Impact of Endometrial Receptivity Analysis on Pregnancy Outcomes In Patients Undergoing Embryo Transfer: A Systematic Review and Meta-Analysis.

To analyze the influence of endometrial receptivity analysis (ERA) on embryo transfer (ET) results in patients undergoing in vitro fertilization (IVF) treatment. PubMed, Embase, Cochrane Central Register of Controlled Trials, and BioMed Central databases were searched from inception up to December 2022 for studies comparing pregnancy outcomes in patients undergoing personalized embryo transfer (pET) by ERA versus standard ET. Data were pooled by meta-analysis using a random effects model. We identified twelve studies, including 14,224 patients. No differences were observed between patients undergoing ERA test and those not undergoing ERA test prior to ET in terms of live birth (OR 1.00, 95% CI 0.63-1.58, I2 = 92.7%), clinical pregnancy (OR 1.20, 95% CI 0.90-1.61, I2 = 86.5%), biochemical pregnancy (OR 0.83, 95% CI 0.46-1.49, I2 = 87%), positive pregnancy test (OR 0.99, 95% CI 0.80-1.22, I2 = 0%), miscarriage (OR 0.91, 95% CI 0.62-1.34, I2 = 67.1%), and implantation rate (OR 1.18, 95% CI 0.44-3.14, I2 = 93.2%). pET with ERA is not associated with any significant differences in pregnancy outcomes as compared to standard ET protocols. Therefore, the utility of ERA in patients undergoing IVF should be revisited.

Estudio del efecto intercromosómico en portadores de anomalías cromosómicas estructurales equilibradas mediante PGT-SR / Study of the interchromosomal effect in carriers of balanced structuralchromosomal rearrangements by PGT-SR

Los portadores de anomalías estructurales cromosómicas equilibradas, a pesar de ser fe-notípicamente normales, tienen una competencia reproductiva disminuida de manera significativa conrespecto a la población general. Esto se debe a que, durante la gametogénesis, dependiendo de cómo sesegregue la alteración cromosómica en la meiosis I, se generarán gametos normales, equilibrados o des-equilibrados en mayor proporción que en portadores de cariotipos normales. Esta es la causa principalEstudio del efecto intercromosómico en portadores de anomalías cromosómicasestructurales equilibradas mediante PGT-SRStudy of the interchromosomal effect in carriers of balanced structuralchromosomal rearrangements by PGT-SR de la mayor tasa de abortos y descendencia con alteraciones que presentan los individuos portadores de inversiones ytranslocaciones recíprocas o robertsonianas. Otra posible fuente de gametos y/o embriones aneuploides, es el denominadoefecto intercromosómico (EIC), que consiste en una interferencia producida por una alteración cromosómica estructuralsobre la adecuada disyunción y segregación de otros cromosomas no involucrados en dicha alteración.Material y Métodos:Un total de 40 parejas fueron incluidas en el estudio, de las cuales 31 pertenecieron al grupo de es-tudio: catorce translocaciones robertsonianas, trece translocaciones recíprocas y cuatro de inversiones pericéntricas. Endiecinueve casos la mujer era portadora y en los doce restantes era el hombre el afecto. Nueve parejas con cariotipo normal,portadoras de una mutación responsable de enfermedad monogénica fueron incluidas en el grupo control. (AU)

Introduction: Carriers of balanced structural rearrangements, despite being phenotypically normal, they have a signifi-cantly decreased reproductive competence compared to the general population. The reason is because, during gametoge-nesis, depending on how the chromosomal alteration is segregated in meiosis I, normal, balanced, or unbalanced gameteswill be generated in greater proportion than in carriers of normal karyotypes. This is the main cause of the higher rate ofabortions and offspring with alterations that carriers of inversions, reciprocal translocations or Robertsonian translocationspresent. Another possible source of aneuploid gametes and/or embryos is the so-called interchromosomal effect (ICE),which consists of an interference produced by a structural chromosomal alteration on the proper disjunction and segregationof other chromosomes not involved in the rearrangement.Material and methods:A total of 40 couples were included in the study, of which 31 belonged to the study group: fourteenRobertsonian translocations, thirteen reciprocal translocations and four pericentric inversions. As for the affected parent,in nineteen of the cases the woman was the carrier of the chromosomal alteration and in the remaining twelve it was theman who was affected. Nine couples with a normal karyotype, carriers of a mutation responsible for monogenic disease,were included in the control group. (AU)

[Results of the implementation of a protocol of attention to victims of sexual assault in Emergencies of a reference tertiary hospital.] / Resultados de la implantación de un protocolo de atención a víctimas de agresiones sexuales en Urgencias de un hospital terciario de referencia.

