Consensus on the diagnosis and treatment of cow's milk protein allergy of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition.

Cow's milk protein allergy (CMPA) is the most frequent cause of food allergy in the first months of life. Despite the fact that there are different guidelines and recommendations on the management of children with CMPA, there continues to be great variability in diagnostic and therapeutic criteria in Latin America. The Food Allergy Working Group of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition summoned a group of Latin American experts to reach a consensus and formulate a document to unify diagnostic and therapeutic criteria for CMPA. Three teams were formed, each with a coordinator, and the members of each team developed a series of statements for their corresponding module: a) clinical manifestations and diagnosis; b) diagnostic tools, and c) treatment. A search of the medical literature was carried out to support the information presented in each module and 28 statements were then selected. The statements were discussed, after which they were evaluated by all the experts, utilizing the Delphi method. Their opinions on statement agreement or disagreement were anonymously issued. The final statements selected were those with above 75% agreement and their corresponding recommendations were formulated, resulting in the document presented herein.

Sociodemographic and clinical characteristics related with hyperprolactinaemia in psychiatric clinical population.

BACKGROUND: Hyperprolactinaemia (HyperPRL) induced by psychotropic drugs is a high-prevalence consequence which has repercussions in psychical and mental health in the psychiatric population, so this research had the objective to expand which sociodemographic and clinical features are associated with prolactin (PRL) elevation in patients treated with antidepressant and/or antipsychotic drugs. METHODS: An observational, cross-sectional, comparative and retrolective study was conducted on 300 patients who received clinical attention in a third level of psychiatric care unit in Mexico during 2017. These patients have been reported to show PRL levels greater than 25 ng/mL among women and greater than 20 ng/mL among men. In the same way, sociodemographic and clinical variables were collected, as well as psychiatric diagnosis and type of psychopharmacological treatment used by the patients. RESULTS: HyperPRL was more frequent in women (80.7%) than men (19.3%). The mean levels of PRL were 68.94 ± 62.28 ng/mL with higher levels in women (71.9 ± 67.3, p=.02). Regarding the treatment, 78.3%, 71.3% and 49.7% consumed antipsychotics, antidepressants, and both drugs, respectively. The relationship between hyperPRL (>100 n/mL) and typical antipsychotics was dose-dependent (33.23 ± 13.24 mg, p=.01). In the multivariate regression models according to the type of treatment, as well as the demographic and clinical features, hyperPRL was associated independently with the use of antipsychotic treatment, pituitary adenoma and hypertension (R2=0.05). CONCLUSIONS: HyperPRL is a complex clinical syndrome frequent in the psychiatric population with detrimental long-term consequences, as well as its relationship with the use of psychotropic drugs as in the case of antipsychotics. Effective actions should be implemented in the prevention, approach and treatment of this condition paying special attention to the accompanying medical comorbidities.

Serotonergic innervation of the amygdala is increased in autism spectrum disorder and decreased in Williams syndrome.

BACKGROUND: Williams syndrome (WS) and autism spectrum disorder (ASD) are neurodevelopmental disorders that demonstrate overlapping genetic associations, dichotomous sociobehavioral phenotypes, and dichotomous pathological differences in neuronal distribution in key social brain areas, including the prefrontal cortex and the amygdala. The serotonergic system is critical to many processes underlying neurodevelopment and is additionally an important neuromodulator associated with behavioral variation. The amygdala is heavily innervated by serotonergic projections, suggesting that the serotonergic system is a significant mediator of neuronal activity. Disruptions to the serotonergic system, and atypical structure and function of the amygdala, are implicated in both WS and ASD. METHODS: We quantified the serotonergic axon density in the four major subdivisions of the amygdala in the postmortem brains of individuals diagnosed with ASD and WS and neurotypical (NT) brains. RESULTS: We found opposing directions of change in serotonergic innervation in the two disorders, with ASD displaying an increase in serotonergic axons compared to NT and WS displaying a decrease. Significant differences (p < 0.05) were observed between WS and ASD data sets across multiple amygdala nuclei. LIMITATIONS: This study is limited by the availability of human postmortem tissue. Small sample size is an unavoidable limitation of most postmortem human brain research and particularly postmortem research in rare disorders. CONCLUSIONS: Differential alterations to serotonergic innervation of the amygdala may contribute to differences in sociobehavioral phenotype in WS and ASD. These findings will inform future work identifying targets for future therapeutics in these and other disorders characterized by atypical social behavior.

