[Sepsis Code: dodging mortality in a tertiary hospital]. / Código Sepsis: esquivando la mortalidad en un hospital terciario.

OBJECTIVE: In the hospital of La Princesa, the "Sepsis Code" (CSP) began in 2015, as a multidisciplinary group that provides health personnel with clinical, analytical and organizational tools, with the aim of the detection and early treatment of patients with sepsis. The objective of this study is to evaluate the impact of CSP implantation on mortality and to determine the variables associated with an increase in it. METHODS: A retrospective analytical study of patients with CSP alert activation from 2015 to 2018 was conducted. Clinical-epidemiological variables, analytical parameters, and severity factors such as admission to critical care units (UCC) and the need for amines were collected. Statistical significance was established at p < 0.05. RESULTS: We included 1,121 patients. The length of stay was 16 days and 32% required admission to UCC. Mortality showed a statistically significant linear downward trend from 24% in 2015 to 15% in 2018. The predictive mortality variables with statistically significant association were lactate > 2 mmol/L, creatinine > 1.6 mg/dL and the need for amines.>5.0%, mortality at the time of chart review 62.0%, and 6-months-post-discharge readmission 47.7%. CONCLUSIONS: The implementation of Sepsis Code decreases the mortality of patients with sepsis and septic shock. The presence of a lactate > 2 mmol/L, creatinine > 1.6 mg/dL and/or the need to administer amines in the first 24 hours, are associated with an increase in mortality in the patient with sepsis.

Implementation results of the assessment and management of pain guideline within Best Practice Spotlight Organisations (BPSO®). / Resultados de la implantación de la Guía de valoración y manejo del dolor en Centros Comprometidos con la Excelencia en Cuidados (CCEC®) en España.

AIM: to analyse the progress of implementing the process recommendations of the RNAO Assessment and Management of Pain guideline and health outcomes. METHOD: An observational, longitudinal, retrospective study conducted in 3tertiary-level hospitals in Spain. All patients discharged over the last 5 days of each month from the units selected in the implementation process were included. We evaluated structural data, mean hospital stay, implementation strategy and degree of implementation of the process recommendations of the RNAO guideline over the first 3 years of implementation, and outcomes. A descriptive analysis was performed by calculating means and absolute and relative frequencies in periods: baseline (T0), annual, over the 3first years of implementation (T1, T2 and T3 respectively), and inferential. RESULTS: 8128 patients were included in the study. Hypotheses were contrasted between the different periods. The initial pain assessment in the first 24h following admission or post-surgery increased after the baseline period in all the hospitals, especially those that did not meet the guidelines from the outset. It continued to rise progressively up to 3 years following implementation (reaching 94.6% in hospital 2). By contrast, implementation of the care plan did not exceed 37.5% and 38.5% in hospitals 1 and 3 respectively. With regard to the outcome indicators, the prevalence of pain at 24hours and intense pain generally decreased in the 3hospitals from T0 or T1 to T3, however no conclusive statistically significant differences were obtained. CONCLUSIONS: Implementation of the process recommendations improved from the outset, as did patient outcomes. A decrease in the prevalence and intensity of pain was achieved, although no conclusive data were obtained; all of which leads to better nursing practice with more recording, continuity of care and improved pain management for patients.

Is the re-use of sterilized implant abutments safe enough? (Implant abutment safety).

