[Prognostic power of soluble urokinase plasminogen activator receptor (suPAR) for short-term mortality in patients seen in Emergency Departments due to infections]. / Poder pronóstico de mortalidad a corto plazo del receptor soluble activador del plasminógeno tipo uroquinasa (suPAR) en los pacientes atendidos en urgencias por infección.

OBJECTIVE: To analyse and compare 30-day mortality prognostic power of several biomarkers (C-reactive protein, procalcitonin, lactate and suPAR) in patients seen in emergency departments (ED) due to infections. Secondly, if these could improve the accuracy of systemic inflammatory response syndrome (SIRS) and quick Sepsis-related Organ Failure Assessment (qSOFA). METHODS: A prospective, observational and analytical study was carried out on patients who were treated in an ED of one of the eight participating hospitals. An assessment was made of 32 independent variables that could influence mortality at 30 days. They covered epidemiological, comorbidity, functional, clinical and analytical factors. RESULTS: The study included 347 consecutive patients, 54 (15.6%) of whom died within 30 days of visiting the ED. SUPAR has got the best biomarker area under the curve (AUC)-ROC to predict mortality at 30 days of 0.836 (95% CI: 0.765-0.907; P <.001) with a cut-off > 10 ng/mL who had a sensitivity of 70% and a specificity of 86%. The score qSOFA ≥ 2 had AUC-ROC of 0.707 (95% CI: 0.621-0.793; P < .001) with sensitivity of 53% and a specificity of 89%. The mixed model (suPAR > 10 ng/mL plus qSOFA ≥ 2) has improved the AUC-ROC to 0.853 [95% CI: 0.790-0.916; P < .001] with the best prognostic performance: sensitivity of 39% and a specificity of 97% with a negative predictive value of 90%. CONCLUSIONS: suPAR showed better performance for 30-day mortality prognostic power from several biomarkers in the patients seen in ED due to infections. Score qSOFA has better performance that SRIS and the mixed model (qSOFA ≥ 2 plus suPAR > 10 ng/mL) increased the ability of qSOFA.

Handover in Intensive Care. / Traspaso de información en Medicina Intensiva.

Handover is a frequent and complex task that also implies the transfer of the responsibility of the care. The deficiencies in this process are associated with important gaps in clinical safety and also in patient and professional dissatisfaction, as well as increasing health cost. Efforts to standardize this process have increased in recent years, appearing numerous mnemonic tools. Despite this, local are heterogeneous and the level of training in this area is low. The purpose of this review is to highlight the importance of IT while providing a methodological structure that favors effective IT in ICU, reducing the risk associated with this process. Specifically, this document refers to the handover that is established during shift changes or nursing shifts, during the transfer of patients to other diagnostic and therapeutic areas, and to discharge from the ICU. Emergency situations and the potential participation of patients and relatives are also considered. Formulas for measuring quality are finally proposed and potential improvements are mentioned especially in the field of training.

Performance of the Finnish Diabetes Risk Score and a Simplified Finnish Diabetes Risk Score in a Community-Based, Cross-Sectional Programme for Screening of Undiagnosed Type 2 Diabetes Mellitus and Dysglycaemia in Madrid, Spain: The SPREDIA-2 Study.

