Manejo integral de los factores de riesgo en enfermedad arterial periférica. Consenso de expertos / Comprehensive management of risk factors in peripheral vascular disease. Expert consensus

Antecedentes y objetivo: Actualmente existe cierta divergencia entre las principales guías de práctica clínica sobre el manejo de los factores de riesgo de la enfermedad arterial periférica (EAP). El objetivo de este proyecto es conocer el manejo de los factores de riesgo de la EAP en la práctica clínica y alcanzar un consenso multidisciplinar sobre las estrategias que se tienen que seguir para optimizar su identificación, tratamiento y seguimiento. Metodología: Consenso multidisciplinar mediante metodología Delphi. Resultados: En la consulta participaron 130 profesionales con amplia experiencia en EAP. Los resultados sugieren que para optimizar el control de los factores de riesgo, los esfuerzos deben dirigirse a: 1) promover la involucramiento y concienciación de todas las especialidades en la identificación y el cribado de la enfermedad; 2) garantizar la posibilidad de realizar el índice tobillo-brazo (ITB) en todas las especialidades implicadas; 3) fomentar estrategias de deshabituación del tabaquismo mediante el uso de fármacos, programas o derivaciones a unidades especializadas; 4) promover el seguimiento de una alimentación adecuada basada en la dieta mediterránea y la prescripción de ejercicio diario; 5) concienciar sobre la importancia de alcanzar unos valores de colesterol unido a lipoproteínas de baja densidad (cLDL) inferiores a 70 mg/Dl, especialmente en pacientes sintomáticos, pero también en asintomáticos (< 55 mg/dL tras la publicación de la guía de la European Society of Cardiology y la European Atherosclerosis Society [ESC/EAS]); 6) recomendar el uso de antiagregantes plaquetarios en pacientes asintomáticos con diabetes mellitus (DM) y/o ITB patológico; y 7) protocolizar la reevaluación del ITB anualmente en pacientes de alto riesgo. Conclusión: Las 22 estrategias consensuadas en el presente documento pretenden ayudar a los profesionales a optimizar el manejo multidisciplinar de los factores de riesgo de la EAP (AU)

Introduction: There is currently a degree of divergence among the main clinical practice guidelines on the management of risk factors for peripheral arterial disease (PAD). This project aims to gain understanding of the management of PAD risk factors in clinical practice and to reach a multidisciplinary consensus on the strategies to be followed in order to optimize its identification, treatment, and follow-up. Methodology: A multidisciplinary consensus following the Delphi methodology. Results: Professionals (n = 130) with extensive experience in PAD participated in this consultation. The results suggest that in order to optimize the control of risk factors, efforts should be aimed at: (1) promoting the involvement and awareness of all specialists in the identification of and screening for the disease; (2) guaranteeing the possibility of evaluating the ankle-brachial index (ABI) in all the medical specialties involved; (3) promoting strategies for patients to quit smoking through the use of drugs, programs, or referrals to specialized units; (4) promoting an appropriate Mediterranean-based diet and the prescription of daily exercise; (5) raising awareness of the importance of ensuring LDL cholesterol values below 70 mg/dL, especially in symptomatic but also in asymptomatic patients (< 55 mg/dL following the publication of the ESC/EAS guide); (6) recommending the use of antiplatelet therapy in asymptomatic patients with diabetes mellitus (DM) and/or a pathological ABI; and (7) protocolizing the annual evaluation of ABI in high-risk patients. Conclusion:This document presents the 22 agreed-upon strategies which are intended to help professionals optimize multidisciplinary management of PAD risk factors (AU)

Comprehensive management of risk factors in peripheral vascular disease. Expert consensus.

INTRODUCTION: There is currently a degree of divergence among the main clinical practice guidelines on the management of risk factors for peripheral arterial disease (PAD). This project aims to gain understanding of the management of PAD risk factors in clinical practice and to reach a multidisciplinary consensus on the strategies to be followed in order to optimize its identification, treatment, and follow-up. METHODOLOGY: A multidisciplinary consensus following the Delphi methodology. RESULTS: Professionals (n = 130) with extensive experience in PAD participated in this consultation. The results suggest that in order to optimize the control of risk factors, efforts should be aimed at: (1) promoting the involvement and awareness of all specialists in the identification of and screening for the disease; (2) guaranteeing the possibility of evaluating the ankle-brachial index (ABI) in all the medical specialties involved; (3) promoting strategies for patients to quit smoking through the use of drugs, programs, or referrals to specialized units; (4) promoting an appropriate Mediterranean-based diet and the prescription of daily exercise; (5) raising awareness of the importance of ensuring LDL cholesterol values below 70 mg/dL, especially in symptomatic but also in asymptomatic patients (<55 mg/dL following the publication of the ESC/EAS guide); (6) recommending the use of antiplatelet therapy in asymptomatic patients with diabetes mellitus (DM) and/or a pathological ABI; and (7) protocolizing the annual evaluation of ABI in high-risk patients. CONCLUSION: This document presents the 22 agreed-upon strategies which are intended to help professionals optimize multidisciplinary management of PAD risk factors.

