Analgesia no farmacológica durante la realización del cribado metabólico. Aplicación en otros procedimientos dolorosos / Non-pharmacological analgesia during the heel lance procedure in newborns. Application in other painful procedures

INTRODUCCIÓN: uno de los primeros estímulos dolorosos al que es sometido un recién nacido sano es el cribado neonatal, mediante punción en el talón y extracción de muestra sanguínea. Tradicionalmente se ha tendido a menospreciar la sensibilidad al dolor neonatal y no se ha visto la necesidad de aplicar técnicas de analgesia para evitarlo. MATERIAL Y MÉTODOS: se diseñó un estudio experimental con una muestra de 106 recién nacidos en el Hospital San Pedro de Logroño (España) durante el año 2018. Se dividió la muestra en tres grupos en función de la analgesia recibida durante el procedimiento y se evaluó la respuesta al dolor mediante una escala validada. RESULTADOS: el dolor producido fue significativamente mayor en el grupo de no intervención frente a los grupos de suero glucosado o lactancia materna (p <0,001). Sin embargo, no se encontraron diferencias estadísticamente significativas entre ambos procedimientos analgésicos (p = 0,851). CONCLUSIONES: a la vista de los resultados, proponemos la implementación de estas intervenciones en otros procedimientos dolorosos. Los profesionales sanitarios han de tomar conciencia de la percepción del dolor en los procedimientos llevados a cabo tanto en el ámbito hospitalario como en Atención Primaria

INTRODUCTION: neonatal screening is one of the first painful stimuli in newborns. It consists in the extraction of a capillary blood sample by puncturing the heel. Neonatal pain is often underestimated and also the need to apply analgesia in these cases has not always been taken into account. PATIENTS AND METHODS: an experimental study was conducted on a sample of 106 newborns in the San Pedro Hospital in Logroño during 2018. Depending on the analgesia received during the heal lance, the population sample was divided into three groups. Pain response was evaluated using a validated scale. RESULTS: pain was significantly higher in the non-intervention group compared to the groups treated with glucose or breastfeeding (p <0.001). However, no statistically significant differences were found between both the analgesic procedures (p = 0.851). CONCLUSIONS: we propose the implementation of these interventions in other painful procedures. Health professionals must be aware of the perception of pain in the procedures carried out in Hospitals or Primary Care Centers

Immunologic responses to the major allergen of Olea europaea in local and systemic allergic rhinitis subjects.

OBJECTIVE: To evaluate the in vivo and in vitro responses to nOle e 1 in allergic rhinitis (AR) and local allergic rhinitis (LAR) patients sensitized to olive tree pollen (OL) confirmed by nasal allergen provocation test (NAPT). METHODS: Twelve subjects with AR, 12 with LAR and 12 subjects as control group (CG) were selected. Skin testing and NAPT with nOle e 1 were performed. Eosinophilic cationic protein (ECP) and tryptase were measured in nasal lavages before and after NAPT. Serum IgE to OL allergens was measured by ELISA. Basophil activation tests (BAT) with OL and nOle e 1 and dendritic cell maturation/proliferation studies were carried out. RESULTS: All AR (12/12) and 10/12 (83%) of LAR had a +NAPT to nOle e 1. ECP levels in nasal lavages were significantly increased after NAPT in both AR and LAR compared with CG at 15 min (P < 0.05). Serum IgE was positive only in AR. All AR had +BAT responses to OL and 10/12 to nOle e 1 (83%); 8/12 LAR (66.6%) had a +BAT to OL and 4/12 (33%) to nOle e 1, with only one subject of the CG with a +BAT to both OL and nOle e 1 (8%). Dendritic cell proliferation to nOle e 1 was increased in AR compared to LAR and CG (P = 0.019 and P = 0.001, respectively). CONCLUSION: Both AR and LAR had a similar in vivo response to nOle e 1 with release of inflammatory mediators. Specific basophil activation with OL and nOle e 1 was observed in LAR confirming previous data obtained with dust mites.

