[Clinical profile and non-recreational methamphetamine abuse (shabu) among stroke patients in the Philippine population]. / Perfil clínico y abuso de metanfetamina no recreativa (shabú) entre los pacientes con ictus en la población filipina.

INTRODUCTION: Chronic non-recreational use of methamphetamine (shabu) is increasing among the Filipino population in Barcelona. The Asian population presents a different stroke pattern, with a higher incidence of haemorrhage, and different vascular risk factors and health behaviours. The objective of this study is to describe the stroke profile and incidence of methamphetamine use in patients of Filipino origin admitted to our centre. PATIENTS AND METHODS: Demographic data, vascular risk factors, clinical data and prognosis were recorded. Methamphetamine exposure was analysed in plasma samples collected on admission, which were then analysed by liquid chromatography-mass spectrometry. RESULTS: Of a total of 6,418 stroke patients, 73 (1.1%) were identified as being of Filipino origin. The mean age was 54.4 ± 12.1 years, 54% were male and the stroke was ischaemic in 64.4% of cases. Arterial hypertension was the main risk factor. Ten (13.7%) patients tested positive for methamphetamine and amphetamine. These results confirm recent substance use prior to the stroke, mostly in men (80%). In patients who were consumers, 60% had a haemorrhagic stroke, with a poor functional prognosis at three months in 55.6% of patients. CONCLUSIONS: In our setting, patients of Filipino ethnicity admitted for stroke related to the consumption of shabu belonged a younger age bracket, with a lower prevalence of vascular risk factors and a predominance of the haemorrhagic subtype. Methamphetamine testing in Filipino stroke patients is recommended due to the high prevalence of methamphetamine use in our country.

TITLE: Perfil clínico y abuso de metanfetamina no recreativa (shabú) entre los pacientes con ictus en la población filipina.Introducción. En la población filipina de Barcelona está aumentando el consumo crónico no recreativo de metanfetaminas (shabú). La población asiática presenta un patrón de ictus diferente, con mayor incidencia de hemorragias, y diferentes factores de riesgo vascular y conductas de salud. El objetivo es describir el perfil de ictus e incidencia de consumo de metanfetaminas en pacientes de origen filipino ingresados en nuestro centro. Pacientes y métodos. Se registraron datos demográficos, factores de riesgo vascular, datos clínicos y pronóstico. Se analizó la exposición a metanfetamina en muestras de plasma recogidas en el ingreso, que se analizaron por cromatografía líquida-espectrometría de masas. Resultados. Del total de 6.418 pacientes con ictus, se identificó a 73 pacientes filipinos (1,1%). La edad media era de 54,4 ± 12,1 años, el 54% eran hombres y el ictus era isquémico en el 64,4%. La hipertensión arterial fue el principal factor de riesgo. Diez (13,7%) pacientes dieron positivo a metanfetamina y anfetamina. Estos resultados confirman un consumo reciente de sustancias previo al ictus, principalmente en hombres (80%). En pacientes consumidores, un 60% presentaba un ictus hemorrágico, con mal pronóstico funcional a tres meses en el 55,6% de los pacientes. Conclusiones. En nuestro medio, los pacientes de etnia filipina ingresados por ictus en relación con consumo de shabú presentaron un perfil de edad más joven, con menor prevalencia de factores de riesgo vascular y predominio del subtipo hemorrágico. Se recomienda la determinación de metanfetamina en los pacientes filipinos con ictus debido a la alta prevalencia del consumo de metanfetamina en nuestro país.

