Unexpected better outcome in a liver transplant recipient with COVID-19: a beneficial effect of tacrolimus? / Evolución clínica en un receptor de trasplante de hígado con la COVID-19: ¿Un efecto benéfico del tacrolimus?

Coronavirus disease 2019 (COVID-19) is a serious respiratory illness caused by SARS-CoV-2. There is controversy about whether their immunosuppressive status is a risk factor or a protective factor for developing severe disease. We report herein the clinical outcome of three family members that had COVID-19 infection, presenting with and without different risk factors that have been described in more severe disease. Paradoxically, the patient with more risks of developing a severe disease, a 64-year-old woman, 2-years liver transplant recipient under treatment with tacrolimus, presented a similar outcome compared to the two other members of the family. She showed shorter hospitalization time, similar clinical outcome with fewer oxygen needs. The present clinical observation raises the question about the possible beneficial effect of tacrolimus in patients with COVID-19. Indeed, tacrolimus (FK-506) have an inhibitory effect on human coronaviruses by: 1) an antiviral effect by binding to the FK-506-binding proteins (FKBP) with a subsequent inhibition of their peptidyl-prolyl cis/trans isomerase (PPIase) activity, which seems to be important for the coronavirus life cycle; and 2) regulating the immune response by the inhibition of the activity of the nuclear factor of activated T-cells (NFAT) required for immunosuppression. The present observation states that liver recipients' patients with COVID-19 may not have worse outcomes when compared with other patients that have COVID-19 risk factors and puts in evidence the two mechanisms related to tacrolimus.

Increased survival time or better quality of life? Trade-off between benefits and adverse events in the systemic treatment of cancer.

INTRODUCTION: Primary objective of the study was to assess the relative weighting between benefit in survival time (SV), benefit in quality of life (QoL) and willingness to experience adverse events (AEs), in patient preferences for chemotherapy treatment. MATERIALS AND METHODS: We included cancer patients with current or past systemic treatment of cancer (STC) as well as physicians placed as hypothetical patients. Participants filled a choice-based conjoint analysis questionnaire with 19 choices among three STC scenarios with variable amounts of benefit in SV or QoL and different types AEs. RESULTS: One hundred patients (50 on curative and 50 on palliative intention treatment) and 114 physicians (61 oncologists and 53 non-oncologists) were included and asked about their preferred chemotherapy treatment. The relative weighting (sum 100%) of SV-QoL-AEs for making the choice in the 100 patients was SV35%-CV33%-AEs31% what was not significantly different from a random distribution (Goodness of fit Chi square P = 0.91) just as it was not for both subgroups, palliative (SV37%-QoL29%-AEs34%; GoF Chi square P = 0.55) and curative (SV34%-QoL36%-AEs30%; GoF Chi square P = 0.73) treatment. The observed distribution in the group of 114 physicians (SV46%-QoL31%-AEs23%) was significantly different from a random distribution (GoF Chi square P = 0.018) just as it was for both subgroups, medical oncologists (SV48%-QoL29%-AEs23%; GoF Chi square P = 0.006) and non-medical oncologists (SV44%-QoL33%-AEs23%; GoF Chi square P = 0.04). CONCLUSIONS: The three attributes (SV, QoL, and AEs) are considered in the same way by cancer patients to make choices on their STC. On the contrary, when placed as hypothetical patients, physicians prefer for themselves those treatments that provide more SV.

Valor nutricional de los alimentos ofrecidos en las máquinas de vending de la universidad complutense de madrid, españa. Habitos de consumo de los estudiantes universitarios

RESUMEN Introducción: El NutriScore es una herramienta diseñada con el objetivo de simplificar la información que aporta el etiquetado nutricional de los alimentos. Clasifica los alimentos en cinco colores que van desde el verde (más saludable) hasta el rojo (menos saludable). Estos colores están asociados a cinco letras (A/B/C/D/E). Los estudiantes universitarios pasan muchas horas en las facultades y tienen un consumo elevado de snacks y refrescos Objetivos: Calcular el NutriScore de los alimentos y bebidas disponibles en las máquinas expendedoras de las facultades de la Universidad Complutense de Madrid y obtener datos de los hábitos de consumo de los estudiantes de dicha universidad. Material y Métodos: El estudio ha sido realizado en 16 facultades y la biblioteca universitaria analizando los alimentos y bebidas de las máquinas expendedoras de dichas facultades en marzo de 2019. Se calculó la puntuación de cada uno y según la puntuación obtenida se clasificaron en una de las cinco categorías. 146 estudiante rellenaron una encuesta sobre la frecuencia de consumo y tipo de productos preferidos de las máquinas expendedoras. Resultados: Se clasificaron 143 alimentos y 53 bebidas que estaban disponibles en máquinas expendedoras. Los alimentos se distribuyeron: A 4,2%, B 4,2%, C 21,6%, D 53% y E 47% y las bebidas: A 1,9%, B 9,4%, C 13,2%, D 35,9% y E 39,6%. Los estudiantes consumen algún producto de las maquinas expendedoras fundamentalmente cuando tienen hambre, en momentos entre horas y eligiendo agua como primera opción seguido de refrescos azucarados como bebidas y bollería industrial seguido de patatas fritas como snacks más consumidos Conclusión: Aunque la universidad debería desarrollar una función en la promoción de un estado de vida saludable, las máquinas expendedoras de las facultades ofrecen un número muy elevado de productos con baja calidad nutricional.

