Guidelines for enhanced recovery after cardiac surgery. Consensus document of Spanish Societies of Anesthesia (SEDAR), Cardiovascular Surgery (SECCE) and Perfusionists (AEP)

The ERAS guidelines are intended to identify, disseminate and promote the implementation of the best, scientific evidence-based actions to decrease variability in clinical practice. The implementation of these practices in the global clinical process will promote better outcomes and the shortening of hospital and critical care unit stays, thereby resulting in a reduction in costs and in greater efficiency. After completing a systematic review at each of the points of the perioperative process in cardiac surgery, recommendations have been developed based on the best scientific evidence currently available with the consensus of the scientific societies involved.

A Community Program of Integrated Care for Frail Older Adults: +AGIL Barcelona

OBJECTIVES

To assess the 3-month impact on physical function of a program for community-dwelling frail older adults, based on the integration of primary care, geriatric medicine, and community resources, implemented in "real life".

DESIGN

Interventional cohort study.

SETTING

Primary care in Barcelona, Spain.

PARTICIPANTS

Individuals aged ≥80 years (n=134), presenting at least one sign of frailty (i.e., slow gait speed, weakness, memory complaints, involuntary weight loss, poor social support).

INTERVENTION

After frailty screening by the primary care team, candidates were referred to a geriatric team (geriatrician + physical therapist), who performed a comprehensive geriatric assessment and designed a tailored multidisciplinary intervention in the community, including a) multi-modal physical activity (PA) sessions, b) promotion of adherence to a Mediterranean diet c) health education and d) medication review.

MEASUREMENTS

Participants were assessed based on a comprehensive geriatric assessment including physical performance (Short Physical Performance Battery -SPPB- and gait speed), at baseline and at a three month follow-up.

RESULTS

A total of 112 (83.6%) participants (mean age=80.8 years, 67.9% women) were included in this research. Despite being independent in daily life, participants' physical performance was impaired (SPPB=7.5, SD=2.1, gait speed=0.71, SD=0.20 m/sec). After three months, 90.2% of participants completed ≥7.5 physical activity sessions. The mean improvements were +1.47 (SD 1.64) points (p<0.001) for SPPB, +0.08 (SD 0.13) m/sec (p<0.001) for gait speed, -5.5 (SD 12.10) sec (p<0.001) for chair stand test, and 53% (p<0.001) improved their balance. Results remained substantially unchanged after stratifying the analyses according to the severity of frailty.

CONCLUSIONS

Our results suggested that a "real-world" multidisciplinary intervention, integrating primary care, geriatric care, and community services may improve physical function, a marker of frailty, within 3 months. Further studies are needed to address the long-term impact and scalability of this implementation program.

Correlations between plasma and PET beta-amyloid levels in individuals with subjective cognitive decline: the Fundació ACE Healthy Brain Initiative (FACEHBI)

BACKGROUND

Peripheral biomarkers that identify individuals at risk of developing Alzheimer's disease (AD) or predicting high amyloid beta (Aβ) brain burden would be highly valuable. To facilitate clinical trials of disease-modifying therapies, plasma concentrations of Aβ species are good candidates for peripheral AD biomarkers, but studies to date have generated conflicting results.

METHODS

The Fundació ACE Healthy Brain Initiative (FACEHBI) study uses a convenience sample of 200 individuals diagnosed with subjective cognitive decline (SCD) at the Fundació ACE (Barcelona, Spain) who underwent amyloid florbetaben(18F) (FBB) positron emission tomography (PET) brain imaging. Baseline plasma samples from FACEHBI subjects (aged 65.9 ± 7.2 years) were analyzed using the ABtest (Araclon Biotech). This test directly determines the free plasma (FP) and total plasma (TP) levels of Aβ40 and Aβ42 peptides. The association between Aβ40 and Aβ42 plasma levels and FBB-PET global standardized uptake value ratio (SUVR) was determined using correlations and linear regression-based methods. The effect of the APOE genotype on plasma Aβ levels and FBB-PET was also assessed. Finally, various models including different combinations of demographics, genetics, and Aβ plasma levels were constructed using logistic regression and area under the receiver operating characteristic curve (AUROC) analyses to evaluate their ability for discriminating which subjects presented brain amyloidosis.

