Last twenty-years activity of cardiovascular tissue banking in Barcelona.

The Barcelona Tissue Bank was established from the merge of two previous multi-tissue banks. Potential donors are screened by Donor Center staff and multi-tissue retrieval is performed by specialized own teams. Tissue processing and preservation is performed in clean room facilities by specialised personnel. After quality control of both donor and all tissues results, the heart valves and vascular segments are stored until medical request. The aim of this report is to present the cardiovascular tissue activity and retrospectively evaluate the outcomes of the changes performed in last 20 years. Cardiovascular tissue from 4088 donors was received, specifically 3115 hearts and 2095 vascular segments were processed and evaluated. A total of 48% of the aortic valves, 68% of the pulmonary valves and 75% of the vascular segments were suitable for transplant. The main reason for discarding tissue was macroscopic morphology followed by microbiological results, for both valves and arteries. Altogether, 4360 tissues were distributed for transplantation: 2032 (47%) vascular segments, 1545 (35%) pulmonary valves and 781 (18%) aortic valves. The most common indication for aortic valve surgery was the treatment of endocarditis, while for pulmonary valves, it was congenital malformation reconstruction. Vascular segments were mainly used for reconstruction after ischemia. During this period, a number of changes were made with the goal of enhancing tissue quality, safety and efficacy. These improvements were achieved through the use of a new antibiotic cocktail, increasing of donor age criteria and changing the microbiological control strategy.

The hip fracture surgery in elderly patients (HIPELD) study to evaluate xenon anaesthesia for the prevention of postoperative delirium: a multicentre, randomized clinical trial.

BACKGROUND: Postoperative delirium occurs frequently in elderly hip fracture surgery patients and is associated with poorer overall outcomes. Because xenon anaesthesia has neuroprotective properties, we evaluated its effect on the incidence of delirium and other outcomes after hip fracture surgery. METHODS: This was a phase II, multicentre, randomized, double-blind, parallel-group, controlled clinical trial conducted in hospitals in six European countries (September 2010 to October 2014). Elderly (≥75yr-old) and mentally functional hip fracture patients were randomly assigned 1:1 to receive either xenon- or sevoflurane-based general anaesthesia during surgery. The primary outcome was postoperative delirium diagnosed through postoperative day 4. Secondary outcomes were delirium diagnosed anytime after surgery, postoperative sequential organ failure assessment (SOFA) scores, and adverse events (AEs). RESULTS: Of 256 enrolled patients, 124 were treated with xenon and 132 with sevoflurane. The incidence of delirium with xenon (9.7% [95% CI: 4.5 -14.9]) or with sevoflurane (13.6% [95% CI: 7.8 -19.5]) were not significantly different (P=0.33). Overall SOFA scores were significantly lower with xenon (least-squares mean difference: -0.33 [95% CI: -0.60 to -0.06]; P=0.017). For xenon and sevoflurane, the incidence of serious AEs and fatal AEs was 8.0% vs 15.9% (P=0.05) and 0% vs 3.8% (P=0.06), respectively. CONCLUSIONS: Xenon anaesthesia did not significantly reduce the incidence of postoperative delirium after hip fracture surgery. Nevertheless, exploratory observations concerning postoperative SOFA-scores, serious AEs, and deaths warrant further study of the potential benefits of xenon anaesthesia in elderly hip fracture surgery patients. CLINICAL TRIAL REGISTRATION: EudraCT 2009-017153-35; ClinicalTrials.gov NCT01199276.

The need to educate future dental professionals on E-cigarette effects.

OBJECTIVE: To compare knowledge and attitude of dental students in two countries towards E-cigarettes and their long-term effects. MATERIAL AND METHODS: An anonymous cross-sectional survey, using self-administered questionnaires, was conducted amongst dental students from the University of California, Los Angeles School of Dentistry (UCLA) and Universidad Europea of Madrid (UE). RESULTS: There were significant differences in knowledge and perception of E-cigarettes between dental students from both countries. Three (3%) of the participants from UE sample smoked E-cigarettes every day, compared to none of the students from UCLA. Almost 54 (80%) students from UCLA claimed that they had never experimented with an E-cigarette, whereas 61 (65%) of UE sample reported not having experimented with E-cigarettes in the past. More than 15% of students in both populations were unsure of the potentially harmful effects of E-cigarette usage. A significantly higher proportion of the Spanish sample used conventional cigarettes compared to the US sample 53 (56%) compared to 36 (24%), P < 0.001). In addition, when compared to the UE sample, UCLA students rated E-cigarettes as being less harmful overall than tobacco P < 0.001. Furthermore, more than 86% of both populations indicated interest in learning more about the potential risks associated with E-cigarettes. CONCLUSIONS: This survey indicated that students from one dental school in the United States of America (USA) and one in Spain lacked the knowledge to address the rising E-cigarette population usage and provide information regarding them to patients. Specific educational programmes on E-cigarette hazards and long-term effects on oral and systemic health should be implemented in dental curricula in both of these schools in order to stay receptive to the changing field of tobacco education.

