Tendinitis aquílea en el anciano

IntroducciónLas quinolonas son un grupo de agentes antibacterianos sintéticos relacionados estructuralmente con el ácido nalidíxico1. Atendiendo al espectro antibacteriano se clasifican en quinolonas no fluoradas o de primera generación (ácidos nalidíxicos, pipemídico y oxolínico), que tienen un espectro limitado y no alcanzan niveles sistémicos eficaces; fluoroquinolonas de segunda generación (ciprofloxacino, norfloxacino, ofloxacino y perfloxacino), con gran potencia frente a gramnegativos incluidas Pseudomonas, y fluoroquinolonas de tercera generación (levofloxacino y moxifloxacino), con actividad frente a microorganismos grampositivoso y gramnegativos y atípicos. Entre las precauciones que se deben tener en cuenta al prescribir este grupo terapéutico están el evitar la exposición solar prolongada por la fototoxicidad que ocasionan y restringir su uso en niños y adolescentes por la afección del cartílago de crecimiento2.Caso clínicoVarón de 74 años que acudió a nuestra consulta al presentar de forma brusca dificultad a la deambulación por dolor en el pie izquierdo de 48 h de evolución que posteriormente se hizo bilateral. No refería ningún sobreesfuerzo físico ni traumatismo directo y no mejoró tras la toma de antiinflamatorios. En la exploración física no se observaba deformidad, hematoma ni inflamación en ambos tobillos, y destacaba el dolor selectivo en ambos tendons aquíleos, así como la limitación de la flexión dorsal del pie. Al repasar la historia clínica se comprobó que se trataba de un paciente alérgico a las penicilinas y asmático en tratamiento habitual con una inhalación cada 12 h de salmeterol 50 μg/fluticasona 250 μg, y que en ocasiones había necesitado pautas de corticoides por vía oral. Había sido tratado hacía 4 días por una reagudización asmática leve secundaria a una bronquitis aguda, para cuyo tratamiento se aconsejó doblar la dosis de los broncodilatodores y añadir moxifloxacino 400mg/24 h/5 días. Ante la sospecha de una reacción adversa medicamentosa secambió la antibioterapia, y desde entonces el paciente notó una mejoría progresiva de su cuadro clínico. El hecho se notificó al Centro de Farmacovigilancia.Discusión y conclusionesLa tendinitis se considera un efecto adverso poco frecuente del grupo de las quinolonas que puede ocasionar rotura del tendón en el 31% de los casos. El tendón de Aquiles es el más afectado y hasta en un 50% de los casos la afección es bilateral3. La sintomatología aparece dentro de las primeras 2 semanas de tratamiento y cede espontáneamente al retirar la medicación, aunque hasta en un 11% de los pacientes puede persistir 2 meses después. Un número importante de pacientes suele ser anciano y/o recibe tratamiento con corticoides4

Nuevos datos sobre la sucesión del "CXG" (Grupo das Beiras) : evidencia sedimentaria del origen glacioderivado de las facies conglomeráticas de la FM. del Cabeço das Popas, en la región de Monfortinho (Portugal Central)

La presencia de "dropstones" en las facies finas laminadas que se intercalan entre los orto y paraconglomerados característicos de la Fm. del Cabeço das opas (CXG: Grupo das Beiras), prueba su origen glacioderivado. La edad véndica media-superior considerada para esta Fm. permite postular la existencia de episodios glaciares postvarangerienses en el Macizo Hespérico

Novel effects of strains in graphene and other two dimensional materials

The analysis of the electronic properties of strained or lattice deformed graphene combines ideas from classical condensed matter physics, soft matter, and geometrical aspects of quantum field theory (QFT) in curved spaces. Recent theoretical and experimental work shows the influence of strains in many properties of graphene not considered before, such as electronic transport, spin-orbit coupling, the formation of Moir\'e patterns, optics, ... There is also significant evidence of anharmonic effects, which can modify the structural properties of graphene. These phenomena are not restricted to graphene, and they are being intensively studied in other two dimensional materials, such as the metallic dichalcogenides. We review here recent developments related to the role of strains in the structural and electronic properties of graphene and other two dimensional compounds.Comment: 75 pages, 15 figures, review articl

Prevalence, characteristics, and impact of adverse events in 34 Madrid hospitals. The ESHMAD study

Introduction: Adverse Events (AE) are one of the main problems in healthcare. Therefore, many policies have been developed worldwide to mitigate their im pact. The Patient Safety Incident Study in Hospitals in the Community of Madrid (ESHMAD) measures the results of them in the region. Methods: Cross-sectional study, conducted in May 2019, in hospitalised patients in 34 public hospitals using the Harvard Medical Practice Study methodology. A logistic regression model was carried out to study the association of the variables with the presence of AE, calibrated and adjusted by patient. Results: A total of 9975 patients were included, estimating a prevalence of AE of 11.9%. A higher risk of AE was observed in patients with surgical procedures (OR[CI95%]: 2.15[1.79 to 2.57], vs. absence), in Intensive Care Units (OR[CI95%]: 1.60[1.17 to 2.17], vs. Medical) and in hospitals of medium complexity (OR[CI95%]: 1.45[1.12 to 1.87], vs. low complexity). A 62.6% of AE increased the length of the stay or it was the cause of admission, and 46.9% of AE were considered prevent able. In 11.5% of patients with AE, they had contributed to their death. Conclusions: The prevalence of AE remains similar to the previously estimated one in studies developed with the same methodology. AE keep leading to longer hospital stays, contributing to patient's death, showing that it is necessary to put focus on patient safety again. A detailed analysis of these events has enabled the detection of specific areas for improvement according to the type of care, centre and patient

