Effectiveness and Safety of the Switch from Remicade® to CT-P13 in Patients with Inflammatory Bowel Disease.

BACKGROUND AND AIMS: To evaluate the clinical outcomes in patients with IBD after switching from Remicade® to CT-P13 in comparison with patients who maintain Remicade®. METHODS: Patients under Remicade® who were in clinical remission with standard dosage at study entry were included. The 'switch cohort' [SC] comprised patients who made the switch from Remicade® to CT-P13, and the 'non-switch' cohort [NC] patients remained under Remicade®. RESULTS: A total of 476 patients were included: 199 [42%] in the SC and 277 [58%] in the NC. The median follow-up was 18 months in the SC and 23 months in the NC [p < 0.01]. Twenty-four out of 277 patients relapsed in the NC; the incidence of relapse was 5% per patient-year. The cumulative incidence of relapse was 2% at 6 months and 10% at 24 months in this group. Thirty-eight out of 199 patients relapsed in the SC; the incidence rate of relapse was 14% per patient-year. The cumulative incidence of relapse was 5% at 6 months and 28% at 24 months. In the multivariate analysis, the switch to CT-P13 was associated with a higher risk of relapse (HR = 3.5, 95% confidence interval [CI] = 2-6). Thirteen percent of patients had adverse events in the NC, compared with 6% in the SC [p < 0.05]. CONCLUSIONS: Switching from Remicade® to CT-P13 might be associated with a higher risk of clinical relapse, although this fact was not supported in our study by an increase in objective markers of inflammation. The nocebo effect might have influenced this result. Switching from Remicade® to CT-P13 was safe.

[Narcolepsy: update on etiology, clinical features and treatment]. / Narcolepsia: actualización en etiología, manifestaciones clínicas y tratamiento.

Narcolepsy is a disease that involves an alteration in the generation and organisation of sleep. The main symptoms are excessive daytime sleepiness and cataplexy, followed by hypnagogic hallucinations, sleep paralysis and disrupted nocturnal sleep. The prevalence of typical narcolepsy oscillates between 25-50: 100.000 in general. Recently there has been a peak incidence in patients born in the month of March. According to the new classification, the Multiple Sleep Latency Test (MSLT) is mandatory for diagnosing narcolepsy without cataplexy, and advisable for diagnosing narcolepsy with cataplexy. Until now, the attempt has been made to control each symptom by its own specific treatment. At present, new American and European treatment guidelines propose new drugs that act on all the symptoms. The application of new criteria of diagnosis and treatment has improved the diagnosis, giving better options of treatment.

Narcolepsia: actualización en etiología, manifestaciones clínicas y tratamiento / Narcolepsy: update on etiology, clinical features and treatment

La narcolepsia es una enfermedad que consisteen una alteración en la generación y organización delsueño. Los principales síntomas son la excesiva somnolenciadiurna y la cataplejía así como las alucinacioneshipnagógicas, parálisis del sueño y fragmentación delsueño nocturno. La prevalencia de la narcolepsia típicaoscila entre el 25 y 50 por cada 100.000 habitantes. Recientementese ha observado un pico de incidencia enpacientes nacidos en el mes de marzo.Según la nueva clasificación, el test de latenciasmúltiples de sueño (TLMS) es imprescindible para eldiagnóstico de narcolepsia sin cataplejía y aconsejablepara el diagnóstico de la narcolepsia típica.Hasta ahora se trataban de forma independiente lossíntomas, aunque actualmente las más recientes directricesde tratamiento proponen nuevos fármacos queactúan en todo el grupo de síntomas de forma global.La aplicación de nuevos criterios diagnósticos yterapéuticos permitirá un diagnóstico precoz y mejoresopciones de tratamiento en esta patología(AU)

Narcolepsy is a disease that involves an alterationin the generation and organisation of sleep. The mainsymptoms are excessive daytime sleepiness and cataplexy,followed by hypnagogic hallucinations, sleep paralysisand disrupted nocturnal sleep. The prevalenceof typical narcolepsy oscillates between 25-50: 100.000in general. Recently there has been a peak incidence inpatients born in the month of March.According to the new classification, the MultipleSleep Latency Test (MSLT) is mandatory for diagnosingnarcolepsy without cataplexy, and advisable for diagnosingnarcolepsy with cataplexy.Until now, the attempt has been made to controleach symptom by its own specific treatment. At present,new American and European treatment guidelinespropose new drugs that act on all the symptoms.The application of new criteria of diagnosis andtreatment has improved the diagnosis, giving betteroptions of treatment(AU)