BACKGROUND: The reuse of implant healing abutments is common in dental practice. Effective elimination of bacteria and viruses is accomplished by conventional sterilization. The aim of this work was to explore the eventual survival of microorganisms on sterilized healing abutments and to rule out the presence of transmissible organic material after standard procedures. MATERIAL AND METHODS: A total of 55 healing abutments previously used in patients will be washed and sterilized in a steam autoclave at 121 C for 15 min. Each healing abutment will be cultured in Brain Heart Infusion broth (BHI) under strict aseptic conditions. Besides, two control groups will be included: one of 3 unused healing abutments, and the other of just medium. After 10 days at 37°C under a 5% CO2 100 µl of the broth will be plated on solid media (Brain Infusion Agar, BHIA) and Columbia Blood agar to test for sterility. The remaining volume will be centrifuged, the sediment fixed, and a Gram stain performed to discard the presence of non-cultivable microorganisms. Moreover, to determine the presence of remaining organic material after the cleaning and sterilizing treatments, the bioburden will be determined by measuring total organic carbon (TOC) in another 10 previously used healing abutments, cleaned and sterilized, that will be submerged in Milli-Q water and sonicated. RESULTS: No bacterial growth was detected on any of the 58 cultured abutments, indicating that the sterilization was completely satisfactory in terms of removal of live bacteria or spores. Nevertheless, significant amounts of organic carbon may still be recovered (up to 125,31 µg/abutment) after they have been sterilized. CONCLUSIONS: Significant amounts of the bioburden remained adhered to the surfaces in spite of the cleaning and sterilization procedures. Taking into account our results and data from other authors, the presence of infectious particles on the reused healing abutments such as prions cannot be ruled out.

Initial clinical outcomes and prognostic variables in the implementation of a Code Sepsis in a high complexity University Hospital.

OBJECTIVE: To assess the impact of the first months of application of a Code Sepsis in a high complexity hospital, analyzing patient´s epidemiological and clinical characteristics and prognostic factors. METHODS: A long-term observational study was carried out throughout a consecutive period of seven months (February 2015 - September 2015). The relationship with mortality of risk factors, and analytic values was analyzed using uni- and multivariate analyses. RESULTS: A total of 237 patients were included. The in-hospital mortality was 24% at 30 days and 27% at 60 days. The mortality of patients admitted to Critical Care Units was 30%. Significant differences were found between the patients who died and those who survived in mean levels of creatinine (2.30 vs 1.46 mg/dL, p <0.05), lactic acid (6.10 vs 2.62 mmol/L, p <0.05) and procalcitonin (23.27 vs 12.73 mg/dL, p<0.05). A statistically significant linear trend was found between SOFA scale rating and mortality (p<0.05). In the multivariate analysis additional independent risk factors associated with death were identified: age > 65 years (OR 5.33, p <0.05), lactic acid > 3 mmol/L (OR 5,85, p <0,05), creatinine > 1,2 mgr /dL (OR 4,54, p <0,05) and shock (OR 6,57, P <0,05). CONCLUSIONS: The epidemiological, clinical and mortality characteristics of the patients in our series are similar to the best published in the literature. The study has identified several markers that could be useful at a local level to estimate risk of death in septic patients. Studies like this one are necessary to make improvements in the Code Sepsis programs.

[Implementation of a best practice guideline for the prevention of falls: Perception among hospitalized patients and its caregivers]. / Implantación de una guía de buenas prácticas para la prevención de caídas: percepción de los pacientes hospitalizados y sus cuidadores.

OBJECTIVE: To analyze the influence that the implementation of a fall prevention Best Practice Guideline (BPG) could have on the perception of patients and their caregivers about the utility of the activities implemented, about the care provided during admission and the adherence (the level of follow-up) to the recommendations received at discharge. MATERIAL AND METHOD: Design. Quasi-experimental study. Patients >65 years admitted≥48h to the Medical Area of the General Hospital of Albacete. SAMPLE: 104 subjects (consecutive sampling January-March 2013). Experimental group (EG). Patients admitted to BPG implementation units. Control group (CG). Usual care units. VARIABLES: Sociodemographic characteristics; previous and during admission falls, cognitive status (Pfeiffer); independence in daily life activities (ADLs); satisfaction with care and information provided, utility perceived, adherence to recommendations at discharge. DATA SOURCES: Interview and clinical history. Statistical analysis (SPSS 15.0). Descriptive and bivariant. Relative Risk. CI95%. RESULTS: 104 patients, EG 46.2% (48) and CG 53.8% (56). Women 51.9%, average age 79.9 years (s.d.=7.8). Pfeiffer 4,3 (s.d.=3.7). Previous falls 31.1%. In process, 1 fall in each group. There were statistically significant differences between EG/CG: age, cognitive status and independence in ADLs. In the EG was higher the percentage of perception about the usefulness of the recommendations to prevent falls (P<.001), greater adherence to them (P=0.0002), and to be very or quite satisfied with the information (P<.00004) and care received (P=.002). CONCLUSION: To implement recommendations according to an Evidence-based BPG to prevent falls in older people has shown, in users and caregivers, greater satisfaction, better perception of its usefulness and greater adherence to the recommendations.

