Sarcoma de Kaposi con afectación gástrica y rectal en paciente VIH / Kaposi's sarcoma with gastric and rectal involvement in HIV patient

Presentamos el caso de un varón de 67 años que ingresa por cuadro de disnea, lesiones cutáneas violáceas y anemia normocítica a estudio. Durante el ingreso, el paciente es diagnosticado de infección por VIH en fase de SIDA, además de afectación de sarcoma de Kaposi con afectación cutánea, digestiva múltiple (gástrica y rectal) y probablemente pulmonar. El sarcoma de Kaposi es un tumor de origen vascular causado por el virus herpes humano tipo 8. Existen cuatro variantes, nuestro paciente corresponde a la variante relacionada con SIDA. La afectación gastrointestinal cursa con clínica muy variada y la imagen endoscópica es muy característica, pero al tratarse de un tumor de afectación submucosa a veces precisa de biopsia guiada por ecoendoscopia para realizar el diagnóstico. El tratamiento se basa en la terapia antirretroviral y quimioterapia sistémica. (AU)

Kaposi's sarcoma with gastric and rectal involvement in HIV patient.

A 67-year-old man admitted due to dyspnea, violaceous skin lesions and normocytic anemia under study. During admission, the patient is diagnosed with HIV infection in the AIDS phase, in addition to Kaposi's sarcoma with cutaneous, multiple digestive (gastric and rectal) and probably pulmonary involvement. Kaposi's sarcoma is a tumor of vascular origin caused by the human herpes virus type 8. There are four variants, our patient corresponds to the variant related to AIDS. Gastrointestinal involvement presents varied symptoms and the endoscopic image is very characteristic, but as it is a tumor with submucosal involvement, it sometimes requires endoscopic ultrasound-guided biopsy to make the diagnosis. Treatment is based on antiretroviral therapy and systemic chemotherapy.

Reestenosis de stents liberadores de paclitaxel frente a stents convencionales

RESUMEN Introducción: La reestenosis de los stents liberadores de paclitaxel utilizados en Cuba no ha sido estudiada. Objetivo: Evaluar la reestenosis de los stents liberadores de paclitaxel y los convencionales. Métodos: Se incluyeron 64 pacientes con reestenosis de stent, de un estudio prospectivo previo; en 318 pacientes seguidos por 3 años luego de intervención coronaria percutánea; 25 con stent liberador de paclitaxel y 39 stent metálico convencional. Se consideró reestenosis como nueva lesión ≥ 50 % de la luz del vaso con isquemia demostrada. Se describió el tiempo de aparición, patrón angiográfico y alternativa de revascularización. Resultados: La reestenosis en el grupo de stents liberadores de paclitaxel fue 15,7 % con tiempo medio de supervivencia sin reestenosis de 32,4 meses vs. 24,5 % en stents convencionales, con supervivencia sin reestenosis de 29,8 meses, (p= 0,047). En el grupo de stents liberadores de paclitaxel predominó el patrón IB, (30,3 %) y stent convencional el III (28,3 %). En el 28,0 % del grupo de stents liberadores de paclitaxel, se recurrió a la cirugía de revascularización vs. 5,1 % en el grupo de stent convencional. Conclusiones: El stent liberador de paclitaxel logra una supervivencia libre de reestenosis superior y más perdurable que el stent convencional. La reestenosis en los de stents liberadores de paclitaxel es focal, con mayor frecuencia de nueva revascularización por cirugía y en los stents convencionales es mayormente difusa.

ABSTRACT Introduction: The restenosis of the paclitaxel-eluting stents used in Cuba has not been studied. Objective: To evaluate the restenosis of paclitaxel-eluting stents and conventional stents. Methods: 64 patients with stent restenosis were included, from a previous prospective study; in 318 patients followed up for 3 years after percutaneous coronary intervention; 25 with a paclitaxel-eluting stent and 39 conventional metal stent. Restenosis was considered as a new lesion ≥ 50 % of the vessel lumen with proven ischemia. The time to onset, angiographic pattern and alternative revascularization were described. Results: Restenosis in the group with paclitaxel-eluting stents was 15.7 % with a mean survival time without restenosis of 32.4 months vs. 24.5 % in conventional stents, with restenosis-free survival of 29.8 months, (p = 0.047). In the group with paclitaxel-eluting stents, the IB pattern predominated (30.3 %) and the conventional stent III (28.3 %). In 28.0 % of the paclitaxel-eluting stent group, revascularization surgery was used vs. 5.1 % in the conventional stent group. Conclusions: The paclitaxel-eluting stent achieves a superior and more durable restenosis-free survival than the conventional stent. Restenosis in paclitaxel-eluting stents is focal, with a higher frequency of revascularization by surgery, and in conventional stents it is mostly diffuse.

