Absorption, Fluorescence, and Two-Photon Excitation Ability of 5-Phenylisolidolo[2,1-a]quinolines.

We report on the absorption, fluorescence, and two-photon excitation spectra of a series of 5-phenylisoindolo[2,1-a]quinoline dyes. Depending on the substituents, we observed increasing two-photon absorption cross sections, with values up to 56 GM@973 nm, which are similar to those of the enhanced green fluorescent protein and fluorescein, common fluorescent chromophores.

Spanish society of laboratory medicine external quality assurance programmes: evolution of the analytical performance of clinical laboratories over 30 years and comparison with other programmes.

The purpose of this study is to understand the evolution of the analytical performance of the laboratories participating in the Spanish society of laboratory medicine (SEQCML) external quality assurance (EQA) programmes during its 30 years of operation and to compare it with the performance of other EQA programmes to establish whether the results are similar. The results obtained during this period are evaluated by applying the biological variability (BV) and state of the art-derived quality specifications. In addition, the results are compared with those obtained by other EQA programme organisations. It is noted that the laboratories participating in the EQA-SEQCML programmes have improved their performance over 30 years of experience and that the specifications derived from biological variation are achievable. It is difficult to compare EQA programmes, due to lack of accessibility and the differences in the design of these programmes (control materials, calculations used and analytical specifications established). The data from this study show that for some biological magnitudes the results obtained by the programmes are not yet harmonised, although efforts are being made to achieve this. Organisers of EQA programmes should also join the harmonisation effort by providing information on their results to enable comparison.

State-of-the-art Approach to Goal Setting.

Four external quality assurance programs combined their data to calculate the minimum acceptable quality specifications for laboratory testing. Other sources of quality specifications may be too stringent for the current market, or too lenient given the clinical demands on the test result, but these state-of-the-art goals may be practical and useful. Two main approaches were used: (1) defining the 95% percentile and comparing with other quality specifications, and (2) using an iterative approach to increase the quality specification until 90% of laboratories could achieve 75% of their results within the specification. 72 out of 82 analytes followed procedure 2.

Biologically aggressive regions within glioblastoma identified by spin-lock contrast T1 relaxation in the rotating frame (T1ρ) MRI.

Spin-lattice relaxation in the rotating frame magnetic resonance imaging allows for the quantitative assessment of spin-lock contrast within tissues. We describe the utility of spin-lattice relaxation in the rotating frame metrics in characterizing glioblastoma biological heterogeneity. A 84-year-old man presented to our institution with a right frontal temporal mass. Prior tissue sampling from a peripheral nonenhancing lesion was nondiagnostic. Stereotactic image-guided tissue sampling of the nonenhancing T2-fluid-attenuated inversion recovery hyperintense region involving the anterior cingulate gyrus with elevated spin-lattice relaxation in the rotating frame metrics provided a pathologic diagnosis of glioblastoma. This case illustrates the utility of spin-lattice relaxation in the rotating frame magnetic resonance imaging in identifying biologically aggressive regions within glioblastoma.

Respuesta de los autores «Ventajas del control de calidad interno de gestión externa» / Reply for author «Advantages of externally managed internal quality control»

No disponible

Metastasis in Adult Brain Tumors.

Metastatic cancer to the central nervous system is primarily deposited by hematogenous spread in various anatomically distinct regions: calvarial, pachymeningeal, leptomeningeal, and brain parenchyma. A patient's overall clinical status and the information needed to make treatment decisions are the primary considerations in initial imaging modality selection. Contrast-enhanced MR imaging is the preferred imaging modality. Morphologic MR imaging is limited to delineating anatomic deraignment of tissues. Dynamic susceptibility contrast-enhanced perfusion and diffusion-weighted physiology-based MR imaging sequences have been developed that complement morphologic MR imaging by providing additional diagnostic information.

Control interno de la calidad vs control externo de la calidad / Internal quality control vs external quality control