Patrones de tratamiento con agentes biológicos: Eficacia y sobrevida a largo plazo en pacientes con artritis reumatoidea / Treatment patterns with biological agents: Efficacy and long-term survival in patients with rheumatoid arthritis

En nuestro país existen pocos datos acerca de los patrones de tratamiento y la sobrevida de las Drogas Modificadoras de la Artritis Reumatoidea biológicas (DMARb) en pacientes con Artritis Reumatoidea (AR). El objetivo de nuestro estudio fue estimar la sobrevida del 1° y 2° agente biológico, determinar sus causas de suspensión y evaluar factores que influyan en la sobrevida de estos agentes. Material y métodos: Se realizó un estudio multicéntrico retrospectivo. Se incluyeron pacientes ≥18 años de edad que cumplieran con criterios ACR/EULAR 2010 para AR y que iniciaron su 1° y/o 2° DMARb entre 01/2006 y 06/2017, la recolección de datos se realizó mediante la revisión de historias clínicas. Se consignaron variables sociodemográficas y clínicas. Resultados: Se incluyeron 347 pacientes con edad mediana de 57,8 años, 89,6% mujeres, 96,5% tenían Factor Reumatoideo (FR) positivo. El 53,9% de los pacientes discontinuaron el tratamiento con la 1°DMARb, treinta y ocho pacientes (41,3%) discontinuaron el 2° DMARb. La causa más frecuente de suspensión del primer biológico fue la falta de provisión, mientras que la del segundo biológico fue la ineficacia. Las supervivencias medianas fueron: para la 1° DMARb 31 meses (IC 95%: 21,8-40,1) y para 2° DMARb 11 meses (IC 95%: 4-17,9), no observamos diferencias significativas en la supervivencia entre los distintos agentes, los factores independientemente asociados a menor supervivencia del 1° DMARb fueron el tabaquismo y menor edad y del 2° DMARb fue haber discontinuado el primer agente biológico debido a evento adverso. Conclusión: Las supervivencias medianas del 1° DMARb y del 2° DMARb fueron 2,6 años y menor a 1 año, respectivamente. A diferencia de otras cohortes de países desarrollados, la causa más frecuente de suspensión del primer biológico fue la falta de provisión de la medicación por parte del pagador, mientras que la del segundo biológico fue la ineficacia.

In our country there are few data about the treatment patterns and the survival of the Biologic Disease Modifying Antirheumatic Drugs (bDMARD) in patients with Rheumatoid Arthritis (RA). The objective of our study was to evaluate the survival of the 1st and 2nd biological agent, determine the causes of suspension and factors that influence on the survival of these agents. Material and methods: A retrospective multicenter study was conducted. We included patients ≥18 years of age who met the ACR/EULAR 2010 criteria for RA and who started in 1st and/or 2nd bDMARD between 01/2006 and 06/2017, the data collection was done by reviewing clinical charts The sociodemographic and clinical variables were recorded. Results: We included 347 patients with a median age of 57.8 years, 89.6% women, 96.5% had positive Rheumatoid Factor (RF). 53.9% of patients discontinued treatment with 1st bDMARD, thirty-eight patients (41.3%) discontinued the 2nd bDMARD. The most frequent cause of suspension of the first biological was the lack of provision, while the second biological was inefficacy. The median survivals were: for the 1st bDMARD 31 months (95% CI: 21.8-40.1) and for the 2nd bDMARD 11 months (95% CI: 4-17.9), we did not observe significant differences in survival between the different agents. The independent factors associated with lower survival of the 1st bDMARD were smoking and lower age and the 2nd bDMARD was to have discontinued the first biological agent due to an adverse event. Conclusion: The median survivals of the 1st bDMARD and the 2nd bDMARD were 2.6 years and less than 1 year, respectively. Unlike other cohorts of developed countries the most frequent cause of suspension of the first biological was the lack of provision of the drug by the payer, while the second biological was inefficacy.

