Approaches to the epidemiology of NOHL in the region of Madrid: Survey of neuro-ophthalmologists.

OBJECTIVE: To estimate the epidemiology of Leber's optic neuropathy (NOHL) in the Region of Madrid. MATERIAL AND METHODS: The neuro-ophthalmologists who work at public hospitals of the CAM were interviewed by telephone. They were asked about the number of patients with NOHL that they had diagnosed during the time that they had been responsible for the neuro-ophthalmology department of that public hospital. The time worked and the population attended by the hospital were used to calculate the number of inhabitant-years in follow-up by each center during the corresponding period. The basic information of each case (date of birth, mutation, date of visual loss) was registered to avoid duplications. RESULTS: Our work estimates a global incidence of 2.34 cases for 10,000,000 inhabitants-year and a prevalence estimated from incidence of one case for each 106.682 inhabitants. This prevalence was very similar in all the studied areas and considerably lower than that reported by other studies. CONCLUSION: This work constitutes the first approach to the epidemiology of this disease in Spain. The prevalence of LHON in the region of Madrid, is probably lower than that reported in the literature in other regions. The prevalence and the incidence were homogeneously low in the 26 studied areas.

Tratamiento combinado con etanercept y fármacos sistémicos/fototerapia en psoriasis / Etanercept Combined With Systemic Drugs or Phototherapy for Treatment of Psoriasis

Los fármacos biológicos han mostrado un excelente perfil en el tratamiento de la psoriasis moderada-grave. Sin embargo, existen situaciones de la práctica clínica habitual que se pueden beneficiar de combinaciones con los diferentes fármacos sistémicos, asi como de la fototerapia, permitiendo mejorar la eficacia, disminuir toxicidades o reducir los costes de tratar la enfermedad psoriásica. Hasta ahora la experiencia publicada de estas combinaciones es escasa pero los resultados son en muchos casos satisfactorios. En esta revisión se repasan las experiencias publicadas más relevantes con respecto a la combinación del fármaco biológico con más experiencia en este campo, etanercept, con metotrexato, acitretina, ciclosporina y fototerapia con ultravioleta B de banda estrecha. La experiencia procedente de la literatura puede ayudar a la hora de tomar decisiones importantes en el manejo de fármacos biológicos y sistémicos en la psoriasis moderada-grave

Biologic drugs have provided excellent results in the treatment of moderate to severe psoriasis. Nevertheless, in routine clinical practice, combinations of biologic drugs with phototherapy or systemic drugs can increase efficacy, diminish toxicity, and reduce the cost of treatment. Published experience with these combinations is scarce, although the results are often satisfactory. This review examines the most relevant published experience in the combination of the most studied drug in this field -etanercept- with methotrexate, acitretin, ciclosporin, and narrowband UV-B phototherapy. Findings reported in the literature can help when taking major decisions on the management of biologic and systemic drugs in moderate to severe psoriasis

Etanercept combined with systemic drugs or phototherapy for treatment of psoriasis.

Biologic drugs have provided excellent results in the treatment of moderate to severe psoriasis. Nevertheless, in routine clinical practice, combinations of biologic drugs with phototherapy or systemic drugs can increase efficacy, diminish toxicity, and reduce the cost of treatment. Published experience with these combinations is scarce, although the results are often satisfactory. This review examines the most relevant published experience in the combination of the most studied drug in this field-etanercept-with methotrexate, acitretin, ciclosporin, and narrowband UV-B phototherapy. Findings reported in the literature can help when taking major decisions on the management of biologic and systemic drugs in moderate to severe psoriasis.

Estudio descriptivo sobre accidentes infantiles de 0-14 años en un centro de salud urbano de Huesca / Descriptive study on accidents of 0-14 year old children in an urban health care center of Huesca (Spain)

Introducción. Los accidentes infantiles son la primera causa de muerte en niños de 1 a 14 años. Su importancia reside sobretodo en sus graves consecuencias y en que se pueden prevenir. Para ello es necesario conocer la epidemiología. Existen, en nuestro medio, muy pocos estudios realizados a nivel de asistencia primaria. El objetivo de este estudio es el de conocer la epidemiología de los accidentes infantiles en niños atendidos en un Centro de Salud de Huesca. Material y método. Se trata de un estudio prospectivo iniciado el 1 de abril de 2008 y terminado el 30 de marzo de 2009. Se registraron todos los accidentes infantiles padecidos por los niños que acudieron a la consulta durante este período. Resultados. Se registraron 172 accidentes siendo las caídas lo más frecuentes. 11 niños (9,6%) sufrieron quemaduras. No se encontraron diferencias en relación al día. El pico horario de 19 a 20 horas fue el de máxima incidencia. Un 14,5% habían padecido un accidente con anterioridad. El 69,2% estaban acompañados por un adulto en el momento del accidente, 33 niños (19,1%) fueron tratados en el hospital y 4 (2,3%) requirieron ingreso hospitalario. Comentario. Aunque el número de niños estudiados por nosotros no es muy elevado la incidencia no es nada despreciable. Creemos necesario un mayor conocimiento epidemiológico a nivel de asistencia primaria para poder mejorar la prevención (AU)

