Relevancia epidemiológica y clínica de la técnica elisa para SARS-COV-2 en Tegucigalpa y Comayaguela, Honduras / Epidemiological and clinical relevance of the ELISA Technique for SARS-COV-2 in Tegucigalpa and Comayagüela, Honduras

El virus SARS-CoV-2, es responsable de la enfermedad COVID-19; para su detección indirecta se utilizan inmunoensayos que cuantifican anticuerpos séricos contra algunas de sus proteínas. Objetivo: documentar resultados de la técnica ELISA, para la identificación cualitativa de anticuerpos contra SARS-CoV-2 en sujetos de Tegucigalpa y Comayagüela y la determinación de relevancia epidemiológica y clínica que presenta esta prueba. Material y Métodos: estudio correlacional transversal de 596 sujetos, a quienes se les practicó ELISA para la determinación de anticuerpos contra el SARS-CoV-2. Se recolectó datos epidemiológicos y clínicos del 13 de mayo al 31 de agosto 2020. Resultados: se analizó datos de 492 sujetos, 271 mujeres y 221 hombres, 313 de Tegucigalpa y 179 de Comayagüela. La edad media fue de 42.1 años; 253 tuvieron nexo epidemiológico negativo y 239 fueron positivos, se identificaron 88 profesiones, con base en la clasificación del Departamento de Trabajo de Estados Unidos y se categorizaron en grupos de riesgo bajo, medio y alto. Se encontraron 12 síntomas clínicos y 2 enfermedades concomitantes. De acuerdo al resultado de la prueba ELISA, los resultados se estructuraron en cuatro grupos: IgM e IgG negativos, IgM positivos, IgM e IgG positivos e IgG positivos, los que se asociaron con las variables epidemiológicas y clínicas. Los habitantes de Comayagüela presentaron mayor número de casos de ELISA positiva en comparación con los de Tegucigalpa. 1Facultad de Ciencias Médicas, UNAH. 2 Laboratorios Molina, Tegucigalpa, Honduras. 3 Western International School, San Pedro Sula. 4 Grupo de Investigación Historia. 5 Dirección General de Documentos Normativos, SESAL. 6 Grupo de Investigación Historia. 7 Departamento de Ciencias Fisiológicas, UNAH. Autor corresponsal: Mayra Gabriela Handal Lorenzana. mayr_gt@hotmail.com Recibido: 15/04/2021 Aceptado: 28/06/2021 Conclusiones: no hubo difer encia entr e edad (p=0.528) y sexo (p=0.245) en cuanto a los resultados del ELISA. Un tercio de los sujetos a los que se detectó algún anticuerpo no refirieron nexo epidemiológico. Las profesiones u ocupaciones más afectadas fueron las de riesgo medio y los síntomas identificados más frecuentes fueron fiebre, cefalea y odinofagia.

Clinical spectrum of BICD2 mutations.

BACKGROUND AND PURPOSE: Mutations in the BICD2 gene cause autosomal dominant lower extremity-predominant spinal muscular atrophy 2A (SMALED2A), a condition that is associated with a specific pattern of thigh and calf muscle involvement when studied by magnetic resonance imaging (MRI). Patients may present minor clinical sensory impairment, but objective sensory involvement has yet to be demonstrated. METHODS: We collected clinical data from 11 patients from five different families carrying mutations in BICD2. Genetic diagnosis was achieved using gene panel testing and skin biopsies were taken from two patients to study the epidermal nerve fiber density. RESULTS: In the studied patients, three new pathogenic mutations were detected as well as the already defined pathogenic p.Ser107Leu mutation. The most frequent clinical picture was characterized by lower-limb weakness in combination with foot deformities. One patient manifested clinical and electrophysiological sensory impairment, and the epidermal nerve fiber density study of another patient revealed the existence of a small-fiber neuropathy. Muscle MRI showed a common pattern of fat deposition including selective involvement of gluteus medius and minimus at the pelvic level, the anterior compartment of the thigh and the posterior compartment of the calf, with only mild or no involvement of the intrinsic foot muscles. CONCLUSIONS: We report three new pathogenic mutations in the BICD2 gene. Muscle MRI confirms the existence of a selective pattern of thigh and leg muscle involvement in SMALED2A, providing additional information regarding pelvic and foot muscles. Moreover, our results raise the possibility of sensory involvement in the disease.

