[Drug exposure associated with exacerbation of symptoms in patients with myasthenia gravis]. / Exposición a fármacos asociados a agravamiento de síntomas en pacientes con miastenia grave.

INTRODUCTION: Numerous drugs have been related to exacerbation of myasthenia gravis. So far there are no studies examining the extent of use of drugs related to exacerbation of myasthenia gravis. AIMS: We sought to assess the extent of use of drugs related to exacerbations and the annual incidence rate of exacerbations in a cohort of myasthenia gravis patients. We explored possible risk factors of severe exacerbations. PATIENTS AND METHODS: We performed a retrospective cohort study. We included adult patients followed in neurology department. We estimated frequencies, rates and built a recurrent events model. RESULTS: We included 91 patients. 94.51% of patients had at least one prescription of a drug. 51 patients had at least one prescription of a drug contraindicated according to its drug label. 145 exacerbation episodes were reported in 50 patients. The annual incidence rate of exacerbation episodes was 0.35. 48 exacerbations were severe (in 18 patients). The annual incidence rate of severe exacerbation episodes was 0.12. Generalized myasthenia gravis and thymectomy were associated with a higher risk of severe exacerbation episodes. CONCLUSIONS: Our patients were extensive and widespread exposed to drugs during the follow-up period but we did not find and association with severe exacerbation episodes. Just over half of the patients had at least one exacerbation episode during the study period, most of them were mild. Further studies with larger sample sizes are necessary to corroborate these conclusions and to study possible correlations between the use of drugs and the risk of exacerbation episodes.

TITLE: Exposición a fármacos asociados a agravamiento de síntomas en pacientes con miastenia grave.Introducción. Numerosos fármacos se han relacionado con el agravamiento de síntomas en pacientes con miastenia grave, pero hasta la fecha no existen estudios sobre la exposición a fármacos en estos pacientes. Objetivos. Describir el consumo de fármacos y calcular la tasa anual de episodios de exacerbación en una cohorte de pacientes con miastenia grave, y explorar posibles factores de riesgo de exacerbaciones graves. Pacientes y métodos. Estudio observacional longitudinal retrospectivo que incluye a pacientes adultos con miastenia grave seguidos en consulta. Cálculo de frecuencias, tasas y construcción de modelo de eventos repetidos. Resultados. De 91 pacientes incluidos, el 94,51% estuvo expuesto al menos a un fármaco durante el período de estudio (siete años y un mes). De ellos, 51 tuvieron al menos una prescripción de un fármaco contraindicado en la ficha técnica (56,04%). Se contabilizaron 145 exacerbaciones en 50 pacientes. La tasa anual de incidencia fue de 0,35 exacerbaciones por paciente y año. De estas exacerbaciones, 48 fueron graves (en 18 pacientes), con una tasa anual de incidencia de 0,12. Se halló una posible asociación entre diagnóstico de miastenia grave generalizada y timectomía, con un aumento del riesgo de episodios de exacerbación graves. Conclusiones. En esta cohorte se encontró una amplia exposición a fármacos, pero no asociación con el riesgo de episodios de exacerbación graves. Algo más de la mitad de pacientes tuvo al menos un episodio de exacerbación durante el período de estudio, la mayoría leves. Son necesarios estudios que corroboren estas conclusiones y puedan estudiar posibles correlaciones entre fármacos y el riesgo de episodios de exacerbación.

Mutation of a bHLH transcription factor allowed almond domestication.

Wild almond species accumulate the bitter and toxic cyanogenic diglucoside amygdalin. Almond domestication was enabled by the selection of genotypes harboring sweet kernels. We report the completion of the almond reference genome. Map-based cloning using an F1 population segregating for kernel taste led to the identification of a 46-kilobase gene cluster encoding five basic helix-loop-helix transcription factors, bHLH1 to bHLH5. Functional characterization demonstrated that bHLH2 controls transcription of the P450 monooxygenase-encoding genes PdCYP79D16 and PdCYP71AN24, which are involved in the amygdalin biosynthetic pathway. A nonsynonymous point mutation (Leu to Phe) in the dimerization domain of bHLH2 prevents transcription of the two cytochrome P450 genes, resulting in the sweet kernel trait.

