Análisis ajustado de la mortalidad operatoria en cirugía cardíaca de adultos en Uruguay; 14 años de aplicación y validación del EuroSCORE I ajustado por el Fondo Nacional de Recursos / Adjusted analysis of operative mortality in cardiac surgery of adults in Uruguay, 14 years of application and validation of EuroSCORE I by the Fondo Nacional de Recursos / Análise ajustada da mortalidade operatória em cirurgia cardíaca de adultos no Uruguai, 14 anos de aplicação e validação do EuroSCORE I pelo Fondo Nacional de Recursos

Introducción: la mortalidad posoperatoria ha sido el indicador principal de los resultados a corto y mediano plazo en la evaluación de la cirugía cardíaca. Una forma de analizar dicho evento es mediante los modelos de ajuste del riesgo que identifican variables que predicen su ocurrencia. Uno de los más utilizados es el EuroSCORE I que pro-porciona la probabilidad de morir de cada individuo y que está constituido por 18 variables de riesgo. Objetivos: presentar los resultados de la aplicación y la validación del modelo EuroSCORE I en Uruguay entre los años 2003 y 2020. Metodología: inicialmente se desarrolló una validación externa del EuroSCORE I en la población uruguaya adulta tomando como población de referencia la intervenida entre los años 2003 y 2006. Una vez que se validó el EuroSCORE I, este se aplicó prospectivamente durante los años 2007 al 2020 en su versión original y con el ajuste desarrollado con población del período 2003-2006. Resultados: la aplicación del modelo original encontró que hubo 5 años en los que la razón de mortalidad observada y esperada (MO/ME) fue significativamente mayor que 1. En el período 2007-2020 el EuroScore I no calibró en 6 oca-siones, y fue aplicada la versión ajustada en la evaluación de las instituciones de medicina altamente especializada. La aplicación del modelo ajustado mostró una buena calibración para el período 2007-2020, salvo en el año 2013, y mostró una buena discriminación (área bajo la curva ROC) en todo el período evaluado. Conclusiones: las escalas de riesgo son herramientas metodológicas y estadísticas que tienen gran utilidad para la toma de decisiones en salud. Este trabajo tiene como fortaleza el de presentar datos nacionales aplicando un modelo de riesgo ampliamente utilizado en todo el mundo, lo que nos permite comparar nuestros resultados con los obte-nidos a nivel internacional (EuroSCORE I logístico original) y, por otro lado, evaluar la performance comparativa interna a lo largo de un largo período de tiempo (EuroSCORE I logístico ajustado). Para el futuro resta el desafío de comparar estos resultados, ya sea con un modelo propio o con otros internacionales de elaboración más reciente.

Introduction: postoperative mortality has been the main indicator of short- and medium-term results in the eva luation of cardiac surgery. One way to analyze such outcomes is through risk adjustment models that identify varia bles that predict the occurrence. One of the most used is the EuroSCORE I, which provides the probability of death for each individual and is made up of 18 risk variables. Objectives: present the results of the application and validation of the EuroSCORE I model in Uruguay between 2003 and 2020. Methodology: initially, an external validation of the EuroSCORE I was developed in the Uruguayan adult popula tion, taking as reference population the intervened population between 2003 and 2006. Once the EuroSCORE I was validated, it was applied prospectively during the years 2007 to 2020 in its original version and with the adjustment developed with the population of the period 2003 to 2006. Results: the application of the original model found that there were 5 years during which the observed versus ex pected mortality ratio (OM/ME) was significantly greater than 1. In the period 2007 to 2020, the EuroScore I did not calibrate on 6 occasions, the adjusted version being applied in the evaluation of highly specialized medicine institu tions. The application of the adjusted model showed a good calibration for the period 2007-2020 except in the year 2013 and showed good discrimination (area under the ROC curve) throughout the evaluated period. Conclusions: risk scales are methodological and statistical tools that are very useful for decision-making in health care. This work has the strength of presenting national data applying a risk model widely used across the world, which allows it to be compare with results at an international level (original logistical Euroscore I) and, on the other hand, to evaluate the internal comparative performance over long period of time (adjusted logistic Euroscore I). Up next is the challenge of comparing these results either with our own model or with other more recent international ones.

