BIOBADATOP: Registro Español de Dermatitis Atópica. Descripción y primeros resultados / BIOBADATOP Spanish Atopic Dermatitis Registry: Description and Early Findings

Antecedentes En los últimos años se ha producido una revolución en el conocimiento de la dermatitis atópica (DA) que ha revertido en un salto cualitativo en las expectativas terapéuticas. En este contexto, resulta fundamental disponer de datos de práctica clínica de calidad. Material y método BIOBADATOP es el Registro Español de Dermatitis Atópica, un estudio observacional, prospectivo y multicéntrico, con una cohorte de pacientes de cualquier edad con DA que requieren el empleo de tratamiento sistémico (convencional o innovador). Se registraron los datos demográficos, de diagnóstico, los tratamientos y los acontecimientos adversos (AA). Resultados Se incluyeron 258 pacientes, con 347 tratamientos sistémicos iniciados para la DA. Se suspendieron el 29,4% de los tratamientos, principalmente por falta de eficacia (10,7%). Durante el período de seguimiento se registraron 132AA. Del total, el 65% (86) relacionaron con el tratamiento sistémico iniciado, siendo los más frecuentes dupilumab (39AA) y ciclosporina (38AA). Los AA más frecuentes fueron: conjuntivitis (11pacientes), cefalea (6), hipertricosis (5) y náuseas (4). Se registró un AA grave (mastoiditis aguda) relacionado con ciclosporina. Conclusiones En este primer informe, la descripción de AA está limitada por los cortos períodos de seguimiento, que no permiten el cálculo de tasas de incidencias crudas ni ajustadas y no se han realizado comparaciones. Hasta la fecha del análisis no se han registrado AA graves en relación a las nuevas terapias. BIOBADATOP permitirá generar conocimiento en términos de efectividad y seguridad de los tratamientos sistémicos clásicos y las nuevas terapias en DA (AU)

Background In recent years, remarkable improvements in our understanding of atopic dermatitis (AD) have revolutionized treatment perspectives, but access to reliable data from clinical practice is essential. Materials and method The Spanish Atopic Dermatitis Registry, BIOBADATOP, is a prospective, multicenter database that collects information on patients of all ages with AD requiring systemic therapy with conventional or novel drugs. We analyzed the registry to describe patient characteristics, diagnoses, treatments, and adverse events (AEs). Results We studied data entries for 258 patients who had received 347 systemic treatments for AD. Treatment was discontinued in 29.4% of cases, mostly due to a lack of effectiveness (in 10.7% of cases). A total of 132 AEs were described during follow-up. Eighty-six AEs (65%) were linked to a systemic treatment, most commonly dupilumab (39AEs) and cyclosporine (38AEs). The most common AEs were conjunctivitis (11patients), headache (6), hypertrichosis (5), and nausea (4). There was 1severe AE (acute mastoiditis) associated with cyclosporine. Conclusions Initial findings on AEs from the Spanish BIOBADATOP registry are limited by short follow-up times precluding comparisons or calculation of crude and adjusted incidence rates. At the time of our analysis, no severe AEs had been reported for novel systemic therapies. BIOBADATOP will help answer questions on the effectiveness and safety of conventional and novel systemic therapies in AD (AU)

[Translated article] BIOBADATOP Spanish Atopic Dermatitis Registry: Description and Early Findings / BIOBADATOP: Registro Español de Dermatitis Atópica. Descripción y primeros resultados

