El proceso de divulgación de la donación y el trasplante del siglo XXI: experiencia en redes sociales de «Coordinación Sectorial de Trasplantes de Sevilla-Huelva» / The donation and transplant divulgation process of 21st century: Social media experience from «Coordinación Sectorial de Trasplantes de Sevilla-Huelva»

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Interpretación de resultados estadísticos / Interpretation of statistical results

La interpretación de los resultados estadísticos es un elemento crucial para la comprensión de los avances en las ciencias médicas. Las herramientas que nos ofrece la estadística nos permiten transformar la incertidumbre y aparente caos de la naturaleza en parámetros medibles y aplicables a nuestra práctica clínica. La importancia de entender el significado y alcance real de estos instrumentos es fundamental para el investigador, para los financiadores de las investigaciones y para los profesionales que precisan de una actualización permanente basada en buena evidencia y ayudas a la toma de decisiones. Se repasan diversos aspectos de los diseños, resultados y análisis estadísticos, intentando facilitar su entendimiento desde lo más elemental a aquello que es más común pero no por ello mejor comprendido y aportar una mirada constructiva y realista, sin ser exhaustiva

The appropriate interpretation of the statistical results is crucial to understand the advances in medical science. The statistical tools allow us to transform the uncertainty and apparent chaos in nature to measurable parameters which are applicable to our clinical practice. The importance of understanding the meaning and actual extent of these instruments is essential for researchers, the funders of research and for professionals who require a permanent update based on good evidence and supports to decision making. Various aspects of the designs, results and statistical analysis are reviewed, trying to facilitate his comprehension from the basics to what is most common but no better understood, and bringing a constructive, non-exhaustive but realistic look

Interpretation of statistical results. / Interpretación de resultados estadísticos.

The appropriate interpretation of the statistical results is crucial to understand the advances in medical science. The statistical tools allow us to transform the uncertainty and apparent chaos in nature to measurable parameters which are applicable to our clinical practice. The importance of understanding the meaning and actual extent of these instruments is essential for researchers, the funders of research and for professionals who require a permanent update based on good evidence and supports to decision making. Various aspects of the designs, results and statistical analysis are reviewed, trying to facilitate his comprehension from the basics to what is most common but no better understood, and bringing a constructive, non-exhaustive but realistic look.

Quiste pericárdico post-traumático de localización atípica / Atipically postraumatic pericardial cyst

Los quistes pericárdicos son raros, y la mayoría de ellos son de origen congénito. Normalmente se localizan en los ángulos cardiofrénicos, principamente en el lado derecho. A pesar de que la forma de presentación clínica más frecuente es asintomático y el pronóstico es benigno, se han descrito importantes complicaciones. Por ello clásicamente se ha tendido a una actitud terapeútica agresiva como aspiración percutánea o resección quirúrgica mediante toracotomía o toracoscopia. El caso que describimos es interesante por tratarse de un quiste pericárdico de localización inusual, paramediastínico superior izquierda, y de origen fue postraumático, no congénito. El diagnóstico se realizó por las pruebas de imagen, y tomamos una actitud terapéutica conservadora debido a la buena evolución. Proponemos por ello la opción de tratamiento conservador como actitud válida y razonable en la ausencia de complicaciones o síntomas en su evolución

Pericardial cyst are rare, most of them congenital in origin. They usually are located in the cardiophrenic angles, mainly on the right side. Although the most frequent clinical presentation is asyntomatic, and the prognosis is benign, important complications had been described. For this reason we used to take agressive therapeutic interventions like percutaneous aspiracion or surgical reseccion by thoracotomia or thoracoscophy. The case we report is interesting because it was an atipically located left upper paramediastinal cyst, and not congenital in origin but postraumatic. The diagnosis was made by imaging techniques and we accomplished conservative alternative because of the favourable evolution. We think that it should be a good option in case of asyntomatic and no complicated cases

Derrame pericárdico crónico atribuible a minoxidil / Chronic pericardial effusion attributable to minoxidil

