Fracaso de un anticuerpo monoclonal anti-CGRP en el tratamiento de la migraña. ¿Tiene sentido probar otro? / Failure of an anti-CGRP monoclonal antibody in the treatment of migraine. Is it worthwhile trying another one?

Introducción: La migraña es una enfermedad neurológica altamente prevalente y la búsqueda de un tratamiento eficaz que mejore la calidad de vida del paciente es fundamental. En 2018 se aprobaron en España los anticuerpos monoclonales anti-CGRP como tratamiento preventivo, y han demostrado eficacia al reducir el número de crisis de migraña al mes frente a placebo. Pacientes y métodos: Estudio descriptivo y retrospectivo de 14 pacientes con migraña episódica de alta frecuencia y crónica, en seguimiento en nuestra unidad de cefaleas, en los que se ha realizado el cambio de un monoclonal anti-CGRP por ineficacia. Se han recogido datos epidemiológicos y variables relacionadas con la respuesta a ambos fármacos, como los días de cefalea al mes y los días de migraña al mes, además de escalas validadas de calidad de vida (Migraine Disability Assessment Scale y Headache Impact Test-6). Resultados: El 50% de los pacientes son varones, con una mediana de edad de 46,5, y el 92% estaba diagnosticado de migraña crónica. Se realizó un seguimiento de entre seis y 12 meses tras el cambio de tratamiento en el 91,6%, y se observó mejoría significativa en el 33% de los pacientes. Además, en el 50% se objetivó respuesta inicial tras tres dosis con el primer monoclonal. Conclusiones: En nuestra serie, el 66% de los pacientes que no respondieron a un primer fármaco respondió inicialmente al cambio, y esta mejoría se mantuvo en el 36%. Se precisan estudios más amplios para aclarar esta diferencia de respuesta a los distintos anticuerpos monoclonales anti-CGRP.(AU)

Introduction: Migraine is a highly prevalent neurological disease and the search for an effective treatment to improve the patient’s quality of life is essential. In 2018, anti-CGRP monoclonal antibodies were approved in Spain as a preventive treatment, and have proved to be effective in reducing the number of migraine crisis per month compared to placebo. Patients and methods: We conducted a descriptive and retrospective study of 14 patients suffering from high-frequency or chronic episodic migraine, under follow-up in our headache unit, in whom an anti-CGRP monoclonal was changed due to its ineffectiveness. Epidemiological data and variables related to the response to both drugs were collected, such as headache days per month and migraine days per month, as well as validated quality of life scales (Migraine Disability Assessment Scale and Headache Impact Test-6). Results: 50% of patients were males, with a median age of 46.5 years and 92% were diagnosed with chronic migraine. A follow-up of 6 to 12 months after the change of treatment was performed in 91.6% and significant improvement was observed in 33% of the patients. In addition, 50% had an initial response after three doses of the first monoclonal drug. Conclusions: In our series, 66% of patients who did not respond to a first drug responded initially to the switch and this improvement was maintained in 36% of them. Larger studies are needed to clarify this difference in response to different anti-CGRP monoclonal antibodies.(AU)

[Failure of an anti-CGRP monoclonal antibody in the treatment of migraine. Is it worthwhile trying another one?] / Fracaso de un anticuerpo monoclonal anti-CGRP en el tratamiento de la migraña. ¿Tiene sentido probar otro?

INTRODUCTION: Migraine is a highly prevalent neurological disease and the search for an effective treatment to improve the patient's quality of life is essential. In 2018, anti-CGRP monoclonal antibodies were approved in Spain as a preventive treatment, and have proved to be effective in reducing the number of migraine crisis per month compared to placebo. PATIENTS AND METHODS: We conducted a descriptive and retrospective study of 14 patients suffering from high-frequency or chronic episodic migraine, under follow-up in our headache unit, in whom an anti-CGRP monoclonal was changed due to its ineffectiveness. Epidemiological data and variables related to the response to both drugs were collected, such as headache days per month and migraine days per month, as well as validated quality of life scales (Migraine Disability Assessment Scale and Headache Impact Test-6). RESULTS: 50% of patients were males, with a median age of 46.5 years and 92% were diagnosed with chronic migraine. A follow-up of 6 to 12 months after the change of treatment was performed in 91.6% and significant improvement was observed in 33% of the patients. In addition, 50% had an initial response after three doses of the first monoclonal drug. CONCLUSIONS: In our series, 66% of patients who did not respond to a first drug responded initially to the switch and this improvement was maintained in 36% of them. Larger studies are needed to clarify this difference in response to different anti-CGRP monoclonal antibodies.

