La punción seca aumenta el rendimiento de salto en jugadores élite de vóley playa / Deep Dry Needling Enhances Jump Performance in Elite Beach Volleyball Players

El objetivo del presente estudio es evaluar si la aplicación de la punción seca en los puntos gatillo miofasciales latentes se asocia con cambios en el rendimiento de salto. Seis jugadores internacionales de vóley playa sub-21 recibieron tratamiento en el vasto lateral y medial. Se midió la altura de salto SJ y CMJ en cuatro sesiones: antes y después de la intervención (efecto agudo), 48 h y 7 días tras la intervención (efectos a largo plazo). Los jugadores mostraron una pequeña disminución post-intervención seguida de un aumento no significativo a las 48 h. Sin embargo, ambos tipos de salto dieron lugar a un aumento con efecto moderado muy probable tras una semana: 4,13 cm (+10,8%) y 3,54 cm (+8,9%) para SJ y CMJ, respectivamente. A pesar de este aumento significativo, la disminución del rendimiento post-test desalienta su uso inmediatamente antes de una competición. (AU)

The present study aims to assess whether Deep Dry Needling in latent Myofascial Trigger Points is associated with changes in jumping performance. Six Under-21 international beach volleyball players received intervention in vastus lateralis and medialis of the quadriceps. Three squat jump (SJ) and countermovement jump (CMJ) heights were measured in four sessions: pre- and post-intervention (acute effect), 48 h and 7 days after intervention (long-term effects). The players showed a small decrease after the intervention followed by a non-significant increase at 48 h. However, both jump types resulted in very likely moderate increase after one week of intervention: 4.13 cm (+10.8%) and 3.54 cm (+8.9%) for SJ and CMJ, respectively (3 times the smallest worthwhile change). Despite this significant increase, the decreased performance in post-test results discourages practitioners from using this technique just before a competition. (AU)

Challenges of Radiology education in the era of artificial intelligence.

Artificial intelligence is a branch of computer science that is generating great expectations in medicine and particularly in radiology. Artificial intelligence will change not only the way we practice our profession, but also the way we teach it and learn it. Although the advent of artificial intelligence has led some to question whether it is necessary to continue training radiologists, there seems to be a consensus in the recent scientific literature that we should continue to train radiologists and that we should teach future radiologists about artificial intelligence and how to exploit it. The acquisition of competency in artificial intelligence should start in medical school, be consolidated in residency programs, and be maintained and updated during continuing medical education. This article aims to describe some of the challenges that artificial intelligencve can pose in the different stages of training in radiology, from medical school through continuing medical education.

Assessment of chloride natural background levels by applying statistical approaches. Analyses of European coastal aquifers in different environments.

Estimated natural background levels (NBLs) are needed to assess groundwater chemical status according to the EU Groundwater Directive. They are commonly derived for different substances by applying statistical methodologies. Due to the complexity of the sea water intrusion process, some of those methods do not always provide appropriate assessment of chloride NBLs. This paper analyzes the applicability of different NBL estimation methods in five EU coastal aquifers with significant differences in available datasets and hydrogeological settings. A sensitivity analysis of results to different constraints was performed to remove samples with anthropogenic impacts. A novel statistical approach combining different methods to identify the range of chloride NBLs is proposed. In all pilots the estimated NBLs were below 85 mg/L and fitted well with previous studies and expert judgment, except Campina del Faro aquifer (the maximum being 167.5 mg/L). Although this approach is more time consuming, it provides a more robust solution.

Retos de la formación en radiología en la era de la inteligencia artificial / Challenges of Radiology education in the era of artificial intelligence

La inteligencia artificial (IA) es una rama de las ciencias computacionales que está generando enormes expectativas en la medicina en general y en la radiología en particular. La IA no va a alterar solo la forma en que ejercemos la radiología, sino que también va a impactar en el modo en que la enseñamos y la aprendemos. Aunque se ha llegado a cuestionar la necesidad de seguir formando radiólogos como consecuencia de la llegada de la IA, la literatura científica reciente parece estar de acuerdo en que debemos seguir formándolos, incorporando a su capacitación nuevos conocimientos y competencias en IA. Esta nueva formación debería comenzar en la fase universitaria, consolidarse durante la residencia y mantenerse durante la etapa de formación continuada. Este artículo pretende describir algunos de los desafíos que la IA puede plantear en las diferentes fases formativas del radiólogo, desde la educación universitaria hasta la formación continuada.(AU)

