Biochemical and immunological characteristics of Peruvian Loxosceles laeta spider venom: neutralization of its toxic effects by anti-loxoscelic antivenoms.

This manuscript describes the general biochemical properties and immunological characteristics of Peruvian spider Loxosceles laeta venom (PLlv), which is responsible for the largest number of accidents involving venomous animals in Peru. In this work, we observed that the venom of this spider is more lethal to mice when compared with L. laeta venom from Brazil (BLlv). The LD50 of PLlv was 1.213 mg/kg when the venom was intradermally injected. The venom displayed sphingomyelinase activity and produced dermonecrotic, hemorrhagic and edema effects in rabbits. 2-D SDS-PAGE separation of the soluble venoms resulted in a protein profile ranging from 20 to 205 kDa. Anti-PLlv and anti-BLlv sera produced in rabbits and assayed by ELISA showed that rabbit antibodies cross-reacted with PLlv and BLlv and also with other Brazilian Loxosceles venoms. Western blotting analysis showed that bands corresponding to 25-35 kDa are the proteins best recognized in every Loxosceles spp venoms analyzed. The immunized rabbits displayed protective effect after challenge with PLlv and BLlv. In vitro assays with horse anti-loxoscelic antivenoms produced in Brazil and Peru demonstrated that these commercial antivenoms were efficient to inhibit the sphingomyelinase activity of PLlv and BLlv.

[Epidermoid carcinoma larynx in stage IV]. / Carcinoma epidermoide de laringe estadio IV. Evolución a largo plazo.

OBJECTIVE: To determine the survival, loco-regional control, distant metastases and second primary in stage IV laryngeal carcinoma treated by surgery and radiotherapy. MATERIAL: Retrospective study of 147 patients treated with surgery and radiotherapy with a 5 year minimun follow-up. RESULTS: Overall and cause specific survival at 5 and 10 years was 42%, 35% and 49%, 45.8% respectively. Loco-regional control was 57.7 % and 54.7% at 5 and 10 years. Local recurrences presented in 25.7%, regional recurrences in 74.2%, and distant metastases 10.9%. Second primary tumors developed in 12% of the patients, 50% of the cases in the lungs. Factors related to survival are evaluated. CONCLUSIONS: In our experience, surgery with postoperative radiotherapy in N+, controls 45% of stage IV laryngeal carcinoma. Regional recurrencies are the main cause of failure, more frequent in N+ patientes, present in the first 36 months after treatment.

[Deep neck infections: etiology, bacteriology and treatment]. / Infecciones cervicales profundas: etiología, bacteriología y terapéutica.

Deep neck infections are dangerous for its potential ease to fascial spread, sepsis, and upper airway obstruction. This article reviews 77 cases of deep cervical infection, focus on etiological, clinical and therapeutic aspects. The most frequent location was the submaxillary area (29%), followed by the parapharyngeal space (28%), floor of the mouth (27%) and retropharyngeal (14%) spaces. Etiology was dental in 32%; pharyngoamigdalar infection in 27%; foreign bodies in 13%. In 22% the cause is unknown. Two or more bacteria were isolated in 72%, with Streptococcus B haemolytic being the most frequent germ. All patients were treated with intravenous broad-spectrum antibiotics. Surgical drainage was needed in 54%, and tracheotomy in 18%. Four patients developed mediastinitis, and one died as a consequence of it. The incidence of deep neck infections has decreased after the itroduction of antibiotics but they still may be lethal especially when life-threatening complications occur. Early recognition and management are necessary.

Review article: Population screening for colorectal cancer.

Colorectal cancer is a common cancer and common cause of death. The mortality rate from colorectal cancer can be reduced by identification and removal of cancer precursors, adenomas, or by detection of cancer at an earlier stage. Pilot screening programmes have demonstrated decreased colorectal cancer mortality; as a result many countries are developing colorectal cancer screening programmes. The most common modalities being evaluated are faecal occult blood testing, flexible sigmoidoscopy and colonoscopy. Implementation of screening tests has been hampered by cost, invasiveness, availability of resources and patient acceptance. New technologies such at computed tomographic colonography and stool screening for molecular markers of neoplasia are in development as potential minimally invasive tools. This review considers who should be screened, which test to use and how often to screen.

[Implementation of an assisted electronic prescription system applied to parenteral nutrition in a general hospital]. / Implantación de un sistema de prescripción electrónica asistida aplicada a la nutrición parenteral en un hospital general.

