Corticosteroid safety in COVID-19 patients: a pharmacovigilance study / Seguridad de corticoesteroides en pacientes con COVID-19: un estudio de farmacovigilancia

The use of oral and intravenous corticosteroids as a treatment for SARS-CoV-2 infection has been shown to inhibit the exaggerated inflammatory response, reducing symptoms and days of hospitalization of patients. However, its use is controversial because not enough clinical studies have been made to verify the safety of the drugs. Objective: To assess the safety profile of corticosteroids treatment, at high and low doses, in suspected or confirmed patients with COVID-19, determining the most frequent side effects in patients, and assessing whether the administration of the drugs represents a greater benefit than the risk of presenting these effects. Methods: Ambispective study of active pharmacovigilance at a cohort of confirmed or suspected COVID-19 patients, treated with intravenous and oral corticosteroids. 366 patients were evaluated and divided into 3 groups: use of methylprednisolone (155 mg average) every 24 hours for 3 days, dexamethasone (6 mg) every 24 hours for 10 days, and a control group. Results: The distribution of the cases with hyperglycemia was 33 in high doses and 82 with low doses of corticosteroids and both high and low doses have a similar distribution in cases of infections. When evaluating the harshness and severity of hyperglycemia in the two groups with corticosteroids, it is observed that patients with high doses present more harsh (48%). In case of harshness and severity of infections it is observed that patients with high doses present more harsh (62%) and more severe (79%) cases than those who were administered low doses. (AU)

El uso de corticoides orales e intravenosos como tratamiento para la infección por SARS-CoV-2 ha demostrado inhibir la respuesta inflamatoria exagerada, reduciendo los síntomas y los días de hospitalización de los pacientes. Sin embargo, su uso es controvertido porque no se han realizado suficientes estudios clínicos para verificar la seguridad de los medicamentos. Objetivo: Evaluar el perfil de seguridad del tratamiento con corticoides, a dosis altas y bajas, en pacientes con sospecha o confirmación de COVID-19, determinando los efectos secundarios más frecuentes en los pacientes, y valorando si la administración de los fármacos representa un mayor beneficio que el riesgo de presentar estos efectos. Métodos: Estudio ambispectivo de farmacovigilancia activa en una cohorte de pacientes confirmados o sospechosos de COVID-19, tratados con corticoides intravenosos y orales. Se evaluaron 366 pacientes y se dividieron en 3 grupos: uso de metilprednisolona (155 mg promedio) cada 24 horas por 3 días, dexametasona (6 mg) cada 24 horas por 10 días y un grupo control. Resultados: La distribución de los casos con hiperglucemia fue de 33 casos usando dosis altas y 82 con dosis bajas de corticoides, tanto las dosis altas como las bajas tienen la misma distribución en los casos de infecciones. Al evaluar la severidad y gravedad de la hiperglucemia en los dos grupos con corticoides, se observa que los pacientes con dosis altas presentan mayor gravedad (48%). En caso de severidad y gravedad de las infecciones se observa que los pacientes con dosis altas presentan casos más graves (62%) y más severos (79%) que los que recibieron dosis bajas. (AU)

Measurement of temperature profile induced by the optical signal in fiber Bragg gratings using whispering-gallery modes.

The temperature sensitivity of whispering-gallery mode resonances of an optical fiber is exploited to measure thermal effects induced by an optical signal of moderate power along a fiber Bragg gating (FBG). The UV inscription technique used for the fabrication of FBG introduces a permanent change in the absorption coefficient of the fiber; thus, thermal effects are expected. The resonance wavelength shift of whispering-gallery modes provides information about the temperature change in the fiber, point to point. We present the experimental characterization of the thermal effects in FBG as a function of the wavelength and the power of the launched optical signal through the grating.

¿Son aplicables los criterios analíticos generales para definir el hipotiroidismo en personas con síndrome de Down? / Are suitable general clinic criteria for defining hypothyroidism in people with Down syndrome?