TITLE: Fracaso de un anticuerpo monoclonal anti-CGRP en el tratamiento de la migraña. ¿Tiene sentido probar otro?Introducción. La migraña es una enfermedad neurológica altamente prevalente y la búsqueda de un tratamiento eficaz que mejore la calidad de vida del paciente es fundamental. En 2018 se aprobaron en España los anticuerpos monoclonales anti-CGRP como tratamiento preventivo, y han demostrado eficacia al reducir el número de crisis de migraña al mes frente a placebo. Pacientes y métodos. Estudio descriptivo y retrospectivo de 14 pacientes con migraña episódica de alta frecuencia y crónica, en seguimiento en nuestra unidad de cefaleas, en los que se ha realizado el cambio de un monoclonal anti-CGRP por ineficacia. Se han recogido datos epidemiológicos y variables relacionadas con la respuesta a ambos fármacos, como los días de cefalea al mes y los días de migraña al mes, además de escalas validadas de calidad de vida (Migraine Disability Assessment Scale y Headache Impact Test-6). Resultados. El 50% de los pacientes son varones, con una mediana de edad de 46,5, y el 92% estaba diagnosticado de migraña crónica. Se realizó un seguimiento de entre seis y 12 meses tras el cambio de tratamiento en el 91,6%, y se observó mejoría significativa en el 33% de los pacientes. Además, en el 50% se objetivó respuesta inicial tras tres dosis con el primer monoclonal. Conclusiones. En nuestra serie, el 66% de los pacientes que no respondieron a un primer fármaco respondió inicialmente al cambio, y esta mejoría se mantuvo en el 36%. Se precisan estudios más amplios para aclarar esta diferencia de respuesta a los distintos anticuerpos monoclonales anti-CGRP.

Use of the Minimum Basic Data Set as a tool for the epidemiological surveillance of mesothelioma / Uso del Conjunto Mínimo Básico de Datos (CMBD), como instrumentode vigilancia epidemológica del mesotelioma

Background:Mesothelioma is a very aggressive tumor that appears after several decades of asbestos exposure. The Minimum Basic Data Set (MBDS) has been validated for the incidence of mesothelioma in Italy, but not in Spain. The objectives of this investigation are: to estimate the prevalence, incidence and mortality of mesothelioma in the Community of Madrid (CM); to evaluate the distribution of this risk within the territory; and to explore validity of the MBDS in the epidemiological surveillance of mesothelioma. Methods:Prevalence, incidence and mortality mesothelioma rates were calculated for the CM from data of the MBDS (2016 and 2017), and mortality data of the Spanish National Statistics Institute (INE) for the same period. The geographical distribution of cases and deaths, and its correlation at municipal level was studied. Statistical analysis with R and Excel tools was carried out.Results:The incidence of mesothelioma in the CM was higher than in previous years. Mortality estimated by the MBDS and calculated using INE data for 2016 were similar in the CM. The correlation between the geographical patterns of risk of mesothelioma obtained from the two sources was high (r = 0.86). The aggregation of cases continues in municipalities in the south, detecting the maximum risk in Aranjuez. Conclusion:The MBDS and INE are good resources for monitoring the risk of mesothelioma. New studies that investigate the aggregation of cases in Aranjuez are required.(AU)