Factors associated with infection of primary total knee prosthesis in older adults in a referral hospital in Peru. 2012-2015. / Factores asociados a infección de prótesis total de rodilla primaria en adultos mayores en un hospital de referencia en Perú. 2012-2015.

OBJECTIVE: To determine the risk factors associated with prosthetic knee infection in elderly patients in a referral hospital in Peru. PATIENTS AND METHODS: A case and control study was performed. The calculated sample was 44 cases and 132 controls. The data were collected retrospectively from clinical records. U-Mann Whitney and Chi-square tests were performed in the comparison of cases and controls. Odds ratios (OR) were calculated in a binary logistic regression analysis to identify the risk factors, a P<.05 and a 95% confidence interval (CI) were considered significant. RESULTS: Significant (P<.05) risk factors evidenced in the bivariate analysis were obesity (OR=9.72; 95%CI: 4.47-21.14), smoking (OR=4.06; 95%CI: 1.59-10.39), rheumatoid arthritis (OR=4.66; 95%CI: 1.52-14.32), diabetes mellitus type2 (OR=5.63; 95%CI: 2.69-11.78), persistent drainage (OR=9.27; 95%CI: 3.85-22.31), superficial infection (OR=6.87; 95%CI: 3.25-14.49) and prolonged hospital stay (OR=4.67; 95%CI: 2.26-9.64). In the multivariate analysis where it was adjusted for confounding variables, it was determined that risk factors were obesity (ORa=9.14; 95%CI: 3.28-25.48), diabetes mellitus (ORa=3.77; 95%CI: 1.38-10.32), persistent drainage (ORa=4.64; 95%CI: 1.03-20.80) and superficial wound infection (ORa=27.35; 95%CI: 2.57-290.64). CONCLUSIONS: Risk factors for prosthetic knee infection identified in this study are preventable. The main risk factors were obesity, diabetes mellitus type2, superficial wound infection and persistent drainage, which were considered together or separately to be risk factors in the population studied.

Indicaciones, eficacia y complicaciones en el uso de productos sanguíneos, Hospital General San felipe, Honduras / Indications, efficacy and complications of blood products, Hospital General San Felipe, Honduras

Los hemoderivados son productos valiosos cuya utilización puede salvar vidas, pero pueden dañar aquien los recibe. El país no dispone de información publicada sobre la utilización de productossanguíneos a nivel hospitalario, sus indicaciones, eficacia y complicaciones. Objetivo: Determinar las indicaciones, eficacia y complicaciones en el usode productos sanguíneos en el Hospital General San Felipe. Material y Métodos: se realizó un estudio descriptivo de tipo transversal en 166 pacientes mayores de 18 años, hospitalizados, que precisaban productos sanguíneos en el periodo comprendido entre el 18 de marzo 2013 al 4 de marzo 2014. Parala recolección de datos se utilizó un cuestionario con preguntas abierta y cerradas; la información para el análisis se extrajo de las boletas de requisiciónde productos sanguíneos recibidas en el Banco de Sangre, del expediente clínico y del instrumento de trabajo. Los pacientes fueron evaluados antes,durante y después de la transfusión. Resultados: 166 pacientes fueron transfundidos, 107(64.5%) mujeres y 59(35.5%) hombres. 138(83.1%) pacientes adolecían alguna enfermedad neoplásica. De 174 transfusionesrealizadas, los productos indicados fueron 154(88.5%) glóbulos rojos empacados, 8(4.8%) plaquetas y 6(3.4%) plasma. 104(62.6%) de los 166 pacientes transfundidos refirieron mejoría subjetiva, 26(15.7%)mejoraron su rendimiento físico, medido por la escala del Eastern Collaborative Oncology Group. Se encontró diversas complicaciones clínicas en 87(57.6%) de pacientes transfundidos con glóbulosrojos empacados. Conclusión: Más del 60% de los pacientes transfundidos experimentaron una sensación de bienestar, sin embargo la frecuencia decomplicaciones es considerable...(AU)

Efectividad y seguridad de los esquemas de tratamiento corto y largo para meningoencefalitis tuberculosa en dos hospitales de Lima-Perú / Effectiveness and safety of the schedules of short and long term treatment for tuberculous meningoencephalitis at two hospitals of Lima — Peru

