Importance of blood pressure monitoring in the acute phase of stroke. An update.

INTRODUCTION: The evaluation of blood pressure (BP) is essential in the acute phase of stroke. Although ambulatory blood pressure monitoring (ABPM) is a validated method for BP control, there are few studies assessing the usefulness of ABPM in the acute phase of stroke. DEVELOPMENT: A systematic review was carried out according to the PRISMA criteria in the PubMed/Medline and Scopus databases. Those articles that analysed the use of ABPM in the first days after suffering a stroke from 1992 to 2022 were selected. Those articles focused on the post-acute or sequelae phase of the stroke, with a sample size of less than 20 and those where the primary objective was different from the defined one. A total of 28 articles were included. CONCLUSIONS: The use of ABPM in patients with recent stroke demonstrates that the normal circadian profile of BP is altered in more than two-thirds of patients and that this will be fundamentally conditioned by the haemodynamic changes that occur on autoregulation of cerebral blood flow, the type of stroke or the response to treatment. Furthermore, these changes in BP have prognostic implications and are correlated with functional status, stroke recurrence and mortality, among others. However, although they continue to be a growing area of research, new studies are needed to clarify the real role of this technique in patients with acute stroke.

Potential of High-Resolution Mass Spectrometry for the Detection of Drugs and Metabolites in Hair: Methoxetamine in a Real Forensic Case.

The analysis of drugs of abuse in hair and other biological matrices of forensic interest requires great selectivity and sensitivity. This is done traditionally through target analysis, with one or more analytical methods, or with different and specific preanalytical phases, and complex procedures performed by the toxicological laboratories, and there is no exception with ketamine-like compounds, such as methoxetamine, a new psychoactive substance whose use has increased in the last decades, and continues to grow quickly year by year. More validated methods of analysis are needed to detect these substances in low concentrations selectively. Reanalyzing the samples of a former case of a polydrug consumer accused of a crime against public health in Spain, five metabolites of methoxetamine (normethoxetamine, O-desmethylmethoxetamine, dehydromethoxetamine, dihydronormethoxetamine and hydroxynormethoxetamine) were tentatively detected using a high-resolution technique, that is, liquid chromatography coupled to high-resolution mass spectrometry (LC-HR-MS-MS). The highest analytical selectivity of LC-HR-MS-MS method together a universal and simpler pretreatment stages has demonstrated to allow faster analysis and more sensitivity than the one performed traditionally at the INTCF laboratories, which was gas chromatography coupled to mass spectrometry.

A simulator study of adverse wear with metal and cement debris contamination in metal-on-metal hip bearings.

OBJECTIVES: Third-body wear is believed to be one trigger for adverse results with metal-on-metal (MOM) bearings. Impingement and subluxation may release metal particles from MOM replacements. We therefore challenged MOM bearings with relevant debris types of cobalt-chrome alloy (CoCr), titanium alloy (Ti6Al4V) and polymethylmethacrylate bone cement (PMMA). METHODS: Cement flakes (PMMA), CoCr and Ti6Al4V particles (size range 5 µm to 400 µm) were run in a MOM wear simulation. Debris allotments (5 mg) were inserted at ten intervals during the five million cycle (5 Mc) test. RESULTS: In a clean test phase (0 Mc to 0.8 Mc), lubricants retained their yellow colour. Addition of metal particles at 0.8 Mc turned lubricants black within the first hour of the test and remained so for the duration, while PMMA particles did not change the colour of the lubricant. Rates of wear with PMMA, CoCr and Ti6Al4V debris averaged 0.3 mm(3)/Mc, 4.1 mm(3)/Mc and 6.4 mm(3)/Mc, respectively. CONCLUSIONS: Metal particles turned simulator lubricants black with rates of wear of MOM bearings an order of magnitude higher than with control PMMA particles. This appeared to model the findings of black, periarticular joint tissues and high CoCr wear in failed MOM replacements. The amount of wear debris produced during a 500 000-cycle interval of gait was 30 to 50 times greater than the weight of triggering particle allotment, indicating that MOM bearings were extremely sensitive to third-body wear. Cite this article: Bone Joint Res 2015;4:29-37.

