Situación actual de la rehabilitación respiratoria en los hospitales de la Comunidad de Madrid / No disponible

Introducción: A pesar de que la rehabilitación respiratoria (RR) es considerada como una intervención terapéutica con alto nivel de evidencia científica, la estructura y la organización de las unidades de RR pueden repercutir en sus resultados. Nuestra intención era conocer la situación actual de las unidades de RR de la Comunidad de Madrid. Material y métodos: Análisis de los resultados de la encuesta distribuida a todos los hospitales de la Comunidad de Madrid mediante correo electrónico desde la Sociedad Madrileña de Neumología y Cirugía Torácica (NEUMOMADRID) y la Sociedad Española de Rehabilitación Cardiorrespiratoria (SORECAR). La encuesta fue diseñada de acuerdo a los estándares de calidad asistencial en RR propuestos por la Sociedad Española de Neumología y Cirugía Torácica (SEPAR). Resultados: Once (61,6%) hospitales señalaron que contaban con una unidad de RR y en el 54,5% de ellas no existía acceso desde atención primaria. El 72,7% de unidades indicó que la derivación de pacientes no era adecuada. Casi todas las unidades ofrecían programas de fisioterapia, entrenamiento aeróbico, de fuerza muscular y soporte educativo, sin embargo solo el 27,3% daba soporte nutricional y 18,2% apoyo psicosocial. El 45,4% usaba la prueba de esfuerzo progresivo para pautar el entrenamiento. Existían 3 cicloergómetros (rango intercuartílico 2-5) y 1 tapiz rodante (0-2) por unidad. Todas las unidades contaba con médicos rehabilitadores y fisioterapeutas y en el 60% también participaban neumólogos. Conclusiones: No todos los hospitales de la Comunidad de Madrid cuentan con unidades de RR. Además, el análisis de los indicadores de calidad asistencial en RR demuestran limitaciones en protocolos, evaluación del paciente, componentes y características de los programas, y aspectos administrativos y de investigación

Introduction: Although respiratory rehabilitation (RR) is considered as a therapeutic intervention with a high level of scientific evidence, the structure and organization of the RR units may have repercussions on its results. Our intention was to know the current situation of RR units in the Community of Madrid. Material and Methods: Analysis of results of the survey distributed to all hospitals in the Community of Madrid by email from the Sociedad Madrileña de Neumología y Cirugía Torácica (NEUMOMADRID) and the Sociedad Española de Rehabilitación Cardiorrespiratoria (SORECAR). The survey was designed according to the standards of care quality in RR proposed by the Sociedad Española de Neumología y Cirugía Torácica (SEPAR). Results: 11 (61.6%) hospitals reported that they had a RR unit. 54.5% of them did not have an access from primary care. 72.7% of the units indicated that referral of patients was not adequate. Almost all the units offered programs of physical therapy, aerobic training, muscular strength and educational support, however only 27.3% gave nutritional support and 18.2% psychosocial support. Progressive incremental test was used by 45.4% RR units. There were 3 cycle ergometers (interquartile range 2-5) and 1 treadmill (0-2) per unit. All units had rehabilitation physicians and physiotherapists, and 60% also had pulmonologists. Conclusions: Not all hospitals in the Community of Madrid have RR units. Moreover, the analysis of the indicators of care quality of the RR shows limitations in protocols, patient evaluation, components and characteristics of the programs, administrative and research aspects

How can a climate change perspective be integrated into public health surveillance?

OBJECTIVES: Climate change may be considered as a key factor for environmental change, exposure to health risks and pathogens, consequently impairing the state of health among populations. Efficient health surveillance systems are required to support adaptation to climate change. However, despite a growing awareness, the public health surveillance sector has had very little involvement in the drafting of adaptation plans. This paper proposes a method to raise awareness about climate change in the public health community, to identify possible health risks and to assess the needs for reinforced health surveillance systems. METHODS: A working group was set up comprising surveillance experts in the following fields: environmental health; chronic diseases and; infectious diseases. Their goal was to define common objectives, to propose a framework for risk analysis, and to apply it to relevant health risks in France. RESULTS: The framework created helped to organize available information on climate-sensitive health risks, making a distinction between three main determinants as follows: (1) environment; (2) individual and social behaviours; and (3) demography and health status. The process is illustrated using two examples: heatwaves and airborne allergens. CONCLUSION: Health surveillance systems can be used to trigger early warning systems, to create databases which improve scientific knowledge about the health impacts of climate change, to identify and prioritize needs for intervention and adaptation measures, and to evaluate these measures. Adaptation requires public health professionals to consider climate change as a concrete input parameter in their studies and to create partnerships with professionals from other disciplines.

