Strategies to improve the insecticidal activity of Cry toxins from Bacillus thuringiensis.

Bacillus thuringiensis Cry toxins have been widely used in the control of insect pests either as spray products or expressed in transgenic crops. These proteins are pore-forming toxins with a complex mechanism of action that involves the sequential interaction with several toxin-receptors. Cry toxins are specific against susceptible larvae and although they are often highly effective, some insect pests are not affected by them or show low susceptibility. In addition, the development of resistance threatens their effectiveness, so strategies to cope with all these problems are necessary. In this review we will discuss and compare the different strategies that have been used to improve insecticidal activity of Cry toxins. The activity of Cry toxins can be enhanced by using additional proteins in the bioassay like serine protease inhibitors, chitinases, Cyt toxins, or a fragment of cadherin receptor containing a toxin-binding site. On the other hand, different modifications performed in the toxin gene such as site-directed mutagenesis, introduction of cleavage sites in specific regions of the protein, and deletion of small fragments from the amino-terminal region lead to improved toxicity or overcome resistance, representing interesting alternatives for insect pest control.

Management and outcomes in digestive cancer surgery: design and initial results of a multicenter cohort study.

BACKGROUND: most studies that analyze the influence of structure factors on clinical outcomes are retrospective, based on clinical-administrative databases, and mainly focusing on surgical volume. OBJECTIVE: to study variations in the process and outcomes of oncologic surgery for esophagus, stomach, pancreas, liver metastases and rectum cancers in Catalonia, as well as the factors associated with these variations. PATIENTS AND METHOD: a retrospective (2002) and prospective (2003-05) multicenter cohort study. Data forms were designed to collect patient, process, and care outcome characteristics before surgery, at hospital discharge, and at 3 and 6 months after discharge. Main outcome measures were hospital and follow-up mortality, complications, re-interventions, and relapse rates. RESULTS: 49 hospitals (80%) participated in the retrospective phase, 44 of which (90%) also participated in the prospective phase: 3,038 patients (98%) were included. No differences were observed in the profile of operated patients according to hospital level of complexity, but clinical-pathological staging and other functional status variables could not be assessed because of over 20% of missing values. There was significant variability in the volume of interventions as well as in certain aspects of the healthcare process depending on type of cancer and center complexity. High rates of esophageal cancer mortality (18.2% at discharge, 27.3% at 6 months) and of complications and re-interventions for all cancers assessed, especially rectal cancer (18.4% re-interventions at 6 months), were identified. CONCLUSIONS: the study of the variability identified will require adequate risk-adjustment and should take into account different structure factors. It is necessary that information included in medical records be improved.

[Approximation to palliative care in the advanced non-malignant diseases]. / Aproximación a los cuidados paliativos en las enfermedades avanzadas no malignas.

Nowadays Palliative Medicine (PM) is changing from a specific point of view towards patients with advanced cancer, to another more generic that also keep in mind patients with advanced non malignant disease. Likewise it is more and more deeply rooted customs that the end-of-life care has become a fundamental right of our Society. But as a matter of fact, these patients with non-cancer diseases unusually go into a Palliative Care (PC) programme. It is known the difficulty to diagnosis the end of life clinical condition (EOLCC) in them. In this article we comment the justification and restriction of PC in patients with non-malignant cancer diseases, as well as the paradoxical situation to come out, in spite of the increasing programes of PC gradually. But above all we propose in a practical way resolve when a patient with non malignant organ advanced disease (NMOAD) could be subsidiary of PC. For that purpose we have to know the diagnosis and the prognostic factors in connection with the EOLCC of the NMOAD more common (advanced chronical pulmonary disease, advanced chronical heart failure, advanced cirrhosis hepatic, advanced chronical renal failure and very evolved dementia), to set up an appropriate make decisions keeping in mind the preferences and wishes of the patient and family, to document and record in the clinical history all those parameters and offerer to the patient the treatment more suitable with the intention to get a worthy death bearing in mind clinical, cultural and ethical standards. It is pointed out the necessity to carry out prospective studies to help setting up some inclusion criterions in PC programmes for patients with NMOAD.

Open heart surgery in public and private practice.

