Detection of SARS-CoV-2 in aerosols in long term care facilities and other indoor spaces with known COVID-19 outbreaks.

Coronavirus outbreaks are likely to occur in crowded and congregate indoor spaces, and their effects are most severe in vulnerable long term care facilities (LTCFs) residents. Public health officers benefit from tools that allow them to control COVID-19 outbreaks in vulnerable settings such as LTCFs, but which could be translated in the future to control other known and future virus outbreaks. This study aims to develop and test a methodology based on detection of SARS-CoV-2 in aerosol samples collected with personal pumps that could be easily implemented by public health officers. The proposed methodology was used to investigate the levels of SARS-CoV-2 in aerosol in indoor settings, mainly focusing on LTCFs, suffering COVID-19 outbreaks, or in the presence of known COVID-19 cases, and targeting the initial days after diagnosis. Aerosol samples (N = 18) were collected between November 2020 and March 2022 in Castelló (Spain) from LTCFs, merchant ships and a private home with recently infected COVID-19 cases. Sampling was performed for 24-h, onto 47 mm polytetrafluoroethylene (PTFE) and quartz filters, connected to personal pumps at 2 and 4 L/min respectively. RNA from filters was extracted and SARS-CoV-2 was determined by detection of regions N1 and N2 of the nucleocapsid gene alongside the E gene using RT-PCR technique. SARS-CoV-2 genetic material was detected in 87.5% samples. Concentrations ranged ND-19,525 gc/m3 (gene E). No genetic traces were detected in rooms from contacts that were isolated as a preventative measure. Very high levels were also measured at locations with poor ventilation. Aerosol measurement conducted with the proposed methodology provided useful information to public health officers and contributed to manage and control 12 different COVID-19 outbreaks. SARS-CoV-2 was detected in aerosol samples collected during outbreaks in congregate spaces. Indoor aerosol sampling is a useful tool in the early detection and management of COVID-19 outbreaks and supports epidemiological investigations.

Siete años de experiencia en pacientes intervenidos por patología proctológica bajo modalidad cirugía mayor ambulatoria y estudio del grado de satisfacción usuaria

Objetivo: Exponer los resultados de 7 años de cirugía proctológica por cirugía mayor ambulatoria (CMA) y determinar el grado de satisfacción usuaria. Material y Método: Se realizó un estudio observacional descriptivo de pacientes sometidos a cirugía proctológica bajo modalidad CMA en el Hospital Regional de Concepción entre los años 2012 y 2019. Se realizó la encuesta telefónica de satisfacción SUCMA-14. Resultados: Se evaluaron a 632 pacientes en el período de estudio. Con diferencias estadísticamente significativas entre patologías para edad, género e IMC. Se aplicó la encuesta a 270 pacientes que contestaron y respondieron. Los resultados mostraron que en general la percepción de los pacientes es positiva salvo puntuales excepciones, como el dolor postoperatorio para condilomas y hemorroides, y las complicaciones postoperatorias para la enfermedad pilonidal. Cuando se realiza el análisis multivariado a los datos correspondientes a la encuesta, no se logran diferencias significativas entre los diagnósticos, pero al aplicarlo a las variables clínico-quirúrgicas se evidencia, claramente, que existe una distinción entre éstas, en especial para la enfermedad pilonidal. Discusión: Las diferencias en términos de tiempos quirúrgicos, complicaciones y re-hospitalizaciones, no necesariamente afectan la percepción que los pacientes tienen de la CMA, ya que ésta depende de otros factores y no solo de los resultados quirúrgicos. Conclusión: Se obtuvieron resultados acorde a la literatura internacional, con peores resultados para enfermedad pilonidal. La satisfacción usuaria fue positiva en general, sin una clara distinción por patologías. Creemos que la CMA es recomendable en patología proctológica tanto por sus resultados, como por la satisfacción que genera en los pacientes.

