[Perceived stress and subjective memory complaints in young adults: the mediating role of the executive functions]. / Estres percibido y quejas subjetivas de memoria en adultos jovenes: papel mediador de las funciones ejecutivas.

INTRODUCTION: Previous studies have shown that executive functions can be mediators between perceived stress and subjective memory complaints. However, it has not been evaluated which executive functions are those that most mediate this relationship. AIM: To determine if executive functions have a mediating role in the relationship between perceived stress and subjective memory complaints, and which ones have the greatest explanatory power. PATIENTS AND METHODS: The sample consisted of 743 university students (76.4% women), with an average age of 22.24 ± 3.64 years. The subjective memory complaints were evaluated with the Memory Failure of Everyday Questionnaire, the stress with the Perceived Stress Scale, and the executive functions with the Prefrontal Symptoms Inventory. RESULTS: The executive functions and the perceived stress explained altogether 57% of the subjective memory complaints, being the attentional problems and the executive control problems the two variables with a greater weight in the model. On the other hand, the executive control problems, attentional problems and social behaviour problems showed a mediating effect between perceived stress and subjective memory complaints. CONCLUSIONS: The executive control problems and the attentional problems could be factors of choice for clinical intervention, since they act on their own as generators of subjective memory complaints and, moreover, are involved in mediation processes of perceived stress.

TITLE: Estres percibido y quejas subjetivas de memoria en adultos jovenes: papel mediador de las funciones ejecutivas.Introduccion. En estudios previos se ha señalado que las funciones ejecutivas pueden actuar como mediadoras entre el estres percibido y las quejas subjetivas de memoria. Sin embargo, no se ha evaluado que funciones ejecutivas son las que median en mayor medida dicha relacion. Objetivo. Determinar si las funciones ejecutivas tienen un papel mediador en la relacion entre el estres percibido y las quejas subjetivas de memoria, y cuales son las que tienen un mayor poder explicativo. Pacientes y metodos. La muestra estuvo compuesta por 743 universitarios (76,4% mujeres), con una edad media de 22,24 ± 3,64 años. Las quejas subjetivas de memoria se evaluaron con el cuestionario de fallos de memoria de la vida cotidiana; el estres, con la escala de estres percibido; y las funciones ejecutivas, con el inventario de sintomas prefrontales. Resultados. Las funciones ejecutivas y el estres percibido explicaron en conjunto un 57% de las quejas subjetivas de memoria, y los problemas atencionales y los problemas del control ejecutivo fueron las dos variables con un mayor peso en el modelo. Por otro lado, los problemas del control ejecutivo, los problemas atencionales y los problemas de la conducta social mostraron un efecto mediador entre el estres percibido y las quejas subjetivas de memoria. Conclusiones. Los problemas del control ejecutivo y los problemas atencionales podrian ser factores de eleccion para la intervencion clinica, puesto que actuan por si solos como generadores de quejas subjetivas de memoria y ademas se encuentran implicados en procesos de mediacion del estres percibido.

Increased levels of inflammatory plasma markers and obesity risk in a mouse model of Down syndrome.

Down syndrome (DS) is caused by the trisomy of human chromosome 21 and is the most common genetic cause of intellectual disability. In addition to the intellectual deficiencies and physical anomalies, DS individuals present a higher prevalence of obesity and subsequent metabolic disorders than healthy adults. There is increasing evidence from both clinical and experimental studies indicating the association of visceral obesity with a pro-inflammatory status and recent studies have reported that obese people with DS suffer from low-grade systemic inflammation. However, the link between adiposity and inflammation has not been explored in DS. Here we used Ts65Dn mice, a validated DS mouse model, for the study of obesity-related inflammatory markers. Ts65Dn mice presented increased energy intake, and a positive energy balance leading to increased adiposity (fat mass per body weight), but did not show overweight, which only was apparent upon high fat diet induced obesity. Trisomic mice also had fasting hyperglycemia and hypoinsulinemia, and normal incretin levels. Those trisomy-associated changes were accompanied by reduced ghrelin plasma levels and slightly but not significantly increased leptin levels. Upon a glucose load, Ts65Dn mice showed normal increase of incretins accompanied by over-responses of leptin and resistin, while maintaining the hyperglycemic and hypoinsulinemic phenotype. These changes in the adipoinsular axis were accompanied by increased plasma levels of inflammatory biomarkers previously correlated with obesity galectin-3 and HSP72, and reduced IL-6. Taken together, these results suggest that increased adiposity, and pro-inflammatory adipokines leading to low-grade inflammation are important players in the propensity to obesity in DS. We conclude that DS would be a case of impaired metabolic-inflammatory axis.

