Intervenciones farmacéuticas en usuarios de benzodiacepinas durante la pandemia COVID-19 / Pharmaceutical interventions in benzodiazepine users during the COVID-19 pandemic

Introducción: la Intervención Farmacéutica busca optimizar y racionalizar el uso, la efectividad y la seguridad de los medicamentos dispensados resolviendo problemas relacionados con el medicamento (PRM) y resultados negativos asociados a la medicación (RNM).Objetivo: evaluar las Intervenciones Farmacéuticas realizadas a usuarios de benzodiacepinas durante la pandemia COVID-19 desde una Farmacia Comunitaria.Método: estudio prospectivo observacional, descriptivo y transversal (código AEMPS: DAA-CLO-2020-01) de las Intervenciones Farmacéuticas llevadas a cabo por una farmacia comunitaria tinerfeña entre agosto 2020 y febrero 2021.Resultados: un total de 306 Intervenciones Farmacéuticas fueron realizadas sobre 127 pacientes. La educación sanitaria y la información personalizada sobre el medicamento fueron las Intervenciones Farmacéuticas mayoritarias tras detectar entre los pacientes un alto grado de desconocimiento sobre las benzodiacepinas usadas. Las Intervenciones Farmacéuticas que se acompañan de derivación al médico alcanzan el 37,8 % tras detectar PRM y/o RNM o identificar al paciente como candidato para deprescripción. Estas derivaciones incluyen a los pacientes con un estado de depresión muy alto según el test Euroqol 5D-3L. La Intervención Farmacéutica con derivación al Servicio de Seguimiento Farmacoterapéutico se realiza en el 3,1 % de los pacientes. El grado de aceptación de la Intervención Farmacéutica por parte de los pacientes alcanza el 98,4 %.Conclusiones: el alto porcentaje de aceptación de las Intervenciones Farmacéuticas refuerza el valor de la Farmacia Comunitaria en la optimización y racionalización del uso de benzodiacepinas y fortalece el vínculo farmacéutico-paciente. La pandemia COVID-19 dificultó la colaboración farmacéutico-médico, a pesar de la existencia de protocolos telemáticos de comunicación entre sanitarios.(AU)

Impacto del tamaño tumoral y la invasión de la rete testis en la supervivencia libre de progresión de nuestros pacientes con seminoma testicular en estadio I. Estudio observacional retrospectivo en un hospital de referencia y revisión bibliográfica / Evaluation of tumour size and rete testis invasion in progression free survival of our patients with stage i testicular seminoma. A retrospective observational study of a reference hospital center and literature review

Introducción El objetivo de este estudio fue evaluar el impacto del tamaño tumoral y la invasión de la rete testis en la supervivencia libre de progresión de nuestros pacientes con seminoma testicular en estadio I. También se llevó a cabo una revisión bibliográfica. Material y métodos Se realizó un estudio observacional retrospectivo incluyendo a los pacientes con seminoma en estadio I entre enero de 2010 y julio de 2022. Se compararon los pacientes sin factores de pronóstico favorable (Grupo A) con pacientes que presentaban factores de pronóstico desfavorable (Grupo B). Se utilizaron curvas de Kaplan-Meier y pruebas de log-rank para comparar la supervivencia libre de progresión (SLP) entre estos grupos. La significación estadística se consideró a p ≤ 0,05. Resultados Se incluyeron 55 pacientes en este estudio. Veinte pacientes (36,4%) tenían un pronóstico favorable (grupo A) y 35 (63,6%) presentaban factores de pronóstico desfavorable (grupo B). La edad media fue similar en ambos grupos (media ± desviación estándar), 38,62 ± 9,04 años. El tiempo medio de seguimiento fue de 63,5 ± 33,6 meses. Todos los pacientes del grupo A y 25,7% de los pacientes del grupo B se sometieron a vigilancia activa (VA). Veintiséis pacientes (74,3%) del grupo B fueron tratados con un ciclo de carboplatino adyuvante. Tres pacientes sufrieron recidiva en ganglios retroperitoneales (10,3%), todos tratados con tres ciclos de bleomicina, etopósido, y cisplatino (BEP), presentando remisión completa de la enfermedad. No se encontraron diferencias estadísticamente significativas en la SLP entre los grupos A y B (log-rank p = 0,317). Conclusiones La individualización del tratamiento adyuvante en el seminoma estadio I es esencial para evitar los efectos adversos derivados del mismo. (AU)

