Prognostic value of bioelectrical impedance analysis in head and neck cancer patients undergoing radiotherapy: a VALOR® study.

Introduction: Bioelectrical impedance analysis (BIA) serves as a method to estimate body composition. Parameters such as phase angle (PA), standardized phase angle (SPA), body mass cell (BCM), BCM index (BCMI), and fat-free mass (FFM) might significantly impact the prognosis of head and neck cancer (HNC) patients. The present study aimed to investigate whether bioelectrical parameters can be used to predict survival in the HNC population and establish the optimal cutoff points for predictive accuracy. Methods: A multicenter observational study was performed across 12 tertiary hospitals in Andalusia (a region from the south of Spain). A total of 494 patients diagnosed with HNC between 2020 and 2022 at different stages were included in this study, with a minimum follow-up period of 12 months. The BIA assessment was carried out during the first 2 weeks of radical radiotherapy treatment with chemotherapy or other systemic treatments. A multivariate logistic regression analysis of overall survival, complications, hospital admission, and palliative care and its relationship with BIA nutritional assessment was performed. Results: Significant prognostic factors identified in the multivariable analysis encompassed phase angle (PA), standardized phase angle (SPA), body cell mass (BCM), and BCM index (BCMI). Lower PA and BCM values were significantly associated with adverse clinical outcomes. A BCM threshold above 17 kg/m2 was the most significant predictor for predicting survival within the overall HNC population. The PA values of <5.1° in male and <4.8° in female patients showed the best predictive potential for mortality. Increased PA (as a continuous variable) demonstrated a significantly reduced risk for mortality (OR, 0.64; 95% CI, 0.43-0.94; p < 0.05) and a decreased likelihood of hospital admission (OR, 0.75; 95% CI, 0.52-1.07; p < 0.05). Higher BCM correlated with a lower risk of mortality (OR, 0.88; 95% CI, 0.80-0.96; p < 0.01) and a diminished probability of hospital admission (OR, 0.91; 95% CI, 0.83-0.99; p < 0.05). Conclusion: BIA is a crucial tool in the nutritional assessment of HNC patients. BCM and PA are the main bioelectrical parameters used to predict clinical outcomes in this population. Future studies are needed to validate BIA variables in a large cohort to ensure whether early intensification of nutritional treatment would improve survival.

Identificación de necesidades psicosociales de un grupo de escolares españoles con problemas visuales: un estudio con metodología mixta / Psychosocial needs of Spanish schoolchildren with visual impairment: a mixed methods research

Resumen Este estudio presenta un análisis de las necesidades psicosociales de un grupo de escolares españoles que padecen problemas visuales. La investigación utiliza metodología mixta aplicada en una muestra de 26 menores que acuden con sus progenitores a una consulta de oftalmología pediátrica con y sin problemas visuales. Se realizan entrevistas a los niños, adolescentes y/o progenitores sobre las repercusiones de su problema visual en el ámbito educativo, en la realización de actividades de ocio y tiempo libre y en la interacción con sus iguales, además de los sentimientos que les produce su problema visual. A los datos obtenidos se aplican análisis descriptivos, de medias, de varianza y pruebas de independencia entre variables, mediante las pruebas de chi-cuadrado de Pearson (χ²) y de U de Mann-Whitney. Los resultados encontrados indican que el grupo de escolares con problemas visuales graves tienen mayores dificultades que los que no los tienen en el bienestar físico y emocional, en el rendimiento escolar y en la interacción con los otros. Estos resultados sugieren la importancia de programar intervenciones integrales y conjuntas de carácter sanitario y socioeducativo que incidan en la mejora en cada una de las áreas de necesidad.

Abstract This study investigates the psychosocial needs of a group of schoolchildren with visual impairments. Based on a CUAN+CUAL mixed methods, it analyzed 26 children, with and without visual impairment, who attended a pediatric ophthalmology consultation with their parents. Several descriptive, mean and variance tests of independence between variables were performed using Pearson's Chi-square (χ²) and Mann-Whitney U tests. The interviews conducted with the children and/or parents on the impact of their visual impairment on education, leisure activities and peer interaction, as well as the feelings derived from the impairment, underwent discourse analysis. Results show that schoolchildren with severe visual impairments experience greater difficulties regarding physical and emotional well-being, school performance, and peer interaction when compared with those without. These findings suggest the importance of developing comprehensive and joint health and socio-educational interventions to improve these areas.

