Spanish primary care in pediatric trauma (AITP) consensus: An AITP checklist. / Consenso AITP español: Una lista de verificación AITP.

INTRODUCTION: The course in Primary Care in Pediatric Trauma (ATIP in Spanish) has been taught in Spain since 1997, and there are currently 9 accredited training centers. Care of polytraumatized pediatric patients often takes place in an environment conducive to errors resulting from forgetfulness, which is why checklists - mnemonic tools widely used in industry and medicine - are particularly useful to avoid such errors. Although several checklists exist for pediatric trauma care, none have been developed within the setting of our course. MATERIALS AND METHODS: The criteria for being selected as an expert in Primary Care in Pediatric Trauma were agreed upon with the scientific polytrauma committee of the Spanish Pediatric Surgery Society. The items that make up the checklist were obtained from a review of the literature and consultation with selected experts, using the Delphi Technique. RESULTS: 10 experts representing the 9 groups or training centers in Primary Care in Pediatric Trauma were selected, and a 28-item checklist was drawn up in accordance with their design recommendations. CONCLUSIONS: With the consensus of all the groups, a checklist for the treatment of polytraumatized pediatric patients was drawn up using the Delphi Technique, an essential requirement for the dissemination of this checklist, which should be adapted and validated for use in each healthcare center.

INTRODUCCION: El curso de Asistencia Inicial al Trauma Pediátrico se imparte en España desde 1997, existiendo en la actualidad 9 centros formadores acreditados. La asistencia al paciente pediátrico politraumatizado se produce muchas veces en un ambiente proclive al error por olvido, por lo que las listas de verificación, como herramientas mnemotécnicas de amplia difusión en la industria y en medicina, serían especialmente útiles para evitarlos. Aunque existen varias listas de verificación para la asistencia al traumatismo pediátrico, ninguna se ha desarrollado en el entorno de nuestro curso. MATERIAL Y METODOS: Se acordaron los criterios para ser seleccionado como experto en Asistencia Inicial al Trauma Pediátrico con la comisión científica de politrauma de la Sociedad Española de Cirugía Pediátrica. Los ítems para formar la lista de verificación se obtuvieron a partir de una revisión bibliográfica y de la consulta a los expertos seleccionados, empleando un método Delphi. RESULTADOS: Se seleccionaron 10 expertos que representan los 9 grupos o centros formadores en Asistencia Inicial al Trauma Pediátrico y se elaboró una lista de verificación con 28 ítems, siguiendo sus recomendaciones de diseño. CONCLUSIONES: Se diseñó una lista de verificación para el manejo del paciente pediátrico politraumatizado, con el consenso de todos los grupos empleando un método Delphi, requisito fundamental para facilitar la difusión de esta lista. Sería preciso adaptar y validar dicha lista para su uso en cada centro asistencial.

Consenso AITP español: Una lista de verificación AITP / Spanish primary care in pediatric trauma (AITP) consensus: An AITP checklist

Introducción: El curso de Asistencia Inicial al Trauma Pediátricose imparte en España desde 1997, existiendo en la actualidad 9 centrosformadores acreditados. La asistencia al paciente pediátrico politraumatizado se produce muchas veces en un ambiente proclive al errorpor olvido, por lo que las listas de verificación, como herramientasmnemotécnicas de amplia difusión en la industria y en medicina, serían especialmente útiles para evitarlos. Aunque existen varias listas deverificación para la asistencia al traumatismo pediátrico, ninguna se hadesarrollado en el entorno de nuestro curso. Material y métodos: Se acordaron los criterios para ser seleccionado como experto en Asistencia Inicial al Trauma Pediátrico con lacomisión científica de politrauma de la Sociedad Española de CirugíaPediátrica. Los ítems para formar la lista de verificación se obtuvierona partir de una revisión bibliográfica y de la consulta a los expertosseleccionados, empleando un método Delphi. Resultados. Se seleccionaron 10 expertos que representan los 9grupos o centros formadores en Asistencia Inicial al Trauma Pediátri-co y se elaboró una lista de verificación con 28 ítems, siguiendo susrecomendaciones de diseño. Conclusiones: Se diseñó una lista de verificación para el manejodel paciente pediátrico politraumatizado, con el consenso de todos losgrupos empleando un método Delphi, requisito fundamental para facilitarla difusión de esta lista. Sería preciso adaptar y validar dicha lista parasu uso en cada centro asistencial.(AU)

