Parasitological versus molecular diagnosis of strongyloidiasis in serial stool samples: how many?

Strongyloidiasis is usually an asymptomatic disease in immunocompetent patients, caused by Strongyloides stercoralis. However, in immunocompromised patients it can produce a severe clinical profile. Therefore, a correct diagnosis is necessary in these cases and in those chronic asymptomatic patients. The low sensitivity of classical parasitological techniques requires the analysis of multiple serial stool samples. Molecular diagnostic techniques represent an improvement in the detection of the parasite. The objective of this study was to evaluate the minimum number of samples necessary to achieve maximum sensitivity by real-time polymerase chain reaction (PCR). A total of 116 stool samples from 39 patients were analysed by direct microscopic observation, agar culture, Harada-Mori and real-time PCR, in one, two, three and four or more consecutive samples. After two serial samples, 6 out of 39 patients were positive by parasitological and molecular techniques, while 16 of them were real-time PCR positive, and all the patients detected by parasitology were also detected by the molecular technique, reaching 100.00% sensitivity versus 83.00% when analysing a single sample. These data also reflect apparently low specificity (51.52%) and positive predictive value (PPV) (27.27 %) values, due to the high number of cases detected by real-time PCR and not by parasitological techniques. These cases were confirmed as true positives when analysing three, four or more samples from the same patient. In conclusion, the application of molecular techniques decreases the number of serial stool samples necessary to give a diagnosis with the maximum sensitivity.

Peritoneal tuberculosis due to Mycobacterium caprae.

The incidence of tuberculosis in humans due to Mycobacterium caprae is very low and is almost confined to Europe. We report a case of a previously healthy 41-year-old Moroccan with a 6 month history of abdominal pain, weight loss, fatigue and diarrhea. A diagnosis of peritoneal tuberculosis due to M. caprae was made.

Monitorización de las presiones de la vía aérea con la modalidad de flujo continuo en cirugía toracoscópica pediátrica. Estudio en modelo animal / Airway pressure monitoring by the continuous flow method in paediatric thoracoscopic surgery. A study in an animal model

Objetivo. Comparar las presiones en la vía aérea obtenidas antes del tubo endotraqueal con las intratraqueales en la modalidad ventilatoria de flujo continuo, en cirugía toracoscópica para ventilación unipulmonar, en modelo pediátrico en animales. Material y métodos. Estudio prospectivo observacional simple. Se emplearon 10 cerdos Large White, con un peso de 4,6±0,8kg. Los animales se ventilaron en modo neonatal (flujo continuo) con un respirador Temel Supra. Mediante traqueotomía realizamos un sellado completo del sistema respiratorio para usar tubos sin neumotaponamiento especiales que permiten el registro traqueal de presiones sin interferir en la ventilación. Se realizó colapso del pulmón derecho por videotoracoscopia y se mantuvo durante 120min. Las variables se analizaron en 10 tiempos: inicio y 5min en bipulmonar, tras el colapso en los tiempos 5, 15, 30, 60, 90 y 120min, y 5 y 15min tras la reexpansión pulmonar. Registramos la presión basal, pico, meseta y teleespiratoria en la boca del animal e intratraqueal. Resultados. La media de la presión pico en la boca del animal en ventilación unipulmonar fue de 23,38mmHg y traqueal de 21,24mmHg, mientras que la media de la presión meseta en la boca de animal en ventilación unipulmonar fue de 21,88mmHg y traqueal de 21,39mmHg, respectivamente, con diferencias significativas en todas (p<0,05). Encontramos diferencias estadísticamente significativas (p<0,05) para la presión pico y meseta al comparar el registro en la boca del animal con el registro traqueal, siendo la diferencia en valor absoluto mayor para el registro de presión pico. Conclusiones. Los parámetros de presiones registrados en la boca del animal fueron asumibles para la cirugía, manteniéndose una adecuada estabilidad respiratoria y hemodinámica. Podemos afirmar que la modalidad de flujo continuo según el estudio de presiones puede ser idónea para este tipo de cirugía, y que el registro en la boca del animal (paciente) para la presión pico no refleja lo que realmente ocurre en el alvéolo, pero sí podemos tener una aproximación clínica adecuada para la presión meseta(AU)

