Detección y tipificación de HPV 6, 11, 16 y 18 en lesiones estomatológicas

Los papilomas virus humanos (HPV) corresponden a un grupo heterogéneo de virus y han sido identificados a la fecha más de 75 genotipos. La infección con HPV está considerada como una virosis permanente capaz de existir en latencia dentro de células huésped por largos períodos de tiempo. Estos virus están implicados en la etiología de lesiones de piel y de mucosas. Estudios ginecológicos demostraron una relación directa de lesiones clínicas con la infección con los genotipos de HPVs 6,11,16 y 18. En tanto que en lesiones orales se detectaron los genotipos 1,2,4,6,7,11,13,16,18,32 y 57. La infección con HPV ha sido relacionada con modificaciones epiteliales oncogénicas progresivas en vulva, vagina y cuello uterino. En lesiones premalignas también se han detectado los genotipos mencionados pero no se ha realizado un estudio sistemático donde se correlacionen los aspectos clínicos semiológicos de las lesiones sospechosas de infección viral con la anatomía patológica y la detección y tipificación de los HPVs. (...) Objetivos específicos - Detección e identificación de los HPV 6 y 11 de bajo riesgo de malignidad y de los tipos de HPV 16 y 18 de alto grado de malignidad presentes en lesiones de boca. - Estudio epidemiológico de la incidencia de HPVs en la población de Córdoba y alrededores. Los resultados obtenidos permitirán correlacionar el diagnóstico clínico e histológico con la frecuencia de la infección con HPV y el genotipo de HPV detectado. (...)

Validity and reliability of the Spanish version of the DN4 (Douleur Neuropathique 4 questions) questionnaire for differential diagnosis of pain syndromes associated to a neuropathic or somatic component

BACKGROUND This study assesses the validity and reliability of the Spanish version of DN4 questionnaire as a tool for differential diagnosis of pain syndromes associated to a neuropathic (NP) or somatic component (non-neuropathic pain, NNP). METHODS A study was conducted consisting of two phases: cultural adaptation into the Spanish language by means of conceptual equivalence, including forward and backward translations in duplicate and cognitive debriefing, and testing of psychometric properties in patients with NP (peripheral, central and mixed) and NNP. The analysis of psychometric properties included reliability (internal consistency, inter-rater agreement and test-retest reliability) and validity (ROC curve analysis, agreement with the reference diagnosis and determination of sensitivity, specificity, and positive and negative predictive values in different subsamples according to type of NP). RESULTS A sample of 164 subjects (99 women, 60.4%; age: 60.4 +/- 16.0 years), 94 (57.3%) with NP (36 with peripheral, 32 with central, and 26 with mixed pain) and 70 with NNP was enrolled. The questionnaire was reliable [Cronbach's alpha coefficient: 0.71, inter-rater agreement coefficient: 0.80 (0.71-0.89), and test-retest intra-class correlation coefficient: 0.95 (0.92-0.97)] and valid for a cut-off value > or = 4 points, which was the best value to discriminate between NP and NNP subjects. DISCUSSION This study, representing the first validation of the DN4 questionnaire into another language different than the original, not only supported its high discriminatory value for identification of neuropathic pain, but also provided supplemental psychometric validation (i.e. test-retest reliability, influence of educational level and pain intensity) and showed its validity in mixed pain syndromes.

Validation and clinical use of the CECA, a disease-specific quality of life questionnaire for patients with anogenital Condylomata Acuminata

The aim of this validation study was to assess the measurement properties of the CECA (Spanish acronym for the Specific Questionnaire for Condylomata Acuminata) in patients with anogenital condylomas. A total of 247 patients aged > 18 years completed the questionnaire on 2 occasions as well as the Dermatology Life Quality Index (DLQI). The CECA questionnaire showed good internal consistency (Cronbach's alpha values of 0.86 and 0.91 in the emotional and sexual activity dimensions) and good testretest reliability (intraclass correlation coefficient 0.76 emotional dimension, 0.82 sexual activity dimension). Patients with de novo lesions and those with more extensive lesions and larger number of warts showed poorer health-related quality of life. CECA and DLQI scores correlated moderately. Patients whose lesions cleared at follow-up or with a reduction of >or= 50% showed a better improvement of health-related quality of life. The CECA questionnaire is a valid, reliable and sensitive tool for the assessment of health-related quality of life in patients with anogenital warts.

