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Introduction and Objectives: Endoscopic ultrasound guided portal pressure gradient measurement (EUS-PPGm) would provide useful clinical information in patients with liver diseases. However, there is yet scarcely data on the clinical relevance of this EUS-guided procedure.We report our experience on EUS-PPGm focus on safety, clinical relevant findings, technical drawbacks and how to overcome them, aiming to make this procedure more safe, accurate and available. Materials and Patients: EUS-PPGm was performed with a therapeutic echoendoscope and a dedicated 25G needle in 30 consecutive patients. Assessment of NAFLD 25; idiopathic portal hypertension 3; evaluation for curative therapy in hepatocellular carcinoma (HCC) 2. EUS-guided bilobar liver biopsies (EUS-BLB) were also immediately performed in 26 patients (87%) with a 19G needle Results: EUS-PPGm was obtained in 25/30 patients (83%) being >5 mmHg in 10/22 NALFD patients (45%) without endoscopic and/or ultrasonographic signs of portal hypertension neither liver fibrosis on EUS-BLB. Mean time to obtain EUS-PPGm was 21±2 minutes.EUS-PPGm was not obtained in 5 cases. In 4 cases for excesive use of the elevator and up&down wheel and bending of the needle. In another case for exacerbating breathing movements. The hepatic and portal vein were difficult to punction in one and two cases, respectively having to transverse the vessels and reposition the needle.A self-limited bleeding from the cardias and a mild epigastric pain 2 day after a combined procedure were observed without other adverse events one month later. Conclusions: EUS-guided PPGm, even when combined with EUS-BLB, seems safe providing useful clinical information. Almost half of patients affected with NAFLD have portal hypertension diagnosed precociously in reversible stages providing a useful tool in precision Medicine, especially in the setting of obesity pandemic. There are technical aspects related to the needle and the position of the echoendoscope that should be known to improve the safety, accuracy and availibility of this procedure.

ABSTRACT Therapeutic options to treat bacterial infections caused by Gram-negative pathogens are limited due to the spread of multidrug resistance. Protein engineering of phage-derived lysins can play a key role in the search for new antimicrobial compounds targeting Gram-negative pathogens. A previous high-throughput screen of a combinatorial lysin library identified lysin 1D10 active against Acinetobacter baumannii under elevated human serum concentrations. The engineered lysin consists of four modules: cecropin A, a linker, cell wall-binding domain, and an enzymatic active domain. Using time-lapse microscopy, we show that 1D10 has a distinct antibacterial mode of action resulting in local cell wall bulging at the septum instead of cell-wide lysis, as observed for previously reported engineered lysins that target Gram-negative bacteria. Our results indicate that the activity of 1D10 relies on the antibacterial activity of both cecropin A (CecA) and the enzymatically active domain. Based on a truncation analysis, the role of each of the four modules of 1D10 was dissected. We further compared the antibacterial spectrum, thermostability, and cytotoxicity of cecropin A alone and lysin 1D10. Both lysin 1D10 and CecA are most active against A. baumannii and are not cytotoxic toward human keratinocytes. Lysin 1D10 unfolds at 57°C and has a remarkable refolding capacity, as it regains its activity even after exposure to 90°C and sterilization conditions, whereas CecA is inactivated at 70°C. Overall, the present study shows that an improved understanding of the killing mechanism and the protein properties will further support lysin engineering designs in the future. IMPORTANCE Engineered lysins are considered as highly promising alternatives for antibiotics. Our previous screening study using VersaTile technology identified 1D10 as a possible lead compound with activity against Acinetobacter baumannii strains under elevated human serum concentrations. In this manuscript, we reveal an unexpected mode of action and exceptional thermoresistance for lysin 1D10. Our findings shed new light on the development of engineered lysins, providing valuable insights for future research in this field.

Objectives: The course of progressive liver damage after achieving sustained virological response (SVR) with direct-acting antivirals (DAAs) remains undetermined. We aimed to determine risk factors associated with the development of liver-related events (LREs) after SVR, focusing on the utility of non-invasive markers. Methods: An observational, retrospective study that included patients with advanced chronic liver disease (ACLD) caused by hepatitis C virus (HCV), who achieved SVR with DAAs between 2014 and 2017. Patients were followed-up until December 2020. LREs were defined as the development of portal hypertension decompensation and the occurrence of hepatocellular carcinoma (HCC). Serological markers of fibrosis were calculated before treatment and one and two years after SVR. Results: The study included 321 patients, with a median follow-up of 48 months. LREs occurred in 13.7% of patients (10% portal hypertension decompensation and 3.7% HCC). Child–Pugh [HR 4.13 (CI 95% 1.74; 9.81)], baseline FIB-4 [HR 1.12 (CI 95% 1.03; 1.21)], FIB-4 one year post-SVR [HR 1.31 (CI 95% 1.15; 1.48)] and FIB-4 two years post-SVR [HR 1.42 (CI 95% 1.23; 1.64)] were associated with portal hypertension decompensation. Older age, genotype 3, diabetes mellitus and FIB-4 before and after SVR were associated with the development of HCC. FIB-4 cut-off values one and two years post-SVR to predict portal hypertension decompensation were 2.03 and 2.21, respectively, and to predict HCC were 2.42 and 2.70, respectively. Conclusions: HCV patients with ACLD remain at risk of developing liver complications after having achieved SVR. FIB-4 evaluation before and after SVR may help to predict this risk, selecting patients who will benefit from surveillance.

This prospective single-center study was designed to assess the clinical utility of the FilmArray® blood culture identification (BCID) panel for improving the diagnostic accuracy in neonatal sepsis. Results obtained using the FilmArray® BCID panel were correlated with results of blood culture in all consecutive neonates with suspicion of early-onset (EOS) and late-onset sepsis (LOS) attended in our service over a two-year period. A total of 102 blood cultures from 92 neonates were included, 69 (67.5%) in cases of EOS and 33 (32.3%) in LOS. The FilmArray® BCID panel was performed in negative culture bottles at a median of 10 h of blood culture incubation (IQR 8–20), without differences by the type of sepsis. The FilmArray® BCID panel showed a 66.7% sensitivity, 100% specificity, 100% positive predictive value, and 95.7% negative predictive value. There were four false-negative cases, three of which were Streptococcus epidermidis in neonates with LOS, and there was one case of Granulicatella adiacens in one neonate with EOS. We conclude that the use of the FilmArray® BCID panel in negative blood cultures from neonates with clinical suspicion of sepsis is useful in decision-making of starting or early withdrawal of empirical antimicrobials because of the high specificity and negative predictive values of this assay.

The prevalence of postnatal growth faltering (PGF) in preterm infants with very low birth weight (VLBW) (n = 112; and 2013–2017, n = 92) were compared. Results. In the second five-year period, a decrease in prevalence of PGF was observed (36.6% vs. 22.8%, p = 0.033), an increase in growth rate in the first 28 days (5.22 (4.35–6.09) g/kg/day vs. 11.38 (10.61–12.15) g/kg/day, p < 0.0001) and an increase in height standard deviation (SD) at 2 years (−1.12 (−1.35–−0.91) vs. −0.74 (−0.99–−0.49) p = 0.023). Probability of short stature at 2 years was directly related to daily weight gain in the first 28 days. Conclusions: when comparing two five-year periods in the last two decades, growth in VLBW preterm infants has improved, both during neonatal period and at two years of age.

