Awareness of U = U among Sexual and Gender Minorities in Brazil, Mexico, and Peru: Differences According to Self-reported HIV Status.

The slogan Undetectable equals Untransmittable (U = U) communicates that people living with HIV (PLHIV) who are on antiretroviral therapy (ART) will not transmit HIV to their sexual partners. We describe awareness of U = U among sexual and gender minorities (SGM) living in Brazil, Mexico, and Peru by self-reported HIV status (PLHIV, negative, unknown) during 2021 using an online survey. We estimated two models using Poisson regression for each population group: Model A including socio-demographic factors (country, gender, age, race, education, and income), and then Model B including taking ART (for PLHIV) or risk behavior, ever-taking PrEP, and HIV risk perception (for HIV-negative or of unknown HIV status). A total of 21,590 respondents were included (Brazil: 61%, Mexico: 30%, Peru: 9%). Among HIV-negative (74%) and unknown status (12%), 13% ever used PrEP. Among PLHIV (13%), 93% reported current use of ART. Awareness of U = U was 89% in both Brazil and Mexico, which was higher than in Peru 64%. Awareness of U = U was higher among PLHIV (96%) than HIV-negative (88%) and HIV-unknown (70%). In multivariate models, PLHIV with lower education were less aware of U = U, while those taking ART were more aware. Among HIV-negative, non-cisgender, lower income, and those with lower education had lower awareness of U = U, while individuals ever using PrEP had higher awareness. In conclusion, awareness of U = U varied by HIV status, socio-demographic characteristics, and HIV risk behavior. The concept of U = U should be disseminated through educational strategies and include a focus on SGM to combat HIV stigma.

RESUMEN: Indetectable = Intransmisible (I = I) comunica que las personas que viven con VIH (PVVIH) y reciben tratamiento antirretroviral (TAR) no transmitirán el VIH a sus parejas sexuales. En este estudio, describimos la concienciación sobre I = I entre las minorías sexuales y de género (MSG) de Brasil, México y Perú según el estado de VIH autoreportado (PVVIH, negativo, desconocido) durante 2021 utilizando una encuesta en línea. Se estimaron dos modelos mediante regresión de Poisson para cada grupo: Modelo A, que incluyó factores sociodemográficos (país, sexo, edad, raza, educación e ingresos) y Modelo B, que incluyó recibir TAR (para PVVIH) o comportamiento de riesgo, uso de PrEP y percepción de riesgo (para VIH negativo o desconocido). Se incluyó 21,590 encuestados (Brasil: 61%, México: 30%, Perú: 9%). Entre aquellos negativos para VIH (74%) y con estado desconocido (12%), el 13% utilizó alguna vez PrEP. Entre las PVVIH (13%), el 93% reportó recibir actualmente TAR. La concienciación de I = I fue del 89% tanto en Brasil como en México, superior al 64% de Perú. La concienciación de I = I fue mayor entre PVVIH (96%) que entre los VIH-negativos (88%) y los VIH-desconocidos (70%). En los modelos multivariados, las PVVIH con menor educación eran menos conscientes de I = I, mientras que los que tomaban TAR eran más conscientes. Entre los VIH-negativos, las personas no cisgéneros, con menores ingresos y con menor educación eran menos consciente de I = I, mientras que los que tenían experiencia usando PrEP eran más conscientes. En conclusión, la concienciación sobre I = I varió según el estado serológico de VIH, las características sociodemográficas y el comportamiento de riesgo. El concepto de I = I debe difundirse a través de estrategias educativas, incluyendo un enfoque en MSG para combatir el estigma del VIH.

Corpus callosum-fastigium and tectal lengths in late-onset small fetuses.

OBJECTIVE: To investigate measurements on neurosonography of midbrain morphology, including corpus callosum-fastigium length and tectal length, in late-onset small fetuses subclassified as small-for-gestational-age (SGA) or growth-restricted (FGR). METHODS: This was a case-control study of consecutive singleton pregnancies delivered at term at a single center between January 2019 and July 2021, including those with late-onset smallness (estimated fetal weight (EFW) < 10th centile) and appropriate-for-gestational-age controls matched by age at neurosonography. Small fetuses were further subdivided into SGA (EFW between 3rd and 9th centile and normal fetoplacental Doppler) and FGR (EFW < 3rd centile or EFW < 10th centile with abnormal cerebroplacental ratio and/or uterine artery Doppler). Transvaginal neurosonography was performed at a mean ± SD gestational age of 33 ± 1 weeks in all fetuses to evaluate corpus callosum-fastigium length and tectal length in the midsagittal plane. Intra- and interobserver agreement was evaluated using the intraclass correlation coefficient and Bland-Altman plots. RESULTS: A total of 70 fetuses with late-onset smallness (29 with SGA and 41 with FGR) and 70 controls were included. Compared with controls, small fetuses showed significantly shorter corpus callosum-fastigium length (median (interquartile range), 44.7 (43.3-46.8) mm vs 43.7 (42.4-45.5) mm, P < 0.001) and tectal length (mean ± SD, 10.5 ± 0.9 vs 9.6 ± 1.0 mm, P < 0.001). These changes were more prominent in FGR fetuses, with a linear trend across groups according to severity of smallness. Corpus callosum-fastigium length and tectal length measurements showed excellent intra- and interobserver reliability. CONCLUSIONS: Small fetuses exhibited shorter corpus callosum-fastigium length and tectal length compared with controls, and these differences were more pronounced in fetuses with more severe smallness. These findings illustrate the potential value of midbrain measurements assessed on neurosonography as biomarkers for brain development in a high-risk population. However, further studies correlating these parameters with postnatal functional tests and follow-up are needed. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Linseed oil supplementation and DGAT1 K232A polymorphism affect the triacylglycerol composition and crystallization of milk fat.