Overweight Mice Show Coordinated Homeostatic and Hedonic Transcriptional Response across Brain.

Obesogenic diets lead to overeating and obesity by inducing the expression of genes involved in hedonic and homeostatic responses in specific brain regions. However, how the effects on gene expression are coordinated in the brain so far remains largely unknown. In our study, we provided mice with access to energy-dense diet, which induced overeating and overweight, and we explored the transcriptome changes across the main regions involved in feeding and energy balance: hypothalamus, frontal cortex, and striatum. Interestingly, we detected two regulatory processes: a switch-like regulation with differentially expressed (DE) genes changing over 1.5-fold and "fine-tuned" subtler changes of genes whose levels correlated with body weight and behavioral changes. We found that genes in both categories were positioned within specific topologically associated domains (TADs), which were often differently regulated across different brain regions. These TADs were enriched in genes relevant for the physiological and behavioral observed changes. Our results suggest that chromatin structure coordinates diet-dependent transcriptional regulation.

Posttransplant outcomes of peritoneal dialysis versus hemodialysis patients.

The impact of dialysis modality on posttransplant outcomes remains controversial. The authors have compared primary failure, delayed graft function (DGF), acute rejection episodes as well as patient and allograft survivals among patients undergoing renal transplantation between 2004 and 2009, according to the modality of hemodialysis (HD) versus peritoneal dialysis (PD). We studied 306 patients (268 HD and 38 PD) with a mean follow-up of 29 ± 16 months. The PD cohort included a predominance of females (68.4% vs 36.2%; P = .001), lower age at transplantation (38 ± 14 vs 46 ± 12 years; P = .004), shorter time on dialysis (33 ± 49 vs 59 ± 157 months; P = .043), and higher rate of living donor grafts (PD 31.6% vs HD 13.1%; P = .003). Donor age (PD 43 ± 13 vs HD 45 ± 14 years; P = .30), human leukocyte antigen mismatch (P = .17), panel reactive antibody values (HD 11 ± 22 vs PD 13 ± 26; P = .55), and hyperimmunized patients (HD 3.73%; PD 7.89%; P = .23) were not different. Primary graft failure (3.4% vs 0%; P = .025) and DGF (37.1% vs 13.1%; P = .037) were more frequent among HD patients, but incidences of acute rejection episodes were similar (HD 10.5% vs PD 5.3%; P = 0.19). Neither recipient survival at 1 (97% in PD and HD) or 3 years (HD 90% vs PD 94%; P = .657) nor allograft survival at 1 year (HD 94% vs PD 95%; P = .80) or 3 years: (HD 70%, vs PD 81%; P = .73) were different. Graft function was similar at 1 (HD 64.2 ± 25 vs PD 56.4 ± 24 mL/min; P = .17) and 3 years (HD 62.3 ± 21 vs PD 46 ± 23 mL/min; P = .16). In our study, HD patients showed an higher incidence of DGF and primary allograft failure, but there was no difference in acute rejection episodes, long-term survivals, or renal function.

