Luz pulsada intensa combinada con expresión de las glándulas de Meibomio para el tratamiento del chalación / Intense pulsed light combined with meibomian gland expression for chalazion management

Objetivo Investigar la eficacia y la seguridad del protocolo de luz pulsada intensa (IPL) combinando el protocolo de tratamiento con IPL para la disfunción de las glándulas de Meibomio/enfermedad de ojo seco con IPL aplicada directamente en los párpados, asociada a la expresión de las glándulas de Meibomio (GM) para el tratamiento del chalación. Material y métodos Estudio retrospectivo de serie de casos. Los pacientes que presentaron chalación, recibieron un tratamiento combinado de terapia con IPL que consistió en usar el protocolo habitual de IPL para disfunción de las glándulas de Meibomio/enfermedad de ojo seco empleando una fluencia de acuerdo al tipo de piel según Fitzpatrick, seguido de una segunda fase (en la misma sesión) de aplicación IPL directamente sobre los párpados de ambos ojos empleando una fluencia de 10J/cm2. A continuación, todos los pacientes recibieron expresión de las GM, higiene de los párpados, antibiótico tópico y medicación ocular antiinflamatoria tópica. Los efectos adversos relacionados con este protocolo se evaluaron en cada sesión de IPL. Resultados Se incluyeron 26 chalaciones de diecinueve pacientes (24 ojos) con una edad media de 49,89±20,43 años. Fueron necesarias 2,07±0,97 sesiones de IPL de media para la resolución del chalación. El tratamiento combinado de protocolo IPL y expresión de GM mostró un 96,15% de eficacia y no se observaron efectos adversos. Conclusiones El tratamiento combinado de IPL para disfunción de las glándulas de Meibomio/enfermedad de ojo seco con IPL aplicado directamente sobre los párpados y expresión de GM podría ser eficaz y seguro para el tratamiento de los chalaciones (AU)

Objective To investigate the efficacy and safety of an intense pulsed light (IPL) combined IPL treatment protocol for meibomian gland dysfunction (MGD)/dry eye disease (DED) with IPL applied directly to the eyelids, associated with meibomian gland (MG) expression for the treatment of chalazion. Material and Methods Retrospective case series study. Patients presenting with chalazion received a combined IPL therapy treatment consisting of using the usual IPL protocol for DGM/EOS using a fluence according to skin type according to Fitzpatrick, followed by a second phase (in the same session) of IPL application directly on the eyelids of both eyes using a fluence of 10 J/cm2. All patients then received GM expression, eyelid hygiene, topical antibiotic and topical ocular anti-inflammatory medication. Adverse effects related to this protocol were assessed at each IPL session. Results Twenty-six chalazions from nineteen patients (24 eyes) with a mean age of 49.89 ± 20.43 years were included. An average of 2.07 ± 0.97 IPL sessions were required for chalazion resolution. The combined treatment of IPL protocol and GM expression showed 96.15% efficacy and no adverse effects were observed. Conclusions Combined IPL treatment for DGM/EOS with IPL applied directly on the eyelids and GM expression could be effective and safe for the treatment of chalazions (AU)

Intense pulsed light combined with meibomian gland expression for chalazion management.

OBJECTIVE: To investigate the efficacy and safety of an intense pulsed light (IPL) combined IPL treatment protocol for meibomian gland dysfunction (MGD)/dry eye disease (DED) with IPL applied directly to the eyelids, associated with meibomian gland (MG) expression for the treatment of chalazion. MATERIAL AND METHODS: Retrospective case series study. Patients presenting with chalazion received a combined IPL therapy treatment consisting of using the usual IPL protocol for DGM/EOS using a fluence according to skin type according to Fitzpatrick, followed by a second phase (in the same session) of IPL application directly on the eyelids of both eyes using a fluence of 10J/cm2. All patients then received GM expression, eyelid hygiene, topical antibiotic and topical ocular anti-inflammatory medication. Adverse effects related to this protocol were assessed at each IPL session. RESULTS: Twenty-six chalazions from nineteen patients (24 eyes) with a mean age of 49.89±20.43 years were included. An average of 2.07±0.97 IPL sessions were required for chalazion resolution. The combined treatment of IPL protocol and GM expression showed 96.15% efficacy and no adverse effects were observed. CONCLUSIONS: Combined IPL treatment for MGD/DED with IPL applied directly onto the eyelids and MGX could be effective and safe for the management of chalazions.

