Manejo integral de los factores de riesgo en enfermedad arterial periférica. Consenso de expertos / Comprehensive management of risk factors in peripheral vascular disease. Expert consensus

Antecedentes y objetivo: Actualmente existe cierta divergencia entre las principales guías de práctica clínica sobre el manejo de los factores de riesgo de la enfermedad arterial periférica (EAP). El objetivo de este proyecto es conocer el manejo de los factores de riesgo de la EAP en la práctica clínica y alcanzar un consenso multidisciplinar sobre las estrategias que se tienen que seguir para optimizar su identificación, tratamiento y seguimiento. Metodología: Consenso multidisciplinar mediante metodología Delphi. Resultados: En la consulta participaron 130 profesionales con amplia experiencia en EAP. Los resultados sugieren que para optimizar el control de los factores de riesgo, los esfuerzos deben dirigirse a: 1) promover la involucramiento y concienciación de todas las especialidades en la identificación y el cribado de la enfermedad; 2) garantizar la posibilidad de realizar el índice tobillo-brazo (ITB) en todas las especialidades implicadas; 3) fomentar estrategias de deshabituación del tabaquismo mediante el uso de fármacos, programas o derivaciones a unidades especializadas; 4) promover el seguimiento de una alimentación adecuada basada en la dieta mediterránea y la prescripción de ejercicio diario; 5) concienciar sobre la importancia de alcanzar unos valores de colesterol unido a lipoproteínas de baja densidad (cLDL) inferiores a 70 mg/Dl, especialmente en pacientes sintomáticos, pero también en asintomáticos (< 55 mg/dL tras la publicación de la guía de la European Society of Cardiology y la European Atherosclerosis Society [ESC/EAS]); 6) recomendar el uso de antiagregantes plaquetarios en pacientes asintomáticos con diabetes mellitus (DM) y/o ITB patológico; y 7) protocolizar la reevaluación del ITB anualmente en pacientes de alto riesgo. Conclusión: Las 22 estrategias consensuadas en el presente documento pretenden ayudar a los profesionales a optimizar el manejo multidisciplinar de los factores de riesgo de la EAP (AU)

Introduction: There is currently a degree of divergence among the main clinical practice guidelines on the management of risk factors for peripheral arterial disease (PAD). This project aims to gain understanding of the management of PAD risk factors in clinical practice and to reach a multidisciplinary consensus on the strategies to be followed in order to optimize its identification, treatment, and follow-up. Methodology: A multidisciplinary consensus following the Delphi methodology. Results: Professionals (n = 130) with extensive experience in PAD participated in this consultation. The results suggest that in order to optimize the control of risk factors, efforts should be aimed at: (1) promoting the involvement and awareness of all specialists in the identification of and screening for the disease; (2) guaranteeing the possibility of evaluating the ankle-brachial index (ABI) in all the medical specialties involved; (3) promoting strategies for patients to quit smoking through the use of drugs, programs, or referrals to specialized units; (4) promoting an appropriate Mediterranean-based diet and the prescription of daily exercise; (5) raising awareness of the importance of ensuring LDL cholesterol values below 70 mg/dL, especially in symptomatic but also in asymptomatic patients (< 55 mg/dL following the publication of the ESC/EAS guide); (6) recommending the use of antiplatelet therapy in asymptomatic patients with diabetes mellitus (DM) and/or a pathological ABI; and (7) protocolizing the annual evaluation of ABI in high-risk patients. Conclusion:This document presents the 22 agreed-upon strategies which are intended to help professionals optimize multidisciplinary management of PAD risk factors (AU)

Comprehensive management of risk factors in peripheral vascular disease. Expert consensus.