Consensus recommendations for anaesthetic peripheral nerve block. / Guía consenso sobre técnicas de infiltración anestésica de nervios pericraneales.

INTRODUCTION: Anaesthetic block, alone or in combination with other treatments, represents a therapeutic resource for treating different types of headaches. However, there is significant heterogeneity in patterns of use among different professionals. DEVELOPMENT: This consensus document has been drafted after a thorough review and analysis of the existing literature and our own clinical experience. The aim of this document is to serve as guidelines for professionals applying anaesthetic blocks. Recommendations are based on the levels of evidence of published studies on migraine, trigeminal autonomic cephalalgias, cervicogenic headache, and pericranial neuralgias. We describe the main technical and formal considerations of the different procedures, the potential adverse reactions, and the recommended approach. CONCLUSION: Anaesthetic block in patients with headache should always be individualised and based on a thorough medical history, a complete neurological examination, and expert technical execution.

Burning mouth syndrome: Clinical description, pathophysiological approach, and a new therapeutic option. / Síndrome de boca ardiente: descripción clínica, planteamiento fisiopatológico y una nueva opción terapéutica.

INTRODUCTION: Burning mouth syndrome is defined as scorching sensation in the mouth in the absence of any local lesions or systemic disease that would explain that complaint. The condition responds poorly to commonly used treatments and it may become very disabling. METHODS: We prospectively analysed the clinical and demographic characteristics and response to treatment in 6 cases of burning mouth syndrome, diagnosed at 2 tertiary hospital headache units. RESULTS: Six female patients between the ages of 34 and 82 years reported symptoms compatible with burning mouth syndrome. In 5 of them, burning worsened at the end of the day; 4 reported symptom relief with tongue movements. Neurological examinations and laboratory findings were normal in all patients and their dental examinations revealed no buccal lesions. Each patient had previously received conventional treatments without amelioration. Pramipexol was initiated in doses between 0.36mg and 1.05mg per day, resulting in clear improvement of symptoms in all cases, a situation which continues after a 4-year follow up period. CONCLUSIONS: Burning mouth syndrome is a condition of unknown aetiology that shares certain clinical patterns and treatment responses with restless leg syndrome. Dopamine agonists should be regarded as first line treatment for this entity.

Identification of male-produced aggregation pheromone of the curculionid beetle Acrotomopus atropunctellus.

The sugarcane stem weevil, Acrotomopus atropunctellus (Boheman) (Curculionidae: Molytinae: Cholini) is an important economic pest from the Northwestern region of Argentina. Analyses of the headspace volatiles produced by separated males and females revealed one male-specific compound. Its structural identification is reported here in using gas chromatography coupled with mass spectroscopy analysis and chemical micro-reactions. Besides, two laboratory olfactometry assays allowed us to propose 6-methyl-5-hepten-2-one (sulcatone) as an aggregation pheromone for this insect, being attractive to both conspecific males and females. This compound is reported for the first time as involved in the Curculionidae family communication.

Selective vitamin D receptor activation as anti-inflammatory target in chronic kidney disease.

Paricalcitol, a selective vitamin D receptor (VDR) activator used for treatment of secondary hyperparathyroidism in chronic kidney disease (CKD), has been associated with survival advantages, suggesting that this drug, beyond its ability to suppress parathyroid hormone, may have additional beneficial actions. In this prospective, nonrandomised, open-label, proof-of-concept study, we evaluated the hypothesis that selective vitamin D receptor activation with paricalcitol is an effective target to modulate inflammation in CKD patients. Eight patients with an estimated glomerular filtration rate between 15 and 44 mL/min/1.73 m(2) and an intact parathyroid hormone (PTH) level higher than 110 pg/mL received oral paricalcitol (1 µg/48 hours) as therapy for secondary hyperparathyroidism. Nine patients matched by age, sex, and stage of CKD, but a PTH level <110 pg/mL, were enrolled as a control group. Our results show that five months of paricalcitol administration were associated with a reduction in serum concentrations of hs-CRP (13.9%, P < 0.01), TNF-α (11.9%, P = 0.01), and IL-6 (7%, P < 0.05), with a nonsignificant increase of IL-10 by 16%. In addition, mRNA expression levels of the TNFα and IL-6 genes in peripheral blood mononuclear cells decreased significantly by 30.8% (P = 0.01) and 35.4% (P = 0.01), respectively. In conclusion, selective VDR activation is an effective target to modulate inflammation in CKD.