El control interno de la calidad es el procedimiento que monitoriza la calidad de los resultados y permite aceptar o rechazar las series analíticas. Existen 2 variedades, el modelo de gestión interna, donde el tratamiento estadístico de los resultados control se realiza únicamente con los datos obtenidos por el propio laboratorio, y el control interno con gestión externa, donde el procesamiento estadístico se realiza con los datos obtenidos por el propio laboratorio y por otros laboratorios. Ambos sirven para calcular la imprecisión analítica y no son adecuados para evaluar el error total ni el sesgo. El control externo de la calidad es la determinación del desempeño de cada laboratorio mediante la comparación con otros laboratorios. Existen 3 modelos, los 2 primeros: evaluación externa de la calidad y ensayo de aptitud son muy similares, y se centran en las prestaciones analíticas, mientras que el tercero, denominado garantía externa de la calidad, tiene en cuenta todas las fases del laboratorio. Con el control externo de la calidad, en cualquiera de sus modelos, se mide el error total de cada mensurando, porque la muestra de control, que es ciega para el participante, se analiza una única vez. A largo plazo, cuando se dispone de todos los resultados del programa, se puede medir el error sistemático o sesgo. A la luz de los requisitos legales vigentes, las buenas prácticas del laboratorio y los artículos de referencia internacionales, el control interno de la calidad no es ni sustituye al control de la calidad externo (AU)

Internal quality control is the procedure used for monitoring the analytical process and to accept or reject the analytical run. There are two models: internal quality control that exclusively uses the control results from the own laboratory, and internal control externally managed, that also uses control data from other laboratories reported to an external organization. Both of them measure the analytical imprecision but are not adequate to estimate neither bias nor inaccuracy (total error). External quality control evaluates the laboratory performance by comparing with other laboratories, through an external organization. There are three models, external quality assessment and proficiency testing which are almost the same and are focused on the analytical process and external quality assurance that applies to all laboratory processes. The three models of external control measure total error, because the control sample (blind for the laboratory) is tested in singleton. At long-term, when all results for one cycle are available, laboratory bias may also been calculated. From the light of legal requirements, good laboraotry practices and papers from widely accepted authors, internal quality control is not and do not substitute external quality control (AU)

PASMet: a web-based platform for prediction, modelling and analyses of metabolic systems.

PASMet (Prediction, Analysis and Simulation of Metabolic networks) is a web-based platform for proposing and verifying mathematical models to understand the dynamics of metabolism. The advantages of PASMet include user-friendliness and accessibility, which enable biologists and biochemists to easily perform mathematical modelling. PASMet offers a series of user-functions to handle the time-series data of metabolite concentrations. The functions are organised into four steps: (i) Prediction of a probable metabolic pathway and its regulation; (ii) Construction of mathematical models; (iii) Simulation of metabolic behaviours; and (iv) Analysis of metabolic system characteristics. Each function contains various statistical and mathematical methods that can be used independently. Users who may not have enough knowledge of computing or programming can easily and quickly analyse their local data without software downloads, updates or installations. Users only need to upload their files in comma-separated values (CSV) format or enter their model equations directly into the website. Once the time-series data or mathematical equations are uploaded, PASMet automatically performs computation on server-side. Then, users can interactively view their results and directly download them to their local computers. PASMet is freely available with no login requirement at http://pasmet.riken.jp/ from major web browsers on Windows, Mac and Linux operating systems.

Metastatic Diffuse Intrinsic Pontine Glioma to the Peritoneal Cavity Via Ventriculoperitoneal Shunt: Case Report and Literature Review.

Extraneural metastatic disease resulting from a primary central nervous system neoplasm is a rare clinical finding in the pediatric population. We report a case of peritoneal glioblastoma carcinomatosis following placement of a ventriculoperitoneal shunt and chemoradiotherapy in a 6-year-old female patient who initially presented with diffuse intrinsic pontine glioma. This case demonstrates the importance of evaluation of extraspinal structures when imaging for extension of disease. Additionally, this report highlights the cross-sectional imaging characteristics of glioblastoma peritoneal carcinomatosis and presents additional information that will facilitate the timely diagnosis of extraneural metastases of primary high-grade glial neoplasms in the pediatric population.

Grado de implantación de especificaciones de la calidad analítica en España / Level of implementation of analytical quality specifications in Spain

Objetivos: Este trabajo pretende conocer el grado de implantación de las especificaciones de la calidad en los laboratorios clínicos de España y concretamente de las especificaciones mínimas de la calidad analítica consensuadas por el Comité de Expertos Interdisciplinar sobre Especificaciones de la Calidad (CEIEC) en el Laboratorio Clínico, así como la opinión del sector respecto a la necesidad del establecimiento de valores preceptivos de requisitos de la calidad analítica: Material y método: Se diseñó una encuesta que constaba de 22 preguntas, 4 de ellas de tipo descriptivo, 16 retrospectivas y 2 prospectivas. El periodo de recogida de respuestas fue de septiembre a noviembre de 2012. Como requisito de los encuestados solo se consideró que participasen en algún programa de intercomparación de las sociedades científicas españolas representadas en el citado comité. El número de encuestas remitidas fue de 1.738. Resultados: Se recibieron 340 respuestas (19,6% del total). El 59% de los que respondieron tiene implantado un sistema de reconocimiento formal de la calidad. El 83% comprueba si cumplen o no con las especificaciones, el 68% dispone de un compromiso documental de cumplirlas y el 64% ha elaborado el listado con los valores concretos de especificaciones. El 55% conoce la existencia de unas especificaciones mínimas de la calidad consensuadas por el CEIEC. El 49% estaría de acuerdo en que estas especificaciones fueran preceptivas, mientras que el 33% no se define (AU)

