Recambio de bomba intratecal en esclerosis múltiple. Factores que interfieren en la eficacia y ajuste de dosis de baclofeno. A propósito de un caso / Intrathecal baclofen pump exchange in multiple sclerosis. Factors affecting baclofen efficacy and dose adjustement. A case report

La esclerosis múltiple es una enfermedad neurológica con clínica variada, que en algunos casos es progresiva y muy invalidante, y que requiere tratamientos invasivos para el dolor y la espasticidad. El uso de perfusiones de baclofeno intratecal es una alternativa eficaz y segura para pacientes con espasticidad refractaria y severa, y logra mejorar la calidad de vida, pero es preciso disponer de una unidad del dolor con personal entrenado para emplear estas terapias invasivas y conocer las indicaciones, farmacología y posibles riesgos tanto del implante como del uso del baclofeno. Se tiene que individualizar el tratamiento y hacer seguimientos periódicos.(AU)

Multiple sclerosis is a neurological disease that presents with various symptoms; in some cases it is progressive and highly disabling, requiring invasive techniques to treat pain and spasticity. The use of intrathecal baclofen infusions is an effective and safe alternative for patients with severe and refractory spasticity. The therapy can improve quality of life, but must be performed in a pain unit by medical staff trained in the technique, its indications, pharmacology, and the potential risks of both the implant and the drug. The treatment can be individualized and patients must be followed up periodically.(AU)

Intrathecal baclofen pump exchange in multiple sclerosis. Factors affecting baclofen efficacy and dose adjustement. A case report. / Recambio de bomba intratecal en esclerosis múltiple. Factores que interfieren en la eficacia y ajuste de dosis de baclofeno. A propósito de un caso.

Multiple sclerosis is a neurological disease that presents with various symptoms; in some cases it is progressive and highly disabling, requiring invasive techniques to treat pain and spasticity. The use of intrathecal baclofen infusions is an effective and safe alternative for patients with severe and refractory spasticity. The therapy can improve quality of life, but must be performed in a pain unit by medical staff trained in the technique, its indications, pharmacology, and the potential risks of both the implant and the drug. The treatment can be individualized and patients must be followed up periodically.

Bisphosphonate-related osteonecrosis. Application of adipose-derived stem cells in an experimental murine model.

BACKGROUND: Bisphosphonate-related osteonecrosis of the jaw is a pathological condition without effective established treatment and preventive strategies. The aim of this study was to analyse the effect of adipose-derived stem cells (ASC) in an experimental murine model of osteonecrosis. MATERIAL AND METHODS: 38 Wistar rats were injected intraperitoneally with zoledronic acid. After treatment, upper jaw molars were extracted. The animals were randomly assigned to one of two groups. In the control group, saline solution was applied over the alveolar sockets after the tooth extractions. In the treatment group, ASCs were applied instead of saline solution. The control and treatment groups were subdivided based on the time of euthanasia. A clinical and histological analysis was performed. RESULTS: The presence of osteonecrosis in alveolar bone was observed in a similar distribution in both groups. In the ASC-treated group, new bone formation was greater than in controls. CONCLUSION: In this study, application of ASCs showed greater new bone formation in an osteonecrosis-like murine model. Previous inhibited post-extraction bone remodelling could be reactivated, and these findings appeared to be secondary to implantation of ASCs.

Beckwith-Wiedemann Syndrome: Open bite evolution after tongue reduction.

BACKGROUND: Macroglossia causes functional deficits such as airway obstruction, drooling, phonation difficulties, and leads to protrusion of dentoalveolar structures resulting in an anterior open bite and a prognathic mandibular appearance. Macroglossia is present in the majority of patients with Beckwith-Wiedemann syndrome (BWS) and surgical treatment may be indicated. MATERIAL AND METHODS: A retrospective review was conducted including BWS patients who underwent surgical tongue reduction between 2000 and 2015 at the Hospital Universitario La Paz, Madrid. RESULTS: Out of 16 patients with BWS, surgery was performed in 11 cases. Tongue protrusion with open bite was the main indication for surgical treatment. Reduction glossectomy was performed using the keyhole technique. We analysed the relationship between age at surgery and evolution of open bite. Complications were minimal and satisfactory outcomes were observed with a decrease in anterior open bite. CONCLUSIONS: In this study we have observed that surgical treatment in patients with BWS and open bite accompanied by macroglossia seems to provide positive results with a satisfactory outcome in dentoskeletal alterations.

