Preservation of white wine pomace by high hydrostatic pressure.

The effect of different high hydrostatic pressure (HHP) treatments (400, 600 MPa for 1, 6 min) on white wine pomace was studied throughout storage conditions (270 days) at different temperature conditions (4° and 20 °C). The final use of this product would be as an ingredient for food products preservation. Microbiological, enzyme and physico-chemical parameters were evaluated after processing and during storage. HHP greatly reduced the microbial counts of treated pomace and allowed obtaining a safe product with a long shelf-life at 4 and 20 °C. The HHP treatment also preserved phenolic compounds content, however an important reduction of these compounds was found during storage since the polyphenol oxidase enzyme remained active after the treatment and during storage. Phenolic compounds were better preserved during storage at 4 °C than at 20 °C. The application of HHP at 600 MPa/6 min and the refrigeration of the treated pomace would allow obtaining a microbiologically safe pomace with high levels of phenolic compounds with a shelf-life of 90 days. The activity of the enzyme should be limited in future to ensure a long shelf-life of the processed pomace.

Predictive factors of six-week mortality in critically ill patients with SARS-CoV-2: A multicenter prospective study.

OBJECTIVE: The objective of the study is to identify the risk factors associated with mortality at six weeks, especially by analyzing the role of antivirals and munomodulators. DESIGN: Prospective descriptive multicenter cohort study. SETTING: 26 Intensive care units (ICU) from Andalusian region in Spain. PATIENTS OR PARTICIPANTS: Consecutive critically ill patients with confirmed SARS-CoV-2 infection were included from March 8 to May 30. INTERVENTIONS: None. VARIABLES: Variables analyzed were demographic, severity scores and clinical condition. Support therapy, drug and mortality were analyzed. An univariate followed by multivariate Cox regression with propensity score analysis was applied. RESULTS: 495 patients were enrolled, but 73 of them were excluded for incomplete data. Thus, 422 patients were included in the final analysis. Median age was 63 years and 305 (72.3%) were men. ICU mortality: 144/422 34%; 14 days mortality: 81/422 (19.2%); 28 days mortality: 121/422 (28.7%); 6-week mortality 152/422 36.5%. By multivariable Cox proportional analysis, factors independently associated with 42-day mortality were age, APACHE II score, SOFA score at ICU admission >6, Lactate dehydrogenase at ICU admission >470U/L, Use of vasopressors, extrarenal depuration, %lymphocytes 72h post-ICU admission <6.5%, and thrombocytopenia whereas the use of lopinavir/ritonavir was a protective factor. CONCLUSION: Age, APACHE II, SOFA>value of 6 points, along with vasopressor requirements or renal replacement therapy have been identified as predictor factors of mortality at six weeks. Administration of corticosteroids showed no benefits in mortality, as did treatment with tocilizumab. Lopinavir/ritonavir administration is identified as a protective factor.

Predictive factors of six-week mortality in critically ill patients with SARS-CoV-2: A multicenter prospective study / Factores predictivos de la mortalidad a las seis semanas en pacientes críticos con SARS-CoV-2: estudio multicéntrico prospectivo

Objective: The objective of the study is to identify the risk factors associated with mortality at six weeks, especially by analyzing the role of antivirals and munomodulators. Design: Prospective descriptive multicenter cohort study. Setting: 26 Intensive care units (ICU) from Andalusian region in Spain. Patients or participants: Consecutive critically ill patients with confirmed SARS-CoV-2 infection were included from March 8 to May 30. Interventions: None. Variables: Variables analyzed were demographic, severity scores and clinical condition. Support therapy, drug and mortality were analyzed. An univariate followed by multivariate Cox regression with propensity score analysis was applied. Results: 495 patients were enrolled, but 73 of them were excluded for incomplete data. Thus, 422 patients were included in the final analysis. Median age was 63 years and 305 (72.3%) were men. ICU mortality: 144/422 34%; 14 days mortality: 81/422 (19.2%); 28 days mortality: 121/422 (28.7%); 6-week mortality 152/422 36.5%. By multivariable Cox proportional analysis, factors independently associated with 42-day mortality were age, APACHE II score, SOFA score at ICU admission >6, Lactate dehydrogenase at ICU admission >470U/L, Use of vasopressors, extrarenal depuration, %lymphocytes 72h post-ICU admission <6.5%, and thrombocytopenia whereas the use of lopinavir/ritonavir was a protective factor. Conclusion: Age, APACHE II, SOFA>value of 6 points, along with vasopressor requirements or renal replacement therapy have been identified as predictor factors of mortality at six weeks. Administration of corticosteroids showed no benefits in mortality, as did treatment with tocilizumab. Lopinavir/ritonavir administration is identified as a protective factor (AU)

