Approach to COVID-19 pandemic management in Madrid. Chronic of a year.

After more than a year of pandemic, the international medical community has changed the perception of fear to one of respect for SARS-COV-2. This has been the consequence of the integral study of all the dimensions of the disease, from viral recombinant capacity to transmissibility, diagnosis, care and prevention. This document summarizes the main strategic lines of study and approach to the pandemic in Madrid.

Physical activity questionnaires for Spanish children and adolescents: a systematic review / Cuestionarios de actividad física para niños y adolescentes españoles: una revisión sistemática.

Questionnaires aimed at assessing the prevalence of physical activity are tools frequently used by health professionals. It is important to provide them with information about the characteristics and quality of these questionnaires. This systematic review aimed to identify and analyse the characteristics and psychometric properties of this type of questionnaires when administered to Spanish children and adolescents. A total of 14 questionnaires were found. Accurate validity values were obtained in two of them. Only two questionnaires obtained a score >5 in the "Qualitative Attributes and Measurement Properties of Physical Activity Questionnaires" checklist. Among the available questionnaires, the APALQ (9-18 years) and the ENERGY (12-14 years) seem to be the most accurate tools for assessing physical activity prevalence in Spanish children and adolescents, albeit with limitations that should be taken into account.

The ambrosanolide cumanin inhibits macrophage nitric oxide synthesis: some structural considerations.

Since its role in inflammatory diseases was recognized, nitric oxide (NO) has become an important mediator to evaluate anti-inflammatory agents. Sesquiterpene lactones, which occur in several medicinal plants, inhibit the NO production in macrophage-like cells. This action is probably due to a 1,4 addition reaction between its alpha,beta-unsaturated carbonyl group with sulfhydryl (SH)-containing compounds. For this reason it is believed that these compounds are cytotoxic, which restricts their therapeutic use. In this contribution, the ability of the ambrosanolide-type sesquiterpene lactone cumanin (from the Asteraceae Ambrosia psilostachya) to inhibit NO biosynthesis was evaluated in lipopolisaccharide-induced peritoneal murine macrophages and its cytotoxicity was assessed in the MTT assay. Cumanin showed a potent inhibitory effect in NO production (IC(50) = 9.38+/-0.38 microM) with low cytotoxicity. The 1,4-addition reaction of thiols was slow, which does not explain the inhibition of NO production but does explain the low cytotoxicity of cumanin with respect to other lactones.

Isolation of Corynebacterium suis from the prepuce of boars.

A survey for prevalence of Corynebacterium suis infection in boars was conducted on a Minnesota farm and at a slaughter plant. Preputial swab specimens were streaked onto Columbia colistin-nalidixic blood agar to which metronidazole (50 mg/L) had been added. Of 97 boars surveyed at a slaughterhouse, 32 (32.9%) were culture-positive, whereas 23 of 38 (60.5%) boars from 1 farm were culture-positive. The lower isolation rate at a slaughterhouse was attributed to the fact that these boars ejaculated before sampling.

Isolation of toxigenic strains of Pasteurella multocida from lungs of pneumonic swine.

Lungs from 113 pneumonic pigs were examined for Pasteurella multocida. The lungs were smeared directly onto blood agar and homogenized in brain-heart infusion broth and then inoculated intraperitoneally in mice. Pasteurella multocida isolates were typed for serotypes A (by hyaluronidase inhibition of capsule) and D (by acriflavine autoagglutination). Strains were tested for toxin production by intradermal injection of 0.2 ml of filtered 24-hour culture supernatants into guinea pigs. Most lungs (70.8%) yielded isolations. Most isolants (87.5%) were type A and 12.5% were type D. Of the type D strains, 80% were toxigenic. Of the type A isolants, 18.2% were toxigenic.

[Neurophysiological study and use of P300 evoked potentials for investigation in the diagnosis and of follow-up of patients with Alzheimer s disease]. / Estudio neurofisiológico y potenciales evocados P300 en el diagnóstico y seguimiento de pacientes con enfermedad de Alzheimer.

