The percentage of CD39+ monocytes is higher in pregnant COVID-19+ patients than in nonpregnant COVID-19+ patients.

Current medical guidelines consider pregnant women with COVID-19 to be a high-risk group. Since physiological gestation downregulates the immunological response to maintain "maternal-fetal tolerance", SARS-CoV-2 infection may constitute a potentially threatening condition to both the mother and the fetus. To establish the immune profile in pregnant COVID-19+ patients, a cross-sectional study was conducted. Pregnant women with COVID-19 (P-COVID-19+; n = 15) were analyzed and compared with nonpregnant women with COVID-19 (NP-COVID-19+; n = 15) or those with physiological pregnancy (P-COVID-19-; n = 13). Serological cytokine and chemokine concentrations, leucocyte immunophenotypes, and mononuclear leucocyte responses to polyclonal stimuli were analyzed in all groups. Higher concentrations of serological TNF-α, IL-6, MIP1b and IL-4 were observed within the P-COVID-19+ group, while cytokines and chemokines secreted by peripheral leucocytes in response to LPS, IL-6 or PMA-ionomicin were similar among the groups. Immunophenotype analysis showed a lower percentage of HLA-DR+ monocytes in P-COVID-19+ than in P-COVID-19- and a higher percentage of CD39+ monocytes in P-COVID-19+ than in NP-COVID-19+. After whole blood polyclonal stimulation, similar percentages of T cells and TNF+ monocytes between groups were observed. Our results suggest that P-COVID-19+ elicits a strong inflammatory response similar to NP-COVID19+ but also displays an anti-inflammatory response that controls the ATP/adenosine balance and prevents hyperinflammatory damage in COVID-19.

[Epidemiology, treatment and mortality in infection by carbapenemase-producing Enterobacteriaceae: retrospective study]. / Epidemiología, tratamiento y mortalidad en pacientes infectados por enterobacterias productoras de carbapenemasas: estudio retrospectivo.

BACKGROUND: Carbapenemase-producing Enterobacteriaceae (CPE) has become a significant problem in terms of public health and clinical outcome. OBJECTIVE: To assess the epidemiology, treatment and mortality in patients with infection due to CPE. MATERIAL AND METHODS: A retrospective analysis of 163 patients with CPE infection was carried out in a university hospital from July 2013 to October 2015. RESULTS: A total of 163 patients were included over the study period. Klebsiella pneumoniae was isolated in 95.1% of cases, and most of carbapenemases belonged to the OXA-48 group (93.0%). Acquisition was nosocomial in 124 cases (77.0%), healthcare-associated in 30 (18.6%), and 7 cases (4.3%) were community-acquired. The most frequent infections identified in this study were urinary tract (48.4%) and respiratory (19.5%) infections. Approximately half of the patients received antibiotic monotherapy. The 30-day mortality rate was 23.3%. Multivariate analysis revealed that the presence of septic shock at diagnosis (OR 4.2; IC 95% 1.5-11) was independently associated with an increase in death during the first month, unable to identify association with inappropriate antibiotic treatment. DISCUSSION: Further studies are needed to clarify whether antibiotic treatment of EPC infections should be combined or if monotherapy might be sufficient in mild infections.

Epidemiología, tratamiento y mortalidad en pacientes infectados por enterobacterias productoras de carbapenemasas: estudio retrospectivo / Epidemiology, treatment and mortality in infection by carbapenemase-producing Enterobacteriaceae: retrospective study

Resumen Introducción: Las enterobacterias productoras de carbapenemasas (EPC) suponen un reto para la salud pública y la práctica clínica. Objetivo: Analizar la epidemiología, el tratamiento y la mortalidad en pacientes infectados por EPC. Material y Métodos: Análisis retrospectivo de 163 pacientes infectados por EPC en un hospital universitario desde julio de 2013 a octubre de 2015. Resultados: Klebsiella pneumoniae fue aislada en 95,1% de los casos, y la mayoría de las carbapenemasas pertenecían al grupo OXA-48 (93%). La adquisición fue nosocomial en 124 casos (77%), asociada a cuidados sanitarios en 30 (18,6%), y 7 (4,3%) fueron de adquisición comunitaria. Las infecciones más frecuentes fueron las del tracto urinario (48,4%) y las respiratorias (19,5%). Aproximadamente, la mitad de los pacientes recibieron monoterapia antimicrobiana. La tasa de mortalidad a los 30 días fue de 23,3%. El análisis multivariante identificó que la presencia de shock séptico al diagnóstico (OR 4,2; IC 95% 1,5-11) estaba asociada de manera independiente con mayor mortalidad en el primer mes, sin lograr identificar asociación con el tratamiento antimicrobiano inapropiado. Discusión: Son necesarios más estudios para aclarar si el tratamiento antimicrobiano de las infecciones por EPC debe ser combinado o si podría ser suficiente la monoterapia en infecciones leves.

