Otro desafío de la naturaleza: el nuevo coronavirus virología y fisiopatología del SARS-COV-2 / Another challenge of nature: the new coronavirus virology and physiopathology of SARS-CoV-2

The recent outbreak of emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) has been brought to global attention in the search of knowledge about the virus and its pathogenesis. The immune response is essential to control and eliminate the infection, however, maladjusted immune responses may result in severe disease fisiopathology. Gaining a deeper understanding of the interaction between SARS-CoV-2 and the immune systems of the hosts may help us anticipate the development of persistent pulmonary inflammation and, why not, be the first step to therapeutic success and trying to save more lives. In this review, we provide an update on CoV virology and our vision of pathogenesis understanding it from the stages of infection, without forgetting the cytokine storm resulting from the interaction of the virus with ACE2 receptors widely distributed in the body.

La reciente emergencia de síndrome de distrés respiratorio agudo producido por coronavirus 2 (SARS-CoV-2), enfermedad denominada COVID-19 ha traído la atención mundial a la búsqueda de conocimiento sobre este virus y su patogenia. La respuesta inmune es esencial para controlar y erradicar la infección, sin embargo, las respuestas inmunes descontroladas pueden resultar en la fisiopatología de la enfermedad grave. Lograr una comprensión más profunda de la interacción entre SARS-COV-2 y el sistema inmune de los huéspedes podría ayudar a anticiparnos al desarrollo de una inflamación pulmonar persistente causada por el SARS-CoV-2, y por qué no, ser la puerta de entrada al éxito terapéutico e intentar salvar mayor número de vidas. En esta revisión, proporcionamos una actualización sobre la virología y nuestra visión de la patogenia, entendiéndola desde las fases o etapas de la infección, sin olvidar el estallido de citoquinas resultantes de la interacción del virus con los receptores ACE2 ampliamente distribuidos en el organismo.

Inflammatory bowel disease in Mexico: Epidemiology, burden of disease, and treatment trends. / Epidemiología, carga de la enfermedad y tendencias de tratamiento de la enfermedad inflamatoria intestinal en México.

INTRODUCTION AND AIMS: There is no systematized information for determining/monitoring the burden of inflammatory bowel disease in Mexico. The aim of the present study was to estimate the annual burden of inflammatory bowel disease on the Mexican National Healthcare System, by number of patients seen, hospitalizations, and specific deaths, stratified into age groups. MATERIALS AND METHODS: Utilizing specific databases of the Mexican National Healthcare System registries coded as ICD-10: K50 and K51, we retrieved and analyzed the data corresponding to the patients seen and hospitalized in 2015, stratified by age group, as well as the specific deaths. Treatment trends among physicians were also examined. RESULTS: In 2015, 5,009 women (8.1) and 4,944 men (8.4) with Crohn's disease received medical attention (prevalence of cases seen) and 35.1% of those patients were ≥50years of age. In that same period, 17,177 women (27.7) and 15,883 men (26.9) with ulcerative colitis were seen and 31.6% of those patients were ≥50years of age. The hospitalized cases (prevalence of hospitalized cases) were 1,097 patients (0.91) with Crohn's disease and 43.7% of those patients were ≥50years of age; and 5,345 patients (4.42) with ulcerative colitis and 47.6% of those patients were ≥50years of age. Deaths (specific mortality rate) were: 32 women (0.52) and 36 men (0.50) due to Crohn's disease, and 267 women (4.31) and 186 men (3.15) due to ulcerative colitis. CONCLUSIONS: Inflammatory bowel disease is a burden on the health of Mexican adults and the Mexican National Healthcare System, and it is expected to increase over the next 15years.

