Virulence properties and antimicrobial resistance of Pseudomonas aeruginosa isolated from cave waters at Roraima Tepui, Guayana Highlands.

Pseudomonas aeruginosa is a prominent member of emerging waterborne pathogens. The environmental reservoirs of multi-resistant phenotypes and other virulence factors in this bacterium are poorly understood. Our study aimed to determine the virulence properties of P. aeruginosa isolated from Roraima Sur Cave (RSC) waters at Guayana Highlands. Based on the best identification at species level by biochemical tests, 16S rRNA sequencing and phylogenetic inferences, one RSC isolate named LG11 was characterized for virulence properties in comparison with P. aeruginosa reference strains. PCR amplification of alginate, elastase, exoenzyme S, exotoxin A, neuraminidase and Quorum-Sensing genes showed a high virulence potential in LG11. This isolate demonstrated multi-resistance to ceftriaxone, tigecycline and imipenem. Pyocyanin production was greater in LG11 (0·478 µg ml-1 ) than the strain ATCC 10145 (0·316 µg ml-1 ), but the highest pigment concentration (2·140 µg ml-1 ) was displayed by the clinical strain CVCM 937 (P = 0·000175). Pronounced biomass production on granite and glass (P < 0·05) and well-developed biofilms indicated the ability of P. aeruginosa from RSC to colonize surfaces found in human and healthcare environments. These data suggest that waters from pristine ecosystems such as RSC could be reservoirs of this opportunistic bacterium carrying important virulence properties with potential epidemiological implications. SIGNIFICANCE AND IMPACT OF THE STUDY: This study shows for the first time the occurrence of virulence genes and multi-resistance to antimicrobials in Pseudomonas aeruginosa isolated from cave waters at Guayana Highlands. These findings, together with the biofilm formation on surfaces found in human and healthcare settings, suggest public health risks and the potential of these virulence properties to be transferred from or to native populations in waters. Our results provide important insights to the current knowledge of P. aeruginosa in the environment, setting the basis for future studies driven to assess reservoirs of multi-resistant bacteria and virulence features unknown in pristine ecosystems.

[The telemedicine as tool of management on chronic disease: the experience of ASL ROMA 3 (Italian Local Authority). Impact, outcomes and results]. / La telemedicina come strumento di presa in carico globale e per la concreta integrazione ospedale territorio: l'esperienza della ASL ROMA 3.

The increase of chronic diseases prevalence has created the need to adapt care models. Telemedicine applications play an increasingly important role in health care and provide tools that are indispensable for home health care, remote patient monitoring, disease management, and lastly are enable patients to have more control of their own well being. The paper presents an Italian Healthcare Local Authority Experience. The objective of paper was to evaluate the impact of telemedicine on patients with long-term conditions at high risk for rehospitalization or an emergency department visit, in terms of target disease control (diabetes, hypertension, heart failure, and chronic obstructive pulmonary disease). The outcomes are highly positive. They register the decrease of access to emergency care, the reduction of waiting list for the next visits and the increase of customer satisfaction.

Molecular detection of Chlamydia trachomatis and semen quality of sexual partners of infertile women.

Chlamydia trachomatis is considered as the bacterium that is more sexually transmitted as cause of male urethritis, epididymitis, orchitis and infertility. A total of 116 semen samples of men whose couples are infertile women were analysed. The quality of the semen was measured by standard procedures recommended by WHO while C. trachomatis was detected by the PCR assay. Thirty-seven semen samples were positive for C. trachomatis (31.9%). Regarding semen analysis, no different values were observed between positive and negative samples to C. trachomatis. However, the presence of leucocytes and erythrocytes suggests an inflammatory process; however, these were high in negative samples to C. trachomatis. Furthermore, an association between low seminal volume at 1, 5 ml and the positivity to C. trachomatis was observed (OR=2, 1; CI95 % 1,16-3,07). The total semen volume is a contribution by the various accessory glands (this reflects the secretory activity of the glands); a low semen volume could be due to an obstruction of the ejaculatory duct or infection of accessory glands by C. trachomatis. More studies are necessary to identify the causes of a reduced semen volume.