Fundamento: El mesotelioma es un tumor muy agresivo que surge tras varias décadas de exposición al amianto. El Conjunto Mínimo Básico de Datos (CMBD), ha sido validado para conocer la incidencia del mesotelioma en Italia, pero no en España. El objetivo de este trabajo es conocer la prevalencia, incidencia y mortalidad por mesotelioma en la Comunidad de Madrid (CM), evaluar la distribución del riesgo dentro de su territorio y explorar la validez del CMBD en la vigilancia epidemiológica del mesotelioma en España. Material y métodos: Se han utilizado los datos del CMBD de la CM con diagnóstico de mesotelioma y las causas de muerte registradas en el Instituto Nacional de Estadística (INE), durante el periodo 2016-2017. Los cálculos de tasas ajustadas, de distribución geográfica de casos y fallecidos, y de correlación del patrón geográfico a nivel municipal entre ambas fuentes (CMBD eINE), se realizaron mediante los programas R y Excel. Resultados: La incidencia del mesotelioma en la CM fue más alta en 2016 y 2017 que en años precedentes. La mortalidad calculada (INE) y la estimada (CMBD) fueron similares. La correlación entre patrones geográficosde riesgo obtenidos mediante CMBD e INE fue elevada (r = 0.86). La agregación de casos continúa concentrándose en los municipios del sur de la CM, detectándoseel máximo riesgo en Aranjuez. Conclusiones: Tanto el CMBD como el INE representan fuentes adecuadas para monitorizar el riesgo de mesotelioma. Se precisa de nuevos estudios que expliquen laagregación de casos detectada en Aranjuez.(AU)

Use of the Minimum Basic Data Set as a tool for the epidemiological surveillance of mesothelioma.

BACKGROUND: Mesothelioma is a very aggressive tumor that appears after several decades of asbestos exposure. The Minimum Basic Data Set (MBDS) has been validated for the incidence of mesothelioma in Italy, but not in Spain. The objectives of this investigation are: to estimate the prevalence, incidence and mortality of mesothelioma in the Community of Madrid (CM); to evaluate the distribution of this risk within the territory; and to explore validity of the MBDS in the epidemiological surveillance of mesothelioma. METHODS: Prevalence, incidence and mortality mesothelioma rates were calculated for the CM from data of the MBDS (2016 and 2017), and mortality data of the Spanish National Statistics Institute (INE) for the same period. The geographical distribution of cases and deaths, and its correlation at municipal level was studied. Statistical analysis with R and Excel tools was carried out. RESULTS: The incidence of mesothelioma in the CM was higher than in previous years. Mortality estimated by the MBDS and calculated using INE data for 2016 were similar in the CM. The correlation between the geographical patterns of risk of mesothelioma obtained from the two sources was high (r = 0.86). The aggregation of cases continues in municipalities in the south, detecting the maximum risk in Aranjuez. CONCLUSION: The MBDS and INE are good resources for monitoring the risk of mesothelioma. New studies that investigate the aggregation of cases in Aranjuez are required.

Biorreactores de un solo uso en la industria biofarmacéutica y su uso en la producción de candidatos vacunales contra SARS- COV-2. Artículo de revisión / Single-use systems bioreactors in the biopharmaceutical industry and its use in SARS-CoV-2 vaccine's candidates production. A review

Los biorreactores de sistemas de un solo uso (SUSs), también conocidos como biorreactores desechables, se han convertido en una parte integral de las instalaciones biotecnológicas de fabricación para bioproductos con un mercado potencial que espera una tasa de crecimiento de casi el 15,5% durante el período pronosticado: 2018 a 2023. Los biorreactores SUSs son más seguros, simples y flexibles al compararlos con sus contrapartes, biorreactores de acero inoxidable, por lo que su uso se está incrementando en la industria biofarmacéutica principalmente en la planificación de vías rápidas de proyectos complejos, incluidos los relacionados con la pandemia de SARS-CoV-2. Así, el uso de SUS se ha convertido en una alternativa eficaz para la producción rápida de candidatos a vacunas. Pero algunas desventajas técnicas y operativas aún obstaculizan su uso en todo el mundo. Esta revisión brinda una visión racional del uso, los tipos, los parámetros operativos y las nuevas aplicaciones de los biorreactores SUSs en la industria biofarmacéutica. Asimismo, también se discuten los parámetros apropiados y las limitaciones de este equipo, enfocándose en su uso para la producción de vacunas contra COVID-19

