Thoracoabdominal manifestations of immunoglobulin G4-related disease.

Immunoglobulin G4-related disease (IgG4-RD) comprises a group of immune-mediated diseases that, until recently, were considered separate entities. These entities have a similar clinical presentation, serological findings, and pathogenesis, so they are currently considered a single multisystemic disease. The common characteristic is the infiltration of involved tissues by plasma cells and lymphocytes that are positive for IgG4. Three major criteria have been proposed for the diagnosis of IgG4-RD: clinical, laboratory, and histological. The pancreas is the organ that is most affected by IgG4-RD, which can simulate a tumor. In this respect, a series of signs could help us suspect that the pancreatic findings do not reflect a tumor (halo sign, duct-penetrating sign, absence of vascular invasion, etc.). The differential diagnosis is important to avoid unnecessary surgical interventions.

Manifestaciones toracoabdominales de las enfermedades relacionadas con la inmunoglobulina G4 / Thoracoabdominal manifestations of immunoglobulin G4-related disease

Las enfermedades relacionadas con la IgG4 (ER-IgG4) son un conjunto de enfermedades inmunomediadas que, hasta no hace mucho tiempo, se consideraban como entidades individuales. Se ha demostrado la existencia de una clínica, una serología y una patogenia similares, por lo que, actualmente, se considera como una única enfermedad multisistémica. Su característica común es la infiltración de los tejidos afectados por células plasmáticas y linfocitos IgG4 positivos. Se han propuesto 3 criterios mayores para su diagnóstico, que son el clínico, el analítico y el anatomopatológico. El páncreas es el órgano que más se afecta en esta enfermedad, pudiendo simular un proceso tumoral. De ahí que se haya descrito una serie de signos que podrían hacernos sospechar que no se trata de una neoplasia (signo del halo, del conducto penetrante, ausencia de invasión vascular, etc.). El diagnóstico diferencial es importante de cara a evitar cirugías innecesarias (AU)

Immunoglobulin G4-related disease (IgG4-RD) comprises a group of immune-mediated diseases that, until recently, were considered separate entities. These entities have a similar clinical presentation, serological findings, and pathogenesis, so they are currently considered a single multisystemic disease. The common characteristic is the infiltration of involved tissues by plasma cells and lymphocytes that are positive for IgG4. Three major criteria have been proposed for the diagnosis of IgG4-RD: clinical, laboratory, and histological. The pancreas is the organ that is most affected by IgG4-RD, which can simulate a tumor. In this respect, a series of signs could help us suspect that the pancreatic findings do not reflect a tumor (halo sign, duct-penetrating sign, absence of vascular invasion, etc.). The differential diagnosis is important to avoid unnecessary surgical interventions (AU)

Evaluación de la actualización de los criterios STOPP-START en atención primaria / Updated report on STOPP-START criteria in Primary Care

Introducción: El objetivo de este trabajo es averiguar la prevalencia de prescripción potencialmente inapropiada (PPI) en población mayor de 64 años en Avilés, Asturias. Material y métodos: Estudio descriptivo transversal multicéntrico en seis centros de salud. Se seleccionó una muestra de 400 personas obtenida por muestreo aleatorio proporcional a la población adscrita a cada centro de salud. Se revisaron las historias clínicas informatizadas y se aplicaron los criterios STOPP-START (versión 2014 con 114 ítems) para evaluar la PPI. Resultados: Se estudiaron 378 (95,5%) pacientes, con una media de edad de 75,4 años (DE: 7,4) y una proporción de 57,7% mujeres. El 94,2% (IC95%:91,7-96,7) presentaban alguna PPI. Atendiendo solo a los criterios STOPP un 52,4% (IC95%:47,2-57,6) de pacientes presentaba al menos un incumplimiento y en los START un 90,5% (IC95%:87,4-93,6) que se reducía a 40,5% (IC95%: 36,4-45,6) si se eliminaban los criterios referidos a vacunaciones. Entre los criterios STOPP, la PPI más frecuente fue la toma de benzodiacepinas seguido del uso de medicamentos sin indicación basada en la evidencia; entre los START fueron la vacunación antineumocócica y la ausencia de la toma de suplementos de vitamina D y calcio en osteoporosis. Conclusiones: Nivel elevado de PPI, muy superior al resultante en la versión previa especialmente para los criterios START. Existe un elevado nivel de PPI en relación con el uso de benzodicepinas y el empleo de medicamentos sin evidencia clínica. Los criterios STOPP-START son útiles en atención primaria para evaluar la PPI

