Uso del complejo protrombínico en pacientes anticoagulados que desarrollan hemorragia intracraneal / Use of prothrombin complex in patients with an intracerebral hemorrhage who are on oral anticoagulants

El uso cada día más extendido de los anticoagulantes orales ha llevado al aumento del número de complicaciones con las que diariamente se enfrentan los servicios de urgencias (SU). El concentrado de complejo protrombínico (CCP) constituye una importante opción terapéutica cuando es urgente la reversión de la anticoagulación, ya que actúa de forma más rápida y completa que el plasma fresco congelado (PFC). A través del siguiente caso clínico, se revisa el uso e indicaciones del CCP en pacientes anticoagulados, y su utilización en procesos hemorrágicos intracraneales donde la rapidez de instauración del tratamiento es fundamental (AU)

The use of oral anticoagulants is increasing, leading to a rise in the number of complications emergency health services must cope with. A review of the literature showed that prothrombin complex is an important therapeutic option when emergency reversion of anticoagulation is required, as it acts more quickly and completely than fresh frozen plasma. In this case report we review the use and indications of prothrombin complex in patients on oral anticoagulants, noting that rapid onset of effect is particularly important in cases of intracerebral hemorrhage (AU)

A pilot study of ranolazine in patients with intermittent claudication.

AIM: This pilot study provides preliminary information regarding safety and changes in exercise performance during treatment with ranolazine extended-release in patients with reproducible claudication during exercise treadmill testing (ETT). METHODS: We enrolled 45 patients with documented peripheral arterial disease, reproducible claudication on ETT, and ankle-brachial indices <0.85 at rest that decreased by at least 0.15% or 20% immediately postexercise. Randomized patients received double-blind treatment with either ranolazine 1 000 mg b.i.d. (n=22) or placebo (n=23) for 4 weeks. RESULTS: Compared with baseline, peak walking time (PWT) increased (mean+/-SEM) by 53+/-34 s with ranolazine (P=0.13) and by 41+/-33 s with placebo (P=0.22). Pain-free walking time during ETT increased by 62+/-18 s with ranolazine (P=0.002) and 36+/-18 s with placebo (P=0.045). Supplemental analyses, excluding patients with baseline exercise duration (16 min and (12 min, showed additional improvement with ranolazine on PWT. CONCLUSIONS: Ranolazine was well tolerated and these data provide a rationale for proceeding with a definitive trial.

Immunosuppressive therapy and post-transplantation diarrhea.

Gastrointestinal complications, including diarrhea, are among the anticipated adverse events secondary to immunosuppression. The reported overall rate of diarrhea may be affected by drug-specific effects, dose-response effects, interactions with other medications, drug formulation, the length of study follow-up, reporting bias and population characteristics such as ethnicity and baseline disease, including transplant organ type. The true incidence of diarrhea is often difficult to assess from the numerous published clinical trials. A number of deficiencies, including self-reporting, interstudy comparisons, lack of blinding, concomitant medications and a general lack of standardization and quantification of diarrhea may greatly obscure comparisons among the different immunosuppressive medications. This review considers each of these factors in assessing the overall incidence of post-transplantation diarrhea for the various immunosuppressive medications currently in use.

Sn-MCM-41--a heterogeneous selective catalyst for the Baeyer-Villiger oxidation with hydrogen peroxide.

A new heterogeneous catalyst, Sn-MCM-41, is described for the Baeyer-Villiger reaction with hydrogen peroxide which selectively activates the carbonyl function for the nucleophilic attack by the oxidant, with high chemoselectivities when double bonds are present in the molecule.

ITQ-16, a new zeolite family of the beta group with different proportions of polymorphs A, B and C.

ITQ-16 is a new zeolite family formed by polymorphs A, B and C of the beta intergrowth in which the proportion of polymorph C can be controlled by changing the organic structure directing agent and/or by changing the Ge content of the synthesis gel; ITQ-16 can be synthesised either in fluoride or fluoride-free medium and Al can be introduced in the framework giving a material with very strong Brönsted acidity.

Nitrite reductase mutants as an approach to understanding nitrate assimilation in Chlamydomonas reinhardtii.

