Diagnóstico de reflujo gastro-esofágico mediante impregnación por ácido de férula oclusal

El teflujo gastro-esofágico (RGE) es un trastorno digestivo muy frecuente que se caracteriza por el paso de cantidades patológicas de ácido del estómago hacia el esófago. Esto es debido a una incompetencia de los mecanismos que regulan la retención del contenido gástrico en el estómago por causas primarias o secundarias. Las consecuencias clínicas de este reflujo afectan al tracto aerodigestivo superior, incluyendo la boca. Lo más frecuente es la esofagitis, seguido por la afectación de faringe y laringe y finalmente por alteraciones patológicas en la boca. A éste nivel lo más frecuente es la erosión del esmalte y las lesiones erosivas de la mucosa oral. Presentamos el caso de un paciente en el que el RGE fue diagnosticado de forma indirecta por la impregnación y coloración de una férula oclusal utilizada para el tratamiento de un síndrome miofascial. Partiendo de este caso se discuten las consecuencias del RGE en la cavidad oral y su asociación con el dolor muscular masticatorio.The gastroesophageal reflux (GER) disease is a very frequent digestive disorder, mainly characterised by the reflux of the gastric acidic content to the esophage in abnormal quantities. There are different situations that favour this situation but almost in all of them rely an incompetence of the esophagic sphincter. The clinical consequences are many, including oral manifestations. Among all of them the most frequent is the esophagitis followed by symptoms at the pharynx or larynx and finally, the oral cavity. At this level fundamentally we will find enamel and oral mucosa erosions. We report the case of a patient who was indirectly diagnosed of her esophague disease by the observation of the alterations in the occlusal splint induced by the gastric reflux. We review the literature concerning the above topic and its possible association with the miofascial syndrome

Early predictors of corticosteroid response in acute severe autoimmune hepatitis: a nationwide multicenter study

Background and Aims: To assess whether corticosteroids improve prognosis in patients with AS-AIH, and to identify factors at therapy initiation and during therapy predictive of the response to corticosteroids. Methods: This was a retrospective cohort study including all patients with AS-AIH admitted to 13 tertiary centres from January 2002 to January 2019. The composite primary outcome was death or liver transplantation within 90 days of admission. Kaplan–Meier and Cox regression methods were used for data analysis. Results: Of 242 consecutive patients enrolled (mean age [SD] 49.7 [16.8] years), 203 received corticosteroids. Overall 90-day transplant-free survival was 61.6% (95% confidence interval [CI] 55.4–67.7). Corticosteroids reduced the risk of a poor outcome (adjusted hazard ratio [HR] 0.25; 95% CI 0.2–0.4), but this treatment failed in 30.5%. An internally validated nomogram composed of older age, MELD, encephalopathy and ascites at the initiation of corticosteroids accurately predicted the response (C-index 0.82; [95% CI 0.8–0.9]). In responders, MELD significantly improved from days 3 to 14 but remained unchanged in non-responders. MELD on day 7 with a cut-off of 25 (sensitivity 62.5%[95% CI: 47.0–75.8]; specificity 95.2% [95% CI: 89.9–97.8]) was the best univariate predictor of the response. Prolonging corticosteroids did not increase the overall infection risk (adjusted HR 0.75; 95% CI 0.3–2.1). Conclusion: Older patients with high MELD, encephalopathy or ascites at steroid therapy initiation and during treatment are unlikely to show a favourable response and so prolonged therapy in these patients, especially if they are transplantation candidates, should be avoided.This study was supported in part by grants from the Spanish Ministry of Science and Innovation, Instituto de Salud Carlos III, number PI20/01302, awarded to Agustín Albillos and number PI 21/01310, awarded to Luis Téllez. CIBEREHD is funded by the Instituto de Salud Carlos III using grants cofinanced by the European Development Regional Fund “A way to achieve Europe” (EDRF). María Carlota Londoño received support from the Plan Nacional de I+D+I co- funded by ISCIII-Subdirección General de Evaluación and Fondo Europeo de Desarrollo Regional (FEDER-"Una manera de Hacer Europa") (PI17/00955

