Pandemia y atencion ambulatoria pediatrica de alta complejidad en un hospital publico. Experiencia de un modelo de atención con uso de telemedicina en niños/as con nutrición parenteral domiciliaria / Pandemic and highly complex pediatric outpatient care in a public hospital. Experience of a care model with the use of telemedicine in children with home parenteral nutrition

Introducción: Los pacientes que reciben nutrición parenteral domiciliaria (NPD) en seguimiento desde el Hospital requieren un monitoreo que debió modificarse por la pandemia por SARS-CoV-2. Objetivo: Valorar la utilización y el impacto en los resultados, de estrategias alternativas a la atención presencial de pacientes con NPD, empleando telemedicina, durante el inicio de la pandemia por SARS-CoV-2, comparándolas con las prácticas habituales previas. Materiales y métodos: Estudio analítico descriptivo retrospectivo que analizó el monitoreo, la evolución y las complicaciones de pacientes con NPD asistidos en el Hospital en el período previo a la pandemia (1/4/2019 y 31/3/2019) y durante su primer año (1/4/2020 a 31/3/2021), basado en la revisión de historias clínicas y bases de datos de complicaciones. Resultados: Las características demográficas, diagnósticos, procedencia y provisión de la NPD fueron similares en los dos períodos. Durante el período de la pandemia se redujeron en forma significativa el número de controles presenciales y aumentaron los realizados por telemedicina en forma sincrónica (con una modalidad pautada previamente), y los controles por profesionales locales. La participación de los cuidadores en los procedimientos de administración de la NPD aumentó en pandemia. Las tasas de complicaciones, re-internaciones, el número de inicios y suspensiones de tratamiento fueron similares en ambos períodos. Conclusiones: En pandemia fue posible implementar y monitorizar la NPD utilizando telemedicina sin observar afectación significativa de la evolución, las complicaciones de la enfermedad y del tratamiento. El seguimiento mediante telemedicina sincrónica resultó útil y se incorporará como una herramienta más al monitoreo habitual sin reemplazarlo

Introduction: Patients receiving home parenteral nutrition (HPN) under follow-up from the Hospital require monitoring that had to be modified due to the SARSCoV-2 pandemic. Objective: To assess the use and the impact on the results of other care strategies for patients with HPN, using telemedicine, during the beginning of the SARS CoV2 pandemic, compared with previous usual practices.Materials and methods: Retrospective descriptive analytical study that analyzed the monitoring, evolution and complications of patients with HPN assisted in the Hospital, in the period before pandemic ( 4/1/2019 to 3/31/2020) and during the first year of SARS CoV-2 pandemic (4/1/2020 to 3/31/2021), according to data obtained from medical records and databases. Results: demographic characteristics, diagnoses, place of residence and HPN provision were similar in both periods. During the pandemic period, the number of face-to-face controls were significantly reduced and those carried out by telemedicine synchronously, and by local professionals increased. The participation of caregivers in the administration procedures of the HPN increased in the pandemic period. The rates of complications, readmissions, number of initiations and suspensions of home treatment were similar in both periods. Conclusions: It was possible to implement and monitor HPN during pandemic. The evolution and complications of the disease and treatment were not significantly affected. Synchronous telemedicine follow-up was successfully useful and will be incorporated as another tool to regular monitoring

Long-Term Outcomes of Intestinal and Multivisceral Transplantation at a Single Center in Argentina.

