A Newborn Screening Program for Sickle Cell Disease in Murcia (Spain).

Sickle cell disease (SCD) is an inherited autosomal recessive hemoglobin disorder caused by the presence of hemoglobin S, a mutant abnormal hemoglobin caused by a nucleotide change in codon 6 of the ß-globin chain gene. SCD involves a chronic inflammatory state, exacerbated during vaso-occlusive crises, which leads to end-organ damage that occurs throughout the lifespan. SCD is associated with premature mortality in the first years of life. The process of sickling provokes asplenia in the first years of life with an increased risk of infection by encapsulated germs. These complications can be life-threatening and require early diagnosis and management. The most important interventions recommend an early diagnosis of SCD to ensure that affected newborns receive immediate care to reduce mortality and morbidity. The newborn screening program in the region of Murcia for SCD began in March 2016. We aimed to determine the incidence of sickle cell anemia and other structural hemoglobinopathies in the neonatal population of the region of Murcia, an area of high migratory stress, and to systematically assess the benefit of newborn screening for SCD, leading to earlier treatment, as well as to offer genetic counseling to all carriers. The prevalence of SCD in our region is similar to others in Spain, except for Catalonia and Madrid. The newborns with confirmed diagnoses of SCD received early attention, and all the carriers received genetic counseling.

A Th2-score in the tumor microenvironment as a predictive biomarker of response to Bacillus Calmette Guérin in patients with non-muscle invasive bladder carcinoma: A retrospective study.

Intravesical Bacillus Calmette Guerin (BCG) is the gold standard therapy for intermediate/high-risk non-muscle invasive bladder cancer (NMIBC). However, the response rate is ~60%, and 50% of non-responders will progress to muscle-invasive disease. BCG induces massive local infiltration of inflammatory cells (Th1) and ultimately cytotoxic tumor elimination. We searched for predictive biomarker of BCG response by analyzing tumor-infiltrating lymphocyte (TIL) polarization in the tumor microenvironment (TME) in pre-treatment biopsies. Pre-treatment biopsies from patients with NMIBC who received adequate intravesical instillation of BCG (n = 32) were evaluated retrospectively by immunohistochemistry. TME polarization was assessed by quantifying the T-Bet+ (Th1) and GATA-3+ (Th2) lymphocyte ratio (G/T), and the density and degranulation of EPX+ eosinophils. In addition, PD-1/PD-L1 staining was quantified. The results correlated with BCG response. In most non-responders, Th1/Th2 markers were compared in pre-and post-BCG biopsies. ORR was 65.6% in the study population. BCG responders had a higher G/T ratio and a greater number of degranulated EPX+ cells. Variables combined into a Th2-score showed a significant association with higher scores in responders (p = 0.027). A Th2-score cut-off value >48.1 allowed discrimination of responders with 91% sensitivity but lower specificity. Relapse-free survival was significantly associated with the Th2-score (p = 0.007). In post-BCG biopsies from recurring patients, TILs increased Th2-polarization, probably reflecting BCG failure to induce a pro-inflammatory status and, thus, a lack of response. PD-L1/PD-1 expression was not associated with the response to BCG. Our results support the hypothesis that a pre-existing Th2-polarized TME predicts a better response to BCG, assuming a reversion to Th1 polarization and antitumor activity.

Phenotypic characterization of a pediatric cohort with cystinuria and usefulness of newborn screening.

