A Community Program of Integrated Care for Frail Older Adults: +AGIL Barcelona.

OBJECTIVES: To assess the 3-month impact on physical function of a program for community-dwelling frail older adults, based on the integration of primary care, geriatric medicine, and community resources, implemented in "real life". DESIGN: Interventional cohort study. SETTING: Primary care in Barcelona, Spain. PARTICIPANTS: Individuals aged ≥80 years (n=134), presenting at least one sign of frailty (i.e., slow gait speed, weakness, memory complaints, involuntary weight loss, poor social support). INTERVENTION: After frailty screening by the primary care team, candidates were referred to a geriatric team (geriatrician + physical therapist), who performed a comprehensive geriatric assessment and designed a tailored multidisciplinary intervention in the community, including a) multi-modal physical activity (PA) sessions, b) promotion of adherence to a Mediterranean diet c) health education and d) medication review. MEASUREMENTS: Participants were assessed based on a comprehensive geriatric assessment including physical performance (Short Physical Performance Battery -SPPB- and gait speed), at baseline and at a three month follow-up. RESULTS: A total of 112 (83.6%) participants (mean age=80.8 years, 67.9% women) were included in this research. Despite being independent in daily life, participants' physical performance was impaired (SPPB=7.5, SD=2.1, gait speed=0.71, SD=0.20 m/sec). After three months, 90.2% of participants completed ≥7.5 physical activity sessions. The mean improvements were +1.47 (SD 1.64) points (p<0.001) for SPPB, +0.08 (SD 0.13) m/sec (p<0.001) for gait speed, -5.5 (SD 12.10) sec (p<0.001) for chair stand test, and 53% (p<0.001) improved their balance. Results remained substantially unchanged after stratifying the analyses according to the severity of frailty. CONCLUSIONS: Our results suggested that a "real-world" multidisciplinary intervention, integrating primary care, geriatric care, and community services may improve physical function, a marker of frailty, within 3 months. Further studies are needed to address the long-term impact and scalability of this implementation program.

Effects of topical applications of porcine acellular urinary bladder matrix and Centella asiatica extract on oral wound healing in a rat model.

OBJECTIVES: To evaluate the effects of topical applications of porcine acellular urinary bladder matrix (AUBM) and Centella asiatica extract (CAE) on the healing of tongue wounds in a rat model. MATERIALS AND METHODS: Wounds were made in the tongue using a punch tool in 64 male Sprague-Dawley rats, randomized into four groups (n = 16 per group): group 1 (control), group 2 (CAE), group 3 (AUBM mixed with orabase), and group 4 (orabase). No product was applied in group 1 and groups 2-4 received three daily topical applications. The animals were weighed on day 0 and at the time of euthanasia. Four rats in each group were euthanized at days 2, 7, 14, and 21 and the tongues were processed for: macroscopic morphometric analysis, myeloperoxidase (MPO) and malondialdehyde (MDA) levels, histological wound repair (degree of reepithelialization and inflammation), and CD31 positivity. RESULTS: The animals' weight gain, histological wound repair, and CD31 positivity from greatest to least were: AUBM > CAE > orabase > control. Percentage of tongue occupied by wound, MPO, and MPA levels from least to greatest were: AUBM < CAE < orabase < control, whereby the AUBM group showed significant differences (p ≤ 0.05) in comparison with the other groups on days 2, 7, 14, and 21 for percentage of tongue occupied by wound and MDA and on days 7, 14, and 21 for MPO. CONCLUSIONS: CAE is effective for oral tissue regeneration, while AUBM is an even more potent means of oral mucosa regeneration. CLINICAL RELEVANCE: AUBM may be beneficial to patients with oral wounds; this finding requires further clinical and laboratory investigation.

Pollen and stigma size changes during the transition from tristyly to distyly in Oxalis alpina (Oxalidaceae).