Antifungal stewardship in a tertiary care paediatric hospital: the PROAFUNGI study.

BACKGROUND: The increasing use of antifungal drugs (AF) in children and the concern for related adverse events and costs has led to the development of specific AF stewardship programmes (AFS). Studies in adult patients have shown improvements in AF prescription and usage after implementation, but paediatric data are scant. The aim of this PROAFUNGI study was to describe the use and appropriateness of AF in a high complexity paediatric centre. METHODS: Observational, prospective, single-centre, modified point-prevalence study (11 surveys, July-October 2018), including paediatric (< 18 years) patients receiving at least one systemic AF. Prescriptions were evaluated by the AFS team. RESULTS: The study included 119 prescriptions in 55 patients (53% males, median age 8.7 years [IQR 2.4-13.8]). The main underlying condition was cancer (45.5% of patients; HSCT in 60% of them); and the first indication for AF was prophylaxis (75 prescriptions, 63.2%). Liposomal amphotericin B was used most commonly (46% prescriptions), mainly as prophylaxis (75%). Among the 219 evaluations, 195 (89%) were considered optimal. The reason for non-optimal prescriptions was mostly lack of indication (14/24), especially in critical patients with ventricular assist devices. The use of AF without paediatric approval accounted for 8/24 inappropriate prescriptions. CONCLUSIONS: A high rate of AF appropriateness was found for the children's hospital as a whole, in relation with a well-established AFS. Nonetheless, the identification of specific areas of improvement should guide future actions of the AFS team, which will focus mainly on prophylaxis in critically ill patients receiving circulatory assistance and the use of non-approved drugs in children.

Chronic thromboembolic pulmonary hypertension in Spain: a decade of change.

INTRODUCTION AND OBJECTIVES: Chronic thromboembolic pulmonary hypertension (CTEPH) treatment has evolved in the last decade. However, there is scarce information on the long-term impact of this progress in a real-life population at a national level. This study was designed to analyze the characteristics of CTEPH patients in Spain over the last decade. METHODS: We prospectively collected epidemiological, clinical, and prognostic data from CTEPH patients consecutively included in the Spanish REHAP registry from January 1, 2007, to December 31, 2018. We evaluated differences over time, establishing 2013 as the reference date for analysis. Propensity scores for interventional treatment were calculated using a multivariable logistic regression model. RESULTS: A total of 1019 patients were included; 659 (64.4%) were evaluated at a national CTEPH center. Overall, 350 patients (34.3%) were selected for surgery and 97 (9.6%) for percutaneous treatment. Patients diagnosed between 2007 and 2012 died more frequently than those diagnosed from 2013 onward (HR, 1.83; 95%CI, 1.07-3.15; P=.027). Within the subgroup of patients adjusted by propensity score, baseline pulmonary vascular resistance and the 6-minute walk test distance also determined the outcome (HR, 1.24; 95%CI, 1.15-1.33; P=.011; and HR, 0.93; 95%CI, 0.90-0.97; P=.001, respectively). High survival rates were found in patients who underwent an invasive procedure (pulmonary endarterectomy or balloon pulmonary angioplasty). CONCLUSIONS: CTEPH diagnosis and prognosis have consistently improved in the last decade. Baseline disease severity determines the risk profile. Patients who undergo pulmonary endarterectomy or balloon pulmonary angioplasty have better outcomes.

Low-dose liposomal amphotericin B for antifungal prophylaxis in paediatric allogeneic haematopoietic stem cell transplantation.