[Effectiveness of implementing the reiki method to reduce the weaning failure. A clinical trial]. / Efectividad de aplicación de reiki para disminuir el fracaso en el destete ventilatorio. Ensayo clínico.

INTRODUCTION: Admission to intensive care unit (ICU) is a difficult and stressful time for the patient, with the application of different techniques, such as intubation and ventilation support withdrawal or "weaning", which may fail due to anxiety. OBJECTIVES: To determine whether Reiki is useful in reducing weaning failure, as well as reducing the number of days of mechanical ventilation (MV), length of stay in ICU, amount of sedatives, amines, and antipsychotics. METHOD: Randomized clinical trial. SCOPE: ICU of a Level III University Hospital. POPULATION: ICU patients connected to Mechanical Ventilation for more than 48hours, with a signed informed consent. Patients in a terminal condition or potential organ donors were excluded. SAMPLE: 256 patients divided into two groups: intervention group (GI) and placebo (GP). The intervention involves the application of Reiki, and a simulated technique within the placebo group. An analysis was made of the absolute and relative frequencies, with a significance level of P<.05, 95% CI RESULTS: The percentage of failures at weaning was 9% in GI and 9.5% in GP (P=.42). The mean number of days on MV was 8.85 days for GI and 9.66 for the GP (P=.53). The mean dose of sedatives: GI 1078mg and 1491mg GP. The dose of Haloperidol was lower in the GI (5.30mg vs 16.81mg GP) (P=.03, 95% CI; -21.9 to -1.13). CONCLUSIONS: Reiki reduces the agitation of patients. A decrease was objectively observed in the number of days of Mechanical Ventilation, length of stay, lower doses of sedatives, and a slight decrease in the weaning failure in the GI. No statistically significant difference was found in the main variable.

Quantitative-fluorescent-PCR versus full karyotyping in prenatal diagnosis of common chromosome aneuploidies in southern Spain.

BACKGROUND: Quantitative-fluorescent polymerase chain reaction (QF-PCR) is a reliable, rapid, and economic technique for prenatal diagnosis of the most common abnormalities. However, conventional karyotyping is expensive and requires a much longer time to yield results. It is currently under debate whether the replacement or restriction of karyotyping reduces the quality of prenatal test results. This study was undertaken to determine the percentage of clinically significant chromosomal abnormalities that would not be detected if QF-PCR was the main analysis method and karyotyping reserved for cases with increased nuchal translucency (NT) and/or abnormal ultrasound findings and to estimate the difference in cost between QF-PCR and full karyotyping. METHODS: Nine hundred twenty-eight pregnant women underwent an invasive procedure at our center between May 2009 and December 2012, yielding 580 (62.5%) chorionic villous samples and 348 (37.5%) amniotic fluid samples. Samples were studied by both QF-PCR and full karyotyping. Karyotyping and detailed ultrasound findings were retrospectively analyzed. RESULTS: If QF-PCR was the main analytic method and full karyotyping reserved for cases with elevated NT (≥4.5) and/or abnormal ultrasound findings, 12.7% of the patients would have required full karyotyping, 99% of the clinically significant chromosomal abnormalities would have been detected, and the cost would have been 54% lower than a policy of full karyotyping for all. CONCLUSIONS: Detailed prenatal ultrasound scan can reduce the need for conventional karyotyping as a complement to QF-PCR in most prenatal samples, offering rapid results and reducing parental anxiety and healthcare costs.