Integrated and shared information systems allow obtaining a high degree of information about processes, costs and outcomes, and considerably reducing prescription errors. Assisted electronic prescription, in the setting of total parenteral nutrition, integrated with other hospital databases and with the hospital drugs management system, is a tool that allows increasing patient' safety (by reducing prescription errors), improving quality assistance, improving information systems and information management and the efficiency of used resources. In this work, implementation of an assisted electronic prescription system applied to parenteral nutrition in a hospital and processes reengineering performed in the nutrition setting are described. This implementation was performed by medical staff from the Nutrition and Diet Department and pharmacists from the Pharmacy Department of Ramón y Cajal Hospital using "Nutriwin" computer software. For two months prior and after its implementation, a follow-up of time consumed in the circuit prescription-validation-elaboration-dispensation of parenteral nutrition formulas has been performed. After implementation, treatment orders reach on average 1 h and 15 minutes sooner the Pharmacy Department; by avoiding transcription, a saving of 3 min per nutrition formula calculations is achieved, besides reducing potential errors; elaboration of nutrition formulas can be started on average 1 h and 20 minutes sooner as compared to manual prescription. Besides, the staff that writes down the prescription may know in real time the nutritional profile for each patient in the current episode and the patient's historic. Electronic prescription of treatment orders in this area has represented for our hospital an optimization of the employed resources, a reduction of potential errors that may occur, an improvement in consumption management, and an increase in the whole process quality.

Implantación de un sistema de prescripción electrónica asistida aplicada a la nutrición parenteral en un hospital general / Implementation of an assisted electronic prescription system applied to parenteral nutrition in a general hospital

Los sistemas de información integrados y compartidos permiten obtener un elevado nivel de información sobre los procesos, costes y resultados, y reducir considerablemente los errores de medicación. La prescripción electrónica asistida, en el área de nutrición parenteral total, integrado con otras bases de datos del hospital y con el sistema de gestión de medicamentos del hospital, es una herramienta que permite aumentar la seguridad del paciente (disminuyendo los errores de medicación), mejorar la calidad de la asistencia, mejorar los sistemas de información y la gestión de la misma y la eficiencia de los recursos empleados. En este trabajo se describe la implantación de un sistema de prescripción electrónica asistida aplicada a la nutrición parenteral en un hospital general, y la reingeniería de procesos llevado a cabo en el área de nutrición. Esta implantación se ha llevado a cabo por los facultativos médicos del servicio de Nutrición y Dietética y por farmacéuticos del Servicio de Farmacia del Hospital Ramón y Cajal utilizando para ello el programa informático "Nutriwin". Durante dos meses antes y después de su implantación, se ha realizado un seguimiento del tiempo empleado en el circuito prescripción-validación-elaboración-dispensación de las nutriciones parenterales. Tras la implantación las órdenes de tratamiento llegan, en promedio, 1 h 15 minutos antes al Servicio de Farmacia; al evitarse la trascripción se produce, además de la disminución de errores potenciales, un ahorro de 3 min/ nutrición en los cálculos a realizar; la elaboración de las nutriciones puede comenzarse como promedio 1h 20 minutos antes que si se realizara la prescripción manual. Así mismo los prescriptores pueden conocer en tiempo real el perfil nutricional de cada paciente en el episodio en curso así como su histórico. La prescripción electrónica de las órdenes de tratamiento en éste área ha supuesto para nuestro hospital una optimización de los recursos empleados, una disminución de los errores potenciales que se pueden producir, una mejora en la gestión de consumos, y un aumento en la calidad de todo el proceso (AU)

Integrated and shared information systems allow obtaining a high degree of information about processes, costs and outcomes, and considerably reducing prescription errors. Assisted electronic prescription, in the setting of total parenteral nutrition, integrated with other hospital databases and with the hospital drugs management system, is a tool that allows increasing patient' safety (by reducing prescription errors), improving quality assistance, improving information systems and information management and the efficiency of used resources. In this work, implementation of an assisted electronic prescription system applied to parenteral nutrition in a hospital and processes reengineering performed in the nutrition setting are described. This implementation was performed by medical staff from the Nutrition and Diet Department and pharmacists from the Pharmacy Department of Ramón y Cajal Hospital using "Nutriwin" computer software. For two months prior and after its implementation, a follow-up of time consumed in the circuit prescription-validation-elaboration-dispensation of parenteral nutrition formulas has been performed. After implementation, treatment orders reach on average 1 h and 15 minutes sooner the Pharmacy Department; by avoiding transcription, a saving of 3 min per nutrition formula calculations is achieved, besides reducing potential errors; elaboration of nutrition formulas can be started on average 1 h and 20 minutes sooner as compared to manual prescription. Besides, the staff that writes down the prescription may know in real time the nutritional profile for each patient in the current episode and the patient's historic. Electronic prescription of treatment orders in this area has represented for our hospital an optimization of the employed resources, a reduction of potential errors that may occur, an improvement in consumption management, and an increase in the whole process quality (AU)

Effects of normalization of GH hypersecretion on lipoprotein(a) and other lipoprotein serum levels in acromegaly.