Changes in spinal alignment. / Alteraciones de la alineación vertebral.

Spinal misalignments are a common reason for consultation at primary care centers and specialized departments. Misalignment has diverse causes and is influenced by multiple factors: in adolescence, the most frequent misalignment is scoliosis, which is idiopathic in 80% of cases and normally asymptomatic. In adults, the most common cause is degenerative. It is important to know the natural history and to detect factors that might predict progression. The correct diagnosis of spinal deformities requires specific imaging studies. The degree of deformity determines the type of treatment. The aim is to prevent progression of the deformity and to recover the flexibility and balance of the body.

Yr60, a Gene Conferring Moderate Resistance to Stripe Rust in Wheat.

Stripe rust, caused by Puccinia striiformis f. sp. tritici W., is a devastating disease of wheat worldwide. A new stripe rust resistance gene with moderate seedling and adult plant resistance was mapped using an F5 recombinant inbred line (RIL) population developed from the cross of the resistant parent 'Almop' with the susceptible parent 'Avocet'. The parents and RILs were phenotyped for seedling stripe rust response variation in a greenhouse and in field trials at Toluca, Mexico for 2 years. Almop showed moderate levels of resistance at both seedling and adult plant stages compared with the highly susceptible response of Avocet. The distribution of homozygous resistant, homozygous susceptible, and segregating RILs conformed to segregation at a single locus. Seedlings and adult plant responses were correlated, indicating that the same gene conferred resistance at both stages. A bulk segregant analysis approach with widely distributed simple sequence repeat (SSR) markers mapped the resistance gene to the distal region of the long arm of chromosome 4A. The SSR marker wmc776 cosegregated with this gene, whereas markers wmc219 and wmc313 were tightly linked and both located at 0.6 centimorgans. The resistance locus was designated Yr60.

Genetic Analysis of Resistance to Leaf Rust and Yellow Rust in Spring Wheat Cultivar Kenya Kongoni.

The Kenyan wheat (Triticum aestivum L.) 'Kenya Kongoni' exhibits high levels of adult plant resistance (APR) to leaf rust (LR) and yellow rust (YR). We determined the genomic regions associated with LR and YR resistance in a population of 148 recombinant inbred lines generated from a cross between 'Avocet-YrA' and Kenya Kongoni. Field experiments to characterize APR to LR and YR were conducted in four and two Mexican or Uruguayan environments, respectively. A linkage map was constructed with 438 diversity arrays technology and 16 simple-sequence repeat markers by JoinMap 4.1 software. Genetic analyses showed that resistance to both rusts was determined by four to five APR genes, including Lr46/Yr29 and Sr2/Lr27/Yr30. Quantitative trait loci (QTL) analysis indicated that pleiotropic APR loci QYLr.cim-1BL corresponding to Lr46/Yr29 and QYLr.cim-7BL that is a putative novel QTL accounted for 5 to 57% and 12 to 35% of the phenotypic variation for resistance to LR and YR, respectively. These loci, in combination with another three LR QTL and two YR QTL, respectively, conferred high levels of resistance to both LR and YR in wheat under Mexican and Uruguayan environments. Among other detected QTL, QLr.cim-1DS, QLr.cim-2BL, and QYLr.icm-7BL may be new loci for APR to both rusts in common wheat.

Microsatellite markers for the Cabreúva tree, Myroxylon peruiferum (Fabaceae), an endangered medicinal species from the Brazilian Atlantic Forest.

The Cabreúva tree, Myroxylon peruiferum, is an endangered tropical species from Brazil used in forest restoration projects. It is known for its medicinal properties. Eleven microsatellite markers were developed for this species, from a microsatellite-enriched library. Nine of these markers, characterized in 30 individuals from a semideciduous forest remnant population in southeast Brazil, were polymorphic, with allele numbers ranging from 2 to 8 per locus; expected and observed heterozygosities ranged from 0.103 to 0.757 and 0.107 to 0.704, respectively. One locus (Mpe-C04) showed significant deviation from Hardy-Weinberg equilibrium, probably due to null alleles. Two other loci (Mpe-E09 and Mpe-H07) were monomorphic in this population. These microsatellite loci should be useful for future population genetic studies of this species.

