Medication related to pigmentation of oral mucosa.

BACKGROUND: The diagnosis of oral melanotic lesions is, more often than not, challenging in the clinical practice due to the fact that there are several reasons which may cause an increase in pigmentation on localized or generalized areas. Among these, medication stands out. MATERIAL AND METHODS: In this work, we have carried out a review in the reference pharma database: Micromedex® followed by a review of the scientific published literature to analyse coincidences and possible discrepancies. RESULTS: Our findings show that there are several prescription drugs that can cause pigmented lesions in the oral mucosa. This must be known by clinicians in order to properly diagnose pigmented lesions. We have identified a set of 21 medicaments which cause these lesions, some of which are used frequently in the clinic, such as Metronidazole, Amitriptyline, conjugated oestrogens and Chlorhexidine gluconate. We also found discrepancies with the data published in specialized literature, some of which wasn't reflected in the Summary of Product Characteristics. CONCLUSIONS: Our work highlights the importance of the proper communication of adverse drug reactions (ADR) by health professionals in order to provide thorough and accurate information and diagnosis.

Efectividad de la terapia de movimiento inducido por restricción del lado sano en la rehabilitación del miembro superior en pacientes con parálisis cerebral: revisión sistemática / Effectiveness of constraint-induced movement therapy in upper extremity rehabilitation in patients with cerebral palsy: A systematic review

Antecedentes y objetivo En la parálisis cerebral hemipléjica puede aparecer el «aprendizaje de no uso». La terapia de movimiento inducido por restricción del lado sano parece revertir este fenómeno. El objetivo del presente artículo es revisar la evidencia sobre su efectividad en la funcionalidad del miembro superior, la realización de las actividades de la vida diaria y la calidad de vida. Pacientes y métodos Se llevó a cabo una revisión sistemática entre enero y abril del 2019 en las bases de datos PubMed, Cochrane, PEDro y TripDataBase. Se han incluido 14 estudios clínicos donde se describen sus características. Resultados La mayor parte de los estudios encuentran mejorías significativas frente a grupos controles. Solo un artículo investiga sobre calidad de vida. Conclusiones La terapia de movimiento inducido por restricción parece tener efectos positivos en la rehabilitación motora de la extremidad superior de estos sujetos. Se necesitan más estudios que valoren los factores individuales más influyentes en la rehabilitación (AU)

Background and objective In hemiplegic cerebral palsy, learned non-use may appear. This phenomenon can be reversed by constraint-induced movement therapy in the healthy side. The aim of this article was to review the evidence of the effectiveness of this therapy on upper extremity functioning, the performance of activities of daily living and quality of life. Patients and methods We performed a systematic review between January and April 2019 in the PubMed, COCHRANE, PEDro and TRIPDATABASE databases. We included 14 clinical studies describing their characteristics. Results Most of the studies found significant improvements compared with control groups. Only one article investigated quality of life. Conclusions Constraint-induced movement therapy seems to have positive effects in the motor rehabilitation of the upper extremity in patients with hemiplegic cerebral palsy. Further studies are needed to assess the individual factors of greatest influence in rehabilitation (AU)

[Effectiveness of constraint-induced movement therapy in upper extremity rehabilitation in patients with cerebral palsy: A systematic review]. / Efectividad de la terapia de movimiento inducido por restricción del lado sano en la rehabilitación del miembro superior en pacientes con parálisis cerebral: revisión sistemática.

BACKGROUND AND OBJECTIVE: In hemiplegic cerebral palsy, learned non-use may appear. This phenomenon can be reversed by constraint-induced movement therapy in the healthy side. The aim of this article was to review the evidence of the effectiveness of this therapy on upper extremity functioning, the performance of activities of daily living and quality of life. PATIENTS AND METHODS: We performed a systematic review between January and April 2019 in the PubMed, COCHRANE, PEDro and TRIPDATABASE databases. We included 14 clinical studies describing their characteristics. RESULTS: Most of the studies found significant improvements compared with control groups. Only one article investigated quality of life. CONCLUSIONS: Constraint-induced movement therapy seems to have positive effects in the motor rehabilitation of the upper extremity in patients with hemiplegic cerebral palsy. Further studies are needed to assess the individual factors of greatest influence in rehabilitation.