Perfil clínico y abuso de metanfetamina no recreativa (shabú) entre los pacientes con ictus en la población filipina / Clinical profile and non-recreational methamphetamine abuse (shabu) among stroke patients in the Philippine population

Introducción En la población filipina de Barcelona está aumentando el consumo crónico no recreativo de metanfetaminas (shabú). La población asiática presenta un patrón de ictus diferente, con mayor incidencia de hemorragias, y diferentes factores de riesgo vascular y conductas de salud. El objetivo es describir el perfil de ictus e incidencia de consumo de metanfetaminas en pacientes de origen filipino ingresados en nuestro centro. Pacientes y métodos Se registraron datos demográficos, factores de riesgo vascular, datos clínicos y pronóstico. Se analizó la exposición a metanfetamina en muestras de plasma recogidas en el ingreso, que se analizaron por cromatografía líquida-espectrometría de masas. Resultados Del total de 6.418 pacientes con ictus, se identificó a 73 pacientes filipinos (1,1%). La edad media era de 54,4 ± 12,1 años, el 54% eran hombres y el ictus era isquémico en el 64,4%. La hipertensión arterial fue el principal factor de riesgo. Diez (13,7%) pacientes dieron positivo a metanfetamina y anfetamina. Estos resultados confirman un consumo reciente de sustancias previo al ictus, principalmente en hombres (80%). En pacientes consumidores, un 60% presentaba un ictus hemorrágico, con mal pronóstico funcional a tres meses en el 55,6% de los pacientes. Conclusiones En nuestro medio, los pacientes de etnia filipina ingresados por ictus en relación con consumo de shabú presentaron un perfil de edad más joven, con menor prevalencia de factores de riesgo vascular y predominio del subtipo hemorrágico. Se recomienda la determinación de metanfetamina en los pacientes filipinos con ictus debido a la alta prevalencia del consumo de metanfetamina en nuestro país. (AU)

INTRODUCTION Chronic non-recreational use of methamphetamine (shabú) is increasing among the Filipino population in Barcelona. The Asian population presents a different stroke pattern, with a higher incidence of haemorrhage, and different vascular risk factors and health behaviours. The objective of this study is to describe the stroke profile and incidence of methamphetamine use in patients of Filipino origin admitted to our centre. PATIENTS AND METHODS Demographic data, vascular risk factors, clinical data and prognosis were recorded. Methamphetamine exposure was analysed in plasma samples collected on admission, which were then analysed by liquid chromatography-mass spectrometry. RESULTS Of a total of 6,418 stroke patients, 73 (1.1%) were identified as being of Filipino origin. The mean age was 54.4 ± 12.1 years, 54% were male and the stroke was ischaemic in 64.4% of cases. Arterial hypertension was the main risk factor. Ten (13.7%) patients tested positive for methamphetamine and amphetamine. These results confirm recent substance use prior to the stroke, mostly in men (80%). In patients who were consumers, 60% had a haemorrhagic stroke, with a poor functional prognosis at three months in 55.6% of patients. CONCLUSIONS In our setting, patients of Filipino ethnicity admitted for stroke related to the consumption of shabú belonged a younger age bracket, with a lower prevalence of vascular risk factors and a predominance of the haemorrhagic subtype. Methamphetamine testing in Filipino stroke patients is recommended due to the high prevalence of methamphetamine use in our country. (AU)

Clinical outcomes after tricuspid surgery : The role of previous cardiac surgery.

BACKGROUND: The aim of our study was to assess the outcomes of surgical treatment for severe tricuspid regurgitation according to whether cardiac surgery had been performed before the tricuspid valve intervention. METHODS: Between 1996 and 2013, 201 consecutive patients with severe tricuspid regurgitation underwent tricuspid surgery at our center. Patients were classified according to whether or not they had undergone previous cardiac surgery, which 33% of the sample had. Perioperative as well as long-term morbidity and mortality were analyzed. RESULTS: Mean patient age was 62.3 years. 32.8% underwent suture annuloplasty, 41.3% underwent ring annuloplasty, 15.4% received a bioprosthesis, and 10.4% received a mechanical prosthesis. There were no significant differences in perioperative mortality between the group that had not undergone previous cardiac surgery and the group that had (12.7% vs. 17.9%, respectively; p = 0.32). The long-term mortality rate (median follow-up time: 53 months) was 43.3%. Long-term survival curves showed no significant differences between the two groups (p = 0.884), and previous cardiac surgery was not a predictive factor for long-term mortality (hazard ratio = 1.211; p = 0.521). CONCLUSION: In a series of patients who underwent tricuspid valve surgery, no significant differences were observed in perioperative mortality or in long-term survival according to whether or not subjects had undergone previous cardiac surgery.

