Incidence and management of etoposide hypersensitivity in pediatrics

Introduction: Etoposide is widely used in pediatric chemotherapy. At the moment, there is conflicting data in the literature on the incidence of etoposide hypersensitivity. The aim of this study is to assess etoposide hypersensitivity incidence and to evaluate potential risk factors for hypersensitivity in pediatrics.Methods: Retrospective study of pediatric patients treated with etoposide since June 2013 until September 2020. Symptoms of hypersensitivity, grade of hypersensitivity reaction according to the Common Terminology Criteria for Adverse Events guidelines and management of hypersensitivity reaction data were collected.Results: 213 patients were treated with etoposide during the period of the study. The mean age was 6.8 (range 0.2-17 years), 58.7% were male. Doses administered ranged from 100-200 mg/m2 and from 2.5-6 mg/kg, median infusion rate was 55 (2-200) mg/h and median infusion concentration was 0.3 (0.2-0.5) mg/ml. Hypersensitivity reactions occurred in 23 (10.8%) patients, 3 and 20 cases were classified as grade I and II respectively. All hypersensitivity reactions were successfully managed with medication and reduction of the infusion rate. No statistical significant association between the variables collected and the apparition of hypersensitivity reactions was found.Conclusions: The incidence of hypersensitivity reaction was higher than the described in the summary of products characteristics. All reactions were mild being resolved by standard treatment. (AU)

Introducción: Existen datos contradictorios en la literatura sobre la incidencia de hipersensibilidad a etopósido. El objetivo de este estudio fue evaluar la incidencia de hipersensibilidad asociada a etopósido y posibles factores de riesgo asociados en pacientes pediátricos en un hospital de tercer nivel.Métodos: Estudio retrospectivo de pacientes pediátricos tratados con etopósido desde junio de 2013 hasta septiembre de 2020. Se recogieron los datos acerca de síntomas asociados a la reacción de hipersensibilidad, grado de la reacción de hipersensibilidad según la Common Terminology Criteria for Adverse Events Guidelines y el manejo de la reacción de hipersensibilidad.Resultados: Se identificaron 213 pacientes tratados con etopósido. La mediana de edad fue de 6,75 (rango 0,16-17 años), el 58,68% eran hombres. Las dosis administradas variaron entre 100-200 mg/m2 y 2,5-6 mg/kg, las medianas de velocidad de infusión y concentración fueron 55 (2-200) mg/h y 0,3 (0,2-0,5) mg/ml respectivamente. Las reacciones de hipersensibilidad ocurrieron en 23 (10,8%) pacientes, clasificadas como grado I (3) y II (20). Todas las reacciones fueron manejadas con éxito mediante medicación y reducción de la velocidad de infusión. No se encontró asociación estadística entre las variables evaluadas y las reacciones de hipersensibilidad.Conclusiones: La incidencia de reacciones de hipersensibilidad fue superior a la descrita en ficha técnica. Todas las reacciones fueron moderadas y manejadas con tratamiento estándar. (AU)

La presencia de las enfermeras en las residencias de mayores en Cantabria / The presence of nurses in Cantabria old people's home

Objetivos: Caracterizar la situación de la asistencia sociosanitaria y de dependencia en la comunidad autónoma de Cantabria y analizar la aplicación de cuidados por parte del personal de enfermería tanto del centro de salud como de los propios de los centros sociosanitarios y de dependencia. Metodología:Estudio descriptivo transversal y multicéntrico en el cual se diseñó una encuesta ad-hoc anónima enviada a todos los centros sociosanitarios de la comunidad autónoma de Cantabria para su cumplimentación. Resultados: Se obtuvieron 54 de las 60 encuestas enviadas, el total de residentes en centros sociosanitarios de Cantabria es de 5.335 personas con una media del 86,4% de pacientes dependientes y un total de 169 profesionales de enfermería que trabajan en estos centros. La ratio enfermera/paciente es de 32 pacientes por enfermera y la media de estos profesionales es de 4,12. La enfermera del centro de salud acude a los centros sociosanitarios 51,66 min/semana. Conclusiones: La situación actual es deficitaria en enfermeras por centro y en ratio por residente, cifras que no posibilitan la atención de enfermería adecuada. La ausencia de profesionales de enfermería no garantiza la continuidad de cuidados, la prevención ni el seguimiento de patologías crónicas. La presencia de enfermeras propias supone una mayor implicación, mejoras en la calidad de vida, calidad asistencial, mayor satisfacción general, minimización de errores y un descenso del intrusismo profesional (AU)