Gastroesophageal reflux diagnosed by occlusal splint tintion

The gastroesophageal reflux (GER) disease is a very frequent digestive disorder, mainly characterised by the reflux of the gastric acidic content to the esophage in abnormal quantities. There are different situations that favour this situation but almost in all of them rely an incompetence of the esophagic sphincter. The clinical consequences are many, including oral manifestations. Among all of them the most frequent is the esophagitis followed by symptoms at the pharynx or larynx and finally, the oral cavity. At this level fundamentally we will find enamel and oral mucosa erosions. We report the case of a patient who was indirectly diagnosed of her esophague disease by the observation of the alterations in the occlusal splint induced by the gastric reflux. We review the literature concerning the above topic and its possible association with the miofascial syndrome

La información económico-financiera en la empresa : importancia del sistema contable

Tesis inédita de la Universidad Complutense de Madrid, Facultad de Ciencias Económicas y Empresariales, Departamento de Economía Financiera y Contabilidad II (Contabilidad), leída el 04-10-95El presente estudio pretende aportar un análisis teórico-práctico, a la vez que riguroso, de la importancia de la información económico-financiera en las empresas, así como del protagonismo que los sistemas de información automatizados están asumiendo al ser herramientas que facilitan la labor gerencial. El objetivo del presente trabajo es poner de manifiesto la contribución de los sistemas de información asociados al citado área, destacando por su importancia e interés para las empresas el sistema de información contable, por ser el encargado de recopilar de forma resumida la información objetiva y relevante de los hechos económicos producidos en la organización. La contabilidad es la disciplina idónea para resolver los problemas de información en la empresa, para lo cual es necesario cambiar el concepto tradicional de la misma, ampliando su ámbito de aplicación y entenderla como sistema de información al servicio de la gestión de la empresaDepto. de Administración Financiera y ContabilidadFac. de Ciencias Económicas y EmpresarialesTRUEpu

Management of anemia induced by triple therapy in patients with chronic hepatitis C: Challenges, opportunities and recommendations

SummaryThe addition of protease inhibitors, boceprevir or telaprevir, to peginterferon+ribavirin (PegIFN/RBV) increases the frequency as well as the severity, and hence, clinical relevance of anemia, which has now become one of the major complications associated with triple therapy. Most significant factors associated with anemia in patients receiving triple therapy include older age, lower body mass index (BMI), advanced fibrosis, and lower baseline hemoglobin. The variability in inosine triphosphate pyrophosphatase (ITPA) gene, which encodes a protein that hydrolyses inosine triphosphate (ITP), has been identified as an essential genetic factor for anemia both in dual and triple therapy. The correct management of anemia is based on anticipation, characterization and therapeutic management. Basically, anemia can be characterized in 3 types: ferropenic (mostly in fertile women), thalassemic type hemolytic anemia, and anemia from chronic processes. Functional deficit of iron should also be excluded in patients with normal ferritin and lower saturation of transferrin. Ribavirin dose reduction and epoetin, sequentially, are indicated in the management of anemia. Epoetin non-response can be caused by lack of time, type of anemia, functional iron deficit or erythropoietin resistance. In the transplantation setting, adding a protease inhibitor to PegIFN/RBV results in a significant increase in the incidence and severity of anemia and, as a consequence, a greater need for epoetin, transfusions, and ribavirin dose reductions. Packed red cell transfusions are utilized when hemoglobin decreases to less than 7.5g/dl and/or there are clinical symptoms and/or there is no response to other therapeutic measures

Defining a set of standardised outcome measures for newly diagnosed patients with multiple myeloma using the Delphi consensus method: the IMPORTA project

Objective: To define a standard set of outcomes and the most appropriate instruments to measure them for managing newly diagnosed patients with multiple myeloma (MM). Methods: A literature review and five discussion groups facilitated the design of two-round Delphi questionnaire. Delphi panellists (haematologists, hospital pharmacists and patients) were identified by the scientific committee, the Spanish Program of Haematology Treatments Foundation, the Spanish Society of Hospital Pharmacies and the Spanish Community of Patients with MM. Panellist's perception about outcomes' suitability and feasibility of use was assessed on a seven-point Likert scale. Consensus was reached when at least 75% of the respondents reached agreement or disagreement. A scientific committee led the project. Results: Fifty-one and 45 panellists participated in the first and second Delphi rounds, respectively. Consensus was reached to use overall survival, progression-free survival, minimal residual disease and treatment response to assess survival and disease control. Panellists agreed to measure health-related quality of life, pain, performance status, fatigue, psychosocial status, symptoms, self-perception on body image, sexuality and preferences/satisfaction. However, panellist did not reach consensus about the feasibility of assessing in routine practice psychosocial status, symptoms, self-perception on body image and sexuality. Consensus was reached to collect patient-reported outcomes through the European Organisation for the Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ) Core questionnaire 30 (C30), three items from EORTC-QLQ-Multiple Myeloma (MY20) and EORTC-QLQ-Breast Cancer (BR23), pain Visual Analogue Scale, Morisky-Green and ad hoc questions about patients' preferences/satisfaction. Conclusions: A consensual standard set of outcomes for managing newly diagnosed patients with MM has been defined. The feasibility of its implementation in routine practice will be assessed in a future pilot study

