RESUMEN

Introducción: La Estrategia del Ictus del Sistema Nacional de Salud (EISNS) fue un documento de consenso entre las distintas administraciones y sociedades científicas que se desarrolló con el objetivo de mejorar la calidad del proceso asistencial y garantizar la equidad territorial. Nuestro objetivo fue analizar los recursos asistenciales existentes y si se había cumplido el objetivo de la EISNS. Material y métodos: La encuesta sobre los recursos disponibles se realizó por un comité de neurólogos de cada una de las comunidades autónomas (CC.AA), los cuales también realizaron la encuesta de 2008. Los ítems incluidos fueron el número de Unidades de Ictus (UI), su dotación (monitorización, neurólogo 24 h/7 días, ratio enfermería, protocolos), ratio cama UI/100.000 habitantes, recursos diagnósticos (ecografía cardíaca y arterial cerebral, neuroimagen avanzada), realización de trombolisis intravenosa, intervencionismo neurovascular (INV), cirugía del infarto maligno de la arteria cerebral media (ACM) y disponibilidad de la telemedicina. Resultados: Se incluyeron datos de 136 hospitales. Existen 45 UI distribuidas de un modo desigual. La relación cama de UI por habitantes y comunidad autónoma osciló entre 1/74.000 a 1/1.037.000 habitantes, cumpliendo el objetivo solo Cantabria y Navarra. Se realizaron por neurólogos 3.237 trombolisis intravenosas en 83 hospitales, con un porcentaje respecto del total de ictus isquémico entre el 0,3 y el 33,7%. Los hospitales sin UI tenían una disponibilidad variable de recursos. Se realiza INV en todas las CC.AA salvo La Rioja, la disponibilidad del INV 24 h/7 días solo existe en 17 ciudades. Hay 46 centros con cirugía del infarto maligno de la ACM y 5 con telemedicina. Conclusión: La asistencia al ictus ha mejorado en cuanto al incremento de hospitales participantes, la mayor aplicación de trombolisis intravenosa y procedimientos endovasculares, también en la cirugía del infarto maligno de la ACM, pero con insuficiente implantación de UI y de la telemedicina. La disponibilidad de recursos diagnósticos es buena en la mayoría de las UI, e irregular en el resto de hospitales. Las distintas CC.AA deben avanzar para garantizar el mejor tratamiento y equidad territorial, y así conseguir el objetivo de la EISNS

---

Introduction: The Spanish Health System’s stroke care strategy (EISNS) is a consensus statement that was drawn up by various government bodies and scientific societies with the aim of improving quality throughout the care process and ensuring equality among regions. Our objective is to analyse existing healthcare resources and establish whether they have met EISNS targets. Material and methods: The survey on available resources was conducted by a committee of neurologists representing each of Spain’s regions; the same committee also conducted the survey of 2008. The items included were the number of stroke units (SU), their resources (monitoring, neurologists on call 24 h/7d, nurse ratio, protocols), SU bed ratio/100 000 inhabitants, diagnostic resources (cardiac and cerebral arterial ultrasound, advanced neuroimaging), performing iv thrombolysis, neurovascular interventional radiology (neuro VIR), surgery for malignant middle cerebral artery (MCA) infarctions and telemedicine availability. Results: We included data from 136 hospitals and found 45 Stroke Units distributed unequally among regions. The ratio of SU beds to residents ranged from 1/74,000 to 1/1,037,000 inhabitants; only the regions of Cantabria and Navarre met the target. Neurologists performed 3,237 intravenous thrombolysis procedures in 83 hospitals; thrombolysis procedures compared to the total of ischaemic strokes yielded percentages ranging from 0.3 to 33.7%. Hospitals without SUs showed varying levels of available resources. Neuro VIR is performed in every region except La Rioja, and VIR is only available on a 24 h/7 d basis in 17 cities. Surgery for malignant MCA infarction is performed in 46 hospitals, and 5 have telemedicine. Conclusion: Stroke care has improved in terms of numbers of participating hospitals, the increased use of intravenous thrombolysis and endovascular procedures, and surgery for malignant MCA infarction. Implementation of SUs and telemedicine remain insufficient. The availability of diagnostic resources is good in most SUs and irregular in other hospitals. Regional governments should strive to ensure better care and territorial equality, which would achieve the EISNS objectives

Asunto(s)

Humanos , Accidente Cerebrovascular/epidemiología , Terapia Trombolítica , Infarto Cerebral/epidemiología , Ataque Isquémico Transitorio/epidemiología , Asignación de Recursos para la Atención de Salud/tendencias , Revisión de Utilización de Recursos , Estrategias de Salud Nacionales

RESUMEN

PURPOSE: To analyse the short-term outcome in patients with Listeria monocytogenes meningoencephalitis (LMME) to improve management and outcome. METHODS: Observational study with adult patients with LMME between 1977 and 2009 at a tertiary hospital in Barcelona, Spain. Parameters that predicted outcome were assessed with univariate and logistic regression analysis. RESULTS: Of 59 cases of LMME, 28 occurred in the last decade. Since 1987, a new protocol has been used and 29/45 patients (64%) treated since then received adjuvant dexamethasone. In patients who received this treatment there was a trend towards fewer neurological sequelae (5 vs 33%; p = 0.052). Antiseizure prophylaxis with phenytoin was administered in 13/45 (28%) patients. Seizures occurred in 7/45 (16%) patients, all in the group who did not receive phenytoin. Hydrocephalus presented in 8/59 (14%). It was never present at admission and five patients needed neurosurgical procedures. Sequelae after 3 months were present in 8/45 (18%), mostly cranial nerve palsy. Rhombencephalitis (RE) was related to the presence of neurologic sequelae (OR: 20.4, 95% CI: 1.76-236). Overall mortality was 14/59 (24%), 9/59 (15%) due to neurological causes related to hydrocephalus or seizures. Mortality was defined as early in 36% and late in 64%. In the multivariate analysis, independent risk factors for mortality were presence of hydrocephalus (OR: 17.8, 95% CI: 2.753-114) and inappropriate empirical antibiotic therapy (OR: 6.5, 95% CI: 1.201-35). CONCLUSIONS: Outcome of LMME may be improved by appropriate empirical antibiotic therapy, suspicion and careful management of hydrocephalus. Use of adjuvant dexamethasone or phenytoin in a subgroup of these patients might have a benefit.

