La Enfermedad Research Articles

Between Freud and a Naked Woman: Notes on Sabina Berman’s Dora

In January of 2001, theater-goers in Mexico City were treated to a "scene" worthy of Charcot's notorious séances with hysterics at the Salpêtrière in Paris : on the stage, a young woman called "Dora" is lying naked on an operating table, flanked by two characters called Sigmund Freud and Lou Andreas-Salomé, both of them fully dressed. Mere seconds after the latter announces in an aside to the audience that the doctor has decided to perform a "major surgery" and is preparing his symbolical scalpel to "castrate" his patient: "Si la enfermedad de la mujer independiente es un falo imaginario, hay que cortar el falo." The scene, in which Freud struggles with a woman still boldly talking back at him even though she now finds herself exposed in the utmost vulnerability of her naked body, comes toward the end of Feliz nuevo siglo Doktor Freud, itself a dramatic rewriting of the famous case of Freud's Dora by the Mexican playwright, journalist, producer and psychologist by training, Sabina Berman. Directed by Sandra Félix with a superb stage design by Philippe Amand, the play at the time of its opening featured Ricardo Blume in the role of Sigmund Freud, Marina de Tavira as Dora (also Anna Freud as well as Gloria, described in the stage directions as a 1960s-type feminist, dressed in black and with short hair - I will come back later on to this combination of roles in a single actor, which is the exact opposite of the reduplication of actors for one character that happens in the case of Freud), Juan Carlos Beyer as Freud 2 (also Herr K. and Otto Rank), Enrique Singer as Freud 3 (also Herr F., a railway worker, and Carl Gustav Jung), and Lisa Owen as Lou Andreas Salomé (also Frau K., Martha Freud, Frau F., Dora as adult, and Ernest Jones).

Tau pathology is associated with neuropsychiatric symptoms in a cohort of individuals of predominantly Mexican descent at risk for autosomal‐dominant Alzheimer’s disease

AbstractBackgroundNeuropsychiatric symptoms are common in Alzheimer’s disease (AD), causing significant suffering and diminished quality of life for both individuals and caregivers. The goal of this study was to investigate the relationship between tau pathology in vivo and neuropsychiatric symptoms within a cohort of individuals of predominantly Mexican ancestry at risk for fully penetrant autosomal dominant AD (ADAD) caused by mutations in PSEN1 and APP genes (Figure 1).MethodParticipants from the Estudio de la Enfermedad de Alzheimer en Jalisciences (EEAJ) cohort were selected based on availability of demographic variables, mutation carrier status, tau PET scans (flortaucipir), and completion of the neuropsychiatric inventory (NPI). Linear regression models were used to investigate whether regional tau PET standard uptake value ratio (SUVR) predicted total score on the NPI. Models were adjusted for age, sex, and mutation carrier status. Participants were characterized as carriers if they possessed one of the following ADAD mutations: PSEN1 A431E, PSEN1 I180F, or APP V717I. Analyses were done with and without outliers. The 12‐item total NPI score was used for all analyses. The primary brain regions of interest (i.e., medial orbitofrontal, caudal anterior cingulate, rostral anterior cingulate, parahippocampal, precuneus, and lateral occipital) were selected based on previous findings. Additional analyses were conducted only on individuals who were carriers of 1 of the ADAD mutations.ResultThe sample consisted of 31 participants (45% women, mean age±SD = 37.1±11.7 years, 71% ADAD mutation carriers [81% PSEN1 A431E, 16% PSEN1 I180F, and 3% APP V717I carriers]). A significant relationship was found between regional tau pathology and neuropsychiatric symptoms for all six brain regions (Table 1), all p’s < 0.01. Within all regression models, regional tau pathology explained between 24% to 49% of the variance in neuropsychiatric symptoms. Sub‐set analyses completed on the ADAD mutation carriers sample exhibited similar results (Table 2). No significant results were found for non‐carriers.ConclusionRegional tau pathology within six distinct brain regions is strongly associated with neuropsychiatric symptoms in a cohort of individuals of predominantly Mexican ancestry at risk for fully penetrant ADAD caused by mutations in PSEN1 and APP genes.