Introdução: a mortalidade pós-operatória tem sido o principal indicador de resultados a curto e médio prazo na avaliação da cirurgia cardíaca. Uma forma de analisar esse evento é por meio de modelos de ajuste de risco que identificam variáveis que predizem a ocorrência do evento. Um dos mais utilizados é o EuroSCORE I, que fornece a probabilidade de morrer para cada indivíduo e é composto por 18 variáveis de risco. Objetivos: apresentar os resultados da aplicação e validação do modelo EuroSCORE I no Uruguai entre os anos de 2003 e 2020. Metodologia: inicialmente, foi realizada uma validação externa do EuroSCORE I na população uruguaia adulta, tomando como referência a população operada entre 2003 e 2006. Uma vez validado o EuroSCORE I, foi aplicado prospectivamente durante os anos de 2007 a 2020 em sua versão original e com o ajuste desenvolvido com a popu lação do período de 2003 a 2006. Resultados: a aplicação do modelo original constatou que houve 5 anos em que a razão de mortalidade observada versus esperada (MO/ME) foi significativamente maior que 1. No período de 2007 a 2020, o EuroScore I não calibrou em 6 ocasiões, sendo a versão ajustada aplicada na avaliação de instituições médicas altamente especializadas. A aplicação do modelo ajustado mostrou uma boa calibração para o período 2007-2020 exceto no ano de 2013 e apre sentou boa discriminação (área sob a curva ROC) em todo o período avaliado. Conclusões: as escalas de risco são ferramentas metodológicas e estatísticas muito úteis para a tomada de decisões em saúde. O ponto forte deste trabalho é apresentar dados nacionais aplicando um modelo de risco amplamente uti lizado em todo o mundo, que permite comparar com resultados a nível internacional (original Logistic Euroscore I) e, por outro lado, avaliar o comparativo interno desempenho durante um longo período de tempo (Euroscore Logístico I ajustado). Para o futuro, fica o desafio de comparar esses resultados, seja com um modelo próprio ou com outros internacionais de elaboração mais recente.

Milk-clotting and hydrolytic activities of an aspartic protease from Salpichroa origanifolia fruits on individual caseins.

In recent years, many attempts have been made to find new plant proteases to make artisan cheeses. The global increase in cheese consumption, together with a lower supply and increasing cost of calf rennet, religious factors (Islam and Judaism) and food choices (vegetarianism) have led to the search for suitable rennet substitutes for milk clotting. This study describes the milk-clotting and hydrolytic activities of an aspartic protease from Salpichroa origanifolia fruits (SoAP) on individual caseins to explore its potential use as an alternative to animal rennet. The milk-clotting index obtained for SoAP was 8.4 times lower than that obtained for chymosin. SoAP showed a higher degree of hydrolysis on α-casein than on the other fractions under the proposed conditions. RP-HPLC, mass spectrometry analyses and sequencing of the hydrolysates allowed identifying five peptides from α-casein, one peptide from ß-casein, and three peptides from k-casein. In silico analysis showed that the peptides identified may display a wide variety of potential biological activities. These results demonstrate the possibility of using SoAP for the manufacture of new types or artisan cheeses, with the simultaneous added value of the potential health-promoting benefits of the bioactive peptides generated during the hydrolysis.

A New Rapid Method for the Authentication of Common Octopus (Octopus vulgaris) in Seafood Products Using Recombinase Polymerase Amplification (RPA) and Lateral Flow Assay (LFA).

The common octopus (Octopus vulgaris) is a highly valued cephalopod species which is marketed with different grades of processing, such as frozen, cooked or even canned, and is likely to be mislabeled. Some molecular methods have been developed for the authentication of these products, but they are either labor-intensive and/or require specialized equipment and personnel. This work describes a newly designed rapid, sensitive and easy-to-use method for the detection of Octopus vulgaris in food products, based on Recombinase Polymerase Amplification (RPA) and a detection using a Lateral Flow assay (LFA). After studying several gene markers, a system of primers and nfo-probe was designed in the COI (Cytochrome Oxidase I) region and was successfully tested in 32 reference samples (covering 14 species) and 32 commercial products, after optimization. The method was also validated in a ring trial with eight European laboratories and represents a useful tool for food authenticity control at all levels of the value chain.

Rapid Differentiation of Unfrozen and Frozen-Thawed Tuna with Non-Destructive Methods and Classification Models: Bioelectrical Impedance Analysis (BIA), Near-Infrared Spectroscopy (NIR) and Time Domain Reflectometry (TDR).