Genetic Analysis of Resistance to Leaf Rust and Stripe Rust in Wheat Cultivar Francolin#1.

Leaf rust and stripe rust are important diseases of wheat and can be controlled by growing resistant varieties. We investigated the genetic basis of resistance to both rusts in 198 F5 recombinant inbred lines derived from a cross between 'Avocet' and 'Francolin#1'. The population was phenotyped in greenhouse and field, and genotyped with known gene-associated molecular markers. Seedling resistance of Francolin#1 to leaf and stripe rusts was attributed to the loosely linked genes Lr16 and YrF, respectively, with a recombination frequency of 0.36. Field segregation indicated that adult plant resistance (APR) to leaf and stripe rusts was conferred by three and five additive genes, respectively. Among them, Lr46/Yr29 was associated with resistance to both rusts in Francolin#1, Lr16 reduced field leaf rust severity by 8 to 9%, and YrF contributed to 10 to 25% reductions in stripe rust severity. The Lr16 region was also associated with a 5 to 16% reduction in stripe rust severity, which is likely due to its linkage with YrF or another unidentified stripe rust APR gene. Significant additive effects on stripe rust were detected between YrF and Yr29. We conclude that APR in Francolin#1 to leaf and stripe rusts involves a combination of seedling and APR genes.

Lr72 Confers Resistance to Leaf Rust in Durum Wheat Cultivar Atil C2000.

Leaf rust, caused by Puccinia triticina (Pt), has become a globally important disease for durum wheat (Triticum turgidum subsp. durum) since the detection of race group BBG/BN, which renders ineffective a widely deployed seedling resistance gene present in several popular cultivars including Mexican cultivars Altar C84 and Atil C2000. The resistance gene continues to play a key role in protecting durum wheat against bread wheat-predominant races since virulence among this race group has not been found. We developed F3 and F5 mapping populations from a cross between Atil C2000 and the susceptible line Atred #1. Resistance was characterized by greenhouse seedling tests using three Pt races. Segregation tests indicated the presence of a single gene, which was mapped to the distal end of 7BS by bulk segregant analysis. The closest marker, wmc606, was located 5.5 cM proximal to the gene. No known leaf rust resistance genes are reported in this region; this gene was therefore designated as Lr72. The presence of Lr72 was further investigated in greenhouse tests in a collection of durum wheat using 13 Pt races. It was concluded that at least one additional gene protects durum wheat from bread wheat-predominant Pt races.

Genetic Analysis of Adult Plant Resistance to Yellow Rust and Leaf Rust in Common Spring Wheat Quaiu 3.

Identifying and utilizing rust resistance genes in wheat has been hampered by the continuous and rapid emergence of new pathogen races. A major focus of many wheat breeding programs is achieving durable adult plant resistance (APR) to yellow (stripe) rust (YR) and leaf (brown) rust (LR), caused by Puccinia striiformis and P. triticina, respectively. This study aimed to determine the genetic basis of resistance to YR and LR in the common spring wheat 'Quaiu 3'. To that end, we evaluated 198 F5 recombinant inbred lines (RILs), derived from a cross of susceptible 'Avocet-YrA' with Quaiu 3, for APR to LR and YR in artificially inoculated field trials conducted in Mexico during the 2009 and 2010 growing seasons. High narrow-sense heritability (h2) estimates, ranging between 0.91 and 0.95, were obtained for both LR and YR disease severities for both years. The quantitative and qualitative approaches used to estimate gene numbers showed that, in addition to known resistance genes, there are at least two to three APR genes associated with LR and YR resistance in the RIL population. The moderately effective race-specific resistance gene Lr42 and the pleiotropic slow-rusting APR gene Lr46/Yr29 were found to interact with additional unidentified APR genes. The unidentified APR genes should be of particular interest for further characterization through molecular mapping, and for utilization by wheat breeding programs.

