Randomized placebo-controlled phase II trial of high-dose melatonin mucoadhesive oral gel for the prevention and treatment of oral mucositis in patients with head and neck cancer undergoing radiation therapy concurrent with systemic treatment.

PURPOSE: The objective of this trial was to evaluate the safety and efficacy of melatonin oral gel mouthwashes in the prevention and treatment of oral mucositis (OM) in patients treated with concurrent radiation and systemic treatment for head and neck cancer. METHODS: Randomized, phase II, double-blind, placebo-controlled trial (1:1 ratio) of 3% melatonin oral gel mouthwashes vs. placebo, during IMRT (total dose ≥ 66 Gy) plus concurrent Q3W cisplatin or cetuximab. Primary endpoint: grade 3-4 OM or Severe Oral Mucositis (SOM) incidence by RTOG, NCI, and a composite RTOG-NCI scales. Secondary endpoints: SOM duration and grade 2-4 OM or Ulcerative Oral Mucositis (UOM) incidence and duration. RESULTS: Eighty-four patients were included in the study. Concurrent systemic treatments were cisplatin (n = 54; 64%) or cetuximab (n = 30; 36%). Compared with the placebo arm, RTOG-defined SOM incidence was numerically lower in the 3% melatonin oral gel arm (53 vs. 64%, P = 0.36). In patients treated with cisplatin, assessed by the RTOG-NCI composite scale, both SOM incidence (44 vs. 78%; P = 0.02) and median SOM duration (0 vs. 22 days; P = 0.022) were significantly reduced in the melatonin arm. Median UOM duration assessed by the RTOG-NCI scale was also significantly shorter in the melatonin arm (49 vs. 73 days; P = 0.014). Rate of adverse events and overall response rate were similar between the two arms. CONCLUSIONS: Treatment with melatonin oral gel showed a consistent trend to lower incidence and shorter SOM duration and shorter duration of UOM. These results warrant further investigation in phase III clinical trial.

Removal of flocculated TiO2 nanoparticles by settling or dissolved air flotation.

Engineered nanoparticles of TiO2 (TiO2-NPs) are used in the industry for a great number of applications. After their usage, the particles end up in aquatic environments, contaminating supply waters and watercourses. Bench-scale studies report removal of TiO2-NPs (450 nm, the mean volumetric diameter) by flocculation followed by settling or by dissolved air flotation (4 bar saturation pressure and 30% recycling ratio). Floc formation was conducted after heterocoagulation with iron hydroxide (30-40 mg L-1 Fe3+) and gelatinized corn starch (10-20 mg L-1) as flocculant, at pH 7. Particle size distribution and zeta potential, removal efficiencies as a function of time and microphotography of flocs were analyzed. Mechanisms involve ferric hydroxide precipitation, heterocoagulation with the nanoparticles and flocculation of the loaded carrier precipitates with gelatinized starch. Best results showed removals between 95-100% of TiO2-NPs, either by settling or flotation after 5 min. Clear treated waters with low turbidity < 3 nephelometric turbidity units (NTU) and TiO2-NPs concentrations <1 mg L-1 were obtained. A practical advantage in DAF was the higher solids content (1.9% w/w) of the sludge, when compared to settling (0.7% w/w). This would facilitate the sludge dewatering and disposal, but DAF has the disadvantage of the poor efficiency at high concentration of the nanoparticles of titanium oxide (>100 mg L-1). Conversely, the removal by settling of the flocs increased at high dosages. It is believed that both processes are sustainable in terms of reagents and the removal efficiencies of TiO2 nanoparticles from water.

Separation of emulsified crude oil in saline water by flotation with micro- and nanobubbles generated by a multiphase pump.

