Lactocin AL705 as quorum sensing inhibitor to control Listeria monocytogenes biofilm formation.

AIMS: The control of Listeria monocytogenes biofilm formation using lactocin AL705 bacteriocin at sub-minimum inhibitory concentrations (MICs) through an antiquorum sensing strategy, was preliminarily investigated. METHODS AND RESULTS: The screening for biofilm formation of different Listeria species at 10°C allowed selecting L. monocytogenes FBUNT for its use as biofilm producer. MIC and minimum bactericidal concentration of lactocin AL705 purified extract against the pathogen was determined. Bacteriocin sub-MICs were used to evaluate biofilm reduction. Concentrations between 2·5-20 AU ml-1 of lactocin AL705 produced significant decreases in biofilm formation without affecting the growth of the pathogen after 3 days of incubation. When bacteriocin concentrations (5-20 arbitrary units per millilitre (AU ml-1 )) were investigated as quorum sensing (QS) inhibitors using Vibrio harveyi as reporter strain, a significant reduction in luminescence by lactocin AL705 (20 AU ml-1 ) was observed. Even when L. monocytogenes produced AI-2 like molecules as recognized by the reporter strain, bacteriocins did not interfere with this compound. CONCLUSION: Antilisterial lactocin AL705 used to disrupt QS through a signal molecule inactivation was able to control L. monocytogenes FBUNT biofilm formation. Other molecule(s) different from the AI-2 involved during biofilm formation could be acting as target of the bacteriocin. SIGNIFICANCE AND IMPACT OF THE STUDY: The use of bacteriocins derived from food-grade micro-organisms as a QS inhibition represents an effective strategy to control pathogens as well as an environmentally friendly sanitation method to mitigate postprocessing food contamination.

Lactobacillus spp. impair the ability of Listeria monocytogenes FBUNT to adhere to and invade Caco-2 cells.

OBJECTIVES: The objective of this study was to evaluate the ability of Lactobacillus curvatus CRL705, CRL1532, and CRL1533 and Lactobacillus sakei CRL1613 to survive under simulated gastrointestinal conditions. Moreover, a microencapsulation approach was proposed to improve gastrointestinal survival. Finally, experiments were performed to demonstrate that Lactobacillus spp. can modulate the ability of Listeria monocytogenes FBUNT to adhere to and invade Caco-2 cells. RESULTS: Lactobacillus strains were encapsulated in alginate beads to enhance the survival of bacteria under in vitro gastrointestinal conditions. All strains hydrolyzed bile salts using chenodeoxycholic acid as a substrate and adhered to Caco-2 cells. Cell-free supernatants (CFSs) showed antimicrobial activity against L. monocytogenes as demonstrated by agar diffusion assays. The average percentages of L. monocytogenes adhesion decreased from 67.74 to 41.75 and 38.7% in the presence of 50 and 90% (v/v), respectively, for all CFSs tested. The highest concentrations of CFSs completely inhibited the L. monocytogenes invasion of Caco-2 cells. CONCLUSIONS: The studied Lactobacillus strains have protective effects against the adhesion and invasion of L. monocytogenes FBUNT. Alginate encapsulation of these bacteria improved gastrointestinal tolerance such that they could be further studied as potential probiotics against intestinal pathogenic bacteria.

Lactobacillus sakei CRL1862 improves safety and protein hydrolysis in meat systems.

AIMS: The capacity of Lactobacillus sakei CRL1862 to prevent the growth of pathogens and its ability to degrade sarcoplasmic and myofibrillar proteins in pork meat systems was evaluated. In addition, basic safety aspects of Lact. sakei CRL1862 such as production of biogenic amines and antibiotic susceptibility were addressed. METHODS AND RESULTS: The bacteriocin-producing Lact. sakei CRL1862 showed respectively bactericide and bacteriostatic effect against Listeria monocytogenes and Staphylococcus aureus in beaker sausage assay during 9 days of storage at 22 °C. The hydrolytic effect of Lact. sakei CRL1862 on protein extracts was evaluated by SDS-PAGE and reverse phase HPLC. A more pronounced proteolysis was evidenced in inoculated sarcoplasmic proteins compared with myofibrillar extracts with the generation of predominantly hydrophilic peptides and increase of total free amino acids concentration. Lactobacillus sakei CRL1862 produced neither histamine nor tyrosine and exhibited no resistance to the antibiotics assayed. CONCLUSIONS: Lactobacillus sakei CRL1862 effectively controlled the growth of L. monocytogenes and Staph. aureus; moreover, it was able to hydrolyse pork meat extracts generating peptides and amino acids, which may improve hygienic and sensorial attributes of fermented meat products. SIGNIFICANCE AND IMPACT OF THE STUDY: The use of an integrated approach to evaluate the major traits of Lact. sakei CRL1862 showed it can be applied as an autochthonous functional starter in meat fermentation.