BACKGROUND: Cystinuria is an inherited metabolic disease involving the defective transport of cystine and the dibasic amino acids in the renal proximal tubules that causes the formation of stones in the urinary system. In our regional child health program, cystinuria is included in newborn metabolic screening. Our objectives are the phenotypic characterization of our cystinuric pediatric cohort and to present our experience in neonatal cystinuria screening. METHODS: The study of clinical cases of pediatric patients diagnosed with cystinuria over a period of 32 years. All patients were studied at demographic, clinical, laboratory, radiological, and therapeutic levels. RESULTS: We diagnosed 86 pediatric patients with cystinuria; 36% of them had the homozygous biochemical phenotype. 95.3% of the patients were detected by neonatal metabolic screening. We performed urine biochemical analyses of parents with additional diagnoses of 63 adult patients. The mean follow-up time was 16.8 ± 8.5 years. 11.6% of patients developed one or more episodes of urinary tract infection during that period. Chronic kidney disease, proteinuria, and hypertension were uncommon (1.2%). 10.5% developed kidney stones at the mean age of presentation of 7.78 ± 7.6 years; 33% were recurrent. The risk of developing lithiasis was higher for homozygous biochemical-phenotype patients. Hypercalciuria was a significant risk factor in the development of lithiasis. CONCLUSIONS: Our clinical data suggest that diagnosing cystinuria through neonatal screening could be a useful strategy for the detection of presymptomatic cases, in order to establish preventive measures, as well as for the detection of relatives at risk. A higher resolution version of the Graphical abstract is available as Supplementary information.

Guía de práctica clínica para el tratamiento de infecciones odontogénicas en el Seguro Social de Salud del Perú (EsSalud) / Clinical practice guidelines for the treatment of odontogenic infection of the Peruvian Health Social Security (EsSalud)

Introducción. El presente artículo resume las recomendaciones basadas en evidencias de la guía de práctica clínica (GPC) para el tratamiento de los pacientes con infecciones odontogénicas (absceso dentoalveolar, celulitis facial y absceso cervicofacial) en el Seguro Social de Salud del Perú (EsSalud). Objetivo. Brindar recomendaciones clínicas basadas en evidencia para el tratamiento de pacientes con infecciones odontogénicas en EsSalud. Métodos. Se conformó un grupo elaborador de la guía (GEG) que incluyó cirujanos dentistas, especialistas y metodólogos. El GEG formuló cuatro preguntas clínicas a ser respondidas en la presente GPC. Se realizó búsquedas sistemáticas de revisiones sistemáticas y cuando fue considerado pertinente­ estudios primarios en PubMed y CENTRAL durante el año 2019. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones de trabajo periódicas, el GEG usó la metodología GRADE para revisar la evidencia y formular las recomendaciones, los puntos de buena práctica clínica y el flujo- grama de tratamiento. Finalmente, la GPC fue aprobada con Resolución N° 067­IET- SI-ESSALUD-2020. Resultados. La presente GPC abordó cuatro preguntas clínicas, divididas en dos temas: manejo farmacológico y manejo quirúrgico de las infecciones odontogénicas. En base a dichas preguntas se formularon seis recomendaciones fuertes, dos recomendaciones condicionales, 11 puntos de buena práctica clínica, y un flujograma. Conclusión. El presente artículo resume la metodología y las conclusiones basadas en evidencias de la GPC para tratamiento de las infecciones odontogénicas (absceso dentoalveolar, celulitis facial y absceso cervicofacial) en EsSalud.

Introduction. This article summarizes the evidence-based recommendations of the clinical practice guide (CPG) for the treatment of patients with odontogenic infections (dentoalveolar abscess, facial cellulitis and cervicofacial abscess) in the Social Security of Health of Peru (EsSalud). Objective. To provide evidence-based clinical recommendations for the treatment of patients with odontogenic infections in EsSalud. Methods. A guideline development group (GEG) was formed that included dental surgeons, specialists, and methodologists. The GEG formulated four clinical questions to be answered in this CPG. We conducted systematic searches for systematic reviews and when deemed relevant - primary studies in PubMed and CENTRAL during 2019. The evidence was selected to answer each of the clinical questions posed. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the GEG used the GRADE methodology to review the evidence and formulate the recommendations, the points of good clinical practice and the treatment flow chart. Finally, the CPG was approved with Resolution No. 067 ­ IETSI-ESSALUD-2020. Results. This CPG addressed four clinical questions, divided into two topics: pharmacological management and surgical management of odontogenic infections. Based on these questions, six strong recommen- dations were formulated, two conditional recommendations, 11 points of good clinical practice, and a flow chart. Conclusion. This article summarizes the methodology and evidence-based conclusions of the CPG for the treatment of odontogenic infections (dentoalveolar abscess, facial cellulitis and cervicofacial abscess) in EsSalud.