Objectives: Characterize the situation of the socio-sanitary assistance and dependency situation in the autonomous community (region) of Cantabria and to analyze the application of care by the nurses of the health center and the nurses of the sociosanitary and dependency centers. Methodology: Cross-sectional and multicenter descriptive study in which an anonymous ad-hoc survey was designed and sent to all the socio-sanitary centers of the autonomous community of Cantabria to be filled out. Results: A total of 54 of the 60 surveys sent were returned; the total number of residents in socio-sanitary centers in Cantabria is 5,335 people, with an average of 86.4% of dependent patients and a total of 169 nursing professionals who work in these centers. The nurse/patient ratio is 32 patients per nurse and the average of these professionals is 4.12. The health center nurse goes to the socio-sanitary centers 51.66 min/week. Conclusions: The current situation is deficient in nurses per center and in ratio per resident, figures that do not allow for adequate nursing care. The absence of nursing professionals does not guarantee the continuous care, prevention or monitoring of chronic pathologies. The presence of own nurses implies greater involvement, improvements in quality of life, quality of care, greater general satisfaction, minimization of errors and a decrease in professional intrusion (AU)

Carboplatin Area Under the Curve dosing in pediatric patients: influence of glomerular filtration rate measurement / Dosificación de carboplatino por el Área Bajo la Curva en pediatría: influencia de la medida de la tasa de filtrado glomerular

Introduction: Carboplatin dosage methods are often based on renal clearance. An accurate determination of the glomerular filtration rate (GFR) can be obtained by measuring 51Cr-EDTA clearance; however, this method is laborious. For that matter, various formulae have been developed to estimate the GFR. The aim of this study is to compare carboplatin doses calculated by Mann/Pein formula with GFR measured by 51Cr-EDTA clearance and GFR estimated with Schwartz formulae in children.Methods: All cancer paediatric patients whose GFR was measured by 51Cr-EDTA were included. GFR was also estimated with Schwartz formulae. To calculate carboplatin dose, Mann/Pein formula was used. A target Area Under the Curve (AUC) of 5 mg/ml/min was chosen. Carboplatin doses were calculated with two different values of GFR calculated previously.Results: A total of 33 patients were identified with a median age of 10 years old (range 1-17), 63.6% were males. The median weight, height and BSA were 28 kg (range 8-84.4 kg), 137 cm (range 64-182 cm) and 1.04 m2 (range 0,37-2,1 m2) respectively. The mean of carboplatin doses calculated with GFR measured by 51Cr-EDTA was 274.3±135.7 mg and with GFR estimated with Schwartz formulae was 364.9±156.6 mg. The mean difference between methods was 90.6 mg, P<0.001.Conclusion: Carboplatin doses calculated with GFR estimated by Schwartz were statistically higher than those measured with 51Cr-EDTA. This variability may be a risk factor leading to inadequate dosage of patients treated with carboplatin. (AU)

Introducción: Existen métodos de dosificación de carboplatino que emplean el aclaramiento renal. La tasa de filtrado glomerular (TFG) puede ser determinada de forma precisa mediante el aclaramiento de Cr51-EDTA, sin embargo, este método es laborioso. Por ello, diversas fórmulas se han desarrollado para estimar la TFG. El objetivo de este estudio es comparar las dosis de carboplatino calculadas empleando la TFG medida con Cr51-EDTA y la estimada con la fórmula de Schwartz en pediatría.Métodos: Todos los pacientes oncológicos pediátricos a los cuales se les midió la TFG mediante Cr51-EDTA fueron incluidos. Las TFG fueron también estimadas con la fórmula de Schwartz. Para calcular la dosis de carboplatino se empleó la fórmula de Mann/Pein. Se seleccionó un objetivo de Área Bajo la Curva (AUC) de 5 mg/ml/min. Las dosis de carboplatino fueron calculadas empleando los dos valores de TFG obtenidos previamente.Resultados: Se identificaron un total de 33 pacientes con una mediana de edad de 10 años (rango 1-17 años), el 63,6% eran hombres. La mediana de dosis de carboplatino calculadas con la TFG medida con Cr51-EDTA y la estimada con la fórmula de Schwartz fueron respectivamente 274,3±135,7 mg y 364,9 ±156,6 mg. La diferencia media entre métodos fue de 90,6 mg (p<0,001). Conclusión: Las dosis de carboplatino calculadas con la TFG estimada por la fórmula de Schwartz fueron significativamente superiores a las obtenidas con la TFG medida con Cr51-EDTA. Esta variabilidad puede ser un factor de riesgo pudiendo provocar una dosificación inadecuada en pacientes tratados con carboplatino. (AU)

The rye transcription factor ScSTOP1 regulates the tolerance to aluminum by activating the ALMT1 transporter.