AIM: To evaluate the performance of the Finnish Diabetes Risk Score (FINDRISC) and a simplified FINDRISC score (MADRISC) in screening for undiagnosed type 2 diabetes mellitus (UT2DM) and dysglycaemia. METHODS: A population-based, cross-sectional, descriptive study was carried out with participants with UT2DM, ranged between 45-74 years and lived in two districts in the north of metropolitan Madrid (Spain). The FINDRISC and MADRISC scores were evaluated using the area under the receiver operating characteristic curve method (ROC-AUC). Four different gold standards were used for UT2DM and any dysglycaemia, as follows: fasting plasma glucose (FPG), oral glucose tolerance test (OGTT), HbA1c, and OGTT or HbA1c. Dysglycaemia and UT2DM were defined according to American Diabetes Association criteria. RESULTS: The study population comprised 1,426 participants (832 females and 594 males) with a mean age of 62 years (SD = 6.1). When HbA1c or OGTT criteria were used, the prevalence of UT2DM was 7.4% (10.4% in men and 5.2% in women; p<0.01) and the FINDRISC ROC-AUC for UT2DM was 0.72 (95% CI, 0.69-0.74). The optimal cut-off point was ≥13 (sensitivity = 63.8%, specificity = 65.1%). The ROC-AUC of MADRISC was 0.76 (95% CI, 0.72-0.81) with ≥13 as the optimal cut-off point (sensitivity = 84.8%, specificity = 54.6%). FINDRISC score ≥12 for detecting any dysglycaemia offered the best cut-off point when HbA1c alone or OGTT and HbA1c were the criteria used. CONCLUSIONS: FINDRISC proved to be a useful instrument in screening for dysglycaemia and UT2DM. In the screening of UT2DM, the simplified MADRISC performed as well as FINDRISC.

Deep RNA-Seq profile reveals biodiversity, plant-microbe interactions and a large family of NBS-LRR resistance genes in walnut (Juglans regia) tissues.

Deep RNA-Seq profiling, a revolutionary method used for quantifying transcriptional levels, often includes non-specific transcripts from other co-existing organisms in spite of stringent protocols. Using the recently published walnut genome sequence as a filter, we present a broad analysis of the RNA-Seq derived transcriptome profiles obtained from twenty different tissues to extract the biodiversity and possible plant-microbe interactions in the walnut ecosystem in California. Since the residual nature of the transcripts being analyzed does not provide sufficient information to identify the exact strain, inferences made are constrained to the genus level. The presence of the pathogenic oomycete Phytophthora was detected in the root through the presence of a glyceraldehyde-3-phosphate dehydrogenase. Cryptococcus, the causal agent of cryptococcosis, was found in the catkins and vegetative buds, corroborating previous work indicating that the plant surface supported the sexual cycle of this human pathogen. The RNA-Seq profile revealed several species of the endophytic nitrogen fixing Actinobacteria. Another bacterial species implicated in aerobic biodegradation of methyl tert-butyl ether (Methylibium petroleiphilum) is also found in the root. RNA encoding proteins from the pea aphid were found in the leaves and vegetative buds, while a serine protease from mosquito with significant homology to a female reproductive tract protease from Drosophila mojavensis in the vegetative bud suggests egg-laying activities. The comprehensive analysis of RNA-seq data present also unraveled detailed, tissue-specific information of ~400 transcripts encoded by the largest family of resistance (R) genes (NBS-LRR), which possibly rationalizes the resistance of the specific walnut plant to the pathogens detected. Thus, we elucidate the biodiversity and possible plant-microbe interactions in several walnut (Juglans regia) tissues in California using deep RNA-Seq profiling.

Single layer centrifugation (SLC) improves sperm quality of cryopreserved Blanca-Celtibérica buck semen.

The aim of the present study was to evaluate the effect of sperm selection by means of single layer centrifugation (SLC) on sperm quality after cryopreservation, either when SLC is used before freezing or after thawing, using Blanca-Celtibérica buck semen collected by electroejaculation (EE). Ejaculates from six bucks were collected by EE and divided into two aliquots. One of them (unselected) was diluted with Biladyl(®) by the two-step method and frozen over nitrogen vapor. The other aliquot was selected by the SLC technique and subsequently frozen in the same way as the unselected samples (SLC before freezing). In a further treatment, two unselected straws were thawed and SLC was carried out (SLC after thawing). At thawing, sperm motility of all samples ((i) unselected; (ii) selected before freezing and (iii) selected after thawing) was evaluated by CASA. In addition, integrity of the plasma membrane, mitochondrial membrane potential, ROS production and DNA fragmentation index were assessed by flow cytometry. Most of the sperm parameters were improved (P≤0.001) in samples selected by SLC after thawing in relation to unselected or selected by SLC before freezing. The percentage of progressive motile spermatozoa was greater (86%) for sperm samples selected after thawing compared with unselected (58%) or selected before freezing (54%). Moreover, percentages of spermatozoa with intact plasma membrane and spermatozoa with high mitochondrial membrane potential (hMMP) were also greater for sperm samples selected after thawing compared to sperm samples unselected or selected before freezing (spermatozoa with intact plasma membrane: 80% vs. 32% vs. 12%; spermatozoa with hMMP: 54% vs. 1% vs. 15%; respectively). Therefore, sperm quality after cryopreservation is improved in Blanca-Celtibérica buck ejaculates collected by EE when a sperm selection technique such as SLC is carried out after thawing.

