Presencia de anticuerpos antifosfolípidos en niños con fiebre y petequias / Presence of antiphospholipid antibodies in children with fever and petechiae

Introducción: La presencia de un tiempo de cefalina (APTT) alargado en niños con fiebre y petequias es un hallazgo descrito en la bibliografía. La causa de esta alteración se desconoce, pero se postula que puede deberse a la formación de anticuerpos antifosfolípidos (Ac AFL). El objetivo de este estudio es determinar si el alargamiento del APTT se asocia con la formación Ac AFL. Pacientes y métodos: Estudio observacional, prospectivo, de casos y controles, realizado en niños que consultaron por fiebre y petequias en el servicio de urgencias de un hospital de tercer nivel durante un periodo de 13 meses. Se recogieron variables epidemiológicas, clínicas y analíticas. Se describieron las características de los grupos con APTT alargado y normal, y se comparó la asociación entre las concentraciones de los diferentes anticuerpos y el APTT. Resultados: Se incluyeron 36 pacientes, 12 casos y 24 controles. No se encontraron diferencias significativas respecto a la positividad de Ac AFL entre los casos y los controles (odds ratio [OR]= 1,67; intervalo de confianza [IC] del 95%: 0,31-9,04). No se observó ninguna asociación entre los diferentes tipos de anticuerpos y el APTT, cuyos coeficientes de regresión fueron de 0,04 seg (IC del 95%: -0,31 a 0,40) para anticardiolipina IgG, de 1,11 seg (IC del 95%: -1,24 a 3,46) para la IgM, y de -0,02 seg (IC del 95%: -0,35 a 0,31) y 0,64 seg (IC del 95%: -1,40 a 2,68) para antibeta 2 GPI, IgG e IgM, respectivamente. Conclusión: Ante los resultados de nuestro estudio, no podemos concluir que el alargamiento de APTT se relacione con la presencia de Ac AFL (AU)

Introduction: The presence of a longer time of cephalin (APTT) extended in children who come to emergency department with fever and petechiae is a result previously described in the literature. The cause of this alteration in coagulation is unknown, it is presumed that may be due to the formation of antiphospholipids antibodies. The aim of this study is to determine if the length of APTT is associated to the formation of antiphospholipids antibodies. Patients and methods: Observational, prospective case-control study in children who consulted for fever and petechiae in the emergency department of a tertiary hospital over a 13-month period epidemiological; clinical and laboratory variables were collected. The characteristics of groups with elongated and normal APTT were described and the association between concentrations of different antibodies and APTT were compared. Results: 36 patients, 12 cases and 24 controls, were included. No significant differences were found regarding the positivity of antiphospholipid antibodies between cases and controls (OR= 1.67; 95%CI: 0.31 to 9.04). No association was observed between the different types of antibodies and APTT, resulting regression coefficients in 0.04 s (95%CI: -0.31 to 0.40) for cardiolipin IgG, 1.11 s (95%CI: -1.24 to 3.46) for IgM and -0.02 s (95%CI: -0.35 to 0.31) and 0,64 s (95%CI: -1.40 to 2.68) for antibeta 2 GPI, IgG and IgM, respectively. Conclusion: Given the results of our study we can not conclude that the elongation of APTT is related with the presence of antiphospholipids antibodies (AU)

Protective effect of quercetin against in vitro erythrocyte rheology alterations produced by arsenic.

Humans are exposed to heavy metals such as arsenic (As), through contaminated food and drinking water. The effect of As on RBC membrane is one of the most important biological effects. In a previous work, we have studied the AsVin vitro effect on erythrocytes biophysical properties discovering alterations regarding aggregability deformability, cell morphology, membrane fluidity and osmotic response. We have also observed that the presence of the metal produces an oxidative stress in RBCs that might be the origin of rheological impairment. In the present work we analyzed RBCs rheological properties associated with membrane fluidity and lipid peroxidation in presence of As and quercetin (Qc). From our results we can conclude that RBCs treatment with Qc is efficient to prevent the impairment of the mechanical properties of the cell membrane produced by the As, through oxygen reactive agents in the membrane structure, mainly on the lipids. This protective effect is observed in the preservation of the erythrocytes rheological properties and consequently in the maintenance of an appropriate blood flow, specially in the small vessels in the peripheral circulation.