INTRODUCTION: There is currently a degree of divergence among the main clinical practice guidelines on the management of risk factors for peripheral arterial disease (PAD). This project aims to gain understanding of the management of PAD risk factors in clinical practice and to reach a multidisciplinary consensus on the strategies to be followed in order to optimize its identification, treatment, and follow-up. METHODOLOGY: A multidisciplinary consensus following the Delphi methodology. RESULTS: Professionals (n = 130) with extensive experience in PAD participated in this consultation. The results suggest that in order to optimize the control of risk factors, efforts should be aimed at: (1) promoting the involvement and awareness of all specialists in the identification of and screening for the disease; (2) guaranteeing the possibility of evaluating the ankle-brachial index (ABI) in all the medical specialties involved; (3) promoting strategies for patients to quit smoking through the use of drugs, programs, or referrals to specialized units; (4) promoting an appropriate Mediterranean-based diet and the prescription of daily exercise; (5) raising awareness of the importance of ensuring LDL cholesterol values below 70 mg/dL, especially in symptomatic but also in asymptomatic patients (<55 mg/dL following the publication of the ESC/EAS guide); (6) recommending the use of antiplatelet therapy in asymptomatic patients with diabetes mellitus (DM) and/or a pathological ABI; and (7) protocolizing the annual evaluation of ABI in high-risk patients. CONCLUSION: This document presents the 22 agreed-upon strategies which are intended to help professionals optimize multidisciplinary management of PAD risk factors.

[Evaluation of the diagnostic test for rapid detection of covid-19 antigen (Panbio Covid rapid test) in primary care]. / Evaluación de la prueba diagnóstica de detección rápida de antígeno de covid-19 (Panbio Covid rapid test) en atención primaria.

OBJECTIVE: COVID-19 infection requires early diagnosis, with PCR being the gold standard test. The protocols advocate the use of rapid antigenic tests that require evaluation in actual clinical practice. The objective was to evaluate the diagnostic test for rapid antigen detection, Panbio Covid rapid test, compared with PCR, in patients with symptoms of 5 or less days of evolution and with a high-suspicion of infection by COVID-19 in a health center. MATERIALS AND METHODS: 103 patients over 14 years of age who attended an urban health center located in the Usera District of Madrid, with high-suspicion of COVID-19 infection, in the first 5 days of evolution from the onset of symptoms during the month of November 2020. INTERVENTIONS: diagnostic tests for COVID-19 are performed: antigen and PCR. RESULTS: The prevalence of the disease was 24.3% according to the PCR test and 17.5% according to the rapid antigenic test. The sensitivity was 72% (95% CI: 54.3-89.6%). The specificity was 100%. The positive and negative predictive values were 100% and 91.8% respectively. In the bivariate analysis, there was no relationship between symptoms and the presence of disease, except for myalgias (p=0.030). The multivariate analysis found a relationship between cough, dyspnea, fever, myalgia, anosmia/ageusia, and ocular symptoms and the presence of disease. CONCLUSIONS: The sensitivity and specificity for the Panbio rapid antigen test are similar to other studies performed in primary care. In high-prevalence of disease and with highly suspected symptoms, positive test results can be considered definitive, but negative results will require confirmation. Myalgia, fever, dyspnea, anosmia/ageusia, and ocular symptoms may be more related to the presence of COVID-19.

[Descriptive study of hepatic steatosis and associated morbidity in Primary Care. (ESTEATOAP Study)]. / Estudio descriptivo de la esteatosis hepática y la morbilidad asociada en atención primaria. (Estudio ESTEATOAP).

OBJECTIVE: To study the recorded prevalence of hepatic steatosis in Primary Care, as well as the proportion of patients diagnosed with fatty liver diseases (FLD) including simple non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) versus steatosis by other causes. In addition, the proportion of cardiometabolic morbidities associated with NAFLD liver was studied. MATERIAL AND METHODS: A descriptive observational study was carried out on a population that included all patients with a recorded diagnosis of hepatic steatosis in an urban health centre that serves a population of 25,747 over the age of 14. A sample size of 229 patients was calculated. The demographic and clinical characteristics associated with hepatic steatosis are described. RESULTS: The prevalence of steatosis was 2.17% and 1.51% for NAFLD. The mean age was 62.42 years. The study included 114 (50.2%) women and 113 (49.8%) males. NAFLD was found in 147 (64.8%), and 64 (28.2%) were steatosis due to other causes. The proportion of patients with NAFLD and high transaminases was 24.13%, and the proportion of patients with NAFLD and GGT elevation was 18.6%. A high proportion of NAFLD had been found with cardiometabolic risk factors: 93.9% overweight and obesity, 55.1% diabetes, 54.4% hypertension, 32.9% metabolic syndrome, 35.2% hypertriglyceridaemia, and HDL risk 19.6%. A significant association was found between cardiometabolic risk factors and NAFLD in diabetes, obesity, and metabolic syndrome. DISCUSSION: Prevalence was only 1.51%, perhaps because of the low importance given to this disease. There is a high proportion of NAFLD with cardiometabolic risk factors and more in the general population. If all the causes of steatosis are considered there is a significant association between obesity, diabetes mellitus, and metabolic syndrome with NAFLD. CONCLUSIONS: The recorded prevalence of NAFLD is much lower than that of population studies, and a high presence of cardiometabolic factors has been found in these patients.

