Inter-technique variability between antimicrobial susceptibility testing methods affects clinical classification of cefuroxime in strains close to breakpoint.

OBJECTIVES: The aim of this study was to evaluate the accuracy of various susceptibility methods when testing cefuroxime against a collection of Escherichia coli isolates with MIC values close to the breakpoint. METHODS: 80 E. coli strains with a cefuroxime MIC value of 16 mg/L obtained by broth microdilution with Vitek 2 were selected. Microdilution was considered the reference standard and was performed in duplicate, as were disc and gradient diffusion tests using two different manufacturers in each case. EUCAST 8.0 breakpoints were used for MIC interpretation. RESULTS: All strains were resistant according to Vitek 2 (MIC 16 mg/L) but 72.5% (58/80) were classified as susceptible by reference standard microdilution. Categorical and essential agreements between Vitek 2 and reference standard microdilution were 27.5% (95% CI 1.9-1.4) and 86.3% (95% CI 0.8-0.9), respectively. Differences are statistically significant when isolates are classified as 'susceptible' or 'resistant' according to EUCAST breakpoints between diffusion methods (disc and gradient) and reference standard microdilution. Using BioMérieux (BM) and Liofilchem (LF) gradient testing, 24.1% (14/58) and 13.8% (8/58) of results were identified as false susceptible and 4.5% (1/22) and 40.9% (9/22) were found to be false resistant, respectively. Using Oxoid (OX) and Bio Rad (BR) cefuroxime discs, 22.5% (13/58) and 17.2% (10/58) of results were false susceptible and 9.1% (2/22) and 13.6% (3/22) were false resistant, respectively. DISCUSSION: Intertechnique variation around the cefuroxime breakpoint was a considerable source of disagreements and seriously affected the clinical classification of the isolates. We propose that the definition of the area of technical uncertainty (ATU) be modified to include the variability between approved AST methods.

[Measurement, monitoring and knowledge of blood pressure: May Measurement Month, Colombia 2017]. / Medición, control y conocimiento de la presión arterial: Iniciativa Mayo Mes de la Medición Colombia 2017.

AIM: To describe the findings of implementing May Measurement Month 2017 in the adult Colombian population to raise awareness of the importance of blood pressure measuring, monitoring, and awareness. MATERIALS AND METHODS: May Measurement Month is a cross-sectional survey that follows the directives of the International Society of Hypertension and the World Hypertension League, which gathers information on cardiovascular risk factors and blood pressure readings. Its implementation in Colombia was lead by the Santander Ophthalmological Foundation (FOSCAL) and the Latin American Society of Hypertension (LASH) with the support of the Colombian Network for the Prevention of Cardiovascular Diseases and Diabetes (RECARDI). RESULTS: Data was collected from 11 departments on 21,797 people, 58.7% of whom were female, with an average age of 40.5±17.7 years. The overall prevalence of high blood pressure (HBP) was 20.8% (self-reported antihypertensive treatment or systolic blood pressure reading [systolic blood pressure≥140mmHg]). Of the total number of hypertensives, 46.5% had systolic blood pressure readings classified as uncontrolled (systolic blood pressure<140mmHg), and 26.4% were unaware that they were hypertensive who, in this report, we consider to be new cases of HBP. CONCLUSION: The prevalence of (elevated) blood pressure is high in this young adult population, whose lack of awareness of HBP is also high, and HBP in those aware of their condition is poorly controlled. These results highlight the need to implement effective detection programmes for hypertensive patients and to establish standardised treatments to improve HBP control as a strategy to reduce cardiovascular events.

[Will the new figures from the AHA/ACC guidelines on the definition and treatment of hypertension in Latin America have an impact?] / ¿Repercutirán las nuevas cifras de las guías AHA/ACC en la definición y manejo de la hipertensión en Latinoamérica?

