Consecuencias sociolaborales del confinamiento por la COVID-19 en pacientes con esclerosis múltiple en dos poblaciones muy diferentes / Socio-labor consequences of confinement by COVID-19 in patients with multiple sclerosis in two very different populations

El confinamiento debido a la pandemia de la COVID-19, realizado a nivel mundial, ha tenido consecuencias casi siempre negativas en los pacientes con esclerosis múltiple (EM). OBJETIVO: Hemos comparado el efecto sociolaboral que el confinamiento ha podido tener en pacientes con EM de dos poblaciones tan diferentes como son España y China. MÉTODO: Se elaboraron unos cuestionarios a lo que respondieron un grupo de pacientes de EM que son revisados en la unidad de EM del hospital Vithas (Fundación DINAC) en Sevilla, y pacientes con EM atendidos en varias provincias de China durante el mes de abril de 2020, con el objetivo de analizar las diferencias y similitudes del efecto sociolaboral entre ambas poblaciones. Para llevar a cabo este análisis se creó una base de datos que se analizó posteriormente. RESULTADOS: La población china tiene una mayor proporción de pacientes más jóvenes y no hay diferencia respecto al género. La mayoría de las variables estudiadas se comportaron de igual forma en los pacientes con EM tanto españoles como chinos. Los pacientes españoles presentaron menos impacto (30,7%) en su situación socioeconómica que los chinos (44%), p < 0,05. No hubo diferencias importantes en el resto de las variables entre las dos poblaciones. Las redes sociales fueron muy utilizadas en la mayoría de los enfermos de ambas poblaciones. CONCLUSIONES: Los pacientes con EM padecen de forma muy similar las consecuencias de la pandemia en su situación sociolaboral y utilizan de forma parecida las redes sociales y el apoyo de la familia. Los pacientes españoles disfrutan de más estabilidad económica, probablemente gracias al apoyo social que reciben

The confinement due to the global COVID-19 pandemic has almost had negative consequences in patients with multiple sclerosis (MS). OBJECTIVE: We wanted to compare the socio-labor effect of confinement in two populations as different as Spain and China, in patients with MS. METHOD: Questionnaires were applied to a group of MS patients who have been reviewed in the MS unit of the Vithas hospital (DINAC Foundation) in Seville, and MS patients attended in various provinces of China during the month of April 2020, with the aim of analyzing the differences and similarities of the socio-labor effect between both populations. To carry out this analysis, a database was created and subsequently analyzed. RESULTS: The Chinese population has a higher proportion of younger patients and there is no difference regarding gender. Most of the variables studied behaved the same way in both Spanish and Chinese MS patients. Spanish patients had less impact (30.7%) on their socio-economic situation than Chinese (44%), P < .05. There were no important differences in the rest of the variables between the two populations. Social networks were widely used in the majority of patients in both populations. CONCLUSIONS: MS patients suffer in a very similar way from the consequences of the pandemic on their socio-labor situation and similarly use social networks and family support. Spanish patients seem to have more economic stability, which may be due to social economic support

Social and professional consequences of COVID-19 lockdown in patients with multiple sclerosis from two very different populations. / Consecuencias sociolaborales del confinamiento por la COVID-19 en pacientes con esclerosis múltiple en dos poblaciones muy diferentes.

The global lockdown measures implemented due to the COVID-19 pandemic have nearly always had negative consequences for patients with multiple sclerosis (MS). OBJECTIVE: We compared the social and professional effects of confinement on patients with MS in 2 very different populations, from Spain and China. METHODS: Questionnaires were administered to a group of patients with MS who consulted at the MS unit of Vithas hospital (DINAC Foundation) in Seville, and patients with MS attended in several provinces of China in April 2020, with the aim of analysing the differences and similarities between populations in the social and professional effects of confinement. To this end, a database was created and subsequently analysed. RESULTS: The Chinese population includes a higher proportion of younger patients and no differences were identified regarding sex. Most of the variables studied behaved in the same way in both patient populations. Spanish patients presented a lesser impact (30.7%) on their socio-economic situation than Chinese patients (44%) (P < .05). There were no significant differences between populations in the remaining variables. Social networks were widely used in the majority of patients from both populations. CONCLUSIONS: The social and professional consequences of the pandemic were very similar in both groups; the use of social networks and family support was also similar. Spanish patients seem to present greater economic stability, perhaps due to the social support they receive.