Urate reduction and renal preservation: what is the evidence?

Hyperuricemia is common among chronic kidney disease (CKD) patients. Experimental evidence suggests that uric acid itself may harm patients with CKD by contributing to CKD progression. Although controversial, these observations are supported by many large observational studies indicating that increased serum uric acid level predicts the development and progression of CKD in a variety of populations. Interventional studies also suggest that reducing uric acid levels in asymptomatic hyperuricemic patients with CKD is safe and might slow CKD progression. However, these studies are limited in scope and have included a relatively small number of participants. Thus, although these data suggest treating asymptomatic hyperuricemia, further studies are needed before we can advise reducing uric acid levels in patients with CKD.

Montelukast treatment (cysteinyl leukotriene receptor antagonist) in a model of food allergy: modifications in lymphatic cell population from rectal mucosa.

OBJECTIVE: The aim is to determine immunopathological modifications in rectal mucosa from rabbits after local challenge in ovalbumin (OVA) sensitized animals previously treated with montelukast. EXPERIMENTAL DESIGN: thirty two rabbits divided into four groups: G1: normal; G2: subcutaneously OVA sensitized; G3: sensitized, locally OVA challenged and sampled 4 hours after challenge; and G4: sensitized, locally OVA challenged and treated 4 hours before challenge with montelukast (0.15 mg/kg). Specific anti-OVA IgE levels were evaluated by passive cutaneous anaphylaxis test (PCA). In each group 200 high microscopical power fields (HPF) were counted. Results were expressed as arithmetic mean and SE. Anti -CD4, CD5, micro chain monoclonal antibodies were used. Avidin biotin horseradish peroxidase system was used. RESULTS: CD 4: G1: 8.3 +/- 0.06; G2: 13.4 +/- 0.08, G3: 8.25 +/- 0.06, G4: 11.8 +/- 0.02. CD 5: G1: 7.3 +/- 0.05; G2: 9.4 +/- 0.05, G3: 11.3 +/- 0.06, G4: 8.1 +/- 0.06. mu chain: G1: 10.4 +/- 0.06; G2: 3.8 +/- 0.02, G3: 6.0 +/- 0.10, G4: 2.2 +/- 0.10. In all cases, experimental groups (G3 vs. G4) presented statistical significant differences (p < 0.05). CD4+, CD5+ cells and mu chain+ decrease in experimental group (G4), probably due to lymphocyte migration inhibition to challenged mucosa. mu chain+ cell decrease could be based on B cell activation and expression of different surface immunoglobulins. Cells expressing mu chain decreased in G2 and G3 likely due to activation of B cells and subsequent expression of other immunoglobulin chains in cell surface. CONCLUSIONS: We conclude that obtained data are important to elucidate immunopathology of local anaphylactic reaction in rectal mucosa from systemic sensitized animals after treatment with montelukast.

Immunopathological modifications in the rectal mucosa from an animal model of food allergy.