Asunto(s)

Antiinflamatorios/uso terapéutico , Profilaxis Antibiótica , Anticonvulsivantes/uso terapéutico , Dexametasona/uso terapéutico , Hidrocefalia/tratamiento farmacológico , Meningitis por Listeria/tratamiento farmacológico , Convulsiones/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Hidrocefalia/microbiología , Hidrocefalia/mortalidad , Listeria monocytogenes/fisiología , Masculino , Meningitis por Listeria/complicaciones , Meningitis por Listeria/microbiología , Meningitis por Listeria/mortalidad , Persona de Mediana Edad , Análisis Multivariante , Pronóstico , Factores de Riesgo , Convulsiones/microbiología , Convulsiones/mortalidad , España/epidemiología

Asunto(s)

Inmunoglobulina G/efectos adversos , Inmunosupresores/efectos adversos , Mioclonía/inducido químicamente , Adolescente , Etanercept , Femenino , Humanos , Inmunoglobulina G/uso terapéutico , Inmunosupresores/uso terapéutico , Psoriasis/complicaciones , Psoriasis/tratamiento farmacológico , Receptores del Factor de Necrosis Tumoral/uso terapéutico

RESUMEN

No disponible

Asunto(s)

Humanos , Femenino , Adolescente , Mioclonía/inducido químicamente , Factores de Necrosis Tumoral/antagonistas & inhibidores , Psoriasis/tratamiento farmacológico , Tortícolis/inducido químicamente , Factores de Riesgo

RESUMEN

INTRODUCTION: The Spanish Health System's stroke care strategy (EISNS) is a consensus statement that was drawn up by various government bodies and scientific societies with the aim of improving quality throughout the care process and ensuring equality among regions. Our objective is to analyse existing healthcare resources and establish whether they have met EISNS targets. MATERIAL AND METHODS: The survey on available resources was conducted by a committee of neurologists representing each of Spain's regions; the same committee also conducted the survey of 2008. The items included were the number of stroke units (SU), their resources (monitoring, neurologists on call 24h/7d, nurse ratio, protocols), SU bed ratio/100,000 inhabitants, diagnostic resources (cardiac and cerebral arterial ultrasound, advanced neuroimaging), performing iv thrombolysis, neurovascular interventional radiology (neuro VIR), surgery for malignant middle cerebral artery (MCA) infarctions and telemedicine availability. RESULTS: We included data from 136 hospitals and found 45 Stroke Units distributed unequally among regions. The ratio of SU beds to residents ranged from 1/74,000 to 1/1,037,000 inhabitants; only the regions of Cantabria and Navarre met the target. Neurologists performed 3,237 intravenous thrombolysis procedures in 83 hospitals; thrombolysis procedures compared to the total of ischaemic strokes yielded percentages ranging from 0.3 to 33.7%. Hospitals without SUs showed varying levels of available resources. Neuro VIR is performed in every region except La Rioja, and VIR is only available on a 24h/7 d basis in 17 cities. Surgery for malignant MCA infarction is performed in 46 hospitals, and 5 have telemedicine. CONCLUSION: Stroke care has improved in terms of numbers of participating hospitals, the increased use of intravenous thrombolysis and endovascular procedures, and surgery for malignant MCA infarction. Implementation of SUs and telemedicine remain insufficient. The availability of diagnostic resources is good in most SUs and irregular in other hospitals. Regional governments should strive to ensure better care and territorial equality, which would achieve the EISNS objectives.

Asunto(s)

Recursos en Salud/provisión & distribución , Disparidades en Atención de Salud/organización & administración , Accidente Cerebrovascular/terapia , Procedimientos Endovasculares/métodos , Hospitales , Humanos , Neurología , Calidad de la Atención de Salud , España , Encuestas y Cuestionarios , Terapia Trombolítica/métodos , Recursos Humanos

RESUMEN

Activation of human natural killer (NK) cells is associated with the cleavage of CD16 from the cell surface, a process mediated by matrix metalloproteinases (MMPs). In this report, we examined whether inhibition of MMPs would lead to improved NK cell antibody-dependent cell-mediated cytotoxicity (ADCC) function. Using an in-vitro ADCC assay, we tested the anti-tumour function of NK cells with three different therapeutic monoclonal antibodies (mAbs) in the presence of MMPs inhibitor GM6001 or its control. Loss of CD16 was observed when NK cells were co-cultured with tumour targets in the presence of specific anti-tumour antibodies, and was found particularly on the majority of degranulating NK responding cells. Treatment with MMPs inhibitors not only prevented CD16 down-regulation, but improved the quality of the responding cells significantly, as shown by an increase in the percentage of polyfunctional NK cells that are capable of both producing cytokines and degranulation. Furthermore, MMPs inhibition resulted in augmented and sustained CD16-mediated signalling, as shown by increased tyrosine phosphorylation of CD3ζ and other downstream signalling intermediates, which may account for the improved NK cell function. Collectively, our results provide a foundation for combining MMPs inhibitors and therapeutic mAbs in new clinical trials for cancer treatment.