Effects of a peer health coaching program on college student lifestyle behaviors.

Objective: Health coaching (HC) may promote healthy behaviors in incoming college students. Participants: 187 undergraduate students (76% female; age 18.6 ± 1.6) were recruited to participate in a peer HC program. Methods: Participants received four HC sessions in eight-weeks to work toward self-selected goals of physical activity (PA), diet, or stress management. PA was assessed using the International Physical Activity Questionnaire Short-Form, diet with the Eating Habits Confidence Survey, and stress with the Perceived Stress Scale. Results: Repeated measures ANOVAs investigated lifestyle behavior changes in 130 participants. Significant effects of time were reported, with a 39.6% gain in PA, 9.9% increase in dietary habit, and 16.3% decline in stress levels with moderate to large effect sizes (ηp2: 0.07-0.17; p< 0.01). Conclusion: The peer HC model promoted healthy lifestyles in college students. Additional research is needed to understand the effects of HC specifically for each goal, and student reactions to peer-led HC.

Development of a full-thickness acellular dermal graft from human skin: Case report of first patient rotator cuff patch augmentation repair.

The processing and initial testing of a new human tissue preparation is described. Full-thickness Acellular Dermal Matrix (ftADM) is the extracellular matrix (ECM) obtained by decellularization of full-thickness human skin from cadaveric donors. The safety, stability and usability of the graft are discussed with respect to the results of the residual cellular content, maintenance of ECM components, and biomechanical properties. Quantitative and qualitative analysis of the ECM demonstrated the absence of cell debris, while the native structure of human dermis was maintained. Biomechanical testing showed stiffness values comparable to other commercial products used for tendon reinforcement, suggesting that our ftADM could be successfully used not only in soft tissue regeneration surgeries, but also in tendon reinforcement. First case of ftADM in rotator cuff augmentation is described. Technical management of the patch during surgery and clinical outcomes are discussed.

Bitemporal peripapillary hemorrhages: Toxic-ischemic optic neuropathy caused by ethanol and cocaine abuse.

A 36-year-old man presented complaining of bilateral painless vision loss. He was admitted with chronic ethanol abuse, as well as sporadic cocaine consumption three days before symptom onset. General medical evaluation dismissed cerebral and cardiovascular events. Blood tests revealed folic acid deficiency. Visual acuity (VA) was count fingers in both eyes (OU). Fundoscopic findings included remarkable bitemporal peripapillary hemorrhages. A diagnosis of toxic-ischemic optic neuropathy was made. The hemorrhages resolved after three weeks, with VA recovering to 20/20 OU. The sequelae included bitemporal peripapillary retinal fiber loss on optical coherence tomography, and central scotomas observed on visual field tests. This is the first report of cocaine as a triggering agent for a classical presentation of toxic optic neuropathy and the presence of peripapillary hemorrhages in its initial stages.

The importance of timing in epilepsia partialis continua.

INTRODUCTION: Timing is one of the most important modifiable prognostic factors in the management of status epilepticus. Epilepsia partialis continua (EPC) is a status epilepticus subtype of highly variable, occasionally prolonged, duration. The aim of this study was to analyse the relationship between EPC duration and outcomes. METHODS: We performed an observational prospective study of all patients with EPC admitted to our tertiary hospital between 1 September 2017 and 1 September 2018. RESULTS: The sample included 10 patients, of whom 9 were women; median age was 74 years. The most frequent aetiology was cerebrovascular disease (n = 6). EPC onset occurred outside the hospital in 5 patients, with a median time to hospital admission of 4 hours. The median time to treatment onset (TT) for all patients was 12.3 hours. The median time from treatment onset to EPC control (TC) was 30 hours; TC showed a strong positive correlation with TT (Spearman's rho = 0.88). Six patients presented hyperglycaemia at onset; this was positively correlated with TC (rho = 0.71). All 6 patients with hyperglycaemia presented a brain injury explaining the EPC episode. CONCLUSIONS: Delays were observed in different phases of EPC management, which was related to longer duration of the episode. Glycaemia was also related to episode duration, probably acting as a triggering factor rather than as the aetiology.