Prevalencia y características de uveítis como manifestación extraarticular en Espondiloartritis Axial / Prevalence and characteristics of uveitis as an extra-articular manifestation in Axial Spondyloarthritis

Introducción: La Uveítis Anterior Aguda (UAA) es la manifestación extraarticular más frecuente en la Espondiloartritis axial (EsPax), con una prevalencia global de 32,7%. El objetivo de este estudio fue determinar la prevalencia de UAA en una cohorte Argentina de pacientes con EsPax, describir sus características clínicas, frecuencia de episodios, respuesta al tratamiento y pronóstico a largo plazo, así como su asociación con características generales de la enfermedad. Material y métodos: Se realizó un estudio de corte transversal. Se incluyeron pacientes con diagnóstico de EsPax (criterios ASAS 2009) de la cohorte ESPAXIA (Estudio de Espondiloartritis Axial IREP Argentina). Se consignaron datos sociodemográficos, características de la enfermedad y tratamientos recibidos; números de episodios de uveítis, año de aparición, características del mismo, tratamiento realizado y complicaciones. Se registró rigidez matinal, medidas de movilidad axial por Bath Ankylosing Spondylitis Metrological Index (BASMI), número de articulaciones tumefactas, sitios de entesitis por medio de Maastricht AS Enthesitis Score (MASES), eritrosedimentación (ERS), proteína C reactiva (PCR) y presencia de HLA-B27. Se empleó Escala Visual Numérica (EVN) para evaluar el dolor, dolor nocturno, actividad de la enfermedad según el paciente y el médico. Se administraron autocuestionarios: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI) y Ankylosing Spondylitis Quality of Life (ASQoL). Se calculó Simplified Ankylosing Spondylitis Disease Activity Score con ERS y PCR (SASDAS ERS/PCR). Análisis estadístico: Estadística descriptiva. Test T de Student, test de Chi² y análisis de regresión logística múltiple. Se consideró significativo un valor de p<0,05. Resultados: Se incluyeron 231 pacientes con EsPax, 174 de sexo masculino (75,3%) con una mediana de edad de 46 años (RIC 36-57) y mediana de tiempo de evolución de la enfermedad de 20,5 años (RIC 10,5-30,5). Sesenta pacientes (26%) presentaron al menos un episodio de uveítis, siendo la primera manifestación de la enfermedad en 22 (37,9%) de ellos. La UAA fue la forma más frecuente, observándose en 59 pacientes (98,3%). El promedio de episodios de UAA fue 4,78 (DS 5,64). Las recurrencias fueron unilaterales en 48,8% de los casos. El tratamiento recibido fue local en 42 (79,2%) de los pacientes. Doce pacientes (22,2%) presentaron secuelas luego del primer episodio, siendo la disminución de la agudeza visual y cataratas las más frecuentes (16,7% y 5,6%, respectivamente). Las variables asociadas independientemente con UAA fueron mayor tiempo de evolución de la enfermedad (24,91±14,2 años vs 20,7±13,2 años, p=0,038) y positividad de HLA-B27, (69% vs 47,4%, p=0,006). Conclusión: La prevalencia de uveítis en nuestra cohorte fue del 26%. Fue significativamente más frecuente en pacientes HLA-B27 (+) y con mayor tiempo de evolución de la enfermedad.