Rate of gestational weight gain, pre-pregnancy body mass index and preterm birth subtypes: a retrospective cohort study from Peru.

OBJECTIVE: To examine the shape (functional form) of the association between the rate of gestational weight gain, pre-pregnancy body mass index (BMI), and preterm birth and its subtypes. DESIGN: Retrospective cohort study. SETTING: National reference obstetric centre in Lima, Peru. POPULATION: Pregnant women who delivered singleton babies during the period 2006-2009, resident in Lima, and beginning prenatal care at ≤ 12 weeks of gestation (n=8964). METHODS: Data were collected from the centre database. The main analyses consisted of logistic regression with fractional polynomial modelling. MAIN OUTCOME MEASURES: Preterm birth and its subtypes. RESULTS: Preterm birth occurred in 12.2% of women, being mostly idiopathic (85.7%). The rate of gestational weight gain was independently associated with preterm birth, and the shape of this association varied by pre-pregnancy BMI. In women who were underweight, the association was linear (per 0.1 kg/week increase) and protective (OR 0.88; 95% CI 0.82-1.00). In women of normal weight or who were overweight, the association was U-shaped: the odds of delivering preterm increased exponentially with rates <0.10 or >0.66 kg/week, and <0.04 or >0.50 kg/week, respectively. In women who were obese, the association was linear, but non-significant (OR 1.01; 95% CI 0.95-1.06). The association described for preterm birth closely resembled that of idiopathic preterm birth, although the latter was stronger. The rate of gestational weight gain was not associated with indicated preterm birth or preterm prelabour rupture of membranes. CONCLUSIONS: In Peruvian pregnant women starting prenatal care at ≤ 12 weeks of gestation, the rate of gestational weight gain is independently associated with preterm birth, mainly because of its association with idiopathic preterm birth, and the shape of both associations varies by pre-pregnancy BMI.

Performance of astronomical beam combiner prototypes fabricated by hybrid sol-gel technology.

Integrated optics coaxial two, three and four telescope beam combiners have been fabricated by hybrid sol-gel technology for astronomical applications. Temporal and spectral analyses of the output interferometric signal have been performed, and their results are in mutual good agreement. The results of the characterization method employed are cross-checked using contrast measurements obtained independently, demonstrating that the chromatic differential dispersion is the main contributer to contrast reduction. The mean visibility of the fabricated devices is always higher than 95 %, obtained using a source with spectral bandwidth of 50 nm. These results show the capability of hybrid sol-gel technology for fast prototyping of complex chip designs used in astronomical applications.

Historical perspective of sexually transmitted infections and their control in Peru.

In designing an effective national response to sexually transmitted infections (STIs), one must incorporate a historical perspective of previous efforts that have addressed different aspects of STIs. One must understand who have been the key players, what aspects of STIs were the focus of efforts (prevention, treatment or control), and which, if any, societal subgroups were targeted (i.e. sex workers, military, men who have sex with men [MSM], etc.). In addition, one must consider historical and modern attitudes towards sex, sexuality and STIs, especially in terms of taboos and stigmas that may be attached to each. Most importantly, one must recognize which efforts have succeeded, which have failed, and why. This paper presents a historical overview of the perceptions of and responses to STIs at different points in Peru's history, and discusses current efforts to build upon past successes and avoid repeating previous failures that could be helpful for other countries in the Latin American region.