Given the fact that new guidelines from the American Heart Association (AHA) and American College of Cardiology (ACC) propose important changes in the definition of hypertension, from equal or greater than 140/90mmHg to equal or greater than 130/80mmHg, major debate has been generated about the diagnostic criteria and the treatment of high blood pressure (HBP). In addition, these guidelines recommend that in order to achieve control of hypertension the goal should be a reading lower than 130/80mmHg. These new figures will significantly increase the amount of individuals considered hypertensive, some of whom will need more medication to achieve the new goal. This paradigm has led to questioning the goal's clinical applicability given the enormous financial burden that would result from treating millions of new hypertensive patients. The academic validity of the AHA-ACC guidelines has also been questioned given the fact that the recommendations emerged basically from results obtained from a single study with important methodological differences compared to the majority of studies carried out previously. Furthermore, its outcomes are inconsistent with those of previous studies. This conflict has led to some scientific institutions, such as the Latin American Society of Hypertension (LASH), continuing to adhere to the previous recommendations.

Antibiotic resistance profile in eye infections in a reference centre in Floridablanca, Colombia. / Perfil de resistencia antibiótica en infecciones oculares en un centro de referencia en Floridablanca, Colombia.

BACKGROUND AND OBJECTIVE: In view of the increasing bacterial resistance to antibiotics, it is necessary to determine it locally in order to serve as a guide in clinical management. The purpose of this study was to characterise the pattern of antibiotic sensitivity in cases of eye infections in a third level ophthalmological institution in Floridablanca (Colombia). MATERIALS AND METHODS: An observational cross-sectional study in which an analysis was made of the culture and antibiogram reports of specimens taken from cases of conjunctivitis, infectious keratitis, and endophthalmitis between January 2013 and June 2016. RESULTS: A total of 833 specimens were positive for bacteria. Considering both gram-positive and gram-negative microorganisms gentamicin, tobramycin, and ciprofloxacin showed high resistance rates (64.4%, 40.3%, and 29.1%, respectively). Moxifloxacin, vancomycin, imipenem, and gatifloxacin showed low percentages of resistance: 2.6%, 2.1%, 0.6%, and 0.4%, respectively. When comparing the results with previous studies in our institution, there was a decrease in sensitivity to the fourth-generation quinolones and imipenem, especially within the gram-negative ones. CONCLUSION: Fourth generation quinolones, imipenem and vancomycin continue to have a low in vitro resistance to bacteria that cause eye infections. However, there was a tendency to an increase in the resistance of gram-negative bacteria. Measures should be taken to try to control this phenomenon, and consider possible antimicrobial therapy alternatives to infections caused by these microorganisms.

Randomised crossover trial showed that using breast milk or sucrose provided the same analgesic effect in preterm infants of at least 28 weeks.

AIM: Repeated, ongoing exposure to pain influences the growth, cognitive and motor functions, behaviour, personality and neurodevelopment of preterm infants. We compared the analgesic effects of expressed breast milk (EBM) and 24% oral sucrose on preterm neonates during venipuncture. METHODS: This multicentre randomised, noninferiority, crossover trial focused on five neonatal university units in Madrid, Spain, from October 2013 to October 2014. It comprised 66 preterm infants born at less than 37 weeks and randomly split into two groups. They received either EBM or sucrose two minutes before venepuncture, together with nonnutritive sucking and swaddling, then the opposite procedure at a later point. Pain was measured with the premature infant pain profile (PIPP) and crying was also measured. RESULTS: There were no statistically significant differences between the groups. The PIPP scores were seven (4-9) with breast milk and six (4-8.25) with sucrose (p = 0.28). The 11 infants born at under 28 weeks of age showed higher median scores of nine (9-14) for breast milk and four (4-7) for sucrose (p = 0.009). CONCLUSION: EBM and 24% sucrose had the same analgesic effect during venipuncture in most of the preterm neonates, but sucrose worked better in extremely preterm infants.

Estimación de la adiposidad relativa a partir del peso y del índice cintura talla: ecuaciones de predicción para población española adulta / Estimation of relative adiposity from weight and waist to height ratio: prediction equations for Spanish adult population