Abstract Background: Carbapenemase-producing Enterobacteriaceae (CPE) has become a significant problem in terms of public health and clinical outcome. Objective: To assess the epidemiology, treatment and mortality in patients with infection due to CPE. Material and Methods: A retrospective analysis of 163 patients with CPE infection was carried out in a university hospital from July 2013 to October 2015. Results: A total of 163 patients were included over the study period. Klebsiella pneumoniae was isolated in 95.1% of cases, and most of carbapenemases belonged to the OXA-48 group (93.0%). Acquisition was nosocomial in 124 cases (77.0%), healthcare-associated in 30 (18.6%), and 7 cases (4.3%) were community-acquired. The most frequent infections identified in this study were urinary tract (48.4%) and respiratory (19.5%) infections. Approximately half of the patients received antibiotic monotherapy. The 30-day mortality rate was 23.3%. Multivariate analysis revealed that the presence of septic shock at diagnosis (OR 4.2; IC 95% 1.5-11) was independently associated with an increase in death during the first month, unable to identify association with inappropriate antibiotic treatment. Discussion: Further studies are needed to clarify whether antibiotic treatment of EPC infections should be combined or if monotherapy might be sufficient in mild infections.

Patrones de tratamiento con agentes biológicos: Eficacia y sobrevida a largo plazo en pacientes con artritis reumatoidea / Treatment patterns with biological agents: Efficacy and long-term survival in patients with rheumatoid arthritis

En nuestro país existen pocos datos acerca de los patrones de tratamiento y la sobrevida de las Drogas Modificadoras de la Artritis Reumatoidea biológicas (DMARb) en pacientes con Artritis Reumatoidea (AR). El objetivo de nuestro estudio fue estimar la sobrevida del 1° y 2° agente biológico, determinar sus causas de suspensión y evaluar factores que influyan en la sobrevida de estos agentes. Material y métodos: Se realizó un estudio multicéntrico retrospectivo. Se incluyeron pacientes ≥18 años de edad que cumplieran con criterios ACR/EULAR 2010 para AR y que iniciaron su 1° y/o 2° DMARb entre 01/2006 y 06/2017, la recolección de datos se realizó mediante la revisión de historias clínicas. Se consignaron variables sociodemográficas y clínicas. Resultados: Se incluyeron 347 pacientes con edad mediana de 57,8 años, 89,6% mujeres, 96,5% tenían Factor Reumatoideo (FR) positivo. El 53,9% de los pacientes discontinuaron el tratamiento con la 1°DMARb, treinta y ocho pacientes (41,3%) discontinuaron el 2° DMARb. La causa más frecuente de suspensión del primer biológico fue la falta de provisión, mientras que la del segundo biológico fue la ineficacia. Las supervivencias medianas fueron: para la 1° DMARb 31 meses (IC 95%: 21,8-40,1) y para 2° DMARb 11 meses (IC 95%: 4-17,9), no observamos diferencias significativas en la supervivencia entre los distintos agentes, los factores independientemente asociados a menor supervivencia del 1° DMARb fueron el tabaquismo y menor edad y del 2° DMARb fue haber discontinuado el primer agente biológico debido a evento adverso. Conclusión: Las supervivencias medianas del 1° DMARb y del 2° DMARb fueron 2,6 años y menor a 1 año, respectivamente. A diferencia de otras cohortes de países desarrollados, la causa más frecuente de suspensión del primer biológico fue la falta de provisión de la medicación por parte del pagador, mientras que la del segundo biológico fue la ineficacia.

