Trauma cardiaco en pediatría / Cardiac trauma in pediatrics

El trauma cardiaco constituye una entidad infrecuente en pediatría que requiere de toma de decisiones rápidas y oportunas, además de un manejo óptimo para obtener una mejor sobrevida de los pacientes. En esta revisión en base a un caso clínico, se actualiza el tema de trauma cardiaco, se describen los tipos más frecuentes, las diferentes formas clínicas de presentación y el enfrentamiento terapéutico. Palabras clave: Trauma cardiaco, penetrante cardiaca, cirugía cardiaca.

Cardiac trauma is an uncommon entity in pediatrics that requires quick and timely decision making, as well as optimal management to obtain a better survival of patients. In this review based on a case report, the issue of cardiac trauma is updated, the most frequent types, the different clinical forms of presentation and the therapeutic confrontation are described.

Prácticas alimentarias de los adolescentes de Cantabria / Eating practices of adolescents of Cantabria

Objetivo: Analizar determinadas prácticas alimentarias en adolescentes escolarizados en centros de educación pública de Cantabria, participantes en el Proyecto 'Promoción de Hábitos Saludables en Adolescentes desde el Ámbito Educativo'. Sujetos: Se realizó un estudio transversal, analizando una muestra de 1.101 adolescentes: 568 (51,6%) varones y 533 (48,4%) mujeres, de edades comprendidas entre los 10 y los 17 años, escolarizados en dieciséis centros de enseñanza primaria y secundaria, mediante un cuestionario autocumplimentado. Resultados: Los adolescentes suelen realizar entre cuatro (41,5%) y cinco (31,6%) ingestas diarias. Durante los días de colegio, el 34% emplea entre diez y quince minutos en desayunar, y entre 30 y 35 minutos en comer (33,5%) y cenar (23%). Un elevado porcentaje (49,4%) de adolescentes desayunaba en soledad durante los días lectivos. Las principales ingestas alimenticias se realizan en el hogar. Las bebidas no alcohólicas (53,6%) y los dulces (42%) son los principales destinos de su dinero de bolsillo. En la casi totalidad de los hogares, es la madre la que se encarga de la compra de los alimentos, de la preparación de las comidas y de decidir tanto el almuerzo como la merienda. La pizza (72,6%) y las patatas fritas (70,8%) son los alimentos considerados más ricos entre los analizados, mientras que el perrito caliente (49,4%) y la hamburguesa (48,5%) son considerados como los menos sanos. El 58,6% de los encuestados cena viendo la televisión. Conclusión: En el estudio del comportamiento alimentario es necesario analizar la influencia de otros factores que, en muchas ocasiones, están detrás de las recomendaciones dietéticas y que casi siempre son ignorados. Prácticas alimentarias como las analizadas en el presente estudio, permiten, cuando estas se desarrollan de forma adecuada, una mejora sustancial en la salud alimentaria y nutricional de las personas

Objetive: To analyse some food practices, by age and sex, in primary and secondary schools adolescents in Cantabria, who are participating in the "Adolescents Health Habits Promotion since Education field" project. Methodology: A cross-sectional study was carried out, analysing a sample of 1101 adolescents: 568 (51.6%) were men and 533 (48.4%) were women, aged between 12 and 17, attending 16 different primary and secondary education centers in Cantabria, by means of questionnaire. Results: Adolescents usually eats between 4 and 5 times a day. They use between 10 to 15 minutes in having breakfast, between 30 to 35 minutes in having lunch and dinner on school days. A high percentage have breakfast alone on school days. The main eats were carried on at home. Soft drinks and sweet are the main purchase with their pocket money. Almost always, the mother is charged of buying the foods, preparing the meals and decide the morning and the afternoon snacks. Pizza and fried potatoes are considerated as most taste, whereas hot dog and hamburger are considerated as less healthy. The 58.6% of adolescents having dinner watching television. Conclusions: In the food behavior study, it is necessary to analyse the influence of other factors which, in many occasions, are behind of dietetic recommendations and the almost always are ignored. Food practices as we have analysed permit, when these are carry out in a right way, an important improve in the people nutritional health

Positive outcomes with negative pressure therapy over primarily closed large abdominal wall reconstruction reduces surgical site infection rates.