Técnicas básicas de electroencefalografía: principios y aplicaciones clínicas / Basic techniques of electroencephalography: principles and clinical applications

El electroencefalograma es una técnica de exploración funcional del sistema nervioso central (SNC), de relativa antigüedad, pero que aún hoy día sigue siendo una herramienta de gran ayuda para el clínico en el diagnóstico y seguimiento de algunas patologías, como pueden ser la epilepsia, las encefalopatías, alteraciones del estado de conciencia, infecciones del SNC, etc. Es, por otro lado, una herramienta diagnóstica con aplicaciones que están en plena expansión, en combinación con otras técnicas neurofisiológicas, como es en el campo del estudio y diagnóstico de la patología de sueño (polisomnografía, test de latencias múltiples del sueño...) y la monitorización intraoperatoria junto con los potenciales evocados somatosensoriales. Se describen en este trabajo cuáles son los fundamentos técnicos de la electroencefalografía, haciendo especial hincapié en sus principales aplicaciones clínicas y en las perspectivas del futuro (AU)

The electroencephalogram is a technique for the functional exploration of the central nervous system (CNS). It is a relatively old technique but even today it continues to be a tool of great assistance to the clinician in diagnosing and treating certain pathologies, such as epilepsy, encephalopathies, alterations to the state of consciousness, CNS infections, etc. On the other hand, it is a diagnostic tool whose applications are expanding in combination with other neurophysiological techniques, such as in the field of the study and diagnosis of sleep pathology (polysomnography, multiple sleep latency test...) and in intraoperative monitoring together with somasensory evoked potentials. This article describes the basic techniques of electroencephalography, with special emphasis on its main clinical applications and on future perspectives (AU)

[Basic techniques of electroencephalography: principles and clinical applications]. / Técnicas básicas de electroencefalografía: principios y aplicaciones clínicas.

The electroencephalogram is a technique for the functional exploration of the central nervous system (CNS). It is a relatively old technique but even today it continues to be a tool of great assistance to the clinician in diagnosing and treating certain pathologies, such as epilepsy, encephalopathies, alterations to the state of consciousness, CNS infections, etc. On the other hand, it is a diagnostic tool whose applications are expanding in combination with other neurophysiological techniques, such as in the field of the study and diagnosis of sleep pathology (polysomnography, multiple sleep latency test...) and in intraoperative monitoring together with somasensory evoked potentials. This article describes the basic techniques of electroencephalography, with special emphasis on its main clinical applications and on future perspectives.

Antiinflamatory agents less dangerous for gastrointestinal tract.

NSAIDs represent one of the most commonly used therapeutic drug groups world wide. 1.5% of the world's population is estimated as taking NSAIDs. However, their use is not risk free and gastrointestinal (GI) lesions do appear, which is indeed the main reason for their toxicity. Frequently (50%) NSAID-induced GI lesions are asymptomatic, and perforations or hemorrhages could occur without any previous symptoms. 71% of GI perforations and 50% of upper gastric hemorrhages (UGH) are associated with taking NSAIDs. How frequent GI lesions appear is directly related to whether the patient is in a risk group or not. Factors increasing the risk of GI lesions occurring are the following: being older than 60, using corticoids or other NSAIDs concomitantly, having a history of duodenal ulcer, alcohol consumption, smoking or taking oral anticoagulants. As the toxicity and how frequent the lesions appear depend on which drug is used, there is a need for research into new drugs which are both clinically effective and safer to use. GI toxicity of NSAIDs is mediated by two mechanisms, direct toxicity and prostaglandin synthesis inhibition or sistemic mechanism. Due to the relatively recent discoveries concerning the physiopathology of inflammation and gastric physiology, research into new NSAID derivatives is taking place. Such derivatives are prodrugs, galenic buffer forms, selective COX-2 inhibitors, isomeric compounds, NO-donors, and as a future possibility, phosphodiesterase inhibitors.

[Facial asymmetry with crying: a neurophysiological study and clinical account of this entity]. / Asimetría facial con el llanto: estudio neurofisiológico y recuerdo clínico de esta entidad.

OBJECTIVE: The objectives of this study were to determine in our newborn population the frequency of facial asymmetry during crying or congenital hypoplasia of the depressor anguli oris muscle (DAOM) without associated major malformations and to evaluate the contribution of electrophysiological studies in the diagnosis of this anomaly. PATIENTS AND METHODS: We performed a prospective study of the living newborns with facial asymmetry which did not need to be admitted to the hospital and that were delivered without the use of forceps in our hospital during 4 consecutive years. Newborn evaluation included physical examination, facial nerve electroneurography and DAOM electromyography. RESULTS: This anomaly without major malformations was present in 0.348/1,000 newborns. Electrophysiological studies demonstrated a normal latency in the facial nerve electroneurography and an absence or reduced number of motor unit potential without signs of denervation in the electromyography. CONCLUSIONS: Diagnosis of this entity is important to exclude facial nerve palsy. Only a physical examination is necessary for a correct diagnosis.