Pollen and stigma size have the potential to influence male fitness of hermaphroditic plants, particularly in species presenting floral polymorphisms characterised by marked differences in these traits among floral morphs. In this study, we take advantage of the evolutionary transition from tristyly to distyly experienced by Oxalis alpina (Oxalidaceae), and examined whether modifications in the ancillary traits (pollen and stigma size) respond to allometric changes in other floral traits. Also, we tested whether these modifications are in accordance with what would be expected under the hypothesis that novel competitive scenarios (as in distylous-derived reproductive system) exert morph- and whorl-specific selective pressures to match the available stigmas. We measure pollen and stigma size in five populations of O. alpina representing the tristyly-distyly transition. A general reduction in pollen and stigma size occurred along the tristyly-distyly transition, and pollen size from the two anther levels within each morph converged to a similar size that was characterised by whorl-specific changes (increases or decreases) in pollen size of different anthers in each floral type. Overall, results from this study show that the evolution of distyly in this species is characterised not only by changes in sexual organ position and flower size, but also by morph-specific changes in pollen and stigma size. This evidence supports the importance of selection on pollen and stigma size, which increase fitness of remaining morphs following the evolution of distyly, and raises questions to explore on the functional value of pollen size in heterostylous systems under pollen competition.

Exposure to increased levels of estradiol during development can have long-term effects on the response to undernutrition in female rats.

OBJECTIVES: Undernutrition during development alters the expression of peptides that control energy expenditure and feeding behavior. Estrogens can also modulate these peptides. Here, we analyze whether the early postnatal administration of estradiol modulates the effects of undernutrition on neuroendocrine parameters in adult female Wistar rats. METHODS: Control rats were fed a control diet. Undernourished pups were submitted to a restricted diet with half of the undernourished rats receiving 0.4 mg/kg s.c. of estradiol benzoate (EB) from postnatal day (P) 6 until P13. Quantitative real-time polymerase chain reaction was performed to determine expression in the hypothalamus of agouti-related peptide (AgRP), proopiomelanocortin (POMC), neuropeptide Y (NPY), and cocaine- and amphetamine-regulated transcript. Plasma estradiol, testosterone, and adiponectin levels were measured by enzyme-linked immunosorbent assay. Total and acylated ghrelin levels were measured in plasma by radioimmunoassay. Insulin and leptin were measured by mulitplex immunoassays. RESULTS: Undernourishment decreased body weight, fat mass, plasma leptin and insulin levels, and hypothalamic POMC mRNA levels. An increase in orexigenic signals AgRP and NPY mRNA levels, and in plasma adiponectin levels were found in undernourished animals. Early postnatal treatment with EB to undernourished female rats reversed the effects of undernutrition on adult hypothalamic POMC mRNA levels. In addition, neonatal EB treatment to undernourished females significantly decreased adult plasma testosterone, estradiol, and acylated ghrelin levels. DISCUSSION: Our results suggest that increased estradiol during a critical period of development has the capacity to modulate the alterations that undernutrition produces on energy metabolism.

Fertility of a high-altitude sheep model is compromised by deficiencies in both preovulatory follicle development and plasma LH availability.

At high altitude, hypoxia and/or oxidative stress may compromise fertility. This study tested the relative effect of short- or long-term exposure to high-altitude hypobaric hypoxia and oxidative stress in sheep on preovulatory follicle dynamics and gonadotrophin secretion. Thus, growth dynamics, stereidogenic function and competence to ovulate of preovulatory follicles, as well as FSH and LH availability throughout the entire oestrous cycle, were compared among sheep native from low and high altitude, and sheep newcomers to high altitude. The results indicates that short-term exposure in sheep newcomers to high altitude has a deleterious effect on both the ovarian function (affecting preovulatory follicular development) and the pituitary function (diminishing plasma LH availability). On the other hand, there were no detected differences in the preovulatory follicular development in sheep adapted to high altitude for generations and, conversely, LH secretion was increased, which suggests an adaptive mechanism. The treatment with antioxidant agents during a relative short period for the time of folliculogenesis (approximately 1 month and a half) changed substantially the development of preovulatory follicles in short-term exposed sheep to similar patterns than in sheep native and living to both high and low altitude. These results highlight the role of oxidative stress in the detriment of the reproductive function in individuals recently exposed to high-altitude hypoxic environment.