[Fingolimod: effectiveness and safety in routine clinical practice. An observational, retrospective, multi-centre study in the province of Alicante]. / Fingolimod: efectividad y seguridad en la practica clinica habitual. Estudio observacional, retrospectivo y multicentrico en la provincia de Alicante.

INTRODUCTION: Post-authorisation studies are important to confirm whether the outcomes of clinical trials are reproduced in usual clinical practice. AIMS: To evaluate the effectiveness and safety of fingolimod in clinical practice in the province of Alicante. PATIENTS AND METHODS: A retrospective multi-centre study was conducted with remitting multiple sclerosis patients treated with fingolimod. Demographic, clinical and pharmacological data were collected. We report on the effectiveness of the drug -annualised relapse rate (ARR) and percentage of patients free from attacks- at one and at two years after treatment in relation to the previous year, and data concerning side effects are also provided. RESULTS: The sample consisted of 89 patients. Previous treatment was with immunomodulators (interferon beta or glatiramer acetate) in 54 patients and natalizumab in 32. Fifty patients changed due to failure with the immunomodulator and 31 owing to positive serology for JC virus (JCV+). Overall ARR decreased by 67.3% the first year (p < 0.0001) and by 84.1% the second (p = 0.0078). It diminished in patients with immunomodulator failure (85.6% the first year, p < 0.0001; 88.9% the second year, p = 0.0039) and increased in a non-significant manner in JCV+ patients in the first year. The percentage of patients free from relapses in the overall population increased from 32.6% to 68.1% in the first year (p < 0.0019) and to 82.6% in the second (p = 0.0215). This increase was not observed in JCV+ patients. Side effects were reported by 13 patients, which led to the drug being withdrawn in two of them. CONCLUSION: In clinical practice in the province of Alicante, levels of effectiveness and safety of fingolimod proved to be slightly higher than those found in clinical trials.

TITLE: Fingolimod: efectividad y seguridad en la practica clinica habitual. Estudio observacional, retrospectivo y multicentrico en la provincia de Alicante.Introduccion. Los estudios postautorizacion son importantes para confirmar si los resultados de los ensayos clinicos se reproducen en la practica clinica habitual. Objetivo. Evaluar la efectividad y seguridad del fingolimod en la practica clinica en la provincia de Alicante. Pacientes y metodos. Estudio multicentrico retrospectivo de pacientes con esclerosis multiple remitente tratados con fingolimod. Se recogen las caracteristicas demograficas, clinicas y farmacologicas. Se describe la efectividad del farmaco ­tasa anualizada de brotes (TAB) y porcentaje de pacientes libres de brotes­ al año y a los dos años de tratamiento en relacion con el año previo y datos de efectos secundarios. Resultados. Se incluyo a 89 pacientes. El tratamiento previo fue inmunomodulador (interferon beta o acetato de glatiramero) en 54 pacientes y natalizumab en 32. Cincuenta pacientes cambiaron por fracaso con el inmunomodulador y 31 por serologia positiva del virus JC (VJC+). La TAB global disminuyo el 67,3% el primer año (p < 0,0001) y el 84,1% el segundo (p = 0,0078). Disminuyo en los pacientes con fracaso del inmunomodulador (el 85,6% el primer año, p < 0,0001; el 88,9% el segundo año, p = 0,0039) y aumento de forma no significativa en los pacientes VJC+ en el primer año. El porcentaje de pacientes libres de brotes en la poblacion global aumento del 32,6 al 68,1% en el primer año (p < 0,0019) y al 82,6% en el segundo (p = 0,0215). Este aumento no se observo en los pacientes VJC+. Trece pacientes tuvieron efectos secundarios, que obligaron a la retirada del farmaco en dos de ellos. Conclusion. En la practica clinica de la provincia de Alicante, el fingolimod mostro una efectividad y una seguridad ligeramente superiores a las de los ensayos clinicos.

Carotid atherosclerosis is not associated with lower bone mineral density and vertebral fractures in patients with systemic lupus erythematosus.