Anal cytology in women: Experience from a single tertiary center.

INTRODUCTION: Anal cytology (AC) can be used as a screening tool for detection of anal HPV associated lesions, mainly in men who have sex with men and in immunosuppressed patients. Our aim is to review our experience with AC in women. MATERIAL & METHODS: We have retrospectively reviewed all AC diagnosed between 2010-2017 in a single tertiary hospital (n = 644) and selected those performed in women (n = 158). RESULTS: 24.53% of AC were performed in women. 14.7% of all women were HIV positive and 56.7% referred anal intercourse. Squamous lesions were found in 27.2% of women, most of them ASCUS and LSIL (14% and 11.5%). HPV DNA was detected in 38.6% of patients, and 63.9% of them showed positivity for multiple high-risk types. Anal biopsy showed high grade lesions in 20% of biopsied patients. We observed a significant relationship between HPV status and receptive anal sex, and the association between HPV status and anal histological diagnosis tended to significance. Sensitivity, specificity, negative predictive value and positive predictive value for anal cytology were 57%; 83%; 28% and 94%, respectively. 70.9% of women had synchronous cervical cytology, and squamous cervical lesions were detected in 46.4% of the cases, most of them LSIL or ASCUS (21.4% and 15.2%). We did not confirm a significant association between cytological diagnosis of cervical and anal samples. CONCLUSIONS: AC is less widely used in women than in homosexual men. However, women show important rates of anal lesions, regardless of their HIV status. More studies should be performed to assess the potential impact of screening protocols in this population.

Insectos de importancia forense en cadáveres de cerdo (sus scrofa ) en La Paz Bolivia / Forensic insects in pig carcasses (sus scrofa) in La Paz Bolivia

Resumen:La Entomología Forense es una ciencia que implica el estudio de las especies antropofágicas que practican un ciclo vital en el cadáver. Contribuye en la determinación del Intervalo posmortem. Los insectos de importancia forense que se estudiaron pertenecen a la orden Dípteros y Coleópteros. En el estudio realizado en el municipio de Pucarani, ubicado en la provinciaLos Andes del Departamento La Paz a 3852 m.s.n.m. entre otoño e invierno, se obtuvo dos ejemplares de cerdo S. scrofa, en dos ambientes: abierto (cerdo A) y cerrado: (cerdo B). Se identificó 339 especímenes entre dípteros y coleópteros. No se encontraron diferencias significativas en la sucesión de entomofauna entre ambos ambientes, sin embargo predominó la familia Fannide sp. en el lugar cerrado por ser un ambiente húmedo. Los dípteros de mayor importancia son: Sarconesia Chlorogaster, Clorobrachycoma splendida, que pertenecen a la familia Calliphoridae, que se mantuvo en constante actividaden su estadio larval y su forma adulta en los cuatro estados de descomposición a temperaturas de 14 - 16°C, humedad relativa de 30%; no se encontró a Calliphora nigribasis en la descomposición avanzada; Sarconesiopsis magellánica solo se presenta en la etapa Fresco. Entre los Coleópteros: Oxelitrum apicale apareció desde la etapa hinchado. La sucesión de entomofauna cadavérica y su particularidad en cada etapa de descomposición, es el elemento que nos ayudaría a determinar el IPM, que dependerá de las condiciones climáticas a gran altitud como Bolivia.

Abstract:Forensic entomology is a science that involves the study of the cannibalistic species that plays a vital cycle in the body. It helps to determinate the postmortem interval. Insects with forensic importance that were studied belong to the order Diptera and Coleoptera. In the study conducted in the Municipality of Pucarani, located in the province of Los Andes La Paz Department at 3852 meters between autumn and winter, two copies of pork S. scrofa was obtained in two environments: open (pork A), closed (pig B). 339 specimens between Diptera and Coleoptera were identified. No significant differences were found in the entomofauna sequence between the two environments, however the Fannide sp. In the place closed for being a humid environment. The most important dipterans are: Sarconesia Chlorogaster, Clorobrachycoma splendida, belonging to the family Calliphoridae, which remained in constant activity in its larval stage and its adult form in the four decaying states at temperatures of 14 - 16 ° C, humidity Relative to 30%; Calliphora nigribasis was not found in advanced decomposition; Magellanic sarconesiopsis only occurs in the Fresco stage. Among the Coleoptera: Oxelitrum apicale appeared from the swollen stage. The succession of cadaveric entomofauna and its particularity in each stage of decomposition is the element that would help us determine the MPI, which will depend on high altitude climatic conditions like Bolivia.

