The needs of families who care for individuals with kidney failure on comprehensive conservative care: A qualitative systematic review.

BACKGROUND: Integrating the family of patients with kidney failure on comprehensive conservative care could benefit patients, families, and the health care system. However, there is a knowledge gap in this phenomenon since no systematic review has focused on the families' needs who care for individuals with kidney failure on comprehensive conservative care. OBJECTIVES: To understand the primary needs of families who care for people with kidney failure on comprehensive conservative care. METHOD: A systematic literature review of qualitative studies, followed by a content analysis was carried out. PubMed, CINAHL, and PsycINFO databases were used to search for articles published in English and Spanish between 2010 and 2021. The ENTREQ guideline was used for reporting. RESULTS: Five relevant studies were included in this study. The analysis has allowed identifying key aspects of knowledge, psychological, social and spiritual needs of family members of patients with kidney failure on comprehensive conservative care. CONCLUSIONS: This systematic review has revealed that families experience a lack of information and continuity of care by health care professionals. Added to this is the psychological burden they bear due to the feeling of indefinite care in time and uncertainty about the death of their loved one. All this, without the necessary support from their immediate family environment and social institutions. In light of these data, a paradigm shift in society and the health care received by these families is essential.

Assessment of the methodologies used in microbiological control of sewage sludge.

Sewage sludge usually contains potentially polluting substances such as heavy metals, organic pollutants and various organisms including bacteria, protozoa, helminths, viruses and algae, some of which may be pathogenic. Certain of these pathogens could be transferred to the soil if the sludge is used on agricultural or land recovery applications. For its application on agricultural land, sewage sludge must comply with the limits established in the legislation, which in Europe does not include quality standards regarding microbiological parameters. Nevertheless, the presence of pathogens could limit its agricultural use, as it could pose a risk to human, animal and environmental health. This study compares 4 different methodologies used in microbiological analysis in order to identify the most efficient and reliable method on determining bacteria in sewage sludge. Escherichia coli and Enterococcus faecium are used as bacterial indicators. The results obtained in this work indicate that results obtained with three different plate count methods cannot be comparable with those obtained with the MPN method. The membrane filtration method is recommended for its high precision and sensitivity, both in low and high bacterial loads. It is also concluded that it would be necessary to establish the quality standard in concordance with the method used.

In-vitro development of an effective treatment for Acanthamoeba keratitis.

The aim of this study was to develop an in-vitro topical treatment for Acanthamoeba keratitis (AK) effective against cysts and trophozoites. Qualitative assays were performed with voriconazole, chlorhexidine, propamidine, cellulase, tobramycin, ciprofloxacin and paromomycin as monotherapy and various combinations. Riboflavin with ultraviolet-A (R + UV-A) as monotherapy or combined with voriconazole and moxifloxacin was also tested. Quantitative assays to assess cyst viability after treatment were performed for the chemicals that showed the highest activity in the qualitative assays. Paromomycin and propamidine did not show antiamoebic activity. Regardless of the total dose, no amoebicidal effect was observed for R + UV-A. Tobramycin, ciprofloxacin, voriconazole, chlorhexidine and cellulase were selected for quantitative assays because they appeared to cause greater damage to the structure of amoebae. Chlorhexidine and ciprofloxacin were the most active against Acanthamoeba spp. as monotherapy. Among the combinations evaluated, ciprofloxacin-voriconazole-chlorhexidine showed the greatest amoebicidal activity, with severe damage of the cellular membrane and an important decrease in cell concentration. In summary, ciprofloxacin as monotherapy and in combination with voriconazole and chlorhexidine has been classified as promising treatment. Additional in-vivo studies in animal models and clinical trials in patients with AK should be considered to confirm the efficacy of ciprofloxacin.

[A new case of psychotic break as the presenting symptom of anti-NMDA receptor encephalitis. Treatment from a neuropsychiatric approach]. / Nuevo caso de brote psicotico como presentacion de la encefalitis antirreceptor de NMDA. Enfoque de tratamiento desde la neuropsiquiatria.