PURPOSE: There is a significant morbidity associated with abdominal wall reconstruction (AWR) with a need for overall improvement during the post-operative management. Scientific literature has proven the use of negative pressure therapy (NPT) in wound healing for orthopedic and cardiac surgery with limited data present on its role in AWR. The goal of this study was to examine whether primary wound events were different between patients who had primary closure with NPT versus patients who only had primary closure after AWR. METHODS: This retrospective study examined the rate of post-operative complications in all open-complex AWR that were done in a similar fashion between May 2008 and July 2011 at two large university teaching hospitals. Wound closure was stringent upon attending surgeon preference without randomization. RESULTS: There were a total of 61 patients who met inclusion criteria with an average age of 54 and 60 % were women. Thirty-two patients had primary closure and 29 patients had primary closure with NPT. The mean length of follow-up was 167 days for both groups. The type of wound closure had an effect on the rate of hernia recurrence and surgical site infections. The application of NPT leads to lower hernia recurrence rate of 25 versus 3% and the type of wound closure had a profound effect on the rate and type of SSI. CONCLUSIONS: The data presented in this study demonstrates a potential advantage for adjunctive NPT in patients undergoing AWR. There is an associated decreased incidence in the overall rate of SSI and hernia recurrence with the use of NPT in those patients undergoing AWR. These results show an advantage for adjunctive NPT.

[Assessment of nutritional risk among in-school adolescents from Cantabria]. / Evaluación del riesgo nutricional de los adolescentes escolarizados en Cantabria.

OBJECTIVE: To analyse nutritional risk, by age and sex, among primary and secondary education adolescents from Cantabria. METHODOLOGY: a cross-sectional study was carried out, analysing a sample of 1101 adolescents: 568 (51.6%) were men and 533 (48.4%) were women, aged 12 to 17, attending 16 different primary and secondary education centres in Cantabria, by means of a Krece Plus questionnaire. RESULTS: A high percentage of adolescents with a high nutritional risk (35%) can be observed. Men show a high nutritional risk slightly higher than women (37.8% male vs 32.1% female). Moreover, the high nutritional risk experiences a notable increase as young people get older. Significant statistical differences can be seen both in male and female groups, and as a global group. In all three cases, the nutritional risk distribution in the youngest group is very similar (35.2-35.8% in male, 27.9-29.7% in female, 31.7-32.7% in the global group); whereas in elder adolescents, those values are practically doubled (57.1% in male, 69.0% in female, y 62.2% in the global group). CONCLUSIONS: Results are alarming mainly given the high percentage of adolescents with a high nutritional risk. Men and older adolescents are the groups in which high nutritional risk is more evident.

Objetivo: Evaluar el riesgo nutricional, por edad y sexo, que presentan los adolescentes escolarizados en la Comunidad Autónoma de Cantabria. Sujetos: Se realizó un estudio transversal, analizando una muestra de 1101 adolescentes, de los que 51,6% eran varones y 48,4% fueron mujeres de edades comprendidas entre los 10 y los 17 años, escolarizados en centros de enseñanza pública, mediante el cuestionario Krece Plus. Resultados: Se observa un elevado porcentaje de adolescentes que presentan un riesgo nutricional elevado (35%). Los varones presentan un riesgo nutricional alto en un porcentaje ligeramente superior a las mujeres (37,8 % vs 32,1%). Además, el riesgo nutricional alto sufre un notable incremento a medida que la edad de los jóvenes aumenta. Se aprecian diferencias estadísticamente significativas tanto en los grupos de edad de los varones (p = 0,024), de las mujeres (p < 0,001) como en el grupo global (p = 0,001). En los tres casos, la distribución del riego nutricional en los grupos de menor edad es muy similar (entre 35,2 y 35,8% en los h, entre 27,9 y 29,7% en las m, y entre 31,7 y 32,7% en el grupo total). Mientras que en el grupo de mayor edad estos valores prácticamente se duplican (57,1% en los h, 69,0% en las m, y 62,2 % en el grupo total). Conclusión: Los resultados obtenidos muestran una realidad preocupante debido, principalmente, al elevado porcentaje de adolescentes que presentan un riesgo nutricional elevado. Siendo los varones y los adolescentes de mayor edad los sectores en los que este riesgo nutricional elevado es superior.