Tabaquismo materno como un factor posiblemente implicado en el desarrollo de la obesidad infantil / Possible effects of maternal smoking during pregnancy on the development of childhood obesity

El tabaquismo es la adicción al tabaco provocada principalmente por diversos componentes activos y tóxicos como la nicotina. El consumo de cigarrillo durante la gestación puede provocar desprendimiento de placenta, placenta previa, embarazo ectópico y aborto espontáneo, como también inducir alteraciones en el feto. En la presente revisión de la literatura se recopiló información en bases de datos como Pub-Med, Embase y Google Académico, concerniente a los posibles efectos del tabaquismo materno durante la gestación sobre el desarrollo de la obesidad infantil. Fueron seleccionados 38 artículos escritos en el idioma inglés y español, publicados a partir de año de 1988 hasta el año 2015, que incluyeron metaanálisis, artículos originales, y revisiones de tema. Se encontró que la exposición al humo del tabaco durante la gestación ha sido ampliamente descrita como un factor de riesgo para la manifestación de alteraciones en el desarrollo fetal como retardo del crecimiento intrauterino y bajo peso al nacer. Además, se ha asociado ampliamente con trastornos del desarrollo infantil en etapas avanzadas, como preescolares y escolares, manifestados en un aumento del índice de masa corporal con respecto al percentil adecuado para la edad; incremento de la incidencia de sobrepeso y obesidad en el infante. Se concluye que la exposición al humo del cigarrillo durante la gestación se relaciona con alteraciones en el crecimiento del niño y en el desarrollo de enfermedades prevalentes asociadas a la obesidad.

Most smokers use tobacco regularly because they are addicted to various active and toxic compounds such as nicotine. Cigarette smoking during pregnancy can cause abruption, placenta previa, ectopic pregnancy and spontaneous abortion, as well as induce alterations in the fetus. In this review, information was collected in databases such as PubMed, Embase and Google Scholar, concerning the possible effects of maternal smoking during pregnancy on the development of childhood obesity. Thirty-eigth articles written in English and Spanish published from year 1988 to 2015, which included meta-analysis, original articles and reviews were selected topic. It was found that exposure to cigarette smoke during pregnancy has been widely described as a risk factor for alterations in fetal development such as intrauterine growth retardation and low birth weight. In addition, it has been widely associated with disorders of child development in advanced stages, preschool and school age: increased body mass index regarding the appropriate percentile for age, and increase in childhood overweight and obesity. It is concluded that exposure to cigarette smoke during pregnancy is associated with changes in child growth and development of prevalent diseases associated with obesity.

Late sodium current block for drug-induced long QT syndrome: Results from a prospective clinical trial.

Drug-induced long QT syndrome has resulted in many drugs being withdrawn from the market. At the same time, the current regulatory paradigm for screening new drugs causing long QT syndrome is preventing drugs from reaching the market, sometimes inappropriately. In this study, we report the results of a first-of-a-kind clinical trial studying late sodium (mexiletine and lidocaine) and calcium (diltiazem) current blocking drugs to counteract the effects of hERG potassium channel blocking drugs (dofetilide and moxifloxacin). We demonstrate that both mexiletine and lidocaine substantially reduce heart-rate corrected QT (QTc) prolongation from dofetilide by 20 ms. Furthermore, all QTc shortening occurs in the heart-rate corrected J-Tpeak (J-Tpeak c) interval, the biomarker we identified as a sign of late sodium current block. This clinical trial demonstrates that late sodium blocking drugs can substantially reduce QTc prolongation from hERG potassium channel block and assessment of J-Tpeak c may add value beyond only assessing QTc.

Differentiating drug-induced multichannel block on the electrocardiogram: randomized study of dofetilide, quinidine, ranolazine, and verapamil.

