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Essential processes for living cells such as transcription and replication depend on the formation of specific protein-DNA recognition complexes. Proper formation of such complexes requires suitable fitting between the protein surface and the DNA surface. By adopting doxorubicin (DOX) as a model probe, we report here that Ag3 atomic quantum clusters (Ag-AQCs) inhibit the intercalation of DOX into DNA and have considerable influence on the interaction of DNA-binding proteins such as topoisomerase IV, Escherichia coli DNA gyrase and the restriction enzyme HindIII. Ag-AQCs at nanomolar concentrations inhibit enzyme activity. The inhibitory effect of Ag-AQCs is dose-dependent and occurs by intercalation into DNA. All these effects, not observed in the presence of Ag+ ions, can explain the powerful bactericidal activity of Ag-AQCs, extending the knowledge of silver bactericidal properties. Lastly, we highlight the interest of the interaction of Ag clusters with living organisms, an area that should be further explored due to the potential consequences that it might have, both beneficial and harmful.

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WHAT IS KNOWN AND OBJECTIVE: Stiff-person syndrome (SPS) is an uncommon and disabling disorder characterized by progressive rigidity and episodic painful spasms involving axial and limb musculature. SPS treatment is mostly based on benzodiazepines, baclofen, immunosuppressants and intravenous immunoglobulin. Cannabis derivatives [tetrahydrocannabinol (THC) and cannabidiol (CBD)] are available as an oromucosal spray (Sativex(®)), indicated as add-on treatment, for symptom improvement in patients with moderate to severe spasticity because of multiple sclerosis (MS). Our objective is to report a case of seronegative SPS successfully treated with THC-CBD oromucosal spray. CASE SUMMARY: We report a case of a 40-year-old man presenting with progressive muscle stiffness and intermittent spasms for 6-years. The diagnosis of stiff-person syndrome was based on the clinical features and neuroelectrophysiologic findings of continuous motor unit activity. Glutamic acid decarboxylase autoantibodies was absent in our patient, in both serum and cerebrospinal fluid (CSF). Cannabis derivatives oromucosal spray was introduced after a series of unsatisfactory traditional medical treatments. After 14 months treated with THC-CBD oromucosal spray, improvement was verified in the eight dimensions of the scale of SF-36 quality of life questionnaire. WHAT IS NEW AND CONCLUSION: Clinical experience with cannabis derivatives in patients with multiple sclerosis is accumulating steadily, but there is no current literature about its efficacy for SPS. Because MS and SPS share some neurological symptoms such as spasticity and rigidity, it is thought that THC-CBC can be an option for SPS patient. Our case report suggests that THC-CBD oromucosal spray is an alternative treatment for patients with refractory SPS, and further validation is appropriate.

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Fundamento. Se estudia la comorbilidad, observada en la práctica clínica en centros de salud mental públicos, entre los trastornos ocasionados por el uso de alcohol y los ocasionados por el juego de azar. Material y métodos. Se ha estudiado una muestra de 132 pacientes de los que presentaban el diagnóstico "Síndrome de dependencia del alcohol", en tratamiento en los centros de salud mental de la Comunidad de Navarra. Una vez comprobado el diagnóstico de Síndrome de Dependencia del Alcohol se administró el "Cuestionario de juego patológico de South Oaks" en su versión validada en castellano. Resultados. El 23,5 por ciento de los pacientes estudiados, con dependencia de alcohol comprobada, presentaron puntuaciones dentro del rango indicativo de "Probable jugador problema" (5,3 por ciento) y "Probable jugador patológico" (18,2 por ciento). Se confirmó la asociación entre los problemas de juego y el estado civil. Las personas separadas, divorciadas y viudas presentaron más problemas con el juego de azar. Conclusiones. Casi la cuarta parte de los pacientes que presentan "Síndrome de dependencia del alcohol" sufren o han sufrido problemas con los juegos de azar. Es importante tener en cuenta esta realidad, así como la posible presencia de otras asociaciones, en el abordaje del problema de alcohol (desde su prevención, pasando por su evaluación, hasta su tratamiento) (AU)

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The paper presents a review of pain at the paediatric age, which can be considered a question of maximum interest given the novel application of analgesia or other procedures for avoiding and controlling the different types of pain in the course of normal practice during childhood. After a brief introduction on the history of pain and the scarce attention that it has received until recently, the concepts and different actions for dealing with pain are set out, which depend on its aetiology and localisation: pain in oncology, post-operational pain, pain in chronic or acute diseases, pain in intensive care, etc. Tables are presented with the normal doses used at these ages in the different situations required by the child and which the professional might find himself facing. The non-pharmacological attitude is set out as this can be of great use in the initial stages of controlling pain at these ages, and the different forms of sedation and analgesia at the paediatric age are explained, with regard to the medicines employed, the form of administering them and the importance of a multidisciplinary team: paediatricians, child anaesthetists, nursing personnel as well as the necessary technical support for taking the corresponding action.

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We studied 100 ASA I-II females undergoing general anaesthesia for major gynaecological surgery, in a prospective, double-blind, placebo-controlled, randomized study. Patients received one of four regimens for the prevention of postoperative nausea and vomiting (PONV): ondansetron 4 mg (n = 25), dexamethasone 8 mg (n = 25), ondansetron with dexamethasone (4 mg and 8 mg, respectively, n = 25) or placebo (saline, n = 25) There were no differences in background factors or factors related to operation and anaesthesia, morphine consumption, pain or side effects between groups. The incidence of nausea and emetic episodes in the ondansetron with dexamethasone group was lower than in the placebo (P < 0.01), ondansetron (P < 0.05) and dexamethasone (P = 0.057) groups. There were no differences between ondansetron and dexamethasone, and both were more effective than placebo (P < 0.05 and P < 0.01, respectively). Dexamethasone appeared to be preferable in preventing nausea than emetic episodes. Fewer patients in the ondansetron with dexamethasone group needed antimetic rescue (P < 0.01 vs placebo and P < 0.05 vs ondansetron). We conclude that prophylactic administration of combined ondansetron and dexamethasone is effective in preventing PONV.

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Given the rarity of acute myocardial infarction (AMI) in parturients, we report the case of a 29-years-old woman who suffered 2 AMIs related to her 2 pregnancies. In our patient, the anesthetic technique chosen for the second birth, which was vaginal, was epidural analgesia with invasive hemodynamic monitoring. No complications occurred during the birth or the perinatal period.

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