Comparación de la respuesta hemodinámica durante la inducción y la intubación con 2 modelos de infusión controlada por objetivo en el sitio de efecto para propofol: estudio prospectivo y aleatorizado / Comparison of the hemodynamic response to induction and intubation during a target-controlled infusion of propofol with 2 different pharmacokinetic models. A prospective ramdomized trial

Objetivo. Determinar qué modelo farmacocinético para propofol proporciona una mayor estabilidad hemodinámica durante la inducción anestésica. Material y métodos. Ensayo clínico prospectivo, aleatorizado, no ciego y por intención de tratar donde se incluyeron 280 pacientes ASA I-III, 18-80 años de edad y 45-100 kg de peso, programados para cirugía bajo anestesia general. Los pacientes se distribuyeron aleatoriamente en 2 grupos, dependiendo del modelo farmacodinámico para propofol empleado (Marsh Modificado o Schnider), para analizar el comportamiento hemodinámico durante la inducción y la intubación. Se administró una infusión controlada por objetivo de propofol para mantener un índice biespectral de 35-55. En el minuto 6 se realizó la intubación orotraqueal, finalizando el estudio a los 11 min del comienzo. Fueron recogidos cada minuto la frecuencia cardiaca, la tensión arterial media, las dosis, las concentraciones de propofol y la aparición de hipotensión. El producto de la frecuencia cardiaca y la tensión arterial media (FC × TAM) fue calculado cada minuto y analizado pormenorizadamente, determinando, entre otros, el valor mínimo antes de la intubación, el máximo tras ella, y la relación entre estos 2 valores (GRADIENTE [MÍN, MÁX], variable principal del estudio). Resultados. No hubo diferencias significativas en el comportamiento hemodinámico entre los grupos del estudio. GRADIENTE (MÍN, MÁX): 77,41 vs. 84,86% (p = 0,821); hipotensión: 17,3 vs. 12,8% (p = 0,292); Marsh Modificado y Schnider, respectivamente. Conclusión. No se han podido demostrar diferencias en el comportamiento hemodinámico, a pesar de que el grupo del Marsh Modificado recibió una dosis mayor de propofol (AU)

Objective. Determine the best propofol pharmacokinetic model that meets patient requirements and is devoid of major haemodynamic side effects. Material and methods. Prospective, randomised, open-label, clinical trial was performed on an intention to treat basis. It included 280 patients with ASA physical status i-iii, aged 18 to 80 years and weight range between 45 to 100 kg, scheduled for surgery under general anaesthesia. They were randomized into 2 groups according to the pharmacokinetic model: Modified Marsh group and Schnider group. The haemodynamic changes that occurred during the induction and intubation were analysed. A propofol target controlled infusion was started to achieve and maintain a bispectral index value between 35 and 55. At minute 6, orotracheal intubation was performed and the study finished at minute 11. Heart rate, mean arterial pressure and their product (HR × MAP) were measured and recorded every minute throughout the study. Every HR × MAP value was compared to its baseline value to determine the minimum value before intubation, the maximum value after intubation, the maximum variation after intubation, and its final value. The GRADIENTE (MIN, MAX) variable (primary endpoint of this study) analyses the difference between maximal and minimal values related to intubation. Propofol doses and calculated concentrations and any hypotensive events were also recorded. Results. No differences were found between groups regarding haemodynamic performance. GRADIENTE (MIN, MAX) values and the percentage of hypotensive events were: Modified Marsh group median 77.41% vs. Schnider group 84.86% (p= 0.821) and 17.3% vs. 12.8% (p = 0.292), respectively. Conclusion. The study failed to demonstrate any haemodynamic difference between the 2 groups, even though the Modified Marsh group received a larger dose of propofol (AU)

Polyetheretherketone custom-made implants for craniofacial defects: Report of 14 cases and review of the literature.