Corneal Stroma Regeneration: New Approach for the Treatment of Cornea Disease.

Corneal grafting is one of the most common forms of human tissue transplantation. The corneal stroma is responsible for many characteristics of the cornea. For these reasons, an important volume of research has been made to replicate the corneal stroma in the laboratory to find an alternative to classical corneal transplantation techniques.There is an increasing interest today in cell therapy of the corneal stroma using induced pluripotent stem cells or mesenchymal stem cells since these cells have shown to be capable of producing new collagen within the host stroma and even to improve its transparency.The first clinical experiment on corneal stroma regeneration in advanced keratoconus cases has been reported and included. Fourteen patients were randomized and enrolled into 3 experimental groups: (1) patients underwent implantation of autologous adipose-derived adult stem cells alone, (2) patients received decellularized donor corneal stroma laminas, and (3) patients received implantation of recellularized donor laminas with adipose-derived adult stem cells. Clinical improvement was detected with all cases in their visual, pachymetric, and topographic parameters of the operated corneas.Other recent studies have used allogenic SMILE implantation lenticule corneal inlays, showing also an improvement in different visual, topographic, and keratometric parameters.In the present report, we try to summarize the available preclinical and clinical evidence about the emerging topic of corneal stroma regeneration.

Space-time pattern of hepatitis A in Spain, 1997-2007.

In Spain hepatitis A is a compulsory notifiable disease and individual cases are reported to the national epidemiological surveillance network. Incidence rates show variations in different regions. The aim of this study was to analyse the space-time pattern of hepatitis A risk at municipal level in Spain and at global and local levels during the period 1997-2007. At global level we used two estimates of risk: the standardized incidence ratio (SIR) and the posterior probability that the smoothed relative risk is >1 (PP). At local level we used the scan statistic method to analyse the space-time clusters. The SIR and significant PP (>0·8) showed the highest risk concentrated in areas of the Mediterranean coast. The most likely cluster gave a relative risk of 53·530. These spatial statistics methodologies can be complementary tools in the epidemiological surveillance of infectious diseases.

Prevalence and European comparison of dementia in a ≥75-year-old composite population in Spain.

OBJECTIVES: To estimate dementia prevalence in Spain. MATERIALS AND METHODS: Nine probabilistic and geographically defined samples participated. A screening design based on the MMSE was implemented. Positively screened individuals underwent clinical evaluation. The total number of cases in Spain was estimated. Prevalence was confronted to that of other European countries. RESULTS: Five hundred and forty-six persons aged ≥75 participated, 49 had dementia (35 with Alzheimer's disease [AD], 10 with vascular dementia [VD], 4 other; 25 first diagnosed in the study). Age- and sex-adjusted prevalence and estimated nationwide cases were 7.5% (95% CI 5.4-9.7), 5.6 (95% CI 3.7-7.5) and 1.4 (95% CI 0.5-2.3), and 290,000 (95% CI 208,000-372,000), 214,000 (95% CI 141,000-288,000) and 54,000 (95% CI 20,000-88,000) for dementia, AD and VD, respectively. CONCLUSIONS: Dementia prevalence in Spain is comparable to other European populations, while a high number of undiagnosed cases live in the community. The potential impact of Mediterranean diet, hypertension control and decreasing vascular risk factors is discussed.

Prevalence of dementia subtypes in El Prat de Llobregat, Catalonia, Spain: the PRATICON study.

