In vitro vitamin K3 effect on conjunctival fibroblast migration and proliferation.

PURPOSE: To evaluate the dose effect of vitamin K3 on wound healing mechanisms. METHODS: Conjunctival fibroblasts were incubated for 24 hours. An artificial wound was made and the cells were incubated with fresh medium plus doses of vitamin K3 to be tested. Wound repair was monitored at 0, 18, 24, and 48 hours. Proliferation was measured in actively dividing cells by [(3)H]thymidine uptake. Six different groups were tested: group 1/no drugs added, group 2/ethanol 0.1%, group 3/vitamin K3 1 mg/L, group 4/vitamin K3 2 mg/L, group 5/vitamin K3 4 mg/L, and group 6/vitamin K3 6 mg/L. Each experiment was carried out in triplicate and 4 times. RESULTS: There were no differences among groups at the initial time. In vitro wound repair was slower in groups 4, 5, and 6. There were no differences between control and ethanol groups and between control and vitamin K3 1 mg/L groups. Fibroblast mitogenic activity was statistically decreased in all vitamin K groups; statistical differences were found among vitamin K3 1 mg/mL and higher doses too. In groups 5 and 6, cellular toxicity was presented. CONCLUSIONS: Vitamin K3 is able to inhibit fibroblast proliferation. Vitamin K3 2 mg/L or higher doses inhibit wound healing repair, exhibiting cellular toxicity at 4 and 6 mg/L.

Análisis de la mortalidad neonatal en el Hospital Universitario La Fe de Valencia. Años 1971-2009 / Analysis of neonatal mortality in the University Hospital La Fe Valencia. Years 1971-2009

Introducción y objetivos: La mortalidad neonatal (MNN) es un indicador de calidad asistencial básico. El objetivo primario de este estudio ha sido el análisis de la evolución la MNN en el Hospital Universitario La Fe de Valencia (HULF), unidad de nivel IIIc, desde su inauguración en 1971 hasta el año 2009. Objetivos secundarios han sido la valoración de la tasa de prematuridad (PR) y bajo peso al nacimiento (BPN). Material y métodos: En este periodo se produjeron 308.989 nacimientos, en los que hubo 2.135 muertes neonatales. Resultados: La MNN muestra un descenso significativo (10,18‰ en 1971 vs 6,24‰ en 2009, p<0,001) Este descenso es aún más significativo para los neonatos con peso al nacimiento entre 500-999 gramos (923,1‰ en 1980 vs 238,1‰ en 2009, p<0,0001) y menor para los prematuros con edad gestacional inferior a 28 semanas (403,8‰ en 1993 vs 287,9‰ en 2009, p<0,01). La tasa de PR paso de 8,7% (1993) al 14% (2009) p<0,001. La tasa de BPN ascendió del 5,3% (1979) al 12.8% (2009), p<0,001. Los varones representan el 58,2% de las muertes neonatales y estas se producen en las primeras 24 h de vida en el 48,2%. La patología respiratoria representa el 36,3% de las muertes neonatales, las malformaciones severas el 31,5%, la patología neurológica el 14,6% y las infecciones el 7,9%. Conclusiones: A pesar del aumento de la PR y BPN se ha conseguido un descenso significativo de la MNN en el HULF(AU)

Background and objectives: Neonatal mortality (NM) is a reliable marker of quality clinical care. The primary objective of this study was to analyse evolution of NM in the Division of Neonatology (level IIIc according to the Spanish Classification) University Hospital La Fe Valencia (HULF) from the beginning of its activity in 1971 until 2009. Secondary objectives were the evaluation of prematurity rate (PR) and low birth weight rate (LBWR). Material and methods: There was a total of 308,989 births, with 2.135 neonatal deaths (ND), during the period studied. Results: NM has shown a significant decrease (10.18% in 1971 vs. 6.24% in 2009; P<0.01). This decrease was even more significant for neonates with birth weight between 500-999g (923.1% in 1980 vs. 238.1% in 2009; P<0.0001) and less for preterm with gestational age less than 28 weeks (403.8% in 1993 vs. 287.9% in 2009; P<0.01). The Prematurity rate increased from 8.7% (1993) to 14% (2009) (P<0.01), and LBWR increased from 5.3% (1979) to 12.8% (2009) (P<0.001). Males represent 58.2% of ND, and these occurred in the first day of life in 48.2% of the cases. Respiratory conditions represent 36.3% of ND, severe congenital malformations 31.5%, neurologic conditions 14.6%, and infections 7.9%. Conclusions: In spite of the increase in LBWR and PR, a significant descent of NM has been achieved in the HULF in the last decades(AU)

[Analysis of neonatal mortality in the University Hospital La Fe Valencia. Years 1971-2009]. / Análisis de la mortalidad neonatal en el Hospital Universitario La Fe de Valencia. Años 1971-2009.

