Liaison psychiatry before and after the COVID-19 pandemic.

INTRODUCTION: the COVID-19 pandemic had an impact on hospital admissions. The clinical profiles of patients referred to liaison psychiatry teams (LPT) remained stable over the last few decades. We postulate changes in patient profiles due to the COVID-19 pandemic. MATERIALS AND METHODS: a total of 384 patients admitted to a tertiary care University Hospital in Madrid (Spain) and referred to LPTs were recruited. Patients referred 5 months before and after the first admission for COVID-19 were included. Clinical and sociodemographic characteristics were collected, and non-parametric hypothesis contrast tests were used to study possible differences between both periods. RESULTS: patients referred during the pandemic were significantly older (U = 2.006; p = .045), most of them were admitted to medical hospitalization units (χ2 (2) = 5.962; p = 015), and with a different reason for admission. There was an increase in the rate of adjustment disorders (χ2 (1) =7.893; p = 005) and delirium (χ2 (1) =9.413; p = 002), as well as psychiatric comorbidity (χ2 (2) = 9.930; p = .007), and a reduction in the proportion of patients treated for substance misuse (χ2 (5) = 19.152; p = .002). The number of deaths increased significantly (χ2 (1) = 6.611; p = .010). In persons over 65 years inappropriate prescription was significantly lower (χ2 (1) = 8.200; p = .004). CONCLUSIONS: the pandemic had an impact on the activity of the LPTs due to the change in the clinical profile and evolution of referred patients, maintaining standards of care that are reflected through prescription.

SARS-CoV-2 infection in Spanish children with chronic kidney pathologies.

BACKGROUND: There is little information about Coronavirus Disease 2019 (COVID-19) in children with underlying chronic renal pathologies. CASES REPORT: From March until April 15, 2020, 16 children with chronic renal pathologies were diagnosed with COVID-19 in Spain. Of these, 6 had end-stage kidney disease (ESKD) (3 transplant recipients and 3 on chronic hemodialysis). The severity of symptoms was mild in all the patients, with little radiological involvement. Three patients were asymptomatic. Fever and upper respiratory symptoms were the most frequent findings. Basal glomerular filtration worsened in 3 patients; however, recovery was rapidly achieved with rehydration and drug dose adjustment. In 2 patients diagnosed with steroid-dependent nephrotic syndrome, COVID-19 provoked a disease relapse. None required oxygen therapy, and 7 could be managed as outpatients. CONCLUSIONS: COVID-19 disease appears to have a similar clinical course in children with underlying chronic renal pathologies, even in immunosuppressed cases, as in healthy children of the same age; however, special attention must be paid to fluid management and drug dose adjustment.

Arthroplasty knee registry of Catalonia: What scientific evidence supports the implantation of our prosthesis? / Registro de artroplastias de rodilla de Cataluña: ¿qué evidencia científica respalda la implantación de nuestras prótesis?

INTRODUCTION: In our environment, it is increasingly necessary to perform an activity based on scientific evidence and the field of prosthetic surgery should be governed by the same principles. The national arthroplasty registries allow us to obtain a large amount of data in order to evaluate this technique. The aim of our study is to analyse the scientific evidence that supports the primary total knee arthroplasties implanted in Catalonian public hospitals, based on the Arthoplasty Registry of Catalonia (RACat) MATERIAL AND METHODS: A review of the literature was carried out on knee prostheses (cruciate retaining, posterior stabilized, constricted and rotational) recorded in RACat between the period 2005-2013 in the following databases: Orthopedic Data Evaluation Panel, PubMed, TripDatabase and Google Scholar. The prostheses implanted in fewer than 10 units (1,358 prostheses corresponding to 62 models) were excluded. RESULTS: 41,947 prostheses (96.86%) were analysed out of 43,305 implanted, corresponding to 74 different models. In 13 models (n = 4,715) (11.24%) no clinical evidence to support their use was found. In the remaining 36 models (n = 13,609) (32.45%), level iv studies were the most predominant evidence. CONCLUSIONS: There was a significant number of implanted prostheses (11.24%) for which no clinical evidence was found. The number of models should be noted, 36 out of 110, with fewer than 10 units implanted. The use of arthroplasty registries has proved an extremely useful tool that allows us to analyse and draw conclusions in order to improve the efficiency of this surgical technique.