Background In recent years, remarkable improvements in our understanding of atopic dermatitis (AD) have revolutionized treatment perspectives, but access to reliable data from clinical practice is essential. Materials and method The Spanish Atopic Dermatitis Registry, BIOBADATOP, is a prospective, multicenter database that collects information on patients of all ages with AD requiring systemic therapy with conventional or novel drugs. We analyzed the registry to describe patient characteristics, diagnoses, treatments, and adverse events (AEs). Results We studied data entries for 258 patients who had received 347 systemic treatments for AD. Treatment was discontinued in 29.4% of cases, mostly due to a lack of effectiveness (in 10.7% of cases). A total of 132 AEs were described during follow-up. Eighty-six AEs (65%) were linked to a systemic treatment, most commonly dupilumab (39AEs) and cyclosporine (38AEs). The most common AEs were conjunctivitis (11patients), headache (6), hypertrichosis (5), and nausea (4). There was 1severe AE (acute mastoiditis) associated with cyclosporine. Conclusions Initial findings on AEs from the Spanish BIOBADATOP registry are limited by short follow-up times precluding comparisons or calculation of crude and adjusted incidence rates. At the time of our analysis, no severe AEs had been reported for novel systemic therapies. BIOBADATOP will help answer questions on the effectiveness and safety of conventional and novel systemic therapies in AD (AU)

Antecedentes En los últimos años se ha producido una revolución en el conocimiento de la dermatitis atópica (DA) que ha revertido en un salto cualitativo en las expectativas terapéuticas. En este contexto, resulta fundamental disponer de datos de práctica clínica de calidad. Material y método BIOBADATOP es el Registro Español de Dermatitis Atópica, un estudio observacional, prospectivo y multicéntrico, con una cohorte de pacientes de cualquier edad con DA que requieren el empleo de tratamiento sistémico (convencional o innovador). Se registraron los datos demográficos, de diagnóstico, los tratamientos y los acontecimientos adversos (AA). Resultados Se incluyeron 258 pacientes, con 347 tratamientos sistémicos iniciados para la DA. Se suspendieron el 29,4% de los tratamientos, principalmente por falta de eficacia (10,7%). Durante el período de seguimiento se registraron 132AA. Del total, el 65% (86) relacionaron con el tratamiento sistémico iniciado, siendo los más frecuentes dupilumab (39AA) y ciclosporina (38AA). Los AA más frecuentes fueron: conjuntivitis (11pacientes), cefalea (6), hipertricosis (5) y náuseas (4). Se registró un AA grave (mastoiditis aguda) relacionado con ciclosporina. Conclusiones En este primer informe, la descripción de AA está limitada por los cortos períodos de seguimiento, que no permiten el cálculo de tasas de incidencias crudas ni ajustadas y no se han realizado comparaciones. Hasta la fecha del análisis no se han registrado AA graves en relación a las nuevas terapias. BIOBADATOP permitirá generar conocimiento en términos de efectividad y seguridad de los tratamientos sistémicos clásicos y las nuevas terapias en DA (AU)

Evaluación de la interacción de capecitabina con inhibidores de la bomba de protones en pacientes con cáncer de colon metastásico / Evaluation of the interaction of capecitabin with proton pump inhibitors in patients with metastatic colon cáncer

Objetivo: Evaluar el impacto clínico que la interacción de capecitabina con inhibidores de la bomba de protones (IBP) puede tener sobre la efectividad del tratamiento de mantenimiento en pacientes con cáncer de colon metastásico (CCm). Material y métodos: Estudio retrospectivo, observacional descriptivo que incluyó a todos los pacientes con CCm tratados con capecitabina sola o en combinación entre enero 2013-diciembre 2016. Los pacientes fueron divididos en dos grupos según si fueron o no tratados con IBP concomitantemente con capecitabina. Se evaluaron variables demográficas, farmacológicas y clínicas, siendo la supervivencia libre de progresión (SLP) la variable elegida para evaluar el impacto clínico de la interacción. Resultados: Se incluyeron 150 pacientes. De ellos, el 57,33% varones, media de edad 70,10±12,06 años; el 55,33% tuvieron un ECOG 1 y el 58,67% utilizaron IBP. Un 39,33% fueron tratados con capecitabina en monoterapia, 31,33% CapeOx, y 20% capecitabina+bevacizumab y 9,33% CapeOx+bevacizumab. El 53,33% tuvo un tratamiento basado en capecitabina en primera línea, la frecuencia de variaciones de tratamiento fue de 42,0% reducción de dosis, 38,0% retraso, y 12% interrupción tratamiento. El 78,0% presentó alguna toxicidad, destacando 34,67% diarrea y 30,0% (síndrome mano-pie). La SLP media fue de 6,69 vs 6,0 meses (HR=0,97; IC95% 0,68-1,39; p=0,87) en favor de los pacientes que no utilizaron IBP, aunque la relación fue no significativa. Conclusiones: En la población estudiada, los pacientes con CCm que recibieron tratamiento de mantenimiento basado en capecitabina y que utilizaron IBP simultáneamente, presentaron una tendencia no significativa a la disminución de la SLP. (AU)

