Características clinicoepidemiológicas y tendencias en el tratamiento antirretroviral de una cohorte de pacientes con infección por el virus de la inmunodeficiencia humana. Cohorte PISCIS

BACKGROUND AND OBJECTIVE

The aims of this study were to describe the process of implementation of the PISCIS cohort, and to describe the clinical and epidemiological characteristics and trends of antiretroviral treatment (ART) among patients enrolled from 1998 through 2003.

PATIENTS AND METHOD

Prospective cohort study of HIV-infected patients aged > or = 16 years newly attended in 10 Catalonian hospitals and one Balearic Islands hospital. Analysis were done using the Mantel's chi2 test for trend.

RESULTS

A total of 5,968 patients (mean age 39 yrs; 75% men) were recruited with a mean follow-up of 26.4 months (13,130 person-years). A total of 2,763 patients were newly diagnosed and among these, the most frequent transmission route was the heterosexual one (43%), followed by homosexual (31%). We observed an increasing trend in the proportion of persons < 35 years and immigrants. Among newly diagnosed, 43% had < 200 CD4 T cells/microl in the nearest determination from HIV diagnosis. In the year 2003, 83% of patients were on ART. A decrease of the protease inhibitor-based regimen (from 85% in 1998 to 25% in 2003; p < 0.001) and an increase of nucleoside and non-nucleoside analogue reverse transcriptase inhibitors-containing regimens were observed over time among naive patients who started ART with three or more drugs.

CONCLUSIONS

HIV infected patients' cohorts are feasible in our setting and are an important tool in clinical and public health. The heterosexual route of transmission was the most frequent among newly diagnosed patients. The diagnosis delay is high and, on the other hand, ARV regimens have been changing according to the recommended guidelines.

Soil pollution by a pyrite mine spill in Spain: evolution in time

Soil pollution was studied after the spill of the Aznalcóllar pyrite mine between 1998 and 2001, analyzing As, Zn, Cd, Cu and Pb both in total concentrations as well as in soluble and bioavailable forms. The main remediation measures were: clean-up of the tailings and polluted soils, plus application of amendment materials (liming). The results indicate that, after three years, 50-70% of the acidic soils and 25-30% of the basic soils are still highly polluted in total arsenic. The limit of 0.04 mg kg(-1) for water-soluble arsenic is exceeded in 15-20% of all soils. The EDTA-extractable arsenic (bioavailable) exceeds the limit of 2 mg kg(-1) only in the acidic sectors. After clean-up, the homogenization of the upper 20-25 cm of the soils appears to be the most recommended measure in the reduction of pollution.

Attentional deficit in dyslexia: a general or specific impairment?

Dyslexic and control children were tested in a visuomotor attentional task, which provides independent measures of the alerting, orienting and conflict components of the attentional system. Our results show that dyslexics are impaired with respect to controls in the attentional conflict component (resolution of conflict of incongruent peripheral information), while the alerting and orienting components remain preserved. It excludes an overall attentional impairment and points to more specific attentional processing difficulty i.e. distributed attention strategy. Generally, results of dyslexic boys are within the range of the control group, while reaction times of dyslexic girls are significantly slower than that of all other groups.

Membranous Levels of C-Erbb-2 Oncoprotein in Gastric Cancer: Their Relationship with Clinicopathological Parameters and Their Prognostic Significance

Background

The protein encoded by the c-erbB-2 gene is a membrane receptor expressed in a variety of solid human cancers and directly related to poor prognosis. The objective of this work was to evaluate the clinical value of the quantification of membranous oncoprotein levels in gastric cancer.

Materials and methods

Membranous c-erbB-2 levels were examined by means of a sandwich immunoenzymatic assay in 82 patients with gastric cancer. The median follow-up period for these patients was 16 months. In addition, c-erbB-2 expression was analyzed by immunohistochemistry in 57 gastric carcinomas.

Results

Membranous c-erbB-2 levels ranged widely in the studied tumors (44–112,000 NHU/mg protein). Median c-erbB-2 content was significantly higher in intestinal-type tumors than in diffuse-type tumors (p=0.01). In addition, high levels of c-erbB-2 were significantly associated with shorter relapse-free survival and overall survival in patients with resectable gastric carcinomas (p=0.01 and p=0.04, respectively). However, the correlation between immunohistochemistry and ELISA determinations did not reach statistical significance.

