Effects of Oral Supplementation with Docosahexaenoic Acid (DHA) plus Antioxidants in Pseudoexfoliative Glaucoma: A 6-Month Open-Label Randomized Trial.

PURPOSE: To assess the effects of antioxidant oral supplementation based on docosahexaenoic acid (DHA) in pseudoexfoliative (PEX) glaucoma. PATIENTS AND METHODS: A prospective 6-month open-label randomized controlled trial was conducted in patients with PEX glaucoma and adequate intraocular pressure (IOP) control. Patients in the DHA group received a high-rich DHA (1 g) nutraceutical formulation. Ophthalmological examination, DHA erythrocyte membrane content (% total fatty acids), plasma total antioxidant capacity (TAC), plasma malondialdehyde (MDA), and plasma IL-6 levels were assessed. RESULTS: Forty-seven patients (DHA group 23, controls 24; mean age 70.3 years) were included. In the DHA group, the mean IOP in the right eye decreased from 14.7 [3.3] mmHg at baseline to 12.1 [1.5] mmHg at 6 months (P=0.01). In the left eye, IOP decreased from 15.1 [3.3] mmHg at baseline to 12.2 [2.4] mmHg at 6 months (P=0.007). DHA erythrocyte content increased in the DHA group, with significant differences versus controls at 3 months and 6 months (8.1% [0.9] vs. 4.4% [0.7]; P < 0.0001). At 6 months and in the DHA group only, TAC levels as compared with baseline increased significantly (919.7 [117.9] vs. 856.9 [180.3] µM copper-reducing equivalents; P=0.01), and both MDA (4.4 [0.8] vs. 5.2 [1.1] nmol/mL; P = 0.02) and IL-6 (2.8 [1.3] vs. 4.7 [2.3] pg/mL; P=0.006) levels were lower than in controls. CONCLUSIONS: Targeting pathophysiology mechanisms of PEX glaucoma by reducing oxidative stress and inflammation with a high-rich DHA supplement might be an attractive therapeutic approach. Despite the short duration of treatment, decrease in IOP supports the clinical significance of DHA supplementation.

Influencia de las formas de organización en la asistencia a la población infantil en España / Influence of the forms of organization in the assistance to the infantile population in Spain

La forma de la organización sanitaria puede influir en la asistencia a la población infantil. La Asociación Española de Pediatría de Atención Primaria realiza un análisis de diferentes formas de atención asistencial: pediatra de área, modelos mixtos público-privados, organizaciones interniveles y participación de los pediatras de Atención Primaria en las guardias hospitalarias y aporta posibles actuaciones de mejora en cada uno de ellos

The way in which health care is organized can influence the assistance to children. The Spanish Association of Pediatrics of Primary Care (AEPap) performs an analysis of different forms of care: area pediatrician, mixed public-private models, inter-level organizations and participation of primary care pediatricians as doctors on duty at the hospital, and provides possible improvement actions in each one of them

Pólipos sincrónicos en estómago y yeyuno en un paciente con poliposis adenomatosa familiar / Chronic polyps in the stomach and jejunum in a patient with familial adenomatous polyposis

El manejo de los pólipos digestivos extracolónicos resulta controvertido en los pacientes con poliposis adenomatosa familiar (PAF). El tratamiento de los pólipos adenomatosos con displasia severa en el estómago mediante resecciones gástricas amplias puede dificultar el seguimiento posterior de la aparición de nuevos pólipos en el área duodenoyeyunal. Presentamos el caso excepcional de un varón de 45 años con PAF que desarrolló 2 pólipos adenomatosos sincrónicos, con displasia severa, uno en el antro gástrico y el otro en el yeyuno proximal. Se realizó una gastrectomía subtotal en «Y» de Roux y una resección del segmento yeyunal proximal, ante el diagnóstico preoperatorio de neoplasia gástrica con invasión de la pared (T2N0) (AU)

The management of extracolonic gastrointestinal polyps is controversial in patients with familial adenomatous polyposis (FAP). The treatment of adenomatous polyps with severe dysplasia in the stomach through wide gastric resections can hamper subsequent surveillance of the development of new polyps in the duodenal-jejunal area. We report the exceptional case of a 45-year-old man with FAP who developed two synchronic adenomatous polyps, with severe dysplasia. The first was located in the gastric antrum and the second in the proximal jejunum. Given the preoperative diagnosis of gastric neoplasm with invasion of the gastric wall (T2N0), subtotal Roux-en-Y gastrectomy and resection of the proximal jejunal segment were performed (AU)

[Chronic polyps in the stomach and jejunum in a patient with familial adenomatous polyposis]. / Pólipos sincrónicos en estómago y yeyuno en un paciente con poliposis adenomatosa familiar.

