Optimizing operational parameters for the enzymatic production of furandicarboxylic acid building block.

BACKGROUND: 2,5-Furandicarboxylic acid (FDCA) is a precursor for green plastics due to its structural similarity to terephthalic acid, a common precursor of oil-derived polymers, and its potential production from sugars obtained from plant biomass. Hydroxymethylfurfural oxidase (HMFO) has been reported as a promising biocatalyst for FDCA production since it can convert bio-based 5-hydroxymethylfurfural (HMF) into FDCA building block. This three-step oxidation reaction occurs through the diformylfuran and 2,5-formylfurancarboxylic acid (FFCA) intermediates. Several efforts have been made for the development of HMFO variants that increase FDCA yields by improving their activities over the reaction intermediates. However, there is still limited insight into how operational conditions can influence these enzymatic reactions. The setup of optimal reaction conditions would enable to understand potential problems hampering the effective industrial production of this bioplastic precursor using HMFO as biocatalyst. RESULTS: In this work, several parameters affecting the performance of Methylovorus sp HMFO oxidizing HMF have been analyzed for the wild-type enzyme, and its V367R and W466F single variants, V367R/W466F double variant, and I73V/H74Y/G356H/V367R/T414K/A419Y/A435E/W466F (8BxHMFO) octuple variant. Our results show how the oxidation of HMF by HMFO enzymes is highly influenced by pH, with different optimal pH values for the different improved variants. Moreover, the enzymes are not stable at high hydrogen peroxide concentrations and their activity is inhibited by the FFCA intermediate in a pH-dependent way. These limitations can be efficiently overcome with the addition of catalase to the reaction medium, which removes the hydrogen peroxide formed during the oxidations, and the controlled dosage of the substrate to limit the amount of FFCA accumulated in the reaction. The different behavior of wild-type HMFO and its variants against pH, hydrogen peroxide and FFCA highlights the importance of considering each variant as an individual enzyme with its own operational conditions for an eventual industrial FDCA production. CONCLUSIONS: This work provides information of those parameters that condition a high production of FDCA by HMFO. Unraveling these factors allowed to increase the FDCA yields by using the most stable enzymes at their optimal pH for HMF oxidation, removing the peroxide with catalase, and avoiding FFCA accumulation by controlling substrate and/or enzyme concentration. These above findings will be useful when planning a future scale-up of these conversions and will provide new viewpoints for the design of HMFO variants that render a more effective performance during HMF conversion into FDCA.

Lateral left ventricular wall rupture following acute myocardial infarction: pathophysiological interpretation by multimodality imaging approach.

Lateral left ventricular wall rupture (LVWR) is a rare complication following acute myocardial infarction (AMI) less than 1%. After cardiogenic shock, LVWR constitutes the most common cause of in-hospital death in AMI patients. Around 40% of all LVWR occurred during the first 24 hours and 85% within the first week. In the present case, 76 hours following the intervention, LVWR was observed likely due to a small infarction at the lateral left ventricular wall possibly due to the marginal lesion. Our patient refused surgery and was followed clinically. Eighteen months later, real time three-dimensional echocardiography showed a pseudoaneurysm.

Structure-function characterization of two enzymes from novel subfamilies of manganese peroxidases secreted by the lignocellulose-degrading Agaricales fungi Agrocybe pediades and Cyathus striatus.