INTRODUCTION: Limbic encephalitis generated by anti-N-methyl D-aspartate (NMDA) receptor antibodies is a severe acute neurological condition that is more prevalent in young females and is associated with an underlying tumour. The appearance of severe initial psychiatric signs and symptoms and the fact that it is accompanied by emotional disorders and severe cognitive impairment make it necessary to reconsider the contributions of neuropsychiatry to the diagnosis, development and treatment of the disease, since these have received little attention from researchers to date. CASE REPORT: We report on what is, to our knowledge, the only case in Navarra, associated with an ovarian teratoma, with special attention paid to its assessment, intervention and neuropsychiatric development. CONCLUSION: Anti-NMDA receptor encephalitis is a disease that is usually accompanied by predominant psychiatric manifestations at the outset of the illness, together with cognitive deterioration that commonly affects memory and the executive functions. Treatment consisting in beginning a process of rehabilitation that includes compensatory strategies for deficits, cognitive stimulation and psychopharmacological treatment in the recovery phase has proved to be effective.

TITLE: Nuevo caso de brote psicotico como presentacion de la encefalitis antirreceptor de NMDA. Enfoque de tratamiento desde la neuropsiquiatria.Introduccion. La encefalitis limbica generada por anticuerpos antirreceptor de N-metil-D-aspartato (NMDA) es una entidad neurologica aguda y grave, mas prevalente en mujeres jovenes y asociada a un tumor subyacente. La aparicion de sintomatologia psiquiatrica inicial grave y el curso con alteraciones emocionales y deficit cognitivo grave hacen necesario reflexionar sobre las aportaciones, poco estudiadas hasta el momento, de la neuropsiquiatria al diagnostico, la evolucion y el tratamiento de la enfermedad. Caso clinico. Se presenta el unico caso del que se tiene constancia en Navarra, asociado a un teratoma ovarico, atendiendo especialmente a la evaluacion, la intervencion y la evolucion neuropsiquiatrica. Conclusion. La encefalitis antirreceptor de NMDA es una enfermedad que suele cursar con manifestaciones psiquiatricas predominantes en el inicio de la enfermedad, asi como con deterioro cognitivo que afecta habitualmente a la memoria y a las funciones ejecutivas. Se demuestra eficaz iniciar un proceso de rehabilitacion que incluya estrategias compensatorias del deficit, estimulacion cognitiva y tratamiento psicofarmacologico en la fase de recuperacion.

[Proposed model of executive functions based on factorial analyses]. / Propuesta de un modelo de funciones ejecutivas basado en analisis factoriales.

INTRODUCTION: Since Lezak coined the term executive functions to refer to the mental capabilities that are considered essential for performing efficacious, creative and socially acceptable behaviour, they have gradually grown in importance in neuropsychological research. Different models have been proposed to explain their nature, but there is no general agreement as to whether we are dealing with a unitary construct or a multimodal processing system with independent, but interconnected, components. With the aim of gaining a deeper knowledge of the structure of this construct, researchers have conducted lesion, neuroimaging and, more recently, factorial analysis studies, the latter being seen as a promising methodology for expanding our knowledge about such a generic concept as the executive functions. DEVELOPMENT: The purpose of this study is to carry out a systematic review of factorial models of attention and executive control in adults, between the years 1991 and 2016, using the PubMed, OvidSP and PsycINFO databases. Altogether, 33 papers were reviewed. Based on the literature, an integrating proposal of the executive functions is put forward. CONCLUSIONS: Although we do not have just one single model that can account for the complexity of the executive functions, there does seem to be general agreement on their multidimensionality. In factorial analyses, there is strong evidence of updating, inhibition and alternation, although there are also studies that propose novel factors. Our integrating proposal aims to combine the executive processes found in the literature with their corresponding neuroanatomical correlates, and defends the stance that the ideal methodology should use information from lesion studies, neuroimaging techniques and psychometric-computational models.

