Socioeconomic, health-care access and clinical determinants of disease severity in Multiple Sclerosis in Chile.

BACKGROUND: MS severity may be affected by genetic, patient-related, disease-related and environmental factors. Socioeconomic status, including income and healthcare access, amongst others, may also have a role in affecting diagnostic delay or therapy prescription. In Chile, two main healthcare systems exist, public-healthcare and private-healthcare, nonetheless universal care laws (e.g., access to High Efficacy Therapy-HET), including both systems, have been recently enacted for people with MS. OBJECTIVE: To assess the role of Socioeconomic Conditions (SEC), clinical variables and public health policies on the impact of disease severity of MS patients in Chile. METHODS: Multicentric, observational, cross-sectional study including patients from two reference centres (1 national reference centre from the private-health system and 1 regional reference centre from the public-health system). SEC and clinical variables included healthcare insurance (private or public), subclassification of health insurance according to monthly income, sex, age at onset, diagnostic delay, disease duration, diagnosis before HET law (as a proxy of HET delay), and current HET treatment. Progression Index (PI), EDSS ≥6.0 and Progressive MS diagnosis were used as outcome measures. Multivariable binary logistic regression was performed. RESULTS: We included 604 patients (460 private-health, 144 public-health), 67% women, 100% white/mestizo, 88% RRMS, mean age 42±12 years, mean age at onset 32±11 years, mean disease duration 10±6 years, median diagnostic delay 0 (0-34) years, 86% currently receiving any DMT, 55% currently receiving HET, median EDSS at last visit of 2.0 (0-10), and median PI 0.17 (0-4.5). Lower monthly income was associated with higher EDSS and higher PI. In the multivariable analysis, public-healthcare (OR 10.2), being diagnosed before HET-law (OR 4.89), longer diagnostic delay (OR 1.26), and older age at onset (OR 1.05) were associated with a higher risk of PI>0.2, while current HET (OR 0.39) was a protective factor. Diagnosis before HET-law (OR 7.59), public-healthcare (OR 6.49), male sex (OR 2.56), longer disease duration (OR 1.2) and older age at onset (OR 1.1) were associated with a higher risk of Progressive MS. Public-healthcare (OR 5.54), longer disease duration (OR 1.14) and older age at onset (OR 1.08) were associated with a higher risk of EDSS ≥6.0 while current treatment with HET had a trend as being a protective factor (OR 0.44, p = 0.05). CONCLUSION: MS severity is impacted by non-modifiable factors such as sex and age at onset. Interventions focused on shortening diagnostic delay and encouraging early access to high-efficacy therapies, as well as initiatives that may reduce the disparities inherent to lower socioeconomic status, may improve outcomes in people with MS.

LGI1-antibody associated epilepsy successfully treated in the outpatient setting.

We report six patients with anti-LGI1 associated epilepsy. Two patients presented with new-onset generalized tonic-clonic seizures, four developed faciobrachial dystonic seizures and two piloerection. All patients had significant cognitive complaints at the time of diagnosis. All patients described seizure reduction during the first week of carbamazepine, and seizure freedom was obtained at a median of 13 days (range 7-22), sustained after the initiation of immunosuppression. Median time from symptom onset to carbamazepine initiation was 164 days (range 38-206 days). We discuss the particular seizure response to sodium channel blocking antiepileptic drugs, alone or associated with immunosuppression in this antibody mediated seizures.

Ensayo clínico aleatorizado para evaluar la eficacia y seguridad en la erradicación del Pediculus humanus capitis de un nuevo pediculicida elaborado con aceite de oliva saponificado / Randomised clinical trial to evaluate the efficacy and safety of a new pediculicide made with saponified olive oil in the eradication of Pediculus humanus capitis