Colonic vasculitis in a woman with end-stage kidney disease and HIV infection.

We present the case of a 57-year-old female with bloody diarrhea, fever and abdominal pain. Her medical history included human immunodeficiency virus (HIV) infection with an undetectable viral load and end-stage kidney disease secondary to HIV on dialysis. At admission, she had a painful abdomen, no skin lesions and bloody stools in the rectal examination. Laboratory findings included a white blood cell count of 12,900 x 103 cells/µl, CD4 counts of 243 cells/µl and C-reactive protein of 24.5 mg/dl. Serologies, cytomegalovirus and PCR SARS-CoV-2 were negative.

Deformación miocárdica (strain) circunferencial global en pacientes con cardiopatía isquémica / Global circumferential strain in patients with ischemic heart disease

RESUMEN Introducción: Las enfermedades cardiovasculares constituyen la primera causa de muerte en Cuba y la mayoría de los países desarrollados. La ecocardiografía con rastreo de marcas o speckle-tracking bidimensional (ST-2D) es una técnica reciente en la evaluación de la función cardíaca. Objetivo: Determinar la relación entre la deformación miocárdica (strain) circunferencial (GCS) medida por ST-2D y el estado de la circulación coronaria, en pacientes con cardiopatía isquémica. Método: Se realizó un estudio analítico, transversal, con 55 pacientes con indicación de coronariografía a los que se les realizó ecocardiograma para medir la GCS mediante ST-2D, en el Centro de Investigaciones Médico Quirúrgicas (CIMEQ, La Habana, Cuba), durante un año. Se crearon dos grupos: con enfermedad coronaria significativa (ECS=32) y no significativa (ECNS=23). Se utilizó SSPS para análisis de los resultados. Resultados: La edad promedio fue mayor en ECS (55,6 ±9,3 vs. 61,8±8,8; p=0,014). Predominaron los hombres con ECS (47,3%), los hipertensos (ECS=90,6% y ENCS=65,2%; p=0,02) y los fumadores (ECS=59,4% y ENCS=17,4%; p=0,002). El diagnóstico más frecuente fue la angina crónica estable (87%). En ECS predominó la enfermedad de tres vasos (75%). La GCS fue menor en ECS [(-19,5±3.8 vs. -25,2±5,7; p=0,033); área bajo la curva = 0,208]. No hubo diferencias en GCS, según el número de vasos significativamente enfermos. Conclusiones: Los resultados encontrados no justifican el empleo de la GCS por ST-2D para discriminar la presencia o no de ECS.

ABSTRACT Introduction: Cardiovascular diseases are the top cause of death in Cuba as well as in most developed countries. Two-dimensional speckle-tracking (2D-ST) echocardiography is a recent technique in the evaluation of cardiac function. Objective: To determine the relationship between global circumferential strain (GCS) measured through 2D-ST echocardiography and the state of coronary circulation in patients with ischemic heart disease. Method: An analytical, cross-sectional study was carried out on 55 patients with indication of coronary angiography, who underwent echocardiography to measure the GCS through 2D-ST at the Centro de Investigaciones Medico Quirúrgicas (CIMEQ, Havana, Cuba), during one year. Two groups were created: with significant coronary artery disease (SCAD = 32) and non-significant coronary artery disease (NSCAD = 23). The statistical package for the social sciences (SPSS) was used to analyze the results. Results: Mean age was higher in the SCAD group (55.6 ± 9.3 vs. 61.8± 8.8, p=0.014). Men with SCAD (47.3%), patients with high blood pressure (SCAD = 90.6% and NSCAD = 65.2%, p = 0.02) and smokers (SCAD = 59.4% and NSCAD = 17.4%, p = 0.002) predominated. The most frequent diagnosis was chronic stable angina (87%). Three-vessel disease predominated in the SCAD group (75%). The GCS was lower in the SCAD group [(-19.5.0 ± 3.8 vs. -25.2 ± 5.7, p = 0.033); area under the curve = 0.208]. There were no differences in GCS according to the number of significantly diseased vessels. Conclusions: The results found do not justify the use of GCS through 2D-ST echocardiography to discriminate the presence or nor of SCAD.