Background and study aims: Endoscopy plays an essential role in managing patients with ulcerative colitis (UC), as it allows us to visualize and assess the severity of the disease. As such assessments are not always objective, different scores have been devised to standardize the findings. The main aim of this study was to assess the interobserver variability between the Mayo Endoscopy Score (MES), Ulcerative Colitis Endoscopy Index of Severity (UCEIS) and Ulcerative Colitis Colonoscopy Index of Severity (UCCIS) analyzing the severity of the endoscopic lesions in patients with ulcerative colitis. Patients and methods: This was a single-cohort observational study in which a colonoscopy was carried out on patients with UC, as normal clinical practice, and a video was recorded. The results from the video were classified according to the MES, UCEIS and UCCIS by three endoscopic specialists independently, and they were compared to each other. The Mayo Endoscopy Score (MES) was used to assess the clinical situation of the patient. The therapeutic impact was analyzed after colonoscopy was carried out. Results: Sixty-seven patients were included in the study. The average age was 51 (SD ± 16.7) and the average MES was 3.07 (SD ± 2.54). The weighted Kappa index between endoscopists A and B for the MES was 0.8; between A and C 0.52; and between B and C 0.49. The intraclass correlation coefficient for UCEIS was 0.92 among the three endoscopists (CI 95 %: 0.83–0.96) and 0.96 for UCCIS among the three endoscopists (CI 95 % 0.94–0.97). A change in treatment for 34.3 % of the patients was implemented on seeing the results of the colonoscopy. Conclusions: There was an adequate, but not perfect, correlation between the different endoscopists for MES, UCEIS, UCCIS. This was higher with the last two scores. Thus, there is still some subjectivity to be minimized through special training, on assessing the seriousness of the endoscopic lesions in patients with UC.

Background: Neonatal sepsis is a condition with high mortality and morbidity that contributes to high rates of antibiotic therapy at birth. In addition, very low birth weight newborns (VLBWN) are particularly vulnerable. Interleukin 6 (IL-6) seems to be an early and effective marker that could help a better selection of patients to be treated. This study aimed to evaluate the use of antibiotics in the first 72 hours of life in VLBW infants before and after using IL-6 as an infection marker. Also, we wanted to analyze the differences in morbidity and mortality during admission and other factors associated with the decision to start antibiotic treatment. Methods: We conducted a cohort retrospective study. We included VLBWN born in our hospital or admitted before 72 hours of life in two two-year periods (2007-2008 and 2011-2012). Results: Antibiotics use during the first 72 hours of life was analyzed as the primary variable, which was reduced by 20% on the second period (p = 0.002). Regarding the analysis of secondary variables, we found no significant differences in mortality during hospital admission and the incidence of nosocomial sepsis, enterocolitis, or invasive fungal infection. The multivariate analysis indicated extreme prematurity and the study group as the most strongly related factors to the start of antibiotic therapy. Conclusions: IL-6 was a useful marker of infection to reduce the use of antibiotic therapy in VLBW infants without increasing mortality.

ABSTRACT Background and aims: infliximab has changed the natural history of inflammatory bowel disease (IBD). The advent of biosimilar treatments such as CT-P13 will hopefully improve the availability of biological therapies. Data with regard to drug switching are currently limited. The objective of the study was to assess the effectiveness and safety of switching from the reference product (RP), infliximab, to CT-P13 in patients with IBD. Methods: this was a multicenter prospective observational study in patients with Crohn's disease (CD) and ulcerative colitis (UC). All patients had switched from infliximab RP (Remicade(r)) to CT-P13 treatment and were followed up for 12 months. The efficacy endpoint was the change in clinical remission assessed at 0 and 12 months, according to the Harvey-Bradshaw score and partial Mayo score for patients with CD and UC, respectively. Adverse events were monitored and recorded throughout the study. Results: a total of 167 patients (116 CD/51 UC) were included; 88.8% (103/116) of patients with CD were in remission at the time of the drug switch and 69.7% were in remission at 12 months. The Harvey-Bradshaw (HB) score significantly changed at 12 months (p = 0.001); 84.3% (43/51) of patients with UC were in remission at the time of the drug switch and 76.7% were in remission at 12 months. No significant changes in the median partial Mayo score (p = 0.87) were observed at 12 months. Serious adverse events related to medication were reported in 12/167 (7.2%) cases. Conclusion: switching from infliximab RP to CT-P13 is safe and effective at 12 months. The loss of efficacy at 12 months was 15.7%.

Background: Several studies have reported positive efficacy outcomes for patients with inflammatory bowel disease treated with CT-P13, an infliximab biosimilar. Data from follow-up periods longer than 1 year are still scarce. Here, we assessed the long-term efficacy data, loss of response and safety after switching from infliximab to CT-P13 in patients with inflammatory bowel disease. Methods: This was a prospective single-center observational study involving patients with moderate-to-severe Crohn’s disease and ulcerative colitis switched from infliximab to CT-P13 treatment and reviewed up to 24 months. Efficacy and loss of response were measured using the Harvey–Bradshaw (HB) index and partial Mayo score for patients with Crohn’s disease and ulcerative colitis respectively. C-reactive protein, infliximab drug levels, adverse events and antidrug antibodies were also monitored throughout the study. Results: A total of 64 patients with Crohn’s disease and 36 patients with ulcerative colitis were included. Most of them (72%) remained on CT-P13. Overall, 28% of patients discontinued the therapy due to loss of response, adverse events or long-lasting clinical remission. Remission at 18 and 24 months occurred in 69.9% and 68.5% of patients, respectively. Dose increase was performed in 22% of patients, with remission being reached in 60% of them. HB index, partial Mayo score, C-reactive protein and infliximab drug levels did not show significant changes. Serious adverse events were reported in 14% of patients. Overall, two patients developed low levels of antidrug antibodies. Conclusions: Most of the patients switching from original infliximab were maintained on CT-P13 at 2 years of follow up with a good profile of efficacy and safety.

EL FENÓMENO de la internacionalización de la producción cultural bajo la impronta de la penetración de las empresas estadounidenses en los mercados locales es un hecho preocupante en la sociedad latinoamericana actual.

Introduction: Capsule endoscopy (CE) has become a first-line tool for small bowel (SB) examination. However, adverse events (AEs), such as CE retention or aspiration, may occur. The aims of this study were to evaluate incidence, clinical outcomes and therapeutic approaches of CE-related AEs in the largest series published to date. Methods: Data from 5428 procedures performed at 12 institutions between August 2001 and January 2012 were retrospectively analyzed. Baseline patient characteristics; procedure; type, localization and symptoms before/after AEs; previous patency tests performed; therapeutic management and patient's outcome were recorded. Results: The overall incidence of CE-related AEs was 1.9%: 2.0% for SB, 0.9% for esophageal and 0.5% for colon CE. The incidence of capsule retention was significantly higher than capsule aspiration (1.87% vs. 0.003%; p < 0.05), in patients suffering from inflammatory bowel disease (IBD) than in obscure GI bleeding (OGIB) (3.3% vs. 1.5%; p < 0.05) and in patients with the combination of nausea/vomiting, abdominal pain and distension. The SB was the most frequent localization of retention (88.2%). The use of patency tests -except for Patency© capsule- before CE was not a good predictor for AEs. Most of the patients with AEs developed no or mild symptoms (97%) and were managed by non-surgical methods (64.4%). Conclusions: CE-related AEs are uncommon and difficult to predict by imagiological examinations. SB retention, that is usually asymptomatic, is the most frequent AE. In absence of symptoms, non-surgical management of CE-related AEs is recommended.