Objective. To compare the airway pressures obtained before the endotracheal tube with the intratracheal ones in the continuous flow ventilation mode, in thoracoscopic surgery for one lung ventilation, in a paediatric model in animals. Material and methods. A simple prospective observational study was conducted. Ten Large White pigs weighing 4.6±0.8kg were used. The animals were ventilated in neonatal mode (continuous flow) with a Temel Supra ventilator. Using tracheotomy, we completely sealed the respiratory system in order to use tubes without special endotracheal cuffs, which would enable tracheal pressures to be registered without interfering with ventilation. Collapse of the right lung was performed by videothoracoscopy and was maintained for 120min. The variables were measured at 10 time periods: start and 5min with both lungs, after collapse at 5, 15, 30, 60, 90 and 120min, and 5 and 15min after lung re-expansion. We recorded the baseline, peak, plateau and positive end expiratory pressure in the mouth of the animal and intratracheal. Results. The mean peak pressure in the mouth of the animal in one lung ventilation was 23.38mmHg and tracheal ventilation was 21.24mmHg, while the mean plateau pressure in the mouth of the animal in one lung ventilation it was 21.88mmHg and tracheal was 21.39mmHg, respectively, with significant differences in all of them (P<.05). We found statistically significant differences (P<.05) for peak and plateau pressure on comparing the record in the animal mouth with the tracheal record. The difference in absolute value was higher for the peak pressure record. Conclusions. The pressure parameters recorded in the animal mouth were acceptable for surgery, with a suitable respiratory and haemodynamic stability being maintained. We can state that the continuous flow mode according to the pressures study may be suitable for this type of surgery, and that the mouth of the animal (patient) record for the peak pressure does not reflect what really happens in the alveoli, but we can give a suitable clinical estimate for the plateau pressure(AU)

[Airway pressure monitoring by the continuous flow method in paediatric thoracoscopic surgery. A study in an animal model]. / Monitorización de las presiones de la vía aérea con la modalidad de flujo continuo en cirugía toracoscópica pediátrica. Estudio en modelo animal.

OBJECTIVE: To compare the airway pressures obtained before the endotracheal tube with the intratracheal ones in the continuous flow ventilation mode, in thoracoscopic surgery for one lung ventilation, in a paediatric model in animals. MATERIAL AND METHODS: A simple prospective observational study was conducted. Ten Large White pigs weighing 4.6 ± 0.8 kg were used. The animals were ventilated in neonatal mode (continuous flow) with a Temel Supra ventilator. Using tracheotomy, we completely sealed the respiratory system in order to use tubes without special endotracheal cuffs, which would enable tracheal pressures to be registered without interfering with ventilation. Collapse of the right lung was performed by videothoracoscopy and was maintained for 120 min. The variables were measured at 10 time periods: start and 5 min with both lungs, after collapse at 5, 15, 30, 60, 90 and 120 min, and 5 and 15 min after lung re-expansion. We recorded the baseline, peak, plateau and positive end expiratory pressure in the mouth of the animal and intratracheal. RESULTS: The mean peak pressure in the mouth of the animal in one lung ventilation was 23.38 mmHg and tracheal ventilation was 21.24 mmHg, while the mean plateau pressure in the mouth of the animal in one lung ventilation it was 21.88 mmHg and tracheal was 21.39 mmHg, respectively, with significant differences in all of them (P<.05). We found statistically significant differences (P<.05) for peak and plateau pressure on comparing the record in the animal mouth with the tracheal record. The difference in absolute value was higher for the peak pressure record. CONCLUSIONS: The pressure parameters recorded in the animal mouth were acceptable for surgery, with a suitable respiratory and haemodynamic stability being maintained. We can state that the continuous flow mode according to the pressures study may be suitable for this type of surgery, and that the mouth of the animal (patient) record for the peak pressure does not reflect what really happens in the alveoli, but we can give a suitable clinical estimate for the plateau pressure.

[Update on the current role of plasma cholinesterase]. / Papel de las colinesterasas plasmáticas. Actualización.