Valor pronóstico del speckle-tracking bidimensional en pacientes con sospecha de cardiopatía isquémica / Prognostic value of two-dimensional speckle-tracking echocardiography in patients with suspected ischemic heart disease

RESUMEN Introducción: El estudio ecocardiográfico mediante speckle-tracking ha emergido como un novedoso método para la evaluación cuantitativa de la función miocárdica y se ha correlacionado con la presencia de enfermedad coronaria. Objetivo: Determinar el valor pronóstico de la deformación miocárdica (strain) por speckle-tracking bidimensional en la evolución de pacientes con sospecha de cardiopatía isquémica. Método: Estudio longitudinal prospectivo analítico con 51 pacientes a los que se realizó ecocardiograma con evaluación de la deformación (strain) longitudinal global por speckle-tracking bidimensional y coronariografía en el CIMEQ entre 2016 y 2018. Se siguieron los eventos cardíacos graves (infarto de miocardio, muerte cardíaca y por otras causas, enfermedad cerebrovascular y necesidad de nueva revascularización). Resultados: El 70,6% de los enfermos resultaron ser del sexo masculino, el 81,4% mayores de 50 años y 81,4%, fumadores. El 65,0% tenía enfermedad coronaria significativa y 55,0% de los casos fueron revascularizados. Se registraron 4 muertes (7,8%) y un infarto no fatal (2,0%). Los pacientes con deformación longitudinal global ≤ -15% (en valores absolutos) tuvieron mayor frecuencia de eventos cardíacos graves (p=0,02). Conclusiones: La deformación longitudinal global medida por speckle-tracking bidimensional no pudo predecir la presencia de enfermedad coronaria, pero sí los eventos cardiovasculares graves en los enfermos con enfermedad coronaria significativa.

ABSTRACT Introduction: Two-dimensional speckle-tracking echocardiography has emerged as a novel method for the quantitative evaluation of myocardial function and it has been correlated with the presence of coronary artery disease. Objective: To determine the prognostic value of myocardial strain by two-dimensional speckle-tracking echocardiography in the evolution of patients with suspected ischemic heart disease. Method: An analytical prospective longitudinal study was carried out with 51 patients, who underwent global longitudinal strain assessment by two-dimensional speckle-tracking echocardiography, and coronary angiography at CIMEQ between 2016 and 2018. Major cardiac adverse events (myocardial infarction, cardiac and non-cardiac cause of death, cerebrovascular disease, and need for new revascularization) were followed. Results: The 70.6% of patients were male, the 81.4% were older than 50 years old, and the 81.4% were smokers. The 65.0% of patients had significant coronary artery disease and the 55.0% underwent myocardial revascularization. There were four deaths (7.8%) and one non-fatal myocardial infarction (2.0%). Patients with global longitudinal strain ≤ -15% (in absolute or modular values) had a higher frequency of major adverse cardiovascular events (p=0.02). Conclusions: Global longitudinal strain by two-dimensional speckle-tracking echocardiography could not predict the presence of coronary artery disease, but it did predict major adverse cardiovascular events in patients with significant coronary artery disease.

Light electric vehicle charging strategy for low impact on the grid.

The alarming increase in the average temperature of the planet due to the massive emission of greenhouse gases has stimulated the introduction of electric vehicles (EV), given transport sector is responsible for more than 25% of the total global CO2 emissions. EV penetration will substantially increase electricity demand and, therefore, an optimization of the EV recharging scenario is needed to make full use of the existing electricity generation system without upgrading requirements. In this paper, a methodology based on the use of the temporal valleys in the daily electricity demand is developed for EV recharge, avoiding the peak demand hours to minimize the impact on the grid. The methodology assumes three different strategies for the recharge activities: home, public buildings, and electrical stations. It has been applied to the case of Spain in the year 2030, assuming three different scenarios for the growth of the total fleet: low, medium, and high. For each of them, three different levels for the EV penetration by the year 2030 are considered: 25%, 50%, and 75%, respectively. Only light electric vehicles (LEV), cars and motorcycles, are taken into account given the fact that batteries are not yet able to provide the full autonomy desired by heavy vehicles. Moreover, heavy vehicles have different travel uses that should be separately considered. Results for the fraction of the total recharge to be made in each of the different recharge modes are deduced with indication of the time intervals to be used in each of them. For the higher penetration scenario, 75% of the total park, an almost flat electricity demand curve is obtained. Studies are made for working days and for non-working days.