[Care for immigrant patients: facts and professionals' perception in 6 primary health care zones in Navarre]. / Atención al paciente inmigrante: realidad y percepción de los profesionales de 6 zonas de Atención Primaria de Navarra.

BACKGROUND: To describe utilisation of health care services and motives for consultation in Primary Care in the native and the immigrant population, and compare this with the perception of primary care professionals. METHODS: Data was collected on health care activity during the year 2006 for all people registered (N=86,966) in the 6 basic health care zones with the highest proportion of immigrants (14.4%) and on the following variables: country of origin, age, sex, year of inscription in the public health service. The health card and OMI-AP programme databases were used. A qualitative methodology of focus groups and in-depth interviews was employed. RESULTS: Seventy-two point four percent of immigrants requested care from the primary care professionals in 2006, of whom 50% proceeded from Ecuador and 70% were between 25 and 44 years old. Eighty-two percent of the natives made consultations and required more referrals to specialised care than the immigrants of the same age group. The most frequent consultation with natives and with immigrants was "acute respiratory infections" (7 to 23% according to age group). The second most frequent with immigrants was "administrative problems". The consultations with immigrants were not related to preventive aspects such as smoking and there were more consultations (p>0.001) for gynaeco-obstetric episodes (10.7%) and those related to work (19%) or psychosomatic problems (8.5%). The perception of the primary care professionals was that the immigrants carry out more consultations than the natives and generate a certain "disorder" in the clinic. CONCLUSION: Immigrants use healthcare services less than the native population. Nonetheless, this fact is not perceived in this way by the primary care professionals. Fewer preventive activities are carried out with immigrants, who suffer from more labour and psychosomatic problems.

Development and validation of a dissolution test for meloxicam and pridinol mesylate from combined tablet formulation.

The association of meloxicam and pridinol is indicated for treating muscular contractures and low back pain. A dissolution test for the meloxicam-pridinol combined tablet formulation was developed and validated, using a suitable HPLC method for simultaneously quantitating both dissolved drugs. The optimized conditions include the use of USP apparatus 2 at a paddle rotation rate of 75 rpm and 900 ml of 50 mM phosphate buffer (pH= 7.5) as dissolution medium, at 37.0±0.5°. The test, which demonstrated to be robust against small changes in bath temperature, paddle rotation speed and pH of the dissolution medium, was applied to two different brands of tablets; the corresponding dissolution profiles were constructed and both brands showed to dissolve at least 75% of the drugs at the 45 min time point.

Atención al paciente inmigrante: realidad y percepción de los profesionales de 6 zonas de Atención Primaria de Navarra / Care for immigrant patients: facts and professionals’ perception in 6 primary health care zones in Navarre

