Myelin Oligodendrocyte Glycoprotein Antibody-associated Disease and an Incidental Thyroid Nodule.

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a rare, immune-mediated demyelinating disease of the central nervous system (CNS) that has a predilection for children. Its association with malignancy or other autoimmune diseases is unclear. We present a case of MOGAD in a teenager with a coincidental thyroid malignancy and elevated intracranial pressure.

Validation of Visual Analogue Scale for loss of smell as a quick test in chronic rhinosinusitis with nasal polyps.

BACKGROUND AND OBJECTIVE: Diagnostic criteria of chronic rhinosinusitis with nasal polyps (CRSwNP) include, among others, olfactory dysfunction (OD). We hypothesize that patients suffering with CRSwNP are good at self-assessing their sense of smell through visual analogue scale (VAS) compared to smell tests. METHODS: A controlled cross-sectional study was planned. Adults diagnosed with severe CRSwNP waiting for endoscopic sinus surgery were included. A cohort of healthy controls was also studied. All participants performed Barcelona smell test (BAST-24), sinonasal outcomes test 22 (SNOT-22), and VAS for loss of smell. CRSwNP underwent blood test (eosinophils count, total serum IgE), CT scan (Lund-Mackay Score), and nasal endoscopy. RESULTS: 138 severe CRSwNP and 40 controls subjects were included. The BAST-24 identification score was strongly correlated with the VAS score in the CRSwNP group (rho=-0.79, p<0.001) but not in the control group (rho=-0.14; p=0.39), this difference between groups being statistically significant (p<0.001). A significant correlation of SNOT-22 item 21 (loss of smell) was also found with BAST-24 identification (rho=-0.65, p<0.001), this difference being statistically significant (Z=-2.43; p=0.015). In the ROC curve, the area under the curve (AUC) was 0.85 with 72.5% sensitivity and 93.1% specificity. CONCLUSION: This study demonstrates a potential role of the VAS score for the screening of OD in severe CRSwNP in daily clinical practice.

Papiledema como posible signo guía en el diagnóstico del síndrome periódico asociado a la criopirina: a propósito de un caso / Papilledema as a possible key sign for diagnosis of cryopyrin-associated periodic syndromes (CAPS): A case report

El síndrome periódico asociado a la criopirina es una enfermedad rara y probablemente infradiagnosticada. Se presenta con manifestaciones sistémicas, entre ellas oftalmológicas, muy diversas, por lo que su diagnóstico supone un reto para el clínico. Presentamos el caso de una niña de 4 años en la que la identificación de papiledema en el examen oftalmológico constituyó el signo guía para el diagnóstico de síndrome periódico asociado a la criopirina. Pretendemos así concienciar sobre esta enfermedad de graves implicaciones y cuyo diagnóstico precoz resulta esencial para los afectados, para que sea tenido en cuenta con mayor frecuencia como diagnóstico diferencial (AU)

Cryopyrin-associated periodic syndrome is a rare and probably underdiagnosed disease. It presents with various systemic manifestations, including ophthalmological, making its diagnosis a challenge for the clinician. We present the case of a 4-year-old girl for which the identification of papilledema in the ophthalmological examination was the key sign for the diagnosis of cryopyrin-associated periodic syndrome. Our aim is to raise awareness of this syndrome with serious implications for affected patients, so that it is taken into account more frequently as a differential diagnosis, allowing an early diagnosis (AU)

Abordaje endoscópico extendido del seno frontal: Experiencia en Hospital Clínico Universidad de Chile / Extended endoscopic approach of the frontal sinus: Experience at Hospital Clínico Universidad de Chile