The metabolic response to postnatal leptin in rats varies with age and may be litter dependent.

Hyperleptinemia during postnatal life induces long-term effects on metabolism. However, these effects are controversial as both increased and decreased propensity towards obesity has been reported. To further analyze the effects of chronic neonatal hyperleptinemia on the subsequent metabolic profile, male Wistar rats proceeding from 18 different litters (8 pups/litter) received a daily subcutaneous injection of either saline (10 ml/kg, n=36) or leptin (3 µg/g, n=36) from postnatal day (PND) 2 to PND9. Rats were sacrificed at 10, 40, or 150 days of age. At 10 days of age, leptin treated rats had decreased body weight (p<0.001) and body fat (p<0.05). Leptin levels and glycemia were increased (p<0.01), whereas insulin, total lipids, triglycerides and glycerol levels were decreased (p<0.05). At PND40 rats receiving leptin had increased glycemia (p<0.01) and plasma HDL and LDL levels, but decreased total lipids (p<0.05). At PND150 neonatal leptin treatment induced different effects in rats raised in different litters. Rats from litter 1 had increased body weight (p<0.05), body fat (p<0.01), and plasma leptin (p<0.001), cholesterol (p<0.001), triglyceride (p<0.001), total lipid (p<0.001), LDL (p<0.05), and glycerol (p<0.001) levels. In rats from litter 2 these parameters did not differ from controls. Rats from litter 3 had decreased body weight (p<0.05), visceral fat (p<0.01) and plasma leptin (p<0.001), cholesterol (p<0.001), triglyceride (p<0.001), glycerol (p<0.001), and HDL (p<0.001) levels. In conclusion, the metabolic response to postnatal leptin varies with age, with the response in adulthood being variable and most likely influenced by other factors, including the genetic make-up.

Trajectories of symptom dimensions in short-term response to antipsychotic treatment in patients with a first episode of non-affective psychosis.

BACKGROUND: Trajectory patterns of positive, disorganized and negative dimension symptoms during antipsychotic treatment in drug-naive patients with first-episode psychosis have yet to be examined by using naturalistic data. METHOD: This pragmatic clinical trial randomized 161 drug-naive patients with a first episode of psychosis to olanzapine, risperidone or haloperidol. Patients were assessed with the Scale for the Assessment of Negative Symptoms (SANS) and Positive Symptoms (SAPS) at baseline and at the end of weeks 1, 2, 3, 4 and 6 of antipsychotic treatment. Censored normal models of response trajectories were developed with three dimensions of the SAPS-SANS scores (positive, disorganized and negative) in order to identify the different response trajectories. Diagnosis, cannabis use, duration of untreated psychosis (DUP), smoking and antipsychotic class were examined as possible predictive variables. RESULTS: Patients were classified in five groups according to the positive dimension, three groups according to the disorganized dimension and five groups according to the negative dimension. Longer DUPs and cannabis use were associated with higher scores and poorer responses in the positive dimension. Cannabis use was associated with higher scores and poorer responses in the disorganized dimension. Only schizophrenia diagnosis was associated with higher scores and poorer responses in the negative dimension. CONCLUSIONS: Our results illustrate the heterogeneity of short-term response to antipsychotics in patients with a first episode of psychosis and highlight markedly different patterns of response in the positive, disorganized and negative dimensions. DUP, cannabis use and diagnosis appeared to have a prognostic value in predicting treatment response with different implications for each dimension.

Olive oil has a beneficial effect on impaired glucose regulation and other cardiometabolic risk factors. Di@bet.es study.