OBJECTIVE: To assess the degree of compliance of the Comprehensive Health and Judicial Care Protocol for Victims of Sexual Assaults attended in Emergencies, and to compare the quality indicators of care with those obtained for the 2 years prior to its implementation. METHODS: Retrospective, comparative, cohort study of the 128 victims (124 women and 4 men), aged 4 to 62 years, treated in the Hospital Emergency Department, before and after the publication of the Protocol through the CIE-10 diagnostic code T74.2 Sexual assault and CIE-10 T76.2 Suspected sexual assault, between January 2018 and December 2020. The sample was divided into two groups, before (n=80) and after (n=48) the implementation of the protocol. A sub-analysis of 109 women older than 16 years attended in the Gynecological Emergencies has been performed. RESULTS: The implementation of the Protocol has led to a significant increase in the compliance with the main indicators, more evident in Gynecological Emergencies: HIV prophylaxis (43.4% vs 83.7%, respectively in the Pre and Post-protocol Groups), pregnancy prophylaxis (54.5% vs 81.4%), police intervention (48.5% vs 74.4%) and SIVIO form compliance (16.7% vs 46.5%). Attention time has not shown significant changes. The referral for psychological support has been increased by a very low percentage (0% vs 12.5%). CONCLUSIONS: The implementation of the Protocol has led to an evident improvement in the quality of care in Emergencies, with a significant increase in key indicators. Care time in Emergencies should be reduced, and the SIVIO form compliance, as well as the referral for psychological support should be increased.

OBJETIVO: El objetivo principal de este estudio fue evaluar el cumplimiento del Protocolo de Atención Integral, Sanitaria y Judicial, a Víctimas de Agresiones Sexuales en Urgencias, y comparar los indicadores de calidad asistencial con los obtenidos los 2 años previos a su implantación. METODOS: Se realizó un estudio retrospectivo, comparativo, de cohortes, de 128 víctimas (124 mujeres y 4 hombres) de 4 a 62 años atendidas en Urgencias, entre enero de 2018 y diciembre de 2020 con los códigos diagnósticos CIE 10 T74.2 Agresión sexual y CIE 10 T76.2 Sospecha de agresión sexual. La muestra se dividió en dos grupos, antes (n=80) y después (n=48) de la implantación del protocolo. Se realizó un sub-análisis de 109 mujeres mayores de 16 años atendidas en Urgencias Ginecológicas. RESULTADOS: La implantación del Protocolo supuso un incremento significativo del cumplimiento de los indicadores, más evidente en Urgencias Ginecológicas, siendo los más relevantes: profilaxis VIH (43,4% vs 83,7%, respectivamente en Grupos Pre y Post-protocolo), profilaxis de embarazo (54,5% vs 81,4%), personación de la policía (48,5% vs 74,4%) y cumplimentación del informe en el Sistema de Información de Violencia de Género (SIVIO) (16,7% vs 46,5%). El tiempo de atención en Urgencias no mostró cambios significativos. La derivación para apoyo psicológico aumentó en un porcentaje muy bajo (0% vs 12,5%). CONCLUSIONES: La implantación del Protocolo ha supuesto una mejora evidente de la calidad asistencial en Urgencias, con incremento significativo del cumplimiento de los principales indicadores considerados. Debe reducirse el tiempo de atención, y aumentar la cumplimentación de SIVIO y la derivación para apoyo psicológico para mejorar el seguimiento y prevenir secuelas a largo plazo.

The RANKL/RANK system in female reproductive organ tumors: A preclinical and clinical overview.

The receptor activator of nuclear factor-κB (RANK) and its ligand RANKL are members of the tumor necrosis factor (TNF) super-family of cytokines with a role in progestogen-associated malignancies in breast. Basic and clinical data support the participation of the cytokine pathway in metastatic disease and as poor prognosis markers. The value of RANK/RANKL as prognostic indicators in endometrial and ovarian tumors, as well as the data suggesting a potential role of RANK/RANKL in hormone dependent tumorigenesis in the endometrium, have been described. The D-CARE study could not confirm benefit in the modulation of RANKL in breast cancer.

