C-reactive protein at ICU admission as a marker of early graft dysfunction after liver transplant. A prospective, single-center cohort study / Proteína C reactiva al ingreso en UCI como marcador de disfunción temprana del injerto tras trasplante hepático. Estudio unicéntrico, prospectivo y de cohortes

OBJECTIVE: To explore the behavior of C-reactive protein (CRP) after orthotopic liver transplantation (OLT) during the first postoperative days, and its usefulness as a marker of severe early allograft dysfunction (EAD). DESIGN: A prospective, single-center cohort study was carried out. SETTING: The Intensive Care Unit (ICU) of a regional hospital with a liver transplant program since 1997. PATIENTS: The study comprised a total of 183 patients admitted to our ICU immediately after liver transplantation between 2009 and 2015. VARIABLES OF INTEREST: C-reactive protein levels upon ICU admission and after 24 and 48h, severe EAD and hospital mortality. RESULTS: The CRP levels after OLT were: upon ICU admission 57.5 (51.6-63.3) mg/L, after 24h 80.1 (72.9-87.3)mg/L and after 48h 69.9 (62.5-77.4) mg/L. Severe EAD patients (14.2%) had higher mortality (23.1 vs 2.5; OR 11.48: 2.98-44.19) and lower CRP upon ICU admission (39.3 [29.8-48.7] mg/L) than the patients without EAD (0.5 [53.9-67.0]; p < 0.05] - the best cut-off point being 68mg/L (sensitivity 92.3%; specificity 40.1%; Youden index 0.33). Lower CRP upon ICU admission was correlated to higher mortality (24.5 [9.2-39.7] vs 59.4 [53.4-65.4]; p < 0.01, AUC 0.79 [0.65-0.92]). CONCLUSIÓN: Liver transplant is a strong inflammatory stimulus accompanied by high levels of C-reactive protein. A blunted rise in CRP on the first postoperative day after OLT may be a marker of poor allograft function and is related to hospital mortality

OBJETIVO: Explorar el comportamiento de la proteína C reactiva (PCR) en el postoperatorio inmediato de trasplante hepático y su utilidad como marcador de disfunción grave del injerto hepático. DISEÑO: Estudio de cohortes prospectivo, unicéntrico. ÁMBITO: Unidad de cuidados intensivos (UCI) de un hospital regional. PACIENTES: Ciento ochenta y tres pacientes ingresados en nuestra UCI inmediatamente después del trasplante hepático entre 2009-2015. VARIABLES DE INTERÉS: Niveles de PCR al ingreso en UCI, 24 y 48h, disfunción grave del injerto hepático, mortalidad intrahospitalaria. RESULTADOS: Los niveles de PCR en el postoperatorio inmediato de trasplante fueron: al ingreso en UCI 57,5 (51,6-63,3) mg/L, a las 24h 80,1 (72,9-87,3) mg/L y a las 48h 69,9 (62,5-77,4) mg/L. Los pacientes con disfunción grave del injerto (14,2%) tuvieron una mayor mortalidad (23,1 vs. 2,5; OR 11,48: 2,98-44,19) y PCR más baja al ingreso en UCI (39,3 [29,8-48,7]mg/L) que los pacientes sin disfunción grave (0,5 [53,9-67]; p < 0,05), siendo el mejor punto de corte para la PCR de 68mg/L (sensibilidad 92,3%; especificidad 40,1%; índice de Youden 0,33). La PCR baja al ingreso tuvo correlación directa con la mortalidad (24,5 [9,2-39,7] vs. 59,4 [53,4-65,4]; p < 0,01, AUC 0,79 [0,65-0,92]). CONCLUSIÓN: El trasplante hepático es un estímulo inflamatorio intenso que se acompaña de niveles elevados de PCR. Un ascenso truncado de la PCR, en el primer día del postoperatorio de trasplante hepático, puede ser un marcador de funcionamiento inadecuado del injerto hepático y está relacionado con la mortalidad intrahospitalaria

Early graft dysfunction after liver transplant: Comparison of different diagnostic criteria in a single-center prospective cohort / Disfunción temprana del injerto tras trasplante hepático: Comparación de varios criterios diagnósticos en un estudio unicéntrico, prospectivo y de cohorte