The antagonism of steroidal nondepolarizing neuromuscular blockers (NDMBs) moved forward recently with the introduction of sugammadex, the only drug able to immediately reverse the effects of curarization produced by NDMBs. This advance has necessitated reflection on the future role of pseudocholinesterase. In spite of the side effects of succinylcholine and published opinions on its use, this NDMB continues to be used in clinical anesthesia. Pseudocholinesterase is mainly found in the liver, plasma, and nervous system. The enzyme is synthesized in the liver in greater amounts than required although certain conditions lead to deficiency, which is usually asymptomatic. The only clinical expression is the apnea which develops after administration of succinycholine because this NDMB cannot be metabolized. In some patients, slight reductions in the antagonism of succinylcholine lead to rising neuromuscular concentrations of the drug in accordance with the degree and duration of the blockade. We review the various forms of pseudocholinesterase deficiency, including a discussion of genetic variants, clinical manifestations, and management. In addition to discussing the diagnosis of this condition and the clinical implications, we highlight the importance of practice protocols and access to a referral laboratory if one is not available within the immediate hospital.

Propuesta de un programa de formación usando un modelo experimental para el manejo anestésico del trasplante hepático / Proposed experimental model to provide training in the management of anesthesia in liver transplantation

Objetivos: Proponemos y evaluamos un programa de entrenamiento para anestesiólogos, en modelo porcino, para aumentar la calidad del manejo anestésico durante el trasplante hepático. Material y método: Cinco anestesiólogos, facultativos especialistas de área, sin experiencia previa en el manejo anestésico del trasplante hepático que no trabajan en centros donde se realiza la cirugía de trasplante hepático, realizaron el programa de entrenamiento y evaluación de manera voluntaria, anestesiando cinco animales cada uno. La cirugía se realizó bajo anestesia total balanceada, realizando monitorización hemodinámica, ventilatoria, determinación bioquímica, gasometrías arteriales y coagulación. Para evaluar a los alumnos se utilizaron criterios publicados previamente, considerando su habilidad para mantener al paciente estable. Fueron evaluados en los tiempos T1 (basal), T2-15 min fase preanhepática, T3-final fase preanhepática, T4-15 min fase anhepática, T5-final fase anhepática, T6-15 min fase postanhepática, T7-final fase postanhepática. Los alumnos completaron una encuesta al finalizar el programa para valorar su utilidad. Los cambios en la puntuación de los criterios de calidad fueron analizados utilizando ANOVA. Resultados: Durante la fase postimplantación, los cambios metabólicos (acidosis) y cardiacos (hipotensión y bradicardia) fueron las alteraciones más críticas a las que tuvieron que hacer frente los alumnos. Se evidenció un incremento significativo en las habilidades de los alumnos para hacer frente a los cambios hemodinámicos y metabólicos (p < 0,05). Todos los alumnos expresaron su preferencia por la realización de un entrenamiento previo en modelo porcino. Conclusiones: Utilizando este modelo de entrenamiento, los cambios hemodinámicos y fisiológicos que acontecen durante el trasplante, fueron entendidos y manejados. En nuestra opinión, la realización de un programa de formación en modelo porcino permite al anestesiólogo adquirir experiencia y habilidad para el manejo anestésico del trasplante hepático(AU)

Objetive: To propose and evaluate the use of a porcine model for training in how to manage and improve the quality of anesthesia during liver transplantation. Material and Methods: Five trained anesthesiologists who had no previous experience in managing anesthesia during liver transplantation and who did not work in hospitals where the procedure was performed volunteered for the training course and evaluated it. Each trainee anesthetized 5 animals. Surgery was performed under total balanced anesthesia with monitoring of hemodynamics, ventilation, biochemistry, arterial blood gases, and coagulation. Previously set criteria were used to evaluate the trainees' skill in maintaining patient stability. Their work was assessed 7 times: at baseline, 15 minutes into the preanhepatic phase, at the end of the preanhepatic stage, 15 minutes into the anhepatic phase, at the end of the anhepatic phase, 15 minutes into the postanhepatic phase, and at the end of the postanhepatic phase. After completing the course, the trainees filled in a questionnaire to evaluate its usefulness. Analysis of variance was applied to score changes in anesthetic quality criteria. Results: After implantation, changes in metabolic (acidosis) and cardiac (hypotension and bradycardia) status were the most critical abnormalities the trainees faced. Their skill in coping with hemodynamic and metabolic changes improved significantly (P<.05). All participants expressed a preference for receiving training in a porcine model before providing anesthesia in this surgical setting. Conclusions: Under this training model, the anesthesiologists understood and were able to manage the hemodynamic and physiologic changes that develop during a liver transplant procedure. We believe that training using a porcine model allows an anesthesiologist to acquire experience and skill in this setting(AU)

