Conyza bonariensis as an alternative host for Colletotrichum species in Argentina.

AIMS: This study investigated the diversity of Colletotrichum isolates recovered from Conyza bonariensis leaves through the use of morphological characteristics, growth rate, carbon sources utilization and phylogenetic analysis. METHODS AND RESULTS: In all, 30 Colletotrichum isolates recovered from C. bonariensis leaves showing symptoms of disease were included in the present study. Based on the analysis of morphology and sequences, the isolates were distributed into six Colletotrichum species complexes. The concatenated alignment of GAPDH and ITS sequences showed that 20 out of 30 isolates were included in four species complexes which comprise the most important pathogens causing anthracnose in soybean or anthracnose and stalk rot in maize: C. truncatum, C. orchidearum, C. gloeosporioides and C. graminicola. The remaining 10 isolates were included in the C. boninense and C. destructivum species complexes or could not be assigned to any complex with the available information. CONCLUSION: Weeds belonging to genus Conyza are host to soybean and maize potential pathogenic species of Colletotrichum and could have a role as inoculum reservoir for cross contamination in the agroecosystem. SIGNIFICANCE AND IMPACT OF THE STUDY: The combined use of morphological, kinetics and physiological parameters of growth and phylogenetic analysis in Colletotrichum isolates from Conyza leaves allowed the detection of species complexes previously not identified in Argentina.

Evolution and associated factors of hand hygiene compliance in a pediatric tertiary hospital.

BACKGROUND: The objective is to know the evolution of the Degree of Compliance with Recommendations (DCR) on hand hygiene (HH) and its associated factors in the pediatric care areas (PCAs) of a tertiary hospital. METHODS: Observational, cross-sectional study, repeated over time, with direct observation of the DCR on HH during the daily activity of health care workers. Over 13 years, 9226 HH opportunities were observed. Associations between DCR, PCA and other variables (eg, age, sex, and professional position) were examined using χ² and adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS: DCR on HH in 9 PCAs was 64.3% (95% CI, 63.3-65.3), and in the group of non-pediatric areas it was 49.6% (95% CI, 49.1-50.1). The areas with the highest degree of compliance were Oncology 72.8% (95% CI, 69.2-76.4), Neonatology 73.2% (95% CI, 71.3-75.1), and Neonatal intensive care unit 70.0% (95% CI, 67.5-72.6). These were the areas with the strongest association with HH compliance, with aOR:2.8 (95% CI, 2.2-3.6); aOR, 3.0 (95% CI, 2.6-3.6) aOR:2.6 (95% CI, 2.1-3.1), respectively. Other associated factors were the indications "after an activity," aOR, 1.6 (95% CI, 1.5-1.8) and the availability of pocket-size alcohol-based solution, aOR, 2.1(95% CI, 1.9-2.3). CONCLUSIONS: The DCR on HH in PCAs is higher than in other areas, although there is still margin for improvement. We have identified modifiable factors that have an independent association with HH compliance in PCAs. Focusing on modifiable factors will increase compliance with HH with the ultimate goal of reducing healthcare associated infections.

Actitudes de los médicos de familia ante la insulinización de diabéticos tipo 2 / Family physician attitudes towards insulinization in type II diabetics

Objetivo: Determinar las actitudes de los médicos de familia del Área Sanitaria de Toledo ante el inicio de la insulinización en pacientes con diabetes mellitus tipo 2 (DM2). Material y métodos: Estudio observacional, descriptivo, transversal, mediante encuesta elaborada ad hoc con datos sociodemográficos y laborales, e inclusión de la versión española del cuestionario Diabetes Attitude Scale (DAS-3sp) para evaluar actitudes y motivaciones relacionadas con la diabetes, enviada a 353 médicos de familia del Área Sanitaria de Toledo. Resultados: Se recibieron 66 encuestas, siendo mujeres el 50,8%, con una edad media (± desviación estándar) de 49,97 ± 7,40 años. Los resultados en las diferentes subescalas (valores de 1 a 5) del DAS-3sp fueron, respectivamente: S1 (necesidad de entrenamiento especial): 4,52 ± 0,38; S2 (percepción de gravedad): 4,18 ± 0,42; S3 (valoración del control estricto): 4,15 ± 0,39; S4 (valoración del impacto psicosocial): 3,79 ± 0,48, y S5 (autonomía del paciente): 3,72 ± 0,55. No se obtuvieron diferencias estadísticamente significativas al comparar las 4 primeras subescalas con el sexo, la formación vía MIR, el ser tutor de residentes, el tipo de contrato o la ubicación de la consulta. Se encontraron diferencias en la subescala S5 por sexo (3,90 ± 0,60 en varones vs 3,54 ± 0,45 en mujeres; t = 2,701; p = 0,009) y por ser tutor de residentes (3,99 ± 0,58 frente a 3,64 ± 0,52 de los no tutores; t = 2,188; p = 0,033). Conclusiones: Entre los médicos de familia del Área Sanitaria de Toledo, las actitudes con respecto al inicio del tratamiento con insulina en pacientes con DM2 son positivas, especialmente en lo referido a los aspectos clínicos, siendo menor en los aspectos más relacionados con el impacto psicosocial en el paciente y su autonomía (AU)

