos. El 20%restante solicitó anestesia regional en el período expulsivo.Se produjo un grado de sedación de leve a moderado durantetodo el estudio, que las pacientes valoraron positivamente.Solo en dos casos el grado de sedación fuemoderado-severo, a pesar de lo cual las gestantes decidieroncontinuar en el estudio. No se registraron efectos adversosmaterno-fetales. ConclusionesLa analgesia del parto con Remifentanilo por vía intravenosacontrolada por la paciente es un método efectivo y presentaun aceptable perfil de seguridad materno y fetal

Objective: To assess the analgesic efficacy of patient-controlled intravenousanalgesia with remifentanil and its potential side effectsduring labour.MethodWe analyzed 25 healthy nulliparas at full term pregnancy,in established uncomplicated labour, who demanded pain relief.ResultsAll the patients experienced a significant pain relief duringthe first hour of treatment which was maintained on untildelivery on 80%. The other 20% required additional regionalanaesthesia at the end of second stage. The level of sedationwas mild to moderate and treatment was well toleratedexcept for two, who presented heavy sedation. No maternalor neonatal side effects were registered.ConclusionsPatient-controlled intravenous analgesia with remifentanilis effective for labour pain relief and produces no major maternal and neonatal side effects (AU)

Analgesia del trabajo de parto con remifentanilo por vía intravenosa mediante un sistema de analgesia controlada por el paciente (PCIA) en un caso de esclerosis múltiple / Intravenous patient-controlled analgesia with remifentanil for labor and childbirth in a woman with multiple sclerosis

No disponible

No disponible

Neoadjuvant chemotherapy and resection for initially irresectable colorectal liver metastases.

BACKGROUND: Hepatic surgery is the treatment of choice for resectable colorectal liver metastases. Neoadjuvant chemotherapy can downstage the tumour and enable surgery in up to 38 per cent of patients whose tumours were initially considered irresectable. METHODS: This prospective study included 150 patients who underwent hepatic resection over a 4-year period. One hundred and sixteen patients had resection without neoadjuvant chemotherapy (group 1) and 34 had chemotherapy before liver surgery (group 2). Perioperative features, survival and pattern of recurrence were compared. RESULTS: Median follow-up was 35.1 months. The in-hospital mortality rate was zero. Three-year overall survival in the two groups was comparable (P = 0.232). The 3-year disease-free survival rate was 21 per cent in the neoadjuvant group compared with 50.5 per cent in the immediate resection group (P < 0.001). Recurrence rates were 94 per cent (32 of 34) in group 1 and 66.4 per cent in group 2 (P = 0.001); extrahepatic recurrence, alone or associated with recurrence in the liver, was significantly more common in group 2 than in group 1 (78 versus 55 per cent; P = 0.016). Multivariate analysis revealed that resection of the recurrence was the most important independent prognostic factor for improved disease-free survival (relative risk 0.2; P < 0.001). Patients in group 2 had reduced disease-free survival (RR 1.8; P = 0.012). CONCLUSION: The recurrence rate among patients who had neoadjuvant chemotherapy and surgery for initially irresectable liver metastases was extremely high. Re-resection should be attempted whenever feasible.

Parecoxib frente a ketorolaco en el control del dolor agudo postoperatorio moderado / Parecoxib versus ketorolac for the management of moderate postoperative acute pain

Introducción y objetivos: El parecoxib es un profármaco que tras ser administrado se convierte con rapidez en valdecoxib, un inhibidor selectivo de la cicloooxigenasa 2 (COX-2) y que se administra vía parenteral. Intentamos valorar su eficacia en el tratamiento del dolor postoperatorio de intensidad moderada. Material y métodos: Es un estudio prospectivo, randomizado sobre un total de 96 pacientes intervenidos de: apendicectomías, ooforectomías, hernioplastias y fracturas de cadera entre enero y febrero de 2004. Un grupo recibió parecoxib 40 mg i.v. cada 12 horas (grupo P) y otro ketorolaco 30 mg i.v. cada 8 horas (grupo K). El analgésico de rescate fue paracetamol 1 g i.v. cada 6 horas. Se realizó la escala visual analógica tras 30 minutos de su ingreso en la unidad de recuperación postoperatoria, a las 2, 24 y 48 horas. Resultados: La valoración del dolor a través de la EVA no presentó diferencias entre grupos. La necesidad de analgesia de rescate en el primer día fue del 83,3% (40/48) en el grupo K, frente a un 66,7% (32/48) en el grupo P (p = 0,059). En el segundo día las demandas de analgesia adicional decrecieron. La necesidad de analgesia de rescate fue mayor en los pacientes sometidos a cirugía traumatológica. Los pacientes que recibieron parecoxib mostraron mayor porcentaje de satisfacción de forma significativa. Conclusiones: El control del dolor fue similar para ambos grupos, sin embargo, las pautas analgésicas mostraron limitaciones en el control del dolor, ya que el EVA en las primeras horas y el grado de satisfacción de los pacientes pueden mejorarse. A la vista de los buenos resultados del rescate con paracetamol, la combinación de parecoxib con paracetamol puede ser una mezcla importante en el control analgésico postquirúrgico (AU)