Tau pathology is associated with neuropsychiatric symptoms in a cohort of individuals of predominantly Mexican descent at risk for autosomal‐dominant Alzheimer’s disease

AbstractBackgroundNeuropsychiatric symptoms are common in Alzheimer’s disease (AD), causing significant suffering and diminished quality of life for both individuals and caregivers. The goal of this study was to investigate the relationship between tau pathology in vivo and neuropsychiatric symptoms within a cohort of individuals of predominantly Mexican ancestry at risk for fully penetrant autosomal dominant AD (ADAD) caused by mutations in PSEN1 and APP genes (Figure 1).MethodParticipants from the Estudio de la Enfermedad de Alzheimer en Jalisciences (EEAJ) cohort were selected based on availability of demographic variables, mutation carrier status, tau PET scans (flortaucipir), and completion of the neuropsychiatric inventory (NPI). Linear regression models were used to investigate whether regional tau PET standard uptake value ratio (SUVR) predicted total score on the NPI. Models were adjusted for age, sex, and mutation carrier status. Participants were characterized as carriers if they possessed one of the following ADAD mutations: PSEN1 A431E, PSEN1 I180F, or APP V717I. Analyses were done with and without outliers. The 12‐item total NPI score was used for all analyses. The primary brain regions of interest (i.e., medial orbitofrontal, caudal anterior cingulate, rostral anterior cingulate, parahippocampal, precuneus, and lateral occipital) were selected based on previous findings. Additional analyses were conducted only on individuals who were carriers of 1 of the ADAD mutations.ResultThe sample consisted of 31 participants (45% women, mean age±SD = 37.1±11.7 years, 71% ADAD mutation carriers [81% PSEN1 A431E, 16% PSEN1 I180F, and 3% APP V717I carriers]). A significant relationship was found between regional tau pathology and neuropsychiatric symptoms for all six brain regions (Table 1), all p’s < 0.01. Within all regression models, regional tau pathology explained between 24% to 49% of the variance in neuropsychiatric symptoms. Sub‐set analyses completed on the ADAD mutation carriers sample exhibited similar results (Table 2). No significant results were found for non‐carriers.ConclusionRegional tau pathology within six distinct brain regions is strongly associated with neuropsychiatric symptoms in a cohort of individuals of predominantly Mexican ancestry at risk for fully penetrant ADAD caused by mutations in PSEN1 and APP genes.

Cancer-Associated Thrombosis: Trends in Clinical Features, Treatment, and Outcomes From 2001 to 2020

BackgroundDespite advances in cancer and venous thromboembolism (VTE) management, the epidemiology of cancer-associated thrombosis management over time remains unclear. ObjectivesWe analyzed data from the RIETE (Registro Informatizado de la Enfermedad Trombo Embólica) registry spanning 2001 to 2020 to investigate temporal trends in clinical characteristics and treatments for cancer-associated thrombosis. MethodsUsing multivariable survival regression, we examined temporal trends in risk-adjusted rates of symptomatic VTE recurrences, major bleeding, and death within 30 days after incident VTE. ResultsAmong the 17,271 patients with cancer-associated thrombosis, there was a progressive increase in patients presenting with pulmonary embolism (from 44% in 2001-2005 to 55% in 2016-2020; P < 0.001 for trend), lung (from 12.7% to 18.1%; P < 0.001) or pancreatic cancer (from 3.8% to 5.6%; P = 0.003), and utilization of immunotherapy (from 0% to 7.4%; P < 0.001). Conversely, there was a decline in patients with prostate cancer (from 11.7% to 6.6%; P < 0.001) or carcinoma of unknown origin (from 3.5% to 0.7%; P < 0.001). At the 30-day follow-up, a reduction was observed in the proportion of patients experiencing symptomatic VTE recurrences (from 3.1% to 1.1%; P < 0.001), major bleeding (from 3.1% to 2.2%; P = 0.004), and death (from 11.9% to 8.4%; P < 0.001). Multivariable analyses revealed a decreased risk over time for VTE recurrence (adjusted subdistribution HR [asHR]: 0.94 per year; 95% CI: 0.92-0.98), major bleeding (asHR: 0.98; 95% CI: 0.96-0.99), and death (aHR: 0.97; 95% CI: 0.96-0.98). ConclusionsIn this multicenter study of cancer patients with VTE, there was a decline in thrombotic, hemorrhagic, and fatal events from 2001 to 2020. (Registro Informatizado de la Enfermedad Trombo Embólica [RIETE]; NCT02832245)

FMRI Complexity Correlates with Tau-PET and Cognitive Decline in Late-Onset and Autosomal Dominant Alzheimer's Disease.