Conclusion

Our results suggest a potential prognostic value of membranous c-erbB-2 quantification by immunoenzymatic assay in gastric cancer. However, its possible role in the selection of patients with a view to the possible introduction of Herceptin as a novel drug against gastric cancer is at present uncertain.

Phan3D: design of biological phantoms in 3D electron microscopy

Three-Dimensional Electron Microscopy (3DEM) has turned out to be a major player in structural proteomics. In 3DEM, tens of thousands of EM images from a macromolecule at different views are combined to derive its structure by means of a 3D reconstruction algorithm. However, for an optimal reconstruction, the most suitable algorithm has to be used and its parameters have to be tuned for the macromolecule under study and the experimental conditions found. The use of phantoms is central to objective comparison of reconstruction algorithms and optimization of their parameters. Phan3D is a tool intended to provide a fully visual and interactive environment that facilitates the design of phantoms resembling biological specimens in 3DEM. Phan3D has been developed as an alternative to the tedious, error-prone and old-fashioned phantom design that is based on hand-written text description files.

Significance of cytosolic hyaluronan levels in gastric cancer

BACKGROUND

Hyaluronan a high-molecular weight glycosaminoglycan, is considered to be involved in the growth and progression of malignant tumours. The objective of this work was to evaluate the cytosolic hyaluronan content in gastric cancer cells, its possible relationship with clinicopathological tumour parameters and its potential prognostic significance.

METHODS

Cytosolic hyaluronan levels were examined utilizing immunoenzymatic techniques in 129 patients with gastric cancer. The mean follow-up period for these patients was 28 months.

RESULTS

Cytosolic hyaluronan levels ranged widely in tumours as well as in adjacent mucosal samples (median (range) 2822 (50-24,523) versus 3650 (507-20,782) ng/mg protein). Statistical analysis showed that tumour hyaluronan levels correlated significantly with patient's sex and the presence of lymphatic invasion. In addition, high tumour hyaluronan levels were significantly associated with shorter overall survival period (p<0.05).

CONCLUSIONS

Our results suggest that high tumoral cytosolic hyaluronan levels are associated with lesions of unfavorable outcome in gastric cancer patients. Thus, hyaluronan may provide additional prognostic information to that given by other biochemical markers currently used in gastric cancer.

Possible influence of lipid content on levels of organochlorine compounds in mussels from Galicia coast (Northwestern, Spain). Spatial and temporal distribution patterns

Influence of lipid content of mussel on levels of organochlorine compounds (polychlorinated biphenyls [PCBs] and OC pesticides) has been studied. Mussel samples coming from three sites in Galicia coast (Northwestern, Spain), Moaña and Cangas C from Ría de Vigo and Barallobre from Ría de Ferrol, collected monthly in the period from November 2000 to October 2001, have been analysed. Organochlorine compounds, PCBs (IUPAC nos. 31, 28, 52, 101, 118, 153, 105, 138, 156 and 180) and OC pesticides (pp'-DDE, op'-DDT, pp'-DDT, aldrin, isodrin and endrin) have been extracted by means of Soxhlet and determined by using gas chromatography (electron capture detector [ECD]) and gas chromatography-mass spectrometry. Statistical analysis has been performed using the SPSS statistical package. Few compounds were correlated with lipid content (Pearson product-moment correlation); for samples coming from Barallobre, only the individual PCBs 31, 28, 52 (tri- and tetrachlorinated biphenyls) and 180 (heptachlorinated biphenyl) presented a significant correlation; for Moaña samples, two cyclodiene pesticides, endrin and isodrin, presented a slight significant correlation with lipid content. From these results, it is deduced that the normalization of the concentration of organochlorine compounds to the lipid content is not necessary, in this way, avoiding possible error sources associated to the analytical determination of the lipid contentor reproductive status of mussel. Multivariate techniques (PCA) have been employed in order to study spatial and temporal distribution patterns of organochlorine compounds. The great differences found in studied samples are mainly related to spatial distribution: separations between estuarine bays (samples coming from Ría de Vigo and Ría de Ferrol) and between rural and urban zones (samples coming from Moaña and Cangas C and samples from Barallobre, respectively).

Detection of the plasmid-mediated quinolone resistance determinant qnr among clinical isolates of Klebsiella pneumoniae producing AmpC-type beta-lactamase

OBJECTIVES

Plasmid pMG252 contains the qnr locus, which is responsible for low-level resistance to quinolones by protecting the DNA gyrase. pMG252 also encodes the AmpC-type beta-lactamase (pACBL), FOX-5. The aim of this study was to determine the prevalence of qnr in strains from different geographical locations in America and Europe.