Aim: To determine the attitudes of Toledo Health Area family physicians about starting insulinization in type 2 diabetic patients. Materials and methods: Descriptive, cross-sectional study. A self-completed questionnaire was given to 353 family physicians of the Toledo Health Area, asking about socio-demographic and occupational data, and including the Spanish version of the Diabetes Attitude Scale (DAS-3sp) questionnaire to evaluate attitudes and motivations related to diabetes. Results: A total of 66 responses were received, of which 50.8% were from females. Mean age (± standard deviation) was 49.97 ± 7.40. Results of the different DAS-3sp subscales (values from 1 to 5) were: S1 (need for special training): 4.52 ± 0.38; S2 (seriousness of type 2 diabetes): 4.18 ± 0.42; S3 (value of tight control): 4.15 ± 0.39; S4 (psychosocial impact of diabetes): 3.79±0.48; and S5 (need for patient autonomy): 3.72 ± 0.55. No statistically significant differences were obtained with the four first subscales with sex, specialized training, being a resident tutor, type of contract or clinical setting. There were statistically significant differences in S5 compared with sex (3.90±0,60 in men vs 3.54 ± 0.45 in women; t = 2.701; P = .009) and with being a resident tutor (3.99±0.58 vs 3.64±0.52 in non-tutors; t = 2.188; P = .033). Conclusions: The attitudes regarding starting insulin treatment in type 2 diabetic patients are positives among Toledo Health Area family physicians, specially in the clinical aspects, but they are lower in the psychosocial impact and patient autonomy (AU)

[Family physician attitudes towards insulinization in type II diabetics]. / Actitudes de los médicos de familia ante la insulinización de diabéticos tipo 2.

AIM: To determine the attitudes of Toledo Health Area family physicians about starting insulinization in type 2 diabetic patients. MATERIALS AND METHODS: Descriptive, cross-sectional study. A self-completed questionnaire was given to 353 family physicians of the Toledo Health Area, asking about socio-demographic and occupational data, and including the Spanish version of the Diabetes Attitude Scale (DAS-3sp) questionnaire to evaluate attitudes and motivations related to diabetes. RESULTS: A total of 66 responses were received, of which 50.8% were from females. Mean age (±standard deviation) was 49.97±7.40. Results of the different DAS-3sp subscales (values from 1 to 5) were: S1 (need for special training): 4.52±0.38; S2 (seriousness of type2 diabetes): 4.18±0.42; S3 (value of tight control): 4.15±0.39; S4 (psychosocial impact of diabetes): 3.79±0.48; and S5 (need for patient autonomy): 3.72±0.55. No statistically significant differences were obtained with the four first subscales with sex, specialized training, being a resident tutor, type of contract or clinical setting. There were statistically significant differences in S5 compared with sex (3.90±0,60 in men vs 3.54±0.45 in women; t=2.701; P=.009) and with being a resident tutor (3.99±0.58 vs 3.64±0.52 in non-tutors; t=2.188; P=.033). CONCLUSIONS: The attitudes regarding starting insulin treatment in type2 diabetic patients are positives among Toledo Health Area family physicians, specially in the clinical aspects, but they are lower in the psychosocial impact and patient autonomy.

Anemia en pacientes ingresados por una exacerbación de EPOC. Influencia sobre el pronóstico de la enfermedad / No disponible

Objetivo: Estudiar la prevalencia de anemia en pacientes con EPOC ingresados por exacerbación de su enfermedad, características de estos enfermos, factores asociados a la existencia de anemia e influencia de ésta en la supervivencia. Pacientes y métodos: Estudio de cohortes observacional, prospectivo, realizado en pacientes con EPOC ingresados por exacerbación. Se analizaron datos demográficos, características clínicas, estudio funcional respiratorio, impedanciometría bioeléctrica y analítica sanguínea. Tras el alta se realizó seguimiento para calcular supervivencia y factores determinantes de mortalidad. Resultados: Se evaluaron 106 pacientes (93 varones), con edad media 71 ± 9 años, IMC medio 25,7 ± 5,6 kg/m2 y FEV1 medio 39 ± 13%. El 88,9% eran fumadores o exfumadores. La prevalencia de anemia fue 37,7%. Las comorbilidades más frecuentes fueron: dislipemia (73,6%), hipertensión arterial (59,4%) y cardiopatía (59,4%). El índice de Charlson medio fue de 5,9 ± 1,4 y el índice META medio, medido por bioimpedancia, de 22,3 ± 7,8. El análisis de regresión logística mostró quelos factores determinantes de anemia fueron: edad, niveles de hierro y creatinina e índice META. La supervivencia media de los pacientes que tenían anemia fue 31 ± 4,4 meses frente a 48,1 ± 2,9 en los que no tenían anemia (p < 0,001). Los factores determinantes de mortalidad fueron IMC y niveles de creatinina. Conclusiones: Un elevado porcentaje de pacientes con EPOC ingresados por una exacerbación tienen anemia. Los factores asociados a la existencia de anemia en estos pacientes son edad, niveles de hierro y creatinina e índice META. La presencia de anemia tiene un impacto significativo en la supervivencia (AU)