Capnografía no invasiva en la bronquiolitis aguda: utilidad clínica en urgencias / Use of noninvasive capnography in acute bronchiolitis: clinical utility in emergency

Objetivo: Analizar la utilidad de la capnografía no invasiva, o medición del dióxido de carbono espirado (EtCO2), como herramienta para evaluar la gravedad clínica de pacientes con bronquiolitis aguda que acuden a urgencias. Material y métodos: Estudio longitudinal, prospectivo y observacional, en el que se incluyeron lactantes menores de 18 meses que acudían al servicio de urgencias por bronquiolitis aguda, durante 1 año. Se determinaron los valores de EtCO2 con cánulas nasales por absorción de infrarrojos (Oridion Microcap R) y se recogieron distintas variables epidemiológicas y clínicas de los pacientes. Resultados: Se estudiaron 93 pacientes, un 59% varones, con una media de edad de 5,8 meses (desviación estándar [DE]= 4,2). El 80% fueron bronquiolitis leves y el 20% moderadas. No se encontraron diferencias significativas entre los valores de capnografía de ambos grupos (p= 0,96). Los valores de EtCO2 siguieron una distribución normal, con una media de 27,5 mmHg (DE= 5,34). El coeficiente de correlación entre el EtCO2 y la puntuación de gravedad fue de 0,01 (p= 0,92). Conclusiones: No se ha encontrado ninguna asociación estadísticamente significativa entre el valor de la capnografía y la gravedad de la bronquiolitis, por lo que esta herramienta no parece útil como factor pronóstico de gravedad (AU)

Introduction: This is the first study of noninvasive capnography (EtCO2) performed in nonintubated patients with acute bronchiolitis that analyzes the value of EtCO2 with clinical severity. Material and methods: We present a prospective and observational study that includes infants under 18 months who were attended over one year at Emergency Care for acute bronchiolitis. EtCO2 was determined by nasal prongs with infrared absorption (Oridion Microcap R). There were collected epidemiological and clinical variables of patients. Results: We studied 93 patients, 59% male, mean age of 5.8 months (SD 4.2). 80% were mild bronchiolitis and 20% moderate. There was no significant difference between this groups (p=0.96). EtCO2 values followed a normal distribution with a mean of 27.5 mmHg EtCO2 (SD 5.34). The correlation coefficient between EtCO2 and value of severity score was 0.01 (p= 0.92). Conclusions: We found no statistically significant association between the value of capnography and severity of bronchiolitis. This tool does not seem useful as a prognostic factor of severity (AU)

Arsenic intoxication, a hemorheologic view.

Arsenic (As) is a toxic semi-metal of wide distribution in nature. People living in regions where drinking water contains large quantities of arsenic, have an unusually high likelihood of developing blood-vessel diseases, but little is known about the mechanisms involved, i.e. the blood rheologic alterations that would contribute to the circulatory obstruction. Erythrocytes are the main target cells for arsenic compounds systemically absorbed and their cell membrane is the first place against the toxic. In this paper we have examined the in vitro effect of arsenic (As(V)) on the rheologic properties of human erythrocytes in relation with membrane fluidity and internal microviscosity. According to our present results, As(V) treatment produces oxidative degradation of membrane lipids and alteration of internal microviscosity. These red blood cells (RBCs) membrane and cytoplasmic structural damage consequently alters RBCs rheologic properties: an alteration of the RBCs discoid shape to stomatocytes, a diminution of erythrocyte deformability and an enhancement of osmotic fragility and cell aggregability. These effects impaired blood fluid behaviour that contribute to obstruct peripheral circulation and provides anemia, both clinic evidences typical of arsenic cronic intoxication.

