Efecto de unas gotas a base de ácido hialurónico, Aloe vera y Centella asiática en la calidad de vida de pacientes con ojo seco / Effect of eye drops based on hyaluronic acid, Aloe vera and Centella asiatica on quality of life of patients with dry eye

Introducción: la enfermedad de ojo seco (EOS) es una patología común y un motivo de consulta frecuente en farmacia comunitaria. Esta tiene un gran impacto en la calidad de vida (QoL) de los pacientes; por ello, un tratamiento adecuado debería mejorarla. Las lágrimas artificiales constituyen la base para el manejo de la EOS y el principal tratamiento de indicación farmacéutica.Objetivo: estudiar el efecto de unas gotas oculares a base de ácido hialurónico, Centella asiática y Aloe vera en la QoL de pacientes con EOS. Paralelamente, la adherencia al tratamiento, la tolerancia y seguridad del producto, fueron evaluados.Metodología: estudio clínico posautorización, abierto, prospectivo y multicéntrico. Los pacientes recibieron el tratamiento durante 60 días. Para estudiar el efecto sobre la QoL, los pacientes cumplimentaron el cuestionario OSDI© antes de iniciar el tratamiento y a los 30 y 60 días de tratamiento. La adherencia se evaluó mediante la reconciliación de los envases y la seguridad mediante un seguimiento de los eventos adversos. Resultados: los pacientes tratados con las gotas oculares, población por intención de tratar (ITT, n=44), obtuvieron mejoras clínicamente importantes en la QoL, sintomatología y función visual, pues la puntuación OSDI© disminuyó de 32,80 (DE=23,00) (basal, EOS severo) a 12.64 (DE=15,32) (estado normal, p<0,001), y a 9.22 (DE=10,37) (estado normal, p<0,001), a los 30 y 60 días, respectivamente. Más del 70 % de los pacientes se adhirieron al tratamiento. El perfil de seguridad fue favorable. Se observaron 4 efectos adversos oculares de intensidad leve. No se plantearon problemas de seguridad. Conclusiones: Las gotas oculares objeto de estudio podrían ser una opción de tratamiento efectiva y segura para mejorar la QoL de pacientes con EOS.

La concentración plasmática de microARN-1-3p se asocia con fibrilación auricular subclínica en los pacientes con ictus criptogénico / Plasma levels of miRNA-1-3p are associated with subclinical atrial fibrillation in patients with cryptogenic stroke

Introducción y objetivos La identificación de biomarcadores de fibrilación auricular (FA) subclínica en los pacientes con ictus criptogénico (ICr) es de gran interés. Con dicho objetivo, se evaluó el perfil de microARN circulante de los pacientes con ICr y FA frente a aquellos en ritmo sinusal. Métodos Se incluyó a 64 pacientes con ICr consecutivos monitorizados mediante Holter subcutáneo. Se seleccionó a 18 pacientes (9 con FA y 9 en ritmo sinusal persistente) para determinación de 754 microARN mediante tecnología de alto rendimiento. Se incluyó a 9 pacientes adicionales con ictus y FA concomitante para guiar la selección de microARN. Los microARN de interés se replicaron en una cohorte independiente (n=46). La asociación de biomarcadores con FA a los 6 y 12 meses se analizó mediante regresión logística. Resultados Ocho microARN mostraron expresión diferencial entre los pacientes con y sin FA. El miR-1-3p, un regulador génico involucrado en la arritmogénesis cardiaca, fue el único que permaneció significativamente más elevado en pacientes con ICr y FA de la cohorte de repetición, y además mostró una discreta asociación con la carga arrítmica. Los valores de miR-1-3p por encima de la mediana y la fracción de eyección de la aurícula izquierda se asociaron de forma independiente con la presencia de FA a los 6 y 12 meses. Conclusiones En nuestra cohorte, los valores plasmáticos de miR-1-3p fueron más altos en los pacientes con ICr y FA en el seguimiento. Nuestros resultados indican que el miR-1-3p podría ser un nuevo biomarcador de FA oculta en los pacientes con ICr (AU)