The performances of three non-destructive sensors, based on different principles, bioelectrical impedance analysis (BIA), near-infrared spectroscopy (NIR) and time domain reflectometry (TDR), were studied to discriminate between unfrozen and frozen-thawed fish. Bigeye tuna (Thunnus obesus) was selected as a model to evaluate these technologies. The addition of water and additives is usual in the fish industry, thus, in order to have a wide range of possible commercial conditions, some samples were injected with different water solutions (based on different concentrations of salt, polyphosphates and a protein hydrolysate solution). Three different models, based on partial least squares discriminant analysis (PLS-DA), were developed for each technology. This is a linear classification method that combines the properties of partial least squares (PLS) regression with the classification power of a discriminant technique. The results obtained in the evaluation of the test set were satisfactory for all the sensors, giving NIR the best performance (accuracy = 0.91, error rate = 0.10). Nevertheless, the classification accomplished with BIA and TDR data resulted also satisfactory and almost equally as good, with accuracies of 0.88 and 0.86 and error rates of 0.14 and 0.15, respectively. This work opens new possibilities to discriminate between unfrozen and frozen-thawed fish samples with different non-destructive alternatives, regardless of whether or not they have added water.

Impacto de las políticas de salud en la incidencia de reperfusión de infarto agudo de miocardio durante el inicio de la pandemia por COVID-19 en Uruguay / Impact of public health policies on the incidence of acute myocardial reperfusion during the initial stages of the COVID-19 pandemic in Uruguay / Impacto das políticas de saúde na incidência de infarto do miocárdio durante a pandemia de COVID-19 no Uruguai

Introducción: las medidas sanitarias de emergencia impuestas para contener el SARS-CoV-2 pueden tener efectos colaterales en la atención de enfermedades cardiovasculares. Los datos mundiales de los países sobre la incidencia de infarto agudo de miocardio con elevación del segmento ST (IAMCEST) durante la pandemia son fundamentales para la política sanitaria futura. Objetivos: nuestro objetivo fue determinar si las medidas sanitarias de emergencia impuestas en Uruguay tuvieron un impacto directo en la calidad de la atención en la reperfusión del IAMCEST. Métodos: realizamos un estudio retrospectivo poblacional de todo el país para determinar la incidencia de reperfusión de IAMCEST (fibrinolíticos e intervención coronaria percutánea, FBL e ICP respectivamente) durante el período sanitario de emergencia. La tasa de incidencia de la reperfusión, el tiempo hasta la reperfusión y la mortalidad asociada se recopilaron de la base de datos del Fondo Nacional de Recursos (organización gubernamental única a cargo de la financiación de la reperfusión del IAMCEST en Uruguay). Estos mismos datos se recuperaron para 2019, 2018 y 2017. Resultados: se trataron durante el periodo de estudio del 2020 (136 pacientes) en comparación con 2019 (180 pacientes), 2018 (182 pacientes) y 2017 (174 pacientes). Se realizó FBL como tratamiento único en 5,1%, 7,2%, 7,7% y 12,1%, respectivamente. La razón de tasa de incidencia de IAMCEST durante el período estudiado en 2020 fue de 0,7 (IC95%: 0,59-0,91). La mediana del tiempo hasta la reperfusión fue similar en comparación con 2019, 2018 y 2017 (p = 0,4). No hubieron diferencias en la mortalidad a 15 dias entre los años evaluados.

Introduction: the emergency health measures imposed to contain SARS-CoV-2 can have collateral effects in the care of cardiovascular diseases. Global country data on the incidence of ST acute myocardial infarction during the pandemic are critical for future health policy. Objectives: our objective was to determine if the emergency health measures imposed in Uruguay had a direct impact on the quality of ST elevation acute myocardial infarction care. Methods: we carried out a population-based retrospective study of the entire country to determine the incidence of reperfusion of ST elevation acute myocardial infarction (fibrinolytic and percutaneous) during the emergency health period. The incidence rate of reperfusion, time to reperfusion, and associated mortality were collected from the Fondo Nacional de Recursos (the only government organization in charge of the reperfusion of ST elevation myocardial infarction in Uruguay). These same data were recovered for 2019, 2018 and 2017. Results: fewer patients were treated in 2020 (136 patients) compared to 2019 (180 patients), 2018 (182 patients), and 2017 (174 patients). Fibrinolytics was performed as the only treatment in 5.1%, 7.2%, 7.7% and 12.1% respectively. The proportion in incidence rate of ST elevation myocardial infarction during the study period in 2020 was lower (0.74, 95% CI: 0.59-0.91). The median time to reperfusion was similar compared to 2019, 2018, and 2017 (p = 0.4). Mortality at 15 days was similar in 2017 (8%), 2018 (6%), 2019 (11%) and 2020 (8%). Conclusion: emergency health measures were associated with a decrease in the incidence of reperfusion of ST elevation myocardial infarction without affecting the time to reperfusion and mortality.