BACKGROUND: Low bone mineral density (BMD) and vertebral fractures (VF) have been associated with atherosclerosis in the general population. We sought to investigate the relationship between BMD and VF and carotid atherosclerosis in women with systemic lupus erythematosus (SLE). METHODS: We studied 122 women with SLE. All patients had BMD, carotid intima-media thickness (IMT), and carotid artery atherosclerotic plaque assessment by ultrasound. RESULTS: Mean age at study entry was 44 years and mean disease duration was 11 years. Carotid plaque was found in 13 (11%) patients (9 postmenopausal and 4 premenopausal). Patients in the highest IMT quartile were more likely to be older (p = 0.001), have a higher body mass index (p = 0.008), and exhibit dyslipidemia at study entry (p = 0.041), compared with the lower three quartiles. BMD at the lumbar spine was lower in patients in the highest IMT quartile compared with the lower quartiles in the multivariate logistic analysis, however, there was no association between lumbar or total hip BMD and IMT (p = 0.91 and p = 0.6, respectively). IMT measurements did not differ according to the presence or absence of VF (0.08 ± 0.12 vs. 0.06 ± 0.03 mm, p = 0.11). A trend towards higher incidence of VF was found in patients with carotid plaque compared with those without (33% vs. 21%; p = 0.2). CONCLUSIONS: In patients with SLE, the presence of carotid atherosclerosis is not associated with low BMD or VF.

Switching from natalizumab to fingolimod: an observational study.

BACKGROUND: Multiple sclerosis patients who discontinue using natalizumab are at risk of a rebound in disease activity. However, the optimal alternative therapy is not currently known. AIMS OF THE STUDY: We report on clinical and MRI data and patient safety in a group of relapsing-remitting multiple sclerosis patients who tested seropositive for the JC virus and who have switched from natalizumab to fingolimod because of concerns regarding PML risks. METHODS: The test for JC virus antibodies was performed in 18 relapsing-remitting multiple sclerosis patients who were being treated with natalizumab for more than 1 year. Eight seropositive patients switched to fingolimod while the seronegative patients continued with natalizumab. RESULTS: After switching to fingolimod, five of eight patients (63%) experienced clinical relapses, and MRI activity was detected in six of eight patients (75%). Neither clinical relapses nor MRI activity was observed in the patients who continued with natalizumab. No serious adverse effects were detected. CONCLUSIONS: Natalizumab is an effective treatment for relapsing-remitting multiple sclerosis, but its discontinuation continues to be a complex problem. All of the therapies tried thus far, including fingolimod, have been unable to control the reactivation of the disease. Further studies addressing alternative therapies after natalizumab discontinuation are necessary.

Utilización de la sanidad privada por las embarazadas seguidas en un centro de salud público / Use of private health services by pregnant women followed up in a public health centre

Introducción. Nuestro objetivo fue conocer y analizar los motivos que conducen a las embarazadas, con cobertura sanitaria pública y seguidas en nuestro centro de salud, para utilizar además los servicios sanitarios privados durante el embarazo. Pacientes y métodos. Estudio cualitativo mediante cuestionario autoadministrado. Ámbito de atención primaria, centro de salud urbano. Embarazadas que parieron durante el año 2005 y que realizaron sesiones de educación maternal con la matrona (20 grupos). Se utilizaron las respuestas obtenidas de los cuestionarios cumplimentados. La saturación de la información se garantizó con el análisis por separado de los 20 grupos de participantes. Se realizó un análisis de contenido de las diferentes categorías. Resultados. Se construyeron 6 categorías (ecografías, tranquilidad y seguridad, seguimiento por el ginecólogo privado, el trato recibido, la comodidad y aspectos relacionados con el centro de salud). Los temas relacionados con las ecografías (número y calidad) y con el número de visitas subyacen en la mayoría de las respuestas. Las embarazadas consideran que deben realizarse más ecografías durante el seguimiento del embarazo. La atención recibida en el centro de salud es considerada de manera satisfactoria. Conclusiones. El número y la calidad de las ecografías son los principales motivos que inducen a las embarazadas a utilizar los servicios sanitarios privados. La seguridad y tranquilidad aparecen como motivos recurrentes. El seguimiento del embarazo por el médico de familia en atención primaria no aparece como motivo para utilizar la sanidad privada (AU)