Artificial intelligence is a branch of computer science that is generating great expectations in medicine and particularly in radiology. Artificial intelligence will change not only the way we practice our profession, but also the way we teach it and learn it. Although the advent of artificial intelligence has led some to question whether it is necessary to continue training radiologists, there seems to be a consensus in the recent scientific literature that we should continue to train radiologists and that we should teach future radiologists about artificial intelligence and how to exploit it. The acquisition of competency in artificial intelligence should start in medical school, be consolidated in residency programs, and be maintained and updated during continuing medical education. This article aims to describe some of the challenges that artificial intelligencve can pose in the different stages of training in radiology, from medical school through continuing medical education.(AU)

The Use of Silica Microparticles to Improve the Efficiency of Optical Hyperthermia (OH).

Although optical hyperthermia could be a promising anticancer therapy, the need for high concentrations of light-absorbing metal nanoparticles and high-intensity lasers, or large exposure times, could discourage its use due to the toxicity that they could imply. In this article, we explore a possible role of silica microparticles that have high biocompatibility and that scatter light, when used in combination with conventional nanoparticles, to reduce those high concentrations of particles and/or those intense laser beams, in order to improve the biocompatibility of the overall procedure. Our underlying hypothesis is that the scattering of light caused by the microparticles would increase the optical density of the irradiated volume due to the production of multiple reflections of the incident light: the nanoparticles present in the same volume would absorb more energy from the laser than without the presence of silica particles, resulting either in higher heat production or in the need for less laser power or absorbing particles for the same required temperature rise. Testing this new optical hyperthermia procedure, based on the use of a mixture of silica and metallic particles, we have measured cell mortality in vitro experiments with murine glioma (CT-2A) and mouse osteoblastic (MC3T3-E1) cell lines. We have used gold nanorods (GNRs) that absorb light with a wavelength of 808 nm, which are conventional in optical hyperthermia, and silica microparticles spheres (hereinafter referred to as SMSs) with a diameter size to scatter the light of this wavelength. The obtained results confirm our initial hypothesis, because a high mortality rate is achieved with reduced concentrations of GNR. We found a difference in mortality between CT2A cancer cells and cells considered non-cancer MC3T3, maintaining the same conditions, which gives indications that this technique possibly improves the efficiency in the cell survival. This might be related with differences in the proliferation rate. Since the experiments were carried out in the 2D dimensions of the Petri dishes, due to sedimentation of the silica particles at the bottom, whilst light scattering is a 3D phenomenon, a large amount of the energy provided by the laser escapes outside the medium. Therefore, better results might be expected when applying this methodology in tissues, which are 3D structures, where the multiple reflections of light we believe will produce higher optical density in comparison to the conventional case of no using scattering particles. Accordingly, further studies deserve to be carried out in this line of work in order to improve the optical hyperthermia technique.

Challenges of Radiology education in the era of artificial intelligence. / Retos de la formación en radiología en la era de la inteligencia artificial.

Artificial intelligence is a branch of computer science that is generating great expectations in medicine and particularly in radiology. Artificial intelligence will change not only the way we practice our profession, but also the way we teach it and learn it. Although the advent of artificial intelligence has led some to question whether it is necessary to continue training radiologists, there seems to be a consensus in the recent scientific literature that we should continue to train radiologists and that we should teach future radiologists about artificial intelligence and how to exploit it. The acquisition of competency in artificial intelligence should start in medical school, be consolidated in residency programs, and be maintained and updated during continuing medical education. This article aims to describe some of the challenges that artificial intelligencve can pose in the different stages of training in radiology, from medical school through continuing medical education.

Emerging organic compounds in European groundwater.