[Not Available]. / Encefalopatia por contraste tras cateterismo cardiaco.

TITLE: Encefalopatia por contraste tras cateterismo cardiaco.

Update on adjuvant hormonal treatment of early breast cancer.

Clinical trials conducted over the last two decades have demonstrated that 5 years of treatment with tamoxifen (TAM) after local treatment in postmenopausal patients with positive hormone receptor early breast cancer improves disease-free survival and overall survival. More recently, aromatase inhibitors (AI) have been tested in several randomized clinical trials in this setting. The studies have tested either AI versus TAM or different sequential approaches combining the two agents. While the most effective strategy remains to be determined, overall, incorporation of AI resulted in better disease-free survival, particularly in the worst-prognosis subgroup of patients. In addition, long-term treatment with AI was, in general, well tolerated. However, mature results are needed in order to be able to assess the effect in overall survival. The authors of this supplement paper include the key points of roundtable presentations and discussions of hormonal therapy in breast cancer by topic.

Eficacia de la terapia de grupo en pacientes alcohólicos tras dos años de seguimiento / No disponible

Introducción: Actualmente, la terapia de grupo (TG)está considerada como una herramienta primordial para eltratamiento del alcoholismo. La identificación que hace elalcohólico con los otros integrantes del grupo, que padecenproblemas semejantes, le refuerza de forma positivatanto en lo emocional como en lo cognitivo. El propósitode la TG es la abstinencia de alcohol, y sólo será posiblesu consecución si el enfermo logra adquirir conciencia deenfermedad, más fácil de asumir ante la presencia de otraspersonas que se reconocen alcohólicos.Metodología: Se seleccionaron los 200 primerospacientes incluidos en el Programa de Alcoholismo de unServicio de Salud Mental, con el diagnóstico de dependenciade alcohol según la clasificación diagnóstica DSMIV-TR y con la tipología de alcoholómano o gamma,acorde a la clasificación de tipos de alcoholismo de Alonso-Fernández o Jellinek respectivamente. De estos, el60% acudía a TG y el 40% no. Durante 2 años se hizo unseguimiento de cada uno de estos pacientes, registrando sise encontraba en abstinencia, recaída o abandono.Resultados y conclusiones: No se han encontradodiferencias significativas en las características sociodemográficas,salvo en la edad, en las dos poblaciones dela muestra, los que acudían a TG y los que no. Lospacientes alcohólicos que asistían a TG obtienen tasasde abstinencia a lo largo de los 24 meses de seguimientosignificativamente superiores a los que no iban. A los2 años, el 52% de los pacientes que realizaban TG estabanen abstinencia frente al 19 de los que no. Por otrolado, los que acudían a la TG tienen, de forma estadísticamentesignificativa, tasas de abandono menores, encualquiera de los períodos del seguimiento en los 24meses. Al cabo de los 2 años abandonan un 35% de losque asistían a TG frente al 78% de los que no. La adherenciaal tratamiento de los que van a TG es del 64%(AU)