Background: Acute Anterior Uveitis (AAU) is the most frequent extra-articular manifestation in axial Spondyloarthritis (axSpA), with an overall prevalence of 32.7%. The aim of this study was to determine the prevalence of AAU in an Argentinian cohort of patients with axSpA and to describe their clinical characteristics, frequency of episodes, response to treatment and long-term prognosis, as well as their association with general disease characteristics. Methods: A cross-sectional study was carried out. We included patients with axSpA according to ASAS 2009 criteria from ESPAXIA cohort (Estudio de Espondiloartritis Axial IREP Argentina). Sociodemographic data, characteristics of the disease, and treatments received; numbers of episodes of uveitis, incidence date, and its characteristics, treatment and complications were consigned. Morning stiffness, axial mobility (BASMI), enthesitis (MASES), ESR, CRP and HLA-B27 were registered. Pain, night pain, patient and physician global assessment were evaluated by Numerical Visual Scale (NVA). BASDAI, BASFI and ASQoL self-questionnaires were administered. Statistical analysis: Descriptive statistics. Student's T-test, Chi² test and multiple logistic regression analysis. A p value <0.05 was considered significant. Results: Two hundred and thirty one patients with axSpA were included, 174 male (75.3%) with a median age of 46 years (IQR 36-57) and median disease duration of 20.5 years (IQR 10.5-30.5). Sixty patients (26%) had at least one episode of uveitis, being the first manifestation of the disease in 22 (37.9%) of them. Acute anterior uveitis was the most frequent form, and it was observed in 59 patients (98.3%). The mean number of episodes was 4.78 (SD 5.64). Recurrences were unilateral in 48.8% of cases. They received local therapy in 42 (79.2%) of the patients. Twelve patients (22.2%) presented a complication after the first episode, being the decrease in visual acuity and cataracts, the most frequent ones (16.7% and 5.6%, respectively). The presence of uveitis was significantly associated with longer disease duration (24.9 years vs 20.7 years, p=0.038) and with the positivity for HLA-B27, (69% vs 47.4%, p=0.006) and these variables were maintained in the multivariate analysis, after adjusting for other variables. Conclusion: The prevalence of uveitis in our cohort was 26%. It was significantly more frequent in patients HLA-B27 (+) and with longer disease duration.

Plasmonic resonances in hybrid systems of aluminum nanostructured arrays and few layer graphene within the UV-IR spectral range.

The size-controllable and ordered Al nanocavities and nanodomes arrays were synthesized by electrochemical anodization of aluminum using phosphoric acid, citric acid and mixture both acids. Few layer graphene (FLG) was transferred directly on top of Al nanostructures and their morphology were evaluated by scanning electron microscopy. The interaction between FLG and the plasmonic properties of Al nanostructures arrays were investigated based on specular reflectivity in the ultraviolet-visible-infrared range and Raman spectroscopy. We found that their optical reflectivity was dramatically reduced as compared with unstructured Al. At the same time pronounced reflectivity dips were detectable in the 200-896 nm wavelength range, which were ascribed to plasmonic resonances. The plasmonic properties of these nanostructures do not exhibit evident changes by the presence of FLG in the UV-vis range of the electromagnetic spectrum. By contrast, the surface-enhanced Raman spectroscopy of FLG was observed in nanocavities and nanodomes structures that result in an intensity increase of the characteristic G and 2D bands of FLG induced by the plasmonic properties of Al nanostructures.

Impact of a multidimensional infection control strategy on central line-associated bloodstream infection rates in pediatric intensive care units of five developing countries: findings of the International Nosocomial Infection Control Consortium (INICC).

PURPOSE: To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control strategy including a practice bundle to reduce the rates of central line-associated bloodstream infection (CLAB) in patients hospitalized in pediatric intensive care units (PICUs) of hospitals, which are members of the INICC, from nine cities of five developing countries: Colombia, India, Mexico, Philippines, and Turkey. METHODS: CLAB rates were determined by means of a prospective surveillance study conducted on 1,986 patients hospitalized in nine PICUs, over a period of 12,774 bed-days. The study was divided into two phases. During Phase 1 (baseline period), active surveillance was performed without the implementation of the multi-faceted approach. CLAB rates obtained in Phase 1 were compared with CLAB rates obtained in Phase 2 (intervention period), after implementation of the INICC multidimensional infection control program. RESULTS: During Phase 1, 1,029 central line (CL) days were recorded, and during Phase 2, after implementing the CL care bundle and interventions, we recorded 3,861 CL days. The CLAB rate was 10.7 per 1,000 CL days in Phase 1, and in Phase 2, the CLAB rate decreased to 5.2 per 1,000 CL days (relative risk [RR] 0.48, 95% confidence interval [CI] 0.29-0.94, P = 0.02), showing a reduction of 52% in the CLAB rate. CONCLUSIONS: This study shows that the implementation of a multidimensional infection control strategy was associated with a significant reduction in the CLAB rates in the PICUs of developing countries.