In Europe, emerging organic compounds (EOCs) in groundwater is a growing research area. Prioritisation for monitoring EOCs in Europe was formalised in 2019 through the development of the first voluntary groundwater watch list (GWWL). Despite this, groundwater occurrence data in the peer reviewed literature for Europe has not been reviewed to date. Questions surrounding the effect, toxicity, movement in the subsurface and unsaturated zone make the process of regulating EOC use difficult. The aim in Europe is to develop a unified strategy for the classification, and prioritisation of EOCs to be monitored in groundwater. This paper compiles evidence from the recent published studies from across Europe, since 2012, when the last major literature global review of EOCs in groundwater took place. A total of 39 studies were identified for review based on specific selection criteria (geography, publication date, sample size>10, inclusion of EOCs data). Data on specific compounds, and associated meta-data, are compiled and reviewed. The two most frequently detected EOCs, carbamazepine and caffeine, occurred in groundwater at concentrations of up to 2.3 and 14.8 µg/L, respectively. The most frequently reported category of compounds were 'Pharmaceuticals'; a highly studied group with 135 compounds identified within 31 of the 39 studies. In Europe, the majority of reviewed studies (23) were at a regional scale, looking specifically at EOCs in a specific city or aquifer. The use of analytical methods is not uniform across Europe, and this inevitably influences the current assessment of EOCs in groundwater. A correlation between the number of compounds analysed for, and the number detected in groundwater highlights the need for further studies, especially larger-scale studies throughout Europe. For the development of EU and national regulation, further work is required to understand the occurrence and impacts of EOCs in groundwater throughout Europe and elsewhere.

Diabetes gestacional: conceptos actuales / Gestational diabetes: Current concepts

Resumen OBJETIVO: exponer los conceptos más actualizados de diabetes y embarazo. MÉTODO: búsqueda en PubMed y Lilacs de artículos de revisión publicados en inglés o español entre los años 2001 y 2016 con los términos "diabetes mellitus", "diabetes gestacional", "diabetes y embarazo". RESULTADOS: se encontraron 525 artículos. El consenso total de los principales temas de diabetes y embarazo se concentra en las últimas 27 revisiones y 7 guías clínicas, que son la base de esta revisión. La diabetes gestacional se asocia con mayor riesgo de preeclampsia, de posibilidad de cesárea, macrosomía, distocia de hombros y mortalidad perinatal. Está demostrado que el primer paso en el tratamiento de la diabetes es la dieta adecuada y luego la insulina o metformina. La gliburida no debe indicarse para el control de la diabetes gestacional. CONCLUSIONES: la diabetes gestacional sigue siendo una de las principales complicaciones obstétricas con alta tasa de morbilidad materna, neonatal y pediátrica. El tratamiento debe enfocarse a la dieta como primera medida y, de ser necesario, una estrategia farmacológica de metformina e insulina como únicas opciones.

Abstract OBJECTIVE: To present the most up-to-date concepts of diabetes and pregnancy. METHOD: PubMed and lilacs search articles published in english or spanish between 2001 and 2016 with the terms "diabetes mellitus", "gestational diabetes", "diabetes and pregnancy". RESULTS: 525 articles were found. The overall consensus on the major issues of diabetes and pregnancy is concentrated in the last 27 reviews and 7 clinical guidelines, which are the basis of this review. Gestational diabetes is associated with an increased risk of preeclampsia, caesarean section, macrosomia, shoulder dystocia and perinatal mortality. It is proven that the first step in the treatment of diabetes is the proper diet and then insulin or metfomine. Glyburide should not be indicated for the management of gestational diabetes. CONCLUSIONS: Gestational diabetes continues to be one of the main obstetric complications with a high rate of maternal, neonatal and pediatric morbidity. Treatment should focus on diet as a first step and, if necessary, a pharmacological strategy of metformin and insulin as the only options.

Enzalutamide as monotherapy for advanced prostate cancer: why not? / Enzalutamida como monoterapia para cáncer de próstata avanzado: ¿por qué no?

OBJECTIVES: Prostate cancer (PCa) is an androgen-dependent disease. In some cases, the tumor progresses despite castration levels of serum testosterone, turning into the lethal phenotype of castration-resistant prostate cancer (CRPC), still driven by androgens and requiring the androgen receptor as a driver and responsible for progression. Enzalutamide, an androgen receptor inhibitor, is indicated for the treatment of metastatic CRPC, asymptomatic or mildly symptomatic, after failure of androgen deprivation. In both clinical trials that led to its approval, Enzalutamide was administered with an LHRH analog, setting the "standard of care" for its use. In this article we evaluate the available evidence and theory on the use of Enzalutamide as monotherapy. METHODS: Androgen deprivation well-known adverse events, together with the fact that its clinical benefit is moderate and the evidence strength is weak, and the direct negative impact on the common chronic conditions affecting this age-group led to investigation of Enzalutamide without LHRH analogs. RESULTS: There are clinical trials on Enzalutamide monotherapy for hormone-sensitive prostate cancer with favourable outcomes, and there are also two ongoing studies in different advanced PCa scenarios, the PROSPER and EMBARK trials. It would be up to now a safe alternative, with less toxicity and lower costs. CONCLUSION: It is mandatory to validate these early results on the use on Enzalutamide monotherapy for advanced prostate cancer, hormone-sensitive or castration resistant, metastatic or not, but in the meantime, we wonder, why not?