Quality of life in chronic kidney disease

Background: The evaluation of health-related quality of life (QOL) in chronic kidney disease intends to quantify its consequences, according to the patient’s subjective perception. Aim: To evaluate the health-related QOL in four groups of patients followed at our Nephrology Department: chronic kidney disease (CKD) stages 1-4, kidney transplant (KT), haemodialysis (HD) and peritoneal dialysis(PD) patients. Patients and Methods: Thirty patients with CKD stages 1-4 and 30 KT patients were randomly selected. All patients from our Haemodialysis and Peritoneal Dialysis Units with capacity to answer the inquiry (37 and14, respectively) were also selected. The instruments applied were the SF-36 and KDQOL-SF 1.3. Results: The four groups presented better results in the «Social Functioning» scale (77.68 ± 18.46 in PD; 74.17 ± 29.53 in KT; 66.81 ± 31.39in CKD 1-4; 62.16 ± 32.84 in HD; p = 0.192). The lowest results appeared in the «General Health» scale (39.92 ± 19.12in CKD; 45.95 ± 21.56 in HD; 47.13 ± 23.15 in KT; 51.79 ±18.89 in PD; p = 0.321). Peritoneal dialysis patients achieved the best results in the Physical Health Component, but this difference disappeared after adjustment to confounding factors. Age, gender and haemoglobin level were the variables related with QOL. However, PD patients obtained better scores comparing to HD patients in the following KDQOL-SF scales: «Effects of kidney disease», «Burden of kidney disease» and «Patient satisfaction» (p <0.05).Conclusions: Health-related QOL was better in peritoneal dialysis patients comparing to haemodialysis patients inspecific scales of chronic kidney disease. Age, gender and haemoglobin level interfered with health-related QOL (AU)

Antecedentes: La evaluación de la calidad de vida (CV) relacionada con la salud en la enfermedad renal crónica pretende cuantificar sus consecuencias en función de la percepción subjetiva del paciente. Objetivo: Evaluar la CV relacionada con las alud en cuatro grupos de pacientes controlados en nuestro servicio de nefrología: pacientes con insuficiencia renal crónica (ERC) en fases 1-4, trasplante renal (TR), hemodiálisis (HD) y diálisis peritoneal (DP). Pacientes y métodos: De forma aleatoria se incluyeron 30 pacientes con ERC en fases 1-4 y 30 trasplantados renales. También se incluyeron todos aquellos pacientes de nuestras unidades de hemodiálisis y diálisis peritoneal que eran capaces de responder los cuestionarios (37 y 14, respectivamente).Los cuestionarios que se utilizaron fueron el SF-36 y el KDQOL-SF1.3. Resultados: Los cuatro grupos obtuvieron mejores resultados en la dimensión «Función social» (77,68 ± 18,46 en DP; 74,17 ±29,53 en TR; 66,81 ± 31,39 en ERC 1-4; 62,16 ± 32,84 en HD; p =0,192). Las puntuaciones más bajas se obtuvieron en la dimensión «Salud general» (39,92 ± 19,12 en IRC; 45,95 ± 21,56 en HD; 47,13± 23,15 en TR; 51,79 ± 18,89 en DP; p = 0,321). Los pacientes con diálisis peritoneal presentaron los mejores resultados en cuanto a la salud física, sin que la diferencia se mantuviese tras la corrección de los factores de confusión. La edad, el sexo y la concentración de hemoglobina fueron las variables que se asociaron con la CV. Sin embargo, los pacientes con DP obtuvieron mejores puntuaciones que los pacientes con HD (AU)

Quality of life in chronic kidney disease.