BACKGROUND AND OBJECTIVES: Neonatal mortality (NM) is a reliable marker of quality clinical care. The primary objective of this study was to analyse evolution of NM in the Division of Neonatology (level IIIc according to the Spanish Classification) University Hospital La Fe Valencia (HULF) from the beginning of its activity in 1971 until 2009. Secondary objectives were the evaluation of prematurity rate (PR) and low birth weight rate (LBWR). MATERIAL AND METHODS: There was a total of 308,989 births, with 2.135 neonatal deaths (ND), during the period studied. RESULTS: NM has shown a significant decrease (10.18% in 1971 vs. 6.24% in 2009; P<.01). This decrease was even more significant for neonates with birth weight between 500-999g (923.1% in 1980 vs. 238.1% in 2009; P<.0001) and less for preterm with gestational age less than 28 weeks (403.8% in 1993 vs. 287.9% in 2009; P<.01). The Prematurity rate increased from 8.7% (1993) to 14% (2009) (P<.01), and LBWR increased from 5.3% (1979) to 12.8% (2009) (P<.001). Males represent 58.2% of ND, and these occurred in the first day of life in 48.2% of the cases. Respiratory conditions represent 36.3% of ND, severe congenital malformations 31.5%, neurologic conditions 14.6%, and infections 7.9%. CONCLUSIONS: In spite of the increase in LBWR and PR, a significant descent of NM has been achieved in the HULF in the last decades.

Risk factors for advanced lesions undetected at prior colonoscopy: not always poor preparation.

BACKGROUND AND STUDY AIM: Colonoscopy is regarded as the gold standard for diagnosis of colonic lesions. However, adenoma miss rates in tandem colonoscopy studies vary from 2 % to 26 %. We aimed to investigate the rates of advanced neoplasia in patients with a prior normal colonoscopy in an outpatient endoscopy unit. METHODS: Review of reports for colonoscopies performed in our Endoscopy Unit from 2000 to 2005. Undetected lesions were defined as advanced adenoma or colorectal cancer (CRC) not reported in a colonoscopy performed in the previous 2 or 3 years, respectively. Patients with hereditary nonpolyposis CRC (HNPCC) and familial adenomatous polyposis (FAP) were excluded. RESULTS: Between 2002 and 2005, 795 patients were diagnosed with at least one advanced adenoma and 386 with CRC. Among these, 107/795 patients (13.5 %) had advanced adenoma that had been undetected in a previous colonoscopy (39 % [53/135 lesions] in the right colon); 92/107 (86 %) had an undetected advanced adenoma ≥ 10 mm. Previously undetected CRCs were found in 27/386 patients (6.7 %), located in the left colon in 21/27 (78 %); in 7 the area had not been reached in the previous colonoscopy. Risk factors for undetected advanced adenoma were advanced age, male gender, the presence of another advanced adenoma at first colonoscopy, and history of advanced neoplasia. CONCLUSIONS: Failure to detect advanced neoplasia is common in a community-based endoscopy facility. Previously undetected advanced lesions are more frequently found in the left colon and rectum. Risk factors for non-detection of advanced adenoma are similar to those for advanced neoplasia recurrence. Lowering non-detection rates is crucial for correct follow-up recommendations. Patients should be aware of rates of detection of advanced neoplasia after previous normal colonoscopic findings.

Normal values in ambulatory oesophageal pH monitoring at two levels in Spain.

AIM: Upper oesophageal pH monitoring may play a significant role in the study of extra-oesophageal GERD, but limited normal data are available to date. Our aim was to develop a large series of normal values of proximal oesophageal acidification. METHODS: 155 healthy volunteers (74 male) participated in a multi-centre national study including oesophageal manometry and 24 hours oesophageal pH monitoring using two electrodes individually located 5 cm above the LOS and 3 cm below the UOS. RESULTS: 130 participants with normal manometry completed all the study. Twelve of them were excluded for inadequate pH tests. Twenty-seven subjects had abnormal conventional pH. The remaining 91 subjects (37 M; 18-72 yrs age range) formed the reference group for normality. At the level of the upper oesophagus, the 95th percentile of the total number of reflux events was 30, after eliminating the meal periods 22, and after eliminating also the pseudo-reflux events 18. Duration of the longest episodes was 5, 4 and 4 min, respectively (3.5 min in upright and 0.5 min in supine). The upper limit for the percentage of acid exposure time was 1.35, 1.05 and 0.95%, respectively. No reflux events were recorded in the upper oesophagus in 8 cases. CONCLUSION: This is the largest series of normal values of proximal oesophageal reflux that confirm the existence of acid reflux at that level in healthy subjects, in small quantity and unrelated to age or gender. Our data support the convenience of excluding pseudo-reflux events and meal periods from analysis.

[Respiratory care in neonatal intensive care units. Situation in the year 2005]. / Asistencia respiratoria en las unidades de cuidados intensivos neonatales en España: situación en 2005.

AIM: To learn the characteristic of the neonatal intensive care units (NICUs) that offer neonatal respiratory assistance in Spain. MATERIAL AND METHOD: A structured survey was developed and sent to all Spanish neonatal units to learn about the respiratory care offered in 2005. RESULTS: A total of 96 Units answered the survey, with an estimated representatively of 63%, with a range from 3 to 92%, depending on the geographical area. Level IIIc Units were in the upper range. Answer the survey 26 units type IIb (27%), 16 IIIa (17%), 40 IIIb (42%) and 14 IIIc (14%). The total number of level III NICU beds was 541 (1.2 beds per 1000 livebirths; range, 0.7-1.7). The mean number of beds per NICU was 4.1 in level IIIa Units, 2.8 in those IIIb and 14.6 in type IIIc NICUs. In level III NICUs, the bed per physician ratio was 2.4 and that of beds per registered nurse was 2.8 (2.2 in level IIIc NICUs). There were a total 13,219 admissions, 54% of those needed mechanical ventilation (36% in IIIa and 65% in level IIIc NICUs). Oxygen blenders for resuscitation at birth were available in 42% of level IIIb and IIIc NICUs. NICUs had one neonatal ventilator per bed, and 63% of units had high frequency ventilation available. All units had nasal-CPAP systems, 25% of level IIIa Units, 58% IIIb and 64% of those type IIIc had systems for nasal ventilation. All level IIIc and 93% of level IIIb NICUs were able to provide inhaled nitric oxygen therapy. Four NICUS offered ECMO. CONCLUSIONS: The mean number of NICU beds per 1000 livebirths is within the lower limits of those been recommended, and there were wide variations among different geographical areas. A 54% of those babies admitted to NICUs required mechanical ventilation. The mean number of NICU beds per registered nurse was 2.8. There was an adequate number of neonatal ventilators (one per bed) and 63% were able to provide HFV. All NICUs hand n-CPAP systems.

