[Telemedicine applied to Nephrology. Another form of consultation]. / Telemedicina aplicada a la nefrología. Otra forma de consulta.

UNLABELLED: In 2004, according to socio- demographic criteria and to the improvement in the welfare quality, we incorporated to the portfolio of services of our section a work tool that meant a novel technology; the "telemedicine". The Objective has been to asses the utility of telemedicine in the follow- up of the renal patients, bringing the consultation of nephrology closer to the patient's home as well as the relationship between two welfare levels. MATERIAL AND METHOD: Retrospective and descriptive study of the patients with renal pathology treated in the consultation of telenephrology at our hospital in a period of time of 27 months (November 2004-January 2007). Such study is carried out in primary care centers of our sanitary area (4 centers). The general practician (G.P) starts up the system by elaborating a document of derivation to the consultation of "telenephrology". All this information is included in a computerized data base that arrives via "Intranet" at the Hospital. From the consultation of Telenephrology the question is answered in real- time and through a system of videoconference. RESULTS: A total of 105 first consultations have been made. 52 men and 53 women between 18 and 94 years of age. The diagnoses made in the consultation of Telenephrology have been: HTA (essential and secondary): 90 (85.7%). IRC: 61 (58%). Diabetic Nefropathy: 17 (16%). Renal Polycystic: 3 (2.8%). Urinary Lithiasis: 2 (1.9%). Congenital malformations: 1 (0.95%). Obstructive Nefropathy: 1 (0.95%). Chronic Glomerulonephritis: 6 (5.7%). Urinary infection: 1 (0.95%). Absence of renal pathology: 5 (4.8%). Some of the diagnoses coincide in several patients. The causes of the IRC have been Nephroangioesclerosis: 33. Diabetic Nefropathy: 14. Not drafted: 8. Disease to glomerular: 2. Urinary Lithiasis: 2. Renal Polycystic: 1. Ischemic Nephropathy: 1. 82 out of the 90 patients with HTA had essential arterial hypertension and 8 suffered from secondary HTA. The causes of this were: 5 HTA of parenquimatous renal origin. 2 vasculorrenal HTA and one with a primary hyperaldosteronism. The associated factors of risk to the observed HTA have been: Dyslipemia: 29. Diabetes méllitus: 29. Hyperuricemia: 11. Obesity: 12. CONCLUSION: The telecare in nephrology is possible promoting also the approach between two welfare levels, without a decrease in the quality of assistance. That way, we can get a lower number of hospital visits and, subsequently, a saving in sanitary transport as well as in hospital consultations.

Tratamiento de las fracturas en dos y tres partes de la extremidad proximal del húmero mediante fijación externa / Treatment by external fixation of 2-part and 3-part proximal humeral fractures

Objetivo. Revisar los resultados del tratamiento de las fracturas en dos y tres partes del extremo proximal de húmero mediante fijación externa. Material y método. Estudio retrospectivo con evaluación clínica y radiológica de 62 fracturas de tercio proximal de húmero en 2 y 3 partes en 62 pacientes intervenidos mediante osteotaxis con fijador Hoffmann II. Resultados. Las puntuaciones medias obtenidas en la escala de Constant fueron de 84 puntos, con un 80% de resultados satisfactorios. No influyeron en los resultados las variables sexo (p = 0,25), edad (p = 0,31), lateralidad (p = 0,33), ni tipo de fractura (p = 0,60). Todos los casos consolidaron. La reducción fue considerada como buena en 50 casos, 8 consolidaron en varo y 4 casos en valgo. Conclusiones. Este procedimiento permite obtener resultados funcionales satisfactorios precozmente, facilita la rehabilitación al limitar la movilidad posoperatoria en menor grado que otras técnicas, es menos agresivo que las técnicas de reducción abierta y osteosíntesis, y ofrece un bajo porcentaje de complicaciones