¿En qué medida la empresa privada de América Latina en su conjunto ha comprendido la importancia de la telenovela como la más eficaz correa de transmisión de mensajes en el área? ¿Es la telenovela un subproducto, o parte de la cultura popular?

Endoscopic ultrasound (EUS)-guided drainage is now the treatment of choice in cases of pancreatic pseudocysts and walled-off necrosis, especially in the absence of luminal bulging and in patients with portal hypertension. Malignant refractory ascites usually heralds a poor prognosis and substantially impairs the quality of life of patients because of the symptoms experienced and the need for repeated paracentesis. EUS-guided placement of lumen-apposing, fully covered, self-expandable metal stents (FCSEMS) has been reported for the drainage of malignant ascites. Herein, we present the results of EUS-guided placement of plastic pigtails stents for the drainage of refractory malignant ascites in three patients. The aim was to improve symptoms and minimize the possible drawbacks of large-caliber FCSEMS. In this preliminary experience, EUS-guided placement of plastic stents was feasible and avoided further paracentesis.

Introduction: PillCam© colon capsule endoscopy (CCE) enables the study of colonic diseases in a safe and non-invasive way, although there are aspects that need to be improved. Current methods of bowel preparation lead to discordant rates of adequate cleansing and CCE excretion. Aims: To compare the efficacy of colon cleansing using two different regimes (2L PEG plus ascorbic acid versus 4L PEG alone) for PillCam Colon (C2) capsule endoscopy. Methods: Fifty eight patients included in this prospective study and randomized to: Group A, PEG plus ascorbic acid regimen (n = 28, 12 F/16 M) or group B, PEG alone regimen (n = 30, 14 F/16 M). The degree of cleansing was categorized into "excellent-good" or "fair-poor", according to Leighton's recently published preparation scale. CCE excretion rate and colon cleansing were assessed. Patients underwent to PillCam colon of second generation (C2). Results: Cleansing was considered to be excellent-good in 78 % of cases in group A and in 64 % of cases in group B, with no significant difference between the groups (p = 0.252). Nevertheless, when the grade of cleansing was analyzed in segments, a significant difference was found in the cecum and transverse colon. No differences were observed in the bubble effect between preparations. The excretion rate was 93 % in group A versus 70 % in group B (p = 0.043). Conclusions: These results suggest that a 2L PEG plus ascorbic acid regimen is at least as effective as a 4L PEG regimen. This regimen may be considered an effective alternative which would improve compliance because a smaller volume is required.

Background and study aims: Colon capsules display images from the moment they are ingested, making the study of other extracolonic areas possible. The aim of this study was to analyze the significance of these extracolonic findings. Patients and methods: In this single-center, prospective study, 165 patients underwent colon capsule endoscopy (CCE) between September 2009 and October 2012 to rule out colonic pathology. Images were recorded, without interruptions, from the moment the capsule was ingested until its battery ran out. The study was deemed complete when the capsule had traveled from the esophagus to excretion or until the hemorrhoidal plexus was observed. Results: CCE was used for colorectal cancer (CRC) screening (81.2 %), to investigate for chronic diarrhea (9.7 %) and chronic iron deficiency anemia (6.1 %), and for patients with incomplete colonoscopy (3.0 %). The capsule returned findings in the esophagus in 52.1 % of patients, in the stomach in 45.5 % of patients, and in the small bowel in 70.7 % of patients, with the findings being considered relevant in 4.9 %, 9.7 %, and 22.6 % of patients, respectively. The whole extent of the digestive tract was fully recorded in 86.1 % of patients and the Z line could be fully observed in 57.6 % of patients. There were no adverse events. Conclusions: CCE allows the recording of images from almost the whole extent of the digestive tract in most patients, enabling relevant pathologies to be identified in extracolonic areas, particularly the small bowel. Technical and procedural improvements are still necessary in order to achieve better observation of the stomach and esophagus.

El objetivo de este trabajo es presentar algunos aspectos claves del aprendizaje mercantil que aparecen indisolublemente ligados en diferentes manuales de mercaduría medievales. Con títulos muy esclarecedores, pretendieron la forja de un buen mercader merecedor de éxito. Para ello, le proporcionan una información mercantil rigurosa y necesaria, le muestran unas técnicas consideradas imprescindibles, pero también un conjunto de preceptos, reglas y recomendaciones relativas a su forma de comportamiento, que podían y debían aprenderse. Su práctica ayudaría al nuevo grupo mercantil a conseguir la benevolencia de la sociedad y su definitiva redención social a la vez que reforzaba su coherencia grupal. Entre estos manuales de mercaduría se menciona un brevísimo fragmento de un hasta ahora desconocido manual para mercaderes portugués, sobre el que es necesario seguir trabajando.

Background: adalimumab, a human anti-TNF, is an effective induction and maintenance therapy for patients with moderate to severe Crohn's disease. It seems to be effective in patients with resistance to infliximab, too, though the experience is more limited. Aim: to evaluate the efficacy of adalimumab, in patients with Crohn's disease (CD) and failure to previous treatment with infliximab. B twenty-five patients with CD and failure to previous treatment with infliximab were enrolled; they were treated with 160/80 (24 patients) and 80/40 (1 patient) induction doses. We analyze clinical response to treatment with adalimumab by the Crohn's disease Activity Index (CDAI) and plasma concentration of C-reactive protein (CRP), steroid sparing and complete fistula closure at week 48. Results: eighteen out of twenty-five patients (72%) achieved clinical remission (CDAI score < 150) at week 24 and 15/25 (60%) patients at week 48. There was a statistically significant difference (p < 0.01) in CRP serum levels from 21 to 8 mg/dl at week 48. Nine out of fifteen patients (60%) treated with corticosteroids were able to discontinue steroids. Three out of eleven patients (27%) with fistulizing Crohn's disease had complete fistula closure after the treatment. Seventy two percent of the patients (18/25) needed to increase adalimumab to weekly dose, in order to maintain clinical response. Five out of twenty-five patients (20%) had adverse events; two of them (8%) with serious adverse events (tuberculous meningitis and abdominal abscess) that forced the withdrawal of treatment. Conclusions: according to these data, adalimumab provides a clinical and analytical improvement in patients with CD and failure to previous therapy with infliximab.Introducción: adalimumab, un anti-TNF humano, ha demostrado ser efectivo en la inducción y tratamiento de mantenimiento de la enfermedad de Crohn moderada-grave. Existe menos experiencia, pero este fármaco parece también eficaz en los pacientes con pérdida de respuesta o intolerancia al infliximab. Objetivo: evaluar la eficacia de adalimumab durante un año, en nuestra serie de pacientes con enfermedad de Crohn (EC) y fracaso en el tratamiento previo con infliximab. Métodos: se incluyen 25 pacientes con enfermedad de Crohn y fracaso previo a la terapia con infliximab, que son tratados con adalimumab. Se utilizaron dosis de inducción de 160/80 mg en 24 pacientes y dosis de 80/40 en un paciente. Analizamos la respuesta clínica al tratamiento con adalimumab mediante el Índice de actividad de la enfermedad de Crohn (CDAI) y las concentraciones plasmáticas de proteína C reactiva (PCR), el cese de la corticoterapia y el cierre completo de las fistulas en la semana 48. Resultados: dieciocho de veinticinco pacientes (72%) alcanzan la remisión clínica (CDAI < 150) en la semana 24 y 15/25 pacientes (60%) en la semana 48. Esto se acompañó de un descenso de los niveles de PCR de 21 a 8 mg/l en la semana 48. En nueve de quince pacientes (60%) que tomaban corticoides, se consiguió su retirada. Tres de once pacientes (27%) con enfermedad fistulosa presentaron un cierre completo de las fístulas tras el tratamiento con adalimumab. Un 72% de los pacientes (18/25) necesitaron, a lo largo del seguimiento, acortar el intervalo de tratamiento a una semana para mantener la respuesta. Cinco de veinticinco pacientes (20%) presentan efectos secundarios y en 2 de ellos (8%) fue precisa la retirada del fármaco (meningitis tuberculosa y absceso abdominal). Conclusiones: el tratamiento con adalimumab proporciona una mejoría clínica y analítica en un número significativo de pacientes con EC y fracaso previo a la terapia con infliximab.