Study of longitudinal myocardial deformation in patients with ischemic cardiopathy.

Introducción: Las enfermedades cardiovasculares constituyen la primera causa de muerte en Cuba y la mayoría de los países desarrollados. La ecocardiografía con speckle tracking bidimensional (ST 2D) es una técnica reciente en la evaluación de la función cardíaca. Objetivos: Determinar la relación entre la deformación miocárdica medida por ST 2D y el estado de la circulación coronaria en pacientes con cardiopatía isquémica, en el CIMEQ, durante un año. Material y método: Se realizó un estudio analítico y transversal con 55 pacientes con indicación de coronariografía sometidos a ecocardiograma bidimensional y estudio de ST 2D con medición de la deformación longitudinal (DLG). Se crearon dos grupos: enfermedad coronaria significativa (ECS = 32) y no significativa (ECNS = 23). Se utilizó SSPS para análisis de los resultados. Resultados: La edad promedio fue mayor en la ECS (55.6 ± 9.3 vs. 61.8 ± 8.8; p = 0.014). Predominaron los hombres con ECS (47.3%), los hipertensos (ECS = 90.6% y ENCS = 65.2%; p = 0.02) y los fumadores (ECS = 59.4% y ENCS = 17.4%; p = 0.002). El diagnóstico más frecuente fue la angina crónica estable (87%). En la ECS predominó la enfermedad de tres vasos (75%). La DLG fue menor en la ECS [(-20.0 ± 3.2 vs. -22.1 ± 3.6; p = 0.035); AUC = 0.458]. No hubo diferencias en la DLG según el número de vasos significativamente afectados. Conclusiones: Los resultados encontrados no justifican el empleo del ST 2D para diferenciar la ECS. Introduction: Cardiovascular diseases are the leading cause of death in Cuba and most of the developed countries. Two-dimensional speckle tracking echocardiography (2D ST) is a recent technique in the evaluation of cardiac function. Objectives: To determine the relationship between myocardial deformation measured by 2D ST and coronary circulation in patients with ischemic heart disease, in the CIMEQ, for 1 year. Material and method: An analytical, cross-sectional study was carried out with 55 patients with an indication for coronary angiography who underwent 2D echocardiography and 2D ST study with longitudinal strain measurement (LSM). Two groups significant coronary disease (SCD = 32) and not significant (NSCD = 23) were created. SSPS was used to analyze the results. Results: The average age was higher in SCD (55.6 ± 9.3 vs. 61.8 ± 8.8, p = 0.014). Men with SCD (47.3%), hypertensive (SCD = 90.6% and NSCD = 65.2%, p = 0.02) and smokers (SCD = 59.4% and NSCD = 17.4%, p = 0.002) predominated. The most frequent diagnosis was chronic stable angina (87%). Three-vessel disease (75%) prevailed in SCD. The LMS was lower in SCD ([−20.0 ± 3.2 vs. −22.1 ± 3.6, p = 0.035]; AUC = 0.458). There were no differences in LSM according to the number of significantly diseased vessels. Conclusions: The results found do not justify the use of 2D ST to discriminate SCD.

Estudio de la deformación miocárdica longitudinal en pacientes con cardiopatía isquémica / Study of longitudinal myocardial deformation in patients with ischemic cardiopathy

