Higher reproductive success of small males and greater recruitment of large females may explain strong reversed sexual dimorphism (RSD) in the northern goshawk.

Reversed sexual dimorphism (RSD), which occurs when the female of a species is larger than the male, is the rule for most birds of prey but the exception among other bird and mammal species. The selective pressures that favour RSD are an intriguing issue in animal ecology. Despite the large number of hypotheses proposed to explain the evolution of RSD, there is still no consensus about the mechanisms involved and whether they act on one or both sexes, mainly because few intrapopulation studies have been undertaken and few raptor species have been investigated. Using the strongly size-dimorphic northern goshawk (Accipiter gentilis L.) as a model, we studied a population with one of the highest densities of breeding pairs reported in the literature in order to understand selective pressures that may favour RSD. We evaluated life-history processes, including recruitment of adult breeders and reproductive success, and we explored the mechanisms thought to act on each sex, including hunting efficiency, diet, body condition and mate choice. We found that smaller males produced more fledglings than larger ones, but there was no relationship between size and reproductive success for females. The mean body size of female breeders was larger than that of female fledglings, but male fledglings and breeders did not differ in size. Male body size was related to the type but not to the amount of prey captured during the nestling stage. We conclude that RSD may be favoured in this goshawk population because small males tend to enjoy higher reproductive success and large females greater recruitment. Our results do not support the hypotheses that evolutionary reduction in male size is driven by hunting efficiency, at least during the nestling stage, or the hypotheses that it is driven by greater recruitment. Our findings also suggest that increase in female size is driven by recruitment, rather than by reproductive success as previously postulated.

Kell hemolytic disease of the fetus. Combination treatment with plasmapheresis and intrauterine blood transfusion.

We report the case of a 36-year old pregnant woman with a Kell alloimmunization (anti-K1), probably secondary to a previous blood transfusion, and a severe hemolytic disease of the fetus. Once the first fetal blood transfusion by cordocentesis was performed, we started treatment with repeated plasmapheresis to maintain anti-K1 titer below 1:32. With this scheme we did not need to perform a second intrauterine fetal blood transfusion and only mild anemia was found in the newborn. Taking into account that the rate of serious complications with plasmapheresis is lower than that related with intrauterine blood transfusion, this could be an alternative approach to repeated transfusions.

[Induction treatment by combining immunoglobulins, plasmapheresis and rituximab in hypersensitive patients receiving cadaveric renal allograft]. / Tratamiento de inducción combinando inmunoglobulinas, plasmaféresis y rituximab en pacientes hipersensibilizados que reciben trasplante renal de cadáver.

In our Universitary Hospital of Canarias we iniciated in May 2008 a induction therapy protocol for sensitized patients receiving cadaveric renal graft using intravenous immunoglobulins, plasmapheresis and rituximab plus immunosuppression with prednisone, tacrolimus and mycophenolate mofetil. We present the results of four patients. Everyone had anti-HLA antibodies rate (PRA by CDC) more than 75%, were on a waiting list during 4 to 17 years and follow-up time was 10-14 months after transplantation. Patient and graft survival in this period was 100%. Only one patient suffered a humoral acute rejection and another one cellular rejection, in both cases reversible with treatment. During the first year, no evidence of de novo donor-specific antibodies was detected. All patients had significantly reduced the CD19+ cells percentage after infusion of rituximab. Neurological symptoms suggestive of progressive multifocal leukoencephalopathy or serious viral infections after transplantation have not been observed. Additionally, no immediate side effects were observed after administration of medication. In summary, induction therapy by combining immunoglobulin, plasmapheresis and rituximab in hypersensitive patients allows the realization of deceased kidney transplantation with good results in the short and medium-term without serious side effects. It remains to know whether this success will continue in the long term.

Pine processionary caterpillar allergenicity increases during larval development.

BACKGROUND: In European countries, pine processionary caterpillar (Thaumetopoea pityocampa) is one of the species of Lepidoptera able to affect humans. Its allergenicity has been demonstrated in previous studies. However, in all of them larval extract in the fifth stage of development has been used as antigen. Therefore, allergenicity of other larval stages was unknown. The objective of our study was to detect allergenic changes of pine processionary caterpillar during larval development. METHODS: Pine processionary caterpillar extracts in all larval stages were analyzed by SDS-PAGE. Immunoblotting was performed using patient sera with suggestive history of allergy and a positive prick test.

Caloric rather than protein deficiency predominates in stable chronic haemodialysis patients.