Objective: To study the prevalence of anemia in patients admitted for COPD exacerbations, the characteristics of these patients, the associated factors with the presence of anemia, and the influence of anemia on survival. Patients and methods: A cohort prospective observational study of patients admitted for COPD exacerbation. Demographic data, clinical characteristics, lung function tests, blood tests and bioelectrical impedance were analyzed. After discharge, monitoring was performed to estimate survival and determinants of mortality. Results: We evaluated 106 patients (93 males), mean age 71 ± 9 years, mean BMI 25.7 ± 5.6 kg/m2 and mean FEV1 39 ± 13%. 88.9% were smokers or former smokers. The prevalence of anemia was 37.7%. The most frequent comorbidities were dyslipidemia (73.6%), hypertension (59.4%) and heart disease (59.4%). The mean Charlson index was 5.9 ± 1.4 and the average META index, measured by bioimpedance, 22.3 ± 7.8. The logistic regression analysis showed that associated factors with anemia were age, creatinine levels, iron and META index. The median survival of patients with anemia was 31 ± 4.4 months versus 48.1 ± 2.9 in those without anemia (p <0.001). The determinants of mortality were BMI and creatinine levels. onclusions: A high percentage of COPD patients admitted with an exacerbation have anemia. Factors associated with the presence of anemia in these patients are age, iron and creatinine levels and META index. The presence of anemia has a significant impact on survival (AU)

Resultados clínicos de la cirugía combinada de catarata con vitrectomía 23-gauge / Clinical outcomes of cataract surgery combined with 23-gauge vitrectomy

Objetivo: Describir los resultados clínicos de la cirugía combinada de catarata (facoemulsificación e implante de lente intraocular) y vitrectomía 23-gauge, y evaluar la eficacia y la seguridad de esta técnica. Métodos: Estudio retrospectivo, consecutivo y no comparativo. Se incluyeron 105 ojos a los que se realizó cirugía combinada de catarata (facoemulsificación e implante de lente intraocular en el saco capsular) y vitrectomía 23-gauge por diversas indicaciones. Se midió la mejor agudeza visual corregida (AV logMAR) y la presión intraocular (PIO) previa y posteriormente a la cirugía, y se registraron las complicaciones postoperatorias. Resultados: El periodo de seguimiento posquirúrgico medio fue de 16,6±9,9 meses. La media de la AV logMAR preoperatoria fue 0,83±0,4 y la postoperatoria 0,44±0,38 en la visita final (1 mes), con una mejoría en el 83% de los ojos. La PIO media preoperatoria fue 16,7±3,7mmHg. En el postoperatorio, la PIO media fue 22,5±12,8 el primer día, 17,5±6,8 tras una semana y 15,3±3,8mmHg al mes. Las complicaciones postoperatorias incluyeron: opacificación capsular posterior (n=5), edema macular (n=4), desepitelización corneal (n=3), desprendimiento de retina (n=2), vitreorretinopatía proliferativa (n=2), desprendimiento coroideo (n=1), agujero macular (n=1), hemorragia vítrea (n=1) y membrana epirretiniana (n=1). Conclusiones: Los resultados obtenidos en este estudio demuestran que la cirugía combinada de catarata con vitrectomía 23-gauge es una técnica segura y eficaz. Entre otras ventajas ofrece una rápida rehabilitación, una escasa incidencia de complicaciones y evita una nueva intervención(AU)