Objective: To present the results of 7 years of colorectal surgery on mayor ambulatory surgery (MAS) and to determine patient satisfaction. Methods: A descriptive observational study of patients undergoing proctological surgery under the MAS modality was carried out at Regional Hospital of Concepción between 2012 and 2019. The SUCMA-14 satisfaction survey was applied. Results: 632 patients were evaluated in the study period. With statistically significant differences between pathologies for age, gender and BMI. The survey was applied to 270 patients who answered and responded. The results showed that, in general, the perception of the patients is positive, with exceptions, such as postoperative pain for warts and hemorrhoids, and postoperative complications for pilonidal disease. When the multivariate analysis corresponding to the survey is performed, it does not allow distinguishing between the diagnoses, but when applied to the surgical variables, it clearly shows that there is a distinction between them, with a disadvantage for pilonidal disease. Discussion: The differences in terms of surgical times, complications and re-hospitalizations do not necessarily affect the perception that patients have of the MAS, since it depends on other factors and not only on the surgical results. Conclusion: Results were concordant to what is described in the international literature, with worse results for pilonidal disease. Patient satisfaction was positive in general, without a clear distinction by pathology. We believe that MAS is recommended in proctological pathology both for its results and for the satisfaction it generates in patients.

Acute myocardial infarction: an uncommon complication of takotsubo cardiomyopathy.

Transient left ventricular apical ballooning or Takotsubo syndrome (TS) is characterized by transient left ventricular dysfunction, electrocardiographic changes that mimic acute myocardial infarction (AMI), and minimal release of myocardial enzymes, with no evidence of obstructive coronary artery disease. Although prognosis and outcome are relatively good, reported complications include intraventricular thrombi and embolic events. We report an extremely rare case of AMI complicating the early in-hospital course of a patient with TS.

In vivo virulence of commercial Saccharomyces cerevisiae strains with pathogenicity-associated phenotypical traits.

Two commercial Saccharomyces cerevisiae strains, a baker's strain and the bio-therapeutic agent Ultralevure, have been proposed as a possible exogenous source of human colonization (de Llanos et al., 2004, 2006a). Moreover, these strains express phenotypical traits associated to pathogenicity (de Llanos et al., 2006b). Taking into account that both commercial preparations represent an important source of living S. cerevisiae cells we have performed an in vivo study to evaluate whether there is a potential safety risk to humans. Their virulence was compared with that of other commercial strains with less virulent traits, and with clinical isolates, using two murine models (BALB/c and DBA/2N mice). Burden determination in the brain and kidneys showed that the ability to disseminate, colonize and persist was manifested not only by clinical isolates but also by commercial strains. Among these, the baker's strain and Ultralevure were able to cause the death of BALB/c mice at rates similar to those shown by two of the clinical isolates. These results highlight the pathogenic potential of these strains and show that four-week-old BALB/c mice are an appropriate murine model to study the virulence of yeasts with low or moderate pathogenicity. Furthermore, we have shown the positive effect of an immunosuppressive therapy with cyclophosphamide in the virulence of the baker's strains and Ultralevure but not in the rest of the commercial strains under study. The data suggest that although S. cerevisiae has always been considered a GRAS microorganism, commercial preparations should include only those strains shown to be safe in order to minimize complications in risk groups.

Importance of early adequate exposure to cyclosporine in renal transplant outcome: study of 1-year creatinine.