In our country there are few data about the treatment patterns and the survival of the Biologic Disease Modifying Antirheumatic Drugs (bDMARD) in patients with Rheumatoid Arthritis (RA). The objective of our study was to evaluate the survival of the 1st and 2nd biological agent, determine the causes of suspension and factors that influence on the survival of these agents. Material and methods: A retrospective multicenter study was conducted. We included patients ≥18 years of age who met the ACR/EULAR 2010 criteria for RA and who started in 1st and/or 2nd bDMARD between 01/2006 and 06/2017, the data collection was done by reviewing clinical charts The sociodemographic and clinical variables were recorded. Results: We included 347 patients with a median age of 57.8 years, 89.6% women, 96.5% had positive Rheumatoid Factor (RF). 53.9% of patients discontinued treatment with 1st bDMARD, thirty-eight patients (41.3%) discontinued the 2nd bDMARD. The most frequent cause of suspension of the first biological was the lack of provision, while the second biological was inefficacy. The median survivals were: for the 1st bDMARD 31 months (95% CI: 21.8-40.1) and for the 2nd bDMARD 11 months (95% CI: 4-17.9), we did not observe significant differences in survival between the different agents. The independent factors associated with lower survival of the 1st bDMARD were smoking and lower age and the 2nd bDMARD was to have discontinued the first biological agent due to an adverse event. Conclusion: The median survivals of the 1st bDMARD and the 2nd bDMARD were 2.6 years and less than 1 year, respectively. Unlike other cohorts of developed countries the most frequent cause of suspension of the first biological was the lack of provision of the drug by the payer, while the second biological was inefficacy.

Comparative histological and immunohistochemical study of ameloblastomas and ameloblastic carcinomas.

BACKGROUND: This study aimed to compare the histological and immunohistochemical characteristics of ameloblastomas (AM) and ameloblastic carcinomas (AC). MATERIAL AND METHODS: Fifteen cases of AM and 9 AC were submitted to hematoxilin and eosin (H&E) and immunohistochemical analysis with the following antibodies: cytokeratins 5,7,8,14 and 19, Ki-67, p53, p63 and the cellular adhesion molecules CD138 (Syndecan-1), E-cadherin and ß-catenin. The mean score of the expression of Ki-67 and p53 labelling index (LIs) were compared between the groups using the t test. A value of p<0.05 was considered to be statistically significant. RESULTS: All cases were positive for CKs 5, 14 and 19, but negative for CKs 7 and 8. CKs 5 and 19 were positive mainly in the central regions of the ameloblastic islands, while the expression in AC was variable in intensity and localization. CK14 was also variably expressed in both AM and AC. Ki-67 (P=.001) and p53 (P=.004) immunoexpression was higher in AC. All cases were positive for p63, but values were higher in AC. CD138 was mainly expressed in peripheral cells of AM, with a weak positivity in the central areas, while it was positive in most areas of ACs, except in less differentiated regions, where expression was decreased or lost. E-cadherin and ß-catenin were weakly positive in both AM and AC. CONCLUSIONS: These results shows that Ki-67, p53 and p63 expression was higher in AC as compared to AM, suggesting that these markers can be useful when considering diagnosis of malignancy, and perhaps could play a role in malignant transformation of AM. Pattern of expression of CKs 5 and 19 in AC were different to those found in AM, suggesting genetic alterations of these proteins in malignant cells. It was confirmed that CK19 is a good marker for benign odontogenic tumors, such as AM, but it is variably expressed in malignant cases.

Hipertensión arterial pulmonar y embarazo a gran altitud / Pulmonary arterial hypertension and pregnancy at high altitude

Resumen La hipertensión pulmonar, por tradición, se ha clasificado en dos categorías: primaria o secundaria, con base en las causas o factores de riesgo asociados; sin embargo, a partir del Segundo Simposio Mundial en Hipertensión Pulmonar, realizado en Évian-les-Bains, Francia, en 1998, se estableció una clasificación clínica con el objetivo de individualizar las diferentes categorías de hipertensión pulmonar que comparten hallazgos patológicos, características hemodinámicas y tratamiento similar, estableciéndose, a partir de ello, cinco grupos de entidades claramente definidas. Se describe el caso de una paciente obstétrica con hipertensión arterial pulmonar grave a gran altitud, su abordaje y tratamiento, que tuvo evolución favorable. Las pacientes con cardiopatías congénitas pueden tener descompensación de la misma y volverse sintomáticas con un evento estresante que conlleva cambios fisiológicos que ponen a prueba su capacidad funcional, como es el embarazo. Éste es uno de los pocos casos existentes en la bibliografía acerca de cardiopatía congénita acianógena con hipertensión arterial pulmonar a gran altura en una paciente obstétrica.

