Buenos resultados tras tratamiento con láser CO2 de leiomioma en el pezón / Successful Treatment of Leiomyoma of the Nipple With Carbon Dioxide Laser

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Estudio transversal comparativo de las fórmulas CKD-EPI y MDRD-4 a partir de la historia clínica informatizada de Atención Primaria de Barcelona / A comparative, cross-sectional study of the CKD-EPI and MDRD-4 equations from the Primary Care computerized clinical history of Barcelona

Antecedentes: La prevalencia de enfermedad renal crónica (ERC) en España supera el 7%. Su diagnóstico precoz puede ayudar a frenar la evolución. En Atención Primaria (AP) se calcula el filtrado glomerular estimado (FGe) mediante fórmulas basadas en la creatinina plasmática(CrP).Objetivos: Comparar los FG e según las fórmulas MDRD-4 y CKD-EPI a partir de la historia clínica informatizada (HCI) y la clasificación de ERC en una población de AP. Material y métodos: Estudio transversal. Se incluyó a pacientes de 20-99 años, asignados a centros de AP de Barcelona, con CrP entre julio de 2008 y junio de 2010. Se obtuvieron losdatos de la HCI. Se calculó el FGe mediante CKD-EPI y MDRD-4.Resultados: Se estudió a un total de 447.140 personas: 58,7% mujeres, 56,6 (DE 18,8) años. El 32,5% con diagnóstico de hipertensión arterial, 11% con diabetes mellitus y 9,3% con enfermedad cardiovascular asociada. La CrP media fue 0,89 (0,28) mg/dL, FGe por MDRD-4 de 80,59(21,04) mL/min/1,73 m2y por CKD-EPI de 85,03 (21,13) mL/min/1,73 m2. La CKD-EPI, respecto a MDRD-4, clasificó el 2,3% de los pacientes en estadios menos avanzados de ERC, el 96,8% en el mismo y el 0,9% en más avanzados. El índice kappa fue de 0,87. En números absolutos clasificó en estadios 3b-4-5 (posible derivación a nefrología) a 958 pacientes más, con 691 personas >69 años en estadio 3b.Conclusiones: Utilizar una u otra fórmula puede variar el FGe. La CKD-EPI tiende a clasificar enestadios más avanzados en > 69 años. El uso de cada fórmula puede hacer cambiar el número y tipo de derivaciones a nefrología

Background: The prevalence of chronic kidney disease (CKD) in Spain is higher than 7%. Its early diagnóstico can help to delay its progression. Glomerular filtration rate (GFR) based on serum creatinine (SC) is calculated in primary care (PC) to identify CKD. Objectives: To compare GFR by MDRD-4 and CKD-EPI equations obtained from clinical records(CR) and to compare the classification of CKD in a primary care population. Material and methods: A cross-sectional study was performed, including patients 20-99 years old, assigned to primary care centers of Barcelona, with a SC recorded between July 2008 and June 2010. Data were obtained from the CRs. GFR was calculated from MDRD-4 and CKD-EPI equations. Results: A total of 447,140 persons were studied (58.7% females, 56.6 [SD 18.8] years old).Of these 32.5% were diagnosed of hypertension, 11.0% diabetes and 9.3% had some associated cardiovascular disease. SC 0.89 (0.28) mg/dL (78.7 [SD 24.8] mol/L), GFR being 80.59(21.04) mL/min/1.73 m2by MDRD-4, and 85.03 (21.13) mL/min/1.73 m2by CKD-EPI. CKD-EPI compared to MDRD-4 classified 2.3% of patients in less advanced stages of CKD, 96.8% in the same stage and 0.9% in more advanced stages. Kappa coefficient: 0.87. In absolute numbers, CKD-EPI classified in 3b-4-5 stages (candidates for referral to nephrology) 958 patients more,691 of them being patients > 69 years old and stage 3b.Conclusions: Using one equation or another could vary the estimation of GFR. CKD-EPI tends to classify patients older than 69 into more advanced stages. Each equation can change the number and type of referral to nephrology (AU)

Fenómeno de Koebner tras escleroterapia de varices / Koebner phenomenon after sclerotherapy of varicose veins in the lower limbs

El fenómeno de Koebner fue descrito en 1877 por Heinrich Koebner como la aparición de lesiones típicas de una determinada dermatosis en áreas de piel sana desencadenadas tras diferentes traumatismos. Presentamos el caso de una mujer de 33 años valorada en nuestra consulta por aparición de lesiones psoriasiformes tras el tratamiento mediante escleroterapia con polidocanol de pequeñas varículas en las extremidades inferiores (AU)

Koebner phenomenon was first described in 1877 as the appearance of psoriatic lesions in the uninvolved skin of psoriatic patients as a consequence of trauma. We report a 33-year-old woman referred to our department for evaluation of multiple psoriasiform skin lesions appearing after sclerotherapy for varicose veins of the legs (AU)

Usefulness of TrichoScan professional in the evaluation of hair loss in females. Report of 180 cases.