The management of extracolonic gastrointestinal polyps is controversial in patients with familial adenomatous polyposis (FAP). The treatment of adenomatous polyps with severe dysplasia in the stomach through wide gastric resections can hamper subsequent surveillance of the development of new polyps in the duodenal-jejunal area. We report the exceptional case of a 45-year-old man with FAP who developed two synchronic adenomatous polyps, with severe dysplasia. The first was located in the gastric antrum and the second in the proximal jejunum. Given the preoperative diagnosis of gastric neoplasm with invasion of the gastric wall (T(2)N(0)), subtotal Roux-en-Y gastrectomy and resection of the proximal jejunal segment were performed.

Structural framework for the modulation of the activity of the hybrid antibiotic peptide cecropin A-melittin [CA(1-7)M(2-9)] by Nε-lysine trimethylation.

The 3D structures of six linear pentadecapeptides derived from the cecropin A-melittin antimicrobial peptide CA(1-7)M(2-9) [KWKLFKKIGAVLKVL-NH(2)] have been studied. These analogues are modified by ε-NH(2) trimethylation of one or more lysine residues and showed variation in both antimicrobial and cytotoxic activities, depending on the number and position of modified lysines. Since it is expected that these peptides will display a strong conformational ordering when in contact with membranes, we have investigated their structure on the basis of the data extracted from NMR experiments performed in membrane-mimetic environments. We show that inclusion of N(ε)-trimethylated lysine residues induces a certain degree of structural flexibility, while preserving to a variable extent a largely α-helical structure. In addition, peptide orientation with respect to SDS micelles has been explored by detection of the intensity changes of peptide NMR signals upon addition of a paramagnetic probe (Mn(2+) ions).

Efectividad de la psicoterapia breve en los centros de salud mental II: resultados / Effectiveness of brief psychotherapy in community mental health centers II: results

Introducción: El objetivo de la presente investigación ha sido comparar mediante un ensayo clínico la efectividad de una Psicoterapia Breve con el tratamiento habitual de los Trastornos Mentales Comunes en los Centros de Salud Mental (CSM) de Asturias. La introducción general a este estudio se ha descrito por Fernández-Méndez y cols. (2010) y se remite a los lectores a ese artículo para más detalles respecto al fundamento, diseño, tratamientos y procedimientos de la investigación. Sujetos y método: Se seleccionaron al azar 216 personas mayores de 14 años que consultaban por primera vez en seis CSM y que fueron diagnosticadas de trastornos depresivos, de ansiedad y/o de adaptación. Ciento cuarenta y una cumplían los criterios de inclusión y aceptaron participar en la investigación, siendo asignadas al azar a dos grupos: Psicoterapia breve integradora-ecléctica (n = 76) o Tratamiento habitual en los CSM (n = 65). Se han comparado sus resultados a los 6, 12, 24 y 36 meses en diversos índices de mejoría clínica, funcionamiento psicosocial e indicadores sanitarios indirectos. Los datos se han obtenido del Registro de Casos Psiquiátricos, de la Historia Clínica y del propio paciente. Se han usado los siguientes instrumentos: Impresión Clínica Global (ICG, Guy, 1976), Inventario de Discapacidad de Sheehan (SDI, Sheehan, 1996) y Cuestionario de Satisfacción (Moré y Muñoz, 2000). Resultados: El programa de Psicoterapia breve ha sido más efectivo que el tratamiento habitual: Obtiene una mayor tasa de altas y los sujetos muestran mayores mejorías en estado clínico y discapacidad y mayor satisfacción. Estas diferencias se dan tanto a los seis meses como al año y a los dos años de iniciarse los tratamientos. Además, aunque el número medio de sesiones es igual en ambos grupos (en torno a seis), el tratamiento experimental duró mucho menos tiempo. Conclusiones: La Psicoterapia ha resultado ser un tratamiento viable y efectivo para la mayoría de los casos que consultan en los CSM (AU)

Background: The aim of the current research has been comparing the effectiveness of a brief psychotherapy with the usual treatment of Common Mental Disorders in Mental Health Centers (MHC) of Asturias. The general background of this study has already been described by Fernández-Méndez et al (2010) and readers are referred to that article for details regarding rationale, design, treatments and procedures of the study. Subjects and method: Two hundred and sixteen patients over the age of 14 were selected at random among those who consulted for the first time in six MHC and were diagnosed of depressive, anxiety or adjustment disorders. One hundred and forty-one fulfilled the inclusion criteria and agreed to take part in the study; they were assigned at random into two groups: brief integrative-eclectic psychotherapy (n = 76) or usual treatment in the MHC (n = 65). Their results have been compared at 6, 12, 24 and 36 months against diverse indexes of clinical improvement, psycho-social functioning and sanitary indirect indicators. Information has been obtained from the Psychiatric Cases Record, the Clinical History and from the patients. The following instruments have been used: the Clinical Global Impression of Improvement scale, the Sheehan Disability Inventory and a Satisfaction Survey. Results: Brief psychotherapy was more effective than usual treatment: it resulted in a higher number of discharges and subjects show greater improvements in clinical status and disability, and greater satisfaction. These differences occur both at 6 months to one year and two years of starting treatment. Furthermore, although the average number of sessions is equal in both groups (about six), time-wise the psychological treatment lasted much less (AU)