Plants have evolved different mechanisms to increase their tolerance to aluminum (Al) toxicity and low pH in the soil. The Zn finger transcription factor SENSITIVE TO PROTON RHIZOTOXICITY1 (STOP1) plays an essential role in the adaptation of plants to Al and low pH stresses. In this work, we isolated the ScSTOP1 gene from rye (Secale cereale L.), which is located on chromosome 3RS. The ectopic expression of ScSTOP1 complements the Arabidopsis stop1 mutation in terms of root growth inhibition due to Al and pH stress, as well as phosphate starvation tolerance, suggesting that rye ScSTOP1 is a functional ortholog of AtSTOP1. A putative STOP1 binding motif was identified in the promoter of a well-known STOP1 target from rye and Arabidopsis and was later corroborated by genomic DAP-seq analyses. Coexpression analyses verified that ScSTOP1 activated the promoter of ScALMT1. We have also identified a putative phosphorylatable serine in STOP1 that is phylogenetically conserved and critical for such activation. Our data indicated that ScSTOP1 also regulated Al and pH tolerance in rye.

Isolation and characterization of a new MATE gene located in the same chromosome arm of the aluminium tolerance (Alt1) rye locus.

Aluminium (Al) toxicity is the major constraint for crop productivity in acid soils. Wild rye species (Secale spp.) exhibit high Al tolerance, being a good source of genes related to this trait. The Alt1 locus located on the 6RS chromosome arm is one of the four main loci controlling Al tolerance in rye and is known to harbour major genes but, so far, none have been found. Through synteny among the short arm of the rye chromosome 6R and the main grass species, we found a candidate MATE gene for the Atl1 locus, later named ScMATE3, which was isolated and characterized in different Secale species. The sequence comparisons revealed both intraspecific and interspecific variability, with high sequence conservation in the Secale genus. SNP with replacement substitution that changed the structure of the protein and can be involved in the Al tolerance trait were found in ScMATE3 gene. The predicted subcellular localization of ScMATE3 is the vacuolar membrane which, together with the phylogenetic relationships performed with other MATE genes of the Poaceae related to Al detoxification, suggest involvement of ScMATE3 in an internal tolerance mechanism. Moreover, expression studies of this gene in rye corroborate its contribution in some Al resistance mechanisms. The ScMATE3 gene is located on the 6RS chromosome arm between the same markers in which the Alt1 locus is involved in Al resistance mechanisms in rye, thus being a good candidate gene for this function.

Effectiveness of commercial face masks to reduce personal PM exposure.

Cycling and walking are promoted as means of transportation which can contribute to the reduction of traffic pollution in urban areas. However, cyclists and pedestrians may be exposed to high concentrations of air pollutants due to their proximity to vehicle emissions. Commercial face mask respirators are widely used, in both developing and developed countries, as an individual protective measure against particle pollution. However scientific data on the efficacy of face mask respirators in reducing airborne particle exposure is limited. In this study, a custom experimental set-up was developed in order to measure the effectiveness of nine different respirators under real environmental conditions in terms of particle mass concentration below 2.5 µm (PM2.5), particle number concentration (PNC), Lung Deposited Surface Area (LDSA) and Black Carbon concentration (BC). Face mask performances were assessed in a typical traffic affected urban background environment in the city of Barcelona under three different simulated breathing rates to investigate the influence of flow rate. Results showed a median face mask effectiveness for PM2.5 equal to 48% in a range of 14-96%, 19% in a range of 6%-61% for BC concentration, 19% in a range of 4%-63% for PNC and 22% in a range of 5%-65% for LDSA. For each pollutant under investigation, the best performance was found always with the same mask (N7) although it is not the most expensive (in a range of price of 1 to 44, its cost was 20 euros), which has a filter on the entire surface except for the 2 exhalation valves where air cannot enter but just exit and shows a good fit on the dummy head.

Molecular cloning of TaMATE2 homoeologues potentially related to aluminium tolerance in bread wheat (Triticum aestivum L.).

Recently, members of the MATE family have been implicated in aluminium (Al) tolerance by facilitating citrate efflux in plants. The aim of the present work was to perform a molecular characterisation of the MATE2 gene in bread wheat. Here, we cloned a member of the MATE gene family in bread wheat and named it TaMATE2, which showed the typical secondary structure of MATE-type transporters maintaining all the 12 transmembrane domains. Amplification in Chinese Spring nulli-tetrasomic and ditelosomic lines revealed that TaMATE2 is located on the long arm of homoeologous group 1 chromosomes. The transcript expression of TaMATE2 homoeologues in two diverse bread wheat genotypes, Barbela 7/72/92 (Al-tolerant) and Anahuac (Al-sensitive), suggested that TaMATE2 is expressed in both root and shoot tissues of bread wheat, but mainly confined to root rather than shoot tissues. A time-course analysis of TaMATE2 homoeologue transcript expression revealed the Al responsive expression of TaMATE2 in root apices of the Al-tolerant genotype, Barbela 7/72/92. Considering the high similarity of TaMATE2 together with similar Al responsive expression pattern as of ScFRDL2 from rye and OsFRDL2 from rice, it is likely that TaMATE2 also encodes a citrate transporter. Furthermore, the TaMATE2-D homoeologue appears to be near the previously reported locus (wPt0077) on chromosome 1D for Al tolerance. In conclusion, molecular cloning of TaMATE2 homoeologues, particularly TaMATE2-D, provides a plausible candidate for Al tolerance in bread wheat that can be used for the development of more Al-tolerant cultivars in this staple crop.