Asunto(s)

Anticuerpos Monoclonales Humanizados/farmacología , Anticuerpos Monoclonales de Origen Murino/farmacología , Citotoxicidad Celular Dependiente de Anticuerpos/efectos de los fármacos , Antineoplásicos/farmacología , Dipéptidos/farmacología , Células Asesinas Naturales/inmunología , Inhibidores de la Metaloproteinasa de la Matriz/farmacología , Metaloproteinasas de la Matriz/fisiología , Antígenos de Superficie/metabolismo , Complejo CD3/metabolismo , Degranulación de la Célula/efectos de los fármacos , Línea Celular Tumoral , Cetuximab , Técnicas de Cocultivo , Citocinas/sangre , Regulación hacia Abajo/efectos de los fármacos , Proteínas Ligadas a GPI/metabolismo , Humanos , Células Asesinas Naturales/efectos de los fármacos , Activación de Linfocitos/efectos de los fármacos , Fosforilación/efectos de los fármacos , Procesamiento Proteico-Postraduccional/efectos de los fármacos , Receptores de IgG/metabolismo , Rituximab , Transducción de Señal/efectos de los fármacos , Trastuzumab

RESUMEN

Contexto: En este artículo se revisan diferentes aspectos acerca de la prevención de las infecciones del tracto urinario que incluyen: la confirmación de la existencia de dichas infecciones, la aplicación de medidas higiénico-dietéticas, la profilaxis antibacteriana-preferentemente la toma de una única dosis nocturna diaria oral de un antibiótico o quimioterápico con elevada excreción urinaria y buena tolerancia-, la administración de vacunas elaboradas con Escherichiacoli y otros bacilos gramnegativos completos con fracciones inmunoestimulantes o fimbrias tipo 1 de E. coli por vías parenteral u oral. Objetivo: Revisión de las nuevas medidas de prevención de las infecciones del tracto urinario. Adquisición y síntesis de evidencia: Se revisan diferentes aspectos microbiológicos, la fisiopatología y los factores de virulencia de E. coli uropatógenos productores de fimbrias de tipos 1y P. Se analiza la relación entre los grupos sanguíneos y la infección del tracto urinario en los individuos secretores y no secretores. Conclusiones: El uso de vacunas inactivadas con fenol y administradas por vía mucosa, el empleode inhibidores de la adherencia y de la formación de biopelículas bacterianas y el uso de estimuladores del adenosín-monofosfato cíclico se presentan como nuevas medidas preventivas de la infección urinaria, particularmente para el grupo de mayor incidencia, representado por las mujeres entre la pubertad y la menopausia (AU)

---

Context: This article reviews diverse aspects of the prevention of urinary tract infections, including confirmation of the diagnosis, application of hygiene and dietary measures, antibacterial prophylaxis (preferably consisting of a single nocturnal oral dose per day of an antibiotic or drug with high urinary excretion and good tolerance), and administration of vaccines made with Escherichia coli and other Gram-negative bacilli, consisting of immunostimulating fractions of E. coli strains or E. coli type-1 fimbriae administered through the parenteral or oral route. Objective: We aimed to review the new preventive measures against urinary tract infections. Acquisition and synthesis of evidence: We reviewed various microbiological aspects, as well as the physiopathology and virulence factors of uropathogenic E. coli strains expressing type-1 and P fimbriae. The association between blood groups and urinary tract infections in blood group antigen-secretors and non secretors was analyzed. Conclusions: New preventive measures against urinary tract infection consist of the use of phenol-inactivated vaccines administered via the mucosal route, inhibitors of bacterial adherence and biofilm formation and cyclic adenosine monophosphate stimulators, especially in women aged between puberty and menopause, who show the highest incidence of these infections (AU)

Asunto(s)

Humanos , Femenino , Infecciones Urinarias/prevención & control , Profilaxis Antibiótica , Infecciones por Escherichia coli/prevención & control , Evaluación de Resultados de Acciones Preventivas/métodos , Vacunas contra Escherichia coli , Fimbrias Bacterianas/microbiología , Biopelículas

RESUMEN

CONTEXT: This article reviews diverse aspects of the prevention of urinary tract infections, including confirmation of the diagnosis, application of hygiene and dietary measures, antibacterial prophylaxis (preferably consisting of a single nocturnal oral dose per day of an antibiotic or drug with high urinary excretion and good tolerance), and administration of vaccines made with Escherichia coli and other Gram-negative bacilli, consisting of immunostimulating fractions of E. coli strains or E. coli type-1 fimbriae administered through the parenteral or oral route. OBJECTIVE: We aimed to review the new preventive measures against urinary tract infections. ACQUISITION AND SYNTHESIS OF EVIDENCE: We reviewed various microbiological aspects, as well as the physiopathology and virulence factors of uropathogenic E. coli strains expressing type-1 and P fimbriae. The association between blood groups and urinary tract infections in blood group antigen-secretors and nonsecretors was analyzed. CONCLUSIONS: New preventive measures against urinary tract infection consist of the use of phenol-inactivated vaccines administered via the mucosal route, inhibitors of bacterial adherence and biofilm formation and cyclic adenosine monophosphate stimulators, especially in women aged between puberty and menopause, who show the highest incidence of these infections.

Asunto(s)

Infecciones por Escherichia coli/prevención & control , Infecciones Urinarias/prevención & control , Adolescente , Adulto , Factores de Edad , Profilaxis Antibiótica , Adhesión Bacteriana/efectos de los fármacos , Adhesión Bacteriana/fisiología , Biopelículas , Colforsina/uso terapéutico , Susceptibilidad a Enfermedades , Infecciones por Enterobacteriaceae/microbiología , Infecciones por Enterobacteriaceae/prevención & control , Escherichia coli/genética , Escherichia coli/inmunología , Escherichia coli/patogenicidad , Escherichia coli/ultraestructura , Infecciones por Escherichia coli/inmunología , Infecciones por Escherichia coli/microbiología , Infecciones por Escherichia coli/fisiopatología , Vacunas contra Escherichia coli/inmunología , Vacunas contra Escherichia coli/uso terapéutico , Femenino , Fimbrias Bacterianas/inmunología , Fimbrias Bacterianas/fisiología , Humanos , Higiene , Lactante , Masculino , Menopausia , Persona de Mediana Edad , Embarazo , Complicaciones Infecciosas del Embarazo/microbiología , Complicaciones Infecciosas del Embarazo/prevención & control , Pubertad , Factores Sexuales , Infecciones Urinarias/inmunología , Infecciones Urinarias/microbiología , Infecciones Urinarias/fisiopatología , Virulencia , Adulto Joven