BACKGROUND: Manganese peroxidases (MnPs) are, together with lignin peroxidases and versatile peroxidases, key elements of the enzymatic machineries secreted by white-rot fungi to degrade lignin, thus providing access to cellulose and hemicellulose in plant cell walls. A recent genomic analysis of 52 Agaricomycetes species revealed the existence of novel MnP subfamilies differing in the amino-acid residues that constitute the manganese oxidation site. Following this in silico analysis, a comprehensive structure-function study is needed to understand how these enzymes work and contribute to transform the lignin macromolecule. RESULTS: Two MnPs belonging to the subfamilies recently classified as MnP-DGD and MnP-ESD-referred to as Ape-MnP1 and Cst-MnP1, respectively-were identified as the primary peroxidases secreted by the Agaricales species Agrocybe pediades and Cyathus striatus when growing on lignocellulosic substrates. Following heterologous expression and in vitro activation, their biochemical characterization confirmed that these enzymes are active MnPs. However, crystal structure and mutagenesis studies revealed manganese coordination spheres different from those expected after their initial classification. Specifically, a glutamine residue (Gln333) in the C-terminal tail of Ape-MnP1 was found to be involved in manganese binding, along with Asp35 and Asp177, while Cst-MnP1 counts only two amino acids (Glu36 and Asp176), instead of three, to function as a MnP. These findings led to the renaming of these subfamilies as MnP-DDQ and MnP-ED and to re-evaluate their evolutionary origin. Both enzymes were also able to directly oxidize lignin-derived phenolic compounds, as seen for other short MnPs. Importantly, size-exclusion chromatography analyses showed that both enzymes cause changes in polymeric lignin in the presence of manganese, suggesting their relevance in lignocellulose transformation. CONCLUSIONS: Understanding the mechanisms used by basidiomycetes to degrade lignin is of particular relevance to comprehend carbon cycle in nature and to design biotechnological tools for the industrial use of plant biomass. Here, we provide the first structure-function characterization of two novel MnP subfamilies present in Agaricales mushrooms, elucidating the main residues involved in catalysis and demonstrating their ability to modify the lignin macromolecule.

[Experience in the treatment of interstitial cystitis: review of 17 cases]. / Experiencia en el tratamiento de pacientes con cistitis intersticial: revisión de 17 casos.

BACKGROUND: The Interstitial Cystitis (IC) has been considered in the past an uncommon pathology, however it has received a special attention during the last 20 years, (1678 scientific articles published since 1984 to 2009). There are many therapeutic options not at all satisfactory because there isn't consensus about diagnostic and treatment. OBJECTIVE: To share our experiences in the treatment of interstitial cystitis, additionally, to comment on the therapeutic response of treatment used. MATERIAL AND METHOD: Observational, retrospective an analytic study of 17 treated patients from 22 with diagnosis of IC and Bladder Painful Syndrome (IC/BPS) were managed in Urodifem de Occidente, S.C. a private Urogynecologic unit between January 2001 and April 2010. The diagnosis was done in agreement with the concepts of Interstitial Cystitis group from clinical and cystoscopic characteristics. The treatment was: Dimethyl sulfoxide (DIMSO) and Pentosan Polysulfate. RESULTS: The evaluation was measured by Interstitial Cystitis Symptomatic Index (ICSI) and Interstitial Cystitis Problem Index (ICPI) both validated evaluation instruments, 82% of the patients had a significative improvement of symptomatology and quality of live The ICSI pre and post treatment was of 17.0 and 4.5 and the ICPI was of 14.8 and 4.1 respectively. CONCLUSION: We recommend the use of combine treatment of DIMSO and PPS in cases of I.C.

Observation of a giant nonlinear wave-packet on the surface of the ocean.

In many physical systems such as ocean waves, nonlinear optics, plasma physics etc., extreme events and rare fluctuations of a wave field have been widely observed and discussed. In the field of oceanography and naval architecture, their understanding is fundamental for a correct design of platforms and ships, and for performing safe operations at sea. Here, we report a measurement of an impressive and unique wave packet recorded in the Bay of Biscay in the North-East of the Atlantic Ocean. An analysis of the spatial extension of the packet that includes three large waves reveals that it extents for more than 1 km, with individual crests moving faster than 100 km/h. The central and largest wave in the packet was 27.8 m high in a sea with significant wave height of 11 m. A detailed analysis of the data using the nonlinear Fourier analysis reveals that the wave packet is characterized by a non trivial nonlinear content. This observation opens a new paradigm which requires new understanding of the dynamics of ocean waves and, more in general, of nonlinear and dispersive waves.

Agaricales Mushroom Lignin Peroxidase: From Structure-Function to Degradative Capabilities.