Introduction and objectives Identifying biomarkers of subclinical atrial fibrillation (AF) is of most interest in patients with cryptogenic stroke (CrS). We sought to evaluate the circulating microRNA (miRNA) profile of patients with CrS and AF compared with those in persistent sinus rhythm. Methods Among 64 consecutive patients with CrS under continuous monitoring by a predischarge insertable monitor, 18 patients (9 with AF and 9 in persistent sinus rhythm) were selected for high-throughput determination of 754 miRNAs. Nine patients with concomitant stroke and AF were also screened to improve the yield of miRNA selection. Differentially expressed miRNAs were replicated in an independent cohort (n=46). Biological markers were stratified by the median and included in logistic regression analyses to evaluate their association with AF at 6 and 12 months. Results Eight miRNAs were differentially expressed between patients with and without AF. In the replication cohort, miR-1-3p, a gene regulator involved in cardiac arrhythmogenesis, was the only miRNA to remain significantly higher in patients with CrS and AF vs those in sinus rhythm and showed a modest association with AF burden. High (= above the median) miR-1-3p plasma values, together with a low left atrial ejection fraction, were independently associated with the presence of AF at 6 and 12 months. Conclusions In this cohort, plasma levels of miR-1-3p were elevated in CrS patients with subsequent AF. Our results preliminarily suggest that miR-1-3p could be a novel biomarker that, together with clinical parameters, could help identify patients with CrS and a high risk of occult AF (AU)

Criterios de justificación de discrepancias en el Servicio de Conciliación de la medicación al alta hospitalaria: Guía para farmacéuticos comunitarios / Criteria for Justifying Discrepancies in the Hospital Discharge Medication Reconciliation Service: Guidance for Community Pharmacists

JUSTIFICACIÓN: más del 90 % de los pacientes conciliados al alta hospitalaria presentan algún tipo de discrepancia en su medicación, aunque solo entre 5-15% son errores de conciliación. Para la prestación del Servicio de Conciliación, es necesario conocer la justificación clínica de la mayoría de las discrepancias.OBJETIVOS: seleccionar criterios que faciliten al farmacéutico comunitario la justificación de las discrepancias identificadas al alta hospitalaria, elaborar una guía y evaluar la satisfacción de los farmacéuticos con su uso en el estudio Concilia Medicamentos.MATERIAL Y MÉTODOS: un grupo constituido por un farmacéutico comunitario, un farmacéutico hospitalario, un profesor de farmacología y dos de atención farmacéutica seleccionaron los grupos terapéuticos que presentan discrepancias más habitualmente. Los criterios se seleccionaron de acuerdo con la evidencia científica disponible en las guías clínicas y fichas técnicas. Utilizaron la guía 188 farmacéuticos comunitarios de 8 provincias españolas para la justificación de las discrepancias detectadas en el estudio Concilia Medicamentos 2. La satisfacción de los farmacéuticos se analizó mediante un cuestionario online al finalizar el estudio.RESULTADOS/DISCUSIÓN: la guía de evaluación de discrepancias desarrollada recoge 20 grupos terapéuticos de tratamientos crónicos habituales, estructurados en 13 tablas: Inhibidores de la bomba de protones, antidiabéticos, antiagregantes plaquetarios, anticoagulantes orales, diuréticos, betabloqueantes, calcioantagonistas, IECA, ARA-II, estatinas, AINE, opioides, benzodiazepinas y análogos. (AU)

Ultra-early continuous cardiac monitoring improves atrial fibrillation detection and prognosis of patients with cryptogenic stroke.

BACKGROUND AND PURPOSE: Subclinical atrial fibrillation (AF) is known to underlie a number of cases of cryptogenic stroke (CrS). However, there is need to define the most effective strategy for AF detection. The diagnostic usefulness was analysed of a strategy based on ultra-early continuous monitoring in patients with CrS in terms of AF detection, oral anticoagulation treatment and stroke recurrence, in comparison to a standard outpatient strategy. METHODS: Patients with ischaemic stroke of undetermined origin and confirmed to be cryptogenic after extensive work-up were searched for AF with (i) a conventional strategy (historical cohort, n = 101) with serial electrocardiograms and 24-h Holter monitoring or (ii) an ultra-early monitoring strategy with insertable cardiac monitor (ICM) implanted before discharge (prospective cohort, n = 90). AF episodes lasting >1 min, anticoagulant treatment and stroke recurrence were recorded. RESULTS: During admission, AF was similarly detected in both cohorts (24% of patients). After discharge (mean follow-up 30 ± 10 months), AF detection rates were 17/80 (21.3%) and 38/65 (58.5%) for patients in the conventional versus the ultra-early ICM group (P < 0.001). Up to 41% of AF cases in the ICM cohort were detected within the first month. Oral anticoagulation was initiated in 37.6% versus 65.5% (P < 0.001) and stroke recurrence was recorded in 10.9% versus 3.3% (P 0.04) in the conventional versus the ICM cohort. CONCLUSIONS: Pre-discharge ICM implant allows detection of AF during follow-up in up to 58% of selected patients with CrS. Compared to a conventional strategy, ultra-early ICM implant results in higher anticoagulation rates and a decrease in stroke recurrence.