BACKGROUND: TrichoScan Professional is a computerized program used for digital measurement of hair growth and hair loss. The aim of our study was to undertake an evaluation with TrichoScan Professional of female patients consulting at our hospitals for hair loss. The purpose of our study was to determine whether TrichoScan was able to identify differences in hair parameters that would correlate with the pattern of alopecia or according to the age of the patients evaluated. MATERIAL AND METHODS: One hundred-eighty women that consulted consecutively for loss of hair were included. Patients were aged between 8 and 85 years (mean age 36 years). Data including age, the number of hairs, hair density per square centimetre, anagen and telogen percentage and percentage of terminal and miniaturized hair were analysed. RESULTS: Results observed with TrichoScan were as below: number of hairs (mean 154.9; range 34-316). Hair density per square centimetre (mean 239; range 52-486). Hair in anagen phase (mean 62.4%; range 9-93%). Hair in telogen phase (mean 37.4%; range 7-91%). Terminal hair (mean 95.2%; range 82-100%). Vellus hair (mean 4.7%; range 0-17%). Pearson's correlation test was used to measure the strength of the association of age with the rest of parameters. The statistical analysis showed a significant correlation between age and both the number of hairs and the hair density per square centimetre. However, no significant correlation between age and rest of the parameters was observed. CONCLUSIONS: TrichoScan Professional may help to quantify hair density and in our sample, this was the only parameter showing a significant decrease according to age in various types of alopecia affecting the females.

Adalimumab-induced lupus erythematosus.

Adalimumab, an anti-tumour necrosis factor agent, especially used in the treatment of rheumatoid arthritis, has a good safety profile. One of the most common side-effects of adalimumab is the development of autoantibodies. Despite the induction of autoantibodies, the clinical presentation of immune-mediated complications upon adalimumab therapy, including a lupus-like syndrome, is very rare. We have recently evaluated a new case of adalimumab-induced lupus erythematosus.

Utilidad de la dermatoscopia para el diagnóstico de la pediculosis capitis / No disponible

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Primary cutaneous CD30+ anaplastic large-cell lymphomas mimicking keratoacanthomas.

Primary cutaneous anaplastic large cell lymphoma (ALCL) may be associated with keratoacanthoma (KA)-like epithelial hyperplasia and dense eosinophilic and neutrophilic infiltrates. Diagnosis in such cases is challenging both clinically and histologically, because the large atypical lymphoid cells may be obscured by the massive infiltrate of eosinophils and neutrophils, or confused with invasive squamous cell carcinoma or KA. We recently encountered two cases of CD30+ ALCL presenting with a KA-like tumour on the eyelid and nose, respectively. One showed features of KA histologically, with marked tissue eosinophilia and neutrophilia.

Platelet activation and red blood cell phosphatidylserine exposure evaluated by flow cytometry in patients with Behçet's disease: are they related to thrombotic events?

Behçet's disease (BD) is associated with an increased risk of venous and arterial thromboses that are associated with morbidity and mortality increase, although the mechanisms are not well established. In the present study, we used whole blood cytometry to determine the exposure of CD62 on the surface of platelets and the expression of phosphatidylserine (PS) on the surface of circulating red blood cells. Microparticle and microaggregate formation from platelets were also determined in a well-classified group of 72 patients (39 males, 33 females, aged 46.5 +/- 12.5 years) with BD, in comparison with a well-matched control group of 72 healthy volunteers. Results showed no differences in the above-mentioned parameters when BD patients and controls were compared. However, when we compared BD patients with/without thrombosis using these parameters, there were significant differences between both groups. BD patients with previous thrombosis had a higher percentage of circulating CD62-positive platelets and a higher number of circulating microaggregates than those without thrombosis, suggesting that platelet activation may be involved in the development of thrombotic events in these patients.

DFT characterization of adsorbed NH(x) species on Pt(100) and Pt(111) surfaces.