Hybrid sol-gel planar optics for astronomy.

Hybrid sol-gel planar optics devices for astronomy are produced for the first time. This material system can operate from the visible (0.5 microm) up to the edge of astronomical J-band (1.4 microm). The design, fabrication and characterization results of a coaxial three beam combiner are given as an example. Fringe contrasts above 94% are obtained with a source with spectral bandwidth of 50 nm. These results demonstrate that hybrid sol-gel technology can produce devices with high quality, opening the possibility of rapid prototyping of new designs and concepts for astronomical applications.

Internet as a tool to access high-risk men who have sex with men from a resource-constrained setting: a study from Peru.

OBJECTIVES: In Peru, current interventions in high-risk men who have sex with men (MSM) reach a limited number of this population because they rely solely on peer education. The objective of this study was to assess the use of the internet as an alternative tool to access this population. METHODS: Two nearly identical banner ads-both advertising an online survey but only one offering free HIV/syphilis tests and condoms-were displayed randomly on a Peruvian gay website. RESULTS: The inclusion of the health incentive increased the frequency of completed surveys (5.8% vs 3.4% of delivered impressions; p<0.001), attracting high-risk MSM not previously tested for HIV but interested in a wide variety of preventive Web-based interventions. Eleven per cent (80/713) of participants who said they had completed the survey offering free testing visited our clinic: of those who attended, 6% had already been diagnosed as having HIV, while 5% tested positive for HIV. In addition, 8% tested positive for syphilis. CONCLUSIONS: The internet can be used as a tool to access MSM in Peru. The compensation of a free HIV/syphilis test increased the frequency of participation in our online survey, indicating that such incentives may be an effective means of reaching this population. However, as only a small percentage of participants actually reported for testing, future research should develop and assess tailored internet interventions to increase HIV/STI testing and delivery of other prevention services to Peruvian MSM.

[Predictive clinical factors of response to subthalamic nucleus stimulation in Parkinson's disease]. / Factores clínicos predictivos de la respuesta a la estimulación subtalámica en la enfermedad de Parkinson.

INTRODUCTION: Subthalamic nucleus stimulation (SNE) is currently a reasonable treatment for patients with advanced Parkinson's disease (PD). Predictive factors for effective SNE have not yet been identified with precision. We have prospectively evaluated response to SNE in a series of patients with advanced PD to study the factors that influence clinical improvement after functional surgery. METHODS: We prospectively studied 20 patients with advanced PD (age: 59 +/-6.1; stage: 3.0+/-0.8) candidates for SNE. We studied these patients preoperatively and 6 months postoperatively according to Core Assessment Program for Intracerebral Transplantation (CAPIT) protocol including timed tests. CONCLUSIONS: We found a negative correlation between age and Unified Parkinson Disease Rating Scale (UPDRS) improvement; however, age did not correlate with timed tests improvement. In addition, preoperative severity (UPDRS and Hoehn-Yahr) did not correlate with UPDRS and timed tests improvement. In summary, age is a negative predictor for effective SNE.

Sexually transmitted and reproductive tract infections in symptomatic clients of pharmacies in Lima, Peru.