Aplicación del diagnóstico genético preimplantacional en la distrofia miotónica tipo 1 o enfermedad de Steinert / Application of pre-implantation genetic diagnosis in Myotonic dystrophy type 1 - Steinert's disease

La distrofia miotónica tipo 1 (DM1) es la forma más común de distrofia muscular en adultos causada por la expansión de una repetición de trinucleótidos CTG en el gen DMPK (Distrofia miotónica proteína quinasa) y su herencia es autosómica dominante. Hasta el momento, la técnica de Diagnóstico Genético Preimplantacional parece ser la aproximación reproductiva más eficaz para aquellas parejas en las que alguno de sus progenitores es afecto de DM1. En este estudio se evaluó la técnica de Diagnóstico Genético Preimplantacional en función del sexo del progenitor afecto y el número de repeticiones CTG y su influencia sobre el resultado reproductivo de la misma. Un total de 13 parejas, del programa de Diagnóstico Genético Preimplantacional de la Unidad de Reproducción Asistida del Hospital Universitari i Politècnic La Fe, fueron incluidas en el estudio. En 8 de éstas la afecta es la mujer, mientras que en las 5 restantes es el hombre el portador de la enfermedad. En todas ellas se llevaron a cabo todos los pasos del programa. Los embriones fueron analizados mediante mTP-PCR y PCR multiplex. El efecto de ambas variables se analizó mediante análisis bivariado (prueba T, Chi-cuadrado, regresión lineal y test Anova) y análisis multivariante utilizando análisis de correlación (Rho de Spearman). Los resultados obtenidos revelaron una transmisión preferencial de los alelos expandidos en DM1, independiente del sexo del progenitor afecto. A pesar de ello, no mostraron ninguna relación estadísticamente significativa entre el sexo del progenitor afecto ni el número de repeticiones CTG y el resultado reproductivo de la técnica. De modo que, atendiendo a nuestros resultados, el Diagnóstico Genético Preimplantacional sería una buena aproximación reproductiva en casos de DM1 con una tasa de gestación de 53,8 % y de nacidos sanos de 38,5 %, independientemente del sexo del progenitor afecto y del número de repeticiones CTG

Myotonic dystrophy type 1 (DM1) is the most common form of muscular dystrophy in adults caused by the expansion of a CTG trinucleotide repeat in the DMPK gene (dystrophia myotonica-protein kinase gene) and its inheritance is autosomal dominant. So far, the technique of Preimplantation Genetic Diagnosis (PGD) seems to be the most effective reproductive approach for those couples in which one of their parents is affected by DM1. In this study, the Preimplantation Genetic Diagnosis technique was evaluated according to the sex of the affected progenitor and the number of CTG repetitions and their influence on the reproductive result of itself. A total of 13 couples from the Preimplantation Genetic Diagnosis program of the Assisted Reproduction Unit of the Hospital Universitario i Politècnic La Fe were included in the study were included in the study. In 8 of them the affected parent is the woman, whereas the 5 remaining is the man who is the disease carrier. In all of them, all the steps of the program were followed. The embryos were analyzed by mTP-PCR and multiplex PCR. The variables effect was analyzed by bivariate analysis (T-test, Chi-square, linear regression and Anova test) and multivariate analysis using correlation analysis (Spearman's rho). The results obtained revealed a preferential transmission of the expanded alleles in DM1, regardless of the sex of the affected parent. In spite of, the results obtained do not show any statistically significant relation between the sex of the progenitor and the number of repetitions and the reproductive result of the technique. Thus, according to our results, Preimplantation Genetic Diagnosis would be a good reproductive approach in cases of DM1 with a gestation rate of 53.8% and healthy births of 38.5%, regardless of the sex of the affected parent and the number of CTG repetitions

Análisis de la interacción de acenocumarol y levofloxacino en ancianos institucionalizados / Analysis of acenocoumarol and levofloxacin interaction in elderly institutionalized patients