Non-crosslinked porcine-derived acellular dermal matrix for the management of complex ventral abdominal wall hernias: a report of 45 cases.

PURPOSE: Ventral abdominal wall hernias are common and repair is frequently associated with complications and recurrence. Although non-crosslinked intact porcine-derived acellular dermal matrix (PADM) has been used successfully in the repair of complex ventral hernias, there is currently no consensus regarding the type of mesh and surgical techniques to use in these patients. This report provides added support for PADM use in complex ventral hernias. METHODS: In a consecutive series of adult patients (2008-2011), complex ventral abdominal wall hernias (primary and incisional) were repaired with PADM by a single surgeon. Patient comorbidities, repair procedures, and postoperative recovery, recurrence, and complications were noted. RESULTS: Forty-four patients (mean age, 57.5 years) underwent 45 single-stage ventral abdominal wall hernia repairs (3 primary; 42 incisional). Previously placed synthetic mesh was removed in 17 cases. In 40 cases, primary fascial closure was achieved; in 5 cases, PADM was used as a bridge. Vacuum-assisted closure (VAC) was used for 38/45 cases: 19 closed incisions, 16 cases using the "French fry" technique, and 3 cases with open incisions. Mean hospital stay was 8.2 days (range, 3-32) and mean follow-up was 17 months (range, 1-48). There were 4 (8.9 %) hernia recurrences, 3 requiring additional repair and 1 requiring PADM explantation. There were 3 (6.7 %) skin dehiscences, 4 (8.9 %) deep wound infections requiring drainage, and 5 (11.1 %) seromas (4 self-limited, 1 requiring drainage). CONCLUSIONS: Non-crosslinked intact PADM yielded favorable early outcomes when used to repair complex ventral abdominal wall hernias in high-risk patients.

Evaluación del riesgo nutricional de los adolescentes escolarizados en Cantabria / Assessment of nutritional risk among in-school adolescents from Cantabria

Objetivo: Evaluar el riesgo nutricional, por edad y sexo, que presentan los adolescentes escolarizados en la Comunidad Autónoma de Cantabria. Sujetos: Se realizó un estudio transversal, analizando una muestra de 1101 adolescentes, de los que 51,6% eran varones y 48,4% fueron mujeres de edades comprendidas entre los 10 y los 17 años, escolarizados en centros de enseñanza pública, mediante el cuestionario Krece Plus. Resultados: Se observa un elevado porcentaje de adolescentes que presentan un riesgo nutricional elevado(35%). Los varones presentan un riesgo nutricional alto en un porcentaje ligeramente superior a las mujeres (37,8% vs 32,1%). Además, el riesgo nutricional alto sufre un notable incremento a medida que la edad de los jóvenes aumenta. Se aprecian diferencias estadísticamente significativas tanto en los grupos de edad de los varones (p =0,024), de las mujeres (p < 0,001) como en el grupo global(p = 0,001). En los tres casos, la distribución del riego nutricional en los grupos de menor edad es muy similar(entre 35,2 y 35,8% en los h, entre 27,9 y 29,7% en las m, y entre 31,7 y 32,7% en el grupo total). Mientras que en el grupo de mayor edad estos valores prácticamente se duplican (57,1% en los h, 69,0% en las m, y 62,2 % en el grupo total).Conclusión: Los resultados obtenidos muestran una realidad preocupante debido, principalmente, al elevado porcentaje de adolescentes que presentan un riesgo nutricional elevado. Siendo los varones y los adolescentes de mayor edad los sectores en los que este riesgo nutricional elevado es superior (AU)

Objective: To analyse nutritional risk, by age and sex, among primary and secondary education adolescents from Cantabria. Methodology: a cross-sectional study was carried out, analysing a sample of 1101 adolescents: 568 (51.6%) were men and 533 (48.4%) were women, aged 12 to 17,attending 16 different primary and secondary education centres in Cantabria, by means of a Krece Plus questionnaire. Results: A high percentage of adolescents with a high nutritional risk (35%) can be observed. Men show a high nutritional risk slightly higher than women (37.8% h vs32.1% m). Moreover, the high nutritional risk experiences a notable increase as young people get older. Significant statistical differences can be seen both in male and female groups, and as a global group. In all three cases, the nutritional risk distribution in the youngest group is very similar (35.2-35.8% in h, 27.9-29.7% in m, 31.7-32.7% in the global group); whereas in elder adolescents, those values are practically doubled (57.1% in h, 69.0% in m, y62.2% in the global group).Conclusions: Results are alarming mainly given the high percentage of adolescents with a high nutritional risk. Men and older adolescents are the groups in which high nutritional risk is more evident (AU)