Patterns of skin prick test positivity in allergic patients: usefulness of a nationwide SPT chart review.

BACKGROUND: A previous survey on allergens used by Mexican allergists in their skin prick test (SPT) panel showed wide variation. Humidity varies in different zones of Mexico. This might lead to differences in natural exposure and allergic sensitisation throughout the country. We aim to describe the SPT sensitivity patterns in the different climatic zones in Mexico and to show the usefulness of a structured SPT chart-review including multiple clinics in obtaining these allergen sensitisation patterns. METHODS: A retrospective, structured chart-review of SPT results was undertaken in allergy clinics throughout Mexico. Ratios of SPT positivity were calculated for individual allergens, per climatic zone and nation-wide. Per allergen group the most important allergens were identified. Statistically significant differences between zones and the nation-wide data were tested with Pearson's Chi-squares test. RESULTS: 4169 skin test charts were recollected. The most important allergens causing sensitisation were very similar in different zones, despite climate variation. The allergen with highest ratio of SPT positivity was Dermatophagoides pteronyssinus (51%), with trees (Ash-27%, Alder-22%, Oak19%), and Bermuda grass (26%) as second and third. In the hot zones (humid and dry) Aspergillus was statistically significant more frequently than in more temperate zones. Cockroaches thrive in big cities and humid zones and Mesquite and Poplar in dry zones. Weeds are less important. CONCLUSION: Mexico has its own SPT sensitisation pattern, which is different from America and Europe. A structured chart-review of SPT results is able to show this and might be a tool for allergists in other countries.

Role of effector cells (CCR7(-)CD27(-)) and effector-memory cells (CCR7(-)CD27(+)) in drug-induced maculopapular exanthema.

Maculopapular exanthema (MPE) induced by drugs is a T-cell mediated reaction and effector cells may play an important role in its development. We assessed the effector and cutaneous homing phenotype in peripheral blood cells from allergic patients after drug stimulation. This study included 10 patients and 10 controls. The effector phenotype (CCR7(-)CD27(+/-)), chemokine receptors (CCR4 and CCR10), and activation (CD25(low)) and regulatory markers (CD25(high)) were measured by flow cytometry in both peripheral blood mononuclear cells (PBMCs) and CD4-T-lymphocytes. Proliferation was determined by 5-(-6)-carboxyfluorescein diacetate succinimidyl ester (CFSE) assay and the migratory capacity by a chemotaxis assay using CCL17 and CCL27. Compared to controls, CCR7(-)CD27(-) cells were increased in patients without (p=0.003) and with drug stimulation (p less than 0.001) and had significantly higher proliferation (p=0.010). CCR10 expression was increased in patients after drug stimulation in total and memory CD27(+) T-cells. Lymphocyte migration with CCL27 was higher in patients with drug stimulation (p=0.048), with a decrease in CCR7(-)CD27(-) (p less than 0.0001) and an increase in CCR7(-)CD27(+) (p=0.017). In patients, CD4-T-lymphocytes were significantly activated after drug stimulation (p less than 0.001). In conclusion, we show that effector memory CD4(+) T-cells (CCR7(-)CD27(+)) respond specifically to the drug responsible for MPE and confirm previous data about the involvement of CCR10 in cell trafficking to the skin.

Relevancia clínica de hallazgos electrocardiográficos en examen de salud periódico (a propósito de un caso) / No disponible

No disponible

Incidence, patterns of care and prognostic factors for outcome of gastroenteropancreatic neuroendocrine tumors (GEP-NETs): results from the National Cancer Registry of Spain (RGETNE).