BACKGROUND: Primary antifungal prophylaxis in paediatric allogeneic HSCT recipients is mainly based on azoles, which can have related toxicity and drug interactions. Low-dose liposomal amphotericin B (L-AmB) is an attractive intravenous alternative because of its low toxicity and lower risk of interactions. OBJECTIVES: To evaluate the effectiveness and safety of L-AmB (1 mg/kg/day) for primary antifungal prophylaxis in pre-engraftment paediatric HSCT patients. PATIENTS AND METHODS: Retrospective, observational study including all consecutive patients aged ≤18 years who underwent HSCT and received antifungal prophylaxis with intravenous L-AmB (1 mg/kg/day, from day -1 to 48 h before discharge) between January 2012 and December 2016. RESULTS: In total, 125 HSCT procedures in 118 patients were included, median age 7.2 years (IQR 4.2-11.5). Haematological malignancies were the main underlying condition (63.6%), and 109 (87.2%) were considered at high risk for invasive fungal infection (IFI). Ten patients (7.7%), all high risk, developed breakthrough IFI (three Candida spp., seven invasive mould infections) and tended to have higher overall mortality. The only statistically significant risk factor for IFI was cytomegalovirus co-infection. Adverse events, all grade I, occurred in 25 (20%), requiring L-AmB withdrawal in one case. Overall survival at 30 days was 99.2%. At study completion, one patient had died of IFI. CONCLUSIONS: The incidence of breakthrough IFI was comparable to that of previous reports, with a very low rate of significant toxicity. Thus, prophylactic L-AmB may be a safe, effective option for antifungal prophylaxis in the pre-engraftment phase for children undergoing HSCT, even those at high risk.

Radiofrequency Ablation of the Surgical Bed After Lumpectomy in Breast-conserving Surgery. / Ablación por radiofrecuencia del lecho quirúrgico tras tumorectomía en cirugía conservadora del cáncer de mama.

INTRODUCTION: Obtaining tumor-free margins during breast conservative surgery (BCS) is essential to avoid local recurrence and frequently requires reoperation. Radiofrequency ablation (RFA) of surgical margins after lumpectomy seems to be a helpful tool to avoid reoperations, but evidence is insufficient. This study analyzes the efficacy and safety of RFA after BCS to obtain free surgical margins. METHODS: Non-randomized experimental study performed in an intervention group of 40 patients assigned to receive RFA after lumpectomy and successive resection of surgical margins, and a historical control group of 40 patients treated with BCS alone. In the intervention group, the RFA effect on tumor cell viability in the surgical margins was analyzed. Also, reoperation rate, complications and cosmetic results were compared in both groups. RESULTS: A total of 240 excised margins were analyzed after RFA, obtaining a high number of tumor-free margins. Compared to the control group, the reoperation rate decreased significantly (0% vs 12%; P=.02), without differences in terms of postoperative complications (10% vs 5%; P=.67) or cosmetic results (excellent or good 92.5% vs 95%; P=.3). CONCLUSIONS: RFA after lumpectomy is a reliable, safe and successful procedure to obtain tumor-free surgical margins and to decrease the reoperation rate without affecting complications or compromising cosmetic results.

Deprescribing of non-antiretroviral therapy in HIV-infected patients.

PURPOSE: In recent decades, the life expectancy of HIV-infected patients has increased considerably, to the extent that the disease can now be considered chronic. In this context of progressive aging, HIV-infected persons have a greater prevalence of comorbid conditions. Consequently, they usually take more non-antiretroviral drugs, and their drug therapy are more complex. This supposes a greater risk of drug interactions, of hospitalization, falls, and death. In the last years, deprescribing has gained attention as a means to rationalize medication use. METHODS: Review of the different therapeutic approach that includes optimization of polypharmacy and control and reduction of potentially inappropriate prescription. RESULTS: There are several protocols for systematizing the deprescribing process. The most widely used tool is the Medication Regimen Complexity Index, an index validated in HIV-infected persons. Anticholinergic medications are the agents that have been most associated with major adverse effects so, various scales have been employed to measure it. Other tools should be employed to detect and prevent the use of potentially inappropriate drugs. Prioritization of candidates should be based, among others, on drugs that should always be avoided and drugs with no justified indication. CONCLUSIONS: The deprescribing process shared by professionals and patients definitively would improve management of treatment in this population. Because polypharmacy in HIV-infected patients show that a considerable percentage of patients could be candidates for deprescribing, we must understand the importance of deprescribing and that HIV-infected persons should be a priority group. This process would be highly feasible and effective in HIV-infected persons.

Chronic pulmonary aspergillosis in a tertiary care centre in Spain: A retrospective, observational study.