Lignin biodegradation has been extensively studied in white-rot fungi, which largely belong to order Polyporales. Among the enzymes that wood-rotting polypores secrete, lignin peroxidases (LiPs) have been labeled as the most efficient. Here, we characterize a similar enzyme (ApeLiP) from a fungus of the order Agaricales (with ~13,000 described species), the soil-inhabiting mushroom Agrocybe pediades. X-ray crystallography revealed that ApeLiP is structurally related to Polyporales LiPs, with a conserved heme-pocket and a solvent-exposed tryptophan. Its biochemical characterization shows that ApeLiP can oxidize both phenolic and non-phenolic lignin model-compounds, as well as different dyes. Moreover, using stopped-flow rapid spectrophotometry and 2D-NMR, we demonstrate that ApeLiP can also act on real lignin. Characterization of a variant lacking the above tryptophan residue shows that this is the oxidation site for lignin and other high redox-potential substrates, and also plays a role in phenolic substrate oxidation. The reduction potentials of the catalytic-cycle intermediates were estimated by stopped-flow in equilibrium reactions, showing similar activation by H2O2, but a lower potential for the rate-limiting step (compound-II reduction) compared to other LiPs. Unexpectedly, ApeLiP was stable from acidic to basic pH, a relevant feature for application considering its different optima for oxidation of phenolic and nonphenolic compounds.

A Multiomic Approach to Understand How Pleurotus eryngii Transforms Non-Woody Lignocellulosic Material.

Pleurotus eryngii is a grassland-inhabiting fungus of biotechnological interest due to its ability to colonize non-woody lignocellulosic material. Genomic, transcriptomic, exoproteomic, and metabolomic analyses were combined to explain the enzymatic aspects underlaying wheat-straw transformation. Up-regulated and constitutive glycoside-hydrolases, polysaccharide-lyases, and carbohydrate-esterases active on polysaccharides, laccases active on lignin, and a surprisingly high amount of constitutive/inducible aryl-alcohol oxidases (AAOs) constituted the suite of extracellular enzymes at early fungal growth. Higher enzyme diversity and abundance characterized the longer-term growth, with an array of oxidoreductases involved in depolymerization of both cellulose and lignin, which were often up-regulated since initial growth. These oxidative enzymes included lytic polysaccharide monooxygenases (LPMOs) acting on crystalline polysaccharides, cellobiose dehydrogenase involved in LPMO activation, and ligninolytic peroxidases (mainly manganese-oxidizing peroxidases), together with highly abundant H2O2-producing AAOs. Interestingly, some of the most relevant enzymes acting on polysaccharides were appended to a cellulose-binding module. This is potentially related to the non-woody habitat of P. eryngii (in contrast to the wood habitat of many basidiomycetes). Additionally, insights into the intracellular catabolism of aromatic compounds, which is a neglected area of study in lignin degradation by basidiomycetes, were also provided. The multiomic approach reveals that although non-woody decay does not result in dramatic modifications, as revealed by detailed 2D-NMR and other analyses, it implies activation of the complete set of hydrolytic and oxidative enzymes characterizing lignocellulose-decaying basidiomycetes.

[Contribution of bladder biopsy to the study of urogynaecological patient]. / Contribución de la biopsia vesical al estudio de la paciente uroginecológica.

BACKGROUND: One of the characteristics of urinary symptoms in women is their lack of specificity. Patients with stress incontinence or urgency, local irritation, infection, distal stenosis or a neoplastic process have very similar symptoms. OBJECTIVE: Determine the frequency of bladder structural lesions detected by urethrocistoscopy in which we performed bladder biopsies. MATERIAL AND METHOD: Descriptive, retrospective, analytical study of files and videos of 331 patients treated in Urodifem de Occidente (private Urogynecology Center). Thirty-five biopsies were taken. The statistical analysis was expressed as means standard deviations, ranges, percentages and Fishers test. RESULTS: Patients ages range 30-90 years average 60+13.76. Predominant symptoms were: irritative vesical syndrome 62.8%; pelvic pain 45.71%; urge incontinence 31.4%; hematuria 31.4%; vesical voiding dysfunction 11.4%. Principal endoscopic findings: Urethrotrigonitis; glomerular lesions or Hunner ulcers; vesical trabeculations; tumor or suspect lesions. Histopathologic findings were: Interstitial Cystitis 42.9%; chronic Cystitis 11.4%; Cystitis glandularis 8.6%; Cystitis follicular 11.4%; bladder cancer 5.7%; Vesical Papilloma 5.7%. CONCLUSIONS: This study supports the practice of vesical biopsy when lesions other than those from chronic infection are observes in the presence of tumors or suspect lesions.

[Clinical and diagnostic evaluation in patients with interstitial cystitis]. / Evaluación clínica y diagnóstica en pacientes con cistitis intersticial.