Introdução: as medidas emergenciais de saúde impostas para conter o SARS-CoV-2 podem ter efeitos colaterais no cuidado das doenças cardiovasculares. Os dados globais do país sobre a incidência de infarto agudo do miocárdio durante a pandemia são essenciais para a futura política de saúde. Objetivos: nosso objetivo foi determinar se as medidas de saúde de emergência impostas no Uruguai tiveram um impacto direto na qualidade do atendimento infarto agudo do miocárdio. Métodos: foi realizado um estudo retrospectivo de base populacional em todo o país para determinar a incidência de reperfusão do infarto agudo do miocárdio (fibrinolítico e percutâneo) durante o período de emergência de saúde. A taxa de incidência de reperfusão, tempo de reperfusão e mortalidade associada foram coletados do Fondo Nacional de Recursos (a única organização governamental responsável pela reperfusão de infarto agudo do miocárdio no Uruguai). Esses mesmos dados foram recuperados para 2019, 2018 e 2017. Resultados: menos pacientes foram tratados em 2020 (136 pacientes) em comparação com 2019 (180 pacientes), 2018 (182 pacientes) e 2017 (174 pacientes). Fibrinolisis foi realizado como o único tratamento em 5,1%, 7,2%, 7,7% e 12,1%, respectivamente. A proporção na taxa de incidência de infarto agudo do miocárdio durante o período estudado em 2020 foi menor (0,74, IC 95%: 0,59-0,91). O tempo médio para reperfusão foi semelhante em comparação com 2019, 2018 e 2017 (p = 0,4). A mortalidade em 15 dias foi semelhante em 2017 (8%), 2018 (6%), 2019 (11%) e 2020 (8%). Conclusão: as medidas emergenciais de saúde foram associadas à diminuição da incidência de reperfusão do infarto agudo do miocárdio, sem afetar o tempo de reperfusão e a mortalidade.

Characterization and potential strategies for the valorisation of the Southwest Atlantic butterfish (Stromateus brasiliensis).

The waste of fish resources constitutes a serious environmental problem that must be avoided. The valorisation of by-catch species and decreasing the discard rate constitute a more efficient and sustainable use of these marine biomasses. In this work, we characterize and propose different potential uses for Stromateus brasiliensis, another frequently discarded (≥ 90%) and poorly studied by-catch species captured in the South Atlantic Ocean (FAO 41) by trawler fishing fleets. Furthermore, in the case of this species, freezing and frozen storage of the whole fish is the only strategy currently employed for its exploitation. The results revealed that muscle from S. brasiliensis presented a high content of polyunsaturated fatty acids (20.34%) and that the concentrations of both total diacyl glyceryl ethers (2.41%) and heavy metals (Hg 0.038, Pb 0.006 and Cd 0.018 mg/kg) were below the established limits for safe human consumption. Likewise, the protein hydrolysates proved to be a good source of amino acids for human consumption or animal feeding. Minced muscle blocks could be made by a mechanical separation process of the flesh, and the composition of minced muscle did not differ much from that of the whole fish. Furthermore, this process allows the incorporation of cryoprotectants and antioxidants to extend the frozen shelf life of this fatty fish. An extraction process from mechanically mixed skin and bones yielded a good source of collagen that should not be neglected.

A Real-Time PCR Method for the Authentication of Common Cuttlefish (Sepia officinalis) in Food Products.