Introduction and objectives: Parecoxib is a pro-drug that after being injected into the body, it is rapidly converted into the active drug valdecoxib, an injectable selective inhibitor of cyclooxygenase 2 (COX-2). Our aim was to determine its effectiveness for the management of moderate postoperative pain. Material and methods: A prospective randomized study was conducted on a total of 96 patients undergoing: appendectomies, oophorectomies, hernioplasties and hip fractures between January and February 2004. One group received parecoxib 40 mg IV each 12 hours (group P) and the other one received ketorolac 30 mg IV each 8 hours (group K). Rescue analgesia was paracetamol 1 g IV each 6 hours. An analogical visual scale was used 30 minutes after admittance to the postoperative recovery unit, and after 2, 24 and 48 hours. Results: Pain was assessed through the VAS scale, with no differences found between groups. The need of rescue analgesia on the first day was 83.3% (40/48) in group K, versus 66.7% (32/48) in group P; (p = 0.059). On the second day, the demand of additional analgesia decreased. The need of rescue analgesia was greater among patients undergoing traumatological surgery. Patients that received parecoxib showed a greater percentage of satisfaction, this difference being significant. Conclusions: Pain management was similar in both groups. However, the analgesic patterns showed limitations in the management of pain, since the VAS score and the degree of satisfaction during the first hours can be improved. Considering the effectiveness of rescue therapy with paracetamol, parecoxib combined with paracetamol may be an useful combination for postoperative analgesic management (AU)

Dietary restriction counteracts age-related changes in cholesterol metabolism in the rat.

The effects of ageing on the metabolism of cholesterol were examined in three different organs (liver, aorta and brain) of 6-, 12- and 24-month-old male Sprague-Dawley rats. Ageing was associated with a significant increase in intracellular cholesterol esters in all three organs. Steady state mRNA levels of multidrug resistance protein (MDR) and acylCoA:cholesterol acyl transferase (ACAT), enzymes involved in cholesterol import and esterification, were also increased. By contrast, expression of mRNA for neutral cholesterol ester hydrolase (nCEH) and caveolin-1, proteins involved in cholesterol ester hydrolysis and export, were significantly reduced. Dietary restriction is the only intervention shown to extend lifespan and retard age-related declines in function in mammals. To further explore the possible correlation between changes in cholesterol esterification and ageing, we analysed cholesterol metabolism in liver, aorta, and brain of aged rats exposed to two dietary restriction regimens: intermittent (alternate-day) fasting (IF) and food intake restriction (60% of ad libitum feeding). Both dietary regimens attenuated the age-related changes in cholesterol esters and in the expression of genes involved in cholesterol metabolism. These results provide evidence that distinctive age-associated changes in intracellular cholesterol metabolism occur in rats. Furthermore, these modifications can be partially reversed by dietary restriction, a condition known to affect the ageing process. Age-related changes in cholesterol metabolism may play a role in triggering and/or aggravating senescence-related disorders characterized by altered cholesterol homeostasis.

Influencia de la analgesia epidural sobre la incidencia de taquiarritmias en el postoperatorio de la cirugía pulmonar / Influence of epidural analgesia on the incidence of tachyarrhythmia during pulmonary surgery postoperative