Autoimagen en las dos primeras fases de la adolescencia y factores ralacionados / Self-image in two first stages of the adolescence and related factors

Se trata de la descripción de la imagen corporal en un amplio grupo de alumnos escolarizados en Cantabria (n=1179 adolescentes), de 10 a 17 años de edad (adolescencia temprana e intermedia) dentro de un estudio más amplio encaminado a evidenciar un estilo de vida saludable en estos adolescentes, llevado a cabo por profesores de universidad y profesores de educación física de los centros educativos. Los principales hallazgos consisten en que los adolescentes tienen, en general, una buena imagen de sí mismos y, aunque no reconocen la elevada prevalencia de sobrepeso y obesidad, desean adelgazar y el grado de satisfacción que tienen con su imagen corporal va empeorando conforme avanza la adolescencia, significativamente más en las del sexo femenino. Esta insatisfacción debe ser tenida en cuenta en el abordaje de los adolescentes con obesidad

This paper describes the body image in an large group of students from Cantabria, Spain (n=1179 adolescents), 10 to 17 years old (early and intermediate adolescence) within a ampler study directed to demonstrate a healthful lifestyle in these adolescents carried out by professors of university and professors of physical education of the educative centers. The main findings are that the adolescents have, generally, a good self-image, and although they do not recognize the high prevalence of overweight and obesity, they wish to become thin and the satisfaction degree that they have with his body image is getting worse as advances the adolescence, significantly more in girls. This dissatisfaction must be considered in the boarding of the adolescents with obesity

EEG de superficie y de actividad epileptiforme interictal en niños y adolescentes con diagnóstico de epilepsia / Surface electroencephalogram and interictal epileptiform activity in children and teenagers with diagnosis of epilepsy

IntroduccIón: los estudios de electroencefalografía (EEG) constituyen la técnica de elección para diagnóstico y clasificación de las epilepsias. objetIvo: determinar los hallazgos electroenefalográficos de superficie en pacientes pediátricos con diagnóstico de sindrome epiléptico MaterIales y Métodos: estudio descriptivo restrospectivo en 2 grupos de pacientes con diagnóstico de epilepsia en edades entre 5-10 años (grupo 1) y 11-19 años (grupo 2). Se realizó registro convencional mediante EEG de superficei determinándose la prevalencia de anormalidades en los grupos estudiados.. resultados: del total de casos 76,54% evidenciaron hallazgos de DEI; 72,6% activadas o incrementadas por maniobra de hiperventilación y 38% por sueño espontáneo (p<0.05, IC95%). Área irritativa comprometida: temporal 29,51% y frontal 24,59%. Ondas lentas de presentación paroxística 22,58%; ondas lentas angulares 21,1%; puntas y punta onda en 14,52% respectivamente (p<0.05, IC95). conclusIones: el electroencefalograma de superficie evidenció actividad epileptiforme interictal en vigilia y sueño espontáneo en alto porcentaje de pacientes pediátricos, siendo las áreas temporales y frontales izquierdas las zonas más irritativas. Las ondas lentas de presentación paroxísticas es la actividad más frecuente en niños menores de 10 años de edad; a diferencia de puntas, punta onda y ondas lentas angulares que aparecen más frecuentes en niños mayores.

Prevalence of mutations in TSHR, GNAS, PRKAR1A and RAS genes in a large series of toxic thyroid adenomas from Galicia, an iodine-deficient area in NW Spain.