RESULTS

FBB-PET global SUVR correlated weakly but significantly with Aβ42/40 plasma ratios. For TP42/40, this observation persisted after controlling for age and APOE ε4 allele carrier status (R2 = 0.193, p = 1.01E-09). The ROC curve demonstrated that plasma Aβ measurements are not superior to APOE and age in combination in predicting brain amyloidosis. It is noteworthy that using a simple preselection tool (the TP42/40 ratio with an empirical cut-off value of 0.08) optimizes the sensitivity and reduces the number of individuals subjected to Aβ FBB-PET scanners to 52.8%. No significant dependency was observed between APOE genotype and plasma Aβ measurements (p value for interaction = 0.105).

CONCLUSION

Brain and plasma Aβ levels are partially correlated in individuals diagnosed with SCD. Aβ plasma measurements, particularly the TP42/40 ratio, could generate a new recruitment strategy independent of the APOE genotype that would improve identification of SCD subjects with brain amyloidosis and reduce the rate of screening failures in preclinical AD studies. Independent replication of these findings is warranted.

SNF472, a novel inhibitor of vascular calcification, could be administered during hemodialysis to attain potentially therapeutic phytate levels

BACKGROUND

Cardiovascular calcification (CVC) is a major concern in hemodialysis (HD) and the loss of endogenous modulators of calcification seems involved in the process. Phytate is an endogenous crystallization inhibitor and its low molecular mass and high water solubility make it potentially dialyzable. SNF472 (the hexasodium salt of phytate) is being developed for the treatment of calciphylaxis and CVC in HD patients. We aimed to verify if phytate is lost during dialysis, and evaluate SNF472's behaviour during dialysis.

METHODS

Dialyzability was assessed in vitro using online-hemodiafiltration and high-flux HD systems in blood and saline. SNF472 was infused for 20 min and quantified at different time points.

RESULTS

Phytate completely dialyzed in 1 h at low concentrations (10 mg/l) but not when added at 30 or 66.67 mg/l SNF472. In bypass conditions, calcium was slightly chelated during SNF472 infusion but when the system was switched to dialysis mode the calcium in the bath compensated this chelation.

CONCLUSION

Phytate dialyses with a low clearance. The administration of SNF472 as an exogenous source of phytate allows to attain supra-physiological levels required for its potential therapeutic properties. As SNF472 is infused during the whole dialysis session, the low clearance would not affect the drug's systemic exposure.

Consensus guidelines for diagnosis, treatment and follow-up of patients with pancreatic cancer in Spain

The management of patients with pancreatic cancer has advanced over the last few years. We convey a multidisciplinary group of experts in an attempt to stablish practical guidelines for the diagnoses, staging and management of these patients. This paper summarizes the main conclusions of the working group. Patients with suspected pancreatic ductal adenocarcinoma should be rapidly evaluated and referred to high-volume centers. Multidisciplinary supervision is critical for proper diagnoses, staging and to frame a treatment plan. Surgical resection together with chemotherapy offers the highest chance for cure in early stage disease. Patients with advanced disease should be classified in treatment groups to guide systemic treatment. New chemotherapeutic regimens have resulted in improved survival. Symptomatic management is critical in this disease. Enrollment in a clinical trial is, in general, recommended.

Development of simplified sampling methods for behavioural data in rabbit does

<p>The aim of this study was to compare the results of different simplified sampling methods for behavioural data compared to reference records of 24-h in order to assess rabbit doe behaviours at different physiological stages (gestation and lactation) in animals housed in 2 types of cages (conventional and alternative). In total, we analysed 576 h of continuous video of 12 rabbit does at the end of lactation and the same females after weaning. The behavioural observations were studied using 3 independent categories of classification (location in the cage, posture and functional behaviours). Continuous behavioural recordings of 24 h were considered as the reference method to validate another 4 data collection sampling methods by aggregated video recordings of different frequency and duration [regular short and long methods with 2.4 and 8 h of observation respectively, and irregular (more frequent during the active period) short and long methods with 6 and 8 h of observation, respectively]. The current results showed that, independently of the housing system, the best method to reduce the total observation time required to assess rabbit does’ behaviour depends on the trait studied and physiological stage of the does. In gestating does, irregular methods were not suitable to estimate behaviours of long duration such as lying, sitting, resting and grooming. However, in both physiological stages, regular methods were accurate for location behaviours, postures and functional behaviours of long duration. Instead, for the study of infrequent behaviours performed mainly during dark period, where coefficients of variation were high, the irregular long method led to the lowest mean estimation errors.</p>