RESUMEN

Introduction: Stroke is currently a major social health problem. For this reason, the Spanish Ministry of Health approved the Stroke National Strategy (SNS) in 2008 to improve the prevention, treatment and rehabilitation of stroke patients. This plan intends to guarantee 24-hour, 365-days neurological assistance in the whole country by the end of 2010. Our aim was to analyse the situation of stroke assistance in Spain in 2009. Material and methods: A committee of neurologists practicing in the different autonomous communities (AC), and who had not participated in the preparation of the SNS, was created. A national survey was performed including the number of stroke units (SU) and their characteristics (monitoring, 24-h/7-day on-call neurology service, nursing staff ratio and the use of protocols), bed ratio of SU/100,000 people, availability of intravenous thrombolysis therapy, neurovascular intervention (NI) and telemedicine. Results: We included data from 145 hospitals. There are 39 SU in Spain, unevenly distributed. The ratio between SU bed/number of people/AC varied from 1/75,000 to 1/1,037,000 inhabitants; Navarra and Cantabria met the goal. Intravenous thrombolysis therapy is used in 80 hospitals; the number of treatments per AC was between 7 and 536 in 2008. NI was performed in the 63% of the AC, with a total of 28 qualified hospitals (although only 1 hospital performed it 24h, 7days a week in 2009). There were 3 hospitals offering clinical telemedicine services. Conclusions: Assistance for stroke patients has improved in Spain compared to previous years, but there are still some important differences between the AC that must be eliminated to achieve the objectives of the SNS (AU)

---

Introducción: El ictus constituye un importante problema sociosanitario. Por ese motivo, el Ministerio de Sanidad aprobó en 2008 la Estrategia Nacional en Ictus (ENI) con el objetivo de mejorar la prevención, tratamiento y rehabilitación del paciente con ictus. Se pretende garantizar una atención neurológica en todo el país y a cualquier hora del día para final del 2010. Nuestro objetivo fue analizar la situación de la atención al ictus en España en el año 2009. Material y métodos: Se constituyó un comité de neurólogos de las diferentes CC. AA. que no hubieran participado en la ENI. Se elaboró una encuesta nacional que recogió el número de unidades de ictus (UI) y la dotación (monitorización, guardia de neurología 24h/7 días, ratio de enfermería y existencia de protocolos), ratio cama UI/100.000 habitantes, presencia de trombólisis iv, intervencionismo neurovascular (INV) y telemedicina. Resultados: Se incluyeron datos de 145 hospitales. Existen 39 UI distribuidas de un modo desigual. La relación cama de UI/número de habitantes/comunidad autónoma osciló entre 1/75.000 a 1/1.037.000 habitantes, cumpliendo el objetivo Navarra y Cantabria. Se realiza trombólisis iv en 80 hospitales, el número osciló entre 7-536 tratamientos/CC. AA. durante el año 2008. Se realiza INV en el 63% de las CC. AA., teniendo 28 centros capacitados, aunque sólo 1 la realizaba en 2009 las 24h/7 día. Existen 3 centros con telemedicina. Conclusiones: La asistencia al ictus ha mejorado en España respecto a unos años atrás, pero todavía existen importantes desigualdades por CC. AA. que deberían superarse si se quiere cumplir el objetivo de la ENI (AU)

Asunto(s)

Humanos , Accidente Cerebrovascular/epidemiología , Asignación de Recursos para la Atención de Salud/tendencias , Terapia Trombolítica/estadística & datos numéricos , Accidente Cerebrovascular/economía , /estadística & datos numéricos , Disparidades en el Estado de Salud

RESUMEN

INTRODUCTION: Stroke is currently a major social health problem. For this reason, the Spanish Ministry of Health approved the Stroke National Strategy (SNS) in 2008 to improve the prevention, treatment and rehabilitation of stroke patients. This plan intends to guarantee 24-hour, 365-days neurological assistance in the whole country by the end of 2010. Our aim was to analyse the situation of stroke assistance in Spain in 2009. MATERIAL AND METHODS: A committee of neurologists practicing in the different autonomous communities (AC), and who had not participated in the preparation of the SNS, was created. A national survey was performed including the number of stroke units (SU) and their characteristics (monitoring, 24-h/7-day on-call neurology service, nursing staff ratio and the use of protocols), bed ratio of SU/100,000 people, availability of intravenous thrombolysis therapy, neurovascular intervention (NI) and telemedicine. RESULTS: We included data from 145 hospitals. There are 39 SU in Spain, unevenly distributed. The ratio between SU bed/number of people/AC varied from 1/75,000 to 1/1,037,000 inhabitants; Navarra and Cantabria met the goal. Intravenous thrombolysis therapy is used in 80 hospitals; the number of treatments per AC was between 7 and 536 in 2008. NI was performed in the 63% of the AC, with a total of 28 qualified hospitals (although only 1 hospital performed it 24h, 7 days a week in 2009). There were 3 hospitals offering clinical telemedicine services. CONCLUSIONS: Assistance for stroke patients has improved in Spain compared to previous years, but there are still some important differences between the AC that must be eliminated to achieve the objectives of the SNS.