BACKGROUND: Interstitial cystitis is a disease of unknown origin; in the last twenty years several epidemiological studies reported an increase in frequency. OBJECTIVE: To describe the symptoms, cystoscopic and histologic findings of 18 cases of interstitial cystitis. PATIENTS AND METHOD: A descriptive, retrospective and analytical study of 331 women with lower urinary tract symptoms studied in Urodifem de Occidente, (private Urogynecology Clinic), between January 2001 and April 2008. The diagnostic criterion was in agreement with the NIDDK and the Interstitial Cystitis DataBase Study. The statistical analysis was in interval scale means, standard deviations and ranges. Indeed Spearman's rank correlation coefficient. RESULTS: The most common symptoms were: urinary frequency (100%) nocturia (94.4%), urgency (72%), pain (66.6%), urgency-incontinence (16.7%). Endoscopic lesions were glomerular in 55% and Hunner ulcers in 44.5%. The severity of quality of life resulted in average of 16.7 +/- 2.9 and 15 +/- 2, p < 0.001. CONCLUSIONS: Urogynecologists must considerer interstitial cystitis when patients show symptoms of bladder irritability and associate pain with the bladder filling. The association of hematuria accompanied by long-term irritability and pain associated with the desire of urination suggests this disease. Cystoscopy is sufficient to confirm the diagnosis.

Is cannabidiol an effective treatment for schizophrenia? / ¿Es el cannabidiol un tratamiento efectivo para la esquizofrenia?

Cannabidiol has recently been proposed as an antipsychotic for schizophrenia. However, its clinical use and safety is controversial. To answer this question, we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We identified six systematic reviews incorporating four primary studies overall, including two randomized trials. We extracted data from the systematic reviews, reanalyzed data from primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. We concluded cannabidiol probably does not improve symptoms in schizophrenia and leads to frequent side effects.

Recientemente se ha propuesto el uso de cannabidiol como antipsicótico para la esquizofrenia. Sin embargo, su utilidad clínica y seguridad genera controversia. Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud a nivel mundial, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Identificamos seis revisiones sistemáticas que en conjunto incluyen cuatro estudios, entre ellos dos ensayos controlados aleatorizados. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos tablas de resumen de los resultados utilizando el método GRADE. Concluimos que el cannabidiol probablemente no disminuye la sintomatología en pacientes con esquizofrenia, y está asociado a efectos adversos frecuentes.

Art therapy for schizophrenia? / Arteterapia, ¿es efectiva en la esquizofrenia?

Art therapy is used as a complementary treatment to antipsychotics in schizophrenia. However, its effectiveness is not clear. To answer this question, we searched in Epistemonikos database, which is maintained by screening multiple databases. We identified five systematic reviews including 20 studies overall, of which four were randomized trials. We extracted data and prepared summary of findings tables using the GRADE method. We concluded it is not clear whether art therapy leads to clinical improvement in schizophrenia because the certainty of the evidence is very low.

La arteterapia se utiliza como tratamiento complementario a los antipsicóticos en la esquizofrenia, sin embargo, no está clara su efectividad. Para responder esta pregunta, se utilizó la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en múltiples bases de datos. Identificamos cinco revisiones sistemáticas que en conjunto incluyen 20 estudios, de los cuales cuatro corresponden a estudios aleatorizados. Extrajimos los datos y preparamos tablas de resumen de los resultados utilizando el método GRADE. Concluimos que no está claro si la arteterapia produce mejoría en la esquizofrenia porque la certeza de la evidencia existente es muy baja.

Is it worth adding loperamide to antibiotic treatment of traveler’s diarrhea? / ¿Vale la pena agregar loperamida al tratamiento antibiótico de la diarrea del viajero?

Travelers' diarrhea is a frequent condition, especially in those traveling to high-risk areas. Although antibiotic treatment reduces the duration of diarrhea, it has been suggested adding loperamide could further reduce the symptoms. To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We identified two systematic reviews including 28 studies overall, of which 15 were randomized trials relevant for the question of interest. We extracted data from the systematic reviews, reanalysed data of primary studies and generated a summary of findings table using the GRADE approach. We concluded adding loperamide to antibiotic treatment might accelerate resolution of symptoms in traveler’s diarrhea with minimal or no adverse effects.