Modelization of anaerobic processes during co-digestion of slowly biodegradable substrates.

The influence of the soluble substrates over the anaerobic processes has been extensively investigated, but little is known about the effects of particulate substrate. The biodegradation of these substrates starts with the hydrolytic step, this process is slower than the other ones involved in the biodegradation of particulate substrates and usually becomes the rate-limiting step. This study investigate the effect of the initial total solids (TS) concentration on the anaerobic co-digestion of two slowly biodegradable organic substrates. The wastes mixtures were prepared at different dilutions in the range from 10% to 28% TS. From these experiments it was observed that as TS concentration increased, the methane production decreased. These results were modelled and it was observed that neither hydrolysis nor fermentation stages controlled the methane production rate. Being a substrate inhibition event experienced at the methanogenic stage the responsible of the lower methane production when operating at high TS concentrations.

Enfermedad de Graves-Basedow e hiperplasia tímica: una asociación que no nos debe extrañar / raves-Basedow disease and thymic hyperplasia: an association that must not surprise us

RESUMEN El aumento del tamaño del timo asociado a hiperplasia tímica (HT) es frecuente en los pacientes con enfermedad de Graves-Basedow (EGB), si bien es poco habitual detectarla en la práctica clínica diaria. Presentamos el caso de una mujer de 38 años con EGB, a quien se le detectó de manera incidental un aumento del timo. La paciente no tenía síntomas compresivos locales y la tomografía computarizada demostró engrosamiento homogéneo de mediastino anterior sugestivo de HT. Durante la evolución, se evidenció reducción del tamaño tras el control de la función tiroidea con fármacos antitiroideos. La presencia de algunas características radiológicas como aumento difuso y homogéneo de la glándula, ausencia de invasión de estructuras vecinas, calcificaciones o imágenes quísticas, sugiere la presencia de una HT. En estos casos, el tratamiento del hipertiroidismo y un control expectante son actitudes razonables. Conocer esta evolución puede evitar intervenciones diagnósticas o terapéuticas innecesarias.

ABSTRACT Thymic enlargement associated with thymic hyperplasia (TH), in patients with Graves-Basedow disease (GBD) is common, although it remains largely unrecognized in routine clinical practice. We present the case of a 38 year-old woman with GBD, to whom an incidental thymic enlargement was detected. The patient did not have local compressive symptoms and the computerized tomography showed homogenous thickening of the anterior mediastinum suggestive of TH. During evolution, a reduction in size was observed after thyroid function was controlled by anti-thyroid drugs. The presence of some radiological features such as diffuse and homogeneous gland enlargement, absence of invasion of neighboring structures, calcifications or cystic images suggests the presence of TH. In these cases treatment of hyperthyroidism and expectant management are reasonable responses. Recognizing this evolution can avoid unnecessary diagnostic or therapeutic interventions.

Effect of high-intensity resistance circuit-based training in hypoxia on aerobic performance and repeat sprint ability.