Complicaciones agudas inusuales de la infección por el virus de Epstein-Barr / Unusual acute complications of Epstein-Barr virus infection

La infección por el virus de Epstein-Barr es muy prevalente en la infancia y, aunque en la mayoría de los casos el diagnóstico es sencillo y su evolución favorable, hay casos como el que presentamos que pueden tener un amplio espectro clínico y complicaciones agudas que dificultan el diagnóstico y pueden ensombrecer el pronóstico. Se han descrito muchas complicaciones agudas que afectan a todos los sistemas y aparatos. Presentamos un caso que presenta complicaciones respiratorias, neurológicas y hepáticas (AU)

The infection caused by the Epstein-Barr virus is very common in childhood. In most cases the diagnosis is easy and its evolution of the illness is favourable, but there are some patients in whom the infectious mononucleosis can have a large clinical spectrum with acute complications that make the diagnosis difficult. We report a patient who had respiratory, neurological and hepatic complications (AU)

Lupus neonatal: manifestaciones cutáneas asociadas con trombopenia neonatal / No disponible

El lupus neonatal es un síndrome raro que afecta a recién nacidos y lactantes, que se define por la presencia e autoanticuerpos maternos y características clínicas, como lesiones cutáneas típicas, bloqueo cardíaco completo, miocardiopatía, alteraciones hematológicas y hepatobiliares. Presentamos un lactante de 5 semanas derivado desde Atención Primaria por lesiones cutáneas anulares en tronco, cuero cabelludo y cara. Como antecedentes destaca en la mare afecta de síndrome Overlap (esclerosis sistémica, lupus y miositis). Se inicia estudio confirmándose el diagnóstico de lupus neonatal mediante punch biopsia y ANA moteado positivo con anti SSA-Ro y anti RNP positivos (AU)

Neonatal Lupus Erythematosus is a rare disroder that affects newborns and infants and it is caused by mother´s autoantibodies and several clinical features as typical skin rash, congenital complete heart block, miocardiapathies, haematoligical and hepatobiliary diseases. We attended a 5 weeks male infant, who was derived from the primary care center because of an annular skin rash on trunk, scalp and face. There was maternal history of Overlap syndrome (systemic sclerosis, lupus and myosistis). Diagnosis of neonatal Lupus was made by the skin biopsy and an ANAs with autoantibodies against Ro and U1-ribonucleoprotein (RNP) (AU)

Características de la presión arterial en pacientes con diabetes tipo 2 y nefropatía diabética tomada en consulta, automedida, domiciliaria y monitorización ambulatoria / Characteristics of blood pressure in patients with diabetes type 2 and diabetic kidney disease, measured in the surgery, at home, and in the health care center

El paciente con Diabetes Mellitus (DM) tipo 2 y Nefropatía Diabética presenta frecuentemente hipertensión arterial añadida a su patología. Esta hipertensión arterial es de difícil control y además presenta importantes alteraciones del ritmo circadiano. Nuestro objetivo es estudiar las características de la presión arterial en estos pacientes mediante tres métodos: Presión arterial en consulta (PAC, Automedida de presión arterial (AMPA) y Monitorización ambulatoria de presión arterial (MAPA).Se incluyen en el trabajo 60 pacientes con una edad media de 66,7 ñ 9 años, duración de DM de 11,3 ñ 7 años, hemoglobina glicada 7,7 por ciento y creatinina plasmática de 1,3 mg/dl. El 70 por ciento presentaba microalbuminuria y el 30 por ciento proteinuria. Se determina la presión arterial (PA) mediante los tres métodos (PAC, AMPA y MAPA) sin modificar el tratamiento antihipertensivo, se realizan las determinaciones bioquímicas habituales y se lleva a cabo una ecocardografía bidimensional en modo M. Las cifras de presión arterial mediante los tres métodos mostraron una buena correlación, apreciándose fenómeno de bata blanca en un 50 por ciento de los pacientes. La PA no descendía de forma adecuada por la noche en un 70 por ciento de los pacientes, apreciándose en ellos un mayor índice de masa ventricular izquierda en la ecocardiografía. La media de PA en las primeras horas de la mañana estaba elevada en los dos métodos ambulatorios. El paciente con DM tipo 2 y nefropatía diabética presenta alteraciones importantes en el ritmo circadiano de presión arterial, con un pobre descenso nocturno y elevación de la PA en las primeras horas de la mañana. Este dato es importante puesto que estas alteraciones se relacionan con un mayor riesgo de eventos cardiovasculares (AU)

Thiopurine methyltransferase activity in a Spanish population sample: decrease of enzymatic activity in multiple sclerosis patients.