Block of the hERG potassium channel and prolongation of the QT interval are predictors of drug-induced torsade de pointes. However, drugs that block the hERG potassium channel may also block other channels that mitigate torsade risk. We hypothesized that the electrocardiogram can differentiate the effects of multichannel drug block by separate analysis of early repolarization (global J-Tpeak) and late repolarization (global Tpeak-Tend). In this prospective randomized controlled clinical trial, 22 subjects received a pure hERG potassium channel blocker (dofetilide) and three drugs that block hERG and either calcium or late sodium currents (quinidine, ranolazine, and verapamil). The results show that hERG potassium channel block equally prolongs early and late repolarization, whereas additional inward current block (calcium or late sodium) preferentially shortens early repolarization. Characterization of multichannel drug effects on human cardiac repolarization is possible and may improve the utility of the electrocardiogram in the assessment of drug-related cardiac electrophysiology.

Efecto de la adición de nitratos a la dieta sobre la mortalidad de pollos broiler / Effect of nitrate addition in food on chicken broiler mortality

Objetivos: este estudio investigó el efecto de la adición de nitratos en la dieta sobre la mortalidad de pollos broiler. Materiales y métodos: se utilizaron 100 pollos de estirpe ross de un día de nacidos, divididos aleatoriamente en cuatro grupos. Se cuantificó el contenido de nitratos en el pienso comercial y el agua de bebida por una técnica colorimétrica basada en la nitridación del ácido sulfúrico. Los sujetos experimentales de los cuatro grupos recibieron pienso y agua ad libitum en las cantidades recomendadas para pollos broiler. Los animales de tres de los grupos recibieron nitrato de sodio adicional en el agua de bebida. La adición de nitrato fue 1, 2 ó 3 veces la concentración hallada en el pienso. Resultados: la adición de nitrato en el agua de bebida resultó en aumento de la mortalidad en relación dosis dependiente con la concentración adicionada. El análisis patológico realizado el último día del ciclo a los animales sobrevivientes de cada uno de los grupos experimentales demostró que aquellos expuestos a las mayores adiciones de nitrato presentaron lesiones compatibles con el síndrome ascítico. Adicionalmente, los hallazgos de necropsia en los animales que fallecieron durante el experimento mostraron lesiones compatibles con enfermedades infecciosas y con la enfermedad de edema aviar. Conclusiones: los resultados de este estudio sugieren que el consumo de nitratos representa un factor determinante para el aumento de la mortalidad en las explotaciones avícolas.

Aim: This study investigated the effect on broiler chickens mortality by addition of nitrate intake.Materials and methods: One hundred (100), one day old ross chickens were used, and randomly assigned into 4 groups. The nitrate contents in food and drinking water was quantified by means of a colorimetric technique based on the sulfuric acid nitridation. The recommended amount of food for broiler chickens and water ad libitum were delivered for the animals of the four (4) experimental groups. Sodium nitrate was added in the drinking water for the animals of groups 1, 2, and 3. The nitrate added in water was 1, 2 and 3 times the nitrate concentration found in food. Results: The additional nitrate intake showed a dose-dependent mortality increase. Pathological study was done on the last day of the cycle for the surviving animals from each one of the experimental groups. This showed that the animals exposed to higher intake of nitrate had lesions compatible with ascitic syndrome. Additionally, necropsy findings during the experiment were compatible with infectious pathologies and avian edema disease. Conclusions: results from this study suggest that nitrate intake is a determinant factor in the avian mortality increase.

A genomic parasite in the evolution of metazoan development.

It is a challenge to understand how development emerged as a mechanism to dismantle and dismiss the intromission of foreign parasites in order to consolidate a higher-level multicellular unit of selection where more heritable variations in fitness, required for complex organization, can be procured. Levels in biological hierarchy genes, networks of genes, chromosomes, cells, organisms, etc., possess heritable variations in fitness to varying degrees, and as such, they function as units of selection in the evolutionary process [Lewontin, (1970). The units of selection. Annu. Rev. Ecol. Syst. 1: 1-18]. To proceed from each of these levels to the next constitutes a major transition in evolutionary history. When analyzing the splendid road epitomized by these transitions in units of selection, it is possible to conceive three processes: firstly, the molecular "recognition" of the "convenience" of exchanging the higher energy cost of cooperating cells with more fitness than single-cell selection (after that first recognition the emergence of cooperation among cells is possible); secondly, the establishment of the mechanisms to regulate conflict, and finally, the regulation of cell differentiation and compartmentalization.