Actualización en manejo de alergia a la proteína de leche de vaca: fórmulas lácteas disponibles y otros brebajes / Update on management of cow's milk protein allergy: available milk formulas and other juices

La alergia a la proteína de leche de vaca (APLV) es una enfermedad frecuente, con una prevalencia entre 2-7%, cifras que van en aumento. Se caracteriza por una reacción alérgica a una o más pro teínas de la leche de vaca. No existen manifestaciones clínicas patognomónicas, y éstas dependerán del tipo de reacción inmunológica involucrada. Una buena aproximación diagnóstica evita el sub y sobre diagnóstico y por lo tanto, sub y sobre tratamiento. El tratamiento de la APLV es la eliminación de la proteína de leche de vaca de la dieta. Una dieta de restricción en un niño que no la requiere o que ha desarrollado tolerancia, puede alterar el crecimiento, la calidad de vida y producir costos innecesarios. El objetivo de esta actualización es presentar las diferentes fórmulas y brebajes usados en Chile para tratar la APLV en aquellos casos en que no sea posible la lactancia materna con dieta de exclusión. Para ello se revisó la composición nutricional, ingredientes y otras características relevan tes de todas aquellas fórmulas o brebajes que se comercializan en Chile como tratamiento de APLV. La información se obtuvo desde los distribuidores o vendedores oficiales, o en su defecto, desde las páginas web oficiales. Se puede concluir que existen y se usan múltiples fórmulas y brebajes para el tratamiento de APLV, no todas ellas del todo adecuadas desde el punto de vista nutricional y de seguridad. Conocerlas en detalle ayudará al pediatra a indicarlas de manera más informada de acuerdo a sus beneficios y sus carencias para el manejo adecuado de esta patología.

Cow's milk protein allergy (CMPA) is a common disease with a prevalence of 2-7%, increasingly so. It is characterized by an allergic reaction to one or more cow's milk proteins. There are not pathog nomonic clinical symptoms, and these will depend on the type of immune reaction involved. A good diagnostic approach avoids under and over diagnosis and, therefore, under and over treatment. The CMPA treatment is the elimination of cow's milk protein from the diet. A restricted diet in a child does not require it or who has developed tolerance can alter growth, quality of life, including unne cessary costs. The objective of this review is to present the different milk formulas available in Chile to treat CMPA in those cases where breastfeeding with exclusion diet is not possible. For this purpose, nutritional composition, ingredients and other relevant characteristics of all the milk formulas and juices marketed in Chile as CMPA treatment were reviewed. The information was obtained from the official distributors or sellers or failing that, from the official websites. There are multiple milk formulas and beverages used for the treatment of CMPA, and not all of them are nutritionally or immunologically secure. Knowing them in detail will help the pediatrician to indicate them in a more informed way according to their benefits and their deficiencies for the proper management of this pathology.

Ultraviolet radiation in the Atacama Desert.

The world's highest levels of surface ultraviolet (UV) irradiance have been measured in the Atacama Desert. This area is characterized by its high altitude, prevalent cloudless conditions, and a relatively low total ozone column. In this paper, we provide estimates of the surface UV (monthly UV index at noon and annual doses of UV-B and UV-A) for all sky conditions in the Atacama Desert. We found that the UV index at noon during the austral summer is expected to be greater than 11 in the whole desert. The annual UV-B (UV-A) doses were found to range from about 3.5 kWh/m2 (130 kWh/m2) in coastal areas to 5 kWh/m2 (160 kWh/m2) on the Andean plateau. Our results confirm significant interhemispherical differences. Typical annual UV-B doses in the Atacama Desert are about 40% greater than typical annual UV-B doses in northern Africa. Mostly due to seasonal changes in the ozone, the differences between the Atacama Desert and northern Africa are expected to be about 60% in the case of peak UV-B levels (i.e. the UV-B irradiances at noon close to the summer solstice in each hemisphere). Interhemispherical differences in the UV-A are significantly lower since the effect of the ozone in this part of the spectrum is minor.

[Response to adjuvant chemotherapy after radical cystectomy in patients with infiltrative bladder: Analysis of 397 cases]. / Respuesta a la quimioterapia adyuvante post-cistectomía en pacientes con tumor de vejiga infiltrante:análisis de 397 casos.

