Consenso Delphi sobre Estrategias Terapéuticas y de Prevención Sanitaria de la hipovitaminosis D / Delphi Consensus on Therapeutic and Preventive Health Strategies for Hypovitaminosis D

Antecedentes: La elevada prevalencia de hipovitaminosis D en España es considerada una verdadera epidemia con importantes implicaciones para la salud por las múltiples funciones que ejerce la vitamina D tanto a nivel esquelético como extraesquelético. Para que las personas con insuficiencia o deficiencia en vitamina D alcancen los niveles séricos más adecuados, deben recibir suplementos de vitamina D. Este estudio se realizó con la finalidad de evaluar si en la práctica clínica habitual, el manejo de la hipovitaminosis D era llevada a cabo según las recomendaciones internacionales establecidas por las sociedades científicas.Métodos: Se realizaron dos rondas de circulación de un cuestionario Delphi entre un panel formado por médicos prescriptores habituales de vitamina D.Resultados: En general, los médicos del panel reconocieron la alta prevalencia de la hipovitaminosis D en España, la necesidad del cribado en los distintos grupos de riesgo y los beneficios de la suplementación en los pacientes con insuficiencia o déficit de vitamina D. Sin embargo, no se alcanzó el consenso en algunas de las aseveraciones relacionadas con los métodos de cuantificación de la vitamina D o con las recomendaciones para el manejo de la hipovitaminosis D.Conclusiones: La ausencia de acuerdo para algunos de los ítems reveló la necesidad de realizar acciones formativas destinadas a proporcionar un conocimiento adecuado y actualizado sobre las evidencias científicas y las recomendaciones para la práctica clínica de la suplementación de vitamina D. (AU)

Medication Non-Adherence in Rheumatology, Oncology and Cardiology: A Review of the Literature of Risk Factors and Potential Interventions.

Medication adherence is directly associated with health outcomes. Adherence has been reviewed extensively; however, most studies provide a narrow scope of the problem, covering a specific disease or treatment. This project's objective was to identify risk factors for non-adherence in the fields of rheumatology, oncology, and cardiology as well as potential interventions to improve adherence and their association with the risk factors. The project was developed in three phases and carried out by a Steering Committee made up of experts from the fields of rheumatology, oncology, cardiology, general medicine, and hospital and community pharmacy. In phase 1, a bibliographic review was performed, and the articles/reviews were classified according to the authors' level of confidence in the results and their clinical relevance. In phase 2, 20 risk factors for non-adherence were identified from these articles/reviews and agreed upon in Steering Committee meetings. In phase 3, potential interventions for improving adherence were also identified and agreed upon. The results obtained show that adherence is a dynamic concept that can change throughout the course of the disease, the treatments, and other factors. Educational interventions are the most studied ones and have the highest level of confidence in the authors' opinion. Information and education are essential to improve adherence in all patients.

Factors Associated with Non-Adherence to Drugs in Patients with Chronic Diseases Who Go to Pharmacies in Spain.

BACKGROUND: Pharmacological non-adherence in chronic diseases is 40-65%. No predictive profile of non-adherence exists in patients with multiple chronic diseases. Our study aimed to quantify the prevalence of non-adherence to pharmacological treatment and its associated factors in patients who visit pharmacies in Spain. METHODS: This observational cross-sectional study included patients with one or more chronic diseases. The variables analyzed were demographics, diseases involved, self-medication, information about disease, and lifestyle. The main variable was adherence using the Morisky-Green test. A total of 132 pharmacies collaborated, providing 6327 patients representing all Spain regions (April-December 2016). Bivariate and multivariate analyses were performed and the area under the receiver operating characteristic (ROC) curve was calculated. RESULTS: Non-adherence was 48.4% (95% confidence interval (CI): 47.2-49.7%). The variables that reached significance in the multivariate model were: difficulty in taking medication, self-medication, desire for more information, smoking, lower physical activity, younger age and number of chronic treatments. Discrimination was satisfactory (area under the ROC curve = 70%). Our study found that 50% patients was non-adherent and we obtained a profile of variables associated with therapeutic non-adherence. CONCLUSIONS: It is cause for concern that in patients with multiple diseases and taking multiple medications, there is an association between non-adherence, self-medication and worse lifestyle.

