Severe Allergy as a Chronic Inflammatory Condition From a Systems Biology Perspective.

Persistent and unresolved inflammation is a common underlying factor observed in several and seemingly unrelated human diseases, including cardiovascular and neurodegenerative diseases. Particularly, in atopic conditions, acute inflammatory responses such as those triggered by insect venom, food or drug allergies possess also a life-threatening potential. However, respiratory allergies predominantly exhibit late immune responses associated with chronic inflammation, that can eventually progress into a severe phenotype displaying similar features as those observed in other chronic inflammatory diseases, as is the case of uncontrolled severe asthma. This review aims to explore the different facets and systems involved in chronic allergic inflammation, including processes such as tissue remodelling and immune cell dysregulation, as well as genetic, metabolic and microbiota alterations, which are common to other inflammatory conditions. Our goal here was to deepen on the understanding of an entangled disease as is chronic allergic inflammation and expose potential avenues for the development of better diagnostic and intervention strategies.

Human red blood cell polymorphisms prevalent in Colombian population and its protective role against malaria.

The populations infected with malaria have developed genetic defense mechanisms in order to protect themselves against the most serious complications of this disease. Those mechanisms have been associated from the perspective of co-adaptive process with some genetic diseases widely present in humans as sickle-cell disease, sickle cell trait and glucose-6-phosphate dehydrogenase deficiency (G6PD). Biochemically, polymorphic mutations at the erythrocyte level have been widely studied, however there is no clear statement of the mechanisms used for resistance against the causative agent of malaria. The purpose of this review is to introduce the molecular and biochemical basis of defense mechanisms associated with two of those adaptations: sickle-cell trait and Glucose-6-phosphate Dehydrogenase Deficiency (G6PD). The first one is a hemoglobinopathy while the second one is the most frequent enzymopathy present in humans.

Tratamiento transdisciplinario del linfedema mediante terapia físico-combinada compleja. Análisis de nuestra experiencia / Complex physical-combined decongestion therapy in lymphedema: Analysis of our experience

INTRODUCCIÓN: El tratamiento actual del linfedema se realiza por un equipo transdisciplinario y con terapia físico-combinada descongestiva compleja. OBJETIVO: Evaluar la respuesta a las primeras 10 sesiones continuas de terapia físico-combinada compleja, en pacientes con linfedema de las extremidades inferiores. MÉTODO: Se analizan 20 pacientes ingresados por linfedema con compromiso del miembro inferior. Se comparó el porcentaje de reducción del edema, en función de la perimetría realizando 9 mediciones en el miembro inferior tomadas al ingreso y al finalizar las 10 sesiones, más cálculos de volumetría. Los pacientes fueron tratados con terapia físico-combinada descongestiva compleja: drenaje linfático manual, vendaje multicapa y ejercicios miolinfokinéticos. RESULTADOS: Los pacientes varones que cumplieron terapia descongestiva compleja completa redujeron su perimetría en un 5,2% y las mujeres en un 6,2%, la volumetría disminuyó en un 8,7% para los hombres y en un 13,6% para las mujeres. CONCLUSIÓN: Para obtener un óptimo resultado en corto tiempo (10 sesiones), especialmente para pacientes que residen alejados de nuestro centro, se requiere hacer terapia descongestiva compleja completa

INTRODUCTION: Lymphedema treatment is being currently being performed by a multi-disciplinary health team using a complex physical-combined decongestion therapy. OBJECTIVE: To evaluate patient response to the first 10 sessions of a complex physical-combined decongestion therapy to treat lower-limb lymphedema. METHOD: Twenty patients with lower-limb lymphedema were evaluated and treated with 10 sessions of a complex physical-combined decongestion therapy, which includes: manual lymphatic drainage, multi-layer bandage and mio- lymphatic kinetic exercises. The edema reduction percentage was compared, based on the lower limb perimeter by evaluating 9 measurements s taken at the beginning and at the end of the sessions cycle, along with volumetric calculations. RESULTS: Male patients that completed the therapy showed a 5.2% decrease in their lower limb perimeter, while female patients showed a 6.2% decrease. Volumetric measurements decreased by 8.7% in males and 13.6% in females. CONCLUSION: To achieve an optimal result in a short period of time (10 sessions), a complex physical-combined decongestion therapy is required

Conocimiento y actitud frente a exposición solar del personal de salud en Atención Primaria, comuna Recoleta, Santiago, Chile / Knowledge and attitude regardings sun exposure in the workers from primary health care, district of Recoleta, Santiago, Chile

