Las colecciones de restos humanos de la expedición del Pacífico y los museos españoles / Human remains collections of the Pacific Expedition and the Spanish Museums

La conocida como Expedición del Pacífico (1862-1866) fue la última de las grandes expediciones transoceánicas organizadas por España en el siglo XIX y está bien documentada gracias a los estudios de varios historiadores. Menos se ha trabajado sobre las vicisitudes posteriores a su llegada a España de los restos humanos y las colecciones etnográficas recopiladas durante el viaje. Además de otros restos óseos, fundamentalmente cráneos, se trajeron a España una serie de momias que fueron extraídas, junto con sus ajuares mortuorios, del sitio arqueológico de Chiu-Chiu (Bolivia, hoy Chile) por Manuel Almagro en 1864. El artículo se dedica a reconstruir en lo posible la historia de estas colecciones por distintos museos y los estudios que se llevaron a cabo a partir de ellas

The so-called Pacific Expedition (1862-1866) was the last of the great transoceanic expeditions organized by Spain in the nineteenth century and is well known thanks to the studies of several scholars. Less has been investigated on the vicissitudes after his arrival in Spain of the human remains and ethnographic collections gathered during the trip. In addition to other skeletal remains, mainly skulls, a series of mummies were brought to Spain, along with their grave goods, from the archaeological site of Chiu-Chiu (Bolivia, now Chile) by Manuel Almagro in 1864. This article is dedicated to reconstruct as thoroughly as possible the history of these collections in different museums and the studies that were undertaken on them

Síndrome de Sweet mielodisplásico corticodependiente. A propósito de un caso / Corticosteroid-dependent myelodysplastic Sweet's syndrome. Presentation of a case

Fundamento y objetivo: El síndrome de Sweet o dermatosis neutrofílica febril aguda es una enfermedad inflamatoria infrecuente de fisiopatología desconocida, aunque las evidencias clínicas y bioquímicas sugieren que las citocinas tienen un papel importante en su etiopatogenia. Se distinguen 5 grupos etiológicos: idiopático, parainflamatorio, secundario a fármacos, asociado a embarazo y paraneoplásico. Este último grupo representa el 20% de los casos, asociados el 85% de ellos a neoplasias hematológicas y el 15% a tumores sólidos. Paciente: Se presenta el caso de un paciente afecto de síndrome de Sweet con afectación dermatológica atípica, asociado a un síndrome mielodisplásico y también a un síndrome de Cushing iatrogénico secundario a altas dosis de corticoides cuya evolución fue desfavorable. Resultados: Positividad de los reactantes de fase aguda (RFA) durante los brotes, destacando la elevación precoz de la interleucina 6 (IL-6) seguida del seroamiloide A (SAA) y proteína C reactiva (PCR), encontrándose diferencias estadísticamente significativas (p<0,05) entre la PCR y el SAA. Conclusiones: Un síndrome de Sweet en un varón con múltiples recaídas y localización dermatológica no clásica, cuando se asocia a alteraciones hematológicas, con un incremento de los RFA y elevación precoz de la IL-6 debe orientar el diagnóstico clínico hacia un origen paraneoplásico y hematológico

Background and objective: Sweet's syndrome or acute febrile neutrophilic dermatosis is a rare inflammatory disease of unknown pathophysiology, although clinical and biochemical evidence suggests that cytokines play an important role in its aetiopathogenesis. It is classified into five groups: idiopathic, para-inflammatory, secondary to drugs, associated with pregnancy, and para-neoplastic in 20% of cases, with 85% of these linked to haematological disorders, and 15% to solid tumours. Patient: A report is presented on a patient with Sweet's Syndrome with atypical dermatological involvement, associated with myelodysplastic syndrome, and iatrogenic Cushing's syndrome secondary to high-doses of corticosteroids, with an unfavorable outcome. Results: Acute phase reactants (APR) were increased during the outbreaks, with the early elevation of interleukin 6 (IL6) being highlighted, followed by serum amyloid A (SAA) and C-reactive protein (CRP), with statistically significant differences (P<.05) between CRP and SAA. Conclusions: A Sweet's syndrome in a male with multiple relapses and a non-classical dermatological location, associated haematological abnormalities, and an increase in APR with early elevation of IL6, should lead to a clinical diagnosis of paraneoplastic and haematological origin

Newly impaired glucose metabolism and prognosis after percutaneous revascularization.