Gold glyconanoparticles coupled to listeriolysin O 91-99 peptide serve as adjuvant therapy against melanoma.

Dendritic cell-based (DC-based) vaccines are promising immunotherapies for cancer. However, several factors, such as the lack of efficient targeted delivery and the sources and types of DCs, have limited the efficacy of DCs and their clinical potential. We propose an alternative nanotechnology-based vaccine platform with antibacterial prophylactic abilities that uses gold glyconanoparticles coupled to listeriolysin O 91-99 peptide (GNP-LLO91-99), which acts as a novel adjuvant for cancer therapy. GNP-LLO91-99, when used to vaccinate mice, exhibited dual antitumour activities, namely, the inhibition of tumour migration and growth and adjuvant activity for recruiting and activating DCs, including those from melanoma patients. GNP-LLO91-99 nanoparticles caused tumour apoptosis and induced antigen- and melanoma-specific cytotoxic Th1 responses (P ≤ 0.5). We propose this adjuvant nanotherapy for preventing the progression of the first stages of melanoma.

Interlaboratory reproducibility and proficiency testing within the human papillomavirus cervical cancer screening program in Catalonia, Spain.

In Catalonia, a screening protocol for cervical cancer, including human papillomavirus (HPV) DNA testing using the Digene Hybrid Capture 2 (HC2) assay, was implemented in 2006. In order to monitor interlaboratory reproducibility, a proficiency testing (PT) survey of the HPV samples was launched in 2008. The aim of this study was to explore the repeatability of the HC2 assay's performance. Participating laboratories provided 20 samples annually, 5 randomly chosen samples from each of the following relative light unit (RLU) intervals: <0.5, 0.5 to 0.99, 1 to 9.99, and ≥10. Kappa statistics were used to determine the agreement levels between the original and the PT readings. The nature and origin of the discrepant results were calculated by bootstrapping. A total of 946 specimens were retested. The kappa values were 0.91 for positive/negative categorical classification and 0.79 for the four RLU intervals studied. Sample retesting yielded systematically lower RLU values than the original test (P<0.005), independently of the time elapsed between the two determinations (median, 53 days), possibly due to freeze-thaw cycles. The probability for a sample to show clinically discrepant results upon retesting was a function of the RLU value; samples with RLU values in the 0.5 to 5 interval showed 10.80% probability to yield discrepant results (95% confidence interval [CI], 7.86 to 14.33) compared to 0.85% probability for samples outside this interval (95% CI, 0.17 to 1.69). Globally, the HC2 assay shows high interlaboratory concordance. We have identified differential confidence thresholds and suggested the guidelines for interlaboratory PT in the future, as analytical quality assessment of HPV DNA detection remains a central component of the screening program for cervical cancer prevention.

Valoración de los resultados del Plan Oncológico 2007-2010 de la Comunidad Valenciana: el punto de vista de los pacientes, familiares, ciudadanos y profesionales / Results assessment of the Valencian Community Cancer Plan: The point of view of patients, relatives, citizens and professionals

Objetivo. Analizar la percepción de los resultados alcanzados por el Plan Oncológico de la Comunidad Valenciana (POCV) desde el punto de vista de sus agentes clave: pacientes, familiares de pacientes, ciudadanos y profesionales sanitarios. Métodos. Estudio descriptivo en el que se combinó un análisis cualitativo (2 entrevistas grupales con 34 participantes y 4 grupos focales con 37 participantes) y otro cuantitativo (470 encuestas de opinión). Resultados. La propia existencia de un POCV se destacó como factor positivo. Se ha conseguido que, entre la población, se transmita el mensaje de que el cáncer es «curable». Se han definido objetivos clave, unificado criterios y que los comités de tumores y las comisiones contribuyan, en mayor medida, a realizar una asistencia multidisciplinar. Se consideró innovador el POCV especialmente por la introducción del Programa de Consejo Genético. Los representantes de asociaciones ciudadanas y de pacientes consideraron el Programa de Prevención de Cáncer de Mama el más conocido y mejor valorado y el Programa de Cáncer Colorrectal el menos conocido. Tanto en los grupos cualitativos como en la consulta realizada a profesionales, los aspectos mejor valorados fueron los comités de tumores, la recomendación de la citología vaginal para la prevención del cáncer de cérvix o que se haya transmitido a la población que el cáncer puede curarse, son aspectos valorados positivamente. Conclusiones. Las valoraciones del POCV 2007-2010 son positivas en términos generales, con excepciones puntuales claramente identificadas. La información de tipo cualitativo y cuantitativo obtenida en los distintos análisis es prácticamente coincidente(AU)