TITLE: Propuesta de un modelo de funciones ejecutivas basado en analisis factoriales.Introduccion. Desde que Lezak acuñara el termino de funciones ejecutivas como las capacidades mentales esenciales para llevar a cabo una conducta eficaz, creativa y aceptada socialmente, estas han adquirido progresivo protagonismo en la investigacion neuropsicologica. Diversos modelos han sido planteados para explicar su naturaleza, pero no existe consenso respecto a si nos encontramos ante un constructo unitario o un sistema de procesamiento multimodal con componentes independientes, pero interconectados. Para conocer la estructura de este constructo se han utilizado estudios de lesion, neuroimagen y, recientemente, el analisis factorial, que se plantea como una metodologia prometedora para ampliar nuestro conocimiento sobre un concepto tan generico como las funciones ejecutivas. Desarrollo. El proposito de este estudio es realizar una revision sistematica de modelos factoriales de atencion y control ejecutivo en adultos, entre los años 1991-2016, utilizando las bases de datos PubMed, OvidSP y PsycINFO. En total, se revisaron 33 articulos. A partir de la bibliografia, se realiza una propuesta integradora de los procesos ejecutivos. Conclusiones. Aunque no disponemos de un unico modelo que pueda explicar la complejidad de las funciones ejecutivas, si parece existir acuerdo respecto a su multidimensionalidad. En analisis factoriales, actualizacion, inhibicion y alternancia gozan de fuerte evidencia, si bien hay trabajos que plantean factores novedosos. Nuestra propuesta integradora trata de combinar los procesos ejecutivos hallados en la bibliografia con sus correspondientes correlatos neuroanatomicos, defendiendo que la metodologia ideal deberia utilizar informacion procedente de estudios de lesion, tecnicas de neuroimagen y modelos psicometricos-computacionales.

[Contributions of neuropsychology to anti-NMDA receptor antibody encephalitis: a literature review]. / Aportaciones de la neuropsicologia a la encefalitis por anticuerpos antirreceptor de NMDA: revision de la bibliografia.

Limbic encephalitis generated by anti-N-methyl-D-aspartate (NMDA) receptor antibodies is an acute and severe neurological entity, which is more prevalent in young females and is associated to an underlying tumour. Since it leads to severe cognitive impairment, thought needs to be given to the contributions of neuropsychology to the diagnosis, development and treatment of the disease, which have received little attention from researchers to date. A review is conducted of the prior literature, evaluating the measurement of the cognitive symptoms (predominantly mnemonic and executive) associated to this disease. Valid, reliable neuropsychological instruments are proposed, and it is suggested that neuropsychological measures may be used as parameters to follow up these patients which help monitor their functionality in daily living once they have recovered from the acute phase. Similarly they can become a basis on which to assemble rehabilitation programmes that favour the accomplishment of personal autonomy and the patients' reintegration in the community. Nevertheless, we stress the need to include neuropsychologists and neuropsychiatrists in not only the detection but also the treatment of these patients so as to enable them to recover their personal independence and re-adapt to their natural settings.

TITLE: Aportaciones de la neuropsicologia a la encefalitis por anticuerpos antirreceptor de NMDA: revision de la bibliografia.La encefalitis limbica generada por anticuerpos antirreceptor de N-metil-D-aspartato (NMDA) es una entidad neurologica aguda y grave, mas prevalente en las mujeres jovenes y asociada a un tumor subyacente. El curso con deficit cognitivo grave hace necesario reflexionar sobre las aportaciones de la neuropsicologia al diagnostico, evolucion y tratamiento de la enfermedad, poco estudiadas hasta el momento. Se revisa la bibliografia precedente, criticando la medicion de los sintomas cognitivos (predominantemente mnesicos y ejecutivos) asociados a esta enfermedad. Se proponen instrumentos neuropsicologicos validos y fiables, y se plantea que las medidas neuropsicologicas pueden servir como parametros de seguimiento de estos pacientes que ayuden a monitorizar su funcionalidad en la vida diaria una vez recuperados de la fase aguda, asi como convertirse en una base sobre la que articular programas de rehabilitacion que favorezcan el logro de la autonomia personal y la reinsercion comunitaria de los pacientes. Con todo, se subraya la necesidad de incluir a neuropsicologos y neuropsiquiatras no solo en la deteccion, sino en el tratamiento de los pacientes, en pro de alcanzar la recuperacion de la independencia personal y la readaptacion a sus entornos naturales.

Bioaccumulation of pathogenic bacteria and amoeba by zebra mussels and their presence in watercourses.

Dreissena polymorpha (the zebra mussel) has been invading freshwater bodies in Europe since the beginning of the nineteenth century. Filter-feeding organisms can accumulate and concentrate both chemical and biological contaminants in their tissues. Therefore, zebra mussels are recognized as indicators of freshwater quality. In this work, the capacity of the zebra mussel to accumulate human pathogenic bacteria and protozoa has been evaluated and the sanitary risk associated with their presence in surface water has also been assessed. The results show a good correlation between the pathogenic bacteria concentration in zebra mussels and in watercourses. Zebra mussels could therefore be used as an indicator of biological contamination. The bacteria (Escherichia coli, Enterococcus spp., Pseudomonas spp., and Salmonella spp.) and parasites (Cryptosporidium oocysts and free-living amoebae) detected in these mussels reflect a potential sanitary risk in water.

