The effects of physical activity on the modulation of gut microbiota composition: a systematic review.

Exercise induces many health benefits, preventing or treating diseases. On the other hand, the intestine houses trillions of microbes with the ability to influence the normal physiology of the organism. The intestinal microbiota is immensely diverse, varies between individuals, and can fluctuate according to various factors, including physical activity. In this sense, the aim of this systematic review is to search through the recent knowledge, in order to elucidate the roles played by different exercise modalities on modulation of the intestinal microbiota of adults. A literature search was performed in the PubMed, SCOPUS and Web of Science databases. The main inclusion criteria were randomised controlled trials involving exercise and microbiota in adults. The initial search identified 1,103 publications of which 13 were finally included. The heterogeneity of the training parameters used in the studies, statistical analyses, and sequencing methods did not allow us to carry out a meta-analysis. However, the results tend to show that modulation of the gut microbiome is related to the type of exercise, the intensity and the time of intervention, where these changes are more significant at the level of specific microbial populations than richness and diversity indices.

Resultados de la ablación con catéter con mínimo o nulo empleo de fluoroscopia en pacientes pediátricos con taquiarritmias supraventriculares / Results of catheter ablation with zero or near zero fluoroscopy in pediatric patients with supraventricular tachyarrhythmias

Introducción y objetivos: La exposición a radiación ionizante en los procedimientos de ablación conlleva riesgos para la salud, sobre todo en pacientes pediátricos. Nuestro objetivo es comparar la seguridad y la eficacia de la ablación guiada por un sistema de navegación intracardiaca no fluoroscópica (SNINF) con las de la ablación guiada exclusivamente por fluoroscopia en pacientes pediátricos. Métodos: Se analizaron los resultados de la ablación con catéter en pacientes pediátricos con vías accesorias de riesgo o taquicardias supraventriculares remitidos a nuestro centro en un periodo de 6 años. Se compararon los procedimientos guiados solo por fluoroscopia (grupo A) y los guiados por SNINF (grupo B). Resultados: Se analizaron 120 procedimientos de ablación en 110 pacientes (edad, 11±3,2 años; el 70% varones), 62 procedimientos en el grupo A y 58 en el grupo B. No se encontraron diferencias significativas entre ambos grupos en éxito del procedimiento (el 95% del grupo A y el 93,5% del grupo B; p=0,53), complicaciones (el 1,7 frente al 1,6%; p=0,23) y recurrencia (el 7,3 frente al 6,9%; p=0,61). Sin embargo, el tiempo de fluoroscopia (mediana, 1,1 frente a 12 min; p<0,0005) y el tiempo de ablación (mediana, 96,5 frente a 133,5 s; p=0,03) fueron menores en el grupo B. La presencia de cardiopatía se comportó como un predictor independiente de recurrencia (p=0,03). Conclusiones: El SNINF para guiar los procedimientos de ablación en pacientes pediátricos reduce el tiempo de exposición a la radiación ionizante. Su empleo generalizado en las ablaciones pediátricas podría reducir el riesgo atribuido a la radiación (AU)

Introduction and objectives: Ionizing radiation exposure in catheter ablation procedures carries health risks, especially in pediatric patients. Our aim was to compare the safety and efficacy of catheter ablation guided by a nonfluoroscopic intracardiac navigation system (NFINS) with those of an exclusively fluoroscopy-guided approach in pediatric patients. Methods: We analyzed catheter ablation results in pediatric patients with high-risk accessory pathways or supraventricular tachycardia referred to our center during a 6-year period. We compared fluoroscopy-guided procedures (group A) with NFINS guided procedures (group B). Results: We analyzed 120 catheter ablation procedures in 110 pediatric patients (11±3.2 years, 70% male); there were 62 procedures in group A and 58 in group B. We found no significant differences between the 2 groups in procedure success (95% group A vs 93.5% group B; P=.53), complications (1.7% vs 1.6%; P=.23), or recurrences (7.3% vs 6.9%; P = .61). However, fluoroscopy time (median 1.1minutes vs 12minutes; P <.0005) and ablation time (median 96.5seconds vs 133.5seconds; P=.03) were lower in group B. The presence of structural heart disease was independently associated with recurrence (P=.03). Conclusions: The use of NFINS to guide catheter ablation procedures in pediatric patients reduces radiation exposure time. Its widespread use in pediatric ablations could decrease the risk of ionizing radiation (AU)

Efficacy and safety of Yttrium-90 radioembolization in the treatment of neuroendocrine liver metastases. Long-term monitoring and impact on survival. / Eficacia y seguridad de la radioembolización con 90Y en el tratamiento de metástasis hepáticas de tumores neuroendocrinos. Seguimiento a largo plazo y repercusión en la supervivencia.