Validation of self-reported adherence in chronic patients visiting pharmacies and factors associated with the overestimation and underestimation of good adherence.

BACKGROUND: Studies validating indirect methods to identify nonadherence in chronic patients who visit pharmacies are lacking. The aim of this study was to validate self-reported adherence and assess the variables associated with both overestimation and underestimation of good adherence when using this method. MATERIALS AND METHODS: An observational, cross-sectional study was undertaken to validate self-reported adherence in 132 community pharmacies throughout Spain in 6237 chronic patients. The Morisky-Green test was used as the validation method and through a 2 × 2 table, the validity indicators, predictive values, and likelihood ratios were calculated. To assess the variables associated with both overestimation and underestimation of good adherence, multivariate logistic regression analysis and calculation of the area under the ROC curve were used to evaluate discriminatory capacity. RESULTS: Sensitivity was 27.8% (95% CI: 26.2-29.4) and specificity was 93.9% (95% CI: 93.1-94.7). Discrepancy analysis obtained a significant overestimation of good adherence (p < 0.001). The factors associated with overestimating good adherence were performing a mnemonic trick (p < 0.001), not self-medicating (p < 0.001), a high level of physical activity (p < 0.001), and an older age (p = 0.014). Factors associated with underestimation were self-medication (p < 0.001), desiring more information (p < 0.001), smoking (p = 0.014), not engaging in physical activity in the low (p = 0.006) or high (p < 0.001) categories, having a younger mean age (p = 0.007), and taking two to three (p = 0.029) or four or more (p < 0.001) chronic treatments. CONCLUSION: Self-reported adherence has good specificity but poor sensitivity. The associated profiles of the discrepancies were obtained to identify both good and poor adherence.

Reliability and construct validity of an instrument that measures the willingness to emigrate / Construction y validación de un instrument para medir la voluntad de emigrar

Abstract Provisions for migration underlie asymmetric relations between sending and receiving countries, such as the cases of Mexico and the United States of America, although studies focus on stigma. The objective of this study was to establish the reliability and construct validity of an instrument that measures the phenomenon. A transversal and exploratory work was carried out with a selection of 300 students, considering their affiliation to a public university in a strategic alliance with multinationals for vocational training. A structure of four factors related to risk, utility, hyperopia and identity was observed, although the design of the research limited the results to the research scenario, suggesting the extension of the work towards negative dispositions such as exclusion, discrimination and the stigma.

Resumen Las disposiciones para la migración subyacen en las relaciones asimétricas entre los países de origen y destino, como los casos de México y los Estados Unidos de América, aunque los estudios se centran en el estigma. El objetivo de este estudio fue establecer la fiabilidad y la validez de constructo de un instrumento que mide el fenómeno. Se realizó un trabajo transversal y exploratorio con una selección de 300 estudiantes, considerando su afiliación a una universidad pública en una alianza estratégica con multinacionales para la formación profesional. Se observó una estructura de cuatro factores relacionados con el riesgo, la utilidad, la hipermetropía y la identidad, aunque el diseño de la investigación limitó los resultados al escenario de la investigación, lo que sugiere la extensión del trabajo hacia disposiciones negativas como la exclusión, la discriminación y el estigma. Palabras clave: migración, identidad, hipermetropía, impotencia, confiabilidad

Is vitamin-D supplementation not useful in patients at risk of fractures and falls?

To evaluate numerous publications that question the bone and extraosseous benefits of vitamin D diet supplementation based on results, which often transcend to public opinion, but are not well interpreted. This may have negative consequences on compliance of patients under vitamin D supplementation. Critical appraisal of several articles on vitamin D supplementation and its relationship with fractures, falls, cardiovascular diseases, and cancer incidence. Such publications have certain limitations (i.e. patients excluded because of a diagnosis of osteoporosis, or at a higher risk for fractures and falls, or because they have a vitamin D deficiency, etc.), and conclusions and/or subsequent recommendations should be approached with caution. Our research shows that patients with osteoporosis, vitamin D deficiency, and at high risk of fractures and falls should not discontinue vitamin D supplementation (often associated with calcium). It is becoming increasingly evident that patients with hypovitaminosis D are those that gain a maximal benefit from vitamin D supplementation.

