Enlentecimiento Obsesivo: Caso clínico y revisión bibliográfica / Obsessional slowness: a clinical case and bibliographic review

Introducción: El Enlentecimiento Obsesivo (EO) es un síndrome caracterizado por un enlentecimiento en la ejecución motora. Se caracteriza por un enlentecimiento conductual, una extrema me-ticulosidad, ausencia de ansiedad prodrómica o disconfort antes, durante o después del comportamiento, con relativa resistencia al mismo, siendo altamente incapacitante.Objetivos: Realizar una revisión bibliográfica del fenómeno del EO en la literatura reciente y mostrar un caso paradigmático aten-dido en nuestro Equipo.Métodos: Se ha realizado un método mixto. Por un lado, de descripción de un paciente diagnosticado de EO y por otro, de re-visión no sistemática mediante la base de datos Pubmed usando la palabra clave: “obsessional slowness”. Se excluyeron los estu-dios de validación de escalas del EO y aquellos estudios en que el EO aparece en otras patologías de manera comórbida como en el síndrome de Tourette, síndrome de Down o enlentecimiento aso-ciado a la depresión. Para la preservación de la confidencialidad y anonimato del paciente, se han modificado aspectos en relación a sus antecedentes biográficos.Resultados: El enlentecimiento obsesivo es una condición nor-malmente secundaria a un Trastorno Obsesivo Compulsivo. Tiene una escasa prevalencia, pero manifiesta casi siempre gravedad y tendencia deterioro. Va asociada a diversas comorbilidades psi-quiátricas (por ejemplo, Trastornos del Espectro Autista y/o Sín-drome de Tourette). Afecta fundamentalmente a hombres y tiene especificidades propias, como la falta de malestar prodrómico, la falta de resistencia subjetiva a la clínica y la presencia de clínica encubierta en ocasiones por las manifestaciones conductuales del enlentecimiento. Discusión Y Conclusiones: El tratamiento ha de ser multitécnico (en la parte más psicológica) y multidisciplinar. En todo caso, se ha de destacar que aún nos falta muchos conocimientos y actualización de los datos disponibles actualmente.(AU)

Introduction: Obsessive Slowness (OS) is a syndrome cha-racterized by a slowing in motor execution. It is characterized by behavioral slowing, extreme meticulousness, absence of prodromal anxiety or discomfort before, during or after the behavior, with rela-tive resistance to it, being highly incapacitating.Objectives: To carry out a bibliographic review of the OS phe-nomenon in the recent literature and to show a paradigmatic case treated in our Team.Methods: A mixed method has been carried out. On the one hand, a description of a patient diagnosed with OE and on the other, a non-systematic review using the Pubmed database using the keyword: “obsessional slowness”. Validation studies of OS scales and those studies in which OS appears in other comorbid patho-logies such as Tourette’s syndrome, Down’s syndrome or depres-sion-associated slowing were excluded. For the preservation of the confidentiality and anonymity of the patient, aspects in relation to his biographical background have been modified.Results: Obsessive slowing is a condition usually secondary to Obsessive Compulsive Disorder. It has a low prevalence, but al-most always manifests severity and a tendency to deterioration. It is associated with various psychiatric comorbidities (for example, Autism Spectrum Disorders and/or Tourette’s Syndrome). It fun-damentally affects men and has its own specificities, such as the lack of prodromal discomfort, the lack of subjective resistance to symptoms, and the presence of symptoms sometimes hidden by the behavioral manifestations of slowness.discussion and conclusion: The treatment must be multi-tech-nical as psychological therapies and multidisciplinary. In any case, it should be noted that we still lack much knowledge and updating of currently available data.(AU)

Release and mobility of hexavalent chromium in contaminated soil with chemical factory waste: Experiments, Cr isotope analysis and reactive transport modeling.