Objetivo: Analizar la interacción levofloxacino-acenocumarol en ancianos y determinar la influencia de la hipoalbuminemia en el incremento del international normalized ratio. Método: Estudio observacional retrospectivo en ancianos institucionalizados que recibieron simultáneamente acenocumarol y levofloxacino. Se analizó la variación del international normalized ratio durante el tratamiento con levofloxacino mediante la prueba t-Student. Se estudió la relación entre la albuminemia y la variación del international normalized ratio mediante el coeficiente de correlación de Pearson. Resultados: La media del international normalized ratio previa al tratamiento con levofloxacino fue de 2,5 (desviación estándar 0,6) y durante el tratamiento fue de 4,7 (desviación estándar 1,9) (p < 0,05). En el 54,3% de los casos el valor del international normalized ratio fue igual o superior a 4,5. La prueba de Pearson no mostró asociación lineal entre la albuminemia y el incremento del international normalized ratio (R = -0,16). Conclusiones: En más de la mitad de las ocasiones, el international normalized ratio alcanzó valores de relevancia clínica (≥ 4,5). No se evidenció influencia de la hipoalbuminemia en el incremento del international normalized ratio

Objective: To analyze the interaction between acenocoumarol and levofloxacin in the elderly. We also assessed how hypoalbuminemia affects international normalized ratio variation. Method: Retrospective study carried on elderly institutionalized patients who were prescribed levofloxacin concomitantly with acenocoumarol. International normalized ratio variation during levofloxacin treatment was analyzed with the t-Student test. Correlation between albuminemia and international normalized ratio variation was calculated using Pearson's correlation coefficient. Results: The mean international normalized ratio previous to treatment with levofloxacin was 2.5 (standard deviation: 0.6) and during treatment it was 4.7 (standard deviation: 1.9) (p < 0.05). In 54.3% of the cases, the international normalized ratio value was equal to or greater than 4.5. Not linear association between albuminemia and international normalized ratio increase was found using Pearson's test (R = -0.16). Conclusions: In more than half of the occasions international normalized ratio raised to clinically rellevant values (≥ 4.5). No influence of hypoalbuminemia in the increase in international normalized ratio was shown

Analysis of acenocoumarol and levofloxacin interaction in elderly institutionalized patients.

OBJECTIVE: To analyze the interaction between acenocoumarol and  levofloxacin in the elderly. We also assessed how hypoalbuminemia affects international normalized ratio variation. METHOD: Retrospective study carried on elderly institutionalized patients who were prescribed levofloxacin concomitantly with acenocoumarol.  International normalized ratio variation during levofloxacin treatment was analyzed with the t-Student test. Correlation between albuminemia and international normalized ratio variation was calculated using Pearson´s correlation coefficient. RESULTS: The mean international normalized ratio previous to treatment with levofloxacin was 2.5 (standard deviation: 0.6) and during treatment it was  4.7 (standard deviation: 1.9) (p < 0.05). In 54.3% of the cases, the  international normalized ratio value was equal to or greater than 4.5. Not  linear association between albuminemia and international normalized ratio  increase was found using Pearson´s test (R = -0.16). CONCLUSIONS: In more than half of the occasions international normalized ratio raised to clinically rellevant values (≥ 4.5). No influence of hypoalbuminemia in the increase in international normalized ratio was shown.

Objetivo: Analizar la interacción levofloxacino-acenocumarol en ancianos y  determinar la influencia de la hipoalbuminemia en el incremento del international normalized ratio.Método: Estudio observacional retrospectivo en ancianos institucionalizados que recibieron simultáneamente acenocumarol y  levofloxacino. Se analizó la variación del international normalized ratio  durante el tratamiento con levofloxacino mediante la prueba t-Student. Se  estudió la relación entre la albuminemia y la variación del international  normalized ratio mediante el coeficiente de correlación de Pearson.Resultados: La media de international normalized ratio previa al  tratamiento con levofloxacino fue de 2,5 (desviación estándar 0,6) y durante el tratamiento fue de 4,7 (desviación estándar 1,9) (p < 0,05). En el 54,3% de los casos el valor de international normalized ratio fue igual o superior a 4,5. La prueba de Pearson no mostró asociación lineal entre la albuminemia y el incremento de international normalized ratio (R = ­ 0,16).Conclusiones: En más de la mitad de las ocasiones, el international normalized ratio alcanzó valores de relevancia clínica (≥ 4,5).  No se evidenció influencia de la hipoalbuminemia en el incremento del  international normalized ratio.

Joint nociceptor nerve activity and pain in an animal model of acute gout and its modulation by intra-articular hyaluronan.