The flocculation-column flotation with hydraulic loading (HL, >10 m h-1) was studied for the treatment of oil-in-water emulsions containing 70-400 mg L-1 (turbidity = 70-226 NTU) of oil and salinity (30 and 100 g L-1). A polyacrylamide (Dismulgan, 20 mg L-1) flocculated the oil droplets, using two floc generator reactors, with rapid and slow mixing stages (head loss = 0.9 to 3.5 bar). Flotation was conducted in two cells (1.5 and 2.5 m) with microbubbles (MBs, 5-80 µm) and nanobubbles (NBs, 50-300 nm diameter, concentration of 108 NBs mL-1). Bubbles were formed using a centrifugal multiphase pump, with optimized parameters and a needle valve. The results showed higher efficiency with the taller column reducing the residual oil content to 4 mg L-1 and turbidity to 7 NTU. At high HL (27.5 m h-1), the residual oil concentrations were below the standard emission (29 mg L-1), reaching 18 mg L-1. The best results were obtained with high concentration of NBs (apart from the bigger bubbles). Mechanisms involved appear to be attachment and entrapment of the NBs onto and inside the flocs. Thus, the aggregates were readily captured, by bigger bubbles (mostly MBs) aiding shear withstanding. Advantages are the small footprint of the cells, low residence time and high processing rate.

Effect of red maca (Lepidium meyenii) on prostate zinc levels in rats with testosterone-induced prostatic hyperplasia.

Lepidium meyenii (maca) is a plant that grows exclusively above 4000 m in the Peruvian central Andes. Red maca (RM) extract significantly reduced prostate size in rats with benign prostatic hyperplasia (BPH) induced by testosterone enanthate (TE). Zinc is an important regulator of prostate function. This study aimed to determine the effect of RM on prostate zinc levels in rats with BPH induced by TE. Also, the study attempted to determine the best marker for the effect of RM on sex accessory glands. Rats treated with RM extract from day 1 to day 14 reversed the effect of TE administration on prostate weight and zinc levels. However, RM administered from day 7 to day 14 did not reduce the effect of TE on all studied variables. Finasteride (FN) reduced prostate, seminal vesicle and preputial gland weights in rats treated with TE. Although RM and FN reduced prostate zinc levels, the greatest effect was observed in TE-treated rats with RM from day 1 to day 14. In addition, prostate weight and zinc levels showed the higher diagnosis values than preputial and seminal vesicle weights. In conclusion, RM administered from day 1 to day 14 reduced prostate size and zinc levels in rats where prostatic hyperplasia was induced with TE. Also, this experimental model could be used as accurately assay to determine the effect of maca obtained under different conditions and/or the effect of different products based on maca.

Evaluation of different doses of mashua (Tropaeolum tuberosum) on the reduction of sperm production, motility and morphology in adult male rats.

Mashua is an edible-tuber crop that grows in the Andean region. Folk medicine describes the use of mashua to reduce reproductive function in men. The present study aimed: (i) to determine whether different doses of mashua (0.01, 0.1, 1 and 2 g kg(-1)) produced a dose-response reduction on sperm production and quality; and, (ii) to determine whether these anti-reproductive effects of mashua can be reversible after cessation of treatment (12 and 24 days of recovery time). Mashua-treated rats showed lower values of daily sperm production, epididymal and vas deferens sperm count and sperm motility; meanwhile, mashua increased the percentage of abnormal sperm morphology and epididymal sperm transit rate. The following variables follow a dose-response effect: sperm number in vas deferens, sperm motility and sperm transit rate. In addition, it was demonstrated that the reduction in reproduction function in male rats treated with mashua was reversible after 24 days of recovery time. Finally, lower doses mashua reduces sperm number and quality (motility and morphology), and these adverse effects on male reproductive system may be reversible after 24 days after cessation of the treatment.

Effect of the ethanolic extract from Fagara tessmannii on testicular function, sex reproductive organs and hormone level in adult male rats.