BACKGROUND: Studies on dementia subtypes show a wide variation in the prevalence of Alzheimer's disease (AD) and vascular dementia (VD) worldwide. However, studies reporting on Lewy body dementia (LBD) and frontotemporal dementia (FTD) are sparse. AIMS: To describe the prevalence of dementia and subtypes. METHOD: A 34% sample of 5,150 subjects aged 70 years and over in El Prat de Llobregat (Barcelona) were screened by the Mini-Mental State Examination. When scoring <24, participants were assessed to establish a diagnosis. RESULTS: There were 165 subjects diagnosed with dementia (prevalence of 9.4%). Subtypes of dementia were: AD 69.1%, VD 12.7%, LBD 9.1%, FTD 3% and secondary dementia 1.8%. Prevalences were: AD 6.5%, VD 1.2%, LBD 0.9% and FTD 0.3%. CONCLUSIONS: AD and VD were the most common type of dementia. Prevalence of dementia, AD and FTD were similar to those reported, while prevalence of VD and LBD were lower.

[Prevalence of vascular risk factors among Spanish populations aged 70 years and over, as reported in door-to-door studies on neurological diseases]. / Prevalencia de factores de riesgo vascular en poblaciones españolas de 70 años y más en estudios puerta a puerta de enfermedades neurológicas.

INTRODUCTION: The aim of this study was to re-analyze door-to-door studies on neurological diseases among the elderly, in which vascular risk factors (VRF) were studied, describing methodological characteristics and prevalence of VRF. METHODS: The surveys were identified in two phases. They were aimed at ascertaining prevalence of stroke, dementias or Parkinsonisms and, at the time of individual screening, had collected data on at least three of the following VRF: arterial hypertension (AHT), smoking habit, diabetes mellitus and hypercholesterolemia. A questionnaire was drawn up to collect the data reported in each study, and a database was constructed. VRF prevalences were quantified and analyzed using logistic regression. RESULTS: The total of the re-analyzed population was 12,510 persons aged 70 years and over, residents in seven geographic areas during the period 1994-2002. Information available on VRF was essentially self-reported. The prevalence of self-reported AHT was 25.7 % in men and 44.2 % in women, and that of measured AHT was 61 % and 71.9 %, respectively. Populations with arterial pressure obtained by direct measurement registered 138 higher risks (OR: 1.74; 95 % CI: 1.51-2.01, and OR: 1.48; 95% CI: 1.33-1.64). Reported prevalence of diabetes, hypercholesterolemia and smoking habit were 14.3 %, 23.3% and 8.5 %, respectively. CONCLUSIONS: There was a high prevalence of VRF among the Spanish elderly population. However, its relationship with dementia, Parkinsonisms and cerebrovascular disease could not be studied due to the poor quality of the VRF data. The differences between measured and self-reported arterial pressure suggest the existence of undetected AHT and wide scope for prevention.

Food sources of nutrients in the diet of Spanish children: the Four Provinces Study.

The aim of the present study was to assess the principal food sources of energy and nutrients among Spanish children. We used a cross-sectional study design, based on results obtained from a food-frequency questionnaire. The sample included 1112 children, aged 6-7 years, from Cadiz, Madrid, Orense and Murcia, Spain. Children were selected through random cluster-sampling in schools. We analysed the percentage contributed by each food item to total energy and nutrient intake. The most important food sources were: white bread in the case of carbohydrate (13.4 %); olive oil in the case of total lipids (18.3 %) and monounsaturated fatty acids (29.2 %); whole milk in the case of protein (10.2 %) and saturated fatty acids (14.9 %); chips (French fried potatoes) in the case of polyunsaturated fatty acids (30.4 %). The greatest proportion of Na, consumed in excess, came from salt added to meals. Ham ranked second as a source of saturated fats. Fruits and green leafy vegetables proved to have great relevance as sources of fibre and vitamins, though with regard to the latter, it was observed that fortified foods (breakfast cereals, dairy products, fruit juices, etc.) had come to play a relevant role in many cases. In conclusion, the nutritional profile of Spanish school-aged children aged 6-7 years could be improved by nutritional policies targeted at limiting their consumption of ham (cured or cooked) and of salt added to meals, replacing whole milk with semi-skimmed milk, encouraging the consumption of products rich in complex carbohydrates already present in children's diets (bread, pasta, rice) and promoting less fatty ways of cooking food.