Introduction: several studies have pointed out the effectiveness of the PillCam© colon capsule endoscopy (CCE) compared with the colonoscopy in the study of the colonic pathology. Aims and methods: the objective of our study was to assess the agreement in the diagnosis of CCE with conventional colonoscopy as well as its sensitivity and specificity, and to describe the findings of the CCE in our clinical practice. Consecutive patients with abdominal symptoms were included in the study. The CCE was performed as previously reported (with PEG and sodium phosphate as laxative agents). The nature and location of the findings, colonic transit time, complications, cleanliness degree and consistency with diagnostic colonoscopy, when performed, were analyzed. Results: a total of 144 subjects (67 women and 77 men); (52.17±16.71 years) with the following indications were included: screening of Colorectal cancer (88 patients), control after polipectomy (24), incomplete colonoscopy (7), rectal bleeding (10), anemia (8), diarrhea (7). The CCE exploration was complete in 134/144 cases (93%), with no case of retention. The preparation was good-very good in 88/134 (65,6%), fair in 26/134 (19,4%) and poor in 20/134 (15%) of the cases. The average colonic transit was of 140.76 min (9-603). Any adverse effect was notified. In 44 cases a colonoscopy was carried out after CCE (results were hidden from another endoscopist). Compared to colonoscopy, the rate of agreement was 75,6%, the sensitivity was 84% and the specificity 62,5%, PPV was 77,7% and NPV was 71,4 %. The colonic findings in 134 CCE were: in 34 cases CCE it did not show lesions, diverticulosis in 63 explorations, polyps in 43, angiodysplasias in 15, Crohn's Disease in 9 and ulcerative colitis in other 8 cases. Conclusions: the CCE is an effective and reliable technique for the detection of lesions in colon, and because of its high agree-ment with the colonoscopy, it could be useful in clinical practice. Further studies with large seria and cost-effectiveness analysis are needed to confirm these data.

Introducción. El objetivo de la presente investigación ha sido comparar mediante un ensayo clínico la efectividad de una Psicoterapia Breve con el tratamiento habitual de los Trastornos Mentales Comunes en los Centros de Salud Mental (CSM) de Asturias. La introducción general a este estudio se ha descrito por Fernández-Méndez y cols. (2010) y se remite a los lectores a ese artículo para más detalles respecto al fundamento, diseño, tratamientos y procedimientos de la investigación. Sujetos y método. Se seleccionaron al azar 216 personas mayores de 14 años que consultaban por primera vez en seis CSM y que fueron diagnosticadas de trastornos depresivos, de ansiedad y/o de adaptación. Ciento cuarenta y una cumplían los criterios de inclusión y aceptaron participar en la investigación, siendo asignadas al azar a dos grupos: Psicoterapia breve integradora-ecléctica (n = 76) o Tratamiento habitual en los CSM (n = 65). Se han comparado sus resultados a los 6, 12, 24 y 36 meses en diversos índices de mejoría clínica, funcionamiento psicosocial e indicadores sanitarios indirectos. Los datos se han obtenido del Registro de Casos Psiquiátricos, de la Historia Clínica y del propio paciente. Se han usado los siguientes instrumentos: Impresión Clínica Global (ICG, Guy, 1976), Inventario de Discapacidad de Sheehan (SDI, Sheehan, 1996) y Cuestionario de Satisfacción (Moré y Muñoz, 2000). Resultados. El programa de Psicoterapia breve ha sido más efectivo que el tratamiento habitual: Obtiene una mayor tasa de altas y los sujetos muestranmayor satisfacción. Estas diferencias se dan tanto a los seis meses como al año y a los dos años de iniciarse los tratamientos. Además, aunque el número medio de sesiones es igual en ambos grupos (en torno a seis), el tratamiento experimental duró mucho menos tiempo. Conclusiones: La Psicoterapia ha resultado ser un tratamiento viable y efectivo para la mayoría de los casos que consultan en los CSM.

Objective: to evaluate the type, frequency, and severity of macroscopic small bowel mucosal injury after chronic NSAID intake as assessed by capsule endoscopy (CE), as well as to correlate the severity of gastroduodenal and intestinal damage in these patients. Material and methods:a prospective, endoscopist-blind, controlled trial. Sixteen patients (14F/2M; age: 57.06 ± 10.16 yrs) with osteoarthritis (OA) on chronic therapy with NSAIDs underwent CE and upper gastrointestinal endoscopy (UGE). Seventeen patients with OA (9F/2M; age: 57.47 ± 9.82 yrs) who did not take NSAIDs were included as a control group. A scale ranging from 0 to 2 (0 = no lesions, 1-minor = red spots or petechiae, denuded areas and/or 1-5 mucosal breaks; 2-major = > 5 mucosal breaks and/or strictures, or hemorrhage) was designed to assess the severity of small bowel mucosal injuries. Results: CE found intestinal lesions in 75% (12/16) of patients in the study group and in 11.76% (2/17) of controls (p < 0.01). Seven out of 16 NSAID consumers (43.75%) and none in the control group (0%) had a major small bowel mucosal injury (p < 0.01). The percentages of patients with grade 1 and 2 gastroduodenopathy in the study group, as assessed by UGE, were 37.14 and 23.81%, respectively. There was no significant difference in the rate of major enteropathy between patients with none or minor gastroduodenal injury, and those with major gastroduodenopathy (43.75 vs. 40%; p = N.S.). Conclusions: chronic NSAID intake is associated with a high rate of small bowel mucosal injuries. Our data have failed to demonstrate a relationship between the severity of gastroduodenal and intestinal injury.

Introducción. El objetivo de la presente investigación ha sido comparar mediante un ensayo clínico la efectividad de una Psicoterapia Breve con el tratamiento habitual de los Trastornos Mentales Comunes en los Centros de Salud Mental (CSM) de Asturias. En este artículo se describen la justificación, el diseño y los procedimientos de ese estudio. Los primeros resultados se publican en Fernández-Méndez y cols. (en prensa). Sujetos y método. Se seleccionaron al azar 216 personas mayores de 14 años que consultaban por primera vez en seis CSM y que fueron diagnosticadas de trastornos depresivos, de ansiedad y/o de adaptación. Ciento cuarenta y una cumplían los criterios de inclusión y aceptaron participar en la investigación, siendo asignadas al azar a dos grupos: Psicoterapia breve integradora-ecléctica (n = 76) o Tratamiento habitual en losCSM (n = 65). Se han comparado sus resultados a los 6, 12, 24 y 36 meses en diversos índices de mejoría clínica, funcionamiento psicosocial e indicadores sanitarios indirectos. Los datos se han obtenido del Registro de Casos Psiquiátricos, de la Historia Clínica y del propio paciente. Se han usado los siguientes instrumentos: Impresión Clínica Global (ICG, Guy, 1976), Inventario de Discapacidad de Sheehan (SDI, Sheehan, 1996) y Cuestionario de Satisfacción (Moré y Muñoz, 2000).

