Desprendimiento de retina tras la cirugía de cristalino transparente con lentes intraoculares EDOF y multifocales: una revisión narrativa / Retinal detachment after refractive lens exchange with EDOF and multifocal intraocular lenses: A narrative review

La cirugía de cristalino transparente (RLE) permite corregir las ametropías y la presbicia mediante el reemplazo del cristalino por una lente intraocular (LIO), ya sea monofocal, multifocal (MIOL) o de profundidad de foco extendida (EDOF). El desprendimiento de retina (DR) es uno de los eventos adversos más graves tras la RLE. El objetivo de este estudio fue revisar la evidencia y los resultados clínicos relacionados con el riesgo de DR después de la RLE. Se realizó una búsqueda utilizando PubMed y un procedimiento de bola de nieve para identificar estudios originales y series de casos. Según la bibliografía, los pacientes < 60 años con longitudes axiales > 23 mm tienen el mayor riesgo de DR. Solo nueve artículos reportaron la agudeza visual (AV) tras el DR en RLE, y solo 25% de los ojos mostraron una AV > 20/40. Teniendo en cuenta que la disminución de la AV tras el DR se puede dar con todos los tipos de LIO independientemente de su diseño óptico, la actitud más acertada al realizar una RLE sería una cuidadosa selección del paciente, evitando aquellos ojos con factores de riesgo para DR (AU)

Refractive lens exchange (RLE) allows to correct ametropias and presbyopia by replacing the crystalline lens with a monofocal, extended depth of focus or multifocal intraocular lens (IOL). Retinal detachment (RD) is one of the most serious adverse events after RLE. This study aimed to review the evidence related to the risk of RD after RLE and its clinical outcomes. A search using PubMed and a snowball search approach was conducted to identify articles and case reports. According to the literature, patients <60 years old with axial lengths >23 mm have the higher postoperative risk of RD. Only nine articles reported visual acuity (VA) after RD in RLE, and only 25% of eyes had a VA>20/40. Considering that the decrease in VA might be uniform for all types of IOLs after RD, surgeons should focus on preventing the RD by means of selecting the appropriate patient, rather than choosing on a particular IOL optical design (AU)

Retinal detachment after refractive lens exchange: A narrative review.

Refractive lens exchange (RLE) allows to correct ametropias and presbyopia by replacing the crystalline lens with an extended depth of focus or multifocal intraocular lens (IOL). Retinal detachment (RD) is one of the most serious adverse events after RLE. This study aimed to review the evidence related to the risk of RD after RLE and clinical outcomes. A search using PubMed and a snowball search approach was conducted to identify articles and case reports. According to the literature, the risks of RD should be considered in patients <60 years old with axial lengths >23 mm. Only nine articles reported visual acuity (VA) after RD in RLE, and only 25% of eyes had a VA > 20/40. Considering that the decrease in VA might be uniform for all types of IOLs after RD, surgeons should focus on selecting the patient to prevent RD rather than on a particular IOL optical design based on the potential risk of DR.

[Seroprevalence of antibodies against measles virus in Galicia: trends during the last ten years depending on age and sex]. / Seroprevalencia de anticuerpos frente al virus del sarampión en Galicia: tendencias durante los últimos diez años en función de la edad y sexo.

OBJECTIVE: In 1998, the Europe Region of the World Health Organization set the goal of eliminating measles. In this study, the prevalence of immunity against measles virus in the population of the health area of Santiago de Compostela was analyzed based on data obtained between 2008-2018. METHODS: A total of 7,150 different patients were studied and divided into groups according to their year of birth: 2010-2017, 2000-2009, 1990-1999, 1980-1989, 1953-1979 and <1953. The serum determination of IgG against measles virus was performed using a commercialized chemiluminescent immunoassay. RESULTS: A minimum (76%) was observed for measles virus protection rates in those born between 1990-1999. By age group it was seen that in all groups the women presented a higher percentage of antibodies against measles. In a logistic regression model with year of birth and sex, an odds ratio of 1.06 (p<0.001) was obtained for the year of birth and of 0.82 (p=0.0013) for sex. CONCLUSIONS: It was observed lower seroprevalences from the implantation of the vaccine and a more pronounced change during the implantation period. From the vaccination plan for measles of the year 2000 in Galicia, the rates of protection against the virus of the measles have been increasing in our area. Although there is a greater proportion of women protected against men, these differences are small.