Skin cancer rates have increased worldwide despite the current prevention measures. It’s crucial to evaluate people’s knowledge, attitudes, and behaviour regarding sun exposure. Objective: To assess the knowledge and attitudes regarding sun exposure in the workers from primary health care. Method: 223 workers from three Family Care Centres(CESFAM) and from one Primary Emergency Service (SAPU) in the district of Recoleta were surveyed between the months of October and November 2015. Fisher’s exact test and Chi square test were used for statistic analysis. The survey included questions about demographic variables, knowledge of the association between sun radiation/skin cancer and attitudes towards sun protection. Results: the sample consists of 74 men and 149 women, with a mean age of 37 years ±SD 7.9. Phototype III was the most common (41.3percent). The majority of the surveyed declared to be aware of the association between sun exposure and skin cancer (93.3percent). As photoprotecting measures, sunscreens (87.4percent) and seeking shade (71.3percent) were the most frequently measures used. Regarding sunburns, 91.9percent declared to have at least one during their lifetime, 21.5percent occurring during the previous summer. As to the use of sunscreen, 42.1percent referred only using while at the pool / beach and 12.6percent declared not to use it at all. As for health promotion, 29.1percent declared they never recommend the use of sun protection measures in their working practice. Discussion: Although there is adequate knowledge regarding the effects of sun exposure, it doesn’t always reflect on favourable attitudes and photoprotecting measures. There was a significantly greater amount of females with adequate knowledge and use of sun protection measures. This study is one of the first to assess photoprotection behaviour in health care workers.

Síndrome de Buschke-Ollendorf: reporte de un caso y revisión de la literatura / Buschke-Ollendorf syndrome: a case report and literature review

El Síndrome de Buschke-Ollendorf es una rara entidad, descrita por primera vez en 1928. Se caracteriza por la asociación de nevos del tejido conjuntivo y osteopoiquilia. Es una patología de origen multifactorial. Causas genéticas han sido descritas. Dado que es una enfermedad benigna y que no se ha demostrado asociación con otras patologías, no requiere tratamiento y tiene buen pronóstico. Su importancia radica en el diagnóstico diferencial respecto de otras patologías complejas y severas. Se presenta el caso de una niña de 8 años de edad, que presenta desde los 2 años lesiones papulares en región glútea y zona lumbar izquierda, cuyo estudio histológico evidencia nevos de tejido conectivo. Presenta estudio radiológico que muestra la presencia de imágenes sugerentes de osteopoiquilia en fémur y cadera. La asociación de ambas entidades clínicas configura el diagnóstico de Síndrome de Buschke-Ollendorf. Se presenta el caso clínico y revisión de la literatura.

The Buschke-Ollendorf syndrome is a rare entity, first described in 1928 and is characterized by the association of connective tissue nevi and osteopoikilosis. It´s a disease of multifactorial origin. Genetic causes have been described. Since it is a benign disease and no association with other diseases have been proved, it doesn´t require treatment and has a good prognosis. It´s importance lies in the differential diagnosis with other complex and severe pathologies. We present the case of an 8-year-old girl with long lasting papular lesions in left buttock and lower back, which histological study showed connective tissue nevi. The radiological study showed suggestive images of osteopoikilosis in femur and hip. The association of both clinical entities suggest the diagnose of Buschke-Ollendorf syndrome. Clinical case and review of the literature is presented.

Factores asociados al desarrollo de complicaciones en pancreatitis aguda en niños / Associated factors to complications in acute pancreatitis in children

Introducción. La pancreatitis aguda es una enfermedad poco frecuente en pediatría, y que no cuenta con un sistema adecuado para predecir gravedad. Objetivo: determinar las variables más frecuentes que se asocian a complicaciones de pancreatitis aguda en niños. Métodos. Se revisaron expedientes de pacientes menores de 17 años que fueron hospitalizados de enero de 2001 a diciembre de 2006 con pancreatitis aguda. Se analizaron sus características demográficas, la presencia o no de complicaciones, estado nutricional y tipos, y duración de intervenciones nutricionales. Resultados. De 181 expedientes revisados, 47 cumplieron con criterios de inclusión; 30% correspondieron al sexo masculino, con una media de edad de 8.7 ± 4 años. El peso para la talla fue de 106 ± 21% y el índice de masa corporal (IMC) de 17 ± 3 kg/ m² (zIMC: 0.031 ± 0.21), 13% de pacientes tuvieron sobrepeso, con un peso para la talla (P/T) mayor a 110%; 38% desarrollaron complicaciones y se registraron 2 muertes. Los pacientes con complicaciones vs los que no las tuvieron, mostraron diferencia en P/T, IMC y zIMC (P <0.01), pero no en otros parámetros medidos. El apoyo nutricio se inició en promedio a los 5.7 días con nutrición parenteral total en 89% de los casos, y la vía enteral a los 13 ± 10 días. Conclusiones. En nuestro estudio, casi la mitad de pacientes con pancreatitis aguda tuvo una enfermedad oncológica de base, y etiología farmacológica en 57% de los casos. De los factorespronósticos analizados, no hubo diferencia estadísticamente significativa en leucocitos séricos y en concentraciones plasmáticas de amilasa y lipasa entre pacientes con y sin complicaciones, y el mayor número de complicaciones de pancreatitis aguda se detectó en los pacientes con mayor P/T e IMC; esta asociación orienta al diseño de escalas pronósticas que incluyan estas variables.