ABSTRACT Introduction: NutriScore is a tool designed with the aim of simplify the information of the nutritional composition obtained from the labelling. It classify foods in five colors ranging from green (healthier) to red (less healthy). These colors are associated with five letters (A/B/C/D/E). University students spend many hours in faculties and have a high consumption of snacks and beverages. Objective: We aimed to examine the nutritional value of foods sold in vending machines of the Complutense University of Madrid, by calculating the nutriscore and to obtain data of the snacking habits of the students of this university. Methods: The study was conducted in sixteen universities and in the university library of the Complutense University of Madrid. One hundred and forty six undergraduate university students volunteered to complete a questionnaire to assess frequency of consumption and snack choices of vending machines. Results: We analized 143 snacks and 53 beverages. Snacks were: A 4,2%, B 4,2%, C 21,6%, D 53% y E 47% and beverages A 1,9%, B 9,4%, C 13,2%, D 35,9% y E 39,6%. The students use them when they are hungry and between meals. Water was the first option followed by sugary soft drinks as beverages and processed baked goods followed by chips as more consumed snacks. Conclusión: Although the university should play a role in promoting a healthy lifestyle, the vending machines of the faculties offer a very high number of products with low nutritional quality. group, we can conclude that DTC in acromegaly does not have a worse evolution.

Pregnancy outcomes after maternal Zika virus infection in a non-endemic region: prospective cohort study.

OBJECTIVES: The aim was to describe pregnancy outcomes after Zika virus (ZIKV) infection in a non-endemic region. METHODS: According to the Spanish protocol issued after the ZIKV outbreak in Brazil in 2015, all pregnant women who had travelled to high-burden countries were screened for ZIKV. Serological and molecular tests were used to identify ZIKV-infected pregnant women. They were classified as confirmed ZIKV infection when reverse transcription (RT) PCR tested positive, or probable ZIKV infection when ZIKV immunoglobulin M and/or immunoglobulin G and ZIKV plaque reduction neutralization tests were positive. Women found positive using molecular or serological tests were prospectively followed-up with ultrasound scans and neurosonograms on a monthly basis until delivery; magnetic resonance imaging and amniotic fluid testing were performed after signed informed consent. Samples of placenta, and fetal and neonatal tissues were obtained. RESULTS: Seventy-two pregnant women tested positive for ZIKV infection: ten were confirmed by RT-PCR, and 62 were probable cases based on serological tests. The prevalence of adverse perinatal outcomes was 33.3% (three out of nine, 95% CI 12.1-64.6%): two cases of congenital ZIKV syndrome (CZS) and one miscarriage, all born to women infected in the first trimester of gestation. All ZIKV-confirmed women had persistent viraemias beyond 2 weeks (median 61.50 days; IQR 35.50-80.75). Amniotic fluid testing was only positive in the two fetuses with anomalies. CONCLUSION: The prevalence of perinatal adverse outcomes for women with ZIKV-confirmed infection was 33.3%. Amniocentesis for ZIKV RT-PCR is recommended when fetal abnormalities are found. Intensive prenatal and postnatal follow-up of ZIKV-infected pregnancies is advised in confirmed cases.

Modeling in petri nets of a dispersed system in a physical rehab / Modelado en redes petri de un sistema disperso en una rehabilitación física / Modelagem em redes petri de um sistema disperso numa reabilitação física

Considering the lack of resources in health centers located in rural zones, a part of Colombian population goes affected by the quality of the health Service received. If this is added the low level socioeconomic of some rural population, it is generated a geographic vulnerability. For that reason in this work is presented a Service Oriented Architecture that has as objective support health centers with low technical resources with technology that allows a physical rehab attention independently of the localization of patient and health professional. By way of this, a distributed system it is proposed, using a dispersed communication media like the internet. It is planned to make a modeling process based on a formal tool like the Petri Nets to assure the definition of the services, assistant dispositive teleoperation and the integration and coordination of the system.