Introducción: El seno frontal es una estructura compleja y desafiante en términos quirúrgicos, siendo descritas numerosas técnicas para su abordaje. Dentro de ellas se destaca el abordaje endoscópico extendido de seno frontal: Draf IIB y Draf III, como una importante alternativa para resolución de patología refractaria de seno frontal. Objetivo: Describir las características de pacientes sometidos a abordaje endoscópico extendido de seno frontal en Hospital Clínico Universidad de Chile (HCUCH). Material y Método: Estudio retrospectivo, descriptivo. Se incluyeron a pacientes sometidos a abordaje endoscópico extendido de seno frontal entre los años 2013 y 2021. Se analizaron variables clínicas, intraoperatorias y de seguimiento. Resultados: Se registraron 118 pacientes, de los cuales 64 cumplieron criterios de inclusión al estudio, con una edad promedio de 48 años. La patología más frecuente fue la rinosinusitis crónica poliposa (42%) seguido del mucocele (20%). Del total de pacientes, el 68% fue sometido a cirugía Draf IIB y el resto a Draf III. Todos los pacientes fueron estudiados con endoscopía e imágenes, y seguidos con parámetros clínicos y endoscópicos. El porcentaje de estenosis postoperatoria se estimó en 10%. Conclusión: El abordaje endoscópico nasal extendido figura como una alternativa útil para manejo de patología de seno frontal refractario a tratamiento. En nuestra experiencia las indicaciones, tipos de cirugía y tasa de complicaciones son concordantes con la literatura internacional.

Introduction: The frontal sinus is a complex and challenging structure in surgical terms, numerous techniques have been described for its approach, among them the extended endoscopic approach: Draf IIB and Draf III, figures as an important alternative for the resolution of refractory pathology of frontal sinus. Aim: To describe the characteristics of patients who underwent an extended endoscopic approach to the frontal sinus at the Hospital Clínico Universidad de Chile (HCUCH). Material and Method: A retrospective, descriptive study included patients who underwent an extended endoscopic approach to the frontal sinus between 2013 and 2021. Clinical, intraoperative, and follow-up variables were analyzed. Results: 118 patients were registered, of which 64 met the inclusion criteria for the study, with an average age of 48 years. The most frequent pathology was chronic polypous rhinosinusitis (42%), followed by mucocele (20%). Of the patients, 68% underwent Draf IIB surgery, while the rest received a Draf III type procedure. All patients were studied with endoscopy and images and followed up with clinical and endoscopic parameters. The percentage of post operatory stenosis was 10%. Conclusion: The extended nasal endoscopic approach appears as a valuable alternative for managing frontal sinus pathology refractory to treatment. In our experience, the indications, types of surgery, and rate of complications are consistent with the international literature.

Papilledema as a possible key sign for diagnosis of cryopyrin-associated periodic syndromes (CAPS): A case report.

Cryopyrin-associated periodic syndrome is a rare and probably underdiagnosed disease. It presents with various systemic manifestations, including ophthalmological, making its diagnosis a challenge for the clinician. We present the case of a 4-year-old girl for which the identification of papilledema in the ophthalmological examination was the key sign for the diagnosis of cryopyrin-associated periodic syndrome. Our aim is to raise awareness of this syndrome with serious implications for affected patients, so that it is taken into account more frequently as a differential diagnosis, allowing an early diagnosis.

Pediatric maxillary expansion has a positive impact on hearing? A systematic review and meta-analysis.

OBJECTIVE: Hearing loss is a highly prevalent condition in the pediatric population. Pediatric maxillary expansion is a widespread treatment to address transverse maxillary deficiency. First reports describing an association between improvements for patients with HL and PME initiated in the 1960s. In this systematic review and meta-analysis we aim to review the role of maxillary expansion in reducing conductive hearing loss in pediatric population. REVIEW METHODS: Pubmed (Medline), the Cochrane Library, EMBASE and Trip Database were checked. Main outcome was expressed as the difference between air-bone gap, compliance, ear volume and conductive hearing thresholds before and after treatment and the 95% confidence interval. RESULTS: A total of 10 studies (218 patients) met inclusion criteria. The pooled data in the meta-analysis under a random effects model shows a statistically significant difference of 10.57dB mean reduction after palatal expansion. The air-bone gap was significantly reduced by 5.39dB (CI 95% 3.68, 7.10). Compliance and volume were assessed in three studies, with a non-significant positive difference in the compliance (0.14) and a statistically significant difference for volume (0.80) after palatal expansion. CONCLUSION: This systematic review and meta-analysis found a positive effect of pediatric maxillary expansion in conductive hearing loss in well-select children. However, results cannot be extrapolated for children with conductive hearing loss without an accompanying orthodontic indication (maxillary constriction). It showed that the existing prospective studies exhibited qualitative pitfalls, limiting the ability to obtain conclusive evidence about the role of pediatric maxillary expansion on conductive hearing loss in children.