We studied the effect of dietary linseed oil (LSO) supplementation and DGAT1 K232A (DGAT1) polymorphism on the triacylglycerol composition and crystallization of bovine milk fat. LSO supplementation increased unsaturated triacylglycerols, notably in the C52-C54 carbon range, while reducing the saturated C29-C49 triacylglycerols. These changes were associated with an increase in the low-melting fraction and the crystal lamellar thickness, as well as a reduction in the medium and high-melting fractions and the formation of the most abundant crystal type at 20 °C (ß'-2 polymorph). Furthermore, DGAT1 KK was associated with higher levels of odd-chain saturated triacylglycerols than DGAT1 AA, and it was also associated with an increase in the high-melting fraction and the endset melting temperature. An interaction between diet and DGAT1 for the unsaturated C54 triacylglycerols accentuated the effects of LSO supplementation with DGAT1 AA. These findings show that genetic polymorphism and cows' diet can have considerable effects on milk fat properties.

Corpus callosum size by neurosonography in fetuses with congenital heart defect and relationship with expected pattern of brain oxygen supply.

OBJECTIVE: To evaluate corpus callosum (CC) size by neurosonography (NSG) in fetuses with an isolated major congenital heart defect (CHD) and explore the association of CC size with the expected pattern of in-utero oxygen supply to the brain. METHODS: A total of 56 fetuses with postnatally confirmed isolated major CHD and 56 gestational-age-matched controls were included. Fetuses with CHD were stratified into two categories according to the main expected pattern of cerebral arterial oxygen supply: Class A, moderately to severely reduced oxygen supply (left outflow tract obstruction and transposition of the great arteries) and Class B, near normal or mildly impaired oxygenated blood supply to the brain (other CHD). Transvaginal NSG was performed at 32-36 weeks in all fetuses to evaluate CC length, CC total area and areas of CC subdivisions in the midsagittal plane. RESULTS: CHD fetuses had a significantly smaller CC area as compared to controls (7.91 ± 1.30 vs 9.01 ± 1.44 mm2 ; P < 0.001), which was more pronounced in the most posterior part of the CC. There was a significant linear trend for reduced CC total area across the three clinical groups, with CHD Class-A cases showing more prominent changes (controls, 9.01 ± 1.44 vs CHD Class B, 8.18 ± 1.21 vs CHD Class A, 7.53 ± 1.33 mm2 ; P < 0.05). CONCLUSIONS: Fetuses with major CHD had a smaller CC compared with controls, and the difference was more marked in the CHD subgroup with expected poorer brain oxygenation. Sonographic CC size could be a clinically feasible marker of abnormal white matter development in CHD. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Incidence of pre-eclampsia and other perinatal complications among pregnant women with congenital heart disease: systematic review and meta-analysis.

OBJECTIVE: It has been proposed recently that pre-eclampsia (PE) may originate from maternal cardiac maladaptation rather than primary placental insult. As congenital heart disease (CHD) is associated with reduced adaptation to the hemodynamic needs of pregnancy, it is hypothesized that women with CHD have an increased risk of PE. The aim of this systematic review was to investigate the risk of PE in pregnant women with CHD. METHODS: A systematic search was performed to identify relevant studies published in English, Spanish, French, Italian, Chinese or German, with no time restrictions, using databases such as PubMed, Web of Science and SCOPUS. Randomized controlled trials and observational studies (prospective or retrospective cohorts) of pregnant women with a history of CHD were sought. The main outcome was the incidence of PE (including eclampsia and HELLP syndrome). For quality assessment of the included studies, two reviewers assessed independently the risk of bias. For the meta-analysis, the incidence of PE in pregnancies (those beyond 20 weeks' gestation) was calculated using single-proportion analysis by random-effects modeling (weighted by inverse variance). Heterogeneity between studies was assessed using the χ2 (Cochran's Q), tau2 and I2 statistics. Subgroup analysis was performed, and meta-regression was used to assess the influence of several covariates on the pooled results. RESULTS: A total of 33 studies were included in the meta-analysis, including 40 449 women with CHD and a total of 40 701 pregnancies. The weighted incidence of PE was 3.1% (95% CI, 2.2-4.0%), with true-effect heterogeneity of 93% according to I2 , and no publication bias found. No difference was found in the weighted incidence of PE between studies including cyanotic CHD vs those excluding (or not reporting) cyanotic CHD (2.5% (95% CI, 1.6-3.4%) vs 4.1% (95% CI, 2.4-5.7%); P = 0.0923). Meta-regression analysis showed that the only cofactor that significantly influenced the incidence of PE in each study was the reported incidence of aortic stenosis; studies with a higher incidence of aortic stenosis had a higher incidence of PE (estimate: 0.0005; P = 0.038). CONCLUSIONS: We failed to demonstrate an incidence of PE above the expected baseline risk in women with CHD. This observation contradicts the theory of the cardiac origin of PE. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Third-trimester uterine artery Doppler for prediction of adverse outcome in late small-for-gestational-age fetuses: systematic review and meta-analysis.