Efectividad de la psicoterapia breve en los centros de salud mental I: Diseño, tratamientos y procedimiento / Effectiveness of Brief Psychotherapy in Community Mental Health Centers I: design, treatments and procedures

Introducción. El objetivo de la presente investigación ha sido comparar mediante un ensayo clínico la efectividad de una Psicoterapia Breve con el tratamiento habitual de los Trastornos Mentales Comunes en los Centros de Salud Mental (CSM) de Asturias. En este artículo se describen la justificación, el diseño y los procedimientos de ese estudio. Los primeros resultados se publican en Fernández- Méndez y cols. (en prensa). Sujetos y método. Se seleccionaron al azar 216 personas mayores de 14 años que consultaban por primera vez en seis CSM y que fueron diagnosticadas de trastornos depresivos, de ansiedad y/o de adaptación. Ciento cuarenta y una cumplían los criterios de inclusión y aceptaron participar en la investigación, siendo asignadas al azar a dos grupos: Psicoterapia breve integradora- ecléctica (n = 76) o Tratamiento habitual en los CSM (n = 65). Se han comparado sus resultados a los 6, 12, 24 y 36 meses en diversos índices de mejoría clínica, funcionamiento psicosocial e indicadores sanitarios indirectos. Los datos se han obtenido del Registro de Casos Psiquiátricos, de la Historia Clínica y del propio paciente. Se han usado los siguientes instrumentos: Impresión Clínica Global (ICG, Guy, 1976), Inventario de Discapacidad de Sheehan (SDI, Sheehan, 1996) y Cuestionario de Satisfacción (Moré y Muñoz, 2000) (AU)

Background. The aim of the current research has been comparing the effectiveness of a brief psychotherapy with the usual treatment of Common Mental Disorders in Mental Health Centers (MHC) of Asturias. The present article describes the rationale, design and procedures of the study. Initial outcome findings are reported by Fernández- Méndez et al (in press). Subjects and method. Two hundred and sixteen patients over the age of 14 were selected at random among those who consulted for the first time in six MHC and were diagnosed of depressive, anxiety or adjustment disorders. One hundred and forty-one fulfilled the inclusion criteria and agreed to take part in the study; they were assigned at random into two groups: brief integrative-eclectic psychotherapy (n = 76) or usual treatment in the MHC (n = 65). Their results have been compared at 6, 12, 24 and 36 months against diverse indexes of clinical improvement, psycho-social functioning and sanitary indirect indicators. Information has been obtained from the Psychiatric Cases Record, the Clinical History and from the patients. The following instruments have been used: the Clinical Global Impression of Improvement scale, the Sheehan Disability Inventory and a Satisfaction Survey (AU)

Antimicrobial peptides and their superior fluorinated analogues: structure-activity relationships as revealed by NMR spectroscopy and MD calculations.

The conformations of two synthetic pentapeptides with antimicrobial activity and their 4-fluorophenylalanine (Pff)-containing analogues (ArXArXAr-NH(2); Ar=Phe, Pff; X=Lys, Arg) have been studied. NMR experiments carried out both in aqueous fluoroalcohol solutions and SDS micelles permitted their interactions with membrane-like environments to be explored. WaterLOGSY experiments and Mn(2+)-based paramagnetic probes were also applied to assess their orientations with respect to the SDS micelles. In addition, pulse-field gradient (PFG) diffusion NMR spectroscopy studies were conducted, under different experimental conditions (i.e., concentration, temperature) to characterize the possible changes in the peptides' aggregation states as a putative critical factor for their antimicrobial activity. Finally, molecular dynamics simulations on a variety of conformations showed the intrinsic flexibility of these peptides in both aqueous solutions and membrane-mimetic systems.

NMR studies of ligand binding to P450(eryF) provides insight into the mechanism of cooperativity.