Introduction The aim of this study was to evaluate the impact of tumour size and rete testis invasion in progression free survival of our patients with stage I testicular seminoma. A literature review is also made. Material and methods A retrospective observational study was performed. We included patients with stage I seminoma between January 2010 and July 2022. Patients without factors of poor prognostic –Group A– were compared with patients with factors of poor prognostic –Group B–. Kaplan-Meier curves and log-rank testing were used to compare progression free survival (PFS) between these groups. Statistical significance was considered at P ≤ .05. Results 55 patients were included in this study. 20 patients (36.4%) were of good prognostic –Group A– and 35 (63.6%) had factors of poor prognostic –Group B–. The mean age was similar in both groups (mean ± standard deviation), 38.62 ± 9.04 years. The mean follow-up time was 63.5 ± 33.6 months. All the patients in group A and 25.7% of the patients in group B underwent active surveillance (AS). 26 patients (74.3%) of the patients in Group B were treated with one cycle of adyuvant carboplatin. Three patients suffered a relapse with retroperitoneal lymph nodes (10.3%), all of them were treated with three cycles of BEP, with a complete response of the disease. No statistical significant differences were found in PFS between Group A and B (log Rank P = .317). Conclusions Individualization of adjuvant treatment in stage I seminoma is important, avoiding the adverse effects derived from them. (AU)

Evaluation of tumour size and rete testis invasion in progression free survival of our patients with stage i testicular seminoma. A retrospective observational study of a reference hospital center and literature review.

INTRODUCTION: The aim of this study was to evaluate the impact of tumour size and rete testis invasion in progression free survival of our patients with stage I testicular seminoma. A literature review is also made. MATERIAL AND METHODS: A retrospective observational study was performed. We included patients with stage I seminoma between January 2010 and July 2022. Patients without factors of poor prognostic -Group A- were compared with patients with factors of poor prognostic -Group B-. Kaplan-Meier curves and log-rank testing were used to compare progression free survival (PFS) between these groups. Statistical significance was considered at P≤.05. RESULTS: 55 patients were included in this study. 20 patients (36.4%) were of good prognostic -Group A- and 35 (63.6%) had factors of poor prognostic -Group B-. The mean age was similar in both groups (mean±standard deviation), 38.62±9.04 years. The mean follow-up time was 63.5±33.6 months. All the patients in group A and 25.7% of the patients in group B underwent active surveillance (AS). 26 patients (74.3%) of the patients in Group B were treated with one cycle of adyuvant carboplatin. Three patients suffered a relapse with retroperitoneal lymph nodes (10.3%), all of them were treated with three cycles of BEP, with a complete response of the disease. No statistical significant differences were found in PFS between Group A and B (log Rank P=.317). CONCLUSION: Individualization of adjuvant treatment in stage I seminoma is important, avoiding the adverse effects derived from them.

Prostate health index (PHI) as an accurate prostate cancer predictor.

PURPOSE: This study aims to compare the ability of the PHI versus tPSA test to predict the presence of PCa in our population. METHODS: A prospective observational study was performed. We included patients with tPSA ≥ 2.5 ng/ml, biopsy naïve or previous negative biopsy, undergoing a blood test, which includes tPSA, fPSA, and p2PSA, and a prostate biopsy between March 2019 and March 2022. Patients with PCa found in the biopsy-Group A-were compared with patients with a negative biopsy result-Group B. Diagnostic accuracy of tPSA and PHI was assessed by receiver operating characteristic [ROC] curves and logistic regression. RESULTS: 140 men were included. Fifty-seven (40.7%) had a positive prostate biopsy result (Group A), and 83 (59.3%) had a negative biopsy result (Group B). The mean age was similar in both groups (mean ± standard deviation), 66.86 ± 6.61 years. No difference was found in the tPSA value between the groups (Group A PSA: 6.11 ng/ml (3.56-17.01); Group B: 6.42 ng/ml (2.46-19.45), p = 0.41). The mean value of PHI was statistically different between groups (Group A 65.50 (29-146) vs. Group B 48 (16-233), p = 0.0001). The area under the curve 0.44 for tPSA and 0.77 for PHI. The multivariate logistic regression model applied to PHI showed a significant increase in its predictive accuracy: 72.14% in the model without PHI, 76.09% with PHI. CONCLUSION: The PHI test improves PCa detection compared to tPSA in our population.