Considerando la falta de recursos en centros de salud ubicados en zonas rurales, una parte de la población colombiana se ve afectada por la calidad del Servicio de Salud recibido. Si se suma el bajo nivel socioeconómico de cierta población rural, se genera una vulnerabilidad geográfica. Por ello en este trabajo se presenta una Arquitectura Orientada a Servicios que tiene como objetivo apoyar centros de salud con bajos recursos técnicos con tecnología que permita una atención física de rehabilitación independientemente de la ubicación del paciente y profesional de la salud. De esta manera, se propone un sistema distribuido, utilizando un medio de comunicación disperso como Internet. Para asegurar la definición de los servicios, el asistente de teleoperación dispositiva y la integración y coordinación del sistema, se planea realizar un proceso de modelización basado en una herramienta formal como las redes de Petri.

Considerando a falta de recursos em centros de saúde localizados em zonas rurais, uma parte da população colombiana vê-se afetada pela qualidade do Serviço de Saúde recebido. Ao somar-se o baixo nível socioeconómico de alguma população rural, gera-se uma vulnerabilidade geográfica. Por isso neste trabalho apresenta-se uma arquitetura orientada a serviços que tem como objetivo apoiar centros de saúde com baixos recursos técnicos com tecnologia que permite uma atenção física de reabilitação independentemente da localização do paciente e profissional da saúde. Desta maneira, propõe-se um sistema distribuído, utilizando um médio de comunicação disperso como Internet. Para assegurar a definição dos serviços, o assistente de tele operação dispositiva e a integração e coordenação do sistema, planeja-se realizar um processo de modelização baseado numa ferramenta formal como as redes de Petri.

[LH-FSH ratio and Polycystic Ovary Syndrome: A forgotten test?]. / Proporción LH-FSH y síndrome de ovario poliquístico: ¿prueba olvidada o no útil?

OBJECTIVE: To identify the predictive value of LH-FSH ratio in the Polycystic Ovary Syndrome diagnosis and to evaluate its role according PCOS phenotypes. MATERIAL AND METHOD: A descriptive, comparative, observational, prospective study of PCOS patients and its controls. All participants received a questionnaire and underwent a physical and transvaginal ultrasound examination. Blood samples were also collected for analysis of metabolic markers and hormones. PCOS was diagnosed according to Rotterdam criteria. RESULTS: A total of 267 women were included into the study. PCOS was diagnosed in 162 patients. There was statistical difference in: HOMA, 1.43 ± 1.06, 2.09 ± 1.96; Total Testosterone, 0.31 ± 0.14, 0.41 ± 0.19; and free Androgen index, 1.17 ± 1.30, 1.69 ± 1.18; for control and PCOS group, respectively. FSH, 6.55 ± 2.43 in controls and 5.30 ± 1.66 in PCOS patients (p = 0.001); LH, 4.34 ± 2.12 controls, 6.36 ± 4.61 PCOS patients (p = 0.001). LH-FSH ratio was 0.71 ± 0.39 for control group and 1.25 ± 0.85 in PCOS group, p = 0.001. A correlation was observed between LH-FSH ratio and total antral follicle count (p < 0.001) and with insulin resistance (p = 0.022). CONCLUSION: LH-FSH ratio, although it is a valuable test, it is not diagnostic of PCOS. A correlation was found with LH-FSH ratio and insulin resistance but we must not forget about its association with hyperandrogenism.

Management of infection and febrile neutropenia in patients with solid cancer.

An expert group from the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC, for its acronym in Spanish) and the Spanish Society of Medical Oncology (SEOM, for its acronym in Spanish) have reviewed the main aspects to be considered when evaluating patients with solid cancer and infectious complications contained in this article. Recommendations have, therefore, been put forth regarding the prophylaxis of the most prevalent infections in these patients, the use of vaccines, measures to control infection through vascular catheters, and preventing infection in light of certain surgical maneuvers. The following is a revision of the criteria for febrile neutropenia management and the use of colony-stimulating factors and closes with several guidelines for treating the cancer patient with serious infection. The document concludes with a series of measures to control hospital infection.

Population Growth and Characterization of Plant Injuries of Steneotarsonemus spinki Smiley (Acari: Tarsonemidae) on Rice.