BACKGROUND: Neuroendocrine tumors (NETs) are an unusual family of neoplasms with a wide and complex spectrum of clinical behavior. Here, we present the first report of a National Cancer Registry of gastroenteropancreatic neuroendocrine tumors from a Southern European country. PATIENTS AND METHODS: Data was provided online at www.retegep.net by participating centers and assessed for internal consistency by external independent reviewers. RESULTS: The study cohort comprised 907 tumors. The most common tumor types were carcinoids (55%), pancreatic nonfunctional tumors (20%), metastatic NETs of unknown primary (9%), insulinomas (8%) and gastrinomas (4%). Forty-four percent presented with distant disease at diagnosis, most often those from small intestine (65%), colon (48%), rectum (40%) and pancreas (38%), being most unusual in appendix primaries (1.3%). Stage at diagnosis varied significantly according to sex, localization of primary tumor, tumor type and grade. Overall 5-year survival was 75.4% (95% confidence interval 71.3% to 79.5%) and was significantly greater in women, younger patients and patients with hormonal syndrome and early stage or lower grade tumors. Prognosis also differed according to tumor type and primary tumor site. However, stage and Ki-67 index were the only independent predictors for survival. CONCLUSION: This national database reveals relevant information regarding epidemiology, current clinical practices and prognosis of NETs in Spain, providing valuable insights that may contribute to understand regional disparities in the incidence, patterns of care and survival of this heterogeneous disease across different continents and countries.

Aclaramiento viral en la hepatitis por el virus B, cepa salvaje, tras el tratamiento con interferón alfa-2a pegilado / No disponible

No disponible

Breastfeeding's protection against illness-induced anorexia is mediated partially by docosahexaenoic acid.

OBJECTIVE: To test whether breastfeeding's protection against anorectic responses to infection is mediated by n-3 fatty acids' attenuation of interleukin (IL)-1beta and tumor necrosis factor (TNF)alpha. DESIGN: Experimental and observational studies. SETTING: A hospital-based study was conducted. SUBJECTS: Five groups of infants were followed; three in the experimental and two in the observational study. METHODS: Breast-fed- (BF-1), DHA-supplemented formula- (SFF-1), and non-DHA-supplemented formula-fed (FF-1) infants were studied before and after immunization against diphtheria, tetanus, pertussis and haemophilus influenzae type b. Pre- and post-immunization energy intakes (EI) and serum IL-1beta and TNFalpha were measured. The two other groups, breast-fed (BF-2) and formula-fed (FF-2) infants with pneumonia were followed throughout hospitalization. EI, IL-1beta and TNFalpha were measured at admission and discharge. Baseline erythrocyte fatty acid contents were determined. RESULTS: Both cytokines increased following immunization in all feeding groups. Post-immunization reductions in EI of SFF-1 infants (-11.8+/-5%, CI(95)=-23.3, 1.4%, P=0.07) were intermediate to those observed in BF-1 (-5.2+/-4.2%, CI(95)=-15.2, 5.9%, P=0.27) and FF-1 infants (-18+/-4.4%, CI(95)=-29%, -5.4%, P=0.02). In the observational study, TNFalpha (17.2+/-8.3 vs 3.4+/-3.0 ng/l, P=0.001) and decreases in EI (-31+/-43 vs -15+/-31%, CI(95)=-34%, 0.001%, P=0.056) were greater in FF-2 than in BF-2 infants at admission. Breastfeeding duration was associated positively with docosahexaenoic acid (DHA) erythrocyte contents, and negatively with admission TNFalpha. Decreases in EIs were associated with IL-1beta and TNFalpha concentrations. CONCLUSION: Reductions in EI following immunologic or infectious stimuli were associated with increases in IL-1beta and TNFalpha. Those reductions were attenuated by breastfeeding, and mediated in part by tissue DHA.

T cell assessment in allergic drug reactions during the acute phase according to the time of occurrence.