We constructed mutant strains lacking the nitrite reductase (NR) gene in Chlamydomonas reinhardtii. Two types of NR mutants were obtained, which either have or lack the high-affinity nitrate transporter (Nrt2;1, Nrt2;2, and Nar2) genes. None of these mutants overexpressed nitrate assimilation gene transcripts nor NR activity in nitrogen-free medium, in contrast to NR mutants. This finding confirms the previous role proposed for NR on its own regulation (autoregulation) and on the other genes for nitrate assimilation in C. reinhardtii. In addition, the NR mutants were used to study nitrate transporters from nitrite excretion. At high CO(2), only strains carrying the above high-affinity nitrate transporter genes excreted stoichiometric amounts of nitrite from 100 microM nitrate in the medium. A double mutant, deficient in both the high-affinity nitrate transporter genes and NR, excreted nitrite at high CO(2) only when nitrate was present at mM concentrations. This suggests that there exists a low-affinity nitrate transporter that might correspond to the nitrate/nitrite transport system III. Moreover, under low CO(2) conditions, the double mutant excreted nitrite from nitrate at micromolar concentrations by a transporter with the properties of the nitrate/nitrite transport system IV.

[Tongue abscess. Report of a case and bibliographic review]. / Absceso de lengua. A propósito de un caso y revisión de la bibliografía.

We report a case of tongue abscess due to Streptococcus faecalis. Tongue abscesses are rare infections in our region, which makes the diagnosis difficult. The CT scan provides important diagnostic information for this disease. Treatment is surgical incision and drainage associated with antibiotic therapy.

A randomized double-blind, multicenter plasma concentration controlled study of the safety and efficacy of oral mycophenolate mofetil for the prevention of acute rejection after kidney transplantation.

BACKGROUND: Adding a fixed dose of 1 g b.i.d. of mycophenolate mofetil (MMF) to an immunosuppressive regimen consisting of cyclosporine and prednisone results in a 50% reduction in the incidence of acute rejection after kidney transplantation. This study was designed to investigate the relationship between pharmacokinetic data (mycophenolic acid area under the curve; MPA AUC) and the prevention of rejection after kidney transplantation. METHODS: A total of 154 adult recipients of a primary or secondary cadaveric kidney graft were randomly allocated, in this double-blind trial, to receive MMF treatment aimed at three predefined target MPA AUC values (16.1, 32.2, and 60.6 microg x hr/ml). During the first 6 months after transplantation, plasma samples for nine AUCs were collected. After analysis of the samples, a coded dose adjustment advice was generated using a Bayesian algorithm, maintaining the double blinding. Immunosuppressive therapy further consisted of cyclosporine and prednisone. The primary end point of this study was the occurrence of biopsy-proven acute rejection within the 6-month study period. RESULTS: A total of 150 patients were eligible for analysis. Although after day 21, the mean MMF dose was reduced, the mean MPA AUC gradually increased and target MPA AUC values were exceeded in all three groups. The incidences of biopsy-proven acute rejection in the low, intermediate, and high target MPA AUC groups were 14 of 51 (27.5%), 7 of 47 (14.9%), and 6 of 52 (11.5%), respectively. The incidences of premature withdrawal from the study due to adverse events in the three groups were 4 of 51 (7.8%), 11 of 47 (23.4%), and 23 of 52 (44.2%), respectively. Logistic regression analysis showed a highly statistically significant relationship between median ln(MPA AUC) and the occurrence of a biopsy-proven rejection (P<0.001). The logistic regression using median ln(Cpredose) was also statistically significant for this relationship (P=0.01), whereas it was not when using mean MMF dose (P=0.082). In contrast, the logistic regression using mean MMF dose for comparison of patients who successfully completed the study versus patients experiencing premature withdrawal due to adverse events was highly significant (P<0.001), whereas this was not significant when using median ln(Cpredose) (P=0.512) or median ln(MPA AUC) (P=0.434). CONCLUSION: MPA Cpredose and MPA AUC are significantly related to the incidence of biopsy-proven rejection after kidney transplantation, whereas MMF dose is significantly related to the occurrence of adverse events.

Copying computer-generated-holographic interconnects by the use of partially coherent light.

Dichromated gelatin, bleached photographic emulsion, photoresist, and silver halide-sensitived gelatin are studied as holographic recording materials for holographic optical interconnects. We make the analysis by using a copying process with a computer-generated interconnect, which produces 64 diffracted beams on axis, as a master. The experimental results obtained confirm that it is possible to obtain copies in which we improve the performance of the master.

Solid-state NMR study of ordered mesoporous aluminosilicate MCM-41 synthesized on a liquid-crystal template.

A novel mesoporous aluminosilicate MCM-41, synthesized in a liquid-crystal system, was characterized by magic angle spinning NMR. Conventional Bloch decay and cross-polarization spectra were compared. The 27Al spectra showed that the calcined material was highly siliceous, while 29Si NMR proved that it was rich in single and geminal silanol groups. Two kinds of the silanol groups were detected: exchanging and non-exchanging protons with water on the timescale of the 1H experiment. The 13C spectra of the uncalcined material were consistent with the concept of the micellar arrangement of the cetyltrimethylammonium template inside MCM-41.