Papel de las colinesterasas plasmáticas. Actualización / Update on the current role of plasma cholinesterase

Las novedades recientemente manifestadas en el campo de la antagonizacion de los relajantes neuromusculares no despolarizantes (BNMND) esteroideos, nos ha hecho revisar cual es o seguirá siendo en el futuro el rol que realizaran las enzimas plasmáticas seudocolinesterasas (CP SC) Con la introducción del sugamadex única molécula capaz de antagonizar de forma inmediata los efectos de la curarizacion producida por este tipo de bloqueantes neuromusculares (BNM) A pesar de sus efectos colaterales y la opinion encontrada de numerosos autores, la succinilcolina (SCH) sigue siendo un bloqueante neuromuscular despolarizante (BNMD) utilizado en el mundo de la anestesia clínica. La colinesterasa plasmática (CP), se encuentra presente principalmente en el hígado, plasma y sistema nervioso. Es sintetizada en el hígado en cantidades supriores a las necesarias. Asimismo puede presentarse en cantidades menores en diferentes situaciones patológicas. Los pacientes con déficit de CP son generalmente asintomáticos, y sólo tiene expresión clínica, mediante la aparición de apnea succinilcolínica, tras la administración de succinilcolina, por imposibilidad de metabolizar este fármaco. En algunos sujetos pequeñas disminuciones de la inactivación de la succinilcolina, producen un gran incremento del fármaco en la placa neuromuscular, del grado y duración del bloqueo. En esta revisión hacemos un repaso de los déficit de CP sus diferentes alteraciones por variantes genéticas, su clínica y su tratamiento. Además de sus implicaciones clínicas y método de diagnostico sin olvidar la importancia de tener elaborados protocolos de actuación y posibilidad de tener un laboratorio de referencia si no se determinan en nuestro medio hospitalario(AU)

The antagonism of steroidal nondepolarizing neuromuscular blockers (NDMBs) moved forward recently with the introduction of sugammadex, the only drug able to immediately reverse the effects of curarization produced by NDMBs. This advance has necessitated reflection on the future role of pseudocholinesterase. In spite of the side effects of succinylcholine and published opinions on its use, this NDMB continues to be used in clinical anesthesia. Pseudocholinesterase is mainly found in the liver, plasma, and nervous system. The enzyme is synthesized in the liver in greater amounts than required although certain conditions lead to deficiency, which is usually asymptomatic. The only clinical expression is the apnea which develops after administration of succinycholine because this NDMB cannot be metabolized. In some patients, slight reductions in the antagonism of succinylcholine lead to rising neuromuscular concentrations of the drug in accordance with the degree and duration of the blockade. We review the various forms of pseudocholinesterase deficiency, including a discussion of genetic variants, clinical manifestations, and management. In addition to discussing the diagnosis of this condition and the clinical implications, we highlight the importance of practice protocols and access to a referral laboratory if one is not available within the immediate hospital(AU)

[Proposed experimental model to provide training in the management of anesthesia in liver transplantation]. / Propuesta de un programa de formación usando un modelo experimental para el manejo anestésico del trasplante hepático.