Objetivo: Identificar los factores de riesgo asociados con la mortalidad a las seis semanas. Diseño: Estudio prospectivo multicéntrico. Ámbito: Se incluyeron a 26 pacientes de la Unidad de Cuidados Intensivos (UCI) de Andalucía. Pacientes o participantes: Pacientes ingresados en UCI por neumonía grave por SARS-CoV-2 del 8 de marzo al 30 de mayo de 2020. Intervenciones: Ninguna. Variables de interés principales: Características demográficas, clínicas y escalas de gravedad. Se analizaron tratamientos de soporte, fármacos y la mortalidad. Resultados: Se incluyeron 495 pacientes, 73 fueron excluidos por incompletos y 422 pacientes se incorporaron en el análisis final. La mediana de edad fue de 63 años, 305 (72,3%) eran hombres. La mortalidad en la UCI fue: 144/422 34%; mortalidad a los 14 días: 81/422 (19,2%); mortalidad a los 28 días: 121/422 (28,7%); mortalidad a las seis semanas 152/422 36,5%. Los factores asociados con la mortalidad a los 42 días fueron la edad, APACHE II, SOFA > 6 y LDH al ingreso > 470 U/L, uso de vasopresores, necesidad de técnicas de reemplazo de la función renal, porcentaje de linfocitos a las 72 horas del ingreso en UCI < 6,5%, y trombocitopenia, mientras que el uso de lopinavir/ritonavir fue identificado como un factor protector. Conclusiones: La edad, gravedad y fracaso orgánico junto con la necesidad de terapias de soporte fueron identificadas como factores predictores de mortalidad a las seis semanas. La administración de corticoesteroides a dosis altas no mostró beneficios en la mortalidad, al igual que el tratamiento con tocilizumab, lopinavir/ritonavir se identificaron como un factor protector (AU)

Predictive factors of six-week mortality in critically ill patients with SARS-CoV-2: A multicenter prospective study.

OBJECTIVE: The objective of the study is to identify the risk factors associated with mortality at six weeks, especially by analyzing the role of antivirals and munomodulators. DESIGN: Prospective descriptive multicenter cohort study. SETTING: 26 Intensive care units (ICU) from Andalusian region in Spain. PATIENTS OR PARTICIPANTS: Consecutive critically ill patients with confirmed SARS-CoV-2 infection were included from March 8 to May 30. INTERVENTIONS: None. VARIABLES: Variables analyzed were demographic, severity scores and clinical condition. Support therapy, drug and mortality were analyzed. An univariate followed by multivariate Cox regression with propensity score analysis was applied. RESULTS: 495 patients were enrolled, but 73 of them were excluded for incomplete data. Thus, 422 patients were included in the final analysis. Median age was 63 years and 305 (72.3%) were men. ICU mortality: 144/422 34%; 14 days mortality: 81/422 (19.2%); 28 days mortality: 121/422 (28.7%); 6-week mortality 152/422 36.5%. By multivariable Cox proportional analysis, factors independently associated with 42-day mortality were age, APACHE II score, SOFA score at ICU admission >6, Lactate dehydrogenase at ICU admission >470U/L, Use of vasopressors, extrarenal depuration, %lymphocytes 72h post-ICU admission <6.5%, and thrombocytopenia whereas the use of lopinavir/ritonavir was a protective factor. CONCLUSION: Age, APACHE II, SOFA>value of 6 points, along with vasopressor requirements or renal replacement therapy have been identified as predictor factors of mortality at six weeks. Administration of corticosteroids showed no benefits in mortality, as did treatment with tocilizumab. Lopinavir/ritonavir administration is identified as a protective factor.

Phlebotomus langeroni Nitzulescu (Diptera, Psychodidae) a new vector for Leishmania infantum in Europe.

Burrows of the wild rabbit, Oryctolagus cuniculus, a lagomorph that has been recently suggested as a Leishmania infantum reservoir, constitute an unspoilt biotope in phlebotomine studies in Europe. We hypothesize that Phlebotomus langeroni, a proven vector of L. infantum in North Africa, is associated with rabbits and may have been overlooked in Europe. Sandfly captures were carried out with CDC light traps in an L. infantum endemic area of southern Spain with a high density of lagomorphs and a large numbers of burrows. The stable, permanent, and highly abundant presence of P. langeroni was assessed. After morphological identification, this sandfly species was characterized by comparing it with P. perniciosus and other P. langeroni populations from North Africa through molecular techniques. P. langeroni had not been found in southern Spain to date, despite being a highly investigated area, except for this particular biotope. Its activity period turned out to begin in mid-July, ending in late October, accounting for a maximum activity during this month. This study shows that P. langeroni is associated with the existence of rabbit burrows and has been overlooked in Europe. L. infantum DNA was found in almost half of the female specimens (47.6%) captured inside a biotope where wild rabbits are infected as well.