La diarrea del viajero es una patología frecuente, en especial en quienes se dirigen a regiones de alto riesgo. Si bien el tratamiento antibiótico reduce la duración del cuadro, se ha planteado que la asociación de loperamida podría reducir aún más los síntomas. Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Identificamos dos revisiones sistemáticas que en conjunto incluyen 28 estudios primarios, de los cuales 15 corresponden a ensayos aleatorizados. Extrajimos los datos desde las revisiones identificadas y preparamos tablas de resumen de los resultados utilizando el método GRADE. Concluimos que agregar loperamida al tratamiento con antibióticos podría acelerar la resolución del cuadro, sin asociarse probablemente a efectos adversos importantes.

[Prevalence of urinary and anal incontinence in women from metropolitan area of Guadalajara]. / Prevalencia de incontinencia urinaria y anal en mujeres de la zona metropolitana de Guadalajara.

BACKGROUND: Female urinary and anal incontinence are common entities in pelvic floor dysfunction. The most frequently age affected range from 45 to 69 years. Previous studies performed in the United States report a prevalence of 24-62% for urinary incontinence and 3-60% for anal incontinence. OBJECTIVE: To determine the prevalence of these disorders in the Guadalajara metropolitan area because we do not know it. PARTICIPANTS AND METHODS: A transversal and various stage study was performed recollecting blocks first, then houses, finally interviewing women and applying a structured questionnaire with somatometric and social-demographic data and also clinical-pathological antecedents. The data obtained was registered and processed first manually then using Excel and Epi-Info software. RESULTS: The group of women interviewed (n = 352) were between 15-85 years. The majority were married, housewives, 33% with grammar school, 23% finished high school, 25% professionists and 19% did not finish school; with an average of three pregnancies and with a body mass index (BMI) positive for overweight and obesity. The prevalence for urinary incontinence was 27.8% and anal incontinence of 3.4%. These are results compatible with those reported in the United States. CONCLUSIONS: Women living in Guadalajara have the same behavior that European and American women about prevalence of urinary incontinence. We recommend the performance of this type of studies in other states of this country in order to enrich the present information.

[Prevalence and clinical-urodynamic characteristics of vesical voiding dysfunction in two urodynamic centres]. / Prevalencia de disfunción de vaciado vesical y hallazgos clínico-urodinámicos en dos unidades uroginecológicas.

BACKGROUND: It has been estimated in English medical reports, that the frequency of vesical voiding dysfunction in urogynecological patients is around of 22-24%; however in our country it does not have any published epidemiological study about this problem. OBJECTIVE: To detect the prevalence of vesical voiding dysfunction in our urodynamic unities and describe the clinical and urodynamic findings. MATERIAL AND METHODS: This is a descriptive and retrospective study in which were revised the clinical reports of 300 female patients, that were sent to some of our urodynamic units because they were suffering of lower urinary tract symptoms. Assessment variables included: Patient clinical history, physical examination, urinalysis, urine culture, urethral calibration, Q tip test, urethrocistoscopy, uroflowmetry, multichannel cystometry, electromyography and pressure voiding study. The diagnosis criterion was based in the concept that Blaivas established for vesical voiding dysfunction in women. RESULTS: The diagnosis of vesical voiding dysfunction was established in 72 cases of the total 300 patients analyzed. The most frequent symptom was the irritative vesical type (frequency/urgency), following of weak stream. Some grade of pelvic organ prolapse was detected in 84.8% of cases. Uroflowmetry was normal in 50% of the cases; nevertheless in the morphologic aspect were observed profile signs suggestive of distal vesical obstruction in 75%, and detrusor hypoactivity in 25% of the total of the cases. CONCLUSIONS: The frequency of obstruction in our casuistic was similar to the other authors. The obtained results permit us to confirm that the vesical voiding dysfunction in the urogynecological Mexican patients is a frequent problem in the urogynecological patient; however the diagnostic is complex and require a carefully correlation as clinical as urodynamical aspects in addition to endoscopic and image studies.

Interstitial cystitis/painful bladder syndrome: diagnostic evaluation and therapeutic response in a private urogynecology unit.