Manejo farmacológico del dolor agudo postoperatorio en España. Datos de la encuesta nacional de la Sociedad Española del Dolor (SED) / Pharmacological management of acute postoperative pain in Spain. Data from the national survey from the Spanish Pain Society (SED) (iasp chapter)

Introducción: La Sociedad Española del Dolor (SED), y concretamente el Grupo de Trabajo de Dolor Agudo de la misma (GTDASED), llevó a cabo una encuesta a nivel nacional para conocer la situación del manejo del dolor postoperatorio en España así como las distintas pautas analgésicas empleadas. En este artículo se analizan estas pautas y se comparan atendiendo a la presencia o no de Unidad de Dolor Agudo (UDA) o Programas de Gestión del Dolor Postoperatorio (PGDPO) entre aquellos hospitales de más de 200 camas que participaron en la misma. Pacientes y métodos: Los miembros de la Sociedad Española del Dolor y todos los responsables del tratamiento del dolor postoperatorio de los hospitales españoles fueron invitados a contestar un cuestionario estructurado. Para el análisis los hospitales se dividieron en 2 grupos: < 200 camas y ≥ 200 camas. Las variables categóricas fueron descritas como porcentajes con el 95 % de intervalo de confianza y las continuas con la mediana y el rango intercuartil. Se analizaron las pautas farmacológicas empleadas, sus asociaciones así como las vías de administración. Resultados: En total las respuestas implicaron a 112 (78 con > 200 camas y 34 con < 200 camas) hospitales del Sistema Nacional de Salud Español. Se obtuvieron respuestas del 42,4 % de hospitales con ≥ 200 camas, y del 9,6 % de los de < 200 camas, por lo que solo se analizó el primer grupo en lo que respecta a pautas de administración de analgesia, mientras que en el caso aislado de los fármacos empleados se analizaron los 112 hospitales que respondieron la encuesta. Las pautas orales se emplean en el 60,3 % de los hospitales (sin diferencias entre aquellos con y sin UDA), las intramusculares (i.m.) en un 15,8 %, subcutáneas (s.c.) 48,3 %, intravenosas (i.v) en bolos 75,9 %, intravenosas continuas 77,6 %, intravenosas PCA 60,3 %, catéteres en plexo nervioso a bolos 51,7 %, catéteres en plexo nervioso e infusión continua 56,9 %, epidurales en bolos 40,4 %, epidurales continuas 75,9 %, epidurales en PCA 43,1 %, (63,8 % anestésico local y opioide y 15,8 % anestésico local con otros fármacos [adrenalina/clonidina/ opioide]). Solo hubo diferencia estadísticamente significativa en función de la presencia o no de UDA en el centro, en las pautas: intravenosas en PCA, catéteres en plexo nervioso con infusión continua y epidural en PCA (más empleadas en los hospitales con UDA) e intramusculares (menos empleadas en los hospitales con UDA). De los centros con > 200 camas un 81,3 % utilizaron AINE en sus prescripciones orales (ibuprofeno 38,1 % y dexketoprofeno 28,6 %); un 68,8 % utilizó paracetamol (asociado a AINE en un 22 %) y un 28,1 % empleó opioides orales (tramadol en el 21,9 %). Las pautas intramusculares fueron utilizadas por un 15,8 % de los encuestados. En 55 centros (de los 112 encuestados independientemente del número de camas hospitalarias) aún se utilizan pautas subcutáneas para tratar el dolor agudo postoperatorio y de ellos el 58,3% emplea cloruro mórfico. La protocolización de co-adyuvantes es del 2,3 %. El AINE más empleado es el dexketoprofeno por vía intravenosa y el ibuprofeno por vía oral. El opioide débil más empleado es el tramadol tanto por vía oral como intravenosa. La morfina es el opioide potente más empleado, especialmente en PCA intravenosa (i.v.). El paracetamol se emplea en el 54,7 % (112 hospitales) de las pautas i.v. a bolos. El concepto de analgesia multimodal, aunque es conocido, no se práctica de modo mayoritario entre los encuestados (solo un 30 % de los centros que respondieron la encuesta lo hacen). Conclusión: El paracetamol y los AINE se emplean tanto por vía oral (67,4 y 86,1 %, respectivamente) como intravenosa (54,7 y 56,6 %, respectivamente). Cuando los hospitales de > 200 camas disponen de UDA o PGDPO utilizan significativamente más las pautas: intravenosas en PCA, catéteres en plexo nervioso e infusión continua y epidural en PCA y menos las pautas i.m. La aplicación de analgesia multimodal es baja (AU)