A family cluster of giardiasis with variable treatment responses: refractory giardiasis in a family after a trip to India.

Persistence of giardiasis after some of the recommended drugs is occurring with increasing frequency. We describe the follow-up of four members of a family with giardiasis through microscopic observation, immunochromatography and PCRs of tpi and ß-giardin genes. Three patients did not respond to tinidazole but they were cured after quinacrine. However, PCR became negative at 2 months after negativization of stools in two patients and after 1 year in one patient. In all cases Giardia assemblage B was characterized with high homology between all isolates. Further studies are needed to determine the value of PCR in the diagnosis of Giardia infections.

Identification of pathogen bacteria and protozoa in treated urban wastewaters discharged in the Ebro River (Spain): water reuse possibilities.

The aim of this research work is to identify the presence of pathogens, bacteria and protozoa, in different treated urban wastewaters and to relate biological pollution with the processes used in wastewater treatment plants. A study of the possibilities for water reuse is carried out taking into account bacterial and parasite composition. The analysed bacteria and protozoa are: Enterococcus faecalis, Pseudomonas aeruginosa, Staphylococcus aureus, Clostridium perfringens (spore), Salmonella spp., Legionella spp., helminths eggs, Giardia, Cryptosporidium spp. and free-living amoebae (FLA). The selected municipal wastewater treatment plants (MWTPs) are located in Navarra (Spain) and the main difference between them is the use of natural lagoons as tertiary treatment in some plants. The results concerning bacteriological identification showed contamination of mainly faecal origin, and the use of natural lagoons as tertiary treatment in some MWTPs produced an important disinfection effect. Moreover, pathogen parasites such as Giardia and Cryptosporidium were not detected in the samples studied although FLA were identified in all cases.

A new pentaplex-nested PCR to detect five pathogenic bacteria in free living amoebae.

Changes in water use and anthropogenic activity have major impacts on the quality of natural aquatic ecosystems, water distribution and wastewater plants. One of the main problems is the presence of some pathogenic microorganisms that are resistant to disinfection procedures when they are hosted by free living amoeba and that in many cases are hardly detectable by culture-based procedures. In this work we report a sensitive, low-cost procedure consisting of a pentaplex-nested PCR that allows simultaneous detection of Legionella pneumophila, Mycobacterium spp., Pseudomonas spp., Vibrio cholerae and the microcystin-producing cyanobacteria Microcystis aeruginosa. The method has been used to detect the presence of these pathogenic bacteria in water and inside free living amoeba. Its validation in 72 samples obtained from different water sources from Aragon (Spain) evidences that Mycobacterium and Pseudomonas spp are prevailing as amoeba-resistant bacteria.

Estructura factorial del cuestionario disejecutivo en una muestra de población española con daño cerebral adquirido y quejas de déficit de memoria / Factorial structure of the dysexecutive questionnaire in a sample of the Spanish population with acquired brain injury and memory deficit complaints

Introducción y objetivo. El cuestionario disejecutivo (DEX) se ha utilizado para estudiar los déficits ejecutivos en muestras clínicas (psiquiátricas y neurológicas) y no clínicas, aunque no existe un acuerdo sobre su estructura factorial. El objetivo del presente trabajo es estudiar dicha estructura en la versión autoadministrada en una muestra de población española con daño cerebral adquirido y quejas de pérdida de memoria, y comparar dicha solución con las obtenidas en otros estudios. Pacientes y métodos. Se administró el cuestionario a 119 sujetos con daño cerebral adquirido de diferente etiología (traumática, vascular, tumoral, esclerosis múltiple, tóxico-metabólica y otras). Resultados. El coeficiente alfa de Cronbach fue de 0,88. Todos los ítems muestran una adecuada capacidad discriminativa salvo el ítem 15. No se encuentra relación entre la puntuación total en el DEX y la edad, el sexo y el tiempo transcurrido desde la lesión. Se confirma una correlación negativa entre la puntuación total y el nivel de estudios alcanzado. La puntuación total no sigue una distribución normal. La solución de cinco factores explica mayor porcentaje de la varianza total que las de dos, tres y cuatro factores (63,76%). Conclusiones. La versión española del DEX es un instrumento válido para evaluar síntomas disejecutivos generales en sujetos con daño cerebral adquirido. La estructura factorial de cinco factores (planificación, control cognitivo, inhibición, conciencia social y control de impulsos) aporta una mayor riqueza al medir más aspectos de la patología disejecutiva, y por ello parece más útil en el ámbito clínico. Se aconseja la utilización del cuestionario en una fase de evaluación inicial o de cribado y de forma complementaria a la versión heteroinformada (AU)

