Efecto de la retirada y/o sustitución de los corticoides inhalados a favor de doble broncodilatación en los pacientes con EPOC sintomáticos. Estudio RETICORTEPOC / Effect of withdrawal and/or replacement of inhaled corticosteroids in favor of double bronchodilation in symptomatic COPD patients. RETICORTEPOC study

Objetivo. Evaluar si el riesgo de exacerbación es similar y si se produce una mejoría sintomática cuando se realiza una retirada o sustitución de CI en pacientes con EPOC con sintomatología (GOLD B y D). Material y métodos. Diseño: Estudio experimental, longitudinal y prospectivo de 12 meses de duración. Emplazamiento: Centro de Salud Urbano de Atención Primaria. Participantes: 81 pacientes EPOC grupo GOLD B y D en tratamiento con corticoides inhalados. Intervenciones: se aleatorizan la mitad de pacientes en un grupo de control donde se mantiene el tratamiento con corticoide inhalado, y la otra mitad en un grupo de intervención donde se retira o sustituye el corticoide inhalado por una doble broncodilatación. Mediciones principales: Variables demográficas, número de pacientes con exacerbaciones y puntuación cuestionario CAT al inicio y final del estudio. Resultados. En los pacientes GOLD B la retirada o sustitución del corticoide inhalado por la combinación LABA+LAMA produce un menor número de exacerbaciones y menor puntuación CAT. En los pacientes GOLD D no se producen diferencias entre los grupos. Conclusiones. Parece aceptable sustituir los CI tanto en terapia dual (LABA+CI) como su retirada en triterapia (LABA+LAMA+CI) en pacientes EPOC GOLD B siempre que se mantenga en su lugar un tratamiento doble broncodilatador. En los pacientes EPOC GOLD D podemos concluir que no se produce un aumento del riesgo de exacerbaciones ni empeoramiento sintomático al retirar el CI

Objective. To evaluate if the risk of exacerbation is similar and if there is a symptomatic improvement when IC withdrawal or substitution is performed in patients with COPD with symptomatology (GOLD B and D). Material and methods. Design: Experimental, longitudinal and prospective study of 12 months duration. Location: Urban Health Center for Primary Care. Participants: 81 patients COPD group GOLD B and D in treatment with inhaled corticosteroids. Intervention: Half of the patients are randomized in a control group where treatment with inhaled corticosteroids is maintained and the other half in an intervention group where the inhaled corticosteroid is withdrawn or replaced by a double bronchodilation. Main measures: Demographic variables, number of patients with exacerbations and CAT questionnaire score at the beginning and end of the study. Results. In GOLD B patients the withdrawal or replacement of the inhaled corticosteroid by the LABA + LAMA combination produces a lower number of exacerbations and a lower CAT score. In GOLD D patients, there were no differences between groups. Conclusions. It seems acceptable to replace ICs in both dual therapy (LABA + CI) and their withdrawal in tritherapy (LABA + LAMA + CI) in COPD GOLD B patients provided that a double bronchodilator treatment is maintained instead. In patients with COPD GOLD D, we can conclude that there is no increased risk of exacerbations or symptomatic worsening when IC withdrawal occurs

Adecuación diagnóstica y sobreutilización de corticoides inhalados en pacientes con EPOC / No disponible

No disponible

Evaluation of two, commercial, multi-dye, nucleic acid amplification technology tests, for HBV/HCV/HIV-1/HIV-2 and B19V/HAV, for screening blood and plasma for further manufacture.

BACKGROUND: The cobas TaqScreen MPX Test, version 2.0, a multiplex, multi-dye nucleic acid amplification technology (NAT) test from Roche was evaluated by two European Blood Banks, the German Red Cross Blood Donor Service, Frankfurt, Germany and Centro de Hemoterapia y Hemodonación de Castilla y León, Valladolid, Spain. In addition, the cobas TaqScreen DPX Test was evaluated for the simultaneous detection and quantitation of parvovirus B19 and the detection of hepatitis A virus (HAV). STUDY DESIGN AND METHODS: The performances of the two tests were evaluated regarding the analytical sensitivity, the reproducibility of the tests using samples containing low concentrations of each virus and cross-contamination using samples containing high titres of virus. RESULTS: The analytical sensitivity of the MPX Test, version 2.0, obtained by the German Red Cross Blood Donor Service was 1·1, 3·9 and 43·3 IU/ml for HBV, HCV and HIV-1, respectively. The comparable analytical sensitivity at Centro de Hemoterapia y Hemodonación de Castilla y León was 3·5, 17·6 and 50·6 IU/ml for HBV, HCV and HIV-1, respectively. The analytical sensitivity of the DPX test determined by the German Red Cross Blood Donor Service was 0·6 and 3·8 IU/ml for HAV and B19. CONCLUSION: These multiplex and multi-dye blood screening assays represent a flexible NAT screening system for mini-pools between 6 and 96 samples per pool and fulfil all requirements of the European Pharmacopoeia for HCV and B19V testing of plasma for fractionation. The inclusion of a new multi-dye technology means discriminatory assays are no longer required for either test thus improving workflow, turn-around time and minimize the risk of obtaining a reactive result for which the virus cannot be identified.