Purpose. To review the results of treatment by external fixation of two-part and three-part proximal humeral fractures. Materials and methods. A retrospective study using a clinical and X-ray assessment of 62 two-and three-part fractures of the proximal third of the humerus in 62 patients that underwent external fixation using a Hoffmann II fixation system. Results. Mean scores of 84 points were obtained using the Constant scale, with 80% satisfactory results. The following variables did not influence results: sex (p = 0.25), age (p = 0.31), laterality (p = 0.33), nor type of fracture (p = 0.60). Union was obtained in all cases. Reduction was considered good in 50 cases, there were 8 cases of union in varus and 4 in valgus. Conclusions. This procedure makes it possible to obtain early satisfactory functional results and helps rehabilitation as it limits postoperative mobility to a lesser degree than other techniques; it is also less aggressive than open reduction and osteosynthesis and has a low complication rate

Distinct HLA class II alleles determine antibody response to vaccination with hepatitis B surface antigen.

Major histocompatibility complex (MHC) determinants control antibody production in response to protein antigens. Vaccination with hepatitis B surface antigen (HBsAg) frequently fails in hemodialyzed patients, but the genetic factors that modulate humoral responsiveness are poorly characterized. We studied the distribution of HLA class II alleles in 415 hemodialyzed Caucasian patients who received a full course of HBsAg vaccination, using class II oligotyping after genomic amplification of the DRB1 and DQB1 loci. Phenotype frequencies were compared in 114 non responders (anti-HBs antibodies < or = 10 SI units/liter), 301 responders (anti-HBs antibodies > 10 units/liter) and 471 healthy controls. DRB1*01 (DR1) and DRB1*15 (DR15) frequencies were lower in nonresponders than in responders and controls (DR1, 12.3% vs. 22.9% and 24.8%, respectively; DR15, 14% vs. 22.9% and 25.1%), while DRB1*03 (DR3) and DRB1*14 (DR14) frequencies were higher (DR3, 32.5% vs. 16.6% and 25.3%, respectively; DR14, 9.6% vs. 3% and 6.6%). Overall, 44.5% of DR3 or DR14 patients were nonresponders, compared to 18.1% of DR1 or DR15 patients (P = 0.0001). In conclusion the humoral response to HBsAg vaccine is influenced by class II allelic variants, which differ in their capacity to bind and present peptides to T lymphocytes.

Identification of fatty acids in edible wild plants by gas chromatography.

The total lipidic content and the distribution of fatty acids in twenty edible wild plants in S.E. Spain was determined by GC. The lipidic content was higher than usual in the common vegetables. The high ratio of the omega 3 series of unsaturated fatty acids relative to the omega 6 series demonstrates the good nutritional qualities of these plants.

HLA genetic heterogeneity of hepatitis B vaccine response in hemodialyzed patients.

Major histocompatibility complex (MHC) determinants are critical to the induction or suppression of immune response and have been shown to control the ability to produce antibodies in response to protein antigen. Hepatitis B vaccine commonly fails among patients with renal failure, but genetic factors that modulate response to this vaccination are not yet characterized. The availability of HLA Class II genotyping by hybridization with specific oligonucleotidic probes, following DNA amplification by the polymerase reaction (PCR), has made the analysis of HLA class II loci a reliable and practical approach. Antibody response to HBs and HLA class II oligotyping were assessed among 203 hemodialyzed patients having received a full course of vaccination. Twenty-two percent (N = 45) produced less than 10 IU (radioimmunoassay) of anti-HBs antibodies following the fourth injection. These nonresponder patients had a significantly decreased frequency of the DR2 haplotype compared to responder patients or to a group of 405 normal controls (8.9% vs. 21.5% and 26.2%, P < 0.01). The frequency of the DR3 haplotype was not increased among subjects with lower response. No significant difference appeared in the responder group. These results argue in favor of the presence of HLA-linked immune response gene(s) controlling humoral response to HBs antigen, rather than in favor of the presence of an immune suppressive gene.