The effect of ethanolic extract of Fagara tessmannii, wide medicinal plants used on reproductive function in South Cameroon, was investigated in male rats. Twenty male sexually experienced rats (four groups) were orally treated with vehicle, 0.01, 0.1, 1 g kg(-1) BW per day of F. tessmannii (equivalent to 16.67 g, 33.33 g, 50 g, 66.66 g kg(-1) dry raw material) for 14 days, the upper limit dose without any clinical sign of toxicity was 2 g kg(-1). Fagara tessmannii extract negatively affected weight of accessory organs and significantly affected body weight gain at dose 1 g kg(-1) (P < 0.05) in treated rats. The weight of epididymis and seminal vesicle significantly decreased at low doses (0.01 g kg(-1)) while the prostate weight decreased at all doses (P < 0.05). The transit of spermatozoa in cauda epididymidis significantly increased at lower dose of 0.01 g kg(-1) (P < 0.05). In addition, F. tessmannii extract affected neither daily sperm production (DSP) and DSP per g nor sperm count in vas deferens and epididymis. The length of stages IX-I of the seminiferous tubule and serum testosterone level increased dose-dependently following 14 days of treatment (P < 0.05). The results suggest that F. tessmannii, 14 days after treatment, may improve spermatogenesis, testosterone level and sperm transit in cauda epididymidis but negatively impair reproductive organ activities.

Chondroitin sulfate improves synovitis in rabbits with chronic antigen-induced arthritis.

OBJECTIVE: Our aim was to explore the effect of chondroitin sulfate (CS), a natural glycosaminoglycan with attributed anti-inflammatory properties, on synovitis in a rabbit model of chronic arthritis with intense systemic inflammation bolstered by endothelial lesion and atherosclerotic diet. METHODS: Chronic arthritis was induced by intraarticular injections of ovalbumin in immunized rabbits. Systemic inflammation was boosted in these rabbits by receiving a hyperlipidemic diet after producing an endothelial lesion in the femoral arteries. A group of these rabbits were treated with CS (100mg/kg/day). At sacrifice, synovial membranes were isolated, and cyclooxygenase-2 (COX-2) and chemokine (C-C motif) ligand 2 (CCL2) mRNA, as well as protein expression were assayed by quantitative real-time polymerase chain reaction (RT-PCR) and western blot studies. Histological synovial examination was also carried out employing the histopathological synovitis score (Krenn scale). RESULTS: CS diminished both gene expression and protein synthesis of COX-2 and CCL2, and the histopathological score of the synovial membrane, when compared to untreated rabbits. In fact, CS partially prevented the intimal layer proliferation and the inflammatory cell infiltration in the synovial membrane, which was observed in non-treated animals. CONCLUSION: CS reduced the inflammatory response of the synovial membrane, as well as decreased the synovial histopathological lesions in our animal model. Further studies are warranted to demonstrate whether CS might be beneficial in the treatment of inflammatory arthritis.

Selenium tissue distribution changes after ethanol exposure during gestation and lactation: selenite as a therapy.

Ethanol consumption affects maternal nutrition and antioxidant status together with the future health of their progeny. Selenium (Se) is a trace element with antioxidant activity; we will study the effect of ethanol in dams on Se bioavailability, antioxidant balance and gestational parameters. We also will study if a Se-supplemented diet (0.5 ppm) administered to ethanol-exposed dams avoids the undesirable effects provoked by ethanol. We have used four experimental groups: control (C); chronic ethanol (A); control+Se (CS) and chronic ethanol+Se (AS). Se levels in serum, urine, faeces, and several tissues were measured by graphite-furnace atomic absorption spectrometry. Serum glutathione peroxidase (GPx) activity was determined by spectrometry. Se bioavailability is altered by ethanol, causing a decrease in Se retention, reducing Se levels in cortex, muscle, mammary gland and salivary gland while elevating Se values in heart, liver and spleen. On the other hand, Se supplementation increases some of these parameters. Serum GPx activity was decreased by ethanol, while a Se-supplemented diet restores these values to those found in controls. We have demonstrated that ethanol decreased Se retention in dams, affecting their tissues' Se deposits, decreasing GPx activity in serum, gestational parameters and the weight of their progeny. Selenite supplementation counteracts these decreasing effects, except in cortex.