Background and objectives: the diagnostic yield of push enteroscopy (PE) varies widely from 13 to 78% of cases, according to the various series. The aim of this retrospective cohort study was to determine the endoscopic and histological yield of PE in our health area. Patients and methods: a total of 355 consecutive patients (190 males/165 females; mean age 45 years, range 15-89) underwent PE over a 6-year period, from 1997 to 2003. PE was performed under sedation and without overtube. Small-bowel mucosa biopsies were taken in 199 explorations (56%). Clinical indications for PE included: chronic diarrhea (35%), occult digestive bleeding (ODB) or iron-deficiency anemia (28%), suspected small-bowel malignancy (16%), chronic abdominal pain (28/355; 8%), follow-up of polyposis or malabsorption syndromes (7%), and abnormal radiographic findings (6%). Results: PE detected lesions in 122 cases (34%); in 6 cases (6%) lesions were within the reach of esophagogastroduodenoscopy. A normal macroscopic appearance of the small intestinal mucosa with an abnormal histological study was seen in 16 patients (6%). Major findings included: malabsorptive diseases (14%), nonspecific enteropathy (5%), angiodysplasia (3,5%), lymphangiectasia (3%); jejunal polyps (2%), Crohn's disease (2%), intestinal tumors (2%), extrinsic jejunal strictures (0.5%), and other (10/355; 3%). Abnormal radiographic findings (62%), chronic diarrhea (37%) and ODB (31%) were the indications with a higher diagnostic yield. No major complications were seen. Conclusions: according to our experience, PE is a safe and useful tool for the evaluation of small-bowel disease, especially in some indications (abnormal radiographic findings, chronic diarrhea, and ODB). Small-bowel biopsy increases PE's diagnostic yield in patients with chronic diarrhea.Introducción y objetivos: el rendimiento diagnóstico de la enteroscopia por pulsión (EP) varía ampliamente (13-78%) según las series. El objetivo de este estudio retrospectivo fue determinar el rendimiento endoscópico e histológico de la EP en nuestra área sanitaria. Pacientes y métodos: un total de 355 pacientes consecutivos (190 hombres/165 mujeres; media de edad 45 años, rango 15-89), fueron sometidos a EP en un periodo de 6 años, entre 1997 y 2003. Las EP fueron realizadas bajo sedación y sin sobretubo, tomándose biopsias de la mucosa de intestino delgado en 199 exploraciones (56%). Las indicaciones clínicas fueron: diarrea crónica (126/355; 35%), hemorragia digestiva de origen oscuro o anemia ferropénica (99/355; 28%), sospecha de tumor intestinal (56/355; 16%), dolor abdominal crónico (28/355; 8%), seguimiento de síndromes de poliposis o cuadros malabsortivos (25/355; 7%), y confirmación de anormalidades radiográficas (21/355; 6%). Resultados: la EP identificó lesiones en 122 pacientes (34%), observándose lesiones al alcance del gastroscopio convencional en 6 casos (6%). En 16 pacientes (6%) el aspecto macroscópico de la mucosa intestinal fue normal, objetivándose hallazgos diagnósticos en el estudio histológico. Los principales hallazgos encontrados fueron: proceso malabsortivo (50/355; 14%), enteropatía inespecífica (19/355, 5%), angiodisplasia (13/355; 3,5%), linfangiectasia (10/355; 3%), pólipos yeyunales (6/355; 2%), enfermedad de Crohn (6/355; 2%), tumor intestinal (6/355; 2%), estenosis intestinal extrínseca (2/355; 0,5%), y otros (10/355; 3%). Las indicaciones con mayor rendimiento diagnóstico fueron: confirmación de anormalidades radiográficas (13/21; 62%), diarrea crónica (46/126; 37%), y hemorragia digestiva de origen oscuro (31/99; 31%). No se objetivaron complicaciones graves. Conclusiones: según nuestra experiencia, la EP es una técnica segura y útil para la evaluación de las patologías del intestino delgado, especialmente en ciertas indicaciones (anormalidades radiográficas, diarrea crónica, y hemorragia digestiva de origen oscuro). La biopsia intestinal aumenta el rendimiento diagnóstico de la EP en pacientes con diarrea crónica.

Radiation enteritis is a complex clinical entity secondary to the affectation of intestinal epithelial cells as a result of radiation in the management of pelvic malignancies that may occasionally cause intestinal strictures. We present the case of a 60 year-old woman who had been diagnosed ten years before with endometrial adenocarcinoma, and who underwent hysterectomy with double adnexectomy and subsequent radiation therapy. The patient consulted for abdominal pain and ferropenic anemia of several years' standing, and had negative results following radiographic and endoscopic conventional techniques, reason why she was subjected to a capsule endoscopy study that revealed the presence of an ulcerated ileal stricture, which caused the asymptomatic retention of the capsule within the ileum. A laparotomy was subsequently performed - the strictured segment was resected and the capsule retrieved. The histologic examination of the resected segment confirmed the capsule endoscopy-raised suspicion of radiation enteritis. This case shows the role capsule endoscopy may play in the diagnosis of this condition.La enteritis actínica es una entidad producida por la afectación de las células intestinales como consecuencia del tratamiento radioterápico de tumores abdomino-ginecológicos, que en ocasiones puede causar áreas estenóticas. Presentamos el caso de una mujer de 60 años, diagnosticada diez años antes de adenocarcinoma de endometrio, que fue tratada con resección intestinal y radioterapia abdomino-pélvica. La paciente acudió por dolor abdominal y anemia ferropénica de años de evolución, con técnicas radiológicas y endoscópicas convencionales negativas. La realización de una capsuloendoscopia reveló la presencia de una estenosis ileal ulcerada, que causó la retención asintomática de la cápsula en íleon. Se indicó de forma electiva la realización de una laparotomía con resección del segmento estenótico y extracción de la cápsula, confirmándose histológicamente la sospecha capsuloendoscópica de enteritis actínica. Este caso ilustra el papel que la capsuloendoscopia puede jugar en esta entidad de difícil diagnóstico.