Introduction. Acute pancreatitis is an uncommon disease in childhood that lacks an adequate scale for predicting disease severity. The objective of this study was to determine the main factors that predict severe acute pancreatitis. Methods. A chart review of children under 17 years of age hospitalized with diagnosis of acute pancreatitis from January 2001 to December 2006 was conducted. Demographics, local and systemic complications, nutritional status and nutritional support were analyzed. Results. Forty-seven patients were included with a mean age of 8.7 ± 4 years. Weight for height (W/H) was 106 ± 21% and BMI 17.3 kg/m² (zBMI 0.031 ± 0.21); 13% of patients were overweight, with W/H greater than 110%. Thirty-eight percent of patients developed complications; these patients, compared with patients without complications, showed a difference in W/ H, BMI and zBMI (P <0.01), but not in other parameters. Nutritional support started on average at 5.7 days with parenteral nutrition in 89% of cases, and enteral feeding after 13 ± 10 days of fasting. Conclusion. In our study, more than 50% of patients had oncological diseases, and 57% presented pharmacological etiology. Prognosis factors were analyzed and no statistical differences in serum leucocytes, amylase and lipase were found between patients with or without complications; most complications were found in patients with higher W/H and BMI. This association suggests that future prognosis scales of acute pancreatitis in children should include these variables.

Leucoencefalopatía hipóxico-isquémica retardada: caso clínico y revisión de la literatura / Hypoxic-ischemic delayed leukoencephalopathy: case report and review of the literature

Delayed Hypoxic-isquemic Leucoencephalopathy described in 1976 by Ginsberg is a brain white matter demyelinization phenomenon that occurred days or weeks after a hypoxic-isquemic injury followed by a complete recovery of the episode. The pathogenesis process remains unknown. We describe a 48 year old woman with cervico-uterine cancer in palliative treatment with opoids. She enters the emergency room with a respiratory depression, a prolonged hypotension and confusion, that it was recovered. At admission exhibits a recurrent pneumonia. Two weeks later, in conditions of discharge, initiates with agitation in context with rapidly progressive decline cognition, with concordant lesions of Leucoencephalopathy defined in the Magnetic Resonance (MR) study The metabolic profile, the cerebrospinal fluid and the electroencephalogram allowed dismissing other etiologic hypothesis. In front to the suspicious of Ginsberg syndrome, she had normal levels of Arylsulfatase. This acute post-hypoxic demyelinization process has been pathogenic interpreted as an arylsulfatase deficiency. Although numerous cases develop with normal arylsulfatase and the experimental studies of hypoxia, has support the hypothesis of a central hypoxic axonopathy due to failing in axonal transport as the base of the demyelinization phenomenal.

La leucoencefalopatía hipóxico-isquémica retardada (EHIR), descrita por Ginsberg en el año 1976, es un fenómeno desmielinizante de la sustancia blanca cerebral, que se origina días o semanas después de un daño hipóxico-isquémico que había sido seguido de una recuperación completa del episodio. La patogenia del proceso no está completamente establecida. Se presenta una mujer de 48 años portadora de cáncer cérvicouterino, en tratamiento paliativo con opiáceos. Ingresa al Servicio de Urgencia por una depresión respiratoria, hipotensión prolongada y compromiso de conciencia, donde es recuperada. Se hospitaliza por una neumopatía intercúrrente. Dos semanas más tarde, estando en condiciones de alta, se inicia agitación psicomotora en el contexto de un deterioro cognitivo rápidamente progresivo, que el estudio de Resonancia Magnética (RM) definió como lesiones concordantes con una leucoencefalopatía. El perfil metabólico, el líquido cefalorraquídeo y el electroencefalograma, permitieron descartar otras hipótesis etiológicas. Frente a la sospecha de un síndrome de Ginsberg, los niveles de arilsulfatasa fueron normales. Este proceso desmielinizante agudo post-hipóxico, ha sido interpretado patogénicamente como un déficit de arilsulfatasa. Sin embargo, la existencia de numerosos casos que cursan con arilsulfatasa normal y los estudios experimentales de hipoxia, ha avalado la hipótesis de una axonopatía central hipóxica, atribuible a fallas del transporte axoplásmico, como base para el fenómeno desmielinizante.