Objective. To assess stakeholders’ perceptions (i.e. patients, relatives, the public, and professionals) about results of the Valencian Community Cancer Plan (POCV). Methods. Qualitative analysis (34 participants in 2 interview groups, and 37 participants in 4 focus groups) and quantitative analysis (470 opinion surveys) was combined in a descriptive study. Results. The POCV's existence is highlighted as a positive factor. It has managed to send the message that “cancer can be cured” to the population. The key aims have been defined, criteria have been unified, and there have been achieved the Tumor Committees contribute most to make a multidisciplinary care. The plan is considered innovative, especially because the Genetic Counseling Program was included. Citizens leaders and patient associations find the Breast Cancer Program as the best known and the most valued, while the Colorectal Cancer Program is the least known. In both methodologies, qualitative groups and the online survey conducted on the professionals, it is concluded that the Tumor Committees, the vaginal cytology recommendation for cervical cancer prevention, and the message transmission that “cancer can be cured” are positively assessed. Conclusions. POCV 07-10 assessments are generally positive, with occasional exceptions that are clearly identified. The qualitative and quantitative information obtained in the different analyses is almost coincident(AU)

[Results assessment of the Valencian Community Cancer Plan: the point of view of patients, relatives, citizens and professionals]. / Valoración de los resultados del Plan Oncológico 2007-2010 de la Comunidad Valenciana: el punto de vista de los pacientes, familiares, ciudadanos y profesionales.

OBJECTIVE: To assess stakeholders' perceptions (i.e. patients, relatives, the public, and professionals) about results of the Valencian Community Cancer Plan (POCV). METHODS: Qualitative analysis (34 participants in 2 interview groups, and 37 participants in 4 focus groups) and quantitative analysis (470 opinion surveys) was combined in a descriptive study. RESULTS: The POCV's existence is highlighted as a positive factor. It has managed to send the message that "cancer can be cured" to the population. The key aims have been defined, criteria have been unified, and there have been achieved the Tumor Committees contribute most to make a multidisciplinary care. The plan is considered innovative, especially because the Genetic Counseling Program was included. Citizens leaders and patient associations find the Breast Cancer Program as the best known and the most valued, while the Colorectal Cancer Program is the least known. In both methodologies, qualitative groups and the online survey conducted on the professionals, it is concluded that the Tumor Committees, the vaginal cytology recommendation for cervical cancer prevention, and the message transmission that "cancer can be cured" are positively assessed. CONCLUSIONS: POCV 07-10 assessments are generally positive, with occasional exceptions that are clearly identified. The qualitative and quantitative information obtained in the different analyses is almost coincident.

Calidad de la atención al paciente oncológico. Tiempos asistenciales recomendables entre sospecha clínica y definición del plan terapéutico en cáncer de mama y colorrectal / Quality assurance in cancer. Acceptable delays in deciding the therapeutic plan in breast cancer and colorectal cancer

Fundamento. Determinar tiempos recomendables para el tratamiento desde la sospecha clínica fundada en los procesos asistenciales de cáncer de mama y colorrectal considerando factibilidad y situación personal del paciente. Método. Estudio cualitativo de búsqueda de consenso entre profesionales. Primero, se revisaron mediante 4 sesiones grupales(N=19), los procesos asistenciales de cáncer de mama y cáncer colorrectal y se fijaron los tiempos deseables de ambos procesos. Segundo, mediante una modificación de la técnica Delphi (N=49), se validó la propuesta de tiempos de atención recomendables para cada proceso asistencial. Resultados. La tasa de respuesta en el estudio Delphi fue del 69% en el proceso de cáncer colorrectal y del 58% en el de mama. El tiempo recomendado entre sospecha clínica y plan terapéutico en el caso de cáncer de mama no infiltrante fue entre 5 y 6 semanas, dependiendo de la vía de acceso: atención primaria, especializada o unidad de prevención de cáncer de mama. Si el cáncer detectado fuese infiltrante y se recurriera a medicina nuclear para el estudio del ganglio centinela o vaciamiento axilar se recomendó de 5 a 7 semanas. En el caso de cáncer de colon y recto se consideró necesario un plazo de respuesta entre 7 a 13 semanas según la vía de acceso, tipo de tumor y curso. Conclusiones. El tratamiento en cáncer mama debe iniciarse antes de transcurrir mes y medio. En cáncer colorrectal podría precisarse hasta tres meses. La revisión de los procesos asistenciales contando con los profesionales y de forma interdisciplinaria favorece establecer criterios de calidad realistas(AU)