Fundamento. Describir la utilización de servicios y motivos deconsulta en Atención Primaria entre población autóctona e inmigrantey contrastarla con la percepción que tienen los profesionalesde atención primaria.Material y métodos. Se recogieron datos de actividad asistencialdurante el año 2006 de la totalidad de personas adscritas(N=86.966) a las 6 zonas básicas con mayor proporción de poblacióninmigrante (14,4 %) y las variables: país de origen, edad,sexo, año de alta en el sistema sanitario. Se utilizaron bases datosde tarjeta sanitaria y de programa OMI-AP. Se utilizó metodologíacualitativa de grupos de discusión y entrevistas en profundidad.Resultados. El 72,4% de inmigrantes solicitaron atención de profesionalesde atención primaria en 2006, de los cuales un 50%procedía de Ecuador y un 70% tenía entre 25 y 44 años. Los autóctonosconsultantes fueron el 82% y requirieron más derivacionesa atención especializada que los inmigrantes del mismo grupode edad. La consulta más frecuente en autóctonos e inmigrantesfue «infecciones respiratorias agudas» (7 al 23%, según gruposde edad). La segunda en inmigrantes fue «problemas administrativos». Las consultas de inmigrantes no se relacionan conaspectos preventivos como tabaquismo y sí tuvieron más consultas(p>0,001) de episodios gineco-obstétricos (10,7%) y de losrelacionados con problemas laborales (19%) o psicosomáticos(8,5%). La percepción de los profesionales de atención primariaera que la población inmigrante consulta más que la autóctona ygenera cierto «desorden» en la consulta.Conclusión. Los inmigrantes son menos utilizadores de serviciossanitarios y frecuentadores que los autóctonos. Sin embargo,este hecho no es percibido así por los profesionales de atenciónprimaria. Con inmigrantes se realizan menos actividades preventivasy padecen más problemas laborales y psicosomáticos(AU)

Background. To describe utilisation of health care services andmotives for consultation in Primary Care in the native and theimmigrant population, and compare this with the perception ofprimary care professionals.Methods. Data was collected on health care activity during theyear 2006 for all people registered (N=86,966) in the 6 basic healthcare zones with the highest proportion of immigrants (14.4%) andon the following variables: country of origin, age, sex, year of inscriptionin the public health service. The health card and OMI-APprogramme databases were used. A qualitative methodology offocus groups and in-depth interviews was employed.Results. Seventy-two point four percent of immigrants requestedcare from the primary care professionals in 2006, of whom 50% proceededfrom Ecuador and 70% were between 25 and 44 years old.Eighty-two percent of the natives made consultations and requiredmore referrals to specialised care than the immigrants of the sameage group. The most frequent consultation with natives and with immigrantswas «acute respiratory infections» (7 to 23% according toage group). The second most frequent with immigrants was «administrativeproblems». The consultations with immigrants were notrelated to preventive aspects such as smoking and there were moreconsultations (p>0.001) for gynaeco-obstetric episodes (10.7%) andthose related to work (19%) or psychosomatic problems (8.5%).The perception of the primary care professionals was that the immigrantscarry out more consultations than the natives and generate acertain «disorder» in the clinic.Conclusion. Immigrants use healthcare services less than thenative population. Nonetheless, this fact is not perceived in thisway by the primary care professionals. Fewer preventive activitiesare carried out with immigrants, who suffer from more labourand psychosomatic problems(AU)

Protective action of Lactobacillus curvatus CRL705 on vacuum-packaged raw beef. Effect on sensory and structural characteristics.

Lactobacillus curvatus CRL705 was examined for its effectiveness as protective culture in the biopreservation of vacuum-packaged fresh beef stored during 60 days at 2 degrees C. For this purpose, L. curvatus CRL705, producer of lactocin 705 and lactocin AL705, was inoculated on the meat surface (10(6)cfu g(-1)). This microorganism became the dominating population throughout the storage period controlling the growth of Brochothrix thermosphacta and spoilage lactic acid bacteria naturally present on the meat. When the microstructural characteristics of the meat were evaluated using light microscopy, beef samples inoculated with the bioprotective culture showed a 10days delay for the appearance of tissue degradation signs. Sensory analysis demonstrated that beef samples treated with L. curvatus CRL705 only developed an "acid" off-flavor after 60 days of refrigerated storage, and no undesirable off-odors were found. Therefore, inoculation with this bacteriocinogenic strain would provide an additional hurdle to improve storage life of refrigerated vacuum-packaged beef without affecting its sensory and structural characteristics.

A review of bacteriocinogenic lactic acid bacteria used as bioprotective cultures in fresh meat produced in Argentina.