Trichinella pseudospiralis in the Iberian peninsula.

Nematode worms of the genus Trichinella are zoonotic parasites circulating in most continents, including Europe. In Spain, Trichinella spiralis and Trichinella britovi are highly prevalent in wildlife but seldom in domestic pigs. In Portugal, only T. britovi was documented in wild carnivores. In the period 2006-2013 in Spain, 384 (0.0001%) pigs and 1399 (0.20%) wild boars (Sus scrofa) were positive for Trichinella spp. larvae, which were identified as T. spiralis or T. britovi. In 2014, Trichinella pseudospiralis larvae were isolated from a wild boar hunted in the Gerona province, Cataluña region, North-East of Spain, near the border to France. This is the first report of T. pseudospiralis in the Iberian peninsula, which suggests a broad distribution area of this zoonotic nematode in Europe. Since larvae of this Trichinella species do not encapsulate in the host muscles, they can be detected only by artificial digestion of muscle samples. T. pseudospiralis is the only Trichinella species infecting both mammals and birds. Birds can spread this pathogen over great distances including islands triggering new foci of infections in areas previously considered at low risk for this pathogen.

Effects of whole body vibration on strength and jumping performance in volleyball and beach volleyball players.

The primary aim of this study was to examine the effects of 6-week strength training with whole body vibration (WBV) on leg strength and jumping performance in volleyball and beach volleyball players. Twenty-three sub-elite male volleyball (VB; n=12) and beach volleyball players (BVB; n=11) aged 21.2±3.0 years were divided into two groups and subjected to 6 weeks of strength training (three one-hour sessions per week): (I) 12 players (6 VB and 6 BVB players) underwent training with WBV (30-40 Hz, 1.7-2.5 mm, 3.0-5.7 g), and (II) 11 players (6 VB and 5 BVB players) underwent traditional strength training. Squat jump (SJ) and countermovement squat jump (CMJ) measurements by the Ergo Tester contact platform and maximum leg press test (1RM) were conducted. Three-factor (2 time x 2 WBV use x 2 discipline) analysis of variance for SJ, CMJ and 1RM revealed a significant time main effect (p<0.001), a WBV use effect (p<0.001) and a discipline effect (p<0.001). Significantly greater improvements in the SJ (p<0.001) and CMJ (p<0.001) and in 1RM (p<0.001) were found in the WBV training groups than in traditional training groups. Significant 3-way interaction effects (training, WBV use, discipline kind) were also found for SJ, CMJ and 1RM (p=0.001, p<0.001, p=0.001, respectively). It can be concluded that implementation of 6-week WBV training in routine practice in volleyball and beach volleyball players increases leg strength more and leads to greater improvement in jump performance than traditional strength training, but greater improvements can be expected in beach volleyball players than in volleyball players.

Fracture of the body of hamate associated with a fracture of the base of fourth metacarpal: A case report and review of literature of the last 20 years.

INTRODUCTION: Fractures of the carpal bones are often difficult to diagnose and treat due to the complex bone architecture of this region. Hamate fractures, particularly body fractures, are extremely uncommon. PRESENTATION OF CASE: We present a case of a coronal fracture of the hamate associated with a fracture of the base of the fourth metacarpal, which was treated by open reduction and internal fixation. DISCUSSION: Some of hamate body fractures are associated with other injuries like metacarpal fractures. Its diagnosis is difficult and requires a high clinical suspicion and a proper radiological examination. This fracture is a very rare lesion that can raise questions about their most adequate diagnostic and therapeutic approaches. CONCLUSION: After reviewing the literature, we conclude that there is a high rate of delay in the diagnosis of these lesions, probably due to their rarity and to the lack of radiological studies specifically targeting this region. Despite this, surgical treatment in its different modalities has been shown to have the best clinical and functional results.

Design and characterization of biofunctional magnetic porous silicon flakes.