Introduction: Nowadays, group therapy (GT) is consideredan essential tool in alcoholism treatment. Theidentification of the alcoholic patient with the rest ofparticipants of the group, who suffer from similar problems,reinforce him positively in both emotional andcognitive. The purpose of group therapy is alcoholabstinence what will be only possible by become awareof alcoholism, easier to assume in front of others whorecognized themselves as alcoholic.Methods: There were selected the first 200 patientsenrolled in the alcoholism program of a Mental HealthService who met criteria for “Ethylic Dependence Syndrome”following DSM-IV-TR criteria and also consideredalcoholómano or gamma type following AlonsoFernández’s or Jellinek types of alcoholism: 60%shown up to group therapy. We made a two-year followup, recording whether they were in abstinence, relapseor if they had abandoned.Results and conclusions: There were not statisticaldifferences in sociodemographic characteristics, exceptage, between both groups therapy-group attendants andnon-therapy-group patients. After 24 months of followup, alcoholic patients who attended GT obtained ratesof abstinence significatively superior to those who donot attended. 52% of patients in group therapy were inabstinence comparing with 19% of those who were not.Abandone rates were signiticatively less in patients inGT, in both periods of the 24 moths of follow up, 78%patients in non-GT abandoned treatment in comparisonwith 35% of patients in GT, 64% of treatment adherencein GT patients(AU)

Megestrol acetate-induced adrenal insufficiency

Megestrol acetate is a synthetic progestin that has been used since the 1970s for the treatment of advanced cancer and subsequently to treat anorexia, cachexia and weight loss in AIDS patients. It has been shown that high doses or prolonged treatment with this drug may cause Cushing's syndrome, new-onset diabetes and suppression of plasma ACTH and cortisol levels. Megestrol acetate may cause suppression of the pituitary-adrenal axis due to the affinity of this compound for the glucocorticoid receptor. Recognising the glucocorticoid-like activity of megestrol and its effects at the axis level is important for the diagnosis of sub-clinical adrenal insufficiency. We present the case of a 74-year-old woman with infiltrating ductal breast carcinoma refractory to prolonged hormonal treatment with megestrol acetate, presenting with adrenal insufficiency (AU)

No disponible

Renal primary angiosarcoma.

Angiosarcomas account for 2% of all soft tissue sarcomas and of them, primary renal angiosarcomas represent 1%. Twenty-four cases have been published in the English specialised literature. We report the second case to be described in a middle-aged female, with pulmonary metastases at diagnosis, and fatal outcome despite surgery and chemotherapy.

Renal primary angiosarcoma

Angiosarcomas account for 2% of all soft tissue sarcomas and of them, primary renal angiosarcomas represent 1%. Twenty-four cases have been published in the English specialised literature. We report the second case to be described in a middle-aged female, with pulmonary metastases at diagnosis, and fatal outcome despite surgery and chemotherapy (AU)

Disseminated classic Kaposi's sarcoma.

Kaposi's sarcoma (KS) is characterised by proliferation of vascular endothelial and lymphoreticular cells, frequently with a multicentric expression developed from a single node and evolving to multiple cutaneous lumps or plaque-like appearance. Four types of KS with similar histological patterns have been described in terms of their clinical and epidemiological features: classic KS, endemic (African) KS, iatrogenic KS and epidemic (AIDS-related) KS. The differences in clinical features are quite relevant: classic KS is usually limited to the lower extremities; whereas immunodeficiency-related diseases frequently involve several organs. A case of a 67-year-old woman with metastatic KS and unproven immunodeficiency is presented.

Disseminated classic Kaposi's sarcoma

Kaposi's sarcoma (KS) is characterised by proliferation of vascular endothelial and lymphoreticular cells, frequently with a multicentric expression developed from a single node and evolving to multiple cutaneous lumps or plaque-like appearance. Four types of KS with similar histological patterns have been described in terms of their clinical and epidemiological features: classic KS, endemic (African) KS, iatrogenic KS and epidemic (AIDS-related) KS. The differences in clinical features are quite relevant: classic KS is usually limited to the lower extremities; whereas immunodeficiency-related diseases frequently involve several organs. A case of a 67-year-old woman with metastatic KS and unproven immunodeficiency is presented (AU)

Gliomatosis Cerebri: diagnóstico y tratamiento con temozolomida, a propósito de un caso / No disponible