Introducción. El objetivo del estudio fue evaluar la eficacia y seguridad de un nuevo pediculicida en la erradicación del Pediculus humanus capitis. Material y métodos. Se diseñó un ensayo clínico aleatorizado en el que se seleccionaron niños con edades entre los 5 y los 15 años, en los que se diagnosticó pediculosis. El tratamiento se administró en los días 1 y 7 tras su selección, y fueron evaluados en 4 visitas (días 2, 7, 9 y 14). El producto en evaluación con aceite de oliva saponificado fue Inex Pediculicide Soap®, que fue comparado con Paranix®, con un mecanismo de acción similar. La variable principal de eficacia fue la erradicación del parásito en el día 14, realizándose el análisis por intención de tratar. Resultados. Participaron 6 pediatras pertenecientes a 5 centros de salud de la Comunidad de Madrid (España) y una clínica privada. Se seleccionaron 45 niños, de los que el 75,6% eran niñas (n=34). La media de edad fue de 7,1 años (IC 95% 6,3-7,9), perteneciendo el 80% de los niños a la clase social media. El 82,2% tenían antecedentes de pediculosis previas. La eficacia a los 14 días fue del 76,2% (IC 95% 52,8-91,8) en el grupo tratado con Inex Pediculicide Soap®, y del 79,2% (IC 95% 57,9-92,9) en el grupo de Paranix® (NNT=33,3). No se registraron efectos adversos al tratamiento. Conclusiones. Los 2 productos en evaluación se mostraron eficaces y seguros en el tratamiento de erradicación del Pediculus humanus capitis, sin diferencias estadísticamente significativas entre ellos (AU)

Introduction. The aim of the study was to evaluate the efficacy and safety of a new pediculicide in the eradication of Pediculus humanus capitis infestation. Material and methods. A randomised clinical trial was designed, in which children aged between 5 and 15 years diagnosed with pediculosis were selected. Treatment was administered on days 1 and 7 after selection, and they were evaluated in 4 visits (day 2, 7, 9, and 14). The product under evaluation with saponified olive oil was Inex Pediculicide Soap®, which was compared with Paranix®, with a similar mechanism of action. The primary efficacy endpoint was the eradication of the parasite by day 14 (louse-free rate), using an intention to treat analysis. Results. Six paediatricians from 5 Primary Health Care centres in the Community of Madrid (Spain) and one private clinic participated in the study. A total of 45 children were included, of which 75.6% were girls (n=34). The mean age was 7.1 years (95% CI 6.3-7.9). The large majority (80%) were middle class, and 82.2% had a history of previous pediculosis. The efficacy at 14 days was 76.2% (95% CI 52.8-91.8) in the group treated with Inex Pediculicide Soap® group, and 79.2% (95% CI 57.9-92.9) in Paranix® group (NNT=33.3). No adverse effects were observed with treatment. Conclusions. The 2 products were effective and safe in the eradication therapy Pediculus humanus capitis, with no statistical differences (AU)

[Randomised clinical trial to evaluate the efficacy and safety of a new pediculicide made with saponified olive oil in the eradication of Pediculus humanus capitis]. / Ensayo clínico aleatorizado para evaluar la eficacia y seguridad en la erradicación del Pediculus humanus capitis de un nuevo pediculicida elaborado con aceite de oliva saponificado.

INTRODUCTION: The aim of the study was to evaluate the efficacy and safety of a new pediculicide in the eradication of Pediculus humanus capitis infestation. MATERIAL AND METHODS: A randomised clinical trial was designed, in which children aged between 5 and 15 years diagnosed with pediculosis were selected. Treatment was administered on days 1 and 7 after selection, and they were evaluated in 4 visits (day 2, 7, 9, and 14). The product under evaluation with saponified olive oil was Inex Pediculicide Soap®, which was compared with Paranix®, with a similar mechanism of action. The primary efficacy endpoint was the eradication of the parasite by day 14 (louse-free rate), using an intention to treat analysis. RESULTS: Six paediatricians from 5 Primary Health Care centres in the Community of Madrid (Spain) and one private clinic participated in the study. A total of 45 children were included, of which 75.6% were girls (n=34). The mean age was 7.1 years (95% CI 6.3-7.9). The large majority (80%) were middle class, and 82.2% had a history of previous pediculosis. The efficacy at 14 days was 76.2% (95% CI 52.8-91.8) in the group treated with Inex Pediculicide Soap® group, and 79.2% (95% CI 57.9-92.9) in Paranix® group (NNT=33.3). No adverse effects were observed with treatment. CONCLUSIONS: The 2 products were effective and safe in the eradication therapy Pediculus humanus capitis, with no statistical differences.

