Estudio CRONO: prevalencia del dolor irruptivo en pacientes con dolor crónico no oncológico en Andalucía, España / CRONO study: prevalence of breakthrough pain in patients with non-cancer chronic pain in Andalusia, Spain

Objetivo: El objetivo de este estudio es evaluar la prevalencia de dolor irruptivo (DI) en pacientes ambulatorios con dolor crónico de origen no oncológico y caracterizar la fisiopatología, localización, intensidad y frecuencia de los episodios de DI. Material y métodos: Estudio observacional, prospectivo y no intervencionista realizado en 16 unidades de dolor ambulatorias de hospitales de Andalucía y Ceuta. Se preguntó a los pacientes consecutivos elegibles si experimentan DI definido como "una exacerbación transitoria del dolor que ocurre espontáneamente, o en relación con un desencadenante predecible o impredecible específico, a pesar del dolor de base estable y controlado". En cada día de la encuesta, los dos primeros pacientes que confirmaron DI fueron preguntados sobre las características clínicas de su PTP (etiología, inicio, intensidad, frecuencia y tratamiento). Resultados: Se realizó un cribaje a un total de 3209 pacientes con dolor crónico no oncológico para identificar a 1118 pacientes con DI, lo que representó una prevalencia del 36 %. Se obtuvieron las características del DI de 350 pacientes: la intensidad media fue de 8,3 (± 1,4) en una Escala Analógica Visual (EVA), con una media de 2 episodios/24 horas (rango 1-5/24 h). El mecanismo del dolor fue mixto en 149 (42,6 %), neuropático en 91 (26 %) y nociceptivo en 72 (20,6 %) de los pacientes. Se encontró correlación positiva entre una mayor intensidad de DI con el nivel de dolor basal (r = 0,243, p < 0,001), y el número de crisis diarias de DI (r = 0,123, p = 0,003), ambas estadísticamente significativas. El 78 % de los pacientes estaba en tratamiento con opioides. Los más frecuentes fueron el citrato de fentanilo (52,6 %) y el tramadol (17,4 %). Conclusiones: La tasa de prevalencia del DI en pacientes con dolor crónico no oncológico es superior a un tercio de los pacientes atendidos en las unidades ambulatorias de dolor hospitalario en España. El DI provoca niveles reducidos de funcionalidad, trastornos psicológicos y un aumento del gasto asistencial. La clave del tratamiento es la individualización

Objective: The aim of this study was to evaluate the prevalence of breakthrough pain (BTP) in ambulatory patients with non-cancer chronic pain in Spain and to characterize physiopathology, location, intensity and frequency of BTP episodes. Methods: Prospective, non-interventional, observational study conducted in 16 pain units of hospitals of Andalusia and Ceuta. Eligible consecutive patients were are asked if they experience BTP defined as "a transient exacerbation of pain that occurs either spontaneously, or in relation to a specific predictable or unpredictable trigger, despite stable and controlled background pain". At each survey day, the first two patients reporting BTP were further interrogated on the clinical characteristics of their BTP (etiology, onset, intensity, frequency and treatment). Results: A total of 3,209 patients with non-cancer chronic pain were screened to identify 1,118 patients with BTP, which represented a prevalence of 36 %. BTP characteristics were retrieved from 350 patients: mean BTP intensity was 8.3 (± 1.4) on a Visual Analogue Scale (VAS), with a mean of 2 episodes/24 hour (range 1-5/24 h). Pain mechanism was mixed in 149 (42.6 %), neuropathic in 91 (26 %) and nociceptive in 72 in (20.6 %) of patients. Significant correlation was found between BTP intensity and both higher background pain (r = 0.243, p < 0.001), and daily BTP episodes frequency (r = 0.123, p = 0.003). 78 % of the patients were on opioid treatment. The most frequent were fentanyl citrate (52.6 %) and tramadol (17.4 %). Conclusions: The prevalence rate of BTP in patients with chronic non-oncologic pain is higher than one-third of the patients seen in outpatient hospital pain units in Spain. BTP causes reduced levels of functionality, psychological disorders, and an increase in health care expenditure. Individualization is the key to treatment