METHODS

Four hundred and twenty-five (159 Klebsiella pneumoniae and 266 Escherichia coli) clinical isolates were studied. The detection of qnr was by PCR using specific primers for an internal fragment of 543 bp.

RESULTS

qnr was detected in three cefoxitin-resistant K. pneumoniae strains, which also produced a pACBL. None of the E. coli isolates tested contained qnr. The three qnr-positive K. pneumoniae came from the USA, and all transferred a conjugative plasmid coding for cefoxitin resistance to E. coli J53. qnr was also transferred by the same plasmid in two out of the three strains. The sequences of amplified qnr fragments from the three strains were identical to the qnr sequence from pMG252.

CONCLUSIONS

The qnr determinant is uncommon among clinical isolates of K. pneumoniae and E. coli, but its identification in three pACBL+ K. pneumoniae from the USA indicates the emergence of this quinolone resistance mechanism.

Photochemical access to tetra- and pentacyclic terpene-like products from R-(+)-sclareolide

Fused tetracyclic oxetanes 4, highly substituted cyclobutenes 6, and the pentacyclic derivatives 7 and 8 were obtained by irradiation of derivatives 3 that were prepared from commercial R-(+)-sclareolide (1) in three steps. Compounds 4 are formed through a Paterno-Büchi reaction, while tricyclic derivatives 6 are the fragmentation products of the first formed oxetanes. In clear contrast, cyclopentenyl and 3-furyl derivatives, 3e and 3f, gave the [2+2] adducts, namely pentacyclic derivatives 7 and 8. All the reported reactions are totally regio- and stereoselective, with the exception of the cyclization of furyl derivative 3f, which gave the mixture of both the crossed (7b) and the right (8) isomers.

Oxidative DNA damage of mixed copper(II) complexes with sulfonamides and 1,10-phenanthroline. Crystal structure of [Cu(N-quinolin-8-yl-p-toluenesulfonamidate)2(1,10-phenanthroline)]

Mixed coordination compounds of Cu(II) with sulfonamides and 1,10-phenanthroline as ligands have been prepared and characterised. Single crystal structural determination of the complex [Cu(N-quinolin-8-yl-p-toluenesulfonamidate)(2)(phen)] shows Cu(II) ions are located in a highly distorted octahedral environment, probably as a consequence of the Jahn-Teller effect. The FT-IR and electronic paramagnetic resonance (EPR) spectra are also discussed. The mixed complexes prepared undergo an extensive DNA cleavage in the presence of ascorbate and hydrogen peroxide. Two of the complexes have higher nucleolytic efficiency than the bis(o-phenanthroline)copper(II) complex.

Preliminary experience with living donor liver transplantation in adults and children

INTRODUCTION

Living donor liver transplantation (LDLT) is becoming a widespread technique with good results. Its use may sharply decrease waiting list mortality. However, donor safety is of primary concern. The aim of this work was the preliminary evaluation of the LDLT program initiated in our institution in 1995.

PATIENTS AND METHODS

Among 875 liver transplants (LT) performed from 1986 12 are LDLT in nine adults (50.0+/-10.0 years) and three children (1.9+/-1.1 years). All donors were relatives: son/daughter (six), brother (three), and father/mother (three).

RESULTS

Donor right lobe graft weight was 758.3+/-137.4 g; left liver 525.3+/-97.1 g; and left lobe 293.3+/-30.5 g, with a graft weight/recipient weight ratio of 0.91+/-0.21 (0.64-1.36) in adults. Complications in five donors (42%) included biliary fistula in the first three cases, two pleural effusions and one intra-abdominal collection. Mean hospital stay was 16.9+/-15.2 days (median 12). Recipient indications for adults were: four HCV cirrhosis (+ alcoholic in one), one HBV cirrhosis, one cryptogenic, one alcoholic, one PBC, and one retransplant due to cholangiopathy. In children, the etiologies were two biliary atresia and one liver fibrosis. The first case was the only mortality (8.3%). Two patients were retransplanted (16.6%) due to arterial thrombosis (AT) and graft dysfunction. Actuarial survival at 1 year was 91.7%+/-8.0% for patients and 83.3%+/-10.8% for grafts. Complications in the recipients included AT (two), Acinetobacter sepsis, jaundice and upper digestive hemorrhage (due to a "small-for-size" graft), biliary fistula after T-tube removal, volvulus around the T tube, and intra-abdominal collection.