Resumen Introducción: Las enfermedades cardiovasculares constituyen la primera causa de muerte en Cuba y la mayoría de los países desarrollados. La ecocardiografía con speckle tracking bidimensional (ST 2D) es una técnica reciente en la evaluación de la función cardíaca. Objetivos: Determinar la relación entre la deformación miocárdica medida por ST 2D y el estado de la circulación coronaria en pacientes con cardiopatía isquémica, en el CIMEQ, durante un año. Material y método: Se realizó un estudio analítico y transversal con 55 pacientes con indicación de coronariografía sometidos a ecocardiograma bidimensional y estudio de ST 2D con medición de la deformación longitudinal (DLG). Se crearon dos grupos: enfermedad coronaria significativa (ECS = 32) y no significativa (ECNS = 23). Se utilizó SSPS para análisis de los resultados. Resultados: La edad promedio fue mayor en la ECS (55.6 ± 9.3 vs. 61.8 ± 8.8; p = 0.014). Predominaron los hombres con ECS (47.3%), los hipertensos (ECS = 90.6% y ENCS = 65.2%; p = 0.02) y los fumadores (ECS = 59.4% y ENCS = 17.4%; p = 0.002). El diagnóstico más frecuente fue la angina crónica estable (87%). En la ECS predominó la enfermedad de tres vasos (75%). La DLG fue menor en la ECS [(-20.0 ± 3.2 vs. -22.1 ± 3.6; p = 0.035); AUC = 0.458]. No hubo diferencias en la DLG según el número de vasos significativamente afectados. Conclusiones: Los resultados encontrados no justifican el empleo del ST 2D para diferenciar la ECS.

Abstract Introduction: Cardiovascular diseases are the leading cause of death in Cuba and most of the developed countries. Two-dimensional speckle tracking echocardiography (2D ST) is a recent technique in the evaluation of cardiac function. Objectives: To determine the relationship between myocardial deformation measured by 2D ST and coronary circulation in patients with ischemic heart disease, in the CIMEQ, for 1 year. Material and method: An analytical, cross-sectional study was carried out with 55 patients with an indication for coronary angiography who underwent 2D echocardiography and 2D ST study with longitudinal strain measurement (LSM). Two groups significant coronary disease (SCD = 32) and not significant (NSCD = 23) were created. SSPS was used to analyze the results. Results: The average age was higher in SCD (55.6 ± 9.3 vs. 61.8 ± 8.8, p = 0.014). Men with SCD (47.3%), hypertensive (SCD = 90.6% and NSCD = 65.2%, p = 0.02) and smokers (SCD = 59.4% and NSCD = 17.4%, p = 0.002) predominated. The most frequent diagnosis was chronic stable angina (87%). Three-vessel disease (75%) prevailed in SCD. The LMS was lower in SCD ([−20.0 ± 3.2 vs. −22.1 ± 3.6, p = 0.035]; AUC = 0.458). There were no differences in LSM according to the number of significantly diseased vessels. Conclusions: The results found do not justify the use of 2D ST to discriminate SCD.

Disfagia esofágica secundaria a fístula aortoesofágica / Oesophageal dysphagia secondary to aortoesophageal fistula

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Comparación de las ecuaciones MDRD y de las antiguas ecuaciones CKD-EPI frente a las nuevas ecuaciones CKD-EPI en pacientes con trasplante renal cuando se emplea 51Cr-EDTA para medir el filtrado glomerular / Comparison of MDRD and the old CKD-EPI equations with the new CKD-EPI equations in kidney transplant patients when glomerular filtration rate is measured with 51Cr-EDTA

INTRODUCCIÓN: Para la estimación del filtrado glomerular renal (FG) en trasplantados renales se emplean las ecuaciones MDRD y CKD-EPI de 2009 que han mostrado diferencias importantes cuando se comparan con el FG medido con técnicas de referencia. OBJETIVO: Analizar el rendimiento de las ecuaciones MDRD, CKD-EPI de 2009 y de 2012 en 270 pacientes trasplantados renales de un año de evolución, comparando con el FG medido con aclaramiento plasmático de 51Cr-EDTA. RESULTADOS: El FG medido fue 43,0 ± 11,4 (18,2-79,4) mL/min/1,73 m2, con niveles de creatinina de 1,42 ± 0,46 (0,60-4,33) mg/dL y de cistatina C de 1,45 ± 0,53 (0,42-3,48) mg/L. El FG medido se correlacionó moderadamente con creatinina (r = -0,61; p < 0,001) y cistatina C (r = - 0,52; p < 0,001). Empleando técnicas de regresión lineal observamos que creatinina, cistatina C, sexo y edad solo explicaban el 52% de la varianza total del FG. Todas las ecuaciones sobrestimaron el FG, con sesgo medio de +11,1 mL/min/1,73 m2 para MDRD, +16,4 mL/min/1,73 m2 para CKD-EPI de 2009, +15 mL/min/1,73 m2 para CKD-EPI con cistatina C y +14,1 mL/min/1,73 m2 para CKD-EPI con creatinina y cistatina C de 2012. Las estimaciones con MDRD y CKD-EPI de 2009 se correlacionaron mejor con 51Cr-EDTA que CKD-EPI con creatinina y/o cistatina C. Las sobrestimaciones se correlacionaron negativamente con los niveles de creatinina y cistatina C, siendo más importantes para CKD-EPI con creatinina y/o cistatina C cuando el FG fue mayor de 60 mL/min/1,73 m2. CONCLUSIONES: Las ecuaciones CKD-EPI de 2012 con creatinina y/o cistatina C sobrestiman el FG de forma muy marcada en estadios 1 y 2 de la enfermedad renal crónica, por lo que en ellos sería recomendable emplear la ecuación MDRD. La técnica de referencia empleada para medir el FG parece tener una influencia muy importante en el sesgo de las ecuaciones