Validation of an inhibition enzyme-linked immunosorbent assay system for the diagnosis of Toxoplasma gondii infection in buffaloes (Bubalus bubalis). / Validación de un sistema inmunoenzimático de inhibición de un anticuerpo para el diagnóstico de infección por Toxoplasma gondii en búfalos (Bubalus bubalis).

Toxoplasmosis is one of the most widespread zoonoses in the world, due to the existence of a wide variety of Toxoplasma gondii hosts, which include several domestic animal species. In Cuba, there is sustained production of the Bubalus species, which is highly adaptable and disease resistant, although it has been identified as a reservoir for a range of aetiological agents. Several countries have reported buffaloes as the intermediate host of T. gondii, noting the need to carry out epidemiological studies and confirm the possible presence of this parasitic infection in the Bubalus species. The current study was conducted to validate an inhibition enzyme-linked immunosorbent assay (i/ELISA) system for the diagnosis of T. gondii infection in buffaloes (Bubalus bubalis). This involved evaluating its performance in relation to that of a latex agglutination test. With buffalo sera, the i/ELISA assay showed a sensitivity of 100%, a specificity of 99.5%,and a concordance of 0.99 (considered very good) with respect to the reference diagnostic method. The conclusion is that i/ELISA performs extremely well as a serological test for the diagnosis of T. gondii in buffaloes.

La toxoplasmose est l'une des zoonoses les plus répandues dans le monde, ce qui s'explique par le très large spectre d'hôtes de Toxoplasma gondii, dont plusieurs espèces d'animaux domestiques. À Cuba, les buffles font l'objet d'un élevage durable et présentent de bonnes aptitudes d'adaptation et de résistance aux maladies, bien que cette espèce joue un rôle avéré de réservoir pour un certain nombre d'agents pathogènes. Des rapports émanant de plusieurs pays ont fait état du rôle joué par les buffles en tant qu'hôtes intermédiaires de T. gondii, d'où la nécessité d'effectuer des études épidémiologiques afin de confirmer la présence éventuelle de cette parasitose chez cette espèce. Les auteurs présentent des résultats d'une étude de validation d'une méthode immuno-enzymatique d'inhibition des anticorps pour le diagnostic de T. gondii chez le buffle (Bubalusbubalis). Pour ce faire, les performances de cette méthode ont été évaluées par rapport à celles du test d'agglutination au latex. La comparaison à partir de sérums de buffles a montré que la sensibilité de l'épreuve immuno-enzymatique était de 100 % et sa spécificité de 99,5%, avec une concordance par rapport à la méthode de référence de 0,99, ce qui est considéré un très bon résultat. Cette étude démontre l'aptitude de l'ELISA d'inhibition pour le diagnostic sérologique de T. gondii chez le buffle et conclut à son excellente performance diagnostique.

La toxoplasmosis es una de las zoonosis más difundidas en el mundo debido a que existe una amplia variedad de hospedadores de Toxoplasma gondii, entre los que se encuentran varias de las especies de animales domésticos. En Cuba, la especie bufalina se produce de manera sostenida con buena adaptabilidad y resistencia a las enfermedades, aunque se ha identificado como reservorio de diversos agentes etiológicos. En varios países se ha informado que los búfalos son hospedadores intermediarios de T. gondii y se ha indicado la necesidad derealizar estudios epidemiológicos y de comprobar la posible presencia de dicha parasitosis en esta especie. Este trabajo se realizó para validar un sistema inmunoenzimático de inhibición de un anticuerpo (ELISA/i) para el diagnósticode infección por T. gondii en búfalos (Bubalus bubalis). Para ello, se evaluó su rendimiento respecto a una prueba de aglutinación por látex. Frente a sueros de búfalo, el sistema inmunoenzimático demostró tener una sensibilidad del 100%, una especificidad del 99,5% y una concordancia de 0,99, considerada muy buena, respecto al método de diagnóstico de referencia. Se concluye que el ELISA/i permite el diagnóstico serológico de T. gondii en búfalos con un excelente rendimiento diagnóstico.