Improving heat and moisture exchanger therapy with a hydrogel base adhesive in laryngectomised patients: an open, randomised, crossover trial.

OBJECTIVE: This study aimed to assess individual preference, symptoms and compliance between habitual use of Provox XtraFlow and the combination of Provox XtraFlow during the day and Provox Luna during the night for heat and moisture exchanger therapy in laryngectomised patients. METHOD: This was an open, randomised, crossover trial for 25 days. After this first study period and a 5-day wash-out period, treatments were switched for another 25 days. RESULTS: A total of 28 patients were enrolled. Differences were found (p = 0.009) in the incidence of dermatological problems with XtraFlow (46.4 per cent) versus Provox Luna (14.3 per cent), as well as in the need to abandon the use of adhesives (46.4 per cent vs 10.7 per cent; p = 0.003). A total of 60.7 per cent of the patients preferred the Provox Luna system as their preference for heat and moisture exchanger therapy. CONCLUSION: The Provox Luna system is a viable additive to heat and moisture exchanger therapy, especially in the setting of compliance concerns and in patients who desire dermatological relief overnight.

Respuestas cerebrales al silencio: hacia una nueva forma de evaluación clínica de la audición

Resumen Nuestro cerebro tiene diferentes estados de funcionamiento, uno de ellos es la ausencia de estimulación auditiva o estado de silencio. Para evaluar la capacidad de detección de períodos de silencio auditivo se pueden utilizar diversas pruebas, incluyendo evaluaciones conductuales y electrofisiológicas. En esta última línea existen numerosos estudios que han caracterizado la respuesta cerebral al silencio mediante oscilaciones cerebrales y potenciales evocados con silencio. Esta área promete una importante aplicabilidad clínica, por ejemplo, en patologías como tinnitus, condición en la que no existe el estado de silencio, en donde se cree que la evaluación de respuestas cerebrales al silencio podría surgir como un nuevo marcador o elemento diagnóstico. En este artículo se presenta una revisión de los distintos métodos utilizados para evaluar respuestas cerebrales al silencio en modelos animales y en humanos.

Abstract The brain has different states of operation, one of them is the absence of auditory stimulation or silent states. To assess the capacity to detect auditory silent periods, various tests have been developed, including behavioral and electrophysiological evaluations. Brain responses to silence can be evaluated with brain oscillations and evoked potentials. This area promises important clinical applicability, for example, in pathologies like tinnitus, a condition in which there is no silent state, where it is believed that the evaluation of brain responses to silence could emerge as a new marker or diagnostic element. In this article we review different methods used for assessing brain responses to sound in animal models and humans.

Thresholds for Transverse Stimulation: Fiber Bundles in a Uniform Field.

Cable theory is used to model fibers (neural or muscular) subjected to an extracellular stimulus or activating function along the fiber (longitudinal stimulation). There are cases however, in which activation from fields across a fiber (transverse stimulation) is dominant and the activating function is insufficient to predict the relative stimulus thresholds for cells in a bundle. This work proposes a general method of quantifying transverse extracellular stimulation using ideal cases of long fibers oriented perpendicular to a uniform field (circular cells in a 2-D extracellular domain). Several methods are compared against a fully coupled model to compute electrical potentials around each cell of a bundle and predict the magnitude of applied plate potential (Öp) needed to activate a given cell (Öpact). The results show that with transverse stimulation, the effect of cell presence on the external field must be considered to accurately compute Öpact. They also show that approximating cells as holes can accurately predict firing order and Öpact of cells in bundles. Potential profiles from this hole model can also be applied to single cell models to account for time-dependent transmembrane voltage responses and more accurately predict Öpact. The approaches used herein apply to other examples of transverse cell stimulation where cable theory is inapplicable and coupled model simulation is too costly to compute.

Smell and Taste Dysfunction in COVID-19 Is Associated With Younger Age in Ambulatory Settings: A Multicenter Cross-Sectional Study.