Objective: To evaluate the clinical impact that the interaction of capecitabine with proton pump inhibitors (PPIs) may have on the effectiveness of maintenance treatment in patients with metastatic colon cancer (mCC). Material and methods: Retrospective, observational, descriptive study that included all patients with CCm treated with capecitabine alone or in combination between January 2013-December 2016. The patients were divided into two groups according to whether or not they were treated with PPIs concomitantly with capecitabine. Demographic, pharmacological and clinical variables were evaluated, with progression free survival (PFS) being the variable chosen to evaluate the clinical impact of interaction. Results:150 patients were included. Of them, 57.33% were men, mean age 70.10±12.06 years; 55.33% had an ECOG 1 and 58.67% used it in PPIs. 39.33% were treated with capecitabine in monotherapy, 31.33% CapeOx, and 20% capecitabine+bevacizumab and 9.33% CapeOx+bevacizumab. 53.33% had a first-line capecitabine-based treatment, the frequency of treatment variations was 42.0% dose reduction, 38.0% delay, and 12% treatment interruption. 78.0% presented any toxicity, (highlighting 34.67% diarrhea and 30.0% hand-foot syndrome). The mean PFS was 6.69 vs 6.0 months (HR=0.97; 95% CI 0.68-1.39; p=0.87) in favor of patients who did not use IBP, although the relationship was not significant. Conclusions: In the population studied, patients with mCC who received maintenance treatment based on capecitabine and who used PPIs simultaneously, showed a non-significant trend towards a decrease in PFS. (AU)

Role of IGF2 in the Study of Development and Evolution of Prostate Cancer.

Prostate Cancer (PC) is commonly known as one of the most frequent tumors among males. A significant problem of this tumor is that in early stages most of the cases course as indolent forms, so an active surveillance will anticipate the appearance of aggressive stages. One of the main strategies in medical and biomedical research is to find non-invasive biomarkers for improving monitoring and performing a more precise follow-up of diseases like PC. Here we report the relevant role of IGF2 and miR-93-5p as non-invasive biomarker for PC. This event could improve current medical strategies in PC.

Efectividad y seguridad de regorafenib y trifluridina/tipiracilo en cáncer colorrectal metastático / Effectiveness and safety of regorafenib versus trifluridine/tipiracil in metastatic colorectal cancer

OBJETIVOS: Comparar la efectividad y seguridad de regorafenib y trifluridina/tipiracilo en pacientes con cáncer de colon metastático en la práctica clínica real. MÉTODOS: Estudio retrospectivo observacional entre febrero 2013 y mayo 2017. Se incluyeron todos los pacientes con cáncer de colon metastático que empezaron tratamiento con regorafenib o trifluridina/tipiracilo. Se recogieron variables demográficas, diagnósticas y terapéuticas; y los efectos adversos y reducciones de dosis para evaluar la seguridad. La supervivencia global (SG) y supervivencia libre de progresión (SLP) se calcularon con el método de Kaplan-Meier, evaluándose las diferencias mediante la determinación del hazard ratio (HR) con un modelo de riesgo proporcional de Cox. RESULTADOS: Se incluyeron 39 pacientes (61,54% mujeres, edad media: 62,69 ± 11,51 años, 76,92% ECOG1, mediana de líneas de tratamiento previas 3,28 ± 1,02; 58,97% RAS mutado, 61,54% presentaban metástasis en el diagnóstico): 10 iniciaron regorafenib y 29 trifluridina/tipiracilo. La mediana de SLP fue 1,77 meses con regorafenib y 2,46 con trifluridina/tipiracilo (HR 1,35 (0,64-2,85), p = 0,428), y de SG 7,00 meses con ambos (HR 1,45 (0,68-3,09), p = 0,335). Las diferencias no fueron estadísticamente significativas. La media de efectos adversos por paciente fue 3,70 ± 2,35 con regorafenib y 2,55 ± 2,16 con trifluridina/tipiracilo, siendo los más frecuentes con regorafenib astenia, diarrea, síndrome mano-pie, hiporexia y mucositis; y con trifluridina/tipiracilo astenia, neutropenia y náuseas. El 30,00% de pacientes con regorafenib y el 27,58% con trifluridina/tipiracilo necesitaron reducir la dosis por toxicidad. CONCLUSIÓN: En nuestro estudio, regorafenib y trifluridina/tipiracilo tienen una efectividad similar y modesta. Los distintos perfiles de toxicidad de los fármacos deben tenerse en cuenta en la selección del tratamiento