The aim of this study was to describe the characteristics of patients with chronic pulmonary aspergillosis (CPA) in a tertiary care centre in Spain. Retrospective cohort study of all patients diagnosed with CPA between January 2010 and December 2015. The patients were identified through the Microbiology Registry. Demographic, clinical, laboratory, radiological, microbiological and clinical data were recorded. Patients were followed up for 12 months. Fifty-three patients were included; median age was 61.5 years. Forty-seven had a lung condition, 25 suffered from COPD, 19 an active malignancy, 10 had previous pulmonary tuberculosis and 9 lung interstitial disease. Twenty-eight patients presented with chronic cavitary pulmonary form (CCPA) and 20 with subacute invasive aspergillosis (SAIA). Species identified were A fumigatus (34), A niger (5), A terreus (4) and A flavus (3). All-cause 1-year mortality was 56%. Predictors of mortality were cancer history (OR, 9.5; 95% CI, 2.54-35.51; P < 0.01) and SAIA (OR, 5.49; 95% CI, 1.49-19.82; P < 0.01). Previous pulmonary tuberculosis, surgery for the treatment of CPA and CCPA were found to be associated with lower mortality (OR, 0.05; 95% CI, <0.01-0.47; P < 0.01; OR, 0.16; 95% CI, 0.03-0.88; P = 0.035 and OR 0.2, 95% CI, 0.01-0.67; P = 0.01, respectively). This is the first study providing an overview of the features of CPA in patients from Spain. CCPA was the most frequent form of CPA and A fumigatus the most frequently isolated species. Patients with cancer history and SAIA had a worse prognosis.

Hallazgo de quiste ependimario (ependimoma) intramedular en el estudio de la vía piramidal y síndrome siringomiélico / Finding of intramedullary ependymal cyst (Ependymoma) in the study of pyramidal tract and syringomyelic syndrome

Introducción: Una paresia tiene que ser objeto de un detallado análisis para conocer su correcta etiología. La exploración física debe incluir una minuciosa valoración neurológica que oriente la localización de la lesión. Caso Clínico: Paciente con paresia de extremidad inferior derecha, hiperreflexia, clonus y disminución de sensibilidad térmica y algésica por debajo de la apófisis xifoides. Estos hallazgos señalan a nivel vertebral dorsal, D8, posible localización de una lesión que afecta a la vía piramidal motora y la vía sensitiva. La sospecha clínica se confirma mediante RMN que mostró la presencia de masa intramedular, posible ependimoma. Conclusiones: El conocimiento de la anatomía de los haces nerviosos que discurren por la médula espinal y la información nerviosa que proporcionan, contienen signos clínicos motores y sensitivos que permiten discernir qué haces nerviosos están lesionados. Este juicio clínico puede dirigir, de manera mucho más concreta, hacia el tipo de exploraciones y pruebas complementarias que pueden ser necesarias para concretar un diagnóstico y reducir el gasto sanitario, así como el tiempo de espera para un posible tratamiento quirúrgico(AU)

Introduction: A paresis must be the object of a detailed analysis to know its correct etiology. Physical examination should include a thorough neurological assessment to guide the location of the lesion. Clinical case: Patient with paresis of the lower right extremity, hyperreflexia, clonus, and decreased thermal and algic sensitivity below the xiphoid process is preseneted. These findings point to the dorsal vertebral level, D8, possible location of a lesion that affects the pyramidal motor pathway and the sensory pathway. Clinical suspicion is confirmed by MRI that showed the presence of intramedullary mass, possible ependymoma. Conclusions: The knowledge of the anatomy of the nerve bundles that run through the spinal cord, and the nerve information they provide contain clinical and sensory clinical signs, allowing to discern which nerve bundles are injured. This clinical judgment can lead, in a much more concrete way, to the type of explorations and complementary tests that may be necessary to diagnose and reduce health costs, as well as the waiting time for a possible surgical treatment(AU)

Interfascial intercostal nerves block: alternative to epidural analgesia in open gastrectomy? Report on 4 clinical cases / Interfascial intercostal nerves block: alternative to epidural analgesia in open gastrectomy? Report on 4 clinical cases

Abstract The ultrasound-guided intercostal nerves (cutaneous branches) block in the mid-axillary line at the level of the 8th rib (modified BRILMA) is an analgesic technique described back in 2015. Four patients undergoing open gastrectomy (who are not candidates for epidural analgesia) are discussed. The patients underwent the above-mentioned bilateral block, with the administration of 15 mL of levobupivacaine 0.5% into the fascial plane, between the serratus anterior muscle and the external intercostal muscle, with the aim of blocking the intercostal nerves T6 to 11. Postoperative pain control was adequate, with low levels of opioids used. There were no complications associated with the technique.