Fracturas de astrágalo

Estudio retrospectivo de 63 fracturas de astrágalo recogidas durante un periodo de 13 años. De las 31 fracturas del cuello astragalino se obtuvo un seguimiento de 2 años en 23 de ellas, pudiéndose valorar la aparición en la radiología del signo de Hawkins entre la 6ª y 8ª semana después del traumatismo y el desarrollo o no de necrosis avascular. Se concluye con el estudio que la observación del signo de Hawkins garantiza la correcta perfusión del astrágalo (sensibilidad del 100%). Sin embargo, la no detección de dicho signo no es predictiva del desarrollo de necrosis.

Should screening for Chlamydia trachomatis and Neisseria gonorrhoeae in HIV-men who have sex with men be recommended?

INTRODUCTION Sexually transmitted infections (STI) like Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) have been associated with increased risk of HIV acquisition (1). It has been also described as a high prevalence of asymptomatic CT and NG infections in men who have sex with men (MSM) (2). The aim of this study was to know the prevalence of CT and/or NG infections in asymptomatic HIV-MSM and the related factors. MATERIALS AND METHODS Prospective study of a cohort of asymptomatic HIV-MSM with follow-up in Malaga (southern Spain) during October 2012-May 2014. Patients with an opportunistic event or who received active antibiotic therapy for CT and/or NG in the previous month were excluded. All of them completed a questionnaire about sexual behaviour, barrier methods and recreational drugs use. Demographical, epidemiological, clinical, analytical and therapeutic data were also collected. Pharyngeal and rectal swabs, and urine samples were collected to be tested for CT and NG by nucleic acid amplification test (c4800 CT/NG. Roche Diagnostics, Mannheim, Germany) (3). STATISTICS ANALYSIS SPSS 17.0. RESULTS 255 patients were asked to participate and 248 of them accepted. Median age was 37.7 (30.6-46.3) years, median time since HIV diagnosis was 47.7 (10.5-104.1) months, and median CD4 cells count was 607 (440-824) cell/µL. There were 195 (78.6%) patients on antiretroviral therapy; 81.5% of them had undetectable viral load. 80.5% of the patients had a past history of STI. Infection by CT and/or NG was diagnosed in 24 (9.7%) patients. Overall four urine samples, two pharyngeal, and 15 rectal ones were positive for CT, and five pharyngeal and five rectal swabs were positive for NG. Two patients were co-infected by CT and NG: one with CT in urine and both in rectum, another with CT in urine and rectum and NG in pharynx. One patient presented CT in pharynx and rectum, and two patients NG in pharynx and rectum. Positive CT and/or NG tests were only related with detectable HIV viral load (OR 3.08, 95% CI 1.2-7.4; p=0.01). It was not related with sexual behaviour, nor with alcohol or recreational drugs use. CONCLUSIONS STI screening had a great acceptance in this population. There was a high prevalence of asymptomatic CT and/or NG infections. Rectum sample was the most effective one. Viral suppression could protect from these STI. Screening should be recommended in HIV-MSM.

Perifollicular erythema as a trichoscopy sign of progression in frontal fibrosing alopecia.

INTRODUCTION Frontal fibrosing alopecia (FFA) in an entity characterized by the recession of the frontotemporal hairline (FTHL) with alopecic scarring change. In recent years there are numerous articles discussing the usefulness of dermoscopy for the clinical diagnosis of different types of scarring alopecia. MATERIALS AND METHODS We value 79 patients diagnosed with FFA, evaluating some trichoscopical findings described as typical for FFA: Absence of follicular opening, follicular hyperkeratosis, follicular plugs and erythema. RESULTS In a population of 79 women, 100% showed no follicular opening, 72.1% follicular hyperkeratosis, 66.3% perifollicular erythema and 44.8% follicular plugs. Thus, 100% of patients had at least one of the dermoscopic elements described as suggestive of FFA, 53% two of them, 45% three and 27%, all those elements. Perifollicular erythema was present in 95% of cases in which the disease was active. CONCLUSIONS We consider that the presence of perifollicular erythema will be a direct marker of FFA activity.