Objectives: This work aims to determine the level of implementation of analytical quality specifications in Spanish clinical laboratories and, in particular, the minimum analytical quality specifications obtained by consensus of the Interdisciplinary Expert Committee on Quality Specifications (CEIEC) in the Clinical Laboratory, as well as to determine the opinions of the professionals as regards establishing mandatory analytical quality specifications.. Material and method: A questionnaire was designed including 4 descriptive, 16 retrospective, and 2 prospective questions. The responses were collected during September to November 2012. The requirement for participating was to be involved in an intercomparison program of any of the 4 Spanish scientific societies represented on the abovementioned committee. A total of 1,738 questionnaires were sent. Results: A total of 340 responses (19.6% over the total) were received. The results showed that 59% of respondents have a formally recognized quality system. The attainment of predefined specifications was checked by 83%, with 68% having a commitment for documented quality specifications, and 64% had made a list with specification values. A majority (55%) is aware of the existence of the consensus minimum quality specifications of the CEIEC, and 49% would agree that these specifications should become mandatory, while 33% did not declare a clear position on this subject (AU)

Benefits of dynamic susceptibility-weighted contrast-enhanced perfusion MRI for glioma diagnosis and therapy.

Glioma are the most common supra-tentorial brain tumor in the USA with an estimated annual incidence of 17,000 new cases per year. Dynamic susceptibility-weighted contrast-enhanced (DSC) perfusion MRI noninvasively characterizes tumor biology allowing for the diagnosis and therapeutic monitoring of glioma. This MRI technique utilizes the rapid changes in signal intensity caused by a rapid intravascular bolus of paramagnetic contrast agent to calculate physiologic perfusion metrics. DSC perfusion MRI has increasingly become an integrated part of glioma imaging. The specific aim of this article is to review the benefits of DSC perfusion MRI in the therapy of glioma.

Metabolomic Characterization of Knockout Mutants in Arabidopsis: Development of a Metabolite Profiling Database for Knockout Mutants in Arabidopsis.

Despite recent intensive research efforts in functional genomics, the functions of only a limited number of Arabidopsis (Arabidopsis thaliana) genes have been determined experimentally, and improving gene annotation remains a major challenge in plant science. As metabolite profiling can characterize the metabolomic phenotype of a genetic perturbation in the plant metabolism, it provides clues to the function(s) of genes of interest. We chose 50 Arabidopsis mutants, including a set of characterized and uncharacterized mutants, that resemble wild-type plants. We performed metabolite profiling of the plants using gas chromatography-mass spectrometry. To make the data set available as an efficient public functional genomics tool for hypothesis generation, we developed the Metabolite Profiling Database for Knock-Out Mutants in Arabidopsis (MeKO). It allows the evaluation of whether a mutation affects metabolism during normal plant growth and contains images of mutants, data on differences in metabolite accumulation, and interactive analysis tools. Nonprocessed data, including chromatograms, mass spectra, and experimental metadata, follow the guidelines set by the Metabolomics Standards Initiative and are freely downloadable. Proof-of-concept analysis suggests that MeKO is highly useful for the generation of hypotheses for genes of interest and for improving gene annotation. MeKO is publicly available at http://prime.psc.riken.jp/meko/.