BACKGROUND: Interstitial cystitis/painful bladder syndrome (IC/PBS) is a spectrum of pelvic, bladder or urethral pain, as well as irritative voiding symptoms. The term interstitial cystitis (IC) is reserved for patients with typical cystoscopic features. Diagnosis and management of this syndrome may be difficult. The aim of this study was to describe endoscopic features and our experience on the treatment of this syndrome in Urodifem de Occidente S.C., a private urogynecology unit. METHODS: Observational, retrospective analytic study of 25 treated patients from 33 with diagnosis of IC/PBS between January 2001 and March 2015. The diagnosis was done by clinical, cystoscopic and urodynamic approach. Treatment was based on bladder instillation of dymetilsulfoxido (DMSO), dexamethasone and heparin. Oral pentosan polysulphate was prescribed for at least 1 year. RESULTS: Cystoscopic findings showed petechial hemorrhages in 32%, Hunner's lesions in 28%, glomerulations in 28% and bladder pain in absence of lesions in 12%. The basic treatment included one instillation once a week for 6 weeks, twice a month for 2 months and four monthly instillations. Three cases had complete remission of their symptoms, 21 had significant improvement and we have only one failure. CONCLUSIONS: We recommend the combined use of DMSO instillation and pentosan polysulphate (PPS) in cases of IC/PBS.

Evolución de brotes epidémicos causados por salmonellaspp., en la Región de Murcia (2003-2013 / Evolution of outbreaks caused by salmonellaspp., in the Region of Murcia (2003-2013)

Introducción: A lo largo del presente trabajo se han revisado datos anuales de enfermedades causadas por cepas del género Salmonellaspp., tanto en áreas de salud, en municipios de la Región de Murcia; así como la evolución de estas enfermedades desde 2003 hasta 2013. También se ha estudiado la distribución de los casos por ámbito general y familiar, así como los casos de fiebre tifoidea y fiebre paratifoidea. Métodos: Se han seleccionado estudios publicados en revistas incluidas en Index Citation Reports. Igual - mente se consultaron documentos procedentes del Boletín Epidemiológico de la Región de Murcia y campañas encaminadas a la prevención de enfermedades de declaración obligatoria. Resultados: Salmonellaspp., es el agente causal identificado en 122 brotes (53 de ámbito general, 63 de ámbito familiar y 6 de origen desconocido) y con un total de 1989 afectados por toxiinfecciones alimentarias. Entre los alimentos implicados encontramos en primer lugar el huevo provocando 74 brotes, seguido de la carne y productos cárnicos (18 brotes), crustáceos (15 brotes), pescado y derivados de pescado (12 brotes). Durante los 10 años objeto de estudio, se dieron 37 casos de fiebre tifoidea y paratifoidea, de estos 37 casos, 15 se dieron en varones, 19 en mujeres y 3 en género desconocido por falta de datos. Discusión: Los datos analizados en el presente trabajo, abordan la evolución de brotes de toxiinfecciones alimentarias causadas por cepas del género Salmonellaspp., durante el período que comprende desde 2003 a 2013 en la Región de Murcia. Los resultados obtenidos nos han permitido identificar los ámbitos familiar y general como los que presentan mayor número de brotes. Los brotes causados por Salmonella typhi, y Salmonella paratyphi han ido en un claro descenso gracias a las sanciones y medidas de prevención. Sin embargo, en la Región de Murcia no se han elaborado campañas de prevención que tengan presente sobre todo el ámbito familiar. Por otro lado, los centros declarantes de atención especializada presentaron una cobertura sanitaria desigual, por lo que marca líneas donde es necesario mejorar el protocolo de notificación. Conclusiones: Las sanciones interpuestas en la Región de Murcia han permitido reducir en los 11 años objeto de estudio y de manera significativa el número de brotes por toxiinfecciones alimentarias, donde el agente responsable mayoritario es Salmonellaspp. Los datos sobre cobertura sanitaria obtenidos en algunos municipios, ponen de manifiesto la necesidad de mejorar el sistema de notificación. También exigen una colaboración de los servicios municipales de salud y el Servicio de Epidemiología de la Consejería de Sanidad, con el fin de corregir las limitaciones existentes (AU)