Long term effect of external pituitary irradiation on IGF1 levels in patients with acromegaly free of adjunctive treatment.

OBJECTIVE: It is established that external pituitary irradiation (EPI) effectively reduces serum GH levels in acromegaly. However, its effect in normalising serum IGF1 has been disputed. We looked at the number of our patients who achieved persistently normal IGF1 levels whilst free of adjunctive treatment for at least 1 year after EPI. PATIENTS AND DESIGN: We identified 63 acromegalic patients between 1964 and 2004 who received EPI. Six were excluded: three had surgery after EPI, two had no medical records available, and one had a pituitary Yttrium implant. MEASUREMENTS: Patients received 4500-5000 cGy in fractionated doses. IGF1 levels were correlated with their respective age-related reference ranges. RESULTS: After EPI, the number of patients with normal IGF1 and free of adjunctive medical treatment for at least 1 year were four patients by 3 years, nine patients by 5 years and seventeen by 10 years, with the current number of 25/57 (44%). Concordance between IGF1 levels and random GH dropped from 90% at the time of EPI to 65% at 3 years, 66% at 5 years and 71% at 10 years. CONCLUSIONS: We have demonstrated that, with time, EPI achieves a normal IGF1 in significant numbers of patients with acromegaly, thus obviating the need for life-long expensive medical therapy. For each patient this benefit has to be weighed against the possibility of new hypopituitarism as a result of the treatment. Any decision to use EPI is easier in the context of pre-existent hypopituitarism.

Rationalization of genetic testing in patients with apparently sporadic pheochromocytoma/paraganglioma.

Hereditary susceptibility to pheochromocytoma (PCC) and paraganglioma (PGL) represents a very complex genetic scenario. It has been reported that the absence of familial antecedents of the disease does not preclude the existence of a mutation affecting any of the five major susceptibility genes. In fact, 11-24% of apparently sporadic cases (without familial or syndromic antecedents) harbor an unexpected germline mutation, but we do not know what is happening in "truly apparently" sporadic patients (i.e., apparently sporadic cases diagnosed with only one tumor). In the present study, we have analyzed 135 apparently sporadic patients developing a single tumor for the five major susceptibility genes: VHL, RET, SDHB, SDHC, and SDHD. Fourteen percent of cases were found to harbor a germline mutation, and only 2.2% of patients were older than 45 years at onset. By taking into account the tumor location and a threshold age at onset of 45 years, we propose a rational scheme for genetic testing. Analyzing VHL and RET genes would be recommended only in young patients developing a single PCC. On the other hand, genetic testing of SDHD should be done in all patients developing an extra-adrenal tumor before the age of 45, and SDHC could be the responsible gene in cases developing a single head and neck tumor, independently of age. Finally, the analysis of SDHB should always be performed because of its association to malignancy and the low penetrance of mutations affecting this gene.

From unicellularity to multicellularity - molecular speculations about early animal evolution.

A morphological, physiological, developmental, and genetic organization of great complexity ineluctably unfolded from relatively simple phenomena invested with enormous potential. Sometime long ago in the Protererozoic times, parasitic invasions caused lower evolutionary levels to integrate into higher-level selection. Therefore, we have a multi-level selection problem that ultimately revolves around the question of how natural selection among lower-level units acts to create higher-level units of selection, in which Darwinian competition among replicators ceases to be the foremost force. The first level relinquishes its independence for the benefit of a higher-level cooperative force that is now the criterion of fitness for the new transition in the evolutionary process.

From unicellularity to multicellularity - molecular speculations about early animal evolution

A morphological, physiological, developmental, and genetic organization of great complexity ineluctably unfolded from relatively simple phenomena invested with enormous potential. Sometime long ago in the Protererozoic times, parasitic invasions caused lower evolutionary levels to integrate into higher-level selection. Therefore, we have a multi-level selection problem that ultimately revolves around the question of how natural selection among lower-level units acts to create higher-level units of selection, in which Darwinian competition among replicators ceases to be the foremost force. The first level relinquishes its independence for the benefit of a higher-level cooperative force that is now the criterion of fitness for the new transition in the evolutionary process.

