El índice tobillo-brazo, factor pronóstico de eventos cardiovasculares en pacientes con isquemia crónica de extremidades inferiores.

INTRODUCCIÓN: La asociación entre la arteriopatía periférica y los nuevos eventos cardiovasculares ya es conocida, no así, en función del Índice tobillo-brazo (ITB). OBJETIVOS: Identificar los valores a partir de los que un ITB patológico se correlaciona con la aparición de eventos cardiovasculares. PACIENTES Y MÉTODOS: Se analiza el resgistro FRENA de pacientes a los que se realiza una única medición del ITB. CONCLUSIONES: No hemos encontrado un valor a partir del cual el ITB se asocie significativamente a un peor pronóstico pero sí una asociación entre un ITB & 0.6 y el riesgo de IAM.

Leishmania major metacaspase can replace yeast metacaspase in programmed cell death and has arginine-specific cysteine peptidase activity.

The human protozoan parasite Leishmania major has been shown to exhibit several morphological and biochemical features characteristic of a cell death program when differentiating into infectious stages and under a variety of stress conditions. Although some caspase-like peptidase activity has been reported in dying parasites, no caspase gene is present in the genome. However, a single metacaspase gene is present in L. major whose encoded protein harbors the predicted secondary structure and the catalytic dyad histidine/cysteine described for caspases and other metacaspases identified in plants and yeast. The Saccharomyces cerevisiae metacaspase YCA1 has been implicated in the death of aging cells, cells defective in some biological functions, and cells exposed to different environmental stresses. In this study, we describe the functional heterologous complementation of a S. cerevisiae yca1 null mutant with the L. major metacaspase (LmjMCA) in cell death induced by oxidative stress. We show that LmjMCA is involved in yeast cell death, similar to YCA1, and that this function depends on its catalytic activity. LmjMCA was found to be auto-processed as occurs for caspases, however LmjMCA did not exhibit any activity with caspase substrates. In contrast and similarly to Arabidopsis thaliana metacaspases, LmjMCA was active towards substrates with arginine in the P1 position, with the activity being abolished following H147A and C202A catalytic site mutations. These results suggest that metacaspases are members of a family of peptidases with a role in cell death conserved in evolution notwithstanding possible differences in their catalytic activity.

Sistema de Información de la Coordinación Autonómica de Trasplantes de Andalucía (SICATA) : Subsistema de Insuficiencia Renal Crónica : Informe 2013

Coordinación Autonómica de Trasplantes

Randomised controlled study in the primary healthcare sector to investigate the effectiveness and safety of auriculotherapy for the treatment of uncomplicated chronic rachialgia: a study protocol.

BACKGROUND Uncomplicated chronic rachialgia is a highly prevalent complaint, and one for which therapeutic results are contradictory. The aim of the present study is to evaluate the effectiveness and safety of treatment with auriculopressure, in the primary healthcare sector, carried out by trained healthcare professionals via a 30-hour course. METHODS/DESIGN The design consists of a multi-centre randomized controlled trial, with placebo, with two parallel groups, and including an economic evaluation. Patients with chronic uncomplicated rachialgia, whose GP is considering referral for auriculopressure sensory stimulation, are eligible for inclusion. Sampling will be by consecutive selection, and randomised allocation to one of the two study arms will be determined using a centralised method, following a 1:1 plan (true auriculopressure; placebo auriculopressure). The implants (true and placebo) will be replaced once weekly, and the treatment will have a duration of 8 weeks. The primary outcome measure will be the change in pain intensity, measured on a visual analogue scale (VAS) of 100 mm, at 9 weeks after beginning the treatment. A follow up study will be performed at 6 months after beginning treatment. An assessment will also be made of the changes measured in the Spanish version of the McGill Pain Questionnaire, of the changes in the Lattinen test, and of the changes in quality of life (SF-12). Also planned is an analysis of cost-effectiveness and also, if necessary, a cost-benefit analysis. DISCUSSION This study will contribute to developing evidence on the use of auriculotherapy using Semen vaccariae [wang bu liu xing] for the treatment of uncomplicated chronic rachialgia. TRIAL REGISTRATION Current Controlled Trials ISRCTN01897462.

