Estudio de utilización de Tenofovir DF en el tratamiento antirretroviral de gran actividad / Use study of tenofovir DF in higly active anti-retroviral therapy

Objetivo: Describir la eficacia y seguridad de tenofovir. Métodos: Estudio descriptivo, observacional. Análisis por intención de tratar. La variable principal fue la proporción de pacientes con supresión de la carga viral plasmática del VIH hasta indetectable. Las variables secundarias fueron la respuesta inmunológica, proporción de pacientes con variación positiva del número de CD4+ y la seguridad (eventos adversos clínicos y valores bioquímicos y hematológicos). Se midió la causalidad por el algoritmo de Naranjo. Resultados: Se seleccionaron 154 pacientes, 12 fueron excluidos de todos los análisis. Las variables de eficacia fueron: La proporción de pacientes que disminuyeron la carga viral a 50 copias/ml o menos fue 28,16%, la media de descenso fue -1,29 ± 0,97 log10 copias/ml. La media de aumento de CD4 fue de 40,27 ± 141,50 cel/mm3 La seguridad fue similar a la ficha técnica, destacando tres casos de Síndrome de Fanconi. Conclusión: Tenofovir supone un antirretroviral de gran efectividad en el hospital con un perfil de seguridad óptimo

Objective: Describe the efficacy and safety of tenofovir. Methods: Observational, descriptive study. Data were analyzed for the intention-to-treat sample. The primary efficacy end-point included the proportion of patients with HIV-1 RNA level of 50 copies/ml or less. Secondary efficacy end points was the increase of the CD4 cell count at week 48. The primary safety end-point was the number of patients with abnormalities (clinical adverse events and laboratory toxicities). The causality of the adverse effects was measured by the Naranjo algorithm Results: 154 subjects were enrolled; 12 were excluded from all analyses. Efficacy end points: Plasma HIV-1 RNA response: -1.29 ± 0.97 log10 copies/ml; Patients with HIV-1 RNA levels of 50 copies/ml or less: 28.16%; CD4 cell count response: 40.27 ± 141.50 cel/mm3. Safety profile was similar to showed at prescribing information, 3 Fanconi Syndrome were detected. Conclusion: Tenofovir supposes an antiretroviral of high effectiveness in our hospital, with an optimum safety profile

Edema pulmonar en el tromboembolismo pulmonar masivo / Pulmonary oedema in massive pulmonary thromboembolism

La aparición de un infiltrado alveolar bilateral en el contexto de un episodio agudo de tromboembolismo pulmonar (TP) es un hecho infrecuente que puede producirse por diversas causas con diferente mecanismo fisiopatológico. Entre ellas se encuentran la aparición de un síndrome de distrés respiratorio del adulto, el desarrollo de insuficiencia cardiaca, el edema por sobreperfusión y el edema por reperfusión. Presentamos el caso de un paciente con TP masivo que fue tratado con fibrinolisis sistémica y que desarrolló un infiltrado pulmonar bilateral extenso con hipoxemia grave y necesidad de ventilación mecánica. Se discuten las distintas causas que pudieron precipitar esta evolución (AU)

The appearance of bilateral pulmonary infiltrates during acute pulmonary embolism is a rare event. It may be produced by several causes with different physiopathologyc mechanism, such as the appearance of adult respiratory distress syndrome, development of cardiac failure, overperfusion edema and reperfusion edema. We report the case of a patient with massive pulmonary embolism that was treated with systemic thrombolysis, who developed bilateral diffuse pulmonary infiltrates with severe hypoxia requiring mechanical ventilation. We discuss the different causes that could precipitate this evolution (AU)

[Use study of tenofovir DF in highly active anti-retroviral therapy]. / Estudio de utilización de Tenofovir DF en el tratamiento antirretroviral de gran actividad.

OBJECTIVE: Describe the efficacy and safety of tenofovir. METHODS: Observational, descriptive study. Data were analyzed for the intention-to-treat sample. The primary efficacy end-point included the proportion of patients with HIV-1 RNA level of 50 copies/ml or less. Secondary efficacy end points was the increase of the CD4 cell count at week 48. The primary safety end-point was the number of patients with abnormalities (clinical adverse events and laboratory toxicities). The causality of the adverse effects was measured by the Naranjo algorithm. RESULTS: 154 subjects were enrolled; 12 were excluded from all analyses. Efficacy end points: Plasma HIV-1 RNA response: -1.29 +/- 0.97 log10 copies/ml; Patients with HIV-1 RNA levels of 50 copies/ml or less: 28.16%; CD4 cell count response: 40.27 +/- 141.50 cel/mm3. Safety profile was similar to showed at prescribing information, 3 Fanconi Syndrome were detected. CONCLUSION: Tenofovir supposes an antiretroviral of high effectiveness in our hospital, with an optimum safety profile.