Cephalopods are very relevant food resources. The common cuttlefish (Sepia officinalis) is highly appreciated by consumers and there is a lack of rapid methods for its authentication in food products. We introduce a new minor groove binding (MGB) TaqMan real-time PCR (Polymerase Chain Reaction) method for the authentication of S. officinalis in food products to amplify a 122 base pairs (bp) fragment of the mitochondrial COI (Cytochrome Oxidase I) region. Reference and commercial samples of S. officinalis showed a threshold cycle (Ct) mean of 14.40, while the rest of the species examined did not amplify, or showed a significantly different Ct (p < 0.001). The calculated efficiency of the system was 101%, and the minimum DNA quantity detected was 10-4 ng. No cross-reactivity was detected with any other species, thus, the designed method differentiates S. officinalis from other species of the genus Sepia and other cephalopod species and works for fresh, frozen, grilled, cooked and canned samples of Sepia spp. The method has proved to be reliable and rapid, and it may prove to be a useful tool for the control of fraud in cuttlefish products.

An EQ-5D-5L value set based on Uruguayan population preferences.

PURPOSE: To derive a value set from Uruguayan general population using the EQ-5D-5L questionnaire and report population norms. METHODS: General population individuals were randomly assigned to value 10 health states using composite time trade off and 7 pairs of health states through discrete choice experiments. A stratified sampling with quotas by location, gender, age and socio-economic status was used to respect the Uruguayan population structure. Trained interviewers conducted face-to-face interviews. The EuroQol valuation technology was used to administer the protocol as well as to collect the data. OLS and maximum likelihood robust regression models with or without interactions were tested. RESULTS: We included 794 respondents between 20 and 83 years. Their characteristics were broadly similar to the Uruguayan population. The main effects robust model was chosen to derive social values. Values ranged from -0.264 to 1. States with a misery index = 6 had a mean predicted value of 0.965. When comparing the Uruguayan population with the Argentinian EQ-5D-5L crosswalk value set, the prediction for states which differed from full health only in having one of the dimensions at level 2 were about 0.05 higher in Uruguay. The mean index value, using the selected Uruguayan EQ-5D-5L value set, for the general population in Uruguay was 0.895. In general, older people had worse values and males had slightly better values than females. CONCLUSION: We derived the EQ-5D-5L Uruguayan value set, the first in Latin America. These results will help inform decision-making using economic evaluations for resource allocation decisions.

Isolation and characterization of an aspartic protease from Salpichroa origanifolia fruits.

This report describes the purification of an aspartic protease (salpichroin) from ripe fruits of Salpichroa origanifolia (Solanaceae) starting with precipitation using organic solvents and anionexchange chromatography with 32.1% recovery and 13.4-fold purification. SDS-PAGE and zymograms of this enzyme showed a single band corresponding to an apparent molecular mass of approximately 32 kDa. The biochemical and kinetic characterization of the pure enzyme showed an acidic behavior with an optimal pH value around 3.0-4.5 with hemoglobin and 5.5-6.0 with casein. Salpichroin activity was inhibited by pepstatin but not by phenylmethylsulfonyl fluoride, E-64, EDTA or 1,10-phenanthroline, thus suggesting an aspartic protease behavior. Salpichroin hydrolyzed natural substrates, such as casein and hemoglobin, with high specific activity. Kinetic studies conducted with the synthetic peptide H-Pro- Thr-Glu-Phe-p-(NO2)-Phe-Arg-Leu-OH showed lower affinity (Km 494 µM) than other representative aspartic proteases. By investigating the cleavage of oxidized insulin ß-chain to establish the hydrolytic specificity of salpichroin, we found six cleavage sites on the substrate of peptide bonds similar to those of chymosin. MALDI-TOF/TOF-MS of the tryptic ingel digest of salpichroin showed that the isolated protease shared homologous sequences with other plant proteases of the A1 aspartic protease family. This is the first report concerning the isolation and biochemical characterization of an aspartic protease isolated from Salpichroa origanifolia fruits.

Primera etapa del proyecto de investigación "Las rutinas diarias y el balance ocupacional de los alumnos de la Universidad Nacional de Quilmes" / First stage of the research project: daily routines and occupational balance of students from the National University of Quilmes