Recent acute studies have shown that high-intensity resistance circuit-based (HRC) training in hypoxia increases metabolic stress. However, no intervention studies have yet proven their effectiveness. This study aimed to analyze the effect of 8 weeks of HRC in hypoxia on aerobic performance, resting energy expenditure (REE), repeat sprint ability (RSA) and hematological variables. Twenty-eight subjects were assigned to hypoxia (FiO2  = 15%; HRChyp : n = 15; age: 24.6 ± 6.8 years; height: 177.4 ± 5.9 cm; weight: 74.9 ± 11.5 kg) and normoxia (FiO2  = 20.9%; HRCnorm : n = 13; age: 23.2 ± 5.2 years; height: 173.4 ± 6.2 cm; weight: 69.4 ± 7.4 kg) groups. Each training session consisted of two blocks of three exercises (Block 1: bench press, leg extension, front pull down; 2: deadlift, elbow flexion, ankle extension). Each exercise was performed at 6 repetitions maximum. Participants exercised twice weekly for 8 weeks and before and after the training program blood test, REE, RSA and treadmill running test were performed. Fatigue index in the RSA test was significantly decreased in the HRChyp (-0.9%; P < .01; ES = 2.75) but not in the HRCnorm . No changes were observed in REE and hematological variables. Absolute (4.5%; P = .014; ES = 0.42) and relative (5.2%; P = .008; ES = 0.43) maximal oxygen uptake (VO2 max), speed at VO2 max (4%; P = .010; ES = 0.25) and time to exhaustion (4.1%; P = .012; ES = 0.26) were significantly increased in HRChyp but not in the HRCnorm . No significant differences between groups were found. Compared with normoxic conditions, 8 weeks of HRC training under hypoxic conditions efficiently improves aerobic performance and RSA without changes in REE and red blood O2 -carrying capacity.

Glycemic control and maternal and fetal outcomes in pregnant women with type 1 diabetes according to the type of basal insulin.

OBJECTIVE: To examine the potential role of the type of basal insulin on glycemic control and maternal and foetal outcomes in pregnant women with type 1 diabetes (T1DM). STUDY DESIGN: Retrospective cohort study of pregnancies attended at 18 Spanish tertiary hospitals. INCLUSION CRITERIA: T1DM, singleton pregnancies, delivery between 2002-2010, and use of the same basal and prandial insulin from before pregnancy until delivery. RESULTS: A total of 1534 pregnancies were included. The basal insulin most commonly used was Neutral Protamine Hagedorn (NPH) (51.7%), followed by glargine (23.2%) and continuous subcutaneous insulin infusion (CSII) (21.1%). CSII users had longer diabetes duration. Multiple logistic regression analysis showed that CSII was independently associated with lower doses of insulin, higher glycated haemoglobin (HbA1c) in all trimesters, and higher rates of miscarriage, preterm birth and neonatal hypoglycemia. Glargine was related to a higher risk of preterm birth and a small-for-gestational age infant (SGA). The odds ratios (OR) of the associations between insulin type and clinical outcomes (from 0.642 to 4.894) have a relevant magnitude. CONCLUSIONS: In this observational study of pregnant women with T1DM, the type of basal insulin was independently associated with metabolic variables and foetal outcomes.

Effects of droperidol and ondansetron on dispersion of ventricular repolarization: A randomized double-blind clinical study in anesthetized adult patients.

BACKGROUND AND OBJECTIVE: Droperidol and ondansetron prolong QT interval, a circumstance that has raised some concerns regarding the possibility of inducing torsades de pointes (TdP). However drug-induced spatial dispersion of ventricular repolarization has been shown to be the principal arrhythmogenic substrate for TdP. The aim of this study is to explore the effects of droperidol and ondansetron on the dispersion of repolarization, measured using the T peak-to-end interval (Tp-e) and Tp-e/QT and Tp-e/RR(1/2) ratios in surgical anesthetized patients. METHODS: A randomized, double-blind study carried out on sixty-three adult patients without cardiac disease or factors favoring QT prolongation and undergoing non-cardiac surgery were randomly assigned to the droperidol or ondansetron group. Under propofol anesthesia, a 12-lead EKG was obtained, and 1.25mg droperidol or 4mg ondansetron was injected. Five minutes later, a new 12-lead EKG was recorded. EKG analyses were independently performed by two cardiologists blinded to the state of the traces or group allocation. QT, RR and Tp-e intervals were measured by averaging five successive beats in leadII (QT) or V5 (Tp-e). The mean value for each measurement was calculated for statistical analysis. RESULTS: Thirty-two patients (19 women) received droperidol, and 31 (22 women) ondansetron. Droperidol and ondansetron prolonged the QTcF interval (Fridericia formula) by 6.8 and 7.2ms (mean values) respectively, but neither droperidol nor ondansetron increased the Tp-e interval or Tp-e/QT and Tp-e/RR(1/2) ratios. CONCLUSION: At antiemetic doses, neither ondansetron (4mg) nor droperidol (1.25mg) increases the dispersion of ventricular repolarization in healthy adult patients anesthetized with propofol.