Single-Use-Systems (SUSs) Bioreactors, also known as disposable bioreactors, have become an integral part of biotechnology manufacturing facilities for bioproducts with a potential market expecting a growth rate of nearly 15.5% over the forecast period: 2018 to 2023. SUSs bioreactors are comparatively safe, simple, and flexible than their stainless-steel bioreactors counterparts thus, their usage is being augmented in the biopharmaceutical industry mainly in planning fast tracks of complex projects, including those related to the SARS-CoV-2 pandemic. Thus, the use of SUSs has become an effective alternative for the rapid production of vaccine candidates. However, some technical and operational disadvantages still hamper their worldwide use. This review gives a rational insight into SUSs bioreactors use, types, operational parameters and new applications in the biopharmaceutical industry. Likewise, the appropriate parameters and limitations of this equipment, focusing on its use for vaccine production against COVID-19 are also discussed

Forced degradation study and characterization of main impurities of ibuprofen soft gelatin capsules by LC-MS-QTOF.

Ibuprofen soft gelatin capsules were subjected to degradation under acidic, basic, oxidation, photolytic, thermal, humidity, and metal ions conditions. To analyse the degradation products, a reversed-phase liquid chromatography (RP-LC) indicative stability method was successfully developed. Chromatographic separation was achieved using a Poroshell HPH-C18 150 x 4.6 mm, 4 µm, column at 25 °C, with a mobile phase constituted by 0.1% phosphoric acid and acetonitrile in gradient at a flow rate of 1.0 mL• min -1 , using ultraviolet detection at 220 nm and injection volume of 20 µL. In total, eight unknown impurities were found. The peaks RRt 0.49, RRt 0.75, and RRt 0.95 were above 0.17%, corresponding to the identification threshold. Those were identified and characterized by LC-MS-QTOF, with the same chromatographic conditions, except for the exchange of 0.1% phosphoric acid for 0.1% formic acid. The impurities originated from the interaction of ibuprofen with excipients: esterification with PEG, with sorbitol/sorbitan, and with glycerol by-products, which has not yet been reported in the literature. The developed method can be used in several pharmaceutical areas as quality control of impurities, studies of forced degradation, and for the development of future formulations.

Miller-Fisher syndrome after SARS-CoV-2 infection.

INTRODUCTION: On March 11th, 2020, the WHO declared the SARS-Cov-2 pandemic. Syndromes have been detected in relation to COVID-19 such as encephalitis, acute necrotizing hemorrhagic encephalopathy and cerebrovascular complications. There are also cases of peripheral nervous system involvement. METHODS: Our case would be the 3rd patient with MFS associated with COVID-19 as far as we know. RESULTS: We present a 51 years old female diagnosed with MFS two weeks after COVID-19. RTPCR to SARS-CoV-2 was negative but IgG was positive. CONCLUSION: Most of the cases were mild or moderate with typical signs and symptoms. All were treated with IV immunoglobulin with good response in most cases. Despite the short evolution time of the cases surviving the current pandemic, the description of cases of post-infectious neurological syndromes suggests that this is probably not an infrequent complication in the subacute stage of Covid-19 disease.

Physical inactivity and excessive sucrose consumption are associated with higher serum lipids in subjects with Taq1B CETP polymorphism.

BACKGROUND: Dyslipidaemias result from the interaction between genetic and environmental factors, including diet disequilibrium and physical inactivity. Among the genetic factors associated with serum lipids, the Taq1B CETP polymorphism has been investigated. The B1 allele has been considered as a risk factor for dyslipidaemia because of its association with greater CETP levels and higher serum triglycerides. The present study aimed to determine the role of the Taq1B polymorphism with lipid and anthropometric variables and its interaction with diet and physical activity. METHODS: In total, 215 subjects were enrolled in this cross-sectional study. Diet intake was evaluated using a 3-day food consumption record and physical activity was determined in accordance with World Health Organization recommendations. The Taq1B CETP polymorphism was determined by allelic discrimination. RESULTS: Subjects with the B1B2/B2B2 genotype, who had a sucrose consumption ≥5% of the total kcal day-1 , had higher levels of total cholesterol (TC) [165.55 (142.21-188.89) mg dL-1 versus 200.19 (184.79-215.60) mg dL-1 ; P for interaction = 0.034] and low-density lipoprotein [99.29 (75.52-123.05) mg dL-1 versus 128.64 (113.59-143.69) mg dL-1 ; P for interaction = 0.037] than subjects with the B1B1 genotype. Subjects who did not perform physical activity and had the B1B2/B2B2 genotype showed significantly higher levels of TC [177.48 (161.36-193.60) mg dL-1 versus 194.49 (185.43-203.56) mg mL-1 ; P for interaction = 0.033] than subjects with the B1B1 genotype. CONCLUSIONS: We provide evidence that subjects with inadequate environmental factors carriers of the polymorphic genotype had higher serum lipid levels than subjects with the B1B1 genotype.