Actualización de las especificaciones de la calidad analítica 2014. Consenso de las Sociedades Científicas nacionales / Updates of analytical quality specifications 2014. Consensus of national scientific societies

El objetivo de este estudio es calcular las especificaciones mínimas de la calidad (EMC) en bioquímica de orina, hemoglobina glucosilada en sangre y diversas determinaciones hematológicas, comparar estas especificaciones con las publicadas por organizaciones de diversos países y actualizar el listado con las 80 magnitudes estudiadas. Los materiales empleados en este estudio son todos los resultados de las EMC incluidas en los programas de garantía externa de la calidad organizadas por 4 sociedades científicas españolas, obtenidos desde 2007 hasta 2010. El número total de resultados obtenidos para hemoglobina glucosilada es de 13.054, para orina según cada magnitud va desde 14.180 (albúmina) hasta 20.594 (creatinina), y en hematología desde 1.839 (hemoglobina fetal) a 6.961 (antitrombina). Se concluye que cumplir la EMC de hemoglobina glucosilada no es suficiente para asegurar la calidad analítica según criterios clínicos, mientras que sí lo garantizan las EMC de orina; las magnitudes de hematología estudiadas en esta fase no pudieron compararse con especificaciones de obligado cumplimiento en otros países (no se encuentran publicadas), y algunas de ellas podrían requerir el cálculo de especificaciones diferentes para distintos niveles de concentración (AU)

The aim of this study is to calculate minimum quality specifications (MQS) in urine biochemistry, blood glycosylated hemoglobin and several hematological analytes, and to compare these specifications with those from other countries, as well as to update the values for the 80 analytes studied. Materials used in this work are the results from laboratories participating in the external quality assurance programs organized by four Spanish scientific societies, and obtained in the time period 2007-2010. A total of 13,054 results were obtained for glycosy-lated hemoglobin, and from 14,180 (albumin) to 20,594 (creatinine) for urine biochemistry, andfor hematology, from 1,839 (fetal hemoglobin) to 6,961 (antithrombin).The conclusions found were: to achieve the MQS for glycosylated hemoglobin does not ensure meeting clinical requirements, whereas MQS for urine biochemistry also meet the requirements based on biological variation. The MQS studied in this work could not be compared witht hose from other countries (there are no published values), and some of them could require calculations stratified according to several concentration levels (AU)

Aplicación práctica de las especificaciones mínimas de la calidad analítica obtenidas por consenso / Application of the minimum specifications for analytical quality obtained by consensus

Cuatro sociedades científicas españolas, organizadoras de programas de garantía externa de la calidad en el ámbito del laboratorio clínico, crearon un grupo de trabajo para definir y divulgar especificaciones mínimas de la calidad analítica obtenidas por consenso (EMC) elaboradas con base en los resultados de sus programas de garantía externa de la calidad durante el período 2005-2010. Se definieron EMC para 60 magnitudes. En este trabajo se dan unas directrices sobre cómo utilizar estas especificaciones en la práctica diaria del laboratorio clínico. Se concluye que ante un resultado de un programa de evaluación externa con un error total superior a la EMC el laboratorio realizará un análisis de causas y establecerá las acciones correctivas oportunas para evitar que esta circunstancia vuelva a ocurrir. El cumplimiento de las EMC es un requisito necesario pero no suficiente en el sistema de la calidad del laboratorio. Debido a su condición de mínimas no deberían utilizarse como un objetivo de la calidad (AU)

A working group was created to define and explain the minimum specifications for analytical quality obtained by consensus (MSC) by the four Spanish scientific societies that organise external quality assurance programs in laboratory medicine. The basis of these MSC were results obtained in the external programs of the 2005-2010 period, and were defined for 60 analytes. This paper gives guidelines on how the individual laboratory should use these specifications in its daily routine. It is concluded that laboratories should perform a cause analysis study and take the appropriate corrective action when a single result in an external program falls outside the MSC for an analyte. Fulfilling MSC is a necessary -but not sufficient- requirement in the laboratory quality system, but due to its condition of ‘minimum quality’ they should not be used as quality goals (AU)

Imaging diagnosis of brain metastasis.

Hematogeneous spread of primary neoplasm can result in central nervous system (CNS) disease burden in various anatomically distinct regions; calvarial, pachymeningeal, leptomeningeal, and intraparenchymal. The choice of imaging modality is dependent on the individual clinical situation, but, largely depends on the patients overall clinical status and the information needed to make treatment decisions. Contrast-enhanced magnetic resonance (MR) imaging is the preferred imaging modality of choice; however, computed tomography (CT) is often utilized as the first-pass screening modality for CNS disease. Despite the superior soft tissue resolution, multiplanar capability, and noninvasive nature of MR imaging, T(1)- and T(2)-weighted sequences are limited to delineating morphologic anatomical deraignment of tissues by tumor. Several physiology based MR imaging sequences have been developed which compliment anatomic MR imaging. Proton magnetic resonance spectroscopic and dynamic susceptibility contrast-enhanced perfusion-weighted imaging are two physiologic sequences which add additional diagnostic information allowing for improved tumor characterization. Common pitfalls in evaluating for metastatic disease burden include the misidentification of non-neoplastic hematomas, remote microvascular ischemia, and acute onset of ischemic stroke. In the pediatric population, CNS metastases are rare; however, the onset of acute neurological symptoms in a child with known primary tumor should prompt imaging of the neuroaxis.