Characterization of glycolytic activities from non-Saccharomyces yeasts isolated from Bobal musts.

A large number of non-Saccharomyces yeasts were isolated from grapes of Bobal variety and identified according to their physiological and molecular characteristics. The yeasts were tested to determine the presence of ß-glucosidase, ß-xylosidase, α-arabinosidase, and α-rhamnosidase activities and five isolates were selected. All enzymatic activities were induced by the presence of glycosides as the only carbon source in the medium, which seems to be a characteristic of the yeast isolate, and were characterized according to different parameters of enological interest.

Reboxetine for the treatment of patients with Cocaine Dependence Disorder.

BACKGROUND: Although several approaches have been attempted for cocaine dependence, the pharmacological treatment of this serious disorder remains unclear. To date, desipramine, a tricyclic antidepressant of great noradrenergic activity, has shown the best results. Reboxetine, a selective noradrenaline reuptake inhibitor, might be an effective therapeutic option for this severe drug addiction. The aim was preliminarily to assess reboxetine in a group of cocaine dependent patients, selected from The Madrid City Council Drug Addiction Program primary care centres. METHOD: Twenty six patients with a diagnosis of cocaine dependence disorder (DSM-IV 304.20) were selected to receive open treatment with reboxetine, 8 mg/day, for 12 weeks. Follow up assessments comprised cocaine consumption, treatment retention rate and change in standard structured psychometric instrument scores: cocaine selective severity assessment, Hamilton anxiety scale, Hamilton depression scale and clinical global impression, throughout the treatment period. RESULTS: Data were obtained from 20 patients; 10 of them remained abstinent, whereas the other 10 consumed cocaine at some time during the study. The treatment retention rate at week 12 was 61.5%. The psychometric instrument mean scores showed marked decreases throughout the treatment period. CONCLUSION: Reboxetine might be an effective and safe therapeutic option for cocaine dependence disorder. The aversive effects, as well as the high blockage reported by some patients consuming cocaine during the trial, might be related to treatment. If confirmed in large clinical trials, the trends suggested by this study would confirm the role of noradrenergic function in the treatment of cocaine dependence.

The Cdk5-p35 kinase associates with the Golgi apparatus and regulates membrane traffic.

We show here that an active Cdk5-p35 kinase is present in Golgi membranes, where it associates with a detergent-insoluble fraction containing actin. In addition, Cdk5-p35-dependent phosphorylation of alpha-PAK immunoreactive protein species was detected in Golgi membranes, as well as an interaction with the small GTPase, Cdc42. Moreover, antisense oligonucleotide suppression of Cdk5 or p35 in young cultured neurons, as well as inhibition of Cdk5 activity with olomoucine, blocks the formation of membrane vesicles from the Golgi apparatus. Taken together, these results show a novel subcellular localization of this kinase and suggest a role for Cdk5-p35 in membrane traffic during neuronal process outgrowth.

Evidence for the involvement of KIF4 in the anterograde transport of L1-containing vesicles.

In this study we present evidence about the cellular functions of KIF4. Using subcellular fractionation techniques and immunoisolation, we have now identified a type of vesicle that associates with KIF4, an NH(2)-terminal globular motor domain kinesin-like protein. This vesicle is highly concentrated in growth cones and contains L1, a cell adhesion molecule implicated in axonal elongation. It lacks synaptic vesicle markers, receptors for neurotrophins, and membrane proteins involved in growth cone guidance. In cultured neurons, KIF4 and L1 predominantly localize to the axonal shaft and its growth cone. Suppression of KIF4 with antisense oligonucleotides results in the accumulation of L1 within the cell body and in its complete disappearance from axonal tips. In addition, KIF4 suppression prevents L1-enhanced axonal elongation. Taken collectively, our results suggest an important role for KIF4 during neuronal development, a phenomenon which may be related to the anterograde transport of L1-containing vesicles.

Tau protein function in axonal formation.