OBJECTIVE: Comparison of different diagnostic criteria for early liver allograft dysfunction (EAD) and their capability to predict mortality. DESIGN: Single-center, prospective, cohort study. SETTINGS: ICU in a Regional Hospital with a liver transplant program since 1997. PATIENTS: 253 consecutive patients admitted to our ICU immediately after liver transplantation between 2009 and 2015. Variables of interest: Differences in the incidence of EAD and its relation with ICU, Hospital and 2-year mortality depending on the definition applied using as comparator the UNOS (United Network for Organ Sharing) primary non-function criterion. RESULTS: The incidence of early liver allograft dysfunction according to UNOS was 13.8%, to Makowka 6.3%, to Ardite 10.7%, to Nanashima 20.6%, to Dhillon 30.8% and to MEAF 13.4%. Kappa test did not show a good correlation among these criteria. EAD was related with ICU mortality for all diagnostic criteria except Dhillon but only UNOS, Makowka and MEAF were associated with 2-year mortality. Hospital mortality was poorly predicted by all criteria except for the MEAF score. CONCLUSIÓN: We found a poor agreement between different criteria analyzed for the diagnosis of EAD. In our population, the MEAF score showed the best relationship with short- and long-term mortality

OBJETIVO: Comparar diferentes criterios diagnósticos de disfunción temprana del aloinjerto hepático y su capacidad para predecir mortalidad. DISEÑO: Estudio de cohortes prospectivo, unicéntrico. Ámbito: Unidad de Cuidados Intensivos de un Hospital Regional con programa de trasplante hepático desde 1997. PACIENTES: 253 pacientes consecutivos ingresados en nuestra UCI inmediatamente después del trasplante entre 2009-2015. Variables de interés: Incidencia de disfunción temprana del aloinjerto hepático según cada criterio diagnóstico, relación entre disfunción grave acorde a cada criterio y mortalidad en UCI, mortalidad hospitalaria y a los 2 años utilizando como comparador el criterio para fallo primario de la UNOS (United Network for Organ Sharing). RESULTADOS: La incidencia de disfunción temprana según UNOS fue 13.8%, Makowka 6.3%, Ardite 10.7%, Nanashima 20.6%, Dhillon 30.8% y MEAF 13.4%. El coeficiente kappa mostró una pobre correlación entre ellos. Todos los criterios, excepto el de Dhillon, mostraron relación con la mortalidad en la UCI, pero solo los criterios de UNOS, Makowka y MEAF se asociaron con la mortalidad a 2 años. Finalmente, la capacidad predictiva de la mortalidad hospitalaria fue baja para todos, excepto para MEAF. CONCLUSIÓN: Existe una pobre correlación entre diferentes criterios diagnósticos de disfunción temprana del injerto hepático. El MEAF muestra la mejor relación con el pronóstico a corto y largo plazo en nuestra población

Percepción del etiquetado nutricional en población con obesidad y sobrepeso / Perception of the nutritional labels by population in risk of being obese or overweight

FUNDAMENTOS: El etiquetado nutricional representa una valiosa herramienta para ayudar a los consumidores a tomar decisiones informadas acerca de su dieta y estilo de vida. Son escasos los estudios realizados en España sobre la percepción de la información alimentaria por el consumidor y ninguno considera la población con obesidad y sobrepeso como objetivo principal. Por ello el objetivo de este trabajo es evaluar la percepción de esta población frente a la información que le proporciona el etiquetado de los alimentos, su comprensión, utilidad y uso. MÉTODOS: Se realiza 133 encuestas en personas de la Comunidad Valenciana con obesidad (27,8%) y sobrepeso (72,2%) sobre la lectura, hábitos de compra, comprensión y uso de la información alimentaria. RESULTADOS: Se observa que a pesar del interés por seguir una dieta saludable (27,8%) y la valoración positiva del etiquetado de los alimentos (91%), se lee poco (35,3%) y resulta difícil de comprender (35,6%). El precio es el condicionante que más influye a la hora de la compra (72,9%). El 72,9% no sigue una dieta especial. El semáforo nutricional es el etiquetado frontal mejor comprendido. CONCLUSIONES: La población con obesidad y sobrepeso tiene dificultad para interpretar y comprender el etiquetado de los alimentos