Asunto(s)

Trastornos Cerebrovasculares , Atención a la Salud , Recursos en Salud , Accidente Cerebrovascular/terapia , Recolección de Datos , Fibrinolíticos/uso terapéutico , Hospitales , Humanos , Infusiones Intravenosas , Neurología , Sociedades , España , Telemedicina , Terapia Trombolítica/métodos , Recursos Humanos

RESUMEN

The discrepancies among data reported by using olive oil (OO) in humans appear to be due to the great differences between the different OO used. Based on structure/function relationships we have chemically optimized an OO through the rational mixture ("coupage") of several Spanish extra virgin olive oils (methodology "oHo"). Patients with chronic kidney disease (CKD) develop a progressive picture of malnutrition and inflammation that lead them to an elevated risk of cardiovascular disease. In a pilot, randomised trial the nutritional efficacy and safety of "oHo" were evaluated in 32 patients (mean age 60,8 +/- 13,2 years old; 16 women) with CKD (KDIGO stages 4-5) at predialysis. After a 7 days wash out for statins and ACE inhibitors 19 patients had "oHo" at doses of 60 mL/day (20 mL t.i.d) for 30 consecutive days, whilst 13 patients remain as a control group without "oHo". At the end of the study only patients having "oHo" showed significant increases of serum albumin (p<0.05) and not significant increases of total proteins, weight, and BMI. Total cholesterol (p<0.05) and HDL-cholesterol (p<0.01) increased with "oHo". The number of cases with pathologic HOMA-IR in the control group increased from 1 to 2 patients whilst in the "oHo" group decreased from 2 to none. No significant changes of minerals, arterial pressure, hemoglobin, and other parameters related to CKD were seen. After a 30 days follow-up in the "oHo" group all parameters came back to basal ones, excepting for blood pressure that significantly decreased (p<0,05). Tolerance was excellent and constipation significantly diminished (p<0,001) in the "oHo" group. Of importance, none of these biological changes were seen in regular consumers of other conventional olive oils (control group). These intriguing results, seen by the first time, appear to partially satisfy the recent claims ("reverse epidemiology") about the need of a more correct nutrition in CKD patients. However, these data need to be proved in more larger trials as well as in CKD patients under dialysis with harder inflammatory/malnutrition conditions.

Asunto(s)

Inflamación/dietoterapia , Inflamación/etiología , Enfermedades Renales/complicaciones , Desnutrición/dietoterapia , Desnutrición/etiología , Aceites de Plantas , Enfermedad Crónica , Femenino , Humanos , Inflamación/sangre , Enfermedades Renales/sangre , Masculino , Desnutrición/sangre , Persona de Mediana Edad , Aceite de Oliva , Proyectos Piloto

RESUMEN

Introducción. El síndrome de Foix-Chavany-Marie (FCM) fue descrito como una diplejía labio-facio-faringo-laringogloso- masticatoria con disociación automático-voluntaria del movimiento. Se correlaciona habitualmente con lesiones corticales bilaterales con afectación de ambos opérculos (síndrome biopercular). Describimos tres pacientes con síndrome de FCM asociado a lesiones isquémicas en dos topografías atípicas: a) subcortical bilateral, y b) opercular unilateral. Casos clínicos. Paciente 1: varón de 66 años que consultó por paresia facial, lingual y faríngea bilaterales junto con anartria de inicio ictal. En la exploración destacaba la presencia de disociación automático-voluntaria de la motilidad facial. La resonancia magnética (RM) craneal mostró un infarto reciente subcortical izquierdo, así como múltiples lesiones isquémicas antiguas subcorticales contralaterales. Paciente 2: varón de 61 años, diabético, que consultó también por anartria y parálisis facial y lingual bilaterales con disociación automático-voluntaria junto con alteración de la deglución de inicio brusco. La RM craneal mostró la presencia de una única lesión isquémica opercular izquierda. Paciente 3: varón de 36 años que consultó por aparición brusca de disartria grave, disfagia, diplejía facial con disociación automático-voluntaria y pérdida de fuerza de la extremidad superior izquierda. La RM craneal mostró un infarto opercular derecho sin lesiones contralaterales. Conclusiones. El síndrome de FCM no se asocia únicamente a lesiones operculares bilaterales, sino que además puede deberse a lesiones subcorticales bilaterales e incluso a lesiones corticales unilaterales

---

Introduction. Bilateral facio-pharyngo-laryngo-glosso- masticatory palsy with automatic-voluntary dissociation is known as Foix-Chavany-Marie (FCM) syndrome. It is usually due to bilateral cortical lesions involving both anterior opercula (biopercular syndrome). We describe three patients with FCM syndrome associated with ischemic lesions in two atypical localizations: a) bilateral subcortical infarcts, and b) unilateral opercular infarct. Cases report. Patient 1, a 66 year old male, was admitted for a sudden onset of anarthria and facial, lingual and masticatory paralysis. Neurological examination revealed automatic-voluntary dissociation of facial motility. MRI showed an acute left subcortical infarct and multiple bilateral subcortical ischemic lesions. Patient 2, a 61 year old male, also suffered a sudden onset of anarthria, with bilateral facial and lingual paralysis and automatic-voluntary dissociation together with sudden onset swallowing alteration. MRI showed a single ischemic lesion involving the left operculum. Patient 3, a 36 year old male, presented sudden onset of dysarthria, dysphagia and bilateral facial palsy with automatic-voluntary dissociation and loss of force in left upper limb. MRI showed an acute right opercular infarct and no contralateral lesions. Conclusions. FCM syndrome is not only due to bilateral opercular lesions but can also be seen in bilateral subcortical and even unilateral opercular lesions

Asunto(s)

Masculino , Adulto , Persona de Mediana Edad , Anciano , Humanos , Parálisis Facial/complicaciones , Corteza Cerebral/lesiones , Síndrome de la Costilla Cervical/complicaciones , Infarto Cerebral/complicaciones , Parálisis de los Pliegues Vocales/complicaciones

RESUMEN

INTRODUCTION: Bilateral facio-pharyngo-laryngo-glosso-masticatory palsy with automatic-voluntary dissociation is known as Foix-Chavany-Marie (FCM) syndrome. It is usually due to bilateral cortical lesions involving both anterior opercula (biopercular syndrome). We describe three patients with FCM syndrome associated with ischemic lesions in two atypical localizations: a) bilateral subcortical infarcts, and b) unilateral opercular infarct. CASES REPORT: Patient 1, a 66 year old male, was admitted for a sudden onset of anarthria and facial, lingual and masticatory paralysis. Neurological examination revealed automatic-voluntary dissociation of facial motility. MRI showed an acute left subcortical infarct and multiple bilateral subcortical ischemic lesions. Patient 2, a 61 year old male, also suffered a sudden onset of anarthria, with bilateral facial and lingual paralysis and automatic-voluntary dissociation together with sudden onset swallowing alteration. MRI showed a single ischemic lesion involving the left operculum. Patient 3, a 36 year old male, presented sudden onset of dysarthria, dysphagia and bilateral facial palsy with automatic-voluntary dissociation and loss of force in left upper limb. MRI showed an acute right opercular infarct and no contralateral lesions. CONCLUSIONS: FCM syndrome is not only due to bilateral opercular lesions but can also be seen in bilateral subcortical and even unilateral opercular lesions.