Minimum analytical quality specifications of inter-laboratory comparisons: agreement among Spanish EQAP organizers.

BACKGROUND: Four Spanish scientific societies organizing external quality assessment programs (EQAP) formed a working group to promote the use of common minimum quality specifications for clinical tests. Laboratories that do not meet the minimum specifications are encouraged to make immediate review of the analytical procedure affected and to implement corrective actions if necessary. METHODS: The philosophy was to use the 95th percentile of results sent to EQAP (expressed in terms of percentage deviation from the target value) obtained for all results (except the outliers) during a cycle of 1 year. The target value for a number of analytes of the basic biochemistry program was established as the overall mean. However, because of the substantial discrepancies between routine methods for basic hematology, hormones, proteins, therapeutic drugs and tumor markers, the target in these cases was the peer group mean. RESULTS: The resulting specifications were quite similar to those established in the US (CLIA), and Germany (Richtlinie). CONCLUSIONS: The proposed specifications stand for the minimum level of quality to be attained for laboratories, to assure harmonized service performance. They have nothing to do with satisfying clinical requirements, which are the final level of quality to be reached, and that is strongly recommended in our organizations by means of documents, courses, symposiums and all types of educational activities.

Anaphylaxis in Latin America: a report of the online Latin American survey on anaphylaxis (OLASA).

OBJECTIVES: The aims of the Online Latin American Survey of Anaphylaxis (OLASA) were to identify the main clinical manifestations, triggers, and treatments of severe allergic reactions in patients who were seen by allergists from July 2008 to June 2010 in 15 Latin American countries and Portugal (n =634). RESULTS: Of all patients, 68.5% were older than 18 years, 41.6% were male, and 65.4% experienced the allergic reaction at home. The etiologic agent was identified in 87.4% of cases and predominantly consisted of drugs (31.2%), foods (23.3%), and insect stings (14.9%). The main symptom categories observed during the acute episodes were cutaneous (94.0%) and respiratory (79.0%). The majority of patients (71.6%) were treated initially by a physician (office/emergency room) within the first hour after the reaction occurred (60.2%), and 43.5% recovered in the first hour after treatment. Most patients were treated in an emergency setting, but only 37.3% received parenteral epinephrine alone or associated with other medication. However, 80.5% and 70.2% were treated with corticosteroids or antihistamines (alone or in association), respectively. A total of 12.9% of the patients underwent reanimation maneuvers, and 15.2% were hospitalized. Only 5.8% of the patients returned to the emergency room after discharge, with 21.7% returning in the first 6 hours after initial treatment. CONCLUSION: The main clinical manifestations of severe allergic reactions were cutaneous. The etiologic agents that were identified as causing these acute episodes differed according to age group. Following in order: drugs (31.2%), foods (23.3% and insect stings (14.9%) in adults with foods predominance in children. Treatment provided for acute anaphylactic reactions was not appropriate. It is necessary to improve educational programs in order to enhance the knowledge on this potentially fatal emergency.

Empleo de la oxigenoterapia hiperbárica en Urología / Hypebaric oxygen treatment in urology

OBJETIVO: La oxigenoterapia hiperbárica (OHB) se ha empleado de forma existosa en numerosas patologías que derivan de la hipoxia tisular gracias al aporte extra de oxígeno que permite a los tejidos.En este trabajo se realiza una revisión exhaustiva acerca de toda la literatura existente en 2010 en la que se emplea OHB en patología urológica.MÉTODOS: Realizamos una búsqueda en Medline introduciendo los términos “hyperbaric oxygen”, “radic cistitis”, “interstitial cistitys”, “ hemorraghic cistitys”, “urological/pelvic fistula” y “Fournier´s gangrene”.Las búsquedas se centraron en estudios en humanos únicamente publicados en cualquier idioma.RESULTADOS: 56 trabajos publicados, 1 ensayo clínico controlado aleatorizado (ECA), 7 revisiones (review) y 48 series de casos (SC) de los que tan solo uno fué prospectivo en los que se exponen a un total de 695 pacientes. Sólo en un estudio se emplearon mediciones de oxígeno tisular para definir la hipoxia. El número de las sesiones de terapia de oxígeno hiperbárico varió desde 4 hasta 44 sesiones. (media 19,2 sesiones/paciente)CONCLUSIONES: La evidencia que se extrae de la mayoría de trabajos consultados procede de series de casos, de modo que es baja, sin embrago, en la mayoría de estudios los resultados en cuanto al manejo de los pacientes es bueno o muy bueno así que parece que la OHB puede ser de gran utilidad en enfermedades urológicas que deriven de hipoxia tisular(AU)

