Resultados de la ablación con catéter con mínimo o nulo empleo de fluoroscopia en pacientes pediátricos con taquiarritmias supraventriculares / Results of catheter ablation with zero or near zero fluoroscopy in pediatric patients with supraventricular tachyarrhythmias

Introducción y objetivos: La exposición a radiación ionizante en los procedimientos de ablación conlleva riesgos para la salud, sobre todo en pacientes pediátricos. Nuestro objetivo es comparar la seguridad y la eficacia de la ablación guiada por un sistema de navegación intracardiaca no fluoroscópica (SNINF) con las de la ablación guiada exclusivamente por fluoroscopia en pacientes pediátricos. Métodos: Se analizaron los resultados de la ablación con catéter en pacientes pediátricos con vías accesorias de riesgo o taquicardias supraventriculares remitidos a nuestro centro en un periodo de 6 años. Se compararon los procedimientos guiados solo por fluoroscopia (grupo A) y los guiados por SNINF (grupo B). Resultados: Se analizaron 120 procedimientos de ablación en 110 pacientes (edad, 11±3,2 años; el 70% varones), 62 procedimientos en el grupo A y 58 en el grupo B. No se encontraron diferencias significativas entre ambos grupos en éxito del procedimiento (el 95% del grupo A y el 93,5% del grupo B; p=0,53), complicaciones (el 1,7 frente al 1,6%; p=0,23) y recurrencia (el 7,3 frente al 6,9%; p=0,61). Sin embargo, el tiempo de fluoroscopia (mediana, 1,1 frente a 12 min; p<0,0005) y el tiempo de ablación (mediana, 96,5 frente a 133,5 s; p=0,03) fueron menores en el grupo B. La presencia de cardiopatía se comportó como un predictor independiente de recurrencia (p=0,03). Conclusiones: El SNINF para guiar los procedimientos de ablación en pacientes pediátricos reduce el tiempo de exposición a la radiación ionizante. Su empleo generalizado en las ablaciones pediátricas podría reducir el riesgo atribuido a la radiación (AU)

Introduction and objectives: Ionizing radiation exposure in catheter ablation procedures carries health risks, especially in pediatric patients. Our aim was to compare the safety and efficacy of catheter ablation guided by a nonfluoroscopic intracardiac navigation system (NFINS) with those of an exclusively fluoroscopy-guided approach in pediatric patients. Methods: We analyzed catheter ablation results in pediatric patients with high-risk accessory pathways or supraventricular tachycardia referred to our center during a 6-year period. We compared fluoroscopy-guided procedures (group A) with NFINS guided procedures (group B). Results: We analyzed 120 catheter ablation procedures in 110 pediatric patients (11±3.2 years, 70% male); there were 62 procedures in group A and 58 in group B. We found no significant differences between the 2 groups in procedure success (95% group A vs 93.5% group B; P=.53), complications (1.7% vs 1.6%; P=.23), or recurrences (7.3% vs 6.9%; P = .61). However, fluoroscopy time (median 1.1minutes vs 12minutes; P <.0005) and ablation time (median 96.5seconds vs 133.5seconds; P=.03) were lower in group B. The presence of structural heart disease was independently associated with recurrence (P=.03). Conclusions: The use of NFINS to guide catheter ablation procedures in pediatric patients reduces radiation exposure time. Its widespread use in pediatric ablations could decrease the risk of ionizing radiation (AU)

Application of the assay of aflatoxins by liquid chromatography with fluorescence detection in food analysis.

HPLC using fluorescence detection has already become the most accepted method for the determination of aflatoxins due to its several advantages over other analytical methods. Both normal- and reversed-phase HPLC can be used. However the reversed-phase HPLC methods are more popular. Liquid chromatographic determination of aflatoxins using fluorescence detection and its application in food analysis is reviewed in this article.

Application of a modified culture medium for the simultaneous counting of molds and yeasts and detection of aflatoxigenic strains of Aspergillus flavus and Aspergillus parasiticus.