La gliomatosis cerebri (GC) constituye un raroproceso neoplásico cerebral primario de crecimientodifuso, infiltrativo y no destructivo, de naturalezaglial. El término GC implica afectación de al menosdos lóbulos cerebrales con posible extensión al tallocerebral, cerebelo, médula espinal y espacio subaracnoideo.Las manifestaciones clínicas son inespecíficasy, aunque las pruebas de neuroimagen (fundamentalmentela RMN) muestran alteraciones características,el diagnóstico definitivo requiere confirmaciónhistológica. El tratamiento con radioterapiapuede estabilizar o mejorar la función neurológicaen algunos pacientes sin implicaciones en lasupervivencia global. Recientemente han surgidonuevas alternativas terapéuticas esperanzadoras, comoel empleo de quimioterapia con temozolomida.Presentamos el caso de un varón de 49 años diagnosticadode gliomatosis cerebri y tratado con temozolomidaen monoterapia

Gliomatosis cerebri (GC) is a rare difuse,infiltrative and non destructive primary brain tumorfrom glial origin The term GC implies the affectionof two or more brain lobes with possible extensionto brain stem, cerebellum, spinal cord andsubarachnoid space.Clinical features are unspecific, so diagnosiscomes from characteristic features in neuroimaginstudies (fundamentally IRM) but histologicalconfirmation is required for diagnosis. Radiotherapytreatment can improve or stabilizeneurological function in some patients, its impacton survival has not been demonstrated. Encouragingalternative treatment, as chemotherapy treatmentwith temozolomide, has recently arisen.We present a case of GC in a 49 years old maletreated with temozolomide as a single therapy

Uncinaria stenocephala: antigenic characterization of larvae and adults worms using sera from naturally infected dogs.

An antigenic characterization of the larval (somatic) and adult (somatic and excretory-secretory) antigens of Uncinaria stenocephala was made, employing immunoblotting and immunoblotting-inhibition with 10 selected sera from dogs naturally infected by this hookworm. The results indicated that each one of the three parasitic extracts has different antigenic components. Sixty percent of the dog sera consistently recognised four antigens of 20, 25, 30, and 38kDa of the larval extract and the immunoblotting inhibition showed that these antigens were only observed at the larval stage. All these results indicated that these antigens can be considered as major antigens and they could be useful for the immunodiagnosis of this parasitic infection.

[Up-date in the treatment of rapid cycling and other refractory bipolar disorders]. / Actualización en el tratamiento de pacientes cicladores rápidos y otros bipolares resistentes.

INTRODUCTION: Up-date in the treatment of rapid cycling and other resistant bipolar disorders. METHODS: A Medline research of the literature was performed in several databases as Pub-Med, Cochrane and Embasse, from 1998 to December 2001. We have also reviewed bibliography supplied by different laboratories and several monographies. RESULTS: 30 articles were selected: 11 reviews, 17 openlabeled studies and 2 articles on general recommendations. From the 17 open-labaled studies, 10 were on topiramate (25 to 400 mg/day) as a coadjuvant of another stabilizer. Improvement ranged from 40 to 70%; 4 adding gabapentin to the previous treatment, at the dosage of 60 to 5,600 mg/day, 27 and 92% showed improvement; 1 with mexiletine (200 to 1,200 mg/day) in which 46% were full responders, 15% partial responders and 38 % had no response, 100% response in manic or mixed and 38 % in depressed patients; and 2 with lamotrigine (50 to 500 mg/day) in which 52 to 80 % showed improvement. With risperidone at the dosage of 2-3 mg/day as coadjuvant, improvement was seen in 62 %. Olanzapine had direct short-term antimanic effects, with 49 % improvement in single drug therapy and 57 % as coadjuvant. CONCLUSIONS: More double-blind studies are necessary to assess efficacy in monotherapy or as coadjuvants, in short-term or even in monotherapy, and to compare the different treatments with each other as well as with the conventional treatment. The authors agree in pointing out the efficacy of gabapentin and topiramate associated to another stabilizer, and also of lamotrigine in depressed phases.