Introduction: The course in Primary Care in Pediatric Trauma(ATIP in Spanish) has been taught in Spain since 1997, and there arecurrently 9 accredited training centers. Care of polytraumatized pedi-atric patients often takes place in an environment conducive to errorsresulting from forgetfulness, which is why checklists –mnemonic toolswidely used in industry and medicine– are particularly useful to avoidsuch errors. Although several checklists exist for pediatric trauma care,none have been developed within the setting of our course. Materials and methods: The criteria for being selected as an expertin Primary Care in Pediatric Trauma were agreed upon with the scientific polytrauma committee of the Spanish Pediatric Surgery Society.The items that make up the checklist were obtained from a review ofthe literature and consultation with selected experts, using the DelphiTechnique. Results: 10 experts representing the 9 groups or training centers inPrimary Care in Pediatric Trauma were selected, and a 28-item checklistwas drawn up in accordance with their design recommendations.Conclusions: With the consensus of all the groups, a checklist forthe treatment of polytraumatized pediatric patients was drawn up usingthe Delphi Technique, an essential requirement for the disseminationof this checklist, which should be adapted and validated for use in eachhealthcare center.(AU)

New fabrication method for producing reduced graphene oxide flexible electrodes by using a low-power visible laser diode engraving system.

The fabrication of bendable electronic devices is a scientific-technological area of very rapid advance in which new materials and fabrication techniques are being continuously developed. In these kinds of devices, the fabrication of flexible conductive electrodes adherent to the substrate is a key factor. Further, eco-friendliness, low cost and fast production are essential requirements for the successful progress of new technologies. In this work, a novel method for obtaining graphene-based flexible electrodes is presented. Conductive films were obtained by means of the visible laser irradiation of graphene oxide layers deposited on polyethylene terephthalate substrates and self-standing membranes sandwiched between glass slides. Despite the low power of the laser system, the numerical simulations indicate the development of temperatures over 1000 K throughout the irradiated material. The laser-induced spatially confined heating leads to the reduction of the graphene oxide material, whereas the glass-based sandwich assembly avoids reoxidation from the surrounding air. By scanning and pixelated modes, reduced graphene oxide electrodes, up to 100 µm in thickness, and with a resistivity as low as 6 × 10-4 Ωm, were obtained in an easy and versatile way. Proof-of-concept microsupercapacitors and electrochemical sensors were fabricated with this technique, showing promising performance.

Mindfulness-based stress reduction in adolescents with mental disorders: a randome / Reducción del estrés basada en mindfulness en adolescentes con trastornos mentales: un ensayo clínico aleatorio

BACKGROUND: Currently, there is a strong movement to implement mindfulness interventions with young people. The objective of this randomised clinical trial was to assess the potential effects of a mindfulness-based stress reduction (MBSR) programme for adolescent outpatients in mental health facilities in Cordoba, Spain. METHOD: A total of 101 adolescents aged 13-16 years old, receiving psychological or psychiatric treatment for various disorders, were eligible for the study. The participants' scores on mindfulness, self-esteem, perceived stress, state-trait anxiety and other psychological symptoms were examined at two time-points. Eighty adolescents completed the study (MBSR+TAU group = 41; TAU group = 39). RESULTS: The MBSR+TAU group showed a statistically significant decrease in anxiety state compared to the treatment-as-usual (TAU) group. No statistically significant differences were found between groups on the other scores, but the intervention was observed to have a greater impact on the MBSR+TAU group than in the TAU group, especially in reducing symptoms of depression, anxiety, paranoia and perceived stress. CONCLUSION: These results suggest that MBSR may be a useful adjunct treatment for adolescents in mental health facilities

ANTECEDENTES: actualmente, existe un fuerte movimiento respecto a la implantación de las intervenciones de mindfulness con adolescentes. El objetivo de este ensayo clínico fue evaluar el efecto potencial de un programa de reducción del estrés basado en la atención plena (MBSR) para pacientes ambulatorios adolescentes en los servicios de salud mental de Córdoba, España. MÉTODO: un total de 101 adolescentes (13-16 años) con trastornos heterogéneos que recibían tratamiento psicológico o psiquiátrico fueron seleccionados para participar en el estudio. Las puntuaciones de los participantes en mindfulness, autoestima, estrés percibido, ansiedad estado-rasgo y otros síntomas psicológicos fueron evaluados en dos momentos. Ochenta adolescentes completaron el estudio (grupo-MBSR+TAU = 41, grupo-TAU = 39). RESULTADOS: el grupo MBSR+TAU muestra una disminución estadísticamente significativa en ansiedad-estado comparado con el grupo de tratamiento habitual (grupo-TAU). No hay diferencias estadísticamente significativas entre los grupos en el resto de puntuaciones, pero hemos encontrado un mayor impacto de la intervención en el grupo MBSR+TAU que en el grupo TAU, especialmente en la reducción de los síntomas de depresión, ansiedad, paranoia y estrés percibido. CONCLUSIÓN: estos resultados sugieren que MBSR puede ser un tratamiento complementario útil para los adolescentes en los servicios de salud mental