OBJECTIVES: To define the usefulness of adjuvant chemo-therapy in patients with pT2, pN0, pT3-4, pN0 and pN+ disease. METHODS: Retrospective analysis of 397 patients with transitional bladder cancer who underwent radical cys-tectomy between 1986 and 2005. Adjuvant chemo-therapy was administered to 40.2% of patients. Three cycles of adjuvant MVAC (methotrexate, vinblastine, adriamycin and cisplatin) were given. RESULTS: In patients with pT3, pN0 (p=0.04) and/or N+ stages (p=0.001), adjuvant chemotherapy significantly improved cancer-specific survival, which did not occur in pT2N0 (p=0.9) and pT4, pN0 (p=0.6) patients. In the univariate analysis, adjuvant chemotherapy was significantly associated with a lower cancer-specific survival rate (RR 1.452 95% CI: 1.028- 2.057 p= 0.03), while the multivariate analysis showed a trend (RR: 0.651 95% CI 0.398-1.065, p=0.08) towards a decrease in cancer-specific mortality. CONCLUSIONS: Although adjuvant chemotherapy was not shown to improve survival in patients with pT0-2, pN0 and pT4, pN0 disease, it did increase survival in those with extravesical disease, pathological state T3, pN0 and/or pN+. Considering its tendency to improve cancer-specific survival, adjuvant chemotherapy may be considered as a "protective factor" (RR=0.651, p=0.08).

Reconstrucción de lesiones de extremidad inferior con Colgajo de Arteria Sural Superficial, experiencia de 10 años / Reconstruction of lower extremity lesions with superficial sural artery flap: a ten-year experience

La cobertura de heridas complejas en extremidades inferiores es un desafío de difícil manejo. Se realizó un estudio retrospectivo, analizando el resultado y las complicaciones en el uso del colgajo sural a pedículo distal para cobertura de defectos de extremidad inferior. Material y Método: Revisión de fichas clínicas de todos los pacientes sometidos a colgajo sural en los Hospitales Militar y Trabajador de Santiago entre los años 1995 y 2005, analizando características epidemiológicas, técnica quirúrgica y complicaciones del procedimiento. Resultados: Colgajos surales totales: 40 casos. Etiología de lesión: Fracturas: 33 casos (82,5%), heridas complejas (infectadas, inestables) 4 casos (10%), desforrramiento: 2 casos (5%) y quemadura: 1 caso (2,5%). En 20 casos no hubo complicación, y dentro de las complicaciones se encontraron necrosis parcial: 8 casos (20%), infección: 5 casos (12,5%), epidermolísis: 4 casos (10%) y seroma en 3 casos (7,5%). No se reportaron casos de necrosis total. Conclusión: El colgajo sural a pedículo distal es una alternativa válida de cobertura en lesiones complejas de extremo distal de extremidad inferior, con complicaciones de manejo aceptables, y con buen resultado a largo plazo.

Background: The covering of complex wounds of lower extremities is a difficult challenge. Aim: To analyze the results and complications on the use of sural flaps with distal pedicle for the covering of lower extremity defects. Material and Methods: We reviewed the clinical records of all the patients that had sural flaps between 1995 and 2005 at the Military Hospital and Workers Hospital of Santiago, Chile. We analyzed the epidemiologic characteristics, surgical techniques and complications of the procedure. Results: We found 40 cases of sural flaps. The etiology of the lesions were fractures in 33 cases (82.5%), complex wounds: four cases (10%), skin tearing and muscle laceration in 2 cases (5%) and burns 1 case (2.5%). In 20 cases there were no complications. Eight cases had partial necrosis (20%), five had infections (12.5%), four had epidermolysis and three had a seroma (7.5%). There were no reports of total necrosis. Conclusions: Sural flaps with a distal pedicle are a valid alternative for the covering of complex wounds of the distal portion of lower extremities, with a low rate of complications and good long term results.