Acupuncture and rehabilitation of the painful shoulder: study protocol of an ongoing multicentre randomised controlled clinical trial [ISRCTN28687220]

BACKGROUND Although the painful shoulder is one of the most common dysfunctions of the locomotor apparatus, and is frequently treated both at primary healthcare centres and by specialists, little evidence has been reported to support or refute the effectiveness of the treatments most commonly applied. According to the bibliography reviewed, physiotherapy, which is the most common action taken to alleviate this problem, has not yet been proven to be effective, because of the small size of sample groups and the lack of methodological rigor in the papers published on the subject. No reviews have been made to assess the effectiveness of acupuncture in treating this complaint, but in recent years controlled randomised studies have been made and these demonstrate an increasing use of acupuncture to treat pathologies of the soft tissues of the shoulder. In this study, we seek to evaluate the effectiveness of physiotherapy applied jointly with acupuncture, compared with physiotherapy applied with a TENS-placebo, in the treatment of painful shoulder caused by subacromial syndrome (rotator cuff tendinitis and subacromial bursitis). METHODS/DESIGN Randomised controlled multicentre study with blind evaluation by an independent observer and blind, independent analysis. A study will be made of 465 patients referred to the rehabilitation services at participating healthcare centres, belonging to the regional public health systems of Andalusia and Murcia, these patients presenting symptoms of painful shoulder and a diagnosis of subacromial syndrome (rotator cuff tendinitis and subacromial bursitis). The patients will be randomised into two groups: 1) experimental (acupuncture + physiotherapy); 2) control (TENS-placebo + physiotherapy); the administration of rescue medication will also be allowed. The treatment period will have a duration of three weeks. The main result variable will be the change produced on Constant's Shoulder Function Assessment (SFA) Scale; as secondary variables, we will record the changes in diurnal pain intensity on a visual analogue scale (VAS), nocturnal pain intensity on the VAS, doses of non-steroid anti-inflammatory drugs (NSAIDs) taken during the study period, credibility scale for the treatment, degree of improvement perceived by the patient and degree of improvement perceived by the evaluator. A follow up examination will be made at 3, 6 and 12 months after the study period has ended. Two types of population will be considered for analysis: per protocol and per intention to treat. DISCUSSION The discussion will take into account the limitations of the study, together with considerations such as the choice of a simple, safe method to treat this shoulder complaint, the choice of the control group, and the blinding of the patients, evaluators and those responsible for carrying out the final analysis.

Crònica gironina d'una dècada de conferències

Crònica de deu anys de conferències anuals de la Societat Catalana de Comunicació a Girona

Effectiveness of glatiramer acetate compared to other multiple sclerosis therapies.

OBJECTIVE To assess the effectiveness of glatiramer acetate (GA) compared to other multiple sclerosis (MS) therapies in routine clinical practice. MATERIALS AND METHODS Observational cohort study carried out in MS patients treated with GA (GA cohort) or other MS therapies -switched from GA- (non-GA cohort). Study data were obtained through review of our MS patient database. The primary endpoint was the Expanded Disability Status Scale (EDSS) scores reached at the end of treatment/last check-up. RESULTS A total of 180 patients were included: GA cohort n = 120, non-GA cohort n = 60. Patients in the GA cohort showed better EDSS scores at the end of treatment/last check-up (mean ± SD, 2.8 ± 1.8 vs. 3.9 ± 2.2; P = 0.001) and were 1.65 times more likely to show better EDSS scores compared to the non-GA cohort (odds ratio, 0.606; 95%CI, 0.436-0.843; P = 0.003). Patients in the GA cohort showed longer mean time to reach EDSS scores of 6 (209.1 [95%CI, 187.6-230.6] vs. 164.3 [95% CI, 137.0-191.6] months; P = 0.004) and slower disability progression (hazard ratio, 0.415 [95%CI, 0.286-0.603]; P < 0.001). The annualized relapse rate was lower in the GA cohort (mean ± SD, 0.5 ± 0.5 vs. 0.8 ± 0.5; P = 0.001) and patients' quality of life was improved in this study cohort compared to the non-GA cohort (mean ± SD, 0.7 ± 0.1 vs. 0.6 ± 0.2; P = 0.01). CONCLUSIONS GA may slow down the progression of EDSS scores to a greater extent than other MS therapies, as well as achieving a greater reduction in relapses and a greater improvement in patients' quality of life. Switching from GA to other MS therapies has not proved to entail a better response to treatment.

Enfermedad pulmonar obstructiva crónica : proceso asistencial integrado. 3ª ed

Proceso publicado en la página web de la Consejería de Salud: www.juntadeandalucia.es/salud (Consejería de Salud / Profesionales / Nuestro Compromiso por la Calidad / Procesos Asistenciales Integrados)

Manejo perioperatorio de medicación crónica : documento de apoyo al PAI atención al paciente quirúrgico

Documento de Apoyo al Proceso Asistencial Integrado Atención al Paciente Quirúrgico (http://hdl.handle.net/10668/1713). Publicado en la página web de la Consejería de Igualdad, Salud y Políticas Sociales: www.juntadeandalucia.es/salud (Consejería de Salud / Profesionales / Nuestro Compromiso por la Calidad / Procesos Asistenciales Integrados)

Management of hepatitis B virus infection after liver transplantation.