Preliminary comparison of magmatic manifestations, calc-alkaline affinity and stephanian-permian age, in the Iberian Chain

[Resumen] En este trabajo se estudian, de forma sintética y actualizada, las manifestaciones (hipovolcánicas y volcanoclásticas) calco-alcalinas que, con carácter epizonal, pluriepisódico y edad Stephaniense-Pérmico, afloran en la Cadena Ibérica. El estudio del magmatismo en la cuenca de Sauquillo de Alcázar (Soria) permite identificar la geometría y la modalidad de este magmatismo con mayor precisi6n, respecto a lo obtenido en los cuatro afloramientos volcano-clásticos seleccionados. Los resultados obtenidos facilitan realizar consideraciones sobre el estudio espacio-temporal de este magmatismo..[Abstract] A synthetic and actualized study of several magmatic calc-alkaline manifestations of Stephanian-Permian age, of the Iberian Chain, is proposed in this papero The Sauquillo de Alcázar (Soria) outcrop allows a more complete study (with drilling logs and a surface profile) giving improved spacetime information on the geometry and evolution of this magmatism. Four pyroclastic outcrops are integrated in this compariso

Neoflavonoids as Inhibitors of HIV-1 Replication by Targeting the Tat and NF-kB Pathways

Twenty-eight neoflavonoids have been prepared and evaluated in vitro against HIV-1. Antiviral activity was assessed on MT-2 cells infected with viral clones carrying the luciferase reporter gene. Inhibition of HIV transcription and Tat function were tested on cells stably transfected with the HIV-LTR and Tat protein. Seven 4-phenylchromen-2-one derivatives showed HIV transcriptional inhibitory activity but only the phenylchrome-2-one 10 inhibited NF- B and displayed anti-Tat activity simultaneously. Compounds 10, 14, and 25, inhibited HIV replication in both targets at concentrations <25 M. The assays of these synthetic 4-phenylchromen-2-ones may aid in the investigation of some aspects of the anti-HIV activity of such compounds and could serve as a scaffold for designing better anti-HIV compounds, which may lead to a potential anti-HIV therapeutic dru

Inappropriate Hospital Admission According to Patient Intrinsic Risk Factors: an Epidemiological Approach

Background: Inappropriate hospital admissions compromise the efficiency of the health care system. This work analyzes, for the first time, the prevalence of inappropriate admission and its association with clinical and epidemiological patient characteristics. Objectives: To estimate the prevalence, associated risk factors, and economic impact of inappropriate hospital admissions. Design and Participants: This was a cross-sectional observational study of all hospitalized patients in a high complexity hospital of over 901 beds capacity in Spain. The prevalence of inappropriate admission and its causes, the association of inappropriateness with patients’ intrinsic risk factors (IRFs), and associated financial costs were analyzed with the Appropriateness Evaluation Protocol in a multivariate model. Main Measures and Key Results: A total of 593 patients were analyzed, and a prevalence of inappropriate admissions of 11.9% (95% CI: 9.5 to 14.9) was found. The highest number of IRFs for developing health care-related complications was associated with inappropriateness, which was more common among patients with 1 IRF (OR [95% CI]: 9.68 [3.6 to 26.2.] versus absence of IRFs) and among those with surgical admissions (OR [95% CI]: 1.89 [1.1 to 3.3] versus medical admissions). The prognosis of terminal disease reduced the risk (OR [95% CI]: 0.28 [0.1 to 0.9] versus a prognosis of full recovery based on baseline condition). Inappropriate admissions were responsible for 559 days of avoidable hospitalization, equivalent to €17,604.6 daily and €139,076.4 in total, mostly attributable to inappropriate emergency admissions (€96,805.3). Conclusions: The prevalence of inappropriate admissions is similar to the incidence found in previous studies and is a useful indicator in monitoring this kind of overuse. Patients with a moderate number of comorbidities were subject to a higher level of inappropriateness. Inappropriate admission had a substantial and avoidable financial impact

Estudio PET-TC con 18F-fluoro-L-DOPA combinado con el análisis genético para la optimización de la clasificación y tratamiento de un niño con hiperinsulinismo congénito grave

Abstract BACKGROUND: Congenital hyperinsulinism (CHI) is the most common cause of persistent hypoglycaemia in infancy. The differential diagnosis between focal and diffuse forms of CHI is of great importance when planning surgery. The aim of this article is to show the first case of focal CHI diagnosed in Spain using PET-CT imaging combined with genetic analysis. METHODS: A 13 month child with CHI and normal conventional radiological investigations treated with diazoxide, diet control and feeding by gastrostomy is presented. Genetic analysis of ABCC8 and KCNJ11 genes and PET-TAC using 18F-fluoro-L-DOPA were performed. RESULTS: A pathological mutation (G111R) in the paternal allele of ABCC8 was detected. PET-CT scanning using 18F-fluoro-L-DOPA showed a focus of high uptake in the body of the pancreas compatible with adenoma that was hystopathologically confirmed. After surgical resection the patient is asymptomatic without needing either pharmacological treatment or dietetic control. CONCLUSIONS: The combination of genetic analysis and 18F-fluoro-L-DOPA PET-TAC shows a great potential for the identification, location and guideline for surgery in CHI