Our study focused on the leaching processes in soil contaminated with hexavalent chromium (Cr(VI)), traced to industrial waste from a disused site and resulting in groundwater contamination. Mineral and geochemical characterization of the soil by means of XRD, SEM-EDS, total digestion and sequential extractions revealed that the main Cr content was from solid waste located in the upper meter of the soil profile. Flow-through and column experiments were carried out to investigate the processes responsible for Cr(VI) release. Cr(VI) mobility along the soil profile was also assessed. Moreover, Cr isotope signatures were used to evaluate a potential Cr(VI) reduction process, which preferably could immobilize toxic Cr(VI) complexes. One-dimensional (1D) numerical simulations reproduced the Cr(VI) release from the flow-through experiment containing the Cr(VI) rich-solid waste and also the Cr(VI) mobility along the column experiment. These results enabled us to interpret quantitatively the processes resulting in Cr(VI) contamination and mobility along the soil profile. Cr(VI) was released from dissolving Cr(VI)-rich phases (e.g., sodium chromate, Cr(VI)-hydrocalumite and Cr(VI)-ettringite) of the solid waste layer. Cr(VI) reduction and Cr(VI) adsorption did not take place along the column. Such accurate characterization of these processes is necessary for the mitigation of Cr(VI) mobility in contaminated soils.

Release of trace elements during bioreductive dissolution of magnetite from metal mine tailings: Potential impact on marine environments.

Adverse impacts of mine tailings on water and sediments quality are major worldwide environmental problems. Due to the environmental issues associated with the deposition of mine tailings on land, a controversial discussed alternative is submarine tailings disposal (STD). However, Fe(III) bioreduction of iron oxides (e.g., magnetite) in the tailings disposed might cause toxic effects on coastal environments due to the release of different trace elements (TEs) contained in the oxides. To study the extent and kinetics of magnetite bioreduction under marine conditions and the potential release of TEs, a number of batch experiments with artificial seawater (pH 8.2) and a marine microbial strain (Shewanella loihica) were performed using several magnetite ore samples from different mines and a mine tailings sample. The elemental composition of the magnetite determined in the tailings showed relatively high amounts of TEs (e.g., Mn, Zn, Co) compared with those of the magnetite ore samples (LA-ICP-MS and EMPA analyses). The experiments were conducted at 10 °C in the dark for up to 113 days. Based on the consumption of lactate and production of acetate and aqueous Fe(II) over time, the magnitude of Fe(III) bioreduction was calculated using a geochemical model including Monod kinetics. Model simulations reproduced the release of iron and TEs observed throughout the experiments, e.g., Mn (up to 203 µg L-1), V (up to 79 µg L-1), As (up to 17 µg L-1) and Cu (up to 328 µg L-1), suggesting a potential contamination of pore water by STD. Therefore, the results of this study can help to better evaluate the potential impacts of STD.

A Serious Game on the First-Aid Procedure in Choking Scenarios: Design and Evaluation Study.

BACKGROUND: Choking is one of the causes of unintentional injury death. Gaining the knowledge of the first-aid procedure that has to be applied in case of choking can increase the chances of survival of persons with choking. Serious games can be a good channel for educating people about choking scenarios and the actions to be taken to save the persons with choking. OBJECTIVE: The objective of this study is to present and evaluate the effectiveness of a serious game designed to prevent choking and to promote the first-aid procedure that needs to be applied in case of choking. METHODS: In this study, we present a serious game as a set of minigames that reproduces the main steps of the protocol for the first-aid performed in choking. In the proposed game, the player acquires the role of a helper who has to save the person in a choking emergency by applying the main steps of the protocol. Time and score restrictions are imposed to pass each minigame. To test this game, we performed a pilot study with 48 high school students. Different tests were performed to assess the students' preferences and their knowledge on choking before and after playing the proposed game. The obtained results were analyzed using Mann-Whitney U test when a grade variable was involved and by using Fisher exact test when 2 categorical variables were involved. RESULTS: The findings of our study showed that the players enjoyed the game. No statistical differences were detected when considering the gender of the player, their preferences for video games, or their previous experience in choking emergencies. By comparing the knowledge of these students before and after playing the game, we found that all the indicators of the knowledge about how to act in case of a choking emergency were improved through this serious game. CONCLUSIONS: The findings of our study show that the proposed game is a good strategy for promoting and teaching first-aid procedures in choking emergencies to nonexperts in this field.

Identifying Predictors of the Visceral Fat Index in the Obese and Overweight Population to Manage Obesity: A Randomized Intervention Study.