Asistencia respiratoria en las unidades de cuidados intensivos neonatales en España: situación en 2005 / Respiratory care in neonatal intensive care units. Situation in the year 2005

Objetivo: conocer el tipo de unidades de cuidados intensivos neonatales (UCIN) que proporcionan asistencia respiratoria neonatal en España y sus características. Material y método: encuesta multicéntrica estructurada para conocer la actividad asistencial respiratoria prestada por las UCIN en 2005. Resultados: contestaron 96 unidades neonatales con una representatividad estimada en un 63%, con un intervalo entre el 3 y el 92%, según las áreas geográficas; las unidades IIIc se encuentran en el rango superior. Contestaron la encuesta 26 unidades tipo IIb (27%), 16 IIIa (17%), 40 IIIb (42%) y 14 IIIc (14%). Las camas totales de intensivos de nivel III fue de 541 (1,2 camas cada 1.000 recién nacidos vivos; intervalo, 0,7-1,7). La media de camas por unidad fue de 4,1 para las IIIa, 2,8 para las IIIb y 14,6 para las IIIc. En las unidades de nivel III, la relación camas/médicos fue de 2,4 camas/medico y la de camas/enfermeras 2,8 camas/enfermera (2,2 en nivel IIIc). Hubo un total de 13.219 ingresos, de los que el 54% precisó ventilación (el 36% en las IIIa y el 65% en las IIIc). La posibilidad de reanimación en el paritorio con mezcla de gases (aire y oxígeno) sólo la tiene el 42% de las IIIb y IIIc. La relación respirador/cama fue de 1/1; el 63% puede proporcionar ventilación de alta frecuencia (VAF). Todas disponen de sistemas de presión positiva continua nasal (CPAP-n). Sistemas para aplicar ventilación nasal intermitente están disponibles en el 25% de las IIIa, el 58% de las IIIb y el 64% de las IIIc. Todas las IIIc y el 93% de las IIIb pueden proporcionar oxido nítrico inhalado. Cuatro unidades disponían de ECMO. Conclusiones: la media de camas de UCIN de nivel III cada mil nacidos está en el límite bajo de lo recomendable, con notables diferencias regionales. La necesidad de ventilación mecánica fue del 54%. La relación de camas por enfermera fue de 2,8. Existe una buena dotación de respiradores (1 por cama) con alta disponibilidad de VAF (63%). Todas las unidades disponen de CPAP-n (AU)

Aim: To learn the characteristic of the neonatal intensive care units (NICUs) that offer neonatal respiratory assistance in Spain. Material and method: A structured survey was developed and sent to all Spanish neonatal units to learn about the respiratory care offered in 2005. Results: A total of 96 Units answered the survey, with an estimated representatively of 63%, with a range from 3 to 92%, depending on the geographical area. Level IIIc Units were in the upper range. Answer the survey 26 units type IIb (27%), 16 IIIa (17%), 40 IIIb (42%) and 14 IIIc (14%). The total number of level III NICU beds was 541 (1.2 beds per 1000 livebirths; range, 0.7–1.7). The mean number of beds per NICU was 4.1 in level IIIa Units, 2.8 in those IIIb and 14.6 in type IIIc NICUs. In level III NICUs, the bed per physician ratio was 2.4 and that of beds per registered nurse was 2.8 (2.2 in level IIIc NICUs). There were a total 13,219 admissions, 54% of those needed mechanical ventilation (36% in IIIa and 65% in level IIIc NICUs). Oxygen blenders for resuscitation at birth were available in 42% of level IIIb and IIIc NICUs. NICUs had one neonatal ventilator per bed, and 63% of units had high frequency ventilation available. All units had nasal-CPAP systems, 25% of level IIIa Units, 58% IIIb and 64% of those type IIIc had systems for nasal ventilation. All level IIIc and 93% of level IIIb NICUs were able to provide inhaled nitric oxygen therapy. Four NICUS offered ECMO. Conclusions: The mean number of NICU beds per 1000 livebirths is within the lower limits of those been recommended, and there were wide variations among different geographical areas. A 54% of those babies admitted to NICUs required mechanical ventilation. The mean number of NICU beds per registered nurse was 2.8. There was an adequate number of neonatal ventilators (one per bed) and 63% were able to provide HFV. All NICUs hand n-CPAP systems (AU)

[Ibuprofen versus indomethacin in the preterm persistent patent ductus arteriosus therapy: review and meta-analysis]. / Ibuprofeno frente a indometacina para el tratamiento de la persistencia del conducto arterioso del prematuro: revisión sistemática y metaanálisis.