Several lactic acid bacteria (LAB) associated with meat products are important natural bacteriocin producers. Bacteriocins are proteinaceous antagonistic substances that are important in the control of spoilage and pathogenic microorganisms. The use of LAB as bioprotective cultures to extend the shelf life of fresh meat can improve microbial stability and safety in commercial meat preservation. Lactobacillus curvatus CRL705 used as a protective culture in fresh beef is effective in inhibiting Listeria innocua and Brochothrix thermosphacta as well as the indigenous contaminant LAB, retaining its inhibitory effect at low temperatures and having a negligible effect on meat pH. In addition to the hurdle represented by low temperature and vacuum-packaging, the use of live cells of Lb. curvatus CRL705 seems more feasible from an economic point of view - and without legal restrictions - compared to the addition of purified bacteriocins. A description of meat-borne bacteriocins and their application in meat to extend shelf life is discussed.

Cetuximab, a chimeric human mouse anti-epidermal growth factor receptor monoclonal antibody, in the treatment of human colorectal cancer.

The recent successful development of monoclonal antibodies that target key components of biological pathways has expanded the armamentarium of treatment options for patients with colorectal cancer (CRC). In particular, the epidermal growth factor receptor (EGFR), a tyrosine kinase growth factor receptor involved in CRC development and progression, is exploited by the newest monoclonal antibody that is available for use in CRC patients. Cetuximab, the first chimeric monoclonal antibody, which has been generated against the EGFR, is currently registered in USA, Europe and worldwide, in combination with irinotecan in the treatment of metastatic CRC patients who have progressed on irinotecan containing chemotherapy. Cetuximab is well tolerated and does not exacerbate the toxicity of concomitant chemotherapy. Furthermore, a series of phase III clinical trials are currently evaluating the combination of cetuximab with standard chemotherapy regimens in the first-line treatment chemotherapy-naïve patients with metastatic CRC.

Reduction of Escherichia coli population following treatment with bacteriocins from lactic acid bacteria and chelators.

The inhibitory activity of lactocin 705/AL705 (2133 arbitrary units per ml (AU ml(-1))), two bacteriocins produced by Lactobacillus curvatus CRL705 and nisin (1066AU ml(-1)) produced by Lactococcus lactis CRL1109 in combination with chelating agents against Escherichia coli strains in TSB medium at 21 and 6 degrees C was investigated. Treatment with EDTA (500 and 1000 mm) and Na lactate (800 mm) alone produced a variable effect depending on the strain, Na lactate being inhibitory against E. coli NCTC12900 at both assayed temperatures while EDTA (1000 mm) led to its inactivation only at 6 degrees C. Direct and deferred strategies using EDTA and Na lactate showed that the direct addition of bacteriocins and chelators was not as effective as compared to deferred treatments. When the deferred treatment effectiveness was evaluated at 6 degrees C, the use of EDTA (500 and 1000 mm) and Na lactate (800 mm) in combination with lactocin 705/AL705 demonstrated to be the most inhibitory strategy against both E. coli strains. Nevertheless, treatments with chelators and bacteriocins was highly dependent upon strain sensitivity. Permeabilization of the outer membrane of E. coli strains with EDTA and Na lactate combined with lactocin 705/AL705 showed to be valuable in controlling this foodborne bacteria at low temperatures.

[Study on the interaction between the skin detoxifying enzyme glutathione S-transferase and the substances listed in the CE/39/2000 rules with the "skin" annotation, finalized to the biological monitoring of exposed subjects]. / Studio dell'interazione fra l'enzima detossificante cutaneo glutatione S-trasferasi e le sostanze elencate nella normativa CEE/39/2000 con notazione 'skin' finalizzato al monitoraggio biologico di soggetti esposti.

The interaction among chemicals listed in the Directive CE/39/2000 with skin notation and glutathione S-transferase (GSTP1-1) was studied by following two different experimental approaches. The compounds were incubated with the purified GST isoenzyme GSTP1-1 as well as with the human keratinocytes (PR5) selectively expressing GSTP1-1. Some of the molecules affected the enzymatic activity of both the purified and the intracellular GSTP1-1. In particular, 1,2-dichlorobenzene (DCB), ethylbenzene (ETB), cumene, Sulphotep and 2-eptanone (2-EPT) behaved as inhibitors of the purified GSTP1-1 enzyme, with different inhibition properties according to molecular structure. With the exception of Sulphotep showing a Ki value of 0.2 mM, all compounds reported above were characterized by high Ki values (between 2 and 16 mM) and therefore by low affinity towards GSTP1-1. These results make unlikely the use of a biosensor, based on immobilized GSTP1-1, for the detection of these molecules. On the contrary, Sulphotep can be the object of future investigations. It has to be stressed that the above listed compounds were effective on human keratinocytes, at concentrations two order of magnitude lower than that effective on purified GSTP1-1. In particular, cumene and DCB triggered a clear increase of the intracellular GSTP1-1 activity at concentrations lower than 0.1mM. These interesting results let to hypothesize the use of GSTP1-1 present in the keratinocytes as a marker for biological monitoring of workers exposed to these compounds as well as to evaluate the skin permeability of toxic compounds, not yet identified with a skin notation.