Nanoemulsion of Minthostachys verticillata essential oil. In-vitro evaluation of its antibacterial activity.

Infectious diseases constitute a problem of great importance for animal and human health, as well as the increasing bacterial resistance to antibiotics. In this context, medicinal plants emerge as an effective alternative to replace the use antibiotics. The essential oil (EO) of Minthostachys verticillata (Griseb.) Epling (Lamiaceae) has demonstrated a strong antimicrobial activity. However, its instability and hydrophobicity under normal storage conditions are limitations to its use. Nanoemulsion technology is an excellent way to solubilize, microencapsulate, and protect this compound. This study aimed to obtain a nanoemulsion based on M. verticillata EO and evaluate its antibacterial activity against Staphylococcus aureus. The EO was obtained by steam distillation. Identification and quantification of their components were determined by GC-MS revealing that the dominated chemical group was oxygenated monoterpenes. Nanoemulsions (NE) were characterized by measuring pH, transmittance, separation percentage, release profile, and morphology. The effect of NE on the growth of S. aureus and cyto-compatibility was also evaluated. The results showed that NE containing a higher percentage of tween 20 exhibited higher stability with an approximated droplet size of 10 nm. The effect of encapsulation process was evaluated by GC-MS revealing that the volatile components in EO were no affected. After 24 h, 74.24 ± 0.75% of EO was released from NE and the antibacterial activity of EO was enhanced considerably by its encapsulation. The incubation of S. aureus with the NE and pure EO, show a bacterial growth inhibition of 58.87% ± 0.99 and 46.72% ± 3.32 (p < 0.05), respectively. In addition, nanoemulsión did not cause toxicity to porcine and equine red blood cells. The results obtained showed that NE could be a potential vehicle for M. verticillata EO with promissory properties to emerge as a tool for developing advanced therapies to control and combat infections.

Fast protocol for the processing of split-thickness skin into decellularized human dermal matrix.

BACKGROUND: Dermal scaffolds for tissue regeneration are nowadays an effective alternative in not only wound healing surgeries but also breast reconstruction, abdominal wall reconstruction and tendon reinforcement. The present study describes the development of a decellularization protocol applied to human split-thickness skin from cadaveric donors to obtain dermal matrix using an easy and quick procedure. METHODS: Complete split-thickness donor was decellularized through the combination of hypertonic and enzymatic methods. To evaluate the absence of epidermis and dermal cells, and ensure the integrity of the extracellular matrix (ECM) structure, histological analysis was performed. Residual genetic content and ECM biomolecules (collagen, elastin, and glycosaminoglycan) were quantified and tensile strength was tested to measure the effect of the decellularization technique on the mechanical properties of the tissue. RESULTS: Biomolecules quantification, residual genetic content (below 50 ng/mg dry tissue) and histological structure assessment showed the efficacy of the decellularization process and the preservation of the ECM. The biomechanical tests confirmed the preservation of native properties in the acellular tissue. CONCLUSIONS: The acellular dermal matrix obtained from whole split-thickness skin donor with the newly developed decellualrization protocol, maintains the desired biomechanical and structural properties and represents a viable treatment option for patients.

Sodium accumulation has minimal effect on metabolite profile of onion bulbs.

Onions (Allium cepa L.) are considered a salt-sensitive crop. However, to date, little evidence supports this claim and information about the physiological and metabolomic effects of Na+ accumulation in onion plants is lacking. The purpose of our research has been to assess changes in onion bulbs of three different cultivars after soil and foliar applications with moderate doses of chloride-free Na2SO4. The antioxidative defense mechanism in onion and the accumulation of Na+ within the plant has also been analyzed. Based on Na+ leaf and bulb concentrations, our findings demonstrate that Na+ is only transported from bulbs to leaves not vice versa, therefore foliar application does not lead to Na+ accumulation in the bulbs. Soil application with Na2SO4 results in an accumulation of Na+ in the leaves and bulbs, but with the exception of one onion variety this accumulation does not alter the metabolite profile of onions significantly. Even the K+ concentration and organic solute levels are unchanged after accumulation of Na+. Nevertheless, after Na2SO4 treatment, the antioxidative defense system moderately increases in onion bulbs. This study demonstrates that onion plants have the ability to exclude Na+ at moderate Na2SO4 treatment, and that the potential for quality onion production in soils with increased sodium concentration is much higher than previously assumed.