Microanatomía de los segmentos M1 y M2 de la arteria cerebral media en hemisferios humanos de origen chileno: correlación con la literatura internacional / Median cerebral artery segments M1 and M2 microanatomy in chilean human hemispheres: correlation with international literature

La arteria cerebral media (ACM) es el más largo y complejo de todos los vasos intracerebrales, irrigando la mayor parte de los lóbulos frontales, parietales y temporales de ambos hemisferios cerebrales. Además de suplir el riego sanguíneo de una gran parte del cerebro, la ACM y sus ramas, están frecuentemente involucradas en enfermedades intracerebrales como hemorragias cerebrales, patología ateroesclerótica o degenerativa de la pared arterial, embolias y procesos inflamatorios. La alta frecuencia de patología y el amplio volumen cerebral irrigado por esta arteria hacen que el conocimiento de su anatomía sea fundamental en la descripción de los posibles mecanismos fisiopatológicos de las enfermedades que la involucran, así como para su estudio imagenológico y abordaje quirúrgico. El objetivo de este trabajo es comparar la anatomía macroscópica y microscópica de la ACM de sujetos chilenos con la publicada en series internacionales. Se estudiaron 10 hemisférios cadavéricos provenientes de 5 pacientes adultos de nacionalidad chilena cuya muerte no fue de causa encefálica, fijados con solución de formalina sometiendo a tinción los vasos arteriales. Se realizaron mediciones de la ACM y sus segmentos M1 y M2 comparando mediante análisis estadístico los resultados obtenidos con los publicados en la literatura. El análisis de éstos sugiere que las características anatómicas de la ACM de hemisferios provenientes de sujetos de nacionalidad chilena son similares a los reportados por estudios realizados con hemisferios cerebrales de sujetos de origen anglo-sajón.

Hipocinetismo: un problema de salud entre jóvenes ucevistas? / Hypokinetism: a problem of health among young ucevistas?

Se explora la evaluación del hipocinetismo como factor de riesgo para la salud. A tal fin fueron analizados los hábitos de actividad física y el nivel de riesgo cardiovascular, en 314 estudiantes no atletas de la Universidad Central de Venezuela con edades entre 17 y 29 a¤os, mediante la aplicación del Cuestionario Internacional de Actividad Física-IPAQ (2004) y un cuestionario de Hoeger y Hoeger (2002) para la estimación del riesgo cardiovascular. Los resultados indicaron que globalmente 31,53 por ciento de los sujetos tenían un nivel de actividad física que se relaciona con hipocinetismo. Se evidenció que las jóvenes estudiadas mostraron mayores niveles de riesgo cardiovascular. Se identificaron asociaciones entre las variables género y la categoría de riesgo cardiovascular, asícomo entre esta última y los niveles de actividad física, apuntando a que el hipocinetismo representa un factor de riesgo adicional en el desarrollo de enfermedades crónicas no transmisibles en los ucevistas evaluados.

Validation of techniques to detect illicit heroin use in patients prescribed pharmaceutical heroin for the management of opioid dependence.

BACKGROUND: The clinical implementation and evaluation of heroin substitution programmes have been confounded by the lack of objective and validated biomarkers for illicit heroin use in patients prescribed pharmaceutical heroin. This study examined the capacity to detect illicit heroin use by gas chromatography-mass spectrometry (GC-MS) analysis of urine samples for the presence of opium impurities common to illicit, but not pharmaceutical heroin. AIMS: To characterize the diagnostic properties of the metabolites of noscapine and papaverine in comparison to morphine as a gold-standard marker of illicit heroin use; and to examine the relationships between the self-reported time since most recent heroin use and the detection of these opioids in urine. DESIGN: A cross-sectional study of 52 opioid-dependent patients in treatment (not prescribed heroin), who self-reported illicit heroin use within the preceding 2 weeks. Self-report data regarding recent drug use and a urine sample were collected. GC-MS analyses of urines were conducted and reported by laboratory staff blinded to self-report data. FINDINGS: The metabolites of papaverine (hydroxypapaverine and dihydroxypapeverine) were found to have high sensitivity, specificity and negative predictive values as markers for illicit heroin use compared to the 'gold-standard' morphine. Other opioids, including 6-mono-acetylmorphine (6-MAM), codeine and noscapine metabolites (e.g. meconine) were less adequate in detecting heroin use. CONCLUSIONS: GC-MS detection of papaverine metabolites in urine appears to be suitable method of identifying illicit heroin use for clinical and research purposes.