Molds and yeasts from 91 samples of feed and raw materials used in feed formulation were enumerated on a new culture medium to which a beta cyclodextrin (beta-W7M 1.8-cyclodextrin) had been added. This medium was compared with other media normally used in laboratories for the routine analysis of fungi, such as Sabouraud agar, malt agar supplemented with 2% dextrose, and potato dextrose agar. When a t test for paired data (0.05 significance level, 95% confidence interval) was applied, no statistically significant differences between the results obtained with the new culture medium and those obtained with the other media used to enumerate molds and yeasts were found. For the evaluation of contamination due to aflatoxin for all of the samples, Sabouraud agar and yeast extract agar, both supplemented with 0.3% beta-W7M 1.8-cyclodextrin, and APA (aflatoxin-producing ability) medium were used. Aflatoxin was detected in 21% of the feed samples and in 23% of the raw-material samples analyzed, with maximal amounts of 2.8 and 6.0 microg of aflatoxin B1 per kg, respectively, being detected. In any case, the aflatoxin contents found exceeded the legally stipulated limits. The t test for paired data (0.05 significance level, 95% confidence interval) did not show statistically significant differences between the results obtained with the different culture media used for the detection of aflatoxins. The advantage of the new medium developed (Sabouraud agar with 0.3% beta-W7M 1.8-cyclodextrin) is that it allows simultaneous fungal enumeration and determination (under UV light) of the presence of aflatoxin-producing strains without prior isolation and culture procedures involving expensive and/or complex specific media and thus saves work, time, and money.

[Do drug using inmates have social support?: A case study in an Andalusian prisons]. / ¿Tienen apoyo social los reclusos drogodependientes?: Estudio en una prisión andaluza.

OBJECTIVES: To discover and compare the social support received by drug-dependent inmates in a drug free program and other inmates participating in a methadone maintenance program (MMP). MATERIALS AND METHODS: Transversal descriptive observational study carried out at Albolote Prison (Granada). The prison population at the time of the study was 1,763 inmates. The drug addicts were divided into two groups: those in a methadone maintenance program (MMP, 279 inmates) and those participating in a drug free program (58 inmates). A random sample of 60 inmates in the MMP was obtained. All the members of the drug free program participated. The two groups were interviewed to discover more about their family structure, socio-economic level and qualifications. The MOS social support survey was also used in a self applied format with assistance from the interviewer. The percentages obtained from each dimensionof the MOS questionnaire for each group was compared using Pearson's chi-square test. RESULTS: The social network of the MMP group was a mean 13.2. In the drug free group it was 12.9. Value of p= 0.0047. Global support was low amongst 38 individuals (74.5%) in the MMP group and 9 (15.62%) in the drug free program. It was normal amongst 13 subjects (25.5%) in the MMP group and amongst 49 (84.38%) in the drug free group. Value of p=0.0001. All the dimensions of the MOS social support survey are higher amongst the drug free group: there are statistically significant differences with the MMP group. CONCLUSIONS: Inmates in the drug free program have (and they perceive this to be the case) a greater degree of social support than participants in the MMP.

[Morbimortality of acute endocarditis caused by Streptococcus agalactiae]. / Morbimortalidad de la endocarditis aguda por Streptococcus agalactiae.

INTRODUCTION: Streptococcus agalactiae is an uncommon cause of acute endocarditis. It is more likely to occur in people with underlying diseases and usually evolves poorly. MATERIALS AND METHODS: We have conducted a retrospective study comparing the clinical features of Streptococcus agalactiae acute endocarditis attended in our Hospital during the last twelve years with the ones caused by other microorganisms; we have analized as dependent variables the vegetation size, surgery needing, complications, time of hospitalisation and global mortality. RESULTS: All the cases by SGB had a great vegetation size, all needed surgery in its management with long hospitalisation periods, and the mortility was of 40%; everything was higher than other microorganism's endocarditis. CONCLUSION. Streptococcus agalactiae acute endocarditis is a serious disease which requires early surgery in its management. Its mortality rate, complications and hospitalisation time are high.

Metabolic syndrome in patients with systemic lupus erythematosus from Southern Spain.