Síndrome de Lance-Adams: presentación de dos casos / Lance-Adams syndrome: report of two cases

Lance-Adams syndrome was described in 1963 is a rare complication due to recovered hypoxic episodes or prolonged hypotension events. Is characterized by action myoclonus and cerebellar ataxia. We report two patients studied with this syndrome. A 51 year-old men and a 72 years-old men fully recovered after a brief cardiorespiratory arrest they developed intention myoclonus, triggered by voluntary movements, posture, also by sounds, touches and emotional stimuli. It also was accompanied by cerebellar syndrome, ataxia and posture control alterations. They had a Magnetic Resonance (MR), EEG and normal metabolic parameters. Myoclonus was treated with sodium valproate and clonazepam. The neurophysiologic interpretation of this motor imbalance is an abnormal functioning of the Central Pattern Generator Netwoks (CPGN) located in the mesencephalic region. Hypoxic lesions in vermian purkinje and paravermal cerebellum neurons have an inhibitory effect in this system, producing motor control attenuation, generating an imbalance in the motoneurons of the spinal cord contraction sequence, which starts shooting in an uncoordinated way. As in almost all cerebellar lesions with time they tend to compensate and to diminish myoclonus.

El Síndrome de Lance-Adams descrito en 1963, es una rara complicación que sigue tardíamente a episodios hipóxicos o de hipotensión prolongada, ya recuperados. Se caracteriza por mioclonías de acción y ataxia cerebelosa. Se describen dos pacientes estudiados con este síndrome. Son dos hombres de 51 y 72 años que después de un paro cardiorrespiratorio breve, de recuperación completa, iniciaron mioclonías de intención, activadas por movimientos voluntarios, posturas, estímulos sonoros, táctiles y afectivos. Acompañado además de un síndrome cerebeloso, ataxia de la marcha y alteraciones del control postural. Cursaron con RM (Resonancia Magnética), EEG (Electroencefalograma) y parámetros metabólicos sin relevancia patológica. Las mioclonías fueron controladas con ácido valproico y clonazepam. La interpretación neurofisiológica de este desajuste motor es la alteración en el funcionamiento del patrón central de circuitos generadores (PCCG) ubicado en la región mesencefálica. Las lesiones hipóxicas de las neuronas de Purkinje del vermis y paravermianas del cerebelo, que tienen un efecto inhibitorio para este sistema, producen una atenuación del control motor del PCCG, generando desajuste en la secuencia de la contracción de las motoneuronas de la médula espinal, que comienzan a dispararse de manera independientemente. Como ocurre con la mayoría de las lesiones cerebelosas, con el tiempo tienden a compensarse y por consiguiente a disminuir las mioclonías.

Pseudo-infarto cerebral como primera manifestación de un MELAS tardío / Stroke-like as the first debut late onset MELAS

MELAS is an acronym for the convergence of mitochondrial myopathy, encephalopathy lactic acidosis and stroke like episodes. It was described by Pavlakis et al. in 1984.This is a genetic disease caused by mutations in the maternal mitochondrial genome, affecting the adenosine triphosphate (ATP) synthesis. The mutations have heteroplasmic loads on different tissues, which could specially involve those highly energy-dependent such as muscles, brain and CNS tissues. We describe a 33 year old female presenting migraine headaches associated to stroke-like episodes, related to an infection. Neurological manifestations include language and visual disturbances. The magnetic resonance imaging (MRI) showed low-intensity areas, predominantly in the temporal, parietal and occipital left lobes. She further presented a status epilepticus. The complementary study shows elevated basal and post exercise lactic acidosis, ragged red fibers in the muscle biopsy, and the mutation of A3243G in the mitochondrial genome. Her asymptomatic mother and sister showed ragged red fibers in muscle biopsy. The patient showed clinical and radiological features improvement, maintaining non epileptic slow focal occipital discharges in the electroencephalogram. The assumption is that this mitochondrial disorder could be more frequent than detected in our medium, given that a significant number of women could be just asymptomatic bearers (Like the patient's mother and sister). This pathology should always be assessed in patients less than 40 years of age with strokes, regardless whether they have family history with the disease.