BACKGROUND: Nutritional food label represents a valuable tool to help consumers to make informed decisions about their diets and lifestyle. There are few studies carried out in Spain about the perception of the consumer and none of them has obese or overweight population as their main target. Consequently the high interest to conduct this research in order to assess the perception of this population to food label, their understanding, utility and use. METHODS: 133 surveys are conducted in Comunidad Valenciana on obese (27.8%) and overweight (72.2%) people regarding their reading, shopping habits, use and understanding of food information. RESULTS: It is observed that despite their interest to follow a healthy diet (27.8%) and the positive assessment of the food label (91.0%) little is read (35.3%) and it is difficult to understand (35.6%). Price is the most determining factor regarding purchase (72.9%). 72.9% of the population don't follow a special diet. Traffic light colours used on the front packaging is the best understood food label. CONCLUSIONS: Obese and overweight population has difficulty in interpreting and understanding food labels

C-reactive protein at ICU admission as a marker of early graft dysfunction after liver transplant. A prospective, single-center cohort study.

OBJECTIVE: To explore the behavior of C-reactive protein (CRP) after orthotopic liver transplantation (OLT) during the first postoperative days, and its usefulness as a marker of severe early allograft dysfunction (EAD). DESIGN: A prospective, single-center cohort study was carried out. SETTING: The Intensive Care Unit (ICU) of a regional hospital with a liver transplant program since 1997. PATIENTS: The study comprised a total of 183 patients admitted to our ICU immediately after liver transplantation between 2009 and 2015. VARIABLES OF INTEREST: C-reactive protein levels upon ICU admission and after 24 and 48h, severe EAD and hospital mortality. RESULTS: The CRP levels after OLT were: upon ICU admission 57.5 (51.6-63.3)mg/L, after 24h 80.1 (72.9-87.3)mg/L and after 48h 69.9 (62.5-77.4)mg/L. Severe EAD patients (14.2%) had higher mortality (23.1 vs 2.5; OR 11.48: 2.98-44.19) and lower CRP upon ICU admission (39.3 [29.8-48.7]mg/L) than the patients without EAD (0.5 [53.9-67.0]; p<0.05] - the best cut-off point being 68mg/L (sensitivity 92.3%; specificity 40.1%; Youden index 0.33). Lower CRP upon ICU admission was correlated to higher mortality (24.5 [9.2-39.7] vs 59.4 [53.4-65.4]; p<0.01, AUC 0.79 [0.65-0.92]). CONCLUSION: Liver transplant is a strong inflammatory stimulus accompanied by high levels of C-reactive protein. A blunted rise in CRP on the first postoperative day after OLT may be a marker of poor allograft function and is related to hospital mortality.

Early graft dysfunction after liver transplant: Comparison of different diagnostic criteria in a single-center prospective cohort.

OBJECTIVE: Comparison of different diagnostic criteria for early liver allograft dysfunction (EAD) and their capability to predict mortality. DESIGN: Single-center, prospective, cohort study. SETTINGS: ICU in a Regional Hospital with a liver transplant program since 1997. PATIENTS: 253 consecutive patients admitted to our ICU immediately after liver transplantation between 2009 and 2015. VARIABLES OF INTEREST: Differences in the incidence of EAD and its relation with ICU, Hospital and 2-year mortality depending on the definition applied using as comparator the UNOS (United Network for Organ Sharing) primary non-function criterion. RESULTS: The incidence of early liver allograft dysfunction according to UNOS was 13.8%, to Makowka 6.3%, to Ardite 10.7%, to Nanashima 20.6%, to Dhillon 30.8% and to MEAF 13.4%. Kappa test did not show a good correlation among these criteria. EAD was related with ICU mortality for all diagnostic criteria except Dhillon but only UNOS, Makowka and MEAF were associated with 2-year mortality. Hospital mortality was poorly predicted by all criteria except for the MEAF score. CONCLUSION: We found a poor agreement between different criteria analyzed for the diagnosis of EAD. In our population, the MEAF score showed the best relationship with short- and long-term mortality.

[Minor stroke in a patient with thrombocytopenia]. / Ictus menor en una paciente con trombocitopenia.

TITLE: Ictus menor en una paciente con trombocitopenia.

Prevalence of Abdominal Aortic Aneurysm in Men Aged 65-74 Years in a Metropolitan Area in North-East Spain.