INTRODUCTION AND OBJECTIVE: Neuroendocrine tumors (NETs) debut in 75% of cases with liver metastases (LMNETs), whose therapeutic approach includes surgical resection and liver transplantation, while liver radioembolization with 90 Y-microspheres (TARE) is reserved for non-operable patients usually due to high tumor burden. We present the accumulated experience of 10 years in TARE treatment of LMNETs in order to describe the safety and the effectiveness of the oncological response in terms of survival, as well as to detect the prognostic factors involved. MATERIAL AND METHODS: Of 136 TARE procedures, performed between January 2006 and December 2016, 30 LMNETs (11.1%) were retrospectively analyzed. The study variables were: Tumor response, time to liver progression, survival at 3 and 5 years, overall mortality and mortality associated with TARE. The radiological response assessment was assessed using RECIST 1.1 and mRECIST criteria. RESULTS: An average activity of 2.4 ± 1.3 GBq of 90 Y was administered. No patient presented postembolization syndrome or carcinoid syndrome. There were also no vascular complications associated with the procedure. According to RECIST 1.1 criteria at 6 months, 78.6% presented partial response and 21.4% stable disease, there was no progression or complete response (1 by mRECIST). Survival at 3 and 5 years was 73% in both cases. CONCLUSION: TARE treatment with 90 Y-microspheres in LMNETs, applied within a multidisciplinary approach, is a safe procedure, with low morbidity, capable of achieving a high rate of radiological response and achieving lasting tumor responses.

IL-12 and IL-18 levels in serum and gingival tissue in aggressive and chronic periodontitis.

OBJECTIVE: The aim of this study was to compare the levels of interleukin-12 (IL-12) and IL-18 in gingival tissue and serum between patients with chronic (n = 18) or aggressive periodontitis (n = 12) and healthy subjects (HS) (n = 9). METHODS: Gingival tissue biopsies and serum were obtained from all study subjects. The tissue was homogenized and cytokines IL-12 and IL-18 were quantified by enzyme-linked immunosorbent assay. RESULTS: Interleukin-12 levels in gingival tissue were significantly higher in aggressive periodontitis patients than in HS; serum IL-12 was significantly elevated in aggressive periodontitis relative to both chronic periodontitis (CP) and HS. IL-18 levels in gingival tissue showed no significant differences between the groups. Patients with CP showed significantly elevated levels of serum IL-18 compared with HS; however, the aggressive periodontitis group showed no significant differences with either the CP group or the HS. CONCLUSIONS: Our results showed higher levels of IL-12 in gingival tissue and serum of patients with aggressive periodontitis, and IL-18 was elevated in the serum of CP patients. The patterns of IL-12 and IL-18 are different in chronic and aggressive periodontitis; this finding suggests distinctive mechanisms of immunopathogenesis between these forms of periodontitis.

¿Cómo identificar los efectos adversos en urgencias? Una guía consensuada para el cribado / How to identify adverse events in emergency services? A guide agreed for the screening

Objetivo: Dado que un tercio de los efectos adversos (EA) ocurren antes de la hospitalización, los servicios de urgencias constituyen un lugar idóneo para estimar su incidencia. Nuestro objetivo fue diseñar una guía de cribado para identificación de los EA debidos a la asistencia adecuada a las condiciones de urgencias. Material y métodos: Técnica cualitativa de grupo nominal. Participaron 14 profesionales que analizaron qué factores de riesgo intrínseco, riesgo extrínseco y condiciones de alerta eran los idóneos para cribado de EA en urgencias. Moderada por un especialista en este tipo de técnicas. Resultados: Existió alto consenso en que los EA más frecuentes en urgencias son los relacionados con medicamentos, pruebas diagnósticas e identificación correcta del motivo de urgencia. Se propuso añadir a la guía de cribado abuso de alcohol, problemática social del paciente, deterioro cognitivo y autonomía basal. En relación con los factores de riesgo extrínsecos, apuntaron la necesidad de incluir la realización de cardioversión, punción lumbar o colocación de drenajes. Respecto al formulario de condiciones de alerta, todos los criterios parecieron correctos y adecuados, salvo el relacionado con daño en relación con el parto. Conclusiones: Mediante esta técnica se ha logrado validar unos materiales ya reconocidos y en nuestro país ampliamente utilizados. La guía de cribado se consideró apta con leves modificaciones en algunos factores de riesgo y condiciones de alerta, mientras que respecto al cuestionario Modular Revision Form (MRF2), los profesionales estuvieron de acuerdo con que, en general, es adecuado para la caracterización del EA que se produce en urgencias (AU)