BACKGROUND: Despite the marked increase in cardiovascular risk factors in Spain in recent years, the prevalence and incidence of cardiovascular diseases have not risen as expected. Our objective is to examine the association between consumption of olive oil and the presence of cardiometabolic risk factors in the context of a large study representative of the Spanish population. SUBJECTS AND METHODS: A population-based, cross-sectional, cluster sampling study was conducted. The target population was the whole Spanish population. A total of 4572 individuals aged ≥ 18 years in 100 clusters (health centers) were randomly selected with a probability proportional to population size. The main outcome measures were clinical and demographic structured survey, lifestyle survey, physical examination (weight, height, body mass index, waist, hip and blood pressure) and oral glucose tolerance test (OGTT) (75 g). RESULTS: Around 90% of the Spanish population use olive oil, at least for dressing, and slightly fewer for cooking or frying. The preference for olive oil is related to age, educational level, alcohol intake, body mass index and serum glucose, insulin and lipids. People who consume olive oil (vs sunflower oil) had a lower risk of obesity (odds ratio (OR)=0.62 (95% confidence interval (CI)=0.41-0.93, P=0.02)), impaired glucose regulation (OR=0.49 (95% CI=0.28-0.86, P=0.04)), hypertriglyceridemia (OR=0.53 (95% CI=0.33-0.84, P=0.03)) and low HDL cholesterol levels (OR=0.40 (95% CI=0.26-0.59, P=0.0001)). CONCLUSIONS: The results show that consumption of olive oil has a beneficial effect on different cardiovascular risk factors, particularly in the presence of obesity, impaired glucose tolerance or a sedentary lifestyle.

Acute dietary zinc deficiency before conception compromises oocyte epigenetic programming and disrupts embryonic development.

Recent findings show that zinc is an important factor necessary for regulating the meiotic cell cycle and ovulation. However, the role of zinc in promoting oocyte quality and developmental potential is not known. Using an in vivo model of acute dietary zinc deficiency, we show that feeding a zinc deficient diet (ZDD) for 3-5 days before ovulation (preconception) dramatically disrupts oocyte chromatin methylation and preimplantation development. There was a dramatic decrease in histone H3K4 trimethylation and global DNA methylation in zinc deficient oocytes. Moreover, there was a 3-20 fold increase in transcript abundance of repetitive elements (Iap, Line1, Sineb1, Sineb2), but a decrease in Gdf9, Zp3 and Figla mRNA. Only 53% and 8% of mature eggs reached the 2-cell stage after IVF in animals receiving a 3 and 5 days ZDD, respectively, while a 5 day ZDD in vivo reduced the proportion of 2-cells to 49%. In vivo fertilized 2-cell embryos cultured in vitro formed fewer (38%) blastocysts compared to control embryos (74%). Likewise, fewer blastocyst and expanded blastocyst were collected from the reproductive tract of zinc deficient animals on day 3.5 of pregnancy. This could be due to a decrease in Igf2 and H19 mRNA in ZDD blastocyst. Supplementation with a methyl donor (SAM) during IVM restored histone H3K4me3 and doubled the IVF success rate from 17% to 43% in oocytes from zinc deficient animals. Thus, the terminal period of oocyte development is extremely sensitive to perturbation in dietary zinc availability.

Neonatal treatment with a pegylated leptin antagonist has a sexually dimorphic effect on hypothalamic trophic factors and neuropeptide levels.

It is clear that the prenatal and early neonatal environments are important for determining the metabolic equilibrium in the adult animal, with prenatal/neonatal leptin levels being at least one of the factors involved. Leptin modulates hypothalamic development and, in particular, the neuronal circuits involved in metabolic control. We have recently reported that maternal deprivation (MD) for 24 h on postnatal day (PND) 9 modifies trophic factors and markers of cell turnover and neuronal maturation in the hypothalamus, as well as body weight and circulating leptin levels at PND13, with long- term effects on weight gain and circulating metabolic hormones in the adult. Moreover, these responses are sexually dimorphic. During MD, a dramatic decline in leptin levels is observed; thus, we aimed to determine which of the previously observed changes in markers of hypothalamic development might be attributed to the decline in this metabolic signal. Accordingly, male and female rats were treated with a pegylated leptin antagonist on PND9. In both sexes, hypothalamic signal transducer and activator of transcription 3 activation in response to acute leptin treatment was blocked by the antagonist. In females, hypothalamic mRNA levels for brain-derived neurotrophic factor, cocaine- and amphetamine-regulated transcript and the leptin receptor were increased, as were nestin and vimentin levels. There was also an increase in cell death in the hypothalamus, with a shift towards an anti-apoptotic balance in the Bcl2/BAX ratio. No hypothalamic effects were seen in males. Because antagonism of the actions of leptin at this specific neonatal stage affects hypothalamic cell turnover and maturation in a sex-specific manner, changes in this hormone, at least at this postnatal age, may differentially affect hypothalamic development in males and females, and may explain some of the reported sexually dimorphic responses to modifications in the early nutritional environment.