Análisis cuantitativo de la ingesta de nutrientes en niños menores de 3 años. Estudio ALSALMA / Quantitative analysis of nutrient intake in children under 3 years old. ALSALMA study

OBJETIVO: El objetivo del estudio fue analizar el patrón de alimentación de niños menores de 3 años y comparar los resultados con las recomendaciones de consumo energético y de nutrientes. PACIENTES Y MÉTODOS: En este estudio epidemiológico transversal, los padres completaron un diario dietético sobre el consumo de alimentos de sus hijos, durante 4 días no consecutivos. Se analizó la proporción de niños con ingestas medias inferiores a las recomendaciones para cada edad y nutriente, mediante el método «Estimated Average Requirement (EAR) cut-point method». RESULTADOS: Participaron 186 pediatras, que incluyeron a 1.701 niños. El 95,9% (n=1320) de los niños de 7 a 36 meses consumieron proteínas por encima del doble de las Recommended Dietary Allowances. Las deficiencias observadas (% < EAR) en los grupos de edad de 13-24 meses y 25-36 meses, respectivamente, fueron: vitamina D en el 81,7 y el 92,1%; vitamina E en el 39,3 y el 53,4%; ácido fólico en el el 12,5 y el 14,8%; calcio en el 10,1 y el 5,5%; yodo en el 27,1 y el 31%. Se observó que una mayor proporción en el consumo diario de proteínas (p = 0,013) y de hidratos de carbono (p < 0,0001), y una menor proporción de lípidos totales (p < 0,0001), estaban relacionadas con un mayor índice de masa corporal, independientemente del consumo energético. CONCLUSIONES: El estudio mostró una visión muy detallada de los patrones de alimentación de los niños españoles menores de 3 años. La promoción de una alimentación saludable debería ir dirigida a la corrección de los desequilibrios dietéticos detectados, para favorecer la salud futura de los niños

OBJECTIVE: The objective of the study was to analyze the nutritional patterns of children under three years of age and to compare the results against the recommendations for energy and nutrient intake. PATIENTS AND METHODS: In this cross-sectional epidemiological study, parents completed a dietary diary on their food intake of their children on 4 non-consecutive days. The percentage of children with mean intakes below the recommendations for each age and nutrient was analyzed using the 'Estimated Average Requirement (EAR) cut-point method.' RESULTS: A total of 186 pediatricians included 1701 children in the study. A total of 95.9% (n=1320) of the children between 7 and 36 months had a protein consumption more than twice that of the Recommended Daily Allowances. The deficiencies observed (% < EAR) in the age groups 13-24 months and 25-36 months, respectively, were: vitamin D in 81.7% and 92.1%; vitamin E in 39.3% and 53.4%; folic acid in 12.5% and 14.8%; calcium in 10.1% and 5.5%; iodine in 27.1% and 31%. It was observed that a higher percentage in the daily intake of proteins (P = .013) and of carbohydrates (P < .0001), and a lower percentage of total lipids (P < .0001), were related to a greater body mass index, regardless of energy intake. CONCLUSIONS: The study presents a very detailed view of the eating patterns of Spanish children less than three years of age. The encouragement of healthy feeding should be directed towards the correction of the dietary imbalances detected, in order to promote the future health of children

[Quantitative analysis of nutrient intake in children under 3 years old. ALSALMA study]. / Análisis cuantitativo de la ingesta de nutrientes en niños menores de 3 años. Estudio ALSALMA.

OBJECTIVE: The objective of the study was to analyze the nutritional patterns of children under three years of age and to compare the results against the recommendations for energy and nutrient intake. PATIENTS AND METHODS: In this cross-sectional epidemiological study, parents completed a dietary diary on their food intake of their children on 4 non-consecutive days. The percentage of children with mean intakes below the recommendations for each age and nutrient was analyzed using the "Estimated Average Requirement (EAR) cut-point method." RESULTS: A total of 186 pediatricians included 1701 children in the study. A total of 95.9% (n=1320) of the children between 7 and 36 months had a protein consumption more than twice that of the Recommended Daily Allowances. The deficiencies observed (% < EAR) in the age groups 13-24 months and 25-36 months, respectively, were: vitamin D in 81.7% and 92.1%; vitamin E in 39.3% and 53.4%; folic acid in 12.5% and 14.8%; calcium in 10.1% and 5.5%; iodine in 27.1% and 31%. It was observed that a higher percentage in the daily intake of proteins (P=.013) and of carbohydrates (P<.0001), and a lower percentage of total lipids (P<.0001), were related to a greater body mass index, regardless of energy intake. CONCLUSIONS: The study presents a very detailed view of the eating patterns of Spanish children less than three years of age. The encouragement of healthy feeding should be directed towards the correction of the dietary imbalances detected, in order to promote the future health of children.