PURPOSE: To compare effectiveness and safety of regorafenib and trifluridine/tipiracil in patients with metastatic colorectal cancer in real clinical practice. METHODS: A retrospective observational study including all patients with metastatic colorectal cancer who started treatment with regorafenib or trifluridine/ tipiracil (February 2013-May 2017) was carried out. Demographic, diagnostic and therapeutic variables were collected. Adverse effects and dose reductions were recorded to measure safety. Median progression free survival (PFS) and overall survival (OS) were recorded. Differences in survival were evaluated using the Cox's proportional hazard models to determine the hazard ratio. RESULTS: Throughout the period of the study 39 patients were included (61.54% women, median age 62.69 ± 11.51 years, 76.92% ECOG1, median previous lines 3.28 ± 1.02, 58.97% mutant RAS, 61.54% had metastasis in the diagnosis): 10 patients started treatment with regorafenib and 29 with trifluridine/tipiracil. The median PFS with regorafenib was 1.77 months and with trifluridine/tipiracil 2.46 months (HR 1.35 (0.64-2.85), p = 0.428), and the median OS was 7.00 months with both drugs (HR 1.45 (0.68-3.09), p = 0.335). Differences in survival were not statistically significant

[Validation of the French version of the self-evaluation of negative symptoms (SNS)]. / Validation de la version française de l'échelle autoévaluation des symptômes négatifs (SNS).

INTRODUCTION: Schizophrenia is a disorder affecting 1% of the population and is associated with severe functional impairment. Negative symptoms are responsible for the majority of this impairment, and many patients with schizophrenia have negative symptoms. However, their evaluation is still a challenge. Thus, standardized assessments are needed to facilitate identification of these symptoms. Many tools have been developed, but most are based on observer ratings. Self-evaluation can provide an additional outcome measure and allow patients to be more engaged in their treatment. The Self-evaluation of Negative Symptoms (SNS) has been developed recently. This is a remarkably understandable instrument for patients with schizophrenia as it allows them to readily complete it without assistance, providing information with respect to their own perception of negative symptoms. The SNS is a self-assessment that permits patients to evaluate themselves in 5 dimensions of negative symptoms. This validation study for the SNS revealed good psychometric properties alongside satisfactory acceptance by patients. AIM: This study was to confirm the validation of the French version of the self-evaluation of negative symptoms (SNS). METHODS: Patients with schizophrenia or schizoaffective disorder according to the DSM-IV-R, with a stable regimen of anti-psychotic drugs for the last two months, aged more than 18 years old were eligible for the study. Symptoms were rated using the SNS, the Scale for the Assessment of Negative Symptoms (SANS), the Calgary Depression Scale for Schizophrenics (CDSS), the Brief Psychiatric Rating Scale (BPRS) and the Clinical Global Impression and Parkinsonism. Patients were asked to fulfill the SNS twice, 6 weeks apart. RESULTS: Sixty patients were evaluated. Cronbach's coefficient (α=0.8) showed good internal consistency. The SNS significantly correlated with the SANS (r=0.6), the negative sub-score of the BPRS (r=0.6) and the Clinician Global Impression on the severity of negative symptoms (r=0.7). SNS scores did not correlate with level of insight (r=0.08) or Brief Psychiatric Rating Scale positive sub-scores (r=0.2). SNS scores correlated with CDSS scores. However, we did not find correlation between the first item of the CDSS which evaluates depression and the "diminished emotional range" sub-score of SNS. The test-retest of SNS revealed no changes of scores at two evaluations 6 weeks apart. CONCLUSION: The acceptance by patients of the SNS was excellent. The French version of the SNS demonstrated a good internal consistency, good convergent validity and good discriminant validity. The study demonstrates the ability of patients with schizophrenia to accurately report their own experiences. Self-assessments of negative symptoms should be more widely employed in clinical practice because they may allow patients with schizophrenia to develop appropriate coping strategies.