Introducción: El índice de cintura-talla (ICT), se ha revelado como el parámetro antropométrico más ventajoso para la identificación de las alteraciones fisiometabólicas ligadas a la diabetes y las enfermedades cardiovasculares. El objetivo fue utilizarlo junto al peso para predecir la adiposidad relativa o porcentaje de grasa corporal (%GC) en adultos españoles. Material y métodos: Se analizaron 579 individuos sanos de ambos sexos con edades comprendidas entre los 20 y 65 años, midiendo la talla, el peso, el perímetro de la cintura a nivel umbilical y los pliegues adiposos subcutáneos. Se estimó el %GC mediante antropometría, impedancia eléctrica tretrapolar (Bodystat 1500) e interactancia de infrarrojos (Futrex 5500). Se aplicaron modelos de regresión para desarrollar ecuaciones predictivas de la adiposidad relativa tomando como variables independientes el ICT y el peso y como variable dependiente el %GC obtenido por cada uno de los tres métodos analíticos de la composición corporal. Las ecuaciones fueron validadas con las dos terceras partes de la muestra. Resultados: Las ecuaciones se han construido para cada sexo por separado y para cada intervalo de edad: 20-29, 30- 39, 40-49 y de 50 a 65 años. Los valores de adiposidad relativa obtenidos mediante las fórmulas han sido contrastados con los estimados mediante los tres procedimientos analíticos aplicados comprobando que la mayor similitud entre valores reales y pronosticados corresponde al método antropométrico basado en la medida de los pliegues. Conclusiones: Las ecuaciones propuestas permiten estimar el % GC a partir del peso y del ICT. Son de cálculo sencillo y han sido validadas reflejando gran fiabilidad. Se recomienda su aplicación en hombres y mujeres españoles que se encuentren en el intervalo de edad considerado (20 a 65 años)

Introduction: The waist-height ratio (WHtR) has been revealed as the most advantageous anthropometric parameter for the identification of physiometabolic alterations linked to diabetes and cardiovascular diseases. The objective was to use WHtR and weight, to predict the relative adiposity or body fat percentage (%BF). Material and methods: We analyzed 579 healthy individuals of both sexes between the ages of 20 and 65 years, measuring height, weight, waist circumference at umbilical level and subcutaneous skinfolds. The %BF was estimated by anthropometry, tretrapolar electrical impedance (Bodystat 1500) and infrared interaction (Futrex 5500). Regression models were applied to develop predictive equations of relative adiposity taking as independent variables the WHtR and weight and as dependent variable %BF obtained by each of the three analytical methods of body composition. The equations were validated with two thirds of the sample. Results: The equations have been constructed for each sex separately and age interval: 20-29, 30-39, 40-49 and from 50 to 65 years old. The values of relative adiposity obtained by means of the formulas have been contrasted with those estimated by means of the three applied analytical procedures verifying that the greatest similarity between real and predicted values corresponds to the anthropometric method based on the measurement of the skinfolds thicknes. Conclusions: The proposed equations allow to estimate the % BF from the weight and the WHtR. They are of simple calculation and have been validated reflecting great reliability. Their application is recommended for Spanish men and women in the considered age range (20 to 65 years)

Infecciones necrosantes de partes blandas atendidas en un servicio de urgencias de tercer nivel: evolución y correlación con la escala laboratory risk indicator for necrotizing fasciitis (LRINEC) / Necrotizing fasciitis attended in the Emergency Department in a tertiary Hospital: evaluation of the LRINEC scale

Objetivo. Describir la mortalidad y las complicaciones de pacientes atendidos en urgencias, con diagnóstico de infección necrosante de partes blandas (INPB) y su correlación con la escala Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC). Método. Estudio observacional retrospectivo con inclusión de pacientes con diagnóstico de INPB en urgencias de un hospital terciario durante 7 años. Los resultados se muestran como mediana, rango intercuartílico y rango absoluto para las variables cuantitativas. En el caso de las variables cualitativas, como frecuencias absoluta y relativa. La comparación se ha llevado a cabo mediante comparación post-hoc a partir de un análisis ANOVA con aproximación no paramétrica. Las comparaciones entre grupos de LRINEC en las variables cualitativas se han realizado con la prueba exacta de Fisher. Resultados. Se identificaron 24 pacientes con edad media de 51,9 años. La escala LRINEC se determinó en 21 pacientes: en 10 indicó bajo riesgo (<6), en 4 riesgo intermedio (6 o 7) y en 7 alto riesgo (≥8). La tasa de amputación en riesgos bajo, intermedio y alto fue del 10, 25 y 66%, respectivamente, con una mortalidad del 4,2%. Se observa un aumento en la estancia hospitalaria entre los niveles bajo y alto de la escala (p=0,007). Conclusiones. En general no se ha podido constatar un cambio en el pronóstico entre los niveles medio y alto de la escala LRINEC. Pero sí entre la estancia hospitalaria entre el nivel bajo y el alto, triplicando prácticamente la mediana de días de estancia hospitalaria (AU)

