[Modification of the immune response in the elderly with nutritional treatments]. / Modificación de la respuesta inmune en los ancianos con tratamientos nutricionales.

The aging associates to it unites alteration of the immune response, this is well documented. This alteration can contribute to much of the illnesses associated to the age like repetition infections, cancer and illnesses autoinmunes. Is in the immunity mediated by cells where the main dysfunction resides, although with accuracy it is not clarified which is the intimate cause that produces it, although certainly the smallest presence in a co-estimulative of the recognition and the immune response as the receiver CD28, seem to play a key paper between to the descent of the thymic activity. The relationship between immunity and nutrition is known, as well as the high nutritional deficit prevalence in the elderly. In this work we pass reviews to that published in relation to the possibilities of improving the immune response in the elderly with nutritional treatments.

Modificación de la respuesta inmune en los ancianos con tratamientos nutricionales / Modification of the immune response in the elderly with nutritional treatments

Está bien documentado que se produce una alteración de la respuesta inmune asociada al envejecimiento. Este declinar puede contribuir a mucha de las enfermedades asociadas a la vejez como infecciones de repetición, cáncer y enfermedades autoinmunes. Es en la inmunidad mediada por células donde radica la principal disfunción, aunque con exactitud no está aclarada cual es la causa íntima que la produce, aunque ciertamente la menor presencia de un coestimulador del reconocimiento y la respuesta inmune como el receptor CD28, parece jugar un papel clave junto al descenso de la actividad tímica. La relación entre inmunidad y nutrición es conocida, así como la alta prevalencia de déficit nutricionales en los ancianos. En este trabajo pasamos revista a lo publicado en relación a las posibilidades de mejorar la respuesta inmune en el anciano con tratamientos nutricionales (AU)

The aging associates to it unites alteration of the immune response, this is well documented. This alteration can contribute to much of the illnesses associated to the age like repetition infections, cancer and illnesses autoinmunes. Is in the immunity mediated by cells where the main dysfunction resides, although with accuracy it is not clarified which is the intimate cause that produces it, although certainly the smallest presence in a co-estimulative of the recognition and the immune response as the receiver CD28, seem to play a key paper between to the descent of the thymic activity. The relationship between immunity and nutrition is known, as well as the high nutritional deficit prevalence in the elderly. In this work we pass reviews to that published in relation to the possibilities of improving the immune response in the elderly with nutritional treatments (AU)

Síndrome RS3PE como forma de presentación de arteritis de células gigantes

No disponible

Presentación simultánea de actinomicosis y carcinoma faríngeo metastásico / Coincidental occurrence of actinomycosis and metastatic oropharinx cancer

Si bien es frecuente que la actinomicosis se manifieste clínicamente como un cuadro seudotumoral, la presentación sincrónica de actinomicosis y cáncer es excepcional. La actinomicosis puede aparecer como una infección oportunista que complica el tratamiento antineoplásico, o bien el cáncer puede actuar como factor etiopatogénico favorecedor de la actinomicosis. Describimos un paciente con cáncer orofaríngeo avanzado (T4 N1 M0) que en el momento del diagnóstico presentaba una infección actinomicótica asociada. Lo excepcional de la asociación y la importancia de su detección precoz creemos justifican la comunicación del caso (AU)

[Community-acquired bacteremic pneumonia in the elderly]. / Neumonía bacteriémica de origen comunitario en el anciano.

OBJECTIVE: To assess the risk factors associated with the development of bacteremic community-acquired pneumonia in the elderly (BCPE) and its clinical and prognostic aspects. METHODS: We studied 36 BCPE and 72 patients with community-acquired pneumonia and negative blood cultures as control group. RESULTS: The presence of the following risk factors was more common in cases than in control subjects: alcoholism, malnutrition, diabetes and chronic renal insufficiency. The multivariate analysis demonstrated that the malnutrition (OR:3.3; CI95%:1.4-7.8) and diabetes (OR:2.5; CI95%:1.1-6.7) were independent risk factors significantly related to the development of BCPE. The presence of chills, tachycardia, tachypnea, decreased level of consciousness and hypotension blood pressure were more common in case subjects. The microbial agents implicated more frequently were S. pneumoniae and gram-negative bacilli. The bilateral involvement and two or more affected lobes on chest radiograph were more common in the cases of BCPE. The mortality rate was higher in case subjects (22.2% vs. 2.8%; p = 0.001). CONCLUSIONS: We stress the relevance of the bacteremia as prognostic factor in the community-acquired pneumonia in the elderly.

[The cost effectiveness of the study of the familial contacts of tuberculosis patients coinfected with the human immunodeficiency virus]. / Rentabilidad del estudio de los contactos familiares de enfermos con tuberculosis coinfectados por el virus de la inmunodeficiencia humana.