Preliminary characterization of dexamethasone-loaded cross-linked hyaluronic acid films for topical ocular therapy.

The aim of this work was to design and characterize cross-linked hyaluronic acid (HA)-itaconic acid (IT) films loaded with dexamethasone sodium phosphate salt (DEX) for topical therapy of inflammatory ocular surface diseases. Films were chemically cross-linked with polyethylene glycol diglycidyl ether (PEGDE), then physical and mechanical characterization by stress-strain, X-ray diffraction, X-ray fluorescence spectrometry and swelling assays was conducted. A sequential in vitro therapeutic efficacy model was designed to assess changes in interleukin (IL)-6 production in an inflamed human corneal epithelial (HCE) cell line after film exposure. Changes in cell proliferation after film exposure were assessed using the alamarBlue(®) proliferation assay. Experimental findings showed desirable mechanical properties and in vitro efficacy to reduce cell inflammation. A moderately decreased proliferation rate was induced in HCE cells by DEX-loaded films, compared to commercial DEX eye drops. These results suggest that DEX and HA have opposite effects. The sequential in vitro therapeutic efficacy model arises as an efficient tool to study drug release from delivery systems by indirect measurement of a biological response.

Electrochemical growth of CoNi and Pt-CoNi soft magnetic composites on an alkanethiol monolayer-modified ITO substrate.

CoNi and Pt-CoNi magnetic layers on indium-tin oxide (ITO) substrates modified by an alkanethiol self-assembled monolayer (SAM) have been electrochemically obtained as an initial stage to prepare semiconducting layer-SAM-magnetic layer hybrid structures. The best conditions to obtain the maximum compactness of adsorbed layers of dodecanethiol (C12-SH) on ITO substrate have been studied using contact angle, AFM, XPS and electrochemical tests. The electrochemical characterization (electrochemical probe or voltammetric response in blank solutions) is fundamental to ensure the maximum blocking of the substrate. Although the electrodeposition process on the SAM-modified ITO substrate is very slow if the blocking of the surface is significant, non-cracked metallic layers of CoNi, with or without a previously electrodeposited seed-layer of platinum, have been obtained by optimizing the deposition potentials. Initial nucleation is expected to take place at the pinhole defects of the C12-SH SAM, followed by a mushroom-like growth regime through the SAM interface that allows the formation of a continuous metallic layer electrically connected to the ITO surface. Due to the potential of the methodology, the preparation of patterned metallic deposits on ITO substrate using SAMs with different coverage as templates is feasible.

Alginate electrodeposition onto three-dimensional porous Co-Ni films as drug delivery platforms.

Three-dimensional porous Co-Ni films/alginate hybrid materials have been successfully prepared by electrodeposition to be used as a steerable magnetic device for drug delivery. Firstly, 3D porous Co-Ni films were prepared as substrates for the subsequent electrodeposition of the alginate biopolymer. Cyclic voltammetry, galvanostatic and potentiostatic studies were performed to establish the best conditions to obtain porous Co-Ni films. The electrochemical experiments were carried out in an electrolyte containing the metal salts and ammonium chloride at low pHs. In a second stage, the electrochemical deposition of alginate as a biocompatible polymer drug delivery carrier was performed. The characteristics of the alginate matrix were investigated in terms of electrochemical properties, morphology and drug release. The hybrid material obtained showed soft-magnetic behavior and drug release indicating its suitability to be used as a steerable magnetic drug delivery device.

Novel bioadhesive hyaluronan-itaconic acid crosslinked films for ocular therapy.