Aim: to study the usefulness and safety of capsule endoscopy as a diagnostic tool in various small bowel disorders. Design: a retrospective analysis of a series of cases. Material and methods: between August 2001 and August 2002, 92 capsule endoscopy procedures were performed in 88 patients (53M/39F, age: 43.87 ± 16.78). Indications included: chronic diarrhea (n = 33); unknown abdominal pain (n = 29); occult gastrointestinal bleeding or iron-deficiency anemia (n = 13); abdominal discomfort in NSAID takers (n = 7); staging of gastrointestinal tumors (n = 4), and asymptomatic controls (n = 2). Previously performed gastroscopy, colonoscopy, and small-bowel follow-through were not conclusive in all patients. Results: most frequently relevant findings included: jejuno-ileal apthas and ulcerations (29 patients), vascular malformations (13 patients), and intestinal neoplasm (6 patients). The groups with a higher rate of findings related to this indication were occult gastrointestinal bleeding (76.92%) and chronic diarrhea (67.85%), with the lowest rate in the abdominal pain group (34.48%). Therapeutic strategy was directly changed in 36 of 88 patients (40.90%) because of capsule-endoscopic findings. The only observed complication was the failed excretion of one of the capsules because of an unknown ulcerated intestinal stricture. Conclusions: capsule endoscopy is a safe procedure which can study the entire small bowel, meaning a valuable tool for the management of patients with suggestive signs and symptoms of intestinal disorders.Objetivo: estudiar la utilidad y seguridad de la cápsula endoscópica como prueba diagnóstica en distintas patologías de intestino delgado. Diseño: análisis retrospectivo de una serie de casos. Material y métodos: entre agosto de 2001 y agosto de 2002 se realizaron 92 cápsulo-endoscopias a 88 pacientes (53H/39M, edad: 43,87± 16,78). Las indicaciones fueron: diarrea crónica (n = 33); dolor abdominal no filiado (n = 29); hemorragia digestiva de origen oscuro o anemia ferropénica (n = 13); molestias abdominales en pacientes consumidores de AINE (n = 7); estudio de extensión de tumores gastrointestinales (n = 4); y controles asintomáticos (n = 2). Todos los pacientes fueron sometidos previamente a tránsito intestinal, gastroscopia y colonoscopia, cuyos hallazgos no fueron concluyentes para el diagnóstico. Resultados: los hallazgos relevantes más frecuentemente encontrados fueron ulceraciones y aftas yeyunoileales (29 pacientes), malformaciones vasculares (13 pacientes) y neoplasias intestinales (6 pacientes). Los grupos con mayor tasa de hallazgos relacionados con la indicación fueron el de hemorragia digestiva de origen oscuro (76,92%) y el de diarrea crónica (67,85%), mostrando el grupo de pacientes con dolor abdominal el porcentaje más bajo (34,48%). En el 40,90% de casos (36/88) se cambió directamente la estrategia terapéutica del paciente a la luz de los resultados capsuloendoscópicos. La única complicación observada consistió en la falta de excreción de una de las cápsulas por la existencia de una estenosis ulcerada no conocida. Conclusiones: la cápsula endoscópica es una técnica segura y capaz de estudiar el intestino delgado en su totalidad, suponiendo una valiosa herramienta para el manejo de pacientes con clínica sugestiva de patología intestinal.

Se presenta brevemente el Tratado de Cuentas del licenciado del Castillo, escrito en castellano y publicado en 1522. Está considerado en los medios histórico-contables como el primer escrito conocido en el que se estudian los libros de cuenta de modo específico, aunque desde una óptica jurídica más que contable. Puede mostrar la difusión de unas técnicas y prácticas mercantiles y el uso de las mismas por otros sectores sociales y campos de actividad.

El objeto de este trabajo es presentar un manuscrito de aritmética comercial del siglo XIV escrito en castellano. Este tipo de escritos constituye una prueba de la práctica de una actividad didáctica de esta disciplina en Castilla, puesta al servicio de un comercio activo, que establecía relaciones entre mercaderes castellanos y centros europeos tanto atlánticos como mediterráneos. La nueva producción aritmética aparece íntimamente ligada a la "revolución"; comercial y urbana, y contaba en Castilla con una rica tradición andalusí, tradición que permitió a la sociedad castellana utilizar, en un momento determinado, todo el acervo cultural matemático que poseía y conocía desde años atrás y que iba a ser objeto de nuevas y fecundas influencias. El manuscrito estudiado presenta una pequeña colección de problemas (48), que deben proporcionar unos conocimientos apropiados de las operaciones con fracciones.The aim of this work is to introduce a manuscript on commercial arithmetic written in Castilian in the fourteenth century. This kind of document proves the general practice of an educational activity on the subject in Castile, meant to serve a lively trade which involved deals between Castilian merchants and European centres both Atlantic and Mediterranean. The new arithmetic production is closely linked to the urban and commercial "revolution";, there being a rich Andalusi tradition in Castile, which enabled Castilian society to use all the mathematical cultural heritage acquired over a long time, and which would be affected by new influences. The document contains a small collection of problems (48) meant to provide the reader with the appropriate knowledge on operations with fractions.

CD is a chronic inflammatory disorder associated to mucosal and transmural inflammation of the bowel wall. It is well known that CD can affect the entire gastrointestinal. Therefore, ileocolonoscopy and biopsies of the terminal ileum as well as of each colonic segment to look for microscopic evidence of CD are the first-line procedures to establish the diagnosis. However, it has been observed that up to 30% of the patients have only small bowel involvement. Evaluation of the small bowel has been made with radiological procedures, barium radiography, and abdominal computed tomography or by ileocolonoscopy or enteroscopy, but they have many recognized limitations. CE is undoubtedly a very useful diagnostic tool proposed to observe small-bowel lesions undetectable by conventional endoscopy or radiologic studies. We review different studies that have been published reporting the use of CE in suspected and evaluation of the extension or the recurrence in CD and also its use in pediatric population and its complications.

Se realiza un estudio de prevalencia de disquinesias Tardías (D.T.) en una muestra de 329 pacientes psiquiátricos de larga estancia del Hospital Psiquiátrico Regional (H.P.R.) de Asturias. La evaluación fue efectuada por dos investigadores en momentos distintos, utilizando la Escala de Simpson (Abbreviate Dyskinesia Rating Scale). Los resultados de dicho trabajo muestran un aumento de prevalencia de D.T. en las mujeres, incrementándose con la edad, tiempo de estancia de hospitalización y en aquellos que sufrieron trastornos afectivos, problemas cardio-respiratorios y endocrinológicos, sin que hubiera diferencias significativas entre los que padecían psicopatología defectual o productiva.

Este trabajo trata de mostrar el rápido ocaso de una de las grandes familias burgalesas dedicadas al tráfico mercantil en el tránsito del siglo XV al XVI. Miembros de una tercera generación de mercaderes, tras superar serios problemas familiares e iniciar algunas operaciones comerciales, las abandonan viéndose envueltos en el «movimiento cumunero» que prendió en Castilla a principios del siglo XVI. Ello ocasionó, en parte, su ruina.It intends to show the fast decline of one of the outstanding families devoted to trade in Burgos within transition from 15th to 16th centuries. Being 3rd generation descendants of merchants they face and get over several family disputes; they decide to start some business to give them up later, getting involved in the «Movimiento Comunero» that ocurred in Castille in early 16th century. Partly, that led to bankrupcy.

Los mercaderes castellanos que negociaban en Europa buscaron formas de asociación que, además de favorecer sus intereses profesionales, cumpliesen una tarea asistencial, proporcionando a sus miembros ayuda y apoyo. Es en una de esas funciones en la que vamos a fijar nuestra atención en el presente trabajo, en la protección que la Nación española de Brujas ofrecía a sus miembros más desvalidos: viudas y fiuérfanos de mercaderes allí residentes. Contemplamos los períodos de minoría de edad como especialmente delicados en la historia de las familias de mercaderes, pues podemos decir que suponían el principio del fin, al menos en lo que se refiere a su vinculación con el mundo de los negocios. La obsesión por conservar sus bienes suponía no incrementarlos. La ya disgregada hacienda paterna, que había sufrido diversas particiones, no podía soportar ni resistir la inactividd de la inversión durante una larga espera.The Castilian merchante who traded in Europe looked for forms of association which, apart from fulfilling a helping task, also favoured their professional interests, providing their members with help and support. It is in one of these functions that we are going to look at in this work, focusing our attention on the protection which the Spanish Nación in Bruges offered its more helpless members: widows and orphans of the merchants who were resident there. We will look at the periods of age of minority especially sensitive in the history of the merchants families, we could say which were the beginning of the end, and least in what was referred to as their links with the trading world. The obsession for conserving their goods meant non increasing them. The already disintegrated paternal propery that had suffered various divisions could not wittistand or endure the inactivity in investment during a long period of time.