Pectin influences the kinetics of in vitro lipid digestion in oil-in-water emulsions.

Oil-in-water emulsions were prepared with 5% (w/v) carrot-enriched olive oil and stabilized with Tween 80 (TW), phosphatidylcholine (PC), citrus pectin (CP) or a combination of these emulsifiers. Additionally, the methylesterification degree (DM) of citrus pectin was modified, resulting in three different studied pectin structures: CP82, CP38 and CP10. All initial emulsions presented small initial oil droplet sizes and were submitted to an in vitro simulated gastric and small intestinal phase. The latter was executed in a kinetic way to determine the time dependency of the lipolysis reaction, micelle formation and carotenoid bioaccessibility. The results showed that the pectin DM mainly influenced the reaction rate constants, while the emulsifier (combination) determined the extent of lipolysis and carotenoid bioaccessibility. Moreover, a direct relation was observed between the lipolysis reaction and bioaccessibility extent. The presented study showed that targeted emulsion design can be used to tailor lipid digestion kinetics.

Emulsion stability during gastrointestinal conditions effects lipid digestion kinetics.

Oil-in-water emulsions were prepared with carrot- or tomato-enriched olive oil (5%w/v) and stabilized with Tween80 or sucrose esters (0.5%w/v) with different hydrophilic-lipophilic balance (8; 11 or 16). All emulsions had similar initial oil droplet sizes and were submitted to simulated gastrointestinal conditions using a kinetic digestion procedure. Sucrose esters induced an unstable system after gastric conditions leading to coalesced oil droplets, while Tween80 emulsions remained stable. Emulsion particle sizes at the end of the gastric phase were directly associated with the lipolysis kinetics during the intestinal phase. Moreover, a direct relationship was observed between lipolysis and carotenoid micellarisation for all emulsions, and depended mainly on the surfactant structure used. Tween80 emulsions led to a higher lipolysis extent (53-57%) and carotenoid bioaccessibility (17-42%) compared to sucrose ester emulsions (33-52% and 9-27%, respectively). These findings show the importance of the emulsifier structure and emulsion stability during gastrointestinal conditions in modulating lipolysis kinetics.

Gallstone ileus: An overview of the literature. / El íleo biliar: una revisión de la literatura médica.

INTRODUCTION: Gallstone ileus represents 4% of the causes of bowel obstruction in the general population, but increases to 25% in patients above the age of 65 years. Gallstone ileus does not present with unique symptoms, making diagnosis difficult. Its management is surgical, but there is no consensus as to which of the different surgical techniques is the procedure of choice. At present, there is no recent review of this pathology. AIM: To conduct an up-to-date review of this disease. MATERIALS AND METHODS: Articles published within the time frame of 2000 to 2014 were found utilizing the PUBMED, EMBASE, and Cochrane Library search engines with the terms "gallstone ileus" plus "review" and the following filters: "review", "full text", and "humans". RESULTS: The results of this review showed that gallstone ileus etiology was due to intestinal obstruction from a gallstone that migrated into the intestinal lumen through a bilioenteric fistula. The presence of 2 of the 3 Rigler's triad signs was considered diagnostic. Abdominal tomography was the imaging study of choice for gallstone ileus diagnosis and the surgical procedures for management were enterolithotomy, one-stage surgery, and two-stage surgery. Enterolithotomy had lower morbidity and mortality than the other 2 procedures. CONCLUSIONS: The aim of gallstone ileus treatment is to release the obstruction, which is done through enterolithotomy. It is the recommended technique for gallstone ileus management because of its lower morbidity and mortality, compared with the other techniques.