Lipoma endobronquial / Endobronchial lipoma

El lipoma endobronquial es un tumor benigno extremadamente raro, que suele causar síntomas por obstrucción bronquial. En la tomografía computarizada de tórax se presenta como una masa homogénea de densidad grasa que no capta contraste. El diagnóstico definitivo se realiza con broncoscopia y biopsia del tumor. El tratamiento de elección es la resección por vía endoscópica. Presentamos un caso de lipoma endobronquial en una paciente de 74 años, con antecedente de carcinoma papilar de tiroides, resecado por vía endoscópica(AU)

Endobronchial lipoma is an extremely rare benign tumour, which usually causes symptoms related with bronchial obstruction. Chest computed tomography shows a homogeneous mass with fat density and without contrast enhancement. Definitive diagnosis is made with bronchoscopy and biopsy of the tumour. The treatment of choice is endoscopic resection. We present a case of an endobronchial lipoma in a 74 year old patient, with a medical history of papilar thyroidgl and carcinoma, resected endoscopically(AU)

[Endobronchial lipoma]. / Lipoma endobronquial.

Endobronchial lipoma is an extremely rare benign tumour, which usually causes symptoms related with bronchial obstruction. Chest computed tomography shows a homogeneous mass with fat density and without contrast enhancement. Definitive diagnosis is made with bronchoscopy and biopsy of the tumour. The treatment of choice is endoscopic resection. We present a case of an endobronchial lipoma in a 74 year-old patient, with a medical history of papilar thyroid gland carcinoma, resected endoscopically.

Lymphangioleiomyomatosis: a study of 72 patients from the Spanish registry.

BACKGROUND: Pulmonary lymphangioleiomyomatosis (LAM) is a rare lung disease that almost exclusively affects young women of childbearing age. The true incidence and prevalence of LAM are unknown. This study was conducted to evaluate the characteristics of lymphangioleiomyomatosis in Spain. METHODS: Over a 2-year period, a questionnaire designed for this study was collected. This questionnaire included sociodemograhic, clinical, radiological and functional data. Information about the study and this questionnaire were both sent by e-mail to all the participants of the interstitial disease registry of 2004. RESULTS: Seventy-two patients, all of whom were women, were included in the registry, with a mean age of 44.56 +/- 11.1 yr. Sixty-three patients (87.5%) presented the sporadic LAM and 9 (12.5%) presented LAM associated with tuberous sclerosis (LAM-TS). LAM diagnosis was confirmed with an open lung biopsy in 57 patients (79.2%) and was performed with thoracic HRCT compatible with LAM diagnosis in the other 15 cases. The most frequent symptom was dyspnoea (90%) followed by cough (44.4%). Almost 40% of patients presented renal angiomyolipomas in the study and the most frequent spirometric pattern was obstructive in more than half of the patients. Most patients with LAM-TS (88.8%) had renal angiomyolipomas compared with 31.7% in the sporadic LAM group. CONCLUSION: The characteristics of the Spanish population affected with LAM are similar to those of other countries. Most patients were symptomatic, had a history of previous pneumothorax and presented abnormal radiological findings and pulmonary function tests.

Apoptosis is involved in the antiproliferativeeffect of corticosterone innon-tumoral ACTH pituitary cells

No disponible

No disponible

Polimorfismos genéticos en la sepsis / Genetic polymorphisms in sepsis

Un polimorfismo genético (PG) es una variante alélica que existe de forma estable en una población. Para ser considerado un PG, debe presentar una frecuencia de al menos el 1%. Son, por lo tanto, diferentes de las mutaciones, que son mucho menos frecuentes y van asociadas, habitualmente, a enfermedades hereditarias. Se han descrito varios PG en la sepsis y en el shock séptico. Pueden asociarse con una mayor incidencia de sepsis en la población general, o con una mayor gravedad y mortalidad una vez que la sepsis se ha presentado. Se han descrito PG de la proteína ligadora de la endotoxina, receptor CD14, factor de necrosis tumoral beta (TNF-ß), TNF-α, interleucina 1 alfa (IL-1α), IL-1ß IL-1 ra, IL-6 e IL-10. Los diversos estudios difieren al definir la relevancia de cada PG en particular, probablemente debido en parte a diferentes momentos en la inclusión de los enfermos, pequeño tamaño muestral, inclusión de enfermos de diferentes etnias y errores metodológicos en la determinación del PG