Conducta ante los estados hipertensivos del embarazo / Management of hypertension in pregnancy

Los estados hipertensivos del embarazo son unconjunto de desórdenes que acontecen durante la gestacióncuyo nexo común es la hipertensión. Deben serdestacados dada su implicación en la morbimortalidadmaterna y neonatal.Se realiza una clasificación de los diferentes estadoshipertensivos poniendo especial interés en la preeclampsia.En el texto se definen los síntomas y signosde la enfermedad y se realiza un diagnóstico diferencialentre enfermedades que debemos descartar. Es de interésidentificar las gestantes con preeclampsia y todavíaresulta de mayor interés descartar en ellas algún criteriode gravedad ya que esto nos obligará a realizar unmanejo diferente.A lo largo del texto, se adjuntan las indicacionesy el momento de finalización de la gestación. De igualforma se detallan los controles que deben realizarse sise opta por una conducta expectante en beneficio delprematuro. Se detallan las diferentes opciones terapeúticasantihipertensivas así como el tratamiento profilácticode la eclampsia con sulfato de magnesio.Destacamos por su interés el Síndrome de HELLPy la eclampsia como complicaciones. Se describe eltratamiento y la conducta que se debe tomar en la gestación(AU)

Hypertensive states of pregnancy are a set of disordersthat occur during gestation whose common nexusis hypertension. They must be given special emphasisdue to their implication in maternal and neonatal morbidityand mortality.A classification is made of the different hypertensivestates, with special emphasis placed on preeclampsia.This article defines the symptoms and signs of thedisease and a differential diagnosis is made amongstdiseases that must be ruled out. It is important to identifyexpectant mothers with preeclampsia, and it is ofeven greater importance in such cases to rule out somecriterion of seriousness, as this will enable a differentmanagement to be carried out.The article includes the indications and the momentwhen the pregnancy finalises. Similarly, it detailsthe controls that must be made if an expectant managementis chosen for the benefit of the premature baby.The different anti-hypertensive therapeutical optionsare detailed, as well as the prophylactic treatment ofeclampsia with magnesium sulphate.Because of their intrinsic interest, we draw specialattention to the HELLP syndrome and to eclampsia ascomplications. The treatment and conduct that must befollowed in gestation is described(AU)

In vitro effect of aluminium upon erythrocyte membrane properties.

The link between aluminium (Al(III)) and a range of disorders in organisms (plants and animals including human beings) has been stated in diverse studies. As regards as human beings in particular, there are numerous studies on this metal's toxicity in relation to pathological processes. Only few references to the metal's effect upon cell rheological properties can be found. In this study, we present evidence for alterations in the rheological properties of cells as consequence of the Al(III)'s interaction with human red blood cell membrane. Al(III) could damage membrane functions of the red blood cell by favouring lipid peroxidation reactions due to the presence of Fe(II) as an initiator. The metal's effect on lipid bilayer, and probably on the cytoskeleton as well, would constitute the cause for the impaired erythrocyte rheology.

Treatment of chronic he1patitis C genotype 1 with peginterferon-alpha2a (40 kDa) plus ribavirin under routine clinical practice in Spain: early prediction of sustained virological response rate.

BACKGROUND: Sustained virological response rates of up to 52% have been obtained with peginterferon alpha2a (40 kDa) plus ribavirin in patients suffering from chronic hepatitis C genotype 1 in randomized-controlled trials. AIM: To assess early virological response and its clinical utility in predicting an sustained virological response in patients suffering from chronic hepatitis C genotype 1 in routine clinical practice in Spain. METHODS: Treatment-naïve patients received pegylated interferon alpha2a (40 kDa) 180 microg/week plus ribavirin 1000/1200 mg/day for 48 weeks, and were followed for a further 24 weeks. Overall, 475 patients received at least one dose of medication and were included in the efficacy population. RESULTS: The overall sustained virological response rate was 48%. Of those with week 12 virological data, 83% had an early virological response. The negative predictive value of an early virological response was 93%. CONCLUSION: If sustained virological response is the goal, a treatment-decision based on a 12-week evaluation during routine clinical practice is feasible.