OBJECTIVE: To investigate the predictive ability for adverse perinatal outcome of abnormal third-trimester uterine artery Doppler in late small-for-gestational-age (SGA) fetuses. METHODS: A systematic search was performed to identify relevant observational studies and randomized controlled trials evaluating the performance of abnormal third-trimester uterine artery Doppler for the prediction of adverse perinatal outcome in suspected SGA fetuses and SGA neonates. Abnormal uterine artery Doppler was defined as uterine artery pulsatility index > 95th percentile or ≥ 2 SD above the mean, or bilateral uterine artery notching. Hierarchical summary receiver-operating-characteristics (ROC) curves were constructed using random-effects modeling. Bayesian analysis was used to calculate the posterior probability of adverse perinatal outcome following an abnormal or normal uterine artery Doppler assessment. RESULTS: Seventeen observational studies (including 7552 fetuses either diagnosed with suspected SGA (n = 3461) or later diagnosed as a SGA neonate (n = 4091)) met the inclusion criteria; no randomized-controlled trials met the inclusion criteria. Summary ROC curves showed that, among suspected SGA fetuses, the best predictive accuracy of abnormal third-trimester uterine artery Doppler was for perinatal mortality and the worst was for composite adverse perinatal outcome, with areas under the summary ROC curves of 0.90 and 0.66, respectively. The corresponding positive and negative likelihood ratios were 16.5 and 0.6 for perinatal mortality and 2.82 and 0.65 for composite adverse perinatal outcome, respectively. Following an abnormal vs normal uterine artery Doppler assessment, the posterior risks for composite adverse perinatal outcome, admission to the neonatal intensive care unit, Cesarean section for intrapartum fetal compromise, 5-min Apgar score < 7, neonatal acidosis and perinatal death were: 52.3% vs 20.2%, 48.6% vs 18.7%, 23.1% vs 15.2%, 3.59% vs 1.32%, 9.15% vs 5.12% and 31.4% vs 1.64%, respectively. CONCLUSION: Abnormal uterine artery Doppler in the third trimester appears to be moderately useful in predicting perinatal death in pregnancies with suspected SGA. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Doppler uterino en el tercer trimestre para la predicción de resultados adversos en fetos pequeños para la edad gestacional: revisión sistemática y metaanálisis OBJETIVO: Investigar la capacidad de predicción de resultados perinatales adversos del Doppler uterino anómalo en el tercer trimestre en fetos pequeños para la edad gestacional (PEG). MÉTODOS: Se realizó una búsqueda sistemática para identificar estudios observacionales pertinentes y ensayos controlados aleatorizados que hubieran evaluado el comportamiento del Doppler uterino anómalo en el tercer trimestre para la predicción de resultados perinatales adversos en fetos con sospecha de ser PEG y en neonatos PEG. El Doppler uterino anómalo se definió como el índice de pulsatilidad de la arteria uterina >95 percentil o DE ≥2 por encima de la media, o escotadura bilateral de la arteria uterina. Se elaboraron modelos de efectos aleatorizados para la elaboración de una curva jerárquica resumen de las características operativas del receptor (ROC, por sus siglas en inglés). Se utilizó el análisis bayesiano para calcular la probabilidad a posteriori de un resultado perinatal adverso después de una evaluación de Doppler uterino anómalo o normal. RESULTADOS: Diecisiete estudios observacionales (incluidos 7552 fetos diagnosticados como sospechosos de ser PEG (n=3461) o diagnosticados posteriormente como neonatos PEG (n=4091)) cumplieron los criterios de inclusión; ningún ensayo controlado aleatorizado cumplió los criterios de inclusión. Las curvas resumen ROC mostraron que, entre los fetos sospechosos de ser PEG, la mayor precisión predictiva del Doppler uterino anómalo en el tercer trimestre fue para la muerte perinatal y la peor fue para el resultado perinatal adverso compuesto, con áreas por debajo de las curvas resumen ROC de 0,90 y 0,66, respectivamente. Los cocientes de verosimilitud correspondientes, positivo y negativo, fueron de 16,5 y 0,6 para la mortalidad perinatal y de 2,82 y 0,65 para el resultado perinatal adverso compuesto, respectivamente. Los riesgos posteriores a una evaluación de Doppler uterino anómalo vs normal, para el resultado perinatal adverso compuesto, la admisión en la unidad de cuidados intensivos para neonatos, la cesárea por deterioro fetal durante el parto, el test de Apgar a los 5 minutos <7, la acidosis neonatal y la muerte perinatal, fueron: 52,3% vs 20,2%, 48,6% vs 18,7%, 23,1% vs 15,2%, 3,59% vs 1,32%, 9,15% vs 5,12% y 31,4% vs 1,64%, respectivamente. CONCLUSIÓN: El Doppler uterino anómalo en el tercer trimestre parece ser moderadamente útil para predecir la muerte perinatal en embarazos con sospecha de ser PEG.