Introduction. The objective of the study is to identify and analyse the reasons that lead pregnant women with public health cover and followed up in our public health clinic, to use private health services during pregnancy. Patients and methods. A qualitative study using a self-administered questionnaire completed during the year 2005. Setting: Urban Primary Care Health Centre. Pregnant women who delivered during 2005 and had maternal education sessions with the midwife (twenty groups). The responses from the questionnaires were analysed. Information saturation was ensured by the separate analysis of the 20 groups of participants. A content analysis was made of the different categories. Results. Six categories were constructed (ultrasound, tranquillity and safety, monitored by the private gynaecologist, the treatment, comfort and aspects relating to the ¿private? health centre). Issues related to ultrasound (number and quality) and the number of visits underlie most of the responses. Pregnant women believe there should be more follow-up ultrasound examinations during pregnancy. The care provided at the public health centre is considered satisfactory. Conclusions. The number and quality of the scans are the main reasons that lead pregnant women to use private health services. Safety and tranquillity appear as recurring themes. The monitoring of pregnancy by the family physician in primary care is not listed as a reason for using private healthcare (AU)

El fenómeno de la inmigración en la Europa comunitaria y su impacto en la asistencia neurológica en el área de la Marina Baixa, Alicante / The phenomenon of immigration within the european community and its impact on neurological care in the Marina Baixa Area, Alicante

Introducción. La inmigración configura un nuevo modelo de sociedad, con nuevas necesidades y demandas, cuya caracterización debe orientar las políticas de salud. Objetivo. Conocer la repercusión del fenómeno de la inmigración sobre la asistencia neurológica extrahospitalaria llevada a cabo en el Departamento 16 de la Agencia Valenciana de Salud y cómo influye en la consulta la dificultad idiomática. Pacientes y métodos. Estudio prospectivo durante 26 consultas ambulatorias consecutivas en el primer trimestre de 2006. Resultados. El 9,5% de los pacientes atendidos era extranjero. El 77,7% pertenecía a países comunitarios. De los extracomunitarios, el 13% provenía de países latinoamericanos, el 5% de países europeos no comunitarios y el 5% de África. Las edades medias fueron 61,5 años para el grupo de europeos comunitarios y 42,6 años para el resto de nacionalidades. Los motivos de consulta principales fueron la cefalea y el deterioro cognitivo. A menor calidad de comunicación, mayor era la duración de la consulta. Conclusiones. La alta prevalencia de población inmigrante comunitaria, mayoritariamente de edad avanzada y con patología neurológica crónica, contribuye, junto con el envejecimiento de la población autóctona, al progresivo crecimiento de la demanda asistencial en nuestra área. La barrera idiomática complica la práctica clínica y conlleva un aumento del tiempo necesario por paciente. Estos hechos han de tenerse en cuenta a la hora de planificar tanto los recursos sanitarios de nuestra área como los tiempos de consulta por paciente (AU)

Introduction. Immigration is shaping a new model of society, with new needs and demands, whose characteristics must guide health-care policies. Aim. To determine the repercussions of the phenomenon of immigration on the extra-hospital neurological care carried out in Department 16 of the Agencia Valenciana de Salud (Valencian Health Service) and how language problems affect visits. Patients and methods. We conducted a prospective study during 26 consecutive outpatientvisits in the first three months of 2006. Results. Of all the patients who were attended, 9.5% were foreigners. Of these, 77.7% came from EU countries. And of those from outside the Community, 13% were from Latin American countries, 5% came from European countries that do not belong to the EU and 5% were from Africa. Mean ages were 61.5 years for the EU group and 42.6 years for the other nationalities. The main reasons for visiting were headache and cognitive impairment. The poorer the quality of communication was, the longer the visit lasted. Conclusions. The high prevalence of immigrants from the EU, mostly elderly persons and with chronic neurological pathologies, together with the ageing of the autochthonous population, have led to a progressive growth in the demand for health care in our area. The language barrier makes clinical practice more complicated and results in an increase in the time needed for each patient. These facts must be taken into account when planning both the health care resources in our area and visiting times per patient (AU)

[The phenomenon of immigration within the European Community and its impact on neurological care in the Marina Baixa area, Alicante]. / El fenómeno de la inmigración en la Europa comunitaria y su impacto en la asistencia neurológica en el área de la Marina Baixa, Alicante.