INTRODUCTION AND OBJECTIVES: At the present time the diagnosis of Alzheimer's disease (EA) is based on clinical evaluation of the symptoms and various complementary investigations mainly directed towards ruling out secondary dementias. However, definite diagnosis can only be made on cerebral biopsy. We wished to evaluate the efficacy of different neurophysiological investigations used in the diagnosis and follow-up of EA. PATIENTS AND METHODS: After drawing up a table of normal values, we selected a samples of 33 patients with suspected EA. Following assessment clinical, neuropsychological (Mini-Mental State Examination- MMSE-) and neurophysiological (electroencephalography-EEG-, P300 potentials, reaction time and rate of error)-, the patients were classified as having probable EA, possible EA or other dementia according to the criteria of NINCDS-ADRDA. Statistical analysis was done on the series of cases studied. RESULTS: In our experience, the most interesting findings were obtained from the EEG, MMSE and latency of the P300 evoked potentials. The most useful neurophysiological parameters for help in diagnosis of EA was the P300 latency, with a sensitivity of 77% and a specificity of 83%. The MMSE seems to show the degree of cognitive deterioration better, whilst the P300 latency seems to behave as a marker of a characteristic feature of the disorder. CONCLUSION: The P300 latency is very useful in diagnosis, since it is found to be altered in cases with EA at an early stage, with very little cognitive degeneration and even with a score of 30 on the MMSE.

[Associated EMG responses in Alzheimer's disease and in healthy subjects]. / Respuestas electromiográficas asociadas en la enfermedad de Alzheimer y en sujetos sanos.

INTRODUCTION AND AIMS: Recently, the appearance of associated EMG responses in patients with probable Alzheimer s disease (AD) have been reported during the performance of cue stimuli recognition tasks using an oddball model. We present our work with AD patients and on the possibility of obtaining these responses in normal subjects by modifying the conditions under which the exploration is carried out. PATIENTS AND METHODS: We review 38 cases of probable AD, mild and moderate in intensity, in which we explored reaction time by bilateral EMG recording in the extensor muscles of the hand. The same exploration was performed in 20 healthy subjects in basal conditions and again while a simple mathematical task was being performed. RESULTS: In two of the 38 cases, both of moderate intensity, we observed associated EMG responses. On varying the conditions of exploration, 12 of the 20 normal subjects presented associated EMG responses. CONCLUSION: Associated EMG responses are a neurophysiological phenomenon that can be observed in some patients with AD. In normal subjects, it is possible to trigger the appearance of associated EMG responses by reducing their capacity to concentrate on the task to be performed. During the performance of unilateral motor tasks, inhibition pathways are activated physiologically to prevent the mirror contraction of contralateral muscles, which can be affected by the lowered capacity to pay attention.

[Electromyographic diagnosis of 772 patients in the Móstoles Hospital]. / Diagnósticos electromiográficos de 772 pacientes en el Hospital de Móstoles.

INTRODUCTION AND OBJECTIVE: There are few references in the literature to demographic data of the disorders most frequently studied by electromyography. Our objective was to obtain a demographic description of the patients usually sent to us for electromyographic studies. MATERIAL AND METHODS: Descriptive and analytical assessment was done of 914 electromyographic diagnoses seen in a sample of 722 patients sent to Mostoles Hospital, referral centre of Health District VIII of the Community of Madrid with an estimated population of 407,836 inhabitants, for conventional electroneurographic and electromyographic studies between May 1995 and February 1996. We recorded data regarding electromyographic diagnosis, localization, intensity, whether the study was for diagnostic purposes or follow-up, medical centre referring the patient, medical speciality sending the patient, clinical impression, age and sex. RESULTS: The commonest pathology seen was carpal trapping of the median nerve, both in men and in women (three times more frequent in women). There was an estimated incidence of 136 cases per year per 100,000 women and 36 cases per year per 100,000 men (most frequent in patients aged 20-70, with a maximum frequency in those in their fifties). There was marked right sided predominance. The commonest pathology in men was polyneuropathy, with an estimated incidence of 80 cases per 100,000 men and 72 cases per 100,000 women. This was the commonest diagnosis in the patients aged over 70. Mononeuropathy of the legs was most commonly seen in men and in the first twenty years of life.

[Abdominal pregnancy with fetal survival. A report of 2 cases]. / Embarazo abdominal con supervivencia fetal. Presentación de dos casos.