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Se purificó a partir de la leche de cerdas transgénicas, factor IX recombinante, y se obtuvieron rendimientos entre 1 a 2 g de esta proteína por litro, lo que resulta una nueva vía para la obtención de este producto con una alta eficiencia, ya que su expresión es 1 000 veces superior a la del factor IX plasmático humano. Mediante la combinación de 2 pasos cromatográficos: intercambio iónico en DEAE-Shephadex A-50 y cromatografía de afinidad con heparina, se realizó la purificación del factor IX, con esta leche como material de partida. Se estudiaron diferentes métodos para la eliminación de las caseínas, contaminante principal del proceso, y se escogió finalmente la ultracentrifugación, por las numerosas ventajas que presenta con respecto a la precipitación isoeléctrica y la precipitación por sales. El factor IX puede ser purificado de la leche transgénica con una alta pureza utilizando métodos cromatográficos que no usan inmunoafinidad y son finalmente escalables en la producción industrial, lo cual proporciona nuevas perspectivas para el tratamiento de la hemofilia B mediante la preparación de posibles formulaciones oralesRecombinant factor IX was purified from milk of transgenic sows, and yieldings between 1 and 2 g of this protein per liter were obtained. This is a new way to get this product with a high efficiency, since its expression is 1 000 times higher than of the human plasmatic factor IX. By combining 2 chromatographic steps (ion exchange in DEAE-Shephadex A-50 and affinity chromatography with heparin), the factor IX was purified, with this milk as a starting material. Different methods were studied to eliminate caseins, the main pollutant of the process, and ultracentrifugation was selected due to its numerous advantages over the isoelectric precipitation and salt precipitation. Factor IX may be purified from transgenic milk with an elevated purity by chromatographic methods that do not use immunoaffinity and are finally scalable in industrial production, which provides new perspectives for treating hemophilia B by preparing new oral formulations

Se realizó un estudio retrospectivo de los resultados de la determinación del anticoagulante lúpico (AL) realizadas en el período comprendido entre julio del 2000 y julio del 2004 en el laboratorio de hemostasis del Instituto de Hematología e Inmunología. En este período se le realizó la determinación del AL a 380 muestras, el 86 % de las cuales pertenecían a pacientes del sexo femenino, la positividad global fue del 7,3 %, el tiempo de veneno de víbora de Russell diluido fue la prueba que detectó más casos positivos (50 %), pero se evidenció la necesidad de realizar más de una prueba para detectar todos los casos positivos. La prevalencia del AL se comportó de la siguiente forma: en el lupus eritematoso sistémico fue del 17,8 %, en la anemia hemolítica autoinmune del 21 %, en la púrpura trombocitopénica idiopática del 7,6 %, en un grupo de misceláneas que incluyó principalmente artralgias, vasculitis, síndrome de Evan- Fischer, tiempo parcial de tromboplastina prolongado, sangramientos e infecciones a repetición fue del 3,5 %, en pacientes con trombosis fue del 7,6% y en pacientes con abortos a repetición y/o pérdidas fetales del 4,6 %; resulta de gran importancia su determinación en enfermedades autoinmunes, ya que el 39 % de los casos positivos pertenecían a este grupo, aunque su positividad fue baja en el grupo de mujeres con abortos y/o pérdidas fetales a repetición y en pacientes con trombosisA retrospective study of the results of the determination of the lupus anticoagulant (LA) carried out from July 2000 to July 2004 at the hemostasis laboratory of the Institute of Hematology and Immunology, was conducted. During this period, the determination of LA was performed in 380 samples. 86 % of them were from females. There was 7.3 % of global positivity. The time of Russell's diluted snake poison was the test that detected more positive cases (50 %). It was evidenced the need to carry out more than a test to identify all the positive cases. The prevalence of LA behaved as follows: 17.8 % in the systemic lupus erythematosus, 21 % in the autoimmune hemolytic anemia, 7.6% in the idiopathic thrombocytopenic purpura, 3.5 % in a group of miscellanea that include mainly arthralgia, vasculitis, Evan-Fischer's syndrome, partial prolonged time of thromboplastin, bleedings and recurrent infections. 7.6 % in patients with thrombosis, and 4.6 % in patients with various abortions and/or fetal losses. Its determination in autoimmune diseases is very important, since 39 % of the positive cases corresponded to this group, although its positivity was low in the group of women with abortions and/or repeated fetal losses and in patients with thrombosis.

La diabetes mellitus (DM) se clasifica en 2 tipos de acuerdo con su patogénesis: la tipo 1 representa menos del 10 % del total de pacientes, la DM tipo 2 es más común dentro de la población de pacientes diabéticos. Se han encontrado múltiples alteraciones de la hemostasia en los pacientes con este padecimiento. Estudios realizados en plaquetas, coagulación sanguínea y fibrinólisis han permitido asegurar que estos trastornos son posiblemente un factor importante en el estado pretrombótico que presentan estos enfermos. Las investigaciones en las plaquetas han demostrado una hiperreactividad plaquetaria, un aumento de la actividad procoagulante de las plaquetas. Por otra parte, la mayoría de los autores coinciden en la actualidad en que la DM es un estado de hipercoagulabilidad,lo cual se basa en numerosas investigaciones sobre la enfermedad y el mecanismo de la coagulación que demuestran el aumento del fibrinógeno, factor VII y factor von Willebrand, así como de los marcadores de activación de este sistema. Además, se han demostrado alteraciones en el sistema fibrinolítico, como el aumento del inhibidor del activador del plasminógeno y del inhibidor de la fibrinólisis activado por trombina. En este trabajo se presentan algunos mecanismos que pudieran explicar las alteraciones en la hemostasia que posiblemente contribuyan al desarrollo de complicaciones trombóticas que se presentan en estos pacientes.Diabetes mellitus is classified into 2 types according to its pathogenesis: type 1 accounts for less than 10 % of the total of patients, whereas type 2 is the most common in the population of diabetic patients. Multiple alterations of hemostasis have been found among the patients suffering from this disease. The studies conducted in platelets, blood coagulation and fibrinolysis have allowed to assert that these disorders are probably an important factor in the prethrombotic state of these patients. The investigations carried out with platelets have shown a platelet hyperreactivity, an increase of the procoagulant activity of platelets. On the other hand, most of the authors coincide at present that diabetes mellitus is a state of hypercoagulability, which is based on several investigations on the disease and on the coagulation mechanism that prove the rise of fibrinogen, factor VII and von Willebrand factor, as well as of the markers of activation of this system. Besides, alterations such as the increase of the plasminogen activator inhibitor and of the fibrinolysis inhibitor activated by thrombin have been demonstrated in the fibrinolytic system. In this paper, some mechanisms are presented that may explain the alterations in the hemostasis and that may contribute to the development of thrombotic complications that are observed in these patients.