Use of platelet rich plasma in human infertility.

Successful embryo implantation requires good quality embryo but also needs a receptive endometrium site. In our clinical practice, we daily verify that an adequate endometrial growth is reached for successful implantation. To understand whether platelet rich plasma (PRP) can improve endometrium thickness and performance, PRP treatment was carried out after at least three of the classic medical protocols currently in use had been unsuccessfully adopted. Eight patients with more than 3 cryo-transfers cancelled because of failure of endometrial growth, defined as endometrium less than 6 mm, with negative hysteroscopic screening for endometrial pathology, and with negative bacteriologic screening, before present and all previous treatment, were selected to undergo PRP treatment. In 7 out of 8 treatments, an endometrial thickness greater than 6.5 mm (mean 6.9 mm) was reached, with endometrial three-layer pattern, before progesterone administration and embryo transfer was performed. In 6 out of 7 patients, who underwent embryo transfer, beta-HCG were positive, with 2 biochemical abortions, one miscarriage at 6-week pregnancy, two babies born and one drop-out. In this study, 8 patients had extraordinarily poor endometrial quality, and the endometrium was non-responsive to conventional estrogenic therapy, resulting in cycle cancellation. After application of PRP, the endometrial thickness was satisfactory in all the patients except one. Of these, beta-HCG was positive in 6 women, the pregnancy was progressing normally in 2 women, and one had an early miscarriage. We can suppose that the multiple implantation failures were caused by inefficient expression adhesion molecules, which can hypothetically be more represented after PRP application.

Milk fat triacylglycerols and their relations with milk fatty acid composition, DGAT1 K232A polymorphism, and milk production traits.

Milk fat (MF) triacylglycerols (TAG) determine the physical and functional properties of butter and products rich in MF. To predict these properties, it is necessary to understand the variability of fatty acids, TAG, their associations, and their effect on milk productive traits, days in milk (DIM), and genes related to fat synthesis. Therefore, the aim of this research was to study the variability of TAG using MF from individual cows and to investigate the effect of fatty acid composition, DGAT1 K232A polymorphism, DIM, and milk production traits (fat content and morning milk yield) on MF TAG profile in the Dutch Holstein-Friesian dairy cattle population. Large differences in MF TAG profiles were seen among cows. We showed that the variability of TAG is highest for low and high molecular weight TAG [TAG with carbon numbers (Cn) 26-30 and Cn52-54, respectively] and lowest for TAG with Cn38, which was the most abundant TAG. Saturation index (saturated fatty acid/unsaturated fatty acid) and the ratio C16:0/C18:1 cis-9 showed significant effects on TAG Cn34, Cn36, Cn52, and Cn54: TAG Cn34 and Cn36 increased as the saturation index and ratio C16:0/C18:1 cis-9 increased, whereas the opposite was seen for TAG Cn52 and Cn54. Moreover, the DGAT1 K232A polymorphism significantly affected TAG Cn38. We showed that the relative concentration of TAG with Cn38 was higher in cows with DGAT1 KK genotype. Production traits (fat content and morning milk yield) and DIM had no significant effect on TAG profile. This is a relevant observation because considerable increases of milk yield and fat content have been seen in the Netherlands over the last 60 yr. The large differences shown between individual cows in MF TAG profile imply differences in physical properties of MF.

Influence of C16:0 and long-chain saturated fatty acids on normal variation of bovine milk fat triacylglycerol structure.

Fatty acids (FA) are nonrandomly distributed within milk fat triacylglycerols (TAG). Moreover, the structure of milk fat TAG differs with feeding regimens. So far, nothing is known about the variation of milk fat TAG structure among individual cows. A deep understanding of the normal variation of TAG structures and the relationships between milk fat FA profile and its TAG structure could help to better control functional and compositional differences between milk fats from various sources and to increase the knowledge on milk fat synthesis. The focus of the present study was to determine the regiospecific TAG structure of individual samples of winter milk fat from Dutch Holstein-Friesian cows with a wide variation of FA profiles and with 2 diacylglycerol acyltransferase 1 (DGAT1) genotypes: DGAT1 K232A genotype AA and DGAT1 K232A genotype KK. From an initial set of 1,918 individual milk fat samples, 24 were selected. The selected samples had a wide range of FA composition and had either DGAT1 K232A genotype AA or KK. The structure analysis was done with a regiospecific approach. This analysis is based on the acyl degradation of TAG by a Grignard reagent and further isolation of sn-2 monoacylglycerols by thin-layer chromatography. An intra- and interpositional approach was used to study the structural variation. With the intrapositional approach, the amount of an FA at the secondary (sn-2) and primary (sn-1,3) positions was related to its total amount in the TAG. With the interpositional approach, the proportion of C8:0, C10:0, C14:1 cis-9, C16:1 cis-9, and C18:1 cis-9 at sn-2 was positively correlated with the amount of C16:0 in the triacylglycerol; in contrast, saturated C14:0, C16:0, and long-chain saturated FA (C14:0-C18:0) were negatively correlated. These observations suggest that the amount of long-chain saturated FA in TAG influences the positioning of other FA in the TAG. With an interpositional approach, the DGAT1 polymorphism had a significant effect on the proportional positioning of C16:0 at sn-2. These results provide a new direction to controlling functional and compositional differences between milk fats.