Tissue and serum immune response in chronic hepatitis C with mild histological lesions.

The immunopathogenesis of chronic hepatitis C virus (HCV) infection is a matter of great controversy and has been suggested to involve a complex balance between cytokines with pro and anti-inflammatory activity. We investigated the expression of inflammatory cells and cytokines in the liver and serum of 51 chronically HCV infected patients and compared them to data from two sets of normal controls: 51 healthy blood donors and 33 liver biopsies of healthy liver donors. We also assessed the relationship between selected cytokines and cell populations in hepatic compartments and the disease stage. Compared with controls, hepatitis C patients had a greater expression of portal TNF-alpha, TGF-beta and CD4(+) and acinar IFN-gamma, TNF-alpha, IL-1beta and IL-4, as well as a higher serum concentration of IL-2, IL-10 and TGF-beta. Significant positive correlations were found between portal CD4+ and TNF-alpha, portal CD8(+) and TGF-beta, portal CD45(+)RO and TNF-alpha, acinar CD45(+)RO and IFN-gamma and acinar CD57(+) and TGF-beta. In conclusion, we have shown that (i) in this sample of predominantly mild disease, the immune response was associated with a pro-inflammatory response pattern, (ii) CD4(+) T-lymphocytes played a major role in orchestrating the immune response and (iii) these events primarily took place in the portal space.

Actuaciones inspectoras relacionadas con el control y prevención de la legionelosis: análisis de muestras (2006) / No disponible

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5-HT(4) receptor antagonists: structure-affinity relationships and ligand-receptor interactions.

Among serotonin receptors (5-HTRs), the 5-HT(4) subtype is of considerable interest because it is involved in (patho)physiological processes both in peripheral and central nervous systems. In addition to the clinical use of 5-HT(4R) agonists in the treatment of gastrointestinal motility disorders, the potential use of antagonists in the treatment of irritable bowel syndrome, arrhythmias and micturition disturbances are currently under investigation. This article will review the development of the most important classes of 5-HT(4R) antagonists with an emphasis on benzimidazole derivatives, their structure-affinity relationships, ligand-receptor interactions and pharmacological applications.

Arylpiperazine derivatives acting at 5-HT(1A) receptors.

Serotonin (5-hydroxytryptamine, 5-HT) is one of the most attractive targets for medicinal chemists. Among 5-HTRs, the 5-HT(1A) subtype is the best studied and it is generally accepted that it is involved in psychiatric disorders such as anxiety and depression. Several structurally different compounds are known to bind 5-HT(1A)R sites. Among these, arylpiperazine derivatives represent one of the most important classes of 5-HT(1A)R ligands. This article will review the development of arylpiperazine derivatives acting at 5-HT(1A)Rs with an emphasis on structure-affinity relationships of agonists and antagonists, ligand-receptor interactions and pharmacological applications.

Design, synthesis and biological evaluation of novel arachidonic acid derivatives as highly potent and selective endocannabinoid transporter inhibitors.

In the present work, we have designed and synthesized a series of arachidonic acid derivatives of general structure I which have been characterized as highly potent and selective inhibitors of anandamide transporter (IC(50) = 24-0.8 microM, K(i) > 1000-5000 nM for CB(1) and CB(2) cannabinoid receptors and vanilloid VR(1) receptor). Among them, N-(3-furylmethyl)eicosa-5,8,11,14-tetraenamide deserves special attention as being the most potent endocannabinoid transporter inhibitor (IC(50) = 0.8 microM) described to date.

3-D-QSAR/CoMFA and recognition models of benzimidazole derivatives at the 5-HT(4) receptor.

3-D-QSAR/CoMFA methodology and computational simulation of ligand recognition have been successfully applied to explain the binding affinities of a series of benzimidazole derivatives 1-24 acting at serotonin 5-HT(4)Rs. Both derived computational models have facilitated the identification of the structural elements of the ligands that are key to high 5-HT(4)R affinity. The results provide the tools for predicting the affinity of related compounds, and for guiding the design and synthesis of new ligands with predetermined affinities and selectivity.