Allergic drug reactions can be classified as immediate, accelerated or delayed. This classification usually correlates with the mechanism involved: immediate reactions are IgE mediated and delayed reactions are T cell dependent. We analyzed lymphocyte involvement in patients with these reactions by determining cell subpopulations, activation state and skin homing receptor expression (CLA) in blood and skin. Patients with immediate, accelerated and delayed reactions were evaluated during the acute phase and after resolution. Controls taking drugs were included. Phenotypic immunofluorescence analysis was done by flow cytometry in peripheral blood, and by immunohistochemistry in skin for delayed reactions. Forty-six patients were included, 17 with immediate reactions, 10 accelerated and 19 delayed. At the acute phase CLA was significantly increased in delayed reactions and HLA-DR in all three types of reaction. In the severest delayed reactions, Steven-Johnson/Lyell syndromes, the CD4 subsets were increased in peripheral blood and skin compared to maculopapular exanthemas and urticaria and HLA-DR when compared with urticaria. In maculopapular exanthemas CLA was significantly increased in peripheral blood and skin compared to urticaria and the severe reactions. We found that T-cells are implicated, besides delayed reactions, in immediate and accelerated reactions. In delayed reactions there is a parallelism between results found in skin and peripheral blood with a higher participation of CD4+ cells the more severe the reaction.

Malformación adenomatoide quística. Diagnóstico diferido de una anomalía congénita / Cystic adenomatoid malformation: late onset of a congenital anomaly

La malformación adenomatoide quística es una lesión pulmonar congénita que resulta de la proliferación adenomatosa de bronquiolos y alvéolos terminales, con formación de quistes. El diagnóstico se realiza habitualmente durante el período perinatal, pero existen casos asintomáticos que se descubren durante la infancia o en la edad adulta. Se presenta el caso de una niña de 9 años en estudio por dolor torácico. La radiología de tórax demostró una imagen quística en el lóbulo superior izquierdo que se confirmó mediante tomografía computarizada torácica y angiorresonancia. Se realizó resección quirúrgica del lóbulo afectado confirmándose mediante anatomía patológica el diagnóstico de malformación adenomatoide quística tipo 1 (AU)

[13C]linoleic acid oxidation and transfer into milk in stunted lactating women with contrasting body mass indexes.

BACKGROUND: The fat concentration of human milk is associated with maternal adiposity, but there is no clear understanding of the mechanisms controlling milk fat concentration. OBJECTIVE: We evaluated the effect of postpartum body mass index (BMI; in kg/m(2)) on the metabolic distribution of an oral dose of [13C]linoleic acid in lactating women. DESIGN: Ten lactating women stratified by BMI (either <22.5 or >23.5) at 5 mo postpartum received orally 2.5 mg [13C]linoleic acid/kg body wt. Exhaled air, milk, and plasma samples were collected in relation to tracer administration. Linoleic acid was determined by gas chromatography. Dietary intake, serum, milk composition, [13C]linoleic acid enrichment in milk and plasma, and exhaled 13CO2 (by isotope ratio mass spectrometry) were assessed. RESULTS: Women with a higher BMI exhaled more 13CO2 than did women with a lower BMI (22.8 +/- 9.4% compared with 8.6 +/- 3.5% of dose, P < 0.03). Cumulated 72-h transfer of [13C]linoleic acid to milk was not significantly different between groups (14.8 +/- 6.5% compared with 17.7 +/- 6.7% of dose). Within the first 9 h after dose administration, 51.6 +/- 4.9% of the total isotope transfer into milk had passed in women with a higher BMI, but only 24.0 +/- 15.3% had passed in those with a lower BMI (P = 0.02). CONCLUSIONS: Women with a lower BMI, who were reputed as having less body fat, oxidized and secreted into milk less dietary linoleic acid within 12 h after tracer administration than did women with a higher BMI. In both groups, a large proportion of [13C]linoleic was retained in the maternal compartment, most likely fat tissue, in a slow turnover pool, and released slowly in later hours.

Contribution of dietary and newly formed arachidonic acid to human milk lipids in women eating a low-fat diet.