Introduction: The aim of this study is to determine the rate of potentially inappropriate prescriptions (PIP) in people older than 64 years of age in Avilés, Asturias, Spain. Materials and methods: A descriptive cross-sectional study was conducted in six Health Care Centres. A sample of 400 people was selected, obtained by a random sampling proportional to the population registered in each Health Centre. A review was made of the computerised clinical records, and the STOPP-START (version 2014 with 114 items) criteria were applied to evaluate the PIP. Results: The study contained 378 (95.5%) patients with a mean age of 75.4 (SD: 7.4) and of which 57.7% were women. Almost all (94.2%: 95% CI; 91.7-96.7) met some PIP criteria. Taking only the STOPP criteria into consideration, 52.4% (95%CI: 47.2-57.6) met at least one breach, and in the START criteria a 90.5% (95%CI; 87.4-93.6), which was reduced to 40.5% (95%CI; 36.4-45.6) if criteria on vaccination were removed. In the STOPP criteria, the most frequent PIP was taking benzodiazepines followed by the use of medication without indications based on the evidence; in the START, the criteria was the anti-pneumococcus vaccination, and the lack of taking vitamin D supplements and calcium in osteoporosis. Conclusions: There were high levels of PIP, very superior to the previous version, especially for the START criteria. There is a high level of PIP related to the use of benzodiazepines and the use of medication without any clinic evidence. The STOPP-START criteria are useful in Primary Care to assess the PIP

[Updated report on STOPP-START criteria in Primary Care]. / Evaluación de la actualización de los criterios STOPP-START en atención primaria.

INTRODUCTION: The aim of this study is to determine the rate of potentially inappropriate prescriptions (PIP) in people older than 64 years of age in Avilés, Asturias, Spain. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted in six Health Care Centres. A sample of 400 people was selected, obtained by a random sampling proportional to the population registered in each Health Centre. A review was made of the computerised clinical records, and the STOPP-START (version 2014 with 114 items) criteria were applied to evaluate the PIP. RESULTS: The study contained 378 (95.5%) patients with a mean age of 75.4 (SD: 7.4) and of which 57.7% were women. Almost all (94.2%: 95% CI; 91.7-96.7) met some PIP criteria. Taking only the STOPP criteria into consideration, 52.4% (95%CI: 47.2-57.6) met at least one breach, and in the START criteria a 90.5% (95%CI; 87.4-93.6), which was reduced to 40.5% (95%CI; 36.4-45.6) if criteria on vaccination were removed. In the STOPP criteria, the most frequent PIP was taking benzodiazepines followed by the use of medication without indications based on the evidence; in the START, the criteria was the anti-pneumococcus vaccination, and the lack of taking vitamin D supplements and calcium in osteoporosis. CONCLUSIONS: There were high levels of PIP, very superior to the previous version, especially for the START criteria. There is a high level of PIP related to the use of benzodiazepines and the use of medication without any clinic evidence. The STOPP-START criteria are useful in Primary Care to assess the PIP.

Protocolo de observación de la tipología facial y maloclusiones / Observation protocol of facial tipology and malocclusions

Ciertas dificultades del habla son consecuencia de una formación inadecuada de algún componente del aparato estomatognático y de no haber logrado desarrollar mecanismos compensatorios suficientes para la producción oral correcta. Las maloclusiones forman parte de los trastornos que pueden llegar a generar alteraciones en el habla. Una vez las disfunciones orofaciales y malos hábitos articulatorios están instaurados, con mejorar el aspecto estructural de los órganos fonoarticulatorios no será suficiente. Así, la actuación logopédica, junto con la del ortodoncista, puede ser necesaria para reeducar la función de nuevos patrones musculares y de articulación del habla. En este artículo, se exponen algunas ideas básicas, procedentes de bibliografía específica, que consideramos importantes en relación con ciertas disfunciones orofaciales, además de un protocolo de observación de la tipología facial y maloclusiones que hemos elaborado. La finalidad de éste es facilitar la valoración de las condiciones orgánicas y funcionales del aparato estomatognático, intentando detectar las alteraciones morfológicas y de movimiento, así como su relación con la articulación de los sonidos del habla. Para ello se han organizado los ítems a observar en diferentes apartados: en relación con el perfil facial, la forma de la cabeza, la oclusión dentaria (en función de los tres planos que dividen la boca) y la arcada dentaria (refiriéndonos, en particular, a la dentición primaria)

