Double or nothing: red flag symptoms of critical carotid stenosis, a case report

Abstract Background Detailed knowledge of every possible manifestation of Internal Carotid Artery (ICA) disease is important. For improving detection and a timely adoption of secondary prevention procedures or treatments. Transient oculomotor nerve palsies have been described associated with stenosis or occlusion of the ICA. Case presentation We described a patient that develop a sequential combination of transient monocular loss of vision followed by binocular diplopia secondary to an unstable atherosclerotic preocclusive stenosis of an internal carotid artery previously treated with radiotherapy. Conclusions The peculiar sequence of transient monocular vision that give rise later into a transient binocular diplopia (double or nothing) should be kept in mind as a possible manifestation of critical stenosis of ICA

Tratamiento ambulatorio grupal para dependientes de cocaína combinando terapia cognitivo conductual y entrevista motivacional

Resumen: Las intervenciones psicológicas en pacientes con dependencia de cocaína han demostrado ser eficaces, destacando el Manejo de Contingencias y la Terapia Cognitivo-Conductual [TCC], siendo la falta de adherencia la limitación más importante. La Entrevista Motivacional [EM] mejora la adherencia. El objetivo de este estudio es evaluar la retención y abstinencia con tratamiento combinado de EM y TCC grupal en pacientes cocainómanos que han alcanzado el estadio de mantenimiento según el modelo transteórico de Prochaska y DiClemente (1982). Para ello se realizó un estudio longitudinal, en dependientes de cocaína con o sin trastorno mental concomitante. Se realizó un grupo abierto de 12 sesiones con periodicidad semanal. Se incluyeron 19 pacientes (78,9% hombres, edad media 36,58 años), el 95% consumía vía intranasal y el 47% tenía otra comorbilidad psiquiátrica. La tasa de retención fue del 84%. Durante el tratamiento y el primer mes de seguimiento todos los pacientes se mantuvieron abstinentes, mientras que entre el primer y tercer mes de seguimiento tres pacientes recayeron. Los datos avalan que el tratamiento combinado de EM+TCC para dependientes de cocaína en estadio de mantenimiento mejora la adherencia y es eficaz para mantener la abstinencia. Abstract: Ambulatory group treatment for cocaine dependent patients combining cognitive behavioral therapy and motivational interviewing. Psychological interventions in cocaine dependent patients have demonstrated efficacy. Remarkable approaches are Contingency Management (CM) and Cognitive Behavioral Therapy (CBT). Lack of treatment adherence is the most important limitation. Motivational Interview (MI) has been shown to be an adherence enhancer. The objective of this study is to evaluate retention and abstinence in a combined CM and CBT group treatment in patients who have reached maintenance stage according to Prochaska and DiClemente's transtheoretical model (1982). Therefore, a longitudinal study was carried out with cocaine dependent patients with or without concomitant mental health disease. A 12-session open group was conducted weekly. Nineteen patients were included (78.9% men, mean age 36.6 years), 95% consumed intranasally and 47% had another psychiatric comorbidity. Treatment retention was 84%. During treatment and the first month of follow-up, all patients remained abstinent whereas at three months, 3 patients relapsed. These data confirm that using combined CM and CBT group therapy in cocaine dependents undergoing maintenance treatment enhances adherence and is effective to achieve abstinence

History and being of the eborian female conventual spaces: an approach to the analysis of its adaptations, uses and transformations

The conventual city of Évora stands out in the Portuguese ecclesiastical panorama for the fate of its old convent buildings. Secularized since 1834, only the female convents continued with their religious use for seventy years, a situation that will lead to the readaptation and reuse of their conventual spaces. In this article, we will analyse the current situation of the Evora’s convents, focusing mainly on female convents, in order to determine if the reuse of the building has changed or not its original conventual structure and its heritage values. The analysis carried out has shown that, in some instances that we detail in the study, the functional coherence of its spaces has been transformed, as well as its architectural configuration.La ciudad conventual de Évora destaca en el panorama eclesiástico portugués por el destino que presentan sus antiguas edificaciones religiosas. Exclaustrados desde 1834, sólo los conventos femeninos prolongaron su uso religioso durante setenta años más, escenario que provocará la readaptación y reutilización de sus espacios conventuales. En este estudio analizaremos la situación actual que presentan los conventos eborenses, centrándonos especialmente en los femeninos, para dictaminar si la reutilización del edificio ha alterado o no su estructura conventual primigenia y, por ende, sus valores patrimoniales. El análisis realizado ha puesto en evidencia que, en determinados casos que detallamos en el estudio, se ha transformado la coherencia funcional de sus espacios, así como de su configuración arquitectónica