Introducción: Comparar la efectividad y seguridad de los esquemas corto de 6 meses y largo de 12 meses en el tratamiento de la meningoencefalitis tuberculosa de pacientes VIH negativos de dos hospitales de Lima-Perú. Métodos:Estudio comparativo, retrospectivo y observacional. Los pacientes recibieron uno de los siguientes esquemas de tratamiento: grupo 1, curso largo de 12 meses de tratamiento con isoniazida, rifampicina, pirazinamida y etambutol los primeros 2 meses; luego isoniazida y rifampicina durante 10 meses. Grupo 2, curso corto de 6 meses con isoniazida, rifampicina, pirazinamida y etambutol los primeros 2 meses; luego isoniazida y rifampicina durante 4 meses. Se revisó las historias clínicas y se evaluó en ambos grupos la efectividad, recaídas, fracaso terapéutico, reacciones adversas a fármacos antituberculosos, mortalidad y secuelas luego de concluir tratamiento. Resultados: Se presentaron 26 pacientes con meningoencefalitis grado I, de los cuales 10 recibieron el esquema de tratamiento largo y 16 el esquema corto; 51 con meningoencefalitis grado II, 27 recibieron el esquema largo y 24 el esquema corto; y 31 con meningoencefalitis grado III, recibiendo 18 el esquema largo y 13 el esquema corto. Al evaluarse la efectividad de los esquemas corto y largo no se encontró diferencia estadísticamente significativa en los grados I, II y III; tampoco existió diferencia estadísticamente significativa en la frecuencia de recaídas, fracaso terapéutico, reacciones adversas a fármacos antituberculosos, en la mortalidad y secuelas. Conclusiones: Los esquemas largo de 12 meses y corto de 6 meses tendrían similar efectividad y seguridad en el tratamiento de la meningoencefalitis tuberculosa de pacientes VIH negativos (AU)

Introduction: To compare the effectiveness and safety of short term 6 month-treatment andlong term 12 month-treatment schedules for meningoencephalitis due to tuberculosis in twohospitals from Lima-Peru.Methods: Comparative, retrospective and observational study. The patients were divided intwo groups: Group 1: long term 12 month-treatment with isoniazid, rifampin, pyrazinamide,and ethambutol for the first 2 months; then isoniazid and rifampin for 10 months. Group 2:short term 6 month-treatment with isoniazid and rifampin, pyrazinamide and ethambutol forthe first 2 months; then isoniazid and rifampin for 4 months. Clinical records, effectiveness,treatment failure, treatment side effects, mortality and late consequences after treatmentwere reviewed. Results: Twenty-six patients with meningoencephalitis level I were included, 10 received the long term schedule and 16 the short term schedule treatment. From 51 patients with meningoencephalitis level II, 27 received the long term schedule and 24 the short term scheduletreatment and of 31 patients with meningoencephalitis level III, 18 received the long termschedule treatment and 13 the short term schedule treatment. There was no statistically significantdifferences among levels I, II and III when effectiveness of short and long term schedulewas evaluated. Moreover, there was no statistically significant difference in the frequency oftreatment failure, treatment side effects, mortality and late consequences among groups.Conclusions: Long term 12 month-treatment and short term 6 month-treatment had similareffectiveness and safety in the treatment of meningoenchephalitis due to tuberculosis in HIVnegative patients (AU)

Characterization of bacterial communities exposed to Cr(III) and Pb(II) in submerged fixed-bed biofilms for groundwater treatment.