Effects of a tartar control whitening dentifrice on tooth shade in a population with long-standing natural stain.

Changing and whitening tooth color in people with long-standing tooth stain without excessive hard tissue abrasion may represent one of the more difficult challenges for whitening dentifrices. An eight-week clinical trial was conducted to evaluate change in tooth color by a silica-based, enamel-safe tartar control whitening dentifrice compared to a marketed baking soda dentifrice control. First, a screening exercise was conducted to identify individuals with long-standing extrinsic dental stain. This exercise targeted adults who reported "stained teeth" and coffee/tea drinking or smoking, but who had no recent history of dental prophylaxis. Targeted subjects were examined for stain (Lobene Index) and tooth shade/color (Vita). A total of 291 adults having extrinsic stain and discolored teeth were enrolled in the study. Subjects were randomized to one of the two treatment groups, and all dentifrice use was unsupervised. Tooth color was measured at 4 and 8 weeks from shade values collected from the 8 incisors, and averages were determined from a linear ordering of the shade guide. A total of 278 evaluable subjects completed the 8-week study. Overall, the tartar control whitening dentifrice group experienced an improvement in color, differing statistically from baseline (p < 0.001) and from the marketed control (p < 0.05). Safety profiles for the two dentifrices were generally similar. Among patients with long-standing extrinsic stain, use of the tartar control whitening dentifrice resulted in superior overall tooth shade and reduced maximum or worst color compared to the marketed baking soda dentifrice control.

Analysis of urine for drugs of abuse using mixed-mode solid-phase extraction and gas chromatography-mass spectrometry.

A method for the simultaneous analysis of urine for the major drugs of abuse is described. The analytical procedure uses solid-phase extraction (SPE), gas chromatography-mass spectrometry (GC-MS) and a semi-automated identification process. It allows simultaneous extraction, derivatization and analysis of acidic, neutral and basic drugs from urine. Urine samples were subjected to enzymatic hydrolysis followed by SPE using Bakerbond narc-2 columns. The eluant was selectively derivatized with N-methyl-bis-trifluoroacetamide (MBTFA) and N-methyl-N-trimethylsilyltrifluoroacetamide + 1% trimethylchlorosilane. Analysis was performed using a GC-MS system operating in full scan mode. A simple macro programme was written to enhance the mass spectra identification capabilities of the MS software by producing extracted ion chromatograms (EIC) for the drugs of interest. Once a suspect compound was indicated by EIC, the mass spectrum of the compound was searched manually against reference libraries for positive identification and the retention time checked against that of the standard. This procedure has increased both the amount and the reliability of information given to clinicians without increasing the cost per sample. The system has been in routine operation for 24 months, processing up to 40 urine samples per day, with a usual turn-around time of 48 h.

Total intravenous anesthesia with midazolam, remifentanil, propofol and cistracurium in morbid obesity.

BACKGROUND: According to physical impairments of massive obesity, cardiac, respiratory and gastrointestinal physiology must be considered as much as pharmacokinetic behavior. Anesthetic management of morbidly obese patients has to be carefully planned, in order to minimize the increased risks of aspirative pneumonitis, hemodynamic instability and delay in recovery. The ideal anesthesia should provide a smooth and quick induction, allowing rapid airway control, prominent hemodynamic stability, and rapid emergence from anesthesia. To approach these ideal conditions, a Total Intravenous Anesthesia (TIVA) with midazolam, remifentanil, propofol and cisatracurium was designed and analyzed. METHODS: 10 consenting morbidly obese patients scheduled for elective Laparoscopic Adjustable Gastric Banding participated in the study. TIVA with midazolam, remifentanil, propofol and cisatracurium was used in all cases. Time to loss of consciousness, tracheal intubation, perianesthetic physiological parameters and complications, incidence of awareness with recall, recovery times, postoperative analgesia and costs of drugs were evaluated. RESULTS: The analyzed data showed adequate time and physiological conditions for induction and tracheal intubation, stable maintenance with easy handling of deepness, low incidence of perianesthetic complications, excellent recovery performance and institutional efficiency. CONCLUSIONS: TIVA with midazolam, remifentanil, propofol and cisatracurium was found to be effective, secure, predictable and economic for the anesthetic management of morbidly obese patients.