MELAS es un acrónimo inglés que define la convergencia de miopatía mitocondrial, encefalopatía, acidosis láctica y episodios de pseudo-infarto cerebral, descrita por Pavlakis et al, en 1984. Es una enfermedad mitocondrial originada por mutaciones en el genoma mitocondrial materno. Se afectan las funciones aeróbicas como consecuencia del déficit que se produce en la generación de adenosina trifosfato (ATP). El compromiso de los distintos tejidos es variable, debido a la heteroplasmia de la mutación, aunque preferentemente se suelen dañar el tejido muscular y el sistema nervioso central, tejidos con mayores requerimientos energéticos. Presentamos una paciente de 33 años que inicia su enfermedad con un síndrome jaquecoso, seguido de un episodio de pseudo infarto cerebral, en relación a un cuadro infeccioso. Clínicamente, evolucionó con alteraciones visuales y del lenguaje que eran concordantes con las áreas de hipointensidad en ambas cortezas temporales y en la corteza del lóbulo parietal y occipital izquierdo, vistas en la Resonancia Magnética. Varios días después de su ingreso cursó con un estatus epiléptico. Su estudio demostró aumento de la lactoacidemia de reposo (39,7) y de esfuerzo (89,4). En la biopsia muscular se observó la presencia de fibras rojas raídas, al igual que en su madre y hermana menor, ambas asintomáticas. El análisis genético demostró la presencia de la mutación A3243G del genoma mitocondrial, estimada en un 26 por ciento del total. La paciente mejoró espontánea y completamente en lo clínico y radiológico, sólo mantuvo una actividad lenta occipital izquierda, de carácter no epiléptico. Se presume que esta alteración mitocondrial podría ser más frecuente de lo detectado en nuestro medio, porque numerosas mujeres podrían ser sólo portadoras asintomáticas (como la madre y hermana de la paciente). Es una patología que debiera investigarse siempre en los accidentes vasculares de jóvenes menores de 40 años, aunque no tengan antecedentes familiar.

Síndrome de Eisenmenger y embarazo / Eisenmenger syndrome and pregnancy

ANTECEDENTES: El embarazo está contraindicado en toda paciente con hipertensión pulmonar, y particularmente en aquellas con síndrome de Eisenmenger. OBJETIVO: Describir 3 casos de embarazadas con síndrome de Eisenmenger, tratadas con sildenafil. RESULTADOS: El desarrollo del embarazo se complicó en las tres pacientes con parto prematuro, a las 30, 28 y 35 semanas, respectivamente. En 2 pacientes el parto se resolvió mediante operación cesárea. No hubo mortalidad materna ni perinatal. CONCLUSIÓN: El síndrome de Eisenmenger es de alto riesgo de morbimortalidad materno-perinatal y el manejo multidisciplinario optimiza los resultados. Se describe el uso de sildenafil.

BACKGROUND: Pregnancy in contraindicated in patient with pulmonary hypertension, especially in dose with Eisenmenger syndrome. OBJECTIVE: To present 3 cases of pregnancy in patients with Eisenmenger syndrome treated with sildenafil. RESULTS: The pregnancy becomes complicated in the 3 cases, with premature delivery at 30, 28 and 35 weeks respectively. Cesarean delivery was performed in two cases. There was no maternal or perinatal mortality. CONCLUSION: The Eisenmenger syndrome is a high risk condition of maternal-perinatal morbimortality and the multidisciplinary handling optimizes the results. The sildenafil use is described.

Attitudes of general dental practitioners in Europe to the microbial risk associated with dental unit water systems.

UNLABELLED: Dental Unit Water Systems (DUWS) are used in dental practices to provide water for cooling of dental equipment and irrigation of the oral cavity. However, they have been demonstrated to be contaminated with micro-organisms. There are currently no European Union (EU) Commission guidelines for the microbial quality of water discharged by DUWS. This study was part of an EU research programme to investigate the microbial contamination of DUWS in general dental practice (GDP) in the UK, Denmark, Germany, The Netherlands, Ireland, Greece and Spain. OBJECTIVE: To undertake a questionnaire survey on the type of DUWS in use and determine the attitude of GDPs to the risk of microbial infection from DUWS. MATERIALS AND METHODS: The questionnaire was written and translated into the language of each country before being posted to each participating dentist. Dentists were asked to complete the questionnaire survey and return it by post. RESULTS AND CONCLUSIONS: The major findings were that the majority of dentists did not clean, disinfect or determine the microbial load of their DUWS, and that dentists would welcome regular monitoring and advice on maintaining their DUWS; the introduction of guidelines; and recommendations on controlling the microbial load of DUWS.