CONCLUSIONS

Our experience suggests that good results can be achieved with LDLT. Standardization of the technique will allow refinement of the operation and decrease waiting list mortality. However, donor safety remains a fearful threat.

Results of an upper endoscopy protocol in liver transplant candidates

OBJECTIVE

our aims is to understand endoscopic findings from a preoperative systematic study of patients with hepatic cirrhosis who were candidates for transplantation and their impact on a protocol for primary and secondary prophylaxis of variceal haemorrhage.

PATIENTS AND METHODS

this study involves a retrospective evaluation of upper digestive tract lesions detected before inclusion and a prospective evaluation of new episodes of variceal haemorrhage, associated mortality rates, and factors that are likely to be involved in the development of this condition. Primary prophylaxis with beta-blockers was considered indicated in cases of varices of grande II or greater or with signs associated with increased risk. Secondary prophylaxis was essentially always associated with medical and endoscopic treatment.

RESULTS

of 134 patients, there were 9 deaths, with a median time on the waiting list of 3 months. Of all patients, 33.6% presented with high risk oesophageal varices, 11.2 % with gastric varices, 42.6% with portal hypertensive gastropathy, and 26.9% with peptic lesions. Primary prophylaxis was indicated in 33 of 90 patients, and was initiated in almost half of the cases as a results of the study. Optimum fulfiment of the pre-established objectives was 75.3%. The incidence of new haemorrhagic events due to varices was 10.4% and accounted for almost half of the deaths during the monitoring period. The only statistically significant predictive factors were the presence of gastrict varices and previous history.

CONCLUSION

upper endoscopy should play a role in the preoperative examination of liver transplant candidates due to the significant impact it has on subsequent management.

Effect of siliconized latex urinary catheters on the activity of carbapenems against Pseudomonas aeruginosa strains with defined mutations in ampC, oprD, and genes coding for efflux systems

The decreased activity of carbapenems against Pseudomonas aeruginosa in the presence of eluates from siliconized latex urinary catheters is related to the loss of OprD and the expression of a new outer membrane protein (OMP). To understand this phenomenon, the activity of carbapenems and quinolones against P. aeruginosa strains, some producing AmpC beta-lactamase (BL), OprD, MexA-MexB-OprM and MexE-MexF-OprN, were determined in Mueller-Hinton broth (MH) and in MH-containing eluates. OMP profiles and BL activities were also studied. Resistance to imipenem in P. aeruginosa grown in eluate is due to both the loss of OprD and expression of BL. For meropenem this phenomenon is related to both the loss of OprD and the integrity of MexA-MexB-OprM.

Effect of proinflammatory cytokines (IL-6, TNF-alpha, IL-1beta) on hemodynamic performance during orthotopic liver transplantation

BACKGROUND

Proinflammatory cytokines (IL-6, IL-1beta, TNF-alpha) released during liver transplantation may affect hemodynamic stability. The aim of the present study was to analyze the association between IL-6, TNF-alpha, and IL-1beta and systemic vascular resistance during the phases of liver transplantation.

MATERIAL AND METHODS

The proinflammatory cytokines IL-6, IL-1beta, and TNF-alpha were analyzed in the blood of 20 consecutive patients who underwent transplantation. Blood samples were drawn from the pulmonary artery at serial times during surgery. Hemodynamic parameters were determined using a cardiac output monitor. Correlations between parameters were analyzed using the Spearman's rho and Kendall's tau-b methods.

RESULTS

Both in the vena cava and the pulmonary artery, significant association was observed between basal values of IL-6 during hepatectomy and systemic vascular resistance during the phases of liver transplantation: hepatectomy phase (r=.76, P=.02), anhepatic phase (r=.78, P=.03) and reperfusion phase (r=.87, P=.005).

CONCLUSIONS

Basal values of IL-6 may be considered a prognostic factor for hemodynamic performance during the phases of liver transplantation.

Liver transplantation and transjugular intrahepatic portosystemic shunt

OBJECTIVE

Describe the results of liver transplantation after installing Transjugular Intrahepatic Portosystemic Shunt (TIPS) and compare them with those of a control group in a comparative, longitudinal, retrospective study.

MATERIALS AND METHODS

Between April 1986 and October 2002, we performed 875 liver transplantations. Between January 1996 and October 2002, 26 transplantations were performed on TIPS carriers. This group was compared with a control cohort of 50 randomly selected patients who underwent transplantation in this period (non-TIPS carriers). Both groups were homogeneous with no significant differences between age, sex United Network for Organ Sharing (UNOS) score, Child stage, or etiology.