DNA adducts in relation to lung tumour outcome are not markers of susceptibility following a single dose treatment of SWR, BALB/c and C57BL/6J mice with N-nitrosodiethylamine.

The formation of DNA adducts by the covalent binding of genotoxic chemicals to DNA represents a valuable marker for assessing exposure to carcinogens but as yet the role of DNA adducts as a biomarker of carcinogenic susceptibility still needs to be clearly ascertained. To address this question an animal study was instigated using mice (SWR (high), BALB/c (intermediate) and C57BL/6J (low)) varying in their susceptibility to lung carcinogenesis. Groups of animals from each strain were dosed with a single intraperitoneal injection of saline or N -nitrosodiethylamine (NDEA) at 15 or 90 mg kg(-1) body weight. Lung and liver tissues were removed at different time points following dosing. Further groups of mice dosed with the same regime had urine samples collected 24 h post dosing and were then left up to 18 months to allow for the development of tumours. Immunoslot-blot analysis was used for the determination of N-7 ethylguanine (N-7EtG) and O(6) ethylguanine (O(6)EtG) adduct levels in the DNA from the tissues and gas chromatography-mass spectrometry (GC-MS) was used to determine N-3 ethyladenine (N-3EtA) adduct levels in the urine samples. Levels of alkyltransferase (ATase) were also determined in the tissues. The results showed that the DNA adduct levels and persistence were similar across the three strains of mice following dosing with 15 and 90 mg kg(-1) NDEA. High levels of adducts were observed in the urine of the BALB/c strain, implying an increased metabolic or repair capacity in this strain. However there were no differences in the levels of ATase in the lung and liver of the three strains of mice following dosing with 15 mg kg(-1) NDEA. The incidence of tumours in C57BL/6J mice was lower compared with the other two strains and showed a dose dependent increase. The results from this study show that the differences in susceptibility to lung carcinogenesis between the three strains of mice do not appear to be linked to the formation of the two adducts detected. These results imply that dosing with NDEA resulted in toxicity which may have led to cell death and induction of tumours by compensatory cell proliferation. Although these results do not allow decisive conclusions to be drawn concerning the relationship between total levels of DNA adducts and differences in carcinogenic susceptibility for the three strains of mice it is clear that the increased presence of a DNA adduct in the target tissue increases the likelihood of tumour development.

Clonación y transcripción del gen EBER-1 del virus Epstein-Barr: estudio de su expresión genética por hibridación in situ / Cloning and transcription of gene EBER-1 of Epstein-Barr virus: study of its genetic expression by hybridization in situ

La capacidad de virus de Eptein Barr (VEB) de inducir transformación e inmortalización de linfocitos y su alta prevalencia en algunas neoplásias linfoides ha motivado intensa investigación de su biología y comportamiento. Describimos la hibridación in situ (HIS), para la identidicación de transcriptos del virus de Epstein-Barr, desarrollado en la Unidad de Biología Molecular del Centro de Investigación en Cáncer Maes Heller, en biopsias de linfoma incluidas en parafina.El gen EBER-1 (Epstein Barr-encoded RNA) fue clonado y transcrito, el ARN transcrito fue evaluado con óptimos resultados en las líneas celulares Raji y Daudi que expresan EBER. Este transcrito marcado fue usado como sonda para determinar la expresión genética del virus en 159 especimenes biológicos en estudio y en controles positivos y negativos conocidos empleando la HIS.La actividad transcripcional del virus fue observada en 44 de los casos estudiados. Concluimos que la HIS en tejido incluido en parafina es una buena alternativa para detectar actividad del VEB y la presencia o ausencia de EBER puede ser considerada como marcador biológico en la etiopatología de estos linfomas

Serum levels of thyroxine-binding prealbumin, C-reactive protein and interleukin-6 in protein-energy undernourished children and normal controls without or with associated clinical infections.