Association of topical amphotericin B lipid complex treatment to standard therapy for rhinomaxillary mucormycosis after liver transplantation: a case report.

Solid organ transplantation is becoming increasingly more common in the treatment of end-stage organ failure. The advent of newer immunosuppressive protocols and refined surgical techniques has allowed therapy to become standard care. Infection is a major and frequently life-threatening complication after transplantation and the incidence of opportunistic fungal infections in organ transplant recipients ranges from 2%-50% depending on the type of organ transplanted. We present a case of rhinomaxillary form of mucormycosis infection after liver transplantation. The succession of multiple risk factors in a torpid postoperative period was a key factor in the development of this disease. Multidisciplinary management with an early diagnosis, aggressive surgery, and intravenous and topical antifungal therapy care were definitive for the eradication of infection. The goal of the present report was to show efficacious management including the association of topical treatment with amphotericin B complex lipid to standard therapy and the absence of side effects.

[Spine cord descompresion and instrumentation in a case of solid aneurysmal bone cyst in the lumbar spine]. / Descompresión medular e instrumentación en un caso de variante sólida de quiste óseo aneurismático en raquis lumbar.

We report a 8-year-old boy with two month history of pain and stiffness in his left lower extremity. On x-ray, MRI and scintigraphy examinations a lytic lesion affecting the body and posterior arc of his third lumbar vertebral become evident. The tumour was excised through a double, anterior and posterior approach; spinal fusion with posterior transpedicular instrumentation was also performed in the same procedure; in order to achieve solid fusion tricortical liofilized graft was also inserted. Histological studies evidenced finding compatible with aneurysmal bone cyst solid variant. Five years after surgery the patient is pain free and no recurrence is evident under diagnostic images tools. For the treatment of aneurysmal bone cyst of the spine we recommend complete excision of the tumour in a combined anterior and posterior one staged procedure, together with hardware instrumentation and bone graft, no recurrence or instability is seen after five years followup.

[Incidence of lower extremity amputations in Area 3 of Madrid. Retrospective study during the period 2001-2006]. / Incidencia de amputaciones de extremidades inferiores en el área 3 de Madrid. Estudio retrospectivo del periodo 2001-2006.

OBJECTIVE: To quantify the Lower Extremity Amputations (LEA) incidence in population with and without diabetes mellitus (DM). MATERIAL AND METHODS: Retrospective cohort study of all the LEA carried out during 2001-2006 in area 3 of Madrid, from the codification of the reports of discharge reports. RESULTS: 310 LEA were carried out. The age-ajusted LEA incidence for any reason was 19,2/10(5) inhabitants per year (27,2 y 11,2 for men and women respectively). 261 were not-traumatic and non-tumoural (NTT) LEA, 76% were associated with DM and the incidence was 191/10(5) people with DM per year (95% confidence interval [CI(95)] 122-299) and 4,4/10(5) for people without DM per year (CI(95) 7-23), with a risk ratio of 44 (CI(95) 23-73). CONCLUSIONS: The LEA rates in population with o without diabetes are higher than the previously communicated in Madrid. It would appear convenient to design strategies to reduce the LEA rates.

Incidencia de amputaciones de extremidades inferiores en el área 3 de Madrid. Estudio retrospectivo del periodo 2001–2006 / Incidence of lower extremity amputations in Area 3 of Madrid. Retrospective study during the period 2001–2006

Objetivo Conocer la incidencia de las amputaciones de miembro inferior (AMI) en población con y sin diabetes mellitus (DM). Material y métodos Estudio retrospectivo de cohortes de las AMI realizadas durante 2001–2006 en el área 3 de Madrid a partir de la codificación de los informes de alta hospitalaria. Resultados Se realizaron 310 AMI. La incidencia ajustada a la edad de AMI de cualquier causa fue de 19,2/105 habitantes/año (27,2 y 11,2 para varones y mujeres, respectivamente). Doscientos sesenta y uno fueron AMI no traumáticas ni tumorales, el 76% se realizaron en DM y la incidencia fue de 191/105 sujetos con DM por año (intervalo de confianza del 95% [IC95] 122–299) y de 4,4/105 sujetos sin DM (IC95 7–23) con un riesgo relativo (RR) de 44 (IC, 23–73). Conclusiones La tasa detectada de AMI en población con y sin diabetes es mayor que la comunicada previamente en Madrid. Se plantea la necesidad de diseñar estrategias para reducir las tasas de AMI(AU)