RESULTS

Actuarial survival rates at 1 and 3 years: TIPS group 96.15% and 89.29% versus control cohort 87.8% and 81%, respectively. In 73.9%, the TIPS was clearly effective; in 88.9%, a postoperative Doppler revealed normal flow. There were no statistically significant differences compared with time on the waiting list for transplant, duration of the operation, ischemia times, intraoperative consumption of hemoderivates, vascular or nonvascular postoperative complications, duration of stay in the intensive care unit, hospital stay, or retransplantation rate.

CONCLUSIONS

In our experience, TIPS insertion does not affect either the intraoperative or postoperative evolution and is not associated with an increased time on the liver transplant waiting list.

Changes in the incidence and severity of recurrent hepatitis C after liver transplantation over 1990-1999

BACKGROUND/AIM

Changes in immunosuppression and other factors may have changed the severity of recurrent hepatitis C during recent years. This study sought to establish the changes in incidence and severity of recurrent hepatitis C, and its association with the changes in acute rejection and induction immunosuppressive therapy between 1990 and 1999.

PATIENTS AND METHODS

Among 213 liver transplants in HCV-infected recipients, 129 grafts were selected for this study: all grafts with severe recurrent hepatitis C (fibrosis 3-4 in Scheuer's score or fibrosing cholestatic hepatitis), and those grafts without severe recurrence with at least 2 years of follow up. Grafts were divided in 5 groups depending on the year of transplantation to compare recurrent hepatitis C-related variables, AR incidence and induction immunosuppression.

RESULTS

Hepatitis-free survival decreased in recent years (p=0.015). The incidence of fibrosing cholestatic hepatitis was higher among 1996-1997 and the 1998-1999 periods (p=0.019). Survival free of severe hepatitis at 1 year follow up was 95% in 1990-1991 and 80% in 1998-1999; however, in the long-term the survival was similar between groups (p=0.933). HCV-related graft survival at 5 years was 93.5% in the 1990-95 period and 82.5% in 1996-99 (p=0.068). Neither AR nor any regimen of induction immunosuppression was associated with changes in the occurrence of recurrent hepatitis C related survival.

CONCLUSIONS

Severity of recurrent hepatitis C and HCV-related graft loss after liver transplantation were higher in the second half of the 1990s; however, there was no association with AR or induction immunosuppression.

Accumulation and activity of cethromycin (ABT-773) within human polymorphonuclear leucocytes

OBJECTIVES

To evaluate the penetration of ketolide cethromycin (ABT-773) into human polymorphonuclear leucocytes (PMNs) and its intracellular activity.

METHODS

The uptake of radiolabelled cethromycin by PMNs was determined by a velocity gradient centrifugation technique. The activity of cethromycin against intracellular Staphylococcus aureus ATCC 25923 in PMNs was also evaluated.

RESULTS

The cellular to extracellular concentration (C/E) ratio for cethromycin was >200 at an extracellular concentration of 2 mg/L. The uptake of cethromycin into PMNs was rapid and saturable. Cethromycin was slowly released from the loaded PMNs (cell associated drug>50% after 2 h of incubation). Intracellular penetration was significantly affected by the environmental temperature (C/E ratio at 4 degrees C and 37 degrees C: 13 +/- 6 and 226 +/- 31, respectively; P < 0.05), by cell viability (C/E ratio for dead and viable cells: 100 +/- 38 and 226 +/- 31, respectively; P < 0.05), by pH (C/E ratio was significantly increased at basic pH) and by the metabolic inhibitors 2,4-dinitrophenol and carbonyl cyanide m-chlorophenylhydrazone. The intracellular accumulation of cethromycin also decreased significantly when cells were activated with phorbol myristate acetate or opsonized zymosan. These data indicate that a potentially active mechanism could be involved in the uptake of cethromycin by PMNs. At high extracellular concentrations of 5 and 10 mg/L, cethromycin showed significant intracellular activity against S. aureus.

CONCLUSIONS

Cethromycin achieves high intracellular concentrations within human PMNs, remaining active intracellularly.

Zinc eluted from siliconized latex urinary catheters decreases OprD expression, causing carbapenem resistance in Pseudomonas aeruginosa

The activities of carbapenems against Pseudomonas aeruginosa decreased in the presence of siliconized latex urinary catheters (SLUCs). This effect was associated with the loss of OprD. The zinc that eluted from SLUCs is responsible for this phenomenon. We have found that zinc exerts a negative effect on the expression of OprD, the porin responsible for carbapenem entry into P. aeruginosa.