Kinematic evaluation of the finger's interphalangeal joints coupling mechanism--variability, flexion-extension differences, triggers, locking swanneck deformities, anthropometric correlations.

The human finger contains tendon/ligament mechanisms essential for proper control. One mechanism couples the movements of the interphalangeal joints when the (unloaded) finger is flexed with active deep flexor. This study's aim was to accurately determine in a large finger sample the kinematics and variability of the coupled interphalangeal joint motions, for potential clinical and finger model validation applications. The data could also be applied to humanoid robotic hands. Sixty-eight fingers were measured in seventeen hands in nine subjects. Fingers exhibited great joint mobility variability, with passive proximal interphalangeal hyperextension ranging from zero to almost fifty degrees. Increased measurement accuracy was obtained by using marker frames to amplify finger segment motions. Gravitational forces on the marker frames were not found to invalidate measurements. The recorded interphalangeal joint trajectories were highly consistent, demonstrating the underlying coupling mechanism. The increased accuracy and large sample size allowed for evaluation of detailed trajectory variability, systematic differences between flexion and extension trajectories, and three trigger types, distinct from flexor tendon triggers, involving initial flexion deficits in either proximal or distal interphalangeal joint. The experimental methods, data and analysis should advance insight into normal and pathological finger biomechanics (e.g., swanneck deformities), and could help improve clinical differential diagnostics of trigger finger causes. The marker frame measuring method may be useful to quantify interphalangeal joints trajectories in surgical/rehabilitative outcome studies. The data as a whole provide the most comprehensive collection of interphalangeal joint trajectories for clinical reference and model validation known to us to date.

[Gated single photon emission computer tomography for the detection of silent myocardial ischemia]. / Utilidad de la tomografía computarizada de emisión de fotón único sincronizada con el electrocardiograma para la detección de isquemia miocárdica silente en diabéticos tipo 2.

BACKGROUND: Asymptomatic patients with severe coronary atherosclerosis may have a normal resting electrocardiogram and stress test. AIM: To assess the yield of Gated Single Photon Emission Computer Tomography (SPECT) for the screening of silent myocardial ischemia in type 2 diabetic patients. MATERIAL AND METHODS: Electrocardiogram, stress test and gated-SPECT were performed on 102 type 2 diabetic patients aged 60+/-8 years without cardiovascular symptoms. AH subjects were also subjected to a coronary angiography whose results were used as gold standard. RESULTS: Gated-SPECT showed myocardial ischemia on 26.5% of studied patients. The sensibility, specificity accuracy, positive predictive value and negative predictive value were 92.3%, 96%, 95%, 88.8%, 97.3%, respectively. In four and six patients ischemia was detected on resting electrocardiogram and stress test, respectively. Eighty percent of patients with doubtful resting electrocardiogram results and 70% with a doubtful stress test had a silent myocardial ischemia detected by gated-SPECT There was a good agreement between the results of gated-SPECT and coronary angiography (k=0.873). CONCLUSIONS: Gated-SPECT was an useful tool for the screening of silent myocardial ischemia.