OBJECTIVES: To compare open heart surgery services provided by public and private hospitals in Catalonia (Spain) according to case mix, procedures undergone and surgical mortality. METHODS: Data on all adult patients undergoing open heart surgery procedures were collected prospectively in a sample of public and privately owned centres for a 6.5-month period in 1994. Sociodemographic, clinical and procedural variables were collected. A predictive model stratifying patients according to their surgical mortality risk was used to adjust for differences in case mix between providers. RESULTS: Included were 1287 open heart surgery procedures. Public and private patients differed significantly in terms of gender, clinical history (e.g. hypertension, pulmonary disease, recent infarction) and procedural variables (e.g. reoperation, type of intervention). There were also statistically significant differences related to educational level, with better educated patients more likely to be treated in private centres. Crude surgical mortality rates differed between providers, although public centres operated on higher-risk patients. After adjusting for differences in case mix, the association between the type of provider and surgical mortality was not statistically significant (odds ratio 1.68; 95% CI from 0.94 to 3.0). CONCLUSIONS: Although crude mortality rates differ between public and private providers, there is a significant trend towards higher surgical risk in public centres. After adjusting for surgical risk, differences between types of provider decreased and were no longer statistically significant. The importance of other social and health-related factors, such as educational level, may explain differences between providers in their patients' surgical risk and in their performance in open heart surgery.

Effect of parasite burden on the detection of Fasciola hepatica antigens in sera and feces of experimentally infected sheep.

The effect of Fasciola hepatica parasite burden on the detection of excretory/secretory (E/S) antigens in sera and feces of experimentally infected sheep was evaluated using a double antibody-based capture enzyme-linked immunosorbent assay (ELISA). Four groups of five sheep each were used. The first three groups were infected with 50, 100 and 200 metacercariae of F. hepatica, and the fourth group remained as non-infected control. On the day of infection and weekly thereafter, serum and fecal samples were taken. ELISA detected F. hepatica E/S antigen levels in serum from the first week post-infection (wpi) and in fecal supernatant from the fourth wpi, which were significantly (p<0.05) higher than controls. F. hepatica eggs were not detected until after the eighth wpi. The correlation between absorbance of E/S antigens in serum with the fluke burden was 0.77 (p<0.0001) and in feces 0.76 (p<0.0001) at 12th wpi. The sensitivity of the assay to detect E/S antigens in serum was 86.6% and in feces 93.3%. It is concluded that the ELISA technique used in this study offers a diagnostic alternative for detecting early infections of F. hepatica in sheep.

Subolesin/Akirin vaccines for the control of arthropod vectors and vectorborne pathogens.

Diseases transmitted by arthropod vectors such as mosquitoes, ticks and sand flies greatly impact human and animal health, and therefore, their control is important for the eradication of vectorborne diseases (VBD). Vaccination is an environmentally friendly alternative for vector control that allows control of several VBD by targeting their common vector. Recent results have suggested that subolesin (SUB) and its orthologue in insects, akirin (AKR) are good candidate antigens for the control of arthropod vector infestations and pathogen infection. SUB was discovered as a tick-protective antigen in Ixodes scapularis. Vaccination trials with recombinant SUB/AKR demonstrated effective control of arthropod vector infestations in various hard and soft tick species, mosquitoes, sand flies, poultry red mites and sea lice by reducing their numbers, weight, oviposition, fertility and/or moulting. SUB/AKR vaccination also reduced tick infection with tickborne pathogens, Anaplasma phagocytophilum, A. marginale, Babesia bigemina and Borrelia burgdorferi. The effect of vaccination on different hosts, vector species, developmental stages and vectorborne pathogen infections demonstrated the feasibility of SUB/AKR universal vaccines for the control of multiple vector infestations and for reduction in VBD.

Experimental infection of C3H/HeJ mice with the NY18 isolate of Anaplasma phagocytophilum.

Human granulocytic anaplasmosis (HGA), an emerging disease of public health concern in many areas of the world, is caused by Anaplasma phagocytophilum. Small animal models of A phagocytophilum in laboratory mice have been developed and used to study the pathogenesis of HGA. In this study, we characterized the pathologic changes in acute infection of C3H/HeJ mice experimentally infected with the NY18 isolate of A phagocytophilum. Although no clinical signs were noted, acute infection was associated with gross splenomegaly, microscopic inflammatory lesions in the lung and liver, hyperplastic lesions on the spleen, and clinical pathology abnormalities including neutropenia and monocytosis. This study emphasizes the use of well-defined animal models as a valuable tool for the study of A phagocytophilum infections.