Neurofibrillary tangle pathology detected with tau-PET correlates closely with neuronal injury and cognitive symptoms in Alzheimer's disease (AD). Complexity of rs-fMRI has been demonstrated to decrease with cognitive decline in AD. We hypothesize that the rs-fMRI complexity provides an index for tau-related neuronal injury and cognitive decline in the AD process. Data was obtained from the Alzheimer's Disease Neuroimaging Initiative (ADNI3) and the Estudio de la Enfermedad de Alzheimer en Jalisciences (EEAJ) study. Associations between tau-PET and rs-fMRI complexity were calculated. Potential pathways relating complexity to cognitive function mediated through tau-PET were assessed by path analysis. We found significant negative correlations between rs-fMRI complexity and tau-PET in medial temporal lobe of both cohorts, and associations of rs-fMRI complexity with cognitive scores were mediated through tau-PET. The association of rs-fMRI complexity with tau-PET and cognition, suggests that a reduction in complexity is indicative of tau-related neuropathology and cognitive decline in AD processes.

Safety of the Pulmonary Embolism Rule-Out Criteria Rule: Findings from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) Registry.

The diagnostic strategy for pulmonary embolism (PE) includes a D-dimer test when PE probability is low or intermediate, but false positive D-dimer results are frequent and can result in an unnecessary computed tomography pulmonary angiogram. The PE rule-out criteria (PERC) rule excludes PE without D-dimer testing when pre-test probability is <15%. The aim of this study was to assess the safety of the PERC rule strategy in patients included in the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) registry. This retrospective cohort study used data from the RIETE registry, an ongoing, international prospective registry of patients with objectively confirmed venous thromboembolism. The primary outcome was the failure rate of the PERC strategy, represented by the proportion of PERC-negative (PERC-N) patients with a PE included in the registry. Secondary outcomes were a comparison of the clinical characteristics, treatment strategy, and outcome of PERC-N versus PERC-positive (PERC-P) patients at 3 months. From 2001 to 2021, 49,793 patients with acute PE were enrolled in the RIETE registry. We included 48,903 in the final analysis after exclusion of 890 patients with an undetermined PERC status. Only 346 patients were PERC-N with a failure rate of 0.7% (95% confidence interval 0.6-0.8%). PERC-N patients presented more frequently with chest pain, but less often with dyspnea, syncope or hypotension. They had also sub-segmental or segmental PE more frequently, were more often treated with direct oral anticoagulants, and received mechanical or pharmacological thrombolysis less often. In addition, PERC-N patients had a lower incidence of recurrent deep vein thrombosis, major bleeding, and death attributed to PE during the 3-month follow-up. A low failure rate of the PERC rule was observed in the RIETE registry, thus supporting its use to safely identify patients with an unlikely probability of PE.

Cognitive decline in Autosomal Dominant Alzheimer’s Disease and its relation to TauPET and fMRI Complexity in the Hippocampus