The present study was performed in order to obtain the thiopurine methyltransferase (TPMT) activity frequency distribution histogram in a Spanish population. A total of 3640 Spanish clinical laboratory samples were evaluated, which included 1249 patients with Crohn's disease, 589 with ulcerative colitis, 348 with multiple sclerosis (MS), 487 with several autoimmune diseases different from the above-mentioned diseases and 967 a donor group. We have measured the TPMT activity in red blood cells (RBCs) by a radiochemical method, using S-adenosyl-L-[methyl-3H]methionine as methyl donor. The different groups present in their entirety a normal distribution histogram and a wide range of TPMT activity from 0 to 41 U/ml RBCs. The differences found between the Spanish population TPMT activity frequency distribution histogram and the pattern previously described in a North American population were not due to azathioprine treatment or gender. The effect of autoimmune diseases on TPMT activity was evaluated: the enzymatic activity was similar in the donor group (19.9 +/- 6.3 U/ml RBCs) and in the patients with Crohn's disease (20.0 +/- 5.8 U/ml RBCs) and ulcerative colitis (19.7 +/- 6.1 U/ml RBCs); however, it decreased significantly (p<0.0001) in MS patients (17.1 +/- 6.1 U/ml RBCs) with respect to the donor group. In conclusion, our results show that the Spanish population TPMT distribution is closer to that of the Jewish population of Israel than to North American populations, and that in MS the enzymatic activity of TPMT decreases significantly. This observation may take into account the usage of azathioprine as therapeutic agent in Spanish MS patients.

[Percutaneous placement of covered stents for treatment of post discectomy arterial rupture]. / Rotura arterial posdiscectomía. Tratamiento mediante implante percutáneo de una endoprótesis cubierta.

INTRODUCTION: Vascular lesions produced as a consequence of surgical spinal treatment are rare, but serious. Fast diagnosis and treatment are essential in lesions that produce massive blood loss. Following the use of non covered stents in the treatment of peripheral vascular stenotic obstructive pathologies, the appearance of covered stents allowed aneurysms, pseudo aneurysms, fistulas or bleedings to be treated. Being able to graft a stent in serious patients, during diagnosis itself, with a minimum amount of aggression and local anaesthesia affords this technique huge advantages over others. CASE REPORT: In this work we report the case of an arterial rupture which came about as a complication of a discectomy. After the surgical intervention, there was an important haematocrit reduction within a short space of time. The patient s quickly becoming anaemic and the existence of a retroperitoneal mass of heterogeneous echogenicity pointed towards a postoperative haemorrhage. This was confirmed by arteriography, which revealed an important contrast extravasation. A covered stent was placed at the same time and, in the post graft follow up, it was confirmed that there was no bleeding. At 12 hours after the operation the patient was moved from the postoperative recovery unit to a hospital ward and, 5 days later, was discharged. In a check up carried out in the Neurosurgery unit 2 months after being sent home, the patient was found to be asymptomatic. CONCLUSION: The placement of covered stents is a valid therapeutic option for treating postoperative haemorrhagic lesions. It can be performed at the same time as diagnosis and does not require general anaesthesia. In the case we have described, the patient recovered quickly and ambulatory check ups showed he continued to be asymptomatic

Determination of thiopurine methyltransferase activity in human erythrocytes by high-performance liquid chromatography: comparison with the radiochemical method.

The current article describes a new assay to measure thiopurine methyltransferase (TPMT) activity from red blood cells. This method is based on the measurement of the reaction product 6-methylmercaptopurine (6-MMP) by high-performance liquid chromatography (HPLC). 6-MMP is extracted by ethyl acetate with recoveries of 85%, 80%, 80%, and 92% for 50, 250, 500, and 1,000 ng/100 microL packed red blood cells, respectively. 6-MMP was identified and measured by a Zorbax CN column installed in an HPLC system. The chromatograms were resolved using a mobile phase consisting of 40 mmol/L sodium phosphate buffer (pH 3) and methanol in a gradient from 1% to 20% of methanol. Under these conditions 6-MMP is well resolved from substrates (6-mercaptopurine and S-adenosyl-L-methionine) and endogenous peaks. When the TPMT activity from 20 patients was measured by the HPLC-linked assay and the classic radiochemical method, a linear correlation was obtained between both procedures ( y = 0.99x + 0.33; x-axis, radiochemical assay; y-axis, HPLC-linked assay; r = 0.98). In conclusion, the current report describes a new, reliable, safe, and nonradioactive method to measure TPMT activity that is shorter and simpler than the previously described ones.