[Beginnings, evolution and current situation of the Newborn Screening Programs in Spain.] / Inicio, evolución y situación actual de los Programas de Cribado Neonatal en España.

Newborn Screening Programs (NSP) in Spain were born in the city of Granada in 1968. Till the 1980s, they were developed around the so-called "National Plan for Preventing Subnormality", covering up to 30% of the Spanish newborns. From 1982, when the health system management was transferred to the different autonomous regions, the NSP began to expand, and the bases to transform them into an organized and multidisciplinary activity, integrated and coordinated from the National Health System were settled. Despite this expansion, it is not until the 1990s when their coverage reaches almost 100% newborns in Spain. NSP grew up asymmetrically across the different autonomous regions. In 2005 and 2006 the scientific societies SEQC (Spanish Society of Clinical Chemistry) and AECNE (Spanish Society of Newborn Screening), coordinated by the Health Promotion Area of the General Directorate of Public Health, gathered together the necessary information to elaborate a report on the NSP in Spain addressed to the Interterritorial Council of the National Health System. In July 2013, that Council approved the seven diseases that should be part of each region newborn screening panel, being the first step towards the NSP harmonization in Spain. Currently, the NSP include between 8 and 29 diseases in their panels, thus more still more efforts are needed in order to achieve a higher uniformity.

Los Programas de Cribado Neonatal (PCN) nacen en España en Granada en el año 1968. Posteriormente, y hasta los años 80, se fueron desarrollando en torno al llamado "Plan Nacional de Prevención de la Subnormalidad" con una cobertura cercana al 30% de los recién nacidos españoles. A partir de 1982, con el inicio de la gestión de la sanidad a las comunidades autónomas (CCAA), los PCN se expandieron y se comenzaron a sentar las bases para que éstos se convirtieran en una actividad organizada y multidisciplinar, integrados y coordinados desde el Sistema de Salud. A pesar de dicha expansión no es hasta el inicio de la década de los 90 cuando se consigue una cobertura próxima al 100% de los RN en España. Los PCN fueron creciendo de forma muy asimétrica en las diferentes CCAA y en los años 2005 y 2006 las Sociedades Científicas SEQC (Sociedad Española de Química Clínica) y AECNE (Asociación Española de Cribado Neonatal), con la coordinación del Área de Promoción de la Salud de la Dirección General de Salud Pública, recopilaron la información y elaboraron un informe, sobre los PCN en España para el Consejo Interterritorial del sistema Nacional de Salud (CISNS). En julio de 2013 este Consejo aprobó las siete enfermedades que debían formar parte del panel de detección de los PCN territoriales, primer paso hacia la armonización de estos programas. Actualmente, los PCN incluyen entre 8 y 29 enfermedades por lo que es necesario seguir trabajando para conseguir una mayor uniformidad.

Squamous cell carcinoma related with dental implants. A clinical cases report.

One third of all cases of head and neck carcinoma (CA) concern the oral mucosa. The use of dental implants (DI) for dental rehabilitation is widely extended. However, a few studies have reported some cases with neoplasic alterations, among the tissue surrounding implants. Our aim was to analyze possible alterations at the bone-implant interface in patients with oral squamous cell carcinoma (SCC), providing new evidence that could relate or discard a possible link between these factors. We used, for the first time, different techniques, including electron microscopy and histology, to analyze the implant ´s surface and the surrounding tissue from four clinical cases with neoplasic alterations surrounding DI. Histologically, ample inflammatory tissue was found in direct contact with the implant surface. Surface analysis of this tissue, revealed titanium percentages. According to our study, no oncological relation with deterioration of the implant surface was found, although DI were constantly related with peri-implantitis, a chronic trauma of the oral mucosa that could involve a neoplastic factor. Key words:Dental implants, carcinoma, peri-implantitis.