AIM: The aim is to determine immunopathological modifications in rectal mucosa from rabbit after local challenge in sensitized animals with ovalbumin (OVA). EXPERIMENTAL DESIGN: Thirty rabbits divided into three groups: G1: normal, G2: subcutaneously OVA sensitized, G3: sensitized, locally OVA challenged and sampled 4 hours after challenge. Specific anti-OVA IgE levels were evaluated by passive cutaneous anaphylaxis test (PCA). In each group 200 high microscopical power fields (HPF) were counted. Results were expressed as arithmetic mean and SE. Statistical analysis was made using Student t test. Anti-CD4, CD5, micro chain, CD25 and RLA II monoclonal antibodies were used. Avidin biotin horseradish peroxidase system was used. RESULTS: CD 4: G1: 8.3 +/- 0.06; G2: 13.4 +/- 0.08 and G3: 8.25 +/- 0.06. CD 5: G1: 7.3 +/- 0.05; G2: 9.4 +/- 0.05 and G3: 11.3 +/- 0.06. CD 25: G1: 13 +/- 0.08; G2: 15.1 +/- 0.13 and G3: 25.5 +/- 0.15. mu chain: G1: 10.4 +/- 0.06; G2: 3.8 +/- 0.02 and G3: 6.0 +/- 0.10. RLA II (DR): G1: 11.6 +/- 0.05; G2: 19.2 +/- 0.09 and G3: 19.1 +/- 0.11. In all cases, experimental groups (G2 and G3) presented statistical significant differences vs. control group (G1) (p < 0.001). CONCLUSIONS: Interleukin-2 receptor (CD25+ cells) increase in experimental groups. Cells expressing micro chain decreased in G2 and G3 likely due to activation of B cells and subsequent expression of other immunoglobulin chains in cell surface. RLA II expression is higher in G2 and G3. This receptor is considered an activation marker expressed by macrophages, T and B cells. We conclude that obtained data are important to elucidate immunopathology of local anaphylactic reaction in rectal mucosa from systemic sensitized animals.

Sensitization increases esterase-positive macrophage number in appendix from an animal model of food allergy.

BACKGROUND: Macrophages are mononuclear cells with phagocytic and antigen presenting properties. The role of macrophages in IgE-dependent allergic reactions and oral tolerance remains unclear. In previous works we demonstrated that ovalbumin (OVA)-sensitized rabbits present histopathological modifications of the mucosa in different regions of the digestive tract. The present study analyzes macrophage distribution and quantitative modifications in the cecal appendix of OVA-sensitized animals. METHODS: Adult new Zealand rabbits were divided into two groups: G1 (non-sensitized normal controls) and G2 (rabbits sensitized to OVA twice by subcutaneous route, with aluminum hydroxide as adjuvant). The alpha-naphthyl esterase technique was used for macrophage detection. RESULTS: Specific anti-OVA IgE was detected in sensitized animals by the PCA (passive cutaneous anaphylaxis) method. In 5 regions of the cecal appendix we observed a significant increase in the number of macrophages in sensitized animals (G2) versus the control group (G1). The observed sensitization-mediated increase in cells is probably related to enhanced recruitment of monocytes from peripheral blood towards the appendix. This process could be induced by chemical mediators, and demonstrates macrophage participation in local immune response during sensitization phenomena.

Olvido de los contenidos de histologia en alumnos de medicina / Forgetfulness of the histology curriculum in medical students

Memoria: capacidad de grabación, archivo, clasificación y recuperación posterior de información., esencial en el procesamiento de información y el aprendizaje en analogía con la computadora. Olvido: fracaso para transferir información de la memoria a corto plazo a la memoria a largo plazo o para recuperar información de esta Objetivo: evaluar en los alumnos el olvido de los contenidos de Histología un año y medio después del cursado; recabar el grado de utilidad asignado a los mismos en las asignaturas de segundo y tercer año Alumnos de alto rendimiento en 2002 (n=26) fueron evaluados con 20 preguntas de citología y tejidos y 20 de organografía Con respuesta sugeridas 20 y 20 de breve completación. Expresaron el grado de utilidad de los contenidos en el cursado de Fisiología y Físico-Química, y en el primer cuatrimestre de Anatomía Patológica, Microbiología y Farmacología. Se cotejó el rendimiento del curso 2002 con la prueba actual y en esta los resultados de preguntas de citología y tejidos versus órganos y de respuesta sugerida versus a completar. La pérdida fue del orden del 50% en la rememoración de los contenidos (37.07 :!: 1,76 = 92,6% vs. l8,52:!: 4,33 = 46,3%) sin diferencia entre citología y tejidos versus órganos ni entre respuesta sugerida versus a completar. La mayor utilidad de los contenidos se refiere a Anatomía Patológica (69%) y Fisiología (50%) y la menor a Fisicoquímica. (7%) Estimamos que el olvido en nuestros alumnos hubiese sido aun mayor sin el empleo de técnicas activas de aprendizaje.