BACKGROUND: Intestinal failure (IF) patients received parenteral nutrition (PN) as the only available therapy until intestinal transplantation (ITx) evolved as an accepted treatment. The aim of this article is to report the long-term outcomes of a series of ITx performed in pediatric and adult patients at a single center 9 years after its creation. PATIENTS AND METHODS: This is a retrospective analysis of the ITx performed between May 2006 and January 2015. Diagnoses, pre-ITx mean time on PN, indications for ITx, time on the waiting list for types of ITx, mean total ischemia time, and warm ischemia time, time until PN discontinuation, incidence of acute and chronic rejection, and 5-year actuarial patient survival are reported. RESULTS: A total of 42 patients received ITx; 80% had short gut syndrome (SG); the mean time on PN was 1620 days. The main indication for ITx was lack of central venous access followed by intestinal failure-associated liver disease (IFALD) and catheter-related infectious complications. The mean time on the waiting list was 188 days (standard deviation, ±183 days). ITx were performed in 26 children and 14 adults. In all, 32 procedures were isolated ITx (IITX); 10 were multiorgan Tx (MOT; 3 combined, 7 multivisceral Tx (MVTx), 1 modified MVTx and 2 with kidney); 2 (4.7 %) were retransplantations: 1 IITx, 1 MVTx, and 5 including the right colon. Thirteen patients (31%) received abdominal rectus fascia. All procedures were performed by the same surgical team. Total ischemia time was 7:53 ± 2:04 hours, and warm ischemia time was 40.2 ± 10.5 minutes. The mean length of implanted intestine was 325 ± 63 cm. Bishop-Koop ileostomy was performed in 67% of cases. In all, 16 of 42 Tx required early reoperations. The overall mean follow-up time was 41 ± 35.6 months. The mean time to PN discontinuation after Tx was 68 days (P = .001). The total number of acute cellular rejection (ACR) episodes until the last follow-up was 83; the total number of grafts lost due to ACR was 4; and the total graft lost due to chronic rejection was 3. At the time of writing, the overall 5-year patient survival is 55% (65% for IITx vs 22% for MOT; P = .0001); 60% for pediatric recipients vs 47% for adults (P = NS); 64% when the indication for ITx was SG vs 25% for non-SG (P = .002). CONCLUSIONS: At this center, candidates with SG, in the absence of IFALD requiring IITx, showed the best long-term outcomes, independent of recipient age. A multidisciplinary approach is mandatory for the care of intestinal failure patients, to sustain a rehabilitation and transplantation program over time.

[Development of a program of nutritional education and valuation of the change of healthful nourishing habits in a population of students of Obligatory Secondary Education]. / Desarrollo de un programa de educación nutricional y valoración del cambio de hábitos alimentarios saludables en una población de estudiantes de Enseñanza Secundaria Obligatoria.

INTRODUCTION: Adolescence is a critical period for the acquisition and configuration of healthy dietary habits and lifestyle for the young future, which will likely persist throughout the adulthood. Paediatric and juvenile obesity is a public health problem which control necessarily implies prevention and nutritional education. OBJECTIVES: To evaluate the nutritional status of the adolescents and determine the proportion with overweight or obesity, and to establish a Nutritional Intervention Programme and analyse the improvement in the pattern of dietary habits among the adolescents. METHODS: The study has been carried out in a population of 372 Obligatory Secondary Education (OSE) students from the Institute of Secondary Education of Gandía (Valencia). RESULTS: 37.8% of the adolescents have improved the level of their diet quality. Those consuming a high quality diet have increased from 30.0% to 58.6%. Also significant is the number of students that have taken up having breakfast and those having discontinued taking industrial bakery with this meal. The decrease in the number of adolescents going to fast food places and of those that have discontinued eating candies regularly is statistically significant. The data from the KIDMED index show that 47.4% (p < 0.001) of de the students have improved the quality of their diet and in none of them it has worsened. DISCUSSION: Before starting the programme, 30% of the students followed a high quality diet comparable to the traditional Mediterranean Diet, and after the education programme, this percentage increased to 58.6%. Forty-seven point four percent of overweighed or obese students receiving the Nutritional Education and Intervention have improved their diet quality and the percentage of those following a high quality diet varied from 28.9% to 71.0%.

Sindrome de Realimentacion en pacientes con anorexia nerviosa / Refeeding Syndrome in patient with nervous anorexia

El Sindrome de Realimentacion (SR) representa las consecuencias metabolicas de la homeostasis del agua con los macro y micro nutrientes como glucosa, el sodio, el potasio, el magnesio, los oligoelementos y las vitaminas

Utilizacion de la nutricion enteral en el Hospital de Niños Sor Maria Ludovica / Use of enteral nutrition in Sor Maria Ludovica children hospital

Evaluar la frecuencia de utilizacion de la nutricion enteral (NE) en el hospital y en el domicilio, caracteristicas de los pacientes, formula, tiempo de uso y responsable de la indicacion

Antibodies to a synthetic 1-9-N-terminal amino acid fragment of mature pediocin PA-1: sensitivity and specificity for pediocin PA-1 and cross-reactivity against Class IIa bacteriocins.