Existen argumentos teóricos y antecedentes de investigación que prueban la relación entre las rutinas diarias y las tensiones que afectan la salud y el bienestar. En el diario vivir las personas respondemos de manera cada vez más acelerada a necesidades y exigencias ocupacionales laborales, de estudio y del hogar. El estrés y el síndrome de la mente en carrera son ejemplos típicos de algún desajuste. Las Universidades se han estudiado a sí mismas desde aspectos históricos, políticos, didácticos y problemáticas de los estudiantes como la deserción temprana y tardía y el desempeño académico. Las rutinas diarias y las percepciones que los alumnos tienen del balance ocupacional es un tema de estudio poco desarrollado. La presente investigación acreditada por la Universidad Nacional de Quilmes se encuentra en la etapa inicial. Se realizará una investigación cualitativa con enfoque fenomenológico, de tipo Investigación Acción Participativa que propiciará la participación de los alumnos de la Universidad. Se espera lograr la producción de conocimientos que permitan caracterizar las rutinas diarias y la percepción del balance ocupacional de los alumnos para la detección temprana de indicadores de desbalance ocupacional y la elaboración de propuestas para su afrontamiento, lo que reducirá eventuales costos de salud.

There are theoretical arguments and research background to prove the relationship between daily routines and tensions that affect health and well-being. In the daily life people respond increasingly accelerated to needs and work, occupation, study and home demands. Stress and the career mind syndrome are typical examples of some imbalance. Universities have studied themselves from historical, political and didactic aspect and students problematic such as: early and late desertion and academic performance. Daily routines and the students perception of the occupational balance, it is a slightly developed topic. This research, accredited by the National University of Quilmes, is now in the initial stage. It is going to be a qualitative research, with phenomenological approach, a participatory action research – type, to encourage the students from the University to participate. It hopes to achieve the production of knowledge to characterize the daily routines and the students occupational balance perception, for the early detection of indicators of occupational imbalance and the elaboration of proposals to confront it, which will reduce any health costs.

Association between left atrial size and measures of adiposity among normal adolescent boys.

Obesity (OB) in adults is associated with insulin resistance, hypertension, and left atrial (LA) enlargement. This study aimed to determine the association between LA size and (1) different components of the metabolic syndrome (body mass index [BMI], waist circumference [WC], insulin levels, lipid levels, and blood pressure), and (2) left ventricular (LV) diameters and diastolic function. Data were collected cross-sectionally from 142 healthy adolescent boys age 16.8 ± 2.0 years in 2009. Measurements of BMI, WC, blood pressure, lipid profile, and insulin were performed. Mode M, two-dimensional Doppler echocardiography was performed. Measurements of LA area, LV end diastolic diameter (EDD), end systolic diameter (ESD), posterior wall, interventricular septum (IVS), and shortening fraction were performed. Tisular Doppler of the diastolic mitral annular E wave (DTE) and A wave (DTA) and the ratio of maximal early diastolic filling wave velocity to maximal early diastolic myocardial velocity (E/e') were recorded. The study group included 38 OB boys (26.8%) and 32 overweight boys (22.5%). Significant univariate association was found between LA area and BMI (r = 0.61), WC (r = 0.56), systolic blood pressure (r = 0.21), insulinemia (r = 0.28), high-density lipoprotein-cholesterol (HDL-C) (r = -0.24), triglycerides (r = 0.20), EDD (r = 0.25), LV posterior wall (r = 0.25), IVS (r = 0.25), DTE (r = 0.27), DTA (r = 0.30), and E/e' (r = -0.28). Multiple linear regression analysis showed that LA area was associated with BMI (B = 0.61; R (2) = 0.47) adjusted for confounding variables. In adolescents, BMI and WC were significantly associated with LA, suggesting that OB could be associated with LA enlargement as early as adolescence.

[Massive transfusion and trauma patient management: pathophysiological approach to treatment].

Bleeding that requires massive blood transfusion is one of the main causes of cardiac arrest and death in the operating room. Its mortality varies widely between 15 and 54%, and it is strongly related to multiple factors such as acidosis, hypothermia and hypocoagulation. We undertook this study to describe the mechanisms that perpetuate bleeding during massive hemorrhage and the particular issues under the different clinical conditions of controlled and uncontrolled tissue damage. Laboratory tests for coagulation status diagnosis as well as treatment guidelines for usage of different fluid replacement solutions and hemoderivatives are described. A well-established response plan is needed by the surgical team and the blood bank in order to quickly facilitate blood products to the patient. Measures to avoid hypothermia and availability of rapid infusion systems are also necessary.