The mechanisms whereby deposition of monosodium urate (MSU) crystals in gout activates nociceptors to induce joint pain are incompletely understood. We tried to reproduce the signs of painful gouty arthritis, injecting into the knee joint of rats suspensions containing amorphous or triclinic, needle MSU crystals. The magnitude of MSU-induced inflammation and pain behavior signs were correlated with the changes in firing frequency of spontaneous and movement-evoked nerve impulse activity recorded in single knee joint nociceptor saphenous nerve fibers. Joint swelling, mechanical and cold allodynia, and hyperalgesia appeared 3 hours after joint injection of MSU crystals. In parallel, spontaneous and movement-evoked joint nociceptor impulse activity raised significantly. Solutions containing amorphous or needle-shaped MSU crystals had similar inflammatory and electrophysiological effects. Intra-articular injection of hyaluronan (HA, Synvisc), a high-MW glycosaminoglycan present in the synovial fluid with analgesic effects in osteoarthritis, significantly reduced MSU-induced behavioral signs of pain and decreased the enhanced joint nociceptor activity. Our results support the interpretation that pain and nociceptor activation are not triggered by direct mechanical stimulation of nociceptors by MSU crystals, but are primarily caused by the release of excitatory mediators by inflammatory cells activated by MSU crystals. Intra-articular HA decreased behavioral and electrophysiological signs of pain, possibly through its viscoelastic filtering effect on the mechanical forces acting over sensitized joint sensory endings and probably also by a direct interaction of HA molecules with the transducing channels expressed in joint nociceptor terminals.

Interdisciplinary approach to the management of medical supplies in the nursing home setting / Abordaje interdisciplinar de la gestión de productos sanitarios en el ámbito sociosanitario

Objective: To describe and evaluate the management of medical supplies by an interdisciplinary team in order to promote their rational use in the nursing home setting. Methods: An interdisciplinary team was set up, coordinated by a Pharmacy Unit including representatives of 18 elderly nursing homes (1,599 beds). Team interventions were assessed in terms of improvements in the management of wound care supplies. In addition, a retrospective descriptive study was carried out on those patients with pressure ulcers, in order to consider future interventions. Results: The team interventions led to a selection of 15% of the 180 wound care supplies from the public tender process. The monthly savings in wound dressing material purchases was at least 17%. Furthermore, a reduction in consumption greater than 50% was found in 7 centres. The prevalence of ulcers was 5.59%. A fourth of these ulcers were originated outside nursing homes. Conclusions: The creation of an interdisciplinary team, in which the pharmacist gets closer to patient needs, and where nurses share responsibility for the selection and management of medical supplies, leads to positive results and represents an opportunity for improvement in elderly care (AU)

Objetivo: Describir y evaluar la gestión de los productos sanitarios por un equipo interdisciplinar con la finalidad de racionalizar su utilización en el ámbito de la atención sociosanitaria. Métodos: Se creó un equipo interdisciplinar coordinado por un servicio de farmacia con representantes de 18 residencias para personas mayores dependientes (1.599 plazas asistenciales). Las intervenciones del equipo se valoraron en términos de mejora en la gestión de los productos sanitarios para curas. Además, se realizó un estudio descriptivo retrospectivo de los pacientes con úlceras por presión para considerar futuras intervenciones. Resultados: Las intervenciones del equipo resultaron en una selección del 15% de los 180 productos sanitarios para curas a partir del concurso público. El ahorro mensual en las compras de productos para cuidado de las úlceras fue como mínimo de un 17%. Además, se constató una reducción en el consumo superior al 50% en 7 centros. La prevalencia de úlceras fue del 5,59%. La cuarta parte de las úlceras tuvo un origen externo a la residencia. Conclusiones: La formación de un equipo interdisciplinar, en el que el farmacéutico se aproxima a las necesidades del paciente, y los profesionales de enfermería comparten la responsabilidad en la selección y gestión de los productos sanitarios, conduce a resultados positivos y supone una oportunidad de mejora en la atención a los mayores (AU)

Interdisciplinary approach to the management of medical supplies in the nursing home setting.

INTRODUCTION: Given the impact of pressure ulcers in institutionalized elderly people, an interdisciplinary approach to the care of ulcers and the management of medical supplies is essential. The aim of this study is to describe and evaluate the management of medical supplies by an interdisciplinary team in order to promote their rational use in the nursinghome setting. METHODS: An interdisciplinary team was set up, coordinated by a Pharmacy Unit including representatives of 18 elderly nursing homes (1,599 beds). Team interventions were assessed in terms of improvements in the management of wound care supplies. In addition, a retrospective descriptive study was carried out on those patients with pressure ulcers, in order to consider future interventions. RESULTS: The team interventions led to a selection of 15% of the 180 wound care supplies from the public tender process. The monthly savings in wound dressing material purchases was at least 17%. Furthermore, a reduction in consumption greater than 50% was found in 7 centres. The prevalence of ulcers was 5.59%. A fourth of these ulcers were originatedoutside nursing homes. CONCLUSIONS: The creation of an interdisciplinary team, in which the pharmacist gets closer to patient needs, and where nurses share responsibility for the selection and management of medical supplies, leads to positive results and represents an opportunity for improvement in elderly care.