BACKGROUND: Clinical practice guidelines recommend ad hoc screening of diabetes in patients admitted for macrovascular disease; however, these recommendations are rarely followed in real practice. This study was undertaken to assess whether impaired glucose metabolism, newly diagnosed after percutaneous coronary intervention (PCI) or known diabetes, provides prognostic information. METHODS: We studied 374 patients who underwent PCI. An oral glucose tolerance test was carried out in the known non-diabetic patients with fasting glucose < 7 mmol/L. RESULTS: Eighty-one percent of the patients presented impaired glucose metabolism, from which 35.3% were previously diagnosed with diabetics, 21.4% were newly detected diabetics, and 24.3% were pre-diabetics. After a mean follow-up of 35.8 ± 13.4 months, only a known history of diabetes was an independent predictor of revascularization (OR = 2.03, p = 0.025), non-fatal acute myocardial infarction (OR = 2.70, p = 0.029) and readmission due to heart failure during the follow-up (OR = 3.82, p = 0.022). CONCLUSIONS: Screening for impaired glucose metabolism after PCI permits the detection of a high proportion of patients with abnormal glucose regulations. However, previously known diabetes remains the only independent predictor of cardiovascular events in the follow-up.

Incidence of liver damage of uncertain origin in HIV patients not co-infected with HCV/HBV.

BACKGROUND AND AIMS: Several studies have reported that a significant number of HIV patients not co-infected with HCV/HBV develop liver damage of uncertain origin (LDUO). The objective of our study was to evaluate the incidence of and risk factors for the development of LDUO in HIV infected patients not co-infected with HCV/HBV. METHODS: Prospective longitudinal study that included HIV-infected patients free of previous liver damage and viral hepatitis B or C co-infections. Patients were followed up at 6-monthly intervals. Liver stiffness was measured at each visit. Abnormal liver stiffness (ALS) was defined as a liver stiffness value greater than 7.2 kPa at two consecutive measurements. For patients who developed ALS, a protocol was followed to diagnose the cause of liver damage. Those patients who could not be diagnosed with any specific cause of liver disease were diagnosed as LDUO and liver biopsy was proposed. RESULTS: 210 patients matched the inclusion criteria and were included. 198 patients completed the study. After a median (Q1-Q3) follow-up of 18 (IQR 12-26) months, 21 patients (10.6%) developed ALS. Of these, fifteen patients were diagnosed as LDUO. The incidence of LDUO was 7.64 cases/100 patient-years. Histological studies were performed on ten (66.6%) patients and all showed liver steatosis. A higher HOMA-IR value and body mass index were independently associated with the development of LDUO. CONCLUSION: We found a high incidence of LDUO in HIV-infected patients associated with metabolic risk factors. The leading cause of LDUO in our study was non-alcoholic fatty liver disease.

Remote ischaemic postconditioning: does it protect against ischaemic damage in percutaneous coronary revascularisation? Randomised placebo-controlled clinical trial.

OBJECTIVE: Determine whether remote ischaemic postconditioning (RIP) protects against percutaneous coronary intervention-related myocardial infarction (PCI-MI). DESIGN: Single-centre, randomised, blinded to the researchers, clinical trial. ClinicalTrials.gov (NCT 01113008). SETTING: Tertiary hospital centre. PATIENTS: 232 patients underwent elective PCI for stable or unstable angina. INTERVENTIONS: Patients were randomised to RIP (induction of three 5-min cycles of ischaemia in the arm after the PCI) versus placebo. MAIN OUTCOME MEASURES: The primary outcome measure was the peak 24-h troponin I level. PCI-MI was defined by an elevation of troponin values >3 or >5 of the 99th percentile according to the classical or the new definition. The secondary outcome measure was hospital admission, PCI for stable angina or acute coronary syndrome and mortality after 1 year of follow-up. The use of RIP in diabetic patients was specifically studied. RESULTS: The mean age was 64.6 years, and 42% were diabetic. The peak troponin in the RIP patients was 0.476 vs 0.478 ng/mL (p=0.99). PCI-MI occurred in 36% of the RIP patients versus 30.8% in the placebo group (p=0.378). Diabetic RIP patients had more PCI-MI (new definition): OR 2.7; 95% CI 1.10 to 6.92; p=0.027. The secondary outcome measure was seen in 11.7% of the RIP patients versus 10.8% in the placebo group (p=0.907). CONCLUSIONS: RIP did not reduce the damage associated with elective PCI or cardiovascular events during the follow-up. The diabetic population who underwent RIP had more PCI-MI.