Physiological variations in the pigmentation of newborn infants.

Skin pigmentation is a physiological feature of great value and usefulness from both an anthropological point of view and a clinical point of view. This article is a first approach to the study of the skin pigmentation of 126 full-term newborn infants (37-42 weeks gestational age) at the Maternity Hospital "La Paz" (Madrid, Spain) using the reflectance method. We provide the normal patterns, which have to be taken into account when applying this method to detect transcutaneous bilirubin and some physiopathological conditions, such as hyperbilirubinemia, anemia, plethora, and hormonal disturbances. Measurements of the reflectance were taken at the forehead, the internal and external aspects of the arm, the thorax, and the gluteus with blue, green, and amber tristimulus filters. With all filters the least pigmented zone was the thorax, and the most pigmented zone was the forehead; the internal aspect of the arm, the gluteus, and the external aspect of the arm were intermediate in increasing order. Our data confirm a higher pigmentation at birth than during the first year. We think that the idea of cephalocaudal progression of hyperbilirubinemia must be rejected. Our results also indicate that the thickening of the skin with gestational age is one of the most important factors in the skin color changes of newborn infants with an apparently different rhythm in males than in females.

[Neonatal transitional care unit (author's transl)]. / Valoración de una unidad neonatal de reanimación-transición.

Statistical analysis between a two year period with a five year interval (1972-1975) in a neonatal transitional care unit is evaluated. Number of resucitations doubled and neonatal mortality in the first seven days of life as well as in the first twenty four hours decreased significantly, being newborns under 1,000 gr. of weight and malformations the first two causes of death in both periods. Factors related to hypoxia which accounted for other 25% of deaths should be prevented. Importance of this type of units in huge maternities is emphasized considering their role in immediate neonatal care.

Traumatic lumbosacral meningocele. Case report.

A case of traumatic avulsion of the L-5 and S-1 nerve roots is described. Surgical intervention was undertaken and long-term functional recovery obtained.

Irradiation lesions of the growth plate in rabbits.

The effects of gamma irradiation on the growth plate have been studied in nineteen rabbits with a 1,000 rads/skin dose. The rabbits were killed after one to ninety days. The growth plates were studied by microscopic examination, thymidine-H3 autoradiography, and fluorescence with radiographic measurement. Changes were already detected after twenty-four hours at the cell mitosis level, which showed the sensitiveness of the chondrocyte itself. The lesions were clearly seen with the optical microscope after seven days, and they were most advanced between the fourteenth and twenty-first day after irradiation. Regeneration of the cartilage began in the fourth week and the histological appearance became normal after seventy days. Fluorescence with tetracycline showed a temporary retardation of growth, with consequent shortening of the affected limb.

Sites of sulfatation in the chondrocytes of the articular cartilage of the rabbit. A study by quantitative radioautography of high resolution.

35S sulfate uptake by the articular cartilage chondrocytes, from biopsies of rabbit, have been studied by high resolution autoradiography. The Golgi apparatus, rough endoplasmic reticulum, cytosol, cytoplasmic membrane and extracellular space were considered as cell compartments in the quantitative analysis of the autoradiograms. The results obtained show: 1) a high activity of radiosotope incorporation in the Golgi apparatus; 2) a fast rhythm of transfer of the substances labelled in the Golgi apparatus to the cell membrane; 3) significant labelling of the rough endoplasmic reticulum, throughout the experiment. It is concluded: 1) The grains observed in the rough endoplasmic reticulum show a significant radioisotope uptake on this level, and this evidence some sulfotransferase activity. 2) The high 35S sulfate uptake level which is observed in the Golgi apparatus demonstrates that the highest sulfotransferase enzyme activity is located in this cell area, thus showing that the "early" sulfation that began in the rough endoplasmic reticulum was completed by a "late" sulfation in the Golgi apparatus. It is here that complete chondromucoprotein building takes place before being excreted. 3) The high transfer level of the labelled substances from the Golgi apparatus shows that the sulfated product secretion for building the cartilage matrix takes place rapidly since a great label increase can be already observed at the beginning of the chase period in the outer surrounding area of the chondrocyte membrane.