Tratamiento conservador del embarazo ectópico cornual / Conservative treatment of cornual ectopic pregnancy

El embarazo cornual es una forma infrecuente de embarazo ectópico. El uso de la ecografía vaginal permite hacer un diagnóstico temprano y realizar un tratamiento conservador con metotrexato. La histeroscopia se puede utilizar como técnica complementaria en el seguimiento de estas pacientes. Presentamos 3 casos de embarazo ectópico cornual atendidos en nuestro hospital en el plazo de un año. La introducción de la ecografía vaginal permite hacer un diagnóstico temprano de este tipo de embarazos y plantear un tratamiento conservador con metotrexato, si la situación hemodinámica de la paciente lo permite. De los 3 casos que presentamos, 2 tuvieron una evolución favorable con metotrexato. En el tercer caso se produjo una rotura uterina a pesar del metotrexato y fue necesario realizar una resección cornual de urgencia

Cornual pregnancy is and infrequent type of ectopic pregnancy. With the use of transvaginal ultrasounds we can make an earlier diagnostic and try a conservative treatment with metotrexate. The hysteroscopy can be used as a complementary technique in the following of these patients. We present three cases of cornual ectopic pregnancies diagnosticated in our hospital during a year. With the use of transvaginal ultrasound we can made and early diagnosis and a conservative treatment with methotrexate if the hemodinamyc situation of de patient is good. In two of the cases we observed a satisfactory evolution with the methotrexate. In the third case there was a rupture in the uterus in addition of the methotrexate, and an emergency surgery was needed

[Virology, diagnostic tests, epidemiology and transmission mechanisms of hepatitis C virus infection]. / Virología, pruebas diagnósticas, epidemiología y mecanismos de transmisión del VHC.

The hepatitis C virus is a human virus, classified within a third type (Hepacivirus) of the Flaviviridae family. It is a spherical virus, of approximately 50 nm in diameter, with a glycoprotein covering that contains lipids, and its genome is a simple chain RNA molecule. It is characterised by a high degree of genomic heterogeneity, whose evolutionary consequence in the long term is the appearance of genetically different viral groups, genotypes and quasispecies. There are different diagnostic techniques for detecting hepatitis C virus infection. Serological assays: the detection of specific IgG against HCV by means of enzyme immunoassays is the most practical method for diagnosing infection by this virus. Supplementary immunblot tests are employed to confirm the specificity of the results of the EIA test. Molecular assays: qualitative and quantitative techniques have been developed for detecting RNA-HCV, based on the direct detection of the virions. The pathogeny of hepatitis C is not well understood. Its world prevalence is estimated at some 3%, which is why routine screening for its detection is not recommended. HCV transmission basically occurs through percutaneous exposure to infected blood, with higher rates observed in imprisoned persons, vagabonds, intravenous drug addicts, haemophiliacs and patients on haemodialysis. Although it can be transmitted sexually, it seems that this path is not very efficient, with a greater prevalence observed in persons with multiple sexual partners. Vertical transmission is estimated at some 2%, reaching 20% in cases of maternal coinfection with HIV.

PA subunit from influenza virus polymerase complex interacts with a cellular protein with homology to a family of transcriptional activators.

The PA subunit of the influenza virus polymerase complex is a phosphoprotein that induces proteolytic degradation of coexpressed proteins. Point mutants with reduced proteolysis induction reconstitute viral ribonucleoproteins defective in replication but not in transcriptional activity. To look for cellular factors that could associate with PA protein, we have carried out a yeast two-hybrid screen. Using a human kidney cDNA library, we identified two different interacting clones. One of them was identified as the human homologue of a previously described cDNA clone from Gallus gallus called CLE. The human gene encodes a protein of 36 kDa (hCLE) and is expressed ubiquitously in all human organs tested. The interaction of PA and hCLE was also observed with purified proteins in vitro by using pull-down and pep-spot experiments. Mapping of the interaction showed that hCLE interacts with PA subunit at two regions (positions 493 to 512 and 557 to 574) in the PA protein sequence. Immunofluorescence studies showed that the hCLE protein localizes in both the nucleus and the cytosol, although with a predominantly cytosolic distribution. hCLE was found associated with active, highly purified virus ribonucleoproteins reconstituted in vivo from cloned cDNAs, suggesting that PA-hCLE interaction is functionally relevant. Searches in the databases showed that hCLE has 38% sequence homology to the central region of the yeast factor Cdc68, which modulates transcription by interaction with transactivators. Similar homologies were found with the other members of the Cdc68 homologue family of transcriptional activators, including the human FACT protein.

[Sexuality in neurological patients. The nurse's intervention]. / Sexualidad en el paciente neurológico. Intervención enfermera.