Porphyromonas gingivalis outer membrane vesicles modulate cytokine and chemokine production by gingipain-dependent mechanisms in human macrophages.

OBJECTIVE: The aim was to determine the changes of inflammatory mediator expression in human macrophages stimulated with outer membrane vesicles purified from Porphyromonas gingivalis. DESIGN: outer membrane vesicles purified by ultracentrifugation from ATCC 33277 and W83 P. gingivalis strains were used for stimulating human macrophages and determine their inflammatory mediator expression changes. U937 monocyte cells line were differentiated into macrophages and stimulated with outer membrane vesicles for 30 min and six hours. In Independent experiments, the outer membrane vesicles and viable bacteria control were pre-treated with the gingipain inhibitors KYT-1 and KYT-36 (Arg-gingipain and Lys-gingipain, respectively) or Polymyxin-B to block the lipopolysaccharide activity to evaluate the secretion changes of immune mediators IL-1ß, IL-6, TNF-α, IL-8, MCP-1, MIP-1α and RANTES by flow cytometry. A factorial ANOVA was used to analyze the data. RESULTS: The outer membrane vesicles of P. gingivalis ATCC 33277 displayed higher Arg-gingipain activity than those obtained from the P. gingivalis W83 strain (0.6 U/µg vs. 0.46 U/µg). Although the outer membrane vesicles of P. gingivalis stimulated the production of cytokines and chemokines, specific Arg-gingipain and Lys-gingipain inhibition induced significant increases in IL-1ß, IL-6, IL-8, MCP-1, and RANTES levels, and this induction was significantly greater at 6 h compared to 30 min (*p < 0.05). On the contrary, TNF-α secretion decreased when gingipains were blocked. CONCLUSIONS: outer membrane vesicles may play a dual role during P. gingivalis infection based on their ability to induce changes in the immune responses of human macrophages, probably via gingipain-dependent events.

Check-list and questionnaire datasets on diversity in Spain's higher education.

Universities around the world, and particularly Spanish universities, are involved in the process of implementing diversity policies and practices, although productivity rankings have not yet considered inclusion indicators in their quality approaches. The current paper, which is a result of a national research project (No. EDU2017-82,862-R), describes two rich datasets on the issue of diversity in Spain's universities. Data were obtained by using a check-list and a questionnaire, collected in samples of 81 and 33 institutions, respectively. In particular, the paper provides extended descriptive data on institutionalisation of diversity indicators corresponding to philosophy and policy, and practices, that have been analysed in the article entitled 'Exploring the Status of Diversity in Policies and Practices of Spanish Universities. An Asymmetric Dual Model' [1]. It also reports descriptive statistics for indicators and areas by type of university (public vs. private). In addition, it shows graphical comparative data on standard scores of policies and practices vs. productivity indicators (global and partial U-Ranking indexes). Researchers, policy makers and practitioners could benefit from datasets, as they provide information on a good number of indicators reflecting strengths and weaknesses in university policies and practices in the field of diversity.

Cell fishing: A similarity based approach and machine learning strategy for multiple cell lines-compound sensitivity prediction.

The prediction of cell-lines sensitivity to a given set of compounds is a very important factor in the optimization of in-vitro assays. To date, the most common prediction strategies are based upon machine learning or other quantitative structure-activity relationships (QSAR) based approaches. In the present research, we propose and discuss a straightforward strategy not based on any learning modelling but exclusively relying upon the chemical similarity of a query compound to reference compounds with annotated activity against cell lines. We also compare the performance of the proposed method to machine learning predictions on the same problem. A curated database of compounds-cell lines associations derived from ChemBL version 22 was created for algorithm construction and cross-validation. Validation was done using 10-fold cross-validation and testing the models on new data obtained from ChemBL version 25. In terms of accuracy, both methods perform similarly with values around 0.65 across 750 cell lines in 10-fold cross-validation experiments. By combining both methods it is possible to achieve 66% of correct classification rate in more than 26000 newly reported interactions comprising 11000 new compounds. A Web Service implementing the described approaches (both similarity and machine learning based models) is freely available at: http://bioquimio.udla.edu.ec/cellfishing.