INTRODUCTION: Immigration is shaping a new model of society, with new needs and demands, whose characteristics must guide health-care policies. AIM. To determine the repercussions of the phenomenon of immigration on the extra-hospital neurological care carried out in Department 16 of the Agencia Valenciana de Salud (Valencian Health Service) and how language problems affect visits. PATIENTS AND METHODS: We conducted a prospective study during 26 consecutive outpatient visits in the first three months of 2006. RESULTS: Of all the patients who were attended, 9.5% were foreigners. Of these, 77.7% came from EU countries. And of those from outside the Community, 13% were from Latin American countries, 5% came from European countries that do not belong to the EU and 5% were from Africa. Mean ages were 61.5 years for the EU group and 42.6 years for the other nationalities. The main reasons for visiting were headache and cognitive impairment. The poorer the quality of communication was, the longer the visit lasted. CONCLUSIONS: The high prevalence of immigrants from the EU, mostly elderly persons and with chronic neurological pathologies, together with the ageing of the autochthonous population, have led to a progressive growth in the demand for health care in our area. The language barrier makes clinical practice more complicated and results in an increase in the time needed for each patient. These facts must be taken into account when planning both the health care resources in our area and visiting times per patient.

Mononeuropatía múltiple asociada a tratamiento con pravastatina / Multiple mononeuropathy associated to treatment with pravastatin

Introducción. La neuropatía secundaria al tratamiento con estatinas se conoce desde 1994. aunque es una complicación poco frecuente. Habitualmente se trata de una polineuropatía axonal, predominantemente sensitiva, distal y simétrica, subaguda o crónica. Presentamos el segundo caso que se recoge en la bibliografía de mononeuritis múltiple asociada al uso de estatinas. Caso clínico. Mujer de 51 años que, tras iniciar tratamiento con pravastatina, presentó parestesias progresivas distales en miembros, de distribución asimétrica, con inestabilidad en la marcha. El estudio electromiográfico fue compatible con mononeuritis múltiple. Las pruebas complementarias realizadas para descartar otras causas de mononeuropatía múltiple fueron normales. La enferma mejoró al abandonar el tratamiento y empeoró de nuevo tras retomarlo. Con la suspensión definitiva de la pravastatina volvió a mejorar de forma progresiva hasta quedar prácticamente asintomática. Conclusiones. La relación entre el tratamiento con estatinas y la aparición de polineuropatía ha quedado establecida en distintos estudios epidemiológicos de casos y controles. No sólo se puede presentar como la clásica polineuropatía distal y simétrica, sino que se han descrito formas clínicas atípicas, incluido algún caso como el nuestro de mononeuropatía múltiple. El riesgo de desarrollar esta complicación es pequeño y se ve compensado por los beneficios cardiovasculares de las estatinas, aunque posiblemente en un futuro se verá con más frecuencia, dado el uso creciente de estos fármacos. Es importante tener en cuenta esta causa de neuropatía, dada su reversibilidad potencial

Introduction. The first reports of neuropathy due to treatment with statins appeared in 1994, although it is an infrequent complication. It usually consists of an axonal polyneuropathy, which is predominantly sensory, distal and symmetric, and may be subacute or chronic. We present here the second case reported in the literature of multiple mononeuropathy associated to the use of statins. Case report. A 51-year-old female patient who, after beginning therapy with pravastatin, presented with progressive, asymmetrically distributed, distal paresthesias in the limbs and an unstable gait. An electromyographic study was compatible with multiple mononeuritis. Results of complementary tests that were carried out to preclude other causes of multiple mononeuropathy were normal. The patient’s condition improved on withdrawing treatment with the drug and it became worse again when therapy was restarted. When pravastatin therapy was stopped for good, the patient's condition progressively improved until she was practically free of symptoms. Conclusions. The relationship between treatment with statins and the appearance of polyneuropathy has been proved in different epidemiological case-control studies. It does not only appear as the classical distal symmetrical olyneuropathy, but has also been reported as taking on atypical clinical forms including a few cases, like ours, of multiple mononeuropathy. The risk of developing this complication is low and is offset by the cardiovascular benefits offered by statins, although it may become more common in the future due to the increasing rate of use of these agents. It is important to bear this cause of neuropathy in mind, given the fact that it is potentially reversible

[Multiple mononeuropathy associated to treatment with pravastatin]. / Mononeuropatía múltiple asociada a tratamiento con pravastatina.