Evaluación de la alimentación y consumo de nutrientes en menores de 3 años. Estudio piloto ALSALMA / Evaluation of diet and nutrient intake in children under three years old. ALSALMA pilot study

OBJETIVO: El objetivo de este estudio fue evaluar el consumo de energía y nutrientes en niños españoles menores de 3 años y comparar los resultados con las recomendaciones actuales, para comprobar si su ingesta era adecuada. PACIENTES Y MÉTODOS: Estudio piloto transversal. Las madres completaron un diario dietético sobre el consumo de alimentos de sus hijos, durante 4 días no consecutivos, registrando los productos y las cantidades consumidas. Se calcularon el consumo de nutrientes y los resultados se compararon con las Dietary Reference Intakes (DRI)) para cada grupo de edad. RESULTADOS: Se incluyó a 188 niños (93 niños, 95 niñas) con edades de 0-6 meses (41), 7-12 meses (24), 13-24 meses (57) y 25-36 meses (66). Se observaron diferencias estadísticamente significativas respecto a las DRI en el consumo de la mayoría de los nutrientes analizados. Destacó el exceso de consumo de proteínas, que alcanza el 376% de las DRI en los niños entre uno y 3 años. El 96% de los niños de 7 a 12 meses, el 88% de los niños de 13 a 24 meses y el 97% de los niños de 25 a 36 meses consumían proteínas por encima del doble de las DRI. CONCLUSIONES: La ingesta de nutrientes difirió de las DRI, especialmente en lo referido a las proteínas. Se debería evaluar si las desviaciones observadas en el estudio son extensibles a la población nacional de este grupo de edad en un estudio con una muestra representativa y las posibles repercusiones sobre la salud de los niños

OBJECTIVE: The present study evaluates energy and nutrient intake in Spanish children under three years of age, and compares the results with the current recommendations in order to identify possible inadequate nutrient intake. PATIENTS AND METHODS: A cross-sectional pilot study. The mothers completed a diet diary for four non-consecutive days, recording the products and amounts consumed by their children. Nutrient intake was calculated, and the results were compared with the dietary reference intakes (DRI) for each age group. RESULTS: A total of 188 children (93 boys and 95 girls) aged 0-6 (n=41), 7-12 (n=24), 13-24 (n=57), and 25-36 months (n=66) were included. Statistically significant differences in DRI were observed for most of the nutrients analyzed. Protein intake, in particular was 376% of DRI in children between 1-3 years of age. By age groups, 96% of the children aged 7-12 months, 88% of the children aged 13-24 months, and 97% of the children aged 25-36 months showed protein intakes more than two-fold DRI. CONCLUSIONS: Nutrient intake differed from the DRI, particularly as regards proteins. A new study is required to determine whether the observed study deviations could be representative of the national population of this age group, as well as the possible effects on child health

[Evaluation of diet and nutrient intake in children under three years old. ALSALMA pilot study]. / Evaluación de la alimentación y consumo de nutrientes en menores de 3 años. Estudio piloto ALSALMA.

OBJECTIVE: The present study evaluates energy and nutrient intake in Spanish children under three years of age, and compares the results with the current recommendations in order to identify possible inadequate nutrient intake. PATIENTS AND METHODS: A cross-sectional pilot study. The mothers completed a diet diary for four non-consecutive days, recording the products and amounts consumed by their children. Nutrient intake was calculated, and the results were compared with the dietary reference intakes (DRI) for each age group. RESULTS: A total of 188 children (93 boys and 95 girls) aged 0-6 (n=41), 7-12 (n=24), 13-24 (n=57), and 25-36 months (n=66) were included. Statistically significant differences in DRI were observed for most of the nutrients analyzed. Protein intake, in particular was 376% of DRI in children between 1-3 years of age. By age groups, 96% of the children aged 7-12 months, 88% of the children aged 13-24 months, and 97% of the children aged 25-36 months showed protein intakes more than two-fold DRI. CONCLUSIONS: Nutrient intake differed from the DRI, particularly as regards proteins. A new study is required to determine whether the observed study deviations could be representative of the national population of this age group, as well as the possible effects on child health.