[Cystinosis: an infrequent cause of distal myopathy]. / Cistinosis: una causa infrecuente de miopatía distal.

INTRODUCTION: Cystinosis is a hereditary disease with clinical symptoms that are caused by the accumulation of cystine crystals in different tissues. Distal vacuolar myopathy has been reported as one of its later complications. CASE REPORT: Here, we present the case of a 20-year-old male diagnosed with cystinosis at the age of 2 years, with severe renal involvement that required a transplant. The patient gradually developed weakness and atrophy of the muscles in his hands. Neurophysiological and histological studies enabled a diagnosis of distal vacuolar myopathy to be established, and electron microscopy revealed deposits of cystine crystals. CONCLUSIONS: Cystinosis must be included within the differential diagnosis of distal myopathies. Timely treatment with cysteamine could prevent the development of this complication.

Cistinosis: una causa infrecuente de miopatía distal / Cystinosis: an infrequent cause of distal myopathy

Introducción. La cistinosis es una enfermedad hereditaria cuyas manifestaciones clínicas se producen por la acumulación de cristales de cistina en diversos tejidos. Entre sus complicaciones tardías se ha descrito una miopatía distal vacuolar. Caso clínico. Se trata de un varón de 20 años, diagnosticado de cistinosis a los 2 años, con grave afectación renal que requirió trasplante. De forma insidiosa desarrolló debilidad y atrofia de los músculos de las manos. Mediante estudios neurofisiológicos e histológicos se estableció el diagnóstico de miopatía distal vacuolar, y se objetivaron depósitos de cristales de cistina en la microscopía electrónica. Conclusiones. La cistinosis debe incluirse en el diagnóstico diferencial de las miopatías distales. Un tratamiento precoz con cisteamina podría evitar el desarrollo de esta complicación

Introduction. Cystinosis is a hereditary disease with clinical symptoms that are caused by the accumulation of cystine crystals in different tissues. Distal vacuolar myopathy has been reported as one of its later complications. Case report. Here, we present the case of a 20-year-old male diagnosed with cystinosis at the age of 2 years, with severe renal involvement that required a transplant. The patient gradually developed weakness and atrophy of the muscles in his hands. Neurophysiological and histological studies enabled a diagnosis of distal vacuolar myopathy to be established, and electron microscopy revealed deposits of cystine crystals. Conclusions. Cystinosis must be included within the differential diagnosis of distal myopathies. Timely treatment with cysteamine could prevent the development of this complication

Masa pélvica hipervascularizada: una causa poco frecuente de hemorragia digestiva

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[Reversible posterior leukoencephalopathy, severe hypertension, and cocaine abuse]. / Leucoencefalopatía posterior reversible, hipertensión severa y abuso de cocaína.

Reversible posterior leukoencephalopathy syndrome is a brain disorder characterized by headache, nausea, vomiting, visual disturbance, depressed level of consciousness, convulsions and occasionally focal neurologic deficits. It is commonly associated with malignant hypertension, toxemia of pregnancy or the use of immunosuppressive agents. Early diagnosis and specific treatment is essential. We report a case of reversible posterior leukoencephalopathy in the context of a hypertensive crisis in an habitual cocaine sniffer. Reversible posterior leukoencephalopathy must be suspected in every patient with hypertensive crisis and compatible clinic manifestation. Neuroimaging studies show characteristic features which confirm the diagnosis.

Aplicación del AEP en el área de Urgencias de un hospital / AEP utilization in the emergency department of a hospital

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Immunocytohistochemical characterization of pituitary cells of the bluefin tuna, Thunnus thynnus L.