MEMORY: ability to record, file, classify and later recover of information., essential in processing information and learning, in analogy with a computer. FORGETFULNESS: failure to transfer information from short term memory to long term memory or to recover information from the latter. AIM: to study forgetfulness in contents of Histology in students one and half year after regular course. To evaluate level of re-utilization of contents in second and third year courses. Students with high performance in 2002 (n=26) were evaluated with 20 cytology and histology questions and 20 questions related to organs. 20 multiple choice and 20 brief filled answers were used, expressing the level of usefulness of the contents in Physiology and Physicochemistry, and in the first quarter of Pathology, Microbiology and Pharmacology. The performance of 2002 course was compared with the current test, results of cytology and histology questions versus organs ones and multiple choice answers versus brief filled answers. The loss was in the order of 50% in the recovery of contents (37.07 +/- 1,76 = 92,6% vs. 18,52 +/- 4,33 = 46,3%) without difference between cytology and histology versus organs neither among multiple choice answers versus brief filled answers. The highest usefulness in the contents refers to Pathology (69%) and Physiology (50%) and the lesser to PhysicoChemistry.(7%) We estimate that forgetfulness in our students would have been even higher without the employment of active techniques of learning.

[Association between soybean dust exposure, allergic sensitivity and profile of respiratory symptoms]. / Asociación entre exposición a polvo de soja, sensibilidad alérgica y perfil de síntomas respiratorios.

The purpose of this study was to correlate soybean dust (SD) exposure, skin reactivity to soybean hull (SH) allergens, and symptoms of asthma and/or allergic rhinitis. A group of 365 subjects with asthma and/or allergic rhinitis and a control group of 50 individuals without respiratory symptoms were studied. The level of exposure to SD is defined as follows: 1) direct (DE); 2) indirect (ID), and 3) urban (UE). All subjects completed standard questionnaires. Skin tests with a SH extract and with common allergens were performed by the prick technique (SPT). Fifty-six (15.3%) patients and no subjects from control group had positive SPT (histamine index > or = 0.5) with a SH allergen extract. The percentages of positive SPT to SH extract were 38.7%, 20.3% and 8.4% in subjects with DE, IE and UE, respectively (p < 0.001). Monosensitization to SH was absent in all subjects. The percent of subjects with positive SPTs to mites (p < 0.01), pollen (p < 0.01) and molds (p < 0.05) were higher in subjects with a positive SPT to SH versus those with a negative SPT to SH. Sixty-six percent of subjects with DE and 13.6% of subjects with IE or UE reported respiratory symptoms after SD inhalation (Odds Ratio: 12.67 [2.4-74.9], p < 0.001). Compared to subjects exclusively sensitized to mites, patients sensitized to SH presented significantly different clinical characteristics. Soybean production has been increasing in Argentina during the last 20 years, determining an increase in the population exposed to chronic SD inhalation. This fact determines a high risk of sensitization and triggering of respiratory symptoms in atopic subjects. This study demonstrates that there is: 1) a high prevalence of skin reactivity to SH in subjects with asthma and/or allergic rhinitis from Argentina and that this prevalence is associated with the level of exposure to SD, and 2) an association between sensitivity to SH and severity of asthma. Measures to avoid release and inhalation of SD in rural areas from Argentina are needed.

[Enteroendocrine cells modifications in Helicobacter pylori gastritis]. / Modificaciones de las células enteroendócrinas en gastritis por Helicobacter pylori.