BACKGROUND & AIMS: Lipoprotein(a) has been recognized as an important risk factor for cardiovascular disease. Lipoprotein(a) has been found to be elevated in sera of acromegalic patients, possibly contributing to the increased incidence of coronary heart disease found in these patients. In the present study we sought to determine the effects of GH hormonal status on lipoprotein(a) and other lipid parameters, including lipoprotein lipase (LPL) activity. DESIGN: Cross-sectional study. PATIENTS: Twenty acromegalic patients, with either active (n = 12) or controlled (n = 8) acromegaly, were studied. Twenty-nine healthy subjects served as control group for serum lipid measurements. MEASUREMENTS: Serum GH, IGF-1, IGF binding protein-3 (IGFBP-3) and insulin levels were measured in patients. Insulin resistance was measured by the homeostatic model assessment (HOMA). Plasma total cholesterol, triglycerides, HDL-lipids, apolipoproteins A-I and B, lipoprotein(a) and lipoprotein lipase activity were also measured. RESULTS: The highest lipoprotein(a) levels were observed in patients with active acromegaly, followed by patients with controlled acromegaly, whose lipoprotein(a) concentrations were still significantly higher than those of the control group (means +/- SEM: active acromegaly, 0.67+/-0.13 g/l; controlled acromegaly, 0.41+/-0.12 g/l; controls 0.17+/-0.02 g/l; P<0.05). There were no differences in other lipid and lipoprotein values among the groups. In patients, significant correlations were observed between lipoprotein(a) and basal GH levels (r = 0.56, P<0.02), mean GH levels (r = 0.48, P<0.05) and with insulin resistance estimated by HOMA (r = 0.62, P<0.01). No correlations were found between lipoprotein(a) and IGF-1 or IGFBP-3 levels. CONCLUSIONS: Our present results demonstrate that both active acromegalic patients and those with controlled disease have elevated serum lipoprotein(a) concentrations. The findings might suggest that the present biochemical criteria for cure of acromegaly are not strict enough to result in the normalization of all the undesirable metabolic changes found in this disease, and also that significant cardiovascular risk may persist despite successful treatment of acromegaly.

[Ambulatory septopyramidal surgery: methods, results and patient satisfaction]. / Cirugía septopiramidal ambulatoria: métodos, resultados y satisfacción de los pacientes.

Outpatient surgery is an activity that increases constantly in Otolaryngology. There are studies about some nasal surgery techniques, such as septoplasty or endonasal endoscopic performed as outpatient surgery, but so far nobody has reported any comparative analysis on the results of outpatient septorhinoplasty, although this is a frequent practice. We report our experience with 40 cases of outpatient septoplasty and 40 outpatient septorhinoplasty, performed by the same surgeon, and we make a comparative study with the same number of operations performed on in-patients with traditional surgical techniques. Aesthetic and functional results and satisfaction level in postoperative interviews were compared in both cases. No serious complications were present in either group. The number of complications, the functional and aesthetic results and the degree of patients satisfaction were similar in both groups. Septopyramidal surgery (septoplasty and septorhinoplasty) is suitable to be performed on outpatient with the same quality as in-patients.

Genetic expression of hexokinase and glucose phosphate isomerase in late-stage mouse preimplantation embryos: transcription activities in glucose/phosphate-containing HTF and glucose/phosphate-free P1 media.

In mouse and human preimplantation development, pyruvate is consumed preferentially during early embryogenesis; however, during the morula and blastocyst stages, glucose is the preferred energy substrate. Studies have suggested that the glycolytic enzymes, hexokinase and glucose phosphate isomerase, are important enzymes in glucose metabolism during these later stages of human and mouse preimplantation development. In order to investigate the genetic activities of these enzymes in late-stage mouse embryos developing in vitro, we analysed hexokinase and glucose phosphate isomerase transcription activities by qualitative RNA assays using reverse transcriptase-nested polymerase chain reaction amplification of individual mouse morulae and early blastocysts incubated in glucose/phosphate-free preimplantation stage one (P1) medium and glucose/phosphate-containing human tubal fluid (HTF) medium. We observed an increased incidence of hexokinase transcripts in the population of blastocysts compared with morulae, and differences in transcript incidence between early blastocysts developing in HTF medium and in P1 medium. In contrast, glucose phosphate isomerase transcripts were consistantly present in all embryos analysed, and appear to be constitutively expressed during late-stage mouse embryogenesis. The different activity patterns of the two glycolytic genes may reflect different mechanisms of gene regulation or differential transcript stability during the later stages of mouse preimplantation development.