[A descriptive study of pediatric dermatologic diseases diagnosed at the Manises Health Center over 1 year]. / Estudio descriptivo de la patología dermatológica pediátrica diagnosticada en el Centro de Salud de Manises durante un año.

OBJECTIVE: To determine the frequency and types of paediatric dermatological pathologies diagnosed at a Primary Care Centre, and the referrals for them to specialists. DESIGN: Descriptive study. SETTING: Primary Care Paediatrics clinic at the Manises Health Centre, Valencia. PATIENTS: Children under 14 attending the clinic during 1995. MEASUREMENTS AND RESULTS: The diagnostic groups were: skin infections, Dermatitis-Eczema, Urticaria-Erythema, Zoonosis, hair and nail disorders, pigmentation disorders and miscellaneous. Age groups were: under one, from 1 to 4, from 5 to 9 and from 10 to 13. Referrals were to the Specialist Centre and to the hospital. There were 1309 first dermatological consultations (5.91% if all paediatric consultations). 38.20% were for skin infections; 25.67% for Dermatitis; 17.11% for Urticarias; 8.33% for Zoonosis; 4.89% for disorders of hair and nail; 1.83% for pigmentation disorders; and the remaining 3.97% miscellaneous. 160 (12.22%) were referred to specialists. CONCLUSIONS: There is a great deal of dermatological pathology in non-hospital paediatric clinics. Over 90% of this pathology is in one of the first five groups above.

[Approach to the use of screening mammography in 2 health regions]. / Aproximación a la utilización de la mamografía de cribado en dos regiones sanitarias.

OBJECTIVE: To find the present use of mammography screening in relation to the reference criteria on what age to begin breast cancer screening, as defined in the Health Plan for Catalonia, and to evaluate the activity of the mammography technicians. DESIGN: Crossover survey. SETTING: The Costa de Ponent and Centre de Cataluña Health Regions. PATIENTS: There were 1,587 mammography requests from patients seen in these health sectors. MEASUREMENTS AND MAIN RESULTS: The variables collected were age, date of investigation, place of residence, reason for request. 45.4% of screening mammographies requested in the health sectors under study corresponded to the age-group recommended in the reference criteria. Similar results were observed in the centres where mammographies were performed. Average daily activity per mammogram technician is 11.1 investigations (average: 11.1 mammographies; SD 4.5). CONCLUSIONS: About half the mammographies performed as part of screening for breast cancer are performed outside the recommended age-group and for ages where effectiveness has not been demonstrated. Therefore, publicising the recommended screening criteria must be a priority when initiating preventive activities. It is also important to use the available resources efficiently in line with the criteria laid down for breast cancer screening.

Inconsistent journalism: the coverage of chronic diseases in the Mexican press.

The mass media are recognized by many social scientists as important sources of medical information for lay people and as a positive influence on those working in the health care professions. However, there is a lack of study about print and mass media reporting on major health problems in developing countries such as Mexico. This article presents the findings of a study conducted to identify specific messages that the Mexican print media convey to the general reader about chronic diseases, especially one of the most important and pervasive, diabetes. We undertook a comprehensive review and content analysis of secondary source media reporting in the Boletin (Bulletin)--published by the Department of Education and Health, Universidad Autónoma Metropolitana, Xochimilco. The Boletin summarizes all articles related to health matters published in 12 national daily newspapers and 3 magazines. Our study covered all issues of the Boletin from 1992 through 1996. Our findings indicate that at times the press and popular print media disseminate an incomplete and often biased picture of chronic diseases prevalent in Mexico. Specifically, the press gives equal or more important coverage of acute diseases, or to AIDS, than to other major chronic conditions. The press also reproduces the biomedical model of disease and does not address topics important to certain segments of the population, including the patient. Moreover, the media may present an overly idealized impression of the capability of health services. Consequently, this failure to address the issues of certain widespread, chronic illnesses is severe enough to ask about the role of the press in medical health care reform. We conclude by suggesting areas for further research.

Sindrome de Beckwith-Wiedeman en tres hermanas. / Beckwith-Wiedeman syndrome in 3 sisters

Se presentan los casos clinicos de tres hermanas, dos de ellas gemelas, fallecidas a corta edad y una tercera hermana de doce anos de edad procedentes de embarazos de la misma madre con diferentes padres. Los tres casos presentan rasgos sugerentes del Sindrome de Beckwith-Wiedeman. Se discutem algunos hechos de la transmision genetica de este cuadro