Ingesta alimenticia y utilidad de los suplementos nutricionales enterales en hemodiálisis periódica / Fudd intake and use of enteral nutition suppements in periodical haemodyalisis

En los pacientes en tratamiento con hemodiálisis periódica (HDP) se detectan elevados porcentajes de malnutrición, dato destacable puesto que se correlaciona con un incremento marcado de morbimortalidad. Dentro del origen multifactorial de esta desnutrición, la ingesta inadecuada es una causa importante. Pretendemos en este estudio analizar la ingesta alimentaria de los pacientes en HDP y las opciones de complementarla con suplementos nutricionales entera les para cubrir de forma adecuada las necesidades proteico calóricas, que se cifran en un aporte proteico de: 1,2 gr/Kg/día y calórico de 35 Kcal/Kg/día. También queremos estudiar la eficacia y tolerancia de los dos suplementos utilizados, uno específico de diálisis Nephro © y otro estándar hipercalórico Precitene Energético ©.Realizamos el trabajo sobre 24 pacientes en HDP en los que determinamos edad, sexo, tiempo en diálisis, causa de IRC y parámetros de calidad de diálisis. El estudio nutricional incluye: parámetros antropométricos (Indice de masa corporal (IMC), pliegue cutáneo tricipital (PCT), circunferencia muscular del brazo (CMB)), parámetros bioquimicos y encuesta dietética ( por el método de registro alimentario de 7 días). Seleccionamos 10 pacientes con pobre ingesta alimentaria (1,12 ñ 0,6 gr/Kg/día de proteínas y 30,2 ñ 12 Kcal/Kg/día de calorías) y ensayamos complementar su dieta con los dos suplementos enterales. Analizamos la tolerancia y los resultados obtenidos con estos suplementos contrastando las dos semanas previas a su administración con las dos semanas de su toma. La tolerancia a ambos suplementos fue buena, con un solo abandono del tratamiento. No registramos diferencias importantes en la ganancia de peso ni en las complicaciones intradiálisis. Se produce un aumento en la urea prediálisis y en el PCR. El K no sufre variaciones importantes cuando el suplemento administrado es específico para la diálisis, incrementándose cuando se utiliza el no específico. Conseguimos complementar la ingesta proteica y calórica con ambos suplementos, pasando a aportes proteico calóricos adecuados superiores a las necesidades consideradas en el apartado de objetivos. Podemos concluir que es importante la vigilancia de la ingesta alimenticia de nuestros pacientes para poder corregir de forma precoz los déficits y evitar el desarrollo de malnutrición. El tiempo analizado es demasiado corto para detectar cambios importantes en el estado nutricional pero sí hemos conseguido un incremento de la urea prediálisis y del PCR que sugieren una mayor ingesta proteica y unos adecuados objetivos en el aporte protéico-calórico. La tolerancia es buena, pero el cansancio producido por la toma continuada de dichos suplementos puede llevar al abandono por parte del paciente. Con la administración de varios preparados, aunque no sean específicos para la diálisis, podemos obtener una mayor adherencia, teniendo en cuenta que al no ser específicos y tener mayor contenido en K, pueden producir hiperpotasemia, lo que nos limita la cantidad que podemos administrar (AU)

[Percutaneous treatment of peripheral vascular malformations]. / Tratamiento percutáneo de las malformaciones vasculares periféricas.

OBJECTIVE: Vascular malformations are uncommon pathologic entities in which surgery is usually not possible or is inefficient. Our experience with the percutaneous treatment of peripheral vascular malformations, by means of transarterial embolization or direct puncture is here reported. MATERIAL AND METHODS: During the 1993-1997 period a total of 35 patient, 20 females (57%) and 15 males (43%) aged 11 to 75 years, were treated at our Unit. Sixteen vascular malformations were hemodynamically active (45.7%) and 19 hemodynamically inactive (54.3%). A total of 126 embolizations (mean 3.6) were performed. Malformations were studied by means of doppler-echography, magnetic resonance, arteriography and direct puncture angiography. Considering location, size and hemodynamic characteristics a specific approach and therapy was performed in each case. In two cases (5.7%) a surgical exeresis after embolization was performed. RESULTS: A technical success, defined as the possibility of embolizing the malformation, was achieved in 100% of cases. No technical complications during the procedure occurred. The mean follow-up time was 23 months (6-69). All patients but one improved both objectively and subjectively and all but one have recovered their daily activities in the following days. The exception was one patient who developed a severe complication--cutaneous necrosis--a few days after the procedure which required repairing surgery. All patient had edema, pain and increased functional impairment after the embolization which subsided with medical treatment. CONCLUSIONS: Percutaneous embolization of vascular malformations is an effective method associated with a low complication rate. Our results are encouraging although more extensive investigation are required to draw definite conclusions.