Inhibition of Listeria innocua and Brochothrix thermosphacta in vacuum-packaged meat by addition of bacteriocinogenic Lactobacillus curvatus CRL705 and its bacteriocins.

AIMS: To evaluate the inhibition effectiveness of Lactobacillus curvatus CRL705 used as a bioprotective culture and of its bacteriocins, lactocin 705 and lactocin AL705, against Listeria innocua, Brochothrix thermosphacta and indigenous lactic acid bacteria (LAB) in vacuum-packaged meat stored at 2 degrees C. METHODS AND RESULTS: The live culture of Lact. curvatus CRL705 as well as synthetic lactocin 705 and purified lactocin AL705 were shown to be similarly effective in preventing the growth of B. thermosphacta and L. innocua in meat discs in contrast to control samples in which these micro-organisms grew rapidly, their numbers increasing by 3.0- and 2.1-log cycles respectively. In addition, indigenous LAB population showed a lower growth rate in the presence of lactocin 705. Bacteriocin activity was detected in the meat discs during 36 days at 2 degrees C irrespective of the biopreservation strategy applied. Changes in pH were not significantly different in meat discs treated with the protective culture when compared with control samples. CONCLUSIONS: Lactobacillus curvatus CRL705 and the produced bacteriocins, lactocin 705 and lactocin AL 705, were effective in inhibiting L. innocua and B. thermosphacta. The use of the bioprotective culture in refrigerated vacuum-packaged fresh meat would be more feasible from an economic and legal point of view. SIGNIFICANCE AND IMPACT OF THE STUDY: Establishment of biopreservation as a method to ensure the microbiological safety of vacuum-packaged fresh meat at 2 degrees C.

A phase II study of biweekly oxaliplatin plus infusional 5-fluorouracil and folinic acid (FOLFOX-4) as first-line treatment of advanced gastric cancer patients.

The aim of the study was to assess the toxicity and the clinical activity of biweekly oxaliplatin in combination with infusional 5-fluorouracil (5-FU) and folinic acid (FA) administered every 2 weeks (FOLFOX-4 regimen) in patients with advanced gastric cancer (AGC). A total of 61 previously untreated AGC patients were treated with oxaliplatin 85 mg m(-2) on day 1, FA 200 mg m(-2) as a 2 h infusion followed by bolus 5-FU 400 mg m(-2) and a 22 h infusion of 5-FU 600 mg m(-2), repeated for 2 consecutive days every 2 weeks. All patients were assessable for toxicity and response to treatment. Four (7%) complete responses and 19 partial responses were observed (overall response rate, 38%). Stable disease was observed in 22 (36%) patients, with progressive disease in the other six (10%) patients. Median time to progression (TTP) and median overall survival (OS) were 7.1 and 11.2 months, respectively. National Cancer Institute Common Toxicity Criteria grade 3 and 4 haematologic toxicities were neutropenia, anaemia and thrombocytopenia in 36, 10 and 5% of the patients, respectively. Grade 3 peripheral neuropathy was recorded in three (5%) patients. FOLFOX-4 is an active and well-tolerated chemotherapy. Response rate (RR), TTP and OS were comparable with those of other oxaliplatin-based regimens, suggesting a role for this combination in gastric cancer.

[Quality study of diagnostic and follow-up procedures of bone involvement in type 1 Gaucher"s disease in Spain]. / Estudio de calidad del diagnóstico y seguimiento de los trastornos esqueléticos asociados a la enfermedad de Gaucher tipo 1 en España.