Utilidad de la tomografía computarizada de emisión de fotón único sincronizada con el electrocardiograma para la detección de isquemia miocárdica silente en diabéticos tipo 2 / Gated single photon emission computer tomography for the detection of silent myocardial ischemia

Background: Asymptomatic patients with severe coronary atherosclerosis may have a normal resting electrocardiogram and stress test. Aim: To assess the yield of Gated Single Photon Emission Computer Tomography (SPECT) for the screening of silent myocardial ischemia in type 2 diabetic patients. Material and methods: Electrocardiogram, stress test and gated-SPECT were performed on 102 type 2 diabetic patients aged 60 ± 8 years without cardiovascular symptoms. AH subjects were also subjected to a coronary angiography whose results were used as gold standard. Results: Gated-SPECT showed myocardial ischemia on 26.5 percent of studied patients. The sensibility, specifity accuracy, positive predictive value and negative predictive value were 92.3 percent, 96 percent, 95 percent, 88.8 percent, 97.3 percent, respectively. In four and six patients ischemia was detected on resting electrocardiogram and stress test, respectively. Eighty percent of patients with doubtful resting electrocardiogram results and 70 percent with a doubtful stress test had a silent myocardial ischemia detected by gated-SPECT There was a good agreement between the results of gated-SPECT and coronary angiography (k =0.873). Conclusions: Gated-SPECT was an useful tool for the screening of silent myocardial ischemia.

Utilidad de la tomografía computarizada de emisión de fotón único sincronizada con el electrocardiograma para la detección de isquemia miocárdica silente en diabéticos tipo 2 / Gated single photon emission computer tomography for the detection of silent myocardial ischemia

Asymptomatic patients with severe coronary atherosclerosis may have a normal resting electrocardiogram and stress test. To assess the yield of Gated Single Photon Emission Computer Tomography (SPECT) for the screening of silent myocardial ischemia in type 2 diabetic patients. Electrocardiogram, stress test and gated-SPECT were performed on 102 type 2 diabetic patients aged 60+/-8 years without cardiovascular symptoms. AH subjects were also subjected to a coronary angiography whose results were used as gold standard(AU)

[Infections of the central nervous system in emergency department]. / Infecciones del sistema nervioso central en urgencias.

Infections of the central nervous system are frequent diseases in emergency care. They can have a bacterial, parasitic or viral origin. Initial symptoms can be non-specific, which can complicate and delay diagnosis, hence the extreme importance of all the information that can be obtained through anamnesis and physical exploration, with frequent complementary explorations. In the last hundred years, with the introduction of antibiotic drugs, there has been a significant fall in mortality secondary to meningoencephalitis, but in spite of that they continue to provoke high morbidity and mortality. Other phenomena, such as vaccination campaigns, migratory movements, infection by HIV and other states of immunosuppression, have given rise to important epidemiological changes such as the virtual disappearance of some infections or the appearance of others that rarely existed previously. The list of potential infections of the central nervous system is extensive, which is why in this review we set out, from the clinical, diagnostic and therapeutic point of view, those that are most frequent in our environment and some that, although very infrequent, might require emergency attention due to their severity.

Assessment of individual finger muscle activity in the extensor digitorum communis by surface EMG.

The extensor digitorum communis (ED) is a slender muscle group in the dorsal forearm from which tendons arise to the index (D2), medius (D3), ring (D4), and little (D5) fingers. Limited independence has been attributed to the parts that actuate the individual fingers. However, in a detailed anatomical analysis, it was found that the ED parts to the different fingers have constant and widely spaced anatomical locations that promote independent function. These observations and the superficial muscle belly locations prompted the hypothesis that these ED parts would be individually assessable by small anatomically placed surface EMG electrodes. In the present study, this hypothesis was evaluated by measuring electromyography (EMG) from the ED parts and surrounding muscles during individual finger tapping tasks with the forearm resting on a flat surface. It was found that individual ED activity can be well measured in ED2, ED3, ED4, and extensor digiti minimi (EDM). ED3 did not give nor did its electrodes receive significant crosstalk from other ED parts. ED4 electrodes recorded an EMG level of 30 +/- 19% (mean +/- SD) ED2 EMG in D2 tapping and ED2 electrodes a level of 53 +/- 22% ED4 EMG in D4 tapping, by hypothesis mostly crosstalk. EDM electrodes may record EMG at the level of ED4 EMG in D4 tapping. In D2 tapping, the mutual ED2 and extensor indicis redundancy reflected in large intersubject EMG differences with sometimes one or the other almost silent. The results may expand the possibilities of EMG analysis and finger muscle electrostimulation in ergonomic and clinical applications.