Abstract Pulmonary hypertension has been traditionally classified in two categories: primary or secondary pulmonary hypertension, based on associated causes or risk factors; although, during the Second World Symposium in Pulmonary Hypertension held in Évian-les-Bains, France, in 1998, a new classification was developed, with the objective to individualize the different categories of pulmonary hypertension sharing pathologic features, hemodynamic characteristics and similar treatment and nowadays this classification includes five well distinguished types of pulmonary hypertension. We relate the case of an obstetric patient with severe pulmonary hypertension at high altitude, fortunately with favorable evolution. Patients with congenital cardiac disease can become symptomatic in front of a stressful event such as pregnancy. This is one of the few cases in literature about congenital cardiac disease with severe pulmonary hypertension in an obstetric patient.

Correlación de diferentes métodos de valoración de la rigidez matinal con índices de actividad y discapacidad en pacientes con artritis reumatoidea / Correlation of different methods of assessment of morning stiffness with activity and disability indexes in patients with rheumatoid arthritis

La rigidez matinal (RM) es un síntoma complejo en los pacientes con AR. Existen diferentes formas de valorar la RM. Sin embargo, la mejor manera de evaluarla es aún controversial. Objetivos: Comparar la severidad y la duración de la RM, evaluada por el médico y por cuestionarios autorreportados, con la actividad de la enfermedad y la capacidad funcional en pacientes con AR. Métodos: Estudio observacional de corte transversal. Se incluyeron pacientes con diagnóstico de AR. Se consignaron datos demográficos, características de la AR y medidas clinimétricas. Los pacientes fueron asignados aleatoriamente a uno de dos grupos: el primer grupo fue interrogado sobre la duración de la RM en minutos; el segundo grupo fue evaluado mediante un cuestionario autorreportado que cuantificaba la severidad de la RM (EVA numérica y no numérica) y la duración (en minutos y en escala de Likert). Resultados: Participaron 111 pacientes (86% mujeres). La edad media fue de 52 años y la mediana de duración de la enfermedad fue 8 años. El 51% presentaba RM. La correlación de la RM en minutos medida por el médico fue buena con HAQ-A y aceptable con DAS28 y CDAI; mientras que la severidad medida por EVA correlacionó mejor con los índices de actividad de la AR que con discapacidad. Cuando la intensidad de la RM fue evaluada por EVA se observó que un valor >5,5 cm se asoció con actividad severa de la enfermedad (Sensibilidad: 44%; Especificidad: 100%). Conclusión: La duración de la rigidez matinal, evaluada en minutos por el médico, estaría relacionada tanto con la actividad de la enfermedad como con la discapacidad. La intensidad de la rigidez matinal se asoció más fuertemente con la actividad inflamatoria en los pacientes con AR

Características de los tratamientos biológicos en enfermedades reumáticas en Argentina: quinto informe del registro BIOBADASAR / Features of rheumatic diseases biological treatments in Argentina: BIOBADASAR fifth report

Introducción: El proyecto BIOBADASAR (Registro argentino deeventos adversos con tratamientos biológicos en reumatología)comenzó en agosto de 2010, para recabar información a largo plazosobre los eventos adversos en tratamientos biológicos en pacientescon enfermedades reumáticas en la práctica clínica cotidiana enArgentina.Pacientes y método: Se registraron datos de cada paciente,tratamientos y acontecimientos adversos relevantes o importantes.Los pacientes debían tener enfermedad diagnosticada y tratadacon un agente biológico. Cada caso se comparó con un control:un paciente con tratamiento no biológico con característicasdemográficas similares. Se analizaron los datos con análisis de lavarianza, con test de t de Student, Mann Whitney, test chi2, o testexacto de Fisher. El análisis de supervivencia de los tratamientoshasta su discontinuación o interrupción se realizó con el método deKaplan-Meier y test log-rank...