INTRODUCTION: Nowadays, obesity is one of the main causes of death and disability. In recent years, it has been shown that the excess and distribution of body fat increases morbidity, with excess visceral fat being the most important factor that triggers pathologies. Thus, estimation of visceral fat makes it possible to identify patients with a higher cardiovascular risk, aiding the management of obesity. The main objective of the study was to identify predictors of the visceral fat index through a lifestyle intervention and to observe the effect of the intervention on dietary habits and functional capacity. METHODS: A randomized intervention, parallel-group study was made. This study included 97 obese and overweight people (control group, n = 48; experimental group, n = 49) with a low socioeconomic status in an 8-month lifestyle intervention. Anthropometric, fitness and nutritional tests were assessed. RESULTS: It was found that being female, eating the recommended daily portions of fruit, gaining strength in the legs and gaining flexibility are factors predictive of a lower visceral fat index. Age over 45 years and eating the recommended weekly portions of cereals and meats, fat and processed meats increases the visceral fat index after a lifestyle intervention. There were changes in the visceral fat index and in the different physical condition variables, but not in eating habits. CONCLUSION: A multicomponent lifestyle intervention reduces the visceral fat index; age over 45 and consuming cereals and meat increases the visceral fat index.

Dissimilatory bioreduction of iron(III) oxides by Shewanella loihica under marine sediment conditions.

Shewanella is a genus of marine bacteria capable of dissimilatory iron reduction (DIR). In the context of deep-sea mining activities or submarine mine tailings disposal, dissimilatory iron reducing bacteria may play an important role in biogeochemical reactions concerning iron oxides placed on the sea bed. In this study, batch experiments were performed to evaluate the capacity of Shewanella loihica PV-4 to bioreduce different iron oxides (ferrihydrite, magnetite, goethite and hematite) under conditions similar to those in anaerobic sea sediments. Results showed that bioreduction of structural Fe(III) via oxidation of labile organic matter occurred in all these iron oxides. Based on the aqueous Fe (II) released, derived Fe(II)/acetate ratios and bioreduction coefficients seem to be only up to about 4% of the theoretical ones, considering the ideal stoichiometry of the reaction. A loss of aqueous Fe (II) was caused by adsorption and mineral transformation processes. Scanning electron microscope images showed that Shewanella lohica was attached to the Fe(III)-oxide surfaces during bioreduction. Our findings suggest that DIR of Fe(III) oxides from mine waste placed in marine environments could result in adverse ecological impacts such as liberation of trace metals in the environment.

How the gender of a victim character in a virtual scenario created to learn CPR protocol affects student nurses' performance.

BACKGROUND AND OBJECTIVE: Virtual simulations recreate scenarios where student nurses can practice procedures in a safe and supervised manner and with no risk to the patient. Virtual scenarios include digital characters that reproduce human actions. Generally, these characters are modeled as males and restricted roles are assigned to females. Our objective is to evaluate how the character gender of a victim in a scenario created to practice the cardiopulmonary resuscitation protocol (CPR) affects performance of student nurses. METHODS: Three virtual scenarios with cardiac arrest victims modeled as males or females were assigned to 41 students of the Nursing Faculty to practice the CPR protocol. We evaluated student performance with respect to the time to remove clothes, the time to perform the CPR maneuver, and the hands position for CPR. Chi-square, Fisher exact, and Mann-Whitney U were used to test primary outcome measures in the experimental design of victim character sex (male vs. female) and student sex (men vs. women). RESULTS: The analysis performed did not find statistically differences in time to remove clothes or in time to start CPR. With respect to hands placement we also did not find significant difference in any of the cases. CONCLUSION: Nurse student actions are not influenced by the character gender of the victim. Excellent results with respect to hands placement to start CPR are obtained. Virtual scenarios can be a suitable strategy to reduce gender differences in gender sensitive situations such as CPR performance.

Comparative modeling of an in situ diffusion experiment in granite at the Grimsel Test Site.

An in situ diffusion experiment was performed at the Grimsel Test Site (Switzerland). Several tracers ((3)H as HTO, (22)Na(+), (134)Cs(+), (131)I(-) with stable I(-) as carrier) were continuously circulated through a packed-off borehole and the decrease in tracer concentrations in the liquid phase was monitored for a period of about 2years. Subsequently, the borehole section was overcored and the tracer profiles in the rock analyzed ((3)H, (22)Na(+), (134)Cs(+)). (3)H and (22)Na(+) showed a similar decrease in activity in the circulation system (slightly larger drop for (3)H). The drop in activity for (134)Cs(+) was much more pronounced. Transport distances in the rock were about 20cm for (3)H, 10cm for (22)Na(+), and 1cm for (134)Cs(+). The dataset (except for (131)I(-) because of complete decay at the end of the experiment) was analyzed with different diffusion-sorption models by different teams (IDAEA-CSIC, UJV-Rez, JAEA) using different codes, with the goal of obtaining effective diffusion coefficients (De) and porosity (ϕ) or rock capacity (α) values. From the activity measurements in the rock, it was observed that it was not possible to recover the full tracer activity in the rock (no activity balance when adding the activities in the rock and in the fluid circulation system). A Borehole Disturbed Zone (BDZ) had to be taken into account to fit the experimental observations. The extension of the BDZ (1-2mm) is about the same magnitude than the mean grain size of the quartz and feldspar grains. IDAEA-CSIC and UJV-Rez tried directly to match the results of the in situ experiment, without forcing any laboratory-based parameter values into the models. JAEA conducted a predictive modeling based on laboratory diffusion data and their scaling to in situ conditions. The results from the different codes have been compared, also with results from small-scale laboratory experiments. Outstanding issues to be resolved are the need for a very large capacity factor in the BDZ for (3)H and the difference between apparent diffusion coefficients (Da) from the in situ experiment and out-leaching laboratory tests.