Two pilot-scale submerged-bed microbial biofilms were set up for the removal of Cr(III) and Pb(II) from groundwater, and the biological activities and structure of the bacterial communities developed in the presence of the heavy metals were analyzed. Artesian groundwater was polluted with Cr(III) or Pb(II) (15 mg/l) and amended with sucrose (250 mg/l) as carbon source. While Pb(II) was over 99% removed from groundwater during long-term operation (130 days), the efficiency of the removal of Cr(III) significantly decreased in time (95-73% after 60 days). Cr(III)-amended biofilms displayed significant lower sucrose consumption, ATP cell contents and alkaline phosphatase activity, compared to biofilms formed in the presence of Pb(II), while analysis of exopolymers demonstrated significant differences in their composition (content of carbohydrates and acetyl groups) in response to each heavy metal. According to transmission electron microscopy (TEM) and electron-dispersive X-ray analysis (EDX), Cr(III) bioaccumulated in the exopolymeric matrix without entering bacterial cells, while Pb(II) was detected both extra and intracellularly, associated to P and Si. Temperature-gradient gel electrophoresis (TGGE) profiling based on partial amplification of 16S rRNA genes was used to analyze the differences in the structure of the biofilm bacterial communities developed under exposure to each heavy metal. Prevalent populations in the biofilms were further identified by reamplification and sequencing of isolated TGGE bands. 75% of the sequences in the Pb(II) biofilter were evolutively close to the Rhodobacterales, while in the Cr(III) biofilter 43% of the sequences were found affiliated to the Rhizobiales and Sphingomonadales, and 57% to Betaproteobacteria.

Alendronato en el tratamiento de la osteoporosis secundaria a la distrofia muscular de Duchenne / Alendronate treatment of osteoporosis secondary to Duchenne muscular dystrophy

Introducción: La reducción de la movilidad y el empleo de los glucocorticoides como terapia coadyuvante son causa de osteoporosis en la distrofia muscular de Duchenne. El alendronato ha sido utilizado en la osteoporosis infantil de otras etiologías con buenos resultados y sin efectos adversos. Pacientes: Tres pacientes con distrofia de Duchenne, síntomas de afectación ósea (historia previa de fracturas y dolor óseo generalizado) y densidad mineral ósea (DMO) por densitometría radiológica de doble energía con Z-score ≤-2 desviaciones estándar. Se inicia tratamiento con alendronato oral (10mg/día). Resultados: se produce en todos los casos un incremento de la DMO lumbar (L2-L4) con mejoría del dolor óseo. No fracturas ni efectos adversos durante el seguimiento. Conclusiones: El alendronato oral produce en estos pacientes un incremento de la DMO con buena tolerancia y sin necesidad de ingreso hospitalario, por lo que mejora la calidad de vida y reduce el gasto sanitario (AU)

Introduction: Reduced mobility and glucocorticoids as adjunctive therapy causes osteoporosis in Duchenne muscular dystrophy. Alendronate has been used in childhood osteoporosis of other aetiologies with good results and no adverse effects. Patients and methods: Three patients with Duchenne dystrophy, symptoms of bone involvement (prior history of generalized bone pain and fractures) and bone mineral density (BMD) by dual-energy X-ray absorptiometry with Z-score ≤-2 SD. Treatment with oral alendronate was initiated (10mg/day). Results: There was an increase in lumbar (L2-L4) BMD in all cases, with improvement of bone pain. No fractures and adverse effects were observed during follow up. Conclusion: Oral alendronate produces an increase in BMD in these patients, with good tolerance and no need for hospitalization, and so improves quality of life and reduces health care costs (AU)

[Alendronate treatment of osteoporosis secondary to Duchenne muscular dystrophy]. / Alendronato en el tratamiento de la osteoporosis secundaria a la distrofia muscular de Duchenne.

INTRODUCTION: Reduced mobility and glucocorticoids as adjunctive therapy causes osteoporosis in Duchenne muscular dystrophy. Alendronate has been used in childhood osteoporosis of other aetiologies with good results and no adverse effects. PATIENTS AND METHODS: Three patients with Duchenne dystrophy, symptoms of bone involvement (prior history of generalized bone pain and fractures) and bone mineral density (BMD) by dual-energy X-ray absorptiometry with Z-score ≤-2 SD. Treatment with oral alendronate was initiated (10mg/day). RESULTS: There was an increase in lumbar (L2-L4) BMD in all cases, with improvement of bone pain. No fractures and adverse effects were observed during follow up. CONCLUSION: Oral alendronate produces an increase in BMD in these patients, with good tolerance and no need for hospitalization, and so improves quality of life and reduces health care costs.

Effectiveness and safety of the schedules of short and long term treatment for tuberculous meningoencephalitis at two hospitals of Lima--Peru.