OBJECTIVE: Toxic thyroid adenoma (TA) is a common cause of hyperthyroidism. Mutations in the TSH receptor (TSHR) gene, and less frequently in the adenylate cyclase-stimulating G alpha protein (GNAS) gene, are well established causes of TA in Europe. However, genetic causes of TA remain unknown in a small percentage of cases. We report the first study to investigate mutations in TSHR, GNAS, protein kinase, cAMP-dependent, regulatory, type I alpha (PRKAR1A) and RAS genes, in a large series of TA from Galicia, an iodine-deficient region in NW Spain. DESIGN AND METHODS: Eighty-five TA samples were obtained surgically from 77 hyperthyroid patients, operated on for treatment of non-autoimmune toxic nodular goitre. After DNA extraction, all coding exons of TSHR, GNAS and PRKAR1A genes, and exons 2 and 3 of HRAS, KRAS and NRAS were amplified by PCR and sequenced. Previously unreported mutants were cloned in expression vectors and their basal constitutive activities were determined by quantification of cAMP response element (CRE)-luciferase activity in CO7 cells transfected with wild-type and mutant plasmids. RESULTS: TSHR gene mutations were found in 52 (61.2%) samples, GNAS gene mutations in 4 (4.71%) samples and no PRKAR1A or RAS mutations were found. Only three previously unreported mutations were found, two affecting the TSHR, A623F and I635V, and one affecting the G-protein alpha-subunit (Gsalpha), L203P. All mutant proteins showed higher CRE-luciferase activity than their wild-type counterparts. CONCLUSIONS: TA in a hyperthyroid population living in Galicia, a Spanish iodine-deficient region, harbours elevated frequencies of TSHR and GNAS mutations activating the cAMP pathway. However, the genetic cause of TA was undetermined in 34% of the TA samples.

Antibioticoprofilaxis perioperatoria en neurocirugía / Perioperative antibiotic prophylaxis in neurological surgery

Introducción. La antibioticoprofilaxis perioperatoria constituye un tema de actualidad, pero en la neurocirugía no existen estudios controlados, ni informes suficientes, que avalen su utilización. Por otro lado, nos hemos percatado de la ausencia de uniformidad en el uso de los antibióticos en este tipo de cirugía. Este método se ha utilizado en otras especialidades y ha logrado reducir el riesgo de sepsis postoperatoria, por lo que a nuestro juicio puede aplicarse a la neurocirugía, tomando en consideración ciertas particularidades. Objetivos. Conocer los resultados respecto a la sepsis postoperatoria en un grupo consecutivo de pacientes a quienes se aplicó la profilaxis en intervenciones neuroquirúrgicas. Pacientes y métodos. Se realizó un estudio prospectivo, observacional y descriptivo de 100 pacientes que requirieron intervenciones neuroquirúrgicas y en los que se administraron antimicrobianos para prevenir la sepsis . Se relacionó la cirugía intracraneal y extracraneal con el uso o no de estos agentes, así como la aparición de sepsis o no. Para aplicar el método se utilizó la clasificación del National Research Council de EE.UU. Resultados. En la cirugía espinal fue donde más se utilizó el método. No existieron diferencias entre el uso o no de antibióticos en la cirugía espinal cervical con respecto a la aparición de sepsis. Los factores exógenos desempeñaron un papel importante en el desarrollo de sepsis no relacionadas con la técnica quirúrgica. Conclusión. Las complicaciones relacionadas con la cirugía fueron mínimas, mientras que las generales fueron más frecuentes (AU)

Water relationships in Phyllantus orbicularis and Punica granatum antiviral extracts and their influence on stability after freezing and freeze-drying.

The effect of freezing, freeze-drying and storage on inhibitory half dose (ID(50)) and on cytotoxic concentration (CC(50)) of Phyllantus orbicularis and Punica granatum extracts was studied. Selective index SI=(CC(50) /ID(50)) was considered as the antiviral criterion. Both frozen and freeze-dried extracts were analyzed by differential scanning calorimetry (DSC). The values of vitreous transition temperatures of P. granatum (Tg' and Tg) were lower than those of P. orbicularis. Sorption isotherms of freeze-dried products showed a typical sigmoidal shape, where GAB model was fitted instead of bet model. Water adsorption in freeze-dried P. prbicularis extract was higher than in the case of P. granatum. No significant changes in SI were induced by freezing or freeze-drying after a 6 months storage at -20 degrees c, but in the case of P. granatum extract, the effectiveness was highly affected after exposure to 37 degrees c or higher.

[Perioperative antibiotic prophylaxis in neurological surgery]. / Antibioticoprofilaxis perioperatoria en neurocirugía.