OBJECTIVE: To propose and evaluate the use of a porcine model for training in how to manage and improve the quality of anesthesia during liver transplantation. MATERIAL AND METHODS: Five trained anesthesiologists who had no previous experience in managing anesthesia during liver transplantation and who did not work in hospitals where the procedure was performed volunteered for the training course and evaluated it. Each trainee anesthetized 5 animals. Surgery was performed under total balanced anesthesia with monitoring of hemodynamics, ventilation, biochemistry, arterial blood gases, and coagulation. Previously set criteria were used to evaluate the trainees' skill in maintaining patient stability. Their work was assessed 7 times: at baseline, 15 minutes into the preanhepatic phase, at the end of the preanhepatic stage, 15 minutes into the anhepatic phase, at the end of the anhepatic phase, 15 minutes into the postanhepatic phase, and at the end of the postanhepatic phase. After completing the course, the trainees filled in a questionnaire to evaluate its usefulness. Analysis of variance was applied to score changes in anesthetic quality criteria. RESULTS: After implantation, changes in metabolic (acidosis) and cardiac (hypotension and bradycardia) status were the most critical abnormalities the trainees faced. Their skill in coping with hemodynamic and metabolic changes improved significantly (P<.05). All participants expressed a preference for receiving training in a porcine model before providing anesthesia in this surgical setting. CONCLUSIONS: Under this training model, the anesthesiologists understood and were able to manage the hemodynamic and physiologic changes that develop during a liver transplant procedure. We believe that training using a porcine model allows an anesthesiologist to acquire experience and skill in this setting.

Propuesta de un programa de formación usando un modelo experimental para el manejo anestésico del trasplante hepático / Proposed experimental model to provide training in the management of anesthesia in liver transplantation

Objetivos: Proponemos y evaluamos un programa de entrenamiento para anestesiólogos, en modelo porcino, para aumentar la calidad del manejo anestésico durante el trasplante hepático. Material y método: Cinco anestesiólogos, facultativos especialistas de área, sin experiencia previa en el manejo anestésico del trasplante hepático que no trabajan en centros donde se realiza la cirugía de trasplante hepático, realizaron el programa de entrenamiento y evaluación de manera voluntaria, anestesiando cinco animales cada uno. La cirugía se realizó bajo anestesia total balanceada, realizando monitorización hemodinámica, ventilatoria, determinación bioquímica, gasometrías arteriales y coagulación. Para evaluar a los alumnos se utilizaron criterios publicados previamente, considerando su habilidad para mantener al paciente estable. Fueron evaluados en los tiempos T1 (basal), T2-15 min fase preanhepática, T3-final fase preanhepática, T4-15 min fase anhepática, T5-final fase anhepática, T6-15 min fase postanhepática, T7-final fase postanhepática. Los alumnos completaron una encuesta al finalizar el programa para valorar su utilidad. Los cambios en la puntuación de los criterios de calidad fueron analizados utilizando ANOVA. Resultados: Durante la fase postimplantación, los cambios metabólicos (acidosis) y cardiacos (hipotensión y bradicardia) fueron las alteraciones más críticas a las que tuvieron que hacer frente los alumnos. Se evidenció un incremento significativo en las habilidades de los alumnos para hacer frente a los cambios hemodinámicos y metabólicos (p < 0,05). Todos los alumnos expresaron su preferencia por la realización de un entrenamiento previo en modelo porcino. Conclusiones: Utilizando este modelo de entrenamiento, los cambios hemodinámicos y fisiológicos que acontecen durante el trasplante, fueron entendidos y manejados. En nuestra opinión, la realización de un programa de formación en modelo porcino permite al anestesiólogo adquirir experiencia y habilidad para el manejo anestésico del trasplante hepático(AU)

Objetive: To propose and evaluate the use of a porcine model for training in how to manage and improve the quality of anesthesia during liver transplantation. Material and Methods: Five trained anesthesiologists who had no previous experience in managing anesthesia during liver transplantation and who did not work in hospitals where the procedure was performed volunteered for the training course and evaluated it. Each trainee anesthetized 5 animals. Surgery was performed under total balanced anesthesia with monitoring of hemodynamics, ventilation, biochemistry, arterial blood gases, and coagulation. Previously set criteria were used to evaluate the trainees' skill in maintaining patient stability. Their work was assessed 7 times: at baseline, 15 minutes into the preanhepatic phase, at the end of the preanhepatic stage, 15 minutes into the anhepatic phase, at the end of the anhepatic phase, 15 minutes into the postanhepatic phase, and at the end of the postanhepatic phase. After completing the course, the trainees filled in a questionnaire to evaluate its usefulness. Analysis of variance was applied to score changes in anesthetic quality criteria. Results: After implantation, changes in metabolic (acidosis) and cardiac (hypotension and bradycardia) status were the most critical abnormalities the trainees faced. Their skill in coping with hemodynamic and metabolic changes improved significantly (P<.05). All participants expressed a preference for receiving training in a porcine model before providing anesthesia in this surgical setting. Conclusions: Under this training model, the anesthesiologists understood and were able to manage the hemodynamic and physiologic changes that develop during a liver transplant procedure. We believe that training using a porcine model allows an anesthesiologist to acquire experience and skill in this setting(AU)