Dietary patterns among children aged 6-7 y in four Spanish cities with widely differing cardiovascular mortality.

OBJECTIVE: Classic cardiovascular risk factors, such as smoking, arterial hypertension and hypercholesterolaemia, cannot explain a substantial part of the geographic differences in cardiovascular mortality. Anthropometric and nutritional factors in early stages of life may contribute to adult cardiovascular disease. Therefore, this work examines certain anthropometric variables and diet among children aged 6-7 y, living in four Spanish cities with widely differing ischaemic heart disease (IHD) mortality. DESIGN AND SETTING: Cross-sectional anthropometric and dietary survey in four cities in Spain. SUBJECTS: A total of 1112 children (50.1% males, 49.9% females) attending public and private schools in Cadiz and Murcia, cities with a relatively high IHD mortality, and Madrid and Orense, cities with a relatively low IHD mortality. A standardized method was used to measure anthropometric variables, and a food-frequency questionnaire completed by subjects' mothers, to measure diet. OUTCOME MEASURES: Body mass index (BMI), overweight (BMI>17.6 kg/m(2)), obesity (BMI>20.1 kg/m(2)) and intake of food and nutrients. RESULTS: Children in the four cities showed a high prevalence of overweight (range across cities, 28.9-34.5%) and obesity (8.5-15.7%). They also had a moderately hypercaloric diet (range, 2078-2218 kcal/day), marked by an excessive intake of lipids (45.0-47.3% kcal), particularly saturated fats (16.6-16.9% kcal), proteins (17.0-17.3% kcal), sugars (20.0-21.9% kcal) and cholesterol (161.6-182.9 mg/1000 kcal/day), and a low intake of complex carbohydrates (17.5-18.1% kcal) and fibre (19.6-19.9 g/day). Compared with children in the two low-IHD-mortality cities, those in the two high-IHD-mortality cities had a greater BMI (mean difference, 0.61 kg/m(2); P=0.0001) and ponderal index (0.58 kg/m(3); P=0.0001) and a higher intake of energy (104 kcal/day; P=0.007), cholesterol (16.00 mg/1000 kcal/day; P=0.0001) and sodium (321 mg/day; P=0.0001). Inter-city differences in anthropometric variables remained after adjustment for birthweight. CONCLUSIONS: Intake of fats, especially saturated fats, and cholesterol should be reduced among Spanish children. It could contribute to a needed reduction of the high prevalence of overweight and obesity in children. If the differences in anthropometric variables and diet between children from the cities with high and low coronary mortality are maintained in future or continue into adulthood, this could contribute to consolidate or even increase the IHD mortality gradient across cities. The finding that differences in anthropometric variables are independent of birthweight suggests that the childhood, rather than intrauterine environment, is involved in the development of such differences. SPONSORSHIP: This study was partly funded by grants from the International Olive Oil Board (Consejo Oleícola Internacional), Comunidad Autónoma de Madrid, Fundación Pedro Barrié de la Maza, and Fundación Eugenio Rodríguez Pascual.

[Varicella pneumonia in the adult. Study of 9 cases]. / Neumonía varicelosa en el adulto. Estudio de nueve casos.