Aneurysmal bone cyst of the mandible : case presentation and review of the literature

The aneurysmatic osseus cyst is a very infrequent bone lesion which in some occasions can be found at the craneofacial skeleton. Among all the cystic lesions that can be found at the mandible or the maxilla it is very rare. On the other side it is at the same time very interesting in terms of its differential diagnose with other types of maxillary bone lesions We present the case of a Caucasian male with an aneurysmatic cyst located at the right angle of the mandible and a review of the literature concerning the case. We have focused on the differential diagnose, mainly with the malignancies that can be found at this location. We also comment the therapeutic options clasically described for these kind of pathologies. In our patient, the surgical excision allowed a complete removal of the lesion and a posterior bone healing which made possible a implant-supported rehabilitation of the edentulous segment

Rhinoorbitocerebral mucormycosis : A case report and literature review

Mucormycosis is a rare oportunistic infection typically described in diabetic patients with a ketoacidotic status, as well as neutropenic patients. The infection is caused by a group of saprophytic fungi of the class Phycomicetes, being the most frequent ones the Rhizomucor, Rhizopus and Mucor. Its hystological findings include vascular trombosis and tissue necrosis, predominantly in the rino-orbito-cerebral area. Even though the frequency of presentation is very low, given its rapid evolution and severe consequences which include a high mortality rate, it is very important to be aware of the main features of the disease and treat it promptly. Although the diagnosis is based on the high clinical suspect, the computed tomography (CT) and the magnetic resonance image (MRI) plays an important role in determining the extension. The patients should receive treatment in a reference hospital so that a multidisciplinary approach is ensured. In this sense, we present a case of rhino-orbito-cerebralmucormycosis in a diabetic patient, recently treated in our Department. A comprehensive review of the literature has been performed to update the physiopathology and diagnosis. Finally, we describe the different treatment options focusing in the surgical approach, as well as the medical treatment with amphotericine and posaconzol

Visión actual de la apicultura en españa

La apicultura es una actividad agropecuaria orientada a la cría de abejas para obtener beneficios derivados de la venta de los productos apícolas y de la acción polinizadora en los cultivos. Es un sector que se distribuye principalmente en Castilla y León con el 16% del total de explotaciones, de las cuales la mayoría son no profesionales y estantes. Le siguen en importancia Galicia con el 14,3% de explotaciones, y Andalucía con el 13%, donde están a la par las colmenas profesionales y no profesionales con trashumancia. Dentro del panorama comunitario, España ocupa el primer lugar en el censo con un 17,1% del total de colmenas de Europa, con un volumen exportador del 27,9%; los destinos principales son Francia y Alemania. En el plano extracomunitario, España importa miel de China y Argentina ocupando el 5º lugar (3,4%) de las importaciones a nivel mundial. No obstante el nivel de autoabastecimiento español alcanza un 88,2%.The beekeeping is a farming activity orientated to the young of bees in order to obtain benefits derived from the sale of apicultural products and the pollinating action on the cultivates. It’s a sector distributed mainly in Castilla and Leon with 16% of the total of operations, of which the majority is nonprofessional and permanent. They are followed in importance by Galicia with 14.3% of operations, and Andalucia with 13% where the non professional beehives with seasonal migrations are similar.Within the communitarian perspective, Spain occupies the first place in the census with the 17.1% of the total of beehives of Europe, with an exporting volume of 27,9%; the main destinies are France and Germany. In the extracommunitarian plane, Spain imports honey from China and Argentina occupying the fifth place (3.4%) of the imports at world-wide level. Despite the level of Spanish self-supplying it reaches a 88.2%