Riesgo cardiovascular durante el climaterio y la menopausia en mujeres de Santa Cruz del Norte, Cuba / Cardiovascular risk during perimenopause and menopause in women of Santa Cruz del Norte, Cuba

Antecedentes: El estudio del climaterio se ha elevado por ser un problema socio-demográfico dado el incremento de la esperanza de vida de la mujer. Objetivo: Identificar factores de riesgo cardiovasculares en mujeres climatéricas y menopáusicas de Santa Cruz del Norte en el período 2011 y 2012. Método: Se realizó un estudio analítico transversal con un universo de 317 mujeres atendidas en consulta y una muestra escogida al azar de 186 divididas en un grupo de 93 pacientes en etapa del climaterio o menopausia y 93 mujeres entre 20 y 39 años. Los datos se recolectaron mediante encuesta y para el análisis estadístico se emplearon medidas descriptivas y pruebas inferenciales. Resultados: Las pacientes climatéricas presentaron significativamente mayor circunferencia de cintura (t=5,2696; p=0,0000), índice cintura-cadera (t=2,2070; p=0,0298), índice de masa corporal (t=7,1652; p=0,0000), y valores de colesterol (t=4,2531; p=0,0001), triglicéridos (t=2,5980; p=0,0109) y glicemia (t=2,5274; p=0,0132). Se observó correlación fuerte y significativa entre la edad y los valores de índice cintura-cadera (r=0,8116; p=0,0000) y de glicemia (r=0,8400; p=0,0000). Hubo una débil pero significativa correlación entre la edad y la circunferencia de cintura (r=0,2875; p=0,0000), índice de masa corporal (r=0,3246; p=0,0000) y colesterol (r=0,2876; p=0,0000). Hubo más fumadoras entre las climatéricas (p=0,0360) y ambos grupos fueron similares en tensión arterial, hábitos alimentarios y actividad física. Conclusiones: Durante el climaterio y menopausia se produce un incremento en algunos valores antropométricos y metabólicos, que incrementan el riesgo de enfermedades cardiovasculares en esta etapa.

Background: The study of the climacteric has risen, being a social and demographic problem due to the increase of the life expectancy of women. Aims: To identify cardiovascular risk factors during climacteric and menopause in women from North's Santa Cruz in 2011 and 2012. Methods: A cross-sectional analytical study was conducted with a universe of 317 women attended in consultation and a random sample of 186 divided in a group of 93 patients in climacteric or menopause stage and other of 93 women between 20 and 39 years old. The data were collected by survey, and for the statistical analysis a descriptive measures and inferential tests were used. Results: Climacteric patients presented significantly greater waist circumference (t=5.2696; p=0.0000), waist-hip index (t=2.2070; p=0.0298), body mass index (t=7.1652; p=0.0000), and values of cholesterol (t=4.2531; p=0.0001), triglycerides (t=2.5980; p=0.0109) and fasting glucose (t=2.5274; p=0.0132). It was observed strong and significant correlation between age and values of waist-hip index (r=0.8116; p=0.0000) and fasting glucose (r=0.8400; p=0.0000). There was a weak but significant correlation between age and waist circumference (r=0.2875; p=0.0000), body mass index (r=0.3246; p=0.0000) and cholesterol (r=0.2876; p=0.0000). There were more smokers between climacteric (p=0.0360) and both groups were similar in blood pressure, nourishing habits and physical activity. Conclusion: During the climacteric and menopause, an increase in some anthropometric and metabolic values take place, that increases the risk of cardiovascular diseases in this stage.

[Modified EMJH medium for cultivation of Leptospira interrogans serogroup ballum]. / Medio EMJH modificado para el cultivo de Leptospira interrogans serogrupo Ballum.

Strains within the Ballum serogroup of spirochete Leptospira show fastidious growth with more exigent nutritional requirements than those of other Leptospira pathogenic strains. The influence of 37 nutritional compounds on the growth of Leptospira interrogans serogroup Ballum was investigated employing the synthetic EMJH medium as the base for the study. Microbial growth was estimated spectrophotometrically and direct counts were performed with a Petroff-Hausser counting chamber. Virulence stability was evaluated by calculating the mean lethal dose in hamsters. Antigenicity stability was evaluated by Western blotting using a specific antiserum. Cell yields commonly obtained in EMJH were triplicated without virulence or antigenicity depletions after culturing in a modified EMJH medium with an increased concentration of Tween 80, and the incorporation of sodium acetate and beef extract. Neither the increased concentration of at least 6 components of EMJH nor the incorporation of a variety of new nutrients stimulated cell yields or the growth rate of the microorganism. The results allow us to make use of an enriched culture medium that promotes high cell yields of this fastidious serogroup most prevalent in humans in Cuba.