Resumen El bloqueo ecoguiado de los nervios intercostales (ramas cutáneas) en la línea media axilar a nivel de la 8 costilla (BRILMA modificado) es una técnica analgésica descrita en 2015. Se presentan cuatro pacientes sometidos a gastrectomía abierta (sin posibilidad de administrar la analgesia epidural), a los que se realizó este bloqueo de manera bilateral. Se depositaron 15 ml de levobupivacaína 0,5% en el plano fascial entre el musculo serrato anterior y el intercostal externo, con el objetivo de bloquear los nervios intercostales T6-11. El control postoperatorio del dolor en los pacientes fue adecuado, con escaso consumo de opioides. No hubo complicaciones asociadas a la técnica.

Toward appropriate criteria in medication adherence assessment in older persons: Position Paper.

Nonadherence to medication regimens is a worldwide challenge; adherence rates range from 38 to 57 % in older populations with an average rate of less than 45 % and nonadherence contributes to adverse drug events, increased emergency visits and hospitalisations. Accurate measurement of medication adherence is important in terms of both research and clinical practice. However, the identification of an objective approach to measure nonadherence is still an ongoing challenge. The aim of this Position Paper is to describe the advantages and disadvantages of the known medication adherence tools (self-report, pill count, medication event monitoring system (MEMS) and electronic monitoring devices, therapeutic drug monitoring, pharmacy records based on pharmacy refill and pharmacy claims databases) to provide the appropriate criteria to assess medication adherence in older persons. To the best of our knowledge, no gold standard has been identified in adherence measurement and no single method is sufficiently reliable and accurate. A combination of methods appears to be the most suitable. Secondly, adherence assessment should always consider tools enabling polypharmacy adherence assessment. Moreover, it is increasingly evident that adherence, as a process, has to be assessed over time and not just at one evaluation time point (drug discontinuation). When cognitive deficits or functional impairments may impair reliability of adherence assessment, a comprehensive geriatric assessment should be performed and the caregiver involved. Finally, studies considering the possible implementation in clinical practice of adherence assessment tools validated in research are needed.

α,ß-meATP mimics the effects of the purinergic neurotransmitter in the human and rat colon.

The purine receptor involved in inhibitory responses in the gastrointestinal tract has been recently identified. P2Y1 receptor activation mediates the fast component of the inhibitory junction potential (IJPf) and the non-nitrergic relaxation. The aim of the present work has been to investigate which purinergic agonist better mimics endogenous responses. We used different agonist and antagonist of P2 receptors. Contractility and microelectrode experiments were used to compare the effects of exogenously added purines and electrical field stimulation (EFS)-induced nerve mediated effects in rat and human colonic strips. In rat colon, the IJPf and EFS-induced inhibition of contractions were concentration-dependently inhibited by the P2Y1 antagonist MRS2500 but not by iso-PPADS or NF023 (P2X antagonists) up to 1 µM. In samples from human colon, EFS-induced inhibition of contractions was inhibited by either MRS2500 or apamin (1 µM) but not by iso-PPADS. In both species, α,ß-meATP, a stable analog of ATP, caused inhibition of spontaneous contractions. α,ß-meATP effect was concentration-dependent (EC50: 2.7 µM rat, 4.4 µM human) and was antagonized by either MRS2500 or apamin but unaffected by P2X antagonists. ATP, ADP, ß-NAD and ADP-ribose inhibited spontaneous contractions but did not show the same sensitivity profile to purine receptor antagonists as EFS-induced inhibition of contractions. The effect of α,ß-meATP is due to P2Y1 receptor activation leading the opening of sKca channels. Accordingly, α,ß-meATP mimics the endogenous purinergic mediator. In contrast, exogenously added putative neurotransmitters do not exactly mimic the endogenous mediator. Quick degradation by ecto-nuclease or different distribution of receptors (junctionally vs extrajunctionally) might explain these results.

Daptomycin is effective as antibiotic-lock therapy in a model of Staphylococcus aureus catheter-related infection.