New hyaluronic acid (HA)-itaconic acid (IT) films have been previously synthesized and used as potential topical drug delivery systems (DDS) for ocular administration. In this study we explored homogeneous and heterogeneous crosslinking reactions of HA using glutaraldehyde (GTA) and polyethylene glycol diglycidyl ether (PEGDE) in the presence of IT, a naturally occurring compound that is non-toxic and readily biodegradable. We have studied the morphology, mechanical properties and in vitro biocompatibility between these new materials and ocular surface cells (human corneal epithelial cell line) and evaluated the biopharmaceutical performance of the designed formulations. Although all the synthesized materials exhibited good mechanical properties, the PEGDE modified films exhibited the best biocompatibility, with in vivo assays showing good adhesive performance and minimal irritation. PEGDE films were also tested for their effects in the treatment of intraocular pressure (IOP) in rabbits using timolol maleate (TM) as the model drug. These results may be useful for further design of novel bioadhesive matrix containing drugs by topical application in ophthalmology.

Drenaje linfático manual y presoterapia / Manual lymph drainage and pressotherapy

El drenaje linfático manual (DLM) es una técnica específica de masoterapia en la que se realiza una suave aplicación de presión cuyo objetivo es estimular la salida de linfa y líquidos intersticiales de la zona afectada. Existen diferentes escuelas de DLM pero todas mantienen los aspectos básicos en común, estando indicado en los linfedemas estadio I y II según la Clasificación de la Sociedad Internacional de Linfología. La presoterapia es una técnica de tratamiento por compresión externa, habitualmente neumática, producida por un sistema de bombeo a través de una cámara de aire, produciendo así una presión intermitente en la extremidad afecta. Existen múltiples estudios que avalan su indicación en patología venosa, sin embargo su uso para el tratamiento del linfedema es controvertido y no está recomendado de manera aislada por el riesgo de desarrollar fibrosis a largo plazo empeorando así el linfedema. Aunque faltan estudios de calidad metodológica que demuestren la eficacia del DLM y de la presoterapia, diferentes documentos de consenso incluyen ambas técnicas como parte de la primera fase de la TFD para el tratamiento del linfedema acompañado de prendas de contención, ejercicios y cuidados de la piel (AU)

Manual Lymph Drainage (MLD) is a specific message therapy that consists of applying soft-pressure massage. Its main objective is to stimulate drainage of lymph and interstitial fluids from the affected area. There are different schools of MLD, however, all of them have the basic aspects in common and indicate MLD for Stage I and II lymphedema according to the Classification of the International Society of Lymphology (ISL). Pressotherapy is a technique that uses external compression created by a pneumatic pump through an air/pump chamber. This procedure creates intermittent pressure on the affected area or limb. There are many studies that support its indication for venous conditions. However, its use in the treatment of lymphadema is controversial and using it alone is not recommended because of the long-term risk of developing fibrosis, which would therefore worsen the condition. Although sufficient methodological studies do not exist in order to demonstrate the efficacy of MLD and pneumatic compression, there are several articles that include both procedures as part of the first stage of Decongestive Physical Therapy for the treatment of lymphedema, along with elastic compression garments, exercises and skin care (AU)

Comparación de dos programas de rehabilitación tras artroplastia total de rodilla / Comparison of two rehabilitation programs following total knee arthroplasty

Objetivo: Comparar los resultados funcionales de dos programas de rehabilitación distintos tras Artroplastia Total de Rodilla (ATR). Material y métodos: Estudio prospectivo de 122 pacientes intervenidos de ATR, valorándolos en el preoperatorio, al 8º día y al 6º mes de la intervención. Al alta hospitalaria, dividimos a los pacientes en 2 grupos según el recorrido articular y la disponibilidad de acudir al tratamiento. El grupo A (40 pacientes) siguieron un programa de rehabilitación domiciliario y el grupo B (82 pacientes) ambulatorio. Se estudió: el dolor mediante la escala visual analógica (EVA), la funcionalidad usando el Hospital Special Surgery (HSS), la independencia para las actividades de la vida diaria mediante el Índice de Barthel, la capacidad de marcha con la Fuctional Ambulatory Clasification (FAC) y la calidad de vida con el cuestionario de salud SF-36. Comparamos los resultados usando el paquete estadístico SPSS 15.0. Resultados: La valoración global mostró un mejoría de: 7,2 a 2,4 en la EVA, 63 a 80,8 en el HSS, 27,9 a 37,2 en el SF36 físico y 43,4 a 46,9 entre la valoración inicial y al sexto mes en todos los pacientes, siendo estas mejorías estadísticamente significativas (p < 0,05). No hay una diferencia significativa en el Índice de Barthel y el FAC. En la comparación entre ambos grupos, no encontramos diferencias significativas en ninguna variable. Conclusiones: La ATR mejora el dolor, la funcionalidad y la calidad de vida en pacientes con gonartrosis con independencia de los dos programas de rehabilitación estudiados tras el alta hospitalaria (AU)