Introduction. The childish injuries are the first cause of death in boys of 1 to 14 years. His importance overcoat owes in h is grave consequences and in that they can to prevent. For this is necessary to know the epidemiology. Exist, in our half, very few studies realized to level of primary assistance. The aim of this study is the one to know the epidemiology of the childish injuries in boys attended in a Centre of Health of Huesca. Material and method. Treat of a prospective study initated the 1 of April of 2008 and finished the 30 of march of 2009. The registered all the childish injuries suffered by the boys that they came to the Center during this period . Results. They registered 172 accidents being the falls the most frequent. 11 boys 89,6%) suffered burns. They did not find differences in relation to the day. The time beak of 19 to 20 hours was the one of maximum incidence. A 14,5% had previously suffered and accident. 69,2% were accompanied by an adult in the moment. 33 boys (19,1%) were treated in the hospital and 4(2,3%) required hospitable entry. Coment. Althouh the number of boys studied by us is not very elevated the incidence is important. We believe necessary a main epidemiological knowledge to primary care level (AU)

Sida y oftalmología: una visión actual / AIDS and ophthalmology: a contemporary view

La aparición del Síndrome de InmunodeficienciaAdquirida (SIDA) significó una revolución en medicina,de la que no es ajena la Oftalmología: la presencia rutinariade patologías oftalmológicas hasta el momentoexcepcionales, como la retinitis por citomegalovirus(CMV), y la aparición de otras nuevas como la necrosisretiniana externa progresiva (NREP). La utilizacióngeneralizada de la terapia anterretroviral de gran actividad(TARGA), desde la segunda mitad de la décadade los 90, produce un punto de inflexión a partir delcual la mejoría inmunológica de los pacientes coninfección por el virus de la inmunodeficiencia humana(VIH) provoca la disminución de casos con patologíaoftalmológica asociada a inmunodepresión (retinopatíaVIH, retinitis por CMV, NREP…), y la mejoría espontáneade cuadros hasta entonces de evolución tórpida(sarcoma de Kaposi ocular, Molluscum palpebral…).Por contra, el continuo aumento de prevalencia de sífilisen estos pacientes se traduce en un aumento delnúmero de casos de sífilis ocular, no asociados a inmunodepresión.También aparecen nuevas alteraciones oftalmológicasrelacionadas con la TARGA: la uveítis por recuperacióninmune en pacientes con retinitis CMV en remisióncompleta y el enoftalmos por atrofia de la grasaorbitaria en el contexto de la lipodistrofia, asociada aantirretrovirales.En la actualidad deben realizarse controles oftalmológicospreventivos en pacientes con inmunodepresiónsevera hasta confirmar un recuento de linfocitosCD4 por encima de 100 células/ml. Si además presentanretinopatía VIH, es aconsejable una revisión mensualhasta la recuperación inmune, dado el mayor riesgo deinfección por CMV

The appearance of the Acquired ImmuneDeficiency Syndrome (AIDS) meant a revolution inmedicine, which has also affected Ophthalmology: theroutine presence of ophthalmological pathologieswhich until then had been exceptional, such as retinitisdue to cytomegalovirus (CMV), and the appearance ofother new pathologies such as progressive outerretinal necrosis (PORN). The generalised use of highactivity antiretroviral therapy (HAART) in the secondhalf of the 1990s represented a turning point, sincewhen the immunological improvement of patients withHuman Immunodeficiency Virus (HIV) resulted in a fallin the cases with ophthalmological pathologyassociated to immunodepression (HIV retinopathy,retinitis due to CMV, PORN…), and the spontaneousimprovement of symptoms which until then had had atorpid evolution (Kaposi’s ocular sarcoma, PalpebralMolluscum…). On the other hand, the continuousincrease in the prevalence of syphilis in these patientsmeans an increase in the number of cases of ocularsyphilis unassociated with immunodepression.New ophthalmological alterations also appear thatare related to HAART: uveitis due to immune recoveryin patients with CMV retinitis in complete remissionand the enophthalmos due to the atrophy of orbital fatin the context of lipodystrophy, associated withantiretrovirals.At present preventive ophthalmological checksmust be carried out on patients with severeimmunodepression until a count of lymphocytes above100 cells/ml is confirmed. If they also show HIVretinopathy, a monthly check up is advisable untilimmune recovery, given the greater risk of infection byCMV (AU)

Noninvasive positive pressure ventilation prevents postoperative pulmonary complications in chronic ventilators users.