Anestesia en un paciente con síndrome de Pallister-Killian / Anesthesia in a patient with Pallister-Killian's syndrome

El Síndrome de Pallister-Killian está determinado por la tetrasomía del brazo corto del cromosoma 12p, se caracteriza por retraso mental y diferentes dismorfias. Se describe aquí la técnica anestesiológica utilizada en una niña de 12 años de edad portadora de esta afección con el antecedente de un cuadro febril con convulsiones a las 40 horas de la intervención en un procedimiento anterior, que se sometió a anestesia general para extracción de múltiples piezas dentarias en mal estado. La técnica utilizada fue una anestesia general intravenosa en base a propofol y remifentanyl con colocación de una máscara laríngea. No se observaron complicaciones de ningún tipo.

Pallister-Killian syndrome is characterized by tetrasomy of the short arm of chromosoma 12p, which produces mental retardation and dysmorphic characteristics. We described the anesthesyologic technique used in a 12 year old child affected by this syndrome, who underwent surgery for teeth extraction. She has had a febril syndrome with seizures in the postoperative period (40 hours) in a prior surgery.Total intravenous anesthesia was done with propofol and remifentanyl under laryngeal mask.There has been no complication of any type.

A Síndrome de Pallister-Killian é determinada pela tetrassomía do braço curto do cromossoma 12 p, e se caracteriza por retardo mental e diferentes dismorfias. Aqui se descreve a técnica de anestesia utilizada em uma menina de 12 anos portadora desta doença com antecedentes de febre e convulsões 40 horas antes da intervenção em um procedimento anterior realizado com anestesia geral para extração de múltiplos dentes em mau estado. A técnica utilizada foi uma anestesia geral intravenosa com propofol e remifentanyl com colocação de uma máscara laríngea. Não se observaram complicações de nenhum tipo.

Isolation and characterization of a dual function protein from Allium sativum bulbs which exhibits proteolytic and hemagglutinating activities.

A dual function protein was isolated from Allium sativum bulbs and was characterized. The protein had a molecular mass of 25-26 kDa under non-reducing conditions, whereas two polypeptide chains of 12.5+/-0.5 kDa were observed under reducing conditions. E-64 and leupeptin inhibited the proteolytic activity of the protein, which exhibited characteristics similar to cysteine peptidase. The enzyme exhibited substrate specificity and hydrolyzed natural substrates such as alpha-casein (K(m): 23.0 microM), azocasein, haemoglobin and gelatin. It also showed a high affinity for synthetic peptides such as Cbz-Ala-Arg-Arg-OMe-beta-Nam (K(m): 55.24 microM, k(cat): 0.92 s(-1)). The cysteine peptidase activity showed a remarkable stability after incubation at moderate temperatures (40-50 degrees C) over a pH range of 5.5-6.5. The N-terminus of the protein displayed a 100% sequence similarity to the sequences of a mannose-binding lectin isolated from garlic bulbs. Moreover, the purified protein was retained in the chromatographic column when Con-A Sepharose affinity chromatography was performed and the protein was able to agglutinate trypsin-treated rabbit red cells. Therefore, our results indicate the presence of an additional cysteine peptidase activity on a lectin previously described.

[Evaluation of bioethical aspects in health professionals]. / Evaluación de aspectos bioéticos en los profesionales de la salud.

OBJECTIVE: To evaluate training in bioethics, as well as knowledge and perceptions of bioethical issues, among health professionals. METHOD: A descriptive cross-sectional study was performed in 2005 by means of a validated questionnaire. The study population consisted of the health team working in the cardiology area in the Marqués de Valdecilla University Hospital. RESULTS: There were 186 health professionals, and 117 questionnaires were returned, representing 63.5% of the study population: 58 nurses (49.5%), 23 physicians (19.6%), and 34 nursing auxiliaries. More than half (64.6%) had no training in bioethics. The health professionals with the most training in bioethics were those with more than 20 years' experience (p = 0.019). Less than half (45.7%) knew of the existence (p = 0.004) or the content (p = 0.03) of law 41/2002. A total of 12.8% believed that users knew their rights. Health professionals with no bioethics training were those most likely to believe that users' confidentiality (p = 0.002) and privacy (p = 0.039) were always or usually respected. More than one third (37.8%) reported facing bioethical problems in their professional activity. CONCLUSION: The members of the health team have insufficient knowledge of bioethics parallel to low levels of training in this discipline and perceive insufficient respect for users' basic rights. Training in bioethics should be increased, and information pathways should be established in institutions to allow continual adaptation to ethical and legal requirements.