Criterios de extracción de muestra en situaciones especiales del cribado neonatal. Revisión / Criteria for specimen collection in special situations of newborn screening. Review

La espectrometría de masas en tándem (MS-MS) ha permitido ampliar el alcance del cribado neonatal. Eso hace más complicado determinar el momento más adecuado para la toma de muestra, sobre todo en recién nacidos prematuros y/o bajo peso y/o ingresados en unidades neonatales. El objetivo del presente estudio ha sido revisar las normas de toma de muestra de los distintos programas en estas situaciones, a nivel nacional e internacional. Se obtienen los datos a través de páginas web de salud pública, de plataformas de búsqueda o por contacto con los centros. Existe gran disparidad de criterios para la toma de una nueva muestra, incluso dentro de un mismo país. La limitación de información disponible, hizo imposible obtener resultados de muchos países, en particular de África, Asia o Latinoamérica. A pesar de que cada vez más estados se acogen a las recomendaciones del Clinical and Laboratory Standards Institute u otros organismos internacionales, el aumento del coste que implica, hace muy difícil conseguir la estandarización

The most significant breakthrough in the newborn screening (NBS) programs was the introduction of the tandem mass spectrometry (MS-MS) to the laboratory, which makes it possible to detect multiple disorders. However, it is difficult to choose the ideal time for the specimen collection, particularly in preterm, low birth weight, and sick newborns. The aim of this study was to revise the protocols, in national and international programs for specimen collection in these newborns. Data were collected from web pages of public health, internet searches, and contact with the laboratories. The results showed a great disparity in criteria for a new specimen collection, as well as among different centres within a country. It has been difficult to obtain this information from many countries in Africa, Asia, and Latin America. Although an increasing number of laboratories follow the recommendations of the Clinical and Laboratory Standards Institute or other international guidelines, the increased cost involved makes standardisation difficult

Probable, pero incierto / Likely, but uncertain

No disponible

Protocolos / Protocols

No disponible

Determination of antioxidant activity of spices and their active principles by differential pulse voltammetry.

The anodic oxidation of mercury in the presence of hydrogen peroxide in differential pulse voltammetry (DPV) was used to determine the antioxidant (AO) character of radical scavengers. Hydroperoxide radical is formed at the potentials of the oxidation peak on mercury electrodes, such radical reacting with the antioxidants in different extension. The parameter C10 (antioxidant concentration at which the peak area decreases by 10%) is used to measure the scavenging activity of the individual antioxidants. To establish the scavenging activity of antioxidant mixtures as a whole, the parameter, µ10 as the reverse of V10, V10 being the volume necessary to decrease the peak area in DPV by 10%, was selected. Higher µ10 values correspond to higher scavenging activity. The studies have been extended to aqueous extracts of some species. The results may be useful in explaining the effect of spices in vitro and in vivo studies.

Respuesta / Reply

No disponible

Cribado neonatal ampliado en la Región de Murcia. Experiencia de tres años / Expanded newborn screening in the Region of Murcia, Spain. Three-years experience