El minoxidil es un potente vasodilatador oral que era frecuentemente utilizado en hipertensión arterial refractaria a tratamiento con otros fármacos, cuya relación con la aparición de derrame pericárdico se conoce prácticamente desde el comienzo de su uso clínico. Describimos un caso de derrame pericárdico grave asociado a la toma de minoxidil durante más de 20 años que responde favorablemente a la retirada del fármaco a pesar de tan larga evolución. La incidencia descrita de derrame pericárdico por minoxidil se encuentra entre un 0 %-26 % y, a pesar de la posible evolución hacia taponamiento cardíaco en raros casos, el manejo conservador con la retirada del fármaco es la primera opción, que en nuestra opinión debe serlo incluso cuando el derrame sea grave y de muy larga evolución

Minoxidil is a potent oral vasodilator that was frequently used in HBP refractory to treatment with other drugs, whose relationship with the appearance of pericardial effusion has practically been known since the onset of its clinical use. We describe a case of severe pericardial effusion, associated to taking minoxidil for more than 20 years that favorably responds to withdrawal of the drug in spite of such a long course. The incidence described of pericardial effusion due to minoxidil is between 0 %-26 %. In spite of the possible evolution towards cardiac tamponade in rare cases, the conservative management with drug withdrawal is the first option, which, in our opinion, should even be so when the effusion is severe and of long durationMinoxidil is a potent oral vasodilator that was frequently used in HBP refractory to treatment with other drugs, whose relationship with the appearance of pericardial effusion has practically been known since the onset of its clinical use. We describe a case of severe pericardial effusion, associated to taking minoxidil for more than 20 years that favorably responds to withdrawal of the drug in spite of such a long course. The incidence described of pericardial effusion due to minoxidil is between 0 %-26 %. In spite of the possible evolution towards cardiac tamponade in rare cases, the conservative management with drug withdrawal is the first option, which, in our opinion, should even be so when the effusion is severe and of long duration

Derrame pericárdico crónico atribuible a minoxidil / Chronic pericardial effusion attributable to minoxidil

El minoxidil es un potente vasodilatador oral que era frecuentemente utilizado en hipertensión arterial refractaria a tratamiento con otros fármacos, cuya relación con la aparición de derrame pericárdico se conoce prácticamente desde el comienzo de su uso clínico. Describimos un caso de derrame pericárdico grave asociado a la toma de minoxidil durante más de 20 años que responde favorablemente a la retirada del fármaco a pesar de tan larga evolución. La incidencia descrita de derrame pericárdico por minoxidil se encuentra entre un 0 %-26 % y, a pesar de la posible evolución hacia taponamiento cardíaco en raros casos, el manejo conservador con la retirada del fármaco es la primera opción, que en nuestra opinión debe serlo incluso cuando el derrame sea grave y de muy larga evolución

Minoxidil is a potent oral vasodilator that was frequently used in HBP refractory to treatment with other drugs, whose relationship with the appearance of pericardial effusion has practically been known since the onset of its clinical use. We describe a case of severe pericardial effusion, associated to taking minoxidil for more than 20 years that favorably responds to withdrawal of the drug in spite of such a long course. The incidence described of pericardial effusion due to minoxidil is between 0 %-26 %. In spite of the possible evolution towards cardiac tamponade in rare cases, the conservative management with drug withdrawal is the first option, which, in our opinion, should even be so when the effusion is severe and of long duration

[Atypically located posttraumatic pericardial cyst]. / Quiste pericárdico post-traumático de localización atípica.

Pericardial cyst are rare, most of them congenital in origin. They usually are located in the cardiophrenic angles, mainly on the right side. Although the most frequent clinical presentation is asymptomatic, and the prognosis is benign, important complications had been described. For this reason we used to take aggressive therapeutic interventions like percutaneous aspiration or surgical resection by thoracotomia or thoracoscopy. The case we report is interesting because it was an atypically located left upper paramediastinal cyst, and not congenital in origin but posttraumatic. The diagnosis was made by imaging techniques and we accomplished conservative alternative because of the favourable evolution. We think that it should be a good option in case of asymptomatic and no complicated cases.

Influence of dietary arginine on the anabolic effects of androgens.