INTRODUCTION: The first reports of neuropathy due to treatment with statins appeared in 1994, although it is an infrequent complication. It usually consists of an axonal polyneuropathy, which is predominantly sensory, distal and symmetric, and may be subacute or chronic. We present here the second case reported in the literature of multiple mononeuropathy associated to the use of statins. CASE REPORT: A 51-year-old female patient who, after beginning therapy with pravastatin, presented with progressive, asymmetrically distributed, distal paresthesias in the limbs and an unstable gait. An electromyographic study was compatible with multiple mononeuritis. Results of complementary tests that were carried out to preclude other causes of multiple mononeuropathy were normal. The patient's condition improved on withdrawing treatment with the drug and it became worse again when therapy was restarted. When pravastatin therapy was stopped for good, the patient's condition progressively improved until she was practically free of symptoms. CONCLUSIONS: The relationship between treatment with statins and the appearance of polyneuropathy has been proved in different epidemiological case-control studies. It does not only appear as the classical distal symmetrical polyneuropathy, but has also been reported as taking on atypical clinical forms including a few cases, like ours, of multiple mononeuropathy. The risk of developing this complication is low and is offset by the cardiovascular benefits offered by statins, although it may become more common in the future due to the increasing rate of use of these agents. It is important to bear this cause of neuropathy in mind, given the fact that it is potentially reversible.

Bases de datos clínicas y farmacológicas para asistentes personales digitales / Clinical and pharmacological databases for personal digital assistants

No disponible

Asignación de sexo precoz en casos de ambigüedad genital al nacimiento / Early gender assignment in cases of genital ambiguity at birth

No disponible

[Differences between Spanish ischemic stroke patients and those from Central and Northern Europe. A case-control study]. / Diferencias entre pacientes con ictus isquémico españoles frente a centro y nordeuropeos: un estudio de casos y controles.

INTRODUCTION: Studies conducted in the American population have revealed the existence of differences in cerebral vascular pathologies and in the prevalence of vascular risk factors between races. The few studies carried out in Hispanic populations have found a higher prevalence of diabetes mellitus, as well as a lower frequency of cardioembolic strokes and extracranial carotid atheromatosis, in comparison with whites of Anglo-Saxon extraction. PATIENTS AND METHODS: We performed a case-control study in which one case was paired with two controls, according to age and sex. The cases were people from Central and Northern Europe and the controls were Spaniards. All of them had been admitted to hospital because of ischemic stroke or TIA. We compared the frequency of conventional risk factors (RF), the subtype of ischemic stroke and the results from carotid duplex scans. The odds ratio and confidence intervals (CI) at 95% were calculated for paired data. RESULTS: Arterial hypertension (AHT) was less frequent in the cases, with an OR of 0.45 (CI 0.24-0.83). No statistically significant differences were found in the prevalence of diabetes, hypercholesterolemia, heart disease and atrial fibrillation. Fast recovery stroke and TIA were observed more frequently in the cases than in the controls (OR: 3.73; CI: 1.72-8.07), which we interpreted as being due to a bias in admissions. Carotid duplex scanning revealed stenosis > 70% in 21.9% of the cases and in 13% of the controls. CONCLUSIONS: This study did not reveal any differences between Spaniards and Northern Europeans in conventional RF, except for a higher prevalence of AHT in Spaniards. Severe carotid pathology seems to be less frequent in Spaniards. Future research should take into account other RFs (such as cholesterol subfractions, homocysteine, etc.), which are possibly race-linked and may account for the differences described.

[Prevalence of neurosonographic disturbances in chronic instability]. / Prevalencia de alteraciones neurosonológicas en la inestabilidad crónica.

INTRODUCTION: Dizziness is a common symptom at the outpatient clinic of family doctors. Its origin is usually multifactorial and its outcome is often benign. However, exists a tendency to relate the dizziness with a cerebrovascular disturbance. AIM. To determine if there are cerebrovascular disorders in patients with chronic dizziness using a non invasive technique. PATIENTS AND METHODS: A prospective study was conducted. It included 404 patients without limit of age. The patients were evaluated in a Neurology Outpatient Clinic, to select those patients with chronic instability. A neurosonographic exam was performed to all those selected patients. This exam included colour duplex of the cervical arteries and transcranial Doppler. RESULTS: Up to 54 % of the patients who were included in the study had a normal carotid study. For the rest of the patients, the thickness intima-media was the most prevalent finding. At the vertebrobasilar system the study of the vertebral arteries was completely normal in 81.7% followed by the presence of microangiopathy in 12.1%. The basilar system was also normal in a high figure (78%) followed by the microangiopathy (17.1%). CONCLUSIONS: The vascular disturbances in the vertebrobasilar system are an exceptional finding in patients with chronic instability.