Inhibition of multidrug-resistant Staphylococci by sodium chlorate and select nitro- and medium chain fatty acid compounds.

AIMS: Determine the antimicrobial effects of 5 µmol ml-1 sodium chlorate, 9 µmol ml-1 nitroethane or 2-nitropropanol as well as lauric acid, myristic acid and the glycerol ester of lauric acid Lauricidin® , each at 5 mg ml-1 , against representative methicillin-resistant staphylococci, important mastitis- and opportunistic dermal-pathogens of humans and livestock. METHODS AND RESULTS: Three methicillin-resistant Staphylococcus aureus and two methicillin-resistant coagulase-negative staphylococci were cultured at 39°C in 5 µmol ml-1 nitrate-supplemented half-strength Brain Heart Infusion broth treated without or with the potential inhibitors. Results revealed that 2-nitropropanol was the most potent and persistent of all compounds tested, achieving 58-99% decreases in mean specific growth rates and maximum optical densities when compared with untreated controls. Growth inhibition did not persist by cultures treated solely with chlorate or nitroethane, with adaptation occurring by different mechanisms after 7 h. Adaptation did not occur in cultures co-treated with nitroethane and chlorate. The medium chain fatty acid compounds had modest effects on all the staphylococci tested except the coagulase-negative Staphylococcus epidermidis strain NKR1. CONCLUSIONS: The antimicrobial activity of nitrocompounds, chlorate and medium chain fatty acid compounds against different methicillin-resistant staphylococci varied in potency. SIGNIFICANCE AND IMPACT OF THE STUDY: Results suggest that differential antimicrobial activities exhibited by mechanistically dissimilar inhibitors against methicillin-resistant staphylococci may yield potential opportunities to combine the treatments to overcome their individual limitations and broaden their activity against other mastitis and dermal pathogens.

Growth of Candida norvegensis (strain Levazoot 15) with different energy, nitrogen, vitamin, and micromineral sources.

To examine the growth of Candida norvegensis (strain Levazoot 15), four experiments were conducted with different sources of energy, nitrogen, vitamins, and microminerals. Optical density was used as an indirect measure of strain growth in a fully randomized factorial design, in which principal factor A was the source of energy, nitrogen, vitamins, or microminerals and principal factor B was the measurement time point (0, 20, or 40 h). The results showed that the yeast strain used glucose (primarily sucrose and lactose) as the energy source and tryptone as the nitrogen source. The addition of B-complex vitamins or microminerals was not necessary for strain growth. It is concluded that the strain Levazoot 15 preferentially utilizes glucose as a source of energy, tryptone as a source of nitrogen and manganese as a mineral source, and that no vitamin source was necessary for growth.

Intervalo de confianza para las normas del cefalograma resumido de Ricketts en niños de cubanos

Introducción: en hallazgos cefalométricos de diferentes países en poblaciones conpatrones de crecimientos y oclusión normal, se reportan diferencias estadísticamentesignificativas a los valores dados en los cefalogramas de Ricketts, Steiner, Downs,Jarabak y otros. En Cuba no existen estudios de estos patrones en niños con denticiónmixta los que favorecerían un mejor diagnóstico de las anomalías dento-maxilofaciales.Objetivo: proponer el perfeccionamiento de las normas del cefalograma resumido deRicketts para los niños.Materiales y Métodos: investigación observacional, descriptiva en cuatropoblaciones pertenecientes a las siguientes zonas del país: Matanzas, Cárdenas,Camagüey y Sancti Spíritus. El universo estuvo constituido por 1 657 niños de 9 añosde edad. La muestra 163 niños, seleccionados por el método estratificado porconglomerados con oclusión dentaria normal. Se utilizó el análisis del cefalogramaresumido de Ricketts y la prueba t de media para determinar los valores de lasvariables estudiadas y se hicieron estimaciones puntuales y por intervalos de confianza [AU]