Molecular and functional characterization of porcine Siglec-3/CD33 and analysis of its expression in blood and tissues.

A cDNA clone encoding a 380 a-a type 1 transmembrane protein with homology to human Siglec-3/CD33 was obtained from a swine small intestine library. An analysis of protein sequence identified two immunoglobulin-like domains, a transmembrane region, and a carboxi-terminal tail with two tyrosine-based signalling motifs. Binding assays of Siglec-3 transfected CHO cells to polyacrylamide glycoconjugates showed a preference for α2-6-linked sialic acids. Using mAbs raised against a fragment containing the two Ig-like domains, porcine Siglec-3 was found to be expressed on monocytes and granulocytes, and their bone marrow precursors. It was also detected in lymph node, splenic and alveolar macrophages. MAbs immunoprecipitated, from granulocyte lysates, a protein of 51-60 kDa under both non-reducing and reducing conditions. MAbs were also used to analyse functional activity of Siglec-3 on bone marrow and blood cells. Engagement of Siglec-3 by mAb had no apparent effect on cell proliferation or cytokine production.

Pulmonary neuroendocrine (carcinoid) tumors: European Neuroendocrine Tumor Society expert consensus and recommendations for best practice for typical and atypical pulmonary carcinoids.

BACKGROUND: Pulmonary carcinoids (PCs) are rare tumors. As there is a paucity of randomized studies, this expert consensus document represents an initiative by the European Neuroendocrine Tumor Society to provide guidance on their management. PATIENTS AND METHODS: Bibliographical searches were carried out in PubMed for the terms 'pulmonary neuroendocrine tumors', 'bronchial neuroendocrine tumors', 'bronchial carcinoid tumors', 'pulmonary carcinoid', 'pulmonary typical/atypical carcinoid', and 'pulmonary carcinoid and diagnosis/treatment/epidemiology/prognosis'. A systematic review of the relevant literature was carried out, followed by expert review. RESULTS: PCs are well-differentiated neuroendocrine tumors and include low- and intermediate-grade malignant tumors, i.e. typical (TC) and atypical carcinoid (AC), respectively. Contrast CT scan is the diagnostic gold standard for PCs, but pathology examination is mandatory for their correct classification. Somatostatin receptor imaging may visualize nearly 80% of the primary tumors and is most sensitive for metastatic disease. Plasma chromogranin A can be increased in PCs. Surgery is the treatment of choice for PCs with the aim of removing the tumor and preserving as much lung tissue as possible. Resection of metastases should be considered whenever possible with curative intent. Somatostatin analogs are the first-line treatment of carcinoid syndrome and may be considered as first-line systemic antiproliferative treatment in unresectable PCs, particularly of low-grade TC and AC. Locoregional or radiotargeted therapies should be considered for metastatic disease. Systemic chemotherapy is used for progressive PCs, although cytotoxic regimens have demonstrated limited effects with etoposide and platinum combination the most commonly used, however, temozolomide has shown most clinical benefit. CONCLUSIONS: PCs are complex tumors which require a multidisciplinary approach and long-term follow-up.

Molecular characterization of porcine Siglec-10 and analysis of its expression in blood and tissues.

Siglecs are sialic acid binding Ig-like proteins involved in the control of leukocyte responses. In this study we describe the characterization of a porcine orthologue of Siglec-10. A cDNA clone was obtained from a porcine library which encodes a protein with sequence homology to human Siglec-10. This cDNA codes for a type I transmembrane protein containing four Ig-like domains, a transmembrane region, and a cytoplasmic tail with three tyrosine-based motifs, including a membrane-proximal Grb2-binding motif, and two ITIM motifs. When expressed on transfected cells, porcine Siglec-10 was able to bind red blood cells in a sialic acid-dependent manner. Monoclonal antibodies were developed against this protein and used to examine its cell and tissue distribution in the pig. Siglec-10 was found to be expressed on blood B cells and B cell areas of the spleen and lymph nodes. A weak expression was also detected on monocytes.