Comparison of the efficacies of disinfectants to control microbial contamination in dental unit water systems in general dental practices across the European Union.

Water delivered by dental unit water systems (DUWS) in general dental practices can harbor high numbers of bacteria, including opportunistic pathogens. Biofilms on tubing within DUWS provide a reservoir for microorganisms and should be controlled. This study compared disinfection products for their ability to meet the American Dental Association's guideline of <200 CFU x ml(-1) for DUWS water. Alpron, BioBlue, Dentosept, Oxygenal, Sanosil, Sterilex Ultra, and Ster4Spray were tested in DUWS (n = 134) in Denmark, Germany, Greece, Ireland, The Netherlands, Spain, and the United Kingdom. Weekly water samples were tested for total viable counts (TVCs) on yeast extract agar, and, where possible, the effects of products on established biofilm (TVCs) were measured. A 4- to 5-week baseline measurement period was followed by 6 to 8 weeks of disinfection (intermittent or continuous product application). DUWS water TVCs before disinfection ranged from 0 to 5.41 log CFU x ml(-1). Disinfectants achieved reductions in the median water TVC ranging from 0.69 (Ster4Spray) to 3.11 (Dentosept) log CFU x ml(-1), although occasional high values (up to 4.88 log CFU x ml(-1)) occurred with all products. Before treatment, 64% of all baseline samples exceeded American Dental Association guidelines, compared to only 17% following commencement of treatment; where tested, biofilm TVCs were reduced to below detectable levels. The antimicrobial efficacies of products varied (e.g., 91% of water samples from DUWS treated with Dentosept or Oxygenal met American Dental Association guidelines, compared to 60% of those treated with Ster4Spray). Overall, the continuously applied products performed better than those applied intermittently. The most effective products were Dentosept and Oxygenal, although Dentosept gave the most consistent and sustained antimicrobial effect over time.

Análisis de la visión próxima en el ámbito laboral mediante un test de alta precisión / Near vision assessment in occupational medicine through a high-precision near visual acuity test

La agudeza visual constituye un parámetro básico en la salud laboral. Los requisitos visuales para el desempeño de los distintos trabajos y profesionales están basados fundamentalmente en la visión lejana. Sin embargo, muchos cometidos de las modernas profesiones exigen un eficiente rendimiento visual en visión próxima. En su consecuencia, hemos iniciado una investigación del comportamiento del parámetro agudeza visual próxima en un colectivo constituido por 200 técnicos de mantenimiento de aviones, profesión de alto requerimiento visual, y en un grupo de sujetos jóvenes representado por 100 tripulantes de cabina de pasajeros, mediante la aplicación del test de kamiya-uozato. En función de la edad y de la pertenencia al grupo profesional, se han observado distintas respuestas. Se propone el test de kamiya-uozato como una herramienta útil en los reconocimientos preventivos de salud laboral

Visual acuity represents a fundamental parameter in occupational medicine. The visual acuity requirements form different tasks and occupations are mainly dependent on distant visual acuity; however, many tasks in modern occupations demand efficient visual performance in near vision. We have carried out an investigation of near visual acuity among a population comprising 200 Groundcrew maintenance technicians, an occupation with high visual demands, and 100 young stewardesses, using the Kamiya-uozato test. Varying responses were observed depending on age and occupational group. The kamiya-uozato test in proposed as a useful tool for near vision performance checking in occupational health preventive screenings

Efectos de la exposición al humo de tabaco ambiental en no fumadores / Effects in passive smokers of environmental tobacco smoke exposure

National and international environmental tobacco smoke studies were reviewed regarding its effects on passive smokers' health. Environmental tobacco smoke is composed by more than 4,000 known substances, which are different if they are in the mainstream or sidestream. Studies with biomarkers like cotinine have concluded that exposed nonsmokers have an increased cardiovascular morbi-mortality. Passive smokers also have an increased risk of lung, nasal sinus and breast cancer. Children have more acute and chronic respiratory symptoms, low respiratory infections, otitis and sudden infant death syndrome. Environmental tobacco smoke induces asthma and causes exacerbations in both children and adults. In reproductive health, it decreases the age of menopause and produces menstrual disorders. Newborn infants of passive smoking mothers have a higher probability of low birth weight and to be small for gestational age. This international scientific evidence should lead countries to take measures in order to protect nonsmokers' health.