Isolation and characterization of yeasts from fermented apple bagasse as additives for ruminant feeding

Abstract Solid-state fermentation can be used to produce feeds for ruminants, which can provide an enriched population of yeasts to improve ruminal fermentation. Fermentation of apple bagasse was performed to obtain a yeast-rich product, with the objective of isolating, identifying, and characterizing yeast strains and testing their capability to enhance in vitro ruminal fermentation of fibrous feeds. Yeasts were isolated from apple bagasse fermented under in vitro conditions, using rumen liquor obtained from cannulated cows and alfalfa as a fibrous substrate. A total of 16 new yeast strains were isolated and identified by biochemical and molecular methods. The strains were designated Levazot, followed by the isolate number. Their fermentative capacity was assessed using an in vitro gas production method. Strain Levazot 15 (Candida norvegensis) showed the greatest increase in gas production (p < 0.05) compared with the yeast-free control and positively affected in vitro ruminal fermentation parameters of alfalfa and oat straw. Based on these results, it was concluded that the Levazot 15 yeast strain could be potentially used as an additive for ruminants consuming high-fiber diets. However, further studies of effects of these additives on rumen digestion, metabolism, and productive performance of ruminants are required.

Isolation and characterization of yeasts from fermented apple bagasse as additives for ruminant feeding.

Solid-state fermentation can be used to produce feeds for ruminants, which can provide an enriched population of yeasts to improve ruminal fermentation. Fermentation of apple bagasse was performed to obtain a yeast-rich product, with the objective of isolating, identifying, and characterizing yeast strains and testing their capability to enhance in vitro ruminal fermentation of fibrous feeds. Yeasts were isolated from apple bagasse fermented under in vitro conditions, using rumen liquor obtained from cannulated cows and alfalfa as a fibrous substrate. A total of 16 new yeast strains were isolated and identified by biochemical and molecular methods. The strains were designated Levazot, followed by the isolate number. Their fermentative capacity was assessed using an in vitro gas production method. Strain Levazot 15 (Candida norvegensis) showed the greatest increase in gas production (p<0.05) compared with the yeast-free control and positively affected in vitro ruminal fermentation parameters of alfalfa and oat straw. Based on these results, it was concluded that the Levazot 15 yeast strain could be potentially used as an additive for ruminants consuming high-fiber diets. However, further studies of effects of these additives on rumen digestion, metabolism, and productive performance of ruminants are required.

Aspectos sobre la medición del impacto de la caries dental en la calidad de vida de las personas: artículo de revisión / Bearing impact measure of the dental caries in the quality of life: review article

Objetivo: Determinar, mediante una revisión de literatura publicada, la existencia de estudios enfocados en la relación entre historia de caries y calidad de vida relacionada a salud oral (CVRSO) utilizando instrumentos validados. Material y Método: Artículo de revisión bibliográfica de literatura publicada los últimos diez años usando la base de datos MEDLINE. Dos revisores independientes recopilaron y analizaron los artículos en dos etapas: En una primera etapa fueron seleccionados aquellos artículos en que en su resumen relacionaran historia de caries y calidad de vida utilizando un instrumento de medición validado, excluyendo todos aquellos en que los individuos tuvieran alguna patología base que por si misma afecta su calidad de vida y artículos de validación. En una segunda etapa fue analizado el texto completo de los artículos previamente seleccionados, se aceptaron estudios experimentales y observacionales, se excluyeron artículos de revisión. Los desacuerdos fueron resueltos por consenso. Resultados: De un total de 311 artículos, 12 artículos relacionaban enfermedades orales y calidad de vida relacionada a salud oral siendo "historia de caries" uno más de los parámetros medidos y 6 artículos tenían como objetivo relacionar directamente "historia de caries" y "calidad de vida", en estos últimos las dimensiones más afectadas fueron: dolor dental, comer-masticar alimentos, lavarse los dientes y sonreír.