Background. To determine recommended delays for treatment once there is well-founded clinical suspicion in care processes for breast and colorectal cancer, taking into account resources and the psychological well-being of the patients. Method. A qualitative study among professionals. The study was conducted in two phases. Firstly, during 4 sessions (N=19) we conducted a revision of the care processes of breast cancer and colorectal cancer and fixed desirable times. Secondly, through a modification of the Delphi technique(N=49), the proposed times for each care process were validated. Results. Delphi response rates of 69% and 58% for colorectal and breast processes respectively. The recommended time in the case of non-invasive breast cancer was 5 to 6 weeks .If the cancer was invasive and nuclear medicine was used for sentinel node study or axillary clearance 5 to 7 weeks were recommended. In the case of cancer of the colon and rectum 7 to 13 weeks were considered necessary. Conclusions. Breast cancer treatment should be started before six weeks. In colorectal cancer up to three months could be required. An interdisciplinary review of care processes relying on professionals is useful for establishing realistic quality standards(AU)

[Quality assurance in cancer. Acceptable delays in deciding the therapeutic plan in breast cancer and colorectal cancer]. / Calidad de la atención al paciente oncológico. Tiempos asistenciales recomendables entre sospecha clínica y definición del plan terapéutico en cáncer.

BACKGROUND: To determine recommended delays for treatment once there is well-founded clinical suspicion in care processes for breast and colorectal cancer, taking into account resources and the psychological well-being of the patients. METHOD: A qualitative study among professionals. The study was conducted in two phases. Firstly, during 4 sessions (N=19) we conducted a revision of the care processes of breast cancer and colorectal cancer and fixed desirable times. Secondly, through a modification of the Delphi technique (N=49), the proposed times for each care process were validated. RESULTS: Delphi response rates of 69% and 58% for colorectal and breast processes respectively. The recommended time in the case of non-invasive breast cancer was 5 to 6 weeks. If the cancer was invasive and nuclear medicine was used for sentinel node study or axillary clearance 5 to 7 weeks were recommended. In the case of cancer of the colon and rectum 7 to 13 weeks were considered necessary. CONCLUSIONS: Breast cancer treatment should be started before six weeks. In colorectal cancer up to three months could be required. An interdisciplinary review of care processes relying on professionals is useful for establishing realistic quality standards.

Short-term follow-up results in 795 nonpalpable probably benign lesions detected at screening mammography.

PURPOSE: To evaluate short-term follow-up of nonpalpable probably benign lesions in a 2-year mammographic screening. MATERIALS AND METHODS: Of 13,790 women aged 45-65 years who underwent first-round screening, 795 (5.8%) underwent short-term mammographic follow-up (every 6 months for 2 years) of nonpalpable probably benign lesions (eg, masses, focal asymmetric densities, and calcifications) previously assessed at an additional imaging evaluation, including ultrasonography. When no changes were found at short-term mammographic follow-up, women were assigned to the 2-year screening interval. Needle localization and surgical biopsy were performed when the lesion progressed (was enlarged or had an increased number or size of calcifications or modification of their initial characteristics). The effectiveness of this approach was evaluated with statistical analysis. RESULTS: Of 795 lesions, 788 (99%) remained stable, and seven (1%) had changes prompting surgical biopsy. Two cancers (0.3%), one microinvasive intraductal carcinoma and one 7-mm invasive ductal carcinoma without positive nodes, were found. Four of the five benign histologic results were probably benign calcifications with progression at short-term follow-up. The sensitivity, specificity, accuracy, and positive and negative predictive values were 100%, 99%, 99%, 29%, and 100%, respectively. CONCLUSION: The benign nature of most nonpalpable probably benign lesions can be typified with short-term mammographic follow-up. This approach permitted identification of a few low-stage carcinomas, but progression in the probably benign calcifications was usually unrelated to malignancy.

Inconsistent MRI findings in acute pre-Willisian brain ischemia in rabbit: a useful model?