Medio EMJH modificado para el cultivo de Leptospira interrogans serogrupo Ballum / Modified EMJH medium for cultivation of Leptospira interrogans serogroup Ballum

El serogrupo Ballum agrupa cepas de crecimiento fastidioso, con requerimientos nutricionales más exigentes que otras cepas patógenas de Leptospira. Fue evaluada la influencia de 37 compuestos nutricionales sobre el crecimiento de Leptospira interrogans serogrupo Ballum, tomando como base para el estudio al medio sintético EMJH. El crecimiento microbiano fue estimado espectrofotométricamente y por conteo directo en cámara de Petroff-Hausser. La estabilidad de la virulencia fue evaluada en hamsters mediante el cálculo de la dosis letal media. La estabilidad de la antigenicidad fue evaluada mediante Western blotting con antisuero policlonal específico. Bajo condiciones de cultivo controladas se logró triplicar los rendimientos de biomasa comúnmente obtenidos en el medio EMJH sin afectación de la virulencia y antigenicidad tras el incremento de la concentración de Tween 80 y la incorporación de acetato de sodio y extracto de carne. El incremento de la concentración de al menos 6 componentes del EMJH o la incorporación de una variedad de nuevos nutrientes no estimularon apreciablemente los rendimientos de biomasa o la velocidad específica de crecimiento del microorganismo. Los resultados obtenidos permiten disponer de un medio de cultivo enriquecido capaz de sustentar elevados rendimientos de biomasa de este serogrupo exigente de mayor circulación en humanos en Cuba.

Strains within the Ballum serogroup of spirochete Leptospira show fastidious growth with more exigent nutritional requirements than those of other Leptospira pathogenic strains. The influence of 37 nutritional compounds on the growth of Leptospira interrogans serogroup Ballum was investigated employing the synthetic EMJH medium as the base for the study. Microbial growth was estimated spectrophotometrically and direct counts were performed with a Petroff-Hausser counting chamber. Virulence stability was evaluated by calculating the mean lethal dose in hamsters. Antigenicity stability was evaluated by Western blotting using a specific antiserum. Cell yields commonly obtained in EMJH were triplicated without virulence or antigenicity depletions after culturing in a modified EMJH medium with an increased concentration of Tween 80, and the incorporation of sodium acetate and beef extract. Neither the increased concentration of at least 6 components of EMJH nor the incorporation of a variety of new nutrients stimulated cell yields or the growth rate of the microorganism. The results allow us to make use of an enriched culture medium that promotes high cell yields of this fastidious serogroup most prevalent in humans in Cuba.

Inmunogenicidad y capacidad protectora en hamsters de vacunas antileptospirósicas monovalentes de células enteras del serogrupo Ballum / Immunogenicity and protective capacity of leptospiral whole-cell monovalent serogroup Ballum vaccines in hamsters

El serogrupo Ballum de Leptospira constituye en la actualidad la primera causa de leptospirosis humana en Cuba. Vacunas de células enteras químicamente inactivadas fueron formuladas a partir de dos cepas clínicas de Leptospira interrogans serogrupo Ballum empleando como adyuvante hidróxido de aluminio. Los niveles de aglutininas inducidos en hamsters por una u otra preparación vacunal fueron estimados mediante aglutinación microscópica y la actividad IgG específica fue cuantificada mediante ELISA. La capacidad de protección homóloga y heteróloga contra la infección letal y subletal se determinó mediante el desafío con 100 y 10 000 DL50 de cinco cepas virulentas pertenecientes a los serogrupos Ballum, Canicola, Icterohaemorrhagiae y Pomona. Las evaluaciones realizadas demostraron que ambas vacunas fueron inmunogénicas e indujeron una completa protección homóloga en el modelo animal empleado. La protección cruzada frente a serogrupos heterólogos solo fue significativa en una de las preparaciones monovalentes frente al desafío con 100 DL50 de Canicola. Como resultado de este estudio se pudo comprobar la alta inmunogenicidad y capacidad protectora en hamsters de vacunas monovalentes de células enteras formuladas a partir de dos cepas candidatas vacunales del serogrupo de Leptospira de mayor circulación en humanos en Cuba no incluido en la vacuna actualmente disponible.