[Infection by the Epstein-Barr virus between the years 2006-2015 in the health area of Santiago de Compostela. Relationship with age and sex]. / Primoinfección por el virus Epstein-Barr entre los años 2006 a 2015 en el área sanitaria de Santiago de Compostela. Relación con edad y sexo.

OBJECTIVE: In Spain, the age and sex to which the primary infection by EBV is produced is poorly studied. The objective of this work is to know its relation with the presence of the primary infection by EBV between the years 2006 and 2015 in our health area. METHODS: From the Santiago de Compostela health area between 2006 and 2015, 578 patients with serological patterns of EBV primoinfection were selected. This patients presented serological results of IgM-VCA positive, IgG-VCA positive and EBNA negative. RESULTS: We found 260/578 (45%) adolescents (11- 19 years). In the number of cases by age the maximum was observed, at 2 and 16 years. Between 14-19 years, 62% (79/127) of women between 14-16 years of age, median age 15.8 years (IQ: 14.8-16.4) compared to 48% (49/102) of men, median age 16 years (IQ: 15.7-16.6) (p = 0.032, p = 0.02, respectively). CONCLUSIONS: As in our study, in the developed countries the majority of primary infections by EBV occur in adolescence and a bimodal distribution is observed in relation to age. During adolescence women acquire before men the first infection by EBV.

Embarazo en pacientes con lesión medular / Pregnancy in patients with spinal cord injury

ANTECEDENTES: Las gestaciones en pacientes con daño medular representan un reto para la obstetricia. Las complicaciones más frecuentes son las infecciones de las vías respiratorias y de las vías urinarias, y la más grave la hiperreflexia autonómica. El parto vaginal es posible en lesiones por debajo de T5, pero por encima de ese nivel, la imposibilidad de percibir las contracciones, de identificar el trabajo de parto y realizar pujos lleva a la necesidad de una cesárea programada. OBJETIVO: Exponer nuestra experiencia y revisar el manejo más adecuado de la embarazada parapléjica. MÉTODOS: Estudio retrospectivo en el periodo 2003-2014. Hubo 10 pacientes con 24 gestaciones: 6 abortos espontáneos, un 1 aborto inducido, quedando para el análisis 17 gestaciones (1 embarazo gemelar). La evaluación es independiente a la etiología o localización de la lesión. Se analiza las complicaciones perinatales y maternas. Resultados: La edad media fue 33 años. La edad gestacional media al parto fue 37 semanas: 12 de término (70,59%), 4 de pretérmino (23,53%) y una desconocida (5,88%). Hubo 10 cesáreas (58,82%) y 7 partos vaginales (41,18%). Peso medio neonatal de 2940 g, ninguno con retraso de crecimiento intrauterino. CONCLUSIONES: Nuestra experiencia muestra una alta tasa de prematuridad y de cesáreas, pero con buenos resultados maternos y perinatales, que hace permisible que estas pacientes puedan cumplir su deseo genésico, superando su discapacidad.

BACKGROUND: The pregnancies in patients with spinal cord injury represent a challenge for obstetrics. The most common complications are infections of the respiratory and urinary tract, and the most severe is the autonomic hyperreflexia. Vaginal delivery is possible in lesions below T5, but above that level the inability to perceive contractions, to identify labor and perform straining leads to the need for a scheduled cesarean. OBJECTIVE: To describe our experience and review the most appropriate management of paraplegic pregnant. Methods: Retrospective study in the period 2003-2014. There were 10 patients with 24 pregnancies: 6 spontaneous abortions, 1 induced abortion, leaving 17 for analysis pregnancies (one twin pregnancy). The evaluation is independent of the etiology or location of the lesion. Perinatal and maternal complications were analyzed. RESULTS: The mean age was 33 years. The mean gestational age at delivery was 37 weeks: 12 to term (70.59%), 4 preterm deliveries (23.53%) and one unknow. There were 10 cesarean sections (58.82%) and 7 vaginal deliveries (41.18%). Average birth weight of 2940 g, none with intrauterine growth restriction. CONCLUSIONS: Our experience shows a high rate of prematurity and cesarean section, but with good maternal and perinatal outcomes, which makes it permissible for these patients can fulfill their procreative desire, overcoming his disability.