Improved prediction of knee osteoarthritis progression by genetic polymorphisms: the Arthrotest Study.

OBJECTIVE: The aim of this study was to develop a genetic prognostic tool to predict radiographic progression towards severe disease in primary knee OA (KOA) patients. METHODS: This investigation was a cross-sectional, retrospective, multicentric association study in 595 Spanish KOA patients. Caucasian patients aged ≥40 years at the time of diagnosis of primary KOA of Kellgren-Lawrence grade 2 or 3 were included. Patients who progressed to Kellgren-Lawrence score 4 or who were referred for total knee replacement within 8 years after diagnosis were classified as progressors to severe disease. Clinical variables of the initial stages of the disease (gender, BMI, age at diagnosis, OA in the contralateral knee, and OA in other joints) were registered as potential predictors. Single nucleotide polymorphisms and clinical variables with an association of P < 0.05 were included in the multivariate analysis using forward logistic regression. RESULTS: A total of 23 single nucleotide polymorphisms and the time of primary KOA diagnosis were significantly associated with KOA severe progression in the exploratory cohort (n = 220; P < 0.05). The predictive accuracy of the clinical variables was limited: area under the curve (AUC) = 0.66. When genetic variables were added to the clinical model (full model), the prediction of KOA progression was significantly improved (AUC = 0.82). Combining only genetic variables (rs2073508, rs10845493, rs2206593, rs10519263, rs874692, rs7342880, rs780094 and rs12009), a predictive model with good accuracy was also obtained (AUC = 0.78). The predictive ability for KOA progression of the full model was confirmed on the replication cohort (two-sample Z-test; n = 62; P = 0.190). CONCLUSION: An accurate prognostic tool to predict primary KOA progression has been developed based on genetic and clinical information from OA patients.

Direct nanoscale observations of the coupled dissolution of calcite and dolomite and the precipitation of gypsum.

In-situ atomic force microscopy (AFM) experiments were performed to study the overall process of dissolution of common carbonate minerals (calcite and dolomite) and precipitation of gypsum in Na2SO4 and CaSO4 solutions with pH values ranging from 2 to 6 at room temperature (23 ± 1 °C). The dissolution of the carbonate minerals took place at the (104) cleavage surfaces in sulfate-rich solutions undersaturated with respect to gypsum, by the formation of characteristic rhombohedral-shaped etch pits. Rounding of the etch pit corners was observed as solutions approached close-to-equilibrium conditions with respect to calcite. The calculated dissolution rates of calcite at pH 4.8 and 5.6 agreed with the values reported in the literature. When using solutions previously equilibrated with respect to gypsum, gypsum precipitation coupled with calcite dissolution showed short gypsum nucleation induction times. The gypsum precipitate quickly coated the calcite surface, forming arrow-like forms parallel to the crystallographic orientations of the calcite etch pits. Gypsum precipitation coupled with dolomite dissolution was slower than that of calcite, indicating the dissolution rate to be the rate-controlling step. The resulting gypsum coating partially covered the surface during the experimental duration of a few hours.

La competencia: El trabajo colaborativo: una oportunidad para incorporar las TIC en la didáctica universitaria. Descripción de la experiencia...

Material que hace referencia a la importancia de las nuevas tecnologías en la transición de las transformaciones que se han operado en el aprendizaje: la web 2.0 y, más recientemente, la web 3.0, que han modificado los conceptos de información y de comunicación y un buen aporte que analiza el concepto de competencias educativas.