Magnetic porous silicon flakes (MPSF) were obtained from mesoporous silicon layers formed by multi-step anodization and subsequent composite formation with Fe oxide nanoparticles by thermal annealing. The magnetic nanoparticles adhered to the surface and penetrated inside the pores. Their structure evolved as a result of the annealing treatments derived from X-ray diffraction and X-ray absorption analyses. Moreover, by tailoring the magnetic load, the dynamic and hydrodynamic properties of the particles were controlled, as observed by the pressure displayed against a sensor probe. Preliminary functionality experiments were performed using an eye model, seeking potential use of MPSF as reinforcement for restored detached retina. It was observed that optimal flake immobilization is obtained when the MPSF reach values of magnetic saturation >10(-4)Am(2)g(-1). Furthermore, the MPSF were demonstrated to be preliminarily biocompatible in vitro. Moreover, New Zealand rabbit in vivo models demonstrated their short-term histocompatibility and their magnetic functionality as retina pressure actuators.

Viral kinetics during the first month of treatment in patients with genotype 1 chronic hepatitis C.

OBJECTIVE: to identify predictive factors of response to pegylated interferon alpha-2b and ribavirin in patients with genotype 1 chronic hepatitis C. Viral kinetics were studied in weeks 2 and 4. METHODS: a prospective and consecutive study of patients with genotype 1 chronic hepatitis C referred to our Hepatology Clinic between January 2004 and October 2006 for antiviral treatment. Baseline data were recorded and viremia levels were determined hours before the weekly dose of pegylated interferon by qualitative and quantitative PCR. RESULTS: 57 patients were included in the study, although 3 of these were excluded during follow up; 65% were male (n = 35), with a mean age of 42 (26-65) years. Baseline viremia levels were > 800,000 IU/mL in 67% (n = 36). Liver biopsy was performed in 86% (n = 46), 22% (n = 12) had advanced fibrosis. Forty were naïve, 4 relapsing and 10 non-responders. Ribavirin dose was modified in one patient alone due to adverse effects. End treatment response and sustained virological response (SVR) were 59 and 41%, respectively. A univariate analysis revealed a statistically significant association of SVR with baseline viremia (p = 0.006), baseline GGT (p = 0.025), and a reduction in viremia > or =2 logs at 2, 4 and 12 weeks (p = 0.001). The extent of viremia reduction at week 2 was associated with 100% SVR, and at 4 weeks the positive predictive values was 84% and the negative predictive values was 96.5%. A subanalysis of the naïve group yielded analogous results. CONCLUSIONS: in our study, a reduction in viremia > or = 2 logs 2 weeks after treatment could ensure SVR. At 4 weeks, most non-responders could be identified.

Cinética viral durante el primer mes de tratamiento en pacientes con hepatitis crónica C genotipo 1 / Viral kinetics during the first month of treatment in patients with genotype 1 chronic hepatitis C

Objective: to identify predictive factors of response to pegylatedinterferon alpha-2b and ribavirin in patients with genotype 1chronic hepatitis C. Viral kinetics were studied in weeks 2 and 4.Methods: a prospective and consecutive study of patients withgenotype 1 chronic hepatitis C referred to our Hepatology Clinicbetween January 2004 and October 2006 for antiviral treatment.Baseline data were recorded and viremia levels were determinedhours before the weekly dose of pegylated interferon by qualitativeand quantitative PCR.Results: 57 patients were included in the study, although 3 ofthese were excluded during follow up; 65% were male (n = 35),with a mean age of 42 (26-65) years. Baseline viremia levels were> 800,000 IU/mL in 67% (n = 36). Liver biopsy was performedin 86% (n = 46), 22% (n = 12) had advanced fibrosis. Forty werenaïve, 4 relapsing and 10 non-responders. Ribavirin dose wasmodified in one patient alone due to adverse effects. End treatmentresponse and sustained virological response (SVR) were 59and 41%, respectively. A univariate analysis revealed a statisticallysignificant association of SVR with baseline viremia (p = 0.006),baseline GGT (p = 0.025), and a reduction in viremia >= 2 logs at2, 4 and 12 weeks (p = 0.001). The extent of viremia reduction atweek 2 was associated with 100% SVR, and at 4 weeks the positivepredictive values was 84% and the negative predictive valueswas 96.5%. A subanalysis of the naïve group yielded analogousresults.Conclusions: in our study, a reduction in viremia >= 2 logs2 weeks after treatment could ensure SVR. At 4 weeks, mostnon-responders could be identified(AU)