BACKGROUND: Craniofacial defects tend to carry functional and esthetic consequences for the patient. The complex shapes in this region make such reconstructions a challenging procedure and the most suitable material to be used remains controversial. METHODS: We report a series of 14 patients whose craniofacial defects were reconstructed using a computer designed PEEK-PSI (Polyetheretherketone- Patient Specific Implant). We analyzed the complications and outcomes of PEEK custom-made implants and compared our results with those of other case series reported in the current literature. RESULTS: Fourteen patients underwent craniofacial reconstruction using a PEEK-PSI. Three cases involved a one-step primary reconstruction and the rest of cases underwent a delayed reconstruction. Two cases (14.3 %) presented infection and only in one case was the implant definitively removed. Esthetic results were considered to be highly satisfactory. CONCLUSION: With CAD-CAM techniques, it is possible to prefabricate an individual implant. The ideal material for reconstructing maxillofacial defects does not exist, but PEEK has demonstrated good outcomes. When autologous bone is not available or, in selected cases with large or complex defects in the maxillofacial area, PEEK is one of the best options to reconstruct these defects. However, further studies are needed to determine the long-term results.

Comparison of the hemodynamic response to induction and intubation during a target-controlled infusion of propofol with 2 different pharmacokinetic models. A prospective ramdomized trial.

OBJECTIVE: Determine the best propofol pharmacokinetic model that meets patient requirements and is devoid of major haemodynamic side effects. MATERIAL AND METHODS: Prospective, randomised, open-label, clinical trial was performed on an intention to treat basis. It included 280 patients with ASA physical status i-iii, aged 18 to 80 years and weight range between 45 to 100kg, scheduled for surgery under general anaesthesia. They were randomized into 2 groups according to the pharmacokinetic model: Modified Marsh group and Schnider group. The haemodynamic changes that occurred during the induction and intubation were analysed. A propofol target controlled infusion was started to achieve and maintain a bispectral index value between 35 and 55. At minute 6, orotracheal intubation was performed and the study finished at minute 11. Heart rate, mean arterial pressure and their product (HR×MAP) were measured and recorded every minute throughout the study. Every HR×MAP value was compared to its baseline value to determine the minimum value before intubation, the maximum value after intubation, the maximum variation after intubation, and its final value. The GRADIENTE (MIN, MAX) variable (primary endpoint of this study) analyses the difference between maximal and minimal values related to intubation. Propofol doses and calculated concentrations and any hypotensive events were also recorded. RESULTS: No differences were found between groups regarding haemodynamic performance. GRADIENTE (MIN, MAX) values and the percentage of hypotensive events were: Modified Marsh group median 77.41% vs. Schnider group 84.86% (p= 0.821) and 17.3% vs. 12.8% (p = 0.292), respectively. CONCLUSION: The study failed to demonstrate any haemodynamic difference between the 2 groups, even though the Modified Marsh group received a larger dose of propofol.

Arsenic extraction in marine biological materials using pressurised liquid extraction.

A pressurised liquid extraction (PLE) procedure, by using methanol/water mixture, was developed for extracting arsenical species from marine biological material (mussel and fish) and standard reference materials (CRMs). A Plackett-Burman 2(8)x3/64 designs (PBD) was used as a multivariate strategy for the evaluation of the effects of several variables (MeOH/H(2)O solvent mixture, temperature, static time, extraction steps, pressure, mean particle size and diatomaceous earth (DE) mass/sample mass ratio) on the extracting procedure. Electrothermal atomic absorption spectrometry (ETAAS) was used to determine the total As concentration on the methanolic extracts. The accuracy of the optimised extraction procedure was verified by analysing several CRMs (GBW-08751, BCR-278R and DORM-2). The precision obtained (between 4.5 and 6.2%) was adequate. The extracted arsenic species (mainly arsenobetaine (AsB)) were analysed by high performance liquid chromatography coupled to ultraviolet cracking and hydride generation-atomic fluorescence spectrometry (HPLC-UV-HG-AFS). The analytical performances obtained were adequate for the arsenic speciation in marine biological samples; LOD between 10 and 35ng g(-1). The accuracy was verified for AsB using DORM-2. Finally, the proposed method (PLE followed by HPLC-UV-HG-AFS) was applied to mussel and fish samples.