Ocular and systemic adverse effects of ophthalmic and non ophthalmic medications.

Information related to adverse drug effects caused by ocular medications and ocular adverse effects of systemically administered drugs has increased over the last several decades. Here we review the medical literature over the last four decades to both quantitatively and qualitatively determine the adverse effects of ocular drugs and ocular toxicity of non-ocular drugs. A systematic bibliographic review of the literature was performed with the following terms: "drug treatment", "drug therapy", "ocular adverse effects", "ocular side effects", "ocular toxicity", "systemic side effects", "systemic adverse effects", "systemic toxicity", "ocular drug" and "ophthalmic drug" using the Boolean operators or, and, not. Searches focused on: (1) Ocular side/adverse effects of ophthalmic drugs; (2) Ocular side/adverse effects of systemic drugs; (3) Systemic side/adverse effects of ophthalmic drugs. PubMed was used to perform searches. Limits included: species, human and field tag, abstract/title, dates from 01/01/1971 to 31/12/2010. A sub-selection of references was made by discarding articles that were irrelevant for the topics listed above. Adverse effects of alpha2-adrenergic agonists, beta-adrenergic antagonists, quinine derivatives and antituberculosis agents appear in the literature throughout the period of the review. Adverse effects of newer drugs such as amiodarone, phosphodiesterase 5 inhibitors, antiepileptics, tamoxifen, and its interactions have been published principally in the last two decades. It is imperative for patient safety that knowledge of the adverse effects of drugs on the eye whether topically or systemically administered, and the possible systemic effects of drugs given as ophthalmic medications be emphasized to clinicians.

Airborne pollen calendar of Salamanca, Spain, 2000–2007

Background: The determination of pollen types and their proportions in the atmosphere of relevant urban areas have increasingly been evaluated in different regions. The final goal has been to elaborate a pollen calendar, providing data about the occurrence of pollen grains in the air, thus permitting medical treatment and prophylaxis. Methods: An aerobiological study was carried out in the atmosphere of the city of Salamanca, Spain, during eight years (2000–2007) by means of a Hirst type volumetric spore trap. A pollen calendar was elaborated following exponential classes obtained from 10-day average concentrations of the main pollen types. Results: Mean annual pollen index was 16,916, coming from 72 different types of pollen. During the studied period, an increase of annual pollen levels was registered by means of regression analysis index. The most important types of pollen were Quercus, Poaceae, Cupressaceae, Olea, and Plantago. Arboreal pollen grains (62.7%) were more represented in airborne pollen spectrum than non-arboreal pollen (37.3%). Airborne pollen levels were particularly high between April and July, showing the highest values in May and June. Conclusions: In aerobiological terms Poaceae pollen seems to be a major risk for potential sensitised individuals due to its known allergenicity and its high atmospheric concentrations between late spring and early summer, followed by Cupressaceae, Olea and Platanus pollen grains, and taking into account the possible role of Fraxinus and Quercus in earl spring allergenic courses and in processes of cross-sensitivity, respectively

Airborne pollen calendar of Salamanca, Spain, 2000-2007.

BACKGROUND: The determination of pollen types and their proportions in the atmosphere of relevant urban areas have increasingly been evaluated in different regions. The final goal has been to elaborate a pollen calendar, providing data about the occurrence of pollen grains in the air, thus permitting medical treatment and prophylaxis. METHODS: An aerobiological study was carried out in the atmosphere of the city of Salamanca, Spain, during eight years (2000-2007) by means of a Hirst type volumetric spore trap. A pollen calendar was elaborated following exponential classes obtained from 10-day average concentrations of the main pollen types. RESULTS: Mean annual pollen index was 16,916, coming from 72 different types of pollen. During the studied period, an increase of annual pollen levels was registered by means of regression analysis index. The most important types of pollen were Quercus, Poaceae, Cupressaceae, Olea, and Plantago. Arboreal pollen grains (62.7%) were more represented in airborne pollen spectrum than non-arboreal pollen (37.3%). Airborne pollen levels were particularly high between April and July, showing the highest values in May and June. CONCLUSIONS: In aerobiological terms Poaceae pollen seems to be a major risk for potential sensitised individuals due to its known allergenicity and its high atmospheric concentrations between late spring and early summer, followed by Cupressaceae, Olea and Platanus pollen grains, and taking into account the possible role of Fraxinus and Quercus in early spring allergenic courses and in processes of cross-sensitivity, respectively.