OBJECTIVES: Hyperbaric oxygen therapy (HBO) has been successfully used in several disorders derived from tissue hypoxia, due to the extra oxygen supply to the tissues it enables.In this manuscript we performed a systematic review including all the existing data published until 2010 about HBO in urologic disorders.METHODS: We performed a Medline search using the terms “hyperbaric oxygen”, “radical cystitis”, “interstitial cystitis”, “hemorrhagic cystitis”, “urological/pelvic fistula” and “Fournier´s gangrene”. The search was restricted to human clinical trials published in any language. RESULTS: We found 56 papers: 1 randomized controlled trial, 7 reviews and 48 case reports; only one of them was a prospective study. A total of 695 patients were included. Just one study used tissue oxygen measurement to define hypoxia. The number of hyperbaric oxygen therapy sessions ranged from 4 to 44 (mean 19.2 sessions/patient).CONCLUSIONS: The level of evidence from most reviewed papers is low because most of them are case series. Nevertheless, results of most of those studies regarding patient management are good or very good. So it seems that HBO can be very useful in urological diseases related to tissue hypoxia(AU)

Hypebaric oxygen treatment in urology.

OBJECTIVES: Hyperbaric oxygen therapy (HBO) has been successfully used in several disorders derived from tissue hypoxia, due to the extra oxygen supply to the tissues it enables. In this manuscript we performed a systematic review including all the existing data published until 2010 about HBO in urologic disorders. METHODS: We performed a Medline search using the terms "hyperbaric oxygen", "radical cystitis", "interstitial cystitis", "hemorrhagic cystitis", "urological/pelvic fistula"and "Fournier's gangrene". The search was restricted to human clinical trials published in any language. RESULTS: We found 56 papers: 1 randomized controlled trial, 7 reviews and 48 case reports; only one of them was a prospective study. A total of 695 patients were included. Just one study used tissue oxygen measurement to define hypoxia. The number of hyperbaric oxygen therapy sessions ranged from 4 to 44 (mean 19.2 sessions/patient). CONCLUSIONS: The level of evidence from most reviewed papers is low because most of them are case series. Nevertheless, results of most of those studies regarding patient management are good or very good. So it seems that HBO can be very useful in urological diseases related to tissue hypoxia.

Anaphylaxis in Latin America: a report of the online Latin American survey on anaphylaxis (OLASA)

OBJECTIVES: The aims of the Online Latin American Survey of Anaphylaxis (OLASA) were to identify the main clinical manifestations, triggers, and treatments of severe allergic reactions in patients who were seen by allergists from July 2008 to June 2010 in 15 Latin American countries and Portugal (n =634). RESULTS: Of all patients, 68.5 percent were older than 18 years, 41.6 percent were male, and 65.4 percent experienced the allergic reaction at home. The etiologic agent was identified in 87.4 percent of cases and predominantly consisted of drugs (31.2 percent), foods (23.3 percent), and insect stings (14.9 percent). The main symptom categories observed during the acute episodes were cutaneous (94.0 percent) and respiratory (79.0 percent). The majority of patients (71.6 percent) were treated initially by a physician (office/emergency room) within the first hour after the reaction occurred (60.2 percent), and 43.5 percent recovered in the first hour after treatment. Most patients were treated in an emergency setting, but only 37.3 percent received parenteral epinephrine alone or associated with other medication. However, 80.5 percent and 70.2 percent were treated with corticosteroids or antihistamines (alone or in association), respectively. A total of 12.9 percent of the patients underwent reanimation maneuvers, and 15.2 percent were hospitalized. Only 5.8 percent of the patients returned to the emergency room after discharge, with 21.7 percent returning in the first 6 hours after initial treatment. CONCLUSION: The main clinical manifestations of severe allergic reactions were cutaneous. The etiologic agents that were identified as causing these acute episodes differed according to age group. Following in order: drugs (31.2 percent), foods (23.3 percent and insect stings (14.9 percent) in adults with foods predominance in children. Treatment provided for acute anaphylactic reactions was not appropriate. It is necessary to improve educational programs in order to enhance the knowledge on this potentially fatal emergency.