INTRODUCTION: One-year serum creatinine (SCr) level has been used as a surrogate marker for graft survival in kidney transplantation. We evaluated the importance of different factors on this parameter, emphasizing the importance of adequate exposure to Cyclosporine (CyA). METHODS: Ninety-six consecutive renal transplant recipients who underwent transplantation between 1996 and 2002 were treated with CyA, steroids, and azathioprine. Univariate and multivariate regression analyses were performed for 1-year SCr, acute rejection episodes (ARE), and duration of delayed graft function (DGF). We considered adequate CyA levels within 1 week to be >250 ng/mL trough levels (38%) or 3 hour postdose level (C3) >1100 ng/mL (62%). RESULTS: Mean 1-year SCr was 1.52 +/- 0.5, ARE rate was 27%, and DGF rate was 31%. Overall, 53% of patients achieved adequate exposure to CyA at 1 week (68% on those monitored by C3). Univariate analysis identified female recipient gender, decreasing donor age, absence of ARE, and decreased DGF duration to yield lower 1-year SCr (P < .05). On multivariate analysis for donor age (lower), ARE rate, and duration of DGF (shorter) were the only factors considered to be significant for a lower 1-year SCr level. Multivariate analysis for ARE showed that adequate CyA exposure and lower HLA mismatch decreased ARE, whereas the ability to achieve adequate exposure to CyA and shorter cold ischemia time (CIT) correlated with a reduced incidence of DGF. CONCLUSIONS: One-year SCr level is affected primarily by the incidence of ARE, by donor age, and by duration of DGF. Adequate CyA exposure is related to lower ARE; however, its relation to DGF may be influenced by the reluctance to increase exposure on patients with a nonfunctioning graft.

Benefits of early biopsy on the outcome of kidney transplantation.

INTRODUCTION: Delayed graft function has been associated with worse long-term kidney allograft survival. Adequate diagnosis of the etiology of dysfunction is crucial, often requiring routine early biopsies. The aim of this article was to report the results and safety of early kidney allograft biopsies and how they influenced its management. METHOD: Between September 1994 and July 2004, 134 renal transplant recipients were prescribed cyclosporine (CsA; Neoral, Novartis, Chile), steroids, and a third agent (azathioprine in 92% of the graft recipients). Thirty-four patients (26%) had a kidney biopsy performed within the first week because of allograft dysfunction. RESULTS: The main diagnosis was acute tubular necrosis (ATN) in 22 patients (65%), whereas 6 (18%) were diagnosed with an acute rejection episode (ARE), allowing prompt initiation of therapy with reversal of rejection in 4 of them. Two patients (6%) showed signs of thrombotic microangiopathy (TMA) induced by CsA, which subsided following a switch from CsA to tacrolimus (Prograf Pharmainvesti, Chile). In 2 patients, the biopsy specimen showed signs of CsA nephrotoxicity that reverted following dose reduction. Finally, in 2 patients, the biopsy specimen showed chronic nephropathy of donor origin, which had not been previously recognized, resulting in graft loss. There was only one major complication related to the biopsy, intraperitoneal bleeding that required surgical treatment. CONCLUSIONS: Early allograft biopsy is safe and, in a significant number of cases (30%), it detects important allograft pathology (ARE, TMA, and drug toxicity), which when adequately and promptly treated may rescue the graft.

C2 monitoring of cyclosporine in stable renal transplant patients results in lower costs and improved renal function.

INTRODUCTION: C2 (2-hour post-absorption levels) monitoring of cyclosporine (CsA) seems to reduce the rate of acute rejection episodes (ARE) without increasing nephrotoxicity during the first months after transplant. There are a few reports on the impact of adopting this strategy in patients with stable renal transplants. We herein report a prospective trial in long-term renal transplant patients (>6 months) monitored by C0 or C3 who were switched to C2 monitoring. METHODS: Seventy-six (mean age = 43 +/- 11 years) kidney transplant patients (mean = 37 +/- 21 months after transplant) receiving CsA, steroids, and azathioprine were switched to C2 monitoring, seeking to achieve a target range of 800 +/- 100 ng/mL. The patients were followed for at least 6 months. RESULTS: At conversion the C2 values of 61% of the patients were above and 17% below the therapeutic range. Six months after conversion there was a significant reduction in BUN (29 +/- 11 vs 27 +/- 10, P < .01), Creatinine (Cr), cholesterol, and triglyceride levels were unchanged. Mean CsA dose was decreased 10% from 244 +/- 63 to 220 +/- 52 (P < .01), implying a net savings of 390 US dollars per patient per year. Among the group of patients who showed a high C2 level, there was also a reduction in BUN (30 +/- 12 vs 27 +/- 10, P < .01) and a nonsignificant decrease in Cr (1.53 +/- 0.6 vs 1.50 +/- 0.6). CONCLUSIONS: C2 monitoring in stable kidney transplant recipients is feasible and safe. The strategy results in reduced drug costs and improved renal function.