BACKGROUND: Polyunsaturated fatty acids in milk are derived from direct intestinal absorption, endogenous synthesis, or maternal body stores. Arachidonic acid (AA) intake is frequently low in undernourished women, but milk secretion of this fatty acid is similar to that in well-nourished women. OBJECTIVE: The objective was to evaluate the contribution of dietary and endogenously synthesized AA to its total secretion in the milk of women eating a low-fat diet. DESIGN: Ten lactating women who habitually ate a low-fat diet (17% of energy) received 2.5 mg [(13)C]linoleic acid (LA)/kg body wt orally 5 mo postpartum. LA and AA concentrations and (13)C enrichment were measured in milk samples collected before and after the tracer application. Total lipid, LA, and AA contents were determined in diet composites. Fatty acids were assessed by gas chromatography and (13)C enrichment by isotope ratio mass spectrometry. RESULTS: The cumulative 72-h recovery of [(13)C]LA in milk was 16.3 +/- 6.4% of the dose; only 0.01% of the label was found as [(13)C]AA. The calculated transfer of dietary LA and AA into milk was 32.8 +/- 18.0% and 11.8 +/- 6.6%, respectively. AA originating from conversion of dietary LA contributed only 1.1% to the total milk AA secreted. CONCLUSIONS: Little milk AA originates from conversion of LA; 70% of LA and 90% of AA secreted in milk were not derived from direct intestinal absorption. Our results suggest that maternal body stores are the major source of milk LA and AA in these women.

HLA system. Phenotypic and gene frequencies in celiac and healthy subjects from the same geographical area.

OBJECTIVE: To compare the phenotypic and gene frequencies of the HLA system in celiac and healthy subjects the same geographical area. PATIENTS AND METHODS: HLA A, B, C, DR and DQ phenotypic and gene frequencies have been estimated in 38 celiac children and healthy subjects. The HLA typing has been done according to the microlymphocytotoxicity assay. The individual HLA antigen frequencies in each group have been compared by Chi-square test using Yates correction. For each specificity, the strength of association with celiac disease has been estimated by Odds Ratio and 95% confidence limit. RESULTS: The comparative study of both population show increased phenotypic and gene frequencies among celiac patients and significant differences compared with healthy subjects for B8, Cw7, DR3, DR7 and DQ2. On the contrary, Cw4 and DQ1 phenotypic and gene frequencies are significantly increased in the control population. CONCLUSIONS: Our findings support the role of HLA antigens as predisposing factors for celiac disease. The presence of Cw4 and DQ1 can be a protective factor against such disease.

[Two loci HLA haplotypes in celiac children. Linkage imbalance and haplotype frequencies. Comparative study with a control population]. / Haplotipos HLA de dos loci en niños celíacos. Desequilibrio de linkage y frecuencias haplotípicas. Estudio comparativo con una población control.

OBJECTIVE: Celiac disease is closely correlated with certain human lymphocyte antigen (HLA) alleles. The aim of this study was to compare linkage disequilibrium parameters and the frequencies of the two loci haplotypes: HLA A/B, A/C, A/DR, A/DQ; HLA B/C, B/DR, B/DQ; HLA C/DR, C/DQ and HLA DR/DQ in children with celiac disease and in a control population within the same geographical area. METHODS: Thirty-eight children with celiac disease, aged 5months to 18years at diagnosis, were HLA typed by microlymphocytotoxicity assay using T and Bcells separated by monoclonal antibody labeled immunomagnetic particles. The frequency of each haplotype of two loci (Hij) depends on the frequency of each allele (pi and pj) and on a correction factor delta, according to the formula: Hij5 Dij1(pi3pj). The existence of a correction factor delta, or linkage disequilibrium, was assessed by a chi square test using 2 X 2contingency tables for gametic association. RESULTS: Among children with celiac disease the most frequent and significant haplotypes were A1/B8, A9/B5, A19/B12, A28/B22, A28/Cw1, A9/DQ3, B8/Cw7, B18/Cw5, B22/Cw1, B5/DR5, B8/DR3, B12/DR7, B5/DQ3, DR3/DQ2, DR4/DQ8 (3) and DR5/DQ3, showing a positive linkage disequilibrium. Negative linkage disequilibrium was found between B18/Cw7, B12/DR3, Cw4/DR3 and DR3/DQ3. CONCLUSIONS: Our findings show that the frequency of A1/B8,A19/B12, B8/DR3,B12/DR7 and DR3/DQ2 haplotypes is higher in children with celiac disease than in the control population and suggest that these two loci haplotypes confer susceptibility to celiac disease.