Achieving extremely concentrated aqueous dispersions of graphene flakes and catalytically efficient graphene-metal nanoparticle hybrids with flavin mononucleotide as a high-performance stabilizer.

The stable dispersion of graphene flakes in an aqueous medium is highly desirable for the development of materials based on this two-dimensional carbon structure, but current production protocols that make use of a number of surfactants typically suffer from limitations regarding graphene concentration or the amount of surfactant required to colloidally stabilize the sheets. Here, we demonstrate that an innocuous and readily available derivative of vitamin B2, namely the sodium salt of flavin mononucleotide (FMNS), is a highly efficient dispersant in the preparation of aqueous dispersions of defect-free, few-layer graphene flakes. Most notably, graphene concentrations in water as high as ∼50 mg mL(-1) using low amounts of FMNS (FMNS/graphene mass ratios of about 0.04) could be attained, which facilitated the formation of free-standing graphene films displaying high electrical conductivity (∼52000 S m(-1)) without the need of carrying out thermal annealing or other types of post-treatment. The excellent performance of FMNS as a graphene dispersant could be attributed to the combined effect of strong adsorption on the sheets through the isoalloxazine moiety of the molecule and efficient colloidal stabilization provided by its negatively charged phosphate group. The FMNS-stabilized graphene sheets could be decorated with nanoparticles of several noble metals (Ag, Pd, and Pt), and the resulting hybrids exhibited a high catalytic activity in the reduction of nitroarenes and electroreduction of oxygen. Overall, the present results should expedite the processing and implementation of graphene in, e.g., conductive inks, composites, and hybrid materials with practical utility in a wide range of applications.

Fast and sensitive optical toxicity bioassay based on dual wavelength analysis of bacterial ferricyanide reduction kinetics.

Global urban and industrial growth, with the associated environmental contamination, is promoting the development of rapid and inexpensive general toxicity methods. Current microbial methodologies for general toxicity determination rely on either bioluminescent bacteria and specific medium solution (i.e. Microtox(®)) or low sensitivity and diffusion limited protocols (i.e. amperometric microbial respirometry). In this work, fast and sensitive optical toxicity bioassay based on dual wavelength analysis of bacterial ferricyanide reduction kinetics is presented, using Escherichia coli as a bacterial model. Ferricyanide reduction kinetic analysis (variation of ferricyanide absorption with time), much more sensitive than single absorbance measurements, allowed for direct and fast toxicity determination without pre-incubation steps (assay time=10 min) and minimizing biomass interference. Dual wavelength analysis at 405 (ferricyanide and biomass) and 550 nm (biomass), allowed for ferricyanide monitoring without interference of biomass scattering. On the other hand, refractive index (RI) matching with saccharose reduced bacterial light scattering around 50%, expanding the analytical linear range in the determination of absorbent molecules. With this method, different toxicants such as metals and organic compounds were analyzed with good sensitivities. Half maximal effective concentrations (EC50) obtained after 10 min bioassay, 2.9, 1.0, 0.7 and 18.3 mg L(-1) for copper, zinc, acetic acid and 2-phenylethanol respectively, were in agreement with previously reported values for longer bioassays (around 60 min). This method represents a promising alternative for fast and sensitive water toxicity monitoring, opening the possibility of quick in situ analysis.

[Burns in adolescents]. / Quemaduras en adolescentes.