INTRODUCTION: To compare the effectiveness and safety of short term 6 month-treatment and long term 12 month-treatment schedules for meningoencephalitis due to tuberculosis in two hospitals from Lima-Peru. METHODS: Comparative, retrospective and observational study. The patients were divided in two groups: Group 1: long term 12 month-treatment with isoniazid, rifampin, pyrazinamide, and ethambutol for the first 2 months; then isoniazid and rifampin for 10 months. Group 2: short term 6 month-treatment with isoniazid and rifampin, pyrazinamide and ethambutol for the first 2 months; then isoniazid and rifampin for 4 months. Clinical records, effectiveness, treatment failure, treatment side effects, mortality and late consequences after treatment were reviewed. RESULTS: Twenty-six patients with meningoencephalitis level I were included, 10 received the long term schedule and 16 the short term schedule treatment. From 51 patients with meningoencephalitis level II, 27 received the long term schedule and 24 the short term schedule treatment and of 31 patients with meningoencephalitis level III, 18 received the long term schedule treatment and 13 the short term schedule treatment. There was no statistically significant differences among levels I, II and III when effectiveness of short and long term schedule was evaluated. Moreover, there was no statistically significant difference in the frequency of treatment failure, treatment side effects, mortality and late consequences among groups. CONCLUSIONS: Long term 12 month-treatment and short term 6 month-treatment had similar effectiveness and safety in the treatment of meningoenchephalitis due to tuberculosis in HIV negative patients.

Dominance of sphingomonads in a copper-exposed biofilm community for groundwater treatment.

The structure, biological activity and microbial biodiversity of a biofilm used for the removal of copper from groundwater were studied and compared with those of a biofilm grown under copper-free conditions. A laboratory-scale submerged fixed biofilter was fed with groundwater (2.3 l h(-1)) artificially polluted with Cu(II) (15 mg l(-1)) and amended with sucrose (150 mg l(-1)) as carbon source. Between 73 and 90 % of the Cu(II) was removed from water during long-term operation (over 200 days). The biofilm was a complex ecosystem, consisting of eukaryotic and prokaryotic micro-organisms. Scanning electron microscopy revealed marked structural changes in the biofilm induced by Cu(II), compared to the biofilm grown in absence of the heavy metal. Analysis of cell-bound extracellular polymeric substances (EPS) demonstrated a significant modification of the composition of cell envelopes in response to Cu(II). Transmission electron microscopy and energy-dispersive X-ray microanalysis (EDX) showed that copper bioaccumulated in the EPS matrix by becoming bound to phosphates and/or silicates, whereas copper accumulated only intracytoplasmically in cells of eukaryotic microbes. Cu(II) also decreased sucrose consumption, ATP content and alkaline phosphatase activity of the biofilm. A detailed study of the bacterial community composition was conducted by 16S rRNA-based temperature gradient gel electrophoresis (TGGE) profiling, which showed spatial and temporal stability of the species diversity of copper-exposed biofilms during biofilter operation. PCR reamplification and sequencing of 14 TGGE bands showed the prevalence of alphaproteobacteria, with most sequences (78 %) affiliated to the Sphingomonadaceae. The major cultivable colony type in plate counts of the copper-exposed biofilm was also identified as that of Sphingomonas sp. These data confirm a major role of these organisms in the composition of the Cu(II)-removing community.

Effect of the concentration of suspended solids on the enzymatic activities and biodiversity of a submerged membrane bioreactor for aerobic treatment of domestic wastewater.

A pilot-scale submerged membrane bioreactor was used for the treatment of domestic wastewater in order to study the influence of the variations in the concentration of volatile suspended solids (VSS) on the enzymatic activities (acid and alkaline phosphatases, glucosidase, protease, esterase, and dehydrogenase) and biodiversity of the bacterial community in the sludge. The influence of VSS concentration was evaluated in two separated experiments, which were carried out in two different seasons of the year (experiment 1 through spring-summer and experiment 2 through autumn-winter). Cluster analysis of the temperature gradient gel electrophoresis (TGGE) profiles demonstrated that the community composition was significantly different in both experiments. Within the same experiment, the bacterial community experienced sequential shifts as the biomass accumulated, as shown by the evolution of the population profiles through time as VSS concentration increased. All enzymatic activities studied were significantly lower during experiment 2, except for glucosidase. Concentrations of VSS over 8 g/l induced a strong descent of all enzymatic activities, which overlapped with a significant modification of the community composition. Sequences of the major TGGE bands were identified as representatives of the Alpha-proteobacteria, filamentous bacteria (Thiotrix), and nitrite oxidizers (Nitrospira). Some sequences which were poorly related to any validated bacterial taxon were obtained.