Metallo-Liposomes of Ruthenium Used as Promising Vectors of Genetic Material

Gene therapy is a therapeutic process consisting of the transport of genetic material into cells. The design and preparation of novel carriers to transport DNA is an important research line in the medical field. Hybrid compounds such as metallo-liposomes, containing a mixture of lipids, were prepared and characterized. Cationic metal lipids derived from the [Ru(bpy)3]2+ complex, RuC11C11 or RuC19C19, both with different hydrophobic/lipophilic ratios, were mixed with the phospholipid DOPE. A relation between the size and the molar fraction α was found and a multidisciplinary study about the interaction between the metallo-liposomes and DNA was performed. The metallo-liposomes/DNA association was quantified and a relationship between Kapp and α was obtained. Techniques such as AFM, SEM, zeta potential, dynamic light scattering and agarose gel electrophoresis demonstrated the formation of lipoplexes and showed the structure of the liposomes. L/D values corresponding to the polynucleotide's condensation were estimated. In vitro assays proved the low cell toxicity of the metallo-liposomes, lower for normal cells than for cancer cell lines, and a good internalization into cells. The latter as well as the transfection measurements carried out with plasmid DNA pEGFP-C1 have demonstrated a good availability of the Ru(II)-based liposomes for being used as non-toxic nanovectors in gene therapy.España Consejería de Educación y Ciencia de la Junta de Andalucía (Proyecto de Excelencia P12-FQM-1105, FQM-206 and FQM-274, and PI-0005-2018)España,, Universidad de Sevilla, VI Plan Propio Universidad de Sevilla (PP2018-10338)España Ministerio de Ciencia, Innovación y Universidades (RTI2018-100692-B-I00

Tratamiento ambulatorio grupal para dependientes de cocaína combinando terapia cognitivo conductual y entrevista motivacional

Las intervenciones psicológicas en pacientes con dependencia de cocaína han demostrado ser eficaces, destacando el Manejo de Contingencias y la Terapia Cognitivo-Conductual [TCC], siendo la falta de adherencia la limitación más importante. La Entrevista Motivacional [EM] mejora la adherencia. El objetivo de este estudio es evaluar la retención y abstinencia con tratamiento combinado de EM y TCC grupal en pacientes cocainómanos que han alcanzado el estadio de mantenimiento según el modelo transteórico de Prochaska y DiClemente (1982). Para ello se realizó un estudio longitudinal, en dependientes de cocaína con o sin trastorno mental concomitante. Se realizó un grupo abierto de 12 sesiones con periodicidad semanal. Se incluyeron 19 pacientes (78,9% hombres, edad media 36,58 años), el 95% consumía vía intranasal y el 47% tenía otra comorbilidad psiquiátrica. La tasa de retención fue del 84%. Durante el tratamiento y el primer mes de seguimiento todos los pacientes se mantuvieron abstinentes, mientras que entre el primer y tercer mes de seguimiento tres pacientes recayeron. Los datos avalan que el tratamiento combinado de EM+TCC para dependientes de cocaína en estadio de mantenimiento mejora la adherencia y es eficaz para mantener la abstinenciaPsychological interventions in cocaine dependent patients have demonstrated efficacy. Remarkable approaches are Contingency Management (CM) and Cognitive Behavioral Therapy (CBT). Lack of treatment adherence is the most important limitation. Motivational Interview (MI) has been shown to be an adherence enhancer. The objective of this study is to evaluate retention and abstinence in a combined CM and CBT group treatment in patients who have reached maintenance stage according to Prochaska and DiClemente's transtheoretical model (1982). Therefore, a longitudinal study was carried out with cocaine dependent patients with or without concomitant mental health disease. A 12-session open group was conducted weekly. Nineteen patients were included (78.9% men, mean age 36.6 years), 95% consumed intranasally and 47% had another psychiatric comorbidity. Treatment retention was 84%. During treatment and the first month of follow-up, all patients remained abstinent whereas at three months, 3 patients relapsed. These data confirm that using combined CM and CBT group therapy in cocaine dependents undergoing maintenance treatment enhances adherence and is effective to achieve abstinenc

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Las Comisiones de Monumentos y las Sociedades Arqueológicas como instrumentos para la construcción del pasado europeo

Coordinadores: Trinidad Tortosa Rocamora y Gloria Mora.Las Comisiones de Monumentos o de Antigüedades y las Sociedades Arqueológicas aparecen en el contexto europeo del siglo XIX como verdaderos instrumentos, en origen, de la gestión arqueológica percibida como una cuestión nacional. Aprovechando el interés que esta temática ha suscitado en los últimos años en nuestro país hemos querido cotejar las diferentes fases de este proceso con las situaciones confirmadas en otros países como Portugal, Francia e Italia. El debate, sin duda, nos llevará a reflexionar sobre los mitos de la arqueología que, a veces, por otros caminos diferentes a las vías académicas, convierten determinados temas en auténticos baluartes de la identidad nacional.Peer reviewe

B-cell regeneration profile and minimal residual disease status in bone marrow of treated multiple myeloma patients