El proyecto EMECAM: Estudio Multicéntrico Español sobre la Relación entre la Contaminación Atmosférica y la Mortalidad. Antecedentes, participantes, objetivos y métodología.

In recent years, a growing number of studies suggests that increases in air pollution levels may have short-term impact on human health, even at pollution levels similar to or lower than those which have been considered to be safe to date. The different methodological approaches and the varying analysis techniques employed have made it difficult to make a direct comparison among all of the findings, preventing any clear conclusions from being drawn. This has led to multicenter projects such as the APHEA (Short-Term Impact of Air Pollution on Health. A European Approach) within a European Scope. The EMECAM Project falls within the context of the aforesaid multicenter studies and has a wide-ranging projection nationwide within Spain. Fourteen (14) cities throughout Spain were included in this Project (Barcelona, Metropolitan Area of Bilbao, Cartagena, Castellón, Gijón, Huelva, Madrid, Pamplona, Seville, Oviedo, Valencia, Vigo, Vitoria and Saragossa) representing different sociodemographic, climate and environmental situations, adding up to a total of nearly nine million inhabitants. The objective of the EMECAM project is that to asses the short-term impact of air pollution throughout all of the participating cities on the mortality for all causes, on the population and on individuals over age 70, for respiratory and cardiovascular design causes. For this purpose, with an ecological, the time series data analyzed taking the daily deaths, pollutants, temperature data and other factors taken from records kept by public institutions. The period of time throughout which this study was conducted, although not exactly the same for all of the cities involved, runs in all cases from 1990 to 1996. The degree of relationship measured by means of an autoregressive Poisson regression. In the future, the results of each city will be combined by means of a meta-analysis.

New insights into pathophysiology of vestibular migraine.

Vestibular migraine (VM) is a common disorder in which genetic, epigenetic, and environmental factors probably contribute to its development. The pathophysiology of VM is unknown; nevertheless in the last few years, several studies are contributing to understand the neurophysiological pathways involved in VM. The current hypotheses are mostly based on the knowledge of migraine itself. The evidence of trigeminal innervation of the labyrinth vessels and the localization of vasoactive neuropeptides in the perivascular afferent terminals of these trigeminal fibers support the involvement of the trigemino-vascular system. The neurogenic inflammation triggered by activation of the trigeminal-vestibulocochlear reflex, with the subsequent inner ear plasma protein extravasation and the release of inflammatory mediators, can contribute to a sustained activation and sensitization of the trigeminal primary afferent neurons explaining VM symptoms. The reciprocal connections between brainstem vestibular nuclei and the structures that modulate trigeminal nociceptive inputs (rostral ventromedial medulla, ventrolateral periaqueductal gray, locus coeruleus, and nucleus raphe magnus) are critical to understand the pathophysiology of VM. Although cortical spreading depression can affect cortical areas involved in processing vestibular information, functional neuroimaging techniques suggest a dysmodulation in the multimodal sensory integration and processing of vestibular and nociceptive information, resulting from a vestibulo-thalamo-cortical dysfunction, as the pathogenic mechanism underlying VM. The elevated prevalence of VM suggests that multiple functional variants may confer a genetic susceptibility leading to a dysregulation of excitatory-inhibitory balance in brain structures involved in the processing of sensory information, vestibular inputs, and pain. The interactions among several functional and structural neural networks could explain the pathogenic mechanisms of VM.

Tapia's syndrome: pathogenetic mechanisms, diagnostic management, and proper treatment: a case series.