High rates of Leishmania infantum and Trypanosoma nabiasi infection in wild rabbits (Oryctolagus cuniculus) in sympatric and syntrophic conditions in an endemic canine leishmaniasis area: epidemiological consequences.

Leishmania infantum infection has been reported in various host species, both domestic and wild, in some cases with high prevalence rates. However, until the recent discovery of infected hares, no studies had provided clear evidence of any significant reservoir other than domestic dogs. Our focus was on another lagomorph, Oryctolagus cuniculus or wild rabbit. This species is native to the Iberian Peninsula and its presence and abundance gave rise to the name of Spain. In an endemic area for canine leishmaniasis in the southeast of Spain, 150 rabbits were captured over a period of three years. Samples of blood, bone marrow, liver, spleen, heart and skin were taken and analysed through parasitological, serological and molecular techniques in order to detect Leishmania and Trypanosoma. 20.7% of the rabbits were infected with L. infantum and 82.4% with Trypanosoma nabiasi, and 14.8% of mixed infections were detected. Both parasites were found in all the animal organs analysed, a factor which, along with the presence of serological cross-reactions, must be taken into account in epidemiological studies on leishmaniasis. O. cuniculus is an abundant and gregarious species, with a long enough average lifespan to ensure L. infantum transmission. The presence of the parasite in the skin and blood of these rabbits with no acute manifestation of disease ensures its contact with the vector, which finds in their warrens a suitable biotope to inhabit. The rabbit therefore seems to meet the most of conditions for being considered a reservoir host of L. infantum.

Atypical carcinoid tumours of the lung: prognostic factors and patterns of recurrence.

BACKGROUND: Atypical carcinoids (AC) of the lung are rare intermediate-grade neuroendocrine neoplasms. Prognostic factors for these tumours are undefined. METHODS: Our cooperative group retrieved data on 127 patients operated between 1980 and 2009 because of an AC. Several clinical and pathological features were studied. RESULTS: In a univariable analysis, T-status (p=0.005), N-status (p=0.021), preoperative M-status (previously treated) (p=0.04), and distant recurrence developed during the outcome (p<0.001) presented statistically significant differences related to survival of these patients. In a multivariable analysis, only distant recurrence was demonstrated to be an independent risk factor for survival (p<0.001; HR: 13.1). During the monitoring, 25.2% of the patients presented some kind of recurrence. When we studied recurrence factors in a univariable manner, sublobar resections presented significant relationship with locoregional recurrence (p<0.001). In the case of distant recurrence, T and N status presented significant differences. Patients with preoperative M1 status presented higher frequencies of locoregional and distant recurrence (p=0.004 and p<0.001, respectively). In a multivariable analysis, sublobar resection was an independent prognostic factor to predict locoregional recurrence (p=0.002; HR: 18.1). CONCLUSIONS: Complete standard surgical resection with radical lymphadenectomy is essential for AC. Sublobar resections are related to locoregional recurrence, so they should be avoided except for carefully selected patients. Nodal status is an important prognostic factor to predict survival and recurrence. Distant recurrence is related to poor outcome.

Molecular characterization and expression of porcine Siglec-5.

In this study we describe the characterization of the porcine orthologue of Siglec-5. A cDNa clone was obtained from a porcine cDNa library derived from swine small intestine which encodes a 555 a-a type 1 transmembrane protein with sequence homology to human Siglec-5. This protein consists of four Ig-like domains, a transmembrane region, and a cytoplasmic tail with two tyrosine-based signalling motifs. When expressed as a recombinant protein fused to the Fc region of human IgG1, porcine Siglec-5 was able to bind porcine red blood cells in a sialic acid-dependent manner. Monoclonal antibodies (mAb) were developed against porcine Siglec-5 and used to analyse its expression in bone marrow and blood cells, and lymphoid tissues. Porcine Siglec-5 expression was mainly restricted to myelomonocytic cells and their precursors, being detected also, although at low levels, on plasmacytoid dendritic cells and B lymphocytes. In lymphoid tissues, ellipsoids of the spleen and subcapsular and medullar sinuses of lymph nodes were positive for Siglec-5. These mAbs were able to precipitate, from granulocyte lysates, a protein of approximately 85 kDa under non-reducing conditions, indicating that porcine Siglec-5 is expressed as a monomer in the plasma membrane.

Predicting the risk of an endemic focus of Leishmania tropica becoming established in South-Western Europe through the presence of its main vector, Phlebotomus sergenti Parrot, 1917.