INTRODUCTION: Persistent patent ductus arteriosus (PDA) is a common pathology in the preterm whose traditional treatment has been indomethacin. Recently, ibuprofen has shown its effectiveness in closing the PDA with less hemodynamic effects. The objective of this paper is to review the current literature in order to determine if there is any benefit of ibuprofen versus indomethacin in the PDA therapy. MATERIAL AND METHODS: Eleven trials comparing intravenous ibuprofen versus indomethacin in the treatment of PDA confirmed by echocardiography in < 35 weeks preterm or < 1,500 g birth weight were included. A meta-analysis of the trials data was performed. RESULTS: No trial show statistically significant differences in the failure of closing PDA, neither the meta-analysis (RR 0.96 [CI 95 %: 0.74-1.26], with a power of 0.995). No differences were found in the rate of reopening and surgical ligation. Complications were similar, except for a significant lower incidence of oliguria in the ibuprofen group (RR 0.23 [CI 95 %: 0.10-0.51]). There were no differences in the respiratory outcomes (RR of bronchopulmonary dysplasia (BPD) at 28 days 1.32 [CI 95 %: 0.99-1.76]). CONCLUSIONS: In our revision ibuprofen was as effective as indomethacin in closing PDA. No significant differences were found in the incidence of complications except for less renal impairment with ibuprofen. A higher risk of BPD in the ibuprofen group is not confirmed, although more studies are needed.

Ibuprofeno frente a indometacina para el tratamiento de la persistencia del conducto arterioso del prematuro: revisión sistemática y metaanálisis / Ibuprofen versus indomethacin in the preterm persistent patent ductu sarteriosus therapy: review and meta-analysis

Introducción El ductus arterioso persistente (DAP) es una patología frecuente en el recién nacido prematuro cuyo tratamiento tradicional ha sido la indometacina. Recientemente, el ibuprofeno ha mostrado ser eficaz en su cierre con menores efectos hemodinámicos. El objetivo de este trabajo es revisar la literatura disponible para determinar si existe alguna ventaja entre ambos fármacos en el tratamiento del DAP. Material y métodos Se incluyeron 11 ensayos que compararon ibuprofeno con indometacina en el tratamiento del DAP confirmado ecográficamente en prematuros de menos de 35 semanas o de menos de 1.500 g de peso al nacimiento. Se realizó un metaanálisis de los resultados aportados por los distintos estudios. Resultados Ningún estudio encontró diferencias significativas en el fracaso del cierre del DAP entre ambos fármacos, ni el metaanálisis tampoco (riesgo relativo [RR]: 0,96; intervalo de confianza [IC] del 95 %: 0,74 a 1,26], con un poder de 0,995). No hubo diferencias en la frecuencia de reaperturas ni de ligaduras quirúrgicas. Las complicaciones fueron similares, excepto una incidencia significativamente menor de oliguria en los tratados con ibuprofeno (RR: 0,23; IC 95 %: de 0,10 a 0,51). No se encontraron diferencias en la evolución respiratoria (RR de displasia broncopulmonar a los 28 días de 1,32; IC 95 %: de 0,99 a 1,76). Conclusiones En nuestra revisión, el ibuprofeno fue igual de eficaz que la indometacina en el cierre del DAP. No hubo diferencias en la incidencia de complicaciones excepto menores problemas renales con el ibuprofeno. No se confirma un mayor riesgo de displasia broncopulmonar en el grupo de ibuprofeno, aunque se necesitan más estudios al respecto

Introduction Persistent patent ductus arteriosus (PDA) is a common pathology in the preterm whose traditional treatment has been indomethacin. Recently, ibuprofen has shown its effectiveness in closing the PDA with less hemodynamic effects. The objective of this paper is to review the current literature in order to determine if there is any benefit of ibuprofen versus indomethacin in the PDA therapy. Material and methods Eleven trials comparing intravenous ibuprofen versus indomethacin in the treatment of PDA confirmed by echocardiography in < 35 weeks preterm or < 1,500 g birth weight were included. A meta-analysis of the trials data was performed. Results No trial show statistically significant differences in the failure of closing PDA, neither the meta-analysis (RR 0.96 [CI 95 %: 0.74-1.26], with a power of 0.995). No differences were found in the rate of reopening and surgical ligation. Complications were similar, except for a significant lower incidence of oliguria in the ibuprofen group (RR 0.23 [CI 95 %: 0.10-0.51]). There were no differences in the respiratory outcomes (RR of bronchopulmonary dysplasia (BPD) at 28 days 1.32 [CI 95 %: 0.99-1.76]). Conclusions In our revision ibuprofen was as effective as indomethacin in closing PDA. No significant differences were found in the incidence of complications except for less renal impairment with ibuprofen. A higher risk of BPD in the ibuprofen group is not confirmed, although more studies are needed

Effects of long-term cyclo-oxygenase 2 selective and acid inhibition on Barrett's oesophagus.