The aim of this cross-sectional study was to establish the frequency, phenotype and characteristics of metabolic syndrome (MS), as defined by the Adult Treatment Panel III, in a cohort of patients with systemic lupus erythematosus (SLE) and its possible association with cardiovascular diseases (CVD). A total of 160 patients with SLE and 245 age, sex, educational level and ethnically matched controls were included. Association with cardiovascular risk factors, SLE features, treatment of SLE and history of CVD were assessed in patients with SLE and controls with and without MS. MS was non-significantly increased in patients with SLE (20%) compared with controls (13%; P = 0.083). It was more commonly observed in patients with SLE < or =40 years old (15.8%) than in controls of the same age group (4.2%; P < 0.001). The mean number of MS criteria was significantly higher among patients with SLE than in controls. The frequency of CVD was also 28-fold higher among patients with SLE (11.3%) than in controls (0.4%). SLE with MS presented higher levels of inflammatory markers than SLE without MS. In a multivariate analysis, educational level, serum triglycerides, HDL-cholesterol and C3 serum levels and hydroxychloroquine use were independently associated with MS.

¿Tienen apoyo social los reclusos drogodependientes? Estudio en una prisión andaluza / ¿Do drug using inmates have social support?. A case study in an andalusian prison

Objetivo: Conocer y comparar el apoyo social que tienen los drogodependientes de una prisión incluidos en el programalibre de drogas y en el programa de mantenimiento con metadona (PMM).Material y metodo: Estudio observacional descriptivo transversal, realizado en el Establecimiento Penitenciario de Albolote(Granada).La población penitenciaria en el momento del estudio era de 1.763 reclusos. Los drogodependientes, se dividieron en dosgrupos: en programa de mantenimiento con metadona (PMM 279 reclusos) y en programa libre de drogas (58 reclusos). Se obtuvouna muestra aleatoria de 60 internos en el grupo en PMM. Participó toda la población del programa libre de drogas. A losdos grupos se les entrevistó a fin de conocer su estructura familiar, nivel socioeconómico y de estudios. También se aplicó elcuestionario MOS de apoyo social de forma autoaplicada asistido por entrevistador. Los porcentajes obtenidos de cada dimensióndel cuestionario MOS de los grupos se compararon mediante Chi cuadrado de Pearson.Resultados: La red social del grupo en PMM fue de media 13,2. En el grupo libre de drogas fue 12,9. Valor de p= 0,0047.El apoyo global fue bajo en 38 personas (74,5%) en el grupo en PMM y 9 (15,62%) en el grupo en programa libre de drogas.Siendo normal en 13 sujetos (25,5%) en el grupo en PMM y en 49 (84,38%) en el grupo incluido en el programa libre de drogas.Valor de p= 0,0001.Todas las dimensiones del cuestionario MOS de apoyo social son más elevadas en el grupo en programa libre de drogas,existiendo diferencias estadísticamente significativas con el grupo en PMM.Conclusiones: Los reclusos en programa libre de drogas tienen, y así lo perciben ellos, un mayor apoyo social que los queestán en PMM(AU)

Aims: To discover and compare the social support received by drug-dependent inmates in a drug free program and otherinmates participating in a methadone maintenance program (MMP).Materials and methods: Transversal descriptive observational study carried out at Albolote Prison (Granada).The prison population at the time of the study was 1,763 inmates. The drug addicts were divided into two groups: those ina methadone maintenance program (MMP, 279 inmates) and those participating in a drug free program (58 inmates). A randomsample of 60 inmates in the MMP was obtained. All the members of the drug free program participated. The two groups wereinterviewed to discover more about their family structure, socio-economic level and qualifications. The MOS social supportsurvey was also used in a self applied format with assistance from the interviewer. The percentages obtained from each dimensionof the MOS questionnaire for each group was compared using Pearson’s chi-square test.Results: The social network of the MMP group was a mean 13.2. In the drug free group it was 12.9. Value of p= 0.0047.Global support was low amongst 38 individuals (74.5%) in the MMP group and 9 (15.62%) in the drug free program. It wasnormal amongst 13 subjects (25.5%) in the MMP group and amongst 49 (84.38%) in the drug free group. Value of p=0.0001. All the dimensions of the MOS social support survey are higher amongst the drug free group: there are statistically significantdifferences with the MMP group.Conclusions: Inmates in the drug free program have (and they perceive this to be the case) a greater degree of social supportthan participants in the MMP(AU)

Determination of alternariol in tomato paste using solid phase extraction and high-performance liquid chromatography with fluorescence detection.