OBJECTIVE: To evaluate the postoperative pulmonary complications and the long-term impact on pulmonary function of different surgical procedures with general anaesthesia in chronic respiratory failure (CRF) patients who were using noninvasive positive pressure ventilation (NPPV). DESIGN: We retrospectively studied 20 stable patients on NPPV for CRF secondary to: kyphoscoliosis (eight), morbid obesity (six), thoracoplasty (four), neuromuscular diseases (two), who underwent surgical procedures with general anaesthesia, between January 1998 and December 2003. MATERIAL AND METHODS: The variables studied were: type of surgery, hours of orotracheal intubation, hours of stay in the postsurgical reanimation unit (PRU), postoperative pulmonary complications and days of hospital stay. These results were compared with those obtained in patients without respiratory pathology and who were submitted to the same type of surgical interventions during the study period. All patients were tested for: arterial blood gases, forced vital capacity (FVC) and forced expiratory volume in 1s (FVE1). These tests were carried out both prior to surgical intervention and 12 months after this intervention, and the use of medical assistance resources the year prior to and the year after the surgical intervention were also analysed. RESULTS: Sixteen patients were using NPPV at home at the time of the intervention and four patients were adapted to NPPV before surgery. The surgical procedures were: gastroplasty: six; mastectomy: five; septoplasty: three; hip prosthesis: two; cholecystectomy: one; Gasserian ganglion thermocoagulation: one; hysterectomy: one; and endoscopic retrograde cholangiopancreatography (ERCP): one. The mean postoperative intubation time was 3.8+/-3.2h, and only one patient remained intubated for more than 12h. The mean stay in the PRU was 19+/-9h (vs 19+/-6h in the general population, p>0.05). The days of hospital stay for the different pathologies were in the majority of cases greater than in the general population. We did not find significant differences on comparing the arterial blood gases, in pulmonary function or in use of assistance resources between the year previous to and the year following the surgical intervention. CONCLUSIONS: In high-risk patients with chronic respiratory failure as a consequence of a restrictive lung pathology, NPPV can play an important role to confront surgical procedure with general anaesthesia with greater security. To obtain these results, it was fundamental to coordinate between the Pulmonary Services and the Anaesthesia Services as well as to follow up jointly in the PRU.

[Influence of the severity of obesity on morbidity and mortality after gastric bypass surgery]. / Influencia del grado de obesidad en la morbimortalidad operatoria de la cirugia bariátrica.

OBJECTIVE: To determine the influence of severity of obesity on morbidity and mortality following Roux-en-Y gastric bypass and vertical ringed gastroplasty, with severity classified as morbid obesity (MO) defined by a body mass index (BMI) between 35 and 55 Kg/m2 and super-morbid obesity (SMO) defined by a BMI exceeding 55 Kg/m2. METHOD: A series of patients who underwent the aforementioned type of gastric bypass surgery were followed for 5 years. The patients were classified as to whether they had associated sleep apnea syndrome, alveolar hypoventilation, or "overlap syndrome". RESULTS: A total of 105 patients were enrolled: 70 (66.7%) classified as having MO and 35 (33.3%) classified as having SMO. Distribution by sex was significantly different in the 2 groups, but respiratory diseases were similar. PaO2 was higher in the MO group, PaCO2 was lower, and the alveolar-arterial gradient was smaller. Duration of surgery was shorter in the MO group (120.43 +/- 32.97 vs. 136.76 +/- 28.28 minutes). The percentage of complications was similar in the 2 groups (32.86% and 45.7% in the MO and SMO groups, respectively), although the incidence of respiratory complications was higher in SMO patients (8.57% vs. 20% in the MO and SMO groups, respectively). No differences were observed in the rates of surgical, hemodynamic, or infectious complications. Length of hospital stay was similar (6.44 vs. 6.69 for MO and SMO patients, respectively). CONCLUSIONS: More severe obesity can be associated with preoperative arterial blood gas alterations in patients with concomitant respiratory disease and a higher incidence of respiratory complications in the early phase of recovery from gastric bypass surgery.

A prospective and multicenter safety-monitoring study of a short up-dosing schedule of immunotherapy with a mass-units-standardized extract of mites.