Aim. To describe mortality and complications of patients seen in the emergency room, diagnosed with necrotizing soft tissue infection (NSTI) and the correlation of such complications with the Laboratory Risk Indicator for Necrotizing fasciitis scale (LRINEC). Methods. Retrospective observational study including patients with a diagnosis of NSTI in the emergency room of a tertiary hospital over 7 years. The results are shown as median, interquartile range and absolute range for quantitative variables. In the case of qualitative variables, the results are shown as absolute and relative frequency. The comparison between the categories of the LRINEC scale was performed through a post-hoc comparison from a non-parametric ANOVA analysis. Comparisons between LRINEC groups in the qualitative variables were performed using Fisher's Exact test. Results. 24 patients with a mean age of 51.9 years were identified. The LRINEC scale was used on 21 patients: in 10, the value indicated low risk (<6), in 4 it indicated intermediate risk (6 or 7) and in 7 it indicated high risk (≥8). The amputation rate in patients with low, intermediate and high risk was 10%, 25% and 66% respectively with a mortality of 4.2%. There was an increase in hospital stay between the low and high level of the scale (p=0,007). Conclusions. In general, a change in the prognosis between the medium and high levels of the LRINEC scale could not be recorded, but was recorded in hospital stay between the low and the high level, practically tripling the median of days of hospital stay (AU)

Necrotizing fasciitis attended in the Emergency Department in a tertiary Hospital: Evaluation of the LRINEC scale. / Infecciones necrosantes de partes blandas atendidas en un servicio de urgencias de tercer nivel: evolución y correlación con la escala laboratory risk indicator for necrotizing fasciitis (LRINEC).

AIM: To describe mortality and complications of patients seen in the emergency room, diagnosed with necrotizing soft tissue infection (NSTI) and the correlation of such complications with the Laboratory Risk Indicator for Necrotizing fasciitis scale (LRINEC). METHODS: Retrospective observational study including patients with a diagnosis of NSTI in the emergency room of a tertiary hospital over 7 years. The results are shown as median, interquartile range and absolute range for quantitative variables. In the case of qualitative variables, the results are shown as absolute and relative frequency. The comparison between the categories of the LRINEC scale was performed through a post-hoc comparison from a non-parametric ANOVA analysis. Comparisons between LRINEC groups in the qualitative variables were performed using Fisher's Exact test. RESULTS: 24 patients with a mean age of 51.9 years were identified. The LRINEC scale was used on 21 patients: in 10, the value indicated low risk (<6), in 4 it indicated intermediate risk (6 or 7) and in 7 it indicated high risk (≥8). The amputation rate in patients with low, intermediate and high risk was 10%, 25% and 66% respectively with a mortality of 4.2%. There was an increase in hospital stay between the low and high level of the scale (p=0,007). CONCLUSIONS: In general, a change in the prognosis between the medium and high levels of the LRINEC scale could not be recorded, but was recorded in hospital stay between the low and the high level, practically tripling the median of days of hospital stay.

Bio-environmental factors associated with myopia: An updated review. / Los factores bioambientales asociados a la miopía: una revisión actualizada.

Experimental studies in animals, as well as observational and intervention studies in humans, seem to support the premise that the development of juvenile myopia is promoted by a combination of the effect of genetic and environmental factors, with a complex interaction between them. The very rapid increase in myopia rates in some parts of the world, such as Southeast Asia, supports a significant environmental effect. Several lines of evidence suggest that humans might respond to various external factors, such as increased activity in near vision, increased educational pressure, decreased exposure to sunlight outdoors, dietary changes (including increased intake of carbohydrates), as well as low light levels indoors. All these factors could be associated with a higher prevalence of myopia.

An emission processing system for air quality modelling in the Mexico City metropolitan area: Evaluation and comparison of the MOBILE6.2-Mexico and MOVES-Mexico traffic emissions.