Introduction and aims. The dysexecutive questionnaire (DEX) has been used to study executive deficits in both clinical samples (both psychiatric and neurological) and non-clinical samples, although agreement on its factorial structure is lacking. The aim of this research is to study that structure in the self-administered version in a sample of the Spanish population with acquired brain injury and memory loss complaints, and to compare that solution with those obtained in other studies. Patients and methods. The questionnaire was administered to 119 subjects with acquired brain injury with different aetiologies (traumatic, vascular, tumours, multiple sclerosis, toxic-metabolic and others). Results. The Cronbach’s alpha coefficient was 0.88. All the items showed adequate discriminatory power, except item 15. No relation was found between the total score on the DEX and the age, gender and time elapsed since the injury. A negative correlation between total score and level of schooling was confirmed. The total score does not follow a normal distribution. The five-factor solution accounts for a higher percentage of the total variance than those of two, three and four factors (63.76%). Conclusions. The Spanish version of the DEX is an instrument that is valid for evaluating general dysexecutive symptoms in subjects with acquired brain injury. The five-factor factorial structure (planning, cognitive control, inhibition, social awareness and impulse control) offers a greater wealth of information because it measures more aspects of the dysexecutive pathology and therefore appears to be more useful in the clinical setting. It is advisable to use the questionnaire in an early stage of evaluation or screening and to use it as a complement to the proxy-reported version (AU)

Evaluation of an immunochromatographic dip strip test for simultaneous detection of Cryptosporidium spp, Giardia duodenalis, and Entamoeba histolytica antigens in human faecal samples.

Immunochromatographic (IC) tests may play an important role in the future diagnosis of parasitic diseases because of their speed and simplicity of use. A recently developed test to detect Cryptosporidium spp, Giardia duodenalis and Entamoeba histolytica was evaluated. Microscopy and PCR were the "gold standard" reference techniques and the results of this IC test were compared with those obtained with ELISA and IC single test for the three parasites. One hundred sixty stool samples were assayed. Using microscopy, 22 samples were diagnosed as positive for Cryptosporidium spp., 31 for Giardia duodenalis, 41 for Entamoeba histolytica/dispar, and 68 had a negative diagnosis for the three parasites. Results of IC tests show sensitivities of 70-72% for Cryptosporidium, 90-97% for Giardia and 62.5% for Entamoeba histolytica. Specificities were of 93.6-94.9%, >99% and 96.1%, respectively. In all diagnoses, agreement with microscopy and PCR was over 90%, except in the triple test and microscopy in E. histolytica detection that was 76.3%, due to the inability of microscopy to differentiate E. histolytica from nonpathogenic species such as E. dispar or E. moshkovskii. The triple stool immunoassays provide adequate sensitivities and specificities for use in outbreak situations, for screening proposals and for massive assays in endemic areas where a large number of samples must be analysed or as complementary test for individual diagnosis.

[Cerebellar contribution to cognitive process: current advances]. / Contribucion del cerebelo a los procesos cognitivos: avances actuales.

INTRODUCTION: The cerebellum has traditionally been considered a neuronal system which is an essential part of coordination and motor control. However, in recent decades the idea of the cerebellum as an organ related to high level cognitive processes has gained strength, a claim supported by studies carried out on animals and humans with cerebellar lesions such as the contribution of modern neuroimaging techniques. DEVELOPMENT: The contribution of the cerebellum is reviewed in different cognitive functions such as the regulation of motor functions, attention, language, visuoconstructional skills, learning, memory and executive functions. The results of said review produce, as the most clarifying data, the influence of the cerebellum on processes such as attention, working memory (covert articulation) and verbal fluency as well as procedural learning. The results found regarding the cerebellum and the executive functions are not conclusive. CONCLUSIONS: We consider it necessary to systematize the table that has already been outlined. This will enable us to answer not only the question of whether the cerebellum plays a role in human cognition but which is its role. Perhaps the basis for understanding the cognitive functions of the cerebellum are not found in the fact that the cerebellum contains functions but that it relates the intention to the action in the emotional as well as the behavioural cognitive plane although the role of 'interface' is found closer to the output processes than processing of functions with a motor component.