Las diversas series publicadas sobre la prevalencia de las alteraciones tiroideas en las personas con síndrome de Down (SD) muestran una gran dispersión de resultados, aunque todas coinciden en señalar una frecuencia mayor que en la población general. La causa de estas diferencias puede que dependa del método de selección de la muestra. En este trabajo se estudia una población sana de adolescentes con SD, perteneciente a la Asociación de Málaga, seleccionada aleatoriamente, al margen del circuito asistencial. Al valorar la tirotropina (TSH) como parámetro bioquímico para definir la función tiroidea, resulta que la media de la distribución de la población con SD estudiada se sitúa 2 desviaciones estándar por encima de la población general. Estos datos muestran que son dos poblaciones diferentes, por lo que sería necesario definir los criterios de normalidad e hipotiroidismo subclínico, dudoso o patológico, y proponer nuevas pautas para iniciar el tratamiento (AU)

Studies on the prevalence of thyroid disorders in people with Down syndrome (DS) show a wide dispersion of results. However, most of these studies agree in indicating a greater frequency than in the general population. The cause of these differences may depend on the method of sample selection. In this work we studied a healthy population of adolescents with DS of the Association of Málaga, selected randomly and regardless of the medical care. Mean TSH distribution, used here as a tool to define the biochemical thyroid function of the studied DS population, was two standard deviation higher than the mean for the general population. These data show that in terms of TSH the DS population is a distinct population with respect to the general population. This clearly indicates that it would be necessary to identify and define new criteria to establish what is normal, subclinical hypothyroidism, borderline or pathological, and to propose new treatment guide (AU)

Dietary unsaponifiable fraction from extra virgin olive oil supplementation attenuates acute ulcerative colitis in mice.

Extra virgin olive oil (EVOO) has demonstrated immunomodulatory and antiinflammatory properties in murine experimental ulcerative colitis (UC). In addition to its high monounsaturated fatty acid content, evidences have accumulated on the favorable properties of minor, although highly bioactive, components present in the unsaponifiable fraction (UF). The present study was designed to evaluate the effects of dietary EVOO's UF supplementation on acute UC. C57BL/6 mice were fed from weaning with sunflower oil (SD), EVOO diet and UF-enriched SD at 5% oil (SD+UF). After 30 days, mice were exposed to 3% dextran sulfate sodium (DSS) for 5 days developing acute colitis. After 4 days of DSS removal, animals were sacrificed and colons were histological and biochemically processed. Disease activity index and microscopic damage score were significantly improved in EVOO and SD+UF dietary groups versus SD group. In addition, both dietary treatments significantly induced decreases in MCP-1 and TNF-α levels, iNOS and COX-2 overexpression and p38 MAPKs activation in colon mucosa. Moreover, an upregulation of IκB expression was also observed after feeding the animals with both diets. However, no statistically differences between data from mice fed with EVOO or UF+SD diets were observed. Dietary enrichment with EVOO's UF reduces the damage in acute colitis model, alleviating the oxidative events and returning proinflammatory proteins expression to basal levels probably through p38 MAPK and NFκB signalling pathways. EVOO's UF diet might provide a basis for developing a new strategy in dietary supplementation for the prevention of UC.

Antiplatelet therapies are associated with hematoma enlargement and increased mortality in intracranial hemorrhage

Objective: Antiplatelet therapy (AT) is increasingly used for treating or preventing vascular diseases, especially as a consequence of population aging. However, the risks may sometimes outweigh the benefits, mostly in relation to intracranial hemorrhage (ICH). Our aim was to determine whether AT is associated with hematoma enlargement and increased mortality in ICH. Design: A prospective, observational cohort study. Setting: The Intensive Care Unit (ICU) of Arrixaca University Hospital (Murcia, Spain). Patients: We studied 156 patients admitted with non-traumatic ICH between January 2006 and August 2008. Interventions: None. Main variables: Demographic data, medical history and clinical and laboratory parameters were recorded, along with hematoma volume upon admission and after 24h, and mortality. Results: A total of 37 patients (24%) received AT. These subjects were older (69±11 vs. 60±15 years, p=0.001) and more frequently diabetic (38% vs. 15%, p=0.003) than those without AT. We detected no difference in hematoma volume upon admission between the two groups, though the volume was significantly greater after 24h in the AT group (66.7 [IQR 42-110] vs. 27 [4.4-64.6]cm3, p=0.03), irrespective of surgical intervention. Moreover, hematoma volume increased by more than a third in AT-users (69% vs. 33%, p=0.002), and AT was the only significant predictor of hematoma enlargement. Patients on AT also had higher mortality during their ICU stay (78% vs. 45%, p<0.001). In addition, of the patients with hematoma enlargement, over one-third had higher overall mortality (62.5 vs. 28.8%, p=0.001). Independent risk factors for death were the Glasgow Coma Scale score, blood glucose upon admission, and AT. Conclusions: Our results show an association between AT and subsequent hematoma enlargement, as well as increased mortality in patients presenting with ICH who were receiving AT (AU)