Tropaeolum tuberosum (Mashua) reduces testicular function: effect of different treatment times.

Tropaeolum tuberosum Ruiz & Pavon, along with other several species, is an edible-tuber crop that grows in the Andean region. Folk medicine describes the use of mashua to reduce reproductive function in men. The present study aimed to evaluate the effect of mashua (1 g kg(-1)) on sperm production in rats during 7, 12, 21 and 42 days of treatment. The following parameters were assessed: reproductive organ weights, spermatid count and daily sperm production (DSP), sperm count in epididymis and sperm transit and serum testosterone levels. Freeze-dried extract of mashua had 3.7 g 100 g(-1) of benzyl glucosinolate. Mashua-treated rats showed a reduction in testicular spermatid number and DSP from day 12 to day 42; meanwhile, the effect of mashua was noted in epididymal sperm count after 12 and 42 days of treatment. In addition, epididymal sperm transit time was delayed at day 7 and it was accelerated on days 12 and 21 of treatment. No differences in serum testosterone levels were found between rats treated with vehicle and mashua after 42 days of treatment. Finally, mashua reduces testicular function after one spermatogenic cycle by reducing spermatid and sperm number, DSP and epididymal sperm transit time.

Design and validation of a scale to assess preferences of type 2 diabetic patients towards different nutritional supplements.

OBJECTIVES: To design and validate a scale to evaluate preferences of type 2 diabetic patients towards nutritional supplements (Madrid scale) and to discover those taste attributes that are more discriminating. CONTEXT: ambulatory patients with type 2 diabetes mellitus. MATERIALS AND METHODS: 18 controls and 106 type 2 diabetic patients received 2 of the 7 stimuli studied (6 nutritional supplements and a differential salty stimulus) and then completed both scales and a criterion question. Two weeks later, 30 diabetic patients received a retest. The psychometric properties of the Madrid scale were studied and the relative importance of each stimuli attribute was assessed. RESULTS: Feasibility: The Madrid scale consists of 8 questions and is completed in less than five minutes; Dimensionality: A single dimension which explains 45.1% of the variance. Reliability: Cronbach's , 0.806; intraclass correlation coefficient, 0.835 (95% confidence interval: 0.653-0.922). Concurrent validity: Correlation indexes of the corrected total score with the criterion question and the Modified Wine-Tasting Scale, 0.731 (p < 0.0005) and 0.774 (p < 0.0005), respectively. The scale discriminated between subjects younger and older than 75 years and between supplements and the differential stimulus. Preferences: Glucerna SR chocolate, Glucerna SR strawberry, Glucerna SR vanilla, Diasip vanilla, Clinutren vanilla and Resource diabet vanilla. CONCLUSION: The Madrid scale has adequate psychometric properties for its use in research and daily clinical practice.

Calidad de vida en pacientes con artritis reumatoide en tratamiento ambulatorio con anti-TNF / Quality of life of patients with rheumatoid arthritis undergoing out-patient treatment with TNF inhibitors

Objetivo: Evaluar la calidad de vida en pacientes con artritis reumatoideen tratamiento ambulatorio con anti-TNF (etanercept y adalimumab).Método: Estudio observacional, descriptivo y multicéntrico. Se utilizóun cuestionario específico validado (QOL-RA Scale) en su versión enespañol, manteniendo la confidencialidad al máximo. Para medir lafiabilidad de los resultados se utilizó el coeficiente alfa de Cronbach.Se ha realizado un análisis descriptivo para comparar los resultadosobtenidos con estudios realizados en la población estadounidense ycolombiana.Resultados: Se seleccionaron 82 pacientes. Destacó el perfil de amade casa, casada y con ningún estudio o estudios primarios. La mediade años de diagnóstico fue 11,81 ± 7,30 años y la de tratamiento conanti-TNF fue de 1,71 ± 1,03 años. Los resultados para la encuesta fueron:habilidad física 5,42 ± 1,67), dolor 5,10 ± 1,83, vida social 7,08± 1,96, apoyo 7,45 ± 2,10), estado de ánimo 6,02 ± 2,03, tensiónnerviosa 5,50 ± 2,01, artritis 5,15 ± 1,86), salud 5,50 ± 1,77. Los resultadosobtenidos fueron similares a los encontrados en la poblaciónestadounidense, aunque destaca una menor puntuación en elánimo y la tensión nerviosa. Sin embargo, la alta puntuación en lo referenteal apoyo y la vida social fue más parecida a la obtenida en lapoblación colombiana. Todos los pacientes consideraron que su calidadde vida había mejorado con la medicación anti-TNF.Conclusiones: La calidad de vida en pacientes con artritis reumatoidees baja, determinada por el dolor y los síntomas depresivos. Lospacientes tienen la percepción de que los anti-TNF han mejorado sucalidad de vida