BACKGROUND Tapia's syndrome is an uncommon disease described in 1904 by Antonio Garcia Tapia, a Spanish otolaryngologist. It is characterized by concomitant paralysis of the hypoglossal (XIIth) and pneumogastric (Xth) nerves. Only 69 cases have been described in the literature. Typically, the reported patients presented with a history of orotracheal intubation. Common symptoms are dysphonia, tongue deviation toward the affected side, lingual motility disturbance, and swallowing difficulty. CASE PRESENTATION In the report, we describe three cases of Tapia's syndrome in three Caucasian patients who underwent surgery with general anesthesia. Two of these patients underwent neck abscess drainage, and the third had an open reduction of a shoulder fracture. The clinical symptoms of Tapia's syndrome appeared after extubation. All three of our patients recovered their lost function at 3 months after diagnosis. CONCLUSIONS We underline the importance of performing airway endoscopy and a specific program of swallowing rehabilitation for the proper management of Tapia's syndrome.

Una retrospectiva a El Niño 1982-83: ¿qué hemos aprendido?

El "Niño del siglo" 1982-83, debido a sus peculiaridades inesperadas, sorprendió fuertemente a la comunidad científica. Como consecuencia, incluso en las ciencias biológicas marinas, donde los efectos fueron drásticos y a menudo obvios, en general se colectó menos información de lo que hubiera sido posible y deseable. De este panorama hay algunas excepciones, principalmente en lo referente al estudio de las comunidades bénticas y costeras. La reciente información acumulada en estos campos forma la base para una evaluación crítica del avance científico durante y después del fenómeno. Al mismo tiempo permite la ubicación de problemas y la formulación de proyectos de investigación para el futuro. Si bien es evidente que en este momento ya disponemos de una visión más clara de los efectos inmediatos, sean positivos o negativos, de un fenómeno extraordinariamente fuerte, la incertidumbre ante un nuevo El Niño mucho más tenue en 1986-87, nos dió una lección que hay que evaluar. Por otro lado, se ha avanzado muy poco en el estudio de los mecanismos que desencadenan elevadas mortandades de algunas especies y la proliferación inusual de otras. Sin embargo, ya tenemos alguna visión más integral sobre el efecto latitudinal, la gradiente vertical, los efectos previos a la llegada de las ondas Kelvin, los efectos post-Niño y los efectos de largo plazo. No obstante, hasta el momento, sólo podemos hipotetizar tanto sobre la historia evolutiva de El Niño, como sobre su significancia para el origen de las comunidades marinas del presente. Las investigaciones futuras deben tener un enfoque multidisciplinario, sin descuidar los aspectos básicos. Esto debería implicar: un mayor esfuerzo de las universidades a lo largo del litoral pacífico; investigaciones más continuadas; trabajos experimentales comparativos en diferentes lugares, a fin de saber más sobre los mecanismos involucrados; una mayor cooperación entre los científicos que trabajan en comunidades y problemas semejantes de las diversas latitudes; y un mayor intercambio de información entre los investigadores de comunidades actuales, paleontólogos, sedimentólogos y arqueólogos. Se concluye que sin duda hemos aprendido algo durante El Niño 1982-83; sin embargo, estaríamos aprovechando muy poco si no aceptamos nuestro reto de continuar profundizando estas investigaciones.

Ciclo de vida de la Chita: anisotremus scapularis

En el año 2013, el Laboratorio de Cultivo de Peces del Centro de Investigaciones Acuícolas Alexander von Humboldt, de la Dirección General de Investigaciones en Acuicultura (DGIA) del IMARPE dio inicio a las investigaciones de esta especie, con la captura de ejemplares silvestres para su acondicionamiento al cautiverio en sistemas de recirculación de agua, en el marco del Programa Presupuesto por Resultados “Ordenamiento y Desarrollo de la Acuicultura” del Ministerio de la Producción.