BACKGROUND: The evaluation of health-related quality of life (QOL) in chronic kidney disease intends to quantify its consequences, according to the patient's subjective perception. AIM: To evaluate the health-related QOL in four groups of patients followed at our Nephrology Department: chronic kidney disease (CKD) stages 1-4, kidney transplant (KT), haemodialysis (HD) and peritoneal dialysis (PD) patients. PATIENTS AND METHODS: Thirty patients with CKD stages 1-4 and 30 KT patients were randomly selected. All patients from our Haemodialysis and Peritoneal Dialysis Units with capacity to answer the inquiry (37 and 14, respectively) were also selected. The instruments applied were the SF-36 and KDQOL-SF 1.3. RESULTS: The four groups presented better results in the <> scale (77.68 ± 18.46 in PD; 74.17 ± 29.53 in KT; 66.81 ± 31.39 in CKD 1-4; 62.16 ± 32.84 in HD; p = 0.192). The lowest results appeared in the <> scale (39.92 ± 19.12 in CKD; 45.95 ± 21.56 in HD; 47.13 ± 23.15 in KT; 51.79 ± 18.89 in PD; p = 0.321). Peritoneal dialysis patients achieved the best results in the Physical Health Component, but this difference disappeared after adjustment to confounding factors. Age, gender and haemoglobin level were the variables related with QOL. However, PD patients obtained better scores comparing to HD patients in the following KDQOL-SF scales: <>, <> and <> (p <0.05). CONCLUSIONS: Health-related QOL was better in peritoneal dialysis patients comparing to haemodialysis patients in specific scales of chronic kidney disease. Age, gender and haemoglobin level interfered with health-related QOL.

Pancreas-kidney transplantation: complications and readmissions in 9-years of follow-up.

Over 9 years, we have performed 93 simultaneous pancreas-kidney transplants (SPKT). The morbidity of this procedure is high compared with kidney transplantation alone; readmissions are frequent and costs are higher. Herein we have presented the complications during follow-up of these 93 patients. Their mean age was 34 +/- 6 years and prior dialysis time was 32 +/- 25 months. The median hospital stay on the first admission for the transplant procedure was 22 days, including 2 days in the intensive care unit. Bleeding, thrombosis, and infection were the most frequent reasons for prolonged hospitalization. Thirty patients underwent >or=1 surgical reinterventions. Incidence of acute rejection episodes was 11.8%. After discharge, 74.2% of the patients had 197 readmission episodes with infection being the main cause, urinary tract infections, the most frequent; however, systemic viral and fungal infections required the longest readmission periods. The need for surgical interventions, graft dysfunction, and vascular problems were the remaining causes of readmission. At the end of follow-up, 87 patients were alive, 86 with well-functioning kidneys and 74 with normal functioning pancreata. Global survival rates for patient, kidney, and pancreas were 96%, 95%, and 81% at 1-year; 93%, 90%, and 79% at 5-years; and 93%, 90% and 79% at 9-years. Although pancreas-kidney transplant patients are complex presenting many management difficulties, our overall results represent a positive stimulus for diabetic patients.

Infección de catéteres de hemodiálisis: una revisión retrospectiva / No disponible

No disponible

[SPECT-CT 67Ga studies in lymphoma disease. Contribution to staging and follow-up]. / Estudios SPECT-TAC con Ga de la enfermedad linfomatosa. Su aportación en la estadificación y seguimiento de la enfermedad.

INTRODUCTION: 67Ga scintigraphy is an established method for the staging and follow-up of patients diagnosed of lymphomas. The aim of this study is to evaluate advantages of 67Ga SPECT-CT study over planar, SPECT and high resolution CT studies in lymphoma disease. MATERIAL AND METHODS: One hundred and one 67Ga studies corresponding to 74 patients (46 men) were obtained, mean age 44 years. Thirty-eight patients (51 %) were diagnosed of Hodgkin's lymphoma and 36 were non-Hodgkin's lymphoma. All patients were evaluated with 67Ga and high-resolution CT studies. 67Ga studies were performed in a hybrid system, obtaining planar, SPECT and fused SPECT-CT imaging. Findings obtained from 67Ga studies were correlated with findings obtained from CT studies, both much in number of tumoral lesions and in their localization. RESULTS: Planar, SPECT, SPECT-CT and CT studies detected 123, 146, 155 and 132 lesions respectively. SPECT-CT and CT were concordant in 52 studies, while there was no concordance between SPECT-CT and CT in the remaining 49 studies, SPECT-CT detecting more lesions than CT in 28 of them. These findings changed the disease stage 18 times (18 % of whole studies). CONCLUSION: These results show better efficiency of 67Ga SPECT-CT compared to the other acquisition methods of 67Ga study and to CT for detection of tumoral lymphomatous lesions. 67Ga SPECT-CT study improves the diagnostic yield of the study with 67Ga in patients with lymphoma, providing better anatomical localization of tumoral lesions and detection of extraganglionar disease.