Aproximación a un protocolo quirúrgico para el manejo de dientes supernumerarios: evaluación de un caso y revisión de la literatura / Approximation to surgical protocol for the management of supernumerary tooth: evaluation of one case and literature review

Introducción: Los dientes supernumerarios (DSN) son anomalías del desarrollo, cuyas manifestaciones típicas suelen ser modificaciones en secuencia y erupción dentaria. Metodología: Se realizo una búsqueda en Medline y Pubmed con criterios de selección definidos entre los años1985 y 2005.Resultados: Se encontraron 13 artículos útiles para la revisión, de los cuales 2 fueron revisiones bibliográficas. Discusión: La prevalencia de DSN rodea al 2%, presentándose principalmente en hombres. No siempre la exéresis de DSN es necesaria por lo que se debe conocer claramente sus indicaciones además de presentar un estudio radiográfico previo detallado. El protocolo quirúrgico exige una descripción y clasificación del DSN para planificar su tratamiento en un equipo multidisciplinario. Su tratamiento quirúrgico presenta generalmente un pronóstico favorable y sus complicaciones se asocian con cierta frecuencia a las estructuras anatómicas vecinas. Conclusión: Este protocolo quirúrgico ayuda a sistematizar los procedimientos terapéuticos para DSN y hacerlos más predecibles (AU)

Introduction: The supernumerary teeth (DSN) are development anomalies, which typical manifestations are sequence and eruption modifications. Methodology: We did a search in Medline and Pubmed with definied criteria of selection between the year 1985and 2005.Results: 13 articles were found useful for the review, of which 2 were literature reviews. Discussion: DSN’s prevalence surrounds 2 %, appearing principally between men. Not always DSN’s exodontiais necessary for what must know clearly his indications and presenting a radiographic previous study. The surgical protocol demands a description and classification of the DSN to plan the treatment in a multidisciplinary team. The surgical treatment presents generally a favorable prediction and it’s complications are associated with certain frequency to the anatomical neighboring. Conclusion: This surgical protocol helps to systematize the therapeutic procedures for DSN and to do them more predecible (AU)

[Tolerability and efficiency of a new transdermic nitroglycerin patch in outpatients with chronic stable angina. The PATRICH Trial]. / Tolerabilidad y eficacia de un nuevo parche transdérmico de nitroglicerina en pacientes ambulatorios con angina crónica estable. Estudio PATRICH.

OBJECTIVE: To obtain data on local and systemic tolerability of three different doses (5 mg/24 h, 10 mg/24 h, and 15 mg/24 h) of a new model of nitroglycerin patch (Trinipatch, Sanofi-Synthelabo, S. A.) in patients with chronic stable angina. METHODS: A total of 954 patients were studied for a follow-up period of 12 weeks. Patients were distributed as follows: 132 to the 5 mg/24 h patch, 727 to the 10 mg/24 h patch, and 95 to the 15 mg/24 h patch. The local tolerability was evaluated by using the Draize scale and the systemic tolerability by recording the adverse reactions and assessing the effect on blood pressure. Furthermore, the efficiency of therapy was evaluated by means of the variations observed in the number and severity of angina crises, as well as the weekly use of sublingual nitroglycerine. RESULTS: Ninety-four patients (9.8%) showed signs of cutaneous irritation. Thirty-two patients (3.3%) showed erythema, and one patient (0.1%) showed erythema and induration. Thirty-nine patients (4.1%) had some type of systemic adverse reaction during the study. A total of 44 adverse reactions were recorded, headache being the most common (79.5%). Only one severe adverse reaction was observed (mild heart failure), which in the opinion of the researcher was not related to the medication. No dropouts were recorded on account of adverse reactions. The number of patients with angina crises and the number of weekly angina crises decreased significantly with therapy. CONCLUSIONS: The transdermic nitroglycerin patch was demonstrated to be a safe and well tolerated therapy for chronic stable angina, both in terms of local and systemic tolerability. Moreover, its efficiency was demonstrated as the number of angina crises decreased significantly.

Tolerabilidad y eficacia de un nuevo parche transdérmico de nitroglicerina en pacientes ambulatorios con angina crónica estable. Estudio PATRICH / Tolerability and efficiency of a new transdermic nitroglycerin patch in outpatients with chronic stable angina. The PATRICH Trial