Se realizó una revisión de los estudios nacionales e internacionales sobre los efectos del humo de tabaco ambiental en la salud de los fumadores pasivos. El humo de tabaco ambiental está conformado por más de 4.000 sustancias químicas, las que difieren cuali y cuantitativamente al estar presentes en la corriente principal o en la lateral. Los no fumadores expuestos presentan un aumento de morbi-mortalidad por enfermedad cardiovascular, incluso con estudios con biomarcadores como cotinina. Además los fumadores pasivos tienen un riesgo aumentado de presentar cáncer de pulmón, de senos paranasales y mama. En niños existe un mayor número de síntomas respiratorios agudos y crónicos, infecciones respiratorias bajas, otitis media y síndrome de muerte súbita infantil. El humo de tabaco ambiental favorece la inducción y exacerbación de asma bronquial en niños y adultos. En la salud reproductiva, disminuye la edad de aparición de la menopausia y produce desórdenes menstruales. Los recién nacidos hijos de madres fumadoras pasivas tienen mayor probabilidad de nacer con bajo peso o de ser pequeños para la edad gestacional. La evidencia científica internacional debe contribuir a que los países tomen medidas para proteger la salud de los no fumadores.

Microbiological evaluation of dental unit water systems in general dental practice in Europe.

A range of opportunistic pathogens have been associated with dental unit water systems (DUWS), particularly in the biofilms that can line the tubing. This study therefore aimed to assess the microbiology of DUWS and biofilms in general dental practices across seven European countries, including the United Kingdom (UK), Ireland (IRL), Greece (GR), Spain (ES), Germany (D), Denmark (DK) and the Netherlands (NL). Water supplied by 51% of 237 dental unit water lines exceeded current American Dental Association recommendations of < or = 200 colony-forming units (CFU) ml(-1). Microbiological loading of the source waters was between 0 (Denmark, the Netherlands and Spain) and 4.67 (IRL) log CFU ml(-1); water line samples from the DUWS ranged from 1.52 (ES) to 2.79 (GR) log CFU ml(-1); and biofilm counts ranged from 1.49 (GR) to 3.22 (DK) log CFU.cm(-2). Opportunistic pathogens such as legionellae (DK and ES), including Legionella pneumophila SG1 (DK and GR), and Mycobacterium spp. (DK, NL, GR, D and ES) were recovered occasionally. Presumptive oral streptococci (ES and NL), oral anaerobes (GR), Candida spp. (UK, NL and ES) and blood (GR and IRL) were detected at relatively low frequencies, but their presence indicated a failure of the 3-in-1 antiretraction valve, leading to back siphonage of oral fluids into the water and biofilm phase. These findings confirm that a substantial proportion of DUWS have high levels of microbial contamination, irrespective of country, type of equipment and source water. The study emphasizes the need for effective mechanisms to reduce the microbial burden within DUWS, and highlights the risk of occupational exposure and cross-infection in general dental practice.

Las introducciones de peces exóticos ornamentales y sus afectaciones a la ictiofauna larvívora nativa en el municipio de Yaguajay, Sancti-Spíritus, Cuba

Los peces larvívoros realizan una importante función como consumidores de larvas de mosquitos, causantes de la propagación de archiconocidas arbovirosis y parasitosis al hombre cuando alcanzan la fase adulta. Este método de control se utiliza en Cuba con resultados satisfactorios debido a la abundancia y amplia distribución de los peces que participan en el ictiocontrol, sin embargo, como consecuencia de las introducciones de peces exóticos ornamentales en criaderos de mosquitos, la ictiofauna larvívora autóctona está siendo afectada, situación que se ha incrementado notablemente, pudiendo observarse en reservorios de las provincias occidentales y centrales del país, lo cual motivó a realizar un estudio que permitiera conocer las afectaciones que pudieran estar ocasionando estos intrusos a la ictiofauna nativa. El trabajo se realizó en 20 acuatorios habituales de mosquitos controlados por peces en el municipio Yaguajay, provincia de Sancti - Spiritus, durante los períodos lluvioso y poco lluvioso del año 2002; se colectaron ocho especies de peces, observándose en el 45 por ciento de los criaderos, la especie ornamental introducida identificada como Xiphophorus maculatus Günther, 1866, además de Tilapia sp, y Eucinostomus jonesi (Günther, 1879) conocida como mojarra. Comparando los resultados de esta investigación con los obtenidos en estudios anteriores (años 1985 al 1995) pudo comprobarse que en algunos de los acuatorios hubo pérdida de especies y/o estaban en baja densidad, siendo Gambusia punticulata Poey, 1854 la más perjudicada, estas afectaciones a la ictiofauna se pudo corroborar por medio del análisis del contenido estomacal realizado a los peces advenidizos, reafirmándose que estos entran en competencia con los nativos.