Procedures and recommended times in the care process of the patient with pancreatic cancer: PAN-TIME consensus between scientific societies

PURPOSE

Pancreatic cancer (PC) is a disease with bad prognosis. It is usually diagnosed at advanced stages and its treatment is complex. The aim of this consensus document was to provide recommendations by experts that would ameliorate PC diagnosis, reduce the time to treatment, and optimize PC management by interdisciplinary teams.

METHODS

As a consensus method, we followed the modified Delphi methodology. A scientific committee of experts provided 40 statements that were submitted in two rounds to a panel of 87 specialists of 12 scientific societies.

RESULTS

Agreement was reached for 39 of the 40 proposed statements (97.5%).

CONCLUSIONS

Although a screening of the asymptomatic population is not a feasible option, special attention to potential symptoms during primary care could ameliorate early diagnostic. It is especially important to decrease the period until diagnostic tests are performed. This consensus could improve survival in PC patients by decreasing the time to diagnose and time to treatment and by the implementation of multidisciplinary teams.

Assessment of African Swine Fever Diagnostic Techniques as a Response to the Epidemic Outbreaks in Eastern European Union Countries: How To Improve Surveillance and Control Programs

This study represents a complete comparative analysis of the most widely used African swine fever (ASF) diagnostic techniques in the European Union (EU) using field and experimental samples from animals infected with genotype II ASF virus (ASFV) isolates circulating in Europe. To detect ASFV, three different PCRs were evaluated in parallel using 785 field and experimental samples. The results showed almost perfect agreement between the Universal ProbeLibrary (UPL-PCR) and the real-time (κ = 0.94 [95% confidence interval {CI}, 0.91 to 0.97]) and conventional (κ = 0.88 [95% CI, 0.83 to 0.92]) World Organisation for Animal Health (OIE)-prescribed PCRs. The UPL-PCR had greater diagnostic sensitivity for detecting survivors and allows earlier detection of the disease. Compared to the commercial antigen enzyme-linked immunosorbent assay (ELISA), good-to-moderate agreement (κ = 0.67 [95% CI, 0.58 to 0.76]) was obtained, with a sensitivity of 77.2% in the commercial test. For ASF antibody detection, five serological methods were tested, including three commercial ELISAs, the OIE-ELISA, and the confirmatory immunoperoxidase test (IPT). Greater sensitivity was obtained with the IPT than with the ELISAs, since the IPT was able to detect ASF antibodies at an earlier point in the serological response, when few antibodies are present. The analysis of the exudate tissues from dead wild boars showed that IPT might be a useful serological tool for determining whether or not animals had been exposed to virus infection, regardless of whether antibodies were present. In conclusion, the UPL-PCR in combination with the IPT was the most trustworthy method for detecting ASF during the epidemic outbreaks affecting EU countries in 2014. The use of the most appropriate diagnostic tools is critical when implementing effective control programs.

Atrial Fibrillation and Stroke Risk After Coronary Artery Bypass Grafting Surgery

Background: The present multicentre study was aimed at determining the effect of preoperative atrial fibrillation (preop-AF) as stroke risk factor in coronary artery bypass graft surgery (CABG) during the perioperative period. Methods: Patients undergoing isolated CABG surgery were enrolled from 21 Spanish centers. Baseline variables related with perioperative stroke risk were recorded and analysed. The Northern New England Cardiovascular Disease Study Group (NNECVDSG) stroke risk schema was used to stratify stroke risk and compare predicted vs observed neurologic outcomes in this study. Results: 26347 patients were enrolled in the study. Prevalence of preop-AF was 4.2%, and was associated significantly with major cardiovascular comorbidities. The stroke rate was 1.38% (365 strokes), and it was slightly higher for patients with preop-AF vs non preop-AF, 1.82% vs 1.36%, p = 0.2. NNECVDSG schema showed good predictive ability calculating the area under the receiver operating characteristic curve (c-statistic 0.696; 95% CI 0.668 to 0.723). To investigate the associations of baseline preoperative variables with perioperative CABG-stroke a logistic regression model was performed. Preop-AF impact on perioperative stroke was lower that other variables. Preop-AF did not show an adverse impact in the quartiles groups according to NNECVDSG Stroke Risk Index. Conclusion: Risk of perioperative stroke in isolated CABG surgery patients is not significantly increased by preop-AF.