[New advances in anticoagulation: is it time to forget about heparin and vitamin K antagonists? No]. / Novedades en anticoagulación. Nos olvidamos ya de la heparina y las antivitaminas K? No.

The boost given to the new anticoagulants by the results of clinical trials is beginning to jeopardize the hegemony of coumadin and heparin therapy, the cornerstone of anticoagulation in the last 50 years. The safety and effectiveness of this new drug family with respect to warfarin and low-molecular weight heparin in the different facets of anticoagulation has been demonstrated, both in prophylaxis (total hip and knee replacement) and in treatment (atrial fibrillation and venous thromboembolic disease). These agents seem to offer superior convenience compared with their predecessors, although it is not clear whether this translates into greater treatment adherence when the data are analyzed in depth. Another drawback of these agents is their price, a consideration of major importance in the last few years, and which would only be offset by savings in the cost of the routine blood monitoring required for coumadin agents, available in hospitals. Finally, the populations excluded from the clinical trials should not be forgotten, as they are the last obstacle to be overcome and the basis for justifying the maintenance of heparin or coumadin therapy, depending on the case. The present article provides a more detailed analysis of these arguments, which serve as the basis for a reflection on the early retirement of classical anticoagulants.

Craniofacial and intraoral phenotype of Robinow syndrome forms.

Robinow syndrome (RS) is a rare genetic condition with two inheritance forms, autosomal dominant RS (DRS) and autosomal recessive RS (RRS). The characteristic features of this syndrome overlap in both inheritance forms, which make the clinical differential diagnosis difficult, especially in isolated cases. The objective of this study was to identify differences in the craniofacial and intraoral phenotype of patients with DRS and RRS. The characteristics and frequency of 13 facial and 13 intraoral clinical features associated with both DRS and RRS were assessed by direct dysmorphology examination and using a digital photographic analysis in 12 affected subjects. Although the phenotypic presentation varied and overlapped in the two forms of the syndrome, there were differences in the severity of the craniofacial and intraoral features. The craniofacial dysmorphology of RS was more severe in RRS. Nasal anomalies were the most frequent craniofacial features in both DRS and RRS. In contrast, intraoral features such as wide retromolar ridge, alveolar ridge deformation, malocclusion, dental crowding and hypodontia were more severe in patients with DRS. Overall, facial characteristics appeared less pronounced in adult subjects compared to younger subjects. Craniofacial and intraoral findings are highly variable in RS, with abnormalities of the intraoral structures being more prominent in the DRS form. We propose that the difference in the alveolar ridge deformation pattern and severity of other intraoral characteristics could enhance the differential diagnosis of the two forms of this syndrome.

Analysis of dermatologic events in patients with cancer treated with lapatinib.

PURPOSE: Dermatologic events (DEs) in patients with cancer treated with lapatinib, a small-molecule dual tyrosine kinase inhibitor (TKI) of epidermal growth factor receptor (EGFR [ErbB1]) and HER2 (ErbB2), were characterized. PATIENTS AND METHODS: Nine clinical trials of metastatic cancer were included in this analysis. Lapatinib was administered at doses ranging from 1000 to 1500 mg/day as monotherapy (n=928) or in combination with paclitaxel or capecitabine (n=491). Patients not treated with lapatinib comprised the control group. Dermatologic events included hand-foot syndrome, rash, hair disorder, dry skin, pruritus/urticaria, skin disorder, skin infection, and nail disorder; DEs were characterized based on type, time to onset, severity, duration, and required interventions. RESULTS: Fifty-eight percent of patients treated with lapatinib monotherapy, 74% treated with lapatinib plus paclitaxel or capecitabine, and 53% in the control group developed DEs. Among patients receiving lapatinib monotherapy, 55% experienced grade 1/2 DEs, 3% had grade 3 DEs, and no grade 4 DEs were observed. The most common DE was rash (43%); all other events occurred in

Rhodolith primary and carbonate production in a changing ocean: The interplay of warming and nutrients.