Estudio de satisfacción de los pacientes atendidos en el Servicio de Rehabilitación del CAUSA / Satisfaction study of patients treated in the CAUSA rehabilitation service

Introducción. Conocer el grado de satisfacción de los usuarios del Servicio de Rehabilitación, mediante la elaboración y realización de una encuesta de satisfacción. Material y métodos. Estudio descriptivo transversal. Usuarios de Rehabilitación del Complejo Asistencial Universitario de Salamanca (CAUSA). Cálculo tamaño muestral con precisión del 7% y nivel de confianza del 95. Elaboración cuestionario estructurado, con 24 ítems, validado con índice alfa de Cronbach y coeficiente de correlación intraclase. Entregado en el momento del alta del tratamiento. Variables de estudio sociodemográficas, administrativas, atención recibida, condiciones de las consultas, información y trato, identificación profesionales, tiempo de espera y grado de satisfacción global. Análisis estadístico mediante t de Student, chi al cuadrado, correlación y regresión lineal múltiple. Resultados. Total: 163 pacientes, durante el periodo agosto-octubre del 2016. Edad media 58 años; 59 hombres, 104 mujeres. Resultados globales satisfactorios, con una satisfacción global media de 8,6/10. El 87,5% de los usuarios encuentran mejoría tras el tratamiento. De entre las variables estudiadas, muestran resultados favorables (> 70% bueno o muy bueno) información recibida, trato, tiempo dedicado, etc. Mientras que datos negativos, siendo áreas de mejora detectadas: tiempo de espera consulta (55,8%) y tratamiento (57,8%), servicio de transporte (40%), comodidad sala de espera (66,6%), número informes de alta recibidos (59,5%), así como presencia de facultativo de referencia ante cualquier evento relacionado con su problema de salud (49,6%). Conclusiones. Objetivamos un nivel de satisfacción alto de nuestros usuarios, si bien hemos iniciado las acciones para la corrección de las áreas de mejora detectadas, dentro del enfoque de calidad asistencial de nuestro servicio (AU)

Introduction. To determine the degree of satisfaction among users of the Rehabilitation Service through the design and administration of a satisfaction survey. Material and methods. A cross-sectional descriptive study was conducted in users of the Rehabilitation Service of the CAUSA (Spanish acronym for the University Healthcare Complex of Salamanca). The sample size was calculated with 7% precision and 95% confidence level. A 24-item structured questionnaire was designed and was validated with Cronbach's alpha index and intraclass correlation coefficient. The questionnaire was administered at the time of discharge from treatment. Study variables consisted of sociodemographic and administrative variables, the healthcare received, the conditions of the consultations, the information provided and personal dealings, staff identification, waiting time and overall degree of satisfaction. The statistical analysis was performed using Student's t-test, the chi-square test, correlation and multiple linear regression. Results. There were 163 patients during the period August-October 2016. The mean age was 58 years. There were 59 men and 104 women. The overall mean satisfaction score was 8.6 /10. Most users (87.5%) improved after treatment. Among the variables studied, favourable results (> 70% good or very good) were obtained for the information received, personal dealings with staff, time spent, ... etc. Areas of improvement were waiting time for the consultation (55.8%), treatment (57.8%), transportation service (40%), waiting room comfort (66.6%), the number of discharge reports received (59.5%), and the presence of a physician to be contacted if the patients needed to discuss any matter related to their health problem (49.6%). Conclusions. Satisfaction was high among our users. Measures have been implemented in the areas of improvement detected, within the quality of care approach of our service (AU)

Utility of opium seed extract tests in preventing hypersensitivity reactions during surgery