Aim: To determine, through a review of published literature, the existence of studies focused on the relationship between history of decay and quality of life related to oral health (QOLROH), using validated instruments. Material and Method: Literature review of reports published in the last ten years using the MEDLINE database. Two reviewers independently assessed and analyzed articles in two stages: In the first stage the articles whose abstract related dental caries and quality of life using a validated measurement instrument were selected, excluding those in which individuals had a systemic pathology affecting itself their quality of life, and excluding articles of validation. In a second stage the full text of the previously selected articles was analyzed, experimental and observational studies were accepted and review articles were excluded. Disagreements were resolved by consensus. Results: Out of a total of 311 articles, 12 articles connected oral diseases and quality of life related to oral health, being "history of decay" one more of the measured parameters and only 6 articles related directly "history of decay" and "quality of life". In the latter the most affected dimensions were: Dental pain, eat-chew food, brushing your teeth and smile.

Utilidad y dificultades para la realización del informe de enfermería al alta hospitalaria según las enfermeras del Hospital de Fuenlabrada / Usefulness and difficulties for the elaboration of the nursing discharge report, according to Hospital de Fuenlabrada (Spain) nursing group

Objetivo. Evaluar la percepción de la utilidad y las dificultades de elaboración del actual informe de recomendaciones de cuidados al alta por parte de las enfermeras de hospitalización del Hospital de Fuenlabrada (Madrid). Método. Estudio descriptivo, transversal, a través de cuestionario, realizado a todas las enfermeras de unidades de hospitalizaciónen el Hospital de Fuenlabrada; desarrollado durante el último trimestre de 2006. El cuestionario recogía variables sociodemográficas, variables referidas a la percepción de la utilidad del informe en general y variables para medir la dificultad de cumplimentación del informe. Se entregaron y recogieron personalmente en las unidades de hospitalización. Para el análisis estadístico se utilizaron el test de 2 y el test de la t de Student y/o el análisis de la varianza. Se utilizó el paquete estadístico SPSS/PC versión 12.0.Resultados. Se obtuvieron un total de 74 cuestionarios contestados (57,4% de la población de estudio). De las enfermeras encuestadas, 61 (82,4%) consideraron útil el informe de recomendaciones de cuidados al alta para asegurar la continuidad de los cuidados y 57 (77%) estimaron que es útil para facilitar información a los pacientes. Un total de 60 (82,1%) profesionales consideraron que la estructura del informe es poco o algo adecuada. Conclusiones. El nivel de satisfacción de las enfermeras con el informe es alto. Lo consideran una buena herramienta para asegurarla continuidad de los cuidados, y además es útil para el paciente. El principal elemento que se debe mejorar es su estructura (AU)

Objective. To evaluate the utility and difficulty of writing the nursing discharge report perceived by nurses working in the hospitalization unit of the Fuenlabrada Hospital in Spain. Method. We performed a cross-sectional, descriptive study in all nurses working in hospitalization units in the Fuenlabrada Hospital(Madrid) in the last trimester of 2006. A questionnaire was used to collect sociodemographic variables, variables related to perceived utility of the report in general and variables measuring the difficulty of completing the report. The questionnaires weredelivered to the hospitalization units and collected personally. For the statistical analysis, the chi-square test and Student’s t-test and/or analysis of variance were used. The SPSS/PC statistical package, version 12.0, was used. Results. Seventy-four completed questionnaires were obtained (57.4 % of the population analyzed). Of the nurses surveyed, 61(82.4 %) considered the report to be useful in assuring continuity of care and 57 nurses (77 %) thought it useful in providing information to the patients. In total, 60 nurses (82.1 %) considered the report’s structure to be not very suitable or unsuitable. Conclusions. Nurses’ satisfaction with the report is high. The report is seen as effective in assuring continuity of care and as useful to patients. However, the report’s structure should be improved (AU)

[Clinical epidemiological study of vascular epilepsy]. / Estudio clínico epidemiológico de la epilepsia vascular.