BACKGROUND: In the adult, the primary infection by the varicella-zoster virus acquires an unusual severity due to several complications, the most frequent of them being pneumonia. We study the main characteristics of nine patients diagnosed of pneumonia varicellosa. METHODS: Clinical, therapeutic and evolutive features of 9 adult patients, both immunocompetents and immunodepressed, diagnosed of pneumonia varicellosa are retrospectively reviewed, in the last ten years, at Hospital de Sant Pau, Barcelona. Diagnosis of varicella was established on the basis of the typical rash in the context of a feverish illness. The antecedents of smoking habit, pregnancy and underlying disease, evaluating especially arterial blood and platelet count at entrance, are assessed. RESULTS: Nine patients (4 males and 5 women; mean age 38 years) were included in the study. Seventy-eight percent of patients were smokers of more than 20 cigarettes a day; one met criteria of simple chronic bronchitis, another suffered ankylosing spondylitis and three were known carriers of human immunodeficiency virus. None of the female patients was pregnant. Respiratory symptoms began from the third and fifth day after the skin rash, and the most common symptoms were cough (89%), dyspnea (67%) and hemoptysis (22%). Arterial blood gas determination showed hypoxemia in four patients (45%). Chest X-ray revealed an interstitial pattern predominantly at both bases, with a case of right pleural effusion. Intravenous acyclovir was started in 6 patients, foscarnet in one and symptomatic therapy in two patients. All patients had a favourable clinical course, none of them requiring entrance to the Intensive Care Unit. CONCLUSIONS: Adult patients with varicella pneumonia that suffer respiratory insufficiency, thrombocytopenia or are carriers of base illnesses must be early treated with intravenous acyclovir. However, despite clinical, biological and radiological recovery is earlier with such treatment, the evolution seems equally favourable if it is only conducted, for instance, symptomatic therapy with antithermic and antihistaminic compounds.

Leiomiomatosis cutaneouterina familiar / Familial cutaneous-uterine leiomyomatosis

Presentamos el caso de una familia afectada por leiomiomatosis cutaneouterina familiar o síndrome de Reed. Este proceso asocia leiomiomas múltiples familiares cutáneos y/o uterinos. Es importante su conocimiento tanto por parte del dermatólogo como del ginecólogo. Su diagnóstico obliga a realizar un examen dermatológico a los miembros de la familia afectada, así como controles ginecológicos periódicos a las mujeres de la misma (AU)

Amoxicillin-clavulanic acid versus cefotaxime in the therapy of bacterial infections in cirrhotic patients.

BACKGROUND/AIM: Cefotaxime is considered the first-choice antibiotic for empirical treatment in cirrhotic patients developing bacterial infections. It has been suggested that amoxicillin-clavulanic acid could be an alternative to cefotaxime, particularly in patients developing bacterial infections while on prophylactic norfloxacin. The aim of the present study was to compare amoxicillin-clavulanic acid with cefotaxime in the treatment of bacterial infections in cirrhosis. METHODS: Ninety-six hospitalized cirrhotic patients with suspicion of bacterial infection were prospectively included and randomized into two groups: one group (n=48) received amoxicillin-clavulanic acid, first intravenously 1 g-0.2 g every 8 h, and then orally 500 mg-125 mg every 8 h, and the other group (n=48) received intravenous cefotaxime 1 g every 6 h. Patients were stratified for previous prophylaxis with norfloxacin and ascitic fluid infection. RESULTS: Sixteen patients were excluded from the analysis because bacterial infection was not demonstrated or because of secondary peritonitis. Therefore, 38 patients from the amoxicillin-clavulanic acid group and 42 from the cefotaxime group were finally analyzed. There were 24 ascitic fluid infections in each group. Infection resolution (86.8% vs 88%, 95% CI: -0.15 to 0.13, p NS), spontaneous bacterial peritonitis resolution (87.5% vs 83.3%, 95% CI: -0.15 to 0.24, p NS), duration of treatment, incidence of complications, time of hospitalization and hospital mortality were similar in both groups. Considering patients on prophylactic norfloxacin, infection resolution was also similar (100% vs 83.3%, 95% CI: -0.04 to 0.37, p NS). No adverse events were observed in either of the two groups. The cost of antibiotics was statistically lower in the amoxicillin-clavulanic acid group (p<0.001). CONCLUSIONS: Amoxicillin-clavulanic acid is as effective as cefotaxime in the treatment of bacterial infections in cirrhotic patients, but is less expensive and can be administered orally. These results suggest that amoxicillin-clavulanic acid is an effective alternative to cefotaxime for the empirical treatment of bacterial infections in cirrhosis.