Lipid digestion, micelle formation and carotenoid bioaccessibility kinetics: Influence of emulsion droplet size.

Carotenoid-enriched oil-in-water emulsions with different droplet sizes (small: d43 0.72µm; medium: d43 1.9µm; large: d43 15.1µm) were subjected to simulated gastrointestinal conditions. The kinetics of lipolysis, micelle formation and carotenoid bioaccessibility were monitored during the intestinal phase. The rates of all three processes increased with decreasing droplet size. The large droplet size emulsion contained undigested oil at the end of digestion, whereas an almost complete hydrolysis was observed for the other two emulsions. The sub-micron emulsion presented a higher conversion of MAGs to FFAs during digestion, which led to a higher concentration of FFAs in the mixed micelles. The incorporation of carotenoids into mixed micelles occurred faster and reached a higher final value for the small droplet size emulsion, leading to final carotenoids bioaccessibility values of around 70%. This work provides valuable information for developing in silico models to simulate the lipid digestibility and carotenoid bioaccessibility.

A rare case of a strangulated Littre's hernia with Meckel's diverticulum duplication. Case report and literature review.

INTRODUCTION: The Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract present in approximately 1-4% of the population; the MD duplication is exceedingly rare with only a few reports of it. Here we present the firs case of a strangulated Littre's hernia with MD duplication. PRESENTATION OF CASE: A 30-year-old male presented to the emergency room with clinical signs of small bowel obstruction, at physical examination, a right incarcerated inguinal hernia with erythema was found. We did a laparotomy, and two MD were found, one in the sac with ischemia, and the other 90cm from the Bahuins valve. A diverticulectomy of the ischemic diverticulum was done, and the other MD was left in place; the inguinal region was repaired with a Lichtenstein technique. DISCUSSION: The complications of the MD are 3-4 times more frequent in men, been an intestinal obstruction, hemorrhage, diverticulitis, ulceration, and perforation. A Littrés hernia is when the MD is found in the sac; this is seen in the inguinal region in 50% of the cases. The management of a Littre's hernia is the resection of the MD; it could be done by an intestinal resection or by a diverticulectomy accordingly to the Park criteria. CONCLUSION: As to our knowledge, this is the first case of an incarcerated Littre's hernia with duplication of a Meckel's diverticulum.

The influence of lipid droplet size on the oral bioavailability of vitamin D2 encapsulated in emulsions: an in vitro and in vivo study.

Vitamin D deficiency is prevalent in some populations leading to adverse health effects, and therefore there is a need to supplement functional foods and beverages with this important micronutrient. In this study, we examined the influence of the initial lipid droplet size on the in vitro bioaccessibility and in vivo absorption of vitamin D2 encapsulated in oil-in-water emulsions. Changes in particle size, charge, and microstructure were measured as vitamin-loaded lipid droplets were passed through a simulated GIT (mouth, stomach, small intestine). The in vitro studies showed that smaller lipid droplets were digested more rapidly than larger ones, thereby leading to the more rapid formation of mixed micelles in the small intestine capable of solubilizing the lipophilic vitamins. This effect may account for the highest vitamin D2 bioaccessibility being observed for the emulsions containing the smallest droplets. In contrast, the in vivo rat feeding studies suggested that the absorption of vitamin D2 was the highest for the emulsions containing the largest droplets. The poor in vitro-in vivo correlation observed in our study may have occurred for a number of reasons: the simulated GIT did not accurately model the complexity of a real GIT; the in vivo approach used did not monitor changes in vitamin levels in the blood over time. Overall, this study suggests that particle size does influence the gastrointestinal fate of encapsulated oil-soluble vitamins, but that further work is needed to establish strong correlations between in vitro and in vivo methods.