Molecular alterations of KIT and PDGFRA in GISTs: evaluation of a Portuguese series.

AIM: To assess KIT and PDGFRA mutations frequencies in a Portuguese series of gastrointestinal stromal tumours (GISTs). METHODS: 78 GISTs were evaluated for CD117 expression and screened for mutations in KIT (exons 9, 11, 13, 14 and 17) and PDGFRA (exons 12, 14 and 18) genes. RESULTS: KIT activating mutations were identified in 44 (56%) of the 78 GISTs. Forty cases (91%) presented a mutation in KIT exon 11, and 4 (9%) in exon 9. One case showed a 4 bp deletion in intron 14. PDGFRA mutations were observed in 5 cases (6%): 2 (3%) in exon 12 and 3 (4%) in exon 18. Survival analysis was performed in 63 of the 78 GISTs. The presence of mutated KIT was significantly correlated with shorter survival of patients (p = 0.0460), and inversely associated with epithelioid histological type of GISTs (p = 0.0064). CONCLUSIONS: Overall, the incidence of both KIT and PDGFRA mutations in these Portuguese series was 63%, being in agreement with other studies, mainly of Iberian populations. The great majority of mutations were located in KIT exon 11, statistically associated with worse prognosis and indicative of favourable response to imatinib-based therapy in this Portuguese series of GISTs.

Necrotizing fasciitis after liposuction.

Necrotizing fasciitis is a progressive soft tissue infection (skin, subcutaneous tissue and fascia) caused in the main by Streptococcus pyogenes, which gains entry into the organism through any type of wound and even through intact skin. Diagnosis is essentially clinical, being the sum of non-specific, insidious skin lesions, associated with intense pain and multiorgan failure. Treatment is radical surgical excision of the affected tissues, combined antibiotic therapy and supportive care. However, mortality rates are still very high. It is therefore a disease to be taken very seriously, not only in the population as a whole, but following any surgical intervention, including cosmetic surgery, where there have been reports of cases. We present a case treated in our Department, with the aim of augmenting the references available on the subject and consequently increasing awareness and interest in this serious condition which has such terrible consequences.

[Burns produced by lighters]. / Quemaduras por manipulación de encendedores.

OBJECTIVE: To describe the characteristics of patients requiring hospitalization for burns produced by lighter flame and to review current knowledge about their prevention. PATIENTS AND METHODS: We performed a retrospective, descriptive study through a review of the medical records of children (0-14 years) admitted to our hospital for more than 24 hours with burns and/or smoke inhalation from 2000-2004. Of these, accidents related to the handling of lighters were selected. The variables studied were: age, sex, mechanism, extent of body surface area (BSA) burned, degree of burn, length of hospital stay, the need for skin grafts, mortality, and sequelae. RESULTS: Twenty-two patients were evaluated. Seventy-six percent were boys. Age ranged from 1.5 years to 14 years. Ten patients (45 %) were aged less than 6 years old and 12 were aged 6 years old or older (55 %). The percentage of BSA burned varied: 65 % presented burns of less than 10 % BSA. Twenty-seven percent (6 patients) suffered major burns (> 20 %BSA). The mean length of hospital stay was 25 days (range:4-58 days). Seventy-seven percent of patients required surgery, mainly wound debridement and skin autografting and 33 % showed sequelae. The most severe was hypoxic-ischemic encephalopathy due to smoke and CO inhalation in 1 patient, who developed severe psychomotor sequelae and died 3 months later from infectious complications related to severe encephalopathy. Overall, 2 patients (9 %) died. CONCLUSIONS: Because of the frequency and severity of burns associated with lighter handling by children, pediatricians should increase their efforts to educate families. Effective legislation should be passed in Spain aimed at incorporating childproof safety devices in lighters.