We measured the levels of thyroxine-binding prealbumin (TBPA), C-reactive protein (CRP), and interleukin-6 (IL-6) in sera from protein-energy undernourished and control children either without or with associated clinical infections. Levels of TBPA were significantly lower in undernourished than in control children without clinical infections. Mean serum TBPA concentration was also significantly lower in both clinically infected undernourished and control children than in those of the same nutritional status but without overt infections. Significant positive correlations were observed between the concentration of TBPA and the Z-scores of weight for age, height for age, and weight for height in all children without clinical infections, which disappeared in clinically infected children. CRP and IL-6 increased to approximately similar levels in sera from undernourished and control children with overt infections. An inverse correlation between the levels of TBPA and CRP and a significant positive correlation between the concentration of CRP and IL-6 were observed in children with associated clinical infections. Serum IL-6 and TBPA showed a small negative relationship in patients with overt infections. Thus, TBPA is a sensitive marker of undernutrition only in the absence of clinical infections, and the capacity to increase production of IL-6 and CRP during infections is preserved in protein-energy undernutrition.

Final reflections: wellness after obesity surgery.

The articles presented in this symposium on treatment of clinically severe obesity cover most of the topics related to obesity surgery, from basic research about genetic causes of obesity to surgical techniques and clinical results on the severely obese patient. The most striking feature of those results observed after bariatric surgery for the clinically severe obese is not the remarkable weight loss and normalization of the body mass index but the amelioration of some of the metabolic and physiologic abnormalities related to obesity. In fact, carbohydrate and lipid metabolism show improvement, as do cardiac and pulmonary function. These observations justify all efforts devoted to the design and improvement of sound bariatric surgical techniques. Moreover, surgeons seek the well-being of the ex-obese patient, and in doing so they face special discriminatory attitudes from colleges, patients' families, and the society, mainly because of negative stereotypes related to the obese individuals and the lack of information on the real benefits of bariatric procedures. Bariatric surgeons will reach their goal only when an informed society, educated physicians, and properly oriented obese patients together give to bariatric surgery its real dimension. The objective of any surgeon is the wellness of his or her patient. This is important in bariatric surgery as well; beyond excess weight loss and normalization of biochemical parameters, the ex-obese patient should be able to live a normal, productive, happy life. Approaching this goal is a task that takes months or even years. Bariatric surgeons are committed to support and help their patients until they reach wellness after obesity surgery.

Monitoring human exposure to 2-hydroxyethylating carcinogens.

It is known that human hemoglobin contains low levels of N-terminal N-(2-hydroxyethyl)valine. Possible sources of this modified amino acid are exposure to ethylene oxide or other 2-hydroxy-ethylating agents. Although such processes are likely to occur endogenously, the exogenous contribution to the adduct formation is unclear. In order to explore the latter, we have analyzed N-(2-hydroxyethyl)valine in the globin of 49 pregnant women and evaluated the effect of smoking status, area of residence, and glutathione S-transferase M1 genotype on adduct levels. Transplacental transfer of hydroxyethylating agents was also studied by the analysis of umbilical cord hemoglobin. The adduct levels in smokers were significantly higher than those in nonsmokers. The adduct levels in umbilical cord blood globin were quantitatively related to those in maternal blood (maternal:fetal ratio 2.7 in smokers and 2.8 in nonsmokers). In the nonsmokers, there was no statistically significant difference in the adduct level between the urban and rural areas, but the level in suburbia tended to be lower than that in the rural area. In the combined smoker and nonsmoker groups, there was no effect of the glutathione S-transferase M1 genotype on levels of N-(2-hydroxyethyl)valine.