BACKGROUND AND OBJECTIVE: Since the initial anecdotal reports of coronavirus disease 2019 (COVID-19) from China, a growing number of studies have reported on smell and/or taste dysfunction (STD). Objective: The aim of our study was to investigate the frequency and severity of STD in COVID-19 patients and to evaluate the association with demographic characteristics, hospital admission, symptoms, comorbidities, and blood biomarkers. METHODS: We performed a multicenter cross-sectional study on patients who were positive for SARS-CoV-2 (n=846) and controls (n=143) from 15 Spanish hospitals. Data on STD were collected prospectively using an in-person survey. The severity of STD was categorized using a visual analog scale. We analyzed time to onset, recovery rate, time to recovery, hospital admission, pneumonia, comorbidities, smoking, and symptoms. RESULTS: STD was at least 2-fold more common in COVID-19-positive patients than in controls. COVID-19-positive hospitalized patients were older, with a lower frequency of STD, and recovered earlier than outpatients. Analysis stratified by severity of STD showed that more than half of COVID-19 patients presented severe loss of smell (53.7%) or taste (52.2%); both senses were impaired in >90%. In the multivariate analysis, older age (>60 years), being hospitalized, and increased C-reactive protein were associated with a better sense of smell and/or taste. COVID-19-positive patients reported improvement in smell (45.6%) and taste (46.1%) at the time of the survey; in 90.6% this was within 2 weeks of infection. CONCLUSION: STD is a common symptom in COVID-19 and presents mainly in young and nonhospitalized patients. More studies are needed to evaluate follow-up of chemosensory impairment.

Smell and taste dysfunction in COVID-19 is associated with younger age in ambulatory settings: a multicenter cross-sectional study

BACKGROUND: Since the initial anecdotal reports of coronavirus disease 2019 (COVID-19) from China, a growing number of studies have reported on smell and/or taste dysfunction (STD). OBJECTIVE: The aim of our study was to investigate the frequency and severity of STD in COVID-19 patients and to evaluate the association with demographic characteristics, hospital admission, symptoms, comorbidities, and blood biomarkers. METHODS: We performed a multicenter cross-sectional study on patients who were positive for SARS-CoV-2 (n=846) and controls (n=143) from 15 Spanish hospitals. Data on STD were collected prospectively using an in-person survey. The severity of STD was categorized using a visual analog scale. We analyzed time to onset, recovery rate, time to recovery, hospital admission, pneumonia, comorbidities, smoking, and symptoms. RESULTS: STD was at least 2-fold more common in COVID-19-positive patients than in controls. COVID-19-positive hospitalized patients were older, with a lower frequency of STD, and recovered earlier than outpatients. Analysis stratified by severity of STD showed that more than half of COVID-19 patients presented severe loss of smell (53.7%) or taste (52.2%); both senses were impaired in >90%. In the multivariate analysis, older age (>60 years), being hospitalized, and increased C-reactive protein were associated with a better sense of smell and/or taste. COVID-19-positive patients reported improvement in smell (45.6%) and taste (46.1%) at the time of the survey; in 90.6% this was within 2 weeks of infection. CONCLUSION: STD is a common symptom in COVID-19 and presents mainly in young and nonhospitalized patients. More studies are needed to evaluate follow-up of chemosensory impairment

INTRODUCCIÓN: Desde los informes anecdóticos iniciales de China sobre la enfermedad por coronavirus 2019 (COVID-19), ha habido un número creciente de estudios que describen disfunción del olfato y/o del gusto (DOG). OBJETIVO: El objetivo fue investigar la frecuencia y la gravedad de la DOG en pacientes con COVID-19 y evaluar su asociación con características demográficas, ingreso hospitalario, síntomas, comorbilidades y biomarcadores sanguíneos. MÉTODOS: Estudio transversal multicéntrico en pacientes con SARS-CoV-2 positivo (n=846) y controles (n=143) de 15 hospitales españoles. Los datos de DOG fueron recopilados de manera prospectiva con una encuesta realizada en persona. La gravedad de la DOG se clasificó por escala visual analógica. Se analizaron el tiempo de aparición de DOG, tasa de recuperación, tiempo de recuperación, ingreso hospitalario, diagnóstico de neumonía, comorbilidades, tabaquismo y síntomas. RESULTADOS: La DOG fue al menos 2 veces más común en pacientes COVID-19 en comparación con los controles. Los pacientes hospitalizados con COVID-19 eran mayores, presentaban una menor frecuencia de DOG y se recuperaron antes que los pacientes ambulatorios. El análisis estratificado por gravedad de la DOG mostró que más de la mitad de los sujetos con COVID-19 presentaron pérdida severa del olfato (53,7%) o del gusto (52,2%), en> 90% este deterioro fue de ambos sentidos. En el análisis multivariante, una edad mayor (>60 años), ser hospitalizado y un mayor nivel de proteína C reactiva fueron factores asociados con un mejor sentido del olfato y/o sabor. Los pacientes positivos para COVID-19 informaron una mejoría del olfato (45,6%) y del gusto (46,1%) en el momento de la encuesta, de ellos, un 90,6% en menos de dos semanas después de la infección. CONCLUSIÓN: DOG es un síntoma común en COVID-19, y principalmente presente en pacientes jóvenes y no hospitalizados. Se necesitan más estudios para evaluar el seguimiento de la discapacidad quimio-sensorial