A genetic polymorphism (GP) is an allelic variation that appears in stable form in a population. An incidence of at least 1% is necessary for a GP to be considered as such. So, GP are different from mutations because mutations are less common, and appear associated usually to hereditary diseases. Several GP have been detected in sepsis and septic shock. GP can be associated to higher incidence of sepsis in general population, and to higher sepsis severity and mortality once the disease is evolving GPs of ligand protein endotoxin, CD14 receptor, TNF-ß, TNF-α, IL-1α, IL-1ß, IL-1 ra, IL-6, IL-10 have been described. Results of various studies have been different with regard to relevance of every GP, probably because of differences in the inclusion of patients in the studies, small samples, inclusion of patients of different ethnic groups, and methodological errors in GP ascertainment

Irreversible coma, ergotamine, and ritonavir.

We report the first case in the medical literature (to our knowledge) of a patient with human immunodeficiency virus infection who was being treated with ritonavir and developed signs of severe vascular involvement and irreversible coma after the administration of 3 mg of ergotamine tartrate.

Effects of three intravenous lipid emulsions on the survival and mononuclear phagocyte function of septic rats.

The immunosuppressive effects of intravenous lipid emulsions are a matter of great concern and debate. In a rat model of gram-negative bacteremia, we assessed whether the use of three intravenous lipid emulsions with different triacylglycerol compositions could influence mortality, bacterial clearance, and prostaglandin E(2) (PGE(2)) levels and compared these groups with groups of orally fed rats and rats that received a small amount of calories in form of glucose without enteral feeding (starvation). RATS WERE ASSIGNED TO ONE OF FIVE GROUPS: group 1 (control, n = 15) received rodent chow ad libitum and saline infusion; group 2 (starvation group, n = 12) had no access to chow and received an infusion of 5% glucose; group 3 (n = 17) received total parenteral nutrition (TPN) with long-chain triacylglycerols; group 4 (n = 12) received TPN with medium- and long-chain triacylglycerols; and group 5 (n = 15) received TPN with its emulsion based on olive oil. Animals received isonitrogenous and isocaloric TPN. After 2 d of TPN, a dose of 10(8) colony-forming units of Escherichia coli was introduced via the venous catheter; 2 d later the animals were killed. Blood, spleen, liver, and lungs were cultured. Circulating levels of PGE(2) were measured. Bacterial growth in the liver and lungs were significantly higher in groups 3 and 4 than in group 1, with no differences among the other groups. Rates of bacteremia were significantly higher in groups 3 and 4 than in group 1, with no differences among the other groups. Plasma levels of PGE(2) did not differ, and mortality was unaffected. Bacterial clearance clearly was preserved in orally fed, control rats when compared with rats on TPN with long-chain triacylglycerols or medium- plus long-chain triacylglycerols. However, the use of a lipid emulsion enriched intravenously with oleic acid was a valid way of reducing this disturbance, although plasma levels of PGE(2) and survival were not modified.

Clinical and metabolic effects of two lipid emulsions on the parenteral nutrition of septic patients.