Background: BIOBADASAR (Argentine Registry of Adverse Eventsin Biological Treatments in Rheumatology) was started in August2010 to obtain long-term information of patients with rheumatic diseases,treatments and adverse events in everyday clinical practice.Patients and methods: Data on patients’ demographics,treatments and adverse events were collected. Patients had a diagnosisof a rheumatic disease and were treated with biological agent.To compare information, a control group was included, consisting ofpatients treated with similar demographic characteristics but treatedwith a non-biological agent. Data were analysed with Anova,Student´s t, Mann Whitney, chi2, Fisher´s exact tests, as appropriate.Survival analysis of treatments was performed with Kaplan-Meiercurves and log-rank test...

The resident as teacher: Medical students' perception in a Spanish university. / El residente como docente: percepción de estudiantes de medicina de una universidad española.

BACKGROUND AND OBJECTIVES: Residents play an important but scanty assessed role in medical students teaching. The aim of this study was to assess the perception of medical students about residents' teaching activity. MATERIAL AND METHODS: Autofilled survey provided to medical students of the University of Alcalá (Spain) in the final year in their school of medicine. Student opinion about care and teaching abilities of residents and physicians was evaluated using a 5-point Likert scale. RESULTS: 104 surveys were collected. A 69,9% of students consider that as much as 50% of their knowledge came from rounds with residents. Students believe that resident teaching lacks enough academical acknowledgment (94.2%); they estimate necessary to acquire teaching skills during residency (82,7%), and they would like to provide tutoring other medical students (88,5%). Students rated residents better than physicians on relational and motivational abilities. CONCLUSIONS: There is a positive view about resident as a teacher among medical students, which suggests the need to improve the resident's teaching skills.

Osteoma gigante en mandíbula. Reporte de Caso / Giant osteoma in Jaw. Case Report

El osteoma es una neoplasia benigna poco común, que se caracteriza por presentar un crecimiento óseo progresivo, el cual está  compuesto por la proliferación bien diferenciada de hueso compacto y/o esponjoso. En el área maxilofacial se presenta con mayor frecuencia en la cara lingual posterior de la mandíbula. Se caracteriza por crecimiento lento y asintomático. El caso describe una paciente de 45 ños con un osteoma gigante mandibular de 4 años de evolución tratado quirúrgicamente.

Osteomas are considered a rare benign neoplasm, characterized by a progressive bone growth, which is composed of a proliferation well differentiated of compact or cancellous bone. In the maxillofacial area when present, commonly found in the posterior lingual surface of the mandible. It is characterized by slow growth and asymptomatic. The case describes a mandibular giant osteoma of 4 year of evolution treated with surgical treatment.

[Morbidity and costs in complete thyroidectomies. Improvement in Value of the Process by a change in the management]. / Morbilidad y costes en las tiroidectomías totales. Mejora del Valor del Proceso mediante el cambio de gestión.

OBJECTIVES: 1) To present the postoperative morbidity of complete thyroidectomies and the results of their clinical management and costs obtained after surgery. 2) To compare the results obtained for the morbidity and costs in the complete thyroidectomy Process, after the management changes introduced by the Endocrine Surgical Unit (ESU). 3) To define whether these changes improve the Value (benefit/cost ratio) of the Process. MATERIAL AND METHODS: Prospective study of cohorts conducted on 529 complete thyroidectomies performed between 1998 and 2011. We present their clinical-pathological characteristics and we compare the clinical and management results obtained after surgery in 2 time periods: 1998-2006 without ESU (group 1, 205 patients) and 2007-2011 with ESU (group 2, 324 patients). The clinical results and the possible benefits are assessed by studying the morbimortality (recurrent lesions, hypocalcaemia [<8 mg/dl], suffocative haematomas and bleeding), and those of management, for the evaluation of the use of operating room time, the average stay and the total cost of the Process. The statistical comparison study was made using Student t test, for the comparison of means and the Chi(2) to compare percentages, accepting P<.05 as significant. RESULTS: The global percentage of transient recurrent dysfunctions (TRD) was 6%, and for definitive recurrent paralysis (DRP) it was 1.5%. Hypocalcaemia, at 24 hours was 54.6%, at one month 7%, at six months 6.2% and that of definitive hypoparathyroidism 1.3%. There were 2.8% of suffocative haematomas and 2% adverse effects. The mean surgical time was 98 minutes, and the average stay was 3.66 days. In the comparison of results of the groups, the ESU improved the TRD index by nearly 7 points (10.2 vs. 3.4%, P=.002), that of DRP by 1.5 (2.4 vs. 0.4%; P=.3) until reaching under 1%. The figures on bleeding at 24 hours (53 vs. 44 cc; P=.002) and 48 hours (23 to 17 cc; P<.001), the rate of haematomas by another 6 points (6.3 vs. 0.6%; P<.001), and that of hypocalcaemia at 24 hours (P=.01). The average stay also improved (4.79 vs. 2.94 days; P<.001), the use of operating room time (reduced by 20 minutes/operation; P<.001), the total cost of the Process, decreasing by more than € 2,000/Process (P<.001), and produced a total savings for the hospital in the period of study of € 665,820. CONCLUSIONS: 1) The global results (post-operative morbidity) of our total thyroidectomies are within the quality standards. 2) The surgical specialisation and the changes introduced by the ESU improved the clinical results (greater benefit) and those of management, cutting down the average stay and the operating room usage time and decreasing costs. 3) The change in management increased the Value of the Process.