The aim of the study was the construction of risk maps for exposure to Phlebotomus sergenti, the main vector of Leishmania tropica, with a view to identifying hot spots for the potential establishment of this parasite in the southwest of Europe. Data were collected on the presence/absence of this vector and the ecological and climatic characteristics of 662 sampling sites located in the southeast, centre and northeast of the Iberian Peninsula (south-western Europe). The environmental factors associated with the distribution of P. sergenti were determined. The best predictors for the presence of this dipteran were 'altitude', 'land use', 'land surface temperature', 'aspect', 'adjacent land cover', 'absence of vegetation in wall' and the 'absence of PVC pipes in the drainage holes of retaining walls'. Risk maps for exposure to the vector were drawn up based on these variables. The validation of the predictive risk model confirmed its usefulness in the detection of areas with a high risk of P. sergenti being present. These locations represent potential hot spots for an autochthonous focus of L. tropica becoming established. The risk maps produced for P. sergenti presence revealed several areas in the centre and south of the Iberian Peninsula to be the most prone to this process, which would make it possible for the disease to enter south-western Europe.

[Comparison of the post-surgical analgesic effectiveness of tibial (at internal malleolus level) and common peroneal nerve block with infiltration of the surgical wound in Outpatient Surgery of the hallux valgus]. / Comparación de la eficacia analgésica postoperatoria del bloqueo de los nervios tibial (a nivel de maléolo interno) y peroneo común con la infiltración de la herida quirúrgica en cirugía ambulatoria del hallux valgus.

INTRODUCTION: To compare the post-operative analgesic effectiveness of blocking the posterior tibial and the common peroneal nerves against that of wound infiltration using local anaesthesia, in ambulatory surgery of hallux valgus. MATERIAL AND METHODS: A randomised clinical study was conducted on ambulatory patients subjected to Hallux valgus surgery, assigned into two groups: BNP: peripheral nerve blockage: posterior tibial and the common peroneal with 80mg of lidocaine, 100mg of mepivacaine and 25mg of levobupivacaine. INF: surgical wound infiltration with 50mg of levobupivacaine. The following aspects were evaluated during the first 24h after surgery: pain level using a visual analogue scale (VAS), the need to use rescue analgesia, and the incidence of secondary effects and readmissions due to pain. RESULTS: A total of 111 Patients were included (55 BNP, 56 INF), 93 per cent were women and the average age was 59 (SD10) years. The average VAS score in the first 24h was 2.9 (SD1.7) for the BNP group and 2.7 (SD1.6) for the INF group (P=.62). Less than half (42%) of patients needed rescue anaesthetic with tramadol, with no significant differences between the groups (P=.28). A 33 per cent had secondary postoperative effects were observed in 33% of cases, with a significant difference between INF and BNP (P=.01). One patient from INF group, had to be admitted for pain. CONCLUSIONS: The peripheral nerve block and wound infiltration are valid techniques for controlling pain at home after ambulatory surgery of hallux valgus, therefore both methods appear to be safe in an outpatient setting.

Utilización de eritropoyetina beta pegilada en enfermedad renal crónica en estadio 3, 4 o 5 no-D / Use of methoxy polyethylene glycol-epoetin beta in stage 3, 4 or 5 non-dialysis chronic kidney disease

Antecedentes: La eritropoyetina beta pegilada (PegEPO) está indicada en el tratamiento de la anemia por enfermedad renal crónica. Su larga semivida permite su administración mensual en fases de mantenimiento. Objetivo: Evaluar el uso, efectividad y coste de PegEPO en un grupo de pacientes con insuficiencia renal crónica en estadio prediálisis. Método: Estudio observacional retrospectivo en pacientes prediálisis que iniciaron tratamiento con PegEPO entre mayo de 2008 y febrero de 2009. Se recogieron: edad, sexo, niveles de hemoglobina (Hb) y dosis y frecuencia del agente estimulante de eritropoyesis (AEE) utilizado. El período de seguimiento fue de 12 meses. Resultados: Se incluyeron 198 pacientes. La Hb media al inicio de PegEPO en pacientes sin tratamiento previo fue de 10,8 g/l y de 11,6 g/l a los 90 días (p < 0,0001). En pacientes con AEE previo, la Hb media al inicio de PegEPO fue de 11,2 g/l y de 11,4 g/l a los 12 meses de tratamiento (p = 0,846). El 25% de los pacientes presentaron valores de Hb superiores a 12 g/l (p < 0,0001) a los 12 meses del inicio del tratamiento, de los cuales un 45% superó los 13 g/l. Se observa la utilización de dosis un 39% menores de las indicadas en ficha técnica y, como consecuencia, un coste inferior respecto al teórico esperado. Conclusiones: Las dosis utilizadas de PegEPO en pacientes con AAE previo fueron inferiores a las indicadas en ficha técnica manteniéndose estable la Hb a los 12 meses del inicio. Una mayor proporción de pacientes superan el límite de 13 g/l (AU)