Objetivos: Valorar la influencia del uso de analgesia epidural torácica (AET) intra y postoperatoria sobre la presentación de taquiarritmias en el postoperatorio de las resecciones pulmonares. Material y métodos: Se han analizado, de forma retrospectiva, los cursos postoperatorios de 200 pacientes consecutivos intervenidos de resecciones pulmonares mayores (lobectomías, bilobectomías y neumonectomías) en nuestro hospital durante el periodo comprendido entre octubre de 1998 y junio de 2002. En este tiempo se ha introducido progresivamente en nuestro Servicio la AET como parte de la técnica anestésica en cirugía pulmonar. Se ha analizado la influencia del empleo de AET en la presentación de episodios de taquiarritmia supraventricular en las primeras 48 horas de postoperatorio. Resultados: Se empleó AET para el manejo anestésico y control del dolor postoperatorio en el 49,5 por ciento de los casos (99/200).No existen diferencias significativas entre los grupos de pacientes con y sin AET en cuanto a edad, sexo, riesgo ASA, duración de la intervención y tipo de resecciones practicadas. Presentaron crisis de taquiarritmia el 9,5 por ciento de los pacientes (19/200), tratándose, en todos los casos, de fibrilación auricular paroxística. Entre los pacientes que no recibieron AET la tasa de arritmias fue del 13,86 por ciento (14/101), mientras que en aquellos en los que se empleó AET como parte de la técnica anestésica y durante el postoperatorio, dicha tasa fue del 5,05 por ciento (5/99), siendo dicha diferencia estadísticamente significativa (p=0,034). Conclusiones: El empleo de AET como parte de la técnica anestésica y para el manejo del dolor postoperatorio en cirugía de resección pulmonar parece ejercer un efecto protector en cuanto al desarrollo de fibrilación auricular en el postoperatorio inmediato. Se discuten las posibles causas de este efecto (AU)

Utilidad de rofecoxib en el dolor episódico producido por metástasis óseas / Effectiveness of rofecoxib for the management of episodic pain caused by bone metastasis

Introducción: El dolor episódico se define como un dolor transitorio que aparece sobre un dolor basal controlado. El rofecoxib es un AINE inhibidor de la COX-2.Objetivo: Valorar la eficacia del rofecoxib en el dolor episódico de enfermos oncológicos en estadio avanzado de la enfermedad, con metástasis óseas, y con dolor basal controlado mediante opiáceos.Material y método: Presentamos tres casos clínicos de dolor episódico en pacientes con metástasis óseas secundarias a diferentes tipos de tumores y agotado el arsenal analgésico.Resultado: El rofecoxib, a dosis de 50 mg, como coadyuvante del tratamiento basal con opiáceos, controló perfectamente los episodios de dolor incidental.Conclusiones: El rofecoxib puede ser un AINE muy eficaz en el control del dolor episódico debido a metástasis óseas (AU)

[Surgical treatment of varicocele in day surgery]. / Il trattamento chirurgico del varicocele in day surgery.

Aim of this study is the comparison between spermatic vein ligature (Ivanissevich technique) and low intrafunicular ligature in the surgical treatment of varicocele. The Authors present two groups of patients (total 61) operated between 1995 and 1999 with the above-mentioned surgical techniques. Apart from the utilized method, they didn't ascertain any improvements in the spermiograms of the patients older than 30 years. The low ligature of the spermatic veins demonstrated the advantages of surgery treatment and lower percentage of relapses.

Cell growth and cholesterol metabolism in human glucose-6-phosphate dehydrogenase deficient lymphomononuclear cells.

Atherosclerosis is an inflammatory-fibroproliferative response of the arterial wall involving a complex set of interconnected events where cell proliferation (lymphomonocytes, and endothelial and smooth-muscle cells) and substantial perturbations of intracellular cholesterol metabolism are considered to be among the main features. Glucose-6-phosphate dehydrogenase (G6PD), the key enzyme of the hexose-monophosphate shunt pathway, is an essential enzyme involved in both cell growth and cholesterol metabolism, raising the question as to whether G6PD deficiency may have metabolic and growth implications in a deficient population. In the present study, we investigated cell growth and cholesterol metabolism in peripheral blood lymphomononuclear cells (PBMC) from G6PD-normal (n = 5) and -deficient (n = 5) subjects stimulated with lectins (phytohaemoagglutinin and Concanavalin A). G6PD activity, DNA ([3H]-thymidine incorporation) cholesterol synthesis and esterification ([14C]-acetate and [14C]-oleate incorporation), and G6PD, HMGCoA reductase and low density lipoprotein (LDL) receptor mRNA levels (RT-PCR) all increased following lectin stimulation in both normal and G6PD-deficient cells. However, these parameters were significantly lower in G6PD-deficient cells (P < 0.05). It is of interest that G6PD-deficient PBMC, which showed lower expression of G6PD and higher expression of the LDL receptor gene than normal PBMC under basal conditions, exhibited an opposite pattern after stimulation: G6PD and HMGCoA reductase being expressed at significantly higher levels in deficient than in normal cells (P < 0.05). We conclude that the reduced capability of G6PD-deficient cells to respond to mitogenic stimuli and to synthesize cholesterol esters may represent favourable conditions for reducing the risk of cardiovascular diseases.