Cholestasis induced by total parenteral nutrition: effects of the addition of Taurine (Tauramin®) on hepatic function parameters; possible synergistic action of structured lipids (SMOFlipid®).

OBJECTIVE: Assess the hepatoprotective effect of Taurine (Tau) in cases of hepatic cholestasis induced by Total Parenteral Nutrition (TPN). METHODS: We describe a retrospective series of 54 patients who received TPN, in which cholestasis was detected at an (Intermediate) point that separates the duration of TPN into 2 Phases. From this moment -Phase 2- on, and according to clinical criteria, some patients (Group A, n = 27) received amino acids with Tau (22.41 ± 3.57 mg/kg/day)(Tauramin®), while the rest (Group B, n = 27) received the standard solution without Tau. The mean TPN durations were 39.2 ± 17.1 and 36.4 ± 18.1 days respectively, with the Intermediate points on days 19.56 ± 10.51 and 17.89 ± 11.14. They all received diets that were homogeneous in terms of kcal and macronutrients. In Phase 2, 21 patients from Group A received structured lipids (SMOFlipid®); while 20 from Group B received soy MCT/LCT [ Medium Chain Triglycerides/Long Chain Triglycerides ] (physical or structured mixture). In a retrospective study, differences could not be avoided. The analytical parameters from three periods (Initial, Intermediate, and Final) were obtained from Nutridata® and Servolab®. We compared interperiod values using the Wilcoxon test SPSS® (p < 0.05). RESULTS: After introducing Taurine AST, ALT, and GGT were significantly reduced; Bilirubin was also reduced, but not significantly. The values obtained for GGT in Group A were (Mean(σ)/median): Initial 48.6 (23.1)/46; Intermediate 473.7 (276.2)/438, and Final 328.9 (190.4)/305. We stress that the mean GGT value is reduced by 30.56% after adding Taurine, while in its absence all parameters are elevated, and mean GGT increases 45.36%. CONCLUSION: These results show Taurine's hepatoprotective effect and support its use in cases of TPN-induced cholestasis. We acknowledge the possibility that the differences between SMOF and the MCT/LCT mixtures also may have influenced the results in a combined effect with taurine.

¿Música en la sala de espera? Estudio sobre la aplicación y efectos de la música en la sala de espera de una unidad de salud mental / No disponible

La música se ha utilizado en la historia como un elementoterapéutico y también para ayudar a centrarnosen la vivencia del presente. El estudio realizado mide elpadecimiento de los pacientes de una sala de espera desalud Mental, a los que se expone música especialmentediseñada para rememorar emociones, ideas, relajar,tranquilizar y fomentar la asociación de ideas.Los resultados del estudio denotan la eficacia de lamúsicacomo elemento amortiguador del estrés del tiempo deespera y predisponen positivamente al paciente a su visita

The music has been used as a therapeutic element inhistory. Nowadays, it helps the costumers to focuse inthe present life experiences. Research efectued measuresthe way of thinking on patients at the MentalHealth waiting room. It has exposed specially musicdesigned to remember emotions, relaxation, calm andpromote the association ideas.The research results indicated that the music effectivenessas a pacify element of waiting time stress andpredispose them, in a positive way, to the consultation

Dietary lutein/zeaxanthin partially reduces photoaging and photocarcinogenesis in chronically UVB-irradiated Skh-1 hairless mice.