Polyclonal antibodies specific for pediocin PA-1 (PedA1) were generated by immunization of rabbits with a chemically synthesized 1-9-N-terminal amino acid fragment of this bacteriocin (PH1) conjugated to the carrier protein keyhole limpet haemocyanin (KLH). The PH1 fragment holds a highly conserved amino acid sequence with closely related Class IIa bacteriocins. The sensitivity and specificity of the PH1-KLH-generated rabbit polyclonal antibodies were evaluated by the development of various ELISAs, such as a non-competitive indirect ELISA (NCI-ELISA), a competitive indirect ELISA (CI-ELISA), a competitive direct ELISA (CD-ELISA) and a sandwich ELISA (S-ELISA), and by protein slot-blotting and Western blotting. NCI- and CI-ELISA were valuable for detecting the existence of PedA1-specific antibodies in the sera of immunized rabbits. The limit of detection of PedA1 in MRS medium was found to be 0.5 microg ml(-1) in NCI-ELISA, while CI-ELISA on plates coated with purified PedA1 increased the affinity of the PH1-KLH-generated antibodies for PedA1; the limit of detection of PedA1 was less than 0.01 microg ml(-1) and 50% binding inhibition was achieved with 0.1 microg PedA1 ml(-1). Similarly, the limits of detection of PedA1 in MRS medium were found to be 5 microg ml(-1) by protein slot-blotting and 0.01 microg ml(-1) by Western blotting. Most importantly, PH1-KLH-generated polyclonal antibodies detected the presence of PedA1 in the supernatants of the producing strains of Pediococcus acidilactici 347, Z102, A172, X13 and P20, with no reactivity or negligible immunoreactivity with the supernatants of other lactic acid bacteria producing or not producing closely related or different bacteriocins. The approaches taken for the selection of the bacteriocin peptide fragment, the generation of antibodies and the development of immunoassays could prove useful for the generation and evaluation of antibodies of adequate specificity for other bacteriocins of interest in the food industry.

[Clinical-biological differences between invasive ductal carcinomas and breast lobular carcinomas. Preliminary results]. / Diferencias clínico-biológicas entre carcinomas infiltrantes de tipo ductal y lobulillar de mama. Resultados preliminares.

In order to know the biological differences between both histological types, we have analyzed some clinical and biological parameters in tissues of women having infiltrating carcinomas (247 ductal (IDCs) 17 and lobular (ILCs) of the breast. Our preliminary results led us to suggest the following. 1) In negative axillary lymph node involvement (N-) patients, ILCs were more frequently associated with diploidy and the existence of multiple foci; likewise, they had higher pS2 cytosolic levels than IDC; 2) in N+ patients, ILC were associated with multicentricity and had higher concentrations of progesterone receptors and 3) these findings could help to explain us the clinical and biological peculiarities, as well as, the clinical outcome of both histological types.

[Valoration of the epidermal growth factor receptor (EGFR) in benign breast disease and its relation with expression in malignant tumors classified by hormonal dependence]. / Valoración del receptor del factor de crecimiento epidérmico (EGFR) en patología benigna de la mama y su relación con la expresión en tumores malignos clasificados en función de su dependencia hormonal.

The aim of this work is studying the behaviour of EGFR in benign breast pathologies and correlating it to its expression in CDI with hormonal dependency or independency using a radioligand technique. The EGFR expression was higher in FAD rather than in MFQ (mean +/- S.D.: 13.7 +/- 13.5; range: 1.0-55.3; median: 10.0 fmol/mg prot vs mean +/- S.D.: 4.0 +/- 3.5; range:1.0-11.4; median: 2.2 fmol/mg prot), with a result of a positive correlation in the first ones with RP (r = 0.4557) but not with RE. FAD present similar EGFR concentrations to those in CDI-hormonal independents (mean +/- S.D.: 10.7 +/- 12.6; range: 1.0-60.2; median: 6.75 fmol/mg prot), even though the way they are correlated with the content in RP leads us to the conclusion that they are both involved in the genesis and controled development of themselves. On the other hand, MFQ have got similar contents in EGFR to those of CDI hormono-dependents (mean +/- S.D.: 6.98 +/- 15.72; range: 1.0-118; median: 2.55 fmol/mg prot); this fact proves that the development of this pathology does not only depend on the growth factors but also on the hormonal environment which influences it.