ConBr, A Lectin Purified from the Seeds of Canavalia brasiliensis, Protects Against Ischemia in Organotypic Culture of Rat Hippocampus: Potential Implication of Voltage-Gated Calcium Channels.

Lectins are proteins that bind cellular glycans and can modulate various neuronal functions. We have evaluated the neuroprotective effect of ConBr, a lectin purified from the seeds of Canavalia brasiliensis in a model of rat organotypic hippocampal cultures (OHCs) exposed to oxygen and glucose deprivation (OGD). OGD for 15 min followed by 24 h re-oxygenation significantly increased cell death, caused mitochondrial depolarization and increased reactive oxygen species (ROS) in CA1 region of OHCs. ConBr (0.1 µg/mL) added during the re-oxygenation period counteracted cell death, mitochondrial depolarization and overproduction of ROS induced by OGD. Moreover, ConBr restored the levels of Akt and ERK1 phosphorylation that were reduced by OGD. Modulation of intracellular Ca2+ by ConBr was evaluated in isolated hippocampal neurons loaded with the fluorescent calcium dye Fluo-4/AM. ConBr (0.1 and 1 µg/mL) reduced by 25-30 % the Ca2+ increment induced by 70 mM K+. A sub effective concentration of ConBr (0.01 µg/mL) together with a sub effective concentration of the L-type calcium channel antagonist nifedipine (0.3 µM) conferred a synergic neuroprotective effect in OHCs subjected to OGD. In conclusion, ConBr provides OHCs neuroprotection against OGD. The mechanism was not fully addressed but it may involve modulation of L-type voltage-gated Ca2+ channels by ConBr.

[Assessing the use of procalcitonin in the hospitalised young febrile infant]. / Valoración del uso de la procalcitonina en el lactante febril hospitalizado.

INTRODUCTION: The use of procalcitonin (PCT) in the evaluation of the febrile infant in the emergency care unit has been widespread. The aim of this study is to assess whether the introduction of PCT has changed the management of hospitalised febrile infants and the cost/effectiveness of this marker. MATERIALS AND METHODS: A retrospective study was performed comparing 2 periods: January-December 2009 (without PCT) and January-December 2011 (routine use of PCT). Infants aged 7 to 90 days with fever who were admitted to a university hospital and had a blood test performed were included in the study. Bacterial infection rate, antibiotic use, hospitalisation days, and analytical costs were compared. Evaluations were made using PCT, C-reactive protein (CRP), white cell count, Rochester score, and the lab-score proposed by Galetto-Lacour for the diagnosis of bacterial infection. RESULTS: A total of 109 patients were included in period 1, and 111 in period 2 (87 of which had a PCT value). The prevalence of bacterial infection, use of antibiotics, number of blood tests, and days of hospital admission was similar in both periods. The blood test cost was significantly higher in the second period. Sensitivity, specificity, positive predictive value and negative predictive value were 70.6, 58.1, 52.6 and 75%, respectively for the CRP (cut-off 1mg/dL) and 41.7; 78.4; 57.7, and 65.6% for the PCT (cut-off value 0.5ng/ml). CONCLUSIONS: The use of PCT does not seem to have a significant impact on the management of the hospitalised febrile infant.

Subthreshold Concentrations of Melatonin and Galantamine Improves Pathological AD-Hallmarks in Hippocampal Organotypic Cultures.