AbstractBackgroundIn recent years the neurofibrillary tangle pathology detected with tauPET imaging has been found to be closely related to cognitive decline in Alzheimer’s Disease. However, PET scans are expensive and involve radioactive tracers. We and others have proposed the complexity of rs‐fMRI using MultiScaleEntropy (MSE) as an index for neuronal function. Reduced entropy values have been associated with aging, APOEɛ4 genotype and cognitive function in AD. Here we hypothesize that the BOLD signal complexity is sensitive to tau‐related neuronal injury and cognitive decline in AD.MethodData (N=44, Table1) was obtained from the Estudio de la Enfermedad de Alzheimer en Jalisciences (EEAJ) study, which examines persons at‐risk for autosomal‐dominant AD. All subjects had T1, tauPET (18F‐AV1451) and two resting‐state fMRI scans. FMRI data underwent standard preprocessing before computing MSE. SUVR images were calculated with inferior cerebellum as reference region. Correlations between SUVR tauPET and MSE were calculated voxel‐wise including age, gender and gray ‐matter volume as covariates. Mediation effects in hippocampal clusters between MSE, tauPET and cognitive function (MMSE) were tested in SAS (95% confidence‐interval was estimated with 1000 bootstrapping samples).ResultWe observed gradually decreasing entropy and gradually increasing tauPET from NC to MCI and AD (Fig1). This inverse relationship was significant (p&lt;0.05,corrected) in hippocampus, lateral temporal lobe and anterior cingulate cortex (Fig2). Mediator analysis revealed significant indirect (mediation) effects of PET to the association between MSE and MMSE (log‐transformed) in both hippocampi: Left: total 1.37 95%CI (0.6,2.14) indirect 0.86(0.27,1.85) and Right: total 1.49(0.66,2.31) indirect 1.04(0.48,1.84).ConclusionOur findings show that there is a statistically significant total effect between MSE and cognitive decline that is largely mediated by tauPET, with 63% and 70% of total effect for right and left hippocampus respectively. These results support the relevance of hippocampal tauopathy on cognitive decline. Moreover, complexity of rs‐fMRI is associated with both regional tau protein accumulation and cognitive decline, and thus could provide a safe and cost‐effective alternative marker for regional neuropathology and prediction of cognitive decline in AD.

Chagas disease in northern Chile: Detection of Trypanosoma cruzi in children, dogs and triatomine bugs

Chagas disease is an anthropozoonotic disease caused by the protozoan Trypanosoma cruzi, transmitted by triatomine vectors. In Chile, there are four species of triatomine bugs that are potential vectors of T. cruzi, being Triatoma infestans the main vector in endemic areas of the country. The “Programa Nacional de Control Vectorial de la Enfermedad de Chagas de Chile” has significantly reduced the rates of home infestation to less than 1% and has interrupted vectorial transmission since 1999. The objective of this study was to evaluate the impact of vectorial control and the continuity of the interruption of vectorial transmission in northern Chile (provincia de El Loa, región de Antofagasta). The study comprised fingerstick blood samples of 2104 children, attending local school, venous blood samples of 65 dogs, associated to houses with T. infestans unique findings and vector infestation, and intestine samples of 284 T. infestans specimens, from the provincia de El Loa, during 2014–2016 period. The samples were analyzed by enzyme-linked immunosorbent assay (ELISA), indirect immunofluorescence and/or polymerase chain reaction (PCR) techniques. A total of 5 children (0.24%), 7 dogs (10.8%), and 6 specimens of T. infestans (2.1%) resulted positive to T. cruzi infection. This study showed that the risk of transmission of Chagas disease is low in the north of Chile (provincia de El Loa), detected a low positive rate of chagasic children and of infected triatomine bugs, and showed the existence of T. cruzi transmission in dogs, which are used as natural sentinels for the detection of T. cruzi infection, being especially useful during surveillance program in human population characterized by low seroprevalence.

Thrombosis risk and in vitro fertilization

Assisted reproductive technologies (ART) have been progressively recognized as a widely applied means to fight against infertility. Women after ART were shown to have higher risk of developing venous thromboembolism (VTE) that might be related to using some drugs, particularly gonadotropins. VTE risk emerges at relatively early time points after ovulation induction being sustained virtually until pregnancy is complete. According to the multi-center RIETE Registry (Spanish, Registro Informatizado de la Enfermedad TromboEmbolica), a risk of developing isolated pulmonary embolism (PE) is elevated in women after ART compared to those receiving hormonal contraceptives as well as women having spontaneous pregnancy. Low-molecular-weight heparins (LMWH) are justified to be used as a preventive means. However, commonly recommended preventive LMWH dose in such patient cohort may not always be sufficient. On the other hand, escalating dose for some LMWH results in increased rate of developing hemorrhages. Hence, it is important to take into consideration what exact type of LMWH as well as its dose and duration of therapy should be prescribed to women after ART that requires to be further investigated.