BACKGROUND: When estimating the glomerular filtration rate (GFR) in kidney transplant patients, significant differences have been found between MDRD and the 2009 CKD-EPI equations, and reference techniques. OBJECTIVE: To analyse and compare the performance of MDRD and the 2009 and 2012 CKD-EPI equations against 51Cr-EDTA plasma clearance in measuring GFR in 270 kidney transplant patients after one year. RESULTS: The mean measured GFR was 43.0 ± 11.4 (18.2-79.4) ml/min/1.73 m2, with creatinine levels of 1.42 ± 0.46 (0.60-4.33) mg/dl and cystatin C levels of 1.45 ± 0.53 (0.42-3.48) mg/l. This correlated moderately with creatinine (r = -0.61, P < .001) and cystatin C (r = -0.52, P < .001). Using linear regression techniques, it was found that creatinine, cystatin C, gender and age only explained 52% of GFR total variance. All equations overestimated GFR, with a mean bias of +11.1 ml/min/1.73 m2 for MDRD, + 16.4 ml/min/1.73 m2 for 2009-CKD-EPI, +15 ml/min/1.73m2 for CKD-EPI with cystatin C, and +14.1 ml/min/1.73 m2 for 2012-CKD-EPI with creatinine and cystatin C. eGFR by MDRD and the 2009 CKD-EPI equation correlated better with 51Cr-EDTA than CKD-EPI with creatinine and/or cystatin C. The overestimations were negatively correlated with creatinine and cystatin C levels, most significantly for CKD-EPI with creatinine and/or cystatin C when GFR was greater than 60 ml/min/1.73 m2. CONCLUSIONS: The 2012 CKD-EPI equations with creatinine and/or cystatin C significantly overestimate GFR in stage 1 and 2 chronic kidney disease. The MDRD equations is therefore recommended in these cases. The reference method used to measure GFR seems to heavily influence the bias of the equations

Comparison of MDRD and the old CKD-EPI equations with the new CKD-EPI equations in kidney transplant patients when glomerular filtration rate is measured with 51Cr-EDTA. / Comparación de las ecuaciones MDRD y de las antiguas ecuaciones CKD-EPI frente a las nuevas ecuaciones CKD-EPI en pacientes con trasplante renal cuando se emplea 51Cr-EDTA para medir el filtrado glomerular.

BACKGROUND: When estimating the glomerular filtration rate (GFR) in kidney transplant patients, significant differences have been found between MDRD and the 2009 CKD-EPI equations, and reference techniques. OBJECTIVE: To analyse and compare the performance of MDRD and the 2009 and 2012 CKD-EPI equations against 51Cr-EDTA plasma clearance in measuring GFR in 270 kidney transplant patients after one year. RESULTS: The mean measured GFR was 43.0±11.4 (18.2-79.4)ml/min/1.73m2, with creatinine levels of 1.42±0.46 (0.60-4.33)mg/dl and cystatin C levels of 1.45±0.53 (0.42-3.48)mg/l. This correlated moderately with creatinine (r=-0.61, P<.001) and cystatin C (r=-0.52, P<.001). Using linear regression techniques, it was found that creatinine, cystatin C, gender and age only explained 52% of GFR total variance. All equations overestimated GFR, with a mean bias of +11.1ml/min/1.73m2 for MDRD, +16.4ml/min/1.73m2 for 2009-CKD-EPI, +15ml/min/1.73m2 for CKD-EPI with cystatin C, and +14.1ml/min/1.73m2 for 2012-CKD-EPI with creatinine and cystatin C. eGFR by MDRD and the 2009 CKD-EPI equation correlated better with 51Cr-EDTA than CKD-EPI with creatinine and/or cystatin C. The overestimations were negatively correlated with creatinine and cystatin C levels, most significantly for CKD-EPI with creatinine and/or cystatin C when GFR was greater than 60ml/min/1.73m2. CONCLUSIONS: The 2012 CKD-EPI equations with creatinine and/or cystatin C significantly overestimate GFR in stage 1 and 2 chronic kidney disease. The MDRD equations is therefore recommended in these cases. The reference method used to measure GFR seems to heavily influence the bias of the equations.