Feeding mice an arginine-deficient diet decreased plasma concentrations of arginine, citrulline and ornithine in the females and arginine in the males, abolishing the sexual dimorphic pattern of these amino acids found in mice fed the standard diet. In addition, the restriction of dietary arginine produced a marked decrease in body and renal weights as well as in the activity of renal ornithine decarboxylase, decreases that were gender dependent since they were observed exclusively in males. The fact that these changes were not associated with the decrease in the circulating levels of testosterone and that the dietary arginine restriction prevented the body weight gain induced by testosterone treatment of female mice fed the standard diet indicates that dietary arginine is required for the anabolic action of androgens. Moreover, under certain conditions that could compromise the renal synthesis of arginine, as in the compensatory renal hypertrophy that follows unilateral nephrectomy, the myotrophic effect of testosterone was transiently impaired. The results also revealed that arginine deficiency produced an opposite effect in the expression of IGF-I and IGF-binding protein 1 in the liver and kidney. Taken together, our results indicate that dietary arginine may be relevant to the anabolic action of testosterone, and suggest that this effect may be mediated by changes in the insulin-like growth factor system.

Gender-related differences in carnosine, anserine and lysine content of murine skeletal muscle.

The aminoacyl-imidazole dipeptides carnosine (beta-alanyl-L-histidine) and anserine (beta-alanyl-1-methyl-histidine) are present in relatively high concentrations in excitable tissues, such as muscle and nervous tissue. In the present study we describe the existence of a marked sexual dimorphism of carnosine and anserine in skeletal muscles of CD1 mice. In adult animals the concentrations of anserine were higher than those of carnosine in all skeletal muscles studied, and the content of aminoacyl-imidazole dipeptides was remarkably higher in males than in females. Postnatal ontogenic studies and hormonal manipulations indicated that carnosine synthesis was up-regulated by testosterone whereas anserine synthesis increased with age. Regional variations in the concentrations of the dipeptides were observed in both sexes, skeletal muscles from hind legs having higher amounts of carnosine and anserine than those present in fore legs or in the pectoral region. The concentration of L-lysine in skeletal muscles also showed regional variations and a sexual dimorphic pattern with females having higher levels than males in all muscles studied. The results suggest that these differences may be related with the anabolic action of androgens on skeletal muscle.

Effects of potassium deficiency on potassium, polyamines and amino acids in mouse tissues.

Sexual dimorphism in potassium content was found in plasma, kidney, heart and skeletal muscle of CD1 mice. We observed that feeding mice with a K(+)-deficient diet had an uneven and gender-dependent effect on organ weight and tissue potassium concentrations. Treatment produced a marked decrease in plasma, pancreas and skeletal muscle K(+) levels in both sexes, and a reduction in kidney, liver and heart potassium concentrations in females. Moreover, K(+) deficiency produced a 2-3-fold increase in the concentrations of cationic amino acids, such as arginine and lysine in both heart and skeletal muscle of the two sexes, a slight increase ( approximately 37%) in renal arginine in the male mice. The concentrations of these amino acids in plasma and other tissues in both sexes remained unaltered. Polyamine levels in heart, liver, skeletal muscle and pancreas from male and female mice were not affected by K(+) deficiency. However, in the male kidney potassium deficiency was accompanied by an increase of putrescine and spermidine concentration, and a reduction of putrescine excretion into the urine, even though renal K(+) concentration was not significantly affected and ornithine decarboxylase activity was dramatically decreased. The general lack of correlation between tissue potassium decrease and the increase in organic cations suggests that it is unlikely that the changes observed could be related with an attempt of the tissues to compensate for the reduction in cellular positive charge produced by the fall in K(+) content. The mechanisms by which these changes are produced are discussed, but their physiological implications remain to be determined.

Interference of the antihormone RU486 in the determination of testosterone and estradiol by enzyme-immunoassay.

The antihormone RU486 (mifepristone, 11beta-(4-dimethylaminophenyl)-17beta-hydroxy-17alpha-(prop- 1-ynyl)-estra-4,9-dien-3-one) is currently used in many endocrinological studies and in clinical practice as a contraceptive agent. The results presented here indicate that the synthetic steroid RU486 may interfere in determinations of testosterone and estradiol when using some commercial kits. Although the cross reactivity is low (0.30% for testosterone and 0.16% for estradiol), in animal experiments RU486 doses higher than 5 mg/kg may produce false positive results in the estimation of plasma testosterone (specially in castrated male or female mice) or estradiol concentrations, even in samples obtained 48 h after the administration of this antihormone.