Quemaduras por manipulación de encendedores / Burns produced by lighters

Objetivo: Describir las características de los pacientes que han precisado hospitalización por quemaduras producidas por llama en relación con la manipulación de encendedores, y revisar el estado actual de su prevención. Pacientes y métodos: Estudio retrospectivo de historias clínicas de los pacientes afectados de quemaduras por llama y/o inhalación de humo (de 0 a 14 años) ingresados durante más de 24 h en nuestro Hospital entre el año 2000 y 2004. De ellos, seleccionamos los accidentes producidos en relación con la manipulación de encendedores. Se estudiaron las siguientes variables: edad, sexo, mecanismo, superficie corporal quemada (SCQ), grado de profundidad, duración del ingreso, pacientes que requirieron injerto cutáneo, mortalidad y secuelas. Resultados: Se ha evaluado 22 pacientes, por parte de los niños. El 76 % eran varones. El rango de edad fue desde 1,5 años hasta los 14 años. Diez fueron menores de 6 años (45 %) y 12 tenían 6 o más años (55 %). El porcentaje de SCQ fue variable, siendo el grupo más numeroso, con el 64 %, el que presentaba quemaduras en menos del 10 % de SCQ y encontrado un porcentaje del 27 % (6 pacientes) con superficie de gran quemado (> 20 % SCQ). La estancia media fue de 25 días (límites: 4-58 días). El 77 % precisaron cirugía, principalmente desbridamiento y autoinjerto cutáneo. El 33 % presentaron secuelas, siendo la más grave la de un paciente con encefalopatía hipóxico-isquémica, por inhalación de humos y CO que desarrolló secuelas psicomotoras graves y falleció, posteriormente, al cabo de 3 meses por complicaciones infecciosas relacionadas con su encefalopatía de grado profundo. En total fallecieron 2 pacientes (9 %). Conclusiones: La producción de quemaduras por la manipulación de encendedores en los niños origina una morbilidad importante que justifica establecer una mejor prevención de estos accidentes, mediante la educación de la población. Deberían existir medidas de tipo legislativo en España, al objeto de incorporar dispositivos de seguridad en los encendedores, para niños menores de 5 años

Objective: To describe the characteristics of patients requiring hospitalization for burns produced by lighter flame and to review current knowledge about their prevention. Patients and methods: We performed a retrospective, descriptive study through a review of the medical records of children (0-14 years) admitted to our hospital for more than 24 hours with burns and/or smoke inhalation from 2000-2004. Of these, accidents related to the handling of lighters were selected. The variables studied were: age, sex, mechanism, extent of body surface area (BSA) burned, degree of burn, length of hospital stay, the need for skin grafts, mortality, and sequelae. Results: Twenty-two patients were evaluated. Seventy-six percent were boys. Age ranged from 1.5 years to 14 years. Ten patients (45 %) were aged less than 6 years old and 12 were aged 6 years old or older (55 %). The percentage of BSA burned varied: 65 % presented burns of less than 10 % BSA. Twenty-seven percent (6 patients) suffered major burns (> 20 %BSA). The mean length of hospital stay was 25 days (range:4-58 days). Seventy-seven percent of patients required surgery, mainly wound debridement and skin autografting and 33 % showed sequelae. The most severe was hypoxic-ischemic encephalopathy due to smoke and CO inhalation in 1 patient, who developed severe psychomotor sequelae and died 3 months later from infectious complications related to severe encephalopathy. Overall, 2 patients (9 %) died. Conclusions: Because of the frequency and severity of burns associated with lighter handling by children, pediatricians should increase their efforts to educate families. Effective legislation should be passed in Spain aimed at incorporating childproof safety devices in lighters

Actualización epidemiológica y mortalidad de quemados adultos en Cataluña (España) / Adult burn epidemiology and mortality rate update in Catalonia (Spain)