Registro nacional de melanoma cutáneo. Características del tumor en el momento del diagnóstico: 15 años de experiencia / The Spanish National Cutaneous Melanoma Registry. Tumour characteristics at Diagnosis: 15 Years of Experience

Introducción y objetivos: El registro nacional de melanoma cutáneo (RNMC) se creó en el año 1997 con el objetivo de conocer las características del melanoma en el momento del diagnóstico. Se muestran las características de los tumores en el momento de su diagnóstico inicial. Pacientes y métodos: Registro observacional transversal, con base poblacional. Se incluyeron casos incidentes y prevalentes de melanoma con resultados de la primera biopsia disponibles. Resultados: El RNMC contiene información de 14.039 pacientes. Se analizaron las características del melanoma en los pacientes diagnosticados en el periodo 1997-2011, sumando un total de 13.628 melanomas. El 56,5% de los pacientes eran mujeres y el 43,5% hombres. La edad media fue de 57 años (IC 95%: 56,4 a 57), con mediana de 58 años. La localización más frecuente fue en el tronco (37,1%), seguido de la extremidad inferior (27,3%). El tipo clínico-patológico más observado fue el melanoma de extensión superficial en un 62,6% (n = 7.481), seguido del melanoma nodular en un 16,8% de los casos (n = 2.014). El 86,2% (n = 10.382) tenían enfermedad localizada, el 9,9% metástasis regionales (n = 1.188) y el 3,9% (n = 479) a distancia. Se observó en los hombres, independientemente de la edad de diagnóstico, un mayor espesor del tumor y una mayor proporción de tumores ulcerados, con niveles de lactatodeshidrogenasa elevados y con enfermedad metastásica (p < 0,0001). Conclusiones: Con los resultados observados las campañas preventivas deberían orientarse al colectivo masculino mayor de 50 años, en el que se observan tumores de mayor espesor, y por lo tanto de peor pronóstico (AU)

Background and objectives: The Spanish National Cutaneous Melanoma Registry (Registro Nacional de Melanoma Cutáneo [RNMC]) was created in 1997 to record the characteristics of melanoma at diagnosis. In this article, we describe the characteristics of these tumors at diagnosis. Patients and methods: This was a cross-sectional observational study of prevalent and incident cases of melanoma for which initial biopsy results were available in the population-based RNMC. Results: The RNMC contains information on 14,039 patients. We analyzed the characteristics of 13,628 melanomas diagnosed between 1997 and 2011. In total, 56.5% of the patients studied were women and 43.5% were men. The mean age of the group was 57 years (95% CI , 56.4-57 years) while median age was 58 years. The most common tumor site was the trunk (37.1%), followed by the lower limbs (27.3%). The most frequent clinical-pathologic subtype was superficial spreading melanoma (n = 7481, 62.6%), followed by nodular melanoma (n = 2014, 16.8%). Localized disease was observed in 86.2% of cases (n = 10,382), regional metastasis in 9.9% (n = 1188), and distant metastasis in 3.9% (n = 479). Independently of age at diagnosis, men had thicker tumors, more ulceration, higher lactate dehydrogenase levels, and a higher rate of metastasis than women (P < 0.001). Conclusions: Based on our findings, melanoma prevention campaigns should primarily target men over 50 years old because they tend to develop thicker tumors and therefore have a worse prognosis (AU)

Melanoma characteristics at diagnosis from the Spanish National Cutaneous Melanoma Registry: 15 years of experience.

BACKGROUND AND OBJECTIVES: The Spanish National Cutaneous Melanoma Registry (Registro Nacional de Melanoma Cutáneo [RNMC]) was created in 1997 to record the characteristics of melanoma at diagnosis. In this article, we describe the characteristics of these tumors at diagnosis. PATIENTS AND METHODS: This was a cross-sectional observational study of prevalent and incident cases of melanoma for which initial biopsy results were available in the population-based RNMC. RESULTS: The RNMC contains information on 14,039 patients. We analyzed the characteristics of 13,628 melanomas diagnosed between 1997 and 2011. In total, 56.5% of the patients studied were women and 43.5% were men. The mean age of the group was 57 years (95% CI, 56.4-57 years) while median age was 58 years. The most common tumor site was the trunk (37.1%), followed by the lower limbs (27.3%). The most frequent clinical-pathologic subtype was superficial spreading melanoma (n=7481, 62.6%), followed by nodular melanoma (n=2014, 16.8%). Localized disease was observed in 86.2% of cases (n=10,382), regional metastasis in 9.9% (n=1188), and distant metastasis in 3.9% (n=479). Independently of age at diagnosis, men had thicker tumors, more ulceration, higher lactate dehydrogenase levels, and a higher rate of metastasis than women (P<.001). CONCLUSIONS: Based on our findings, melanoma prevention campaigns should primarily target men over 50 years old because they tend to develop thicker tumors and therefore have a worse prognosis.