BACKGROUND: Anaphylaxis during anaesthesia is fatal in 3-9% of patients and analgesics, including opioids, and is the second most common medicament-related cause, although the prevalence is underestimated. We recently found that patients may generate IgE antibodies to opium seeds. OBJECTIVES: To determine the diagnostic accuracy of specific antibodies to morphine, codeine, rocuronium and oil body and aqueous fractions of Papaver somniferum seeds in the diagnosis and prevention of allergy to opioids. METHODS: Patients with hypersensitivity reactions during surgery, and severe clinical allergy (pollen, tobacco), and illicit heroin users were selected. The sensitivity, specificity and predictive values of in vivo and in vitro diagnostic techniques including oil body and aqueous fractions of P. somniferum seeds were measured. RESULTS: We studied 203 patients, with mean age 35.1 ± 17.1 and 200 healthy controls. Patients sensitised to heroin or with hypersensitivity reactions during surgery responded to P. somniferum seed tests. Of patients not known to be sensitised to opioids, the highest positivity was in patients sensitised to tobacco (p < 0.001). Opium seed skin tests and IgE, especially the oil body fraction, were more sensitive (64.2%) and specific (98.4%) than morphine, codeine and rocuronium tests for opioid sensitivity. Pollen allergy was not a risk factor for sensitisation to morphine. CONCLUSIONS: Sensitivity to opioids and intraoperative anaphylaxis can be diagnosed by routine tests. IgE and skin tests for the oil body fraction of P. somniferum had the highest sensitivity for sensitisation to opioids

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Utility of opium seed extract tests in preventing hypersensitivity reactions during surgery.

BACKGROUND: Anaphylaxis during anaesthesia is fatal in 3-9% of patients and analgesics, including opioids, and is the second most common medicament-related cause, although the prevalence is underestimated. We recently found that patients may generate IgE antibodies to opium seeds. OBJECTIVES: To determine the diagnostic accuracy of specific antibodies to morphine, codeine, rocuronium and oil body and aqueous fractions of Papaver somniferum seeds in the diagnosis and prevention of allergy to opioids. METHODS: Patients with hypersensitivity reactions during surgery, and severe clinical allergy (pollen, tobacco), and illicit heroin users were selected. The sensitivity, specificity and predictive values of in vivo and in vitro diagnostic techniques including oil body and aqueous fractions of P. somniferum seeds were measured. RESULTS: We studied 203 patients, with mean age 35.1±17.1 and 200 healthy controls. Patients sensitised to heroin or with hypersensitivity reactions during surgery responded to P. somniferum seed tests. Of patients not known to be sensitised to opioids, the highest positivity was in patients sensitised to tobacco (p<0.001). Opium seed skin tests and IgE, especially the oil body fraction, were more sensitive (64.2%) and specific (98.4%) than morphine, codeine and rocuronium tests for opioid sensitivity. Pollen allergy was not a risk factor for sensitisation to morphine. CONCLUSIONS: Sensitivity to opioids and intraoperative anaphylaxis can be diagnosed by routine tests. IgE and skin tests for the oil body fraction of P. somniferum had the highest sensitivity for sensitisation to opioids.

Factores pronósticos del traumatismo craneoencefálico grave / Prognostic factors in severe traumatic brain injury

OBJETIVO: Describir los factores asociados a la mortalidad de los pacientes con traumatismo craneoencefálico grave (TCEG). DISEÑO: Estudio observacional retrospectivo de los pacientes con TCEG en el periodo comprendido entre el 1 de enero de 2007 y el 31 de diciembre de 2010. Ámbito: Hospital Virgen de la Vega de Salamanca. PACIENTES: Los 106 pacientes con TCEG ingresados de forma consecutiva en el periodo de estudio. Variables de interés: La variable dependiente ha sido la mortalidad y las distintas variables independientes han sido divididas en 2 grupos: epidemiológicas y clínicas. RESULTADOS: La edad media fue de 50,84 años. El 75,5% de los casos eran varones. La puntuación media en la escala de Glasgow (GCS) fue de 5,09 y el Injury Severity Score (ISS) medio fue de 30,8. Se observa mayor mortalidad en los pacientes con edad más avanzada y puntuación ISS más alta. Un 68,1% de los pacientes en los que se monitorizó la presión intracraneal (PIC) presentaron hipertensión intracraneal (HIC). La mortalidad de los pacientes con TCEG fue del 36,8% y se asoció de forma significativa a una menor puntuación del GCS, a la existencia de hiperglucemia, HIC, coagulopatía, hipoxemia, presencia de midriasis y shock. Los factores responsables de la mortalidad de forma independiente en los pacientes con TCEG fueron la existencia de midriasis (OR: 32,75), puntuación del GCS (OR: 2,65) e hiperglucemia (OR: 6,08). CONCLUSIONES: La existencia de midriasis, la puntuación del GCS y la hiperglucemia deben ser tenidas en cuenta como factores pronóstico del TCEG