The objective of this paper is to present two cases of abdominal pregnancy, secondary, with fetal survival, studied at Hospital General de Zona No. 1, IMSS, at Villahermosa, Tabasco. Both patients were referred to our Unit for cesarean section by pelvic presentation. A review was done of: classification, clinical picture, operative findings, medical and surgical treatment, hemorrhagic complications, fetal findings and specific diagnostic methods. It was concluded that one should know about this condition, in order to offer a therapeutic option to the patients.

[Perforation of the gallbladder during pregnancy. Report of a case]. / Perforación de vesícula biliar durante el embarazo. Informe de un caso.

The case of a 20 year old primigesta with a 30 weeks pregnancy, who was admitted to Emergency Service, with acute abdomen by cholecystitis, is presented. At laparotomy, a vesicular wall perforation, was found, partially sealed with epiplon and free biliary fluid in peritoneal cavity. Cholecystectomy was performed; and cesarean section 24 hours after. Therapeutic options in these patients, are analyzed, and surgical treatment risks, during gestation, and otherwise.

[Extracranial shunts and pregnancy. Presentation of 2 cases]. / Derivaciones extracraneales y embarazo. Presentación de dos casos.

Two cases of extracranial derivations shunts with pregnancy treated at Hospital General de Zona No. 1, IMSS, Villahermosa, Tab. are presented. The world literature about this subject, was reviewed. Pregnancy evolution and resolution via, recommended anesthetic method and prophylactic antimicrobials, are considered. It was concluded that with surgery progress there are more cases of women with extracranial shunt who reach adulthood and are able to carry normal pregnancy and to deliver healthy children.

The chemokine CCL5 induces CCR1-mediated hyperalgesia in mice inoculated with NCTC 2472 tumoral cells.

Although the expression of the chemokine receptor CCR1 has been demonstrated in several structures related to nociception, supporting the nociceptive role of chemokines able to activate it, the involvement of CCR1 in neoplastic pain has not been previously assessed. We have assayed the effects of a CCR1 antagonist, J113863, in two murine models of neoplastic hyperalgesia based on the intratibial injection of either NCTC 2472 fibrosarcoma cells, able to induce osteolytic bone injury, or B16-F10 melanoma cells, associated to mixed osteolytic/osteoblastic bone pathological features. The systemic administration of J113863 inhibited thermal and mechanical hyperalgesia but not mechanical allodynia in mice inoculated with NCTC 2472 cells. Moreover, in these mice, thermal hyperalgesia was counteracted following the peritumoral (10-30µg) but not spinal (3-5µg) administration of J113863. In contrast, hyperalgesia and allodynia measured in mice inoculated with B16-F10 cells remained unaffected after the administration of J113863. The inoculation of tumoral cells did not modify the levels of CCL3 at tumor or spinal cord. In contrast, although the concentration of CCL5 remained unmodified in mice inoculated with B16-F10 cells, increased levels of this chemokine were measured in tumor-bearing limbs, but not the spinal cord, of mice inoculated with NCTC 2472 cells. Increased levels of CCL5 were also found following the incubation of NCTC 2472, but not B16-F10, cells in the corresponding culture medium. The intraplantar injection of CCL5 (0.5ng) to naïve mice evoked thermal hyperalgesia prevented by the coadministration of J113863 or the CCR5 antagonist, d-Ala-peptide T-amide (DAPTA), demonstrating that CCL5 can induce thermal hyperalgesia in mice through the activation of CCR1 or CCR5. However, contrasting with the inhibitory effect evoked by J113863, the systemic administration of DAPTA did not prevent tumoral hyperalgesia. Finally, the peritumoral administration of an anti-CCL5 antibody completely inhibited thermal hyperalgesia evoked by the inoculation of NCTC 2472 cells.

Proarrhythmic response to sodium channel blockade. Theoretical model and numerical experiments.