Pilot-scale anaerobic submerged membrane bioreactor (AnSMBR) treating municipal wastewater: the fouling phenomenon and long-term operation.

An anaerobic submerged membrane bioreactor (AnSMBR) on pilot-scale treating a mixture composed of municipal wastewater and glucose under mesophilic temperature conditions was operated for 206 days. The performance of the AnSMBR was evaluated at different fluxes, biomass concentrations and gas sparging velocities (GSV). GSV was used to control fouling. In addition, the AnSMBR was operated in cycles that included relaxation and backwashing phases. The increase in the transmembrane pressure (fouling rate) was measured under different operational conditions and was used to evaluate the stability of the process. The fouling rate could be controlled for a long period of time at a flux of 7 l m(-2) h(-1) with a GSV of 62 m/h and an average biomass concentration of 14.8 g TSS/L. The membrane was physically cleaned after 156 days of operation. The cleaning efficiency was almost 100% indicating that no irreversible fouling was developed inside the pores of the membrane. The COD removal efficiency was close to 90%. As in anaerobic processes, nutrients were not exposed to degradation and almost no pathogens were found in the effluent, hence the effluent could be used for irrigation in agriculture.

Experiencia del Hospital Universitario de Canarias con pacientes tratados con plasmaféresis / Patients treated with plasmapheresis: a case review from University Hospital of the Canary Islands

Introducción: La plasmaféresis (PF) es una técnica de aféresis terapéutica utilizada en el tratamiento de diversas enfermedades renales y sistémicas con distintos grados de eficacia clínica demostrada. Objetivo: Analizar los resultados globales de la indicación de PF en el Hospital Universitario de Canarias, enfocados a resultados de su efectividad y seguridad en diversos grupos de enfermedades. Material y métodos: Se trata de un análisis descriptivo retrospectivo de una serie de casos que analiza los resultados de la indicación de PF desde el uno de enero de 2006 hasta el 31 de diciembre de 2009 en nuestro centro. Se revisaron las historias clínicas y se recogieron datos demográficas (sexo y edad), parámetros bioquímicos, enfermedad de base, volumen y tipo de reposición utilizado en la sesión de PF (albúmina humana al 5% y/o plasma fresco congelado), complicaciones asociadas con la técnica, días transcurridos desde la sospecha clínica diagnóstica hasta el inicio de la técnica de aféresis, número de sesiones de PF recibidas, mortalidad del paciente, grado de afectación renal y evolución de la función renal. Resultados: Estudiamos a 51 pacientes, de 50 ± 18 años, el 60% eran hombres, 331 sesiones de PF. Las enfermedades tratadas se agruparon como: 11 vasculitis, 15 inmunoactivaciones del trasplante renal, cinco síndromes hemolítico urémicos, siete casos de púrpura trombótica trombocitopénica o idiopática, dos inmunizaciones Rh fetal, dos enfermedades hematológicas y cuatro casos de enfermedades neurológicas, entre otras. La mortalidad global fue del 19,6 % (n = 10); en seis de los casos, secundaria a shock séptico y en el resto como resultado de la evolución de la enfermedad de base y uno por shock hemorrágico en el área de la biopsia renal. No hubo fallecimientos en el grupo de inmunoactivación del trasplante. En el grupo de vasculitis se produjeron tres fallecimientos (dos de ellos secundarios a un shock séptico). Nueve de los 10 pacientes que fallecieron lo hicieron dentro de los tres primeros meses tras el diagnóstico. De las 26 biopsias renales realizadas, las indicaciones más frecuentes fueron: vasculitis (23%), rechazos humorales (42%), rechazo humoral más toxicidad por anticalcineurínicos (12%) y síndrome hemolítico-urémico (8%), entre otros. Veinticuatro pacientes precisaron hemodiálisis al inicio del cuadro clínico, nueve de los 11 pacientes con vasculitis, cuatro de los cinco pacientes con síndrome hemolítico-urémico y cinco de los 15 pacientes con inmunoactivación del trasplante. Al final de la evolución, 14 de ellos permanecieron en programa de hemodiálisis. Concretamente, cinco de 11 pacientes con vasculitis, dos de 15 pacientes sometidos a trasplante y tres de cinco pacientes con síndrome hemolítico-urémico. De forma significativa, los pacientes que evolucionaron hacia enfermedad renal terminal en el grupo de las vasculitis eran de mayor edad y tenían una mayor creatinina en el comienzo de la enfermedad. En los pacientes sometidos a trasplante en quienes se monitorizaron anticuerpos anti-HLA de clases I o II medidos por luminex pre y post-PF se objetivó una media de descenso del título de anticuerpos en todos excepto en un caso; el descenso medio fue del 51 al 31%. En general, la técnica de PF transcurrió prácticamente libre de complicaciones. Se constataron cinco reacciones al plasma fresco (3%) de carácter leve-moderado (hormigueo peribucal y reacciones urticariformes) que requirieron premedicación con esteroides y no supusieron la interrupción del tratamiento. Conclusión: Teniendo en cuenta la gran variedad de enfermedades que pueden beneficiarse de la PF y el carácter esporádico de algunas de ellas, la publicación de la experiencia con esta modalidad terapéutica cobra gran importancia, ya que si incrementamos la descripción de series de casos por centros, podemos ayudar a ampliar el nivel de evidencia en términos de supervivencia y función renal en múltiples patologías infrecuentes. Nuestro estudio aporta una información útil y valiosa para la práctica clínica habitual y, sin duda, nos hace reflexionar sobre estrategias futuras que optimicen el pronóstico en nuestros enfermos (AU)