[Haemorrhage and morbidity associated with the use of tranexamic acid in cardiac surgery: a retrospective, multicentre cohort study]

INTRODUCTION

Postoperative bleeding is common complication, affecting up to 20% of patients, after cardiac bypass surgery. Fibrinolysis is one of the causes of this excessive bleeding, and for this reason the use of tranexamic acid is recommended. The problem with using this is that there are numerous guidelines and differences in the dose to be administered. Our aim was to evaluate whether there were any differences in postoperative bleeding and morbidity after cardiac surgery with the administering of different tranexamic acid doses in three university hospitals.

MATERIAL AND METHODS

A retrospective, multicentre cohort study was conducted. A total of 146 patients who were subjected to elective cardiac bypass surgery according to the anaesthetic-surgical protocol of each hospital were included in the study. The clinical histories were reviewed, and they were divided into two groups according to the tranexamic acid dose: Group A (high doses), initial dose of 20mg/kg and continuous infusion of 4 mg/kg/hour until closure of the sternotomy. A further 100mg was added to prime the bypass machine. Group B (low doses), initial dose of 10mg/kg followed by a continuous infusion of 2mg/kg/hour until closure of the sternotomy. A further 50mg was added to prime the bypass machine. Variables, such as age, sex, weight, height, type of surgical procedure (valvular, coronary or mixed), haematocrit, INR, and preoperative platelet count, time and temperature of the bypass machine, and haematocrit on sternum closure, were recorded. Among the post-operative variables collected were: debit due to drainage at 6, 12 and 24 hours after surgery, number and type of blood products transfused in the first 24 hours, need for further surgery due to haemorrhage, CVA, TIA, or a new acute myocardial infarction, convulsions, and mortality.

RESULTS

The incidence of increased bleeding (patients in the 90 percentile) was higher in Group B at all the study evaluation times (P<.05). The incidence of further surgery due to bleeding, and the need for transfusion of ≥ 3 units of packed red cells was lower in Group A (5.56%) than in Group B (13.89%). There were no significant differences in the requirements for blood products transfusions between the groups. As regards associated morbidity, there was one isolated case of convulsion and a perioperative AMI in another case in Group A, and three cases of perioperative AMI in Group B.

CONCLUSIONS

Elevated doses of tranexamic acid in cardiac bypass surgery appear to significantly reduce bleeding in the first hours after surgery compared to low doses. However, this decrease did not lead to a reduction in the needs for blood products.

[Continuous paravertebral analgesia versus intravenous analgesia in minimally invasive cardiac surgery by mini-thoracotomy]

OBJECTIVES

Minimal access cardiac surgery via minithoracotomy aims faster recovery and shorter hospital length of stay. Pain control is essential in order to achieve this goal. A study was conducted to assess the quality of post-operative analgesia and complications related to the analgesia techniques after cardiac surgery by minithoracotomy.

MATERIAL AND METHODS

A descriptive, observational and retrospective study was conducted on the patients subjected to minimal access cardiac surgery in our centre between the years 2009 to 2011. The patients were divided into two groups according to the type of analgesia received: analgesia through a paravertebral catheter, with an infusion of local anaesthetics (PVB group), and intravenous analgesia with opioids (IOA group). The aim of the study was to compare the analgesic quality and the complications associated to the analgesic technique, extubation time, post-surgical complications, and length of hospital stay between both techniques.

RESULTS

A total of 37 patients underwent to a modified minimally invasive Heart-Port access cardiac surgery. Fifteen patients received analgesia through a paravertebral block and the other 22 IV analgesia with opioids. Data are shown as means and standard deviation (SD). Mean tracheal extubation time less than 4 hours was observed in 60% of the patients in the PVB group, compared to 22% in the IOA group (P<.05). Length of stay in ICU for the PVB group was 1.2 (0.7) days compared to 2.2 (0.7) days in the IOA group (P<.05). Mean hospital stay was 4.8 (1.2) days for the PVB group, and 5.6 (2.8) for the IOA group (P>.05. No complications associated to the continuous paravertebral block were observed.