© 2021 by the authors.B-cell regeneration during therapy has been considered as a strong prognostic factor in multiple myeloma (MM). However, the effects of therapy and hemodilution in bone marrow (BM) B-cell recovery have not been systematically evaluated during follow-up. MM (n = 177) and adult (≥50y) healthy donor (HD; n = 14) BM samples were studied by next-generation flow (NGF) to simultaneously assess measurable residual disease (MRD) and residual normal B-cell populations. BM hemodilution was detected in 41 out of 177 (23%) patient samples, leading to lower total B-cell, B-cell precursor (BCP) and normal plasma cell (nPC) counts. Among MM BM, decreased percentages (vs. HD) of BCP, transitional/naïve B-cell (TBC/NBC) and nPC populations were observed at diagnosis. BM BCP increased after induction therapy, whereas TBC/NBC counts remained abnormally low. At day+100 postautologous stem cell transplantation, a greater increase in BCP with recovered TBC/NBC cell numbers but persistently low memory B-cell and nPC counts were found. At the end of therapy, complete response (CR) BM samples showed higher CD19− nPC counts vs. non-CR specimens. MRD positivity was associated with higher BCP and nPC percentages. Hemodilution showed a negative impact on BM B-cell distribution. Different BM B-cell regeneration profiles are present in MM at diagnosis and after therapy with no significant association with patient outcome.This work has been supported by the International Myeloma Foundation-Black Swan Research Initiative, the EuroFlow Consortium (grant LSHB-CT-2006-018708); Centro de Investigación Biomédica en Red de Cáncer (CIBER-ONC; Instituto de Salud Carlos III, Ministerio de Economía y Competitividad, Madrid, Spain and FONDOS FEDER), numbers: CB16/12/00400, CB16/12/00233, CB16/12/00369, CB16/12/00489 and CB16/12/00480; grant from Bilateral Cooperation Program between Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-CAPES (Brasília/Brazil) and Dirección General de Políticas Universitárias (DGPU)-Ministério de Educación, Cultura y Deportes (Madrid/Spain) number DGPU 311/15; Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro of Brazil (FAPERJ) numbers: E26/110.105/2014 and E26/102.191/2013; grant from Conselho Nacional de Desenvolvimento Científico e Tecnológico of Brazil (CNPQ), number: 400194/2014-7. R.M.d.P. was supported by a grant from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES/DGPU), number: 000281/2016-06 and CAPES/PROEX 641/2018, Brazil; Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro of Brazil (FAPERJ) number: E01/200/537/2018

Risk Factors and Predictive Score for Bacteremic Biliary Tract Infections Due to Enterococcus faecalis and Enterococcus faecium: a Multicenter Cohort Study from the PROBAC Project

Biliary-tract bloodstream infections (BT-BSI) caused by Enterococcus faecalis and E. faecium are associated with inappropriate empirical treatment and worse outcomes compared to other etiologies. The objective of this study was to investigate the risk factors for enterococcal BT-BSI. Patients with BT-BSI from the PROBAC cohort, including consecutive patients with BSI in 26 Spanish hospitals between October 2016 and March 2017, were selected; episodes caused by E. faecalis or E. faecium and other causes were compared. Independent predictors for enterococci were identified by logistic regression, and a predictive score was developed. Eight hundred fifty episodes of BT-BSI were included; 73 (8.5%) were due to target Enterococcus spp. (48 [66%] were E. faecium and 25 [34%] E. faecalis). By multivariate analysis, the variables independently associated with Enterococcus spp. were (OR; 95% confidence interval): cholangiocarcinoma (4.48;1.32 to 15.25), hospital acquisition (3.58;2.11 to 6.07), use of carbapenems in the previous month (3.35;1.45 to 7.78), biliary prosthesis (2.19;1.24 to 3.90), and moderate or severe chronic kidney disease (1.55;1.07 to 2.26). The AUC of the model was 0.74 [95% CI0.67 to 0.80]. A score was developed, with 7, 6, 5, 4, and 2 points for these variables, respectively, with a negative predictive value of 95% for a score ? 6. A model, including cholangiocarcinoma, biliary prosthesis, hospital acquisition, previous carbapenems, and chronic kidney disease showed moderate prediction ability for enterococcal BT-BSI. Although the score will need to be validated, this information may be useful for deciding empirical therapy in biliary tract infections when bacteremia is suspected. IMPORTANCE Biliary tract infections are frequent, and a significant cause of morbidity and mortality. Bacteremia is common in these infections, particularly in the elderly and patients with cancer. Inappropriate empirical treatment has been associated with increased risk of mortality in bacteremic cholangitis, and the probability of receiving inactive empirical treatment is higher in episodes caused by enterococci. This is because many of the antimicrobial agents recommended in guidelines for biliary tract infections lack activity against these organisms. To the best of our knowledge, this is the first study analyzing the predictive factors for enterococcal BT-BSI and deriving a predictive score