INTRODUCTION: Perioperative antibiotic prophylaxis is a current topic of interest. However, in neurosurgery there are no controlled studies or full reports to support its use. We have also observed that there is little consistency in the use of antibiotics in this type of surgery. This method has been used in other specialities, reducing the risk of postoperative sepsis. We therefore consider that it may be used in neurosurgery, bearing in mind certain specific aspects. OBJECTIVES: To find the postoperative sepsis in a consecutive group of patients in whom prophylaxis was used for neurosurgical operations. PATIENTS AND METHODS: We made a prospective, observational, descriptive study of 100 patients who needed neurosurgical operations and were given antimicrobial agents to prevent sepsis. The relation between intracranial and extracranial surgery, the use or not of these agents and the occurrence or not of sepsis was observed. The method was applied using the classification of the National Research Council of the USA. RESULTS. In spinal surgery, the method was used most and no difference was found with or without the use of antibiotics in cervical spinal surgery, with regard to the occurrence of sepsis. Exogenous factors played an important part in the development of sepsis unrelated to the surgical technique. CONCLUSIONS: The complications related to surgery were minimal. However, general complications occurred more frequently.

Recomendaciones para el manejo del climaterio en el ISS / Guide for hadling of climateric in ISS

El término menopausia, se refiere específicamente al cese de la menstruación ya sea fisiológica o quirúrgica en la cual se extirpan los ovarios. Se considera que la paciente ha presentado la menopausia cuando han transcurrido doce meses después de la última menstruación, teniendo lugar en la mayoría de las mujeres entre los 45 y 52 años. Existe un período premenopáusico que se inicia a partir de los 40 años y que se caracteriza por alteraciones del ciclo menstrual y síntomas neurovegetativos. No siempre es necesaria la intervención médica durante esta etapa a menos que la sintomatología sea muy severa o las alteraciones menstruales representen hemorragias uterinas anormales sospechosas de patologías de tipo uterino, endometrial o anexial que justifiquen un manejo médico farmacológico o quirúrgico. Establecida la menopausia, la evidencia epidemiológica demuestra que la terapia hormonal de suplencia (THS) se asocia con un efecto benéfico sobre el riesgo de osteoporosis y fracturas postmenopáusicas, con una reducción aparente del riesgo de enfermedad coronaria. Es igualmente eficaz en la prevención y tratamiento de la atrofia genital y del síndrome uretral con un efecto favorable sobre la sintomatología del síndrome climatérico. La indicación principal no debe ser por lo tanto únicamente la de prevenir los síntomas climatéricos, sino evitar las patologías derivadas del déficit estrogénico a mediano y largo plazo. El mejoramiento de las condiciones de salud de la población colombiana trae consigo un aumento en la expectativa de vida con la consecuente transición epidemiológica que se traduce en un aumento de la franja poblacional de mujeres menopáusicas. Este cambio poblacional se acompaña de la aparición de patologías propias de este período de la vida y justifican una intervención médico social que propenda por una mejor calidad de vida en este grupo de mujeres. Para lograr lo anterior se deben desarrollar políticas de salud con énfasis en aspectos educativos, preventivos y terapéuticos que produzcan un impacto benéfico en la salud de las mujeres postmenopáusicas. La presente guía comprende un marco teórico sobre la fisiopatología de la menopausia y una serie de recomendaciones diagnósticas y terapéuticas basadas en la evidencia epidemiológica existente sobre el tema, que permitan desarrollar programas de manejo integral de la mujer menopáusica

Taino Tomato Mottle Virus, a New Bipartite Geminivirus from Cuba.