DISCUSSION

PVB analgesia is an acceptable safe technique in cardiac surgery via thoracotomy which enables early extubation with optimal pain control when compared with IV analgesia with opioids.

Serum procalcitonin levels in critically ill patients colonized with Candida spp: new clues for the early recognition of invasive candidiasis?

OBJECTIVE

Invasive candidiasis (IC) outcomes in intensive care units (ICUs) could be improved by the early administration of antifungals. The Candida Score (CS) prediction rule has been proposed for the selection of patients who could develop IC. Procalcitonin (PCT) levels allow prompt identification of sepsis, but their behavior in the setting of IC is unclear. We hypothesize that PCT could be helpful in the early diagnosis of IC in patients with Candida sp. colonization.

DESIGN

Prospective observational study.

SETTING

Thirty-six ICUs in Spain, Portugal and France.

PATIENTS

Every non-neutropenic critically ill patient hospitalized for more than 7 days without concurrent bacterial infection. The CS was calculated weekly. Serums were collected concomitantly.

MEASUREMENTS AND RESULTS

Two hundred twenty PCT levels were measured in 136 patients [neither colonized nor infected (NCNI): n = 73; multifocal colonization (MF): n = 43; MF + IC: n = 20]. Baseline PCT levels were significantly higher in the MF + IC group than in other groups (p = 0.001). In patients with MF, the highest CS value calculated during the patient's stay was the sole independent predictor of IC. The receiver-operating curve analysis showed that the diagnosis values of PCT and CS were comparable (AUROCC = 0.713, and 0.727, respectively). Moreover, PCT increased the positive predictive value of CS from 44.7 to 59.3%.

CONCLUSIONS

After 7 days of hospitalization, PCT levels in patients with MF who go on to develop IC are higher than in others. Serum PCT could also improve the predictive value of CS. PCT together with CS could therefore be considered for the assessment of IC risk.

The European contribution to "Sugarbaker's protocol" for the treatment of colorectal peritoneal carcinomatosis

INTRODUCTION

In 1981, Dr. PH Sugarbaker, challenging oncological orthodoxy, considered carcinomatosis to be a locoregional stage of the disease that was still susceptible to treatment with curative intent. To this end he developed a new therapeutic alternative based on the combined treatment. The macroscopic disease treated by maximum radical oncological cytoreductive surgery (through the peritonectomies described by him), followed by treatment of the residual microscopic disease with the direct intra-abdominal application of intraoperative chemotherapy with locoregional intensification, modulated by hyperthermia and early normothermic postoperative intra-abdominal chemotherapy. Using this new therapeutic regimen, known as "Sugarbaker s Protocol", his group has reported 45% survival rates in carcinomatosis of colorectal origin at 5 years, and, in selected groups of patients, 50% survival rates at 5 years. The scientific community, however, has criticized these results considering that: it is a personal experience, with a not homogenous treatment protocol with developmental modifications over time, that it is a retrospective non-randomized study, and finally that the cytostatics used in his protocol are obsolete. Various European groups have replied to these main criticisms confirming the good results that this new therapeutic alternative offers for patients with carcinomatosis of colorectal origin. The purpose of this article is to present these contributions.

MATERIAL AND METHODS

All the articles published in the English language by European groups in the world s medical literature have been reviewed using the Pubmed-MEDLINE database to identify the relevant articles related to the treatment of carcinomatosis of colorectal origin using cytoreduction and intraperitoneal chemotherapy from January 1980 to January 2008.

RESULTS

The European contribution during these 25 years in favour of the "Sugarbaker s Protocol" has consisted fundamentally in: a) one multicenter retrospective study; b) two randomized prospective phase III studies; and c) the use of oxaliplatin and irinotecan as new cytostatic agents in the protocols for intraperitoneal chemotherapy. At the same time, two new transcendental European contributions have been made in which the possibility has been considered of combined simultaneous treatment for patients with hepatic metastases and carcinomatosis, and the introduction, as a selection factor, of patients responsive to intravenous induction chemotherapy within the regimen of sandwich treatment (with systemic neoadjuvant and adjuvant chemotherapy) complementary to intraperitoneal chemotherapy.