Introducción: Dado el impacto de las úlceras por presión en las personas mayores institucionalizadas, es esencial el abordaje interdisciplinar del cuidado de las úlceras y de la gestión de los productos sanitarios. El objetivo de este estudio es describir y evaluar la gestión de los productos sanitarios por un equipo interdisciplinar con la finalidad de racionalizar su utilización en el ámbito de la atención sociosanitaria.Métodos: Se creó un equipo interdisciplinar coordinado por un servicio de farmacia con representantes de 18 residencias para personas mayores dependientes (1.599 plazas asistenciales). Las intervenciones del equipo se valoraron en términos de mejora en la gestión de los productos sanitarios para curas. Además, se realizó un estudio descriptivoretrospectivo de los pacientes con úlceras por presión para considerar futuras intervenciones.Resultados: Las intervenciones del equipo resultaron en una selección del 15% de los 180 productos sanitarios para curas a partir del concurso público. El ahorro mensual en las compras de productos para cuidado de las úlceras fue como mínimo de un 17%. Además, se constató una reducción en el consumo superior al 50% en 7 centros. La prevalencia de úlceras fue del 5,59%. La cuarta parte de las úlceras tuvo un origen externo a la residencia.Conclusiones: La formación de un equipo interdisciplinar, en el que el farmacéutico se aproxima a las necesidades del paciente, y los profesionales de enfermería comparten la responsabilidad en la selección y gestión de los productos sanitarios, conduce a resultados positivos y supone una oportunidad de mejora en la atención a los mayores.

Púrpura de Henoch Schönlein en niños: casuistica del Hospital de Gandia, Valencia. España / Henoch Schonlein purpura in children: Casuistic from the Hospital of Gandia. Valencia. Spain

La Purpura de Henoch Schonlein (PHS) es la vasculitis mas frecuente en pediatría. Su análisis epidemiológico, clínico y evolución, son importantes en el manejo de los pacientes. Objetivo general: Revisar unas serie de pacientes con PHS de un hospital de referencia comarcal. Método: Se recogió información de las historias clínicas y se analizaron los datos de acuerdo a parámetros definidos. Resultados: 17 pacientes menores de 15 años fueron evaluados; esta cifra corresponde a 29 casos/año/100.000 habitantes <15años edad promedio 6.12±4.9 años; predominio del sexo masculino; la mayoría de los casos se presentó en otoño e invierno. Se detectó antecedente infeccioso previo o concomitante en 47% de los casos, predominantemente infecciones del tracto respiratorio superior y, la forma de presentación mas frecuente fue la tríada: purpura cutánea palpable, manifestaciones gastrointestinales y articulares. Se encontró que 53% de los pacientes presentaron manifestación nefrológica inicial, predominando hematuria y proteinuria. Todos los casos mantuvieron función de filtración renal normal. Estreptococo beta hemolítico fue aislado en un tercio de los casos. Todos los pacientes han evolucionado satisfactoriamente después de 11±7 meses de seguimiento ambulatorio. Conclusiones: La casuística de PHS en este hospital muestra que la incidencia es mayor al promedio reportado en la mayoría de las casuísticas internacionales y es mayor en otoño, distinto a lo habitualmente reportado. Esto sugiere la probable existencia de factores ambientales, microbiológicos, o de otra índole, no precisados, lo cual ameritaría estudios pertinentes en materia de salud publica.