Objective: To compare the functional results obtained with two different rehabilitation programs following total knee arthroplasty (TKA). Material and methods: A retrospective study was made of 122 patients subjected to TKA, with evaluation before surgery, and on day 8 and 6 months after the operation. At discharge, the patients were divided into two groups according to the observed joint trajectory and patient availability for treatment. Group A (40 patients) followed a home rehabilitation program, while group B (82 patients) followed an outpatient rehabilitation program. The following was studied: pain as determined by the visual analog scale (VAS); functionality based on the Hospital Special Surgery (HSS) score; independency for activities of daily living based on the Barthel index; walking capacity according to the Functional Ambulatory Classification (FAC); and quality of life based on the SF 36 questionnaire. The results were compared using the SPSS version 15.0 statistical package. Results: The overall assessment showed improvement from 7.2 to 2.4 on the VAS, 63 to 80.8 on the HSS, 27.9 to 37.2 on the physical SF-36, and 43.4 to 46.9 between initial assessment and evaluation after 6 months in all the patients - these improvements being statistically significant (p<0.05). There were no significant differences in the Barthel index and FAC. No significant differences were observed for any variable on comparing the two patient groups. Conclusions: TKA improves pain, functionality and quality of life in patients with gonarthrosis, regardless of whether one or the other rehabilitation program is adopted after hospital discharge (AU)

Ablation of ventricular tachycardia.

Ablation is an important management tool for the treatment of ventricular arrhythmias. Even at experienced centers ventricular tachycardia ablation carries a minor but significant risk for potential complications, including vascular and thromboembolic complications, air embolism, volume overload and the precipitation of congestive heart failure, cardiac tamponade from catheter perforation or from steam pop with RF energy delivery, valve or subvalvular support structure disruption, conduction system disruption with development of heart block, coronary artery injury when ablating in the coronary cusps region or trying to gain access to the LV chamber, precipitation of cardiogenic shock from ablation of viable myocardium in patients with marginal reserve and failure to resuscitate or precipitation of cardiogenic shock from repeated VT induction, and with epicardial ablation the potential complications of epicardial access, coronary arteries and phrenic nerve damage. Recognition of these risks is paramount for their avoidance with careful pre-procedure planning and intraprocedural technique being essential to minimize the potential for complications.

Repercusión de los atentados del 11 de marzo en el Servicio de Rehabilitación del Hospital Gregorio Marañón / Repercussion of the March 11th terrorist attacks on the Rehabilitation Service of the Hospital

No disponible

Alcohol induction of liver nuclear ethanol and N-nitrosodimethylamine metabolism to reactive metabolites.

In previous studies from our laboratory we reported the presence in highly purified liver nuclei, free of contamination with other organelles, of an ethanol metabolizing system (NEMS) able to lead to acetaldehyde and 1-hydroxyethyl free radicals (1HEt). In the present study we tested whether this NEMS is inducible by chronic alcohol administration to rats and whether these nuclei also have increased ability to bioactivate N-nitrosodimethylamine (NDMA). Sprague Dawley male rats (125-150g) were fed with a nutritionally adequate liquid diet containing alcohol to provide 36% of total energy (standard Lieber-De Carli rat diet), for 28 days. Controls received an isocaloric diet without alcohol. Animals were sacrificed, livers were excised and microsomes and purified nuclear fractions were prepared. Both microsomes and nuclei from treated animals had significantly increased ability compared to controls, to biotransform ethanol to acetaldehyde using NADPH as cofactor under an air atmosphere. Both organelles also exhibited significantly increased capacity compared to controls, to bioactivate NDMA to formaldehyde and to reactive metabolites that bind covalently to proteins. Nuclear preparations from control animals were also able to metabolize NDMA to formaldehyde and reactive metabolites. Results indicate that liver nuclei may have a CYP2E1 able to bioactivate both NDMA and EtOH and that these processes are being induced by chronic alcohol drinking. The bioactivation of these xenobiotics to reactive metabolites in the neighborhood of nuclear proteins and DNA might have significant toxicological implications.