Apendicitis crónica en un apéndice atrófico: reporte de un caso

La apendicitis crónica es una entidad poco frecuente que se caracteriza por dolor en fosa iliaca derecha durante 2 años de evolución. Algunos cirujanos y patólogos niegan la existencia de ésta enfermedad, contrariamente, existen estudios de diversos autores que reportan hallazgos de apendicitis crónica. Paciente varón de 71 años de edad, con dolor en fosa iliaca derecha de 2 semanas de evolución que remitía parcialmente a lo largo de su presentación, no asociado a náuseas, vómitos ni anorexia. El examen físico reveló rebote en fosa iliaca derecha y hemograma sin leucocitosis y las formas segmentadas dentro de parámetros normales. Antecedente de 2 años de cuadros similares con resolución espontánea. Se decide realizar laparotomía exploratoria, el hallazgo operatorio fue apéndice cecal de 1 cm de longitud con adherencia de su extremo distal a la pared abdominal, ejerciendo tracción. En el postoperatorio el paciente cursó con leve distensión abdominal y remisión completa del dolor. La anatomía patológica de la pieza operatoria fue informada como apéndice cecal de 1 cm de longitud con inflamación crónica y fibrosis

Chronic appendicitis is a rare entity characterized by pain in the right iliac Fossa during 2 years of evolution. Some surgeons and pathologists deny the existence of this disease; in contrast, there are studies of different authors that reported findings of chronic appendicitis. Male patient, 71 years- old, with pain in the right iliac Fossa of 2 weeks of evolution which remitted partially throughout his presentation, not associated with nausea, vomiting or anorexia. Physical examination revealed bounce in right iliac Fossa and blood count without Leukocytosis and forms segmented within normal parameters. History of 2 years of similar symptoms with resolution spontaneously. It was decided to carry out exploratory laparotomy; the operative finding was a cecal appendix of 1 cm of length with adherence of its distal part to the abdominal wall, exerting traction. Postoperatively the patient presented mild bloating and complete remission of pain. The pathological anatomy of the operative part was informed as cecal appendix 1 cm of length with chronic inflammation and fibrosis

Grynfelt-Lesshaft hernia a case report and review of the literature.

INTRODUCTION: Lumbar hernia account for less than 2% of al abdominal hernias, been the Grynfelt-Lesshaft's hernia (GLH) more frequent than the others. With approximately 300 cases published in the literature, the general surgeon may have the chance of treat it ones in their professional life. CASE REPORT: A 42-years old male with human immunodeficiency virus and Diabetes Mellitus presented to the outpatient clinic with a GLH. Preoperative classified as a type "A" lumbar hernia an open approach was scheduled. We performed a Sandwich technique with a sublay and onlay ULTRAPRO(®) mesh fixed with PDS(®) II suture without complications and discharged the patient 24-h after. After six months, the patient denied any complication. DISCUSSION: Primary (spontaneous) lumbar hernias represent 50-60% of all GLH. The preoperative classification of a lumbar hernia is mandatory to propose the best surgical approach. According to the classification of Moreno-Egea A et al., the best technique for our patient was an open approach. The Sandwich technique has demonstrated good outcomes in the management of the GLH. CONCLUSION: The surgical approach should be according to the classification proposed and to the experience of the surgeon. The Sandwich technique has good outcomes.

Association between bone turnover markers, clinical variables, spinal syndesmophytes and bone mineral density in Mexican patients with ankylosing spondylitis.

OBJECTIVES: To compare bone turnover marker (BTM) levels and bone mineral density (BMD) between patients with ankylosing spondylitis (AS) and healthy controls (HC) and to evaluate, in AS, the association between BTM levels and clinical variables, spinal syndesmophytes, and BMD using multivariate analysis. METHOD: Seventy-eight AS patients were compared with 58 HC matched by gender. Spinal syndesmophytes in AS and other characteristics were assessed. C-terminal telopeptide fragments of type I collagen (CTX), bone-specific alkaline phosphatase (BAP), osteocalcin (OC) serum levels, and BMD of the lumbar spine, femoral neck, and forearm were evaluated. RESULTS: AS males and females had lower BAP levels than their respective HC (p < 0.001 and p = 0.001). AS patients with bridging syndesmophytes had higher OC levels than AS patients either with non-bridging syndesmophytes (p = 0.001) or without spinal syndesmophytes (p < 0.001). OC and CTX levels correlated significantly with the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). In the multivariate linear regression adjusted by age, gender, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), BMD in the lumbar spine, and C-reactive protein (CRP), we observed an association between BAP levels and anti-tumour necrosis factor (anti-TNF) use (p = 0.05) whereas OC levels were associated with mSASSS (p < 0.001) and anti-TNF use (p = 0.05), and CTX levels were exclusively associated with mSASSS (p = 0.03). In the logistic regression analysis, only OC levels were associated with the presence of syndesmophytes in AS [odds ratio (OR) 2.42, 95% confidence interval (CI) 1.19-5.75]. CONCLUSIONS: We observed an increase in OC levels in AS patients with syndesmophytes. BTM levels were associated with the severity of spinal damage. Future longitudinal studies should evaluate whether these BTMs should be included as tools to determine the prognosis and progression of spinal damage.