De novo urgency after tension-free vaginal tape versus transobturator tape procedure for stress urinary incontinence.

OBJECTIVE: To determine the frequency of de novo urgency after tension-free vaginal tape (TVT) compared with the transobturator tape (TOT) procedure in women with stress urinary incontinence (SUI). STUDY DESIGN: Prospective study of all consecutive women with urodynamically confirmed SUI undergoing anti-incontinence surgery between January 2000 and January 2008. All procedures were performed by experienced urogynaecologists well trained in TVT and TOT surgery. Assessments were carried out at 1, 6, 12 and, 36 months after surgery. RESULTS: The study population included 366 women (mean age 59.5 years), 243 in the TVT group and 123 in the TOT group. The groups were similar in terms of demographics, preoperative data, and cure rates. De novo urgency occurred in 13.4% of patients at 6 months after surgery, in 19.3% at 12 months, and in 22.1% at 36 months. De novo urgency was significantly more frequent in the TVT group than in the TOT group at 12 (22.2% vs 11.2%, P=0.025), 24 (24.8% vs 12.3%, P=0.033), and 36 (0% vs 24.7%, P=0.034) months. Cure rates were similar in both groups. The final adjusted cure rate was 87.3% (319/366). CONCLUSION: Treatment of SUI using the TOT procedure was associated with a lower rate of de novo urgency.

La externalización de los Servicios de Alimentación / The outsourcing of the Services of Supply

Las externalizaciones de Servicios en los centros sanitarios, especialmente los Generales, son quizá el mejor ejemplo de la llamada colaboración público-privada, y una oportunidad para la reducción de costes y la contribución a la sostenibilidad del Sistema Sanitario (AU)

The outsourcings services in the sanitary centers, specially the Generals, are probably the best example of the so called collaboration public - private road, and an opportunity for the reduction of costs and the contribution to the sustainability of the Sanitary System (AU)

Anisotropic diffusion in layered argillaceous rocks: a case study with Opalinus Clay.

Anisotropic diffusion was studied in Opalinus Clay, a potential host rock for disposal of spent fuel, vitrified high-level waste, and long-lived intermediate-level waste in Switzerland. Diffusion parallel to the bedding was measured using a radial through-diffusion technique and diffusion perpendicular to the bedding bythe classical (planar) through-diffusion technique. The samples used were from Mont Terri (MT) and from Benken (BE). Diffusion of HTO, 36Cl-, and 22Na+ parallel and perpendicular to the bedding was studied under confining pressures of 7 MPa (MT) and 14 MPa (BE). The results indicate that diffusion parallel to the bedding is faster than diffusion perpendicular to the bedding by a factor of 4-6 for the three radionuclides, indicating that the Opalinus Clay is anisotropic. This might be explained by smaller path lengths (tortuosity) for species diffusing parallel to the fabric. The degree of anisotropy is slightly smaller for Opalinus Clay from Mont Terri than from Benken. This is due to the lower overburden pressure in Mont Terri resulting in a lower preferential orientation of the clay platelets.

Small cell melanoma and ulceration as predictors of positive sentinel lymph node in malignant melanoma patients.

Malignant melanoma (MM) early lymph node (LN) metastasis usually appears first in the sentinel LN (SLN). Breslow thickness is the main factor considered in the selection of patients to be submitted to SLN biopsy. The present study aimed to describe other independent prognostic factors useful in SLN candidate selection. During one year, 94 MM patients (90 primary cutaneous MM with Breslow thickness > or = 0.76 mm, and four cutaneous relapses), were submitted to SLN biopsy in the Melanoma Unit at the Hospital Clinic, Barcelona, Spain. The prognostic factors studied were: Breslow thickness, Clark's level of invasion, mitotic rate, cellular type (small, epithelioid, fusocellular, sarcomatoid), vertical growth phase, regression > 50%, severe vascularization, infiltrate (lymphocytic, plasmocytic), ulceration, neurotropism, intravascular/intraneural invasion, protein p16 expression and recurrence. Nineteen SLN (20.2%) were positive and 75 (79.8%) negative. No positive SLN occurred in MM with Breslow thickness < or = 1.0 mm. Breslow thickness > or = 2 mm (P = 0.005), severe vascularization (P = 0.005), small cell (P = 0.000) and ulceration (P = 0.005) were significant prognostic factors by univariate analysis. Small cell (P = 0.008) and ulceration (P = 0.05) were also significant prognostic factors in a multivariate analysis. The probability of finding a positive SLN for small cell was 56.9% [95% confidence interval (CI), 26.8-82.6%]. The probability of positive SLN for ulceration was 35.5% (95% CI, 14.2-64.7%). For small cell and ulceration together the probability increased to 86.3% (95% CI, 54.3-97.1%). The results of this study corroborated ulceration as a prognostic factor for SLN candidate selection and for the first time we have described small cell melanoma morphology as a significant factor associated with positive SLN.