Objective: Since a third of adverse events (AE) occur outside hospital, the Emergency Services are a suitable place to look at their incidence. We considered designing a screening guide, adapted to the conditions of the emergency services, to identify AE. Material and methods: A qualitative technique was applied (nominal group) in which 14 professionals participated. They analysed which factors of intrinsic risk, extrinsic risk, and alert conditions, were suitable for a screening guide of AE in emergency services. The session was chaired by a specialist in these types of techniques. Results: Consensus was high in that the most frequent AE in emergencies were those related to medicines, diagnostic tests and with the correct identification of the reason for emergency. With respect to screening guide, the group proposed adding alcohol abuse, patient social problems, cognitive deterioration, basal autonomy and disability. In relation to extrinsic risk factors, they pointed to the need of including defibrillation, spinal tap or drainage implantation. With respect to the alert conditions form, the professionals agreed in that all the criteria seemed correct and suitable, except for that related to damage relation childbirth or amniocentesis. Conclusions: By using this technique we have managed to validate materials already recognized, and widely used in our country. The screening guide was considered useful, with slight modifications in some risk factors and alert conditions. The professionals agreed that the MRF2 modular questionnaire is appropriate for the characterisation of AE in emergencies (AU)

[How to identify adverse events in emergency services? A guide agreed for the screening]. / ¿Cómo identificar los efectos adversos en urgencias? Una guía consensuada para el cribado.

OBJECTIVE: Since a third of adverse events (AE) occur outside hospital, the Emergency Services are a suitable place to look at their incidence. We considered designing a screening guide, adapted to the conditions of the emergency services, to identify AE. MATERIAL AND METHODS: A qualitative technique was applied (nominal group) in which 14 professionals participated. They analysed which factors of intrinsic risk, extrinsic risk, and alert conditions, were suitable for a screening guide of AE in emergency services. The session was chaired by a specialist in these types of techniques. RESULTS: Consensus was high in that the most frequent AE in emergencies were those related to medicines, diagnostic tests and with the correct identification of the reason for emergency. With respect to screening guide, the group proposed adding alcohol abuse, patient social problems, cognitive deterioration, basal autonomy and disability. In relation to extrinsic risk factors, they pointed to the need of including defibrillation, spinal tap or drainage implantation. With respect to the alert conditions form, the professionals agreed in that all the criteria seemed correct and suitable, except for that related to damage relation childbirth or amniocentesis. CONCLUSIONS: By using this technique we have managed to validate materials already recognized, and widely used in our country. The screening guide was considered useful, with slight modifications in some risk factors and alert conditions. The professionals agreed that the MRF2 modular questionnaire is appropriate for the characterisation of AE in emergencies.

beta-lactam susceptibility of Escherichia coli isolates from urinary tract infections exhibiting different resistance phenotypes.

Susceptibility to beta-lactams was determined in 203 recent Spanish E. coli isolates from urinary tract infections exhibiting different resistance phenotypes: a) susceptible (n = 60); b) quinolone-resistant (n = 45); c) penicillinase (n=64); d) hyperproduction of penicillinase (n=8); e) inhibitor resistant TEM (IRT) (n=18), and f) extended spectrum betalactamase (ESBL) (n=8).Minimum inhibitory concentration (MIC) determination by agar dilution and susceptibility tests for ESBL detection by macrodilution were performed following CLSI recommendations. All the beta-lactams tested showed high activity against susceptible and penicillinase phenotypes, with close to 100 % susceptibility. Hyperproduction of penicillinase increased MIC90 values for all antibiotics except for meropenem, with 100% resistance to cefuroxime and amoxicillin/clavulanic acid, and 100% susceptibility to cefotaxime, piperacillin/tazobactam and meropenem. All the antibiotics, except for amoxicillin/clavulanic acid, exhibited high activity against IRT. Meropenem, cefminox and piperacillin/tazobactam exhibited the highest activity against ESBL, followed by amoxicillin/clavulanic acid. The most active compound among the parenteral antibiotics was meropenem, regardless of the resistance phenotype. Among the oral antibiotics, the most active compound was cefditoren with the exception of ESBL where amoxicillin/clavulanic acid where the MIC90 value was one dilution lower.