Objective: To assess the quality of life of patients with rheumatoidarthritis undergoing out-patient treatment with TNF inhibitors (etanerceptand adalimumab).Method: Observational, descriptive and multi-centre study. A specificvalidated questionnaire was used (QOL-RA Scale) in its Spanish version,with complete confidentiality ensured. To measure the reliabilityof the results, the Cronbach Alpha Coefficient was used. A descriptiveanalysis was carried out to compare the results obtained withthose obtained from studies in the USA and Colombia.Results: A total of 82 patients were selected who mainly consisted ofmarried housewives who had not undergone any previous studies.The average amount of years from diagnosis was 11.81 years (SD:7.30) and the average duration of treatment with TNF inhibitors was1.71 years (SD: 1.03). The results of the questionnaire were: physicalability 5.42 (SD: 1.67), pain 5.10 (SD: 1.83), social life 7.08 (SD:1.96), support 7.45 (SD: 2.10), mood 6.02 (SD: 2.03), stress 5.50(SD: 2.01), arthritis 5.15 (SD: 1.86), health 5.50 (SD: 1.77). The resultsobtained were similar to those from the USA, although they showeda lower score for mood and stress categories. However, the highscore in the support and social-life categories was more similar tothat obtained with the Colombian questionnaire. All patients consideredtheir quality of life to have improved with the use of TNF inhibitors.Conclusions: The quality of life in patients with Rheumatoid Arthritisis low, determined by pain and symptoms of depression. The patientsbelieve that TNF inhibitors have improved their quality of life

[Guide for the prevention and treatment of glucocorticoid-induced osteoporosis of the Spanish Society of Internal Medicine]. / Guía de prevención y tratamiento de la osteoporosis inducida por glucocorticoides de la Sociedad Española de Medicina Interna.

Our objective has been to elaborate an updated Clinical Guide of the Spanish Society of Internal Medicine (SEMI) for the prevention and treatment of glucocorticoids-induced osteoporosis (GIO), identifying and measuring the grade of evidence that supports the given recommendations. For this, we reviewed studies performed on pathophysiology, diagnosis, prevention and treatment of GIO and after analyzing them we elaborated the present recommendations. This was done after a pre-specified and reproducible process that included an accepted model for the evaluation, and the reference of the evidence that supported it. Once the Scientific Committee elaborated the draft of the Clinical Guide, it was reviewed by all the members of the Working Group on Osteoporosis of the SEMI, and by an External Committee who included experts of many different specialities. Pathophysiology of GIO is complex and yet unknown. Bone effects of glucocorticoids are determined by multiple factors although accumulated doses seems to be the most important one. The best method to diagnose GIO is Dual X-Ray Absorptiometry (DXA), although WHO criteria defined for the diagnosis of postmenopausal osteoporosis are not applicable in GIO. The presence of a T-score lower than -1.5 Tscore indicates the necessity of treatment in any patient who receives or is going to receive more than 3 months treatment with glucocorticoids at a dose higher than 2.5 mg/day (in postmenopausal women) and 5 mg/day (in premenopausal women and men). DXA is also useful to follow up the patients, who can be done annually. Treatment must be prescribed to any patient who is receiving glucocorticoids or is going to receive them at doses higher than 7.5 mg/day for more than 3 months and 5 mg/day if the patient is a postmenopausal woman or has suffered from previous fragility fractures. Risedronate and alendronate are the drugs of election, always together with calcium and vitamin D supplements and general measurements usually prescribed in the treatment of osteoporosis. In very ill patients, parathyroid hormone can be used. The treatment for GIO should be maintained while glucocorticoid therapy is used.