BACKGROUND: There is an overexpression of cyclo-oxygenase 2 (COX-2) in Barrett's oesophagus (BO). AIM: To determine the long-term effect of a COX-2 inhibitor on cellular mechanisms involved in BO. METHODS: A randomized controlled trial was conducted in BO patients allocated to continue the usual proton pump inhibitor (PPI) alone treatment, or PPI combined with rofecoxib (25 mg/day) for 6 months. Cell proliferation index and COX-2 expression in BO glands was determined in biopsy specimens at baseline and after treatment. Cell apoptosis, cyclin D1, p53 and vascular endothelial growth factor (VEGF) expression was also explored in a subset of patients. Student-t test and the U-Mann-Whitney test were used for quantitative and ordinal variables. RESULTS: Of 62 patients, 58 completed the study. A higher proportion of patients on rofecoxib + PPI exhibited a decrease in COX-2 expression compared to those treated with PPI alone, but cell proliferation index was not affected. Unlike PPI alone, rofecoxib + PPI was associated with an increase in the apoptotic cell index, a decrease in p53 cell staining and VEGF expression in mucosal vessels. No effect on low-grade dysplasia or cyclin D1 was observed. CONCLUSIONS: The addition of rofecoxib to PPI therapy does not affect cell proliferation index in BO cells after 6 months of therapy, but does reduce COX-2 and VEGF expression and increases cell apoptosis.

How to advise aspirin use in patients who need NSAIDs.

NSAIDs are widely used all over the world. NSAID use is rising due to increasing availability without a prescription, use of aspirin for prevention of thrombotic disorders and the ageing population. Aspirin is used as an analgesic drug in many countries, but the main current indication is low-dose aspirin for the prevention of cardiovascular events. However, NSAIDs and aspirin use account for approximately 20-25% of all reported drug adverse events. Most of those are gastrointestinal including dyspepsia, hemorrhage, perforation and even death. The COX-2- selective inhibitors (coxibs) have demonstrated equivalent efficacy to nonspecific NSAIDs in the management of arthritis and pain but have less gastrointestinal adverse events, although coxibs and probably all NSAIDs, significantly increase risk of serious thromboembolic events. Concomitant use of low-dose aspirin is present in more than 20% of all patients taking either NSAIDs or coxibs, thus increasing the risk of gastrointestinal side effects. Furthermore, at present, it is not known whether aspirin decreases the cardiovascular risks of COX-2 inhibitors or NSAIDs. Appropriate strategies for gastrointestinal risk reduction with NSAIDs and aspirin must consider the overall health status of our patients including the presence of cardiovascular and gastrointestinal risk factors. Use of the lowest possible dose of these drugs, gastroprotectants, especially proton pump inhibitors and Helicobacter pylori eradication will reduce the risk of gastrointestinal side effects in patients taking low-dose aspirin and NSAIDs or coxibs.

Investigación translacional en patología digestiva: del laboratorio a la clínica y viceversa beneficiario: el paciente / No disponible

No disponible

[Effect of the concomitant administration of indomethacin or ibuprofen on amikacin pharmacokinetics in premature newborns]. / Efecto de la administración concomitante de indometacina o ibuprofeno en la farmacocinética de amikacina en neonatos prematuros.

OBJECTIVE: To evaluate whether the concomitant administration of ibuprofen or indomethacin plus amikacin may alter the latter drug s pharmacokinetic parameters, and hence amikacin plasma levels. METHOD: Retrospective cohort study performed by reviewing the medical records of premature children with persistent ductus arteriosus receiving amikacin and ibuprofen, or amikacin and indomethacin. They were divided up into three groups: group 1: treatment with amikacin went before indomethacin or ibuprofen; group 2: simultaneously treated with amikacin and indomethacin; group 3: simultaneously treated with amikacin and ibuprofen. Pharmacokinetic parameters, distribution volume, and amikacin clearance were measured using the PKS program (a non-linear regression method). Half life was determined from previous parameters. RESULTS: Twenty-eight patients were included. No statistically significant differences were found among pharmacokinetic parameters corresponding to each study group. CONCLUSIONS: Further studies are needed with a greater number of patients and currently recommended doses to assess the influence of indomethacin and ibuprofen in the pharmacokinetics of amikacin in premature children with persistent ductus arteriosus.

TGFB1 gene polymorphisms: their relevance in the susceptibility to Helicobacter pylori-related diseases.

Recent studies have revealed elevated expression of transforming growth factor beta1 (TGF-beta1) in gastric mucosa of patients with gastric cancer (GC) and those undergoing ulcer repair. As production of TGF-beta1 is genetically regulated, we aimed to assess whether functional polymorphisms of the TGFB1 gene are involved in susceptibility to and clinical characteristics of Helicobacter pylori-related diseases. DNA from 142 unrelated Spanish patients with GC, 200 with peptic ulcer and 342 healthy controls was typed for the MspA1I T+869C, and the Sau96I G+915C polymorphisms of the TGFB1 gene using polymerase chain reaction and RFLP analysis. H. pylori infection and CagA/VacA antibody status were determined by Western blot in patients and controls. H. pylori infection (odds ratio (OR): 11.44; 95% confidence interval (CI): 4.45-29.42; P<0.001) and non-steroidal anti-inflammatory drugs (OR: 5.07; 95% CI: 2.53-10.16; P<0.001) were identified as independent risks factors for duodenal ulcer (DU), whereas the TGFB1+869(*)C/C genotype was associated with reduced risk of developing the disease (OR: 0.32; 95% CI=0.15-0.68; P=0.003). Our results show that the TGFB1 T+869C gene polymorphism is involved in the susceptibility to DU and provide further evidence that host genetic factors play a key role in the pathogenesis of H. pylori-related diseases.