Objetivo: Con el envejecimiento progresivo de la población cada es más frecuente la toma de fármacos antiagregantes para el tratamiento o la prevención de las enfermedades vasculares. El beneficio, en ocasiones, está contrarrestado por el riesgo de hemorragias, especialmente la hemorragia intracraneal (HIC). Nuestro objetivo fue determinar si el tratamiento antiagregante (TAG) provoca un aumento del tamaño del hematoma y de mortalidad en la HIC. Diseño: Estudio de cohortes prospectivo y observacional. Ámbito: Unidad de cuidados intensivos (UCI) del Hospital Universitario Virgen de la Arrixaca (Murcia). Pacientes: Estudiamos a 156 pacientes que ingresaron por HIC no traumática entre Enero de 2006 y Agosto de 2008. Intervenciones: Ninguna. Principales variables: Se recogieron datos demográficos, antecedentes personales, parámetros clínicos y analíticos, así como, el volumen del hematoma al ingreso y a las 24 horas, además de la mortalidad. Resultados: Entre los pacientes estudiados, 37 (24%) tomaban TAG. Los antiagregados eran de mayor edad (69±11 vs 60±15 años, p=0,001) y con mayor frecuencia diabéticos (38 vs 15%, p=0,003). No hubo diferencias en el volumen del hematoma al ingreso entre los dos grupos pero este fue significativamente mayor a las 24 horas en los antiagregados (66.7 [IQR 42-110] vs 27 [4.4-64.6] cm3, p=0.03), independientemente de si fueron intervenidos o no. Además, el volumen del hematoma creció en más de un 33% en los antiagregados (69 vs 33%, p=0,002) y el TAG fue el único predictor significativo del crecimiento (..) (AU)

Melatonin, a natural programmed cell death inducer in cancer.

Melatonin, an indolamine derived from the amino-acid tryptophan, participates in diverse physiological functions and has great functional versatility related to the regulation of circadian rhythms and seasonal behaviour, sexual development, retinal physiology, tumour inhibition, as an antioxidant, immunomodulatory and anti-aging properties. In relation to its oncostatic properties, there is evidence that tumor initiation, promotion or progression may be restrained by the night-time physiological surge of melatonin in the blood or extracellular fluid. In addition, depressed nocturnal melatonin concentrations or nocturnal excretion of the main melatonin metabolite, 6-sulfatoxymelatonin, were found in individuals with various tumor types. In the majority of studies, melatonin was shown to inhibit development and/or growth of various experimental animal tumors and some human cell lines in vitro. Many tumors do not respond to drug treatment due to their resistance to undergo apoptosis thereby contributing to the development of cancer. Thus, given the importance of the apoptotic program in cancer treatment, the role of melatonin in influencing apoptosis in tumor cells attracted attention because it seems that it actually promotes apoptosis in most tumor cells, in contrast to the obvious inhibition of apoptotic processes in normal cells. Thus, this paper is also intended to provide to the reader an up-date of all the researches that have been carried out to date, which investigate the proapoptotic effects of melatonin in experimental preclinical models of cancer (in vitro and in vivo) and the underlying proposed action mechanism of this effects. If melatonin uniformly induces apoptosis in cancer cells, the findings could have important clinical implications to improve the quality of live while preventing the appearance of cancer.

Antiplatelet therapies are associated with hematoma enlargement and increased mortality in intracranial hemorrhage.