BACKGROUND: We have investigated a model of "preterminal ischemia" in order A) to assess the MRI findings and the repeatability of the anatomical changes as showed by MRI, and B) to compare the data so obtained with the humans. METHODS: Twenty rabbits were used. Under general anesthesia, the occlusion of 1) the two common carotid arteries (from 2 hours up to 24 hours) was performed in 8 cases, and of 2) the epi-aortic vessels at the aortic arch (from 2 hours up to 4 hours) was performed in 4 cases in general anesthesia. RESULTS: In the vessels occlusion group MRI study showed inconsistent, inconstant, predominantly ill defined, linear and/or spotlike hyperintense deep cerebral alterations, variable in location, unilateral and bilateral in 8 cases. Although in carotid occlusion the damage was already evident within the first two hours, aortic arch occlusion was unable to produce global brain lesional pattern even up to 4 hours. MRI study of the sham operated animals was negative. CONCLUSIONS: The selective vulnerability of mesial deep cerebral structures to hypoxia, different in location from the human's, and the more effective pre-Willisian compensation, suggests to look for different animals when dealing with preterminal ischemic models comparable to the humans' as studied with MRI.

[Evaluation of small intestine mucosal biopsies obtained simultaneously by suction capsule and endoscopic forceps in children with suspected enteropathy]. / Avaliação de biopsias de mucosa de intestino delgado obtidas simultaneamente através de cápsula de sucção e pinça endoscópica em crianças com suspeita de enteropatia.

The aim of the study was to compare biopsy specimens obtained by suction with those obtained by endoscopy morphometrically and histologically in order to evaluate their adequacy for histological interpretation. For this, 23 children with suspected enteropathy underwent upper gastrointestinal endoscopy. For histological evaluation, biopsies were assessed for orientation, depth, length, presence of Brunner's glands and/or lymphoid follicles and presence of artifact. The mucosa total height and villi height were evaluated for morphometric assessment. The results of all the analysed parameters were not statistically significant, except for the presence of Brunner's glands that were most evident in endoscopic biopsies. Although, the suction capsule biopsies and the endoscopic ones were appropriate for histological interpretation in 91.3% respectively, the difference was not statistically significant. Based on the morphometric analysis, the mucosa total height and the villi height values in both biopsy techniques were not statistically significant different. The small intestine mucosal biopsies obtained by endoscopy compared with those obtained by suction capsule were adequate for histological interpretation.

Purification and partial characterization of a new anti-A1 lectin of Phaseolus coccineus collected in Oaxaca, Mexico.

It is well known that Phaseolus species contains lectins of various specificities 1-4. Runner bean5 and different varieties of Ph.coccineus described by Ochoa et al6, are not specific to human blood groups. They react indistinctly with erythrocytes of the ABO system. However the lectin of Ph. lunatus (lima bean)7 is specific to the blood group type A, a classic example of that specificity. Sometime ago, we discovered a new lectin in a variety of edible bean of Ph. coccineus in the flora of the state of Oaxaca in Mexico, cultivated exclusively in the small community of Jamiltepec, near the Pacific coast, which presented strong hemagglutinating anti-A1 activity. In this report we describe a chromatographic technique for the isolation and purification of this lectin. The molecule is a tetramer with a molecular weight of 120 kDa. It requires Ca++ or Mg++ for activity, and it is inhibited by N-Acetylgalactosamine (GalNac) at concentration of 2.8 mM., NN' N' Triacetylchitotriose, 4-O(4-O-D-Galactopyranosyl) -D-Galatopyranosyl-D-Glucopyranose, and N' Diacetylchitobiose inhibited at moderate concentration (20mM). Conalbumin and ovoalbumin, also inhibited hemagglutination.

"Filtering effect" of cerebrospinal fluid on spinal somatosensory evoked potentials: case report.

A 31-year-old man presented complaining of radicular (L4) pain. MRI and myelo-TC of the thoraco-lumbar spine showed the presence of an extradural CSF cyst extending from Th6 to L2, posterior to the cord. The patient underwent a Th12 laminectomy, the cyst was opened and drained. A recording electrode was placed epidurally, dorsal to the cyst, at the level of the Th12 vertebral body, and the potentials evoked by stimulation of the tibial and saphenous nerves were monitored during surgery. After cyst drainage the epidural potentials were significantly larger (x5) in amplitude and more defined in shape than those recorded in the presence of the cyst. Our case demonstrates the "filtering effect" of CSF on spinal somatosensory evoked potentials.