BACKGROUND: The effectiveness of daptomycin versus vancomycin for treating experimental methicillin-susceptible (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) catheter-related infection by antibiotic-lock technique was assessed. METHODS: One MSSA strain and one clinical MRSA isolate were used. A preliminary in vitro study determined the minimum biofilm eradication concentration (MBEC) of vancomycin and daptomycin. An intravenous catheter was implanted in New Zealand white rabbits. Infection was induced by 24 h locking the catheter with 0.3 mL of broth culture containing MSSA or MRSA. The 24 h of antibiotic-lock treatment groups were: control, vancomycin 10 mg/mL, daptomycin 5 mg/mL and daptomycin 50 mg/mL. RESULTS: Daptomycin showed greater in vitro activity than vancomycin against biofilm bacteria (MBECs of vancomycin and daptomycin for MSSA, >2000 mg/L and 7 mg/L; MRSA, >2000 mg/L and 15 mg/L). Daptomycin 5 mg/mL achieved significant reductions relative to vancomycin 10 mg/mL in log10 cfu recovered from catheter tips for both strains (P < 0.05). Only daptomycin 50 mg/mL achieved negative catheter tip cultures (up to 75% in MSSA and 85% in MRSA, P < 0.05), showing the greatest median log10 cfu reduction compared to controls (6.07 in MSSA and 6.59 in MRSA, P < 0.05). CONCLUSIONS: Daptomycin 50 mg/mL showed the highest activity against both strains biofilms.

Efficacy of myofascial trigger point dry needling in the prevention of pain after total knee arthroplasty: a randomized, double-blinded, placebo-controlled trial.

The aim of this study was to determine whether the dry needling of myofascial trigger points (MTrPs) is superior to placebo in the prevention of pain after total knee arthroplasty. Forty subjects were randomised to a true dry needling group (T) or to a sham group (S). All were examined for MTrPs by an experienced physical therapist 4-5 hours before surgery. Immediately following anesthesiology and before surgery started, subjects in the T group were dry needled in all previously diagnosed MTrPs, while the S group received no treatment in their MTrPs. Subjects were blinded to group allocation as well as the examiner in presurgical and follow-up examinations performed 1, 3, and 6 months after arthroplasty. Subjects in the T group had less pain after intervention, with statistically significant differences in the variation rate of the visual analogue scale (VAS) measurements 1 month after intervention and in the need for immediate postsurgery analgesics. Differences were not significant at 3- and 6-month follow-up examinations. In conclusion, a single dry needling treatment of MTrP under anaesthesia reduced pain in the first month after knee arthroplasty, when pain was the most severe. Results show a superiority of dry needling versus placebo. An interesting novel placebo methodology for dry needling, with a real blinding procedure, is presented.

Hallazgos epidemiológicos en infecciones parasitarias intestinales de un grupo de niños ingresados por diarreas / Epidemiological findings in intestinal parasitic infections from a group of hospitalized children with diarrhea

Introducción: la enfermedad diarreica es aún una causa importante de mortalidad en países en desarrollo, en los que afecta principalmente a los niños menores de 5 años de edad. En Cuba, aunque la mortalidad por esta causa se ha reducido, puede ser un importante problema de salud en ciertas épocas del año. Entre los grupos de agentes biológicos que se pueden encontrar en niños con diarreas están los parásitos, de los cuales no siempre se conoce bien su papel como agente causal. Objetivo: determinar algunas características epidemiológicas de las infecciones parasitarias en niños ingresados con diarrea. Métodos: se realizó un estudio observacional descriptivo en niños ingresados con diarrea en la sala de gastroenterología del hospital pediátrico William Soler de La Habana, desde noviembre de 2006 a octubre de 2007. A todos los niños se les recogieron muestras de heces para estudios parasitológicos y se les llenó un cuestionario con datos clínicos y epidemiológicos. Resultados: se encontró una mayor frecuencia de infecciones por protozoos para todas las edades (p< 0,01); el grupo mayor de 2 años resultó el más frecuente infectado en general (68,52 porciento) y el más parasitado por Giardia lamblia (35,18 porciento), mientras que los lactantes presentaron la menor frecuencia de parasitismo intestinal (18,18 porciento). Las infecciones por protozoos en general y por el complejo Entamoeba histolytica/Entamoeba dispar en particular, fueron más frecuentes en la estación de lluvia que en la de seca (p< 0,05). Por último, se encontró que los niños asistentes a círculos infantiles y a escuelas primarias, presentaron una mayor frecuencia de infección con Giardia lamblia que por Entamoeba histolytica/Entamoeba dispar y Cryptosporidium (p< 0,05). Conclusiones: se encontró un predominio de infecciones por protozoos en niños ingresados con diarreas, las cuales se presentaron más frecuentes en los mayores de 2 años y en la estación de lluvia