Estudio comparativo del efecto de la calcitonina, difosfonatos y magnetoterapia en el tratamiento de la osteoporosis postmenopáusica / Comparative study on the effect of calcitonin, diphosphonates and magnetotherapy in the treatment of postmenopausal osteoporosis

Nuestro objetivo ha sido comparar la eficacia de 100 UI/día de calcitonina más un gramo de calcio, con 400 mg de etidronato más un gramo de calcio y 800 UI de vitamina D, y con sesiones de magnetoterapia en el tratamiento de mujeres con osteoporosis postmenopáusica, a lo largo de dos años.Se estudiaron 60 mujeres postmenopáusicas (menopausia mayor de cinco años) que presentaban, bien aplastamiento vertebral (independientemente de la densidad mineral ósea -DMO- que tuviesen) o bien una DMO 0,82 gHA/cm2 sin aplastamiento vertebral. No se admitieron en el estudio las pacientes con aplastamiento vertebral comprendido entre L2 y L4, peso inferior al 20 por ciento por debajo del peso ideal o superior al 50 por ciento, pacientes con tratamiento que interfiera en el metabolismo óseo, así como casos de osteoporosis secundaria. Las participantes sin criterios de exclusión fueron distribuidas a medida que acudieron a consulta (reclutamiento) en tres grupos de tratamiento, constituido cada uno por 20 pacientes. El seguimiento consistió en revisiones cada seis meses, con control clínico y realización de densitometría ósea (columna y fémur), así como analítica con hemograma, bioquímica general y parámetros de remodelado óseo. Cada 12 meses, se practicó un control radiológico, con radiografía de columna dorso-lumbar. En el análisis estadístico se realizó la comparación de variables cuantitativas, utilizando el test estadístico adecuado según el número de grupos que establece una variable cualitativa (t-Student o ANOVA para variables de distribución normal).Al cabo de los dos años de tratamiento, los pacientes que recibieron etidronato más calcio y vitamina D, habían aumentado su masa ósea en un 4,59 por ciento a nivel de columna y en un 2,83 por ciento a nivel de cuello de fémur. Este aumento fue superior al conseguido con los otros dos tratamientos. La diferencia al año de tratamiento fue estadísticamente significativa respecto al grupo de calcitonina más calcio y al de magnetoterapia; aunque a los 24 meses, esa diferencia sólo fue estadísticamente significativa respecto al grupo tratado con calcitonina. Los resultados obtenidos por la magnetoterapia han sido un efecto de mantenimiento de la masa ósea, tanto en columna como en fémur (AU)

Tasas de mortalidad en el Servicio de Medicina Interna de un hospital de segundo nivel del INSALUD en 1999 / Mortality of Internal Medicine Service from hospital category II of INSALUD during 1999

Se analiza la mortalidad Servicio de Medicina Interna y especialidades médicas en el Hospital Morales Meseguer (categoría II del INSALUD de Murcia con 340 camas) durante el año 1999. De los 508 exitus codificados, 312 (61,4 por ciento) estuvieron en las camas del Medicina Interna y especialidades. La tasa de mortalidad de Medicina Interna fue 6,1 por ciento, significativamente mayor a la de Cardiología (0,5 por ciento) (p< =0,001). Los diagnósticos principales más frecuentes fueron la neumonía (n=43;13,5 por ciento), la enfermedad cerebrovascular (n=42; 13,5 por ciento), la enfermedad pulmonar obstructiva crónica (n=31; 9,7 por ciento), la insuficiencia cardíaca (n=21; 6,6 por ciento), el infarto de miocardio (n=11; 3,4 por ciento), el tromboembolismo lmonar (n=9; 2,8 por ciento) y la neoplasia de pulmón (n= 2,8 por ciento). La medición de la mortalidad es aconsejable realizarla de forma periódica para ver la tendencia en el tiempo y valorar las posibles medidas de intervención aplicables (AU)