Towards an optimal treatment algorithm for metastatic pancreatic ductal adenocarcinoma (PDA).

Chemotherapy remains the mainstay of treatment for advanced pancreatic ductal adenocarcinoma (pda). Two randomized trials have demonstrated superiority of the combination regimens folfirinox (5-fluorouracil, leucovorin, oxaliplatin, and irinotecan) and gemcitabine plus nab-paclitaxel over gemcitabine monotherapy as a first-line treatment in adequately fit subjects. Selected pda patients progressing to first-line therapy can receive secondline treatment with moderate clinical benefit. Nevertheless, the optimal algorithm and the role of combination therapy in second-line are still unclear. Published second-line pda clinical trials enrolled patients progressing to gemcitabine-based therapies in use before the approval of nab-paclitaxel and folfirinox. The evolving scenario in second-line may affect the choice of the first-line treatment. For example, nanoliposomal irinotecan plus 5-fluouracil and leucovorin is a novel second-line option which will be suitable only for patients progressing to gemcitabine-based therapy. Therefore, clinical judgement and appropriate patient selection remain key elements in treatment decision. In this review, we aim to illustrate currently available options and define a possible algorithm to guide treatment choice. Future clinical trials taking into account sequential treatment as a new paradigm in pda will help define a standard algorithm.

Tamoxifen induces apoptotic neutrophil efferocytosis in horses.

Macrophages and neutrophils are important cellular components in the process of acute inflammation and its subsequent resolution, and evidence increasingly suggests that they play important functions during the resolution of chronic, adaptive inflammatory processes. Exacerbated neutrophil activity can be harmful to surrounding tissues; this is important in a range of diseases, including allergic asthma and chronic obstructive pulmonary disease in humans, and equine asthma (also known as recurrent airway obstruction (RAO). Tamoxifen (TX) is a non-steroidal estrogen receptor modulator with effects on cell growth and survival. Previous studies showed that TX treatment in horses with induced acute pulmonary inflammation promoted early apoptosis of blood and BALF neutrophils, reduction of BALF neutrophils, and improvement in animals' clinical status. The aim of this study was to describe if TX induces in vitro efferocytosis of neutrophils by alveolar macrophages. Efferocytosis assay, myeloperoxidase (MPO) detection and translocation phosphatidylserine (PS) were performed on neutrophils isolated from peripheral blood samples from five healthy horses. In in vitro samples from heathy horses, TX treatment increases the phenomenon of efferocytosis of peripheral neutrophils by alveolar macrophages. Similar increases in supernatant MPO concentration and PS translocation were observed in TX-treated neutrophils, compared to control cells. In conclusion, these results confirm that tamoxifen has a direct effect on equine peripheral blood neutrophils, through stimulation of the engulfment of apoptotic neutrophils by alveolar macrophages.

Unusual Sequence of Events in a Case of Takotsubo Syndrome.