Tubular and interstitial expression of ICAM-1 as a marker of renal injury in IgA nephropathy.

BACKGROUND: The upregulated renal expression of intercellular adhesion molecule 1 (ICAM-1) is associated with glomerular and interstitial infiltration of leukocytes. AIM: To test the hypothesis that renal expression of ICAM-1 may be predictive in the highly variable IgA nephropathy (IgAN). METHODS: ICAM-1 (CD54) in tubular epithelium and interstitial leukocytes, macrophages (CD14), and T cells (CD3) were assessed using avidin-biotin-peroxidase in renal biopsy specimens from 45 patients with IgAN and from 29 patients with no glomerulonephritis. RESULTS: In IgAN, tubular ICAM-1+ was seen in 25 of 45 (55%) biopsy specimens, associated with glomerular hypercellularity, glomerulosclerosis involving less than 50% of the glomerular area, interstitial cellular infiltration, tubular atrophy, and proteinuria (U = 44, p = 0.005). Interstitial ICAM-1+ leukocytes were correlated with glomerulosclerosis involving less and more than 50% of the glomerular area, tubular atrophy, interstitial fibrosis, and serum creatinine concentration (r = 0.6343, p < 0.001). In patients with an increase of 50% in the serum creatinine concentration, interstitial ICAM-1+ leukocytes and CD14+ and CD3+ cells were significantly more numerous than in patients with a stable creatinine concentration. In patients with no glomerulonephritis, tubular ICAM-1+ was seen in 7 of 29 (24%) biopsy specimens, inversely correlated with the number of normal glomeruli and associated with glomerulosclerosis covering more than 50% of the glomerular area, tubular atrophy, and creatinine. CONCLUSIONS: Tubular and interstitial expression of ICAM-1 can be a marker of tubulointerstitial disturbance in IgAN. Interstitial ICAM-1 may be an adverse predictor of disease progression.

Trough-to-peak ratio, smoothness index, and circadian blood pressure profile after treatment with once-daily fixed combination of losartan 100 and hydrochlorothiazide 25 in essential hypertension.

The once-daily fixed combination of losartan 100 mg/hydrochlorothiazide 25 mg was evaluated for safety and efficacy in a multicenter open study by using 24-h ambulatory blood pressure monitoring in untreated patients with moderate-to-severe essential hypertension or patients with uncontrolled hypertension despite treatment with monotherapy or low-dose combination. After a 2-week washout period, 41 patients (22 men, 19 women) aged 34-74 years, showing a mean daytime blood pressure > 135/85 mm Hg, were treated with losartan 100 mg/hydrochlorothiazide 25 for 8 weeks. Ambulatory blood pressure was monitored at the end of the washout period and during the last week of treatment. A significant reduction in the average values of clinic blood pressure (from 169.9 +/- 13.5 mm Hg to 139.5 +/- 15.6 mm Hg, p < 0.001 for systolic blood pressure [SBP]; and from 102.2 +/- 7.1 mm Hg to 85.1 +/- 9.5 mm Hg, p < 0.001 for diastolic blood pressure [DBP]) was observed after treatment in the whole group of 41 patients. Likewise, average values of both 24-h SBP and 24-h DBP were significantly reduced (from 145.7 +/- 13.1 mm Hg to 128.3 +/- 14.6 mm Hg, p < 0.001 for 24-h SBP; and from 90.3 +/- 7.3 mm Hg to 79.2 +/- 8.6 mm Hg, p < 0.001 for 24-h DBP). The average lowering at peak was 20.2 +/- 11.8 mm Hg for 24-h SBP and 12.1 +/- 7.4 mm Hg for 24-h DBP, whereas the lowering at trough was 17.8 +/- 12.0 mm Hg and 10.4 +/- 8.1 mm Hg, respectively. The trough-to-peak ratio (T/P) was 0.88 for SBP and 0.86 for DBP, and the smoothness index was 7.36 for SBP and 6.37 for DBP. The response rate was 87.8% (blood pressure lowering > 5 mm Hg of either 24-h SBP or 24-h DBP average values). Among responders, T/P ratio was 0.89 for SBP and 0.87 for DBP, and the smoothness index was 8.09 for SBP and 7.15 for DBP. No side effects or changes in metabolic parameters were observed. The fixed combination of losartan 100 mg/hydrochlorothiazide 25 was very effective and well tolerated.