Antioxidant properties of dipyridamole as assessed by chemiluminescence.

The ability of dipyridamole (DIP) to scavenge oxygen metabolites generated by either activated human neutrophils (PMNs) or cell-free systems using luminol(s)- and lucigenin-enhanced chemiluminescence was investigated. In the presence of DIP (15-50 microM) a dose-dependent inhibition period was seen in phorbol myristate acetate (PMA)-stimulated PMNs as assayed by isoluminol-enhanced chemiluminescence (ILCL) with horseradish peroxidase (HRP). Although such a lag period was not observed in the absence of HRP, 50 microM DIP inhibited extracellular ILCL by more than 50%. Intracellular luminol-enhanced chemiluminescence (LCL) as assayed in either PMA- or in ionomycin-activated PMNs was not affected by dipyridamole (15-50 microM). In cell-free systems, DIP produced concentration-dependent inhibition in H2O2-(45% at 50 microM), OH- (40%, at 0.1 microM) and HOCl-(20% at 10 microM). Both absorbance and fluorescence scans revealed that DIP is able to react with equimolar quantities of either H202 or HOCl. These results suggest that DIP scavenges reactive oxygen species (ROS) presumably secreted by activated human PMNs in the following decreasing order: *OH > HOCl > H2O2 >> O2-.

Espatulas de thierry versus forceps de kjelland

Presentamos la experiencia y evolución del parto instrumentado en nuestro Servicio de Obstetricia y Ginecología, en los últimos once años 1992-2002. La evidencia demostró que respecto de las lesiones maternas y fetales, las Espátulas (ET), o instrumento no articulado de la clasificación general de los fórceps (F), son significativamente menores cuando se las compara con el fórceps articulado y fenestrado de Kjelland o Kielland (FK), por lo que se sugiere su conocimiento y adiestramiento en los Servicios de la especialidad, y cambiar el concepto de la presa del cráneo-fetal o biparieto malar por la toma libre facio malar.

Conservation of phage reference materials and water samples containing bacteriophages of enteric bacteria.

The survival was determined in different conservation conditions of: somatic coliphages, F-specific RNA bacteriophages and phages infecting Bacteroides fragilis proposed as model micro-organisms for water quality control. Titres of phages of all groups either in pure culture phage suspensions or in naturally occurring phage suspensions were stable at (-70+/-10) degrees C and at (-20+/-5) degrees C when protected with glycerol. Moreover, phage analysis of stored suspensions demonstrated that their numbers were homogeneous, both between vials and within vials, and consequently they can be used as reference materials. Furthermore, changes in the storage temperature of the vials cause unpredictable changes in the numbers of bacteriophages. Consequently, phage reference materials and samples containing a quantitative number of phages must be maintained and dispatched at a constant temperature. Consequently, the results indicate that bacteriophages should be packed in dry ice during transport and storage. Finally, the number of phages in water samples stored at (5+/-3) degrees C in the dark does not decrease significantly during the first 72 h of storage. In addition, phage concentrates from natural samples obtained by adsorption-elution to cellulose nitrate filters and mixed with 10% glycerol were stable at least for 2 months at (-70+/-10) degrees C and at (-20+/-5) degrees C.

Optimisation of the ISO-method on enumeration of somatic coliphages (draft ISO 10705-2).

As part of the EU project "Bacteriophages in Bathing Waters" (January 1996-June 1999) research was carried out to optimise the method for detection and enumeration of somatic coliphages in water as described in ISO/CD 10705-2 of August 1995. It was concluded that this draft ISO standard needed to be amended in certain aspects. For determining the viable count of the host culture WG5 Escherichia coli, a membrane filtration technique should be used instead of spread plate technique as the latter gives lower and less reproducible results. A freshly prepared inoculum culture of host strain WG5 should be used instead of a frozen inoculum culture as freezing of the inoculum culture is found to negatively influence the phage counts. The double agar layer method (DAL) is preferred to the single agar layer method (SAL) for performing the phage analysis as the DAL method gives higher phage counts than the SAL method.