Geminiviruses have become the most important virus group affecting tomatoes (Lycopersicon lycopersicum (L.) Karsten) in Cuba since they have been detected in all tomato-producing areas, causing serious losses. Recently, a whitefly-transmitted, monopartite geminivirus was detected in Cuba and identified as tomato yellow leaf curl virus-Israel (TYLCV-Is) (1). Samples collected from the main tomato-producing areas during the period 1995 to1996 were further analyzed by polymerase chain reaction (PCR) with degenerate primers (PAL1v1978 and PAR1c496) (2). Whereas in samples from most areas only TYLCV was detected, in some samples from the Havana area, two DNA fragments (approximately 1.4 and 1.1 kb) were amplified by PCR. The larger fragment was identified as part of the TYLCV-Is genome, confirming the previous report (1). The 1.1-kb fragment was cloned and its nucleotide sequence suggested that a new bipartite geminivirus was also present in those tomato samples. To clone the entire genome, tomato plants were inoculated by biolistics with DNA extract from field samples. After symptom expression, a viral DNA-enriched preparation from the inoculated tomatoes was independently digested with several restriction enzymes and the products were ligated into pZero plasmid (Invitrogen, San Diego, CA). Several clones in the 2.6-kb size range were characterized by restriction mapping and hybridization against component A and B heterologous probes. Two clones were selected as containing putative A and B components and their infectivity was tested by biolistic inoculation of tomato and pepper plants. The inoculated tomatoes developed a mild mottle in the younger leaves, whereas no symptoms were visible on the inoculated pepper plants. However, the presence of viral DNA was confirmed in both tomatoes and peppers by Southern blot hybridization analysis with A- and B-specific probes. Partial sequences of both components were obtained and their analysis showed that both components shared a 170-bases common region with a 95% identity. In addition, the nucleotide sequences of two open reading frames, one in each component (AC1 and BC1), were determined and compared with geminivirus sequences deposited in Gen-Bank. A dendogram generated with the CLUSTAL program and obtained with the AC1 and BC1 amino acid sequences, placed the new geminivirus in a cluster with tomato mottle virus (ToMoV; accession nos. L14460, L14461), Abutilon mosaic virus (AbMV; X15983, X15984), potato yellow mosaic virus (PYMV; D00940, D00941), and bean dwarf mosaic virus (BDMV; M88179, M88180). The percentages of identity obtained with the amino acid sequences were as follows. For AC1: ToMoV, 87%; PYMV, 79.5%; BDMV, 78.7%; and AbMV, 78%. For BC1 protein: BDMV, 92.8%; ToMoV, 89.1%; PYMV, 88.1%; and AbMV, 67.5%. In addition, the sequences were compared with partial nucleotide sequences (AC1, coat protein [CP], and common region) of a bipartite geminivirus affecting tomatoes in Jamaica (accession nos. U83855, U83854, and U83850). Interestingly, the common regions showed a higher percentage of identity (88%) than the CP and AC1 partial nucleotide sequences (86 and 74%, respectively). These data suggest that the virus reported here is a new geminivirus and the first bipartite geminivirus reported in Cuba. Thus, the name of Taino tomato mottle virus is proposed. (Taino refers to the name of the inhabitants of Cuba at the time of Columbus's arrival in the Caribbean). References: (1) P. L. Ramos et al. Plant Dis. 80:1208, 1996. (2) M. R. Rojas et al. Plant Dis. 77:340, 1993.

Cyclic nucleotide changes induced in human leukocytes by a product of axenically grown Entamoeba histolytica that inhibits human monocyte locomotion.

Pulse exposure of human mononuclear phagocytes to the monocyte locomotion-inhibitory factor produced by Entamoeba histolytica (i.e., the 369- to 765-Da chromatographic fraction obtained from the supernatant fluid of axenically grown E. histolytica) led to a swift increase in the intracellular concentration of adenosine 3':5' cyclic monophosphate (cAMP). A weaker response was observed in human polymorphonuclear leukocytes, the locomotion of which, however, is not inhibited by this amebic factor. The same chromatographic fraction obtained from the axenic medium control lacked this effect, at least upon mononuclear phagocytes. On the other hand, both the monocyte locomotion-inhibitory factor and the axenic medium control, possibly through shared cultured medium components, induced comparable increases in guanosine 3':5' cyclic monophosphate (cGMP) in human mononuclear phagocytes and in polymorphonuclear leukocytes, thus suggesting that the latter-nucleotide is not critical for the leukotactic inhibitory phenomenon. Our results suggest that like other leukotactic inhibitors, the monocyte locomotion-inhibitory factor produced by E. histolytica operates through modulations of intracellular cAMP.

Coronary artery diameter and coronary risk factors: a study with ultrafast computed tomography.