Introduction: acute diarrhea is a major cause of mortality in developing countries, and children aged less than five years are the most affected. Despite of decreasing mortality rates in Cuba, this illness may be an important health problem in some periods of the year. Among the groups of biological agents found in children with diarrhea are the parasites but their role as etiological agent is not always well recognized. Objective: to determine some epidemiological characteristics of parasitic infections in hospitalized children due to diarrhea. Methods: an observational descriptive study was performed on children who had diarrhea and were admitted to the gastroenterology service ward in William Soler pediatric hospital in Havana from November 2006 to October 2007. Their stool samples were collected for parasitological studies, and some questionnaires were filled out with corresponding clinical and epidemiological data. Results: the frequency of protozoan infections was higher than that of helminthic ones for all the age groups(p< 0.01), and children aged over 2 years was the most frequently infected with all types of parasites in general (68.52 percent), and with Giardia lamblia (35.18 percent) in particular whereas the infant group was the less frequently infected with intestinal parasites (18.18 percent). The infections caused by protozoa and by Entamoeba histolytica/Entamoeba dispar were more frequent in the rainy season than in the dry season (p< 0.05). Finally, a higher prevalence of infections with Giardia lamblia than with Entamoeba histolytica/Entamoeba dispar or Cryptosporidium was found in day care and primary school children (p< 0.05). Conclusions: a higher prevalence of protozoan infections was observed and they occur more frequently in children aged more than two years old and during the rainy season

Purinergic and nitrergic neuromuscular transmission mediates spontaneous neuronal activity in the rat colon.

Nitric oxide (NO) and ATP mediate smooth muscle relaxation in the gastrointestinal tract. However, the involvement of these neurotransmitters in spontaneous neuronal activity is unknown. The aim of the present work was to study spontaneous neuromuscular transmission in the rat midcolon. Microelectrode experiments were performed under constant stretch both in circular and longitudinal directions. Spontaneous inhibitory junction potentials (sIJP) were recorded. Tetrodotoxin (1 microM) and apamin (1 microM) depolarized smooth muscle cells and inhibited sIJP. N(omega)-nitro-l-arginine (l-NNA, 1 mM) depolarized smooth muscle cells but did not modify sIJP. In contrast, the P2Y(1) antagonist MRS-2500 (1 microM) did not modify the resting membrane potential (RMP) but reduced sIJP (IC(50) = 3.1 nM). Hexamethonium (200 microM), NF-023 (10 microM), and ondansetron (1 microM) did not modify RMP and sIJP. These results correlate with in vitro (muscle bath) and in vivo (strain gauges) data where l-NNA but not MRS-2500 induced a sustained increase of spontaneous motility. We concluded that, in the rat colon, inhibitory neurons regulate smooth muscle RMP and cause sIJP. In vitro, the release of inhibitory neurotransmitters is independent of nicotinic, P2X, and 5-hydroxytryptamine type 3 receptors. Neuronal NO causes a sustained smooth muscle hyperpolarization that is responsible for a constant inhibition of spontaneous motility. In contrast, ATP acting on P2Y(1) receptors is responsible for sIJP but does not mediate inhibitory neural tone. ATP and NO have complementary physiological functions in the regulation of gastrointestinal motility.

Exploración de la hemodinámica en la hipertensión pulmonar mediante cateterismo cardíaco derecho / Exploration of hemodynamics in pulmonary hipertension by right heart catherization

El diagnóstico final de hipertensión pulmonar se realizamediante cateterismo cardíaco derecho. Existe hipertensiónpulmonar cuando la presión media en la arteria pulmonarsupera los 25 mmHg en situación basal. Una adecuadaexploración hemodinámica permite encuadrar la hipertensiónpulmonar en algunos de los cinco grupos de la clasificaciónclínica actual. Se dan las recomendaciones para los diferentesespecialistas de cuándo efectuar el cateterismo derecho, quéparámetros se deben de registrar y como realizar e interpretaruna prueba aguda de vasorreactividad en la hipertensiónarterial pulmonar.