BACKGROUND: Bone involvement in type 1 Gaucher"s disease can be devastating and is oftenly silent. Bone MR is generally recommended. The aim of the study was to elucidate whether the size and location of hospitals in Spain implies any difference in management of GD patients. MATERIAL AND METHODS: We surveyed the type of facilities in the hospital (namely MRI) as well as for the presence, type, severity and methodology of follow-up of bone involvement associated to GD, according to the category of hospital (local or reference). RESULTS: 31 patients were followed in reference hospitals whereas 16 other were in local hospitals. 70% of cases had some type of bone involvement, 60% had severe bone disease. MRI was the first choice for diagnosis in 65% and for follow-up in 93% of cases. MRI is less indicated among patients from local hospitals. Chitotriosidase is measured in a high, but insufficient, proportion of the followed patients (60%). CONCLUSIONS: The Spanish hospital network, either reference or local hospitals, have an adequate infrastructure for the management of GD patients. However, main diagnostic resources are being currently underused.

Estudio de calidad del diagnóstico y seguimiento de los trastornos esqueléticos asociados a la enfermedad de Gaucher tipo 1 en España / Quality study of diagnostic and follow-up procedures of bone involvement in type 1 gaucher's disease in spain

Introducción: La afectación ósea de la enfermedad de Gaucher (EG) tipo 1 es invalidante y silente, para su diagnóstico debe realizarse resonancia magnética (RM) sistemáticamente. El objetivo del estudio fue saber si el tipo de hospital implica diferencias en el uso de medios diagnósticos en la EG. Material y métodos: Se analizan los recursos diagnósticos disponibles y su empleo en la afectación ósea según el tipo de hospital. Resultados: Treinta y un pacientes de hospitales de referencia y 16 de comarcales. El 70 por ciento de los casos presentaban afectación ósea (formas graves el 60 por ciento). La RM se empleó en el diagnóstico inicial (65 por ciento), y el seguimiento (93 por ciento) especialmente en hospitales de referencia. La determinación de quitotriosidasa se emplea el 60 por ciento de los casos en seguimiento. Conclusiones: La red de hospitales públicos españoles está suficientemente dotada para la atención de pacientes con EG en todos sus niveles asistenciales, aunque se infrautilizan los recursos disponibles (AU)

A spectrophotometric-partial least squares (PLS-1) method for the simultaneous determination of furosemide and amiloride hydrochloride in pharmaceutical formulations.

A numerical method, based on the use of spectrophotometric data coupled to PLS-1 multivariate calibration, is reported for the simultaneous determination of furosemide and amiloride hydrochloride in synthetic samples and commercial tablets. The method was applied in the concentration ranges of 8.0-13.0 mg l(-1) for furosemide and 1.0-1.6 mg l(-1) for amiloride hydrochloride. Its accuracy and precision were determined, and it was validated by the analysis of synthetic mixtures of both drugs. The method was successfully applied to the quantitation of furosemide and amiloride hydrochloride in three different pharmaceutical formulations, providing results in agreement with those obtained by HPLC. It allowed the rapid, accurate and precise simultaneous estimation of the concentration of both analytes of interest in spite of their important spectral overlap, high concentration relationship and the presence of small amounts of different, unmodelled, absorbing excipients.

["Usual" morbidity of pediatric tonsillectomy: a study of 126 cases]. / Morbilidad "habitual" de la amigdalectomía pediátrica: estudio de 126 casos.

Pediatric tonsillectomy is a common procedure in the ENT practice, usually in a Day-surgery basis. The aim of the present work is to further investigate postoperative morbidity to improve both treatment and quality of assistance. 126 children operated in our Day-surgery unit were included in the study, and a questionnaire with items related to postoperative pain, otalgia, halitosis, vomitig, fever and other aspects was filled by their parents or relatives in charge. Significative pain lasting until the third or fourth day was recorded in half of the cases. At the end of the first week most of the children are improved, although only 55% are eating normally. Vomitting, usually the day of the surgery, is described by one third of cases. In our experience, ambulatory tonsillectomy is a safe procedure with low incidence of complications, which are mild. However, the delay in returning to a normal diet and the relative high incidence of vomiting bring into question the inclusion of tonsillectomy in a Day-Surgery program, making necessary to implement treatment protocols to avoid such problems.