Background: Methoxy polyethylene glycol-epoetin beta (PEG-EPO) is indicated for the treatment of anaemia due to chronic kidney disease. Its long half-life allows it to be administered monthly during maintenance phases. Objective: Evaluate the use, effectiveness and cost of PEG-EPO in a group of pre-dialysis chronic renal failure patients. Method: Retrospective observational study in pre-dialysis patients who began treatment with PEG-EPO between May 2008 and February 2009. The following data were gathered: age, sex, haemoglobin levels (Hb) and erythropoiesis-stimulating agent (ESA) dose and frequency. The follow-up period was 12 months. Results: We included 198 patients. Mean Hb upon starting PEG-EPO in patients ho had received no prior treatment was 18.8g/l, and 11.6g/l at 90 days (P<.0001). In patients previously treated with ESA, mean Hb before starting PEG-EPO treatment was 11.2g/l, and 11.4g/l at 12 months (P=.846). Hb values were higher than 12g/l (P<.0001) after 12 months of treatment in 25% of the patients; of these, 45% had values above 13g/l. We observed use of doses 39% lower than those indicated on the drug leaflet, resulting in a reduction in the originally expected theoretical costs. Conclusions: The doses of PEG-EPO administered to patients with a prior history of ESA treatment were lower than those indicated by the drug leaflet, and Hb remained stable after 12 months of treatment. A large part of the patients had levels above the 13g/l threshold (AU)

Comparación de la eficacia analgésica postoperatoria del bloqueo de los nervios tibial (a nivel de maléolo interno) y peroneo común con la infiltración de la herida quirúrgica en cirugía ambulatoria del hallux valgus / Comparison of the post-surgical analgesic effectiveness of tibial (at internal malleolus level) and common peroneal nerve block with infiltration of the surgical wound in Outpatient Surgery of the hallux valgus

Introducción. Comparar la eficacia analgésica postoperatoria del bloqueo de los nervios tibial a nivel del maléolo interno y peroneo común frente a la infiltración de la herida con anestésico local, en la cirugía ambulatoria del hallux valgus. Material y método. Ensayo clínico aleatorizado. Dos grupos de estudio, grupo BNP, bloqueo de los nervios peroneo común y tibial (con lidocaína 80mg y mepivacaína 100mg + levobupivacaína 25mg). y grupo INF, cirugía con anestesia intradural más infiltración de la herida quirúrgica (con 50mg de levobupivacaína). Se valoró mediante la escala visual analógica (1-10) el dolor durante las primeras 24h del postoperatorio, las necesidades de analgesia de rescate (tramadol), la incidencia de efectos secundarios y los reingresos por dolor. Resultados. Fueron incluidos un total de 111 pacientes (55 en el grupo BNP, 56 en el grupo INF). El 93% fueron mujeres con edad media de 59 (DE 10) años. El valor en la escala visual analógica promedio en las primeras 24h fue de 2,9 (DE 1,7) para el grupo BNP y de 2,7 (DE1,6) para el grupo INF (p=0,62). El 42% de los pacientes precisó analgesia de rescate con tramadol, sin que hubiera diferencias significativas entre grupos (p=0,28). Un 33% presentó efectos secundarios postoperatorios: náuseas, vómitos, retención urinaria, cefalea o dolor en la zona de punción, sin que existieran diferencias entre los 2 grupos. Un paciente del grupo INF tuvo que ingresar para tratamiento del dolor. Conclusiones. El bloqueo nervioso periférico y la infiltración de la herida son técnicas eficaces y equivalentes en el control domiciliario del dolor en la cirugía ambulatoria del hallux valgus, haciendo posible que estos procedimientos puedan ser realizados de forma segura en régimen ambulatorio(AU)