OBJECTIVE: To describe the factors associated to mortality of patients with severe traumatic brain injury (TBI). DESIGN: A retrospective observational study was made of patients with severe TBI covering the period between 1 January 2007 and 31 December 2010. SETTING: Virgen de la Vega Hospital, Salamanca (Spain). PATIENTS: All patients hospitalized during the consecutive study period. Main variables of interest: The dependent variable has been the death rate, while the independent variables were divided into two groups: epidemiological and clinical. RESULTS: The mean patient age was the 50.84 years; 75.5% were males. The average score on the Glasgow Coma Scale (GCS) was 5.09, and the average Injury Severity Score (ISS) was 30.8. Higher mortality was observed in older patients with a higher ISS score. A total of 68.1% of the patients in which intracranial pressure (ICP) was monitored showed intracranial hypertension (ICH). The mortality rate in patients with severe TBI was 36.8%, and was associated mainly to a lower GCS score, the existence of hyperglycemia, coagulopathy, hypoxemia, the presence of mydriasis and shock. The independent mortality indicators in patients with severe TBI were the existence of mydriasis (OR: 32.75), the GCS score (OR: 2.65) and hyperglycemia (OR: 6.08). CONCLUSIONS: The existence of mydriasis, the GCS score and hyperglycemia should be taken into account as prognostic factors in TBI patients

Clinical value of morphine, pholcodine and poppy seed IgE assays in drug-abusers and allergic people

Background: The diagnosis of anaphylactic reactions due to opiates during anaesthesia can be difficult, since in most cases various drugs may have been administered. Detection of specific IgE to poppy seed might be a marker for sensitisation to opiates in allergic people and heroin-abusers. This study assessed the clinical value of morphine, pholcodine and poppy seed skin-prick and IgE determination in people suffering hypersensitivity reactions during anaesthesia or analgesia and drug-abusers with allergic symptoms. Methods: We selected heroin abusers and patients who suffered severe reactions during anaesthesia and analgesia from a database of 23,873 patients. The diagnostic yield (sensitivity, specificity and predictive value) of prick and IgE tests in determining opiate allergy was analysed. Results: Overall, 149 patients and 200 controls, mean age 32.9±14.7 years, were included. All patients with positive prick to opiates showed positive prick and IgE to poppy seeds, but not to morphine or pholcodine IgE. Among drug-abusers, 13/42 patients (31%) presented opium hypersensitivity confirmed by challenge tests. Among non-drug abusers, sensitisation to opiates was higher in people allergic to tobacco (25%), P<0.001. Prick tests and IgE against poppy seed had a good sensitivity (95.6% and 82.6%, respectively) and specificity (98.5% and 100%, respectively) in the diagnosis of opiate allergy. Conclusions: Opiates may be significant allergens. Drug-abusers and people sensitised to tobacco are at risk. Both the prick and specific IgE tests efficiently detected sensitisation to opiates. The highest levels were related to more-severe clinical profiles(AU)

Clinical significance of cross-reactivity between tobacco and latex

Background: Allergen cross-reactivity between tobacco and other species of Solanaceae family (tomato, potato, aubergine and eggplant) have been reported. We have recently studied IgE response to tobacco in asthmatic patients sensitised to Lolium perenne (Perennial rye grass pollen) and have found that 30% of the tobacco responsive patients also have latex sensitisation. Objective: The aim of our study was to investigate the possibility of cross-reactivity between tobacco and latex in asthmatic patients with IgE response to latex. Methods: A study was performed on tobacco and latex exposure in 15 patients who suffered from asthma and latex sensitisation and who were randomly chosen from our database of latex-sensitive patients. To identify tobacco and latex as possible allergens that might cause clinical specific responses, all these patients were tested with prick-tests, specific IgE to tobacco, latex and related allergens, bronchial challenge, and patch tests with tobacco, latex and nicotine. Immunological response was evaluated with immunoblotting, immunoblotting-inhibition and EAST-inhibition tests. Results: Positive prick and bronchial challenge with specific IgE>0.35kU/L to tobacco was demonstrated in 11 asthmatics who were also sensitised to rye grass. Tobacco IgE level was related with sensitisation to latex (p<0.002), but not to other vegetables belonging to the Solanaceae family. EAST-inhibition and immunoblotting-inhibition showed the existence of cross-reactivity between tobacco and latex. Conclusions: Cross-reactivity exists between latex and tobacco allergens. Smoker patients with IgE response to tobacco may be a risk population for latex sensitisation