[123I-MIBG SPECT-CT combined with gamma probe for radioguided localization of pheochromocytoma]. / SPECT-TC con 123I-MIBG y sonda gamma portátil en la localización radioguiada de un feocromocitoma.

We report a case of a 56-year-old male with high suspicion of an intraabdominal catecholamine-producer tumor. The patient underwent different diagnostic procedures including 123I-meta-iodobenzylguanidine (123I-MIBG) scintigraphy, with subsequent SPECT and low resolution CT for attenuation correction and anatomic and functional image fusion. After practicing a new 123I-MIBG scintigraphy the patient was taken to the operating room, where a hand-held gamma probe detector helped to localize the lesion.

[Tumor redifferentiation in papillary thyroid carcinoma alter retinoic acid administration]. / Rediferenciación tumoral en carcinoma papilar de tiroides tras la administración de ácido retinoico.

Male patient, 73 year old, with papillary thyroid carcinoma treated by surgery, 131I and L-Tyroxine, with bone metastasis, detected by bone scintigraphy and CT scan, which negative radioiodine uptake. In order to induce tumoral redifferentiation, retinoic acid (70 mg/day) was administered for three months before 131I treatment. A radioiodine scan performed after treatment showed uptake in some of the bone metastasis. Nine months later, and due to disease progression, a second induction with retinoic acid was performed before 131I treatment. The radioiodine scan performed after treatment showed greater uptake and higher number of bone lesions than the previous scan.

[Determinants of HIV mother-to-child transmission in Catalonia, Spain [1997-2001]: is it possible to eliminate it?]. / Determinantes de la transmisión vertical del VIH en Cataluña (1997-2001): ¿es posible su eliminación?

OBJECTIVES: To identify and describe the factors that have led to new cases of HIV infection through mother-to-child transmission since the introduction of antiretroviral therapy in HIV-seropositive pregnant women (1997-2001) in Catalonia. METHODS: Systematic review of cases identified in the pediatric services of all the hospitals in Catalonia. RESULTS: Twenty-eight cases of pediatric HIV infection were identified: 9, 9, 8, 2 and 0 per year of birth from 1997 to 2001, respectively. Of 16 mothers with a diagnosis of known HIV infection before or during pregnancy, nine underwent antiretroviral prophylaxis during pregnancy (compliance was good in five, unknown in one and poor in one) and seven did not undergo prophylaxis (six refused it and no information was available in one). Of 12 mothers diagnosed after delivery, pregnancy was not monitored in five and was little or well-monitored in the remaining seven. Of mothers with well-monitored pregnancy, a serological HIV test was not performed in six and was negative in the first trimester in one. CONCLUSIONS: Mother-to-child transmission of HIV has decreased in the last few years in Catalonia, but infections have sometimes occurred through poor implementation of preventive measures. Pregnant women should be offered an HIV diagnostic test not only in the first trimester but also at the end of pregnancy if HIV exposure is suspected. In women with unmonitored pregnancies, rapid diagnostic tests for HIV should be used in the delivery room.

Determinantes de la transmisión vertical del VIH en Cataluña(1997-2001): ¿es posible su eliminación? / Determinants of HIV mother-to-child transmission in Catalonia, Spain [1997-2001]: is it possible to eliminate it?