Rhodolith beds, like many other marine ecosystems, are affected by climate change that is causing an increase in the magnitude and frequency of extreme high temperature events (heat waves). Unfortunately, this does not represent the sole peril for these communities, as coastal urbanization in conjunction with altered precipitation patterns can increase terrestrial-derived nutrient input. In Brazil, rhodolith beds are among the most extensive coastal benthic ecosystems, but despite their vast distribution and great ecological and economic importance, studies on the productivity of these communities and the impact of changing environmental conditions are almost non-existent. This study addressed the individual and combined effects of increases in temperature and nutrient concentration on the physiological performance of two widely distributed rhodolith species, Lithothamnion crispatum and Melyvonnea erubescens. The results showed species-specific responses in net photosynthetic performance, with no response in L. crispatum, while M. erubescens responded negatively to both increase in temperature and nutrients. In contrast, calcification in both species showed a significant decline at high temperature. No interactive effects were found between temperature and nutrients, yet their combined negative effects were additive, resulting in negative daily-integrated net productivity and a large decline in daily carbonate production in both species. This has strong implications for rhodolith bed primary productivity and carbonate production, as heat waves may potentially cause a strong decline in carbonate production (ca. 50% loss), accompanied by a severe drop in primary productivity that will be even more pronounced under high-nutrient conditions. Also, the species-specific responses to changes in temperature and nutrient concentration suggest that the magnitude of impact of these factors on rhodolith bed productivity will depend on the species dominating the community and may finally result in changes in rhodolith community composition.

A phase II study of lapatinib monotherapy in chemotherapy-refractory HER2-positive and HER2-negative advanced or metastatic breast cancer.

BACKGROUND: The efficacy and tolerability of the epidermal growth factor receptor/human epidermal growth factor receptor type 2 (HER2) tyrosine kinase inhibitor lapatinib in refractory metastatic breast cancer were assessed. PATIENTS AND METHODS: In a phase II, open-label study, patients with previously treated HER2-positive (n = 140) or HER2-negative (n = 89) metastatic breast cancer received once-daily oral lapatinib 1500 mg/day. RESULTS: Most (76%) patients had received four or more lines of prior therapy. The response rate in the HER2-positive cohort was 4.3% by investigator assessment and 1.4% by independent assessment. Both assessments established that approximately 6% of HER2-positive patients derived clinical benefit from lapatinib, being progression free for >/=6 months. No objective tumor responses occurred in the HER2-negative cohort. Independent review assessments of median time to progression and median progression-free survival were similar in the HER2-positive and HER2-negative cohorts (9.1 and 7.6 weeks, respectively). All responders exhibited HER2 overexpression (3+ by immunohistochemistry), and five of six responders were HER2 amplified by FISH. Lapatinib-related adverse events, including diarrhea (54%), rash (30%), and nausea (24%), were primarily mild to moderate in severity. CONCLUSIONS: Lapatinib monotherapy had modest clinical activity in HER2-positive metastatic breast cancer that progressed on prior trastuzumab regimens. No apparent clinical activity was observed in chemotherapy-refractory, HER2-negative disease.

Obesity, voracity, and short stature: the impact of glutamate on the regulation of appetite.