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Transmisión intrafamiliar del Actinobacillus actinomycetemcomitans

En la literatura científica existen varias líneas de evidencia que relacionan directamente al Actinobacillus actinomycetemcomitans con lesiones de Periodontitis juvenil localizada y aunqueexiste evidencia de transmisión familiar de este patógeno periodontal, no existe constancia de que la enfermedad periodontal sea contagiosa. Las bacterias responsables de la enfermedad periodontal parecen ser transmisibles, pero sólo después de un periodo largo de exposición. La vía de transmisión tampoco está clara. Por el momento no es posible sacar ninguna conclusión alrespecto.(AU)

Acerca de la medidade PTH / No disponible

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Experiencia y resultados en el tratamiento de la leucemia linfoblástica aguda en la edad pediátrica en el periodo comprendido entre 1989 y 2005 en la Comunidad de Navarra / Experience and results of acute lymphoblastic leukaemia treatment in children between 1989-2005 in Navarre

Fundamento. El conocimiento de factores que se comportan como pronósticos en la leucemia linfoblástica aguda (LLA) es cada vez más importante para establecer una estrategia de tratamiento correcta. Se analiza la supervivencia global (SG), supervivencia libre de eventos (SLE) y los factores pronósticos en 16 años de experiencia en nuestra comunidad. Material y métodos. Estudio descriptivo retrospectivo en el que se incluyen los pacientes diagnosticados de leucemia aguda (LA) en ese periodo de tiempo. Análisis uni y multivariante de aquellos factores que hemos considerado relevantes en nuestra serie aplicando el paquete estadístico SPSS para Windows versión 12. Resultados. En el periodo comprendido entre enero de 1989 y diciembre de 2005 se diagnosticaron 58 pacientes de LA, 50 de ellos tipo linfoblástica aguda (LLA). Se analiza un subgrupo de 41 pacientes de forma más exhaustiva por ser el tipo de leucemia más frecuente y por haber estado incluidos en protocolos bien establecidos. En este grupo la SLE fue del 78% y la SG del 87,8%. Las variables multivariante predictoras en nuestra serie fueron: el inmunofenotipo (B-Común/Otras) con un HR de 13,82 (IC95%: 1.019-166.008) p120meses/12-120meses) con un HR de 13,82 (IC95%: 0,58-329,48) p =0,1. Conclusiones. En nuestra serie la tasa de supervivencia es superponible a la de otros grupos colaborativos. El inmunofenotipo y el protocolo vigente se comportan como factores que influyen significativamente en la evolución de los pacientes

Background. The determination of prognostic factors in acute lymphoblastic leukaemia (ALL) is increasingly important in establishing a correct treatment. We analyse the overall survival (OS), event free survival (EFS) and prognostic factors in our 16 years experience of treating acute lymphoblastic leukaemia. Methods. We performed univariate and multivariate analyses of the prognostic factors we considered most significant in our serie of patients Results. From January 1989 to December 2005, 50 cases of ALL were reported in 58 patients with LA. We analysed a subgroup of 41 patients with LLA as they were included in standard protocols. In this group the EFS was 78% and OS 87.8%. Inmunophenotype is a predictor of prognosis when we compare Common with Others, with a HR of 13.82 (CI95%: 1.019-166.008) p120 months/12-120 months) with a HR of 13.82 (CI95%: 0.58-329.48) p=0.1 Conclusions. The OS in our series is similar to that reported in the literature. Inmunophenotype and protocols of treatment are the most significant prognostic factors

Colestasis idiopática asociada a diarrea sanguinolenta como primera manifestación de linfoma de Hodgkin / Idiopathic cholestasis associated with bloody diarrhea as the first manifestation of Hodgkin’s lymphoma