OBJECTIVE: The aim of the present study was to analyze the modifications in the number and distribution of enteroendocrine cells (EEC) in antrum of patients with Helicobacter pylori (HE) gastritis. We also wanted to demonstrate their possible participation in the immune response. MATERIAL AND METHODS: Twenty-six (26) biopsies of gastric antrum from patients between the ages of 40 and 60 were used. Slides were stained with H&E, Giemsa for HP, and chromogranin A to visualize EEC. Five (5) patients were normal controls. Eleven (11) patients had antral chronic gastritis (ACG) with different grades of activity, and ten (10) patients had multifocal atrophic gastritis (MAG), both groups associated to HP. EEC were quantified in relation to 100 epithelial cells. Results were statistically compared. RESULTS: In the normal control group, EEC were sparsely distributed, deep in antral glands, with an average 19.51 EEC/100 epithelial cells. In ACG there were 12.01/100. Besides EEC were irregularly distributed, close to inflammatory areas, or near lymphoid follicles. CONCLUSION: The decrease in EEC is probably due to degranulation and later to a disappearance or inhibition of stem cells by inflammatory products in HP gastritis. The proximity of EEC to prominent inflammatory zones may indicate EEC modulate the immune response. They produce and excrete peptides that interact with membrane receptors found in T lymphocytes and macrophages.

Modificaciones de las células enteroendocrinas en gastritis por Helicobacter pylori / Enteroendocrine cells modifications in Helicobacter pylori gastritis

Objetivo: Estudiar las modificaciones en número y distribución de las células entero endocrinas (CEE) en el antro gástrico de pacientes con infección por Helicobacter pylori (HP), para demostrar su participación en la respuesta inmune. Material y Método: Se utilizaron biopsias de antro gástrico de veintiseis (26) pacientes, entre 40 y 60 años de edad. Las muestras se colorearon con HE y giemsa modificado e inmunomarcaron con Cromogranina A. Cinco pacientes integraron el grupo control. Once pacientes mostraron gastritis crónica activa y los diez restantes gastritis atrófica multifocal (AMF), ambas asociadas a HP. Las CEE se cuantificaron refiriéndoselas cada 100 células epiteliales y se evaluó el patrón de distribución de las mismas. Resultados: En antros de pacientes controles (normales), la distribución de las CEE relacionadas fue uniforme con una media de 19,51 CEE/100. En los procesos inflamatorios, se detectó 12.01 CEE/100 en las gastritis crónicas y 6.31 CEE/100 en las AMF. Asimismo se observó una distribución irregular de las CEE relacionadas con áreas inflamatorias o con folículos linfoides. Conclusiones: La disminución de las CEE correspondería a una degranulación y luego debido a la agresión del HP, a la desaparición o inhibición de las stem cell hacia la línea endócrina. La persistencia de CEE en proximidad a las áreas de mayor infiltrado inflamatório, sugeriría su participación modulando esta respuesta, probablemente liberando péptidos que interactúan con linfócitos T, macrófagos y eosinófilos. Las CEE en el antro gástrico tendrían una intervención activa en la reacción inmune provocada por el HP.

Asociación entre exposición a polvo de soja, sensibilidad alérgica y perfil de síntomas respiratorios / [Association between soybean dust exposure, allergic sensitivity and profile of respiratory symptoms]

The purpose of this study was to correlate soybean dust (SD) exposure, skin reactivity to soybean hull (SH) allergens, and symptoms of asthma and/or allergic rhinitis. A group of 365 subjects with asthma and/or allergic rhinitis and a control group of 50 individuals without respiratory symptoms were studied. The level of exposure to SD is defined as follows: 1) direct (DE); 2) indirect (ID), and 3) urban (UE). All subjects completed standard questionnaires. Skin tests with a SH extract and with common allergens were performed by the prick technique (SPT). Fifty-six (15.3