Risk factors for nosocomial pneumonia in critically ill trauma patients.

OBJECTIVE: To determine risk factors for nosocomial pneumonia in critically ill trauma patients. DESIGN: Prospective cohort study. SETTING: The trauma intensive care unit (ICU) of a 1500-bed tertiary-care hospital. PATIENTS: All critically ill trauma patients (n = 103) admitted consecutively between November 1995 and October 1996. INTERVENTIONS: A comparison of data recorded at the time of ICU admission and during the clinical evolution in patients with (n = 23) and without (n = 80) nosocomial pneumonia was made. Data referred mainly to possible risk factors were recorded; they also included factors related to pneumonia etiology and evolutive factors. Predictors of nosocomial pneumonia were assessed by logistic regression analysis. MEASUREMENTS AND MAIN RESULTS: The presence of significant growth on quantitative cultures of the protected specimen brush (> or = 103 colony forming units/mL) was required to accept pneumonia as microbiologically proven, as well as the concurrence of a cohort of clinical and radiologic signs. Twenty-three (22.3%) patients developed nosocomial pneumonia. The mean age of these patients was 41.7 yrs; 18 of them (78.3%) were men. The microorganisms isolated in significant concentrations were Acinetobacter baumanii (ten cases), Staphylococcus aureus (11 cases), Pseudomonas aeruginosa (five cases), Haemophilus influenzae (two cases), and Klebsiella pneumoniae, Citrobacter freundii, Serratia marcescens, Enterococcus spp., Enterobacter spp., coagulase-negative Staphylococcus, and Streptococcus intermedius (one case each one). Risk factors for pneumonia by univariate analysis included nasogastric tube; continuous enteral feeding; prolonged mechanical ventilation (>1 day); use of H2-receptor antagonist, sucralfate, muscle relaxants, corticosteroids, barbiturates, and inotropic agents; positive end-expiratory pressure; intense sedation; re-intubation; tracheotomy; urgent brain computed tomography (CT) scan; craniotomy; iatrogenic event; and hyperventilation. The mortality rate was 43.5% (10 of 23) in the nosocomial pneumonia group and 18.8% in patients without nosocomial pneumonia (p =.02). Also, the mean stay in the ICU, the therapeutic charge (measured with total and mean punctuation of the Therapeutic Intervention Scoring System) and the complications, infectious and noninfectious, of the clinical evolution were significantly more frequent in patients with nosocomial pneumonia than in those without pneumonia (p <.05). In the multivariate analysis, continuous enteral feeding, craniotomy, prolonged mechanical ventilation (>24 hrs), use of positive end-expiratory pressure, and corticotherapy were independent predictors of nosocomial pneumonia. CONCLUSIONS: It seems that factors related to the patient's clinical course, rather than variables registered on the first days of ICU admission, are those that would exert an influence on the development of nosocomial pneumonia in critically ill trauma patients. In this way, from our point of view, in our study the main risk factors are the use of prolonged mechanical ventilation (>4 hrs) and positive end-expiratory pressure. At the same time, we can conclude that the reduction of this infection incidence could decrease the mean stay in the ICU, the therapeutic charge, and the prognosis in terms of mortality and morbidity.

[The development of verbal communication in aphasic patients treated by neuropsychological therapy]. / Evolución de la communicación verbal en afásicos tratados con terapia neuropsicológica.

OBJECTIVE: Based on the theories dealing with reorganization of the functional system, which are usually the basis of the treatment of aphasology, this paper has as its objective to analyse the evolution of the ability to communicate in a series of 43 right-handed persons with aphasia due to a cerebro-vascular accident of the left hemisphere, who attended sessions of neuropsychological treatment. MATERIAL AND METHODS: The patients were grouped according to the type of aphasia initially diagnosed: global (G), Broca (B), conduction (C), anomia (A), transcortical motor (MT) and Wernicke (W). The output before and after treatment was evaluated using a scale from 0-6 points to grade the capacity of communication (comprehension-expression). In each group the 't' test was done to compare the average scores, initially and finally, both of comprehension and of expression. RESULTS: The results showed that group A had the most favourable course both of comprehension and of expression. Of the patients with a predominantly expression disorder, the best recovery was seen in groups C and MT. In group B verbal expression followed a very varied course. Those of G and W improved significantly, but great difficulty in communication persisted. Comparing expression in these two groups, those of W showed significantly more improvement than those of G, who showed very little improvement.