Infecciones del sistema nervioso central en urgencias / Infections of the central nervous system in emergency department

Las infecciones del sistema nervioso central son enfermedades frecuentes en la atención urgente, pudiendo ser de origen bacteriano, parasitario o vírico. Los síntomas iniciales pueden ser inespecíficos, lo que puede dificultar y retrasar su diagnóstico, por lo que es de suma importancia toda la información que pueda obtenerse a través de la anamnesis y exploración física y con frecuencia exploraciones complementarias. En los últimos cien años, con la introducción de fármacos antibióticos ha disminuido de forma importante la mortalidad secundaria a meningoencefalitis, pero a pesar de ello siguen provocando alta morbi-mortalidad. Otros fenómenos, como las campañas de vacunación, movimientos migratorios, infección por el virus de la inmunodeficiencia humana y otros estados de inmunosupresión, han dado lugar a importantes cambios epidemiológicos como son la práctica desaparición de algunas infecciones o la aparición de otras previamente casi inexistentes. La lista de infecciones potenciales de sistema nervioso central es extensa por lo que en este artículo de revisión expondremos desde el punto de vista clínico, diagnóstico y terapéutico las más frecuentes en nuestro medio y algunas que, aunque poco frecuentes, pueden requerir atención urgente por su gravedad (AU)

Infections of the central nervous system are frequent diseases in emergency care. They can have a bacterial, parasitic or viral origin. Initial symptoms can be non-specific, which can complicate and delay diagnosis, hence the extreme importance of all the information that can be obtained through anamnesis and physical exploration, with frequent complementary explorations. In the last hundred years, with the introduction of antibiotic drugs, there has been a significant fall in mortality secondary to meningoencephalitis, but in spite of that they continue to provoke high morbidity and mortality. Other phenomena, such as vaccination campaigns, migratory movements, infection by HIV and other states of immunosuppression, have given rise to important epidemiological changes such as the virtual disappearance of some infections or the appearance of others that rarely existed previously. The list of potential infections of the central nervous system is extensive, which is why in this review we set out, from the clinical, diagnostic and therapeutic point of view, those that are most frequent in our environment and some that, although very infrequent, might require emergency attention due to their severity (AU)

Biomechanical evaluation of nursing tasks in a hospital setting.

A field study was conducted to investigate spinal kinematics and loading in the nursing profession using objective and subjective measurements of selected nursing tasks observed in a hospital setting. Spinal loading was estimated using trunk motion dynamics measured by the lumbar motion monitor (LMM) and lower back compressive and shear forces were estimated using the three-dimensional (3D) Static Strength Prediction Program. Subjective measures included the rate of perceived physical effort and the perceived risk of low back pain. A multiple logistic regression model, reported in the literature for predicting low back injury based on defined risk groups, was tested. The study results concluded that the major risk factors for low back injury in nurses were the weight of patients handled, trunk moment, and trunk axial rotation. The activities that required long time exposure to awkward postures were perceived by nurses as a high physical effort. This study also concluded that self-reported perceived exertion could be used as a tool to identify nursing activities with a high risk of low-back injury.

The Hamaker constant of anatase aqueous suspensions.

The linear relationship of the yield stress with the square zeta potential may be used to determine the Hamaker constants in suspensions. In this work we have obtained the Hamaker constant for the attractive forces between anatase particles in aqueous suspensions using this method and compared them with those obtained by contact angle measurement. The results show excellent agreement.

Differential contribution of poly(ADP-ribose)polymerase-1 and -2 (PARP-1 and -2) to the poly(ADP-ribosyl)ation reaction in rat primary spermatocytes.