Introduction. To compare the post-operative analgesic effectiveness of blocking the posterior tibial and the common peroneal nerves against that of wound infiltration using local anaesthesia, in ambulatory surgery of hallux valgus. Material and methods. A randomised clinical study was conducted on ambulatory patients subjected to Hallux valgus surgery, assigned into two groups: BNP: peripheral nerve blockage: posterior tibial and the common peroneal with 80mg of lidocaine, 100mg of mepivacaine and 25mg of levobupivacaine. INF: surgical wound infiltration with 50mg of levobupivacaine. The following aspects were evaluated during the first 24h after surgery: pain level using a visual analogue scale (VAS), the need to use rescue analgesia, and the incidence of secondary effects and readmissions due to pain. Results. A total of 111 Patients were included (55 BNP, 56 INF), 93 per cent were women and the average age was 59 (SD10) years. The average VAS score in the first 24h was 2.9 (SD1.7) for the BNP group and 2.7 (SD1.6) for the INF group (P=.62). Less than half (42%) of patients needed rescue anaesthetic with tramadol, with no significant differences between the groups (P=.28). A 33 per cent had secondary postoperative effects were observed in 33% of cases, with a significant difference between INF and BNP (P=.01). One patient from INF group, had to be admitted for pain. Conclusions. The peripheral nerve block and wound infiltration are valid techniques for controlling pain at home after ambulatory surgery of hallux valgus, therefore both methods appear to be safe in an outpatient setting(AU)

Use of methoxy polyethylene glycol-epoetin beta in stage 3, 4 or 5 non-dialysis chronic kidney disease.

BACKGROUND: Methoxy polyethylene glycol-epoetin beta (PEG-EPO) is indicated for the treatment of anaemia due to chronic kidney disease. Its long half-life allows it to be administered once per month in maintenance therapy. OBJECTIVE: To evaluate the use, effectiveness and cost of PEG-EPO in a group of pre-dialysis chronic renal failure patients. METHOD: Retrospective observational study in pre-dialysis patients who began treatment with PEG-EPO between May 2008 and February 2009. The following data were gathered: age, sex, haemoglobin levels (Hb) and erythropoiesis-stimulating agent (ESA) dose and frequency. The follow-up period was 12 months. RESULTS: We included 198 patients. Mean Hb upon starting PEG-EPO in patients who had received no prior treatment was 10.8g/l, and 11.6g/l at 90 days (P<.0001). In patients previously treated with ESA, mean Hb before starting PEG-EPO treatment was 11.2g/l, and 11.4g/l at 12 months (P=.846). Hb values were higher than 12g/l (P<.0001) after 12 months of treatment in 25% of patients; of these, 45% had values above 13g/l. We observed doses 39% lower than those indicated on the drug leaflet, resulting in a reduction in the originally expected theoretical costs. CONCLUSIONS: The doses of PEG-EPO administered to patients with a prior history of ESA treatment were lower than those indicated by the drug leaflet, and Hb remained stable after 12 months of treatment. A large portion of the patients had levels above the 13g/l threshold.

Risk maps for the presence and absence of Phlebotomus perniciosus in an endemic area of leishmaniasis in southern Spain: implications for the control of the disease.

The aim of this study was to construct risk maps for the presence of the dominant Leishmania infantum vector, P. perniciosus, and check its usefulness (a) to predict the risk of canine leishmaniasis and (b) to define effective leishmaniasis control measures. We obtained data for the presence/absence of P. perniciosus at 167 sampling sites in southern Spain, from which we also took a series of ecological and climate-related data. The probability of P. perniciosus presence was estimated as a function of these environmental variables and generated spatial risk maps. Altitude, land use and drainage hole features (with or without PVC piping) were retained as the only predictors for the distribution of this vector species. Drainage hole features in retaining walls, with or without PVC piping, produce significant variations in the probability of P. perniciosus presence, varying from 2·3 to 91·8% if PVC piping is absent and from 0·4 to 66·5% if all holes have PVC piping. It was concluded that the use of PVC piping in drainage holes could help to reduce leishmaniasis transmission.

[Leonine facies in carcinoid syndrome]. / Facies leonina en el síndrome carcinoide.

Carcinoid syndrome is a rare disorder caused when elevated levels of vasoactive substances secreted by a carcinoid tumor fail to be metabolized by the liver. This can occur for a variety of reasons including metastatic invasion of the organ. Carcinoid syndrome results in elevated levels of 5-hydroxyindoleacetic acid in the urine. Clinical manifestations include: flushing, diarrhea, bronchospasm, and heart failure. We describe a patient with carcinoid syndrome and hepatic metastases, in whom the key symptom of persistent facial edema resulted in conspicuous leonine facies; there was a partial response to treatment with oral isotretinoin and intramuscular lanreotide. Differential diagnosis was made with other conditions causing facial edema. A review is performed of the various skin manifestations of carcinoid syndrome, highlighting their role in the early diagnosis and treatment of the disorder.