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Tasas específicas de mortalidad por GRD y diagnóstico principal según la CIE-9-MC en un hospital de II nivel / Mortality rate by DRG and by the principal diagnosis according the ICD-9-CM in a II level Hospital of Insalud of Murcia during 1999

Introducción: La mortalidad hospitalaria es un indicador de la calidad asistencial, se puede evaluar según el diagnóstico principal al alta por éxitus o por los grupos relacionados con el diagnóstico (GRD).Objetivos: Conocer y analizar la mortalidad y tasa de mortalidad (TM) hospitalaria en los ingresados en el Hospital Morales Meseguer (Murcia) de nivel II del INSALUD en el año 1999.Metodología: Estudio del conjunto mínimo básico de datos al alta hospitalaria.Resultados: La TM fue de 3,8 por ciento, de los 508 fallecimientos analizados, el 56,7 por ciento correspondieron a varones. La TM fue similar en varones (3,6 por ciento) y en mujeres (3,9 por ciento). La mediana de edad de los fallecidos era de 77 años. El número de fallecimientos en menores de 80 años era mayor en varones (n=197; 65 por ciento) que en mujeres (n=102; 35 por ciento)(p=0,002). La suma de los éxitus de Medicina Interna y Cuidados Intensivos representa el 70 por ciento de casos ocurridos en el hospital. La TM fue mayor en la Unidad de Cuidados Intensivos (10,5 por ciento) seguido por Hematología (6,9 por ciento) y Medicina Interna (6,1 por ciento). Diez GRDs representa el 50 por ciento de las causas de muertes, todos ellos son de tipo médico. El GRD más frecuente fue el 541, Trastornos respiratorios con complicación (n=61, TM 12,8 por ciento), seguido por el GRD 533, Trastornos cerebrovasculares específicos excepto accidente isquémico transitorio (n=33; TM 34,7 por ciento), GRD123 Infarto agudo de miocardio (IAM) con éxitus (n=31; TM 100 por ciento), GRD 014 Otros trastornos del sistema nervioso (n= 27; TM: 10,3 por ciento) y GRD 552 Trastornos del aparato digestivo excepto esofagitis, gastroenteritis y úlcera no complicada (n=27; TM: 31,0). El diagnóstico principal más frecuente fue la enfermedad cerebrovascular (n=60, TM 12,2 por ciento), neumonía-bronconeumonía (n= 52, TM 10,9 por ciento), enfermedad pulmonar obstructiva crónica (n=36, TM 7,1 por ciento), IAM (n=33, TM 11,5 por ciento), y neoplasia del aparato digestivo (n=26; TM 8,5 por ciento). La TM en las mujeres con IAM (19,5 por ciento) fue superior a la los hombres (7,7 por ciento) (p=0,005), la TM en las mujeres con hernia abdominal (4,3 por ciento) fue superior a la de los hombres (0,6 por ciento) (p=0,01), y La TM de la pielonefritis e infección urinaria en los varones (4,9 por ciento) fue mayor a la de las mujeres (0 por ciento) (p=0,008).Conclusión: La mortalidad y TM por GRD y diagnóstico principal es un indicador que permite conocer y monitorizar la calidad de la asistencia sanitaria (AU)

[Ascariasis: comparison of the therapeutic efficacy between paico and albendazole in children from Huaraz]. / Ascaridiasis: Comparación de la eficacia terapeutica entre paico y albendazol en niños de Huaraz.