Rice is attacked by Steneotarsonemus spinki Smiley, a mite that has dispersed throughout many countries causing important loss on rice production. Rice plants of the variety Morelos A-92 were infested with S. spinki, and its population growth was estimated along plant development. Further, the morphological and histological injuries associated to the mite attack were characterized. The highest infestation level was obtained 13 weeks after plant infestation, with an average of 58.5 mites per plant, predominantly females. Morphological injuries were categorized from level 0 (no injuries from uninfested plants) to level 3, characterized by the highest injuries represented by blotches on the adaxial epidermis of the leaf sheath and on panicles and grains. Plants ranked within levels 0, 1, and 2 for morphological injury did not exhibit clear histological injuries, while those at level 3 exhibited histological injury characterized by destruction of cells of the adaxial epidermis, disorder, color change, and hypertrophy in the mesophyll cells, as well as color change in the abaxial epidermis. Thus, it presented a significant correlation between morphological injuries and mite density level, which can be further adopted to help the control decision-making process for this mite on rice.

Litiasis por cistina: Reporte de un caso / Cystine lithiasis: Case report

La cistinuria es una enfermedad genética cuya expresión clínica es la formación de cálculos en las vías urinarias. Si bien este tipo de litiasis es poco frecuente se caracteriza por un elevado número de recidivas. En este trabajo, presentamos el caso de una paciente de 24 años con litiasis por cistina, en la que el diagnóstico se logró mediante el hallazgo de cristales de cistina en muestras de orina y la presencia de cistina como único componente de los cálculos expulsados espontáneamente en dos ocasiones y removidos por nefrolitotomía percutánea en una ocasión en un lapso de 6 meses. El tratamiento instaurado consistió en aumento de la ingesta de líquido, dieta con restricción de sodio y proteínas y administración de agentes alcalinizantes para aumentar el pH de la orina. Así mismo queremos mostrar la disponibilidad y el uso a nivel nacional de técnicas laboratoriales especializadas para el diagnóstico y seguimiento de pacientes con cistinuria.

Cystinuria is a genetic disease which clinical expression is the formation of stones in theurinary tract.Even though this kind of lithiasis is rare, it is characterized by a highrecurrence rate. In this work,we present the case of a 24-year-old female patient withcystine lithiasisin whom the diagnosis was made by detection of cystine crystals in urinesamples and the presence of cystine as the only component of kidney stonesspontaneously passed in two episodes and removed by percutaneous nephrolithotomyoncein a period of six months. The treatment measures established were increase of thefluid intake,restricted protein and sodium diet and administrationofalkaline agents toincreaseurinary pH. Wealsoshow the availability and use at national level of specializedlaboratory techniques for the diagnosis and follow-up of cystinuric patients.

Frecuencia de dislipidemia y estado nutricional de escolares de áreas rurales paraguayas / Frequency of dislipidemia and nutritional state in schoolchildren of P a raguayan rural areas

Mundialmente la prevalencia de dislipidemias ha crecido en la última década en niños y adultos. En nuestro país las enfermedades circulatorias son la primera causa de muerte. Se determinó la frecuencia de dislipidemia, estado nutricional y factores asociados a dislipidemia en escolares de cuatro escuelas rurales públicas. Estudio observacional descriptivo de corte transverso en una población de escolares de 5 a 13 años de edad, de ambos sexos, con muestreo de casos consecutivos, realizado entre abril de 2008 a setiembre de 2009. Se determinó el estado nutricional por IMC según CDC 2000 y los niveles de colesterol y triglicéridos en sangre por métodos enzimáticos. A través de una encuesta, se consultaron los antecedentes familiares de dislipidemia, actividad física y hábitos alimentarios. El 59% de los 182 escolares incluidos en el estudio presentaron dislipidemia, 33% niveles de colesterol de riesgo moderado o alto, 41% niveles de triglicérido de riesgo moderado o alto. El 8% de los escolares mostró sobrepeso u obesidad. En cuanto a factores de riesgo asociados a dislipidemia, el 60% consumía carnes no magras al menos dos o tres veces por semana y el 56% de los niños que poseían padres con antecedentes de dislipidemia presentaban hipercolesterolemia de riesgo. La prevalencia de dislipidemia en esta población es preocupante y por ello, es necesario introducir estrategias dirigidas a mejorar los hábitos alimenticios en las instituciones educativas.