Potentially pathogenic free-living amoebae (FLA) isolated in Spanish wastewater treatment plants.

This work studies the characterization of pathogenic free-living amoebae (FLA) from sewage effluents. Some of them, such as Acanthamoeba, Naegleria, Hartmannella, Sappinia, Balamuthia and Paravahlkampfia have been reported as a cause of diseases in humans. Therefore, the study of their habitats and their pathogenicity has become necessary. The population of potentially pathogenic FLA was analysed in five Spanish wastewater treatment plants. Five of the seven FLA isolated were identified as genus Acanthamoeba genotypes T3, T4, T7 and T9. Hartmannella and Naegleria were also isolated. Acanthamoeba demonstrated great thermotolerance and osmotolerance. It was also observed that treatment with sodium hypochlorite showed no significative reduction in the number of amoeba at concentrations of 0-100 ppm. The high resistance of FLA cysts to disinfection methods is a trojan horse for public health insofar as they colonize water systems and allow the survival of intracellular microorganisms resistant to FLA. The results of this work advance current knowledge of the FLA population.

[The role of the cerebellum in the regulation of affection, emotion and behaviour]. / Participacion del cerebelo en la regulacion del afecto, la emocion y la conducta.

INTRODUCTION: In recent decades there has been a significant increase in the number of articles that have drawn attention to the possible importance of the role of the cerebellum in non-motor functions. Schmahmann and Sherman, for example, have described the cognitive, behavioural and emotional pattern of what has been called cerebellar cognitive affective syndrome. A central aspect of this disorder is the dysregulation of affect that occurs when lesions involve what has been called the limbic cerebellum (mainly the vermis). DEVELOPMENT: A non-systematic review of the most important literature on the role of the cerebellum in emotional and behavioural regulation was carried out. Two lines of analysis were followed. The first of them was the study of the psycho-pathological symptoms or neuropsychiatric disorders presented by patients suffering from different cerebellar pathologies ranging from congenital pathologies such as agenesis of the cerebellum, dysplasia or hypoplasia to other acquired diseases like tumours in the posterior fossa, cerebellitis or superficial siderosis. In such cases it has been seen that when the cerebellar vermis is compromised, patients display disorders affecting their behaviour and emotions, and psychiatric pathologies are more frequent. In the second line, we analysed the role played by the cerebellum in different psycho-pathological disorders in which the structure of the cerebellum was found to be altered. Although not universal, these alterations were consistent, since they involve the cerebellar vermis. CONCLUSIONS: Although the body of evidence continues to grow, a critical review of the scientific literature leads us to reflect on evolution in the study of the cerebral substrate underlying the cognitive functions and the evolution undergone by this study.

[Alien hand syndrome: a review of the literature]. / Sindrome de la mano ajena: revision de la bibliografia.

INTRODUCTION: Alien hand syndrome (AHS) is a rare neurological disorder, but is an important condition because of its disabling impact on the daily life. The common feature of AHS is the involuntary, autonomous motor activity of the affected limb and the denial of limb ownership, characterized by involuntary, uncontrollable, and purposeless movements. DEVELOPMENT: AHS as a nosologic entity has been modified during the last decades, being able to be a result of several diseases involving corpus callosum or medial frontal cortex, although some authors reported cases of AHS in patients due to posterior cerebral lesions. Frontal AHS occurs in the dominant hand, is associated with grasping, groping and compulsive manipulation of tools. Callosal subtype is characterized by inter-manual conflict and was the first to been described en the context of callosal disconnection. CONCLUSIONS: Alien hand behaviours are increased in conditions of fatigue or anxiety and are usually elicited by nearby objects. The rehabilitative treatment, targeted toward the specific needs of each patient, could allow the improvement of the activities of daily life.