Goblet Cell Carcinoid of the appendix. A 52 years old male with acute appendicitis

El carcinoide de células globoides, también denominadoadenocarcinoide, carcinoma mucinoso, ycarcinoma de células de la cripta, es una rara neoplasiacon características específicas clínicas y patológicas.Revisamos el manejo del carcinoide decélulas globoides del apéndice aprovechando la presentaciónde un caso clínico ilustrativo

Goblet cell carcinoid, also variably known asadenocarcinoid, mucinous carcinoid, and crypt cellcarcinoma, is a rare neoplasm with distincthistological and clinical features. We review themanagement of goblet cell carcinoid of theappendix using an illustrative case report

Experiencia asistencial del programa de Cuidados Paliativos de la Fundación CUDECA / No disponible

Introducción/Objetivos: la Fundación CUDECA esta formada por un equipo asistencial multidisciplinar formado por médicos, enfermeros-as, trabajadora social, psicóloga y voluntarios cualificados, que atiende al paciente paliativo tanto en el Centro CUDECA, como en el propio domicilio del enfermo, consiguiendo así que se puedan cumplir los deseos de las personas en esta situación, enfermos y familiares, de permanecer en su propio hogar. Se analizan, en este estudio, los datos de 3.400 pacientes atendidos en el Programa Asistencial de Cuidados Paliativos de la Fundación CUDECA. Material y métodos: se procesaron los datos de 3.400 pacientes, incluidos en programa desde 1992 hasta 2005, mediante el programa estadístico SPSS 11.0, se realizó un estudio descriptivo de las siguientes características de los pacientes: sexo, edad de los pacientes, edad del cuidador, tiempo de permanencia en programa, tipo de tumor más frecuente y lugar de defunción de los pacientes, que figuraba codificado de la siguiente manera: domicilio, hospital, UCP (Unidad de Cuidados Paliativos), residencia y otros. Resultados: la media de edad es de 67 años. Acorde con la mayor prevalencia de tumores en pacientes mayores y también en relación con el mayor envejecimiento de la población. Predominan los varones: 59,4%. En relación a la mayor incidencia de tumores, destaca el de pulmón en varones, que es el tumor más prevalente en nuestra población. La media de estancia en programa es de 76 días. La mediana es de 36 días. Destaca el tumor de pulmón como el más frecuente con un 24%. Seguido del colorrectal con un 14%, cabeza y cuello y cáncer de mama con un 10%. La mayoría de nuestros pacientes, el 76,8%, fallecen en el domicilio. Conclusiones: la mayoría de nuestros pacientes, el 76,8% fallecen en el domicilio. Es un dato muy importante de calidad de asistencia en Cuidados Paliativos, ya que se consigue que los pacientes mueran en su ambiente familiar. Supone un importantísimo ahorro al Sistema Nacional de Salud y compañías privadas, ya que se evitan estancias prolongadas en hospital, con el ahorro que supone de coste cama/día. Los datos de alta frecuencia de cáncer de pulmón coinciden con los descritos en la literatura, ya que se trata del tumor más prevalente. En nuestra población destaca la alta frecuencia de tumores de cabeza y cuello, en posible relación al tabaco y al consumo de alcohol. La media de estancia en programa es corta, estos datos demuestran la sospecha inicial de que los pacientes son derivados a las Unidades de Cuidados Paliativos por los Servicios de Oncología en situación muy avanzada de su enfermedad, es necesario, por tanto, mejorar la coordinación entre las Unidades de Cuidados Paliativos y los Servicios de Oncología de Procedencia (AU)