Poly(ADP-ribose)polymerases (PARP-1 and -2) are activated by DNA strand breaks to synthesize protein-bound ADP-ribose polymers from NAD+. The two enzymes are overexpressed in rat spermatocytes and are likely to play a role in meiosis. Indeed parp-2-/- mice, but not parp-1 knockouts, show hypofertility. Aside, PARP-1 and PARP-2 are both involved in DNA damage repair and signalling, but their relative contributions to such processes remain as yet unknown, largely because of the lack of PARP isoform-specific inhibitors that has precluded in vivo studies. Here, we used permeabilized rat primary spermatocytes or isolated spermatocyte nuclei and radiolabelled NAD+ to investigate potential isoform-specific effects on basic features of the poly(ADP-ribosyl)ation reaction, including size of ADP-ribose polymers at different NAD+ concentrations, extent of auto- versus etheromodification, and modulation of such reactions by the PARP inhibitor, PJ34. We found that PARP-1 automodification prevailed over PARP-2 modification. In addition, over 50% of cellular poly(ADP-ribose) was covalently bound to histones H1 and H2. The inhibitory effect of PJ34 appeared to be targeted mainly to the elongation step of the reaction. We propose that a different propensity of PARP-1 and PARP-2 to undergo automodification and/or catalyze etheromodification, both in terms of number of enzyme molecules being involved and amount of bound poly(ADP-ribose), may underlie distinct roles in the regulation of spermatocyte functions.

[Neurocysticercosis. An emergent disease]. / Neurocisticercosis. Una enfermedad emergente.

Neurocysticerosis is an affection of the central nervous system by the larvae of the Taenia solium. Although its diagnosis in our country is exceptional, in recent years a notable increase in the number of cases diagnosed has been observed, due to the phenomenon of immigration from countries where the disease is endemic. The most frequent form of presentation of neurocysticercosis is seizures, followed by headache. To diagnose it we must evaluate the epidemiological data, the clinical record and confirm this through neuroimage and immunological studies. The treatment selected should be pharmacological, principally with albendazole, and surgery reserved for cases where the former fails. Hygienic measures and the treatment of patients with teniasis are of great importance. Neurocysticerosis has ceased to be an exceptional diagnosis and given the foreseeable increase of its incidence in our milieu, health professionals must understand this disease and include it at higher levels of the algorithms of differential diagnosis.

Neurocisticercosis. Una enfermedad emergente / Neurocysticercosis. An emergent disease

La neurocisticercosis es una afectación del sistema nervioso central por las larvas de la Taenia solium. Aunque en nuestro país su diagnóstico era excepcional, en los últimos años se ha observado un notable incremento en el número de casos diagnosticados, debido al fenómeno de la inmigración desde países donde la enfermedad es endémica. La forma de presentación más frecuente de la neurocisticercosis es la crisis epiléptica, seguida de la cefalea. Para el diagnóstico de sospecha debemos valorar los datos epidemiológicos y la clínica y confirmarlo mediante los estudios de neuroimagen e inmunológicos. El tratamiento de elección debe ser farmacológico, principalmente con albendazol, y reservar la cirugía para los casos en el que el primero falla. Las medidas higiénico-sanitarias y el tratamiento de los pacientes con teniasis son de suma importancia. La neurocisticercosis ha dejado de ser uno de esos diagnósticos excepcionales y dado el previsible aumento de su incidencia en nuestro medio, los profesionales sanitarios debemos conocer dicha enfermedad e incluirla en niveles más altos de los algoritmos de diagnóstico diferencial (AU)

[Pharyngeal globe and pharyngo-laryngeal reflux]. / Globo faríngeo y reflujo faringo-laríngeo.

The globus sensation is one of the most frequent complaints in a basic ENT clinic. The etiology is still unknown, although some hypotheses have been suggested such as: psychological abnormalities, esophageal and cricopharyngeal muscle disfunction and the laryngopharyngeal reflux. Laryngopharyngeal reflux is the most frequent pathology related to the globus feeling. We've tried in this study to determine the incidence of laryngopharyngeal reflux in a group of 30 patients with globus feeling. We found 26.7% of these patients with an abnormal pH monitoring test.