OBJECTIVE: To determine prevalences and predictors of sexually transmitted and reproductive tract infections among men and women seeking care at pharmacies. METHODS: Men and women with urethral discharge or dysuria and vaginal discharge were enrolled at 12 central and 52 smaller pharmacies in Lima, Peru. All participants answered a questionnaire. Men provided urine for polymerase chain reaction (PCR) testing for Neisseria gonorrhoeae and Chlamydia trachomatis, and for leucocyte esterase testing. Women provided self-obtained vaginal swabs for PCR testing for N gonorrhoeae and C trachomatis, Trichomonas vaginalis culture and bacterial vaginosis and Candida. RESULTS: Among 106 symptomatic men, N gonorrhoeae and C trachomatis were detected in 34% and were associated with urethral discharge compared with dysuria only (odds ratio (OR) 4.3, p = 0.003), positive urine leucocyte esterase testing (OR 7.4, p = 0.009), less education (OR 5.5, p = 0.03), and with symptoms for <5 days (OR 2.5, p = 0.03). Among 121 symptomatic women, 39% had bacterial vaginosis or T vaginalis, and 7.7% had candidiasis. N gonorrhoeae and C trachomatis were detected in 12.4% of the women. Overall, 48.8% had one or more of these infections. No factors were associated with vaginal infection, and only symptoms of vaginal discharge for <5 days were associated with N gonorrhoeae and C trachomatis (OR 4.0, p = 0.02). The main reason reported for seeking advice at pharmacies by both men and women was trust in pharmacy workers. CONCLUSIONS: Among men and women presenting to pharmacies with urethral and vaginal symptoms, rates of urethral and vaginal infections were comparable to those found in other clinical settings. Pharmacies can contribute to the care and prevention of sexually transmitted infection in developing countries.

Utility of the Determine Syphilis TP rapid test in commercial sex venues in Peru.

OBJECTIVES: This study sought to evaluate the utility of the Determine Syphilis TP test performed in Peruvian commercial sex venues for the detection of active syphilis; and determine the feasibility of integrating rapid syphilis testing for female sex workers (FSW) into existing health outreach services. METHODS: We tested 3586 female sex workers for syphilis by Determine in the field using whole blood fingerstick, and by rapid plasma reagin (RPR) and Treponema pallidum haemagglutination assay (TPHA) in a central laboratory in Lima using sera. RESULTS: 97.4% of the FSW offered rapid syphilis testing participated; and among those who tested positive, 87% visited the local health centre for treatment. More than twice as many specimens were RPR reactive using serum in Lima (5.7%) than tested positive by whole blood Determine in the field (2.8%), and although most were confirmed by TPHA, only a small proportion (0.7%) were RPR reactive at >or=1:8 dilutions, and likely indicating active syphilis. Sensitivity, specificity and positive predictive value of the Determine Syphilis TP test in whole blood when compared to serum RPR reactivity at any dilution confirmed by TPHA as the gold standard were 39.3%, 99.2% and 71.4%, respectively. Sensitivity improved to 64.0% when using serum RPR >or=1:8 confirmed by TPHA. Invalid tests were rare (0.3%). CONCLUSIONS: Rapid syphilis testing in sex work venues proved feasible, but Determine using whole blood obtained by fingerstick was substantially less sensitive than reported in previous laboratory-based studies using serum. Although easy to perform in outreach venues, the utility of this rapid syphilis test was relatively low in settings where a large proportion of the targeted population has been previously tested and treated.

Disección coronaria espontánea: una rara forma de presentación de síndrome coronario agudo / Spontaneous coronary dissection: an infrequent presentation of acute coronary syndrome

Presentamos un caso de disección coronaria espontánea en una mujer de 38 años, fumadora y con linfoma no Hodgkin en remisión completa hace 20 años. Clínicamente se manifestó como síndrome coronario agudo (SCA), infarto agudo de miocardio (IAM) anterior y shock cardiogénico. Se realizó angioplastia transluminal percutánea (ACTP) facilitada, observándose en la coronariografía una disección de tercio proximal de arteria descendente anterior. Se procedió a la implantación de dos stent en serie, con sellado angiográfico de la disección y colocación de balón de contrapulsación aórtico. Posteriormente falleció tras persistencia del shock y presentar fibrilación ventricular refractaria a medidas de reanimación cardiopulmonar avanzada (AU)

We report a case of spontaneous coronary artery dissection, in a woman of 38 years old, smoker and with Linfoma no Hodgkin in complete remission 20 years ago. The clinical presentation was a acute coronary syndrome, acute anterior myocardial infarction and cardiogenic shock. Coronary angioplasty revealed dissection of proximal third of anterior descendig artery. Facilitated percutaneus transluminal coronary angioplasty with stenting was performed, with sealed of the dissection and positioning a intra-aortic ballon contrapulsation. Later, she died after persistence of the shock and to present refractory ventricular fibrilation to resuscitation cardiopulmonar outpost measures (AU)

Automated detection of malaria by means of the haematology analyser Coulter GEN.S.