Long-read single molecule real-time (SMRT) sequencing of GBA1 locus in Gaucher disease national cohort from Argentina reveals high frequency of complex allele underlying severe skeletal phenotypes: Collaborative study from the Argentine Group for Diagnosis and Treatment of Gaucher Disease

Gaucher disease is renowned for extreme phenotypic diversity that does not show consistent genotype/phenotype correlations. In Argentina, a national collaborative group, Grupo Argentino de Diagnóstico y Tratamiento de la Enfermedad de Gaucher, GADTEG, delineated uniformly severe type 1 Gaucher disease manifestations presenting in childhood with large burden of irreversible skeletal disease. Here using Long-Read Single Molecule Real-Time (SMRT) Sequencing of GBA1 locus, we show that the RecNciI allele is highly prevalent and it is associated with severe skeletal manifestations with onset in childhood or in young adults. Additionally, we described novel GBA1 variants not previously described.

Bronquiectasias: la enfermedad que nunca fue huérfana

Bronquiectasias: la enfermedad que nunca fue huérfana

Heart Rate and Mortality in Patients With Acute Symptomatic Pulmonary Embolism

The association between heart rate (HR) and pulmonary embolism (PE) outcomes has not been well studied. Furthermore, optimal cutoffs to identify low-risk and intermediate- to high-risk patients are not well known. Does an association exist between baseline HR and PE outcome across the continuum of HR values? The current study included 44,331 consecutive nonhypotensive patients with symptomatic PE from the Registro Informatizado de la Enfermedad TromboEmbólica registry between 2001 and 2021. Outcomes included 30-day all-cause and PE-specific mortality. We used hierarchical logistic regression to assess the association between admission HR and outcomes. A positive relationship was found between admission HR and 30-day all-cause and PE-related mortality. Considering an HR of 80 to 99 beats/min as a reference, patients in the higher HR strata showed higher rates of all-cause death (adjusted OR, 1.5 for HR of 100-109 beats/min; adjusted OR, 1.7 for HR of 110-119 beats/min; adjusted OR, 1.9 for HR of 120-139 beats/min; and adjusted OR, 2.4 for HR of≥ 140 beats/min). Patients in the lower strata of HR showed significantly lower rates of 30-day all-cause mortality compared with the same reference group (adjusted OR, 0.6 for HR of 60-79 beats/min; and adjusted OR, 0.5 for HR of< 60 beats/min). The findings for 30-day PE-related mortality were similar. For identification of low-risk patients, a cutoff value of 80 beats/min (vs 110 beats/min) increased the sensitivity of the simplified Pulmonary Embolism Severity Index (sPESI) from 93.4%to 98.8%. For identification of intermediate- to high-risk patients, a cutoff value of 140 beats/min (vs 110 beats/min) increased the specificity of the Bova score from 93.2%to 98.0%. In nonhypotensive patients with acute symptomatic PE, a high HR portends an increased risk of all-cause and PE-related mortality. Modifying the HR cutoff in the sPESI and the Bova score improves prognostication of patients with PE.

Influence Of Genetic Variability Related To Bone Remodeling and Cytokine Profile In The Development Of Bone Involvement In Gaucher Disease

IntroductionBone disease (BD) is one of the most debilitating and disabling complication of Gaucher disease (GD), leading to bone marrow infiltration by Gaucher cells, failure of remodelling, skeletal changes including osteolysis, osteopenia and intraosseous vascular complications. The most important factor involved in bone remodeling is the genetic component, which may explain between 60% and 80% of bone mass variability. In addition, Gaucher cells activate and induce proinflammatory cytokines synthesis that can modify the activity of osteoblast-osteoclast system and promote lytic phenomena. AimTo analyze the genetic variability in genes related to bone remodeling and to identify the cytokine profile in GD1 patients associated with BD in order to characterize bone markers in GD that can predict the degree of BD. MethodsA total of 18 polymorphisms located in 8 genes (COL1A: -1997,-1663, 1245; ESR1: PvuII, XbaI;(TA)n; VDR: FokI BsmI, ApaI, TaqI, -1012, -1521; BMP4: 6007; ClCN7: V418M; IL6R: -208, D358A; OPG: 950, -1181; OPN: -156) were analyzed by RFLP and DNA sequencing. Furthermore a panel of cytokines: IL4, IL6, IL7, IL10, IL13, MIP1α, MIP1β and TNFα were analyzed in plasma samples by Luminex®100 platform and Millipore cytokine kits. BD was evaluated by X-ray in a group of 83 GD1 patients. Of them 30 presented BD (females 42.5%, mean age: 40 year; range: 20-67). Data were analyzed using Kolmogorov-Smirnov analysis, t-test or Mann-Whitney-U-test, one-Way ANOVA or Kruskall-Wallis test and correlations using the Spearman correlation. ResultsSignificant differences were observed among VDR TaqI genotypes of normal and bone affected patients (p<0.05) and in MIP-1α concentration between affected and non-affected patients. Significant positive correlations were found in non-BD group between IL10/ IL13/IL4/IL6/IL7; MIP1α/MIP1β/IL6/IL7 and in bone affected group between IL10/IL4/IL7/TNFα and IL6/IL13. ConclusionsThese data suggest that the VDR TaqI genotype and MIP-1α concentration have a predictive value in GD bone involvement. Moreover the different correlations between cytokines in the different groups could indicate different bone signal activation pathways.This work was partially financed by a grant from Genzyme a Sanofi Company and Fundación Española para el Estudio y Terapeutica de la Enfermedad de Gaucher (FEETEG) y otras lisosomales. Disclosures:No relevant conflicts of interest to declare.