Cytochrome P450's (P450's) catalyze the oxidative metabolism of most drugs and toxins. Although extensive studies have proven that some P450's demonstrate both homotropic and heterotropic cooperativity toward a number of substrates, the mechanistic and molecular details of P450 allostery are still not well-established. Here, we use UV/vis and heteronuclear nuclear magnetic resonance (NMR) spectroscopic techniques to study the mechanism and thermodynamics of the binding of two 9-aminophenanthrene (9-AP) and testosterone (TST) molecules to the erythromycin-metabolizing bacterial P450(eryF). UV/vis absorbance spectra of P450(eryF) demonstrated that binding occurs with apparent negative homotropic cooperativity for TST and positive homotropic cooperativity for 9-AP with Hill-equation-derived dissociation constants of K(S) = 4 and 200 microM, respectively. The broadening and shifting observed in the 2D-{1H,15N}-HSQC-monitored titrations of 15N-Phe-labeled P450(eryF) with 9-AP and TST indicated binding on intermediate and fast chemical exchange time scales, respectively, which was consistent with the Hill-equation-derived K(S) values for these two ligands. Regardless of the type of spectral perturbation observed (broadening for 9-AP and shifting for TST), the 15N-Phe NMR resonances most affected were the same in each titration, suggesting that the two ligands "contact" the same phenylalanines within the active site of P450(eryF). This finding is in agreement with X-ray crystal structures of bound P450(eryF) showing different ligands occupying similar active-site niches. Complex spectral behavior was additionally observed for a small collection of resonances in the TST titration, interpreted as multiple binding modes for the low-affinity TST molecule or multiple TST-bound P450(eryF) conformational substates. A structural and energetic model is presented that combines the energetics and structural aspects of 9-AP and TST binding derived from these observations.

Factores de riesgo e intervenciones psicológicas eficaces en los trastornos cardiovasculares / Risk factors and succesful psychological interventions in cardiovascular disfunctions

El propósito de este trabajo es examinar los factores de riesgo de los trastornos cardiovasculares que pueden ser modificados a través de intervenciones psicológicas. Entre estos factores se incluyen los conocidos como clásicos (p.e., obesidad, sedentarismo, hipertensión arterial), los denominados emocionales (p.e., conducta Tipo A, ira y hostilidad, ansiedad) y, en general, todos aquellos que poseen un componente psicológico o social. Una vez examinados estos factores de riesgo se analizan, en primer lugar, las intervenciones conductuales que reducen la vulnerabilidad cardiovascular. Posteriormente, se tratan las principales técnicas y programas de intervención y rehabilitación aplicados en esta área. (AU)

The aim of this work is to examin the risk factors of cardiovascular dysfunctions that can be modified through psychological interventions. These risk factors are mainly classic (e.g., obesity, physical inactivity, hypertension) and emotional (e.g.,Type A behavior pattern, anger and hostility, anxiety), in general all those that possess a psychological or social component. Once examined these risk factors are analyzed, in the first place, the behavioral interventions that reduce the cardiovascular vulnerability. Later on, main technics and intervention programs and applied rehabilitation in this area are analyzed (AU)

Evidence of complete hydrophobic coating of bombesin by trifluoroethanol in aqueous solution: an NMR spectroscopic and molecular dynamics study.

Bombesin is a tetradecapeptide that possesses a random coil structure in pure water. In the presence of 30 % (v/v) 2,2,2-trifluoroethanol (TFE), it adopts a partial helical conformation involving the C-terminal amino acids 6-14. This conformational change, known as the TFE effect, is studied here in terms of the solvation state of the peptide at different TFE concentrations by means of intermolecular homo- and heteronuclear NOE measurements. When an aqueous solution of bombesin is titrated with TFE, a continual decrease in the water/peptide interactions and a concomitant increase in the TFE/peptide interactions is observed, and at 30 % (v/v) TFE no homonuclear NOEs between water and the peptide can be detected. The conformational transition of the bombesin molecule is thus accompanied by a complete surface covering with TFE. A parallel molecular dynamics (MD) study of the peptide in aqueous solution with the single-point charge (SPC) water model and in a 30 % (v/v) TFE/water mixture with a recently developed TFE model has also been performed. The 10 ns simulations were in agreement with the experimental data. The calculations indicate stabilisation of the alpha-helix in the H(2)O/TFE mixture, in contrast to the situation in pure water, and clustering of the TFE molecules around the peptide.

Socio-economic health inequalities in Brazil: gender and age effects.

This paper analyses Brazilian socio-economic inequalities in health by measuring the concentration indices for the following variables: health expectancy, self-assessed health status and chronic health problems. Data used were taken from the 1996/1997 Living Standard Measurement Study (LSMS). In summary, as far as gender distinction is concerned, the results showed that up to 5 years of age the mortality rates, reported appearance of chronic health problems as well as the self-assessed health indicated that the boys were in worse health condition than the girls. After this age group there was a tendency for differences to disappear until adulthood, when the situation changed and the women consistently considered themselves less healthy. With reference to the socio-economic inequalities, one generally finds larger differences within the women's groups. The analysis for the different age groups indicated that the pro-rich inequalities increased with age. Both results were clearly proved, especially for the health expectancy variable, by adopting an adjustment of the dominance concept derived from literature on economic inequalities, consisting of comparing concentration curves.