Radioprotectors as late preventive agents against carbon tetrachloride induced liver necrosis: protection by 2-(3-aminopropylamino) ethylphosphorothioic acid (WR2721).

Administration of the radioprotective agent 2-(3-aminopropylamino) ethylphosphorothioic acid (WR2721) at 3 or 6 hr after carbon tetrachloride (CCl4) administration significantly prevented the liver necrosis produced by the hepatotoxin at 24 hr. It is well known that WR2721 does not exert or minimally exerts a protective activity by itself. The compound is activated through dephosphorylation to the free thiol WR1065, a process which is catalyzed by an alkaline phosphatase. We observed that this enzyme was widely distributed in the rat body. The WR2721 pretreatment 30 min before CCl4 administration modified the CCl4 levels reaching the liver at 1 hr of poisoning and exerted a significant increase in the covalent binding (CB) of 14CCl4-reactive metabolites to microsomal lipids at 3 hr. WR2721 did not modify the intensity of the CCl4-induced lipid peroxidation (LP) process at 1 or 3 hr of poisoning. CCl4-induced fat accumulation was not prevented when WR2721 was given 6 hr after CCl4. In fact, protection might be due to a favorable modulation of late events occurring after CB or LP, events that remain to be elucidated.

[Fulminant pneumonia caused by Streptococcus milleri: rare or not diagnosed?]. / Neumonía de curso fulminante causada por Streptococcus milleri: infrecuente o no diagnosticada?

Streptococcus milleri is increasingly isolated in laboratory samples and is worthy of consideration as a differential diagnosis in pyogenic infections, particularly in adults with underlying infections. We describe a well-documented case of pleuropulmonary infection in a young man with no known risk factors. We analyze the diversity of microbiological features of these bacteria in culture, as well as their clinical importance as pathogens.

Late protective effects against CCl4-induced liver necrosis by the radioprotective agent 2-aminoethyl-isothiouronium bromide hydrobromide (AET).

Administration of the radioprotective agent 2-aminoethyl-isothiouronium bromide hydrobromide (AET) (240 mg/kg, i.p. in saline 30 min before or 6 or 10 h after CCl4 (1 ml/kg i.p. as a 20% v/v solution in olive oil) significantly prevented the necrogenic effect of the hepatotoxin at 24 h. Protection was more intense when the drug was given 6 h after CCl4 than when administered 30 min before. CCl4-induced fat accumulation was prevented only when AET was given 30 min before. AET did not prevent the CCl4-induced initiation of a lipid peroxidation (LP) process as evidenced by diene hyperconjugation of microsomal lipids. AET pretreatment 30 min before CCl4 did not significantly modify the CCl4 levels reaching the liver and only exerted a transient significant effect on the covalent binding of [14C]Cl4 reactive metabolites to microsomal lipids (CB) at 1 h but not at 3 h. The markedly intense protective effects of AET when given 6 or 10 h after CCl4 can not be attributed to decreased amounts of CCl4 reaching the liver or to decreasing effects in CB or to chain breaking effects in LP. Really, protection might be due to a favorable modulation of late events occurring after CB or LP, events that remain to be elucidated.

N-acetyl cysteine is an early but also a late preventive agent against carbon tetrachloride-induced liver necrosis.

N-Acetyl cysteine (NAC) treatment 30 min before or 6 or 10 h after carbon tetrachloride (CCl4) administration significantly prevented the liver necrosis produced by the hepatotoxin at 24 h. NAC pretreatment was able to partially decrease the covalent binding of CCl4 reactive metabolites at 1 and 3 h of poisoning and, to a small extent, the concentration of CCl4 reaching the liver at 3 h. NAC also diminished partially the CCl4-promoted increases in lipid peroxidation at 3 h, but had an enhancing effect of its own of small intensity. Results suggest that early and late protective effects of NAC might be attributable to its prior conversion to cysteine and glutathione.