Mutations in the EXT1 and EXT2 genes in Spanish patients with multiple osteochondromas

Multiple osteochondromas is an autosomal dominant skeletal disorder characterized by the formation of multiple cartilage-capped tumours. Two causal genes have been identified, EXT1 and EXT2, which account for 65% and 30% of cases, respectively. We have undertaken a mutation analysis of the EXT1 and EXT2 genes in 39 unrelated Spanish patients, most of them with moderate phenotype, and looked for genotype-phenotype correlations. We found the mutant allele in 37 patients, 29 in EXT1 and 8 in EXT2. Five of the EXT1 mutations were deletions identified by MLPA. Two cases of mosaicism were documented. We detected a lower number of exostoses in patients with missense mutation versus other kinds of mutations. In conclusion, we found a mutation in EXT1 or in EXT2 in 95% of the Spanish patients. Eighteen of the mutations were novel.

Mutations in the EXT1 and EXT2 genes in Spanish patients with multiple osteochondromas

Multiple osteochondromas is an autosomal dominant skeletal disorder characterized by the formation of multiple cartilage-capped tumours. Two causal genes have been identified, EXT1 and EXT2, which account for 65% and 30% of cases, respectively. We have undertaken a mutation analysis of the EXT1 and EXT2 genes in 39 unrelated Spanish patients, most of them with moderate phenotype, and looked for genotype-phenotype correlations. We found the mutant allele in 37 patients, 29 in EXT1 and 8 in EXT2. Five of the EXT1 mutations were deletions identified by MLPA. Two cases of mosaicism were documented. We detected a lower number of exostoses in patients with missense mutation versus other kinds of mutations. In conclusion, we found a mutation in EXT1 or in EXT2 in 95% of the Spanish patients. Eighteen of the mutations were novel.

Utilidad de un fórum virtual para realizar trabajos colaborativos con presentación individual evaluable

Objetivos. Valorar la utilidad de un fórum virtual sobre la discusión de un caso clínico por grupos para la presentación de un trabajo individual. Material y métodos. En uno de los seminarios de la asignatura Enfermedades del Aparato Respiratorio y ORL del grado de Medicina, se creó un fórum virtual para discutir un caso clínico por grupos, antes de presentar un trabajo individual. Se realizaron cuatro grupos (A, B, C y D) y se abrieron cuatro temas. Cada grupo sólo podía participar en uno, pero tenían que observar la evolución de los otros foros. El trabajo individual consistía en contestar a varias preguntas planteadas por el profesor relacionadas con el desarrollo del caso clínico virtual. Para analizar los resultados de la experiencia se valoró: el número de participaciones en el foro, el número de participaciones por grupo, la nota del trabajo individual y la opinión del profesor Resultados. Se realizaron 129 participaciones al foro. El grupo A fue el que más participó (27%). El 78% de los alumnos obtuvo una nota comprendida entre el 7 y el 9. Del análisis cualitativo del trabajo individual se observó que los alumnos contestaban correctamente las preguntas, pero no se basaban en lo que sus compañeros habían desarrollado en el foro. Conclusiones. Los foros virtuales basados en la discusión de casos clínicos pueden facilitar el aprendizaje colaborativo en alumnos del grado de Medicina.

Role of Myotonic Dystrophy Protein Kinase [DMPK] in Glucose Homeostasis and Muscle Insulin Action

Myotonic dystrophy 1 (DM1) is caused by a CTG expansion in the 3′-unstranslated region of the DMPK gene, which encodes a serine/threonine protein kinase. One of the common clinical features of DM1 patients is insulin resistance, which has been associated with a pathogenic effect of the repeat expansions. Here we show that DMPK itself is a positive modulator of insulin action. DMPK-deficient (dmpk−/−) mice exhibit impaired insulin signaling in muscle tissues but not in adipocytes and liver, tissues in which DMPK is not expressed. Dmpk−/− mice display metabolic derangements such as abnormal glucose tolerance, reduced glucose uptake and impaired insulin-dependent GLUT4 trafficking in muscle. Using DMPK mutants, we show that DMPK is required for a correct intracellular trafficking of insulin and IGF-1 receptors, providing a mechanism to explain the molecular and metabolic phenotype of dmpk−/− mice. Taken together, these findings indicate that reduced DMPK expression may directly influence the onset of insulin-resistance in DM1 patients and point to dmpk as a new candidate gene for susceptibility to type 2-diabetes.