La ictericia asociada a la enfermedad de Hodgkin (EH) aparece entre un 3 y un 13% de los casos comunicados en la bibliografía médica y puede deberse a diversas causas. Por otro lado, la ictericia colestásica asociada a ductopenia puede ser consecuencia de un proceso paraneoplásico y aparecer varios meses antes del desarrollo de la EH. Ante el hallazgo de ictericia de origen no filiado con presencia de ductopenia se propone la investigación de la existencia de una posible EH. Describimos un caso de ictericia colestásica asociada a EH que se presentó tras un cuadro de diarrea sanguinolenta como primera manifestación clínica y analítica varios meses antes del desarrollo de la EH. Se comentan los diferentes diagnósticos diferenciales planteados ante la complejidad del cuadro clínico

Jaundice in Hodgkin's disease occurs in 3-13% of the cases reported in the medical literature and can be due to several causes. Cholestatic jaundice associated with ductopenia may be a consequence of an associated paraneoplastic process and can occur several months before the development of Hodgkin's disease. When there is a finding of jaundice of unknown etiology associated with ductopenia, the possible existence of Hodgkin's disease should be investigated. We describe a case of cholestatic jaundice associated with Hodgkin's disease. The first clinical and laboratory manifestations were symptoms of bloody diarrhea months before the development of Hodgkin's disease. We discuss the differential diagnoses considered, given the complexity of the case

Comparación de tres métodos cuantitativos para la determinación de proteínas totales en orina / A comparison of three methods for quantitative determination of total urine protein

Ante la falta de un método de referencia para la cuantificación de proteínas en orina, el objetivo de este trabajo es comparar las distintas metodologías existentes en nuestro Hospital. En nuestro Hospital las muestras con petición de análisis sistemático de orina son analizadas mediante un método semi-cuantitativo de tira reactiva y, en caso de resultado positivo, se efectúa su cuantificación por turbidimetría en el Laboratorio Central y en el Laboratorio de Urgencias por una metodología de unión a colorantes. Además, la determinación de proteínas especificas (albúmina, transferrina e inmunoglobulina G) se realiza mediante nefelometría cinética. En nuestro estudio hemos determinado proteínas totales en 103 muestras de orina positivas en la tira reactiva. Para la comparación de métodos se ha considerado como el más cercano al de referencia el de unión a colorantes. Los resultados obtenidos han sido discrepantes con diferencias constantes y proporcionales y coeficientes de correlación no superiores a 0,8. El conocimiento de estas diferencias nos lleva a la necesidad de profundizar en casos clínicos (AU)

Several methodologies for determination of total urine protein are frequently used in a Clinical Chemistry Laboratory this problem, increased by the lack of an established reference method, could induce confusion in both analysts and clinicians. In this study, urine samples with a positive result for total protein by an automated test strip were analyzed by a quantitative turbidimetric method and by a quantitative dye-binding essay in routine and urgent work, respectively. By the other way, albumin, transferrin and immunoglobulin G were quantified in the same specimens using a cinetic nephelometry method. All protein determinations were performed in 103 consecutive urine sample. The Kodak 250 essay [a dye-binding based assay] was considered as 'gold standard' for method comparison. Statistical differences were found for both y-intercept and siope in regression analysis [Hitachi 917 vs Kodak 250, and Immage vs Kodak 250). The correlation coefficients [r] values were less than 0.8. The knowledge of these differences should carry out to perform alternative methodologies when discrepant/unexpected values were obtained or when further clinical study was necessary (AU)

Living in towers as risk factor of pollen allergy.

BACKGROUND: The effects of fluctuations in pollen counts have important implications for health services. Little research on the clinical implications of the vertical distribution of pollen in allergy symptoms has been carried out. METHODS: We have investigated the allergic symptoms of a population of 17 171 patients coming from our health area (Valladolid, Spain) and living in the city and villages. We compared the prevalence of sensitization to different pollens: Graminae, trees and shrub in relation with the floor of the building where they were living. RESULTS: Relative risk of pollen sensitization (confidence index, CI 95%) was higher in patients who were living at high floors than in those patients who were living in lower floors or at street level, independently of rural or urban conditions The chi-square showed a lineal trend in this relationship in the case of sensitization to grass pollen: chi(2): 1794, P > 0.00001 CONCLUSIONS: On the basis of our local investigations, natural pollen sensitization appears to increase with height where the patient lives. This paper reports clinical results on the influence of vertical pollen distribution in pollen allergy.