The seismic response of shallow alluvial valleys using a simplified model

A simplified model is used to approximately simulate the seismic response of three-dimensional shallow alluvial valleys. It is constructed from the exact solution for a simple configuration. Namely, the antiplane response of a rectangular deposit with a moving rigid base. In such solution, which is used as a framework for our approximations, the spectral signature of locally generater surface waves is explicit. Thus an approximate expression is constructed to separately account for 1D response and lateral effects. Results are presented for two- and three - dimensional cases. Comparisons are provided with rigorous solutions. Our formulas allow for fast computations (AU)

The effect of low-dose dopamine infusion on cardiopulmonary and renal status in premature newborns with respiratory distress syndrome.

To study the effects of infusion of low doses of dopamine hydrochloride on cardiopulmonary and renal status in premature newborns with respiratory distress syndrome, 49 newborns were randomly assigned to three groups: group 1 (18 patients) received no dopamine and was the control group; group 2 (16 patients) was infused with a dose of dopamine measuring 1.0 micrograms/kg of body weight per minute for 72 hours; and group 3 (15 patients) was infused with a dose of dopamine measuring 2.5 micrograms/kg of body weight per minute for 72 hours. Birth weights, gestational ages, post-natal ages, and cardiopulmonary status of all groups at the start of the study were comparable. Continuous infusion of these low doses of dopamine for 3 days after birth did not significantly improve levels of blood gases, acid-base balance, or clinical outcome. In newborns with systemic hypotension, dopamine improved cardiovascular status and caused early return of blood pressure to the normal range. Infusion of low doses of dopamine produced mild to moderate natriuresis and insignificant increases in glomerular filtration rate and urine volume.

Tracheal agenesis.

Tracheal agenesis is a rare congenital anomaly. We report a case and review the cases previously reported. Clinical features that might indicate tracheal agenesis include antenatal polyhydramnios, severe respiratory distress, absence of an audible cry, failure to advance an endotracheal tube beyond the larynx, a palpable distal trachea, clinical improvement after esophageal intubation, and roentgenographic absence of a tracheal air column with an abnormal position of the carina. For immediate management of the affected infant, we recommend intubation of the esophagus with an endotracheal tube to provide an air passage, and determination of the level of the defect by careful use of contrast material and roentgenography. Infants having type I tracheal agenesis may benefit from immediate tracheostomy.

Psychoneurotic and psychopathic personalities of polydrug abusers and effects of didactic instruction.

An investigation into the use of psychometric assessment instruments to produce psychographic profiles which proved superior to the use of individual measures on drug accepting versus drug rejecting age generational gaps is appropriate when considering drug and alcohol education programs. Clinical studies show that polydrug abusers have many psychoneurotic and psychopathic traits which can be measured through valid personality tests. Cuevas (1989), employed the Western Personality Inventory (Manson 1963) to identify individuals whose behavior and personality structure indicated they were polydrug users or had serious polydrug problems. The instrument revealed that a combinative process utilizing comparison groups from known polydrug abusers as a discriminant analysis technique with controls provided a high degree of accuracy. A high degree of precision in prediction was maintained in validation trials on independent samples. The personality characteristics and traits were extracted from a combination of commonly ordered personality tests. Results of the investigation indicate that clinical usage of the screening procedure is readily available without sophisticated computer support or the need for trained psychometricians. Additional results identified the process as interventive, therefore providing a simple way to produce early didactic preventive instruction.

Subunit structure of karatasin, the proteinase isolated from Bromelia plumieri (karatas).

Close to 15% of the karatasin proteinase activity in the fruit juice of Bromelia plumieri (karatas) is present outside dialysis Visking tubing in 7 days in 0.2 M acetate buffer (pH) 3.5 or 6.5) containing phenyl mercuric acetate. The small proteinase(s), distinct from the 85% activity in juice due to nondialysable karatasin with a reported Mr of 24,868, separates across Spectrapore (13 kDa) membranes but not across Spectrapore with 3.5 kDa average pore diameter. The dialyzed proteinase is named karatasin-D (K-D). Purified non-Dialysable karatasin can be dissociated to what seems to be K-D by incubation in a buffer solution, containing SDS and 2-mercaptoethanol with phenyl mercuric acetate, in dialysis experiments for 8 days at room temperature using Spectrapore 13 kDa tubing. Thus, native karatasin in B. plumieri fruit juice seem to be the result of association of 2 small molecular mass K-D subunits, linked together by disulfide bonds and electrostatic forces, in equilibrium with small amounts of free K-D molecules. The amino acid composition and partial sequence of karatasin up to the 14th position from the amino terminus have discrete analogies with papain and with stem bromelain.