Introduction: The Spanish Pain Society SED-IASP launched a national survey in order to determine how was postop pain managed throughout Spain. This article analyses the drugs and routes employed comparing them according to the presence or not of an Acute Pain Unit (APU) or Acute Pain Management program (APMP) in hospitals with > 200 beds that participated and answered the survey. Patients and methods: Members of the Spanish Pain Society and APS/APMP heads were asked to respond to a survey. Responses were stratified by hospital size (< 200 or ≥ 200 beds) and APS/APMP presence or not. Categorical variables were described by percentages and the 95 % confidence interval and continuous ones by the median and interquartile range. The drugs employed, associations of them and routes of administration were also analysed. Results: A total of 112/537 hospitals responded the survey (78 with >200 beds and 34 < 200) which represents a 20,9 % response tax). Responses were received from 42.4 % of hospitals with ≥ 200 beds (vs. 9.6 % of the smaller ones). We fully analysed data concerning routes and ways of administration only for the larger hospitals, 57.7 % of which had an APS or APMP. Solely drugs were analysed considering all 112 hospitals. Oral route is employed in 60,3 % hospitals (no differences between those with or not APU), intramuscular (IM) in 15,8 %, subcutaneous (SC) 48,3 %, intravenous (IV) bolus 75,9 %, IV continuous 77,6 %, IV PCA 60,3 %, catheters in nerve plexus using bolus 51,7 %, catheters in nerve plexus with continuous infusion 56,9 %, epidurals with bolus 40,4 %, continuous epidurals 75,9 %, epidural PCA 43,1 %, (63,8 % local anesthetic and opioid and 15,8 % local anesthetic with adrenaline/clonidine/opioid). Statistical significant differences were found in IV PCA route, continuous infusión through catheters in nervous plexus and epidural PCA (more employed in hospitals having an APU) and IM route (significantly less employed in them). A total of 81,3 % hospitals with > 200 beds used oral NSAIDs to treat postoperative pain (ibuprophen 38,1 % and dexketoprophen 28,6 %); paracetamol was employed in 68,8 % of them (associated to NSAID in 22 %) and 28,1 % employed oral opioids (tramadol 21,9 %). Coadjuvants are only employed in 2,3 % of 112 hospitals. IV dexketoprophen and oral ibuprophen were the most frequent NSAIDs employed. Tramadol is the most commonly IV and oral opioid employed. Morphine is the strong opiod more frequently used, especially in IV PCA. Paracetamol is used in 54,7 % (112 hospitals) of IV bolus way of administration. Multimodal analgesia concept although well known is not widely established among the survey responders (only 30 % apply it). Conclusion: Paracetamol and NSAIDs are used by IV (54,7 y 56,6 % respectively) and oral routes (67,4 y 86,1 % respectively). Hospitals with > 200 beds having an APU or APMP significantly employ more IV PCA, nerve plexus catheters continuous infusion and epidural PCA and less IM route to treat postoperative pain. Multimodal analgesia is not widely used in Spanish Hospitals (AU)

Preparation of organic monolithic columns in polytetrafluoroethylene tubes for reversed-phase liquid chromatography.

In this work, a method for the preparation and anchoring of polymeric monoliths in a polytetrafluoroethylene (PTFE) tubing as a column housing for microbore HPLC is described. In order to assure a covalent attachment of the monolith to the inner wall of the PTFE tube, a two-step procedure was developed. Two surface etching reagents, a commercial sodium naphthalene solution (Fluoroetch®), or mixtures of H2O2 and H2SO4, were tried and compared. Then, the obtained hydroxyl groups on the PTFE surface were modified by methacryloylation. Attenuated total reflectance Fourier-transform infrared (ATR-FTIR) spectroscopy and scanning electron microscopy (SEM) confirmed the successful modification of the tubing wall and the stable anchorage of monolith to the wall, respectively. Special emphasis was also put on the reduction of the unwanted effects of shrinking of monolith during polymerization, by using an external proper mold and by selecting the adequate monomers in order to increase the flexibility of the polymer. Poly(glycidyl methacrylate-co-divinylbenzene) monoliths were in situ synthesized by thermal polymerization within the confines of surface-vinylized PTFE tubes. The modified PTFE tubing tightly held the monolith, and the monolithic column exhibited good pressure resistance up to 20 MPa. The column performance was also evaluated via the isocratic separation of a series of alkylbenzenes in the reversed-phase mode. The optimized monolithic columns gave plate heights ranged between 70 and 80 µm. The resulting monoliths were also satisfactorily applied to the separation of proteins.

Molecular diversity and genetic relationships in Secale.