The investigation of contacts of patients with tuberculosis is a highly cost-effective measure to detect new cases of disease and infected individuals; nevertheless, its efficacy has not been contrasted with persons living with patients with tuberculosis (TB) coinfected with HIV. A total of 152 family contacts were studied corresponding to 84 HIV-positive tuberculosis patients. As a control group, 516 persons living with HIV-negative TB patients were included. Contacts were classified according to the bacteriologic status of the index case (IC): group I, contacts of patients with negative bacterioscopy and positive culture of respiratory specimens; group II, contacts of patients with negative bacterioscopy and positive culture of respiratory specimens, and group III, contacts of pulmonary and/or extrapulmonary TB patients with negative bacterioscopy and culture. Among IC coinfected with HIV there was a higher percentage of extrapulmonary clinical forms and therefore a lower proportion of bacillary forms, which accounted for a lower rate of infection among contacts of HIV-positive patients than among contacts of HIV-negative patients (20.4% vs 48.8%; OR: 3.7; 95% CI: 2.4-5.9). After controlling for bacteriologic status of the IC, differences remained when bacillary (group I) of HIV-coinfected patients were compared with those of patients not coinfected with HIV (35.9% vs 52.3%; OR: 2.1%; 95% CI: 1.2-5.9). Overall, 28 new TB cases were detected (4.2% of the total of studied persons living with TB patients) with no differences among contacts of both groups. The lower rate of infections among persons living with HIV-positive patients might be due not only to a lower number of pulmonary forms in HIV-coinfected IC and therefore less bacillary forms but also to a lower degree of crowding and a higher protection against exposure to their contacts.

Neumonía bacteriémica de origen comunitario en el anciano / Bacteremic community-acquired pneumonia in the elderly

Objetivos: Para analizar los aspectos clínicos y pronósticos y los factores asociados al desarrollo de la neumonía bacteriémica de origen comunitario en el anciano (NBA). Métodos: Estudiamos 36 casos de NBA diagnosticados en nuestro centro en un periodo de 2 años. Se incluyó 2 pacientes, por cada caso de NBA, con neumonía adquirida en la comunidad con hemocultivo repetidamente negativo. Resultados: Los factores asociados al desarrollo de bacteriemia fueron etilismo crónico, malnutrición, diabetes mellitus e insuficiencia renal crónica. Tras análisis multivariante sólo la malnutrición (OR: 3,3; IC95%: 1,4-7,8) y la diabetes mellitus (OR: 2,5; IC95%: 1,1-6,7) se mostraron como factores de riesgo independientes. Los pacientes con NBA presentaron mayor proporción de escalofríos, taquicardia, taquipnea, disminución del nivel de conciencia e hipotensión arterial. Los gérmenes más frecuentemente aislados fueron S. pneumoniae y bacilos gram negativos. La NBA se asoció con afectación radiográfica de 2 o más lóbulos pulmonares, y a la presencia de infiltrados bilaterales. La mortalidad fue mayor en los casos de NBA (22,2% vs. 2,8%; p<0,001). Conclusiones: Se destaca la importancia de la bacteriemia como factor pronóstico en la neumonía de la comunidad del anciano (AU)

[Simultaneous presentation of actinomycosis and metastatic pharyngeal carcinoma]. / Presentación simultánea de actinomicosis y carcinoma faríngeo metastásico.

Although actinomycosis frequently presents as a pseudotumoral syndrome, the simultaneous diagnosis of actinomycosis and cancer is exceptional. Actinomycosis can occur as an opportunistic infection secondary to the antineoplastic treatment and even the cancer itself can act as facilitating factor. We report a patient who was diagnosed simultaneously of advanced oropharinx cancer (T4-N1-M0) and actinomycosis associated to the tumoral mass. This exceptional association and the importance of its early diagnosis justify the communication of the case.

[Percutaneous liver biopsy: comparative study on the efficacy of and tolerance to the automatic tru-cut technique]. / Biopsia hepática percutánea: estudio comparativo sobre la eficacia y tolerancia de la técnica de tru-cut automática.

Percutaneous liver biopsy (PLB) is an useful tool in accurately diagnosing difuse hepatopathy and systemic procedures like fever of unknown origin (FUO) and human immunodeficiency virus infection. Present job compares two different PLB procedures, automatic tru-cut needle versus Menghini needle. We have achieved 143 PLBs,74 of them through Menghini needle and 69 with automatic tru-cut technique. No differences were observed about diagnostic efficiency and secondary complications but we have noted a significant presence of pain reactions when Menghini needle is used. So we conclude that tru-cut technique is as safe as Menghini needle with the same diagnostic efficiency and better tolerance.