BACKGROUND: The use of flecainide and encainide was terminated in the Cardiac Arrhythmia Suppression Trial because of an excess of sudden cardiac deaths in the active treatment group. Such events might arise from reentrant rhythms initiated by premature stimulation in the presence of anisotropic sodium channel availability. Drugs that bind to sodium channels increase the functional dispersion of refractoriness by slowing (a result of the drug-unbinding process) the transition from an inexcitable state to an excitable state. It is interesting that encainide and flecainide unbind slowly (15-20 seconds), whereas lidocaine and moricizine unbind rapidly (0.2-1.3 seconds). METHODS AND RESULTS: With a computer representation of a cable with Beeler-Reuter membrane properties, we found a small (6 msec) vulnerable window that occurred 338 msec after the last drive stimulus. Premature stimuli falling within the vulnerable window resulted in unidirectional block and reentrant activation. In the presence of a slowly unbinding drug, the window was delayed an additional 341 msec, and its duration was extended to 38 msec. The delay (antiarrhythmic effect) before the onset of the vulnerable window and its duration (proarrhythmic effect) were both dependent on the sodium channel availability and the recovery process. Both effects were also prolonged when sodium channel availability was reduced by membrane depolarization. Defining the proarrhythmic potential as the duration of the vulnerable window, we found that hypothetical use-dependent class I drugs have a greater proarrhythmic potential than non-use-dependent drugs. CONCLUSIONS: The antiarrhythmic and proarrhythmic properties of pure sodium channel antagonists are both dependent on sodium channel availability. Consequently, the price for increased antiarrhythmic efficacy (suppressed premature ventricular contractions) is an increased proarrhythmic vulnerability to unsuppressed premature ventricular contractions.

A proarrhythmic response to sodium channel blockade: modulation of the vulnerable period in guinea pig ventricular myocardium.

The vulnerable period (VP) is an interval of time during the cardiac cycle within which premature stimulation may lead to trains of responses (one: many stimulus-response coupling). Although the VP parallels the recovery of sodium channel availability, modulators of its boundaries remain unclear. Numerical studies of a uniform cable demonstrated that reduction in sodium channel availability increased the range of premature stimuli, resulting in unidirectional block, a precursor of reentrant activation. Consequently, we hypothesized that the kinetics of use-dependent sodium channel blockade could reflect one dimension of a drug's proarrhythmic potential. In strips from guinea pig right ventricle, we probed the boundaries of the VP in the presence of use-dependent sodium channel antagonists utilizing a train of stimuli followed by a premature stimulus. Under drug-free conditions when the sites of drive and premature stimulation were the same, the VP was less than 4 ms in duration. When the drive and premature sites were different, the drug-free VP was greater than 5 ms in 22 of 24 preparations and 0 in the other two, with an average VP duration of 16 +/- 10 ms (mean +/- SD). In the presence of 1 microM moricizine, VP = 17 +/- 4 ms; 12 microM moricizine, VP = 35 +/- 4 ms; 3 microM flecainide, VP = 50 +/- 17 ms; and 4 microM quinidine, VP = 2 +/- 1 ms. These results suggest that residual unsuppressed premature ventricular contractions (PVCs) in the presence of some class 1 drugs have a greater potential for initiating a proarrhythmic response than PVCs in the absence of a class 1 drug.

Cardiac instability amplified by use-dependent Na channel blockade.

Drugs that exhibit use-dependent Na channel blockade, including antiarrhythmic agents, tricyclic antidepressants, opiate-like analgesics, and cocaine, are linked with an increased susceptibility to cardiac arrhythmias and sudden death. Computer simulations indicate that Na channel blockade retards recovery of excitability, thereby increasing the spatial dispersion of refractoriness, a precursor of many cardiac arrhythmias. In isolated rabbit left atria, stimuli timed to occur at increasing intervals following conditioning stimuli reveal an unstable interval (vulnerable period) during which single stimuli initiate trains of responses. The vulnerable period is extended by use-dependent Na channel blockade and provides a model for assaying proarrhythmic potential and probing cardiac instability.

A comparative study of the analgesic and anti-inflammatory activities of pectolinarin isolated from Cirsium subcoriaceum and linarin isolated from Buddleia cordata.

The dried aqueous extract of aerial parts of Cirsium subcoriaceum (Asteraceae) and its major flavonoid glycoside, pectolinarin, have been evaluated for analgesic and anti-inflammatory effects in mice and rats, respectively. Both the extract and pectolinarin exerted significant and dose-dependent analgesic and anti-inflammatory activities. Also, the anti-inflammatory activities of an aqueous extract of Buddleia cordata and its principal glycoside linarin were evaluated. The results of pharmacological testing proved that linarin is a better anti-inflammatory agent than pectolinarin and indomethacin. On the other hand, pectolinarin exerted a better analgesic effect than linarin.