A single amino acid substitution in isozyme GST mu in Triclabendazole resistant Fasciola hepatica (Sligo strain) can substantially influence the manifestation of anthelmintic resistance.

The helminth parasite Fasciola hepatica causes fascioliasis in human and domestic ruminants. Economic losses due to this infection are estimated in U$S 2000-3000 million yearly. The most common method of control is the use of anthelmintic drugs. However, there is an increased concern about the growing appearance of F. hepatica resistance to Triclabendazole (TCBZ), an anthelmintic with activity over adult and young flukes. F. hepatica has eight Glutathione S-Transferase (GST) isozymes, which are enzymes involved in the detoxification of a wide range of substrates through chemical conjugation with glutathione. In the present work we identified and characterized the GST mu gene isolated from the TCBZ-susceptible and TCBZ-resistant F. hepatica strains. Total RNA was transcribed into cDNA by reverse transcription and a 657 bp amplicon corresponding to the GST mu gene was obtained. The comparative genetic analysis of the GST mu gene of the TCBZ susceptible strain (Cullompton) and TCBZ resistant strain (Sligo) showed three nucleotide changes and one amino acid change at position 143 in the GST mu isozyme of the TCBZ-resistant strain. These results have potential relevance as they contribute better understand the mechanisms that generate resistance to anthelmintics.

Carcinoma de recto de alto riesgo: factores pronóstico y resultados del tratamiento combinado postquirúrgico en el Hospital Universitario Doce de Octubre / High-risk rectal carcinoma: prognostic factors and postoperative adjuvant combined treatment results at Doce de Octubre University Hospital

Propósito: Análisis retrospectivo de los resultados del tratamiento adyuvante combinado postquirúrgico en el carcinoma de recto de alto riesgo en el H.U. Doce de Octubre (Madrid). Material y métodos: Entre 1992 y 1997, 186 pacientes diagnosticados de carcinoma de recto estadios II y III recibieron tratamiento postquirúrgico con radioterapia (50.4Gy) y quimioterapia (146 con 5 FU bolus o infusión continua y 40 con Tegafur oral). Resultados: La supervivencia global a 5 años es del 70 por ciento, la supervivencia libre de enfermedad del 65 por ciento, y el control loco-regional del 80 por ciento. Resultaron factores pronóstico significativos la afectación ganglionar, el estadio patológico, el grado histológico, el T y la prolongación del tratamiento radioterápico. Ni la localización del tumor en recto ni el esquema de quimioterapia empleado han influido significativamente en los resultados. Conclusiones: Los resultados obtenidos con el tratamiento adyuvante combinado postquirórgico en el carcinoma de recto son muy satisfactorios. El factor con mayor valor pronóstico es la afectación ganglionar. No existen diferencias significativas en función del régimen de quimioterapia administrado (AU)

[Enteral nutrition and changes in taste in diabetic patients: a double-blind prospective study]. / Nutrición enteral y alteraciones del gusto en pacientes diabéticos: estudio prospectivo doble ciego.

The authors present a prospective double blind test aimed at objectively determining the acceptance of flavoured orally administered enteric diets specific to patients with glucose metabolism alterations (Glucerna and Precitene Diabet), in the light of the taste disorders described in such patients. Sixty-two patients were studied, 32 diabetics and 32 control patients, who were given a sample of each product; the level of acceptance was quantified on a modified wine-tasting scale. The average taste of the diabetics was 12.1 points (SD = 4.34) for Glucerna, and 10.1 (SD = 3.91) for the Precitene Diabet. In the control patients, the scores were 12.7 (SD = 3.78) and 13.2 (SD = 3.23) respectively. Multiple regression analysis did not reveal significant differences in taste according to age, sex or place of origin. Average taste among the diabetic patients as a whole with both products was 11.2 points and, for the nondiabetics, 12.92. The model detected significant differences (p = 0.01) between the two groups. The average taste of the diabetics was less than that of the non-diabetics, irrespective of all the remaining variables examined, including the type of preparation. These results confirm the lower oral acceptance in diabetic patients, possibly associated with disorders in the sense of taste, showing the utility of the modified wine-tasting scale as a test in evaluating the acceptance of enteric diets which must be administered orally.

Neurocognitive impairment: the unrecognized component of dual diagnosis in substance abuse treatment.

Brief neuropsychological tests were administered to an inpatient substance abuse population to (1) evaluate the status of neurocognitive functioning at admission, (2) assess changes that may occur during the treatment program, and (3) compare various testing devices for clinical application in this setting. Patients entering a 14-day inpatient substance abuse unit were tested within a few days of admission with the Neurobehavioral Cognitive Status Examination (NCSE), the screening test for the Luria-Nebraska Neuropsychological Battery, and the Trail Making Test. Impaired neurocognitive performance was observed in approximately two-thirds of patients; the most frequently compromised areas of functioning involved attention and memory, calculation, abstraction, ability to follow complex commands, and visuospatial skills. Readministration of the NCSE prior to discharge detected a statistically significant improvement in attentional abilities, and a tendency toward improvement for verbal comprehension and abstraction. Discussion of these findings addresses several issues: (1) the frequency and degree of impairment in this population; (2) the observed variability of cognitive functioning; (3) the question of clinical improvement in neurocognitive functioning observed during a program of this length; and (4) a preference for the NCSE in this setting. The authors argue for the routine neuropsychological assessment of substance abusers, and discuss the above issues in terms of their implications for treatment at both the individual and programmatic level. Discussion of two cases illustrates the application of the NCSE, and the effect of finding organic impairment on staff attitudes and treatment issues.