Lutein and zeaxanthin are xanthophyll carotenoids with potent antioxidant properties protecting the skin from acute photodamage. This study extended the investigation to chronic photodamage and photocarcinogenesis. Mice received either a lutein/zeaxanthin-supplemented diet or a standard nonsupplemented diet. Dorsal skin of female Skh-1 hairless mice was exposed to UVB radiation with a cumulative dose of 16,000 mJ/cm(2) for photoaging and 30,200 mJ/cm(2) for photocarcinogenesis. Clinical evaluations were performed weekly, and the animals were sacrificed 24 h after the last UVB exposure. For photoaging experiments, skin fold thickness, suprapapillary plate thickness, mast cell counts and dermal desmosine content were evaluated. For photocarcinogenesis, samples of tumors larger than 2 mm were analyzed for histological characterization, hyperproliferation index, tumor multiplicity, total tumor volume and tumor-free survival time. Results of the photoaging experiment revealed that skin fold thickness and number of infiltrating mast cells following UVB irradiation were significantly less in lutein/zeaxanthin-treated mice when compared to irradiated animals fed the standard diet. The results of the photocarcinogenesis experiment were increased tumor-free survival time, reduced tumor multiplicity and total tumor volume in lutein/zeaxanthin-treated mice in comparison with control irradiated animals fed the standard diet. These data demonstrate that dietary lutein/zeaxanthin supplementation protects the skin against UVB-induced photoaging and photocarcinogenesis.

Treatment of vitiligo vulgaris with narrow-band UVB and oral Polypodium leucotomos extract: a randomized double-blind placebo-controlled study.

BACKGROUND: The first choice treatment for vitiligo vulgaris is narrow-band UVB (NB-UVB), but no satisfactory treatment exists. OBJECTIVES: To investigate if Polypodium leucotomos, an antioxidative and immunomodulatory plant extract, improves NB-UVB-induced repigmentation. METHODS: Fifty patients with vitiligo vulgaris randomly received 250 mg oral P. leucotomos or placebo three times daily, combined with NB-UVB twice weekly for 25-26 weeks. RESULTS: Repigmentation was higher in the P. leucotomos group vs. placebo in the head and neck area (44% vs. 27%, P = 0.06). Small repigmentation increases (P = n.s.) were observed for the trunk (6% increased repigmentation), extremities (4%), and hands and feet (5%) in the P. leucotomos group vs. placebo. Patients attending more than 80% of required NB-UVB sessions showed increased repigmentation in the head and neck area in the P. leucotomos group vs. placebo (50% vs. 19%, P < 0.002); no significant differences were seen in the other body areas. Patients with skin types 2 and 3 showed more repigmentation in the head and neck area in the P. leucotomos group vs. placebo (47% vs. 21%, P = 0.01), and no significant differences were seen in the other body areas. No conclusions could be drawn on skin types 4 and 5 due to low patient numbers. CONCLUSION: There is a clear trend towards an increase in repigmentation of vitiligo vulgaris affecting the head and neck area when NB-UVB phototherapy is combined with oral P. leucotomos. This effect may be more pronounced in light skin types.

Erupción vesiculosa intermitente en un niño / Intermittent vesiculous eruption in a child

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Manejo de la neumonía comunitaria del adulto en el Servicio de Salud Viña del Mar-Quillota: Abril - Septiembre de 2003 / Management of community-acquired pneumonia by general practitioners in Viña del Mar and Quillota Health Service, Chile

Community-acquired pneumonia (CAP) is a potentially serious infection that results in numerous general practitioner visits and hospital admissions each year. Objective: to evaluate the clinical management of CAP by general practitioners in the emergency setting. Results: From April 1 to September 30, 2003, 3,701 adult cases of CAP were reported in Viña del Mar and Quillota Health Service, 73 percent of cases presented to emergency department and 27 percent to primary care units. Overall, 84 percent were treated as ambulatory patients and 16 percent were admitted to hospital. During a 6-month period, 229 ambulatory patients with CAP ( +/- SD = 56 +/- 21 years old) were prospectively evaluated in the emergency setting. Patients with CAP class I (40 percent) were treated with Clarithromycin (67.4 percent) or Amoxicillin (32.6 percent) during 10 days; and CAP type II cases (60 percent) were treated with Amoxicillin-clavulanate (74.5 percent) or Levofloxacin (24.8 percent) during 10 days. 226 of initial ambulatory patients (98.7 percent) were cured without hospitalization; three patients (1.3 percent) were subsequently hospitalized because of the failure of ambulatory treatment. Overall, three patients (1.3 percent) died; all deaths occurred during or immediately after hospitalization and were related to the severity of lung infection but not to the choice of antibiotic treatment. Conclusions: The majority of adult patients with CAP, without clinical severity criteria, could be managed as outpatients with low rates of hospital admission and mortality.