The final diagnosis of pulmonary hypertension is made byright heart catheterization. Pulmonary hypertension is presentwhen the average pressure in the pulmonary artery exceeds 25mm Hg at baseline. Proper hemodynamic assessment allowsclassification of pulmonary hypertension into one of five clinicalcategories. Recommendations are provided for specialists, whento conduct right heart catheterization, which parameters mustbe recorded and how to perform and interpret a test for acutevasoreactivity in pulmonary arterial hypertensio.

Inhibitory effect of jasmonic acid and ethylene on epicotyl growth and bud induction in the maritime pine, Pinus pinaster Soland. in Ait

Two independent parameters, epicotyl height (cm) and number of induced buds were studied on Pinus pinaster explants to analyse the effects of three phytohormones (6-benzylaminopurine, jasmonic acid, ethylene) which were combined or not in 11 different treatments. Epicotyle length diminished significantly in relation to the control medium (medium without exogen phytohormones) in presence of jasmonic acid, 6-benzylaminopurine or Ethephon (which is converted to ethylene in plants) in any of treatments. Concentrations of 100 microM of jasmonic acid and Ethephon had a greater inhibitory effect than the treatments with 10 microM. In addition to that, jasmonic acid was a stronger inhibitor than Ethephon in any of the tried combinations. There were no significant differences between the control treatment and the treatment s with only 10 microM of jasmonic acid or Ethephon. However, 10 microM 6-benzylaminopurine induced bud formation. The different combinations of 6-benzylaminopurine with jasmonic acid and Ethephon showed that concentrations of 10 to 100 microM did not affect the number of induced buds. Jasmonic acid had an inhibitory effect which Ethephon only showed when combined with 100 microM of jasmonic acid and 10 microM of 6-benzylaminopurine. Three response groups were defined by cluster analysis: group 1 produced the greatest mean number of buds (4 to 5) and a mean epicotyl growth of 1 to 1.5 cm; group 2 produced 2 to 4 buds and a mean growth of 0.5 to 1.2 cm; group 3 produced only one bud and a mean epicotyl length of 1.2 to 2 cm.

P2Y(1) receptors mediate inhibitory neuromuscular transmission in the rat colon.

BACKGROUND AND PURPOSE: Inhibitory junction potentials (IJP) are responsible for smooth muscle relaxation in the gastrointestinal tract. The aim of this study was to pharmacologically characterize the neurotransmitters [nitric oxide (NO) and adenosine triphosphate (ATP)] and receptors involved at the inhibitory neuromuscular junctions in the rat colon using newly available P2Y(1) antagonists. EXPERIMENTAL APPROACH: Organ bath and microelectrode recordings were used to evaluate the effect of drugs on spontaneous mechanical activity and resting membrane potential. IJP and mechanical relaxation were studied using electrical field stimulation (EFS). KEY RESULTS: N(omega)-nitro-L-arginine (L-NNA) inhibited the slow component of the IJP and partially inhibited the mechanical relaxation induced by EFS. MRS2179, MRS2500 and MRS2279, all selective P2Y(1) receptor antagonists, inhibited the fast component of the IJP without having a major effect on the relaxation induced by EFS. The combination of both L-NNA and P2Y(1) antagonists inhibited the fast and the slow components of the IJP and completely blocked the mechanical relaxation induced by EFS. Sodium nitroprusside caused smooth muscle hyperpolarization and cessation of spontaneous motility that was prevented by oxadiazolo[4,3-alpha]quinoxalin-1-one. Adenosine 5'-O-2-thiodiphosphate, a preferential P2Y agonist, hyperpolarized smooth muscle cells and decreased spontaneous motility. This effect was inhibited by P2Y(1) antagonists. CONCLUSIONS AND IMPLICATIONS: The co-transmission process in the rat colon involves ATP and NO. P2Y(1) receptors mediate the fast IJP and NO the slow IJP. The rank order of potency of the P2Y(1) receptor antagonists is MRS2500 greater than MRS2279 greater than MRS2179. P2Y(1) receptors might be potential pharmacological targets for the regulation of gastrointestinal motility.