INTRODUCTION: The aim of this study was to know the epidemiology of burns in teenagers. PATIENTS AND METHODS: Burn patients over 11 years old admitted in our Institution in the last 10 years were included. Etiology, burn size, hospital stay, quirurgical interventions and long term sequelae were registered. RESULTS: One thousand and eight patients were admitted, 89 were over 11 years (8.8%), 70.7% were boys and 29.3% girls. Fire was the principal agent in 58 cases (65.1%), due to fireworks in 13 (22.4%), alcohol in 7 (12%), explosion of flammable containers (spray) in 4 (6.8%) and gasoline in 3 (5.2%). Fireworks injuries and spray explosions affected face and hand in 88% cases. The median hospital stay was 8 days after admission (1 to 90). 83.1% required surgical treatment with mean of 1.8 +/- 1.4 interventions and 21.3% had long-term sequelaes that required at least one surgical intervention. CONCLUSION: Fire is the main cause of burns in adolescents. Fireworks injuries represented a quarter of that lesions, and highlights paint spray explosions as new causative agents. Considering the high morbidity in this age group, with permanent functional and aesthetic sequelae, prevention campaigns are needed to reduce such accidents.

Quemaduras en adolescentes / Burns in adolescents

Objetivos. El objetivo de este estudio es valorar la epidemiología y etiopatogenia de las quemaduras en adolescentes. Pacientes y métodos. Estudio descriptivo retrospectivo de los pacientes mayores de 11 años ingresados en nuestro servicio por quemaduras en los últimos 10 años. Se registraron la etiología, superficie corporal quemada, estancia hospitalaria, intervenciones quirúrgicas y secuelas. Resultados. De un total de 1.008 pacientes ingresados por quemaduras, se incluyeron 89 con edad superior a 11 años (8,8%), siendo el 70,7% niños y el 29,3% niñas. El agente principal fue el fuego en 58 casos (65,1%), resultando secundario a explosión pirotécnica en 13 (22,4%), alcohol como combustible en 7 (12%), explosión de envases inflamables (spray) en 4 (6,8%) y gasolina en 3 (5,2%). La cara y las manos se vieron afectadas en las explosiones pirotécnicas y por spray de pintura en el 88% de los casos. La mediana de estancia hospitalaria fue de 8 días de ingreso (1 a 90). El 83,1% precisó de tratamiento quirúrgico con una media de 1,8 ± 1,4 intervenciones y el 21,3% presentaron secuelas que necesitaron al menos una intervención quirúrgica posterior. Conclusión. El fuego es la principal causa de quemadura en adolescentes, representando las explosiones pirotécnicas una cuarta parte y destacando la aparición de nuevos agentes causales, como la deflagración de botes de pintura (graffiti).Dada la alta morbilidad en este grupo de edad, con secuelas estéticas y funcionales permanentes, creemos conveniente la necesidad de campañas preventivas que contribuyan a disminuir este tipo de accidente (AU)

Introduction. The aim of this study was to know the epidemiology of burns in teenagers. Patients and methods. Burn patients over 11 years old admitted in our Institution in the last 10 years were included. Etiology, burn size, hospital stay, quirurgical interventions and long term sequelae were registered. Results. One thousand and eight patients were admitted, 89 were over 11 years (8.8%), 70.7% were boys and 29.3% girls. Fire was the principal agent in 58 cases (65.1%), due to fi reworks in 13 (22.4%), alcohol in 7 (12%), explosion of flammable containers (spray) in 4 (6.8%) and gasoline in 3 (5.2%). Fireworks injuries and spray explosions affected face and hand in 88% cases. The median hospital stay was 8 days after admission (1 to 90). 83.1% required surgical treatment with mean of 1.8 +1.4 interventions and 21.3% had long term sequelaes that required at least one surgical intervention .Conclusion. Fire is the main cause of burns in adolescents. Fireworks injuries represented a quarter of that lesions, and highlights paint spray explosions as new causative agents. Considering the high morbidity in this age group, with permanent functional and aesthetic sequelae, prevention campaigns are needed to reduce such accidents (AU)

[Thrombosis of the cavernous sinus following prone-position spinal surgery in a patient with factor V Leiden]. / Trombosis de seno cavernoso tras una cirugía raquídea en decúbito prono en un paciente portador del factor V de Leiden.