Diagnóstico de aneuplodias en células en interfase de líquido amniótico mediante hibridación in situ fluorescente. Concordancia con el cariotipo / Diagnosis of aneuploidy in interphase cells of amniotic fluid by fluorescence in situ hybridization. Concordance with the karyotype

Introducción. En los últimos años la aplicación de la hibridación in situ fluorescente (FISH) permite el diagnóstico precoz de aneuploidias. El objetivo de este estudio es el análisis descriptivo mediante FISH de los líquidos amnióticos procesados en el laboratorio y la concordancia con el cariotipo. Material y métodos. Análisis de 821 muestras de líquidos amnióticos (enero 2009 a diciembre 2010) remitidas por Medicina Fetal desde la semana 13 a 36 de gestación para estudio prenatal de aneuploidias, (kit Aneuvysion) con sondas centroméricas para los cromosomas X, Y y 18, y locus específicas para los cromosomas 13 y 21. El estudio se completa con el cariotipo mediante método de bandeo G. Resultados. De las 821 muestras, 776 (94,52%) fueron normales y 45 (5,48%) presentaron aneuploidias: en 22 casos (48,88%) el sexo cromosómico del feto fue masculino, en las 23 restantes (51,12%) femenino. La cromosopatía más frecuente fue la trisomía 21 (19 casos en fetos masculinos y 11 femeninos), la de menor presentación fue la trisomía 13 (2 casos) que representa el 0,24% del total de los líquidos amnióticos procesados. En todos los casos, la concordancia con el cariotipo fue del 100%. Conclusiones. El estudio de aneuploidias mediante FISH en núcleos en interfase en líquido amniótico permite un diagnóstico prenatal rápido de las principales cromosomopatías, siendo la trisomía 21 la más frecuentemente detectada. Los resultados del FISH coincidieron en el 100% con el cariotipo, gold estándar en el diagnóstico prenatal de cromosomopatías (AU)

Background. The application of fluorescence in situ hybridization (FISH) techniques in the last few years has led to the prenatal diagnosis of aneuploidies. The objective of this investigation was a descriptive analysis of amniotic fluids processed in the laboratory using FISH and the agreement with the karyotype. Material and methods. A total of 821 amniotic fluid samples (January 2009 to December 2010) at gestational ages 13 to 36 weeks, from Fetal Medicine Unit for prenatal testing for aneuploidies (Aneuvysion kit) with centromeric probes for chromosomes X,Y and 18, and locus specific for chromosomes 13 and 21. The study was complemented by the karyotype by G-banding method. Results. Of the 821 samples, 776 (94.52%) were normal and 45 (5.48%) had aneuploidy: in 22 cases (48.88%) the chromosomal sex of the foetus was male, in the remaining 23 (51.12%) female. The most common chromosomal abnormality detected was trisomy 21 (19 cases in males and 11 cases in female foetuses), the lowest performance was the trisomy 13 (2 cases) representing 0.24% of total processed amniotic fluids. In all cases, the concordance with the karyotype was 100%. Conclusions. The study of aneuploidy by FISH of interphase nuclei present in the amniotic fluid enables rapid prenatal diagnosis of major chromosomal abnormalities, trisomy 21 was more frequently detected. FISH results in 100% agreed with the karyotype, the gold standard in prenatal diagnosis of chromosomal abnormalities (AU)

Poor reproducibility of the oral glucose tolerance test in the diagnosis of diabetes during percutaneous coronary intervention.

BACKGROUND: Early de novo diagnosis of diabetes mellitus in patients admitted with acute coronary syndromes who have undergone percutaneous coronary revascularization may have prognostic implications. The ideal diagnostic method and its time of performance are unknown due to the uncertain reproducibility of the oral glucose tolerance test (OGTT). METHODS: We assessed 88 patients with no known diabetes mellitus admitted with an acute coronary syndrome who underwent successful percutaneous revascularization. The patients received an OGTT the day after coronary revascularization (7.7+/-6 days after admittance in hospital) and 1 month later. RESULTS: The mean age of the patients was 60.8+/-10.3 years and 82% were men. The most common reason for admission was acute coronary syndrome without ST elevation (42%), followed by acute coronary syndrome with ST elevation (36%) and stable angina (21%). After the first OGTT, 66 patients (75%) were found to have carbohydrate metabolism disorders (41% glucose intolerance and 34% diabetes mellitus). After the second OGTT 39 patients (44.3%) had carbohydrate metabolism disorders (26% glucose intolerance and 18% diabetes mellitus). The correlation between both tests was low (weighted kappa, 0.23+/-0.1; 0.03-0.43) (p=0.02). CONCLUSIONS: The correlation of the OGTT done in patients admitted with acute coronary syndromes who underwent percutaneous coronary revascularization the day after admittance and the OGTT 1 month later was poor. The prevalence of carbohydrate intolerance in these patients was high.