Melatonin is a neurohormone whose levels are significantly reduced or absent in Alzheimer's disease (AD) patients. In these patients, acetylcholinesterase inhibitors (AChEI) are the major drug class used for their treatment; however, they present unwanted cholinergic side effects and have provided limited efficacy in clinic. Because combination therapy is being extensively used to treat different pathological diseases such as cancer or acquired immune deficiency syndrome, we posed this study to evaluate if melatonin in combination with an AChEI, galantamine, could provide beneficial properties in a novel in vitro model of AD. Thus, we subjected organotypic hippocampal cultures (OHCs) to subtoxic concentrations of ß-amyloid (0.5 µM ßA) plus okadaic acid (1 nM OA), for 4 days. This treatment increased by 95 % cell death, which was mainly apoptotic as shown by positive TUNEL staining. In addition, the combination of ßA/OA increased Thioflavin S aggregates, hyperphosphorylation of Tau, oxidative stress (increased DCFDA fluorescence), and neuroinflammation (increased IL-1ß and TNFα). Under these experimental conditions, melatonin (1-1000 nM) and galantamine (10-1000 nM), co-incubated with the toxic stimuli, caused a concentration-dependent neuroprotection; maximal neuroprotective effect was achieved at 1 µM of melatonin and galantamine. Most effective was the finding that combination of sub-effective concentrations of melatonin (1 nM) and galantamine (10 nM) provided a synergic anti-apoptotic effect and reduction of most of the AD-related pathological hallmarks observed in the ßA/OA model. Therefore, we suggest that supplementation of melatonin in combination with lower doses of AChEIs could be an interesting strategy for AD patients.

Clinical, serologic, and immunogenetic characterization (HLA-DRB1) of late-onset lupus erythematosus in a Colombian population.

INTRODUCTION: Late-onset systemic lupus erythematosus (SLE) represents a specific subgroup that is defined as onset after 50 years of age. Late-onset lupus may have a different clinical course and serological findings, which may delay diagnosis and timely treatment. OBJECTIVES: The objective of this paper is to determine the clinical, serologic, and immunogenetic differences among Colombian patients with late-onset SLE versus conventional SLE patients. METHODOLOGY: This was a cross-sectional study in a Colombian population. Patients and their medical records were analyzed from the services of Rheumatology in Bogotá and met the criteria for SLE, according to the American College of Rheumatology (ACR) revised criteria for the classification of SLE.In a reference group of late-onset SLE patients (98 participants, with an onset after 50 years of age) and a group of conventional SLE patients (72 participants, with an onset of age of 49 years or less), multiple clinical variables (age, clinical criteria for lupus, alopecia, weight loss, fever, Raynaud's phenomenon) and multiple serological variables (blood count, blood chemistry profile, autoantibodies) were analyzed. Additionally, the HLA class II (DRB1) of all the patients was genotyped, including an additional group of patients without the autoimmune disease. Statistical analysis was performed using the STATA 10.0 package. RESULTS: In the group of late-onset lupus, there was a higher frequency of pleurisy (p = 0.002), pericarditis (p = 0.026), dry symptoms (p = 0.029), lymphopenia (p = 0.007), and higher titers of rheumatoid factor (p = 0.001) compared with the group of conventional SLE. Late-onset SLE patients had a lower seizure frequency (p = 0.019), weight loss (p = 0.009), alopecia (p < 0.001), and Raynaud's phenomenon (p = 0.013) compared to the conventional SLE group. In late-onset SLE, HLA DR17 (DR3) was found more frequently compared with individuals without autoimmune disease (OR 3.81, 95% CI 1.47 to 10.59) (p = 0.0016). CONCLUSION: In the Colombian SLE population analyzed, there may be a probable association of several clinical and serologic variants, which would allow the differentiation of variables in the presentation of the disease among patients with late-onset SLE vs. conventional SLE.

Texture analysis of preoperative CT images for prediction of postoperative hepatic insufficiency: a preliminary study.

BACKGROUND: Texture analysis is a promising method of analyzing imaging data to potentially enhance diagnostic capability. This approach involves automated measurement of pixel intensity variation that may offer further insight into disease progression than do standard imaging techniques alone. We postulated that postoperative liver insufficiency, a major source of morbidity and mortality, correlates with preoperative heterogeneous parenchymal enhancement that can be quantified with texture analysis of cross-sectional imaging. STUDY DESIGN: A retrospective case-matched study (waiver of informed consent and HIPAA authorization, approved by the Institutional Review Board) was performed comparing patients who underwent major hepatic resection and developed liver insufficiency (n = 12) with a matched group of patients with no postoperative liver insufficiency (n = 24) by procedure, remnant volume, and year of procedure. Texture analysis (with gray-level co-occurrence matrices) was used to quantify the heterogeneity of liver parenchyma on preoperative CT scans. Statistical significance was evaluated using Wilcoxon's signed rank and Pearson's chi-square tests. RESULTS: No statistically significant differences were found between study groups for preoperative patient demographics and clinical characteristics, with the exception of sex (p < 0.05). Two texture features differed significantly between the groups: correlation (linear dependency of gray levels on neighboring pixels) and entropy (randomness of brightness variation) (p < 0.05). CONCLUSIONS: In this preliminary study, the texture of liver parenchyma on preoperative CT was significantly more varied, less symmetric, and less homogeneous in patients with postoperative liver insufficiency. Therefore, texture analysis has the potential to provide an additional means of preoperative risk stratification.