Asunto(s)

Parálisis Facial/fisiopatología , Parálisis/fisiopatología , Adulto , Anciano , Parálisis Facial/diagnóstico , Parálisis Facial/patología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Parálisis/diagnóstico , Parálisis/patología , Síndrome

Asunto(s)

Glomeruloesclerosis Focal y Segmentaria/complicaciones , Síndrome Nefrótico/etiología , Alveolos Pulmonares , Sarcoidosis Pulmonar/complicaciones , Sarcoidosis/complicaciones , Femenino , Humanos , Persona de Mediana Edad

RESUMEN

CD94/NKG2A is an inhibitory receptor expressed by natural killer (NK) cells and a subset of CD8+ T cells. Ligation of CD94/NKG2A by its ligand HLA-E results in tyrosine phosphorylation of the NKG2A immunoreceptor tyrosine-based inhibitory motifs, and recruitment and activation of the SH2 domain-bearing tyrosine phosphatase-1, which in turn suppresses activation signals. The nkg2a gene encodes two isoforms, NKG2A and NKG2B, with the latter lacking the stem region. We identified three new alternative transcripts of the cd94 gene in addition to the originally described canonical CD94Full. One of the transcripts, termed CD94-T4, lacks the portion that encodes the stem region. CD94-T4 associates with both NKG2A and NKG2B, but preferentially associates with the latter. This is probably due to the absence of a stem region in both CD94-T4 and NKG2B. CD94-T4/NKG2B is capable of binding HLA-E and, when expressed in E6-1 Jurkat T cells, inhibits TCR mediated signals, demonstrating that this heterodimer is functional. Coevolution of stemless isoforms of CD94 and NKG2A that preferentially pair with each other to produce a functional heterodimer indicates that this may be more than a serendipitous event. CD94-T4/NKG2B may contribute to the plasticity of the NK immunological synapse by insuring an adequate inhibitory signal.

Asunto(s)

Empalme Alternativo/genética , Familia de Multigenes , Subfamília C de Receptores Similares a Lectina de Células NK/genética , Subfamília D de Receptores Similares a Lectina de las Células NK/genética , ARN Mensajero/biosíntesis , Secuencia de Aminoácidos , Línea Celular , Humanos , Sinapsis Inmunológicas/genética , Sinapsis Inmunológicas/inmunología , Células Jurkat , Datos de Secuencia Molecular , Subfamília C de Receptores Similares a Lectina de Células NK/biosíntesis , Subfamília C de Receptores Similares a Lectina de Células NK/fisiología , Subfamília D de Receptores Similares a Lectina de las Células NK/biosíntesis , Subfamília D de Receptores Similares a Lectina de las Células NK/fisiología , ARN Mensajero/metabolismo

RESUMEN

UNLABELLED: Autologous access is the best vascular access for dialysis also in older patients and it should be mature when patient needs hemodialysis. It is not always possible. Surgeon availability and demographic characteristics of patients (age, diabetes, vascular disease...) are factors that determine primary vascular access. AIM: To analyse outcome and vascular access complications in elderly who start hemodialysis without vascular access. PATIENTS AND METHODS: All patients older than 75 years who initiated hemodialysis without vascular access between January 2000 and June 2002 were included, They were divided en two groups depending on primary vascular access. GI: arterio-venous fistulae. GIIl: Tunnelled cuffed catheter. Epidemiological and analytical data, vascular access complications related, as well as patient and first permanent vascular access survival from their inclusion in dialysis up to December 2002 were analysed and compared in both groups. RESULTS: 32 patients were studied. GI: n = 17 (4 men) and GIIl: n =1 5 (8 men), age: 79.9 +/- 3.8 and 81.7 +/- 4 years respectively (ns). There were no differences in sex and comorbidity (diabetes, ischemic heart disease, peripheral vascular disease and hypertension). It took GI 3 months to get a permanent vascular access suitable for using, while it took GIIl 1.3 months (p < 0.005) The number of temporary untunnelled catheters was higher in GI (3.35 vs 1.87 p < 0.05). Vascular access complications: 70.6% of infections occur in GI (incidence (I) = 48 infections/100 patients-year) while only 29.4% were detected in GII (I = 25 infections/100 patients-year). 70% of central venous thrombosis happen in GI (I: 25 CVT/100 patients-year) vs 30% in GIIl (I = 14.4/100 patients-year) (ns). No significant differences neither in bleeding (66.7% vs 33.3%) nor ischemia (75% vs 25%) were found. Dialysis dose (Kt/V) as well as anaemia degree were similar in both groups. Permanent vascular access survival after 2 years was 45.8% in GI and 24% in GII (ns). Patient survival was similar in GI and GII (72% vs 51% ns). CONCLUSIONS: Elderly who start hemodialysis without vascular access took longer to get a suitable permanent vascular access when arterio-venous fistulae is placed than with a tunnelled cuffed hemodialysis catheter. As a consequence, vascular access complications are larger, infection ones are the most common. In these patients a tunnelled catheter should be inserted at the time a peripheral arterio-venous access is created, in order to avoid temporary untunnelled catheters.