â - lactam susceptibility of Escherichia coli isolates from urinary tract infections exhibiting different resistance phenotypes

Susceptibility to â-lactams was determined in 203 recentSpanish E. coli isolates from urinary tract infectionsexhibiting different resistance phenotypes: a) susceptible(n = 60); b) quinolone-resistant (n = 45); c) penicillinase(n=64); d) hyperproduction of penicillinase (n=8); e) inhibitorresistant TEM (IRT) (n=18), and f) extended spectrumbetalactamase (ESBL) (n=8). Minimum inhibitory concentration(MIC) determination by agar dilution and susceptibilitytests for ESBL detection by macrodilution were performedfollowing CLSI recommendations. All the â-lactamstested showed high activity against susceptible and penicillinasephenotypes, with close to 100 % susceptibility.Hyperproduction of penicillinase increased MIC90 values forall antibiotics except for meropenem, with 100% resistanceto cefuroxime and amoxicillin/clavulanic acid, and 100%susceptibility to cefotaxime, piperacillin/tazobactam andmeropenem. All the antibiotics, except for amoxicillin/clavulanicacid, exhibited high activity against IRT. Meropenem,cefminox and piperacillin/tazobactam exhibited thehighest activity against ESBL, followed by amoxicillin/clavulanicacid. The most active compound among the parenteralantibiotics was meropenem, regardless of the resistancephenotype. Among the oral antibiotics, the most activecompound was cefditoren with the exception of ESBL whereamoxicillin/clavulanic acid where the MIC90 value wasone dilution lower (AU)

Se determinó la susceptibilidad a betalactámicos de203 aislados recientes de E. coli procedentes de infeccionesdel tracto urinario en España y que presentaban distintosfenotipos de resistencia: a) susceptible (n = 60);b) resistente a quinolonas (n=45); c) productor de penicilinasa(n=64); d) hiperproductor de penicilinasa (n=8);e) resistente a inhibidores de TEM (IRT) (n=18), y f) productorde betalactamasas de espectro extendido (BLEE)(n=8). La determinación de la concentración mínima inhibitoria(CMI) por dilución en agar y los tests de susceptibilidadpara la detección de BLEE se realizaron siguiendolas recomendaciones del Clinical and Laboratory StandardsInstitute (CLSI). Frente a los fenotipos susceptible yproductor de penicilinasa, todos los betalactámicos ensayadosexhibieron gran actividad, con una sensibilidadcercana al 100% de los aislados. La hiperproducción depenicilinasa incrementó los valores de CMI90 de todos losantibióticos, excepto de meropenem, con un 100% de resistenciaa cefuroxima y amoxicilina/clavulánico y un 100% desensibilidad a cefotaxime, piperacilina/tazobactam y meropenem.Todos los antibióticos, excepto amoxicilina/clavulánico,presentaron gran actividad frente a las cepas IRT.Meropenem, cefminox y piperacilina/tazobactam presentaronla mayor actividad frente a BLEE, seguidas de amoxicilina/clavulánico. Entre los antibióticos parenterales, elcompuesto más activo fue meropenem, con independenciadel fenotipo de resistencia. Entre los antibióticos oralesel compuesto más activo fue cefditoren, excepto frentea las cepas BLEE, donde amoxicilina/clavulánico presentóen un valor de CMI90 una dilución menor (AU)

Evaluation of the in-vitro cidal activity and toxicity of a novel peroxygen biocide: 2-butanone peroxide.

The monomer of 2-butanone peroxide is a novel peroxygen derivative with potential use as biocide in the hospital environment. The aim of this study was to test the biocidal activity of different concentrations of the compound against American Tissue Culture Collection strains from 11 different micro-organisms, including bacteria, mycobacteria, spores, fungi and virus, following the European Standard guidelines. Toxicity tests were also carried out following United States Environmental Protection Agency Standards. 2-Butanone peroxide exhibited biocidal activity at 0.12% against Legionella pneumophila, at 0.5% against Escherichia coli, Pseudomonas aeruginosa and Enterococcus hirae, and at 1% against Staphylococcus aureus after 5 min contact at room temperature. Mycobactericidal activity was obtained at 0.5% after 60 min contact at 20 degrees C, and sporicidal activity was obtained at 4% after 60 min at 40 degrees C. Good fungicidal (against yeasts and moulds) and virucidal (adenovirus and poliovirus) activities were obtained at 0.5% after 60 min contact. Toxicity assessment showed negative results in the acute dermal irritation test, acute eye irritation test and acute oral toxicity test. The skin sensitisation test was negative. The safety profile in the toxicity tests and the basic cidal activity against the strains tested suggest that 2-butanone peroxide in the control of hospital infections.