INTRODUCTION: Non-infectious thrombosis of the cavernous sinus has sometimes been reported as a complication following neurosurgical procedures and, in one case, after carrying out the operation in a prone position. Factor V Leiden is a genetic risk factor for presenting an intracranial venous thrombotic disease. We report the case of a patient who suffered thrombosis of the cavernous sinus following prolonged surgery in the prone position and in whom a mutation of factor V Leiden in a heterozygotic state was discovered. CASE REPORT: A 64-year-old male, with arterial hypertension as the only known vascular risk factor, who, after prolonged surgery in a prone position, presented amaurosis in the left eye accompanied some hours later by ocular pain, conjunctival ecchymosis, proptosis and abolition of extrinsic ocular mobility. An angiography scan confirmed the existence of thrombosis in the cavernous sinus. Treatment was established with low-molecular-weight heparin without the occurrence of any other kinds of complications. The patient gradually recovered extrinsic ocular mobility but not visual acuity. A heterozygotic mutation for factor V Leiden was found in a hypercoagulability study that was later performed. CONCLUSIONS: The coexistence of a risk factor for presenting a venous thrombotic disease and a mechanical phenomenon, venous statis, due to the posture adopted for the surgical intervention together account for the complication presented by the patient.

Trombosis de seno cavernoso tras una cirugía raquídea en decúbito prono en un paciente portador del factor V de Leiden / Thrombosis os the carvenous sinus following prone-position spinal surgery in a patient with factor y leiden

Introducción. La trombosis del seno cavernoso no infecciosa ha sido descrita en ocasiones como complicación tras la realización de procedimientos neuroquirúrgicos y, en un caso, después de llevarla a cabo en decúbito prono. El factor V de Leiden es un factor de riesgo genético para presentar una enfermedad trombótica venosa intracraneal. Presentamos el caso de un paciente que sufre una trombosis del seno cavernoso tras una cirugía prolongada en decúbito prono y en quien se descubrió una mutación del factor V de Leiden en estado heterocigoto. Caso clínico. Varón de 64 años de edad, con hipertensión arterial como único factor de riesgo vascular conocido, quien, tras una intervención quirúrgica prolongada en decúbito prono, presentó una amaurosis en el ojo izquierdo acompañada, en las horas posteriores, de dolor ocular, equimosis conjuntival, proptosis y abolición de la motórica ocular extrínseca. Una angiografía confirmó la existencia de una trombosis del seno cavernoso. Se instauró tratamiento con heparinas de bajo peso molecular sin que se produjeran otros tipos de complicaciones. El paciente recuperó paulatinamente la motórica ocular extrínseca, pero no la agudeza visual. En el estudio de hipercoagulabilidad realizado posteriormente se encontró una mutación heterocigota para el factor V de Leiden. Conclusión. La coexistencia de un factor de riesgo para presentar una enfermedad trombótica venosa junto con un fenómeno mecánico, de estasis venosa, a causa de la posición quirúrgica, explican la complicación que presentó el paciente (AU)

Introduction. Non-infectious thrombosis of the cavernous sinus has sometimes been reported as a complication following neurosurgical procedures and, in one case, after carrying out the operation in a prone position. Factor V Leiden is a genetic risk factor for presenting an intracranial venous thrombotic disease. We report the case of a patient who suffered thrombosis of the cavernous sinus following prolonged surgery in the prone position and in whom a mutation of factor V Leiden in a heterozygotic state was discovered. Case report. A 64-year-old male, with arterial hypertension as the only known vascular risk factor, who, after prolonged surgery in a prone position, presented amaurosis in the left eye accompanied some hours later by ocular pain, conjunctival ecchymosis, proptosis and abolition of extrinsic ocular mobility. An angiography scan confirmed the existence of thrombosis in the cavernous sinus. Treatment was established with low-molecular-weight heparin without the occurrence of any other kinds of complications. The patient gradually recovered extrinsic ocular mobility but not visual acuity. A heterozygotic mutation for factor V Leiden was found in a hypercoagulability study that was later performed. Conclusions. The coexistence of a risk factor for presenting a venous thrombotic disease and a mechanical phenomenon, venous statis, due to the posture adopted for the surgical intervention together account for the complication presented by the patient (AU)

[Severe acquired aplastic anemia: historical outcome of patients treated by allogeneic bone marrow transplantation from matched sibling donors. A study by the Spanish Group for Bone Marrow Transplantation in Children (GETMON)]. / Aplasia medular grave adquirida: evolución histórica de los resultados obtenidos con trasplante de progenitores hematopoyéticos de donante familiar. Estudio del Grupo Español para el Trasplante de Médula Osea en Niños (GETMON).