OBJECTIVE: We compared the metabolic and clinical effects of two lipid emulsions, long-chain triacylglycerols (LCT) and a mixture of medium- and long-chain triacylglycerols (MCT/LCT), in septic patients. METHODS: Both groups received total parenteral nutrition (TPN) with a solution enriched with branched-chain amino acids (BCAA). Seventy-two septic patients received TPN with MCT/LCT (group 1) or LCT (group 2). Before starting TPN (basal) and 10 d after (final), various parameters were evaluated. RESULTS: Twenty-six subjects in each group completed the study. Both groups showed an increase in cholestasis enzymes, with no significant changes in lipid parameters. The rise of retinol-binding protein and the recovery of nitrogen balance were significantly greater in group 1. A multivariate analysis of nutritional markers and catabolic parameters showed a better evolution in group 1 (P = 0.002). The MCT/LCT group exhibited a significant increase of insulin levels. Overall mortality and length of stay in the intensive care unit were not affected by the lipid emulsion. CONCLUSIONS: In septic patients who received TPN with a solution enriched with BCAAs, the use of an emulsion containing MCT provided them with a greater recovery of their nutrition status than the traditional LCT formula, without influencing the outcome.

Evaluation of the BactiCard Neisseria for identification of pathogenic Neisseria species and Moraxella catarrhalis.

The BactiCard Neisseria (Remel, USA) is a chromogenic enzyme substrate system for identifying Neisseria gonorrhoeae, Neisseria meningitidis, Neisseria lactamica, and Moraxella catarrhalis. The identification system consists of a card with four test circles impregnated with chromogenic substrates for indoxyl butyrate esterase (IB), prolyl aminopeptidase (PRO), gamma-glutamyl aminopeptidase (GLUT), and ss-galactosidase (BGAL). These substrates permit the identification of Moraxella catarrhalis, Neisseria gonorrhoeae, Neisseria meningitidis, and Neisseria lactamica, respectively. After hydration of the circles with buffer, colonies from growth on selective media or a subculture are applied to the four circles. IB and BGAL reactions are read for a blue-green color after 2 and 15 min, respectively. PRO and GLUT reactions are read at 15 min for a red color after addition of a developer reagent. Identifications obtained with the BactiCard Neisseria were compared with those obtained using conventional procedures for 558 isolates in a blinded fashion. The BactiCard Neisseria identified 100% of 254 Neisseria gonorrhoeae, 100% of 125 Neisseria meningitidis, 53 (98.2%) of 54 Neisseria lactamica, and 123 (98.4%) of 125 Moraxella catarrhalis isolates. The BactiCard Neisseria is an accurate and rapid system for identification of these microorganisms in the clinical laboratory.

Critical illness polyneuropathy: risk factors and clinical consequences. A cohort study in septic patients.

OBJECTIVE: To determine risk factors and clinical consequences of critical illness polyneuropathy (CIP) evaluated by the impact on duration of mechanical ventilation, length of stay and mortality. DESIGN: Inception cohort study. SETTING: Intensive care unit of a tertiary hospital. PATIENTS: Septic patients with multiple organ dysfunction syndrome requiring mechanical ventilation and without previous history of polyneuropathy. INTERVENTIONS: Patients underwent two scheduled electrophysiologic studies (EPS): on the 10th and 21st days after the onset of mechanical ventilation. RESULTS: Eighty-two patients were enrolled, although nine of them were not analyzed. Forty-six of the 73 patients presented CIP on the first EPS and 4 other subjects were diagnosed with CIP on the second evaluation. The APACHE II scores of patients with and without CIP were similar on admission and on the day of the first EPS. However, days of mechanical ventilation [32.3 (21.1) versus 18.5 (5.8); p=0.002], length of ICU and hospital stay in patients discharged alive from the ICU as well as in-hospital mortality were greater in patients with CIP (42/50, 84% versus 13/23, 56.5%; p=0.01). After multivariate analysis, independent risk factors were hyperosmolality [odds ratio (OR) 4.8; 95% confidence intervals (95% CI) 1.05-24.38; p=0.046], parenteral nutrition (OR 5.11; 95% CI 1.14-22.88; p=0.02), use of neuromuscular blocking agents (OR 16.32; 95% CI 1.34-199; p=0.0008) and neurologic failure (GCS below 10) (OR 24.02; 95% CI 3.68-156.7; p<0.001), while patients with renal replacement therapy had a lower risk for CIP development (OR 0.02; 95% CI 0.05-0.15; p<0.001). By multivariate analysis, CIP (OR 7.11; 95% CI 1.54-32.75; p<0.007), age over 60 years (OR 9.07; 95% CI 2.02-40.68; p<0.002) and the worst renal SOFA (OR 2.18; 95% CI 1.27-3.74; p<0.002) were independent predictors of in-hospital mortality. CONCLUSIONS: CIP is associated with increased duration of mechanical ventilation and in-hospital mortality. Hyperosmolality, parenteral nutrition, non-depolarizing neuromuscular blockers and neurologic failure can favor CIP development.