In this paper we report the first complete mapping of the pituitary in a tuna species. The various different adenohypophysis cell types of the bluefin tuna, Thunnus thynnus L. have been identified and located using different antisera against mammalian and piscine hormones and various histochemical techniques: PAS, Alcian Blue pH 2.5 and lectins -ConA and WGA(Neutral and Acidic Glycoproteins); Bromophenol Blue (Proteins) and Tioglycollate-Ferric-Ferricianide-FeIII (-S-S- groups). Prolactin (PRL) and adrenocorticotrophic (ACTH) cells were located in the rostral pars distalis (RPD) of the pituitary, while the proximal pars distalis (PPD) displayed gonadotrophic (GTH), thyrotrophic (TSH), somatotrophic (GH) and also a few PRL cells. Moreover, somatolactin (SL) and melanotrophic (MSH) cells were identified inside the pars intermedia (PI). Interestingly, some SL-immunoreactive fibers were also detected in the neurohypophysis. Some GTH cells were also located on the exterior surface of the PI. Glycoproteins containing mannose (Man) and/or glucose (Glc); N-acetyl-glucosamine (GlcNAc) and/or sialic acid sugar residues, as well as -S-S- groups, were observed in GTH, TSH and SL cells. The Bromophenol Blue technique stained amphiphilic SL, acidophilic GH cells and weakly ACTH cells. GH and ACTH cells were unreactive to PAS, Alcian Blue, Tioglycollate-Ferric-Ferricianide-FeIII and lectin (Con A and WGA) techniques. Finally, PAS reaction was positive in amphiphilic SL cells, which were PbH unreactive, while MSH and ACTH cells were stained with PbH technique.

Leucoencefalopatía posterior reversible, hipertensión severa y abuso de cocaína / Reversible posterior leukoencephalopathy, severe hypertension and cocaine abuse

La leucoencefalopatía posterior reversible es una alteración del sistema nervioso central que cursa clínicamente con cefalea, náuseas y vómitos, alteraciones visuales, disminución del nivel de conciencia, crisis convulsivas y ocasionalmente signos de focalidad neurológica. Suele asociarse con hipertensión arterial maligna, toxemia del embarazo o el uso de inmunosupresores. Son fundamentales un diagnóstico precoz y tratamiento adecuado. Se presenta un caso de leucoencefalopatía posterior reversible en el contexto de una crisis hipertensiva en un paciente consumidor habitual de cocaína por vía intranasal. La leucoencefalopatía posterior reversible cursa con manifestaciones clínicas sugestivas y debe ser sospechada en todo paciente con crisis hipertensiva y clínica compatible. Los estudios de neuroimagen caracterizan y apoyan el diagnóstico. (AU)

Distribution of neuropeptide Y-like immunoreactivity in the brain of the Senegalese sole (Solea senegalensis).

We present the results of an immunohistochemical study aimed at localizing the neuropeptide Y (NPY) in the brain of the Senegalese sole, Solea senegalensis, using an antiserum raised against porcine NPY and the streptavidin-biotin-peroxidase method. In this species, we have identified immunoreactive cells in the ventral and dorsal telencephalon, caudal preoptic area, ventrocaudal hypothalamus, optic tectum, torus longitudinalis, synencephalon and isthmic region. NPY-immunoreactive fibers were profusely distributed throughout the brain, also reaching the adenohypophysis. The extensive distribution of NPY suggests an important role for this neuropeptide in a variety of physiological processes, including the neuroendocrine control of adenohypophyseal functions. Our results are compared with those obtained in other teleosts and discussed in relation to putative functions of NPY in the control of metabolism and reproduction in the Senegalese sole.

Localization of tyrosine hydroxylase-immunoreactivity in the brain of the Senegalese sole, Solea senegalensis.

The localization of catecholamines in the brain of the Senegalese sole was determined by immunohistochemical techniques using antibodies against tyrosine hydroxylase. Although the general pattern of distribution of catecholamines is consistent with that reported in other teleosts, some remarkable differences are observed. The most rostral tyrosine hydroxylase immunoreactive (TH-ir) cells were identified in the olfactory bulbs, in which a clear asymmetry in the number and location of TH-ir perikarya and fibers was observed. The number of TH-ir cells is manifestly higher in the right olfactory bulb, especially in the internal cell layer. TH-ir fibers are also much more abundant in the right bulb, principally in the glomerular and internal cell layers. Other TH-ir cell masses were identified in the ventral telencephalon, preoptic area, caudoventral hypothalamus, posterior tuberculum, synencephalon, isthmic region and rhombencephalon. Surprisingly, no ir cell bodies were identified in the ventromedial thalamic nucleus, which exhibits a large number of TH-ir cells in other teleosts. The presence of TH-ir fibers in the brain of sole is particularly evident within and around the nuclei in which immunoreactive cells are found. However, other zones such as the dorsal telencephalon, posterior commissure, optic tectum, torus semicircularis, reticular formation or inferior olive also displayed TH-ir fibers. TH-ir axons also enter the infundibulum, reaching the proximal pars distalis of the adenohypophysis. The distribution of TH-ir cells and fibers is compared with that observed in other teleosts and is discussed in a comparative context.