BACKGROUND: The monitoring of energy and protein intake is considered fundamental in uraemic patients. However, in the clinical practice only protein ingestion is indirectly evaluated by the protein catabolic rate. METHODS: In a cross-sectional study we evaluated the relationship between caloric and protein intake of 29 stable chronic haemodialysis patients (18M, 11F, mean age 49 +/- 17 years, 68 +/- 6 months on maintenance haemodialysis), and the validity of protein catabolic rate determination. Normalized protein catabolic rate was obtained according to Sargent's formula, and Watson's equation was used to calculate urea distribution volume. Caloric and protein intake were recorded during a 3-day period, and average daily ingestion of nutrients was calculated using a computerized diet analysis system. RESULTS: A greater reduction of daily energy intake (26.8 +/- 11.9 Kcal/kg bw) than daily protein intake (1.02 +/- 0.4 g/kg bw) was observed. Fifty-nine percent of patients had low protein intake while 86% of patients had lower caloric intake than recommended. An inverse relationship between age and protein (r = -0.65, P < 0.001) or caloric intake (r = -0.67, P < 0.001) was observed. Negative relationships between daily protein (r = -0.60, P < 0.01) and also caloric intake (r = -0.39, P < 0.05) and the ratio between the urea generation rate and the total dietary nitrogen were found, indicating that in patients with low nutrient intake the nitrogen balance tends to be negative. Normalized protein catabolic rate was directly correlated with protein intake (r = 0.77, P < 0.001). A protein catabolic rate cut-off of 1 g/kg bw correctly identified all patients with normal daily protein intake, and 14 of 17 patients with deficient daily protein intake (< 1 g/kg bw). Thus in only 10% of haemodialysis patients an imbalance between both parameters was observed. Moreover, patients with a daily protein intake lower than 1 g/kg bw were older and showed lower BUN and protein catabolic rate values than their counterparts. CONCLUSIONS: Nutritional abnormalities are frequently found, even in apparently clinically stable patients on chronic haemodialysis. Caloric rather than protein undernutrition is the major abnormality of their wasting. Inadequate intake of proteins and calories appears more commonly in older patients, and in association with lower BUN and protein catabolic rate values. Although normalized protein catabolic rate shows a direct correlation with a daily protein intake, the identity line shows that when daily protein intake was lower than 1 g/kg bw, it was overestimated by protein catabolic rate. Conversely, when daily protein intake is higher than 1 g/kg bw it is underestimated by the protein catabolic rate. This relationship should to be considered when interpreting the protein catabolic rate in a clinical setting.

Is it possible to control hyperphosphataemia with diet, without inducing protein malnutrition?

Dietary intervention, phosphate (P) removal during dialysis and, especially, phosphate binders are current methods for the management of hyperphosphataemia. Ideally, the amount of P absorbed from the diet should equal the amount of P removed during dialysis, and this must occur in the context of an adequate protein intake. We evaluated the relationship between P intake and protein intake in 60 stable chronic uraemic patients (mean age 55+/-15 years, 25% diabetics, 68% males) on standard 4 h haemodialysis. The dietary counselling was relatively free for protein and calories. Nutrient intake was recorded during a 5 day period, and average daily ingestion of P and proteins was calculated using a computerized diet analysis system. A highly significant correlation was observed between protein and P intake. The mean daily ingestion of P and proteins was 998+/-316 mg and 64+/-19 g (1+/-0.4 g/kg/day), respectively. For an optimal protein diet of 1-1.2 g/kg/day, the P intake was 778-1444 mg. The amount of P removed by haemodialysis, extrapolated to an average week, is 250-300 mg/day. Since approximately 40% of P ingested is absorbed from the gut by uraemic patients treated with intestinal P binders, 750 mg of P intake should be the critical value above which a positive balance of P may occur. This value corresponds to a protein intake of 45-50 g per day (>0.8 g/kg body weight/day for a 60 kg patient). In patients undergoing standard chronic haemodialysis, a neutral P balance is difficult to achieve, despite phosphate binder therapy, when protein intake is >50 g. Additional protein restriction, in order to obtain a neutral balance, may impose the risk of protein malnutrition.

Transient hemolytic anemia after transjugular intrahepatic portosystemic stent shunt.

Management of variceal bleeding secondary to portal hypertension constitutes a challenging issue, particularly in child's C cirrhotic patients. Recently, transjugular placement of self-expanding metallic stents in the liver (TIPS), creating a shunt between the portal and hepatic branches has provided a safe and promising therapeutic approach in this clinical situation. We report here the case of a 66-year-old male cirrhotic patient who developed a moderately severe clinical picture of Coombsnegative hemolytic anemia (serum hemoglobin, 93 g/l, serum bilirubin 160.74 umol/L (9.4 mg/dl), indirect 6.3 mg/dl (107.73 umol/L); serum LDH 1220 mu/l, reticulocytes, 5.1%, serum ferritin 1221 micrograms/l, schistocytes in peripheral blood smear) the week after undergoing a TIPS, suggesting the development of microangiopathic hemolytic anaemia secondary to red blood cell disruption by passing through the metallic network of the stent.