The worldwide prevalence of dislypidemiain children and adults has increased in the lastdecade.In our country, circulatory diseases are the first cause of death. The frequency ofdislypidemia, nutritional state and factors associated to dislypidemias in schoolchildren offour public rural schoolswas determined. This was a cross-sectional descriptiveobservational studywith consecutive samplingcarried out in a population of schoolboysand girlsaged5to13years oldfrom April 2008 to September 2009.The nutritional statewas determined by BMI according toCDC 2000and colesterol and triglycerides bloodlevels by enymatic methods. A survey collected family backgrounds about dislypidemia,physical activity and food habits.Fifty nine percent of the 182schoolchildren included inthe study presented dislypidemia, 33%had moderated or high risk for colesterol levelsand41%moderated or high risk for triglycerids levels while8%had overweight orobesity. In relation to risk factors associated to dislypidemia,60%ate lean meatat leasttwo to three times a week and56%of the children, who had parents with dislypidemiabackgrounds,showed risk hipercholesterolemia.The prevalence of dislypidemiafoundin this population is worrisomeshowing that it is necessary to introduce educationalstrategies aimed at improving food habits in the educational institutions.

Genetic relationships in an international collection of Puccinia horiana isolates based on newly identified molecular markers and demonstration of recombination.

The obligate biotrophic pathogen Puccinia horiana is the causal agent of chrysanthemum white rust. Although P. horiana is a quarantine organism, it has been able to spread to most chrysanthemum-producing regions in the world since the 1960s; however, the transfer routes are largely obscure. An extremely low level of allelic diversity was observed in a geographically diverse set of eight isolates using complexity reduction of polymorphic sequences (CRoPS) technology. Only 184 of the 16,196 contigs (1.1%) showed one or more single-nucleotide polymorphisms (SNPs). Thirty-two SNPs and one simple-sequence repeat were translated into molecular markers and used to genotype 45 isolates originating from North and South America, Asia, and Europe. In most cases, phylogenetic clustering was related to geographic origin, indicating local establishment. The European isolates mostly grouped in two major populations that may relate to the two historic introductions previously reported. However, evidence of recent geographic transfer was also observed, including transfer events between Europe and South America and between Southeast Asia and Europe. In contrast with the presumed clonal propagation of this microcyclic rust, strong indications of marker recombination were observed, presumably as a result of anastomosis, karyogamy, and somatic meiosis. Recombination and transfer also explain the geographic dispersal of specific markers. A near-to-significant correlation between the genotypic data and previously obtained pathotype data was observed and one marker was associated with the most virulent pathotype group. In combination with a fast SNP detection method, the markers presented here will be helpful tools to further elucidate the transfer pathways and local survival of this pathogen.

Sedación y analeesia con bolos de xilazina y mofina en infusión continua en unna yegua criolla Colombiana sometida a ovarioectomía en estación / Sedation and analgesia with xylazine bolus and morphine in continuous infusion in a mare standing subjected to ovariectomy: case report

En el acto quirúrgico la anestesia es un proceso que siempre conlleva riesgos. Un procedimiento común en equinos es realizar cirugías en estación para disminuir el riesgo de la anestesia general. Para los procedimientos anestésicos en estación en equinos se han utilizado las combinaciones de bolos de xilazina y anestesia local; sin embargo, la analgesia irregular y la marcada ataxia son complicaciones frecuentes. En el presente caso clínico se evaluó un protocolo de bolos de xilazina 0,6 mg/kg I.V. y morfina en infusión I.V. continua a 30 µg/kg/hora, con aplicación de anestesia local para la extraccción de un tumor de células de la granulosa en una yegua. Durante el procedimiento quirúrgico se observó una buena analgesia, sedación moderada y ataxia leve, sin alteraciones cardiovasculares o respiratorias, lo que favoreció el procedimiento quirúrgico; solamente se observó un corto periodo de amotilidad intestinal el cual fue superado espontáneamente. La yegua se recuperó totalmente del procedimiento quirúrgico y presentó evidencia de estro en dos ocasiones dentro del año siguiente a la intervención. Los procedimeintos anestésico y quirúrgico empleados en esta yegua fueron apropiados y la llevaron a su normalidad reproductiva.

Anesthesia is always a procedure that leads many risks in the quirurgical act. A common procedure in horses is to make standing surgeries to decrease the general anesthesia risks. For standing anesthetic procedures in horses there have been used combinations of xilazine bolus and local anesthesia; however, irregular analgesia and marked ataxia are frequent complications. In this clinical case it was evaluate a protocol of xilazine bolus 0,6 mg/kg I.V. and a constant rate infusion of morphine 30 µg/kg/h I.V., with local anesthesia for the extraction of a granulosa cell tumor in one mare. In general, during the surgical procedure it was observed good analgesia, moderate sedation and slight ataxia, without cardiovascular or respiratory problems which favored the surgical procedure; it was observed only a short period without intestinal motility that returned to normality spontaneously. The mare recovered fully from the surgical procedure and presented evidence of estrus twice within one year after the intervention. The anesthetic and surgical procedures used in this case were appropriate and lead recovery of the normal reproductive behavior of this mare.