Purpose: To report the clinical outcomes of cataract surgery (phacoemulsification and intraocular lens implantation) combined with 23-gauge vitrectomy, and to evaluate the effectiveness and safety of this technique. Methods: A retrospective, consecutive, non-comparative study which included 105 eyes. Phacoemulsification and intraocular lens implantation (in the capsular sac) combined with 23-gauge vitrectomy were performed. Indications for undergoing surgery were varied. Best corrected logMAR visual acuity (VA) and intraocular pressure (IOP) were measured pre- and postoperatively, and postoperative complications were recorded. Results: Patients were followed-up for a mean of 16.6±9.9 months. The mean preoperative VA was 0.83±0.40 logMAR, and mean postoperative VA one month after surgery was 0.44±0.38 logMAR. The postoperative visual acuity improved in 83.8% of cases. The mean preoperative IOP was 16.6±3.7mmHg, while the mean postoperative IOP was 22.5±12.8mmHg (1 day after surgery), 17.5±6.8mmHg (after 1 week), and 15.3±3.8mmHg (after 1 month). Postoperative complications included posterior capsular opacification (n=5), macular edema (n=4), corneal de-epithelization (n=3), retinal detachment (n=2), proliferative vitreoretinopathy (n=2), choroidal detachment (n=1), macular hole (n=1), vitreous hemorrhage (n=1), epiretinal membrane (n=1), and transient elevated intraocular pressure (n=36). Conclusions: The surgery reported in this study involving phacoemulsification combined with 23-gauge vitrectomy was found to be safe and effective, and was associated with improved clinical features, including rapid rehabilitation, a low incidence of complications, and avoids repeat surgery(AU)

[Clinical outcomes of cataract surgery combined with 23-gauge vitrectomy]. / Resultados clínicos de la cirugía combinada de catarata con vitrectomía 23-gauge.

PURPOSE: To report the clinical outcomes of cataract surgery (phacoemulsification and intraocular lens implantation) combined with 23-gauge vitrectomy, and to evaluate the effectiveness and safety of this technique. METHODS: A retrospective, consecutive, non-comparative study which included 105 eyes. Phacoemulsification and intraocular lens implantation (in the capsular sac) combined with 23-gauge vitrectomy were performed. Indications for undergoing surgery were varied. Best corrected logMAR visual acuity (VA) and intraocular pressure (IOP) were measured pre- and postoperatively, and postoperative complications were recorded. RESULTS: Patients were followed-up for a mean of 16.6±9.9 months. The mean preoperative VA was 0.83±0.40 logMAR, and mean postoperative VA one month after surgery was 0.44±0.38 logMAR. The postoperative visual acuity improved in 83.8% of cases. The mean preoperative IOP was 16.6±3.7mmHg, while the mean postoperative IOP was 22.5±12.8mmHg (1 day after surgery), 17.5±6.8mmHg (after 1 week), and 15.3±3.8mmHg (after 1 month). Postoperative complications included posterior capsular opacification (n=5), macular edema (n=4), corneal de-epithelization (n=3), retinal detachment (n=2), proliferative vitreoretinopathy (n=2), choroidal detachment (n=1), macular hole (n=1), vitreous hemorrhage (n=1), epiretinal membrane (n=1), and transient elevated intraocular pressure (n=36). CONCLUSIONS: The surgery reported in this study involving phacoemulsification combined with 23-gauge vitrectomy was found to be safe and effective, and was associated with improved clinical features, including rapid rehabilitation, a low incidence of complications, and avoids repeat surgery.

Tromboembolismo pulmonar no sospechado en el Servicio de Urgencias / Unsuspected pulmonary thromboembolism in the Emergency Department

Antecedentes y objetivos. El tromboembolismo pulmonar (TEP) es una enfermedad que en ocasiones, se diagnostica con un elevado retraso, lo que puede provocar una mayor morbimortalidad. Hemos definido el perfil clínico de los pacientes con TEP no sospechado en el Servicio de Urgencias, y los factores que influyen en el retraso para establecer el diagnóstico de TEP. Pacientes y métodos. Se analizaron retrospectivamente 148 pacientes ingresados con diagnóstico de TEP confirmado mediante TAC (n=133) o gammagrafía de ventilación/perfusión de alta probabilidad (n=15). Fueron divididos en dos grupos: los que no tenían sospecha diagnóstica de la enfermedad en el Servicio de Urgencias (TEP no sospechado) y aquellos en los que sí se sospechó este proceso (TEP sospechado). Se estudiaron las características clínicas, los factores de riesgo, los signos y los síntomas a su llegada a Urgencias; las pruebas complementarias realizadas, los días de ingreso hospitalario y la mortalidad. Resultados. De los 148 enfermos con TEP, el diagnóstico no se sospechó en el Servicio de Urgencias en 63 pacientes (42,6%). La disnea y el dolor torácico fueron las manifestaciones clínicas más comunes y se identificaron con mayor frecuencia entre los enfermos con TEP sospechado, que entre los pacientes con TEP no sospechado, con diferencias significativas (OR=0,4 [0,2-0,9] para la disnea y OR=0,3 [0,2-0,7], para el dolor torácico). Sin embargo, la presencia asociada de trombopenia (OR=3,4 [1,1-10,2], p<0,05), un electrocardiograma (ECG) normal (OR=3,4 [1,1-10,2], p<0,05), y la localización del TEP en pulmón derecho (OR=4,7 [2-11,3], p<0,001), fueron factores asociados a la no sospecha de la enfermedad. Los días de ingreso y de duración de los síntomas, así como la mortalidad, no fueron estadísticamente diferentes entre ambos grupos. Conclusiones. La proporción de enfermos con TEP confirmado pero no sospechado en el Servicio de Urgencias fue elevada (cerca del 40%). La presencia de disnea y dolor torácico se asociaron a la sospecha de TEP. Por el contrario, la presencia de trombopenia, un ECG normal, y la localización del TEP en el pulmón derecho se asociaron a la no sospecha de TEP en urgencias(AU)