Human tuberculosis due to Mycobacterium bovis and M. caprae in Spain, 2004-2007.

OBJECTIVE: To identify the characteristics associated with human tuberculosis (TB) caused by Mycobacterium bovis and M. caprae in Spain. DESIGN: Retrospective study covering all M. bovis and M. caprae isolates identified at the National Mycobacterial Reference Laboratory (NRL) from 2004 to 2007. We studied the microbiological and epidemiological characteristics of patients and performed a genetic analysis of isolates. RESULTS: The study covered 110 isolates (89 M. bovis and 21 M. caprae) that accounted for respectively 1.9% and 0.3% of the M. tuberculosis complex isolates available at the NRL. Data on risk of exposure to M. bovis or to M. caprae were available in 82 (74%) of the 110 cases, with 60 (73%) registering a probable or possible risk of exposure and 22 (27%) registering no risk. Probable exposure mainly included crop and livestock farmers, and possible exposure included patients born in countries with a high prevalence of bovine TB. Spoligotyping of strains yielded 36 different patterns, with SB0121, SB0134 and SB0157 being predominant. CONCLUSIONS: In Spain, cases of human TB due to M. bovis and M. caprae represent a small proportion of all TB cases, and for a high percentage of cases this is linked to occupational exposure and coming from countries endemic for bovine TB.

Population-based contact investigation of a cluster of tuberculosis cases in a small village.

A cluster of five cases of tuberculosis (TB) in persons aged 19-23 years who were not close contacts was detected in a small village in Spain in 2006. All culture isolates had the same chromosomal-DNA restriction pattern. Contact investigations of family members, friends, workmates and schoolmates were complemented with tuberculin screening offered to the resident population born between 1976 and 1995. Expanded contact tracing detected two new cases of TB, 27 tuberculin conversions and an excess of latent tuberculosis infections (LTI) in persons born between 1978 and 1990. The contacts of two cases had a significantly elevated prevalence of LTI. Two secondary cases of TB, 33.3% of those diagnosed with LTI and 47.8% of the converters were unaware of any contact with the TB cases, but had frequented some of the same bars. This study suggests that a considerable percentage of the episodes of TB transmission in young people may escape detection in conventional contact studies.

Manejo anestésico del síndrome de Brugada / No disponible

El síndrome de Brugada (SB) fue descrito en 1992 por los hermanos P. y J. Brugada en pacientes fallecidos por paro cardiaco sin defecto cardíaco estructural alguno pero con patrón electrocardiográfico (EKG) de bloqueo incompleto de la rama derecha del haz de His (BIRDHH) y elevación del segmento ST en las derivaciones precordiales V1,2 y 3 (1) .Tras este síndrome reside un defecto genético autosómico dominante con penetrancia incompleta que afecta al funcionamiento de los canales de sodio (2). Se diagnostica por un EKG típico casual o tras un episodio de paro cardiaco resucitado, generalmente episodio de taquiarritmia ventricular polimorfa sostenida que desencadena una fibrilación ventricular. Debido a su potencial letalidad, entendemos pues que ante el hallazgo de un BIRDHH en la consulta de preanestesia tengamos el SB presente para completar una anamnesis más dirigida. Si confirmamos su existencia el manejo anestésico debe ser cuidadoso para evitar complicaciones (AU)

Brugada’s syndrome (BS) was first described at 1992 by P. & J. Brugada’s brothers in patients who died by cardiac arrest without any defect in cardiac structure. They only showed an incompleted Right Bruch Block (RBB) and ST segment raised at V1,2 & 3 precordials (1). Behind this syndrome it hides a genetic disorder affecting the normal function of sodium channels (2). Its diagnosis is based either on the typical EKG changes or after resuscitated cardiacarrest generally polimorphus ventricular tachycardia who unleash ventricular fibrillation. Due to its lethalness we understand that under the finding of RBB in the preoperative evaluation a more conscientious anamnesis should be done. With the certainty of SB a careful anaesthetic management is obligatory (AU)

Effects of premedication with tiletamine/zolazepam/medetomidine during general anesthesia using sevoflurane/fentanyl in swine undergoing pancreas transplantation.