OBJECTIVE: Antiplatelet therapy (AT) is increasingly used for treating or preventing vascular diseases, especially as a consequence of population aging. However, the risks may sometimes outweigh the benefits, mostly in relation to intracranial hemorrhage (ICH). Our aim was to determine whether AT is associated with hematoma enlargement and increased mortality in ICH. DESIGN: A prospective, observational cohort study. SETTING: The Intensive Care Unit (ICU) of Arrixaca University Hospital (Murcia, Spain). PATIENTS: We studied 156 patients admitted with non-traumatic ICH between January 2006 and August 2008. INTERVENTIONS: None. MAIN VARIABLES: Demographic data, medical history and clinical and laboratory parameters were recorded, along with hematoma volume upon admission and after 24h, and mortality. RESULTS: A total of 37 patients (24%) received AT. These subjects were older (69 ± 11 vs. 60 ± 15 years, p=0.001) and more frequently diabetic (38% vs. 15%, p=0.003) than those without AT. We detected no difference in hematoma volume upon admission between the two groups, though the volume was significantly greater after 24h in the AT group (66.7 [IQR 42-110] vs. 27 [4.4-64.6]cm(3), p=0.03), irrespective of surgical intervention. Moreover, hematoma volume increased by more than a third in AT-users (69% vs. 33%, p=0.002), and AT was the only significant predictor of hematoma enlargement. Patients on AT also had higher mortality during their ICU stay (78% vs. 45%, p<0.001). In addition, of the patients with hematoma enlargement, over one-third had higher overall mortality (62.5 vs. 28.8%, p=0.001). Independent risk factors for death were the Glasgow Coma Scale score, blood glucose upon admission, and AT. CONCLUSIONS: Our results show an association between AT and subsequent hematoma enlargement, as well as increased mortality in patients presenting with ICH who were receiving AT.

Sirtuin modulators: mechanisms and potential clinical implications.

In the last years, studies about longevity have highlighted that caloric restriction can be linked with a less normal agingassociated damage, and in the same way, with the activity of the Silent Information Regulator 2 (SIR2) gene. Sir2-like genes, known as sirtuins (SIRTs), have been found in organisms ranging from bacteria to mammals promoting health and survival. At the moment, it has been identified seven classes of SIRTs in mammalian and the understanding of many of them remains still rudimentary. However, they are in the spotlight by their potential protection against aging-associated diseases and have emerged as key mediators of longevity in evolutionarily distant organisms models. SIRTs are proteins found in numerous compartments within the cell, which are NAD(+)-dependent protein deacetylases and adenosine diphosphate (ADP)-ribosyltransferases. They catalyse a reaction in which NAD(+) and an acetylated substrate are converted into a deacetylated substrate, nicotinamide and a novel metabolite O-acetyl ADP ribose. Therefore, its enzymatic activity requires NAD(+), which is a crucial molecule intermediary of many metabolic reactions in cells. Basically, SIRTs are mediators of aging process, they have the potential of ameliorating and taking part in important cellular processes associated, such as metabolic homeostasis, tumorigenesis and cancer cell proliferation, inflammatory disorders, cardiovascular diseases and neurodegeneration. This background opens up new lines of investigation into the modulation of SIRTs activity in order to develop novel therapeutic targets to these age-related diseases. Current experiments using molecule activators or inhibitors and genetically engineered animals have facilitated new insights into the role of these enzymes and contributed to highlight some of the potentially relevant targets. This review is intended to provide an appreciation of the possible protection against aging-associated diseases by these enzymes, summarize novel underlying mechanisms and evaluate potential clinical applications.

[The role of the DOG1 antibody in the diagnosis of gastrointestinal stromal tumours - GIST]. / Estudio del anticuerpo DOG1 en el diagnóstico de tumores del estroma gastrointestinal - GIST.