Generation of polyclonal antibodies of predetermined specificity against pediocin PA-1.

Polyclonal antibodies of predetermined specificity for pediocin PA-1 (pedA1) have been generated by immunization of rabbits with a chemically synthesized C-terminal fragment of this bacteriocin (PH2) conjugated to the carrier protein keyhole limpet hemocyanin (KLH). The sensitivity and specificity of the PH2-KLH-generated antibodies were evaluated by the development of various enzyme-linked immunosorbent assays (ELISAs)-a noncompetitive indirect ELISA (NCI-ELISA), a competitive indirect ELISA (CI-ELISA), and a competitive direct ELISA (CD-ELISA)-and by immunodotting. All immunoassays indicated the existence of pedA1-specific antibodies with high relative affinities and adequate sensitivities in the sera of immunized animals. The limits of detection of pedA1 in MRS medium (Oxoid Ltd., Basingstoke, United Kingdom) were found to be 2.5 microg/ml by immunodotting and 1 microg/ml in the NCI-ELISA. However, the CI-ELISA enhanced the limit of detection of pedA1 to 0.025 microg/ml, while the amount of free pedA1 required for 50% binding inhibition was 10 microg/ml. Moreover, the CD-ELISA increased the affinity of the PH2-KLH-generated antibodies for pedA1; the limit of detection of pedA1 was less than 0.025 microg/ml, and the 50% binding inhibition value was reduced to 0.5 microg of pedA1/ml. All immunoassays and the slot dot assay detected the presence of pedA1 in the supernatant of the producing strain Pediococcus acidilactici 347, with no reactivity or negligible immunoreactivity with the supernatants of other lactic acid bacteria producing or not producing different bacteriocins. The approaches taken for the generation of antibodies and the development of immunoassays could prove useful for the generation and evaluation of antibodies of predetermined specificity for other bacteriocins of interest in the food industry.

[Smoking and diabetes. An intervention protocol]. / Tabaquismo y diabetes. Una intervención protocolizada.

Tobacco smoking habit has been considered like an important cause of diabetes mellitus complications. Health education efficiency has been supported by many experiences in order to promote tobacco withdrawal by personal counselling with a direct nurse role at primary health care level. This study was carried out by all this information with tre straight goal of describing changes in the diabetic tobacco behaviour after a stepped counselling and a primary care nurse following. Description details are given of the smoking diabetic population counselled and listed at the same time in a nurse control clinic over a 18 months period. A Smokers Helping Scheme (SHS) was used. SHS understood that tobacco withdrawal is behavioural changing process with a few steps. Smokers were given with special written material for thes purpose. Results data were caught by the researchers from the chronical patient's census and from the tobacco program control sheets. Tobacco withdrawal was verified by espirated air CO determination (Smokorlizar system) and has been maintained by the 25% of managed diabetic people in this investigation. We strongly believe that nursing diabetic tobacco counselling by SHS acts like a behavioural modificator as results are showing. Health state improvement and a better life quality have been got on the diabetic people that has been managed.

Artritis de rodilla por Acremonium SPP en un paciente con nutricion parenteral prolongada / Arthritis of knee for Acremonium SPP in a patient with prolonged parenteral nutrition

Un paciente de 9 años, que recibió nutrición parenteral total en domicilio, desarrollo una artritis aguda por acremonium spp. Este hongo que se halla usualmente en el suelo como saprófito, infectó su cateter a través de la contaminación de solución fisiológica. Describimos los hallazgos clínicos y de laboratorio en el primer episodio, recaida, tratamiento y complicaciones. Conclusiones: 1. Este caso reafirma la necesidad del cumplimiento estricto de las normas y procedimientos del manejo de cateter y vigilancia de la calidad de los materiales y soluciones utilizadas. 2. La recaida de la artritis en este paciente luego de cultivos negativos sugiere la necesidad del uso de drogas antifungicas durante períodos prolongados. 3. El paciente logró niveles terapéuticos de itraconazol, lo que sugiere una buena absorción de esta droga y hace esta indicación posible en pacientes con sindrome de intestino corto. 4. El uso de drogas por vía oral en pacientes con sindrome de intestino corto necesita el monitoreo plasmático.