Background and objectives. Pulmonary embolism (PE) is a disease that sometimes has a significant delay in diagnosis. This situation may lead to an increase in morbidity and mortality in patients who have it. The aim of our study has been to define the clinical profile of patients with unsuspected PE in the emergency department and the factors that influence the delayed diagnosis. Patients and methods. A total of 148 patients admitted with diagnosis of PE confirmed by CT (n=133) or by high-probability ventilation-perfusion scintigraphy scan (n=15) were retrospectively analyzed. They were divided into two groups: those with unsuspected disease in the emergency department (USPE) and those who it was suspected (SPE). Baseline characteristics of the patients, risk factors, signs and symptoms in the emergency department, complementary test, days of hospitalization and mortality were studied. Results. The USPE was found in 63/148 patients (42.6%) in the emergency department. Dyspnea and chest pain were the most frequent clinical manifestations of this disease, this being more commonly identified in the SPE group than in the USPE group, with significant differences (OR=0.4 [0.2-0.9] for dyspnea and OR=0.3 [0.2-0.7] for chest pain). However, However, the presence of thrombocytopenia (OR=3.4 [1.1-10.2], P<.05), normal electrocardiogram (EC) (OR=3.4 [1.1-10.2], P<.05), and localization of PE in right lung (OR=4.7 [2-11.3], P<.001) were risk factors for not suspect it. Days of hospitalization, days of symptoms and mortality were not statistically different between groups. Conclusions. According to the results, the proportion of unsuspected PE in the emergency department was high (close to 40%). The presence of dyspnea and chest pain was associated to suspicion of SPE. On the contrary, the presence of thrombocytopenia, normal EC and right localization of PE were associated to the non-suspicion of SPE in the emergency department(AU)

[Unsuspected pulmonary thromboembolism in the Emergency Department]. / Tromboembolismo pulmonar no sospechado en el Servicio de Urgencias.

BACKGROUND AND OBJECTIVES: Pulmonary embolism (PE) is a disease that sometimes has a significant delay in diagnosis. This situation may lead to an increase in morbidity and mortality in patients who have it. The aim of our study has been to define the clinical profile of patients with unsuspected PE in the emergency department and the factors that influence the delayed diagnosis. PATIENTS AND METHODS: A total of 148 patients admitted with diagnosis of PE confirmed by CT (n=133) or by high-probability ventilation-perfusion scintigraphy scan (n=15) were retrospectively analyzed. They were divided into two groups: those with unsuspected disease in the emergency department (USPE) and those who it was suspected (SPE). Baseline characteristics of the patients, risk factors, signs and symptoms in the emergency department, complementary test, days of hospitalization and mortality were studied. RESULTS: The USPE was found in 63/148 patients (42.6%) in the emergency department. Dyspnea and chest pain were the most frequent clinical manifestations of this disease, this being more commonly identified in the SPE group than in the USPE group, with significant differences (OR=0.4 [0.2-0.9] for dyspnea and OR=0.3 [0.2-0.7] for chest pain). However, However, the presence of thrombocytopenia (OR=3.4 [1.1-10.2], P<.05), normal electrocardiogram (EC) (OR=3.4 [1.1-10.2], P<.05), and localization of PE in right lung (OR=4.7 [2-11.3], P<.001) were risk factors for not suspect it. Days of hospitalization, days of symptoms and mortality were not statistically different between groups. CONCLUSIONS: According to the results, the proportion of unsuspected PE in the emergency department was high (close to 40%). The presence of dyspnea and chest pain was associated to suspicion of SPE. On the contrary, the presence of thrombocytopenia, normal EC and right localization of PE were associated to the non-suspicion of SPE in the emergency department.

Normalization of the sleep-wake pattern and melatonin and 6-sulphatoxy-melatonin levels after a therapeutic trial with melatonin in children with severe epilepsy.

