Centro de Medicina Avanzada Dr. Abel Gonzalez

Después de que la Testigo de Jehová, Rosa Edelmira Pindo Mulla, manifestase en numerosas ocasiones su rechazo a que se le practicasen transfusiones de sangre, siguiendo todos los mecanismos dispuestos en la legislación española, los médicos del hospital de La Paz la sometieron a diversas transfusiones de sangre durante una cirugía para extraerle un mioma uterino. El Tribunal Europeo de Derechos Humanos sentenció una vulneración de su derecho a la vida privada establecido en el artículo 8 del Convenio Europeo de Derechos Humanos y cuantificó el daño moral en 12.000 euros. Sin embargo, el Tribunal no explica las razones de esta cuantificación, que por lo general obedece a criterios opacos y no accesibles para los justiciables, lo cual merma su credibilidad. Empleando los criterios que un sector doctrinal ha identificado mediante un análisis de la jurisprudencia del Tribunal, hemos pretendido poner de manifiesto esta falta de transparencia (que no ha recibido la merecida atención de la doctrina) y examinar la aplicación de dichos criterios en este caso.

Marrero, Odalina H.; Nuñez, Waleska D.; Alvarez, Guillermo; Imbert, Ronald Valdez; Medrano, Nicole A. Author Information

Background Dyspnoea is a common complaint that often remains unexplained with no diagnosis and poor management despite extensive, repetitive and costly testing. Invasive cardiopulmonary testing has been used in the evaluation of dyspnoea, however, its role is not yet well defined. We sought to perform a systematic review of the literature looking at the role of invasive cardiopulmonary testing in the evaluation of chronic dyspnoea and/or exercise intolerance. Methods and results We performed a literature review in accordance with PRISMA, analysing articles published in peer-reviewed journals between January 1st 1985 and January 31st 2020, available in 3 databases. The aim was to identify randomised and non-randomised clinical studies that focussed on the utility of invasive cardiopulmonary exercise test in the evaluation of dyspnoea. Emphasis was placed on studies that noted the use of exercise stress testing with the concomitant use of right heart catheterisation to evaluate hemodynamics as part of the work up for dyspnoea. We identified 6 retrospective studies that assessed the use of exercise hemodynamics to identify the aetiology of dyspnoea. Conclusion Invasive cardiopulmonary exercise test is a useful tool for identifying the cause of unexplained dyspnoea. It can be helpful in early recognition and prognostication of patients with heart failure with preserved ejection fraction and pulmonary hypertension. It has also shown to be beneficial for constructing a multidisciplinary approach to chronic dyspnoea.

Background: The advent of mechanical thrombectomy in acute stroke care has reignited interest in the arena of neuro-inflammation and neuro-plasticity to optimize stroke management and further improve outcome. Even though there is an early evidence suggesting increased risk of ischemic stroke (IS) in pro-inflammatory states like lupus, rheumatoid and even multiple sclerosis, cardiovascular risk factor association has yet to be comprehensively studied in Multiple Sclerosis (MS). This is the first ever North American Study focusing on prevalence of ischemic stroke in the largest MS cohort. Method: This retrospective study included all patients diagnosed with MS from 2000 to 2016, identified using ICD-9/10 codes. The data were extracted from the Cerner's Health Facts database. From the pool of MS patients, IS was identified and their comorbidities are identified. Multiple logistic regression was used to evaluate the odds of having IS in patients with MS. Statistical analysis performed by the SAS v ersion 9.4, Cary, NC, USA. Result: A total of 83,222 patients with a diagnosis of MS were identified. IS was officially diagnosed in 2,159 (2.59%) and intracerebral hemorrhage (ICH) in 191 (0.22%) patients with MS. Patients with MS had 1.6 times more likelihood of having an IS as compared to non-MS patients (p<0.0001). The study identified the presence of vascular risk factors in the patients with MS. Patients who had MS and had ages between 41-64 (OR 1.75, CI 1.51-2.03), hypertension (OR 4.77, CI 4.201-5.412), Coronary Artery Disease (OR 2.09, CI 1.843-2.380), heart failure (OR 1.38, CI 1.175-1.621), atrial fibrillation (OR 1.61, CI 1.361-1.894), diabetes mellitus (OR 1.58, CI 1.40-1.76), peripheral vascular disease (OR 2.38, CI 1.90-2.98), and smoking (OR 1.29, CI 1.15-1.45) were more likely to have an IS as compared to those who did not have MS and these risk factors. Conclusion: This is one of the largest MS cohort studies confirming prior reports of higher incidence of IS in MS population, especially in the 41-64 age group, after adjusting for cardiovascular risk factors. Future prospective epidemiological and molecular studies can open new diagnostic and treatment avenues.