Metabolite profiling of onion landraces and the cold storage effect.

Today, commercial onion breeders focus almost entirely on conventional farming which reduces diversity in the market and leads to loss of desirable traits such as those that impact nutritional and sensory aspects of onions. A way to preserve phenotypic and genetic diversity is to re-evaluate traditional landraces to introduce their benefits to the broader public. Common onion genotypes vary greatly in their storability. In particular, temperature and relative humidity during storage have significant impact on the metabolites in onions after storage. The aim of this study was to assess changes in the metabolite profile of ten onion genotypes after five months of cold storage. In addition, a characterization of onion landraces in their fresh state was also conducted in order to compare their properties against a commercial genotype. Onion genotypes were grown under organic farming conditions. After harvest and curing, bulbs were stored for up to 22 weeks. Before and after storage, bulb samples were analyzed through targeted and untargeted methods. Out of 189 identified metabolites, 128 showed a storage effect. Mainly fructans decreased because of respiration and energy demand, while monosaccharides increased. Further, amino acids were altered in their concentration after storage with an effect on aroma precursors. Eight of the nine landraces had good storability without critical losses. In their fresh state, the onion genotypes clustered into three major groups. For instance, landraces of group III showed consistently and substantially higher levels of amino acids and certain sugars, indicating a high potential of aromatic properties in those onion landraces.

The importance of timing in epilepsia partialis continua. / La relevancia del tiempo en la epilepsia parcial continua.

INTRODUCTION: Timing is one of the most important modifiable prognostic factors in the management of status epilepticus. Epilepsia partialis continua (EPC) is a status epilepticus subtype of highly variable, occasionally prolonged, duration. The aim of this study was to analyze the relationship between EPC duration and outcomes. METHODS: We performed an observational prospective study of all patients with EPC admitted to our tertiary hospital between 1 September 2017 and 1 September 2018. RESULTS: The sample included 10 patients, of whom 9 were women; median age was 74 years. The most frequent aetiology was cerebrovascular disease (n=6). EPC onset occurred outside the hospital in 5 patients, with a median time to hospital admission of 4hours. The median time to treatment onset for all patients was 12.3hours. The median time from treatment onset to EPC control was 30hours; time from treatment onset to EPC control showed a strong positive correlation with TT (Spearman's rho=0.88). Six patients presented hyperglycaemia at onset; this was positively correlated with time from treatment onset to EPC control (rho=0.71). All 6 patients with hyperglycaemia presented a brain injury explaining the EPC episode. CONCLUSIONS: Delays were observed in different phases of EPC management, which was related to longer duration of the episode. Glycaemia was also related to episode duration, probably acting as a triggering factor rather than as the aetiology.

Confirmed mixed bird-insect pollination system of Scrophularia trifoliata L., a Tyrrhenian species with corolla spots.

Both bird and mixed vertebrate-insect (MVI) pollination systems are very rare in Europe and the Mediterranean region. Because MVI can ensure reproduction over a wider range of environmental conditions than when insects are the sole pollinators, under certain circumstances such systems are highly advantageous to plants. Here, we investigated the pollination and some reproductive traits of the Tyrrhenian Scrophularia trifoliata, the only species of the genus possessing two showy dark spots inside the corolla, for which MVI pollination system had been inferred on the basis of limited censuses. We conducted field experiments to study MVI pollination and some reproductive traits and elucidate the role of corolla spots, analysing their ultraviolet pattern, histology and pigments versus the rest of the corolla. The primary pollinators were wasps and passerine birds. Corolla spots absorb UV light, present abundant anthocyanins and are histologically identical to the rest of the corolla. Control flowers had higher visitation frequency than flowers without spots. S. trifoliata is self-compatible, with efficient intrafloral protogyny and herkogamy that prevent self-pollination but not geitonogamy. We confirmed the existence of a mixed bird-insect pollination system in S. trifoliata. This system is found in three other Scrophularia species with large, showy flowers - two Mediterranean (S. grandiflora and S. sambucifolia) and one Macaronesian (S. calliantha). Unlike those species, S. trifoliata has two large spots inside the corolla. These likely operate as nectar guides and their dark colouration is related to abundant anthocyanin content.

[Communication based on the P300 component of event-related potentials: a proposal for a matrix with images]. / Comunicación basada en el componente P300 de los potenciales relacionados con eventos: propuesta de una matriz con imágenes.