La neumonía adquirida en la comunidad (NAC) constituye una causa frecuente de consulta ambulatoria y hospitalización en la población adulta. Objetivos: describir el manejo de la NAC del adulto en el Servicio de Salud de Viña del Mar y Quillota durante la Campaña de Invierno de 2003. Resultados: Entre Abril y Septiembre, se atendieron 3.701 consultas por neumonía comunitaria del adulto, 73 por ciento en los servicios de urgencia y 27 por ciento en los consultorios de atención primaria. El 14 por ciento de los episodios de NAC requirieron hospitalización en el área de Viña del Mar y 21 por ciento en el área de Quillota. Se examinó una cohorte prospectiva de 229 adultos inmunocompetentes con NAC (+/ - DE = 56 +/ - 21 años de edad) de bajo riesgo y manejo ambulatorio según las recomendaciones de la Sociedad Chilena de Enfermedades Respiratorias, quienes fueron atendidos en los hospitales de Quillota, Viña del Mar y Limache durante el período de otoño-invierno. El 40 por ciento de los episodios correspondieron a NAC tipo I y 60 por ciento a NAC tipo II. Los pacientes con NAC tipo I fueron manejados con Claritromicina (67,4 por ciento) o Amoxicilina (32,6 por ciento) y los pacientes con NAC tipo II fueron manejados con Amoxicilina-Acido clavulánico (74,5 por ciento) o Levofloxacina (24,8 por ciento) durante 10 días. El 98,7 por ciento de los casos evolucionaron favorablemente sin requerir hospitalización, y sólo tres pacientes fueron admitidos al hospital debido a fracaso del tratamiento ambulatorio. Los tres pacientes fallecieron debido a la infección pulmonar y/o descompensación de una comorbilidad (1,3 por ciento). Conclusión: La mayoría de los enfermos con NAC, sin criterios de gravedad, pueden ser manejados en el medio ambulatorio con bajos índices de hospitalización, riesgo de complicaciones y muerte.

The effects of feeding fish oil on uterine secretion of PGF2alpha, milk composition, and metabolic status of periparturient Holstein cows.

The objectives were to determine the effect of dietary fish oil (FO) on uterine secretion of PGF2alpha, milk production, milk composition, and metabolic status during the periparturient period. Holstein cows were assigned randomly to diets containing FO (n = 13) or olive oil (OO, n = 13). Cows were fed prepartum and postpartum diets that provided approximately 200 g/d from 21 d before the expected parturition until 21 d after parturition. The FO used contained 36% eicosapentaenoic acid (EPA, C20:5, n-3) and 28% docosahexaenoic acid (DHA, C22:6, n-3). Blood samples were obtained from 14 d before the due date until d 21 postpartum. A total of 6 FO and 8 OO cows without periparturient disorders were used in the statistical analyses of PGF2alpha-metabolite (PGFM) and metabolite concentrations. Length of prepartum feeding with OO or FO did not differ. Proportions of individual and total n-3 fatty acids were increased in caruncular tissue and milk of cows fed FO. The combined concentrations of EPA and DHA in caruncular tissue were correlated positively with the number of days supplemented with FO. Cows fed FO had reduced concentrations of plasma PGFM during the 60 h immediately after parturition compared with cows fed OO. Concentrations of prostaglandin H synthase-2 mRNA and protein in caruncular tissue were unaffected by diet. Production of milk and FCM were similar between cows fed the two oil diets. However, cows fed FO produced less milk fat. Feeding FO reduced plasma concentrations of glucose. Dietary fatty acids given during the periparturient period can reduce the uterine secretion of PGF2alpha in lactating dairy cows and alter the fatty acid profile of milk fat.