Subthreshold symptoms and time to relapse/recurrence in a community cohort of bipolar disorder outpatients.

BACKGROUND: Researchers have previously found that persistent subthreshold symptoms increase the risk and shorten the time until an affective relapse in bipolar disorder (BD) patients. Research has mainly focused on patients from tertiary Care Centers in USA. We tested the hypothesis that even in a different setting, BD outpatients with subsyndromal affective symptoms would re.turn to a subsequent major affective episode significantly faster than completely asymptomatic at baseline. Secondarily, we analysed other variables related to time and risk to relapse. METHODS: A community cohort of BD outpatients from Madrid (Spain) followed-up in a systematic prospective follow-up protocol for up to five years were evaluated. Patients in clinical euthymia at baseline were included and evaluated quarterly. RESULTS: Initially, 225 patients were included in the survival analysis. Of them, according to predefined psychometric criteria, 163 were in euthymia (72.4%) and 62 (27.6%) suffered subsyndromal symptoms. Median follow-up was 157.6 weeks (95% CI, 78.14 to 111); 57.3% of patients experienced at least one affective episode during their follow-up. Median survival time to first affective episode was 109 weeks for patients in euthymia at baseline, versus 35 weeks for those with subsyndromal symptoms (p<0.0001). Psychosocial stress (p=0.003; HR 2.20; 95% CI 1.31-3.68) and the affective mood baseline state, subsyndromal vs. euthymic (p=0.046; HR 1.74; 95%CI 1.009-3.020), were related to time to first affective episode. LIMITATIONS: Naturalistic study, some of the data collected were necessarily retrospective. CONCLUSIONS: In Spanish non-tertiary psychiatric outpatients, subsyndromal BD symptoms and psychosocial stress at baseline predict earlier episode relapse/recurrence.

Syndromal and subsyndromal illness status and five-year morbidity using criteria of the International Society for Bipolar Disorders compared to alternative criteria.

BACKGROUND: Subsyndromal symptoms have been recognized as relevant in the course and outcome of bipolar disorder (BD) patients. Nevertheless, their definition and cutoff points on current depression and mania scales are uncertain. The recently defined International Society for Bipolar Disorders (ISBD) operational criteria for the assessment of the course and outcome of bipolar illness have never been tested until now. METHODS: A naturalistic longitudinal follow-up study of up to 5 years included a cohort of 317 DSM-IV-TR BD outpatients. For the first time, we assessed the proportion of visits in different affective states using the ISBD criteria. Secondarily, we compared the results with those obtained applying other cutoff points. RESULTS: Patients were symptomatic in 39.1% (95% CI 35.3-42.9) of the visits. Subsyndromal symptoms, primarily subsyndromal depression, were present in 15.9% of patients (95% CI 13.4-18.4). No significant differences were found between bipolar I patients and bipolar II patients. There were differences in the total percentage of visits in euthymia depending on the cutoff points (p < 0.05). CONCLUSIONS: Applying ISBD criteria, bipolar patients have significant clinical morbidity and are often symptomatic, both with threshold symptoms and with subthreshold symptoms, especially with depression. The chosen cutoff points modify the apparent results. LIMITATIONS: The cutoff points used have not been validated. Psychopharmacologic treatments were naturalistic.