Asunto(s)

Derivación Arteriovenosa Quirúrgica/estadística & datos numéricos , Catéteres de Permanencia/estadística & datos numéricos , Diálisis Renal/métodos , Anciano , Anciano de 80 o más Años , Anemia/etiología , Derivación Arteriovenosa Quirúrgica/efectos adversos , Enfermedades Cardiovasculares/epidemiología , Catéteres de Permanencia/efectos adversos , Comorbilidad , Remoción de Dispositivos , Complicaciones de la Diabetes/epidemiología , Falla de Equipo , Femenino , Hemorragia/etiología , Humanos , Infecciones/epidemiología , Infecciones/etiología , Isquemia/etiología , Fallo Renal Crónico/mortalidad , Fallo Renal Crónico/terapia , Masculino , Estudios Prospectivos , Diálisis Renal/efectos adversos , Diálisis Renal/instrumentación , Tasa de Supervivencia

RESUMEN

AIMS: An analysis was conducted to determine whether there were any changes in the demand for health care, demography and pathologies attended in outpatient departments within the health care district of Tortosa between 1997 and 2003. PATIENTS AND METHODS: Data about the demand for and attendance at first neurology visits over the period 1997 and from March 2003 to February 2004 was collected prospectively. Information concerning age, sex, groups of pathologies, diagnoses, rates of requests for first visits, source of the demand and destination after the visit were compared. RESULTS: Mean age rose from 49 to 56 years (p < 0.001). Patients above 70 years of age increased from 23.7% to 35.9% (p < 0.001), while in the population within the area the figure only rose from 15.8 to 17.1%. The proportion of females went up from 52 to 62% (p < 0.001). Demand (that is, the rate of requests for first visits per 1000 inhabitants per year among those over the age of 15) rose from 8.5 to 9.3, 9.8% (p = 0.03). Demand from primary care increased from 52 to 69% (p < 0.001). Cognitive disorders (6.5% and 15.9%) grew by 144.6% (p < 0.001). Headaches (23.9% and 24.1%), the largest diagnostic group, and non-neurological diagnoses (18% and 18.5%) remained unchanged (p = NS). No changes were observed in the number of discharges in the first visit: 22.8% and 21.1% (p = NS). CONCLUSIONS: The most striking results are the increase in demand (mainly from primary care), the increased age of the population attended and the notable growth in the number of cognitive disorders. These quantitative and qualitative changes in the demand increase the need for resources.

Asunto(s)

Atención Ambulatoria/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud/tendencias , Enfermedades del Sistema Nervioso/epidemiología , Neurología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Atención Ambulatoria/tendencias , Trastornos Cerebrovasculares/epidemiología , Niño , Trastornos del Conocimiento/epidemiología , Grupos Diagnósticos Relacionados , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos Migrañosos/epidemiología , Enfermedades del Sistema Nervioso/diagnóstico , Enfermedades del Sistema Nervioso/terapia , Estudios Prospectivos , España/epidemiología

RESUMEN

Objetivos. Se analiza si existen cambios en la demanda de asistencia, demografía y patología atendida en las consultas externas de neurología de la región sanitaria de Tortosa entre 1997 y 2003. Pacientes y métodos. Se recogieron prospectivamente los datos de la demanda y asistencia de las primeras visitas de neurología los períodos de 1997 y marzo del 2003 a febrero de 2004. Se compararon edad, sexo, grupos de patologías, diagnósticos, índices de solicitud de primera visita, origen de la demanda y destino tras la visita. Resultados. La edad media creció de 49 a 56 años (p < 0,001). Los pacientes mayores de 70 años aumentaron del 23,7% al 35,9% (p < 0,001), mientras en la población del área sólo del 15,8 al 17,1%. La proporción de mujeres pasó del 52 al 62% (p < 0,001). La demanda (índice de solicitudes de primeras visitas/1.000 habitantes y año mayores de 15 años) creció del 8,5 al 9,3, un 9,8% (p = 0,03). La demanda desde atención primaria creció del 52 al 69% (p < 0,001). Los trastornos cognitivos (6,5% y 15,9%) crecieron un 144,6% (p < 0,001). Las cefaleas (23,9% y 24,1%), el mayor grupo diagnóstico, y los diagnósticos no neurológicos (18% y 18,5%) se mantienen (p = NS). Las altas en primera visita no cambian, 22,8% y 21,1% (p = NS). Conclusiones. Destaca el aumento de la demanda, fundamentalmente desde atención primaria, el aumento de edad de la población atendida y el marcado incremento de los trastornos cognitivos. Estos cambios cuantitativos y cualitativos de la demanda incrementan las necesidades de recursos (AU)

---

Aims. An analysis was conducted to determine whether there were any changes in the demand for health care, demography and pathologies attended in outpatient departments within the health care district of Tortosa between 1997 and 2003. Patients and methods. Data about the demand for and attendance at first neurology visits over the period 1997 and from March 2003 to February 2004 was collected prospectively. Information concerning age, sex, groups of pathologies, diagnoses, rates of requests for first visits, source of the demand and destination after the visit were compared. Results. Mean age rose from 49 to 56 years (p < 0.001). Patients above 70 years of age increased from 23.7% to 35.9% (p < 0.001), while in the population within the area the figure only rose from 15.8 to 17.1%. The proportion of females went up from 52 to 62% (p < 0.001). Demand (that is, the rate of requests for first visits per 1000 inhabitants per year among those over the age of 15) rose from 8.5 to 9.3, 9.8% (p = 0,03). Demand from primary care increased from 52 to 69% (p < 0.001). Cognitive disorders (6.5% and 15.9%) grew by 144.6% (p < 0.001). Headaches (23.9% and 24.1%), the largest diagnostic group, and non-neurological diagnoses (18% and 18.5%) remained unchanged (p = NS). No changes were observed in the number of discharges in the first visit: 22.8% and 21.1% (p = NS). Conclusions. The most striking results are the increase in demand (mainly from primary care), the increased age of the population attended and the notable growth in the number of cognitive disorders. These quantitative and qualitative changes in the demand increase the need for resources (AU)

Asunto(s)