Coronary artery dilation has been described as an early effect of atherosclerosis. No noninvasive technique has been available to measure coronary size. In this study coronary diameters were measured in 100 asymptomatic subjects (89 men and 11 women, mean age 40 +/- 6 years) by means of ultrafast computed tomography (UFCT), with 3 mm thick ECG gated scans. Subjects without evidence of coronary calcium were studied. The diameter of the left main (LD) and right (RD) coronary arteries were measured. Total coronary diameter, TD = LD + RD, was determined, and univariate analysis was performed with respect to total, high-density lipoprotein and low-density lipoprotein cholesterol, mean blood pressure, age, body surface area, and triglycerides. Mean LD was 4.23 +/- 0.85 mm, and mean RD was 3.06 +/- 1.08 mm. TD increased with body surface area (p < 0.001). No other variable showed any significant effect on TD in this group without evidence of atherosclerosis. UFCT can be used to noninvasively measure coronary artery diameters and may be a useful technique to detect early changes of atherosclerosis in individual patients and in population studies.

COP-BLAM multidrug infusion chemotherapies for lymphoma: results in a community hospital setting.

Twenty-two patients with malignant lymphoma were treated with three different COP-BLAM infusional chemotherapy protocols at the Jersey Shore Medical Center. The treatment group included 18 patients with large-cell lymphoma, 3 patients with Hodgkin's disease, and 1 patient with composite lymphoma (large-cell lymphoma and Hodgkin's disease). Three patients were treated with COP-BLAM III, 9 with COP-BLAM IV, and 10 with COP-BLAM V. The age of the patients at diagnosis ranged from 18 to 74 years, with a median age of 64 years. One patient had stage I bulky disease, 4 had stage II bulky disease, 3 had stage III disease, and 14 had stage IV disease. Twenty patients were evaluable for response; 2 were too early to evaluate. Complete response (CR) was seen in 18 of the 20 evaluable patients (90%). Potential cure (excludes non-lymphoma-related deaths) at 24 months is projected at 78%. Eleven patients are presently without disease and off therapy (55%). Projected failure-free survival at 2 years is 71% (a failure being death from any cause). Eleven of 22 patients developed 15 febrile episodes. Vincristine neuropathy was seen in 6 patients. Subclinical pulmonary fibrosis was seen in 1 patient. There was one cardiotoxic death. The COP-BLAM infusional protocols are highly effective, tolerable regiments that are applicable in community hospitals and can yield good response rates, with a high percentage of disease-free survivors in all age groups. The treatment can be completed in a short period with acceptable toxicity.

Further physicochemical characterization of the monocyte locomotion inhibition factor (MLIF) produced by Entamoeba histolytica.

Ultrafiltration, gel-sieve chromatography and HPLC were used to purify MLIF. This material was HCl-hydrolyzed and the amino acids analyzed by HPLC-ortho-ophthaldialdehyde. Two hydrophobic non-polar (ile,leu), two uncharged polar (thr,tyr) and two positively charged (basic) (his, arg) amino acids were found in clear excess to their concentration in AMC and thus may intervene in the composition of MLIF.

Effect of the monocyte locomotion inhibitory factor (MLIF) produced by Entamoeba histolytica upon the respiratory burst of human leukocytes.

In addition to inhibiting the locomotion of human MP, MLIF appears capable of inhibiting the respiratory burst (measured by chemiluminescence) of MP and of PMN as well. The effect on the latter cells may or may not be relevant in the host-E. histolytica interaction, as PMN have been found to be notoriously inefficient in dealing with amebas and, foremost, do not use oxidative mechanisms in dealing with the parasite. On the other hand, the inhibitory effect on MP may represent a true evasion mechanism inasmuch as activated MP are capable of destroying virulent amebas, and do so by both oxidative and non-oxidative mechanisms.

The role of mannose in the receptor of the monocyte locomotion inhibitory factor produced by Entamoeba histolytica.

The effect of the monocyte locomotion inhibitory factor (MLIF) produced by Entamoeba histolytica is diminished, if not cancelled, when human monocytes are pre-exposed to concanavalin A or sodium periodate, respectively, but not when MLIF is pretreated with sodium periodate. When the MLIF-inhibited monocyte locomotion assays were performed in the presence of 12 different carbohydrates, only the runs containing D-mannose, 4-O-beta-galactosyl-mannoside or mannan revealed a significant reduction in the inhibitory effect. Finally, the MLIF activity was virtually absorbed out with mannan-coupled Sepharose 4B beads. This suggests that D-mannose constitutes an essential part of the receptor for MLIF on the human monocyte membrane.