Leptospira serogroup Ballum is at present the first cause of human leptospirosis in Cuba. Killed whole-cell vaccines were formulated with two clinical isolates of Leptospira interrogans serogroup Ballum using aluminum hydroxide as adjuvant. Agglutinins levels induced by each vaccine in hamsters were estimated by microscopic agglutination test and specific IgG activities were quantified by a whole cell-based enzyme-linked immunosorbent assay. Homologous and cross protective capacity against lethal and sublethal infection were determined in vaccinated animals by challenge with 100 and 10 000 LD50 of five virulent strains belonging to serogroups Ballum, Canicola, Icterohaemorrhagiae and Pomona. Both monovalent serogroup Ballum vaccines were immunogenic and induced complete homologous protection in the animal model. Cross-protection was only significant in one of the two vaccines against challenge with 100 LD50 of serogroup Canicola. The results of this study demonstrate the high immunogenicity and protective capacity in hamsters of whole-cell monovalent vaccines formulated with two vaccine candidate strains belonging to the most prevalent serogroup of Leptospira in Cuba.

[Immunogenicity and protective capacity of leptospiral whole-cell monovalent serogroup Ballum vaccines in hamsters]. / Inmunogenicidad y capacidad protectora en hamsters de vacunas antileptospirósicas monovalentes de células enteras del serogrupo Ballum.

Leptospira serogroup Ballum is at present the first cause of human leptospirosis in Cuba. Killed whole-cell vaccines were formulated with two clinical isolates of Leptospira interrogans serogroup Ballum using aluminum hydroxide as adjuvant. Agglutinins levels induced by each vaccine in hamsters were estimated by microscopic agglutination test and specific IgG activities were quantified by a whole cell-based enzyme-linked immunosorbent assay. Homologous and cross protective capacity against lethal and sublethal infection were determined in vaccinated animals by challenge with 100 and 10,000 LD50 of five virulent strains belonging to serogroups Ballum, Canicola, Icterohaemorrhagiae and Pomona. Both monovalent serogroup Ballum vaccines were immunogenic and induced complete homologous protection in the animal model. Cross-protection was only significant in one of the two vaccines against challenge with 100 LD50 of serogroup Canicola. The results of this study demonstrate the high immunogenicity and protective capacity in hamsters of whole-cell monovalent vaccines formulated with two vaccine candidate strains belonging to the most prevalent serogroup of Leptospira in Cuba.

Inmunogenicidad y capacidad protectora en hamsters de vacunas antileptospirósicas monovalentes de células enteras del serogrupo Ballum. / [Immunogenicity and protective capacity of leptospiral whole-cell monovalent serogroup Ballum vaccines in hamsters]

Leptospira serogroup Ballum is at present the first cause of human leptospirosis in Cuba. Killed whole-cell vaccines were formulated with two clinical isolates of Leptospira interrogans serogroup Ballum using aluminum hydroxide as adjuvant. Agglutinins levels induced by each vaccine in hamsters were estimated by microscopic agglutination test and specific IgG activities were quantified by a whole cell-based enzyme-linked immunosorbent assay. Homologous and cross protective capacity against lethal and sublethal infection were determined in vaccinated animals by challenge with 100 and 10,000 LD50 of five virulent strains belonging to serogroups Ballum, Canicola, Icterohaemorrhagiae and Pomona. Both monovalent serogroup Ballum vaccines were immunogenic and induced complete homologous protection in the animal model. Cross-protection was only significant in one of the two vaccines against challenge with 100 LD50 of serogroup Canicola. The results of this study demonstrate the high immunogenicity and protective capacity in hamsters of whole-cell monovalent vaccines formulated with two vaccine candidate strains belonging to the most prevalent serogroup of Leptospira in Cuba.