Objectives: CUDECA Foundation is formed by a multidisciplinary team of doctors, nurses, social workers, psychologists, and qualified volunteers who care for patients at CUDECA's center and in their homes, so that patients can stay with their families in their own houses. We analyzed the data of 3,400 patients who entered the palliative care program of CUDECA Foundation. The main objectives of CUDECA are: to offer «specialised palliative care» to patients suffering from terminal cancer, and also to support their families during illness and the bereavement process. To constitute a study, training, investigation, and awareness program regarding palliative care. Our care is offered completely free of charge to those patients and families who need it and who live in Malaga province, Spain. Methods: We analyzed the data of 3400 patients who entered the palliative program of CUDECA Foundation using the statistical program SPSS 11.0. A descriptive study was performed of the following patient characteristics: sex, median age, median age of caregiver, time in the program, and place of death, which was coded with the following variables -nursing home, hospital, palliative care unit (PCU), home, other. Results: The majority of our patients, 76.8%, died in their homes. Median age of patients: 67 years. Median age of caregiver: 55 years. Males predominated (59.4%) in the prevalence of tumours, especially of the lungs. Mean time in the program: 76 days. Lung cancer was the most frequent malignancy (24%), followed by colorectal cancer (14%), and head and neck tumours (10%). Conclusions: Mean age of patients was high due to the greater prevalence of tumours in older patients and also in relation to population ageing. Mean time in the program was not very long (76 days); as patients are sent to palliative care units by oncology departments when disease is advanced, coordination between palliative care units and oncology departments. The high frequency of lung cancer is consistent with the data described in the literature, as this is the tumour with the highest prevalence. A majority of our patients, 76.8 %, died in their homes. This is avery important quality-of-life issue in palliative care, as we allowed patients to die with their families and in their homes according to their own wishes (AU)

TGGE analysis of the diversity of ammonia-oxidizing and denitrifying bacteria in submerged filter biofilms for the treatment of urban wastewater.

The spatial and temporal diversity of the bacterial community-forming biofilms in a pilot-scale submerged biofilter used for the treatment of urban wastewater was analyzed by a temperature-gradient gel electrophoresis (TGGE) approach. TGGE profiles based on partial sequence of the 16S rRNA gene showed that the community composition of the biofilms remained fairly stable along the column system and during the whole time of operation of the biofilter (more than 1 year). Community-profiling based on the amplification and separation of partial ammonia monooxygenase (amoA) and nitrous oxide reductase (nosZ) genes demonstrated that ammonia-oxidizing and denitrifying bacteria coexisted in both the anoxic and the aerated parts of the system. Several amoA and nosZ bands separated by TGGE were reamplified and sequenced, in order to further analyze the composition of these microbial communities in the biofilm. Phylogeny inferred from amoA/AmoA revealed the prevalence of Nitrosomonas species with five sequences affiliated to Nitrosomonas oligotropha, six sequences affiliated to Nitrosomonas europaea, and three sequences that showed only 75.7-76.1% identity of the DNA sequence with the closest described species (Nitrosomonas nitrosa). According to literature, this low identity value is indicative of previously undiscovered species. Eighteen new partial nosZ sequences were obtained which were mostly related to nosZ of gamma-proteobacteria (Pseudomonas) or clustered in the periphery of previously known denitrifying alpha-proteobacteria (Bradyrhizobium and Azospirillum).

Analysis of community composition of biofilms in a submerged filter system for the removal of ammonia and phenol from industrial wastewater.

The bacterial diversity of a submerged filter, used for the removal of ammonia and phenol from an industrial wastewater with high salinity, was studied by a cultivation-independent approach based on PCR/TGGE (temperature-gradient gel electrophoresis). The wastewater treatment plant (laboratory scale) combined the nitrification and denitrification processes and consisted of two separated columns (one anoxic and one aerated) connected through a valve. The spatial diversity of bacterial communities in the plant biofilms was analysed by taking samples at four different heights in the system. TGGE profiles of PCR-amplified sequences of the 16 S rRNA gene (V3-hypervariable region) showed significant variations of the bacterial diversity, mainly depending on the concentration of O(2) along the system. Several bands separated by TGGE were reamplified and sequenced, in order to explore the composition of the microbial communities in the biofilms. Most of the sequenced bands (10 out of 13) were closely related to the 16 S rRNA gene of marine alpha-proteobacteria, mainly grouping in the periphery of the genus Roseobacter. Other sequences were related to those of gamma-proteobacteria, the nitrite oxidizer Nitrospira marina and anaerobic phenol-degrading bacteria of the Desulfobacteraceae.