Enhancement of tomato allergenicity after treatment with plant hormones

Background: Practical applications to enhance the productivity of agriculture by using plants with improved resistance to pathogens are expected to increase in the near future. Although tomato has been widely investigated for breeding purposes, there have been no studies on tomato allergenicity after plant hormones treatments. Methods: Prick by prick tests were carried out with different tomato samples (fruits grown under biological conditions without addition of chemical products, and treated with ethylene and salicylic acid) in eight patients with ages between 12 and 27 years who suffered from anaphylaxis episodes after eating raw tomatoes. An immunoblot experiment with the different tomato extracts was performed using sera from these eight patients and controls. Results: The wheals obtained in prick tests were significantly higher with the extracts of tomato treated with ethylene and SAA (χ2 = 31.3, p < 0.0001) and the patients who presented higher wheal diameters in skin tests were those who had more severe episodes of anaphylaxis. Neither the protein stain nor the IgE immunodetection patterns clearly varied between the untreated and the hormone-treated samples. Conclusions: In the case of anaphylaxis induced by tomato, the treatment with plant hormones induced a higher cutaneous response than with non-treated tomato, but the "in vitro" response was similar (AU)

Información básica: Se espera que aumenten en un futuro próximo las aplicaciones prácticas para incrementar la productividad de la agricultura utilizando plantas con mayor resistencia a los patógenos. Aunque se ha investigado ampliamente el tomate para fines de producción, no se han realizado estudios sobre su alergenicidad después de tratamientos con hormonas vegetales. Métodos: Se efectuaron pruebas de prick con diferentes muestras de tomate (frutos desarrollados en condiciones biológicas sin añadir productos químicos y tratados con etileno y ácido salicílico) en siete pacientes de 12 a 27 años que habían sufrido episodios de anafilaxia después de comer tomates crudos. Se realizó una prueba de inmunotransferencia con los distintos extractos de tomate empleando sueros de estos ocho pacientes y de controles. Resultados: Los habones obtenidos en las pruebas de punción fueron significativamente mayores con los extractos de tomate tratados con etileno y SAA ( 2 = 31,3, p < 0,0001) y los pacientes que presentaron habones de mayor diámetro fueron los que habían sufrido episodios más graves de anafilaxia. Ni la tinción de proteínas ni los patrones de inmunodetección de IgE variaron con claridad entre las muestras tratadas con hormonas y las no tratadas. Conclusiones: En el caso de la anafilaxia inducida por el tomate, el tratamiento con hormonas vegetales provocó una respuesta cutánea mayor que con el tomate no tratado, pero la respuesta in vitro fue parecida (AU)

Is Lolium pollen from an urban environment more allergenic than rural pollen?

Background: Allergy to grass pollen is a highly prevalent allergic disease. Hay fever is more predominant in urban than in rural areas, despite the increasingly smaller areas of surrounding grassland. The effect of vehicle exhaust pollutants, mainly diesel particles, and other industrial sources of atmospheric pollution leading to plant damage has been implicated in this phenomenon. Objective: This study compared the in vivo and in vitro allergenicity of pooled samples of Lolium perenne grass pollen harvested from 10 different urban areas with that of samples of the same pollen from 10 neighboring rural areas. Methods: Lolium perenne pollen from different parts of a city and from a nearby rural area was harvested in 1999 and 2000 during the peak pollination period. Protein composition was compared by SDS-PAGE and in vivo and in vitro IgE-binding capacity was compared by skin-prick tests, RAST-inhibition and measurement of the major allergen, Lol p 5. Results: In the two years under study, urban samples contained approximately twice the protein content of the rural samples. Biological activity and Lol p 5 content was higher in urban pollen than in rural pollen and showed differences in the two years under study. Conclusions: The protein content and allergenicity of Lolium perenne pollen was higher in urban areas than in rural areas. These differences might explain why allergy to grass pollen is more prevalent in urban areas. This finding should be taken into account in diagnosis, preventive measures and specific immunotherapy (AU)