Remnant growth rate after portal vein embolization is a good early predictor of post-hepatectomy liver failure.

BACKGROUND: After portal vein embolization (PVE), the future liver remnant (FLR) hypertrophies for several weeks. An early marker that predicts a low risk of post-hepatectomy liver failure can reduce the delay to surgery. STUDY DESIGN: Liver volumes of 153 patients who underwent a major hepatectomy (>3 segments) after PVE for primary or secondary liver malignancy between September 1999 and November 2012 were retrospectively evaluated with computerized volumetry. Pre- and post-PVE FLR volume and functional liver volume were measured. Degree of hypertrophy (DH = post-FLR/post-functional liver volume - pre-FLR/pre-functional liver volume) and growth rate (GR = DH/weeks since PVE) were calculated. Postoperative complications and liver failure were correlated with DH, measured GR, and estimated GR derived from a formula based on body surface area. RESULTS: Eligible patients underwent 93 right hepatectomies, 51 extended right hepatectomies, 4 left hepatectomies, and 5 extended left hepatectomies. Major complications occurred in 44 patients (28.7%) and liver failure in 6 patients (3.9%). Nonparametric regression showed that post-embolization FLR percent correlated poorly with liver failure. Receiver operating characteristic curves showed that DH and GR were good predictors of liver failure (area under the curve [AUC] = 0.80; p = 0.011 and AUC = 0.79; p = 0.015) and modest predictors of major complications (AUC = 0.66; p = 0.002 and AUC = 0.61; p = 0.032). No patient with GR >2.66% per week had liver failure develop. The predictive value of measured GR was superior to estimated GR for liver failure (AUC = 0.79 vs 0.58; p = 0.046). CONCLUSIONS: Both DH and GR after PVE are strong predictors of post-hepatectomy liver failure. Growth rate might be a better guide for the optimum timing of liver resection than static volumetric measurements. Measured volumetrics correlated with outcomes better than estimated volumetrics.

Neuroprotective effect of dimebon against ischemic neuronal damage.

Dimebon (dimebolin or latrepirdine), originally developed as an anti-histaminic drug, has been investigated and proposed as a cognitive enhancer for treating neurodegenerative disorders such as Alzheimer's and Huntington's diseases, and more recently schizophrenia. This study was conducted to evaluate the potential neuroprotective effect of dimebon during brain ischemia using rat hippocampal slices subjected to oxygen and glucose deprivation followed by a reoxygenation period (OGD/Reox) or glutamate excitotoxicity. Dimebon, incubated during the OGD/Reox period, caused a concentration -dependent protective effect of hippocampal slices; maximum protection (85%) was achieved at 30µM. Mitochondrial membrane depolarization, reactive oxygen species of oxygen (ROS) production, nitric oxide synthase (iNOS) induction and translocation of p65 to the nucleus induced by OGD/Reox were significantly reduced in dimebon-treated hippocampal slices. In the glutamate-induced excitotoxicity model, dimebon also afforded a concentration-dependent protective effect that was significantly higher than that obtained with memantine, a non-competitive N-methyl-d-aspartate (NMDA) antagonist. When changes in the intracellular calcium concentration were evaluated in Fluo-4-loaded rat hippocampal neurons, glutamate-induced calcium transients were reduced by 20% with dimebon. These results suggest that dimebon could counteract different pathophysiological processes during ischemic brain damage and, could therefore, be considered as a novel therapeutic strategy for cerebral ischemia-reoxygenation injury.