A 73-year-old female with multiple comorbidities including coronary artery disease was admitted for an elective PCI of a lesion detected in the RCA. On the day of the planned PCI, shortly after right femoral artery cannulation, the patient developed a sudden complete heart block requiring the administration atropine and insertion of a temporary pacemaker. Concomitantly, the patient developed acute pulmonary edema, hypotension, and hypoxia requiring intubation for mechanical ventilation. Vasopressors were administered. A coronary angiogram showed patent left and right coronary arteries, unchanged when compared to the previous angiogram. An echocardiogram performed in the cardiac catheterization lab revealed global hypokinesis of the left and right ventricles, with severe LV systolic dysfunction (EF < 20%). Following an insertion of an intra-aortic balloon pump, the patient was transferred to the CICU. A repeat echocardiogram in the CICU two hours later revealed a classical echocardiographic presentation of Takotsubo syndrome, apical hypokinesis. By the next morning the patient's hemodynamic status significantly improved, the balloon pump was removed, and vasopressors were discontinued. Another echocardiogram was performed 24 hours after the event occurred and revealed a marked improvement in LV systolic function (EF 60%), with complete resolution of apical and septal wall motion abnormalities. Three days after the event, the patient was successfully discharged and asymptomatic at two-month follow-up. This case illustrates an atypical presentation of Takotsubo syndrome that was witnessed from onset to its complete resolution during the patient's hospital stay.

Prevalencia de trastornos temporomandibulares en la población adulta beneficiaria de Atención Primaria en Salud del Servicio de Salud Valparaíso, San Antonio / Prevalence of temporomandibular disorders in the beneficiary adult population of Primary Health Care at Servicio de Salud Valparaíso, San Antonio

Los Trastornos Temporomandibulares (TTM) son un conjunto de problemas musculares y articulares que afectan al sistema masticatorio. En Chile, hay pocos estudios epidemiológicos en TTM y no se conoce su distribución, severidad, necesidad de tratamiento y comorbilidad. Estas patologías no están incorporadas a las prestaciones de salud oral de las Garantías Explícitas en Salud (GES) y no existen Guías Clínicas Unificadas a nivel nacional para su diagnóstico y derivación desde la Atención Primaria en Salud (APS). El objetivo general de este estudio fue determinar la prevalencia de trastornos temporomandibulares en adultos beneficiarios del Servicio de Salud de Valparaíso y San Antonio (SSVSA). Para lo anterior se propuso un estudio observacional de corte transversal (prevalencia) de TTM, cuya población objetivo correspondió a adultos (mayores de 18 años) beneficiarios del Fondo Nacional de Salud (FONASA) del SSVSA inscritos en consultorios de APS de la comuna de Valparaíso (n= 273.449 según los registros per capita de pacientes válidamente inscritos en 2012). Se examinaron 270 pacientes (168 mujeres, 102 hombres), seleccionados al azar, utilizando las categorías diagnósticas del Research Diagnostic Criteria de Dworkin (Dworkin 1992, adscritas a la Asociación Internacional para la investigación Dental). Los resultados arrojaron una prevalencia de TTM de un 49,6% (al menos un diagnóstico) en la muestra estudiada; y un 19,6% de la población padecía de un TTM severo (dolor muscular y/o articular, asociado a limitación funcional), siendo el sexo femenino el más comprometido (AU)

Temporomandibular Disorders (TMD) are a set of muscle and joint problems affecting the masticatory system. In Chile, there are few epidemiological studies on TMD, and no distribution, severity, and comorbidity need for treatment is known. These conditions are not incorporated into oral health benefits of Explicit Health Guarantees (GES) and there are no clinical guidelines for diagnosis and referral from Primary Health Care (PHC). The overall objective of this study was to determine the prevalence of Temporomandibular Disorders in adults beneficiaries of the Health Service of Valparaiso and San Antonio (SSVSA). For the above observational cross-sectional study (prevalence) TMD, whose target population corresponded to adults (over 18 years) beneficiaries of the National Health Fund (FONASA) of SSVSA enrolled in PHC clinics of the commune of Valparaiso proposed (n= 273,449 according to per capita patients validly registered records in 2012). 270 patients (168 women, 102 men), selected at random, using the diagnostic categories of Research Diagnostic Criteria Dworkin (Dworkin 1992, assigned to the International Association for Dental Research) were examined. The results showed a prevalence of 49.6% TTM (at least one diagnosis) in the sample; and 19.6% of the population suffered from severe TMD (muscle pain and/or joint pain associated with functional limitation), being the most committed female (AU)

In Vitro effects of tamoxifen on equine neutrophils.