[Activity of cefpodoxime and other oral beta-lactams against Haemophilus influenzae and Streptococcus pneumoniae with different susceptibilities to penicillin]. / Actividad de cefpodoxima y otros betalactámicos orales frente a Haemophilus influenzae y Streptococcus pneumoniae con distinta sensibilidad a la penicilina.

This study explores the influence on the intrinsic activity of different oral beta-lactams of beta-lactamase production in Haemophilus influenzae and penicillin resistance in Streptococcus pneumoniae. Three substudies were performed: a) a general susceptibility study, analyzing 550 strains received by the Spanish Laboratorio de Referencia de Neumococos throughout February and March 2005; b) a study on the influence of penicillin resistance on the activity of beta-lactams, analyzing 251 penicillin-susceptible strains (MICor=2 mg/l) randomly chosen among those received by the Spanish Laboratorio de Referencia de Neumococos throughout 2005; and c) an H. influenzae susceptibility study analyzing 150 strains received by Instituto Valenciano de Microbiologia throughout 2005. A total of 71% of S. pneumoniae strains were susceptible to penicillin, 21% exhibited intermediate resistance and 8% strains presented full resistance. H. influenzae beta-lactamase production rate was 18.6%. Of the non-beta-lactamase-producing strains, 3% were not susceptible to ampicillin. Cefpodoxime and cefixime exhibited the highest intrinsic activity against H. influenzae, while amoxicillin and cefpodoxime were the most active compounds against S. pneumoniae. All H. influenzae strains were susceptible to oral cephalosporins and amoxicillin/clavulanic acid. The increase in penicillin resistance in S. pneumoniae influenced cefixime, cefaclor and cefuroxime to a higher degree than amoxicillin and cefpodoxime.

Actividad de cefpodoxima y otros betalactámicos orales frente a Haemophilus influenzae y Streptococcus pneumoniae con distinta sensibilidad a la penicilina / Activity of cefpodoxime and other oral beta-lactams against Haemophilus influenzae and Streptococcus pneumoniae with different susceptibilities to penicillin

Estudiamos la influencia de la producción de betalactamasas en Haemophilus influenzae y del grado de sensibilidad a la penicilina en Streptococcus pneumoniae sobre la actividad intrínseca de distintos betalactámicos orales. Realizamos tres subestudios: 1) un estudio general de sensibilidad, analizando 550 aislamientos consecutivos recibidos en el Laboratorio de Referencia de Neumococos durante los meses de febrero y marzo de 2005; 2) un estudio de la influencia de la sensibilidad a la penicilina sobre la actividad del resto de los betalactámicos, analizando la sensibilidad de 251 cepas sensibles a la penicilina (CMI ≤0,06 mg/l), 165 cepas con resistencia intermedia (CMI 0,12-1 mg/l) y 139 resistentes (CMI ≥2 mg/l), elegidas aleatoriamente entre todos los aislamientos recibidos durante el año 2005; y 3) un estudio de sensibilidad de H. influenzae, analizando 150 cepas recibidas por el Instituto Valenciano de Microbiología a lo largo del año 2005. El 71% de las cepas de S. pneumoniae fueron sensibles a la penicilina, el 21% presentaron baja resistencia o resistencia intermedia, y un 8% alta resistencia. La tasa de producción de betalactamasas fue del 18,6% en H. influenzae. El 3% de las cepas no productoras de betalactamasas fueron no sensibles a la ampicilina. La cefpodoxima y la cefixima presentaron la mayor actividad intrínseca frente a H. influenzae, mientras que frente a S. pneumoniae ésta correspondió a la amoxicilina y la cefpodoxima. Mientras que el 100% de las cepas de H. influenzae fueron sensibles a las cefalosporinas orales y a amoxicilina-ácido clavulánico, el aumento de la resistencia a la penicilina en S. pneumoniae afectó en mayor grado a la actividad de la cefixima, el cefaclor y la cefuroxima que a la amoxicilina y la cefpodoxima