Advances in our understanding of canine atopic dermatitis.

Canine atopic dermatitis (cAD) is a genetically inherited clinical syndrome that encompasses a diversity of mechanisms and can have a variety of triggers. Development of clinical disease is the result of genetic factors and environmental conditions, which shape the resulting immunological response. Clinical disease becomes evident once a threshold of inflammatory response is achieved. Skin barrier impairment plays a role in promoting cutaneous dysbiosis and increased allergen penetration. Keratinocytes shape the response of dendritic cells and subsequent lymphocytic response. Thymic stromal lymphopoietin is one of the links between the damaged skin barrier and the modulation of a T-helper (Th)2 response. It is still unclear whether mutations in skin barrier genes exist in atopic dogs, as they do in humans, or whether the observed alterations are purely secondary to inflammation. A dysregulated immune response with increased Th2, Th17 and CD4+ CD25+ regulatory T cells has been reported. A variety of cytokines [interleukin(IL)-31, IL-34, Macrophage migration inhibitory factor] are proposed as potential biomarkers and treatment targets because they are increased in the serum of atopic dogs when compared to controls, although a correlation between serum levels of these factors and severity of disease is not always present. The main issue with many published studies is that atopic dogs are always only compared to normal controls. Thus, it is unclear whether the changes that we find are truly a signature of cAD or merely a manifestation of nonspecific broad inflammatory responses. Studies considering comparison with other inflammatory diseases different from cAD are urgently needed to correctly identify what is specific to this complicated syndrome.

Literatura y medicina: Teoría y praxis (1800–1930) ed. by Jorge Avilés Diz y José Manuel Goñi Pérez