BACKGROUND: World-wide obesity has risen to alarming levels. We present experimental support for a new and very challenging hypothesis linking obesity, voracity, and growth hormone (GH) deficiency, to the consumption of elevated amounts of the amino-acid glutamate (GLU). Supraphysiological doses of GLU are toxic for neuronal cells. METHODS: Human data were obtained from 807,592 German conscripts born between 1974 and 1978, and from 1,432,368 women of the German birth statistics (deutsche Perinatalerhebung) 1995-1997. The effects of orally administered monosodium glutamate (MSG) were investigated in 30 pregnant Wistar rats and their offspring. Pregnant animals either received no extra MSG, or 2.5 g MSG, or 5 g MSG per day, up to the end of the weaning period. In all, 2.5 g, respectively 5 g, MSG accounted for some 10%, respectively 20%, of dry weight of the average daily food ration. After weaning, MSG feeding was continued in the offspring. FINDINGS: Morbid obesity associates with short stature. Average stature of conscripts progressively declines when body mass index increases above 38 kg/m2. Also morbidly obese young women are shorter than average though to a lesser extent than conscripts. Oral administration of MSG to pregnant rats affects birth weight of the offspring. Maternal feeding with 5 g MSG per day results in severe birth weight reduction (P<0.01). Weight increments remain subnormal when MSG feeding to the mothers is maintained during weaning (P < 0.01). GH serum levels are affected in animals that received MSG during prenatal life via maternal feeding. Animals that are kept on high MSG diet (5 g MSG per day) continue to show serum GH levels that are as low or even lower than those of MSG injected animals (P < 0.05), both at day 30 and at day 90 of life. Animals that were kept on medium MSG diet (2.5 g MSG per day) showed low serum GH levels at day 30 of life (P < 0.01), but seemed to partially recover before day 90. Almost identical results were observed in IGF-1 serum levels. Oral MSG resulted in dose dependent voracity. The animals fed 5 g MSG per day increased water uptake by threefold (P < 0.01), and food uptake by almost two-fold (P < 0.01). The influence of MSG is in general more marked in males than in females. INTERPRETATION: GLU is a widely used nutritional substance that potentially exhibits significant neuronal toxicity. Voracity, and impaired GH secretion are the two major characteristics of parenterally administered GLU-induced neuronal damage. GLU maintains its toxicity in animals even when administered orally. Males appear to be more sensitive than females. The present study for the first time demonstrates, that a widely used nutritional monosubstance--the flavouring agent MSG--at concentrations that only slightly surpass those found in everyday human food, exhibits significant potential for damaging the hypothalamic regulation of appetite, and thereby determines the propensity of world-wide obesity. We suggest to reconsider the recommended daily allowances of amino acids and nutritional protein, and to abstain from the popular protein-rich diets, and particularly from adding the flavouring agents MSG.

[Results of pulmonary embolism treatment in a tertiary hospital short stay unit. Is this the right place?]. / Resultados del tratamiento médico de la embolia de pulmón en una unidad de corta estancia de un hospital de tercer nivel: ¿es el lugar adecuado?

OBJECTIVES: To determine the mean stay (MS) of patients with pulmonary embolism (PE) in a thrombosis unit (TU) with a short stay unit (SSU) in a tertiary hospital. To compare the data collected with those of other hospitals in the same region, of other regions (Autonomous Communities [AACC]), and within the same hospital in the year before the SSU opened. MATERIAL AND METHODS: A descriptive retrospective observational study that included patients with a diagnosis of PE in the University Hospital Virgen de la Arrixaca (HCUVA) in 2012. These data were classified by hospital department, and used for calculating the mean stay. This was then compared with that of other hospitals in our region, with the rest of the regions, and with the data in 2007 (the last year without a TU). RESULTS: A total of 113patients with PE were included, 60 (53%) in the TU with an MS of 4.39, in Oncology, 7.45, and Internal Medicine (IM), 15.38days. There were no deaths in the TU and only 3 (5%) readmissions. Published data showed that the MS in all hospitals in our region was 8.25, 5.18 in our hospital, and higher in the rest of hospitals. The best AACC was the Basque Country with an MS of 6.85days. In 2007, there were 70patients with PE in the HCUVA, 34 (49%) in IM, with an MS of 8.50, Oncology 11 (31%) with an MS 9.64, and Chest Diseases 3 (4.3%) with an MS 19days, and with an overall mortality of 11% and a rate of readmissions in IM of 6%. CONCLUSION: The mean stay for a PE in the SSU of a TU was lower than in the rest of the hospital departments, lower than the rest hospitals of our region, lower than the rest of the regions, and lower than any department of our hospital before the SSU existed, without increasing the readmission or mortality rate.