This article describes the High-Elective Resolution Modelling Emission System for Mexico (HERMES-Mex) model, an emission processing tool developed to transform the official Mexico City Metropolitan Area (MCMA) emission inventory into hourly, gridded (up to 1km2) and speciated emissions used to drive mesoscale air quality simulations with the Community Multi-scale Air Quality (CMAQ) model. The methods and ancillary information used for the spatial and temporal disaggregation and speciation of the emissions are presented and discussed. The resulting emission system is evaluated, and a case study on CO, NO2, O3, VOC and PM2.5 concentrations is conducted to demonstrate its applicability. Moreover, resulting traffic emissions from the Mobile Source Emission Factor Model for Mexico (MOBILE6.2-Mexico) and the MOtor Vehicle Emission Simulator for Mexico (MOVES-Mexico) models are integrated in the tool to assess and compare their performance. NOx and VOC total emissions modelled are reduced by 37% and 26% in the MCMA when replacing MOBILE6.2-Mexico for MOVES-Mexico traffic emissions. In terms of air quality, the system composed by the Weather Research and Forecasting model (WRF) coupled with the HERMES-Mex and CMAQ models properly reproduces the pollutant levels and patterns measured in the MCMA. The system's performance clearly improves in urban stations with a strong influence of traffic sources when applying MOVES-Mexico emissions. Despite reducing estimations of modelled precursor emissions, O3 peak averages are increased in the MCMA core urban area (up to 30ppb) when using MOVES-Mexico mobile emissions due to its VOC-limited regime, while concentrations in the surrounding suburban/rural areas decrease or increase depending on the meteorological conditions of the day. The results obtained suggest that the HERMES-Mex model can be used to provide model-ready emissions for air quality modelling in the MCMA.

MLVA typing of Mycoplasma hyopneumoniae bacterins and field strains.

Because of the lack of information about both the genetic characteristics of Mycoplasma hyopneumoniae commercial vaccines and their relationship with field strains, the authors attempted to identify genetic subtypes of some M hyopneumoniae bacterins, and to compare them with M. hyopneumoniae field strains. Six commercial M hyopneumoniae bacterins and 28 bronchoalveolar lavages from pigs at slaughter from three herds were analysed by Multiple-Locus Variable number tandem repeat Analysis (MLVA) on p146R1, p146R3, H4, H5 and p95 loci. The results obtained showed the presence of more than one M hyopneumoniae genotype in some pigs and also in one of the bacterins analysed. It is also worth noting that MLVA typing allowed the distinction among circulating field strains and also when comparing them with vaccine strains, which, knowing the relatedness among them, could be useful in the research of the efficacy of the vaccines.

Novel Oxazolidinone-Based Peroxisome Proliferator Activated Receptor Agonists: Molecular Modeling, Synthesis, and Biological Evaluation.

A series of new peroxisome proliferator activated receptors (PPARs) chiral ligands have been designed following the accepted three-module structure comprising a polar head, linker, and hydrophobic tail. The majority of the ligands incorporate the oxazolidinone moiety as a novel polar head, and the nature of the hydrophobic tail has also been varied. Docking studies using the crystal structure of an agonist bound to the ligand binding domain of the PPARα receptor have been performed as a tool for their design. Suitable synthetic procedures have been developed, and compounds with different stereochemistries have been prepared. Evaluation of basal and ligand-induced activity proved that several compounds showed agonist activity at the PPARα receptor, thus validating the oxazolidinone template for PPAR activity. In addition, two compounds, 2 and 4, showed dual PPARα/PPARγ agonism and interesting food intake reduction in rats.

Activity of megestrol acetate in postmenopausal women with advanced breast cancer after nonsteroidal aromatase inhibitor failure: a phase II trial.