The haematology analysers Coulter(R) GEN.S(TM) and LH(TM) give a set of data--'positional parameters'--which define each WBC population by mean of index values, the mean and the standard deviation (SD) of volume, conductivity and scatter, used to identify the WBC populations. These parameters were analysed in patients investigated for suspicion of malaria, in order to show a difference between malaria negative and malaria positive patients and to use it for malaria detection. The six parameters exhibiting a significant difference between the two groups were submitted to a ROC analysis, which showed both sensitivity >90% and specificity >60% for two parameters, lymphocyte and monocyte SDs of volumes. A discriminator combining the two parameters showed a sensitivity of 96.9% and a specificity of 82.5%. The cut off of the discriminative value was calculated. Because of the good stability and reproducibility of the parameters selected, the test can be used in order to detect patients having a high probability to be malaria positive and to pay particular attention to these blood smears. For more extensive diagnostic use, a standard control procedure of the positional parameters should be introduced.

STD trends and patterns of treatment for STD by physicians in private practice in Peru.

OBJECTIVES: To describe trends in STD visits to physicians in private practice in Peru over a 15 year period and in the patterns of treatments used for STD. METHODS: IMS Health conducts for pharmaceutical marketing purposes surveys of a random cluster sample of 1.63% of practising physicians in Peru, stratified by region and specialty. Physicians record details of diagnoses and treatments for all patients seen during a 7 day period every 6 months. Data collected on selected STD syndromes were retrospectively reviewed over a 15 year period. RESULTS: The number of first visits for pelvic inflammatory disease (PID) and trichomoniasis, and total visits for genital herpes increased from 1983-5 to 1996-7; while first visits for gonorrhoea and total visits for syphilis have changed little in recent years. Treatment for gonorrhoea usually involved the use of spectinomycin or an aminoglycoside only. Treatments offered for PID were remarkably inadequate and for trichomoniasis often involved products not known to be effective for trichomoniasis or other causes of vaginal discharge. CONCLUSIONS: This form of active surveillance provides information potentially useful to guide policies for prevention and management of STDs and HIV infections in developing countries.

Alcohol effects on the principal and clear cells of the caput epididymis of albino rats.

Ultrastructural observations of principal cells of the epithelium lining of the proximal caput epididymis in experimental alcoholic albino rats at 180 days of treatment showed pyknotic nuclei, ill-defined cellular organelles and clusters of electrondense bodies, perhaps lysosomes. It was also verified for a progressive accumulation of lipid droplets initially in the basal and perinuclear cytoplasm and finally in the apical cytoplasm of principal cells at 60, 120 and 180 days of experimentation, respectively. The clear cells of alcoholic rats at 180 days showed the cytoplasm totally filled with lipid droplets. These findings were taken comparatively with the morphological features of the same epididymal cells in control (normal) rats.

Ultrastructural study of the cheek oral mucosa of rats submitted to experimental chronic alcoholism.

Ultrastructural features of the cheek oral mucosa of rats (Rattus norvegicus) submitted to experimental chronic alcoholism were studied by transmission electron microscopy. Sixty male rats aged three months and with a mean body weight of 250 g were divided into two experimental groups. The control group received a solid diet (Purina rat chow) and tap water ad libitum. The alcoholic group received the same solid diet but was only allowed to drink sugar cane liquor dissolved in 30 degrees Gay Lussac (v/v). The animals of the two groups were weighed and sacrificed after 60, 120, and 180 days of treatment. Samples of the oral mucosa from the cheek region were dissected and processed for ultrastructural analysis. The results showed cell alterations in the basal and intermediate layer of the mucosal epithelium. The most frequent alterations observed were an increased intercellular space, the presence of lipid droplets in the cytoplasm, and irregular nuclei with a pyknotic aspect.