Neutrophils participate in innate immunity as the first line of host defense against microorganisms. However, exacerbated neutrophil activity can be harmful to surrounding tissues; this is important in a range of diseases, including allergic asthma and chronic obstructive pulmonary disease in humans, and equine asthma (also known as recurrent airway obstruction (RAO). Tamoxifen (TX) is a non-steroidal estrogen receptor modulator with effects on cell growth and survival. Previous preliminary studies showed that TX treatment in horses with induced acute pulmonary inflammation promoted early apoptosis of blood and BALF neutrophils, reduction of BALF neutrophils, and improvement in animals' clinical status. The aim of this study was to evaluate the in vitro effect of TX on functional tests in equine peripheral blood neutrophils. Chemotaxis, respiratory burst production and phagocytosis assays were performed on neutrophils isolated from peripheral blood samples from 10 healthy horses. Results showed that IL-8 stimulated cells decrease their chemotactic index when treated with TX (1 and 10µM). Respiratory burst production was also dampened after treatment with TX. In conclusion, these results confirm that tamoxifen has a direct action on equine peripheral blood neutrophils. However, more in vivo and in vitro studies are required to fully understand the mechanisms of action of TX on neutrophils, in order to elucidate if it can be used as treatment in disorders such as allergic asthma in humans and horses.

Aspectos clínicos en el espectro de neuromielitis óptica: revisión de la literatura / Clinical aspects in neuromyelitis optica spectrum disorders: literature review

Neuromyelitis optica (NMO) is currently recognized as a broad spectrum of autoimmune disorders of the Central Nervous System (CNS), causing demyelinating and inflammatory injuries, primarily in the spinal cord and optic nerves, but also in other regions such as brainstem, diencephalon or specific brain areas. These disorders are grouped under the unifying term "NMO spectrum disorders" (NMOSD). For many years this pathological entity was thought like a variant of the Multiple Sclerosis (MS). However, current evidence shows that there are distinctive features of clinical presentation, pathophysiology, laboratory, neuroimaging and therapy response that distinguish NMOSD from the latter. Most patients with NMOSD are seropositive for autoantibodies (AQP4-IgG) againstAQP4, the major water channel ofastrocytes. New advances in research have allowed recognize that AQP4-IgG is pathogenic in NMOSD, probably by a mechanism involving complement dependent cellular cytotoxicity. Due to the severity of attacks in NMOSD and the high risk for neurological disability, treatment should be initiated as soon as the diagnosis is confirmed. Acute attacks ofoptic neuritis or myelitis are treated with high-dose intravenous corticosteroid and plasmapheresis. Maintenance therapy to avoid further relapses is based on low-dose oral corticosteroid and non-specific immunosuppressant drugs; nevertheless, to date there are no controlled randomized trials to confirm the safety and efficacy for the drugs currently used.

La Neuromielitis óptica (NMO) es reconocida hoy como un espectro amplio de trastornos autoinmunes del Sistema Nervioso Central (SNC), que causan lesiones desmielinizantes e inflamatorias, primariamente, en la médula espinal y nervios ópticos, pero también en otras regiones encefálicas como tronco cerebral, diencéfalo o áreas cerebrales específicas. Estos trastornos se agrupan bajo el término unificador "trastornos del espectro NMO". Por muchos años se pensó que esta entidad patológica era una variante de la Esclerosis Múltiple (EM). Sin embargo, la evidencia actual muestra que existen características de presentación clínica, fisiopatología, laboratorio, neuroimágenes, y respuesta a tratamiento, que diferencian NMOSD de esta última. La mayoría de los pacientes con NMOSD son seropositivos para un autoanticuerpo dirigido contra AQP4 (AQP4-IgG), el principal canal de agua expresado en los astrocitos. Nuevos avances en investigación han permitido reconocer que AQP4-IgG es patogénico en NMOSD, probablemente por un mecanismo de citotoxicidad celular dependiente de complemento. Debido a la severidad de los ataques en NMOSD, y al alto riesgo de generar discapacidad neurológica, el tratamiento debería ser iniciado en cuanto se confirma el diagnóstico. Los ataques agudos de neuritis óptica o mielitis son tratados con altas dosis de corticosteroides intravenosos y plasmaféresis. La terapia de mantención, para evitar futuras recaídas, está basada en la administración de corticosteroides orales a bajas dosis y en drogas inmunosupresoras, aunque a la fecha se carece de ensayos clínicos controlados que confirmen la seguridad y eficacia de las drogas usadas actualmente.