La Unidad de Quemados del Hospital Universitario de la Vall d’Hebron de Barcelona (España) ha realizado un segundo estudio epidemiológico y de mortalidad en quemados adultos que complementa y actualiza el publicado por Barretet al en 1998. La revisión epidemiológica comprende cinco años, desde enero de 1997 a diciembre de 2001. En dicho período se atendieron 1430 urgencias/año con una media de424 ingresos/año hasta un total de 2120 pacientes ingresados vía urgencias. Con una mortalidad global del 3,25 %, se observa una disminución aparente respecto a la obtenida en la primera mitad de la década de los 90 (3,49 %). La causa principal de quemaduras es el accidente casual por llama, destacándola ignición de material altamente inflamable, siendo la mortalidad en mujeres más elevada que en hombres: 3,43 versus3,14 % (p<0,05). Varios son los factores que determinan un peor pronóstico evolutivo de los pacientes como son la edad, la superficie corporal total quemada (SCTQ), la inhalación de humos, el ingreso en la Unidad de Cuidados Intensivos(UCI) y los antecedentes personales previos. La Dosis Letal 50 (DL50) obtenida en este período de 83,2 % de superficie corporal total quemada (SCTQ) conjuntamente con la baja mortalidad, sitúan a la Unidad de Quemados de la Vall d’Hebron en el grupo de centros desarrollados con mejores índices de supervivencia en quemados (AU)

The Val d’Hebron University Hospital Burns Unit in Barcelona (Spain) has carried out a second study of epidemiology and mortality rate in adult burns cases, which complements and updates the one published by Barret et al in 1998 (1). The epidemiology consists of five years between January 1997 and December 2001. In this period , 1430 urgent cases were treated per year, with an average of 424 admissions per year, thus making a total of 2120 patients admitted through emergencies. The average mortality rate (3,25%) shows an apparent decrease compared with the results obtained during the first half of the 90s decade, ( 3,49%). The main cause of burns are accidents with involving fire, which subsequently cause the ignition of highly flammable material. The death rate in women is higher than that in men: 3,43% compared with 3,14%. There are various factors which determine the worst evolutional prognosis: age, TBAB (total body area burned), smoke inhalation, admittance into Intensive Care Unit (ICU), personal antecedents. The Lethal Dose 50 (LD50) (83,2%) and the low mortality rate seen during this period places the Burns Unit of the Val d’Hebron amongs the best developed centres with the highest survival rates of burns cases (AU)

[Tap-water scald burns]. / Quemaduras por agua caliente sanitaria.

OBJECTIVE: To describe the characteristics of patients with tap-water scalds admitted to our hospital and review current knowledge on their prevention. PATIENTS AND METHODS: We performed a retrospective study of admissions for tap-water scalds. The medical records codified as water-tap scalds (MBDS; CIE-9-CM, 940.0-949.5, E.924.0, E.924.2) of patients admitted to our hospital for more than 24 hours from January 1 to December 31, 2003 were reviewed. The following variables were studied: age, sex, mechanism, extent and degree of burn, localization, length of hospital stay, treatment, requirement for skin grafting, mortality, and sequelae. RESULTS: Twenty-nine patients were treated in our hospital. Sixty-two percent were boys. Age ranged from 3 days to 9 years. Six patients (20.6 %) were aged less than 1 year, 19 (63 %) were aged between 1 and 3 years and four (13.8 %) were aged from 3 to 9 years. Body surface area was 10 % or less in 25 patients and more than 20 % in four. Five patients required skin autografting. In two patients, the scald was produced in the neonatal area of our hospital. The mean length of hospital stay was 12 days, ranging from 1 to 38 days. None of the patients died. One patient suffered severe sequelae. CONCLUSIONS: Because of the frequency and severity of the burns reported in this study, pediatricians should increase their efforts in educating families about this type of burn. In addition, effective legislation should be implemented in Spain.