A synthetic conjugate polysaccharide vaccine against Haemophilus influenzae type b

Glycoconjugate vaccines provide effective prophylaxis against bacterial infections. To date, however, no commercial vaccine has been available in which the key carbohydrate antigens are produced synthetically. We describe the large-scale synthesis, pharmaceutical development, and clinical evaluation of a conjugate vaccine composed of a synthetic capsular polysaccharide antigen of Haemophilus influenzae type b (Hib). The vaccine was evaluated in clinical trials in Cuba and showed long-term protective antibody titers that compared favorably to licensed products prepared with the Hib polysaccharide extracted from bacteria. This demonstrates that access to synthetic complex carbohydrate-based vaccines is feasible and provides a basis for further development of similar approaches for other human pathogens(AU)

[Rapid detection of Enterovirus by a direct method of polymerase chain reaction]. / Detección rápida de Enterovirus mediante un método directo de reacción en cadena de la polimerasa.

For the detection of Enterovirus, we devised a direct economical method of polymerase chain reaction which does not require a previous extraction of ribonucleic acid and uses infected cell culture supernatants. The system was developed on the basis of universal primers of Enterovirus and specific primers of vaccinal strain Sabin 1. The achieved results proved that the non-existence of methods of RNA extraction and purification prior to the reaction does not affect the susceptibility and specificity of the system, in the rapid detection of Enterovirus genomes and identification of vaccinal strains of poliovirus.

Multianalytical system (MAS): software for enzyme-linked immunosorbent assay (ELISA) data processing with applications to screening and diagnostic tests.

A microcomputer software package for determining the concentration of either the antibody or antigen from ELISA data for IBM PC compatible is presented. In the program optical densities (OD) and fluorescence obtained from 96-well ELISA plate can be input either directly, by interfacing with different brands of microplate reader such as Multiskan II Plus and Organon Teknika to the computer or manually. This software utilizes some mathematical and statistical models to fit the standard curve of each assay and interpolate analyte concentration using data from OD or fluorescence measurements. Cubic spline (Guardabasso et al., 1988), bezier and polynomial (Rodbard, 1979; Baud et al., 1991) interpolation formulas can be used to fit the data over the entire range for estimating the antibody or antigen concentration of the unknown samples whose OD or fluorescence is beyond the entire range. This software package, based on the concentration values of the analyte determined in different fluids (Núnez et al., 1994; Morales et al., 1994) and with some rules and algorithms, is used to calculate the parameters of screening and diagnostic tests such as sensitivity, specificity and predictive values (Coughlin et al., 1992). With the construction of the Receiver Operating Characteristic (ROC) curve it is possible to analyse different values of the sensitivity and specificity of the screening and diagnostic tests. A comparative statistical test for two populations that are non-normally distributed using a non-parametric Mann-Whitney test is provided. This software is an expandable tool designed for general use in clinical and experimental applications, including diagnostic and screening tests.

Pathologic-clinical characterization of leptospirosis in a golden Syrian hamster model.

Experimental leptospirosis was reproduced in golden Syrian hamsters (Mesocricetus aureatus). Evaluation of three Leptospira serogroups (canicola, icterohaemorrhagiae and pomona) was carried out regarding their virulence, production of symptoms and lethal activity. Macroscopic and microscopic studies of tissue lesions were also made. Animals were inoculated with 3.75 x 10(6) to 6 x 10(7) bacteria through the intraperitoneal (IP) route. The clinical development of the disease in Syrian hamsters was characterized by the presence of general symptoms between the third and fifth day after inoculation. With highly virulent strains, the distinctive clinical picture occurred and death followed before the seventh day. The strain of the pomona serogroup proved to be more virulent than those of the other serogroups and produced the most florid picture of the disease. Pathogenic aspects of this process were also studied.

[Regulation of birth and violence]. / Regulacion de la natalidad y violencia.

PIP: The terms violence and violation are contrasted: the former is defined as an action taken to change or nullify a situation, structure, or phenomenon; and the latter is defined as any attempt against a principle of order, either direct or indirect. Man and his relationship to nature are then discussed and it is concluded that man is using violence on nature in its unlawful form of violation rather than its lawful form of correction. Insofar as the human population is concerned, attempts to control reproduction, both prior to gametogenesis and after fertilization are said to be violations of Natural Law. Arguments on both sides are studied and compared. Present-day aspects of the sexual revolution are examined in their relation to possible conflict between individual rights and group interests. Self-control is described as the best solution to the population problem.^ieng