INTRODUCTION: Allogeneic haematopoietic stem-cell transplantation is the treatment of choice for acquired aplastic anaemia in children. Experience with this approach from Spanish Working Party for Bone Marrow Transplantation in Children in two sequential time periods (1982-1990 and 1991-2004) is reported. PATIENTS AND METHODS: Sixty two consecutive patients with a median age of 10 years were transplanted; 18 in the 1982-1990 period and 44 in the 1991-2004 period. Conditioning regimen consisted mainly of irradiation and cyclophosphamide in the first period (72 % of patients) and cyclophosphamide +/- anti-thymocyte globulin (62 %) in the second. Graft versus host disease prophylaxis consisted of cyclosporine in most patients (57/62). RESULTS: Fifty one patients are alive and disease-free at a median follow-up of 127 months. Five years probability of event-free survival is 82 %. The survival increased from 61 % to 91 % during the two time periods. Eleven patients died from graft failure or rejection (3), acute or chronic graft versus host disease and infection (4) or multi-organ failure (4). Univariate analysis identified two significant prognostic factors: interval diagnostic/transplant and time period of transplant (for both p = 0.03). CONCLUSIONS: This experience corroborates that allogeneic haematopoietic stem-cell transplantation is the best treatment for severe acquired aplastic anaemia, with a current disease-free survival of 90 % of patients.

[Heterogenicity of Gorham-Stout syndrome: association with lymphatic and venous malformations]. / Heterogenicidad del síndrome de Gorham-Stout: asociación a malformaciones linfáticas y venosas.

INTRODUCTION: Gorham-Stout syndrome is a rare disorder of unknown etiology characterized by osteolysis and microscopic proliferation of abnormal vessels. We report two cases of this syndrome associated with lymphatic and venous malformations. CASE REPORTS: The first case is a 5-year-old boy with disseminated lymphangiomatosis of poor prognosis, with significant pleural involvement and osteolytic lesions. The second case is a 5-year-old girl with a diagnosis of Klippel-Trenaunay syndrome with significant skeletal involvement of the lower extremities and secondary pathological fracture. CONCLUSIONS: Gorham-Stout syndrome may occasionally be associated with various lymphatic and venous malformations. Osteolysis and bone resorption may be induced by lymphatic bone involvement.

Heterogenicidad del síndrome de Gorham-Stout: asociación a malformaciones linfáticas y venosas / Heterogenicity of gorham-stout syndrome: association with lymphatic andvenous malformations

Introducción. El síndrome de Gorham-Stout constituye una rara enfermedad de etiología desconocida que se caracteriza por osteólisis rápidamente progresiva y proliferación microscópica de vasos anormales. Presentamos 2 casos clínicos asociados a malformaciones linfaticovenosas. Casos clínicos. El primer caso es un varón de 5 años afecto de linfangiomatosis generalizada de evolución desfavorable, con importante afectación pleural y lesiones osteolíticas. El segundo caso se trata de una niña de 5 años diagnosticada de síndrome de Klippel-Trénaunay con importante afectación ósea en miembros inferiores y fractura patológica secundaria. Conclusiones. El síndrome de Gorham-Stout puede presentarse ocasionalmente asociado a distintas malformaciones linfaticovenosas. La afectación linfática del hueso puede provocar osteólisis y resorción ósea (AU)

Persistencia de anti-HBs en ancianos inmunizados con una vacuna ADN recombinante anti-hepatitis B: dos años de seguimiento / Anti-HBs persistent to immune aged with a DNA recombinant anti-hepatitis B vaccine: two years of follow

Se aplicó la vacuna recombinante cubana contra el virus de la hepatitis B Herberbiovac HB a un grupo de individuos mayores de 65 años, pertenecientes a un hogar de ancianos de Ciudad de la Habana, a la dosis de 20 ug, con el esquema 0,1 y 6 meses para estudiar su inmunogenicidad, la cual fue evaluada a los 2, 7, 12 meses y 2 años después de aplicada la primera dosis. A los 60 días se obtuvo un 47,1 por ciento de títulos protectores (>10 UI/L) y media geométrica (TMG) de 6,04 UI/L. Cuando se evaluó la respuesta inmune a los 7 meses se logró un 100,0 por ciento de seroprotección (>10 UI/L); 78,6 por ciento de buenos respondedores (títulos antiHBs >100 UI/L) y media geométrica de 136,93 UI/L. Al año, la seroprotección también fue del 100 por ciento, y se logró 61,5 por ciento de títulos >100 UI/L y la media geométrica de 204,61 UI/L. La persistencia de niveles de anticuerpos protectores y TMG 2 años después de aplicada la primera dosis de la vacuna fue de 71,4 por ciento y 24,73 UI/L, respectivamente. Estos resultados evidencian el alto poder inmunogénico de esta vacuna, lo que la hace recomendable para la protección de este grupo de edad contra el virus de la hepatitis B

Liver transplantation in patients with homozygotic familial hypercholesterolemia previously treated by end-to-side portocaval shunt and ileal bypass.