Objetivo: identificar qué factores predicen la respuesta al interferónpegilado alfa-2b y ribavirina en pacientes con hepatitiscrónica C genotipo 1. Se estudió la cinética viral en la semana 2 y4.Métodos: se evaluaron de forma prospectiva y consecutiva alos pacientes con hepatitis crónica C genotipo 1 remitidos a nuestraconsulta de hepatología entre enero de 2004 y octubre de2006, para tratamiento antiviral. Se recogieron datos basales y laviremia se determinó horas antes de la dosis semanal de interferónpegilado por PCR cualitativa y cuantitativa.Resultados: cincuenta y siete pacientes fueron incluidos aunque3 fueron excluidos durante el seguimiento. Un 65% fueronvarones (n = 35) con edad media de 42 (26-65) años. La viremiabasal fue > 800.000 UI/ml en 67% (n = 36). Se realizó biopsiahepática en 86% (n = 46), 22% (n = 12) tenían fibrosis avanzada.40 fueron naïves, 4 recidivantes y 10 no respondedores. La dosisde ribavirina se modificó por efecto secundario sólo en un paciente.La RFT y la RVS fueron de 59 y 41%, respectivamente. Elanálisis univariante mostró asociación estadísticamente significativacon RVS de la viremia basal (p = 0,006), GGT basal (p =0,025) y el descenso en la viremia >= 2 logaritmos a las 2, 4 y 12semanas (p = 0,001). El descenso de la viremia en la semana 2 seasoció con 100% de RVS y a las 4 semanas el VPP fue 84% y elVPN 96,5%. Se realizó un subanálisis en el grupo de pacientesnaïves con resultados superponibles.Conclusiones: en nuestro estudio el descenso de la viremia >= 2 logaritmos a las 2 semanas de tratamiento aseguró la RVS. Alas 4 semanas, identificamos a la gran mayoría de los pacientes norespondedores(AU)

Endoscopic follow-up of gastric ulcer in a population at intermediate risk for gastric cancer.

OBJECTIVES: Primary: to assess the necessity of a second endoscopy with a pathology study to confirm the healing of all gastric ulcers previously diagnosed through endoscopy in a population at intermediate risk for gastric cancer. Secondary: to assess correlation between endoscopic findings and pathology diagnosis. PATIENTS AND METHODS: a prospective analysis of patients diagnosed with gastric ulcer through endoscopy at Hospital General de Ciudad Real (Spain) over three years. We collected demographic, clinical, endoscopic, and pathological data for the first and subsequent endoscopies. We collected at least six biopsies obtained from ulcer margins, and assessed H. pylori infection. RESULTS: Three hundred and two patients were included in this study. H. pylori infection was diagnosed in 173 (57%), and 113 (37%) patients had used NSAIDs. The positive and negative predictive value for malignancy of endoscopic diagnosis regarding ulcer fold, base, and margins were 34 and 97%, respectively. Only one patient was diagnosed with a tumor during the second endoscopy. At the end of follow-up, the etiology of the ulcer was considered as peptic in 276 patients; Crohn s disease-related in one, and neoplastic in 25 patients (21 adenocarcinomas, 4 lymphomas). CONCLUSIONS: in an intermediate-risk population for gastric cancer a second endoscopy is not justified for gastric ulcer patients when endoscopy and biopsy results do not suggest malignancy.

Seguimiento endoscópico de la úlcera gástrica en una población de riesgo intermedio de cáncer gástrico / Endoscopic follow-up of gastric ulcer in a population at intermediate risk for gastric cancer