Introduction: Plasmapheresis (PP) is a therapeutic apheresis technique used in the treatment of various renal and systemic diseases with varying degrees of proven clinical efficacy. Objective: To review our experience with PP at the Hospital Universitario de Canarias, focused on effectiveness and safety results in different disease groups. Material and methods: A retrospective-descriptive study of patients treated with PP from 01/01/2006 to 31/12/2009 at the hospital. We analysed medical histories and demographic data (sex, age), biochemical parameters, underlying disease, volume and type of replacement used in the PP sessions (5% human albumin and/or fresh frozen plasma), complications with the technique, delay in starting PP treatment after suspected clinical diagnosis, number of PP sessions received, patient mortality, degree of renal impairment and evolution of renal function. Results: There were 51 patients studied, aged 50±18 years, of whom 60% were male; 331 PP sessions were performed. The diseases treated were grouped as: 11 vasculitis, 15 transplant immune activation, 5 haemolytic-uraemic syndrome (HUS), 7 idiopathic or thrombotic thrombocytopaenic purpura, 2 foetal Rh immunisations, 2 haematological diseases, 4 neurological diseases, among others. Overall mortality was 19.6% (n=10): 6 cases secondary to septic shock and the rest as a result of the evolution of the underlying disease, with 1 due to haemorrhagic shock in the renal biopsy area. There were no deaths in the transplant immune activation group. In the vasculitis group, there were 3 deaths (2 secondary to septic shock). Of the 10 patients who died, 9 did so within the first three months after diagnosis. Of the 26 renal biopsies performed, the most frequent indications were: vasculitis (23%), humoral rejection (42%), humoral rejection with calcineurin-inhibitor toxicity (12%) and HUS (8%), among others. Haemodialysis (HD) was required by 24 patients at the start of clinical symptoms: 9 of the 11 patients with vasculitis, 4 of the 5 patients with HUS and 5 of the 15 patients with transplant immune activation. At the end of evolution, 14 of them remained on the HD programme: 5 of the 11 patients with vasculitis, 2 of the 15 transplant patients and 3 of the 5 HUS patients. Significantly, patients who developed end kiney disease (EKD) in the vasculitis group were older and had higher creatinine at the onset of the disease. The transplant patients were monitored for anti-HLA class I or II before and after PP; there was a mean decrease of antibody titres in all but one patient; with an average decrease of 51% to 31%. In general, the PP technique was virtually free of complications. There were only 5 (3%) mild-moderate reactions to fresh plasma (perioral tingling and urticarial reactions) requiring pre-medication with steroids, but which did not lead to discontinuation of the treatment. Conclusion: Taking into account the wide variety of diseases that can benefit from PP and the nature of some of them, publishing our experience with this therapeutic method is of great importance. By increasing the description of case series by centre, we can add survival and renal function evidence in many uncommon diseases. Our study provides useful information for clinical practice and has also led us to reflect on future strategies to optimise outcomes in our patients (AU)