CONCLUSIONS

The results obtained by European groups using "Sugarbaker s protocol" and "Elias protocol" with oxaliplatin compel us to request that these treatments be considered by all professionals involved in the treatment of patients with colorectal carcinomatosis as the best treatment currently available for this condition. Furthermore a randomized, prospective, multicenter study should be carried out to clarify its value and the degree of scientific evidence. A validation of this treatment will change, in the future, the dogmatic consideration of carcinomatosis as an incurable disease stage.

Simultaneous kinetic spectrophotometric determination of spironolactone and canrenone in urine using partial least-squares regression

A method is proposed for the simultaneous determination of spironolactone and canrenone in urine based on the different rates at which they react with sulphuric acid to yield a trienone. Kinetic spectrophotometric data are processed by partial least-squares (PLS) regression. The optimum sulphuric acid concentration and temperature are determined from response surfaces, using PLS methodology to relate both variables to the relative square error of prediction (RSEP, the parameter to be minimized). The relative errors made in the quantitation of each diuretic by the proposed method are less than 5% and the overall error, as RSEP, ranges from 1.06 and 1.44%.

[Analysis of a weight loss program with meal replacement products on weight and biochemical markers in overweight or type I obese patients]

BACKGROUND

There are scarce data about the efficacy and security of meal replacement products as a strategy to weight loss.

AIM

To evaluate the efficacy and safety of a weight loss program that includes meal replacement products.

METHODS

We evaluated the effect of a hypocaloric diet versus a hypocaloric diet that includes meal replacement products in 55 overweight or type I obese patients. Patients were distributed to a control group (hypocaloric diet) or an intervention group (hypocaloric diet with meal replacement products) during 8 weeks. We registered anthropometric data, smoke habit and level of physical activity. We also studied biochemical parameters at the beginning of the study, at 4th week of the study and at the end of the same.

RESULTS

The control group lost 3.97 kg, while in the intervention group we observed a loss of 4.44 kg. These differences were not statistically significant between groups. Other anthropometric parameters as waist and hip perimeters diminished also in both groups, without differences between them. We observed also a statistically significant decrease (p=0.041) in the values of triglycerides, without differences between groups again.

DISCUSSION

Meal replacement products were as effective and safe to lose weight and to modify other anthropometric parameters in a controlled dietetic program as a conventional dietetic treatment without meal replacement products.

Classic and late-onset neurological disease in two siblings with glutaryl-CoA dehydrogenase deficiency

Late-onset neurological disease has rarely been reported in patients with glutaryl-CoA dehydrogenase (GCDH) deficiency. We present two siblings with GCDH deficiency. One of them presented with the classic neurological disease (patient 1). Routine investigation of family members revealed that her apparently unharmed 13-year-old sister was also affected (patient 2). Patient 2 started to have academic difficulties in the months prior to our assessment. Her clinical examination was normal, with the exception of a cranial circumference of 57 cm (slightly over the 98 th centile). A severe leukoencephalopathy was demonstrated on MRI. Neuropsychological assessment showed an IQ within the normal-low range and a mild impairment of memory and executive function. Previous reports on late-onset neurological disease in GCDH deficiency have revealed that progressive leukoencephalopathy develops over time. Following the recently published guideline for the diagnosis and management of GCDH deficiency, both patients are receiving dietary treatment in combination with L-carnitine supplementation. We emphasize the need to search for chronic neurological changes of late-onset type in apparently unaffected GCDH deficiency cases diagnosed in routine family investigations.