Small synthetic hyaluronan disaccharides afford neuroprotection in brain ischemia-related models.

High molecular weight (HMW) glycosaminoglycanes of the extracellular matrix have been implicated in tissue repair. The aim of this study was to evaluate if small synthetic hyaluronan disaccharides with different degrees of sulfation (methyl 2-acetamido-2-deoxy-3-O-(ß-d-glucopyranosyluronic acid)-O-sulfo-α-d-glucopyranoside, sodium salt (di0S), methyl 2-acetamido-2-deoxy-3-O-(ß-d-glucopyranosyluronic acid)-6-di-O-sulfo-α-d-glucopyranoside, disodium salt (di6S) and methyl 2-acetamido-2-deoxy-3-O-(ß-d-glucopyranosyluronic acid)-4,6-di-O-sulfo-α-d-glucopyranoside, trisodium salt (di4,6S)) could improve cell survival in in vitro and in vivo brain ischemia-related models. Rat hippocampal slices subjected to oxygen and glucose deprivation and a photothrombotic stroke model in mice were used. The three hyaluran disaccharides, incubated during the oxygen and glucose deprivation (15min) and re-oxygenation periods (120min), reduced cell death of hippocampal slices measured as 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide reduction, being the most potent di4,6S; in contrast, high molecular hyaluronan was ineffective. The protective actions of di4,6S against oxygen and glucose deprivation were related to activation of the PI3K/Akt survival pathway, reduction of p65 translocation to the nucleus, inhibition of inducible nitric oxide oxidase induction and reactive oxygen species production, and to an increase in glutathione levels. Administered 1h post-stroke, di4,6S reduced cerebral infarct size and improved motor activity in the beam walk test. In conclusion, di4,6S affords neuroprotection in in vitro and in vivo models of ischemic neuronal damage. Our results suggest that its neuroprotective effect could be exerted through its capability to reduce oxidative stress during ischemia. Its small molecular size makes it a more potential druggable drug to target the brain as compared with its HMW parent compound hyaluronan.

Protective effect of creatine against 6-hydroxydopamine-induced cell death in human neuroblastoma SH-SY5Y cells: Involvement of intracellular signaling pathways.

The guanidine-like compound creatine exerts bioenergetic, antiexcitotoxic, antioxidant and neuroprotective properties; however, the intracellular mechanisms responsible for these effects are still not well established. The purpose of this study was to investigate the protective effect of creatine against 6-hydroxydopamine (6-OHDA)-induced cell death in neuroblastoma SH-SY5Y cells and the possible intracellular signaling pathways involved in such effect. Exposure of SH-SY5Y cells to 100-300µM of 6-OHDA for 24h caused a significant concentration-dependent cell death measured as a diminution of 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl-tetrazolium bromide (MTT) reduction and as an increase in the extracellular release of lactate dehydrogenase. SH-SY5Y cells incubated for 24 or 48h with creatine (10-5000µM) was not cytotoxic. However, pre and co-treatment with creatine (0.3-1000µM) for 24h reduced 6-OHDA-induced toxicity. The protective effect afforded by creatine against 6-OHDA-induced toxicity was reversed by inhibitors of different protein kinases, i.e. phosphatidylinositol-3 kinase (PI3K) (LY294002), Ca(2+)/calmodulin-dependent protein kinase II (CaMKII) (KN-93), protein kinase A (H-89), mitogen-activated protein kinase kinase 1/2 (MEK1/2) (PD98059) and protein kinase C (PKC) (chelerythrine). Furthermore, creatine prevented the 6-OHDA-induced dephosphorylation of glycogen synthase kinase-3ß (GSK-3ß) at the serine 9 residue. In conclusion, the results of this study show that creatine can protect against 6-OHDA-induced toxicity and its protective mechanism is related to a signaling pathway that involves PI3K, PKC, PKA, CaMKII, MEK1/2 and GSK-3ß.

Galantamine elicits neuroprotection by inhibiting iNOS, NADPH oxidase and ROS in hippocampal slices stressed with anoxia/reoxygenation.