The objective of this study was to quantify the molecular diversity and to determine the genetic relationships among Secale spp. and among cultivars of Secale cereale using RAPDs, ISSRs and sequence analysis of six exons of ScMATE1 gene. Thirteen ryes (cultivated and wild) were genotyped using 21 RAPD and 16 ISSR primers. A total of 435 markers (242 RAPDs and 193 ISSRs) were obtained, with 293 being polymorphic (146 RAPDs and 147 ISSRs). Two RAPD and nine ISSR primers generated more than 80% of polymorphism. The ISSR markers were more polymorphic and informative than RAPDs. Further, 69% of the ISSR primers selected achieved at least 70% of DNA polymorphism. The study of six exons of the ScMATE1 gene also demonstrated a high genetic variability that subsists in Secale genus. One difference observed in exon 1 sequences from S. vavilovii seems to be correlated with Al sensitivity in this species. The genetic relationships obtained using RAPDs, ISSRs and exons of ScMATE1 gene were similar. S. ancestrale, S. kuprijanovii and S. cereale were grouped in the same cluster and S. segetale was in another cluster. S. vavilovii showed evidences of not being clearly an isolate species and having great intraspecific differences.

The role of two superoxide dismutase mRNAs in rye aluminium tolerance.

Aluminium (Al) is the main factor that limits crop production in acidic soils. There is evidence that antioxidant enzymes such as superoxide dismutase (SOD) play a key role against Al-induced oxidative stress in several plant species. Rye is one of the most Al-tolerant cereals and exudes both citrate and malate from the roots in response to Al. The role of SOD against Al-induced oxidative stress has not been studied in rye. Al accumulation, lipid peroxidation, H2O2 production and cell death were significantly higher in sensitive than in tolerant rye cultivars. Also, we characterised two genes for rye SOD: ScCu/ZnSOD and ScMnSOD. These genes were located on the chromosome arms of 2RS and 3RL, respectively, and their corresponding hypothetical proteins were putatively classified as cytosolic and mitochondrial, respectively. The phylogenetic relationships indicate that the two rye genes are orthologous to the corresponding genes of other Poaceae species. In addition, we studied Al-induced changes in the expression profiles of mRNAs from ScCu/ZnSOD and ScMnSOD in the roots and leaves of tolerant Petkus and sensitive Riodeva rye. These genes are mainly expressed in roots in both ryes, their repression being induced by Al. The tolerant cultivar has more of both mRNAs than the sensitive line, indicating that they are probably involved in Al tolerance.

On the consequences of aluminium stress in rye: repression of two mitochondrial malate dehydrogenase mRNAs.

Plants have developed several external and internal aluminium (Al) tolerance mechanisms. The external mechanism best characterised is the exudation of organic acids induced by Al. Rye (Secale cereale L.), one of the most Al-tolerant cereal crops, secretes both citrate and malate from its roots in response to Al. However, the role of malate dehydrogenase (MDH) genes in Al-induced stress has not been studied in rye. We have isolated the ScMDH1 and ScMDH2 genes, encoding two different mitochondrial MDH isozymes, in three Al-tolerant rye cultivars (Ailés, Imperial and Petkus) and one sensitive inbred rye line (Riodeva). These genes, which have seven exons and six introns, were located on the 1R (ScMDH1) and 3RL (ScMDH2) chromosomes. Exon 1 of ScMDH1 and exon 7 of ScMDH2 were the most variable among the different ryes. The hypothetical proteins encoded by these genes were classified as putative mitochondrial MDH isoforms. The phylogenetic relationships obtained using both cDNA and protein sequences indicated that the ScMDH1 and ScMDH2 proteins are orthologous to mitochondrial MDH1 and MDH2 proteins of different Poaceae species. The expression studies of the ScMDH1 and ScMDH2 genes indicate that it is more intense in roots than in leaves. Moreover, the amount of their corresponding mRNAs in roots from plants treated and not treated with Al was higher in the tolerant cultivar Petkus than in the sensitive inbred line Riodeva. In addition, ScMDH1 and ScMDH2 mRNA levels decreased in response to Al stress (repressive behaviour) in the roots of both the tolerant Petkus and the sensitive line Riodeva.

Molecular evidence for convergent evolution and allopolyploid speciation within the Physcomitrium-Physcomitrella species complex.

BACKGROUND: The moss Physcomitrella patens (Hedw.) Bruch & Schimp. is an important experimental model system for evolutionary-developmental studies. In order to shed light on the evolutionary history of Physcomitrella and related species within the Funariaceae, we analyzed the natural genetic diversity of the Physcomitrium-Physcomitrella species complex. RESULTS: Molecular analysis of the nuclear single copy gene BRK1 reveals that three Physcomitrium species feature larger genome sizes than Physcomitrella patens and encode two expressed BRK1 homeologs (polyploidization-derived paralogs), indicating that they may be allopolyploid hybrids. Phylogenetic analyses of BRK1 as well as microsatellite simple sequence repeat (SSR) data confirm a polyphyletic origin for three Physcomitrella lineages. Differences in the conservation of mitochondrial editing sites further support hybridization and cryptic speciation within the Physcomitrium-Physcomitrella species complex. CONCLUSIONS: We propose a revised classification of the previously described four subspecies of Physcomitrella patens into three distinct species, namely Physcomitrella patens, Physcomitrella readeri and Physcomitrella magdalenae. We argue that secondary reduction of sporophyte complexity in these species is due to the establishment of an ecological niche, namely spores resting in mud and possible spore dispersal by migratory birds. Besides the Physcomitrium-Physcomitrella species complex, the Funariaceae are host to their type species, Funaria hygrometrica, featuring a sporophyte morphology which is more complex. Their considerable developmental variation among closely related lineages and remarkable trait evolution render the Funariaceae an interesting group for evolutionary and genetic research.