This study explores the influence on the intrinsic activity of different oral β-lactams of β-lactamase production in Haemophilus influenzae and penicillin resistance in Streptococcus pneumoniae. Three substudies were performed: a) a general susceptibility study, analyzing 550 strains received by the Spanish Laboratorio de Referencia de Neumococos throughout February and March 2005; b) a study on the influence of penicillin resistance on the activity of β-lactams, analyzing 251 penicillin-susceptible strains (MIC ≤0.06 mg/l), 165 penicillin intermediateresistant strains (MIC 0.12–1 mg/l) and 139 penicillin-resistant strains (MIC ≥2 mg/l) randomly chosen among those received by the Spanish Laboratorio de Referencia de Neumococos throughout 2005; and c) an H. influenzae susceptibility study analyzing 150 strains received by Instituto Valenciano de Microbiología throughout 2005. A total of 71% of S. pneumoniae strains were susceptible to penicillin, 21% exhibited intermediate resistance and 8% strains presented full resistance. H. influenzae β-lactamase production rate was 18.6%. Of the non–β-lactamase-producing strains, 3% were not susceptible to ampicillin. Cefpodoxime and cefixime exhibited the highest intrinsic activity against H. influenzae, while amoxicillin and cefpodoxime were the most active compounds against S. pneumoniae. All H. influenzae strains were susceptible to oral cephalosporins and amoxicillin/clavulanic acid. The increase in penicillin resistance in S. pneumoniae influenced cefixime, cefaclor and cefuroxime to a higher degree than amoxicillin and cefpodoxime

Rotura de aneurisma de arteria poplíteaseis años después de la intervención / Rupture of popliteal artery aneurysm six years after surgery

Introducción. Los aneurismas de arteria poplítea son los aneurismas periféricos más frecuentes. Su principal complicación es la isquemia aguda por trombosis del mismo; su rotura es rara. El caso que presentamos resulta excepcional porque la rotura tuvo lugar más de seis años después de la intervención. Caso clínico. Paciente de 90 años, intervenido en 1996 de un aneurisma poplíteo bilateral; se le practicó ligadura y by-pass, con prótesis de politetrafluroetileno expandido (PTFE) en la pierna derecha y con vena safena invertida en la izquierda. Sigue controles anuales en nuestras consultas, durante los cuales no se han detectado arteriomegalias y se han mantenido permeables las reconstrucciones. En junio de 2002 ingresó de urgencia por presentar gran tumoración en la cara interna del muslo izquierdo, según el paciente, de 2-3 semanas de evolución. No se apreciaba latido ni signos externos de hemorragia. Se practicó angiorresonancia magnética (angio-RM), que informó de `imagen compatible con pseudoaneurisma, posiblemente originado en la zona de la anastomosis proximal del injerto'. Se intervino al paciente y se encontró un falso aneurisma por rotura de la pared del aneurisma en el hueco poplíteo, con indemnidad de las anastomosis. Se practicó una nueva ligadura de la arteria poplítea distal al final del aneurisma, se resecó parcialmente el falso aneurisma, que estaba trombosado, y se envió una muestra a anatomía patológica. Cuatro meses después de la intervención, coincidiendo con tratamiento anticoagulante por sospecha de trombosis venosa poplítea, la tumoración volvió a crecer y en esta ocasión se practicó embolización de ramas distales de la femoral profunda y de la femoral superficial. Un año después, el paciente permanece estable, sin cambios en una nueva angio-RM (AU)

[Stenting without prior dilatation in intracranial stenosis of the internal carotid artery: a case report]. / Colocación de endoprótesis vascular sin dilatacion previa en estenosis intracraneal de la carótida interna. A propósito de un caso.

INTRODUCTION: Recent reports have described the application of coronary stents for the treatment of intracranial stenosis of the internal carotid artery (ICA), above all in patients who do not respond to medical treatment and display advancing neurological symptoms. Stenting in intracranial vascular lesions of the carotid territory has been used almost exclusively in the treatment of the complications due to transluminal angioplasties with balloons. In selected cases and without prior dilatation of the stenosis it would be possible to place a stent. CASE REPORT: We describe a case of intracranial carotid stenting, without previous dilatation, in a 57 year old male patient with multiple arteriosclerotic risk factors. The patient presented neurological symptoms with no response to medical treatment, caused by a stenosis that affected over 70% of the cavernous segment of the right ICA, which was shown up by the arteriographic study. A favourable anatomy and the material used allowed the stent to pass through the stenosis without the need for dilatation. No immediate complications were observed and the carotid artery was seen to be of a normal calibre for stenosis. The brain angiogram also proved to be normal. The patient continues with the medical treatment and has remained neurologically stable throughout the 9 month clinical follow up. CONCLUSION: In certain selected cases, placing an intracranial carotid stent, without previous balloon dilatation, can give good results and prevent the complications that can accompany angioplasty (such as dissection, rupture or embolism)