Galantamine is a drug currently used to treat Alzheimer's disease (AD); in this group of patients it has been observed that concomitant ischemic brain injury can accelerate their cognitive deficit. We have previously shown that galantamine can afford neuroprotection on in vitro and in vivo models related to brain ischemia. In this context, this study was planned to investigate the intracellular signaling pathways implicated in the protective effect of galantamine on an in vitro brain ischemia-reperfusion model, namely rat hippocampal slices subjected to oxygen and glucose deprivation (OGD) followed by reoxygenation. Galantamine protected hippocampal slices subjected to OGD in a concentration-dependent manner; at 15 µM, cell death was reduced to almost control levels. The neuroprotective effects of galantamine were reverted by mecamylamine and AG490, but not by atropine, indicating that nicotinic receptors and Jak2 participated in this action. Galantamine also prevented p65 translocation into the nucleus induced by OGD; this effect was also linked to nicotinic receptors and Jak2. Furthermore, galantamine reduced iNOS induction and production of NO caused by OGD via Jak2. ROS production by NADPH oxidase (NOX) activation was also inhibited by galantamine. In conclusion, galantamine afforded neuroprotection under OGD-reoxygenation conditions by activating a signaling pathway that involves nicotinic receptors, Jak2 and the consequent inhibition of NOX and NFκB/iNOS. This article is part of a Special Issue entitled 'Post-Traumatic Stress Disorder'.

[An outbreak of scabies in a tertiary-care hospital from a crusted scabies case]. / Brote de sarna en un hospital terciario a partir de un caso de sarna costrosa.

In February 2005 we performed an epidemiological study of an outbreak of scabies in a tertiary-care hospital which started from a crusted scabies case. We detected 10 secondary cases, 8 in healthcare workers and 2 in hospitalized patients. The attack rate was 4.1%. In contrast to previously described outbreaks, the crusted scabies case was recognized at admission. The outbreak causes were: lacking adherence to contact precautions, long stay of the primary case in the hospital ward and delay of specific treatment. The main control measures were: alerting the hospital services about the outbreak, performing epidemiologic surveillance, coordinating with the Hospital Direction and the Occupational Health Department, education of healthcare workers in control measures, implementation of isolation measures and treatment of cases and contacts with 5% permethrin topical lotion.

Brote de sarna en un hospital terciario a partir de un caso de sarna costrosa / An outbreak of scabies in a tertiary-care hospital from a crusted scabies case

Realizamos el estudio epidemiológico de un brote de sarna ocurrido en un hospital terciario, a partir de un caso de sarna costrosa, en febrero de 2005. Detectamos diez casos secundarios; ocho en el personal de salud y dos en pacientes hospitalizados, con una tasa de ataque de 4,1 por ciento. A diferencia de otros brotes, el diagnóstico de sarna costrosa se hizo al ingreso del caso primario al hospital. Las causas del brote fueron: adherencia deficiente a las medidas de aislamiento de contacto, permanencia prolongada del caso primario en sala compartida, y retardo en el inicio del tratamiento específico. Las principales medidas de control fueron: alertar a los servicios sobre el brote, realizar vigilancia epidemiológica, coordinación con la Dirección del Hospital y el Departamento de Salud Ocupacional, capacitar al personal de salud en las medidas de control, instaurar medidas de aislamiento y tratar a los casos y sus contactos con permetrina 5 por ciento loción tópica.

In February 2005 we performed an epidemiological study of an outbreak of scabies in a tertiary-care hospital which started from a crusted scabies case. We detected 10 secondary cases, 8 in healthcare workers and 2 in hospitalized patients. The attack rate was 4.1 percent. In contrast to previously described outbreaks, the crusted scabies case was recognized at admission. The outbreak causes were: lacking adherence to contact precautions, long stay of the primary case in the hospital ward and delay of specific treatment. The main control measures were: alerting the hospital services about the outbreak, performing epidemiologic surveillance, coordinating with the Hospital Direction and the Occupational Health Department, education of healthcare workers in control measures, implementation of isolation measures and treatment of cases and contacts with 5 percent permethrin topical lotion.

[Precautions in the care of patients hospitalized with H5N1 avian influenza]. / Precauciones en la atención de pacientes hospitalizados por influenza aviar H5N1.