INTRODUCTION: Little research has been conducted on vascular epilepsy (VE) in our environment, although some authors claim it accounts for 45% of all symptomatic epilepsies in persons over 60 year of age. PATIENTS AND METHODS: We obtained a cross-sectional sample of the hospital admissions that took place in our health area between 1999 and 2005 using the diagnosis-related group coding system with numbers 14 (specific cerebrovascular disorders, except transient ischemic attacks and intracerebral haemorrhages) and 810 (intracerebral haemorrhages), and crossing them with an admission diagnosis of epileptic seizures or symptomatic status epilepticus. We recruited 101 patients who had been diagnosed with VE (taking into account only those who had seizures two weeks after the acute event). This represented 9.14% of all new cases of epilepsy over that period of time. RESULTS: After rejecting patients who had had their stroke before 1999 and those for whom no accurate record of the event was available, we obtained an incidence of VE in ischaemic strokes of 6.5%, with a figure of 11.6% for haematomas. Status epilepticus was reported in 27.7% of cases. Early status epilepticus was associated with a mortality rate of 77.7%. CONCLUSIONS: Although the incidence of VE is higher than in other series that have appeared in the literature, our sample is too small to be able to extract data concerning demographic characteristics. Nevertheless, its prevalence makes it an important health issue that increases the rate at which resources are used and adds further insecurity in the case of individuals who already suffer some degree of disability.

Estudio clínico epidemiológico de la epilepsia vascular / Clinical epidemiological study of vascular epilepsy

La epilepsia vascular (EV) se ha estudiado poco en nuestro medio; para algunos autores constituyeel 45% de las epilepsias sintomáticas de las personas por encima de 60 años. Pacientes y métodos. Obtuvimos una muestra transversal de los ingresos hospitalarios realizados en nuestra área sanitaria entre 1999 y 2005, utilizando el sistema de codificaciónpor grupos relacionados con el diagnóstico con los números 14 (trastornos cerebrovasculares específicos, excepto accidentes isquémicos transitorios y hemorragias intracerebrales) y 810 (hemorragias intracerebrales), cruzándolos con diagnóstico de ingreso de crisis epiléptica o estado de mal sintomático. Seleccionamos 101 pacientes con el diagnóstico deEV (considerando sólo los que presentaron crisis después de dos semanas del evento agudo). Esto supuso el 9,14% de nuevos casos de epilepsia en ese período. Resultados. Desestimando los pacientes que habían sufrido el ictus antes de 1999 y aquéllos en los que no figuraba con exactitud, obtuvimos una incidencia de EV en ictus isquémico del 6,5%, y en hematomas del11,6%. En el 27,7% se registraron estados de mal epiléptico. El estado de mal epiléptico precoz se asoció con una mortalidad del 77,7%. Conclusiones. Aunque la incidencia de EV es más elevada que en otras series publicadas, la muestra es pequeña para extraer datos sobre las características demográficas. Sin embargo, su prevalencia la convierte en un problema de saludimportante que incrementa el consumo de recursos y añade inseguridad en individuos que ya sufren algún grado de minusvalía

Little research has been conducted on vascular epilepsy (VE) in our environment, although some authors claim it accounts for 45% of all symptomatic epilepsies in persons over 60 year of age. Patients and methods. Weobtained a cross-sectional sample of the hospital admissions that took place in our health area between 1999 and 2005 using the diagnosis-related group coding system with numbers 14 (specific cerebrovascular disorders, except transient ischemicattacks and intracerebral haemorrhages) and 810 (intracerebral haemorrhages), and crossing them with an admission diagnosis of epileptic seizures or symptomatic status epilepticus. We recruited 101 patients who had been diagnosed with VE (taking into account only those who had seizures two weeks after the acute event). This represented 9.14% of all new cases of epilepsy over that period of time. Results. After rejecting patients who had had their stroke before 1999 and those for whom noaccurate record of the event was available, we obtained an incidence of VE in ischaemic strokes of 6.5%, with a figure of 11.6% for haematomas. Status epilepticus was reported in 27.7% of cases. Early status epilepticus was associated with a mortality rate of 77.7%. Conclusions. Although the incidence of VE is higher than in other series that have appeared in theliterature, our sample is too small to be able to extract data concerning demographic characteristics. Nevertheless, its prevalence makes it an important health issue that increases the rate at which resources are used and adds further insecurityin the case of individuals who already suffer some degree of disability

Predictors of left ventricular dysfunction in patients with Takayasu's or giant cell aortitis.