Quilotórax neonatal congénito y posquirúrgico: revisión y algoritmo diagnóstico-terapéutico / Congenital and postoperative chylothorax in newborns: review and diagnostic and therapeutic algorithm

El quilotórax se define como la acumulación de linfa en el espacio pleural. Realizamos un estudio retrospectivo durante un periodo de 14 años, en el que encontramos 15 casos de quilotórax neonatal: 6 congénitos y 9 posquirúrgicos. En los casos congénitos hubo dos casos de hydrops y uno se asoció a feblectasia congénita. Los posquirúrgicos fueron 4 tras cirugía cardiovascular y 5 tras cirugía de reparación de hernias diafragmáticas. La evolución fue buena en los 15 pacientes, con resolución del quilotórax. Todos los casos congénitos fueron diagnosticados prenatalmente mediante ecografía fetal, precisando todos reanimación profunda y/o ventifación mecánica tras el nacimiento. El diagnóstico fue confirmado mediante análisis del líquido pleural. El tratamiento inicial fue conservador en todos los casos, con drenaje del líquido pleural y soporte respiratorio, cardiovascular, hemodinámico y nutricional. Este tratamiento fue efectivo en el 80% de los casos, precisando cirugía sólo 3 quilotórax posquirúrgicos. No hemos encontrado diferencias significativas respecto a los volúmenes drenadas, los días de ventilación mecánica, los días de nutrición parenteral total, la duración del quilotórax y el porcentaje de complicaciones entre los casos congénitos y los posquirúrgicos. En el caso de los congénitos, es importante el diagnóstico prenatal para planificar una reanimación neonatal adecuada. Tras la revisión actual, proponemos un algoritmo de manejo de esta compleja patología

Chylothoraxis defined as an effusion of lymphin to the pleural cavity. In a retrospective study covering a 14-year period, we found 15 cases of chylothorax occurring during the neonatal period: 6 congenital and 9 postoperative. Congenital chylothorax was associated with hydrops in two cases and with congenital phlebectasia in one case. Postoperative chylothorax occurred after cardiovascula surgery in tour cases and after surgical repair of diaphragmatic hernia in five. The clinical outcome was good in all the patients. Congenital chylothorax was diagnosed by prenatal ultrasound, and mechanical ventilation was required after birth in every case. The diagnosis was confírmed by the analysis of the pleural fluid. Initial treatment was conservative, with continuous or intermittent drainage of chyle and respiratory, cardiovascular, hemodynamic and nutritional support, which was effective in 80% of the cases. Three patients with postoperative chylothorax required surgery for resolution. We have observed no significant differences between the two groups in terms of volume of Lymph drained, days on mechanical ventilation, days with total parenteral nutrition, duration of chylothorax or complications. Prenatal diagnosis is important for planning neonatal resuscitation. We propase an algorithm for the diagnosis and treatment of this complex entity

¿Se debe formar el residente de Pediatría en Atención Primaria? ¿Por qué? Encuesta a pediatras y residentes de Valencia / No disponible

Introducción y objetivos: considerando que el residente de Pediatría no se forma en puericulturani en prevención y promoción de salud del niño sano en centros de Atención PediátricaPrimaria, ni para el tratamiento del niño que no precisa atención hospitalaria, se intentasaber si el residente debe formarse en Atención Primaria.Material y métodos: para ello se distribuyó una encuesta anónima dirigida a todos lospediatras que prestan la Atención Primaria en la ciudad de Valencia, a todos los pediatras delHospital La Fe y a todos los residentes de Pediatría de dicho hospital. Se preguntó: ¿Creesque el residente de Pediatría debe rotar –también– por un centro de Atención Primaria acreditadopara completar su formación? Y ¿por qué?Resultados: se obtuvo un porcentaje de respuesta del 44,7%. El 86% respondió sí, el13% no y el 1% en blanco. Dijeron sí el 90% de los pediatras (95% de Primaria y 83% dehospital) y el 50% de los residentes. Los encuestados respondieron a la segunda parte de lapregunta y aportaron su opinión respecto a los motivos a favor de la rotación en AtenciónPediátrica Primaria; el 29% aportó ideas respecto al programa de formación del residente. El13% que opinó que no debe rotar justificó su opinión y aportó ideas para la formación delresidente. Conclusiones: el 86% de encuestados opina que el residente de Pediatría debe rotar porAtención Primaria para completar su formación y el 17% reclama alargar a más de cuatro añosla especialidad de Pediatría

Introduction and objectives: considering that the resident physician in the specialty ofpaediatrics in Valencia never trains in Paediatric Primary Care centres and that he does notreceive any preparation in child care nor in aspects as preventive care and promotion of goodhabits in healthy children or the treatment of ill children who do not need hospitalization,our intention is to find out if residents should be trained in Paediatric Primary Care, accordingto the opinion of paediatricians and residents in paediatrics.Material and methods: for this reason, an anonymous survey was carried out directed toall paediatricians in Primary Care in the city of Valencia and to all paediatricians and residentsin paediatrics who practise hospital care in the Hospital La Fe. The questions were: Doyou think that a paediatric resident should train –additionally– in an accredited primary healthcare center in order to complete his training? Why?Results: a percentage of 44.7% answered. Eighty-six per cent answered yes, 13% no and1% blank. Affirmative responses were from 90% of the paediatricians (95% primary carepaediatricians and 85% hospital care paediatricians) and 50% of the residents. Those surveyedresponded to the second part of the question giving their opinion on the motives in favourof Paediatric Primary Care training. 29% offered ideas for the resident training program,the 13% against Paediatric Primary Care training, that justified with their opinions.Conclusions: 86% say the resident should be trained in Paediatric Primary Care and17% demand more than four years’ training in Paediatrics