Pseudoquiste suprarrenal calcificado: una dolencia infrecuente / Calcified adrenal pseudocyst: A rare pathology

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Effects of adding a weekly eccentric-overload training session on strength and athletic performance in team-handball players.

To investigate the influence of adding a weekly eccentric-overload training (EOT) session in several athletic performance's tests, 18 team-handball players were assigned either to an EOT (n = 11) or a Control (n = 7) group. Both groups continued to perform the same habitual strength training, but the EOT group added one session/week during a 7-week training programme consisting of four sets of eight repetitions for the bilateral half-squat and unilateral lunge exercises. The test battery included handball throwing velocity, maximum dynamic strength (1RM), countermovement jump (CMJ), 20 m sprint, triple hop for distance, and eccentric/concentric power in both the half-squat and lunge exercises. Data were analysed using magnitude-based inferences. Both groups improved their 1RM in the half squat, 20 m sprint time, and CMJ performance to a similar extent, but the EOT group showed a beneficial effect for both right [(42/58/0), possibly positive] and left [(99/1/0), very likely positive] triple hop for distance performance. In addition, the EOT group showed greater power output improvements in both eccentric and concentric phases of the half-squat (difference in percent of change ranging from 6.5% to 22.0%) and lunge exercises (difference in per cent of change ranging from 13.1% to 24.9%). Nevertheless, no group showed changes in handball throwing velocity. Selected variables related to team-handball performance (i.e. functional jumping performance, power output) can be improved by adding a single EOT session per week, highlighting the usefulness of this low-volume/high-intensity training when aiming at optimizing dynamic athletic performance.

Novedades introducidas por el nuevo Real Decreto legislativo 1090/2015 de ensayos clínicos con medicamentos en España / News introduced by the new Real Legislative Decree 1090/2015 of clinical trials with medicines in Spain

Introducción: La participación de España en ensayos clínicos es una prueba fehaciente de su desarrollo en I+D en el sector salud y de intentar seguir a la vanguardia en cuanto a investigación médica se refiere. El nuevo reglamento del Parlamento Europeo y del Consejo sobre ensayos clínicos de medicamentos de uso humano (Reglamento UE 536/2014, de 16 de abril) deroga la legislación hasta ahora vigente (Directiva 2001/20/CE, de 4 de abril) obligando a modificar el Real Decreto español (RD 223/2004, de 16 de febrero), desarrollando aquellos aspectos que se dejan en mano de la legislación nacional. Objetivo: Analizar las principales modificaciones introducidas por el nuevo RD en investigación clínica (RD 1090/2015, de 4 de diciembre) que regula los ensayos clínicos con medicamentos, los Comités de Ética de la Investigación con medicamentos (CEIm) y el Registro español de ensayos clínicos y compararlas respecto a la normativa anterior. Material y Métodos: Se revisaron los RD 1090/2015, de 4 de diciembre y 223/2004, de 16 de febrero y se compararon las diferencias más destacables entre ambas normativas. Resultados: El nuevo desarrollo normativo introduce novedades importantes. Se abre la opción para la unificación del análisis de las solicitudes, de manera que junto con la autorización del ensayo clínico emitida por la AEMPS, únicamente haga falta que un CEIm acreditado emita su dictamen positivo que será vinculante. Regula nuevas definiciones, como la de ensayo clínico de bajo nivel de intervención, sujeto a normas menos rigurosas. Diferencia entre Comité de ética de la investigación (CEI) y CEIm, estableciendo los requisitos adicionales para pasar de ser CEI a CEIm. Define investigación clínica sin ánimo comercial (en la que el promotor es una universidad, hospital, organización científica pública, organización sin ánimo de lucro, organización de pacientes o investigador individual sin participación de la industria farmacéutica). Abre la opción de contratar un ensayo clínico previamente a su autorización. Define las indemnizaciones por daños y cómo se lleva a cabo la evaluación de los ensayos clínicos. Incorpora la figura del representante legalmente designado para sujetos incapaces y menores. Estipula las condiciones en situaciones de urgencia, embarazadas y periodos de lactancia así como del consentimiento informado. La principal novedad es el expediente único del ensayo clínico con dos partes, una de documentación para la Unión Europea (parte I) y otra de documentación nacional (parte II). Todos los datos tienen que ser enviados a una base de datos y un portal web de la Unión Europea de acceso público. Conclusiones: La nueva normativa propone dar un importante impulso a la investigación clínica en España con medicamentos, simplificando las trabas administrativas y agilizando la realización de estudios multicéntricos simultáneos en toda Europa. Mejora la delimitación de responsabilidades de los agentes que participan, aumenta la seguridad de los sujetos del ensayo, y a la vez, incrementa la eficiencia en los procesos de evaluación y comunicación implicados