Fundamento y objetivo. La detección precoz de errores innatos del metabolismo mediante espectrometría de masas en tándem permite ampliar el cribado tradicional de fenilcetonuria e hipotiroidismo primario congénito a aminoacidopatías, acidurias orgánicas y alteraciones de la beta-oxidación mitocondrial. En la Región de Murcia también se detecta la fibrosis quística y la deficiencia de biotinidasa. El objetivo de este estudio es describir nuestra experiencia en el cribado neonatal ampliado y definir la prevalencia de cada uno de los errores congénitos del metabolismo detectados precozmente. Pacientes y método. El programa de cribado metabólico neonatal expandido se ha realizado desde marzo de 2007 hasta octubre de 2010 y ha permitido analizar un total de 71.595 recién nacidos utilizando técnicas como la espectrometría de masas en tándem, el fluoroinmunoensayo o técnicas colorimétricas. Resultados. Se han detectado 38 pacientes (prevalencia 1:1.884) mediante espectrometría de masas en tándem, 13 se han diagnosticado de fibrosis quística (prevalencia 1:5.507), 38 de hipotiroidismo primario congénito (prevalencia 1:1.884) y uno por deficiencia de biotinidasa. La frecuencia global de metabolopatías es de 1:804. El valor predictivo positivo para los resultados obtenidos por espectrometría de masas en tándem fue de 20,25%. Hubo 2 falsos negativos (que fueron diagnosticados posteriormente de fibrosis quística y aciduria metilmalónica) y se detectaron 6 pacientes no neonatales. Conclusiones. Nuestros datos apoyan la necesidad de unificar el cribado neonatal en todas las comunidades españolas para la detección de un panel de enfermedades metabólicas y proporcionar a cada recién nacido las mismas oportunidades para el diagnóstico precoz(AU)

Background and objective. The early detection of inborn errors of metabolism by mass spectrometry allows expanding the traditional neonatal screening of phenylketonuria and congenital hypothyroidism to test for aminoacidopathies, fatty acid oxidation disorders and organic acid metabolic disorders. Cystic fibrosis and biotinidase deficiency screening is implemented in the Region of Murcia. The aim of the study is to describe our experience in the expanded neonatal screening and to define the prevalence of each of the metabolic disorders early detected. Patients and methods. Since March 2007 until October 2010, a total of 71,595 neonates were screened with this expanded program by mass spectrometry, fluoroimmunoassay or colorimetric methods. Results. Thirty-eight patients (prevalence 1:1,884) were diagnosed of inborn errors of metabolism by mass spectrometry, 13 patients of cystic fibrosis (prevalence 1:5,507), 38 of congenital hypothyroidism (prevalence 1:1,884) and one of biotinidase deficiency. To date, the global frequency of inborn errors of metabolism is estimated to be 1:804. The positive predictive value for the results obtained by mass spectrometry was 20.25%. Two false negative patients were not identified (cystic fibrosis and methylmalonic aciduria patients) and 6 non neonatal patients were detected through expanded neonatal screening. Conclusions. Our data support the necessity of unifying the set of metabolic diseases to be screened in all Regions of Spain for early detection of a defined panel of inborn errors of metabolism and to provide every newborn the same opportunities to be early diagnosed(AU)

Uncommon causes of acute abdominal pain: multidetector computed tomography pearls and pitfalls for the radiologist on call.

We review uncommon causes of acute abdominal pain in which inconclusive multidetector computed tomography (MDCT) studies were followed by emergency surgery and unexpected diagnoses. Despite dedicated protocols and technical advances, MDCT of uncommon causes of acute abdominal pain still represents a significant challenge for the radiologist on call. We emphasize diagnostic pearls and pitfalls that may help the radiologist on call identify or suspect these uncommon causes of acute abdominal pain on MDCT.

Comparison of the simple cyclic voltammetry (CV) and DPPH assays for the determination of antioxidant capacity of active principles.

Antioxidant activity of a number of small (low molecular weight) natural compounds found in spices, condiments or drugs (gallic acid, sesamol, eugenol, thymol, carvacrol, vanillin, salicylaldehyde, limonene, geraniol, 4-hexylresorcinol, etc.) has been evaluated using electrochemical and DPPH• radical scavenging measurements. Structural analysis of the tested compound suggest a remarkable activity for phenol derivatives and the importance of the -R groups located on the phenolic ring in the molecule's ability to act as free radical scavenging as well as their influence in the electrochemical behavior. The voltammetric method can be used for the determination of the antioxidant capability in the same manner as the DPPH• radical scavenging because of the correlation found between oxidation potentials and anti-radical power (ARP = 1/EC50). Such electrochemical determination is fast and cheap and allows making measurements under a variety of experimental conditions. The accuracy of the electrochemical measurements is the same for all the compounds, irrespective of their scavenging activity, the opposite of what occurs in the DPPH• test.