[Intraoperative intact parathyroid hormone determination as a predictive factor of hyperparathyroidism resolution]. / La determinación peroperatoria de PTHi como factor predictivo de curación en el hiperparatiroidismo.

INTRODUCTION: The objectives of this study were: a) to evaluate the effectiveness of intraoperative intact parathyroid hormone (PTHi) determination as a marker of hyperparathyroidism resolution; b) to establish the minimum number of blood samples required; and c) to determine whether cervical manipulation increases baseline PTHi levels. PATIENTS AND METHOD: We performed a prospective study in 45 patients. Three intraoperative blood PTHi determinations were performed: at baseline and at 10 and 25 minutes after excising the lesion. To analyze the effects of cervical manipulation, in 19 patients, 2 further determinations were made after 2 minutes of massage on both sides of the neck. A decrease of > 50% in PTHi values between postexeresis samples and the baseline sample (gradient > 50%) was used as diagnostic and therapeutic criteria and normalization of calcemia was used as a criteria for complete resolution. RESULTS: Whenever the lesion causing hyperparathyroidism was extirpated, PTHi levels decreased at 10 and 25 minutes after exeresis. This decrease was predictive of complete resolution when the gradient was > 50. Cervical manipulation (massage) did not increase PTHi values. In patients with complete resolution, blood calcium levels also returned to normal. CONCLUSIONS: 1. Intraoperative PTHi determination with a gradient > 50 is an excellent prognostic marker of resolution. 2. Only 2 PTHi samples are required: one at baseline and another at 10 minutes after exeresis. 3. Preoperative cervical manipulation does not increase PTHi values.

Influence of age and gender on quality-of-life outcomes after cholecystectomy.

Few studies have assessed the role of sociodemographic characteristics on outcomes after a cholecystectomy. Our goal was to evaluate the influence of age and gender on the health related quality of life (HRQoL) changes after cholecystectomy in this prospective observational study of consecutive patients undergoing cholecystectomy. Patients completed the SF-36 and the Gastrointestinal Quality of Life Index (GIQLI) before intervention and 3 months later. The influence of age, gender, and the pre-intervention health status on the HRQoL changes was studied by multivariate regression analysis. Older patients had poorer HRQoL and their post-intervention improvement was lower than younger patients. Compared with men, women had worse health status before the intervention measured with both HRQoL tools. In the unadjusted analysis women had greater improvements than men, measured by the GIQLI, but not with the SF-36. However, after controlling for other relevant variables, the SF-36 measured lower improvements in women more often than men, but the GIQLI showed similar results for both. For men and women, the lower the pre-intervention health status the higher the post-operative improvement. Women presented with worse health status before the intervention and less improvement post-operatively after adjustments. The pre-intervention health status has an important role explaining changes after the intervention. A gender-related difference exists between what a generic and a disease-specific HRQoL instrument captures when measuring HRQoL improvement after cholecystectomy.

Development of explicit criteria for cholecystectomy.