Objetivos: Identificar y describir los factores que han hecho posible la existencia de nuevas infecciones de VIH por transmisión vertical desde la implementación del tratamiento antirretroviral en la gestante seropositiva (1997-2001) en Cataluña.Métodos: Revisión sistemática de casos identificados en servicios de pediatría de todos los hospitales de Cataluña.Resultados: Se identificaron 28 casos de infección pediátrica por VIH: 9, 9, 8, 2 y 0 por año de nacimiento de 1997 a 2001, respectivamente. De 16 madres con diagnóstico de infección por VIH conocido antes o durante el embarazo, 9 realizaron profilaxis antirretroviral durante éste (5 con buena adhesión, uno desconocido y el resto con mala adhesión) y 7 no realizaron profilaxis (6 por rechazo y uno no se conoce).De 12 diagnosticadas después del parto, 5 fueron embarazos no controlados y el resto poco o bien controlados. De estos últimos, en 6 no se practicó serología para VIH y en uno fue negativa en el primer trimestre.Conclusiones: La transmisión vertical del VIH en Cataluña ha disminuido en los últimos años, pero se han producido infecciones por la mala implementación en algún caso de las medidas preventivas conocidas. Debería ofrecerse la prueba diagnóstica para VIH a toda gestante no sólo en el primer trimestre de embarazo sino también al final, si se sospecha exposición al virus, y en caso de gestaciones no controladas hay que usar pruebas diagnósticas de lectura rápida en la sala de partos. (AU)

Aplicación de los métodos de amplificación molecular para el diagnóstico y seguimiento de la infección por el VIH-1 en niños infectados por transmisión vertical / Application of molecular amplification methods to the diagnosis and follow-up of HIV-1 infection in children infected by vertical transmission

Fundamento: Describir mediante métodos moleculares la transmisión vertical por el VIH-1. Pacientes y métodos: Seguimiento prospectivo realizado durante 1995-1998 en dos grupos de pacientes: grupo A, 107 recién nacidos hijos de madre que sabían que estaban infectadas por el VIH-1, y grupo B, 11 lactantes con sospecha clínica de infección por el VIH y desconocimiento de la infección en la madre. Se estudiaron ADN y ARN mediante PCR (reacción en cadena de la polimerasa). Estudio de mutaciones genotípicas del gen RT. Resultados: Se diagnosticaron 11 pacientes infectados, 4 del grupo A y 7 del B. Todos presentaban carga viral superior a 100.000 copias/ml. En 10 pacientes no se detectaron mutaciones. Conclusión: El diagnóstico de la transmisión vertical por el VIH-1 puede realizarse de forma precoz y urgente mediante métodos de amplificación molecular. (AU)

[Neonatal sepsis by Malassezia furfur.]. / Sepsis neonatal por Malassezia furfur.

We report one case of neonatal sepsis caused by Malassezia furfur in an infant who had been in the Intensive Care Unit for 64 days. She had received prolonged therapy with intravenous fat emulsion. We used Sabouraud's medium with an overlay of sterile olive oil for the blood culture, because we had observed yeast forms in one smear of peripheral blood. M. furfur was isolated after three days of incubation. The patient recovered following removal of the port-a-cath and antifungal treatment, and had no further evidence of fungal infection. The skin colonization by the same yeast was demonstrated.

[Study of the viral etiology of lower respiratory tract infections in a neonatal unit]. / Estudio de la etiología viral de las infecciones del tracto respiratorio inferior en una unidad de lactantes.

OBJECTIVE: To study the possible viral etiology in 139 infants with lower respiratory tract infection who required hospitalization in the Infant Unit of our hospital, from October 1994 to June 1995. PATIENTS AND METHODS: 139 patients were admitted, aged from 13 days to 14 months, during this period. The etiological agent was detected by direct immunofluorescence from nasopharyngeal secretions. Monoclonal antibodies were used against Respiratory Syncitial Virus, Influenza A Virus, Influenza B Virus, Adenovirus and Parainfluenza 3 Virus. Antibody detection against these viruses by Complement Fixation Test was done on 29 of these patients, with paired sera (acute and convalescent phase). RESULTS: In 82 patients (59%) we found at least one viral agents from the nasopharyngeal specimens, but in 64 of these only one was detected, in the remaining 18, there were more than one. Significant levels of antibodies were detected in only six of the 29 patients tested. Serology was negative in the remaining 23 patients. CONCLUSIONS: Syncitial Respiratory Virus is the first virus responsible for the lower respiratory tract infection in this age group (49%). There was no correlation between serological diagnosis and antigen detection.