Trasplante de células troncales como terapia para la esclerosis lateral amiotrófica. Una mirada crítica / Stem cells therapy in amyotrophic lateral sclerosis treatment. A critical view

Introducción. La esclerosis lateral amiotrófica (ELA) es una enfermedad neurodegenerativa para la cual no existe tratamiento curativo. En sus mecanismos patogénicos y de progresión participaría el daño oxidativo, acumulación de agregados intracelulares, disfunción mitocondrial, defectos en el transporte axonal, disminución de factores tróficos, alteraciones gliales, metabolismo aberrante del ARN y excitotoxicidad. Objetivo. Evaluar los resultados terapéuticos de las células troncales adultas como terapia en la ELA. Desarrollo. Las células troncales son una posible estrategia terapéutica, puesto que sus mecanismos de acción permitirían revertir varios de los mecanismos patogénicos descritos para la ELA. Entre las células troncales adultas destacan las células mesenquimales obtenidas de la médula ósea. Estas células son capaces de diferenciarse en todas las células del sistema nervioso central y potencialmente reemplazarlas. Además, poseen efectos inmunomoduladores, caracterizándose por secretar, especialmente en ambientes neuroinflamatorios, factores neurotróficos y antiinflamatorios. Estudios en modelos murinos de ELA muestran disminución de la inflamación y progresión de la enfermedad, y aumento de la supervivencia. Hay varios ensayos clínicos publicados, muy heterogéneos entre sí, que sugieren que el trasplante de células troncales sería seguro, pero no mejoraría en la evolución clínica de los pacientes. Conclusión. Se necesitan estudios preclínicos adicionales para refinar esta aproximación terapéutica, evaluando la supervivencia a largo plazo, diferenciación de células mesenquimales, dosificación, actividad biológica y seguridad, para continuar con estudios en pacientes (AU)

Introduction. Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease. At present, there are not curative therapies for ALS. Pathogenic and progression mechanisms suggest the existence of oxidative stress, abnormal intracellular protein aggregation, mitochondrial dysfunction, axonal transport impairment, impairment of trophic support, altered glial cell function, and glutamate excitoxicity. Aim. To evaluate therapeutic results with adult stem cell for ALS treatment. Development. Stem cells represent a potential therapeutic strategy, because their biological mechanisms could act on several of the pathogenic mechanisms proposed for ALS. Bone marrow mesenchymal stem cells are especially interesting among adult stem cells. Mesenchymal stem cells can differentiate in all central nervous system cells and potentially replace them. Furthermore, they have immunomodulatory effects, secreting, especially in neuroinflammatory environments, neurotrophic and antiinflammatory factors. Studies in murine models of ALS show decrease of inflammation and disease progression, and increase on animal highly heterogeneous, suggest that mesenchymal stem cells transplant in ALS appears to be safe. However, they fail showing clinical improvement of patients. Conclusion. Additional preclinical studies are necessary to refine this therapeutic approach, to assess long term survival and differentiation of mesenchymal stem cells, dosing, biological activity and safety should be conducted before any planning further human testing occurs (AU)

Quality of life in mild to moderate acne: relationship to clinical severity and factors influencing change with treatment.

BACKGROUND: Because of its effects on quality of life, acne vulgaris is more than a merely physiological or cosmetic entity. OBJECTIVES: To describe the influence of mild to moderate acne on patients' quality of life, measured using Skindex-29, and to correlate changes in Skindex-29 scores with changes in objective and subjective indices in clinical severity after treatment with topical 4% erythromycin 0.2% zinc. Also, to evaluate efficacy and side-effects of the treatment. METHODS: Observational, prospective study of 1878 patients cared for by 252 clinicians in Spain. Data included epidemiological information and responses to Skindex-29, a subjective change and objective severity index. RESULTS: Baseline Skindex scale scores were worse in women, older patients, and those with more severe clinical disease. Skindex was sensitive to changes in objective severity but changes in Skindex scale scores were also related to other factors. Patients who reported their skin condition to be 'the same' or 'worse' at the end of the study had significantly worse baseline scores on the 'symptoms' and 'emotions' scales but 'functioning' scores were not worse than for those who reported their condition had improved. CONCLUSION: The effects of acne vulgaris on quality of life and changes in quality of life after treatment are not only explainable by objective severity of acne. Patients' and clinicians' judgements about acne severity are different.