Chronic hepatitis B virus (HBV) infection is responsible for up to 30% of cases of liver cirrhosis and up to 53% of cases of hepatocellular carcinoma. Liver transplantation (LT) is the best therapeutic option for patients with end-stage liver failure caused by HBV. The success of transplantation, though, depends on receiving prophylactic treatment against post-transplant viral reactivation. In the absence of prophylaxis, liver transplantation due to chronic hepatitis B (CHB) is associated with high rates of viral recurrence and poor survival. The introduction of treatment with hepatitis B immunoglobulins (HBIG) during the 1990s and later the incorporation of oral antiviral drugs have improved the prognosis of these patients. Thus, LT for CHB is now a universally accepted option, with an estimated 5 years survival of around 85% vs the 45% survival seen prior to the introduction of HBIG. The combination of lamivudine plus HBIG has for many years been the most widely used prophylactic regimen. However, with the appearance of new more potent oral antiviral agents associated with less resistance (e.g., entecavir and tenofovir) for the treatment of CHB, new prophylactic strategies are being designed, either in combination with HBIG or alone as a monotherapy. These advances have allowed for more personalized prophylaxis based on the individual risk profile of a given patient. In addition, the small pool of donors has required the use of anti-HBc-positive donors (with the resulting possibility of transmitting HBV from these organs), which has been made possible by suitable prophylactic regimens.

Dor crônica e depressão: estudo em 92 doentes

O estudo objetivou analisar a existência de relações entre dor e depressão em noventa e dois doentes com doença oncológica avançada. Os doentes foram divididos em 2 grupos, com ou sem dor na semana anterior à entrevista. Havia dor em 62,0% dos avaliados, a duração média do quadro álgico foi 10 meses e a maioria referiu dor moderada. Os indivíduos do grupo com dor apresentaram escores de depressão significativamente mais altos que os do grupo sem dor (p<0,05). Doentes com mais altos escores de depressão experienciaram dor de maior intensidade (p<00,5). Sintomas depressivos associaram-se e agravaram a experiência dolorosa.

A experiência da família ao conviver com a família doença crônica da criança

Esta pesquisa objetivou compreender como a família vivencia os períodos de dificuldades impostos pela doença crônica da criança. Utilizou-se como método de pesquisa a Teoria Fundamentada nos Dados e como referencial teórico o Interacionismo Simbólico. Foram entrevistadas famílias de crianças com doença crônica, fibrose cística do pâncreas e diabetes, possibilitando desvelar o processo vivenciado e o significado atribuído pela família a sua experiência. Os dados foram analisados até a fase de categorização dos significados, tendo emergido o fenômeno: "Sendo Difícil Não Ter Controle".

Relação da temperatura da solução de diálise e a hipotensão arterial sintomática observada durante sessões de hemodiálise em pacientes com insuficiência renal crônica

Realizado estudo prospectivo em um grupo de 21 pacientes portadores de insuficiência renal crônica que apresentavam hipotensão arterial no decorrer da hemodiálise. Avaliada a pressão arterial durante duas sessões com dialisato a 35(9)C e duas a 37°C, observou-se que as pressões sistólica e diastólica, nas temperaturas estudadas, mostraram diferenças estatisticamente significativas quando comparadas aos valores iniciais pré-diálise, queda progressiva das pressões com prevalência de episódios hipotensivos na 3(5) e 4(5) horas de tratamento em ambas temperaturas, diminuição de 7,69% das hipotensões com dialisato a 35ºC e importante queixa de sensação de frio, tornando o tratamento desconfortável.

29/2/20, Inquisitif [monté par le jockey Ed. Haës] gagnant du prix Jean Hennessy [i.e. Robert Hennessy, steeple-chase, hippodrome d'Auteuil] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 58279

The radiation of the clownfishes has two geographical replicates

AimThe study of adaptive radiations provides an evolutionary perspective on the interactions between organisms and their environment, and is necessary to understand global biodiversity. Adaptive radiations can sometimes be replicated over several disjunct geographical entities, but most examples are found on island or in lakes. Here, we investigated the biogeographical history of the clownfishes, a clade of coral reef fish with ranges that now span most of the Indo-Pacific Ocean, in order to explore the geographical structure of an unusual adaptive radiation. LocationIndian Ocean, Indo-Australian Archipelago (IAA) and Central Pacific Ocean. MethodsWe generated DNA sequence data comprising seven nuclear markers for 27 of the 30 clownfish species. We then inferred a Bayesian phylogeny and reconstructed the biogeographical history of the group using three different methods. Finally, we applied a biogeographical model of diversification to assess whether diversification patterns differ between the Indian and Pacific Oceans. ResultsThe phylogenetic tree is highly supported and allows reconstruction of the biogeographical history of the clade. While most species arose in the IAA, one clade colonized the eastern shores of Africa and diversified there. We found that the diversification rate of clownfishes does not differ between the main radiation and the African clade. Main conclusionsThe clownfishes first appeared and diversified in the IAA. Following a colonization event, a geographically independent radiation occurred in the Indian Ocean off East Africa. This rare example of replicated adaptive radiation in the marine realm provides intriguing possibilities for further research on ecological speciation in the sea.