Periodic density functional theory (DFT) calculations using plane waves have been performed to systematically investigate the adsorption and relative stability of ammonia and its dehydrogenated species on Pt(111) and Pt(100) surfaces. Different adsorption geometries and positions have been studied, and in each case, the equilibrium configuration has been determined by relaxation of the system. The vibrational spectra of the various ammonia fragments have been computed, and band assignments have been compared in detail with available experimental data. The adsorption of NH3 (on top) and NH2 (bridge) is more favorable on Pt(100) than on Pt(111), while similar adsorption energies were computed for NH (hollow) and N (hollow) on both surfaces. The remarkably lower adsorption energy of NH2 over Pt(111) as compared with Pt(100) (the difference being approximately 0.7 eV) can be related to different geometric and electronic factors associated with this particular intermediate. Accordingly, the type of platinum surface determines the most stable NH(x) fragment: Pt(100) has more affinity for NH2 species, whereas NH species are preferred over Pt(111).

The importance of the day of the week and duration of data collection in prevalence surveys of nosocomial infections.

In a national prevalence survey setting, we studied whether the day of week selected for data collection, and the number of days needed to complete the survey, were associated with the prevalence of hospital-acquired infection (HAI). The EPINE (Estudio de Prevalencia de las Infecciones Nosocomiales en España) database (1990-2002) was analysed for the purposes of the study. Adjusting for the admission day in the week, the number of intrinsic risk factors, the number of extrinsic risk factors and the prevalence length of stay, a 'weekend effect' was confirmed in this study. The day of the week selected for data collection was related to the presence of infection in the surveyed patients, showing for the period of Saturday-Monday a higher prevalence of patients with HAI (adjusted OR 1.08, 95%CI 1.05-1.10). There was a crude positive trend between number of weeks and prevalence, but the number of days involved in data collection was finally not associated with the prevalence of HAI, once adjustment for hospital size was made. The percentage of repeated records increased linearly with hospital size, and the frequency of infections was higher within this group (OR 2.8, 95%CI 2.6-3.0). The results of this study highlight the need for encouraging hospitals to shorten the time spent in obtaining a prevalence survey. If it is impossible to carry out the survey within the limits of one day, data collection should then be limited to that period of the week, Tuesday to Friday.

Spontaneous cervical epidural hematoma associated with oral anticoagulant therapy.

A 54-year-old woman who was on anticoagulant treatment with acenocoumarol for a mitral prothesis developed a cervical spinal epidural hematoma, probably triggered by coughing fits together with supratherapeutic anticoagulation. Because of the subacute evolution of the hematoma, it was not diagnosed until the patient was admitted to the hospital with profuse hemorrhages. Given the subacute nature of the hematoma, along with the favorable evolution, conservative treatment with dexamethasone was decided upon, and it was resolved with almost no sequelae. This unusual clinical entity definitely should be suspected in patients on anticoagulants who complain of severe localized neck pain, most often with radicular irradiation.

Central retinal vein thrombosis associated with prothrombin 20210G/A gene variant.

We describe a patient with central retinal vein thrombosis associated with the prothrombin gene 20210G/A. The associated risk factors and the patient's personal and family history of thrombosis are dealt with. In addition, the literature on the cases reported up to now is reviewed as is the prevalence of this new mutation in patients with central retinal vein thrombosis.

Computational study of the conformational profiles of model bis-cystine cyclic peptides.

Bis-cystine cyclic peptides are a new kind of molecules with potential use as cavitands, transporters or antagonists of target ligands. Studies aimed at establishing their conformational profiles may prove useful in understanding their characteristics and potentiate their use in molecular design. The present investigation reports the results of a computational study devoted to establishing the conformational preferences of model bis-cystine cyclic peptides and the properties in common with their linear analogs. For this purpose a study of four model compounds: (Ac-Cys-X-Cys-NHMe)2 and (Ac-Cys-X-X-Cys-NHMe)2 with X = Ala, Val, was performed. The goal of the study was to explore the importance of the conformational nature of the central residues, the effect of the number of them, and the loss of conformational freedom after cyclization on model molecules. Accordingly, the conformational space and the dynamic behaviour of the four cyclic peptides as well as the corresponding linear analogs was carefully explored. The results indicate the existence of structural patterns that might be useful for the use of this kind of molecule in de novo molecular design.

Molecular mechanical study of the stability of the Lys-Ala-Ala tripeptide dimer.

A molecular mechanical study of two Lys-Ala-Ala tripeptide chains in interaction is presented. The study was carried out to explore the feasibility of dimer formation and explain some features of the crystal structure not completely understood. The role of the counterions present in the crystal structure on the conformation has been included in this study by investigating the effect of removing the charges on the lysyl side chains. The results of the present molecular mechanical study explains well the structural features found by X-ray crystallography, complementing that study.