Expresión renal de la molécula de adhesión intercelular-1 (ICAM-1) en la nefropatía mesangial por depósitos de IgA. Un marcador de lesión tubulointersticial / Renal expression of ICAM-1 in IgA nephropathy. A marker of tubulointersticial injury

FUNDAMENTO: Conocer el significado clínicopatológico de la expresión renal de ICAM-1 en la nefropatía mesangial por IgA (NIgA). PACIENTES Y MÉTODO: Se identificó la expresión tubular e intersticial ICAM-1 (CD54) en 45 pacientes con NIgA y 29 pacientes con nefropatía no glomerulonefritis (NnoGN), analizándose su relación con la histología y la clínica en el momento de la biopsia renal y al cabo de 2,4 (2) (media [DE]) años en la NIgA y de 1,8 (1,5) años en la NnoGN. RESULTADOS: En 25 biopsias de NIgA (55 por ciento) se apreció expresión de ICAM-1 en el túbulo asociada a proliferación extracapilar (p < 0,05), así como esclerosis glomerular menor del 50 por ciento del área glomerular (p < 0,005), infiltración intersticial (p < 0,001) y atrofia tubular (p < 0,001). La proteinuria fue de 2,7 (1,5) g/24 h en los pacientes con expresión ICAM-1 en el túbulo y 1,5 (1,8) (p = 0,005) en los pacientes sin esta expresión. El número de leucocitos intersticiales ICAM-1 positivos fue de 234 (307)/mm2, y se correlacionó con la esclerosis glomerular en menos (r = 0,386; p < 0,05) y en más (r = 0,549; p = 0,01) del 50 por ciento del área glomerular, con la atrofia tubular (r = 0,442; p < 0,05); con la fibrosis intersticial (r = 0,405; p < 0,05) y con la creatinina (Cr) sérica (r = 0,6343; p < 0,001). Los pacientes con un incremento del 50 por ciento o superior de la Cr inicial presentaron 516 (360)/mm2 leucocitos intersticiales ICAM-1 positivos, frente a 66 (87,8)/mm2 p < 0,005) en los pacientes con Cr estable. En la NnoGN, 7 de las 29 biopsias (24 por ciento) presentaron ICAM-1 en el epitelio tubular. Hubo correlación inversa entre túbulo ICAM-1 positivos y glomérulos normales (r = -0,374; p < 0,05) y asociación con la esclerosis en más del 50 por ciento del área glomerular p < 0,005) y la atrofia tubular (p < 0,05). El número de leucocitos intersticiales ICAM-1 positivos fue de 191 (113)/mm2. Hubo correlación (r = 0,4356; p < 0,05) entre túbulo ICAM-1positivos y Cr en el momento de la biopsia. CONCLUSIONES: La expresión tubular e intersticial de ICAM-1 podría ser un marcador de lesión tubulointersticial en la NIgA. La presencia de ICAM-1 intersticial más que ICAM-1 tubular indicaría la progresión de la enfermedad en la NIgA (AU)

Homeopatia: ciencia o pseudociencia? - Parte I / Homeopathy: science or pseudoscience? - Part I

En el presente trabajo el autor, a traves del estudio y lectura de filosofos, historiadores y cientificos modernos, describe en la primera parte del trabajo las pautas del metodo cientifico, criticandose en la parte central del trabajo la dogmatica exigencia de basar la formulacion de toda nueva hipotesis en la herencia del cuerpo cientifico, argumentando los trabajos de T. Kuhn y K. Popper como critica de esta exigencia. La conclusion del trabajo es que la Homeopatia es un candidato al nuevo paradigma surgido de la crisis de la clasica medicina mecanicista. La pretension del autor, que dirige este trabajo a la Comunidad Homeopatica, es la de invitar a esta a articular la investigacion cientifica Homeopatica dentro del marco de la propia Homeopatia, teniendo en cuenta que esta es una medicina amplia, completa y peculiar que en muchos aspectos no puede compatibilizarse con los metodos de investigacion de la medicina tradicional