Enhancement of lycopene bioaccessibility from tomato juice using excipient emulsions: Influence of lipid droplet size.

The use of excipient emulsions to increase the bioaccessibility of lycopene in tomato juice was studied by simulating gastrointestinal conditions. The influence of droplet diameter (d=0.17 or 19µm) and thermal treatment (90°C, 10min) on lycopene bioaccessibility was evaluated. Lycopene bioaccessibility was relatively low (<8%) in the absence of excipient emulsions due to the crystalline nature of the carotenoids and their entrapment within chromoplasts. Emulsions containing small droplets were fully digested within the small intestine phase, and led to a higher bioaccessibility (12.5%) than emulsions containing large droplets (10.0%) or emulsion-free samples (7.5%). The relatively modest increase in bioaccessibility was attributed to the high level of entrapment in crystalline form. Thermal processing did not appreciably disrupt tomato cells, and therefore only led to a slight increase in lycopene bioaccessibility. Overall, this study shows that excipient emulsions may increase the bioaccessibility of carotenoids in tomato juices.

Droplet size and composition of nutraceutical nanoemulsions influences bioavailability of long chain fatty acids and Coenzyme Q10.

The influence of droplet size (d32=0.21, 0.70 or 2.2µm) and oil digestibility (corn oil versus mineral oil) on the bioavailability of a model long chain fatty acid (heptadecanoic acid) and lipophilic nutraceutical (Coenzyme Q10) was investigated using a rat feeding study. Initially, we showed that small droplets were digested more rapidly than large droplets using a simulated small intestinal model (pH stat), which was attributed to the greater surface area of lipid exposed to intestinal juices. The pH stat model also confirmed that emulsified corn oil was digestible, whereas emulsified mineral oil was indigestible. A rat feeding study showed that the bioavailability of the fatty acid and lipophilic nutraceutical in small intestinal tissues was highest when they were encapsulated within digestible oil droplets with the smallest size. This study provides important information for development of nanoemulsion-based delivery systems that increase oral bioavailability of lipophilic nutraceuticals.

Influence of particle size on lipid digestion and ß-carotene bioaccessibility in emulsions and nanoemulsions.

The interest in incorporating carotenoids, such as ß-carotene, into foods and beverages is growing due to their potential health benefits. However, the poor water-solubility and low bioavailability of carotenoids is currently a challenge to their incorporation into many foods. The aim of this work was to study the influence of particle size on lipid digestion and ß-carotene bioaccessibility using corn oil-in-water emulsions with different initial droplet diameters: large (d43≈23µm); medium (d43≈0.4µm); and small (d43≈0.2µm). There was a progressive increase in the mean particle size of all the emulsions as they passed through a simulated gastrointestinal tract (GIT) consisting of mouth, stomach, and small intestine phases, which was attributed to droplet coalescence, flocculation, and digestion. The electrical charge on all the lipid particles became highly negative after passage through the GIT due to accumulation of anionic bile salts, phospholipids, and free fatty acids at their surfaces. The rate and extent of lipid digestion increased with decreasing mean droplet diameter (small≈medium≫large), which was attributed to the increase in lipid surface area exposed to pancreatic lipase with decreasing droplet size. There was also an appreciable increase in ß-carotene bioaccessibility with decreasing droplet diameter (small>medium>large). These results provide useful information for designing emulsion-based delivery systems for carotenoids for food and pharmaceutical uses.