Long-term treatment with the antioxidant drug EGb 761 at senescence restored some neurobehavioral effects of chronic ultramild stress exposure seen in young mice.

In this study, we compared the effects of chronic ultramild stress (CUMS) exposure on decision-making behavior in a validated test, and on the stress responsive serotoninergic and dopaminergic systems in four age groups of B6D2F1 female mice (5-6, 11-12, 17-18 and 23-24 months old). The levels of serotonin (5-HT) and its metabolite 5-hydroxyindolacetic acid (5-HIAA) were measured in the brain stem, the cortex, the striatum and the hippocampus; the levels of dopamine (DA) and its metabolite dihydroxyphenylacetic acid (DOPAC) were measured in the brain stem and the striatum. The influence of a long-term treatment with the extract of Ginkgo biloba leaves EGb 761 (Tanakan) on age- and stress-related changes was also investigated in the two oldest age groups. In the absence of drug treatment, middle-age mice were the least efficient in making a decision, and senescent mice exhibited reduced levels of both 5-HT and DA and their metabolites in all the brain areas examined. CUMS facilitated evaluation and choice behavior in all age groups, but induced age-dependent reduction of hesitation, acceleration of information processing and reduction in serotoninergic neurotransmission. In senescent mice, EGb 761 reduced the impact of stress on evaluation and hesitation, and restored some stress-related neurobehavioral changes that were only seen in young mice, i.e. acceleration of information processing and reduction in brain 5-HIAA levels. Restoration of some plasticity of the serotoninergic systems might contribute to the stress alleviating influence of EGb 761 in old age.

Evolución clínica y pronóstico del paciente hospitalizado por neumonía adquirida en la comunidad según lugar de admisión / Clinical evolution and prognosis of the hospitalized patient by community-acquired pneumonia according to admission place

La evaluación de la gravedad del paciente con neumonía comunitaria (NAC) permite decidir el lugar de manejo, la extensión del estudio microbiológico y elección del tratamiento antimicrobiano. Objetivos: Describir la evolución clínica y pronóstico del adulto inmunocompetente hospitalizado por neumonía comunitaria según lugar de admisión. Resultados: Durante el período 1999-2001, se evaluaron 463 adultos con NAC en el servicio de urgencia de un hospital docente, 55 por ciento eran varones, 76 por ciento tenía comorbilidad, un tercio había recibido antibióticos antes del ingreso y 75 por ciento correspondían a las categorías de riesgo elevado de Fine (Clases III-V). De acuerdo a su gravedad, cerca del 40 por ciento de los pacientes fueron admitidos a la Unidad de Cuidados Intermedios (UTIM)o UCI. La etiología fue establecida en 25 por ciento de los casos, especialmente en aquellos internados en unidades especializadas. Los patógenos más frecuentes aislados fueron Streptococcus pneumoniae (10,2 por ciento), Haemophilus influenzae (3,7 por ciento), Staphylococcus aureus (2,8 por ciento) y bacilos Gram negativos entéricos (5,2 por ciento). En la admisión al hospital, la edad avanzada, presencia de comorbilidad, disnea, taquipnea, confusión mental, hipotensión, hipoxemia, acidosis metabólica, nitrógeno ureico elevado, hiperglicemia y compromiso radiográfico multilobar fueron más prevalentes en los pacientes admitidos a las unidades especializadas. La neumonía bacterémica, la infección por bacilos gram negativos entéricos y S aureus y la estadía prolongada en el hospital fueron más frecuentes en los pacientes admitidos a UTIM y UCI. El riesgo de complicaciones en el hospital y la letalidad en el hospital y seguimiento a 30 días también fueron más frecuentes en los pacientes admitidos a las unidades especializadas. Conclusión: El cuadro clínico, la evolución, riesgo de complicaciones y la letalidad del adulto inmunocompetente hospitalizado por neumonía comunitaria varía según el lugar de admisión al hospital.