Calcinosis cutánea grave tratada exitosamente con una fórmula magistral tópica W/O de tiosulfato sódico al 10 por ciento / Sever calcinosis cutis successfully treated with a topical W/O-emulsion of sodium thiosulfpercentate 10

La calcinosis cutánea es una enfermedad producida por acumulación y depósito de sales de calcio en los tejidos, que puede dar lugar a importantes lesiones, y cuyo abordaje terapéutico no está claramente establecido: se restringe al tratamiento sintomático o tiosulfato sódico intravenoso en los casos más graves, pero su administración conlleva unos riesgos y se hace especialmente difícil en pacientes pediátricos. Presentamos el caso de un niño de 6 años de edad, diagnosticado de calcinosis cutánea grave secundaria a un tratamiento con gluconato cálcico intravenoso, al que se prescribió una fórmula magistral de tiosulfato sódico tópico al 10%. En el servicio de farmacia del hospital donde se desarrolló el estudio, se llevó a cabo la formulación del tratamiento en forma de emulsión acuosa/oleosa. El paciente experimentó una rápida y progresiva curación con la fórmula magistral prescrita (AU)

Calcinosis cutis is a disease caused by accumulation and deposition of calcium salts in the tissue, which can result in serious injuries, whose therapeutic approach is not clearly established: it is restricted to symptomatic treatment or intravenous sodium thiosulfate in the most severe cases, but its administration carries some risks and is particularly difficult in pediatric patients. We report the case of a 6 year old children diagnosed of severe skin calcinosis secondary to treatment with intravenous calcium gluconate, for who it was prescribed a topical formulation of sodium thiosulfate 10%. In the pharmacy department of the hospital where the study was conducted, the topical formulation was prepared as aqueous/oil emulsion. The patient experienced a successfully, rapid and progressive recovery with the treatment prescribed (AU)

Lista modelo de medicamentos de alto riesgo / A model list of high risk drugs

Introducción: Los «medicamentos de alto riesgo» son aquellos con un «riesgo» muy elevado de causar daños graves o incluso mortales cuando se produce un error en el curso de su utilización. El Institute for Safe Medication Practices (ISMP) elaboró una relación aplicable a la población general, sin diferenciar población pediátrica y adulta, por lo que existe carencia de información para la población pediátrica. El objetivo de este trabajo es elaborar una lista de medicamentos de alto riesgo adaptada a la población pediátrica y neonatal que sirva de referencia para el personal sanitario de un hospital pediátrico. Material y métodos: Se realizó una búsqueda bibliográfica en mayo del 2012 en las principales bases de datos biomédicas, para identificar posibles listas o referencias publicadas en relación con medicamentos de alto riesgo en población pediátrica y neonatal. Resultados: Se encontraron 15 trabajos, seleccionándose 9 para el objetivo principal del estudio. Se elaboró una lista guía tomando como base la del ISMP, añadiendo fármacos con alta percepción de riesgo para la población pediátrica y eliminando aquellos cuyo uso en pediatría era anecdótico. Conclusiones: No se encontró una lista publicada que se adaptase totalmente a nuestro objetivo. La lista de medicamentos de alto riesgo en población pediátrica y neonatal elaborada puede ser modelo de referencia para hospitales pediátricos. Su conocimiento y utilización, así como actividades derivadas de la misma enmarcadas dentro de la política de seguridad, ayudará a evitar errores de medicación en cada proceso de la cadena terapéutica (prescripción, transcripción, dispensación y administración) (AU)

Introduction: «High-risk drugs» are those that have a very high «risk» of causing death or serious injury if an error occurs during its use. The Institute for Safe Medication Practices (ISMP) has prepared a high-risk drugs list applicable to the general population (with no differences between the pediatric and adult population). Thus, there is a lack of information for the pediatric population. The main objective of this work is to develop a high-risk drug list adapted to the neonatal or pediatric population as a reference model for the pediatric hospital health workforce. Material and methods: We made a literature search in May 2012 to identify any published lists or references in relation to pediatric and/or neonatal high-risk drugs. Results: A total of 15 studies were found, from which 9 were selected. A model list was developed mainly based on the ISMP one, adding strongly perceived pediatric risk drugs and removing those where the pediatric use was anecdotal. Conclusions: There is no published list that suits pediatric risk management. The list of pediatric and neonatal high-risk drugs presented here could be a «reference list of high-risk drugs » for pediatric hospitals. Using this list and training will help to prevent medication errors in each drug supply chain (prescribing, transcribing, dispensing and administration) (AU)

[A model list of high risk drugs]. / Lista modelo de medicamentos de alto riesgo.