Quemaduras por agua caliente sanitaria / Tap-water scald burns

Objetivo: Describir las características de los pacientes que han precisado hospitalización por quemaduras producidas por agua sanitaria y revisar el estado actual de su prevención. Pacientes y métodos: Estudio retrospectivo por revisión de historias clínicas codificadas como quemaduras por agua sanitaria (CMBD; CIE-9-CM, 940.0-949.5, E924.0, E.924.2) ingresados durante más de 24 h en nuestro hospital desde el 1 de enero de 1998 hasta el 31 de diciembre de 2003. Se estudiaron las siguientes variables: edad, sexo, mecanismo, extensión y grado de profundidad de la quemadura, duración del ingreso, casos que requirieron injerto cutáneo, mortalidad y secuelas. Resultados: Se ha evaluado a 29 pacientes. El 62 por ciento eran varones. El rango de edad fue desde los 3 días de vida a los 9 años de edad. Seis pacientes eran menores de un año (20,6 por ciento), 19 de 1 a 3 años (63 por ciento), y 4 mayores de 3 años (13,8 por ciento). En cuanto a la superficie corporal quemada, en 25 casos fue igual o inferior a 10 por ciento, y en cuatro fue superior al 20 por ciento. Cinco pacientes requirieron la realización de autoinjerto cutáneo. Dos quemaduras fueron intrahospitalarias, que correspondían a dos recién nacidos. La estancia media fue de 12 días, con un rango de 1 a 38 días. Se observaron secuelas graves en un paciente. No hubo mortalidad. Conclusiones: La incidencia y la gravedad de los pacientes descritos justifican incrementar las medidas preventivas por parte del pediatra, y consideramos que deberían existir medidas de tipo legislativo en España (AU)

Neuroendocrine dopaminergic regulation of prolactin release in systemic lupus erythematosus: a possible role of lymphocyte-derived prolactin.

Prolactin (PRL) secretion by the pituitary is under the control of dopamine. Hyperprolactinemia has been found in patients with systemic lupus erythematosus (SLE) and seems to be associated with clinical activity. T-lymphocytes express PRL and those from SLE patients appear to secrete more PRL than controls. In this study, immuno-(RIA) and bio-(BIO) assayable PRL in both serum and culture media of peripheral blood mononuclear cells (PBMNC) from SLE and control subjects were evaluated in the basal state and in response to 10 mg oral administration of metoclopramide, a dopamine receptor antagonist. Prolactin size heterogeneity in serum and culture media and PRL gene transcription in PBMNC were also studied. Basal serum RIA-PRL, BIO-PRL and the BIO/RIA ratio were similar in both groups. The serum BIO-PRL response after metoclopramide was higher than RIA-PRL in SLE, and this increment was also greater than in control subjects. PBMNC from SLE subjects secreted and produced more BIO-PRL. After metoclopramide, secretion and production of PRL increased only in PBMNC from control women and not in those from SLE patients. Our results demonstrated an increased central dopaminergic tone in SLE and suggest that lymphocyte-derived PRL might contribute to alter the functional activity of the hypothalamic dopaminergic system in SLE attempting to maintain serum PRL within a physiological range.

[New paradigms in the regulation of bone metabolism]. / Nuevos paradigmas en la regulación del metabolismo óseo.

Although multiple hormones and cytokines regulate various aspects of osteoclast formation, the two final effectors, osteoprotegerin (OPG) and its ligand (OPGL/RANKL) have been recently identified. Since then, there have been important advances in the understanding of the molecular mechanisms that regulate the crosstalk between osteoblasts/stromal and hematopoietic osteoclast precursor cells. In this article, we describe the new concepts from the identification of OPG, a protein with potent osteoclastogenesis inhibitory activity, to the isolation of RANKL, a transmembrane ligand expressed on osteoblasts/stromal cells that bind to RANK, a transmembrane receptor on osteoclast cells and its precursors. The interaction between RANK and RANKL triggers a series of mechanisms that result in differentiation, maturation and activation of osteoclasts. OPG inhibits osteoclastogenesis binding to RANKL and blocks its interaction with RANK. Many hormones and cytokines, like PTH and IL-11, act inhibiting production of OPG and stimulating production of RANKL. Contrary to this, estrogens inhibit production of RANKL and RANKL-stimulated osteoclastogenesis. The knowledge of the RANK/RANKL/OPG system and the understanding of osteoclast differentiation and activation has had a great impact on the field of bone metabolism, with new possible treatment strategies for diseases characterized by excessive bone resorption.

[Prevalence of anemia in pregnancy, Pucallpa Regional Hospital, Perú]. / Prevalencia de anemia en gestantes, Hospital Regional de Pucallpa, Perú.