Summary: Throughout this article we show data from diseases caused by Salmonella spp strains and also we reviewed in both health and councils areas in the Region of Murcia. We studied the evolution of these diseases from 2003 to 2013. We analyzed the distribution of cases by general and familiar ranges and cases of typhoid and paratyphoid fever as well. Methods: We selected journals articles included in the Index Citation Reports. We also reviewed data from the Epidemiological Bulletin of the Region of Murcia and informative campaigns oriented to prevention of notifiable diseases. Results: Salmonellaspp. was identified in 122 outbreaks (53 general cases, family cases 63 and 6 unknown) with a balance of 1989 cases. Food like egg caused 74 outbreaks, followed by meat products (18 outbreaks), shellfish (15 outbreaks), fish and processed fish (12 outbreaks). In the last 11 years were detected 37 cases of typhoid and paratyphoid fever. 15 have occurred in men, 19 in women and 3 unknown genders. Discussion: Data showed the evolution of foodborne diseases outbreaks caused by Salmonellaspp. strains during 2003-2013 in the Region of Murcia. The highest number of outbreaks took place in familiar and general ranges. Outbreaks caused by Salmonella typhi and Salmonella paratyphi declined due to sanctions and preventive measures. However, in the Region of Murcia has not developed preventive campaigns aimed at avoid outbreaks in family range. On the other hand, specialized care centers showed uneven health coverage, for that reason is necessary to improve the notification procedure. Conclusions: In the Region of Murcia sanctions in the last 11 years reduced the number of foodborne diseases outbreaks and Salmonellaspp. was the most frequently isolated agent. Health coverage data make evident why is required to improve the reporting system. They also demand collaboration of council health services and Epidemiology Service of the Ministry of Health, in order to correct the current limitations (AU)

Detección de un síndrome de Brugada en un reconocimiento médico laboral / Detection of a Brugada syndrome in a occupational medical examination

El síndrome de Brugada es una cardiopatía genética y no estructural debida a una alteración primaria de los canales iónicos del miocardio y que se asocia a un riesgo de muerte súbita. Hay tres patrones electrocardiográficos diagnósticos o sugerentes de síndrome de Brugada, que pueden ser identificados en un reconocimiento médico rutinario y que, de confirmarse el diagnóstico, pueden llevar a la necesidad de implantar un desfibrilador automático que puede salvar la vida del paciente. Se presente un caso asintomático diagnosticado en un reconocimiento laboral y se revisa la conducta a seguir ante un síndrome de Brugada (AU)

Brugada syndrome is a genetic, non-structural heart disease caused by a primary alteration of the myocardial ion channels and it is associated with increased risk of sudden death. There are three electrocardiographic patterns diagnostic or suggestive of Brugada syndrome which can be identified in routine medical examinations. If the diagnosis is confirmed, implantation of an automatic defibrillator maybe life-saving. We report an asymptomatic case of Brugada syndrome diagnosed during an occupational health check and review the steps to be followed after diagnosis of this syndrome (AU)

Estrategias de aprendizaje en estudiantes de enseñanza secundaria obligatoria y su relación con la autoestima / Learning strategies in secondary-school students and relationship with self-steem

Numerosos estudios han aportado datos para sostener la hipótesis de la relación existente entre la imagen que el alumno tiene de sí mismo y la selección y/o utilización de estrategias de aprendizaje. El objetivo principal de este trabajo es comprobar precisamente si esta relación se mantiene entre la obtención de altas puntuaciones en Autoestima y la selección y/o utilización de distintas estrategias de aprendizaje. El estudio se ha realizado con 324 sujetos de 14 a 16 años, estudiantes de Enseñanza Secundaria Obligatoria. Los resultados obtenidos muestran que no se evidencia relación significativa entre puntuaciones altas en autoestima y la utilización y/o selección de estrategias de aprendizaje, salvo en la estrategia Planificación de Respuesta, que su utilización correlaciona con la obtención de altas puntuaciones en las subescalas Familiar, Académica y Corporal del Cuestionario de Autoestima aplicado

A considerable number of studies have been published providing data in support of the hypothesis of a relationship between pupils’ self-image and the selection and/or use of learning strategies. The main objective of the present work was to examine this hypothesis by exploring the relationship between high scores in self-esteem and the selection and/or use of different learning strategies. The study was carried out with 324 secondary-school pupils aged 14 to 16. The results obtained indicate no significant relationship between high scores in self-esteem and the use and/or selection of learning strategies, except in the Response Planning strategy, whose use correlates with high scores in the Family,Academic and Body subscales of the Self-esteem Questionnaire applied