Ventajas del uso de los infusores elastoméricos / No disponible

Introducción: en pacientes en que la vía oral no es posible, los infusotes elastoméricos (lE) presentan ventajas como la posibilidad de administrar por vía subcutánea, en forma continua y constante, varias drogas de forma simultánea. Las publicaciones del uso de lE a nivel latinoamericano son muy limitadas y ningún estudio ha evaluado costes. Objetivo: analizar uso, efectividad, coste, complicaciones y ventajas de los lE en pacientes tratados en una Unidad de Cuidados Paliativos (UCP) en Uruguay. Material y métodos: evaluamos retrospectivamente todos los pacientes adultos que requirieron uso de lE, asistidos en la UCP del Servicio de Oncología del Hospital Central de las Fuerzas Armadas (Uruguay) entre 1/11/07 y 1/4/09. Se evaluaron las principales características de estos pacientes, del tratamiento, eficacia y complicaciones. Se estimó el coste de determinado tratamiento en un paciente internado sin fE comparándolo con el de un paciente ambulatorio con infusor. Resultados: se incluyeron 34 pacientes (edad mediana 67, 94% oncológicos). Se emplearon 2,2 infusores/paciente, en 64,7% en forma ambulatoria. En 91 % se interrumpió el uso del lE por fallecimiento del paciente. En 91% se emplearon >= 3 drogas simultáneas. El control de síntomas se logró en el 100% y no observamos complicaciones. El coste teórico semanal de un tratamiento en un paciente ambulatorio con lE fue de 45,17 versus 430,64 dólares (EE. UU.) en un paciente internado sin ¡nfusor. Conclusiones: en cuidados paliativos los lE permiten la administración simultánea y continua de varias drogas, siendo altamente eficaces, con baja tasa de complicaciones, práctico uso, facilitan la autonomía del paciente y la posibilidad de manejo ambulatorio, y se asocian a un significativo menor coste que un mismo tratamiento realizado sin infusor en internación (AU)

Introduction: in patients who cannot maintain the oral route elastomeric infusion pumps (EIPs) have several advantages due to the possibility of administering several agents simultaneously and constantly. Published Latin American experience with these EIPs is limited and no study has performed a cost analysis. Objective: To analyze the use, efficacy, cost complications and advantages of EIPs in a palliative care unit in Uruguay. Materials and methods: we retrospectively evaluated all adult patients that required use of EIP at Palliative Care Unit, Oncology Department, "Hospital Central de las Fuerzas Armadas" (Uruguay) between 1/11/07 and 1/4/09. Main patient characteristics, treatment, efficacy and EIP-related complications were evaluated. A cost estimation of a theoretical treatment in an inpatient without EIP was compared to that same treatment in an outpatient with EIP. Results: thirty-four patients were included (median age: 67 years, 94% cancer patients). We used 2.2 EIP/patient, in 64.7% of cases as outpatients. In 91% of cases treatment was interrupted due to patient death. In 91%,3 or more drugs were simultaneously used. Symptom control was achieved in 100% and no EIP-related complications were present. The weekly cost of a theoretical treatment in an outpatient with EIP was U$S 45.17 versus U$S 430.64 in an inpatient without ElP. Conclusions: in a palliative care setting EIPs allow the simultaneous and continuous administration of one or more agents. They are associated with high efficacy, low rate of complications, ease of use, and potential for maintaining patient autonomy in the outpatient setting, and cost is significantly lower than an inpatient treatment without EIP (AU)

Treatment of fatty solid waste from the meat industry in an anaerobic sequencing batch reactor: start-up period and establishment of the design criteria.

An anaerobic sequencing batch reactor (AnSBR) was used to treat the dissolved air flotation skimmings from a cooked pork meat plant. During the start-up period, the reactor was operated in fed-batch mode for 25 days and 7 batches were treated. The SBR was inoculated with sludge taken from a reactor treating distillery vinasse. The results showed that this kind of sludge is a very good source of inoculum for digesters treating residues with a high content in fats and long-chain fatty acids because it was able to adapt very rapidly to the new substrate and, from the second batch on, the sludge was already able to metabolize the fatty residue at quite high rates. The AnSBR was then operated with 5 batches per week for 110 days and the quantity of VS added per batch was regularly increased until the maximum treatment capacity of the reactor (i.e. maximum loading rate) was reached. The maximum organic loading rates were found to be 0.16 g VS/g VSS d, or 0.224 g VS/g VSS.batch when the reactor is fed 5 times a week. The biodegradability of the skimmings was very high, with more than 97% of TS removal, and the methane production was 880+/-90 mL of methane/g of VS(added).

Anaerobic digestion of gelatinous water at laboratory and pilot scale and nitrogen inhibition.

The anaerobic digestion of the liquid residue (gelatinous water) coming from the production of fat from animal residue, was studied at laboratory and pilot scale. Biodegradability (>98%) and biogas potential (675 mL of biogas/g of COD(applied)) of this wastewater are very high. However, due to the high content on nitrogen, an inhibition of the anaerobic activity was observed for quite low concentrations of N-NH(3). Dilution of the wastewater and pH regulation in the reactor around 7.3 are the 2 solutions which were investigated to overcome the nitrogen inhibition at industrial scale. These two solutions were validated at laboratory scale in an anaerobic SBR and then onsite at pilot scale in a continuous reactor. A stable anaerobic digestion was observed in both reactors showing that no nitrogen inhibition was obtained when N-NH(3) concentration in the reactor was kept low.

[Non neoplastic space occupying lesions mimicking central nervous system tumors]. / Lesiones ocupantes de espacio no neoplasicas que simulan tumores del sistema nervioso central.