OBJECTIVE: To assess cardiac and hemodynamic responses and body temperature during long-term general anesthesia using sevoflurane/fentanyl after premedication with a tiletamine/zolazepam/medetomidine combination in swine undergoing experimental pancreas transplantation. MATERIALS AND METHODS: Twelve Landrace female pigs of means weight 46.4 +/- 5.1 kg were premedicated by intramuscular administration of tiletamine/zolazepam (3.5 mg/kg), medetomidine (0.03 mg/kg), and atropine (0.02 mg/kg), before anesthesia with 0.75 minimum alveolar concentration sevoflurane and continuous intravenous fentanyl infusion (5.7 +/- 0.7 microg/kg/h). Assessment of heart rate, arterial blood pressure, and temperature in pigs undergoing allogenic pancreas transplant surgery were registered at the start of anesthesia (T0), as well as at 60 (T60), 120 (T120), and 180 (T180) minutes after T0, and finally at the end of anesthesia (T anesthesia end), when we switched off the sevoflurane vaporizer. Analysis of variance was used to determine differences between times with P < .05 considered significant. Results are given as mean values +/- standard deviations. RESULTS: Arterial blood pressure significantly decreased from T120 to the end of anesthesia, while a significantly decreased heart rate was only evident at T60. Body temperature decreased significantly from T60 to the end of anesthesia. These decreases, however, lacked clinical relevance; all parameters were within normal range. No major anesthetic complications were observed in this study. CONCLUSIONS: The administration of a tiletamine/zolazepam/medetomidine combination as premedication in swine subjected to pancreas transplantation allowed for a safe reduction of sevoflurane/fentanyl requirements during long-term general anesthesia. Despite arterial blood pressure and body temperature evidencing a decrease during anesthetic maintenance, all parameters remained within normal range values.

Short- and long-term modulation of the lutein epoxide and violaxanthin cycles in two species of the Lauraceae: sweet bay laurel (Laurus nobilis L.) and avocado (Persea americana Mill.).

Short- and long-term responses of the violaxanthin (V) and lutein epoxide (Lx) cycles were studied in two species of Lauraceae: sweet bay laurel (Laurus nobilis L.) and avocado (Persea americana L.). The Lx content exceeded the V content in shade leaves of both species. Both Lx and V were de-epoxidised on illumination, but only V was fully restored by epoxidation in low light. Violaxanthin was preferentially de-epoxidised in low light in L. nobilis. This suggests that Lx accumulates with leaf ageing, partly because its conversion to lutein is limited in shade. After exposure to strong light, shade leaves of avocado readjusted the total pools of alpha- and beta-xanthophyll cycles by de novo synthesis of antheraxanthin, zeaxanthin and lutein. This occurred in parallel with a sustained depression of F(v)/F(m). In Persea indica, a closely related but low Lx species, F(v)/F(m) recovered faster after a similar light treatment, suggesting the involvement of the Lx cycle in sustained energy dissipation. Furthermore, the seasonal correlation between non-reversible Lx and V photoconversions and pre-dawn F(v)/F(m) in sun leaves of sweet bay supported the conclusion that the Lx cycle is involved in a slowly reversible downregulation of photosynthesis analogous to the V cycle.

Comparison of GenoType MTBC with RFLP-PCR and multiplex PCR to identify Mycobacterium tuberculosis complex species.