OBJECTIVE: Consensus development techniques were used in the late 1980s to create explicit criteria for the appropriateness of cholecystectomy. New diagnostic and treatment techniques have been developed in the last decade, so an updated appropriateness of indications tool was developed for cholecystectomy in patients with non-malignant diseases. The validity and reliability of panel results using this tool were tested. METHODS: Criteria were developed using a modified Delphi panel judgement process. The level of agreement between the panelists (six gastroenterologists and six surgeons) was analysed and the ratings were compared with those of a second different panel using weighted kappa statistics. RESULTS: The results of the main panel were presented as a decision tree. Of the 210 scenarios evaluated by the main panel in the second round, 51% were found appropriate, 26% uncertain, and 23% inappropriate. Agreement was achieved in 54% of the scenarios and disagreement in 3%. Although the gastroenterologists tended to score fewer scenarios as appropriate, as a group they did not differ from the surgeons. Comparison of the ratings of the main panel with those of a second panel resulted in a weighted kappa statistic of 0.75. CONCLUSIONS: The parameters tested showed acceptable validity and reliability results for an evaluation tool. These results support the use of this algorithm as a screening tool for assessing the appropriateness of cholecystectomy.

Molecular basis of phenylketonuria in Cuba.

In this study we report the mutation analysis performed in Cuban PKU patients using DGGE and direct sequencing. Sixteen different mutations have been detected, which account for 91% of the total mutant alleles. Haplotype analysis and genealogical data support the European (mainly Spanish) origin of the mutations. Two mutations were found at unexpectedly high frequencies, E280K and R261Q, possibly due to consanguinity and genetic drift, among other factors. Hum Mutat 18:252, 2001.

Seasonal differences in ram seminal plasma revealed by partition in an aqueous two-phase system.

Seminal plasma plays an important role in maturation of spermatozoa through hormonal, enzymatic and surface-modifying events. We have previously shown that adsorption of seminal plasma proteins (SPPs) to the sperm cell surface partially restores the functional characteristics of damaged spermatozoa, reproducing those of live cells. In the present report, we investigate the hypothesis that seasonal differences in seminal plasma could affect its ability to recover membrane integrity of cold-shocked sperm. The effect of seminal plasma proteins, obtained in breeding (bsSPPs) and non-breeding (nbsSPPs) season, on cold-shocked ram spermatozoa previously freed from seminal plasma, was analysed by centrifugal counter-current distribution (CCCD) in an aqueous two-phase system as well as membrane integrity determination by fluorescence markers. Cold-shock treatment greatly lowered cell viability in both breeding and non-breeding season spermatozoa. The cold-shocked sperm viability obtained was approximately 20%. The loss of heterogeneity and the decrease in viability revealed by CCCD analysis was reversed by the addition of increasing amounts of bsSPP, which induced restoration of the surface characteristics of viable-like spermatozoa, as well as an increase in the number of recovered viable sperm. However, this restoring effect was much lower when nbsSPPs were added, even in a sixfold higher concentration than used with bsSPPs. Incubation of cold-shocked cells with both kinds of proteins performed in both seasonal periods, showed that the recovering effect was related to the season when the plasma sample was obtained rather than to the semen season. The addition of bsSPPs to cold-shocked sperm accounted for a nearly 50% reversion for both studied breeding seasons. However, the reversion percentages obtained with nbsSPPs were significantly lower (P<0.05) than those found with bsSPPs in both studied seasonal periods. This different reversion capacity of bsSPPs and nbsSPPs was related to a different protein composition, as revealed by comparative sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis. The bands of 20, 21, 24, 36 and 67 kDa of the bsSP sample profile decreased in winter-spring SP, and were even less intensely stained in summer SP. Densitometric analysis of the stained gel patterns allows automatic comparison among the separated bands, and revealed an important decrease in the content of several bands. The 21.5 kDa band showed the highest decrease, lowering to 14% in June-August plasma with respect to the value obtained in September-December plasma.

Translation and validation of the gastrointestinal Quality of Life Index (GIQLI).