Effects of the 3- and 4-methoxy and acetamide substituents and solvent environment on the electronic properties of N-substituted 1,8-naphthalimide derivatives

The photophysical properties of polar molecules in solution with an intramolecular charge-transfer effect in the excited state depend strongly on the polarity and proticity of the solvents. UV-visible spectra of 1,8-naphthalimide and some N-substituted derivatives in acetic acid, acetonitrile, dichloromethane, and p-dioxane were carried out. Several molecular cluster geometries formed with N-substituted 1,8-naphthalimide derivatives and a large set of random positioning of some solvent molecules in their environment were optimized by a semiempirical method. It provided a complete screening of possible solute-solvent configurations and resulted in a multiple minima hypersurface of the supramolecular systems. With such local minima energies, the main thermodynamic association functions were found. They also provided selected cluster geometries for calculations of vertical electronic transitions with a time-dependent density functional theory (TD-DFT), if the lowest energy structures were considered. Calculated vertical electronic transition energies at the TD-DFT level were compared with experimental data. The experimental absorption UV-visible spectra for the six compounds in the four solvents were performed in our laboratory. Moreover, X-ray photoelectron spectroscospy of the 1,8-naphthalimide was carried out in the ICP-CSIC laboratory. Thermodynamic function values show different association energies between each solvent and the molecules, in correlation with the possibility of hydrogen bond formation and the polarity and dielectric constant of the solvents. The 3- and 4-acetamide 1,8-naphthalimide derivatives have the highest conformer number and the most negative Gibbs free association energy values for a determined solvent. This indicates the importance of the entropic factors.

[Idiopathic loss of lateral tarsal suspension]

CASE

A 53-year-old man who showed a loss of tarsal suspension in the lateral third of both lower eyelids underwent lateral canthoplasty with a good post-operative result.

DISCUSSION

Disinsertion of the union of the inferior tarsus with the lateral canthus, of unknown cause, is a very uncommon finding that has almost never been reported in the world literature. There are two cases described of eyelid elastolysis with loss of lateral tarsal suspension, as in our case, but both showed eyelid skin atrophy and had histopathologic confirmation. Our case did not have skin atrophy.

Procedimientos de diagnóstico microbiológico de las micosis y estudios de sensibilidad a los antifúngicos

Fungal infections are a diagnostic and therapeutic problem of increasing concern due to the frequency and severity of disseminated infection in immunocompromised patients. Culture-based methods are characteristically slow and have poor sensitivity; hence, other methods, based on the detection of fungus-specific genetic, antigenic and metabolic components are being developed to enable early diagnosis and specific treatment. Moreover, reproducible antifungal susceptibility methods that can be adapted for use in clinical laboratories have been standardized to allow in vitro detection of resistance, which correlates with a less favorable clinical outcome. In this paper we review the main microbiological procedures available for the diagnosis of fungal infections and for antifungal susceptibility testing.

Diagnóstico de la infección por Chlamydia trachomatis en un centro de diagnóstico y prevención de infecciones de transmisión sexual: evaluación de los exudados cervicales, uretrales y rectales mediante técnica de PCR

INTRODUCTION

The aim of this study is to analyze the clinical and epidemiological characteristics of Chlamydia trachomatis infection in patients attended in a clinic for sexually transmitted disease in Seville (Spain). Microbiological diagnosis was performed in various types of samples.

MATERIAL AND METHODS

The study included 3854 patients (50.8% women and 49.2% men, mean age 30.1 years) seen from 2002 to 2004. Among the total, 50% belonged to groups engaging in high risk sexual practices: female commercial sex workers (CSWs) (47%), men who maintain sexual relationships with other men (MSM) (45%), users of prostitution (4%), promiscuous heterosexual men (4%), those with a risk partner (2.7%) and injection drug users (IDU) (2.2%). We analyzed a total of 5978 samples (2384 cervical exudates, 2645 urethral exudates and 949 rectal exudates), for the detection of C. trachomatis by PCR technique with the COBAS Amplicor CT System.

RESULTS

Prevalence of C. trachomatis infection was 6% (4.3% in women and 7.8% in men). Among the total in women, 51.2% of positive samples were from women with high-risk sex factors and 73.8% of the women were asymptomatic. In men, the proportions were 70.5% and 36.9%, respectively. Cervical, urethral and rectal exudates yielded positive results in 4%, 4.9% and 4.3%, respectively.

CONCLUSIONS

Systematic sampling for C. trachomatis detection is necessary in symptomatic and asymptomatic patients practicing high-risk sex; periodic follow-up studies are also needed for early detection of sexually transmitted infection. Rectal sample collection is important for detecting this infection in MSM and in patients whose sexual habits make it advisable.