Prevalencia de síntomas depresivos en pacientes adultos mayores hospitalizados en el Servicio de Medicina Interna del Hospital Dr. Hernán Henríquez Aravena de Temuco / Prevalence of depressive symptoms in elderly patients admitted to an Internal Medicine Service in Temuco, Chile

INTRODUCCIÓN: La depresión es una patología de alta prevalencia en los adultos mayores, estando asociada a mayor morbimortalidad. Existen escasos estudios sobre prevalencia y caracterización de pacientes geriátricos hospitalizados con síntomas depresivos. MÉTODO: Se entrevistaron pacientes entre enero y marzo de 2020. Criterios de Inclusión: edad > 60 años, admitidos en las últimas 48 horas. CRITERIOS DE EXCLUSIÓN: Pfeiffer ≥ 3, Glasgow < 15, afasia, enfermedad mental, no hispanohablante. RESULTADOS: Se entrevistaron 59 pacientes, 32 mujeres y 27 varones, edad promedio 73,32 (DE 6,63). La prevalencia de test Yesavage-15 positivo fue 32,20% (19), 52,63% (10) en mujeres y 47,37% (9) en hombres. CONCLUSIONES: Los síntomas depresivos en adultos mayores admitidos en un Servicio de Medicina Interna son frecuentes, y no siempre pesquisados durante la hospitalización. La relación significativa entre Yesavage positivo e ideación suicida destaca el rol de los trastornos del ánimo en el suicidio en población geriátrica.

INTRODUCTION: Depression is a highly prevalent pathology in the elderly, associated to higher morbimortality. There are few studies on prevalence and characterization of hospitalized geriatric patients with depressive symptoms. METHOD: Patients were interviewed between january and april 2020. Inclusion criteria: age over 60 years old, admitted in the last 48 hours. EXCLUSION CRITERIA: Pfeiffer ≥ 3, Glasgow < 15, aphasias, mental diseases, no spanish-speaker. RESULTS: 59 patients were interviewed, 32 women and 27 men, mean age of 73,32 (DE 6.63) years old. Positive Yesavage score prevalence was 32,20% (19), 52,63% (10) in women and 47,37% (9) in men. CONCLUSIONS: Depressive symptoms in patients admitted to an Internal Medicine service are frequent, and often undetected during hospitalization.

Purification of a myotoxin from the toadfish Thalassophryne maculosa (Günter) venom.

Venom was milked by gently pressing the base of the opercular and dorsal fin spines. Three fractions were obtained by molecular exclusion high pressure liquid chromatography (HPLC) (Protein Pak 125SW, Millipore Corporation) column, but only the last one with 22.7 min retention time (rt) was biological active (TmPP-22.7). This fraction was rechromatographed on reversed phase HPLC chlorobutylsilane columns (C4, Vydac) nine fractions were obtained, but only one (TmC4-47.2) with 47.2 min rt was biologically active. MALD-TOF mass analysis was carried out on two samples of TmC-47.2 and the results were 15,161.36 and 15,154.70 a.m.u., respectively. Raw venom (1040 microg/ml) depolarised frog (Hyla crepitans) muscle irreversibly from -85 (-88, -81) mV (n=20, median and its 95% CI) to -18 (-24, -15) mV (n=24). The biological activity in TmPP-22.7 (38 microg/ml), which depolarised muscle fibres from -79 (-82, -76) mV (n=20) to -63 (-69 -57) mV (n=24). The depolarising fraction was TmC4-47.2 (50 microg/ml) which depolarised muscles from -87 (91, -82) mV (n=33) to -63 (-76 -51) mV (n=53); the depolarising effect at this concentration was completely reversed on washing with normal saline for 2 h. Muscles treated with 1 microM tetrodotoxin (TTX) were depolarised from -80 (-85, -72) mV (n=49) to -44 (-56, -31) mV (n=44) when 100 microg/ml TmC4-47.2 were applied with TTX; washing 130 min with 1 microM TTX repolarised to -59 (-69, -50) mV (n=25). We also present evidence that TmC4-47.2 induces myonecrosis in mice.