OBJECTIVE: To establish the frequency and nature of space occupying lesions of the central nervous system (CNS) that mimic neoplastic growths. PATIENTS AND METHODS: We reviewed the clinical records, imaging and neuropathological studies of patients operated in different hospitals of Maracaibo, Venezuela during the period January 1 1996 July 31 2002. These patients had a pre operative diagnosis of CNS tumor, and their definitive diagnosis was non neoplastic disease. RESULTS: The 33 cases of expansive, non neoplastic growths represented 8% of 408 CNS lesions diagnosed during the study period. Approximately two thirds of the cases (63,36%) consisted of either inflammatory or vascular lesions, whereas the rest of the cases grouped miscellaneous conditions. CONCLUSIONS: Even though it is not frequent that non neoplastic lesions of the CNS mimic expansive growths of neoplastic nature, on occasions the clinical and neuroimaging features of both groups of entities are remarkably similar.

Sexual protective strategies of late adolescent females: more than just condoms.

OBJECTIVE: To identify the sexual protective strategies of late adolescent heterosexual women. DESIGN: Open-ended questioning regarding sexual protective strategies was included in a larger cross-sectional survey on sexual risk. Participants' responses were recorded verbatim and analyzed using content analysis. PARTICIPANTS: 234 African American, Hispanic/ Latina, and non-Hispanic white 19- to 21-year-old females were recruited from the driver's license records of a mid-Atlantic state. MAIN OUTCOME MEASURES: Participants responded to the open-ended question, "How or what do you do to reduce your risk for sexually transmitted diseases and HIV?" RESULTS: Seven primary sexual protective strategies were identified from participants' responses: using condoms, abstaining or postponing sexual intercourse, getting tested for human immunodeficiency virus (HIV) and sexually transmitted diseases (STDs), selecting safe partners, negotiating condom use, talking about sexual risk histories, and limiting the number of sexual partners. CONCLUSIONS: Some of the sexual protective strategies identified by study participants were less than effective and left young women vulnerable to infection with HIV and STDs. In addition, the use of these alternative strategies may leave young women feeling less at risk and thus less likely to use other more effective strategies such as condoms. The implications for nursing practice and the assessment of the sexual protective strategies of young heterosexual women are discussed.

An experiment using a month-by-month calendar in a family planning survey in Costa Rica.

Recent demographic surveys have incorporated a month-by-month calendar for the five-year reference period before the survey for the recording of fertility-related events (sexual unions, contraceptive use, pregnancies, and breastfeeding). In the 1986 survey of Maternal and Child Health and Family Planning in Costa Rica, approximately one-half of the 3,527 women interviewed were administered a questionnaire with traditional fertility and family planning questions; the other half were asked virtually the same questions, but the women's responses were entered in a month-by-month calendar. The assignment of questionnaire type was randomly alternated by cluster. Comparisons of the number of events (live births, pregnancy losses, and contraceptive use) showed that more events were recorded among the women in the calendar group. Significantly less erroneous superposition of events (contraceptive use in the last trimester of pregnancy and hormonal contraceptive use in the first month postpartum) was noted when the calendar was used.

PIP: There are many approaches to obtaining data on reproductive events. The World Fertility Survey uses a detailed pregnancy history questionnaire and family planning use for the last birth interval. The Demographic and Health Surveys use a live birth history and family planning method use for as many as 2 methods during each birth interval in the prior 5 years. The 1965 National Fertility Survey in the US used a chart or calendar to code respondent's reproductive status and events for each month in the reference period. This report is a comparison of data collection methods for the Costa Rica Maternal and Child Health-Family Planning Survey in 1986. The reference period for respondents' pregnancy history, family planning events, and marital and employment history was 5 years. Out of 322 clusters, the calendar method and the traditional questionnaire are alternated. Questionnaires and interviewer training were the same. The criteria for comparing data quality were established as 1) the higher number of events recorded, 2) the extent of conflicting events for contraception and pregnancy and for contraception and lactation, and 3) extent of method choice data missing from the calendar method. The results showed high response rates for both groups (95%). In the calendar questionnaire the mean number of pregnancy losses was significantly higher (by 17%) and the number of contraceptive use segments was higher (by 11%). A greater proportion of women reported with the calendar method at least 1 event for all variables. Inconsistency was reported for 10% of women in the traditional questionnaire on overlaps between pregnancies of 4 months and contraceptive use. Sometimes the overlapping continued through the entire pregnancy. Only 1% of women reported inconsistencies in reported pregnancy and contraception using the calendar method. Inconsistencies of lactation and contraceptive use occurred with 7% of traditional questionnaire reports and only 3% of calendar reports. 8.6% of women using the traditional questionnaire reported multiple method use. In the calendar method only the most effective method was indicated where there was multiple use. The recording of more events with the calendar method was confirmed by comparison conducted in Peru but not in the Dominican Republic.

[Alveolar microlithiasis. A study of minerals in the lung]. / Microlithiase alvéolaire. Etude minéralogique du poumon.

A pulmonary scintigraph of pyrophosphate was performed to assess calcium metabolism in a man of 39 with alveolar microlithiasis, as was histologic study with a mineral analysis of wave-length dispersion and an analysis crossing the microliths enclosed in the resin. Two treatments were tried without success: First with diphosphonates and then alveolar lavage.