Antecedentes: Los pólenes son una causa muy importante de enfermedades alérgicas. La polinosis es mas prevalente en zonas urbanas que en rurales, a pesar de que cada vez hay menos zonas verdes en las ciudades. Se ha valorado el efecto de las partículas diesel y otras fuentes de contaminantes urbanos sobre los pólenes para tratar de explicar este fenómeno. Objetivo: Este estudio compara la alergenicidad de muestras de Lolium perenne recolectado en diferentes zonas de la ciudad de Valladolid con pólenes de la misma especie recogidos en zonas rurales vecinas. Métodos: Se recolectaron pólenes de Lolium perenne de diferentes partes de la ciudad y de zonas rurales circundantes durante su pico de polinización en los años 1999 y 2000. Se mide su reactividad "in vivo" mediante prick tests e "in vitro" por SDS-PAGE, RAST inhibición y medición de su alérgeno principal Lol p 5, y se comparan los resultados obtenidos por todas la técnicas. Resultados: Demostramos una mayor concentración proteica y alergenicidad de los pólenes de Lolium perenne de zonas urbanas comparadas con las rurales cercanas. Conclusión: Sugerimos que esta diferencia en concentración proteica y actividad biológica del polen según el lugar de procedencia debería ser tenida en cuenta para el diagnóstico, medidas de prevención e inmunoterapia específica (AU)

Aportación al estudio de la otosclerosis y del síndrome de Van der Hoeve / Otosclerosis and Van der Hoeve's syndrome: a contribution

Hemos realizado un estudio ultraestructural y microanalítico de estribos procedentes de pacientes otosclerosos, sanos y afectos por el síndrome de Van der Hoeve a fin de determinar los cambios en la composición mineral de los mismos. Para ello hemos utilizado métodos no destructivos microscopía electrónica de barrido asociado a espectroscopia por dispersión de energía de rayos X (EDAX)- y otros destructivos (espectrografía con infrarrojos mediante transformada de Fourier). Utilizando la relación Ca/P hemos determinado que la composición mineral de los estribos es distinta en individuos normales, otosclerosos y afectos por el síndrome de Van der Hoeve. En esta última entidad hemos detectado una composición mineral inusual en huesos sanos: la brushita (AU)

Morphological and microchemical changes that effect to the otosclerotic stape in the Van der Hoeve's syndrome were examined with a scanning electron microscope equipped with an energy dispersive X-ray fluorescence. Using the Ca/P ratio as criterion--measured by the characteristic x-ray fluorescence--it was shown that the Van der Hoeve stape had a higher Ca/P ratio (2.6:1) as compared to the normal stape (2:1). The Van der Hoeve's syndrome lesions as poorly mineralized, with low calcium salt and apparent increase of phosphates. This finding indicates a possible change from hydroxyapatite (or apatite) to brushite, which imply an acidification of bone (AU)

Transmisión intrafamiliar del Actinobacillus actinomycetemcomitans / Familiar transmission of Actinobacillus actinomycetemcomitans

En la literatura científica existen varias líneas de evidencia que relacionan directamente al Actinobacillus actinomycetemcomitans con lesiones de Periodontitis juvenil localizada y aunque existe evidencia de transmisión familiar de este patógeno periodontal, no existe constancia de que la enfermedad periodontal sea contagiosa. Las bacterias responsables de la enfermedad periodontal parecen ser transmisibles, pero sólo después de un periodo largo de exposición. La vía de transmisión tampoco está clara. Por el momento no es posible sacar ninguna conclusión al respecto (AU)

In scientific literature several lines of evidence exist and link Actinobacillus actinomycetemcomitans with localized juvenile periodontitis lesions directly. Although evidence of familial transmission exist, it doesn't prove periodontal disease is contagious. Bacteria responsible for periodontal disease seem to be transmissible, but only after a long exposure period. No clear transmission paths were observed in the population yet. Up to now drawing conclusions about it is not possible (AU)