Tau protein is a predominantly neuronal microtubule-associated protein that is enriched in axons and is capable of promoting microtubule assembly and stabilization. In the present article we review some of the key experiments directed to obtain insights about tau protein function in developing neurons. Aspects related to whether or not tau has essential, unique, or complementary functions during axonal formation are discussed.

Treatment of major depression complicated by bilateral foot drop and double incontinence with ECT.

This report describes a 56-year-old man with severe depression who developed bilateral foot drop, dual incontinence, and swallowing difficulties, which required several physical investigations and consultations before an excellent response to electroconvulsive therapy occurred with reversal of all symptoms.

[Thiamine deficiency associated with parenteral nutrition: apropos of a new case]. / Déficit de tiamina asociado a nutrición parenteral: a propósito de un nuevo caso.

In thiamine deficiency, the Krebs cycle slows large quantities of pyruvate are diverted to lactate production and anaerobic metabolism begins. The most frequent cause of this syndrome is a dietary deficiency associated to a greater or lesser degree with alcoholism. Other less frequent causes are the ingestion of raw fish contaminated with microbial thiaminases, inborn errors of metabolism and total parenteral nutrition. We present the clinical case of a patient with an acute thiamine deficiency after 15 days of total parenteral nutrition, which improved with intravenous administration of thiamine. The incidence of beriberi among patients undergoing total parenteral nutrition is very low because of the almost systematic addition of vitamin complexes. Our patient's clinical picture was sudden, corresponding to the dry form, with typical neurological symptoms and signs, major metabolic acidosis, hyperglycemia and hyponatremia. The clinical response to the administration of thiamine confirmed the diagnosis.

[Value of preoperative autotransfusion in elective urologic surgery]. / Interés de la autotransfusión preoperatoria en cirugía urológica electiva.

Over a period of 5 months, 50 patients were entered into the preoperative autologous blood donation program of our Service. Two patients were excluded; one had previously had an acute myocardial infarction and the other had epilepsy. The remaining 48 patients, which accounted for one third of our elective surgery procedures, all accepted to enter the program. These patients were not more severely anemic than the other patients not in the program and who underwent the same surgical procedures. No patients required homologous blood transfusion and no complications ascribable to the procedure were observed. Although it is not utilized widely to date, predeposited autologous blood transfusion is a safe and efficient method, with no remarkable morbidity, even in patients aged over 65 years, the age group of one half of our patients. Autologous blood transfusion programs are necessary. The indications, the exclusion criteria for patients at high risk and the objective parameters for evaluating its success must be established.

[The glycemic response to a test breakfast of an enteral diet with fiber and a high starch content in diabetics treated with insulin and oral antidiabetics]. / Respuesta glucémica a un desayuno de prueba con una dieta enteral con fibra y alto contenido en almidón en diabéticos tratados con insulina y antidiabéticos orales.

An enteral nutrition preparation appeared recently on the Spanish market specifically for diabetic patients. It is a normocaloric and normoproteic formula of low osmolarity, rich in soluble fibre and slow-absorption carbohydrates such as fructose and starch, following the classic norms of the American Diabetics Association. The glycemic response was examined at 0, 30, 60 and 120 minutes following the ingestion of 250 cc of Precitene Diabet as breakfast for 40 diabetic patients, half treated with oral antidiabetic substances (DMado) and the other half with insulin (DMins). In both groups, the greatest glycemic increase was at 60 minutes. In the DMado patients, the increase at 60 minutes (70 mg/dl) was not significantly different from that considered by Skyler as acceptable. The same occurred at 120 minutes (40 mg/dl). In the DMins patients, the glycemic increase at 60 minutes was 27 +/- 29 mg/dl, more than that considered acceptable by Skyler (p 0.0006). After 120 minutes this difference was also greater than the acceptable level, by 41 +/- 38 mg/dl (p 0.0002). In conclusion, it may be considered that, for DMado patients, glycemic control remains within the postprandial limits considered to be "acceptable" so that no treatment modification is felt necessary in the administration of enteral nutrition with Precitene Diabet. The glycemic response in the DMins patients was higher than "acceptable", calling for rapid insulin supplements to their habitual NPH insulin doses.

Clinical use of the arterial/alveolar oxygen tension ratio.

A prospective study to verify the behavior of the arterial/alveolar oxygen tension ratio (PaO2/PAO2) at different fractions of inspired oxygen (FIO2), was performed in 15 adult hypoxemic patients. This index was useful not only for predicting the arterial oxygen tension but also for choosing the necessary oxygen supplementary levels. PaO2/PAO2 was a less reliable index in patients with mild intrapulmonary shunts, probably because of changes in the distribution of alveolar ventilation/perfusion ratios.