Effect of linezolid on the phagocytic functions of human polymorphonuclear leukocytes

The effect of linezolid on the phagocytic and bactericidal functions of human polymorphonuclear neutrophils (PMN) against gram-positive cocci was evaluated. Preincubation (30 min; 37 degrees C) of PMN with different concentrations of linezolid (2, 10 and 20 mg/l) did not significantly affect the phagocytosis of either Staphylococcus aureus (methicillin susceptible and resistant) or Enterococcus faecalis (vancomycin susceptible and resistant). Overnight exposure of vancomycin-resistant E. faecalis to 1/4 minimum inhibitory concentrations (MIC) of linezolid slightly increased phagocytosis by PMN. Preincubation of the other three strains with 1/4 MIC of linezolid did not affect phagocytosis by these cells. Preincubation of PMN (30 min; 37 degrees C) using different extracellular concentrations of linezolid (2, 10 and 20 mg/l) did not affect their production of either superoxide or hydrogen peroxide radicals. In conclusion, linezolid did not affect the phagocytic and bactericidal functions of human PMN.

Clinical significance of the epidermal growth factor receptor and HER2 receptor in resectable gastric cancer

BACKGROUND

Epidermal growth factor receptor (EGFR or HER1) and its homolog c-erbB-2 (HER2) are membrane receptors. Both EGFR and HER2 genes are overexpressed in a variety of solid human cancers and are related to poor prognosis of the patients. The objective of this work was to evaluate the EGFR and HER2 contents in resectable gastric cancer, their possible relationship with clinicopathologic parameters of tumors, and their prognostic significance.

METHODS

This was a prospective analysis of 63 patients with resectable gastric carcinomas, with a mean follow-up period of 40.7 months. Membranous EGFR levels were examined by radioligand binding assays, and cytosolic HER2 levels were examined by means of an immunoenzymatic assay.

RESULTS

There was a wide variability of EGFR (1-1,239 fmol/mg of protein) and HER2 (7-20,863 NHU/mg of protein) levels in tumors. There was no significant correlation between these levels and patient or tumor characteristics. However, high levels of EGFR and HER2 were significantly associated with a shorter overall survival period (P =.03 and P =.02, respectively).

CONCLUSIONS

There is a wide variability in membranous EGFR levels and in cytosolic HER2 levels in gastric cancer, which seems to be related to the biological heterogeneity of these tumors. In addition, high tumor EGFR and HER2 levels were associated with an unfavorable outcome in patients with resectable gastric cancer.

[Migraine and MIDAS (MIDASELA) in Colombian hospital workers]

AIMS

The aim of this study was to determine the prevalence of migraine and its implications in the occupational and outside employment/daily activities of the workers at a regional hospital in the Cundiboyacense Plateau in Colombia.

PATIENTS AND METHODS

The available members of the house staff at this institution were interviewed by applying the neuroepidemiological protocol drawn up by the World Health Organization (WHO); general doctors performed the initial screening and the determination of neurological disease was carried out by a clinical neurologist, both in patients who were positive and negative for neurological disease. Quality of life was evaluated by means of the MIDAS (Migraine Disability Assessment) survey, MIDASELA (in Spanish for Latin America); the analysis was performed using the EPI 6.04 software application.

RESULTS

A total of 238 people were studied: 188 females and 50 males; the prevalence of migraine was 22.5% (15.5% by the WHO protocol and 7% false negatives), with predominance in females (OR: 5.49; p< 0.005). In the MIDASELA questionnaire, 47.2% of the patients had a 50% alteration in their productivity, with regard to their occupational and outside employment/daily activities. A minimum number of patients (3.8%) were unable to work because of migraine, as compared to the figures for outside employment/daily activities (29.7%) or those involving leisure/family (66.4%). The average work, outside employment/daily and family time lost per patient because of migraine was 0.3, 2 and 5.2 days, respectively.

CONCLUSION

A sub register in the prevalence of migraine could be reported in places where the WHO protocol is used. This pathology will have to be taken well into account in Colombian hospital workers due to its individual, occupational, family, social and economic impact. It is necessary to introduce health policies and programmes aimed at evaluating, controlling and treating this type of pathology in an appropriate manner, in order to improve the quality of life of those whose job it is to look after and improve that of the other Colombians.