Efecto de la administración concomitante de indometacina o ibuprofeno en la farmacocinética de amikacina en neonatos prematuros / No disponible

Objetivo: Evaluar si la administración concomitante de ibuprofenoo indometacina puede alterar los parámetros farmacocinéticosde amikacina y, por lo tanto, los niveles plasmáticos de lamisma.Método: Estudio de cohortes retrospectivo mediante revisiónde historias clínicas correspondientes a niños prematuros con ductusarterioso persistente tratados con amikacina e ibuprofeno, obien amikacina e indometacina. Se ditribuyen en tres grupos: grupo1: el tratamiento con amikacina fue previo a la administraciónde indometacina o ibuprofeno; grupo 2: tratados simultáneamentecon amikacina e indometacina; grupo 3: tratados simultáneamenteamikacina e ibuprofeno. Los parámetros farmacocinéticos,volumen de distribución y aclaramiento de amikacina se determinaronmediante el programa PKS (método de regresión no lineal).La semivida se determinó a partir de los parámetros anteriores.Resultados: Se incluyen 28 pacientes. No se hallan diferenciasestadísticamente significativas entre los parámetros farmacocinéticoscorrespondientes a cada grupo del estudio.Conclusiones: Serían necesarios estudios con mayor númerode pacientes y con las dosis recomendadas actualmente, en losque se evalúe la influencia de indometacina e ibuprofeno en la farmacocinéticade amikacina en niños prematuros con ductus arteriosopersistente

Objective: To evaluate whether the concomitant administrationof ibuprofen or indomethacin plus amikacin may alter the latterdrug's pharmacokinetic parameters, and hence amikacin plasmalevels.Method: Retrospective cohort study performed by reviewingthe medical records of premature children with persistent ductusarteriosus receiving amikacin and ibuprofen, or amikacin andindomethacin. They were divided up into three groups: group 1:treatment with amikacin went before indomethacin or ibuprofen;group 2: simultaneously treated with amikacin and indomethacin;group 3: simultaneously treated with amikacin and ibuprofen.Pharmacokinetic parameters, distribution volume, and amikacinclearance were measured using the PKS program (a non-linearregression method). Half life was determined from previous parameters.Results: Twenty-eight patients were included. No statisticallysignificant differences were found among pharmacokinetic parameterscorresponding to each study group.Conclusions: Further studies are needed with a greater numberof patients and currently recommended doses to assess theinfluence of indomethacin and ibuprofen in the pharmacokineticsof amikacin in premature children with persistent ductus arteriosus

[Ibuprofen versus indomethacin in the treatment of patent ductus arteriosus in preterm infants]. / Ibuprofeno frente a indometacina en el tratamiento del conducto arterioso persistente del prematuro.

INTRODUCTION: Persistent patent ductus arteriosus (PDA) is a common entity in preterm infants. The most commonly used pharmacological treatment to close the ductus is indomethacin but it can affect cerebral, renal and mesenteric blood flow. Ibuprofen has recently been shown to be effective in closing PDA with fewer hemodynamic effects. In this study we compared the safety and efficacy of ibuprofen and indomethacin in the treatment of PDA in preterm infants. MATERIAL AND METHODS: A randomized trial was performed. Premature infants with symptomatic PDA confirmed by echocardiography in the first week of life and who required respiratory support were included. The patients were randomly assigned to receive either intravenous indomethacin or ibuprofen. The rate of ductal closure, need for additional treatment, complications, and clinical course were evaluated. RESULTS: Twenty-four patients were treated with indomethacin and 23 with ibuprofen. The clinical characteristics before treatment were similar in both groups. Both treatments were effective in closing PDA (87.5% in the indomethacin group and 82.6% in the ibuprofen group). The two cohorts did not differ in the rate of reopening, need for a second pharmacologic treatment, or surgical ductal ligation. No patient in the ibuprofen group developed gastrointestinal adverse effects, but two infants in the indomethacin group had isolated bowel perforation and one had necrotizing enterocolitis. Transient renal dysfunction developed in seven patients (29%) in the indomethacin group versus two (9%) in the ibuprofen group. Transient renal insufficiency was found in one patient in the indomethacin group and in none in the ibuprofen group. The rate of other complications was similar in both groups. CONCLUSIONS: In our trial ibuprofen was as effective as indomethacin in closing PDA. No significant differences were found in the incidence of complications but fewer renal complications and no gastrointestinal complications were found in the ibuprofen group.

Ibuprofeno frente a indometacina en el tratamiento del conducto arterioso persistente del premature / Ibuprofen versus indomethacin in the treatment of patient ductus arteriosus in preterm infants