Litiasis recidivante en cachorro Schnauzer miniatura: reporte de un caso / Recurrent urolithiasis in a miniature Schnauzer puppy: case report

La formación de cálculos urinarios es un problema clínico importante en perros. Existen diferencias en la tendencia de presentar litiasis entre diversas razas. Se presenta un caso de litiasis recidivante en un cachorro, macho,Schnauzer miniatura, que a los dos meses de edad presentó hematuria y disuria por obstrucción de vías urinarias asociada a etiología litiásica. El cachorro expulsó urolitos en dos ocasiones, a los tres y siete meses de edad. El análisis morfológico de estos cálculos mostró que el primero estaba formado por Carbapatita (fosfato de calcio carbonatado cristalizado) correspondiente al tipo morfológico IVa1 y los cálculos del segundo episodio presentaban una combinación del tipo IVa1 + IIa, este último tipo morfológico formado por Weddellita (oxalato de calcio dihidratado). Los análisis de orina mostraron pH 6 a 7,5, con bacterias y cristales de fosfato triple en dos muestras y de oxalato de calcio en una muestra del total de seis analizadas. Se administró antibióticos para controlar infecciones urinarias en ambos episodios litiásicos. El manejo nutricional consistió en alimentación con balanceado especial para perros con litiasis desde los 2 hasta los 7 meses de edad. Luego del segundo episodio litiásico se evitaron los balanceados y se alimentó al cachorro con pollo hervido y verduras. Desde la instauración del nuevo régimen nutricional, hace ya más de un año, no se han observado cristales en las muestras de orina, ni se refieren síntomas urinarios en el cachorro hasta la fecha.

The formation of urinary stones represents an important clinical issue in canines. There are differences in the trend to present urolithiasis among breeds. This is a case of recurrent lithiasis in a Miniature Schnauzermale puppy that presented hematuria and dysuria caused by a urinary tract obstruction associated to lithiasis. The puppy eliminated uroliths at the age of three and seven months old. The morphological analysis of this urinary calculus showed that the first consisted of carbapatite (crystallized carbonated apatite) classified as morphological type IVa1 and the second calculus presented a combination of type IVa1 + IIa. Morphological type IIa is formed by Weddellite (dihydrate calcium oxalate). Urine analysis of six samples showed a pH value from 6 to 7,5 with presence of bacteria and triple phosphate crystals in two samples and calcium oxalate crystals in one sample. Antibiotic therapy was applied to treat urinary infection in both lithiasic episodes. Dietary therapy consisted initially in feeding the puppy with balanced food special for dogs with lithiasis from two to seven months old. After the second lithiasic episode, the puppy was fed with boiled chicken and vegetables avoiding the balanced dog food. Since the implementation of the latter nutritional plan, more than a year ago, nor crystals have been detected in urine samples neither clinical signs of urolithiasis were observed in the puppy up to now.

Evaluación de parámetros litogénicos en pacientes con urolitiasis que concurrieron al Instituto de Investigaciones en Ciencias de la Salud en el año 2009 / Evaluation of lithogenic parameters in urolithiasis patients attending the Instituto de Investigaciones en Ciencias de la Salud in 2009

Los cálculos renales se forman cuando la concentración de los componentes de la orina alcanzan un nivel en el cual es posible la cristalización. Aunque las manifestaciones clínicas de todos los cálculos son similares, los mismos difieren en su composición, patogénesis y tratamiento. El trasfondo metabólico está asociado a la urolitiasis y la evaluación metabólica es fundamental para establecer un tratamiento específico y evitar las recidivas. En este estudio, observacional descriptivo, de corte trasverso sedeterminaron los valores de analitos con potencial litogénico o inhibidor de cristalización, en muestras de sangre y orina de 40 pacientes de ambos sexos con diagnóstico de urolitiasis que concurrieron al Laboratorio de Análisis Clínicos del IICS de junio a octubredel 2009, así como describir las manifestaciones clínicas más frecuentes. El protocolo del estudio fue aprobado por los comités científico y ético del IICS y durante su ejecución serespetaron principios éticos y científicos. Del total de pacientes, 52,5% fueron niños (n=21, edad media 9±4 años) y 47,5% adultos (n=19, edad media 35±17 años). Sedetectaron alteraciones en los valores de parámetros con potencial litogénico en el 48% de los niños y 87% de los adultos litiásicos. La hipocitraturia y la hipercalciuria fueron los desarreglos metabólicos más frecuentes en ambos grupos. Los síntomas más frecuentesreferidos por los pacientes fueron: cólicos, hematuria y fiebre. La mitad de los pacientes presentaron antecedentes familiares de litiasis renal. El 58% de los pacientes adultos estaba excedido de peso. La ingesta de agua fue inferior a 2 litros en 90% y el 47% de niños y adultos respectivamente. Estos hallazgos señalan la importancia de la evaluación metabólica como herramienta para orientar el diagnóstico y tratamiento adecuado.