OBJECTIVE: To translate into Spanish and validate the GIQLI, a health related quality of life questionnaire for gastrointestinal diseases. PATIENTS AND METHODS: All patients with a diagnosis of cholelithiasis, on waiting list to undergo a cholecystectomy, from three public hospitals, were included in this study. All patients were requested to fulfill the GIQLI and the SF-36 before and three months after the intervention. The validity, reliability and responsiveness of the GIQLI were studied. RESULTS: 353 patients completed both questionnaires before and after the intervention. The GIQLI was able to discriminate among levels of severity, measured by the number of previous biliary colics, between those with less (total GIQLI score: 102.7) or more than 6 colics (89.2). GIQLI domains correlated with those of the SF-36 (Pearson correlation coefficient from 0.58 to 0.79). Internal consistency of its domains was good (Cronbach alpha from 0.70 to 0.86). Responsiveness, measured by the standardized response mean, of the GIQLI ranged between 0.45 to 0.82, better than the generic questionnaire SF-36 (0.20 a 0.56). CONCLUSIONS: GIQLI translation into Spanish provides with a new tool to measure quality of life on gastrointestinal diseases. Our results support the validity, reliability and responsiveness of the GIQLI Spanish version.

Seminal plasma proteins revert the cold-shock damage on ram sperm membrane.

Ejaculated ram spermatozoa, freed from seminal plasma by a dextran/swim-up procedure and exposed to cold shock, were incubated with ram seminal plasma proteins and analyzed by fluorescence markers and scanning electron microscopy. Seminal plasma proteins bound to the sperm plasma membrane modified the functional characteristics of damaged spermatozoa, reproducing those of live cells. Scanning electron microscopy showed that the dramatic structural damage induced by cooling reverted after incubation with seminal plasma proteins. Assessment of membrane integrity by fluorescence markers also indicated a restoration of intact-membrane cells. This protein adsorption is a concentration-dependent process that induces cell surface restoration in relation to the amount of protein in the incubation medium. Fractionation of ram seminal plasma proteins by exclusion chromatography provided three fractions able to reverse the cold shock effect. Scanning electron microscopy also confirmed the high activity of one fraction, because approximately 50% of cold-shocked sperm plasma membrane surface was restored to its original appearance after incubation. Differences in composition between the three separated fractions mainly resulted from one major band of approximately 20 kDa, which must be responsible for recovering the sperm membrane permeability characteristic of a live cell.

[Verification of the proteolytic and lipolytic activities of the microbial flora isolated from raw, refrigerated, type B milk. II. Psychrotrophic microorganisms]. / Verificación de las actividades proteolíticas y lipolíticas de la flora microbiana aislada de la leche cruda tipo B refrigerada. II. Microorganismos psicrotróficos.

The aim of this work was to evaluate the microbiological quality of raw type B milk, kept under refrigeration at 3 degrees C, for a period of 15 days. The milk was enumerated and isolated a total of 180 microorganisms, of which 80 were psychrotrophics. The ability of these microorganisms to produce lipolysis and/or proteolysis in the milk was evaluated. Concerning the microbiological analysis, the samples analyzed presented high values for total counting. The results from the initial counting were 2.7 x 10(4) UFC/ml for psychrotrophic, with a predominance of Gram negative bacilli, which were highly lipolytic and had proteolytic activities associated.

Etiological characterization of 512 severely mentally retarded institutionalized patients in havana.

OBJECTIVE: To investigate etiological factors in severe mental retardation (SMR). METHODS: An etiological study is presented of 512 SMR patients in five specialized institutions in Havana. RESULTS: Prenatal, perinatal and postnatal causes were apparent in 58.0, 24.8 and 11.1% of the patients, respectively; infantile psychosis was determined in only 0.4%. The remaining 5.6% were classified as having SMR of undeterminable origin, i.e. patients with apparently normal pre-, peri- and postnatal histories who had neither dysmorphism nor affected first-degree relatives, and had a normal karyotype and metabolic screen. Among prenatal causes, genetic factors were the most frequent (82.8%), while environmental factors were apparent in only 5.3% of these cases. Of the cases with prenatal genetic etiology, chromosomal aberrations were present in 86.5% (Down syndrome 96.2% and 3.7% other chromosomal aberrations), monogenic disorders in 11.3% [neurocutaneous diseases (32.1%) and fragile X syndrome (25%) were the most frequent], and multifactorial disorders in 2.0%. Thirty-five patients (11.7%) presented multiple congenital anomalies of 'prenatal unknown' causes. The latter group may include unidentifiable chromosomal aberrations, uniparental disomy, de novo mutations and multifactorial or teratogenic factors. CONCLUSION: Accurate determination of the etiology of SMR is important not only for genetic counseling purposes, but also in identifying prenatal events which make infants more vulnerable to perinatal risk factors.