Humanos , Atención Ambulatoria/tendencias , Servicios de Salud , Neurología , Necesidades y Demandas de Servicios de Salud , Estudios Prospectivos , Calidad de la Atención de Salud , España/epidemiología , Enfermedades del Sistema Nervioso/epidemiología , Enfermedades del Sistema Nervioso/patología

RESUMEN

Introducción: La fístula arteriovenosa (FAV) autóloga es el acceso vascular permanente (AVP) de elección en los pacientes en hemodiálisis y debería realizarse en prediálisis. Esta situación ideal no siempre es posible. La disponibilidad del cirujano vascular y las características del paciente (edad, comorbilidad...) son factores que, entre otros, determinan el acceso vascular de inicio. Objetivo: Estudiar la evolución y complicaciones derivadas del acceso vascular en pacientes de edad avanzada, que comienzan hemodiálisis sin acceso vascular funcionante. Pacientes y métodos: Incluimos los pacientes mayores de 75 años que iniciaron hemodiálisis desde enero del 2000 hasta junio del 2002 sin acceso vascular permanente funcionante. Los clasificamos en dos grupos según el primer AVP realizado (Grupo I: FAV, Grupo II: Catéter Permanente). Analizamos y comparamos en ambos grupos datos epidemiológicos, analíticos, complicaciones derivadas del acceso vascular y supervivencia de pacientes y del primer AVP funcionante desde su inclusión en diálisis hasta diciembre de 2002. Resultados: Estudiamos 32 pacientes. GI: n = 17 (4 hombres) y GII: n = 15 (8 hombres), edad 79,9 ± 3,8 y 81,7 ± 4 años respectivamente (ns). No existían diferencias en sexo, nefropatía de base y comorbilidad (diabetes, cardiopatía isquémica, arteriopatía periférica e HTA). El GI tardó 3 meses en conseguir un AVP funcionante y el GII 1,3 meses (p < 0,05). El número de catéteres transitorios fue mayor en GI (3,35 vs 1,87 p < 0,05). Complicaciones derivadas del acceso vascular: El 70,6% de las infecciones ocurren en GI (incidencia (I): 48 infecciones/100 pacientes-año) frente al 29,4% en GII (I = 24 infecciones/100 pacientes-año) p < 0,05. El 70% de las trombosis venosas profundas se dan en GI (I: 25 TVP/100 pacientes-año) frente 30% en GII (I = 14,4/100 pacientes-año) (ns). No se encontraron diferencias en hemorragias (66,7% vs 33,3%) ni isquemia (75% vs 25%). La eficacia de diálisis (Kt/V) y el grado de anemia fue similar en ambos grupos. La supervivencia del AVP a los 2 años en GI fue 45,8% y en GII 24 % (ns). La supervivencia de los pacientes fue similar en GI y GII (72% vs 51% ns) Conclusiones: Los pacientes de edad avanzada que inician hemodiálisis sin acceso vascular tardan más tiempo en conseguir un AVP funcionante cuando se opta por una FAV frente a un catéter permanente. Como consecuencia, las complicaciones derivadas del acceso vascular son mayores, siendo más frecuentes las infecciosas. Una opción para estos pacientes sería la colocación de un catéter permanente como primer acceso vascular y la realización simultánea de una FAV, manteniendo el catéter hasta el desarrollo de la misma

---

Autologous access is the best vascular access for dialysis also in older patients and it should be mature when patient needs hemodialysis. It is not always possible. Surgeon availability and demographic characteristics of patients (age, diabetes, vascular disease...) are factors that determine primary vascular access. Aim: To analyse outcome and vascular access complications in elderly who start hemodialysis without vascular access. Patients and methods: All patients older than 75 years who initiated hemodialysis without vascular access between january 2000 and june 2002 were included, They were divided en two groups depending on primary vascular access. GI: arterio-venous fistulae. GII: Tunnelled cuffed catheter. Epidemiological and analytical data, vascular access complications related, as well as patient and first permanent vascular access survival from their inclusion in dialysis up to december 2002 were analysed and compared in both groups. Results: 32 patients were studied. GI: n = 17 (4 men) and GII: n =1 5 (8 men), age: 79.9 ± 3.8 and 81.7 ± 4 years respectively (ns). There were no differences in sex and comorbidity (diabetes, ischemic heart disease, peripheral vascular disease and hypertension). It took GI 3 months to get a permanent vascular access suitable for using, while it took GII 1.3 months (p < 0.005) The number of temporary untunnelled catheters was higher in GI (3.35 vs 1.87 p < 0.05). Vascular access complications: 70.6% of infections occur in GI (incidence (I) = 48 infections/100 patients-year) while only 29.4% were detected in GII (I = 25 infections/100 patients-year). 70% of central venous thrombosis happen in GI (I: 25 CVT/100 patients-year) vs 30% in GII (I = 14.4/100 patients-year) (ns). No significant differences neither in bleeding (66.7% vs 33.3%) nor ischemia (75% vs 25%) were found. Dialysis dose (Kt/V) as well as anaemia degree were similar in both groups. Permanent vascular access survival after 2 years was 45.8% in GI and 24% in GII (ns). Patient survival was similar in GI and GII (72% vs 51% ns). Conclusions: Elderly who start hemodialysis without vascular access took longer to get a suitable permanent vascular access when arterio-venous fistulae is placed than with a tunnelled cuffed hemodialysis catheter. As a consequence, vascular access complications are larger, infection ones are the most common. In these patients a tunnelled catheter should be inserted at the time a peripheral arterio- venous access is created, in order to avoid temporary untunnelled catheters

Asunto(s)

Anciano , Anciano de 80 o más Años , Humanos , Catéteres de Permanencia , Fístula Arteriovenosa , Diálisis Renal , Anemia

Asunto(s)

Lesión Renal Aguda/tratamiento farmacológico , Lesión Renal Aguda/etiología , Síndrome de Lisis Tumoral/complicaciones , Urato Oxidasa/uso terapéutico , Adulto , Femenino , Humanos , Proteínas Recombinantes/uso terapéutico , Inducción de Remisión , Factores de Tiempo