Kidney stones are formed when concentration of urinary components reach such a level in which crystallization is possible. Although clinical manifestations of all kidney stones are similar, they differ in composition, pathogenesis and treatment. Metabolic background is associated to urolithiasis and metabolic evaluation is essential to establish specific treatment and avoid recurrences. In this cross-sectional observational descriptive study,we determined the levels of analytes with lithogenic or crystallization inhibitor potential in blood and urine samples of 40 patients, male and female, with diagnosis of urolithiasisthat attended the Department of Clinical Analysis of the IICS from June to October, 2009. Additionally, we describe the most frequent clinical manifestations present in these patients. The study protocol was submitted and approved by the IICS scientific and ethic committees. Of the total number of patients, 52.5% were children (n=21, 9±4 years old) and 47.5% adults (n=19, 35±17 years old). Alterations in the values of the potentially lithogenic parameters were detected in 48% of the children and 87% of the adults. The most frequent metabolic abnormalities were hypocitraturia and hypercalciuria in both groups. The most frequent symptoms were colics, hematuria and fever. Half of the patients referred a family history of urolithiasis. Overweight was detected in 58% of the adult patients. Water intake lower than 2 litres per day was referred by 90% of children and 47% of adults respectively. These findings point out the importance of the metabolic evaluation as a tool to orient adequate diagnosis and treatment.

Modelling of the influenza A(H1N1)v outbreak in Mexico City, April-May 2009, with control sanitary measures.

We use a time dependent modification of the Kermack and McKendrick model to study the evolution of the influenza A(H1N1)v epidemic reported in the Mexico City area under the control measures used during April and May 2009. The model illustrates how the sanitary measures postponed the peak of the epidemic and decreased its intensity. It provides quantitative predictions on the effect of relaxing the sanitary measures after a period of control. We show how the sanitary measures reduced the maximal prevalence of the infected population from 10% to less than 6% of the total population. We also show how the model predicts the time of maximal prevalence and explains the effect of the control measures.

Pruebas complementarias a la problemática del diagnóstico de la infección por los virus B y C en donantes de sangre / Complementary tests for the problem of B and C virus infection diagnosis in blood donors

El objetivo de este trabajo es determinar si las transaminasas hepáticas tienen valor como pruebas complementarias que orienten el diagnóstico de hepatitis B y C, en donantes de sangre con anticuerpos positivos por el método ELISA a estas infecciones virales; teniendo en cuenta que las pruebas confirmatorias como el inmunoensayo recombinante (RIBA) o la prueba de ácidos nucleicos por técnicas moleculares como PCR (RNA HCV) para hepatitis C y DNA viral (PCR) para hepatitis B no se realizan aún en nuestro país debido a sus elevados costos. Se busca sumar esfuerzos en salud pública desde los bancos de sangre debido a la trascendencia de llegar a un diagnóstico en los donantes seropositivos, que hayan sido captados en el tamizaje, para prevenir la propagación de estas hepatitis. Se realizaron pruebas serológicas para hepatitis C, anticuerpos frente al antígeno del core de la hepatitis B y determinaciones de los niveles de GPT o ALT (Transaminasa Glutámica Pirúvica o Alanina Amino Transferasa), GOT o AST (Transaminasa Glutámico Oxalacética o Aspartato Amino Transferasa) en 236 donantes de sangre seropositivos para hepatitis B y C del Banco de Sangre del Hospital de Clínicas de la Universidad Nacional de Asunción-Paraguay. Las transaminasas elevadas fueron clasificadas de acuerdo a los marcadores serológicos positivos para hepatitis B y C, encontrándose niveles elevados en un 13.9% de individuos con anti-HBc, 40% en individuos con anti HCV y 2 de 7 casos en individuos con serología positiva para ambos marcadores serológicos. Casi la mitad de los donantes con marcador serológico positivo para anti HCV presentan elevación de las transaminasas.