Introducción. El conducto (ductus) arterioso persistente (DAP) es una enfermedad frecuente en el prematuro. La indometacina es el tratamiento más utilizado en su cierre, pero puede alterar el flujo cerebral, renal y mesentérico. Recientemente el ibuprofeno ha mostrado ser eficaz en el cierre del DAP con menores efectos hemodinámicos. Este estudio se realizó para comparar la eficacia y seguridad del ibuprofeno frente a la indometacina en el cierre del DAP en el prematuro. Material y métodos. Estudio aleatorizado que incluyó prematuros con DAP sintomáticos, diagnosticados mediante ecografía en la primera semana de vida, que precisaron soporte ventilatorio. Los pacientes fueron asignados aleatoriamente a indometacina o ibuprofeno por vía intravenosa. Se evaluó la tasa de cierre ductal, la necesidad de tratamiento adicional, las complicaciones y la evolución clínica. Resultados. Se trataron 24 pacientes con indometacina y 23 con ibuprofeno. Sus características clínicas previas al diagnóstico fueron similares. Ambos tratamientos se mostraron eficaces en el cierre, 87,5 % para la indometacina y 82,6 % para el ibuprofeno. Las dos cohortes no se diferenciaron en la frecuencia de reaperturas, necesidad de dos tandas de fármaco, ni proporción de ligaduras quirúrgicas. Ningún paciente tratado con ibuprofeno presentó enfermedad abdominal que sí apareció en el grupo de indometacina (dos perforaciones intestinales y una enterocolitis necrosante). Siete pacientes (29 %) del grupo de indometacina desarrollaron disfunción renal transitoria frente a 2 casos (9 %) en el de ibuprofeno. En el grupo de indometacina un paciente experimentó insuficiencia renal transitoria y ninguno en el de ibuprofeno. El resto de complicaciones fue similar en ambos grupos. Conclusiones. En nuestra serie el ibuprofeno se mostró igual de eficaz que la indometacina en el cierre del DAP. No hubo diferencias significativas en la incidencia de complicaciones entre ambos grupos, aunque los tratados con ibuprofeno tuvieron menos complicaciones renales y ninguna intestinal

Introduction. Persistent patent ductus arteriosus (PDA) is a common entity in preterm infants. The most commonly used pharmacological treatment to close the ductus is indomethacin but it can affect cerebral, renal and mesenteric blood flow. Ibuprofen has recently been shown to be effective in closing PDA with fewer hemodynamic effects. In this study we compared the safety and efficacy of ibuprofen and indomethacin in the treatment of PDA in preterm infants. Material and methods. A randomized trial was performed. Premature infants with symptomatic PDA confirmed by echocardiography in the first week of life and who required respiratory support were included. The patients were randomly assigned to receive either intravenous indomethacin or ibuprofen. The rate of ductal closure, need for additional treatment, complications, and clinical course were evaluated. Results. Twenty-four patients were treated with indomethacin and 23 with ibuprofen. The clinical characteristics before treatment were similar in both groups. Both treatments were effective in closing PDA (87.5 % in the indomethacin group and 82.6 % in the ibuprofen group). The two cohorts did not differ in the rate of reopening, need for a second pharmacologic treatment, or surgical ductal ligation. No patient in the ibuprofen group developed gastrointestinal adverse effects, but two infants in the indomethacin group had isolated bowel perforation and one had necrotizing enterocolitis. Transient renal dysfunction developed in seven patients (29 %) in the indomethacin group versus two (9 %) in the ibuprofen group. Transient renal insufficiency was found in one patient in the indomethacin group and in none in the ibuprofen group. The rate of other complications was similar in both groups. Conclusions. In our trial ibuprofen was as effective as indomethacin in closing PDA. No significant differences were found in the incidence of complications but fewer renal complications and no gastrointestinal complications were found in the ibuprofen group

Propiedades del subcitrato de bismuto coloidal (SBC) en el tratamiento de desórdenes gastrointestinales / Properties of colloidal bismuth subcitrate (CBS) in the treatment of gastrointestinal disorders

Durante dos siglos las preparaciones de bismuto han sido útiles en una variedad de desórdenes gastrointestinales. Una renovada atención sobre la terapia con bismuto surgió cuando se demostró que los compuestos de bismuto son efectivos contra la infección por Helicobacter pylori. La necesidad de su erradicación total ha potenciado el uso del subcitrato de bismuto coloidal (SBC). En este sentido, parece actuar por varios mecanismos. El presente trabajo de revisión describe la farmacología del SBC en el tratamiento de descontroles gastrointestinales. El uso prolongado de compuestos de bismuto a dosis elevadas, que se produjo en el pasado, dio lugar a la aparición de efectos adversos serios. Los estudios sobre la administración oral de SBC sugieren que, utilizado en las dosis recomendadas, ha sido efectivo y seguro. No obstante, la posible toxicidad de las preparaciones de bismuto debe tenerse presente. En el presente trabajo se muestra una descripción de absorción, distribución, eliminación y toxicidad del SBC. Años atrás no había ningún estudio sistemático sobre las relaciones de estructura-actividad del SBC. Sin embargo, recientemente se ha producido un importante progreso en esta área. Así que, otro aspecto interesante de esta revisión es que resume, discute y describe las principales propiedades físicas, químicas y estructurales de SBC

Bismuth preparations have been useful in a variety of gastrointestinal disorders for two centuries. A renewed attention in bismuth therapy arose when it was shown that bismuth preparations are effective against Helicobacter pylori infection. The need for its total eradication has resulted in the use colloidal bismuth subcitrate (CBS). In this sense, it appears to act via several mechanisms. Present review describes CBS pharmacology in the treatment of gastrointestinal disorders. The prolonged use of high dose bismuth compounds in the past has shown some serious side effects. The studies on CBS oral administration suggests that, utilized in recommended dosages, it has been effective and safe. Nevertheless, the possible toxicity of bismuth preparations should be kept in mind. A description about CBS absorption, distribution, elimination and toxicity are shown in the present review. In the past, there had been no systematic study of the structure-activity relationships of CBS. Recently, however, there has been important progress in this area. So, another interesting aspect of this review is that summarizes, discusses and describes the main physical, chemical and structural properties of CBS