BACKGROUND: A declining prevalence of AAA and a shift in the distribution towards the older population have been observed during the last decade in Europe. The aim was to estimate the current screening prevalence of AAA in men aged 65-74 years in a metropolitan area in north-east Spain and to identify associated risk factors. METHODS: A cross sectional prevalence study in men registered in L'Hospitalet Primary Healthcare Services (Barcelona, Spain) was performed. There were 619 randomly selected subjects (expected prevalence of aneurysm, 5%; accuracy of estimation, ±2%; loss to follow up, 30%). Exclusion criteria were life expectancy <1 year, limited quality of life, previous diagnosis of AAA, prior aorto-femoral surgery, and non-Caucasian. The following were measured: internal diameter of the infrarenal abdominal aorta using ultrasound, cardiovascular risk factors, personal (heart disease, stroke, peripheral vascular disease) and family history (AAA), physical examination, and blood tests. We estimated the prevalence and 95% confidence interval of AAA, and used logistic regression analysis to identify risk factors for AAA. RESULTS: Among the 651 individuals included in the analysis the prevalence of aneurysm was 2.30% (95% CI, 1.30-3.77%). In the regression analysis, AAA was associated with smoking (0-10, 11-20, or >20 cigarettes/day), diagnosis of myocardial infarction, and being taller than the median (165 cm). CONCLUSIONS: The current screening prevalence of AAA among men aged 65-74 years in a metropolitan area in north-east Spain is similar to that in northern Europe. Smoking, myocardial infarction, and height were associated with the presence of AAA.

Isotopic discrimination of stable isotopes of nitrogen (δ15N) and carbon (δ13C) in a host-specific holocephalan tapeworm.

During the past decade, parasites have been considered important components of their ecosystems since they can modify food-web structures and functioning. One constraint to the inclusion of parasites in food-web models is the scarcity of available information on their feeding habits and host-parasite relationships. The stable isotope approach is suggested as a useful methodology to determine the trophic position and feeding habits of parasites. However, the isotopic approach is limited by the lack of information on the isotopic discrimination (ID) values of parasites, which is pivotal to avoiding the biased interpretation of isotopic results. In the present study we aimed to provide the first ID values of δ(15)N and δ(13)C between the gyrocotylidean tapeworm Gyrocotyle urna and its definitive host, the holocephalan Chimaera monstrosa. We also test the effect of host body size (body length and body mass) and sex of the host on the ID values. Finally, we illustrate how the trophic relationships of the fish host C. monstrosa and the tapeworm G. urna could vary relative to ID values. Similar to other studies with parasites, the ID values of the parasite-host system were negative for both isotopic values of N (Δδ(15)N = - 3.33 ± 0.63‰) and C (Δδ(13)C = - 1.32 ± 0.65‰), independent of the sex and size of the host. By comparing the specific ID obtained here with ID from other studies, we illustrate the importance of using specific ID in parasite-host systems to avoid potential errors in the interpretation of the results when surrogate values from similar systems or organisms are used.

DNA copy number profiling reveals extensive genomic loss in hereditary BRCA1 and BRCA2 ovarian carcinomas.

BACKGROUND: Few studies have attempted to characterise genomic changes occurring in hereditary epithelial ovarian carcinomas (EOCs) and inconsistent results have been obtained. Given the relevance of DNA copy number alterations in ovarian oncogenesis and growing clinical implications of the BRCA-gene status, we aimed to characterise the genomic profiles of hereditary and sporadic ovarian tumours. METHODS: High-resolution array Comparative Genomic Hybridisation profiling of 53 familial (21 BRCA1, 6 BRCA2 and 26 non-BRCA1/2) and 15 sporadic tumours in combination with supervised and unsupervised analysis was used to define common and/or specific copy number features. RESULTS: Unsupervised hierarchical clustering did not stratify tumours according to their familial or sporadic condition or to their BRCA1/2 mutation status. Common recurrent changes, spanning genes potentially fundamental for ovarian carcinogenesis, regardless of BRCA mutations, and several candidate subtype-specific events were defined. Despite similarities, greater contribution of losses was revealed to be a hallmark of BRCA1 and BRCA2 tumours. CONCLUSION: Somatic alterations occurring in the development of familial EOCs do not differ substantially from the ones occurring in sporadic carcinomas. However, some specific features like extensive genomic loss observed in BRCA1/2 tumours may be of clinical relevance helping to identify BRCA-related patients likely to respond to PARP inhibitors.

Phenotypic characterization of hereditary epithelial ovarian cancer based on a tissue microarray study.