Background: Henoch Schonlein Purpura (HSP) is the commonest vasculitis in children. To perform epidemiological analysis and to evaluate clinic features and results of follow up are important for the adequate management of patients. Objectives: To review epidemiologic characteristics of HSP in a series of patients attended in a referral hospital in Spain and to analyze clinical, laboratory results and evolution of patients. Methods: Data from the clinical records was collected and analyzed according to defined parameters. Results: 17 patients under 15 years of age were evaluated; it corresponds to 29 cases/year/100.000 IH <15 years. Mean age 6.12±4.9 years. The majority of cases presented in autumn and winter. Infectious antecedent or simultaneous infection with the onset was detected in 47% of cases mainly in upper respiratory tract. Clinical presentation was the classical triad of palpable cutaneous purpura, gastrointestinal and joints manifestations. Initial nephrologic manifestations were found in 53% of cases, predominantly hematuria and proteinuria, with normal glomerular filtration ratio. Beta hemolytic streptococcus was isolated in one third of cases. After ambulatory follow up of 11±7 months all patients have had uneventful recovery. Conclusions: this casuistic of PHS shows that the incidence in this geographic area is higher compared with the majority of international and national series and it is more frequent in autumn, which is different to the reported in other series. This suggests the probable presence of environmental, microbiologic or another features, no clearly known, which requires analysis from the public health point of view.

An evaluation method for determination of non-polar pesticide residues in animal fat samples by using dispersive solid-phase extraction clean-up and GC-MS.

A rapid and easy method has been proposed, optimized and evaluated for quantitative determination at trace level of a representative group of non-polar pesticides in fat samples. The method includes n-hexane-saturated acetonitrile extraction, fat precipitation by cooling pre clean-up followed by dispersive solid-phase extraction (d-SPE) based on QuEChERS procedure clean-up. Determination was performed by gas chromatography-mass spectrometry (GC-MS) in selected ion monitoring (SIM) mode. Efficiency of the d-SPE clean-up step was evaluated by comparison with fat oxidation treatment and gel permeation chromatography. Different combinations of d-SPE extraction reagents and sample amounts were tested in order to minimize matrix co-extractives and interferences. Best recoveries were obtained with 1200 mg of MgSO(4), 400 mg of end-capped C(18), 400 mg of PSA and 1 g of sample amount. SIM method, matrix effect, precision, and accuracy were evaluated with spiked pork fat samples for 38 representative pesticides. Results of this study showed that this technique is applicable in routine analysis for its application into monitoring programs. It simplifies time-consuming clean-up steps and allows a satisfactory long-term chromatographic performance.

Agenesia congénita de endometrio. Una etiologia inusual de amenorrea primaria / Congenital absence of the endometrium: an unusual cause of primary amenorrhea

Se describe el caso de una paciente de 25 años que presenta amenorrea primaria y esterilidad como consecuencia de la agenesia congénita de endometrio, sin otro tipo de alteraciones fenotípicas, cromosómicas o endocrinológicas asociadas. Se discuten aspectos de la fisiopatología, el diagnóstico y las posibilidades terapéuticas en la actualidad (AU)

We report a case of primary amenorrhea and infertility due to congenital absence of the endometrium in a 25 year-old woman. There were no other malformations or endocrinological or chromosomal alterations. The physiopathological features, diagnosis and current therapeutic options in this malformation are discussed (AU)

Nociceptive nerve activity in an experimental model of knee joint osteoarthritis of the guinea pig: effect of intra-articular hyaluronan application.

Nociceptive impulse activity was recorded extracellularly from single A delta and C primary afferents of the guinea pig's medial articular nerve after induction of an experimental osteoarthritis in the knee joint by partial medial menisectomy and transection of the anterior cruciate ligament (PMM+TACL). Also, the analgesic effects of intra-articular hyaluronan solutions were evaluated. Healthy, PMM+TACL operated, sham-operated (opening of the joint capsule without PMM and TACL surgery) and acutely inflamed (intra-articular kaolin-carrageenan, K-C) animals were used. The stimulus protocol consisted of torque meter-controlled, standardized innocuous and noxious inward and outward rotations of the joint. This stimulus protocol of 50 s duration was repeated every 5 min for 70 min. One day, one week and three weeks after PMM+TACL, the movement-evoked discharges of A delta articular afferents were increased significantly over values found in sham-operated animals. The discharges of C fibers were significantly augmented only one week after PMM+TACL surgery. Filling of the joint cavity with a high viscosity hyaluronan solution (hylan G-F 20, Synvisc) immediately and three days after surgery reduced significantly the enhanced nerve activity observed in joint afferent fibers one day and one week after surgery. Augmentation of movement-evoked discharges in K-C acutely inflamed knee joints was similar to that observed one week after PMM+TACL. Our results indicate that in the PMM+TACL model of osteoarthritis in guinea pigs, enhancement of nociceptive responses to joint movement was primarily associated to post-surgical inflammation. Intra-articular injection of an elastoviscous hyaluronan solution reduced the augmented nerve activity.