Principios DENG y desplazamiento forzado en Colombia = The Deng principles and forced displacement in Colombia / The Deng principles and forced displacement in Colombia

CONCLUSIONES: 1) Es de reconocer que buena parte del sistema legal y reglamentario diseñado por el Estado para atender el problema del desplazamiento forzado en Colombia está conforme con los principios formulados por el señor Francis Deng Representante del Secretario General de Naciones Unidas para la cuestión de los desplazados internos. 2) La crisis humanitaria que afecta a Colombia derivada de la gravedad, extensión y perspectiva del fenómeno del desplazamiento forzado requiere del diseño de una estrategia concreta que ajuste y dinamice el sistema de atención diseñado por la Ley definiendo metas y objetivos de mediano y corto plazo y responsabilidades específicas para su ejecución. Debería unificarse la dirección del proceso en una sola entidad y diseñar un plan operativo nacional que oriente la aplicación de las estrategias de intervención formuladas. 3) Se valora el apoyo prestado por agencias multi y bilaterales y ONG internacionales, asi como por ONG nacionalesen tanto han contribuído al mejoramiento de la situación de las víctimas, en particular durante la emergencia. Convendría la realización de un evento nacional de todos los organismos no estatales que actúan frente al desplazamiento forzado a efecto de unificar esfuerzos y potencializar el alcance de sus acciones. Parecería conveniente la creación de un espacio institucional de coordinación entre la acción estatal y la no gubernamental para armonizar propósitos y hacer más eficaz el trabajo que se adelanta

Chromametric quantification of pigmentary changes in the solar lentigo after sunlight exposure.

The purpose of this study is to compare by chromametric analysis the changes seen in normal skin and solar lentigos after exposure to sunlight. The color measurements were made with a Minolta CR200 chromameter and expressed in the L*a*b* system, which allows a color to be quantified according to 3 axes: white-black (L*), red-green (a*) and yellow-blue (b*). In order to better assess the sensitivity of physiological mechanisms involved in this pigmentation, we chose the weakest conditions of sunlight: the first series of measurements were made at the end of the winter (March) on areas rarely exposed for several months, and the second measurement was made 2 months later before the first intense summer solar exposure. Solar lentigos underwent a significant change in pigmentation, with a darkening of these lesions and an increase in the red and yellow color components. The pigmentation of healthy skin adjacent to these lentigos remained unchanged.

[Ureter-aorto-iliac prosthesis cross-over and a tumor of the ureter]. / Croisement uretère-prothèse aorto-iliaque et tumeur de l'uretère.

Ureteric stenoses sometimes occur after the insertion of aorto-iliac prostheses. Two cases of neoplastic ureteric stenosis, independent of the ureter-prosthesis crossing are reported, indicating the possibility of such lesions after aorto-iliac prosthetic surgery.

[Quantitative renal DMSA scintigraphy after extracorporeal lithotripsy]. / Scintigraphie rénale quantitative au DMSA après lithotripsie extra-corporelle.

This study reports the results of renal DMSA isotope scan before and after EDAP extracorporeal lithotripsy in 106 patients. An isotope scan was performed before lithotripsy and on the fourth day after lithotripsy and again on the 90th day when alterations were observed on the first post-lithotripsy scan. The assessment of any sequelae was based on the scale of colours of the spectrum, which revealed three types of modifications. The analysis of the results is divided into three periods according to the development in our lithotripsy technique: high firing rates had a success rate of only 40%, with renal scars on isotope scans in 2/3 of cases; low frequency firing rates had a 55% success rate and induced minor changes which were virtually always reversible; in contrast, low frequency firing rates during the 3rd period had a 60% success rate with scars on isotope scans in 1/3 of cases. These isotope scan modifications also depended on the site of the stone. In conclusion, lithotripsy definitely induces renal modifications. The renal parenchyma cannot remain indifferent to lithotripsy beyond a certain threshold. A homogeneous multicentre study with a common protocol is necessary to compare the various lithotriptors and to define cautious and coherent indications for each lithotriptor in the treatment of renal stones.

["Wallstent" endoprosthesis in recurrent urethral stricture in men]. / L'endoprothèse "Wallstent" dans les sténoses récidivantes de l'urètre masculin.

Many patients are condemned to repeated urethral dilatations because of the poor efficacy of treatment for male urethral stricture. The authors have recently used a new urethral prosthesis: a metal-reinforced, meshed tube which opens in the urethra and maintains a it open allowing the urothelium to grow over. The prosthesis therefore becomes incorporated in the wall of the urethra. they have implanted this prosthesis in 21 patients with a mean age of 61 years, essentially in the bulbar urethra, for longstanding strictures measuring 5 to 35 mm and unresponsive to currently available treatments. The endoscopic insertion of the prosthesis is performed after dilatation. The mean follow-up is 9 months. The stricture was correctly treated in all patients (three patients required two sessions). The follow-up of these patients is short and the stability of these favourable results needs to be confirmed by a longer follow-up.