Alternaria spp. produce a wide variety of toxic metabolites with different chemical structures. Tomato products have been considered a likely source of Alternaria toxins in the human diet because Alternaria is an important spoilage mold of tomatoes. A new method for the determination of these mycotoxins in tomato paste, involving solid phase cartridges for extraction before HPLC fluorescence detection with a reversed phase column and isocratic elution, was developed. The method was demonstrated to be linear in the range 5.2-196 ppb of alternariol (AOH) in tomato paste. Good recoveries were obtained for AOH at all levels assayed (minimum 77.2%). The detection limit of the AOH toxin in real samples of tomato paste was low, 1.93 ppb. The precision of the method was demonstrated with a good repeatability (RSD = 2.98%) and reproducibility (RSD = 9.35%).

[Intolerance to hydroxychloroquine marketed in Spain (Dolquine) in patients with autoimmune conditions]. / Intolerancia a la hidroxicloroquina comercializada en España (Dolquine) en pacientes con patología autoinmune.

BASIS: A significant proportion of our patients has described to have problems from tolerance to Dolquine, a new presentation of hydroxychloroquine recently marketed in Spain, compared to Plaquenil. The objective was to know the tolerability and the adverse effects of this new presentation. PATIENTS AND METHOD: A cross-sectional multicenter study on 133 patients treated with Dolquine was conducted. RESULTS: Of the 133 patients (87% women; average age [AA]: 32.9 [15.4] years) who received Dolquine during an average period of 6.7 (1.4) months, 32 patients (24%) described to have more problems with this drug in comparison with other antimalarial. The adverse effects experienced were: bitter taste (62.4%), difficulty in swallowing the tablet (13.5%), dyspepsia (9.8%), nausea (7.5%), vomiting (1.5%), pruritus (1.5%), diarrhea (0.7%), and instability feeling (0.7%). The presence of gastrointestinal adverse effects was not related to the consumption of gastroerosive drugs, gastric protectors, or a high number of drugs. The attrition rate was 9.8%. Conclusions. Dolquine induces lower tolerance and more gastrointestinal adverse effects than Plaquenil, pointing out its bitter taste and the difficulty in swallowing it. Despite this higher intolerance there was not an increase in the attition rate from the antimalarial treatment in comparison to other series.

Morbimortalidad de la endocarditis aguda por Streptococcus agalactiae / Morbimortality of acute endocarditis caused by Streptococcus agalactiae

Introducción. El Streptococcus agalactiae es un agente causal infrecuente de endocarditis aguda. Suele afectar a pacientes con patología de base y tiene un mal pronóstico. Material y métodos. Estudio retrospectivo que compara las características clínicas de5 casos de endocarditis aguda por Streptococcus agalactiae atendidos en nuestro Hospital, en los últimos doce años, con 43 endocarditis producidas por otros microorganismos. Analizamos como variables dependientes el tamaño de la vegetación, la necesidad de cirugía, el desarrollo de complicaciones, el tiempo de hospitalización y la mortalidad global. Resultados. Todos los casos de endocarditis por estreptococo del grupo B (SGB) tenían mayor tamaño de la vegetación, todos requirieron cirugía y tuvieron estancias hospitalarias prolongadas y mortalidad del 40%, todo ello superior a las endocarditis por otros microorganismos. Conclusión. La endocarditis aguda por Streptococcus agalactiae es un cuadro grave que requiere cirugía precoz en su tratamiento, presenta mortalidad elevada, tasa alta de complicaciones y estancias hospitalarias prolongadas (AU)

Introduction. Streptococcus agalactiae is an uncommon cause of acute endocarditis. It is more likely to occur in people with underlying diseases and usually evolves poorly. Materials and methods. We have conducted a retrospective study comparing the clinical features of Streptococcus agalactiae acute endocarditis attended in our Hospital during the last twelve years with the ones caused by other microorganisms; we have analized as dependent variables the vegetation size, surgery needing, complications, time of hospitalisation and global mortality. Results. All the cases by SGB had a great vegetation size, all needed surgery in its management with long hospitalisation periods, and the mortility was of 40%; everything was higher than other microorganism’s endocarditis. Conclusion. Streptococcus agalactiae acute endocarditis is a serious disease which requires early surgery in its management. Its mortality rate, complications and hospitalisation time are high (AU)