Population based health surveys in Peru show that the general fertility rates, proportion of pregnant adolescents, and maternal and child morbidity are higher in the jungle regions than in other parts of the country. Endemic intestinal parasitic diseases increase the risk of anemia in pregnant women already suffering from iron, folic acid, and other nutritional deficiencies. This is the most common complication of pregnancy in many Latin American countries and is often associated with premature labor, low birthweight, and perinatal mortality. There are very few studies on this subject based on jungle populations and no reliable estimates of the prevalence of anemia in local pregnant women. The present study was designed to determine the prevalence of anemia in pregnant women attending the Regional Hospital in Pucallpa, located in the Peruvian jungle, from January 1993 to June 1995. This cross-sectional study, which was based on the registries of prenatal and childbirth services encompassing 1,015 pregnant women, looked into the potential association between anemia and such variables as the mother's chronological age, schooling, previous pregnancies, and weight at the beginning of pregnancy. Maternal hemoglobin levels were compared with the newborns' weight at birth. The prevalence of anemia in this population sample was 70.1%. This value was not modified when adjusted for maternal age, schooling, or interval between births. Anemia prevalence was directly related to the number of previous pregnancies and inversely related to weight gain during pregnancy. The perinatal mortality rate was 37.7 per 1,000 births. Neither this rate nor the birthweights were associated with the mother's degree of anemia. A multivariate regression analysis showed that maternal body weight at the start of pregnancy (P = 0.0001), weight gain during pregnancy (P = 0.0001), and the number of pregnancies (P = 0.008) are predictors of birthweight. Results showed that the high prevalence of anemia in Pucallpa's pregnant women is not associated with low birthweight or a high perinatal mortality rate. Future studies should investigate the principal causes of anemia in the pregnant women of Pucallpa and how the disease affects the psychomotor development of their offspring.

The effectiveness of an interactive computer program versus traditional lecture in athletic training education.

OBJECTIVE: To evaluate the effectiveness of an interactive athletic training educational curriculum (IATEC) computer program as compared with traditional lecture instruction. Instructions on assessment of the quadriceps angle (Q-angle) were compared. Dependent measures consisted of cognitive knowledge, practical skill assessment, and attitudes toward the 2 methods of instruction. DESIGN AND SETTING: Sixty-six subjects were selected and then randomly assigned to 3 different groups: traditional lecture, IATEC, and control. The traditional lecture group (n = 22) received a 50-minute lecture/demonstration covering the same instructional content as the Q-angle module of the IATEC program. The IATEC group (n = 20; 2 subjects were dropped from this group due to scheduling conflicts) worked independently for 50 to 65 minutes using the Q-angle module of the IATEC program. The control group (n = 22) received no instruction. SUBJECTS: Subjects were recruited from an undergraduate athletic training education program and were screened for prior knowledge of the Q-angle. MEASUREMENTS: A 9-point multiple choice examination was used to determine cognitive knowledge of the Q-angle. A 12-point yes-no checklist was used to determine whether or not the subjects were able to correctly measure the Q-angle. The Allen Attitude Toward Computer-Assisted Instruction Semantic Differential Survey was used to assess student attitudes toward the 2 methods of instruction. The survey examined overall attitudes, in addition to 3 subscales: comfort, creativity, and function. The survey was scored from 1 to 7, with 7 being the most favorable and 1 being the least favorable. RESULTS: Results of a 1-way ANOVA on cognitive knowledge of the Q-angle revealed that the traditional lecture and IATEC groups performed significantly better than the control group, and the traditional lecture group performed significantly better than the IATEC group. Results of a 1-way ANOVA on practical skill performance revealed that the traditional lecture and IATEC groups performed significantly better than the control group, but there were no significant differences between the traditional lecture and IATEC groups on practical skill performance. Results of a t test indicated significantly more favorable attitudes (P < .05) for the traditional lecture group when compared with the IATEC group for comfort, creativity, and function. CONCLUSIONS: Our results suggest that use of the IATEC computer module is an effective means of instruction; however, use of the IATEC program alone may not be sufficient for educating students in cognitive knowledge. Further research is needed to determine the effectiveness of the IATEC computer program as a supplement to traditional lecture instruction in athletic training education.