[Carbohydrate deficient transferrin and other markers of alcohol consumption in the general hospital]. / Transferrina deficiente en carbohidratos y otros marcadores de consumo de alcohol en el hospital general.

BACKGROUND: The ascertainment of patients who consume important amounts of alcohol admitted to a hospital is essential to prevent medical and psychological complications. Carbohydrate deficient transferrin (CDT) is a new marker of alcohol consumption which requires validation in the hospital setting. METHODS: The values of carbohydrate deficient transferrin (CDT), glutamic oxalacetic transaminase (GOT), gamma glutamil transpeptidase (GGT) and mean corpuscular volume (MCV) were measured in 101 consecutive patients admitted to the Internal Medicine and Surgery Departments. Considering amounts higher than 60 g/day of ethanol for male patients and higher than 40 g/day for female patients as risk consumption, the values for sensitivity, specificity and area under the curve were calculated for the different biological tests. RESULTS: Twenty-six percent of patients reported a consumption of risk. The sensitivity of the tests were lower than 50% and specificities higher than 77%. CDT had the lowest sensitivity (15%) but it was very specific (98%). CDT had a better sensitivity among women than among men. None of the tests had an area under the curve with adequate efficiency levels. CONCLUSIONS: CDT among the hospitalized patients and other biological markers of alcohol consumption have a low efficiency.

Generation of polyclonal antibodies against a chemically synthesized N-terminal fragment of the bacteriocin pediocin PA-1.

Six mice were immunized intraperitoneally (i.p.) with a chemically synthesized 9-mer fragment (PH1) designed from the N-terminal part of the bacteriocin pediocin PA-1 and conjugated to keyhole limpet haemocyanin (KLH). After three doses of the immunogen had been administered, serum-specific antibodies were detected by a competitive direct ELISA. Myeloma cells were injected i.p. into mice in order to obtain ascites polyclonal antibodies. Although four mice developed ascites, only mouse 2 had detectable specific antibodies in the ascites fluid. The serum and ascites antibodies were specific for PH1 but they did not recognize the whole pediocin PA-1 molecule. This is the first attempt to generate antibodies against bacteriocins with a chemically synthesized oligopeptide as immunogen. This approach still remains attractive for detection, quantification, mode of action studies and purification of bacteriocins, especially those for which the purification process is difficult or inefficient at present.

Enhanced expression of the beta II subspecies of protein kinase C in differentiating erythroleukemia cells.

Polyclonal antipeptide antibodies which recognize selected isozymes (alpha, beta I, beta II, and gamma) of the protein kinase C family were used to identify specific subspecies in undifferentiated Friend erythroleukemia cells and in cells triggered to differentiate with hexamethylene bisacetamide. The beta II isozyme of protein kinase C was the primary isozyme expressed and its abundance was significantly increased (P less than 0.05) in differentiated cells. Differences in immunostaining between control and experimental groups were objectively quantitated by determining percentage transmission of light through cells based on color threshold rather than gray intensity levels. Staining was localized to the cytoplasm predominantly in differentiated cells, whereas nuclei stained more intensely in undifferentiated cells. These results provide immunocytochemical evidence to support the hypothesis that changes in the expression of the beta II subspecies of protein kinase C are essential to the programmed maturation of differentiating Friend erythroleukemia cells.

Treatment of leprosy with weekly intravenous infusion of leukocytes.

Two patients with lepromatous leprosy were treated with weekly intra-venous infusions of leukocyte concentrates for a period of 12 consecutive weeks. A reversal reaction was induced in one of the patients, and it was possible to control chronic erythema nodosum leprosum in the other subject. Possible pathogenetic mechanisms involved in the induction of these changes include the action of transfer factor, interactions between B- and T-lymphocytes or the mediation of a lymphokine necessary for the effective function of the cell-mediated immunity. Immunotherapy for chronic infections, such as leprosy, still has not become a reality.