Facies leonina en el síndrome carcinoide / Leonine Facies in Carcinoid Syndrome

El síndrome carcinoide es un proceso infrecuente que se produce por la presencia en el organismo de niveles elevados de sustancias vasoactivas secretadas por un tumor carcinoide y no metabolizadas por el hígado, debido a diversas circunstancias, entre ellas la invasión metastásica del mismo. Se traduce en una elevación del 5-hidroxi-indol-acético en orina. Clínicamente cursa con síntomas cutáneos (episodios de rubefacción-flushing), digestivos (diarrea), respiratorios (broncoespasmo) y cardiovasculares (insuficiencia cardiaca). Describimos el caso de un paciente con síndrome carcinoide con metástasis hepáticas cuyo síntoma guía fue el edema facial, que se hizo persistente otorgándole una facies leonina muy llamativa, que respondió parcialmente al tratamiento con isotretinoína por vía oral y lanreótida intramuscular. Realizamos diagnóstico diferencial con otros cuadros que cursan con edema facial y revisamos las diversas manifestaciones cutáneas que pueden surgir en el síndrome carcinoide, destacando su importancia para realizar un diagnóstico y tratamiento precoces del proceso (AU)

Carcinoid syndrome is a rare disorder caused when elevated levels of vasoactive substances secreted by a carcinoid tumor fail to be metabolized by the liver. This can occur for a variety of reasons including metastatic invasion of the organ. Carcinoid syndrome results in elevated levels of 5-hydroxyindoleacetic acid in the urine. Clinical manifestations include: flushing, diarrhea, bronchospasm, and heart failure. We describe a patient with carcinoid syndrome and hepatic metastases, in whom the key symptom of persistent facial edema resulted in conspicuous leonine facies; there was a partial response to treatment with oral isotretinoin and intramuscular lanreotide. Differential diagnosis was made with other conditions causing facial edema. A review is performed of the various skin manifestations of carcinoid syndrome, highlighting their role in the early diagnosis and treatment of the disorder (AU)

Situación de la leishmaniosis en Granada (Sur de España) después de 25 años de estudio / Current status of leishmaniasis in Granada (Southern Spain) after 25 years of study

INTRODUCCIÓN: En España, Leishmania infantum es la única especie responsable de la leishmaniosis cutánea (LC) y visceral (LV) humanas, así como de la leishmaniosis canina (L Ca).Como vectores actúan dípteros nematóceros del género Phlebotomus (Diptera, Phlebotomidae), con las especies Phlebotomus perniciosus y P. ariasi actuando en condiciones simpátricas en un mismo foco. OBJETIVO: Pretendemos analizar los cambios acaecidos en la epidemiología de la leishmaniosis en la provincia de Granada durante los últimos 25 años, prestando atención a la incidencia de la enfermedad humana, la prevalencia de la leishmaniosis canina y la densidad de los vectores. METODOLOGÍA: se han recopilado los casos de leishmaniosis humana declarados entre 1984 y2005. En el caso del reservorio, se ha realizado un estudio epidemiológico de la leishmaniosis canina en 20 pueblos de la Alpujarra, que fueron estudiados previamente hace 22 años. Los cambios en las poblaciones de vectores se han determinado haciendo capturas con papeles adhesivos. RESULTADOS Y DISCUSIÓN: En el periodo 1984-2005, la media de la tasa de incidencia de la leishmaniosis humana en la provincia de Granada ha sido de 0,4 casos anuales/100.000 habitantes, observándose un ligero aumento del número de casos a lo largo de los años. Con respecto a la L Ca, hemos observado un incremento progresivo de la seroprevalencia en el piso bioclimático Mesomediterráneo. La densidad de P.perniciosus y P. ariasi ha quedado constante en el Termomediterráneo y ha caído en el Mesomediterráneo; sin embargo se ha incrementado el periodo de actividad de P. perniciosus(AU)

Introduction: The human and canine leishmaniosis are endemic in Granada province (South Spain)since the beginning of 20th century. Object: to study the variation of the rate of human leishmaniosis, the seroprevalence of canine leishmaniosis, and the density of vectors (phlebotomine sandflies).Methodology: we have compiled the reported cases of human leishmaniosis in the period 1984-2004,we have analysed, by IFAT, the dogs of 20 villages of the Alpujarra region, and the results were compared with those obtained 22 years ago. In the same way, the vectors populations were studied using sticky traps. Results and discussion: we have observed a net increase in the rate of human leishmaniosis, and in the seroprevalence of canine leishmaniosis. Respect the vector there is a increase in the activity period but not in the density(AU)