Gastrinoma / Gastrinoma

El gastrinoma es un tumor secretor de gastrina y es el segundo pancreático más frecuente, pudiendo presentarse como esporádico o como parte de la neoplasia endocrina múltiple tipo 1 (MEN1). Las manifestaciones clínicas se deben a la elevación de gastrina y a la hipersecreción ácida, excepto por los síntomas derivados de las metástasis. La confirmación de la hipergastrinemia y de los marcadores tumorales ofrece gran sensibilidad para el diagnóstico. Las nuevas técnicas de imagen, como la ecografía endoscópica, la resonancia magnética y, particularmente, la gammagrafía con análogos de somatostatina, permiten un mejor acercamiento a la localización. El tratamiento exitoso de la enfermedad diseminada requiere un equipo multidisciplinario; la eliminación quirúrgica radical del tumor puede ser curativa, aunque raramente es posible. La bioterapia con análogos de somatostatina (ya conocidos o nuevos) o el interferón se aconseja en tumores bien diferenciados, ya que la quimioterapia se reserva para los pobremente diferenciados y progresivos. La terapia con radionúclidos debe utilizarse en tumores con captación de radiotrazador, tanto tras la cirugía para erradicar la enfermedad residual como si ocurre fallo de la terapia convencional o la bioterapia. El mantenimiento de la calidad de vida deber ser la prioridad, particularmente porque los pacientes con enfermedad diseminada pueden tener una supervivencia prolongada (AU)

Gastrinoma is a gastrin-secreting tumor and is the second most frequent neoplasm of the pancreas. This tumor can occur either sporadically or in association with MEN-1. Except for the symptoms due to the effects of widespread metastases, clinical manifestations are due to elevated gastrin levels and hypersecretion of gastric acid. Confirmation of hypergastrinemia and tumoral markers provide high sensitivity in diagnosis. New imaging techniques include endoscopic ultrasonography, magnetic resonance imaging, and especially, somatostatin analog scintigraphy, which allow a better approach to the location of the tumor. Successful treatment of disseminated disease requires a multidisciplinary team; radical surgery may be curative but is rarely feasible. Biotherapy with classical or new somatostatin analogs, or interferon, is recommended for well-differentiated tumors, since chemotherapy is reserved for poorly differentiated and progressive tumors. Radionucleotide therapy should be used for tumors exhibiting radiotracer uptake, either after surgery to eradicate microscopic residual disease or subsequently if conventional treatment or biotherapy fail. The priority should be to maintain quality of life, particularly because patients with disseminated disease may have prolonged survival (AU)

[The efficiency and cost-utility ratio of interferon beta in the treatment of multiple sclerosis in Andalusia]. / Eficiencia y relación coste-utilidad del interferón beta en la esclerosis múltiple en Andalucía.

INTRODUCTION: The availability of the interferon beta in its three forms at the moment available in our country and of glatiramer acetate has marked a point of flexion in the natural history of multiple sclerosis (MS), but the high cost of these treatments cause that its use is questioned. In this work we have studied the effectiveness and efficiency of the processing with interferon beta, and the cost-utility of these treatments in MS in Spain has been also analyzed. PATIENTS AND METHODS: For this work we studied 102 patients affected of RR MS, treated with the three interferons beta which we have available in our country. We used as control 330 patients who had participated in the pivotal clinical interferon trials with both interferon beta 1a. In these patients in addition to effectiveness data, we have studied the disability measured as area below curve and the quality of life (AVACs). We also calculated the economical costs, considering the relation cost-utility in our country. RESULTS: Besides to confirm the data of effectiveness of three interferons, in this study a saving of 23 days/year is demonstrated what corresponds to 0.063 AVACs. The additional cost of interferons is greater than the avoided cost until the fifth year of treatment in which the tendency is reversed in favor of the group of treated patients, if we assume that the same effectiveness that we found in the first years is maintained in the long term. CONCLUSION: The use of the treatment with interferon beta is justified by its effectiveness, efficacy and efficiency. The additional cost of the treatment will be compensated in the long term if the effectiveness of the interferon beta is maintained.