Gatrointestinal stromal tumours (GIST) harbour oncogenic mutations in tyrosin kynases receptors (RTKs) including KIT and PDGFRA. The inhibition of this activity has been regarded as the primary target for the treatment of these patients. Diagnosis of GIST relies on c-KIT inmunoreactivity; however there is a 4-15% of GISTs that are C-KIT negative which may lead to underdiagnosis of GISTs and possible withholding of therapy. The novel gene DOG1 has been found overexpressed in GISTs and has potential as a diagnostic marker for GISTs showing even more sensitivity (Se) and specificity (Sp) than c-KIT for the diagnosis of these tumors. In this study we compared the (Se) and (Sp) of DOG1 in typical and atypical GISTs (c-KIT positive or negative) with c-KIT and other mesenchymal neoplasms in the differential diagnosis of GISTs We examined 40 GIST (39 showed inmunoreactivity for c-KIT and one was c-KIT negative) and another seven fusiform tumors. An inmunohistochemical panel was performed with c-KIT, CD34, smooth muscle actin, DOG1 and S100 antibodies on both types of neoplasms. The overall Se and Sp of DOG1 and KIT in GISTs were nearly identical: 100 and 97,5%. Negativity for DOG1 was observed in all fusiform mesenchymal neoplasms. DOG1 is highly expressed in GIST and its expression seems quite specific for these tumours when the differential diagnosis includes another mesenchymal neoplasms. DOG1 should be added to the diagnostic panel evaluating GISTs.

Estudio del anticuerpo DOG1 en el diagnóstico de tumores del estroma gastrointestinal – GIST / The role of the DOG1 antibody in the diagnosis of gastrointestinal stromal tumours – GIST

Los tumores del estroma gastrointestinal (GIST)poseen mutaciones en los genes del receptor de la tirosínquinasa (RTKs) KIT y PDGFRA. La posibilidad debloquear esta actividad ha significado una nueva esperanzaterapéutica. El diagnóstico de GIST recae en laexpresión inmunohistoquímica del c-KIT, pero un 4-15%son c-KIT negativos (aún en presencia de mutación), ysin embargo estos pacientes podrían beneficiarse deltratamiento con inhibidores tirosín quinasa (TKIs).El DOG1 es un nuevo anticuerpo cuya sensibilidady especificidad parece ser superior o igual a la del c-KIT.El objetivo de este trabajo es evaluar la sensibilidad(Se) y especificidad (Sp) de DOG1 en GIST de tipo usual(c-KIT positivos), de tipo inusual (c-KIT negativos) yfrente a otros tumores fusocelulares mesenquimales, ycomparar la validez diagnóstica del DOG1 frente al c-KIT.Estudiamos 40 GIST, 39 c-KIT positivos y un c-KITnegativo. Se realizó un panel inmunohistoquímico conlos anticuerpos: c-KIT, CD34, actina músculo liso, DOG1y S100, en los GIST como en siete tumores fusocelulares.La Se y Sp de GIST para DOG1 fue del 100 y 97,5%para c-KIT. La inmunoreactividad para DOG1 en todoslos tumores fusocelulares fue negativa. La validez diagnósticade DOG1 y C-KIT fue similar a la hora de detectarGIST y no GIST.DOG1 es un marcador específico y sensible para eldiagnóstico y diagnóstico diferencial de GISTs (es capazde detectar algunos GIST sin mutación en RTK).El DOG1 debería de formar parte del panel inmunohistoquímicopara el diagnóstico de GIST(AU)

Gatrointestinal stromal tumours (GIST) harbouroncogenic mutations in tyrosin kynases receptors(RTKs) including KIT and PDGFRA. The inhibition ofthis activity has been regarded as the primary target forthe treatment of these patients. Diagnosis of GIST relieson c-KIT inmunoreactivity; however there is a 4-15% ofGISTs that are C-KIT negative which may lead to underdiagnosisof GISTs and possible withholding of therapy.The novel gene DOG1 has been found overexpressedin GISTs and has potential as a diagnostic markerfor GISTs showing even more sensitivity (Se) and specificity(Sp) than c-KIT for the diagnosis of these tumors.In this study we compared the (Se) and (Sp) of DOG1 intypical and atypical GISTs (c-KIT positive or negative)with c-KIT and other mesenchymal neoplasms in thedifferential diagnosis of GISTsWe examined 40 GIST (39 showed inmunoreactivityfor c-KIT and one was c-KIT negative) and anotherseven fusiform tumors. An inmunohistochemical panelwas performed with c-KIT, CD34, smooth muscle actin,DOG1 and S100 antibodies on both types of neoplasms.The overall Se and Sp of DOG1 and KIT in GISTswere nearly identical: 100 and 97,5%. Negativity forDOG1 was observed in all fusiform mesenchymal neoplasms.DOG1 is highly expressed in GIST and its expressionseems quite specific for these tumours when thedifferential diagnosis includes another mesenchymalneoplasms.DOG1 should be added to the diagnostic panel evaluatingGISTs(AU)

Role of different inflammatory and tumor biomarkers in the development of ulcerative colitis-associated carcinogenesis.