Reviewed by: Literatura y medicina: Teoría y praxis (1800–1930) ed. by Jorge Avilés Diz y José Manuel Goñi Pérez John Margenot Avilés Diz, Jorge, y José Manuel Goñi Pérez, editores. Literatura y medicina: Teoría y praxis (1800–1930). Vol. 1, Ediciones de la Torre, 2019. Pp. 302 pp. ISBN 978-8-47960-830-9. This engaging collection of ten interdisciplinary essays by specialists of nineteenth- and early twentieth-century thinkers, writers, and artists provides a wealth of information on the ways in which scientific breakthroughs in the medical world—particularly those related to infectious diseases, mental illness and hygiene—shape the cultural production of the period. The editors argue in their introduction that artistic creation—theatre, novel, short story, essay, travel fiction and painting—serves as a forum to express fundamental concerns, fears and uncertainties related to continuous, and often controversial, discoveries in medicine. Avilés Diz and Goñi Pérez argue that the arts, particularly literature, function as the ideal medium to debate matters such as the conflict between past and present, tradition versus evolution and the historically uneasy relationship between science and religion. While various essays deal with easily recognized figures—Clarín, Galdós, and Larra—others focus on the work of lesser-known journalists, writers and doctors—Rosario de Acuña, Manuel de Tolosa Latour and Sabino Arana, to name a few—thus underscoring the editors’ contention that developments in medicine throughout the nineteenth century have a widespread impact on the arts. In the opening study, “‘¿Qué le duele?’ Representaciones de la medicina en la pintura del siglo XIX,” Esther Sánchez-Couto scrutinizes how medical developments—vaccinations, the creation of asylums, experimental laboratories and the introduction of autopsies—as well as the “professionalization” of the doctor, appear throughout the paintings of Goya, Sorolla, Borrás Abellá and Simonet Lombardo, among others. She shows how numerous scientific developments compel these artists to capture this new reality in original and concrete fashion. Monserrat Escartín Gual’s “La relación de Larra con la medicina y la enfermedad” adeptly explores the writer’s contact with the medical world as seen through terminology in his newspaper articles and his frequent bouts with depression. Most importantly, the fragmentation of Larra’s personality into Fígaro highlights attempts to alleviate his depression through the use of the word. As such, writing is not simply a profession but a therapeutic necessity for Larra. José Avilés Diz’s thoughtful essay, “¿Simila similibus curentur? Teatro y homeopatía en la España del siglo XIX,” explores the intense and often acrimonious nineteenth-century debate surrounding homeopathy and allopathy. He argues that theater serves as a forum for scientific discussion as well as an [End Page 120] indicator of social opinion on the value of homeopathy as a medical system especially when compared to traditional medicine. Works discussed include Juan Peral y Richart’s Una cura por homeopatía, Calixto Boldún’s Simila similibus curantur, o un clavo saca a otro clavo and Luis Martínez’s Homeopáticamente, among others. Solange Hibbs-Lissorgues focuses on hygiene in “‘La higiene es una religión humana . . . ’: regeneración, salud e higiene en España en el siglo XIX,” with emphasis on the work of Rosario de Acuña who tirelessly labored to eradicate irregularities in hygiene throughout the country, especially its rural areas. This activist and writer battled continuously against the religious fanaticism and superstition that impeded scientific development. From another perspective, José Manuel Goñi Pérez scrutinizes how doctors used travel fiction to convey medical ideas and to dissert on the state of medicine in Spain. In “Medicina, instrucción y regeneración: los relatos de viaje de Calatraveño y Valladares (1898) y Tolosa Latour (1908),” Goñi Pérez argues that the hybridism which characterizes the travel genre permits both writers to straddle the line between diversion and socio-scientific information. Margot Versteeg’s fine study, “No Place for Us: Stigmatization and Exclusion in ‘Duo de la tos’ by Leopoldo Alas (Clarín),” probes the author’s metaphorical critique of the nation-state’s inability to create an all...

Prognostic Impact of Obstructive Sleep Apnea in Patients Presenting with Acute Symptomatic Pulmonary Embolism

In patients with pulmonary embolism (PE), there is a lack of comprehensive data on the prevalence and prognostic significance of pre-existing obstructive sleep apnea (OSA). In this study of patients with PE from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) registry, we assessed the prevalence of OSA, and the association between pre-existing OSA and the outcomes of all-cause mortality, PE-related mortality, recurrences, and major bleeding over 30 days after initiation of PE treatment. Additionally, we also examined rates of outcomes within 90 days and 1 year following the diagnosis of PE. Of 4,153 patients diagnosed with PE, 241 (5.8%; 95% confidence interval [CI]: 5.1-6.6%) had pre-existing OSA. Overall, 166 (4.0%; 95% CI: 3.4-4.6%) died during the first 30 days of follow-up. In multivariable analysis, the OSA syndrome was not a significant predictor of death from any cause (odds ratio [OR]: 1.5; 95% CI: 0.8-2.9; p = 0.19). However, patients with pre-existing OSA had an increased PE-specific mortality (adjusted OR: 3.0; 95% CI: 1.3-6.8; p = 0.01) compared with those without OSA. OSA was not significantly associated with 30-day recurrent venous thromboembolism (adjusted OR: 0.6; 95% CI: 0.1-4.7; p = 0.65) or major bleeds (adjusted OR: 1.0; 95% CI: 0.4-2.2; p = 1.0). Findings were similar at 90-day and 1-year follow-ups. In patients presenting with PE, pre-existing OSA is relatively infrequent. Patients with OSA were at increased risk of PE-related mortality when compared with those without OSA.