INTRODUCTION: For more than two decades, several research groups have tried to build a device called "brain computer interface" (BCI) to make it available for people having several disabilities such as the locked in syndrome through the use of the recording of electroencephalography activity while the patients are being visually stimulated. AIM. To obtain a P300 component elicited by intensifications of images arranged in a matrix in an oddball paradigm in two selection modes: assigned and free. SUBJECTS AND METHODS: A 5 x 5 matrix for communication purposes was used to visually stimulate 12 volunteers while their event related potentials were recorded in three leads (Fz, Cz and Pz). Off-line analyses were performed to obtain the P300 component which was elicited by targets images intensified randomly by rows or columns. RESULTS: In both modalities assigned and free, all volunteers generated a reliable P300 component. Confirmation of the selected images was made through a comparison of the P300 when each target, row and column matched. In the free selection mode, higher amplitude and a broader activation including frontal leads was observed. No significant differences in the P300 latency were found. CONCLUSION: In all volunteers the elicited P300 allows the identification of the selected images in the 5 x 5 matrix. In the present study the use of drawings representing ideas instead of letters might increase the communication rate in a P300-based BCI.

Lithotomy's prohibition and referral to experts in medical oaths of hippocratic stemma. / Prohibición de la litotomía y derivación a expertos en los juramentos médicos de la genealogía hipocrática.

OBJECTIVE: The aim is to analyse how the Hippocratic Oath's commitments of not cutting for stone and referral to experts was modified in medical oaths of Hippocratic stemma from different time periods. METHODS: Nineteen oaths of Hippocratic stemma were studied: 4 Medieval, 2 Modern, and 13 Contemporary. They were selected according to: name of the oath when it includes the word «Hippocratic¼ or because their authors recognized having based their oaths on the Hippocratic Oath. Their historical significance and representativity regarding time period, renowned medical schools, and importance and reliability of the sources was also taken into consideration. RESULTS: Four oaths prohibit cutting for stone (one Medieval, 2 Modern, one Contemporary); 4 oaths mention seeking consultation about patients (all Contemporary); 3 mention not performing criminal operations (all Contemporary); 8 do not mention these commitments (3 Medieval, 5 Contemporary). CONCLUSION: The commitment of the Hippocratic Oath of not cutting for stone and referral to experts has been modified mainly in Contemporary oaths. The original commitment seems to have been split into 2 tendencies: those that mention obtaining consultation, and those that refer to not performing criminal operations. Due to the bioethics movement in the second half of the 20th century, referring patients that exceed the physician's limitations to more skilled colleagues constitutes an ethical obligation. Thus, it should be a commitment present in every Contemporary oath.

[Serological and genetic markers in the diagnosis and follow-up of coeliac disease]. / Marcadores serológicos y genéticos en el diagnóstico y seguimiento de la enfermedad celíaca.

INTRODUCTION: Understanding of celiac disease has changed with the advent of serological markers (antigliadin IgA, anti-endomysial IgA and anti-transglutaminase IgA antibodies) and with the identification of major susceptibility genes (HLA-DQA1*05-DQB1*02). Reports of the efficacy of these diagnostic tests have varied, depending on the methodology used and the population investigated. OBJECTIVES: To determine the clinical utility of genetic and serological markers in the diagnosis of celiac disease, their relationship with histological lesions and their changes during treatment, in order to establish an optimal diagnostic algorithm in our environment. PATIENTS AND METHODS: We performed a retrospective study of 590 patients from the health area of Badajoz referred to the Immunology Laboratory for screening or follow-up of celiac disease. The results of intestinal histology, serological markers (antigliadin IgA, anti-endomysial IgA and anti-transglutaminase IgA antibodies), and genomic typing (HLA-DQA1*05-DQB1*02) were analyzed. RESULTS: The sensitivity and specificity of serological tests were greater than 90 %, with a negative predictive value of 98-100 %. HLA-DQA1*05-DQB1*02 was detected in 97 % of celiac patients, with a very high negative predictive value (99 %). On biopsy, 95 % of the patients with some grade of intestinal lesion were positive for antigliadin and/or anti-endomysial antibodies. CONCLUSION: To avoid missed diagnoses, the diagnostic algorithm of celiac disease should include at least two serological markers (antigliadin antibodies and anti-endomysial and/or anti-transglutaminase antibodies) and IgA quantification. Genomic typing should be carried out if one or more markers are positive or if the subject belongs to any of the risk groups. The physician should decide on the advisability of intestinal biopsy on the basis of the patient's clinical and immunological history.