BACKGROUND: Colorectal cancer (CRC) is the most severe complication in inflammatory bowel disease (IBD). In the present study we investigated different mechanistic links between chronic colonic inflammation and its progression to adenocarcinoma. Along these lines, given that adrenomedullin (AM) has been implicated in carcinogenesis, we also analyzed changes in its colonic expression. METHODS: Mice were exposed to 5, 10, and 15 cycles of dextran sulfate sodium (DSS); each cycle consisted of 0.7% DSS for 1 week followed by distilled water for 10 days. After each period, macroscopic and histological studies, as well as characterization of inflammatory and tumor biomarkers, were carried out. RESULTS: The disease activity index (DAI) showed that the disease was present from the third cycle and it gradually increased during the course of DSS treatment. Macroscopic tumors were only seen after 15 cycles, and microscopic study showed that inflammation, dysplasia, and adenocarcinomas correlated with DSS cycles. ß-Catenin and proliferating cell nuclear antigen expressions progressively increased in animals treated with the different cycles of DSS. TNF-α and IFN-γ showed the highest production at the tenth cycle. COX-2, mPGES-1, and iNOS levels were also appreciably higher at the fifth and tenth cycles. Moreover, we observed a progressive enhancement in AM expression and changes in its intracellular location during the progression of the disease. CONCLUSIONS: Our results show an early induction of proinflammatory factors, which may contribute to the development of colon cancer, as well as demonstrate, for the first time, the expression of AM in IBD-derived CRC.

[Carotid revascularisation using angioplasty and stent in 134 consecutive cases in a reference hospital: a risky technique?]. / 134 casos consecutivos de revascularización carotídea mediante angioplastia y stent en un centro de referencia: ¿una técnica de riesgo?

INTRODUCTION: Carotid revascularisation (CR) using angioplasty and stent (ASC) is an effective procedure in the prevention of ischaemic stroke, but with a controversial morbidity and mortality in the different studies conducted in this field. METHODS: The results of the ASCs performed in the Virgen de la Arrixaca University Hospital (Murcia) between January 2006 and April 2009 were analysed (epidemiology, indication, grade of residual stenosis and procedure complications). All patients subjected to ASC were pre-selected and followed up by neurologists, and they followed a strict medical protocol for performing the procedure. All ASCs were performed by a team consisting of two surgeons, an anaesthetist and a nurse. RESULTS: A total of 134 ASC were performed. The mean age of our patients was 72.7 years, with the large majority (75%) being male. The most prevalent diseases were, high blood pressure (81%), smoking (66.4%), and diabetes (38.1%). The most common indications for CR were symptomatic carotid stenosis with a level of stenosis of 75-99%, either in the left (33.6%) or right (32.1%), followed by asymptomatic stenosis combined with risk factors (11.2% in the left side and 10.4% in the right side). A level of stenosis less than 30% was achieved in 132 of the 134 ASC (98.5%). performed. Five patients (3.7%) had complications associated with the procedure, of which four were different clinical presentations of a re-perfusion syndrome and one an asymptomatic thrombosis of the stent. CONCLUSIONS: ASC is a complex technique that must be performed by appropriately trained specialists. The performing a minimum number of procedures per year and an admission protocol controlled by Neurology are essential conditions for a low rate of complications. Under these conditions, the morbidity and mortality of the technique is no higher than that of endarterectomy.

134 casos consecutivos de revascularización carotídea mediante angioplastia y stent en un centro de referencia: ¿una técnica de riesgo? / Carotid revascularisation using angioplasty and stent in 134 consecutive cases in a reference hospital: A risky technique?