Inflammatory responses, energy metabolism enzymes, oxidative status in Clostridium perfringens infection in broilers

The aim of this study was to determine whether infection by Clostridium perfringens negatively interferes with the oxidant/antioxidant status and activity of energy metabolism enzymes (creatine kinase (CK), adenylate kinase (AK) and pyruvate kinase (PK)), as well as the zootechnical performance of broilers. A completely randomized design with three treatments, with five replications by treatment, and 10 birds by repetitions was used: T1: non-infected group; T2: group infected with C. perfringens; T3: group infected with C. perfringens, and basal diet with performance enhancers (antibiotic and coccidiostatic). At 21 days of age, the birds were experimentally infected orally with 4.0 x 108 CFU/mL C. perfringens. At strategic moments during the experimental period, zootechnical data and blood samples were collected. There were no significant differences among treatments in terms of weight gain, feed intake, or feed conversion. At 20 days, heterophils counts were significantly lower in the T3 group birds than in the others. A significant reduction in the number of total leukocytes, because of the lower number of lymphocytes, was observed in groups T2 and T3 on day 34. Neutrophil and monocyte counts were significantly lower in group T3 than in group T1 on day 34. On day 42, there were significantly lower levels of total protein and globulin in birds in T3 than in T1. On day 27, PK activity was significantly higher in groups T2 and T3; similar behavior observed on day 34 when CK and PK activities in T2 and T3 were significantly higher than those of T1. AK activity was significantly higher in the serum of T3 birds than in those of the other groups at 34 days. At 41 days, CK and PK activities were significantly higher only in birds in group T3 compared to other groups. The levels of reactive oxygen species and lipoperoxidation, as well as the activity of glutathione S-transferase, were significantly lower in birds from group T3 compared to other groups at age 20 days. After a challenge with C. perfringens, there were fluctuations in the behavior of oxidative stress biomarkers; in particular, at 41 days of age, birds in T2 had elevated levels of lipoperoxidation, different from what was seen in birds in T3 that consumed feed with a performance enhancer. Preliminary results suggest that clostridiosis affects serum activity of enzymes in the phosphotransfer network, requiring compensatory enzymatic changes in an attempt to maintain energy homeostasis. In addition, the infection reduces the number of inflammatory cells and causes oxidant/antioxidant imbalance that may contribute to the pathophysiology of the disease. Además, la infección reduce el número de células inflamatorias y provoca un desequilibrio en el estado oxidante / antioxidante que puede contribuir a la fisiopatología de la enfermedad.

Reality of Hypertensive Patients from the Uruguay River Coast Assisted by Specialists in Cardiology (Río Uruguay Registry I)

espanolAntecedentes: La hipertension (HTN) es uno de los principales factores que aumentan la carga de la enfermedad aterosclerotica.Objetivo: Analizar las caracteristicas, el tratamiento y el grado de control en pacientes (p) atendidos por cardiologos.Metodo: Se realizo un estudio transversal en 13 consultorios de cardiologia.Resultados: Se enrolaron 519p en 3 meses, hombres 44.9%, edad 61.5 anos, tiempo HTN 11.2 anos, enfermedad cardiovascular (ECV) 24%, BP promedio 133/ 79.8 mmHg. Entre los pacientes sin ECV el 73% tenian riesgo bajo ( EnglishBackground: Hypertension is one of the main factors that increase the “burden” of atherosclerotic disease.Objective: The aim of this study was to analyze the characteristics, treatment and degree of control in patients treated bycardiologists in our area of influence.Material and methods: A cross-sectional study was carried out in 13 cardiology offices analyzing hypertensive patients’ clinicalcharacteristics, blood pressure and pharmacological treatment.Results: A total of 519 patients with the following characteristics were enrolled during a 3-month period: 44.9% were men,mean age was 61.5 years, the spell of hypertension was 11.2 years, 24% of patients had cardiovascular disease and mean bloodpressure was 133/79.8 mmHg. Among patients without cardiovascular disease, 73% had low cardiovascular risk (

Año 2001: asociación entre la susceptibilidad a la enfermedad de Crohn y las variaciones de LRR

Año 2001: asociación entre la susceptibilidad a la enfermedad de Crohn y las variaciones de LRR

Año 2005: clasificación clínica, serológica y molecular de la enfermedad inflamatoria intestinal

Año 2005: clasificación clínica, serológica y molecular de la enfermedad inflamatoria intestinal