Prospective study of new-onset seizures in patients with human immunodeficiency virus infection: etiologic and clinical aspects.

OBJECTIVE: To determine the frequency and etiologic and clinical aspects of new-onset seizures in patients with human immunodeficiency virus (HIV) infection. DESIGN: A prospective survey of an HIV-infected patient cohort. SETTING: Outpatients and inpatients in a university hospital in Barcelona, Spain. PATIENTS: Five hundred fifty HIV-infected patients recruited over 1 year. MAIN OUTCOME MEASURE: Analysis of new-onset seizures, with detailed medical history and appropriate workup. RESULTS: Seventeen HIV-infected patients (3%) had a new-onset seizure during the study period. Fourteen (82%) of 17 patients had acquired immunodeficiency syndrome diagnosed according to the 1993 CDC Expanded AIDS Definition. Mean latency (+/-SD) between diagnosis of HIV infection and the first seizure was 60.7+/-37.6 months. Seizure cause was drug toxicity in 8 patients (47%) and intracranial lesion in 6 patients (35.3%). Two patients had seizures related to metabolic derangements. No cause was found in 1 case. The first seizure was generalized in 12 patients (70.6%), simple partial motor seizure in 2 (11.8%), and simple partial seizure evolving to generalized seizure in 3 (17.6%). We found partial seizures in 66.6% of patients who had intracranial lesions. Most patients were treated with phenytoin, which was well tolerated and effective in controlling seizures. CONCLUSIONS: New-onset seizures are infrequent in patients with HIV. In most cases a definite or probable cause is identified, which is usually related to toxic and/or metabolic factors. Most seizures are generalized, and partial seizures suggest a focal cerebral lesion.

Prevalence of hepatitis A in an institution for the mentally retarded in an intermediate endemicity area: influence of age length of institutionalization.

OBJECTIVE: This study aimed to examine the prevalence of antibodies against hepatitis A (anti-HAV) in a population of institutionalized mentally retarded persons compared with that of institutionalized non-mentally retarded persons in an area with moderate endemicity of HAV infection. METHODS: The study population was a group of mentally retarded persons aged between 10 and 30 years, institutionalized in one residence in Madrid, Spain. A group of non-mentally retarded subjects in the same age range was chosen as controls. Information about demography and duration of institutionalization was obtained by the investigator. Four drops of whole blood were obtained from each person by finger-stick, collected on filter paper, air-dried and stored at +4 degrees C until antibody determination. Eluates were tested by an ELISA method. RESULTS: A total of 314 institutionalized subjects were included: 157 mentally retarded (mean age and mean duration of institutionalization were 24.4+/-3 and 9.7+/-5 years respectively) and 157 non-mentally retarded (mean age and mean duration of institutionalization were 19.2+/-5 and 4.6+/-3 years respectively). The prevalence of anti-HAV antibody was 54% (95% confidence interval (CI) 50-58) in mentally retarded and 22% (95% CI 19-25) in non-mentally retarded [P<0.001; odds ratio (OR): 4.2 (95% CI 2.5-7)]. In both groups, these differences were not statistically significant for anti-HAV antibody prevalence between persons institutionalized for >5 years compared with those institutionalized for < or = 5 years. CONCLUSIONS: There results indicate that in an area of moderate endemicity the institutionalized mentally retarded are at increased risk of having acquired hepatitis A infection compared to the non-mentally retarded. In these institutionalized persons, regardless whether they are mentally retarded or not, prevalence is not influenced by age or length of stay in institutions.