Objetivos: Primario: valorar la necesidad de una segunda endoscopia con estudio anatomopatológico para confirmar la curación de todas las úlceras gástricas diagnosticadas previamente mediante endoscopia, en una población de riesgo intermedio de cáncer gástrico. Secundario: correlacionar el juicio diagnóstico del endoscopista y el diagnóstico anatomopatológico. Pacientes y métodos: análisis prospectivo de todos los pacientes diagnosticados de úlcera gástrica mediante endoscopia en el Hospital General de Ciudad Real durante tres años. Se recogieron datos demográficos, clínicos, endoscópicos y anatomopatológicos de la primera y sucesivas endoscopias. Se tomaron al menos seis muestras de biopsia del nicho y se valoró la presencia de H. pylori. Resultados: se incluyeron 302 pacientes. Se diagnosticó infección por H. pylori en 173 (57%) y se documentó la toma de AINE en 113 (37%). El valor predictivo positivo y negativo para malignidad del diagnóstico endoscópico atendiendo a los pliegues, fondo y bordes del nicho fue de 34 y 97%, respectivamente. La segunda endoscopia sólo diagnosticó un paciente. Al final del seguimiento, el diagnóstico etiológico fue de 276 casos de úlcera péptica, 1 de úlcera por enfermedad de Crohn y 25 de úlcera neo-plásica (21 adenocarcinomas, 4 linfomas). Conclusiones: en una población de riesgo intermedio de cáncer gástrico, no está indicada la realización sistemática de una segunda endoscopia en pacientes con úlcera gástrica en los que la visión endoscópica y la biopsia del nicho no indican malignidad(AU)

Objectives: Primary: to assess the necessity of a second endoscopy with a pathology study to confirm the healing of all gastric ulcers previously diagnosed through endoscopy in a population at intermediate risk for gastric cancer. Secondary: to assess correlation between endoscopic findings and pathology diagnosis. Patients and methods: a prospective analysis of patients diagnosed with gastric ulcer through endoscopy at Hospital General de Ciudad Real (Spain) over three years. We collected demographic, clinical, endoscopic, and pathological data for the first and subsequent endoscopies. We collected at least six biopsies obtained from ulcer margins, and assessed H. pylori infection. Results: Three hundred and two patients were included in this study. H. pylori infection was diagnosed in 173 (57%), and 113 (37%) patients had used NSAIDs. The positive and negative predictive value for malignancy of endoscopic diagnosis regarding ulcer fold, base, and margins were 34 and 97%, respectively. Only one patient was diagnosed with a tumor during the second endoscopy. At the end of follow-up, the etiology of the ulcer was considered as peptic in 276 patients; Crohn's disease-related in one, and neoplastic in 25 patients (21 adenocarcinomas, 4 lymphomas). Conclusions: in an intermediate-risk population for gastric cancer a second endoscopy is not justified for gastric ulcer patients when endoscopy and biopsy results do not suggest malignancy(AU)

Acalculous cholecystitis in a patient with Plasmodium falciparum infection after a trip to the Dominican Republic.

Acalculous cholecystitis has been associated with several infectious agents, but its relation with Plasmodium falciparum infection has not been clearly defined. This is the first case of acalculous cholecystitis produced by Plasmodium falciparum infection that is directly documented and should be included among the differential diagnoses of acalculous cholecystitis.

[Assessment of hypothalamo-pituitary axis in early phase of severe cranioencephalic brain injury]. / Valoración del eje hipotálamo-hipofisario en la fase precoz del traumatismo craneoencefálico grave.

OBJECTIVE: To assess early pituitary function in a sequential cohort of critical care patients after severe traumatic brain injury (TBI). DESIGN: This was a prospective observational study. The pituitary function was always tested on the third day after TBI. SETTING: Neurocritical intensive care unit (ICU) in a University hospital. PATIENTS: A total of 136 adult patients with severe TBI (range, 16-65 years) enrolled over a 2 year and 9 month period having a stay in the ICU treated than 48 hours. INTERVENTION: None. MEASUREMENTS AND DATA COLLECTED: The following data were recorded within the first 72 hours after injury: demographic variables, injury severity, neuromonitoring data, systemic secondary brain insults, use of vasoactive drugs and type of TBI according to the computerized tomography (CT) scan findings. Pituitary function was evaluated by measurement of both the pituitary and target organ hormones, with the exception of the somatotrophic function, which was assessed by measurement of basal serum values of insulin-like growth factor-I (IGF-I). RESULTS: Pituitary dysfunction was observed in 101 patients (74.2%). Seventy-nine patients (58%) had impairment of only one pituitary axis, the axes being affected as follows: gonadotropic 63.7% (87 patients), thyrotropic 8.8% (12 patients) and corticotropic 0.7% (1 patient). Low IGF-1 plasmatic levels in accordance to the patient's age were observed in 90 patients (66.7%). However, only 26 of them had a value below 90 ng/ml. CONCLUSIONS: Our data show that pituitary dysfunction occurs early and with high frequency after severe TBI, but the real significance of these findings still needs to be elucidated.