The pathologic and immunohistochemical features of familial epithelial ovarian cancers are not well understood. We have carried out a comprehensive immunohistochemical study of familial ovarian carcinomas from women with and without BRCA1 or BRCA2 mutations, in order to identify specific and/or common features among these different familial case groups (BRCA1, BRCA2 and non-BRCA1/2) and to identify markers of diagnostic value that might help to select more specific treatments. 73 familial primary ovarian carcinomas were analyzed for the expression of 40 antibodies involved in different genetic pathways using a tissue microarray. Serous carcinomas comprised the majority of all three familial case groups. On the other hand, BRCA1 and BRCA2 carcinomas have similar histopathologic features; i.e. they are often high-grade and are usually diagnosed at a more advanced FIGO stage than non-BRCA1/2 carcinomas. In our series, BRCA1 carcinomas had better clinical evolution and they also more frequently over-expressed PR and P53 than BRCA2 and non-BRCA1/2 carcinomas. Unsupervised cluster analysis and survival analysis identified ERCC1 as a potential marker of better clinical outcome for hereditary epithelial ovarian cancer.

Juvenile Huntington's disease: a case report and literature review.

Huntington's disease is the most frequent neurodegenerative disease with a prevalence of fewer than 10 cases per 10,000 inhabitants; the juvenile form is responsible for less than 10% of all cases. Huntington's disease belongs to the group known as "triad syndromes," which evolve with cognitive, motor and neuropsychiatric manifestations. Around 30% of patients debut with behavioral symptoms, which are a major challenge for management by patients, families, and caregivers. Huntington's disease (HD) is reviewed and a case of juvenile onset is reported in this article. The characteristics of juvenile-onset Huntington's disease (HD) differ from those of adult-onset HD, as chorea does not occur, although bradykinesia, dystonia, and signs of cerebellar disorder, such as rigidity, are present, frequently in association with convulsive episodes and psychotic manifestations.

Concordancia en pacientes críticos entre las ecuaciones diseñadas para la estimación del filtrado glomerular y el aclaramiento de creatinina en orina de 24h / Concordance in critical patients between the equations designed for the calculation of glomerular filtration rate and 24-hour creatinine clearance

Objetivo: Estudiar el comportamiento de las ecuaciones empleadas para estimar el filtrado glomerular cuando se aplican a pacientes críticos y comparar con el método actualmente más aceptado: el aclaramiento de creatinina (ClCr) en orina de 24h (ClCr-24h). Diseño: Estudio retrospectivo de una base de datos procedente de un estudio prospectivo observacional previo. Ámbito: Una unidad de cuidados intensivos polivalente en un hospital de tercer nivel. Participantes: Todos los pacientes adultos ingresados en nuestra unidad con sondaje vesical. Se excluyó a los pacientes en anuria. Intervenciones: A los pacientes seleccionados se les midió el ClCr-24h y aplicamos las ecuaciones Modified Diet in Renal Disease (MDRD), Jelliffe modificada (JF), Clínica Mayo (CM) y Cockroft-Gault (C-G) para estimar el filtrado glomerular. Variables de interés: Para valorar el grado de acuerdo, agrupamos a los pacientes según el ClCr-24h como normales (>70 ml/min/1,73m2), con disfunción moderada (69-50 ml/min/1,73m2) y con disfunción renal grave (<50ml/min/1,73m2). Resultados: Trescientos siete pacientes de 54±18 años, el 69,7% varones. El ClCr-24h fue de 109,2±78,2ml/min/1,73m2 y el estimado de 95,5±56,7 ml/min/1,73m2 para JF, de 87,4±53,4 ml/min/1,73m2 para C-G, de 86,9±55,9 ml/min/1,73m2 para MDRD y de 85,6±39,9 ml/min/1,73m2 para CM. La diferencia fue significativa (p<0,001) para todas las medidas, pero menor para JF (13,7±53,2 ml/min/1,73m2) que para C-G (21,9±58,3 ml/min/1,73m2), CM (23,6±59,6 ml/min/1,73m2) o MDRD (22,3±60,4 ml/min/1,73m2). El coeficiente de correlación fue 0,73 para JF; 0,67 para C-G y CM y 0,64 para MDRD. El grado de acuerdo fue discreto en todos los casos (estadístico κ de 0,55 para JF y MDRD; 0,51 para C-G, y 0,5 para CM). Conclusiones: La ecuación de JF muestra mayor concordancia con el ClCr que las de C-G, MDRD o CM cuando se aplica a pacientes de unidad de cuidados intensivos. Sin embargo, cuando se requiere una medición fiable, ninguna de ellas es adecuada y es necesario en estos casos calcular el ClCr (AU)