Sulfoxide-controlled S(N)2' displacements between cyanocuprates and epoxy vinyl sulfoxides.

Two short and convergent routes have been devised for the preparation of enantiomerically pure acyclic epoxy vinyl sulfoxides. These substrates undergo highly regio- and stereoselective S(N)2' displacements with lithium cyanocuprates to give alpha'-alkylated, gamma-oxygenated Z alpha,beta-unsaturated sulfoxides in moderate to good yields and with good to excellent diastereoselectivities. The absolute configuration of the newly formed carbon-carbon bond is primarily controlled by the chiral sulfur atom, which in a nonreinforcing situation can override the intrinsic anti tendency of the vinyl oxirane moiety and forces the cuprate to undergo syn addition. The hydroxy vinyl sulfoxide functionality of the resulting adducts should allow for subsequent asymmetric transformations thus enhancing the synthetic usefulness of this methodology.

Synthesis of new (benzimidazolyl)piperazines with affinity for the 5-HT1A receptor via Pd(0) amination of bromobenzimidazoles.

The synthesis of a new family of (benzimidazolyl)piperazines has been developed through Pd(0) mediated amination of 4- and 6-bromobenzimidazole derivatives. Preliminary studies showed that some of these compounds are potent 5-HT1A receptor ligands.

Benzimidazole derivatives. Part 1: Synthesis and structure-activity relationships of new benzimidazole-4-carboxamides and carboxylates as potent and selective 5-HT4 receptor antagonists.

New benzimidazole-4-carboxamides 1-16 and -carboxylates 17-26 were synthesized and evaluated for binding affinity at serotonergic 5-HT4 and 5-HT3 receptors in the CNS. Most of the synthesized compounds exhibited moderate-to-very high affinity (in many cases subnanomolar) for the 5-HT4 binding site and no significant affinity for the 5-HT3 receptor. SAR observations and structural analyses (molecular modeling, INSIGHT II) indicated that the presence of a voluminous substituent in the basic nitrogen atom of the amino moiety and a distance of ca. 8.0 A from this nitrogen to the aromatic ring are of great importance for high affinity and selectivity for 5-HT4 receptors. These results confirm our recently proposed model for recognition by the 5-HT4 binding site. Amides 12-15 and esters 24 and 25 bound at central 5-HT4 sites with very high affinity (Ki = 0.11-2.9 nM) and excellent selectivity over serotonin 5-HT3, 5-HT2A, and 5-HT1A receptors (Ki > 1000-10,000 nM). Analogues 12 (Ki(5-HT4) = 0.32 nM), 13 (Ki(5-HT4) = 0.11 nM), 14 (Ki(5-HT4) = 0.29 nM) and 15 (Ki(5-HT4) = 0.54 nM) were pharmacologically characterized as selective 5-HT4 antagonists in the isolated guinea pig ileum (pA2 = 7.6, 7.9, 8.2 and 7.9, respectively), with a potency comparable to the 5-HT4 receptor antagonist RS 39604 (pA2 = 8.2). The benzimidazole-4-carboxylic acid derivatives described in this paper represent a novel class of potent and selective 5-HT4 receptor antagonists. In particular, compounds 12-15 could be interesting pharmacological tools for the understanding of the role of 5-HT4 receptors.

[Active and inactive forms of cerebral cysticercosis. Study of 10 cases]. / Formas activas e inactivas de cisticercosis cerebral. Estudio de diez casos.

Ten cases of neuro-cysticercosis attended in our hospital over the last five years are presented. Six patients presented non-active parenchymatous calcifications of which four manifested epilepsy, one dementia caused by hydrocephalus and one other was asymptomatic. Two patients presented active intraparenchymatous cysts with a clinic of epilepsy. One patient presenting cisternal -ventricular-parenchymal involvement and another with ependymal -meningeal-parenchymal involvement, both suffered of psychiatric alterations. Ataxia and pyramidal deficits. The two patients with active parenchymal form were treated with Praziquantel obtaining a complete cyst remission (normal cranial Ot scan, in one case normal NMR) and neurological clinical symptoms. Two more patients treated with Praziquantel suffering ventricular and meningeal ependymal involvement presented little or no response to this treatment.