Phosphocalcic metabolism after biliopancreatic diversion.

BACKGROUND: Malabsorptive techniques to treat morbid obesity have been followed by alterations in phosphocalcic metabolism. Knowledge of the preoperative situation is important to assess the influence of these techniques on phosphocalcic metabolism and to consider treatments for these alterations. METHODS: 61 consecutive morbidly obese patients (50 women, 11 men, age 19 to 63 years) having had biliopancreatic diversion (BPD) were studied in a prospective manner. Preoperative and postoperative levels of calcium, phosphorus, 25-hydroxyvitamin D, tartrate resistant acid phosphate, plasma parathormone (PTH), tubular absorption of phosphate, and urinary calcium and pyridinolines were analyzed, as well as the potential risk factors for their alterations. Follow-up of all patients was a minimum of 4 years. RESULTS: Before BPD, 42.3% of patients presented an increase in PTH and 54% a decrease in the 25-OH vitamin D, but the values of calcium and plasma phosphorus maintained at normal level. 81.8% of the patients with an increase in the PTH maintained high levels after BPD, while 60% of those with a normal preoperative PTH also presented hyperparathyroidism 4 years after the intervention. A correlation between the levels of plasma PTH and body mass index was not found. CONCLUSION: Morbid obesity is accompanied by a high percentage of hyperparathyroidism. BPD produces malabsorption of vitamin D during the first years, favoring the persistence or appearance of hyperparathyroidism. It is important to recognize and treat the secondary hyperparathyroidism. The postoperative period could necessitate more energetic interventions to get more efficient control of the phosphocalcic metabolism.

Dose-response effect of Red Maca (Lepidium meyenii) on benign prostatic hyperplasia induced by testosterone enanthate.

The main goal of this study was to determine the effect of a freeze-dried aqueous extract of the red variety of Lepidium meyenii (Red Maca) on testosterone-induced benign prostatic hyperplasia (BPH) in adult rats of the Holtzman strain. Rats were treated with freeze-dried aqueous extract of Red Maca at doses of 0, 0.01, 0.05, 0.1, and 0.5 g/kg body wt. A positive control group received Finasteride (0.6 mg/kg body wt.). After treatment, the animals were sacrificed, and the ventral prostate was extracted, and weighed. HPLC was used to determine the presence of glucosinolates in Red Maca. The prostate weight diminished in a dose-dependent fashion in rats treated with Red Maca. The effect of Red Maca was better than that observed with Finasteride. Finasteride, but not Red Maca, reduced seminal vesicles weight. Analysis of the HPLC indicated the presence of benzyl glucosinolate (Glucotropaeolin) with a content of 0.639%. Serum testosterone levels were not affected by Red Maca. Moreover, serum testosterone levels were not related to prostate or seminal vesicles weight in rats treated with vehicle and Red Maca. In conclusion, Red Maca administered orally in rats seems to exert an inhibitory effect at a level post DHT conversion, on the BPH-induced experimentally, although a direct measure of reductase action would still be required.

Effect of Black maca (Lepidium meyenii) on one spermatogenic cycle in rats.