A therapeutical clinical trial was designed to study the effectiveness of Paico and Albendazole, for the treatment of ascariasis in a group of 60 children, between 3 and 14 years old, from a rural community in Huaraz. It was carried out between May and August, 2000. The sample was randomly divided into 30 cases for Paico and 30 for Albendazole, the criteria for entering the trial being a positive examination for Ascaris lumbricoides in feces. The treatment consisted in Paico juice: 1 ml/Kg for less than 10 Kg, and 2 ml/Kg in larger children, one dose before breakfast, for three consecutive days. The Albendazole was administered in a single dose of 400 mg in those over five years of age, and 200 mg in younger children. The effectiveness was evaluated qualitatively (the disappearance of the ascaris eggs from the feces) and quantitatively (decrease in the parasitic burden); in the stool examinations carried out in all cases on entering the study and 15 days after the treatment. All the stool samples were processed in the Referential Laboratory of the Regional Health Authority in Ancash. The qualitative effectiveness between Paico and Albendazole for the eradication of ascariasis was similar at 86.7%. The quantitative effectiveness was 59.5% for Paico and 58.3% for Albendazole. However, it was observed that, unlike Albedazole, Paico is 100% effective in the treatment of Hymenolepsis nana. Adverse effects were presented in 23.3% of the cases for both drugs. It is concluded that, although Paico and Albendazole have a similar effectiveness against Ascaris lumbricoides, Paico has the additional benefit of being effective against Hymenolepsis nana.

[Specific mortality rates by DRG and main diagnosis according to CIE-9-MC at a level-II hospital]. / Tasas específicas de mortalidad por GRD y diagnóstico principal según la CIE-9-MC en un hospital de II nivel.

INTRODUCTION: The in hospital mortality is a marker of health care quality. It can be evaluated according by the principal diagnosis of disease or by Diagnosis Related Groups (DRG). OBJECTIVES: Know and to analyze the in hospital mortality and mortality rate (MR) in the patients admitted in the Hospital Morales Meseguer (Murcia) of II level of the INSALUD during 1999. METHODOLOGY: Study of the minimum basic group of data into the hospital. RESULTS: The MR was 3.8% of 508 deaths analyzes, 56.7% corresponded a male. The MR was equal in male (3.6%) and females (3.9%). The medium of age into deaths was 77 years. The numbers of deaths inpatients under 80 years was higher in males (n = 197; 65%) than in lower in female (n = 102; 35%)(p = 0.002). The addition of deaths of Internal Medicine and Intensive Care Unit represent a 70% of cases of deaths occurred in the hospital. The MR was higher in Intensive Care Unit (10.5%) followed by Hematology (6.9%) and Internal Medicine (6.1%). Ten DRG represents of 50% of the causes of deaths, and all of them were DRG of medical categories. The DRG more frequents was 541, Respiratory disorders with complication (n = 61, MR 12.8%), followed by DRG 533. Specific cerebrovascular disorders without Transit isquemic accident (n = 33; MR 34.7%), DRG 123 Acute myocardical infarction (AMI) with death (n = 31; MR 100%), DRG 014 Others disorders of nervous system (n = 27; TM: 10.3%) y DRG 552 Disorders of digestive tract without esophagitis, gastroenteritis and not complicated ulcer (n = 27; MR: 31.0). The main diagnostic more frequent was cerebrovascular diseases (n = 60, MR 12.2%), pneumonia-bronchopneumonia (n = 52, MR 10.9%), chronic obstructive lung disease (n = 36, MR 7.1%), AMI (n = 33, MR 11.5%), and neoplasia of digestive tract (n = 26; MR 8.5%). The MR of woman with AMI (19.5%) was higher than man (7.7%) (p = 0.005), the MR in woman with abdominal hernia (4.3%) was higher than man (0.6%) (p = 0.01), and MR of pyelonephritis and urinary infection in man (4.9%) was higher than woman (0%) (p = 0.008). CONCLUSIONS: The mortality and MR by DRG and main diagnostic is an indicator than permit to know and monitoring the quality of health care.

Los aminoglucósidos en la nueva década: su uso en la clínica práctica / The new decade of aminoglycosides: Their use in clinical practice

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Potential involvement of C(3) complement factor in amphibian fertilization.