Colocación de endoprótesis vascular sin dilatación previa en estenosis intracraneal de la carótida interna. A propósito de un caso / Stenting without prior dilatation in intracranial stenosis of the internal carotid artery: a case report

Introducción. Se ha publicado recientemente la aplicación de stents coronarios para el tratamiento de las estenosis de la arteria carótida interna (ACI) intracraneal, sobre todo en pacientes sin respuesta a tratamiento médico y con progresión de los síntomas neurológicos. El stenting en las lesiones vasculares intracraneales del territorio carotídeo se ha usado casi exclusivamente para el tratamiento de las complicaciones debidas a la angioplastia transluminal con balón. En casos seleccionados y sin dilata ción previa de la estenosis podríamos colocar un stent. Caso clínico. Presentamos un caso de stenting carotídeo intracraneal, sin dilatación previa, en un paciente varón de 57 años con múltiples factores de riesgo arterioscleróticos. El paciente presentaba síntomas neurológicos sin respuesta a tratamiento médico, debidos a una estenosis mayor del 70% del segmento cavernoso de la ACI derecha, demostrada en el estudio arteriográfico. La anatomía favorable y el material utilizado permitieron el paso del stent por la estenosis sin necesidad de dilatación. No se observaron complicaciones inmediatas, y se visualizó una arteria carótida de calibre normal de la estenosis y se mostraba un angiograma cerebral normal. El paciente continúa con tratamiento médico y permanece neurológicamente estable en el seguimiento clínico durante 9 meses. Conclusión. En casos seleccionados, la colocación de un stent carotídeo intracraneal, sin dilatación previa con balón, puede ofrecer un buen resultado para evitar las complicaciones de la angioplastia (disección, rotura o embolismo) (AU)

Introduction. Recent reports have described the application of coronary stents for the treatment of intracranial stenosis of the internal carotid artery (ICA), above all in patients who do not respond to medical treatment and display advancing neurological symptoms. Stenting in intracranial vascular lesions of the carotid territory has been used almost exclusively in the treatment of the complications due to transluminal angioplasties with balloons. In selected cases and without prior dilatation of the stenosis it would be possible to place a stent. Case report. We describe a case of intracranial carotid stenting, without previous dilatation, in a 57- year-old male patient with multiple arteriosclerotic risk factors. The patient presented neurological symptoms with no response to medical treatment, caused by a stenosis that affected over 70% of the cavernous segment of the right ICA, which was shown up by the arteriographic study. A favourable anatomy and the material used allowed the stent to pass through the stenosis without the need for dilatation. No immediate complications were observed and the carotid artery was seen to be of a normal calibre for stenosis. The brain angiogram also proved to be normal. The patient continues with the medical treatment and has remained neurologically stable throughout the 9-month clinical follow-up. Conclusion. In certain selected cases, placing an intracranial carotid stent, without previous balloon dilatation, can give good results and prevent the complications that can accompany angioplasty (such as dissection, rupture or embolism) (AU)

Epidemiology of invasive streptococcus pneumoniae infections in children in Spain, 1996-1998.

BACKGROUND: Streptococcus pneumoniae is a significant cause of meningitis and septicemia in early infancy, being associated to a high case-fatality rates and serious sequelae. OBJECTIVE: To investigate the burden of invasive disease caused by S. pneumoniae in Valencia, Spain, during a three-year period (1996-1998). METHODS: Hospital-based prospective active surveillance program for invasive bacterial diseases in children < or = 15 years of age in Valencia, from December 1, 1995 to January 1999. RESULTS: A total of 94 cases of invasive pneumococcal disease were detected in patients < or = 15 years of age. The overall annual incidence of invasive pneumococcal disease was 4.6/100,000 persons, < or = 15 years of age. The incidence of invasive disease and meningitis was higher among children younger than 2 years of age (16.8 and 3.8, respectively). Serotypes 19, 14 and 6 accounted for 83% of the isolates. CONCLUSIONS: The age distribution of invasive pneumococcal disease and meningitis shows a peak in the first two years of life and a decline thereafter. Serotypes 19, 14 and 6 are those primarily responsible for invasive pneumococcal disease in children of this region of Spain.

Epidemiological pattern of meningococcal disease in Valencia, Spain. Impact of a mass immunization campaign with meningococcal C polysaccharide vaccine.