The aims of the work presented here were to evaluate a commercial system based on DNA hybridization technology on nitrocellulose strips (GenoType MTBC; Hain Diagnostika, Nehren, Germany) for identifying Mycobacterium tuberculosis complex isolates to the species level and to compare the results with those obtained using the RFLP-PCR and multiplex PCR molecular techniques, biochemical tests and susceptibility testing. The commercial system correctly identified 102 of 103 (99.03%) strains studied, indicating it is capable of discriminating among the tuberculosis complex species.

Relationship of bispectral index values, haemodynamic changes and recovery times during sevoflurane or propofol anaesthesia in rabbits.

The aim of this study was to determine and compare the degree of hypnosis achieved during propofol or sevoflurane anaesthesia in rabbits using bispectral index (BIS), and to evaluate its usefulness as a predictor of both haemodynamic changes during anaesthesia and recovery times. Twenty adult male New Zealand White rabbits, average weight 4.4 +/- 0.4 kg, were used for this study. Animals were randomly allocated to one of two groups with 10 rabbits/group. An electroencephalographic recording was obtained from each conscious rabbit prior to drug administration. All animals received buprenorphine as a preanaesthetic medication (0.05 mg/kg, intravenous [i.v.]). Anaesthesia was induced with propofol (8 mg/kg, i.v.) in all animals; 10 rabbits were maintained with sevoflurane via inhalation (1 minimum alveolar concentration--end-tidal sevoflurane concentration of 3.7%--at a fresh gas flow rate of 3 L/min; group I), and 10 were maintained with i.v. propofol (0.6 mg/kg/min; group II). The rabbits were orotracheally intubated and spontaneous ventilation was maintained throughout the study (100% oxygen). After abdominal surgery through a ventral midline laparotomy, rabbits were allowed to recover from anaesthesia. Cardiovascular variables and BIS values were recorded at intervals throughout the procedure, as was the duration of recovery from anaesthesia. In both groups, mean BIS values were significantly decreased immediately after induction, compared with baseline values obtained during consciousness. Anaesthetic depth (evaluated by clinical observation) was similar in both groups; however, group II rabbits had significantly higher (P<0.001) BIS values from 30 s before incision until anaesthesia was discontinued. There was no significant difference in BIS recorded 1 and 5 min after incision as compared with values obtained 30 s before incision in either group. During sevoflurane or propofol administration, correlations were found between BIS values and mean arterial blood pressure (MABP), and between BIS values and heart rate (HR). Mean BIS values at discontinuation of administration of the anaesthetic agent were greater in group II (69.1 +/- 6.0) than in group I (49.3 +/- 2.2). However, recovery from anaesthesia was significantly longer in group II (38.4 +/- 7.2 min) than in group I (11.5 +/- 2.5 min). In conclusion, BIS can be used to differentiate between conscious and unconscious states during anaesthesia in rabbits. BIS values derived from an electroencephalogram at the end of anaesthesia were not useful for predicting the speed of anaesthetic recovery in sevoflurane or propofol-anaesthetized rabbits undergoing abdominal surgery. Despite the correlation found between BIS and haemodynamic parameters, its usefulness as a predictor of clinically important changes in arterial blood pressure and HR in anaesthetized rabbits was limited.

Systematic molecular characterization of multidrug-resistant Mycobacterium tuberculosis complex isolates from Spain.

We used spoligotyping and restriction fragment length polymorphism (RFLP) of the IS6110-insertion sequence to study the molecular epidemiology of multidrug-resistant (MDR) tuberculosis in Spain. We analyzed 180 Mycobacterium tuberculosis complex isolates collected between January 1998 and December 2000. Consecutive isolates from the same patients (n = 23) always had identical genotypes, meaning that no cases of reinfection occurred. A total of 105 isolates (58.3%) had unique RFLP patterns, whereas 75 isolates (41.7%) were in 20 different RFLP clusters. Characterization of the katG and rpoB genes showed that 14 strains included in the RFLP clusters did not actually cluster. Only 33.8% of the strains isolated were suggestive of MDR transmission, a frequency lower than that for susceptible strains in Spain (46.6%). We found that the Beijing/W genotype, which is prevalent worldwide, was significantly associated with immigrants. The 22 isolates in the largest cluster corresponded to the Mycobacterium bovis strain responsible for two nosocomial MDR outbreaks in Spain.