Objective: To study the behavior of the different equations used to estimate glomerular filtration rate (GFR) applied to critical care patients compared to the standard method: 24-hour creatinine clearance (24-CrCl). Design: Retrospective analysis of data base from a previous observational prospective study. Setting: Polyvalent ICU in a tertiary Hospital. Population: All adult patients admitted to our Unit during the study who had a bladder catheter inserted. Anuric patients were excluded. Interventions: We measured 24-CrCl and estimated GFR by MDRD, modified Jelliffe (JF), Mayo-Clinic (CM) and Cockroft-Gault (C-G) equations. Variables: To evaluate degree of agreement, we grouped patients regarding 24-CrCl as normal (>70), moderate dysfunction (69-50) or severe renal dysfunction (< 50mL/min/1.73m2). Results: 307 patients, aged 54±18, 69.7% males. Measured 24-CrCl was 109.2±78.2mL/min/1.73m2 and the estimate one 95.5±56.7 for JF, 87.4±53.4 for C-G, 86.9±55.9 for MDRD and 85.6±39.9 for CM. The difference was significant (p<0.001) for all estimates but lower for (13.7±53.2mL/min/1.73m2) than C-G (21.9±58.3), CM (23.6±59.6) or MDRD (22.3±60.4). Correlation coefficient was 0.73 for JF, 0.67 C-G or CM and 0.64 for MDRD. The degree of agreement was only fair for all measures (Kappa 0.55 for JF or MDRD, 0.51 for C-G and 0.5 for CM). Conclusions: Modified Jelliffe equation showed higher agreement with 24-CrCl than Cockroft-Gault, MDRD or Mayo-Clinic equations when used in critically ill patients. However, when exact measurement is needed, none of the equations can be considered adequate and in these cases, the CrCl should be calculated (AU)

[Concordance in critical patients between the equations designed for the calculation of glomerular filtration rate and 24-hour creatinine clearance]. / Concordancia en pacientes críticos entre las ecuaciones diseñadas para la estimación del filtrado glomerular y el aclaramiento de creatinina en orina de 24h.

OBJECTIVE: To study the behavior of the different equations used to estimate glomerular filtration rate (GFR) applied to critical care patients compared to the standard method: 24-hour creatinine clearance (24-CrCl). DESIGN: Retrospective analysis of data base from a previous observational prospective study. SETTING: Polyvalent ICU in a tertiary Hospital. POPULATION: All adult patients admitted to our Unit during the study who had a bladder catheter inserted. Anuric patients were excluded. INTERVENTIONS: We measured 24-CrCl and estimated GFR by MDRD, modified Jelliffe (JF), Mayo-Clinic (CM) and Cockroft-Gault (C-G) equations. VARIABLES: To evaluate degree of agreement, we grouped patients regarding 24-CrCl as normal (>70), moderate dysfunction (69-50) or severe renal dysfunction (< 50 mL/min/1.73 m(2)). RESULTS: 307 patients, aged 54+/-18, 69.7% males. Measured 24-CrCl was 109.2+/-78.2 mL/min/1.73 m(2) and the estimate one 95.5+/-56.7 for JF, 87.4+/-53.4 for C-G, 86.9+/-55.9 for MDRD and 85.6+/-39.9 for CM. The difference was significant (p<0.001) for all estimates but lower for (13.7+/-53.2 mL/min/1.73 m(2)) than C-G (21.9+/-58.3), CM (23.6+/-59.6) or MDRD (22.3+/-60.4). Correlation coefficient was 0.73 for JF, 0.67 C-G or CM and 0.64 for MDRD. The degree of agreement was only fair for all measures (Kappa 0.55 for JF or MDRD, 0.51 for C-G and 0.5 for CM). CONCLUSIONS: Modified Jelliffe equation showed higher agreement with 24-CrCl than Cockroft-Gault, MDRD or Mayo-Clinic equations when used in critically ill patients. However, when exact measurement is needed, none of the equations can be considered adequate and in these cases, the CrCl should be calculated.

Heterotopic neuroglial tissue as a congenital laterocervical mass: a case report.

Heterotopic neuroglial tissue in the head and neck area is a rare clinical entity which can cause airway obstruction and feeding problems during the neonatal period. The case is presented of heterotopic neuroglial tissue as a congenital laterocervical and intraoral mass in a neonate.