Introducción: La revascularización carotídea mediante angioplastia y stent (ASC) es un procedimiento eficaz en la prevención del ictus isquémico, pero con una morbimortalidad periprocedimiento muy discutida en los diferentes estudios realizados al respecto.Métodos: Se analizan los resultados (epidemiología, tipo de indicación, grado de estenosis residual y complicaciones periprocedimiento) de las ASC realizadas en el Hospital Universitario Virgen de la Arrixaca entre enero de 2006 y abril de 2009. Todos los pacientes sometidos a ASC fueron preseleccionados y seguidos por neurólogos, y siguieron un protocolo médico estricto para la realización del procedimiento. Todas las ASC fueron llevadas a cabo por un equipo formado por dos intervencionistas, un anestesista y un enfermero. Resultados: Se realizaron 134 ASC. La edad media de nuestros pacientes fue de 72,7 años, con predominio del sexo masculino (75%). Las patologías más prevalentes fueron la hipertensión arterial (81%), el tabaquismo (66,4%), y la diabetes (38,1%). La indicación de RC más frecuente fue la estenosis carotídea sintomática con grado de estenosis 75-99%, tanto izquierda (33,6%) como derecha (32,1%), seguida de las estenosis asintomáticas asociadas a factores de riesgo (11,2% en el lado izquierdo y 10,4% en el lado derecho). En 132 de las 134 ASC (98,5%) se consiguió un grado de estenosis residual menor al 30%. Cinco pacientes (3,7%) presentaron complicaciones relacionadas con el procedimiento, de las cuales cuatro correspondieron a diferentes presentaciones clínicas del síndrome de reperfusión y una, a una trombosis asintomática del stent.Conclusiones: La ASC es una técnica compleja que debe ser llevada a cabo por especialistas con una capacitación adecuada. La realización de un número mínimo de procedimientos al año, y la existencia de un protocolo de ingreso controlado por Neurología son condiciones imprescindibles para una tasa de complicaciones (AU)

Introduction: Carotid revascularisation (CR) using angioplasty and stent (ASC) is an effective procedure in the prevention of ischaemic stroke, but with a controversial morbidity and mortality in the different studies conducted in this field.Methods: The results of the ASCs performed in the Virgen de la Arrixaca University Hospital (Murcia) between January 2006 and April 2009 were analysed (epidemiology, indication, grade of residual stenosis and procedure complications). All patients subjected to ASC were pre-selected and followed up by neurologists, and they followed a strict medical protocol for performing the procedure. All ASCs were performed by a team consisting of two surgeons, an anaesthetist and a nurse. Results: A total of 134 ASC were performed. The mean age of our patients was 72.7 years, with the large majority (75%) being male. The most prevalent diseases were, high blood pressure (81%), smoking (66.4%), and diabetes (38.1%). The most common indications for CR were symptomatic carotid stenosis with a level of stenosis of 75-99%, either in the left (33.6%) or right (32.1%), followed by asymptomatic stenosis combined with risk factors (11.2% in the left side and 10.4% in the right side). A level of stenosis less than 30% was achieved in 132 of the 134 ASC (98.5%). performed. Five patients (3.7%) had complications associated with the procedure, of which four were different clinical presentations of a re-perfusion syndrome and one an asymptomatic thrombosis of the stent. Conclusions: ASC is a complex technique that must be performed by appropriately trained specialists. The performing a minimum number of procedures per year and an admission protocol controlled by Neurology are essential conditions for a low rate of complications. Under these conditions, the morbidity and mortality of the technique is no higher than that of endarterectomy (AU)

Extra-virgin olive oil-enriched diet modulates DSS-colitis-associated colon carcinogenesis in mice.