Familial hypercholesterolemia is the result of mutations in the gene that encodes the synthesis of the cellular receptor for low density lipoprotein (LDL). In the homozygous form of the disease (HFHC), cellular LDL receptors either do not form, or, when present, cannot bond LDL and mediate its cellular uptake LDL, and the cholesterol that it transports accumulate in plasma, producing severe premature atherosclerosis and death from coronary artery disease usually before the age of 20. Currently, the only effective treatment is liver transplantation, which, alone or in association with medications, normalizes plasma cholesterol levels. The authors report the cases of 2 siblings with HFHC who underwent portocaval shunt at the ages of 2.5 and 1.5 years, respectively. Portocaval shunt produced an immediate, but insufficient decrease in cholesterol (by 40% and 35%, respectively), leaving them with cholesterol concentrations of about 500 mg/dL. One year later they each underwent ileal bypass without obtaining any significant response. Liver transplantation at the ages of 18 and 16 years, respectively, reduced plasma cholesterol concentrations to 129 and 225 mg/dL, respectively. The earlier operations seriously increased the technical difficulty of liver transplantation and did not produce a favorable effect on the natural course of the disease, so portocaval shunt and ileal bypass are not indicated in HFHC, not even for the purpose of delaying liver transplantation.

Portable data acquisition system for EKG measurements in marine environments.

In the present paper, an electronic prototype designed to acquire electrocardiographic signals from marine mammals has been developed. The system consists of a portable device that allows the on-line acquisition of EKG signals through a parallel port interface that is connected to a laptop computer. The EKG waveform, the voltage level, the bandwidth and the most relevant information from this type of signals is stored and analysed under real-time conditions by means of specifically implemented software. The whole system has been successfully tested to obtain the EKG from captive dolphins. The characteristics of the equipment presented here, with its low cost, size and energy requirements accomplish a portable system suitable for the acquisition of this type of signals in conductive media such as the seawater.

[Evaluation of the effectiveness of a new vaccine against human leptospirosis in groups at risk]. / Evaluación de la efectividad de una nueva vacuna contra la leptospirosis humana en grupos en riesgo.

In order to evaluate the effectiveness of a new vaccine against human leptospirosis, a prospective cohort study was done with persons in the Cuban province of Holguín who were at risk of becoming ill with leptospirosis. The study included 118,018 persons from 15 to 65 years old who were considered to face either permanent or temporary risk. The vaccinated cohort consisted of 101,137 persons. They received two vaccine doses, 6 weeks apart, of 0.50 mL via deep intramuscular injection into the deltoid muscle of the nondominant arm. The unvaccinated cohort consisted of 16,881 persons. Epidemiological surveillance began 21 days after the application of the second vaccine dose and continued for 1 year. The same criteria for suspected and confirmed cases were maintained throughout the study period. At the end of the surveillance period effectiveness was calculated as being higher than 97%. It is estimated that the vaccination program prevented eight out of ten cases that would have otherwise occurred. Vaccine reactogenicity was also measured in a subsample of 1,500 persons between 15 and 65 years old. The observed symptomatology was low. Slight pain at the injection site was the most frequent symptom (25%). The results of the study indicate the usefulness of the vaccine for disease prevention among people at risk, and its use is thus recommended.

Crystalloid architecture of a sialolith in a minor salivary gland.

A sialolith from a minor salivary gland of the mucosa of the upper lip was studied morphologically and analytically. Under stereoscopic microscopic visualisation, no core or any concentric laminar structure was found in the sialolith and it had a transparent glassy appearance. Scanning electron microscopy revealed differences between the internal structure of the sialolith and its external structure. No microbes were observed but some mineralized inclusion bodies were seen. X-ray diffraction indicated the absence of inorganic crystals in the sialolith, while energy dispersive x-ray microanalysis revealed a high content of S followed by Ca, Si and Na and little and scarce P on the fracture surface, with S, Na, Ca and P being distributed throughout the external coating of the sialolith. The results suggest that the sialolith was young and consisted of a crystalloid body with an incipient coating undergoing calcification.