Neuronal regulation of ornithine decarboxylase induced by androgens in the mouse kidney.

1. Neuronal, but not circulating catecholamines, regulate the induction of ornithine decarboxylase (ODC) by testosterone in the mouse kidney. 2. Central and peripheral catecholamine-depleting agents, such as reserpine or alpha-methyl-p-tyrosine, exerted a more pronounced effect on renal ODC than the selective agents tetrabenazine or guanethidine. 3. Benserazide and haloperidol decreased the induction of renal ODC produced by testosterone in female mice. 4. Renal denervation produced a partial inhibition of renal ODC in male mice and decreased the induction of ODC elicited by testosterone in female mice. 5. These results suggest that both peripheral sympathetic neurons as well as central related factors can modulate the effect of androgens on renal ODC activity.

The effect of glycine administration on taurine concentration in the rat liver.

1. The treatment of rats with glycine (2 mg/g) produced a marked decrease in the hepatic taurine content of neonate rats but not of adult rats. 2. The decrease observed in taurine concentration in the liver of newborn rats was not found in other organs, such as brain or kidney. 3. The results showed that the change in hepatic taurine concentration was dose- and time-dependent, suggesting the existence of an exchange mechanism between taurine and glycine in the rat liver that could participate in regulating the hepatic concentration of these amino acids.

Monosodium glutamate induced convulsions in rats: Influence of route of administration, temperature and age.

Treatment of developing rats with monosodium glutamate (MSG) produces an increase of glutamate levels in the brain, being this elevation dependent on both route of administration and animal's age. The capacity of exogenous MSG to induce convulsions seems to be related to the rate of glutamate elevation in the brain, rather than to the absolute value of glutamate concentration reached. Short exposure of MSG-treated rats to moderate hyperthermia potentiated the convulsive incidence and extended the brain damage to areas not affected by treatment with MSG alone, suggesting that the synergic effect of hyperthermia on glutamate neurotoxicity may be related to an increase in the permeability of the blood-brain barrier in the hyperthermic developing rats.

Glycine administration decreases hepatic taurine content in mice.

The administration of glycine (2 mg/g) to mice showed marked increases in the hepatic content of some amino acids, specially glycine, serine and citrulline, but produced a notorious decrease in the concentration of taurine and aspartic acid. The depletion of taurine was higher than 50% after one hour of treatment, and was observed both in neonate and adult mice. The effect produced by the glycine treatment on hepatic taurine content was not observed in the heart, even after a larger amount of glycine administration. The results suggest the existence of an exchange mechanism of transport between glycine and taurine in the liver of mice.

Free amino acids in the cerebrospinal fluid of children with febrile seizures.

The content of free amino acids in the cerebrospinal fluid from 52 children in different age groups with febrile seizures were determined and compared to 88 age matched children without seizures. We found that the concentrations of some amino acids in CSF in the control group decreased slowly with age, reaching the concentrations found in adults at the age of 3 to 6 years, and that the free amino acid levels were no significantly altered by temperature. The free amino acids in the CSF from patients with febrile seizures showed a different pattern of change with age. These results suggest that the same type of convulsive disorder may show a different alteration in amino acids in CSF depending on the patient's age, and that the degree of elevation of body temperature is not implicated in these changes.

Hyperthermia and the neurotoxicity of exogenous glutamate in infant rats.

A substantial elevation of the excitatory neurotransmitter glutamate can be produced in the brain of 3-day old rats, either after subcutaneous injection of monosodium glutamate (4 mg/g), or by hyperthermic treatment (40 degrees C, 3 h). In the glutamate-treated animals a large increase in the GABA levels has also been observed while the elevation of this amino acid in the hyperthermic animals is insignificant. Although the magnitude of the increase of glutamate in both cases is rather similar, in the hyperthermic animals no cerebral lesions such as those produced in the glutamate-treated animals could be observed. Therefore, high extracellular levels of glutamate seem to be required to produce the variety of neurotoxic effects related to this excitatory amino acid.