BACKGROUND: As novel treatments carry substantial price tags and are mostly cost-prohibitive in low- and middle-income countries, there is an urgent need to develop alternatives, such as off-patent drugs. Megestrol acetate (MA) has a longstanding history in the treatment of breast cancer, but recently it is being used less often due to the advent of newer agents. PATIENTS AND METHODS: This two-stage phase II trial evaluated the antitumor activity and toxicity of MA in postmenopausal women with hormone-sensitive advanced breast cancer who had experienced disease progression on a third-generation nonsteroidal aromatase inhibitor (NSAI). Eligible patients had metastatic breast cancer treated with a NSAI with at least 6-month progression-free survival (PFS), or relapse after ≥1 year on adjuvant NSAI. Patients received MA at a single daily oral dose of 160 mg. Primary end point was clinical benefit rate (CBR). RESULTS: Forty-eight patients were enrolled. The CBR was 40% [95% confidence interval (CI) 25% to 55%], and the median duration of clinical benefit was 10.0 (95% CI 8.0-14.2) months. The median PFS was 3.9 (95% CI 3.0-4.8) months. The most common grade 3 adverse events were anemia (2%), dyspnea (2%), fatigue (2%), musculoskeletal pain (4%), deep vein thrombosis (10%), and weight gain (2%). CONCLUSIONS: This is the first study to prospectively evaluate the efficacy and safety of MA in postmenopausal women with hormone-sensitive disease progressing on a NSAI. MA has demonstrated activity and acceptable tolerability in this setting, and therefore remains a reasonable treatment option in a cost-sensitive environment. These results also provide the background for further evaluation of progestins in the treatment of breast cancer. CLINICAL TRIALS: local trial number, related to the approval by the IRB: CEP 108/06.

Asociación entre obesidad y baja capacidad muscular y función cardiorrespiratoria, factores de riesgo cardiometabólico en niños colombianos / Association between obesity and low muscular and cardiorespiratory capacity, cardiometabolic risk factors in Colombian children

Objetivo: Examinar la asociación entre capacidad cardiorespiratoria y muscular y la presencia de obesidad y otros factores de riesgo cardiovascular y metabólico en escolares. Material y método: Estudio de corte transversal, realizado en 336 niños y niñas escolarizados en los grados 5º y 6º de colegios públicos de Bucaramanga, Colombia. Resultados: Se encontraron correlaciones inversas significativas entre índice de masa corporal (IMC) y fuerza de empuñadura ajustada por peso (-0.532) (P<0.001), salto largo (-0.248) (P<0.001) y la prueba de Yo-Yo (-0.321) (P<0.001). La fuerza de empuñadura máxima se correlacionó de forma inversa con la presión arterial sistólica (PAS) (-0.115) (p<0.05). Conclusión: La obesidad evaluada por el IMC y el porcentaje de grasa corporal se relacionan inversamente con la aptitud muscular y cardiorrespiratoria en escolares (AU)

Objective: To examine the association between cardio respiratory and muscular fitness and the presence of obesity and other cardiovascular and metabolic risk factors in school children. Material and method: Cross-sectional study, conducted in 336 school children (boys and girls) in grade 5º and 6º of public schools in the city of Bucaramanga, Colombia. Results: Significant inverse correlations were found between body mass index (BMI) and grip strength adjusted for weight (-0532) (P <0.001), long jump (-0248) (P <0.001) and Yo-Yo test (- 0.321) (P <0.001). The maximum grip strength was correlated inversely with systolic blood pressure (SBP) (-0115) (p <0.05). Conclusion: Obesity assessed by BMI and body fat percent is inversely related with muscular and cardio respiratory fitness in Colombian school children (AU)

Optimization of municipal sludge and grease co-digestion using disintegration technologies.

Many drivers tend to foster the development of renewable energy production in wastewater treatment plants as many expectations rely upon energy recovery from sewage sludge, for example through biogas use. This paper is focused on the assessment of grease waste (GW) as an adequate substrate for co-digestion with municipal sludge, as it has a methane potential of 479-710 LCH(4)/kg VS, as well as the evaluation of disintegration technologies as a method to optimize the co-digestion process. With this objective three different pre-treatments have been selected for evaluation: thermal hydrolysis, ultrasound and enzymatic treatment. Results have shown that co-digestion processes without pre-treatment had a maximum increment of 128% of the volumetric methane productivity when GW addition was 23% inlet (at 20 days of HRT and with an OLR of 3.0 kg COD/m(3)d), compared with conventional digestion of sewage sludge alone. Concerning the application of the selected disintegration technologies, all pre-treatments showed improvements in terms of methane yield (51.8, 89.5 and 57.6% more for thermal hydrolysis, ultrasound and enzymatic treatment, respectively, compared with non-pretreated wastes), thermal hydrolysis of GW and secondary sludge being the best configuration as it improved the solubilization of the organic matter and the hydrodynamic characteristics of digestates.