Objetivo. Obtener datos sobre la tolerabilidad local y sistémica de tres dosis diferentes (5 mg/24 h, 10 mg/ 24 h y 15 mg/24 h) de un nuevo modelo de parche de nitroglicerina (Trinipatch®', Sanofi-Synthelabo, S. A.) en pacientes con angina crónica estable. Métodos. Se estudiaron 954 pacientes durante un período de seguimiento de 12 semanas. Se distribuyeron del siguiente modo: 132 pacientes con parches de 5 mg/24 h, 727 con parches de 10 mg/24 h y 95 con parches de 15 mg/24 h. La tolerabilidad local se evaluó usando la escala de Draize y la tolerabilidad sistémica registrando los acontecimientos adversos y valorando el efecto sobre la presión arterial.Adicionalmente se evaluó la eficacia del tratamiento mediante las variaciones observadas en el número y la severidad de las crisis anginosas, así como del consumo semanal de nitroglicerina sublingual.Resultados. Noventa y cuatro pacientes (9,8 por ciento) mostraron signos de irritación cutánea. Treinta y dos pacientes (3,3 por ciento) mostraron eritema y un paciente (0,1 por ciento) mostró eritema más endurecimiento. Treinta y nueve pacientes (4,1 por ciento) presentaron algún acontecimiento adverso sistémico durante el estudio. Se documentaron 44 acontecimientos adversos, siendo el más frecuente la cefalea (79,5 por ciento). Sólo se observó un acontecimiento adverso grave (insuficiencia cardíaca ligera), que en opinión del investigador no estaba relacionado con la medicación. No se observó ningún abandono del tratamiento por efectos adversos. El número de pacientes con crisis anginosas y el número de crisis anginosas semanales descendió significativamente con el tratamiento. Conclusiones. Los parches transdérmicos de nitroglicerina estudiados se mostraron como una terapia segura y bien tolerada en la angina de pecho crónica estable, tanto en términos de tolerancia local como sistémica. Se confirmó además su eficacia al reducir significativamente las crisis anginosas (AU)

Serum basic fibroblast growth factor levels in exercise-induced myocardial ischemia more likely a marker of endothelial dysfunction than a marker of ischemia?

Increased levels and activity of fibroblast growth factor (FGF) have been documented in a variety of diseases, including ischemia. Both acute coronary syndromes and exercise are situations that stimulate FGF release. Since experimental studies have demonstrated that FGFs are involved in myocardial preconditioning, it has been suggested that cardiac and circulating FGFs may play a cardioprotective role in ischemic diseases. However, the profile of basic FGF (bFGF) release during transient myocardial ischemia remains uncertain. We sought to determine whether circulating bFGF might be changed in patients with demonstrated coronary artery disease and evidence of ischemia in exercise scintigraphy (Isch +; n = 21). Serum from 22 age-matched patients with no coronary artery disease and no isotopic ischemia (Isch-) were used as controls. Three blood samples were obtained to determine bFGF at different times: baseline (bFGF-A); maximal exercise (bFGF-B), and isotopic redistribution (bFGF-C). An enzyme-linked immunoassay specific for bFGF was used (limit of detection, 1.0 pg/ml). Circulating bFGF was increased at maximal exercise in both Isch + and control patients. However, serum levels of bFGF were elevated up to more than two-fold in Isch-patients compared to Isch+ patients (8.67 +/- 2.10 pg/ml in Isch+ vs 17.83 +/- 2.97 pg/ml in Isch- patients; p<0.01). According to previous data, these findings suggest that bFGF serum levels could be considered more likely a marker of endothelial dysfunction occurring in patients with coronary artery disease, rather than a marker of acute ischemia. This situation could be different in the clinical setting of chronic myocardial ischemia.

[Quantification of T CD4+ lymphocytes and viral RNA in patients with HIV/AIDS]. / Cuantificación de linfocitos T CD4+ y de RNA viral en pacientes con VIH/SIDA.

Quantification of CD4+ T lymphocytes and viral RNA in patients with HIV/AIDS. Levels of progression markers (viral load and CD4+ T lymphocytes) in 410 patients with HIV/AIDS that were in different clinical stages of the disease and under different therapeutic schemes were quantified. The objective was to determine the correlation between values of progression markers and clinical stage of the patients. Commercial methodologies for the quantification of lymphocytes, subpopulations and circulating viral RNA were used. Results indicate that there was a correlation between low CD4+ values and high viral load in patients with antiretroviral treatment but not in patients without treatment. Furthermore, analysis of 1,208 samples processed during 1999 showed that 46% of the patients had less than 200 CD4+ T lymphocytes/mL blood and more than 500 copies of circulating viral RNA. Implications of these results in public health in Mexico are discussed.

[Osgood-Schlatter's disease]. / Enfermedad de Osgood-Schlatter.

Two patients with Osgood-Schlatter's disease studied at the Unidad de Pediatría Hospital General de México are reported. Both with the same ago, sex and clinical symptoms. No surgery was performed. Several considerations are made on etiology, clinical, radiologic and histopathological aspects. Treatment is discussed and a complete review of medical literature is made.