En la década de los 60 comenzó a desarrollarse la técnica de citometría de flujo, pero los primeros trabajos basados en esta técnica aplicados al estudio de las plaquetas, aparecieron a finales de la década de los 80 del siglo pasado. Los ensayos de citometría de flujo complementan e incluso pueden remplazar los estudios convencionales de función plaquetaria. Se describen las ventajas y limitaciones del método, así como los antígenos plaquetarios que más se han empleado como marcadores de activación plaquetaria. El valor diagnóstico del método ha sido bien establecido en el estudio de defectos genéticos, de los síndromes protrombóticos que involucran activación plaquetaria, trombopoyesis, terapia antitrombótica, estudios de trombocitopenias alo y autoinmunes, así como la activación plaquetaria en otras situaciones clínicas como el infarto agudo de miocardio y la angina inestable. La incorporación de la citometría de flujo al estudio de las plaquetas ha tenido una importante repercusión no solo en el diagnóstico, sino también en la fisiopatología de un grupo de enfermedades relacionadas con el comportamiento plaquetarioDuring the 60’s the flow cytometry technique began to be developed, but the first papers based on this technique applied to the study of platelets appeared at the end of the 80’s in the last century. The flow cytometry assays complement and even can replace the conventional studies of platelet function. The advantages and limitations of the method ,as well as the platelet antigens that have been the most used as markers of platelet activation, are described. The diagnostic value of the method has been well established in the study of genetic defects, of the prothrombotic syndromes involving platelet activation, thrombopoiesis, antithrombotic therapy, studies of alo- and autoimmune thrombocytopenias, as well as the platelet activation in other clinical situations, such as acute myocardial infarction and unsteady angina. The incorporation of flow cytometry to the study of platelets has had an important repercussion not only on the diagnosis, but also on the physiopathology of a group of diseases related to platelet behavior

Objective: To evaluate the efficacy and safety of a quadruple regimen (BMTO) of the "3-in-1 capsule" (containing bismuth subcitrate potassium, metronidazole and tetracycline) plus omeprazole in naïve and previously treated patients diagnosed with Helicobacter pylori (H. pylori) infection in the clinical setting in Seville (Spain). Methods: This is a prospective study carried out on consecutive patients with a confirmed H. pylori infection and upper gastrointestinal symptoms. After providing their informed consent, the patients were treated for ten days with a 3-in-1 capsule containing bismuth subcitrate potassium (140 mg), metronidazole (125 mg) and tetracycline (125 mg: Pylera®), three capsules four times daily, plus omeprazole (20 or 40 mg) twice daily. Eradication of infection was determined by a negative urea breath test at least 28 days after the end of treatment. Results: A total of 58 consecutive patients were enrolled into this study, two of whom withdrew early due to vomiting on days three and five, respectively. In this cohort, 17 patients (29.3%) had a prior history of medication to treat H. pylori. In the intent-to-treat population, eradication was achieved in 97.6% (40/41) and 82.4% (14/17) of cases in patients treated with BMTO as a first-line or rescue therapy, respectively. At least one adverse event was reported by 28 (48%) patients, mostly mild effects (86%). Conclusion: A ten day treatment with BMTO is an effective and safe strategy to combat confirmed H. pylori infection in patients.

Background: The incidence of inflammatory bowel disease is increasing in Europe and in Spain. However, there is no recent data from Southern Spain. Objectives: To determine the evolution of the hospital incidence of inflammatory bowel disease in Southern Spain. Material and methods: A retrospective study was performed in two hospitals in Southern Spain. Data was collected from inflammatory bowel disease patients, divided into two periods (1995-2000 and 2001-2014) and compared. The reference population from both areas was 1,011,555 inhabitants. Results: A total of 430 patients were registered during the first period (1995-2000); 50% (215) had Crohn's disease that resulted in a cumulative incidence rate of 7.08 cases/100,000 inhabitants per year. The overall inflammatory bowel disease incidence was 3.54 cases/100,000 inhabitants per year. During the second period (2001-2014), 2,089 patients were collected; 51.7% had ulcerative colitis (1,081). The rate of cumulative incidence of inflammatory bowel disease was 14.7 cases/100,000 inhabitants per year (7.6 cases of ulcerative colitis/100,000 inhabitants/year and 7.1 cases of Crohn's disease/100,000 inhabitants/year). Conclusions: The incidence of inflammatory bowel disease in Southern Spain has doubled in the last decade and is similar to that of the rest of the country and Europe.

Background: Golimumab is a TNF-blocking agent indicated as a second-line therapy in ulcerative colitis. Purpose: To research the effectiveness and safety of golimumab in patients with ulcerative colitis in clinical practice. Methods: Retrospective study of the effectiveness and safety of golimumab in patients with ulcerative colitis. All patients received golimumab 200 mg subcutaneously at week 0, and golimumab 100 mg subcutaneously at week 2. After the induction treatment, each patient received 50 mg sc. every 4 weeks in patients with body weight less than 80 kg, and 100 mg every 4 weeks in patients with body weight greater than or equal to 80 kg. Results: Study of a group of 23 ulcerative colitis patients, 7 of whom were naive to any anti-TNF therapy, and 16 patients who had previously been treated with an anti-TNF agent other than golimumab (non-naive patients). The average treatment time with golimumab was 14.3 weeks. Globally, withdrawal of corticosteroids was observed in 74% of cases. Clinical response was observed in 85.5% of patients who had not received biological treatment previously, and in patients who had previously received biological treatment the response rate was 75%. Conclusions: In this short study, golimumab seems to be an alternative treatment in naive and non-naive anti-TNF ulcerative colitis patients. It is also a safe therapy, given that there were no adverse effects in the patients studied.

Background: Barrett's esophagus (BE) is an acquired disease defined by the presence of intestinal metaplasia with goblet cells in the distal esophagus. The prevalence of BE has increased dramatically over the last years. Aims: The primary aims of the study were to analyze the characteristics of BE and esophageal adenocarcinoma (EAC) in a Spanish health district during a follow-up period. Methodology: Sociodemographic factors, alcohol consumption and cigarette smoking were analyzed. We also studied the histological behavior and cause of death in each group. Results: In the present study 430 patients were included, 338 with BE and 92 with EAC. Incidence rates have risen from 2.25 and 1.25 per 100,000 inhabitants in 1996 to 6.5 and 4.75 per 100,000 in 2011, respectively. In the EAC group, male gender, age and alcohol consumption were higher in comparison to the BE group, and the overall survival was 23 months. In the BE group, the main causes of death were non-esophageal cancer and cardiovascular disease. Conclusions: The incidence and prevalence rates of AEC and BE have risen over the past years. Risk factors for these conditions were male gender, age and alcohol consumption. Long BE (> 3 cm) is involved in dysplasia progression. AEC diagnosis mainly occurs after neoplasia is detected and, in a few cases, due to a previous BE. Cardiovascular diseases and non-esophageal cancers have been found to be the main cause of death in BE patients.

El objeto de este trabajo es presentar un manuscrito de aritmética comercial del siglo XIV escrito en castellano. Este tipo de escritos constituye una prueba de la práctica de una actividad didáctica de esta disciplina en Castilla, puesta al servicio de un comercio activo, que establecía relaciones entre mercaderes castellanos y centros europeos tanto atlánticos como mediterráneos. La nueva producción aritmética aparece íntimamente ligada a la "revolución"; comercial y urbana, y contaba en Castilla con una rica tradición andalusí, tradición que permitió a la sociedad castellana utilizar, en un momento determinado, todo el acervo cultural matemático que poseía y conocía desde años atrás y que iba a ser objeto de nuevas y fecundas influencias. El manuscrito estudiado presenta una pequeña colección de problemas (48), que deben proporcionar unos conocimientos apropiados de las operaciones con fracciones.

Sin resumen