Síndrome de la mano ajena: revisión de la bibliografía / Alien hand syndrome: A review of the literature

Introducción. El síndrome de la mano ajena (SMA) es un trastorno neurológico poco frecuente, pero importante, debido al impacto por incapacitación que produce en la vida diaria. El rasgo común al SMA es la actividad motora autónoma e involuntaria del miembro afecto; y la sensación de extrañeza sentida por el paciente, caracterizado por movimientos involuntarios, incontrolables y sin objetivo. Desarrollo. El síndrome como entidad nosológica se ha modificado durante las últimas décadas, y puede ser resultado de enfermedades que involucren al cuerpo calloso o al córtex frontomedial, aunque algunos autores han descrito casos de SMA en pacientes debido a lesiones posteriores. La forma frontal de SMA aparece en la mano dominante, se asocia a grasping, groping y manipulación compulsiva de instrumentos. El subtipo calloso se caracteriza por el conflicto intermanual, y es el primero en ser descrito en el contexto de casos de desconexión callosa. Conclusiones. Los comportamientos de mano ajena se incrementan en condiciones de fatiga o ansiedad y se desencadenan normalmente por objetos cercanos. El tratamiento rehabilitador, dirigido hacia las necesidades específicas de cada paciente, podría permitir la mejoría en la consecución de las actividades de la vida diaria (AU)

Introduction. Alien hand syndrome (AHS) is a rare neurological disorder, but is an important condition because of its disabling impact on the daily life. The common feature of AHS is the involuntary, autonomous motor activity of the affected limb and the denial of limb ownership, characterized by involuntary, uncontrollable, and purposeless movements. Development. AHS as a nosologic entity has been has been modified during the last decades, being able to be a result of several diseases involving corpus callosum or medial frontal cortex, although some authors reported cases of AHS in patients due to posterior cerebral lesions. Frontal AHS occurs in the dominant hand, is associated with grasping, groping and compulsive manipulation of tools. Callosal subtype is characterized by inter-manual conflict and was the first to been described en the context of callosal disconnection. Conclusions. Alien hand behaviours are increased in conditions of fatigue or anxiety and are usually elicited by nearby objects. The rehabilitative treatment, targeted toward the specific needs of each patient, could allow the improvement of the activities of daily life (AU)

Correlation between the presence of symptoms and the Giardia duodenalis genotype.

Clinical manifestations of Giardia duodenalis infection vary from asymptomatic infection to chronic diarrhoea. We study the correlation between the presence of symptoms and the G. duodenalis genotype in 108 patients with giardiasis. Patient age ranged from 2 to 72 years old. We found a correlation between assemblage AII and symptomatic infections, and between assemblage B and asymptomatic infections in the overall patient group and in patients less than five years of age. Nevertheless, if only patients of more than five years of age were considered, no statistically significant relationship between assemblage and symptomatic or asymptomatic Giardia infections was found. In these patients, host factors may affect the presence of clinical manifestations more than Giardia assemblage.

Combination of analytical and microbiological techniques to study the antimicrobial activity of a new active food packaging containing cinnamon or oregano against E. coli and S. aureus.

The aim of this work is the optimization and application of a group of analytical and microbiological techniques in the study of the activity of essential oils (EOs) incorporated in a new antimicrobial packaging material and the research in depth of the interaction between the microbial cells and the individual compounds present in the active material. For this purpose the antimicrobial activity of the active packaging containing cinnamon or oregano was evaluated against E. coli and S. aureus. The vapour phase activity and the direct contact between the antimicrobial agents themselves, or once incorporated in the packaging material, and the microbial cells have been studied. The direct contact was studied using a broth dilution method. The vapour phase was evaluated by using a new method which involves the use of a filter disk containing the EOs. Furthermore, the kill time assay was used to determine the exposure time for the maximum efficiency in packaging, and transmission electron microscopy was used to investigate the antimicrobial activity and the possible mechanism of action against E. coli and S. aureus. Finally, the compounds absorbed by cells were identified. The results showed that the techniques used provide relevant information about the antibacterial activity of cinnamon and oregano in direct contact as well as in the vapour phase. The antimicrobial packaging showed a fast efficiency which supports its likely application as a food packaging material. Bacteria treated with EOs exhibit a wide range of significant abnormalities; these include formation of blebs, coagulation of cytoplasmatic constituents, collapse of the cell structure and lack of cytoplasmatic material. Some of these observations are correlated to the ability of some of these substances to disrupt envelop structure, especially the inner membrane. After an extraction from dead cells, cinnamaldehyde was detected by GC-MS in E. coli exposed to the active packaging containing cinnamon.