The 12-lead electrocardiogram in anorexia nervosa: A report of 2 cases followed by a retrospective study.

Anorexia nervosa (AN) has been associated with various cardiac disorders and several electrocardiographic abnormalities, the most prominent being sudden death and prolonged QT duration and dispersion. We report 2 cases of AN with marked repolarization abnormalities, the first clearly related to electrolyte imbalance, the second without a good explanation from metabolic, electrolytic or pharmacological sources. A retrospective analysis of 47 other consecutive patients with AN showed that sinus bradycardia was the most common ECG finding, but that QT or QTc interval prolongation was not a typical feature, being present in only 1 patient. The sole variable slightly correlated with QTc duration was the serum potassium concentration. Consequently, marked repolarization changes (QT interval and/or T wave morphology) in AN should not be taken as a feature of the disease, but should call for the search of potential causes such as metabolic and electrolytic disturbances, drug effects, or a possible genetic component.

Sensibilidad y valor predictivo negativo del dímero-D enenfermos con enfermedad tromboembólica venosa / Sensitivity and negative predictive value of D-dimer in patients with venous thromboembolic disease

Objetivo: Conocer la sensibilidad y el valor predictivo negativo de una nueva técnica de látex para la determinación de niveles de dímero-D (D-D) en pacientes con enfermedad tromboembólica venosa (ETEV). Métodos: Análisis retrospectivo de enfermos con ETEV en quienes se determinó la concentración plasmática de D-D mediante STA-LIATEST dímero-D (Boehringer Mannheim).Resultados: Diecinueve pacientes presentaron tromboembolismo pulmonar (TEP), catorce enfermos tuvieron trombosis venosa profunda (TVP) y en 6 individuos se objetivaron TVP y TEP. Todos los pacientes tuvieron unos niveles de D-D superiores a 0,4 µg/ml. El valor medio fue de 11,3 ñ 11,1 µg/l (rango: 1-59,9 µg/ml). Los pacientes que padecían neoplasias malignas (n=8) presentaron concentraciones de dímero-D (16,8 ñ 8,3 µg/ml) superiores a los del resto de pacientes (9,9 ñ 11,4 µg/ml; p < 0,05). Así mismo, los pacientes que habían sufrido un traumatismo en los 2 meses previos tuvieron un dímero-D (4,8 ñ 3,5 µg/ml) que fue inferior al del resto de pacientes estudiados (12 ñ 11,4 µg/ml; p < 0,05). Conclusiones: La sensibilidad y el valor predictivo negativo de la STA-LIATEST dímero-D fue del 100 por ciento en nuestro medio (AU)

A new method for phenotyping red blood cells using microplates.

BACKGROUND AND OBJECTIVES: The supply of phenotyped red blood cells (RBC) for patients with several RBC antibodies presents a difficult task to hospital blood banks and regional blood centers. The aim of this study was to establish a low-cost typing system to allow extensive phenotyping of regular blood donors for clinically significant RBC antigens. MATERIALS AND METHODS: We developed a new buffer that greatly intensifies the antigen-antibody reaction and thus reduces the quantity of serum needed for phenotyping. The procedure was carried out on microplates. RESULTS: A total of 20,435 regular blood donors have been typed to date. For 752 units required for transfusion, 3,584 phenotyping tests were performed, validating the results by tube or gel typing methods; agreement was achieved in all cases. CONCLUSION: This technique seems adequate for phenotyping a large number of RBC units at very low cost, thus facilitating the availability of phenotyped blood.