Lepidium meyenii (Maca) grows exclusively between 4000 and 4500 m above sea level in the Peruvian central Andes. The hypocotyls of this plant are traditionally used in the Andean region for their supposed fertility-enhancing properties. The hypocotyls have different colours. Of these, Black maca has better effects on spermatogenesis. The present study aimed to test the hypothesis that Black maca has early effects during a spermatogenic cycle (12 days) of male rats. For this, testicular spermatid, epididymal sperm and vas deferens sperm counts were measured after 1, 3, 5, 7 and 12 days of treatment with Black maca. Aqueous extract of Black maca was given orally by daily gavage at a dose of 2 g kg(-1). In a spermatogenic cycle, compared with day 1, daily sperm production (DSP) was lower at day 7 (control), whereas with Black maca, the difference was observed at day 12. Epididymal sperm count was higher in rats treated with Black maca at days 1, 3 and 7, but similar to controls at days 5 and 12; similarly sperm counts in vas deferens was higher in rats treated with Black maca in days 3, 5 and 7, but similar to controls at days 1 and 12. From this, it is suggested that first action of Black maca was at epididymal level increasing sperm count after 1 day of treatment, whereas an increase in sperm count was observed in vas deferens at day 3 of treatment. Finally, an increase in DSP was observed after 7 days of treatment with Black maca. Testicular testosterone was not affected after 7 days treatment with Black maca. In conclusion, Black maca affects sperm count as early as 1 day after beginning of treatment.

[What is the opinion of Spanish internists on osteoporosis?]. / 'Qué opinan los internistas españoles de la osteoporosis?

OBJECTIVE: To conduct an opinion survey on osteoporosis in Spanish internists. METHOD: Survey sent by mail and by personal visit to members of the Spanish Internists Society. Collection of data on opinion on the disease, diagnostic and therapeutic attitude and means available (general laboratory analyses, conventional radiology, biochemical markers of bone remodeling, densitometry and ultrasounds) and preference when choosing a certain treatment. RESULTS: A total of 538 internists answered. More than 90% of those surveyed consider that osteoporosis is a disease that should be treated by internists. A total of 93% consider that osteoporosis is a prevalent disease. More than 80% have access to densitometry. CONCLUSIONS: The majority of Spanish internists consider that osteoporosis is a disease that should be treated by internists and that it is a disease that enters into their action scope. In general, they have the means necessary for its study and treatment. Bisphosphonates constitute the drug of choice and calcium and vitamin D supplements are indicated in almost all the cases.

Treatment of municipal wastewater UASB reactor effluent by unconventional flotation and UV disinfection.

Post-treatment of an UASB reactor effluent, fed with domestic sewage, was conducted using two-stage flotation and UV disinfection. Results were compared to those obtained in a parallel stabilisation pond. The first flotation stage employed 5 - 7.5 mg L(-1) cationic flocculant to separate off more than 99% of the suspended solids. Then, phosphate ions were completely recovered using carrier flotation with 5-25 mg L(-1) of Fe (FeCl3) at pH 6.3-7.0. This staged flotation led to high recoveries of water and allowed us to separate organic matter and phosphate bearing sludge. The water still contained about 1 x 10(2) NMP/100 mL total coliforms, which were removed using UV radiation to below detection levels. Final water turbidity was < 1.0 NTU, COD < 20 mg L(-1) O2 and 71 mNm(-1), the liquid/air interfacial tension. This flotation-UV flowsheet was found to be more efficient than the treatment in the stabilisation pond and appears to have some potential for water reuse. Results were discussed in terms of the biological, chemical and physicochemical mechanisms involved.

¿Qué opinan los internistas españoles de la osteoporosis? / What is the opinion of Spanish internists on osteoporosis?

Objetivo. Realizar una encuesta de opinión sobre osteoporosis en internistas españoles. Método. Encuesta remitida por correo y por visita personal a miembros de la Sociedad Española de Medicina Interna. Recogida de datos sobre opinión acerca de la enfermedad, actitud diagnóstica y terapéutica y medios disponibles (analítica general, radiología convencional, marcadores bioquímicos de remodelamiento óseo, densitometría y ultrasonidos) y preferencias a la hora de elegir un determinado tratamiento. Resultados. Contestaron un total de 538 internistas. Más del 90% de los encuestados opina que la osteoporosis es una enfermedad que deben tratar los internistas. El 93% considera que la osteoporosis es una patología prevalente. Más del 80% tiene acceso a una densitometría. Conclusiones. Los internistas españoles opinan mayoritariamente que la osteoporosis es una enfermedad que deben tratar los internistas y que entra en su ámbito de actuación. Por lo general disponen de los medios que necesitan para su estudio y tratamiento. Los bifosfonatos constituyen el fármaco de elección y en la práctica totalidad de los casos indican un suplemento de calcio y vitamina D