Introduction: The participation of Spain in clinical trials is a reliable proof of its development in I+D in the health sector and of trying to follow at the vanguard of medical research. The new Regulation of the European Parliament and of the Council on Clinical Trials on medicines for human use (EU Regulation 536/2014, 16th April) derogates the legislation currently in force (Directive 2001/20/EC, 4th April) and it obliges to modify the Spanish Royal Decree (RD 223/2004, 16th February) to develop those aspects that are left in the hands of national legislation. Objetives: To analyze the main changes introduced by the new RD in clinical research (RD 1090/2015, 4th December), which regulates clinical trials with medicines, the Committees on Ethics of Research with Medicines (CERm) and the Spanish Registry of Clinical Trials and to compare them with the previous legislation. Material and methods: RD 1090/2015, 4th December was analyzed against RD 223/2004, 16th February, and the most important differences between the two regulations were compared. Results: The new regulatory development introduces important innovations. It opens the option for the unification of the analysis of the applications, so that, together with the authorization of the clinical trial issued by the SAMHP, it is only necessary that an accredited CERm emits its positive opinion that it will be binding. It regulates new definitions, such as the low-level clinical trial, subject to less stringent standards. It differentiates between Research Ethics Committee (REC) and CERm, establishing additional requirements to move from being REC to CERm. It defines non-commercial clinical research (in which the sponsor is a university, hospital, public scientific organization, non-profit organization, patient organization or individual researcher without involvement of the pharmaceutical industry). It opens the option to contract a clinical trial prior to its authorization. It defines compensation for damages and how the evaluation of clinical trials is conducted. It incorporates the figure of the legally designated representative for incapable and minor subjects. It stipulates the conditions in situations of urgency, pregnant and periods of lactation as well as informed consent. The main novelty is the single dossier of the two-part clinical trial, one for European Union (Part I) and another one for National Documentation (Part II). All data must be sent to a database and a European public access web portal. Conclusions: The new regulation proposes to give an important impulse to the clinical research in Spain with medicines, simplifying the administrative obstacles and speeding up the realization of multicentric studies simultaneously in all Europe. It improves the delimitation of the responsibilities of the agents involved, it increases the safety of the test subjects, and at the same time, it increases the efficiency in the evaluation and communication processes involved

[Organ and tissue donation and transplantation: three health care centers' attitude]. / Actitud hacia la donación y el trasplante de órganos y tejidos de tres instituciones de salud.

OBJECTIVE: To assess the knowledge and attitude towards organ donation within health professionals in different institutions of Nuevo Leon. METHODS: A prospective, open, observational, descriptive study of parallel groups, through application of a survey formulated by the Hospital Universitario (HU) "Dr. José Eleuterio González". We applied 208 surveys in the HU (n = 100) and other institutions like IMSS, ISSTE (n = 108). RESULTS: From all the participants, 86% had a positive attitude towards organ donation, associated to a higher education, and information regarding organ donation received by other health professionals. Though having a positive attitude toward organ donation, 14% of health professionals don't support it due to being afraid of not receiving medical assistance, knowing their status of donators, religious reasons, and fear of organ trafficking. CONCLUSIONS: Our study shows that, even within the health professionals, there is a need for information regarding organ donation. A well-instructed health professional shows a higher interest in organ donation; this could have a positive impact in the attitude of the population toward organ donation, as well as in the obtainment of organs inside the medical institutions.