Diferencias entre pacientes con ictus isquémico españoles frente a centro y nordeuropeos: un estudio de casos y controles / Differences between Spanish ischemic stroke patients and those from Central and Northern Europe. A case-control study

Introducción. Algunos estudios realizados en población americana han demostrado diferencias entre razas en la patología vascular cerebral y en la prevalencia de los factores de riesgo va-cular. Los pocos estudios sobre población hispana han encontrado una mayor prevalencia de diabetes mellitus, así como una menor frecuencia de ictus cardioembólico y de ateromatosis carotídea extracraneal, en comparación a la raza blanca de origen sajón. Pacientes y métodos. Realizamos un estudio de casos y controles apareando un caso con dos controles, por edad y sexo. Los casos eran personas procedentes del centro y norte de Europa y los controles, personas españolas. Todos se habían hospitalizado por ictus isquémico o AIT. Comparamos la frecuencia de factores de riesgo(FR) convencionales, el subtipo de ictus isquémico y el estudio por ecografía Doppler de las carótidas. Calculamos la odds ratio y los intervalos de confianza (IC) al 95% para datos apareados. Resultados. Los casos presentaron con menor frecuencia hipertensión arterial(HTA), con una OR de 0,45 (IC 0,24-0,83). No encontramos diferencias estadísticamente significativas en la prevalencia de diabetes, hipercolesterolemia, cardiopatía y fibrilación auricular. Obtuvimos una mayor frecuencia de ictus con mejoría rápida y de AIT en los casos que en los controles (OR de 3,73, IC: 1,72-8,07), que interpretamos como un sesgo de ingreso. La ecografía Doppler de las carótidas demostró estenosis superior al 70% en el 21,9% de los casos y en el 13% de los controles. Conclusiones. El presente estudio no revela diferencias entre españoles y noreuropeos en los factores de riesgo convencionales, salvo por una mayor prevalencia de HTA enlos pacientes españoles. La patología carotídea grave parece ser menos frecuente en los españoles. Sería conveniente para futuros trabajos el tener en cuenta otros FR (subfracciones de colesterol,homocisteína, etc.), posiblemente ligados a la raza y que pueden explicar las diferencias descritas

Introduction. Studies conducted in the American population have revealed the existence of differences incerebral vascular pathologies and in the prevalence of vascular risk factors between races. The few studies carried out in Hispanic populations have found a higher prevalence of diabetes mellitus, as well as a lower frequency of cardio-embolic strokes and extracranial carotid atheromatosis, in comparison with whites of Anglo-Saxon extraction. Patients and methods. We performed a case-control study in which one case was paired with two controls, according to age and sex. The cases were people from Central and Northern Europe and the controls were Spaniards. All of them had been admitted to hospital because of ischemic stroke or TIA. We compared the frequency of conventional risk factors (RF), the subtype of ischemic stroke and the results from carotid duplex scans. The odds ratio and confidence intervals (CI) at 95% were calculated for paired data. Results. Arterial hypertension (AHT) was less frequent in the cases, with an OR of 0.45 (CI0.24-0.83). No statistically significant differences were found in the prevalence of diabetes, hypercholesterolemia, heart disease and atrial fibrillation. Fast recovery stroke and TIA were observed more frequently in the cases than in the controls(OR: 3.73; CI: 1.72-8.07), which we interpreted as being due to a bias in admissions. Carotid duplex scanning revealed stenosis > 70% in 21.9% of the cases and in 13% of the controls. Conclusions. This study did not reveal any differences between Spaniards and Northern Europeans in conventional RF, except for a higher prevalence of AHT in Spaniards. Severe carotid pathology seems to be less frequent in Spaniards. Future research should take into account other RFs (such as cholesterol subfractions, homocysteine, etc.), which are possibly race-linked and may account for the differences described