Objective. To conduct an opinion survey on osteoporosis in Spanish internists. Method. Survey sent by mail and by personal visit to member of the Spanish Internists Society. Collection of data on opinion on the disease, diagnostic and therapeutic attitude and means available (general laboratory analyses, conventional radiology, biochemical markers of bone remodeling, densitometry and ultrasounds) and preference when choosing a certain treatment. Results. A total of 538 internists answered. More than 90% of those surveyed consider that osteoporosis is a disease that should be treated by internists. A total of 93% consider that osteoporosis is a prevalent disease. More than 80% have access to a densitometry. Conclusions. The majority of Spanish internists consider that osteoporosis is a disease that should be treated by internists and that it is a disease that enters into their action scope. In general, they have the means necessary for its study and treatment. Bisphosphonates constitute the drug of choice and calcium and vitamin D supplements are indicated in almost all the cases

Effect of Lepidium meyenii (Maca) on spermatogenesis in male rats acutely exposed to high altitude (4340 m).

Lepidium meyenii (Maca) is a Peruvian hypocotyl that grows exclusively between 4000 and 4500 m in the central Andes. Maca is traditionally employed in the Andean region for its supposed fertility-enhancing properties. The aim of this study was to test the hypothesis that Maca can prevent high altitude-induced testicular disturbances. Adult male rats were exposed for 21 days to an altitude of 4340 m and treated with vehicle or aqueous extract of Maca (666.6 mg/day). The lengths of the stages of the seminiferous epithelium and epididymal sperm counts were obtained at 0, 7, 14 and 21 days of exposure. The stages of the seminiferous tubules were assessed by transillumination. A dose-response study was also performed at sea level to determine the effect of Maca given to male rats at doses of 0, 6.6, 66.6 and 666.6 mg/day for 7 days on body weight, seminiferous tubule stages and epididymal sperm count. The length of stage VIII and the epididymal sperm count were increased in a dose-dependent manner in Maca-treated rats but treatment reduced the length of stage I. At the highest dose, sperm count increased 1.58 times, the length of stage VIII increased 2.4 times and the length of stage I was reduced 0.48 times compared with the value at dose 0. Exposure to high altitude resulted in a reduction in epididymal sperm count after 7 days and lower values were maintained up to 21 days. Altitude reduced spermiation (stage VIII) to half and the onset of spermatogenesis (stages IX-XI) to a quarter on days 7 and 14 but treatment with Maca (666.6 mg/day) prevented these changes. Data on transillumination and epididymal sperm count in the Maca-treated group exposed to high altitude were similar to those obtained at sea level. Maca increased the sperm count on day 21 of exposure to high altitude to values similar (1095.25 +/- 20.41x10(6) sperm, means +/- S.E.M.) to those obtained in the Maca-treated group at sea level (1132.30 +/- 172.95x10(6) sperm). Furthermore, in the Maca-treated group exposed for 21 days to high altitude, epididymal sperm count was higher than in the non-treated group at sea level (690.49 +/- 43.67x10(6) sperm). In conclusion, treatment of rats with Maca at high altitude prevented high altitude-induced spermatogenic disruption.

Aproximación a la valoración de la discapacidad en personas ancianas / An approach to the assessment of disability in the elderly

La sociedad española, como la de los demás países de la Unión Europea, es una sociedad envejecida. Tras analizar las modificaciones orgánicas y funcionales que acontecen en la persona durante el envejecimiento, se estudian las dificultades que entraña la valoración de la discapacidad en el anciano. Se propone la aplicación de factores de corrección para ajustar el porcentaje de discapacidad (AU)