The aim of this study was to determine if liver transaminases had value as complementary tests to orientate the diagnosis of hepatitis B and C in blood donors with positive antibody to these viral infections by the EIA method, considering that confirmatory tests such as the recombinant immunoassay (RIBA) or nucleic acid test by molecular techniques such as PCR (HCV RNA) for hepatitis C and viral DNA (PCR) for hepatitis B are not performed in our country due to their high costs. We are looking for joining efforts in public health from the blood banks due to the importance of reaching a diagnosis of seropositive donors who have been detected in the screening to prevent the spread of hepatitises. Serologic tests for hepatitis C, antibodies against the core antigen of hepatitis B and determinations of the levels of ALT or GPT (Alanine aminotransferase or Glutamic pyruvic transaminase), AST or GOT (Aspartate aminotransferase or Glutamic oxalacetic transaminase) were carried out in 236 blood donors seropositive for hepatitis B and C of the Blood Bank of the Hospital de Clinicas, National University of Asuncion, Paraguay. Elevated transaminases were classified according to the positive serological markers for hepatitis B and C finding high levels in 13.9% in donors with anti-HBc, 40% in donors with anti HCV and two of seven cases in donors with positive serology for both serological markers. Almost half of the donors with positive serologic marker for anti HCV had elevated transaminases.

Flocculant in wastewater affects dynamics of inorganic N and accelerates removal of phenanthrene and anthracene in soil.

Recycling of municipal wastewater requires treatment with flocculants, such as polyacrylamide. It is unknown how polyacrylamide in sludge affects removal of polycyclic aromatic hydrocarbons (PAH) from soil. An alkaline-saline soil and an agricultural soil were contaminated with phenanthrene and anthracene. Sludge with or without polyacrylamide was added while emission of CO(2) and concentrations of NH(4)(+), NO(3)(-), NO(2)(-), phenanthrene and anthracene were monitored in an aerobic incubation experiment. Polyacrylamide in the sludge had no effect on the production of CO(2), but it reduced the concentration of NH(4)(+), increased the concentration of NO(3)(-) in the Acolman soil and NO(2)(-) in the Texcoco soil, and increased N mineralization compared to the soil amended with sludge without polyacrylamide. After 112d, polyacrylamide accelerated the removal of anthracene from both soils and that of phenanthrene in the Acolman soil. It was found that polyacrylamide accelerated removal of phenanthrene and anthracene from soil.

The efficiency of potassium removal during bicarbonate hemodialysis.

Patients on chronic hemodialysis often portray high serum [K+]. Although dietary excesses are evident in many cases, in others, the cause of hyperkalemia cannot be identified. In such cases, hyperkalemia could result from decreased potassium removal during dialysis. This situation could occur if alkalinization of body fluids during dialysis would drive potassium into the cell, thus decreasing the potassium gradient across the dialysis membrane. In 35 chronic hemodialysis patients, we compared two dialysis sessions performed 7 days apart. Bicarbonate or acetate as dialysate buffers were randomly assigned for the first dialysis. The buffer was switched for the second dialysis. Serum [K+], [HCO3-], and pH were measured in samples drawn before dialysis; 60, 120, 180, and 240 min into dialysis; and 60 and 90 min after dialysis. The potassium removed was measured in the dialysate. During the first 2 hr, serum [K+] decreased equally with both types of dialysates but declined more during the last 2 hr with bicarbonate dialysis. After dialysis, the serum [K+] rebounded higher with bicarbonate bringing the serum [K+] up to par with acetate. The lower serum [K+] through the second half of bicarbonate dialysis did not impair potassium removal (295.9 +/- 9.6 mmol with bicarbonate and 299.0 +/- 14.4 mmol with acetate). The measured serum K+ concentrations correlated with serum [HCO3-] and blood pH during bicarbonate dialysis but not during acetate dialysis. Alkalinization induced by bicarbonate administration may cause redistribution of K during bicarbonate dialysis but this does not impair its removal. The more marked lowering of potassium during bicarbonate dialysis occurs late in dialysis, when exchange is negligible because of a low gradient.

Primidone is associated with interictal depression in patients with epilepsy.

Depressive symptoms are common in epilepsy. To determine associations between depression and demographic, clinical, and pharmacological factors among epileptic patients, we conducted a cross-sectional survey. We evaluated 241 epileptic outpatients at a neurological center in a 6-month period. Depressive syndrome was diagnosed when both the Montgomery-Asberg Scale and the Beck Depression Inventory were rated above the standard cutoff points. Bivariate and multivariate analyses were performed to assess the differences between depressed and nondepressed patients with respect to demographic, clinical, and pharmacological features. Depressive syndrome was diagnosed in 42.7% of patients (n=103). Factors associated in the bivariate analysis were: cryptogenic etiology, posttraumatic epilepsy, use of primidone, and inadequate seizure control. After logistic regression, inadequate seizure control (OR 3.08, 95% CI 1.40-6.77, P=0.005) and use of primidone (OR 4.08, 95% CI 2.09-7.98; P<0.001) remained significantly associated. Depression was common and associated with inadequate seizure control and use of primidone.