Objective To quantify the Lower Extremity Amputations (LEA) incidence in population with and without diabetes mellitus (DM). Material and methods Retrospective cohort study of all the LEA carried out during 2001–2006 in area 3 of Madrid, from the codification of the reports of discharge reports. Results 310 LEA were carried out. The age-ajusted LEA incidence for any reason was 19,2/105 inhabitants per year (27,2 y 11,2 for men and women respectively). 261 were not-traumatic and non-tumoural (NTT) LEA, 76% were associated with DM and the incidence was 191/105 people with DM per year (95% confidence interval [CI95] 122–299) and 4,4/105 for people without DM per year (CI95 7–23), with a risk ratio of 44 (CI95 23–73). Conclusions The LEA rates in population with o without diabetes are higher than the previously communicated in Madrid. It would appear convenient to design strategies to reduce the LEA rates(AU)

Landing differences between men and women in a maximal vertical jump aptitude test.

AIM: The aim of this study was to analyze the gender differences in the vertical ground reaction forces and the position of the center of gravity during the landing phase of a maximal vertical jump aptitude test. METHODS: The push-off, flight and landing phases of the jumps of 291 males (age = 19.6+/-2.8 years) and 92 females (age = 19.2+/-2.6 years), applicants to a Spanish faculty of sports sciences, were analyzed with a force platform. RESULTS: The greatest differences between men and women were found in the jump performance (women = 25.6+/-3.5 cm; men = 35.5+/-4.5 cm) and second peak vertical force value of the landing phase (women = 5.89+/-2.06 times body weight; men = 7.51 +/-2.38 times body weight), the values being greater in the men's group (P < 0.001). Correlation coefficients showed that the women utilized a different landing pattern than the one utilized by the men. CONCLUSION: Contrary to the authors' expectations, women showed lower second peak vertical force values during the landing. Taking into account only a kinetic point of view, they would have a lower risk of injury during the landing movement of maximal jumps. The lower values in the peak force, the delay of the impact of the calcaneus and the longer path of the center of gravity during the landing phase found in the women's group were related to a landing technique that is different from that of men.

Design and validation of a scale to assess preferences of type 2 diabetic patients towards different nutritional supplements.

OBJECTIVES: To design and validate a scale to evaluate preferences of type 2 diabetic patients towards nutritional supplements (Madrid scale) and to discover those taste attributes that are more discriminating. CONTEXT: ambulatory patients with type 2 diabetes mellitus. MATERIALS AND METHODS: 18 controls and 106 type 2 diabetic patients received 2 of the 7 stimuli studied (6 nutritional supplements and a differential salty stimulus) and then completed both scales and a criterion question. Two weeks later, 30 diabetic patients received a retest. The psychometric properties of the Madrid scale were studied and the relative importance of each stimuli attribute was assessed. RESULTS: Feasibility: The Madrid scale consists of 8 questions and is completed in less than five minutes; Dimensionality: A single dimension which explains 45.1% of the variance. Reliability: Cronbach's , 0.806; intraclass correlation coefficient, 0.835 (95% confidence interval: 0.653-0.922). Concurrent validity: Correlation indexes of the corrected total score with the criterion question and the Modified Wine-Tasting Scale, 0.731 (p < 0.0005) and 0.774 (p < 0.0005), respectively. The scale discriminated between subjects younger and older than 75 years and between supplements and the differential stimulus. Preferences: Glucerna SR chocolate, Glucerna SR strawberry, Glucerna SR vanilla, Diasip vanilla, Clinutren vanilla and Resource diabet vanilla. CONCLUSION: The Madrid scale has adequate psychometric properties for its use in research and daily clinical practice.

Effectiveness of two oral pastes for the treatment of recurrent aphthous stomatitis.