BACKGROUND & AIMS: Patients with inflammatory bowel disease (IBD) are at increased risk for developing ulcerative colitis (UC)-associated colorectal cancer (CRC). Several studies have shown that extra virgin olive oil (EVOO) might possess anti-inflammatory, antiproliferative and antiapoptotic effects. We have evaluated EVOO diet effects on the severity of repeated colitis-associated CRC. METHODS: Six-week-old C57BL/6 mice were randomized into two dietary groups: sunflower oil (SFO) and EVOO diets, both at 10%. Mice were exposed to 15 cycles of 0.7% dextran sodium sulphate (DSS) for 1 week followed by distilled water for 10 days. After, the rats were sacrificed and colonic damage was both histologically and biochemically assessed. RESULTS: Disease activity index (DAI) was significantly higher on SFO vs. EVOO diet at the end of the experimental period. EVOO-fed mice showed less incidence and multiplicity of tumors than in those SFO-fed mice. ß-catenin immunostaining was limited to cell membranes in control groups, whereas translocation from the cell membrane to the cytoplasm and/or nucleus was showed in DSS-treated groups and its expression was higher in SFO-fed animals. Cytokine production was significantly enhanced in SFO-fed mice, while this increase was not significant in EVOO-fed mice. Conversely, cyclooxygenase-2 (COX-2) and inducible nitric oxidase synthase (iNOS) expression were significantly lower in the animal group fed with EVOO than in the SFO group. CONCLUSIONS: These results confirm that EVOO diet has protective/preventive effect in the UC-associated CRC. This beneficial effect was correlated with a better DAI, a minor number of dysplastic lesions, a lower ß-catenin immunoreactivity, a proinflammatory cytokine levels reduction, a non modification of p53 expression and, COX-2 and iNOS reduction in the colonic tissue.

[Renal cell carcinoma presenting as paraneoplastic neurological dysfunction]. / Carcinoma renal que debuta como cuadro neurológico paraneoplásico.

INTRODUCTION: Malignant tumors sometimes initiate as paraneoplastic syndromes even years before the most common symptoms appear. These first manifestations could be the key for the diagnosis of "occult" malignancy. METHODS: We report the case of a 66 year old man with a renal cell carcinoma. The first symptom was a paraneoplastic cerebellar degeneration appeared 6 years before the first urologic manifestations. CONCLUSIONS: A progressive cerebellar syndrome could be the first manifestation of a renal cell carcinoma, even years before the first urologic symptoms. We must suspect an occult neoplasia in such patients.

Carcinoma renal que debuta como cuadro neurológico paraneoplásico / Renal cell carcinoma presenting as paraneoplastic neurological dysfunction

Introducción: Los procesos tumorales pueden de manera ocasional mostrar su primera manifestación con una sintomatología neurológica, no originada por metástasis, sino del denominado tipo paraneoplásico, que puede aparecer incluso años antes de los síntomas habituales del tumor. Este tipo de manifestaciones iniciales pueden ser la clave del descubrimiento de una neoplasia oculta. Métodos: Presentamos el caso de un varón de 66 años afecto de un carcinoma renal, cuya manifestación inicial consistió únicamente en un cuadro neurológico progresivo de tipo cerebeloso paraneoplásico, aparecido 6 años antes de la primera sintomatología urológica. Conclusiones: La aparición de una sintomatología neurológica cerebelosa progresiva puede ser la única y primera manifestación de un carcinoma renal, incluso años antes de las primeras manifestaciones urológicas. Debe sospecharse la existencia de una neoplasia oculta en los pacientes con esta sintomatología (AU)

Introduction: Malignant tumors sometimes initiate as paraneoplastic syndromes even years before the most common symptoms appear. These first manifestations could be the key for the diagnosis of 'occult' malignancy. Methods: We report the case of a 66 year old man with a renal cell carcinoma. The first symptom was a paraneoplastic cerebellar degeneration appeared 6 years before the first urologic manifestations. Conclusions: A progressive cerebellar syndrome could be the first manifestation of a renal cell carcinoma, even years before the first urologic symptoms. We must suspect an occult neoplasia in such patients (AU)

[Cystic adenomatoid malformations of the lung: presentation of 5 cases and review]. / Malformación adenomatoidea quística pulmonar: actualización de la entidad a propósito de cinco casos.

We describe five cases of cystic adenomatoid malformations of the lung collected from our files from 1994 to 2006. It is an unusual malformation and has features of immaturity with less than 400 cases previously published. All patients were surgically treated in our institution. We review the clinical outcome, microscopic findings, current classification schemes and prenatal surgical treatment. Our study includes 3 newborn males and two girls, 3 and 9 years old. All of them radiographically showed air or fluid filled cystic masses involving a single lobe. After lobectomy, four lung specimens were classified as Stoker type 2 lesions and the older one as type 1.