Dealing with neurological patients' sexual problems is a task which nurses can not forget and treat lightly or not at all. After a brief resume of the biological and physical factors involved in controlling the nervous system in regards to sexuality, as well as recent epidemiological studies about sexual disfunction in the neurological patient, we propose a model for nurses to follow. The objectives of this model are to serve as a nursing guide and to stimulate future research on the nurse's role in sexuality.

[Modulation of P-fimbriation by ciprofloxacin in uropathogenic Escherichia coli]. / Modulación de la fimbriación P por ciprofloxacina en Escherichia coli uropatógena.

BACKGROUND: The aim of this study was to determine the effect of ciprofloxacin at subinhibitory concentrations on the expression of P fimbriae of uropathogenic Escherichia coli. Thirty-nine strains of Escherichia coli isolated from out patients with urinary tract infection were studied. Thirty-nine of these strains had been previously characterized as P-fimbriated and the remaining non fimbriated strain was used as a negative control. METHODS: Fimbriation was quantitatively studied by electron microscope observation of the strains before and after treatment. To determine possible qualitative variations in the fimbrial proteins and in the external membrane (OMPs), extraction and electrophoretic separation was performed in polyacrylamide gels. RESULTS: No qualitative differences were observed in the OMPs profile and fimbrial proteins induced by ciprofloxacin in any of the strains studied. However, electron microscopic observation generally showed a decrease in the percentage fimbriated bacterial cells by the antimicrobial effect. CONCLUSIONS: The mechanism of action of ciprofloxacin at subinhibitory doses may correspond to a process of fimbrial protein synthesis inhibition secondary to the initiation of general repair mechanism of the cell exposed to the antimicrobial and not to a process of specific mutations which qualitatively affect fimbrial protein composition.

[Dysphagia as an unusual form of presentation of malignant pleural mesothelioma]. / Disfagia como forma de presentación inusual en mesotelioma pleural maligno.

Dysphagia is an unusual presenting symptom as of extradigestive tumors. Malignant mesothelioma, is a rare tumor localized in the pleural cavity in 80% of all cases and it rarely appears with dysphagia as first symptom. We describe the case of a 74-year-old woman admitted with progressive dysphagia for solid and liquid food, atypical epigastric pain, with in conclusive endoscopic and radiologic studies. Nuclear Magnetic Resonance established the diagnostic suspicion of malignant mesothelioma which was confirmed by the histologic study of a biopsy taken by thoracotomy. We think of interest to report this case of paraesophageal mesothelioma because of its unusual localization and presentation.

[Complications and possible risk factors in endoscopic polypectomy of the colon]. / Complicaciones y eventuales factores de riesgo en la polipectomía endoscópica del colon.

We review the incidence of iatrogenic complications in a serie of 661 patients who underwent endoscopic polypectomy, performed by the same team of endoscopists and using similar technique. We discuss the role of age, sex, associated diseases, coagulation abnormalities and polyp features (size, location, shape and malignancy) in the development of complications. Five severe complications (0.75%, 3 hemorrhages and 2 perforations) were detected. Two patients required blood transfusion and two other patients surgical treatment. Recovery was successful in all patients. In eight patients (1.21%) mild complications which did not required further treatment were present. According to previously published data, these results are satisfactory. Polyp size proved to be the only risk factor with statistical significance; 23.36 +/- 14.17 mm. in complicated polypectomies vs 8.12 +/- 4.21 mm. in non-complicated cases (p less than 0.001). The remaining parameters analyzed showed no significance and therefore no predictive value.

[Primary biliary cirrhosis in Navarra]. / Cirrosis biliar primaria en Navarra.

50 cases of PBC registered in Navarra during 1974-1987 were studied retrospectively. 38% of the diagnosis were carried out in the non-symptomatic period. There were no histological differences between symptomatic (2.24 +/- 1.16) periods. In the first group the delay in diagnosis was very high: 28.21 months, the jaundice being followed by itching of 11.65 months duration. The rate of PBC has increased progressively, rising to a global incidence of 25.15/million and 78.03/million for women over 25 years old. There figures are 3 and 9 times higher than those published in spanish and most foreign literature. We did not find any significant differences between the several health service areas in Navarra, nor between rural or urban areas. Our paper brings to the fore this question: is Navarra an area of especial prevalence of PBC or does it simply offer better diagnosis conditions?