[Wallstent endoprostheses implanted by fluoroscopic guidance in the palliative treatment of malignant esophageal obstructions and esophago-tracheal fistulas]. / Endoprótesis de Wallstent implantadas bajo control fluoroscópico en el tratamiento paliativo de las obstrucciones esofágicas malignas y fístulas esófago-traqueales.

PURPOSE: The objective of this study was to present our experience with metallic stents (Wallstent) for palliation of dysphagia due to malignant esophageal obstruction and esophagotracheal fistula. PATIENTS AND METHODS: From August 1994 to July 1996 20 uncovered and 6 covered stents were inserted in 16 consecutive patients with dysphagia grade 3 (n = 4) or grade 4 (n = 12) caused by incurable malignant obstructions. The obstruction was in the proximal (n = 4), in the middle (n = 3) and the distal (n = 9) third of the esophagus. Five patients presented with esophagotracheal fistula. The stent insertion was performed under fluoroscopic control. RESULTS: Exact positioning of the stent with reduction of the dysphagia was obtained in all patients. There were no complications related with the procedure. Esophagotracheal fistula was solved in those patients treated with covered stents. Six patients had recurrent dysphagia due to tumor ingrowth or overgrowth. In these patients an additional overlapping stent was placed. In latest evaluation 2 patients presented dysphagia grade I, 5 grade III, and 4 grade IV. CONCLUSION: Implantation of stents proved to be an effective and safe method of palliating dysphagia and occluding esofagotracheal fistula. Placement of stents was feasible without major procedure-related complications.

Synchronous fluorimetric determination of salicylic acid and diflunisal in human serum using partial least-squares calibration.

The simultaneous determination of salicylic acid and diflunisal in human serum has been accomplished by synchronous fluorimetry, in combination with partial least-squares multivariate calibration. The total luminescence information of the analytes has been used to optimize the spectral data set for the calibration, by analysis of the three-dimensional excitation-emission matrices. The synchronous spectrum, maintaining a constant difference of Deltalambda = 128 nm between the emission and excitation wavelengths, has been selected as optimum to perform the determination. The method is based on the fluorescence of these compounds in chloroform containing 1% (v/v) acetic acid. Serum samples are treated with trichloroacetic acid to remove the proteins, and both analytes are extracted into chloroform-1% (v/v) acetic acid prior to the determination. For concentrations ranging from 60-240 mug ml(-1) of each drug, analytical recoveries range from 96% to 103% for salicylic acid and from 97% to 105% for diflunisal.

Simultaneous fluorimetric determination of acetylsalicylic acid metabolites in urine by partial least squares multivariate calibration.

A method is described for the simultaneous determination of the main urinary acetylsalicylic acid (aspirin) metabolites, salicyclic, salicyluric and gentisic acids, based on their native fluorescence. The urine was extracted into diethyl ether in acid medium, and back-extracted with glycine/sodium hydroxide buffer solution at pH 9.4. A comparative study of the results found using the excitation, the emission and the combination of the excitation plus the emission spectral data, as analytical signals, was performed. The data set, composed of the excitation plus the emission spectra, was selected as the analytical signal. The optimum wavelengths to record the excitation (lambda(em)=444 nm) and the emission spectra (lambda(ex)=323 nm) were selected to maximize the contribution from gentisic acid, which is the minor urinary metabolite. Partial least squares (PLS-1) multivariate calibration was then applied for the determination. Recovery values from urine samples spiked with salicyclic, salicyluric and gentisic acids varied from 90.1 to 97.6% (mean 93.6%), from 90.0 to 110% (mean 97.9%) and from 89.9 to 104.7% (mean 98.5%), respectively.