This study evaluated the sleep-wake pattern, plasma melatonin levels and the urinary excretion of its metabolite, 6-sulphatoxy-melatonin among children with severe epileptic disorders, before and after a therapeutic trial with melatonin. Ten paediatric patients, suffering from severe epileptic disorders, were selected and given a nightly dose of 3 mg of a placebo, for 1 wk; for the next 3 months, the placebo was replaced with a nightly dose of 3 mg of melatonin. At the end of each treatment period, the urinary excretion of 6-sulphatoxy-melatonin (for the intervals 09.00 - 21:00 hr or 21:00-09:00 hr) and plasma levels of melatonin (recorded at 01:00, 05:00, 09:00, 13:00, 17:00 and 21:00 hr) were recorded, over a period of 24 hr; an actigraph record was also kept. Sleep efficiency among patients who received melatonin was significantly higher than among those given the placebo, with fewer night-time awakenings. Periodic plasma melatonin levels were regained and a better control gained of convulsive episodes, in that the number of seizures decreased. We conclude that melatonin is a good regulator of the sleep-wake cycle for paediatric patients suffering from severe epilepsy, moreover, it to a better control of convulsive episodes.

Neumonía lipoidea por aspiración accidental de queroseno en un «comedor de fuego» / Lipoid pneumonia by accidental aspiration of kerosene in a «fire eater»

La neumonía lipoidea es una entidad clínica causada por la aspiración o inhalación de sustancias grasas de origen animal. En este artículo se presenta el caso de un paciente de 24 años que realizaba actuaciones esporádicas como «tragafuegos», utilizando el queroseno como elemento fundamental, y que presentó una neumonía lipoidea aguda con resolución completa. Asimismo, se realiza una revisión del tema hasta la fecha actual (AU)

Lipoid pneumonia is a clinical entity caused by aspiration of animal fat substances or their inhalation. This article presents the case of a 24-year old male patient who performed sporadic performances as a «fire eater», using kerosene as a fundamental element, and who had acute lipoid pneumonia with complete resolution. Furthermore, a review is made of the subject up to the present date (AU)

Gammagrafía salival cuantitativa en pacientes con cáncer de cabeza y cuello tratados con radioterapia / Quantitative salivary gland scintigraphy in head and neck cancer patients following radiotherapy

Objetivo. Determinar el papel de la gammagrafía salival (GS) cuantitativa en la detección de alteraciones funcionales de las glándulas salivales en pacientes con cáncer de cabeza y cuello tratados con radioterapia (RT). Material y métodos. Se estudió a 19 pacientes (17 varones) con edad media de 62,4 años (44–75). Se realizaron tres estudios a cada paciente: basal, a los 3 y a los 18 meses tras la RT. La gammagrafía salival se realizó con 3,7MBq/kg de 99mTc-pertecnetato durante 25 minutos y zumo de limón al final del minuto 15. Se calculó la fracción de excreción (FE), las cuentas máximas/minuto/píxel/MBq (CMPM), el porcentaje de captación a partir de las curvas actividad/tiempo de áreas de interés sobre ambas glándulas parótidas (GP) y glándulas submaxilares (GSM) y la influencia de las dosis recibidas por las parótidas. Resultados. La FE mostró una disminución significativa del estudio basal a los 3 meses (p<0,001), tanto en las GP como en las GSM, y a los 18 meses en las GSM (p<0,001). Se observó un aumento significativo de la FE del estudio a los 3 meses al de los 18 meses (p<0,05). Resultados. La CMPM no cambió significativamente en las GP desde el estudio basal a los de 3 y 18 meses, pero sí en las GSM con disminución significativa (p<0,01) desde el estudio basal al de 18 meses. El porcentaje de captación no cambió significativamente. Se observó correlación moderada entre la dosis a parótidas y los parámetros a los 3 meses post-RT (p<0,05). Conclusiones. La FE presentó mayor sensibilidad que la captación al efecto de la RT sobre la función salival, mostrando, además, recuperación funcional a lo largo del tiempo en las GP(AU)

Objective. To assess the role of quantitative salivary gland scintigraphy (SGS) in the detection of functional impairment of salivary glands in patients with head and neck cancer treated with radiotherapy (RT). Material and methods. We studied 19 patients (17 men), mean age 62.4 years (44–75). Three studies were performed to each patient: baseline, 3 and 18 months after RT. SGS was acquired for 25 minutes following injection of 3.7MBq/kg of 99mTc-pertechnetate with lemon juice at the end of minute 15. Material and methods. Excretion fraction (EF), counts per minute/pixel/MBq (CMPM) and uptake percentage were obtained from time-activity curves from ROIs placed over parotid (PG) and submandibular glands (SMG) and related to the doses received by the PG. Results. EF showed a significant reduction from the baseline to the 3 months study (p<0.001) for the PG and SMG and from the baseline to the 18 months study for the SMG (p<0.001). A significant improvement of EF was seen from the 3 months to the 18 months study for the PG (p<0.05). Results. CMPM did not change significantly from the baseline to the 3 months and 18 months studies for the PG and showed a significant reduction (p<0.01) for the SMG from the baseline to 18 months study. The uptake percentage did not change significantly between studies. A moderate association was observed between the doses to PG and the 3m study parameters. Conclusions. EF was more sensitive than uptake in assessing post-RT impairment of salivary function. In addition, it reflected functional recovery of parotid glands over time(AU)