Adherence to screening guidelines for breast and cervical cancer in postmenopausal women with coronary heart disease: an ancillary study of volunteers for hers.

Postmenopausal women with coronary heart disease (CHD) who volunteered for the Heart and Estrogen/Progestin Replacement Study (HERS) randomized clinical trial had high rates of gynecological abnormalities. We examined compliance with gynecological cancer screening and factors affecting this behavior. Women who met inclusion criteria for HERS and were seen for screening by the study gynecologist were considered eligible for this study. Data were abstracted from study records, and additional information was obtained by telephone questionnaire. Adherence to mammography, breast examination, pelvic examination, and Pap smear recommendations was assessed. Provider behavior and its effect on compliance were assessed. Compliance rates were 59.1% for monthly breast self-examination (BSE), 67.2% for yearly mammography, 73% for yearly Pap smear and pelvic examination, and 75.7% for provider breast examination. Over 50% of patients had most of their screening tests done within the last year. Provider behavior was significantly related to patient screening compliance for mammography, breast examination, Pap smear, and pelvic examination. Provider gender was not significantly related to adherence. There were no significant differences in compliance rates based on the type of most recent coronary event. Compliance rates did not differ significantly between patients with and without gynecological abnormalities, except for mammography (78.3% versus 48.3%, p = 0.02). The majority of patients were compliant with gynecological screening. Among patients with gynecological abnormalities, mammography compliance was significantly lower. Provider behavior was an important factor in influencing women to obtain preventive screening. There were no significant differences in compliance based on provider gender or type of coronary event preceding HERS enrollment.

Morbilidad "habitual" de la amigdalectomía pediátrica: estudio de 126 casos / "Usual" morbidity of paediatric tonsillectomy: a study of 126 cases

La amigdalectomía pediátrica todavía sigue siendo un procedimiento muy común en la práctica otorrinolaringológica, realizándose generalmente dentro de un programa de cirugía mayor ambulatoria. El objetivo de este trabajo es la investigación de la morbilidad habitual de dicha intervención, con la finalidad de optimizar el tratamiento y la calidad de la asistencia. Se han encuestado 126 pacientes pediátricos intervenidos en nuestra Unidad de Cirugía de Día, contemplándose aspectos como la duración de las molestias a la deglución, la otalgia refleja o la halitosis, así como la existencia de hemorragias u otros motivos de consulta. Se registra un dolor faríngeo significativo que dura hasta el 3º ó 4º día en aproximadamente la mitad de los casos. A la semana, casi el 70 por ciento de los operados ya está bien, coincidiendo con el día en que un 55 por ciento comienza a comer con normalidad. Un tercio de los pacientes sufren vómitos, que suelen ser el día de la intervención. En nuestro medio, la amigdalectomía ambulatoria es un procedimiento muy seguro, con escasas complicaciones y de poca gravedad. Sin embargo, la demora en el retorno a la alimentación habitual y la relativa frecuencia de vómitos postoperatorios cuestionan en cierta forma la inclusión de la amigdalectomía dentro de los programas de Cirugía Mayor Ambulatoria, haciendo al menos necesaria la instauración de protocolos de tratamiento que minimicen dichos problemas (AU)

Pediatric tonsillectomy is a common procedure in the ENT practice, usually in a Day-surgery basis. The aim of the present work is to further investigate postoperative morbidity to improve both treatment and quality of assistance. 126 children operated in our Day-surgery unit were included in the study, and a questionnaire with items related to postoperative pain, otalgia, halitosis, vomitig, fever and other aspects was filled by their parents or relatives in charge. Significative pain lasting until the third or fourth day was recorded in half of the cases. At the end of the first week most of the children are improved, although only 55% are eating normally. Vomitting, usually the day of the surgery, is described by one third of cases. In our experience, ambulatory tonsillectomy is a safe procedure with low incidence of complications, which are mild. However, the delay in returning to a normal diet and the relative high incidence of vomiting bring into question the inclusion of tonsillectomy in a Day-Surgery program, making necessary to implement treatment protocols to avoid such problems (AU)