Some of the difficulties on the spoken language appear as a consequence of the unsuitable formation of some of the constituents of the stomatological system, and they are also due to not having achieved enough evolution in compensatory mechanisms which allow a proper verbal production. Sometimes malocclusions develop into language disorders. After having set up some wrong articulatory habits, a speech therapist and an orthodontist work in order to reeducate the new articulatory and muscular patterns functions, because the only improvement of the phonoarticulatory organs physical appearence is not enough. In this article, the reader will find some ideas belonging to the literature about the subject that we consider important in relation to oro-facial disfunctions and also an observation protocol about facial tipology and malocclusions. We have made it in order to assess the organic and functional conditions of the stomatological system, where we have tried to detect all the morphological and movement disorders and their relationship with the spoken sounds. In order to do so, we have organized the items to be observed into different sections related to facial profile, head shape, dental occlusion (according to the three levels in the mouth division) and mandible (referring, in particular, to primary teething)

Protocolo de observación de la respiración para detectar alteraciones que pueden desencadenar o favorecer trastornos orofaciales o de la voz / Observation protocol of breathing designed in order to detect mechanisms disabilities wich can be reason or the consequence of orofacial or voice disorder

Es manifiesta la importancia de los factores respiratorios para el correcto desarrollo de las estructuras y funciones orofaciales implicadas en el acto de hablar, así como para la emisión vocal. En el presente artículo, se presenta un protocolo de observación de la respiración elaborado para detectar alteraciones de sus mecanismos que pueden ser causa o consecuencia de trastornos orofaciales o de la voz. Se describen, también, las disfunciones más frecuentes observadas por las autoras entre la población escolar, después de utilizar dicho protocolo en su intervención práctica. Paralelamente, se intenta transmitir a los lectores algunas reflexiones sobre la utilidad de los datos obtenidos con este instrumento, para abordar la reeducación (AU)

Color and stability of pigments derived from the acetaldehyde-mediated condensation between malvidin 3-O-glucoside and (+)-catechin.

A pigment derived from the acetaldehyde-mediated condensation between (+)-catechin and malvidin 3-O-glucoside has been prepared and isolated by semipreparative HPLC, and its characteristics of color and stability have been studied and compared with that of malvidin glucoside in aqueous solutions. When the pH was increased from 2.2 to 5.5, the solution of the pigment became progressively more violet (lambda(max) = 560 nm at pH 5.5), whereas similar solutions of the anthocyanin were almost colorless at pH 4.0. This behavior indicated that the anthocyanin moiety of the pigment was more protected against water attack, and thus the formation of its quinonoidal forms was favored. The color of the pigment also showed more stability with regard to bleaching by SO(2) than that of malvidin glucoside. Nevertheless, the pigment was more sensitive to degradation in aqueous solution than the anthocyanin. The cleavage of the ethyl bridge that links the anthocyanin and the catechin constituted the first step in its degradation, as demonstrated by the formation of malvidin glucoside as a major product.

Síndrome de secreción inadecuada de hormona antidiurética asociado al uso de inhibidores selectivos de recaptación de serotonina

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[Intraoperative infiltration of 0.5% bupivacaine in pediatric tonsillectomy]. / Infiltración intraoperatoria de bupivacaína 0.5% en la amigdalectomía pediátrica.

Twenty-eight healthy pediatric patients scheduled for bilateral tonsillectomy under general anesthesia were allocated randomly into two groups. The same anesthetic technique was used in both groups. After oral intubation, tonsils were infiltrated with either 0.5% bupivacaine (group B) or isotonic saline solution (group F). During surgery, hemodynamic stability, blood loss, and need for additional anesthesia were evaluated. After surgery, hemodynamic stability, pain, general behavior, need for analgesics, oral intake, and complications were evaluated. The bupivacaine group had significantly less bleeding in the first tonsil, less need for anesthetics, and less pain in the first eight hours after surgery. None of the other variables showed statistically significant differences. These results suggest that preoperative infiltration of the tonsils with bupivacaine was useful for reducing bleeding and intraoperative anesthesia requirements, and that it reduced pain in the immediate postoperative period.