We have assessed the potential involvement of C(3), the third complement factor, and its receptor in Bufo arenarum fertilization. We show that a polyclonal antibody against a B. arenarum C(3)-like factor (C(3)Ba) reacts specifically with components of the extracellular matrix (ECM) of coelomic eggs and the cell membrane of uterine eggs. Interestingly, we have identified a 163 kD protein immunoreactive with a monoclonal antibody against the CD11b alpha chain of the human C(3) receptor on the cell membrane of the animal pole of uterine eggs, the site of entry of the sperm, but not in coelomic eggs (CR3Ba). Treatment of coelomic eggs with a pars recta oviductal-like protease, trypsin, induced the translocation of C(3)Ba from the ECM to the cell membrane. Furthermore, inhibition of CR3Ba by trypan blue, as well as inhibition of C(3)Ba by anti-C(3)Ba on uterine eggs impaired fertilization, whereas identical treatment on sperm cells did not alter percentage fertilization. Our results suggest, (A) that changes in the localization of C(3)Ba from the ECM to the cell membrane may be triggered by trypsin-like proteases during passage of eggs through the oviduct; and (B) that C(3)Ba/CR3Ba may be involved in B. arenarum fertilization.

Tratamiento de la enfermedad luxante de la cadera con el arnés de Paulik / Treatment of hip dislocation disease with Pavlik's harness

La luxación congénita de cadera representa uno de los problemas ortopédicos de mayor importancia dada su alta incidencia. Su diagnóstico temprano es esencial, pues el tratamiento precoz es muy efectivo y condiciona el pronóstico. El arnés de Paulik permite un alto porcentaje de corrección con mínimas complicaciones en los primeros seis meses de vida. Nuestro objetivo es evaluar los resultados en nuestro medio del tratamiento con dicho arnés, que a pesar de ser una ortesis de abducción con eficacia demostrada, no tiene un uso muy generalizado en nuestro país. Intentamos establecer un protocolo de actuación factible, que nos permita un buen tratamiento y seguimiento de los pacientes, compatible al mismo tiempo con nuestras posibilidades. Hemos realizado un estudio descriptivo prospectivo de 33 casos, 25 niñas y ocho niños, con 54 caderas afectadas por enfermedad luxante que fueron tratadas con arnés de Paulik. Se obtuvo una tasa de curación del 87,8 por ciento, dos pacientes presentaron complicaciones (6 por ciento) y no hubo ningún caso de necrosis avascular de la cabeza del fémur. Existieron cuatro fracasos de reducción (12,1 por ciento), tres de los cuales necesitaron intervención quirúrgica, con una evolución posterior favorable. El arnés de Paulik puede ser un método satisfactorio para tratar la enfermedad luxante de cadera, entre el nacimiento y los seis meses de edad (AU)

Validation of the Cross-Cultural Alcoholism Screening Test (CCAST).

BACKGROUND: When screening instruments that are used in the assessment and diagnosis of alcoholism of individuals from different ethnicities, some cultural variables based on norms and societal acceptance of drinking behavior can play an important role in determining the outcome. The accepted diagnostic criteria of current market testing are based on Western standards. METHODS: In this study, the Munich Alcoholism Test (31 items) was the base instrument applied to subjects from several Hispanic-American countries (Bolivia, Chile, Ecuador, Mexico, and Peru). After the sample was submitted to several statistical procedures, these 31 items were reduced to a culture-free, 31-item test named the Cross-Cultural Alcohol Screening Test (CCAST). RESULTS: The results of this Hispanic-American sample (n = 2,107) empirically demonstrated that CCAST measures alcoholism with an adequate degree of accuracy when compared to other available cross-cultural tests. CONCLUSIONS: CCAST is useful in the diagnosis of alcoholism in Spanish-speaking immigrants living in countries where English is spoken. CCAST can be used in general hospitals, psychiatric wards, emergency services and police stations. The test can be useful for other professionals, such as psychological consultants, researchers, and those conducting expertise appraisal.