A morphological study of the brain of Solea senegalensis. I. The telencephalon.

In this paper we present an anatomical description of the telencephalon of Solea senegalensis based on cresyl violet and haematoxilin-eosin-stained serial transverse sections. This work was conducted as a basis for the precise localization of neuroendocrine territories in the brain of a species with growing interest in marine aquaculture. The external asymmetric morphology of Senegalese sole is correlated with the asymmetry of the forebrain. The right olfactory nerve and bulb are larger than the contralateral ones and this asymmetry is also extended to the cerebral hemispheres. The olfactory bulb comprises an outer olfactory nerve fiber layer, a glomerular layer, an external cellular layer, a secondary olfactory fiber layer and an internal cellular layer. The telencephalic hemispheres can be divided in area dorsalis and area ventralis, consisting of eleven and eight cell masses, respectively. The area dorsalis comprises five subareas: a pars medialis (Dm), subdivided into four nuclei termed Dml to Dm4; a pars dorsalis (Dd); a pars lateralis (D1), which consists of dorsal (Dld), ventral (Dlv) and posterior (Dlp) subdivisions; a pars centralis (Dc); and more caudally, a pars posterioris (Dp), which is very prominent in this species. A nucleus taenia (NT) was observed in the transitional region between area dorsalis and area ventralis. The area ventralis consists of pars dorsalis (Vd), pars ventralis (Vv), pars supracommissuralis (Vs), pars postcommissuralis (Vp), pars lateralis (V1), pars centralis (Vc), pars intermedia (Vi) and nucleus entopeduncularis (E). A periventricular organ, that we have termed lateral septal organ (LSO), was observed in the ventral telencephalon, medial to Vv.

Localization of galanin-like immunoreactive structures in the brain of the Senegalese sole, Solea senegalensis.

The distribution of galanin-like immunoreactive structures was studied in the brain of the Senegalese sole, Solea senegalensis, using immunohistochemical methods. Periventricular immunoreactive cell bodies were observed in the rostral pole of the preoptic recess, within the pars parvocellularis of the nucleus preopticus parvocellularis. Another galanin-immunoreactive cell population was observed more caudal in the ventromedial hypothalamus, along the medial evaginations of the lateral recess. These cells appear within the cytoarchitectonic limits of the nucleus recessus lateralis pars ventralis. We found an extensive presence of galanin-immunoreactive fibres throughout the entire brain, although the most massive network of fibres was observed in the caudal olfactory bulbs, ventral telencephalon, preoptic area and around diencephalic ventricular recesses. Also, the hypophysis, ventricular mesencephalic area, median reticular formation and viscerosensory rhombencephalon displayed important plexuses of galanin-immunoreactive axons. The widespread distribution of these immunoreactive structures in the brain and pituitary of the Senegalese sole suggests an important role for galanin in neuroendocrine regulation of brain and adenohypophyseal functions.

Distribution of serotonin in the brain of the Senegalese sole, Solea senegalensis: an immunohistochemical study.

We report the distribution of serotonin immunoreactive (5-HT-ir) structures in the brain of the adult Senegalese sole, Solea senegalensis, using the streptavidin-biotin-peroxidase complex immunohistochemical method. We have found a wide distribution of immunoreactive fibers throughout the entire brain. 5-HT-ir cell bodies appeared restricted to some periventricular nuclei associated with the diencephalic recesses, and in the rhombencephalic reticular formation and inferior olivary region. Specifically, cerebrospinal fluid-contacting serotoninergic cells were found within the pars dorsalis and pars ventralis of the nucleus recessus lateralis, in the paraventricular organ and in the nucleus recessus posterioris. In the brainstem, 5-HT-ir perikarya appear within the superior and inferior raphe, the nucleus reticularis superioris, the nucleus interpeduncularis and the inferior olive. Although positive fibers were not found in the neurohypophysis, a few 5-HT-ir cells were identified in the adenohypophysis. This distribution is compared with those found in other fishes and discussed in the context of putative roles of 5-HT as a neuroendocrine factor and neurotransmitter in the Senegalese sole.

Inadecuación de los ingresos en un Servicio de Medicina Interna valorados en los protocolos A.E.P / Inappropiateness of the admissions in an Internal Medicine ward according the AEP Protocol

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