Several agencies have proposed infection control guidelines for management of patients admitted with the diagnosis of avian influenza. These guidelines aim to prevent transmission from the patient to hospital personnel and other inpatients. The guidelines presented here by the Advisory Committee of Nosocomial Infections have been elaborated for the local medical community after reviewing currently available recommendations. Key recommendations include admission to an isolation ward, cohorting of confirmed cases, hand hygiene with antiseptic solutions, use of N95 type masks, non-sterile disposable gloves and eye protection equipment during examination or when performing aerosols-generating procedures. Use of patient-exclusive clinical instruments, daily disinfection of the hospital ward, implementation of measures to reduce risk of needle stick injuries and eye splashing, and reinforcement of appropriate sampling and transport of blood and other corporal fluids, are also recommended.

[Plasma malondialdehyde in patients with type 2 diabetes mellitus and in patients with coronary disease]. / Malondialdehído plasmático en pacientes con diabetes mellitus tipo 2 y en pacientes con enfermedad coronaria.

UNLABELLED: After intracoronary platelet aggregation, malondialdehyde (MDA), a lipid peroxide product is released. MDA renders some lipoproteins more atherogenic. OBJECTIVE: The objective of this study was to determine the sanguineous concentration of MDA in patients with type 2 diabetes mellitus (DM2) and patients with coronary disease. We measured methods and material MDA in plasma of 131 consecutive normal subjects, 44 hyperlipidemic, hyperglycemic patients with type 2-diabetes mellitus (DM2), 60 normolipidemic patients with angina, and 62 normolipidemic patients with acute myocardial infarction with and without DM2. STATISTICAL ANALYSIS: The concentration of MDA was lowest in normal subjects (42.5 +/- 7.2 micrograms per deciliter), intermediate in those with DM2 (62.7 +/- 10.1 micrograms per deciliter, p < 0.002), and highest in those with myocardial infarction (101.6 +/- 31.7 micrograms per deciliter, p < 0.001). The mean MDA concentration of patients with infarction was similar to that of patients with angina (121.8 +/- 51.9 micrograms per deciliter, p < 0.07). Stepwise logistic regression analysis showed that MDA was a possible predictor of myocardial infarction. CONCLUSIONS: The increase of plasma MDA might be a biochemical marker of coronary artery disease. We suggest that MDA levels greater than 62.7 micrograms per deciliter could indicate a high risk for myocardial infarction.

[Immunity, the trophoblast and decidua]. / Inmunidad, trofoblasto y decidua.

It is as if the embryo has learnt to foil the maternal inflammatory/immune system. Acting through trophoblastic protein-1, the conceptus inhibits prostaglandin F-2a synthesis and thereby prolongs corpus luteum survival. In addition, that protein (an interferon variant), suppresses T cell proliferation. Other interferons (b and g), prostaglandin E-2 and progesterone, synthesized by trophoblast and decidua, act in concert to help the embryo to elude the aggression of the immune system. Failure of these mechanisms leads to reactivation of maternal killer T cells, mononuclear infiltration in the conceptus and its demise.

[Premature ovarian insufficiency and nuclear organizer regions in triplicate]. / Insuficiencia ovárica prematura y regiones organizadoras nucleolares en tripleta.

Silver-staining of the nucleolus organizer region, which represents transcription of ribosomal ribonucleic acid genes, was herein studied in the acrocentric chromosomes of a patient with premature ovarian failure. The demonstration of an additional nucleolar organizer region in the peripheral lymphocytes, suggests a causal relationship between transcriptive activity and this type of ovarian failure.

[Simultaneous identification of the nucleolar organizing regions and G bands in obstetrical cytogenetic studies]. / Identificación simultánea de las regiones organizadoras nucleolares y de las bandas G en el estudio citogenético en obstetricia.

An improvement of the silver-staining method of the nucleolus organizer region with simultaneous trypsin-Giemsa-banding is described. The combined demonstration of such regions (which express the transcriptive activity of ribosomal ribonucleic acid genes) and the precise identification of chromosomes, particularly acrocentric chromosomes, should be of value in the investigation of parents with spontaneous abortion in whom abnormal acrocentric chromosomes are often encountered.