OBJECTIVE: To compare the effectiveness of two topical medications to reduce the pain and size of recurrent minor aphthous ulcers. SETTING: Ten Colombian Dental Faculties' clinics. DESIGN: A double-blind randomized multi-centre clinical study. SUBJECTS: Ninety-six patients complaining of at least five acute aphthous ulcers were randomized to two intervention groups. Sample size was calculated using an alpha error of 0.05 and beta of 0.20. MATERIALS AND METHODS: Participants were randomly assigned to receive 5% amlexanox or a 0.05% clobetasol propionate magistral preparation. Observers at the participating institutions were previously trained to standardize clinical diagnosis and data recollection. Ulcer size and pain were measured on treatment days 0, 2 and 5. RESULTS: No significant differences were found between the two groups studied in any of the studied variables at baseline. Both treatment medications significantly reduced pain magnitude and the index ulcer's size on days 2 and 5 compared with day 0 without adverse reactions (within groups differences). No statistical differences between groups of the study medications were found. CONCLUSION: The two treatments applied had similar effectiveness as they both relieved pain and reduced the size of recurrent aphthous ulcers.

El proyecto AP21: una oportunidad de mejora / No disponible

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Cushing's syndrome during pregnancy secondary to adrenal adenoma: metyrapone treatment and laparoscopic adrenalectomy.

Cushing's syndrome during pregnancy is a rare and difficult to diagnose disorder. We describe the case of a 30-yr-old woman presenting with symptoms and signs of mild hypercortisolism, in which ACTH-independent Cushing's syndrome was diagnosed. Urinary cortisol excretion was elevated and circadian rhythm of cortisol was absent. ACTH levels were low. In addition, plasma cortisol failed to suppress after a high dexamethasone dose. An abdominal computed tomography scan confirmed a left adrenal mass. While diagnosis work-up was still in progress, the patient became pregnant and wanted to carry her pregnancy to full-term. Hypercortisolism was successfully controlled with metyrapone, which was started at 8 weeks of gestation. At 16 weeks of gestation, a laparoscopic left adrenalectomy was performed. Pathologic examination of the gland showed a benign adrenocortical adenoma. The patient developed secondary adrenal insufficiency and was discharged on 20 mg hydrocortisone daily dose. At 30 weeks of gestation, the patient had a pre-term rupture of membranes and underwent spontaneous vaginal delivery. The newborn was a normal virilized male who weighed 1280 g. No apparent metyrapone-induced teratogenic effects were observed and there was no clinical or biochemical suppression of adrenocortical function. In conclusion, in adrenal Cushing's syndrome during pregnancy, medical treatment with metyrapone as soon as the diagnosis is made, in combination with laparoscopic surgery during the second trimester, are useful in preventing complications secondary to hypercortisolism and safe both for the mother and infant.

Effects of pork vs veal consumption on serum lipids in healthy subjects.

AIMS: To analyse the influence of lean pork (P) and veal (V) consumption on the lipid profile of healthy subjects within the framework of a healthy diet comprising low levels of total fat (TF), saturated fatty acids (SFA) and cholesterol. DESIGN: Double-crossover, randomized and controlled trial SUBJECTS: 44 healthy individuals (22 male and 22 female), recruited voluntarily from the University Complutense of Madrid. The weight and lipid profiles of these volunteers were normal and their dietary patterns were typical for people in our area. INTERVENTIONS: The study comprised 4 phases: stabilisation phase (5 weeks), the participants followed their normal diet; second phase (6 weeks), half of the subjects, were randomised to lean pork or veal consumption, 150 g per day, for their main meal of the day; washout period (5 weeks) and final phase, which was the second phase of intervention (6 weeks). During the intervention stages, only the main meal of the day was taken in the Hospital. The rest of the subjects' diets consisted of different fortnightly menus designed in accordance with the recommendations of the Spanish Society of Arteriosclerosis (SEA). RESULTS: After both stages of intervention had been completed, there was a mean reduction of 5.5% in low-density lipoprotein cholesterol. However, after each intervention there were no significant differences between those who had consumed P, 2.62 (0.55) mmol/L and those who had consumed V, 2.71 (0.47) mmol/L. No differences were observed in any of the other parameters between those who had consumed P and those who had consumed V. CONCLUSIONS: Lean pork and veal produces similar effects on the lipid profiles of healthy subjects. Its consumption, as part of the saturated fat and cholesterol-controlled diet, could therefore be included in food guidelines, both for normal and therapeutic diets.