) patients and no subjects from control group had positive SPT (histamine index > or = 0.5) with a SH allergen extract. The percentages of positive SPT to SH extract were 38.7

in subjects with DE, IE and UE, respectively (p < 0.001). Monosensitization to SH was absent in all subjects. The percent of subjects with positive SPTs to mites (p < 0.01), pollen (p < 0.01) and molds (p < 0.05) were higher in subjects with a positive SPT to SH versus those with a negative SPT to SH. Sixty-six percent of subjects with DE and 13.6

of subjects with IE or UE reported respiratory symptoms after SD inhalation (Odds Ratio: 12.67 [2.4-74.9], p < 0.001). Compared to subjects exclusively sensitized to mites, patients sensitized to SH presented significantly different clinical characteristics. Soybean production has been increasing in Argentina during the last 20 years, determining an increase in the population exposed to chronic SD inhalation. This fact determines a high risk of sensitization and triggering of respiratory symptoms in atopic subjects. This study demonstrates that there is: 1) a high prevalence of skin reactivity to SH in subjects with asthma and/or allergic rhinitis from Argentina and that this prevalence is associated with the level of exposure to SD, and 2) an association between sensitivity to SH and severity of asthma. Measures to avoid release and inhalation of SD in rural areas from Argentina are needed.

Modificaçöes na morfologia dos nódulos hemolinfóides de bovinos esplenectomizados / Morphological alterations in hemal nodes in splenectomized cattle

Pelo estudo das alteraçöes morfológicas nos nódulos hemolinfóides, averiguou-se a compensaçäo da deficiência imunológica transitória em bovinos esplenectomizados. Houve aumento acentuado de tamanho dos nódulos hemolinfóides dois meses após a esplenectomia. Além disso, ocorreu aumento significativo na espessura da zona intermediária dos nódulos hemolinfóides, bem como hiperplasia celular porém sem modificaçäo na populaçäo e distribuiçäo das células. As células B foram detectadas na zona central dos folículos, enquanto que as CD4+ se assentaram no córtex, na área interfolicular e nos cordöes da zona intermediária. As células M2+ estavam dispersas no tecido cordonal e as CD8+ coraram-se de modo similar às células CD4+

[Intraepithelial enteroendocrine cells in cecum and appendix from ovoalbumin sensitized rabbits]. / Células enteroendocrinas intraepiteliales en ciego y apéndice de conejos sensibilizados con ovoalbumina.

Intraepithelial enteroendocrine cells (IEC) produce peptides which influence motility, secretion and absorption of nutrients. Recently the role of these cells in the immune mucosal system is under study. The aim of the present study was to evaluate the modifications in number of IEC in cecum and appendix from Ovalbumin (OVA) sensitized rabbits. Twenty adult New Zealand rabbits were separated in two groups: Group 1 (G1 = 10) not sensitized normal control. Group 2 (G2 = 10) were sensitized twice intraperitoneally with 70 mg OVA and 30 mg ALUM/ml (aluminium hydroxide). Anti OVA specific IgE was evaluated by means of PCA test (passive cutaneous anaphylaxis). Samples form cecum and appendix were fixed in buffered formaldehyde 10%, paraffin embedded and stained with anti-Chromogranin A for neuroendocrine cells. 400 high power fields were counted in each animal, referred as IEC/100 enterocytes. In cecum surface epithelium and crypt were considered. Surface epithelium, deep crypts and superficial crypts were evaluated in appendix. Results showed in cecum in G1:1,6 IEC/100 enterocytes in surface epithelium and 3/100 in crypts; G2 6 IEC/100 in surface epithelium and 12/100 in crypts. The difference between G1 and G2 was statistically significant (p < 0.05). In appendix surface epithelium from G1 showed 5.2/100 while G2 5.4/100. Superficial crypts 8.5 (G1) and 11.3 (G2) (p < 0.05) and deep crypts 4.9 (G1) and 8.5 (G2) (p < 0.01). The results showed that OVA-sensitized animals presented increment in the number of IEC in surface epithelium and crypts which may indicate a relationship between these cells and rabbit mucosal immune system.