A prospective, multicenter pharmacovigilance study was carried out to evaluate the safety of a new 7-dose treatment schedule of subcutaneous immunotherapy as opposed to the conventional 13 doses normally recommended. The study was carried out in 14 centers and included 261 patients (children and adults) with respiratory allergic disease due to sensitization to mites (Dermatophagoides pteronyssinus and/or farinae). A total of 2290 doses were administered under the direct supervision of the participating specialists. One hundred and ten reactions in 63 patients (24.1%) were recorded, representing 4.8% of the total doses administered. Most of the reactions (98) were local. Only 12 were systemic (0.5% of the administered doses) and occurred in 10 patients (3.8% of the sample). Ten reactions reverted quickly with rescue medication. The maintenance dose had to be lowered in one patient and another patient was withdrawn from the study after suffering two asthmatic crises after two consecutive doses. In view of the results obtained, we can conclude that the new schedule shows an acceptable tolerance profile and does not present a greater risk of reactions than the conventional scheme of 13 doses using an identical extract. Moreover, the new schedule represents substantial savings in the number of doses and visits required to reach the maintenance dose.

A prospective and multicenter safety-monitoring study of a short up-dosing schedule of immunotherapy with a mass-units-standardized extract of mites

A prospective, multicenter pharmacovigilance study was carried out to evaluate the safety of a new 7-dose treatment schedule of subcutaneous immunotherapy as opposed to the conventional 13 doses normally recommended. The study was carried out in 14 centers and included 261 patients (children and adults) with respiratory allergic disease due to sensitization to mites (Dermatophagoides pteronyssinus and/or farinae). A total of 2290 doses were administered under the direct supervision of the participating specialists. One hundred and ten reactions in 63 patients (24.1 %) were recorded, representing 4.8 % of the total doses administered. Most of the reactions (98) were local. Only 12 were systemic (0.5 % of the administered doses) and occurred in 10 patients (3.8 % of the sample). Ten reactions reverted quickly with rescue medication. The maintenance dose had to be lowered in one patient and another patient was withdrawn from the study after suffering two asthmatic crises after two consecutive doses. In view of the results obtained, we can conclude that the new schedule shows an acceptable tolerance profile and does not present a greater risk of reactions than the conventional scheme of 13 doses using an identical extract. Moreover, the new schedule represents substantial savings in the number of doses and visits required to reach the maintenance dose (AU)

Se ha llevado a cabo un estudio prospectivo y multicéntrico de farmacovigilancia, con el objetivo de valorar la seguridad de una nueva pauta en inmunoterapia subcutánea de 7 dosis, frente a las 13 de la pauta convencional habitualmente recomendada. El estudio se realizó en 14 centros, incluyéndose 261 pacientes (niños y adultos) con enfermedad alérgica respiratoria por sensibilización a ácaros (Dermatophagoides pteronyssinus y/o farinae). Se administraron un total de 2.290 dosis, todas ellas bajo la supervisión directa de los especialistas participantes. Se registraron 110 reacciones en 63 pacientes (24,1 por ciento), lo que supone un porcentaje sobre el total de dosis administradas del 4,8 por ciento. La mayoría de reacciones (98) fueron locales. Tan sólo 12 fueron sistémicas (0,5 por ciento sobre las dosis administradas) las cuales ocurrieron en 10 pacientes (3,8 por ciento de la muestra). En 10 casos revertieron rápidamente con medicación de alivio, en 1 caso fue necesario bajar la dosis de mantenimiento, y en 1 paciente se decidió retirarle del estudio por padecer 2 crisis asmáticas en dos dosis consecutivas. A la vista de los resultados obtenidos, podemos concluir que la nueva pauta ensayada presenta un adecuado perfil de tolerancia, no existiendo mayor riesgo de reacciones al compararlo con el perfil de la pauta convencional de 13 dosis utilizando idéntico extracto. Además, la nueva pauta supone un notable ahorro en el número de dosis y visitas necesarias para alcanzar la dosis de mantenimiento (AU)

Detection of hepatitis G virus (HGV) RNA and antibodies to the HGV envelope protein E2 in a cohort of hemodialysis patients.

An analysis of the evolution of hepatitis G virus (HGV) infection markers was performed for a cohort of 58 hemodialyzed patients. During follow-up (4.88 +/- 0.42 years), a group of these patients cleared their antibodies against the envelope protein E2 with (4 of 29 cases; 13.8%) or without (9 of 29 cases; 31%) the reappearance of viremia. This finding implies a temporally limited protection in patients previously infected with HGV.

Relationship of hepatitis C viremia to HIV state and to infection by specific hepatitis C genotypes.