Mejoría de la disnea tras el tratamiento con citrato de fentanilo oral transmucoso en paciente con cáncer de pulmón avanzado / Dyspnea improvement following treatment with oral transmucosal fentanyl citrate in a patient with advanced lung cancer

La disnea es un síntoma muy frecuente en medicina paliativa, especialmente en pacientes con diagnostico de cáncer de pulmón, que afecta seriamente la calidad de vida de los pacientes. Presentamos un caso clínico, de un paciente con disnea secundaria a un cáncer de pulmón avanzado, resistente a tratamiento convencional con morfina, donde la disnea se controla con el uso del citrato de fentanilo oral transmucoso. Se realiza una revisión amplia de la literatura donde apenas hay estudios del uso del citrato de fentanilo oral transmucoso en el tratamiento de la disnea, si hemos encontrado estudios con el uso del fentanilo nebulizado en el tratamiento de la disnea, con buenos resultados. Sería interesante la realización de ensayos fase II-III que respondieran a esta pregunta (AU)

Dyspnea is a frequent symptom in palliative medicine, and may seriously affect patient quality of life. We report a case of dyspnea in a patient with advanced lung cancer resistant to conventional treatment with morphine, which was controlled with oral transmucosal fentanyl citrate. We performed a systematic review of the literature, and found little evidence on the use of oral transmucosal fentanyl citrate in the treatment of dyspnea; however, we did find some evidence on the use of nebulized fentanyl with positive results. It is important that new phase II-III clinical studies are designed to answer this question (AU)

Tratamiento con rifampicina del prurito refractario de origen neoplásico no colestásico. A propósito de dos casos / Treatment of non-cholestatic refractory neoplasic pruritus with rifampicin. About two cases

El prurito es un síntoma poco frecuente en medicina paliativa que puede afectar seriamente la calidad de vida de los pacientes. Presentamos dos casos clínicos de prurito no colestásico resistentes a los tratamientos convencionales y que cedieron de forma clara y dosis dependiente a tratamiento con rifampicina. En los dos casos, cedió con dosis mayores que las empleadas en el prurito colestásico, existiendo un fenómeno de tolerancia con la evolución dela enfermedad que obligó a sucesivos incrementos de dosis para mantener el efecto deseado (AU)

The pruritus is an infrequent symptom in palliative medicine that can affect seriously the quality of life of the patients. We present two clinical cases of pruritus not cholestasis, resistant to the conventional treatments, controlled cleared and dose dependent with rifampicin.In both cases, the pruritus disappears with higher doses that are normally used in cholestatic pruritus, creating a phenomenon of tolerance with the evolution of the disease that forced to successive increases of dose to maintain the desired effect (AU)

Detection of antibodies to polyomavirus SV40 in two central European countries.

Simian virus 40 (SV40) is significantly associated with some human cancers. However, the frequency of tumor-associated virus detection differs by geographic regions, so it is important to understand the status of SV40 infections in different populations. Poliovaccines potentially containing live SV40 were used in well-documented nationwide vaccination programs in Hungary and the Czech Republic that are reported here. We analyzed serum samples from periodic surveillance programs in those two countries for antibodies to SV40 using a specific plaque reduction neutralization assay. The prevalence of antibodies was between 1.3 and 8.7% in Hungary and from 1.0 to 4.0% in the Czech Republic. Females had a higher rate of antibodies than males, reaching in certain age groups 15.6% in Hungary and 8.3% in the Czech Republic. Antibodies to SV40 were found in similar proportions in both countries among persons not directly exposed to poliovaccines and subjects vaccinated in the era of SV40-free vaccines. Complexities and limitations of current serological approaches to epidemiological studies of SV40 in humans are discussed. These data suggest that SV40 may be present in these populations and emphasize the importance of follow-up studies to determine the pathogenesis of infections by this emerging human agent.

Valoración estadística de las actividades realizadas en el Centro de Información del Medicamento de Granada durante el último año

El Centro de Información del Medicamento (CIM) es un servicio en el que se realiza la selección, análisis y evaluación de las fuentes de información sobre medicamentos para elaborar y comunicar la información encaminada a facilitar el uso racional de los fármacos (1). Este trabajo es un informe de las actividades desarrolladas en el Centro de Información del Medicamento del Colegio Oficial de Farmacéuticos de Granada durante el año 2001 (AU)