Implantación de la Historia Clínica Electrónica. Hospital Universitario Marqués de Valdecilla / Introducing the Cantabrian Electronic Medical Record in the Hospital Universitario Marqués de Valdecilla

La aplicación de las Tecnologías de la información y las Comunicaciones (TIC) como instrumento de trabajo de los profesionales sanitarios del Servicio Cántabro de Salud (SCS) es el objetivo del proyecto corporativo de la Historia Clínica Electrónica de Cantabria (HCEC), promovido por la Consejería de Sanidad y gestionado por la Oficina de Innovación de Sistemas de Información Sanitaria, entidad creada a tal efecto en enero de 2006. Su ámbito de aplicación engloba todo el SCS, que cuenta en la actualidad con tres centros de Atención Especializada y 150 de Atención Primaria (40 Centros de Salud y 110 consultorios) que dan asistencia sanitaria a más de 500.000 ciudadanos. Durante el año 2007 se ha completado de forma progresiva el desarrollo de los diferentes sistemas de información que componen la primera fase de la HCEC. Debido a sus cualidades como centro de referencia de Atención Especializada, el Hospital Universitario Marqués de Valdecilla (HUMV) ha sido seleccionado como escenario de los pilotos de la mayor parte de estos sistemas. El presente artículo describe la experiencia de implantación y arranque de los mismos (AU)

The application of Information and Communication Technologies (ICTs) as a work instrument for health professionals in the Cantabrian Health Service is the objective of the corporative project of the Cantabrian Electronic Medical Record. This article analyses the main lines of action of this project and describes the adaptation process and proposal of the results (AU)

[Middle cerebral artery ischemic stroke presentation of miliar tuberculosis]. / Infarto de la arteria cerebral media como forma de presentación de la tuberculosis miliar.

Presence of central nervous system by extrapulmonary tuberculosis is an infrequent disease specially among non HIV infected patients, and it is associated with poor prognosis and high mortality rates. We report a case with a middle cerebral artery ischemic strocke as a first symptom of miliar tuberculosis.

Infarto de la arteria cerebral media como forma de presentación de la tuberculosis miliar / Middle cerebral artery ischemic stroke presentation of miliar tuberculosis

La afectacion vascular del SNC por la TBC extrapulmonar no es una patología muy frecuente en ausencia de VIH, siendo un factor predictivo de mal pronóstico, comportando una mayor morbimortalidad. Exponemos el caso de una paciente que presenta afectación nerviosa en forma de isquemia en el territorio de la arteria cerebral media como forma de presentación de una TBC miliar

Presence of central nervous system by extrapulmonary tuberculosis is an infrequent disease specially among non HIV infected patients, and it is associated with poor prognosis and high mortality rates. We report a case with a middle cerebral artery ischemic strocke as a first symptom of miliar tuberculosis

Infarto de la arteria cerebral media como forma de presentación de la tuberculosis miliar / Middle cerebral artery ischemic stroke as a first symtom of miliar tuberculosis

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Application of pressurized fluid extraction to determine cadmium and zinc in plants.

A procedure for the determination of Cd and Zn in plants is proposed. The metals are extracted by pressurized fluid extraction (PFE). Operational conditions are: pressure 1500 psi, temperature 75 degrees C, static time 5 min, flush volume 35%, purge time 60s, cycles 1 and 1,2-diaminocyclohexane-N,N,N',N'-tetraacetic acid (CDTA) 0.01M at pH 4.5 as extracting solution. Determination of Zn is carried out by flame atomic absorption spectroscopy and depending on the concentration level, Cd content is determined by flame or electrothermal atomic absorption spectroscopy. Certified samples of Virginia tobacco leaves, tea leaves, spinach leaves, poplar leaves, a commercial spinach sample (Spinacea oleracea) and genetically modified Arabidopsis thaliana were analysed by the proposed procedure and also by microwave acid digestion and extraction with HCl-Triton X-100. Confidence intervals for Cd and Zn content obtained by the proposed procedure overlap with the certified values. The other procedures, however, provide inaccurate results for Cd. Recoveries obtained for a confidence level of 95% are 96+/-6% and 95+/-5% for Zn and Cd, respectively. Reproducibility of Zn by the proposed procedure is 7% (n=8), similar to the other tests and the detection limit is 2.6 microg. For Cd reproducibility is 8.5% (n=8), better than with HCl-Triton X-100 and similar to acid digestion, the detection limit is 3.5 ng of Cd.