AIMS/BACKGROUND: This study was undertaken to examine the relationship of hepatitis C (HCV) viremia to human immunodeficiency virus (HIV) infection and to investigate the evidence of infection by specific hepatitis C genotypes. PATIENTS AND METHODS: The analysis of HCV viremia was performed by reverse transcription-polymerase chain reaction in serum samples from 186 patients' selected by their positivity for anti-HCV antibodies. All samples were tested for HIV infection. In those patients with sera positivity for HCV RNA, isolates were genotyped by line probe assay. In those patients whose sera were negative for HCV RNA, antibodies specific for genotypes implicated in past HCV infection were detected by ELISA. RESULTS: HCV RNA was detected in 117 patients with anti-HCV antibodies (62.9%). There was no statistically significant association between HCV RNA and HIV positivity (Odds ratio, O.R.: 1.75, Confidence interval 95%, C.I.: 0.92-3.33, p = 0.095). A positive association was demonstrated between infection by HCV genotype 3 and HCV viremia (O.R.: 10.67, C.I.: 1.51-458.05, p = 0.015) in HIV-infected patients, as well as between infection by HCV genotype 1 and HCV viremia (O.R.: 4.71, C.I.: 1.65-13.75, p = 0.002) in HIV-non infected individuals. In both groups, a negative association was observed between past HCV infection by multiple genotypes and HCV viremia (HIV-infected patients, O.R.: 0.10, C.I.: 0.00-1.11, p = 0.033. HIV-non infected patients, O.R.: 0.05, C.I.: 0.00-0.41, p = 0.001). CONCLUSIONS: Infection by specific HCV genotypes (type 3 in HIV-infected patients and by type 1 in HIV-non infected ones) implies a higher risk of HCV viremia, whereas multiple HCV types infection is negatively associated with this probability. HIV coinfection does not influence the probability of HCV viremia.

Molecular structure and gas chromatographic retention behavior of the components of Ylang-Ylang oil.

Using quantitative structure-retention relationships (QSRR) methodologies the Kovats gas chromatographic retention indices for both apolar (DB-1) and polar (DB-Wax) columns for 48 compounds from Ylang-Ylang essential oil were empirically predicted from calculated and experimental data on molecular structure. Topological, geometric, and electronic descriptors were obtained for model generation. Relationships between descriptors and the retention data reported were established by linear multiple regression, giving equations that can be used to predict the Kovats indices for compounds present in essential oils, both in DB-1 and DB-Wax columns. Factor analysis was performed to interpret the meaning of the descriptors included in the models. The prediction model for the DB-1 column includes descriptors such as Randic's first-order connectivity index (1X), the molecular surface (MSA), the sum of the atomic charge on all the hydrogens (QH), Randic's third-order connectivity index (3X) and the molecular electronegativity (chi). The prediction model for the DB-Wax column includes the first three descriptors mentioned for the DB-1 column (1X, MSA and QH) and the most negative charge (MNC), the global softness (S), and the difference between Randic's and Kier and Hall's third-order connectivity indexes (3X-3XV).

[Utility of the brachial plexus block combined with continuous intradural anesthesia for axillo-femoral bypass surgery]. / Utilidad del bloqueo del plexo braquial asociado a la anestesia intradural continua para la cirugía de derivación axilofemoral.

Extra-anatomic axillofemoral bypass is a surgical procedure that is indicated in cases of occlusive aortoiliac pathology in which the transabdominal way is not feasible or in patients of high risk. We present a preliminary study in which we have prospectively evaluated 14 patients who were received an axillofemoral bypass during 1990. After preoperative evaluation two groups were identified: Group ALR (5 patients) with combined anesthetic blockade of supraclavicular brachial plexus and continuous subarachnoid blockade. Group AG (9 patients) who received balanced general anesthesia. In all cases we obtained a good anesthetic level for surgery. The incidence of complications was similar in both groups. One patient subjected to general anesthesia died. Combined blockade induces a satisfactory analgesia in all surgical interventions without exceeding in any case the maximal doses of anesthetic drugs. Additionally, this technique affords the advantages of regional anesthesia and can be used as an alternative anesthetic procedure in patients of high risk who undergo axillofemoral bypass.

Proyectos de mermeladas de frutas y hortalizas

La producción actual en nuestro pais satisface la demanda interna, existiendo una gran disponibilidad de materia prima, que en la mayor veces desaprovechadaesto es en caso de los citricos que se cultivan a lo largo de todo el pais, la producción de naranja aria se destina en su totalidad a la industrialización en forma de cáscaras abrillantada