Neumotórax de repetición / Recurrent pneumothorax

No disponible

No disponible

[Quantitative salivary gland scintigraphy in head and neck cancer patients following radiotherapy]. / Gammagrafía salival cuantitativa en pacientes con cáncer de cabeza y cuello tratados con radioterapia.

OBJECTIVE: To assess the role of quantitative salivary gland scintigraphy (SGS) in the detection of functional impairment of salivary glands in patients with head and neck cancer treated with radiotherapy (RT). MATERIAL AND METHODS: We studied 19 patients (17 men), mean age 62.4 years (44-75). Three studies were performed to each patient: baseline, 3 and 18 months after RT. SGS was acquired for 25 minutes following injection of 3.7 MBq/kg of (99m)Tc-pertechnetate with lemon juice at the end of minute 15. Excretion fraction (EF), counts per minute/pixel/MBq (CMPM) and uptake percentage were obtained from time-activity curves from ROIs placed over parotid (PG) and submandibular glands (SMG) and related to the doses received by the PG. RESULTS: EF showed a significant reduction from the baseline to the 3 months study (p<0.001) for the PG and SMG and from the baseline to the 18 months study for the SMG (p<0.001). A significant improvement of EF was seen from the 3 months to the 18 months study for the PG (p<0.05). CMPM did not change significantly from the baseline to the 3 months and 18 months studies for the PG and showed a significant reduction (p<0.01) for the SMG from the baseline to 18 months study. The uptake percentage did not change significantly between studies. A moderate association was observed between the doses to PG and the 3m study parameters. CONCLUSIONS: EF was more sensitive than uptake in assessing post-RT impairment of salivary function. In addition, it reflected functional recovery of parotid glands over time.

[Cerebellar ataxia of Norman-Jaeken. Presentation of seven Spanish patients]. / Ataxia cerebelosa de Norman-Jaeken. Presentación de siete pacientes españoles.

AIM: To show that the cerebellar ataxias described by Norman and by Jaeken (CDG1a) are the same disease. PATIENTS AND METHODS: Seven patients, five females and two males (there were two siblings pairs), who presented a severe cerebellar disease slowly progressive associated with generalized cerebellar atrophy. The sister of one of the patients of the series had been studied because of psychomotor retardation but she died at two years of age due to respiratory problems. An autopsy was carried out that showed severe cerebellar atrophy, and the histological study revealed loss of granular cells and diverse abnormalities of Purkinje's cells, especially focal swellings of 'asteroid bodies' or 'cactus like' type. This suggested to us that Norman's ataxia and CDG1a could be the same pathological entity. RESULTS: All seven patients had severe cerebellar hypoplasia-atrophy and a small brainstem. Most patients showed peripheral neuropathy with decreased motor nerve conduction velocity, but very little decreased sensory nerve conduction velocity. All seven patients had highly raised serum concentrations of asialotransferrin, and heterozygous molecular PMM2 deficit (CDG1a). One of these seven cases was the patient whose sister had histological cerebellar changes corresponding to Norman's ataxia. CONCLUSION: The findings observed in our series suggest that the diseases described by Norman and Jaeken are the same pathological entity and CDG1a can be the biological basis of the histological changes of the cerebellum in Norman's ataxia. We suggest the name of Norman-Jaeken ataxia or disease for this entity.

Implication of mitochondria-derived ROS and cardiolipin peroxidation in N-(4-hydroxyphenyl)retinamide-induced apoptosis.

We have studied the effect of N-(4-hydroxyphenyl)retinamide on either malignant human leukaemia cells or normal cells and investigated its mechanism of action. We demonstrate that 4HPR induces reactive oxygen species increase on mitochondria at a target between mitochondrial respiratory chain complex I and II. Such oxidative stress causes cardiolipin peroxidation which in turn allows cytochrome c release to cytosol, caspase-3 activation and therefore apoptotic consumption. Moreover, this apoptotic pathway seems to be bcl-2/bax independent and count only on malignant cells but not normal nor activated lymphocytes.