Orden de nacimiento y apoyo parental: su papel en la orientación interpersonal de los adolescentes. Un estudio preliminar / A prelimanary study of the of birth order and parental investment in adolescent interpersonal orientation

El objetivo de este estudio es comprobar el papel que tanto el orden de nacimiento como la percepción del apoyo parental desempeñan en las variables interpersonales y la afectividad de un grupo de adolescentes. Se administró el DOI-J, el PANAS y una escala de percepción del apoyo parental (PAP) a 287 alumnos de enseñanza secundaria. Los resultados señalan que no existen diferencias significativas entre primogénitos y nacidos después ni en las distintas variables interpersonales ni en el tipo de afectos que experimentan. La percepción del apoyo parental, en cambio, contribuye a que los adolescentes sean más considerados con los demás, menos agresivos y a que experimenten afectos positivos. Los efectos de interacción entre las variables recalcan el papel socializador del apoyo parental sobre el desarrollo interpersonal de los nacidos después. Se discuten los resultados y se sugieren nuevas líneas de estudio

This papel addresses the role played by both birth order and perception of parental investment in adolescent interpersonal relationships and effectivity. A sample of 287 high-school students was administered the DOI-J, the PANAS, and a scale of parental investment. The results showed that firstborns did not differ significantly from laterborns on any of the interpersonal dimensions or affectivity. However, parental investment perception had significant effects in the sense that it favored that adolescents were more considerate with others effects emphasize the socializing role of the parental investment perception on laterborn interpersonal development. Results are discussed and new research trends are suggested

Coupled high performance liquid chromatography-microwave digestion-hydride generation-atomic absorption spectrometry for inorganic and organic arsenic speciation in fish tissue.

A high performance liquid chromatography-microwave digestion-hydride generation-atomic absorption spectrometry (HPLC-MW-HG-AAS) coupled method is described for As(III), As(V), monomethylarsonic acid (MMA), dimethylarsinic acid (DMA), arsenobetaine (AsB) and arsenocholine (AsC) determination. A Hamilton PRP-X100 anion-exchange column is used for carrying out the arsenic species separation. As mobile phase 17 mM phosphate buffer (pH 6.0) is used for As(III), As(V), MMA and DMA separation, and ultrapure water (pH 6.0) for AsB and AsC separation. Prior to injection into the HPLC system AsB and AsC are isolated from the other arsenic species using a Waters Accell Plus QMA cartridge. A microwave digestion with K(2)S(2)O(8) as oxidizing agent is used for enhancing the efficiency of conversion of AsB and AsC into arsenate. Detection limits achieved were between 0.3 and 1.1 ng for all species. The method was applied to arsenic speciation in fish samples.

¿Qué variables deberían tenerse en cuenta al asignarnos el presupuesto de farmacia?

Uno de los aspectos fundamentales de la autogestión de los equipos de atención primaria es el ajuste al presupuesto asignado en capítulo IV (prescripción de medicamentos a través de receta médica).Hasta la fecha, el único parámetro empleado para la asignación del presupuesto ha sido la población asignada a cada centro de salud. Sin embargo, empleando sólo esta variable se observan resultados muy dispares entre los centros.El objetivo del presente trabajo es identificar aquellas variables relacionadas con la calidad de la prescripción de medicamentos, la actividad asistencial realizada o la pirámide de población atendida que puedan tener incidencia en la desviación sobre el presupuesto asignado. Concretamente, se seleccionaron 5 equipos de atención primaria, con un total de 38 médicos y 59.319 habitantes, sobre los que se buscó la existencia de correlación entre el ajuste presupuestario y las siguientes variables: población de 65 a 74 años, población mayor de 75 años, presión arterial, envases de medicamentos de utilidad terapéutica baja (UTB) por cada 100 habitantes y prescripción de medicamentos de alta utilidad terapéutica.En el análisis se observó la existencia de relación entre ajuste presupuestario y tres de las variables estudiadas: población entre 65 y 74 años, envases de medicamentos UTB por cada 100 habitantes y porcentaje de medicamentos de alta utilidad, con las que se explica el 72 por ciento de la variabilidad de la desviación sobre el presupuesto, sin encontrar relación con las demás variables estudiadas (AU)