Eficiencia y relación coste-utilidad del interferón beta en la esclerosis múltiple en Andalucía / The efficiency and cost-utility ratio of interferon beta in the treatmentof multiple sclerosis in Andalusia

Introducción. La disponibilidad del interferón (IFN-) en sus tres formas actualmente disponibles en nuestro país, y del acetato de glatiramero han marcado un punto de inflexión en la historia natural de la esclerosis múltiple (EM); pero, el elevado coste de estos medicamentos hace que se cuestione si su utilización está justificada. En este trabajo hemos estudiado la efectividad y eficiencia del tratamiento con IFN-, y hemos analizado la relación coste-utilidad de este tratamiento en la EM en España. Pacientes y métodos. Para este trabajo hemos estudiado conjuntamente 102 pacientes afectados de EMRR, tratados con los tres IFN- de que disponemos en nuestro país, y utilizamos como control a 330 pacientes que habían participado en los ensayos clínicos fundamentales de los dos IFN- 1a. En estos pacientes, además de datos de eficacia, hemos estudiado la discapacidad, medida como el área bajo la curva, y la calidad de vida (AVAC). Hemos calculado los costes, estimando la relación costeutilidad en nuestro medio. Resultados. Además de confirmar los datos de eficacia de los tres IFN, en este estudio se demuestra un ahorro de 23 días/año, lo que corresponde a 0,063 AVAC. El coste añadido de los IFN supone un gasto mayor que el coste económico que se evita hasta el quinto año de tratamiento, en el que se invierte la tendencia en favor del grupo de pacientes tratados, si se asume que se mantendrá la misma eficacia que se aprecia en los primeros años a largo plazo. Conclusiones. La utilización del tratamiento con IFN- se justifica por su eficacia, efectividad y eficiencia. El coste añadido del tratamiento se compensará a largo plazo si se mantiene la eficacia del tratamiento (AU)

Introducción. The availability of the interferon beta in its three forms at the moment available in our country and of glatiramer acetate has marked a point of flexion in the natural history of multiple sclerosis (MS), but the high cost of these treatments cause that its use is questioned. In this work we have studied the effectiveness and efficiency of the processing with interferon beta, and the cost-utility of these treatments in MS in Spain has been also analyzed. Patients and methods. For this work we studied 102 patients affected of RR MS, treated with the three interferons beta which we have available in our country. We used as control 330 patients who had participated in the pivotal clinical interferon trials with both interferon beta 1a. In these patients in addition to effectiveness data, we have studied the disability measured as area below curve and the quality of life (AVACs). We also calculated the economical costs, considering the relation cost-utility in our country. Results. Besides to confirm the data of effectiveness of three interferons, in this study a saving of 23 days/year is demonstrated what corresponds to 0.063 AVACs. The additional cost of interferons is greater than the avoided cost until the fifth year of treatment in which the tendency is reversed in favor of the group of treated patients, if we assume that the same effectiveness that we found in the first years is maintained in the long term. Conclusions. The use of the treatment with interferon beta is justified by its effectiveness, efficacy and efficiency. The additional cost of the treatment will be compensated in the long term if the effectiveness of the interferon beta is maintained (AU)

Determination of the precision of the fatty acid analysis of Iberian pig fat by gas chromatography. Results of a mini collaborative study.

A collaborative study was carried out to determine the repeatability (error in each laboratory) and reproducibility (error between the different laboratories) of the fatty acid analysis of Iberian pig fat by gas chromatography. To do this, a comparison was made, in accordance with the ISO 5725-2 procedure, of the weight percentage (%) of the main fatty acids (C16:0, C18:0, C18:1 and C18:2) in 60 samples, determined by six laboratories. The results obtained for the relative standard deviation of the repeatability (0.56, 0.49, 0.29, and 0.69%) and for the relative standard deviation of the reproducibility (3.04, 3.54, 1.78 and 2.86%) show that the accuracy obtained is adequate for this analysis method, and in the same order or even higher than that obtained by other authors in similar samples. The differences between the results obtained on using two extraction methods of liquid fat from subcutaneous adipose tissue were recorded with no significant differences being observed between them.