The objective of this study was to define the epidemiological pattern of meningococcal disease in the autonomous region of Valencia, Spain, and the impact of a mass immunization campaign against serogroup C meningococcus. Data were obtained from a prospective surveillance program for invasive bacterial diseases in children < 15 y of age that began in the Valencia region on 1 December, 1995. During the period 1996-98, 213 cases of meningococcal disease were detected, representing an annual incidence of 11.3/100,000 children < 15 y. Serogroup C accounted for 31% and 38.5% of cases in 1996 and 1997, respectively (annual incidences of 2.9 and 5.4 cases/100,000 children < 15 y). An immunization campaign with the meningococcal C polysaccharide vaccine, which included all persons between 18 months and 19 y of age, began in late 1997 (vaccination coverage of 86%). In 1998, the annual incidence of meningococcal C disease fell to 1.4 cases per 100,000 children < 15 y of age. These results mirror the increase in the reported incidence of serogroup C meningococcal disease in Spain in the 1990s, a trend that was reversed after the introduction of the mass vaccination campaign. Meningococcal polysaccharide vaccine seems to be an effective public health tool for the management of this serious communicable disease.

Seasonal changes in peripheral blood leukocyte functions of the turtle Mauremys caspica and their relationship with corticosterone, 17-beta-estradiol and testosterone serum levels.

We have studied the most representative functions of lymphocytes such as adherence to substrate, mobility directed to a chemoattractant gradient (chemotaxis), proliferative response to mitogens and antibody-dependent cellular cytotoxicity (ADCC), as well as natural killer (NK) activity in peripheral blood cells from the turtle Mauremys caspica, and the seasonal changes of these functions in both female and male animals. The plasma levels of steroid hormones were determined to study their relationship with the immune functions. Our results show high chemotaxis, lymphoproliferative response and ADCC as well as NK activity in winter when the levels of corticosterone, testosterone and 17-beta-estradiol were depleted. Proliferative responses to phytohaemagglutinin (PHA), concanavalin A (Con A) and pokeweed mitogen (PWM) were increased in spring correlating with low levels of corticosterone and testosterone in middle and late spring. In summer, the proliferative response was decreased but adherence, chemotaxis, ADCC and NK activity were increased, although steroid hormones showed high plasma levels. In autumn, a depletion of both the hormone levels and the immune response were found except for adherence to substrate. The immune functions studied were strikingly influenced by the seasonal cycle, which induced a different pattern of response depending on the function analyzed. Moreover, these immune cells showed a different degree of dependence on steroids in relation to the function and the season considered, suggesting the existence of other factors that modulate the immune response studied.

[Progression to AIDS among HIV-seropositive hemophiliacs]. / Progresión a SIDA en hemofílicos seropositivos frente al VIH.

PURPOSE: To assess the incidence of AIDS, along with its origin and mortality rate, in a group of sero-positive haemophiliacs with long follow-up. MATERIAL AND METHODS: The progression into AIDS in 94 HIV-seropositive haemophiliacs (88 with haemophilia A and 6 with haemophilia B) followed since 1986 has been analyzed. The mean age was 19 years and 64% of the patients had severe haemophilia. All of them had been previously treated with non virus-inactivated factor concentrates. Was detected HIV antigen in 13 of them and 32 were treated with zidovudine. Actuarial analysis started from seroconversion date or from the first positive result and the average observation time was 90 months (5-97). RESULTS: Sixteen patients developed AIDS, resulting in an eight-years accumulative actuarial indice of about 24%. AIDS incidence was lower (p less than 0.0001) in haemophilia A (21%) than in haemophilia B (67%). The eight-years progression rate to AIDS showed a significant dependence on patient age, it being higher in patients aged greater than 30 (77%) than in those aged 15-30 (30%) and less than 15 (9%). Patients who presented CD4+ counts lower than 0.5 x 10(9)/L or CD4/CD8 ratios lower than 0.5 at the beginning of the observation period had a greater 8-year AIDS incidence (63% and 57% respectively) than the remaining patients (16% and 12%). At AIDS diagnosis, all patients had CD4+ lymphocyte counts lower than 0.2 x 10(9)/L, two had detectable HIV antigenaemia and six had been previously treated with zidovudine. The cause of AIDS was an opportunistic infection in all the cases namely, P. carinii pneumonia and candidiasis, but no secondary neoplasia was registered. Nineteen patients died during the follow-up, 12 because of AIDS and 7 because of other reasons unrelated to HIV-infection. CONCLUSION: Our results suggest that 25% of the haemophiliacs will develop AIDS eight years after seroconversion, and a decreasing incidence is not observed. Lower progression rate to AIDS in children than in adults is confirmed.