OBJECTIVES: The aim of this study was to determine the clinical and angiographic predictors of left ventricular systolic dysfunction (LVSD) from a relatively large and angiographically characterized Takayasu's or Giant Cell aortitis (TA/GCA) population. BACKGROUND: LVSD in patients with TA/GCA has been described in case reports and attributed variously to hemodynamic and immunologic factors. The predictors of LVSD in patients with angiographically confirmed TA/GCA are not known. METHODS: We identified 78 patients with angiographically confirmed TA/ GCA that underwent transthoracic echocardiography (TTE) at Mayo Clinic. Echocardiograms were then reviewed independently by reviewers blinded to clinical and angiographic data. LVSD was defined as an ejection fraction (LVEF) less than 50%. RESULTS: The study population was 84% Caucasian (54/78), 91% female (58/78), and had a mean age of disease onset of 30 years (+/- 15 years). LVSD was present in 14 of 78 patients (18%) with TA/GCA. The mean LVEF in the LVSD group (n = 14) was 37% +/- 7%, compared to an LVEF of 62% +/- 6% (p < 0.0001) in those without LVSD (n = 64). LVSD was not associated with hypertension or aortic regurgitation (p > 0.5). However, LVSD was found in 43% (9/21) of patients with aortic arch involvement, versus only 9% (5/57) of patients without aortic arch involvement (p = 0.0013). Patients with LVSD had a median of 2 (range 1-4) involved aortic segments compared to a median of 1 (range 1-4) among those without LVSD (p = 0.013). CONCLUSIONS: In TA/GCA aortitis, LVSD is associated with involvement of the aortic arch and with the greater extent of aortic involvement. The hemodynamic variables, aortic regurgitation and systemic hypertension, were not associated with LVSD, consistent with reports that cardiac inflammation is responsible for LVSD in a majority of cases. Ours is the first study to estimate an incidence of LVSD in patients with TA/GCA aortitis, which was 18%.

Síndrome nefrótico congénito y síndrome de down: reporte de un caso y revisión de la literatura / Congenital nephrotic syndrome and down syndrome: report of case and literature revision

El síndrome nefrótico congénito durante el primer año de vida es poco frecuente en nuestro medio, al igual que en otros países de latinoamérica; lo contrario ocurre en otros países europeos donde la prevalencia es mayor: Se ha encontrado asociaciones de esta síndrome con alteraciones embrionarias como el nefroblastoma, anormalidades genitales, seudohermafroditismo, síndrome uñarótula y displasia congénita de la cadera. Se describe el caso clínico de un lactante menor femenina de 6 meses de edad con síndrome nefrótico congénito y síndrome de down; esta asociación no ha sido descrita previamente en la literatura nacional. El estudio histopatológico mostró disminución en el número de glomerulos y la lesión observada en los gromérulos fue una esclerosis mesangial difusa retráctil

Characterization of local memory cells in stage-classified pulmonary tuberculosis: preliminary observations.

Immunophenotype analysis and proliferative responses were investigated in bronchoalveolar lavage (BAL) cells from 21 patients with stage-classified tuberculosis: six with localized pulmonary infiltrate (LPI); seven with diffuse pulmonary infiltrate (DPI); and eight with pleural effusions (PE). Bronchoalveolar lavage cells from these patients contained a high number of cells/ml. The macrophage number was significantly lower in the DPI group (P < 0.05) compared to the LPI or PE groups. Conversely, neutrophils were markedly increased in DPI patients compared to LPI (P < 0.01) and PE (P < 0.01) patients. Lymphocyte infiltration (97.7 +/- 2.3% CD3+, > 83% alphabeta+ and CD4+ > CD8+) was observed in the three groups. A significant increase in the number of total lymphocytes (P < 0.01) and CD4+ cells (P < 0.05) was observed in the LPI group compared to the PE group. In the LPI group CD4+CD45RO+ cell infiltration was higher than CD4+CD45RA+ cells (P < 0.001), contrasting to similar numbers of these subpopulations in the DPI group. Lymphocytes from three out of three LPI patients (alphabeta+CD4+CD45RO+) responded against tuberculin purified protein derivative contrasting to the unresponsiveness of five patients with either DPI or PE. This impaired response was reverted in two out of five patients by using peripheral blood monocytes instead of alveolar macrophages. It is suggested that, in humans, alphabetaCD4+CD45RO cells are the main lymphocyte type involved in the initial local cell-mediated immune response against Mycobacterium tuberculosis.