[Persistent pulmonary hypertension of the newborn following ingestion of nonsteroidal anti-inflammatory drugs during pregnancy]. / Hipertensión pulmonar neonatal grave tras ingestión de antiinflamatorios no esteroideos durante el embarazo.

Nonsteroidal anti-inflammatory drugs induce the inhibition of prostaglandin synthesis, which can cause constriction of the fetal ductus arteriosus in the pregnancy. We report two cases of antenatal closure of ductus arteriosus with severe pulmonary hypertension following maternal ingestion of nonsteroidal anti-inflammatory drugs (niflumic acid and acetylsalicylic acid) in the last days before delivery. To our knowledge, this is only the second case in literature describing antenatal closure of ductus arteriosus after the administration of niflúmic acid. Prescription of nonsteroidal anti-inflammatory drugs must be avoided during pregnancy. Fetal echocardiography must be monitored in those women treated with nonsteroidal anti-inflammatory drugs.

Hipertensión pulmonar neonatal grave tras ingestión de antiinflamatorios no esteroideos durante el embarazo / Persistent pulmonary hypertension of the newborn following ingestion of nonsteroidal anti-inflammatory drugs during pregnancy

Los antiinflamatorios no esteroideos inhiben la síntesis de prostaglandinas y producen una vasoconstricción del conducto arterioso fetal durante la gestación. Presentamos los casos de dos recién nacidos con hipertensión pulmonar grave secundaria a cierre ductal. En las semanas previas al parto, una de las madres había recibido tratamiento con ácido acetilsalicílico y la otra, con ácido niflúmico. Éste es el segundo caso descrito en la literatura médica de cierre ductal intraútero tras administración de ácido niflúmico. La ingestión de antiinflamatorios no esteroideos durante el embarazo está desaconsejado. No obstante, en las gestantes tratadas se debe realizar una monitorización continua, y la ecocardiografía fetal es de gran utilidad (AU)

Nonsteroidal anti-inflammatory drugs induce the inhibition of prostaglandin synthesis, which can cause constriction of the fetal ductus arteriosus in the pregnancy. We report two cases of antenatal closure of ductus arteriosus with severe pulmonary hypertension following maternal ingestion of nonsteroidal anti-inflammatory drugs (niflumic acid and acetylsalicylic acid) in the last days before delivery. To our knowledge, this is only the second case in literature describing antenatal closure of ductus arteriosus after the administration of niflúmic acid. Prescription of nonsteroidal anti-inflammatory drugs must be avoided during pregnancy. Fetal echocardiography must be monitored in those women treated with nonsteroidal anti-inflammatory drugs (AU)

Síndrome de Rud: observación de un nuevo caso / Rud´s syndrome: report of a new case

La asociación de la tríada oligofrenia, ictiosis congénita e hipogonadismo constituye el síndrome de Rud, entidad con muy pocos casos en la literatura médica mundial. Se han descrito en estos pacientes otras alteraciones menos frecuentes, como crisis convulsivas, epilepsia, talla baja, retinitis pigmentosa, polineuropatía hipertrófica o sordera neurosensorial. Forma parte de los denominados síndromes neurocutáneos queratósicos, junto con otros mejor definidos, como el síndrome de Sjögren-Larson o la enfermedad de Refsum. Se expone el caso de un paciente de 13 años de edad, con criterios clínicos compatibles con el síndrome de Rud, que asocia una agenesia renal unilateral y un sarcoma de partes blandas

The triad of oligophrenia, congenital ictiosis and hypogonadism constitutes Rud´s syndrome, and entity that is rarely reported in the world medical literature. Other less common festures such as seizures, epilepsy, short stature, retinitis pigmentosa, hypertrophic plyneuropathy or neurosensory hearing loss have also been reported in these patients. Rud´s syndrome is one of the so-called keratotic neurocutaneous syndromes, which include other better defined entities such as Sjögren-Larsson syndrome and Refsum disease. We report the case of a 13-years-old boy who met the clinical criteria for Rud´s syndrome, which was associated with unilateral renal agenesis and the development of a soft tissue sarcoma