Objective, Get free interval biochemical failure and toxicity in patients treated with hypofractionated radiotherapy (HFRT, for its acronym in English, Hypofractionated Radiation Therapy) with IMRT (Intensity Modulated Radiation Therapy), administering 70 Gy in 28 fractions of 2.5 Gy. Methods, In May 2013 began in CDD Unit of Radiotherapy and Radiosurgery of AbreuClinic, an hypofractionation program with IMRT as an alternative treatment for patients with localized prostate cancer favorable risk.The four selected patients had histologically confirmed prostate adenocarcinoma without prior radical treatment and categorized as low risk according to the criteria of D'Amico et al.For each patient a treatment plan is made based on Intensity Modulated Radiation Therapy (IMRT) more Image Guided Radiation Therapy (IGRT) with 18 MV photons from a linear accelerator CLINAC 21iX of the prestigious brand Varian®, administering doses of 70 Gy in 28 fractions of 2.5 Gy/day using an α/β 3, biologically equivalent to 76 Gy in 38 fractions of 2 Gy, under-Quadratic Linear Model.Patients were followed every 3 months for 18 months.The gastrointestinal and genitourinary toxicity (GI) (GU), was evaluated prospectively and classified according to the criteria of the RTOG (Radiation Therapy Oncology Group).As a definition of biochemical failure we use the RTOG criteria (definition Pheonix), considered the elevation of post-radiotherapy PSA≥2 ng/mL above the nadir.Results, During follow-up of 18 months, all patients (100%) were free of biochemical failure.Only one patient presented grade 2 acute genitourinary toxicity, without having reported genitourinary or gastrointestinal late toxicity.This study is preliminary, with short follow and discreet patient population, however, is the first program and the first publication of hypofractionated treatment for prostate cancer radiotherapy in our country. Conclusion, HypofractionatedRadiotherapy (HFRT) is a valuable treatment option for patients with favorable risk prostate cancer, with an excellent result of biochemical control and low toxicity.

Pantothenate Kinase-Associated Neurodegeneration (PKAN) is a form of Neurodegeneration with Brain Iron Accumulation (NBIA) associated with mutations in the pantothenate kinase 2 gene (PANK2). Pantothenate kinases catalyze the rate-limiting step of coenzyme A synthesis and Pank2 is the only pantothenate kinase isoform in humans that is localized to mitochondria. Acanthocytosis, the occurrence of spiculated erythrocytes, is observed in about 10% of the PKAN patients. Therefore PKAN is also classified together with other rare neurodegenerative diseases like Chorea Acanthocytosis (ChAc) and McLeod syndrome (MLS) into the Neuroacanthocytosis (NA) syndromes. It has not been investigated yet whether acanthocytosis in PKAN is associated with a specific subset of Pank2 mutations. In this study, we analyzed acanthocytosis of a cohort of 25 PKAN patients from the Dominican Republic that are homozygous for the c.680 A>G mutation in the PANK2 gene as compared to control donors that are heterozygous or wild-type with respect to this mutation. 3D modeling of this mutation indicated that the replacement of a tyrosine by a cysteine at position 227 in Pank2 disrupts a polar interaction within the A domain of the enzyme. Mean acanthocyte count was elevated in the cohort of patients, however, acanthocytosis varied among the patients with nearly half of them showing high (>20%) or elevated acanthocytosis and the rest showing mild (6-10%) or no (<6%) acanthocytosis. Heterozygous control donors revealed a tendency to mild acanthocytosis. Based on the insight that Pank2 is a normal constituent of red blood cells and de novo biosynthesis of coenzyme A is likely to take place in the erythrocyte cytosol we propose a hypothetical model that accounts for the variability in the occurrence of acanthocytic cells in PKAN.

Patients with juvenile-onset spondyloarthritis (SpA) may develop ankylosis of the midfoot resembling the spinal changes seen in patients with ankylosing spondylitis (AS). The study of the histopathology of the feet of patients with tarsitis could help us understand the pathogenesis of bone formation in affected structures in the SpA. The objective of our study was to describe the histopathologic characteristics of the midfoot in patients with tarsitis associated with SpA. We obtained synovial sheaths, entheses, and bone samples from 20 patients with SpA with midfoot pain/tenderness and swelling. Tissue samples underwent H&E staining; immunohistochemistry for CD3, CD4, CD8, CD68, and CD20 cell identification; and immunofluorescence for bone lineage proteins, including osteocalcin, osteopontin, parathyroid hormone-related protein, bone sialoprotein, and alkaline phosphatase. Slight edema and hyalinization were found in some tendon sheaths, and few inflammatory cells were detected in the entheses. In bones, we found some changes suggesting osteoproliferation, including endochondral and intramembranous ossification, but no inflammatory cells. In entheses showing bone proliferation, we detected osteocalcin and osteopontin in cells with a fibroblast-mesenchymal phenotype, suggesting the induction of entheseal cells toward an osteoblast phenotype. Osteoproliferation and abnormal expression of bone lineage proteins, but no inflammatory infiltration, characterize midfoot involvement in patients with SpA. In this sense, tarsitis (or ankylosing tarsitis) resembles the involvement of the spine in patients with AS. Ossification may be in part explained by the differentiation of mesenchymal entheseal cells toward the osteoblastic lineage.

Old and newly synthesized centrosomes have different microtubule nucleating abilities and they contribute to cell polarity when they migrate to opposite poles during cell division. The asymmetric localization of epigenetic marks and kinetochore proteins could lead to the differential recognition of sister chromatids and the biased segregation of DNA strands to daughter cells during cell division. We propose that this asymmetric localization is linked to biased chromatid segregation, which might also be related to the acquisition of distinct cell fates after mitosis.