Contribución de la detección radioguiada y biopsia selectiva del Ganglio centinela al estadiaje de 100 pacientes con melanoma cutáneo / Contribution of the radioguided detection and selective biopsy of the sentinel lymph node with staging in 100 patients with cutaneous melanoma

Objetivo: La biopsia selectiva del Ganglio Centinela (GC) se ofrece como una alternativa a la linfadenectomía regional convencional en el estadiaje de pacientes con melanoma cutáneo maligno. El objetivo de este trabajo es analizar nuestra experiencia en la localización del GC mediante linfogammagrafía y sonda detectora y su utilidad en el estadiaje del melanoma cutáneo maligno (MCM).Material y Métodos: Se estudiaron 100 pacientes, 56 mujeres y 44 hombres, con edad media de 51,5 ñ 31,5 años, diagnosticados de MCM. En todos los casos se realizó linfografía radioisotópica pre-operatoria para detectar el área ganglionar de drenaje tras administración intradérmica peritumoral de 600 microCi de 99mTc- sulfuro coloidal, adquiriendose imágenes planares cada 10 minutos hasta la localización de actividad en áreas ganglionares de drenaje. Posteriormente se efectuó localización intraoperatoria mediante sonda detectora y biopsia selectiva del GC, enviándose al Servicio de Anatomía Patológica para evaluar infiltración metastásica. Resultados: El estudio linfogammagráfico resultó positivo en 99 de los 100 casos, siendo identificados intraoperatoriamente 98 casos. El análisis anatomopatológico fue negativo en el 78,9 por ciento y positivo en el 21,1 por ciento de los ganglios extraídos. Conclusiones: La linfografía radioisotópica y la detección intraoperatoria son dos técnicas extraordinariamente útiles en la localización del GC y estadiaje del MCM. Son muchos los pacientes que se benefician de la biopsia selectiva radioguiada del GC en ésta patología tumoral, tanto en disminución de la morbilidad de la intervención como en un mejor estadiaje de la enfermedad. (AU)

[Contribution of radioguided detection and selective biopsy of the sentinel lymph node to staging in 100 patients with cutaneous melanoma]. / Contribución de la detección radioguiada y biopsia selectiva del Ganglio centinela al estadiaje de 100 pacientes con melanoma cutáneo.

OBJECTIVE: A selective sentinel node (SN) biopsy appears to be an alternative to conventional lymph node dissection for staging patients with cutaneous melanoma. This study has aimed to analyze our experience in the localization of the sentinel node with a probe detector and lymphoscintigraphy and its utility in the staging of this disease. MATERIAL AND METHODS: 100 patients, 56 female and 44 male, 51.5 31.5 mean age, diagnosed of cutaneous melanoma were studied. The lymphoscintigraphy was performed in all cases to detect the area of lymphatic drainage after peritumoral intradermal administration of 600 uCi of 99mTc-colloidal sulfur, and planar images were acquired every 10 minutes until activity was detected in these areas. Afterwards, the intraoperative localization of the sentinel node with a probe detector was performed and the selective biopsy of the node was sent to the Pathology Department for its histologic study. RESULTS: The lymphoscintigraphy study was positive in 99 of the 100 cases and it was identified intraoperatively in 98 cases. The histologic analysis was negative in 78.9% and positive in 21.1% of the nodes. CONCLUSIONS: Radioisotopic lymphography and intraoperative probe detection are two very useful techniques for locating the sentinel node and staging patients with cutaneous melanoma. Many patients are benefiting from the selective biopsy of the sentinel node because of the decreased post-surgical morbidity and better staging of the cutaneous melanoma.

Institutional childcare and the affective deficiency syndrome: consequences on growth, nutrition and development.

It is generally accepted that, in the face of certain family and social circumstances, a minor may need to be taken into care within an institution, a course of action that provides, at least, an alternative to the risks of abandonment and life "on the street". Nevertheless, the reality of life in childcare centres can lead to children undergoing an additional trauma after escaping the miserable situation of the family home. After the advances made in recent years (economic, healthcare, social, legal, etc.), it has been suggested that the institutionalization of a minor, as a rule, does not in itself represent a negative factor for the child's wellbeing. In order to test this hypothesis, we studied two groups of children in care. The first group comprised 101 children being cared for in a large traditional institution during 1986. The second group was composed of 66 children studied in 1996, resident in a smaller, charitable institution, providing a more family-like atmosphere. Growth evaluation methods were applied, including anthropometry (weight, height, weight/height ratio, body mass index, Rorer index and weight index), nutrition (skin folds, body density, percentage of body fat and weight of the fat) and development (psychometry: Boehm test, CMMS, Raven and EIT). The data were analyzed by means of the Student's t-test. The most important result obtained was the demonstration that the second group of children presented results that were clearly higher in nearly all the studied variables, thus showing that institutionalization in itself does not have a negative influence on child development.