INTRODUCTION: «High-risk drugs¼ are those that have a very high «risk¼ of causing death or serious injury if an error occurs during its use. The Institute for Safe Medication Practices (ISMP) has prepared a high-risk drugs list applicable to the general population (with no differences between the pediatric and adult population). Thus, there is a lack of information for the pediatric population. The main objective of this work is to develop a high-risk drug list adapted to the neonatal or pediatric population as a reference model for the pediatric hospital health workforce. MATERIAL AND METHODS: We made a literature search in May 2012 to identify any published lists or references in relation to pediatric and/or neonatal high-risk drugs. RESULTS: A total of 15 studies were found, from which 9 were selected. A model list was developed mainly based on the ISMP one, adding strongly perceived pediatric risk drugs and removing those where the pediatric use was anecdotal. CONCLUSIONS: There is no published list that suits pediatric risk management. The list of pediatric and neonatal high-risk drugs presented here could be a «reference list of high-risk drugs ¼ for pediatric hospitals. Using this list and training will help to prevent medication errors in each drug supply chain (prescribing, transcribing, dispensing and administration).

Correction of distal limb prolapse of a diverting colostomy by stapling under sedation.

AIM: To describe a surgical technique to treat colostomy prolapse as a day case procedure with the patient under sedation and analgesia. METHOD: A 60-mm GIA Universal Stapler is inserted into the lumen of the prolapsed colon at right angles to the contour of the abdominal wall. Several firings are then made to completely divide the prolapsed colon. The instrument is then placed parallel to the skin to remove the prolapsed portion leaving 1-2 cm of bowel above the level of the skin. RESULTS: Two patients underwent the procedure. The operation times were 30 and 13 min. Both took oral liquids 2 h after surgery and solids 2 h later. They were discharged at 24 and 4 h after surgery, respectively. No postoperative pain was reported in either case. At 14 and 6 months of follow-up there has been no recurrence. CONCLUSION: Stapling treatment of prolapsed colostomies has the advantage of being an extra-abdominal procedure. It is performed under sedation and analgesia, the operation time is very short, recovery to normal life is rapid and there is less likelihood of complications by avoiding a laparotomy.

FI on-line chemiluminescence reaction for determination of MCPA in water samples.

This paper reports an economic, simple, and rapid FI-CL method for the determination of MCPA. This method requires simple instrumentation and it is fast enough to be used in routine analyses. A chemiluminescence signal is generated by reaction between photodegraded MCPA and ferricyanide solution in alkaline medium. All physical and chemical parameters in the flow injection chemiluminescence system were optimized in the experimental setting. To eliminate interference, a solid-phase extraction stage with SDB-1 cartridges and ethanol elution is applied. The signal-MCPA concentration relation is linear in concentration intervals between 0.0015 and 0.6 µg·mL(-1). The calibration lines are statistically similar in different working conditions: standards with ethanol without extraction and standards with ethanol and extraction, allowing standards to be excluded from the extraction step, which simplifies the process. The detection limit (DL) is 0.5 ng·mL(-1), which is the same order as the maximum limit established in legislation regarding pesticide limits in water destined for human consumption. A DL of 0.13 ng·mL(-1) can be reached if a sample of 100 mL is preconcentrated. The interday variance coefficient is 3% and the sample throughput is 90 h(-1). The water analysis method is efficient with relative error percentages lower than 5% with respect to the added concentration.

[Combined regional-general anesthesia with use of the Proseal laryngeal mask during prolonged peripheral plastic surgery]. / Anestesia regional combinada con mascarilla laríngea proseal en cirugía plástica periférica prolongada.

The ProSeal laryngeal mask offers a better interface for controlled ventilation than does a traditional mask because of the ProSeal's improved airway seal and the possibility of draining the digestive tract. Limb reconstructive surgery is normally a long procedure involving the use of grafts or flaps located at a distance from the lesion. Regional anesthesia is therefore of limited use. We report a series of 24 adult patients who underwent peripheral plastic surgery under combined regional and general intravenous anesthesia and in whom the ProSeal mask was used. Data recorded included assessment of the airway and intubation difficulty, disease and duration of the procedure, type of regional anesthesia, respiratory and hemodynamic variables, patient satisfaction, laryngeal complications, and postoperative analgesia. All patients were adequately ventilated. One episode of bradycardia was controlled with atropine. In the immediate postoperative period, no patient presented laryngeal complications and only 1 patient reported significant pain (8 on a visual analog scale). The ProSeal mask was a good choice for use with combined regional-general anesthesia, ensuring control of the airway without causing complications. Analgesia was adequate in most cases.