Functional phenotypic plasticity mediated by water stress and [CO2] explains differences in drought tolerance of two phylogenetically close conifers.

Forests are threatened globally by increased recurrence and intensity of hot droughts. Functionally close coexisting species may exhibit differences in drought vulnerability large enough to cause niche differentiation and affect forest dynamics. The effect of rising atmospheric [CO2], which could partly alleviate the negative effects of drought, may also differ between species. We analysed functional plasticity in seedlings of two taxonomically close pine species (Pinus pinaster Ait., Pinus pinea L.) under different [CO2] and water stress levels. The multidimensional functional trait variability was more influenced by water stress (preferentially xylem traits) and [CO2] (mostly leaf traits) than by differences between species. However, we observed differences between species in the strategies followed to coordinate their hydraulic and structural traits under stress. Leaf 13C discrimination decreased with water stress and increased under elevated [CO2]. Under water stress both species increased their sapwood area to leaf area ratios, tracheid density and xylem cavitation, whereas they reduced tracheid lumen area and xylem conductivity. Pinus pinea was more anisohydric than P. pinaster. Pinus pinaster produced larger conduits under well-watered conditions than P. pinea. Pinus pinea was more tolerant to water stress and more resistant to xylem cavitation under low water potentials. The higher xylem plasticity in P. pinea, particularly in tracheid lumen area, expressed a higher capacity of acclimation to water stress than P. pinaster. In contrast, P. pinaster coped with water stress comparatively more by increasing plasticity of leaf hydraulic traits. Despite the small differences observed in the functional response to water stress and drought tolerance between species, these interspecific differences agreed with ongoing substitution of P. pinaster by P. pinea in forests where both species co-occur. Increased [CO2] had little effect on the species-specific relative performance. Thus, a competitive advantage under moderate water stress of P. pinea compared with P. pinaster is expected to continue in the future.

Antigiardial Activity of Foeniculum vulgare Hexane Extract and Some of Its Constituents.

Foeniculum vulgare is used for the treatment of diarrhea in Mexican traditional medicine. Hexane extract showed 94 % inhibition of Giardia duodenalis trophozoites at 300 µg/mL. Therefore, 20 constituents of hexane extract were evaluated to determine their antigiardial activity. Interestingly, six compounds showed good activity toward the parasite. These compounds were (1R,4S) (+)-Camphene (61%), (R)(-)-Carvone (66%), estragole (49%), p-anisaldehyde (67%), 1,3-benzenediol (56%), and trans, trans-2,4-undecadienal (97%). The aldehyde trans, trans-2,4-undecadienal was the most active compound with an IC50 value of 72.11 µg/mL against G. duodenalis trophozoites. This aldehyde was less toxic (IC50 588.8 µg/mL) than positive control metronidazole (IC50 83.5 µg/mL) against Vero cells. The above results could support the use of F. vulgare in Mexican traditional medicine.

Online team-based electrocardiogram training in Haiti: evidence from the field.

BACKGROUND: The electrocardiogram (ECG) is the most relied upon tool for cardiovascular diagnosis, especially in low-resource settings because of its low cost and straightforward usability. It is imperative that internal medicine (IM) and emergency medicine (EM) specialists are competent in ECG interpretation. Our study was designed to improve proficiency in ECG interpretation through a competition among IM and EM residents at a teaching hospital in rural central Haiti in which over 40% of all admissions are due to CVD. METHODOLOGY: The 33 participants included 17 EM residents and 16 IM residents from each residency year at the Hôpital Universitaire de Mirebalais (HUM). Residents were divided into 11 groups of 3 participants with a representative from each residency year and were given team-based online ECG quizzes to complete weekly. The format included 56 ECG cases distributed over 11 weeks, and each case had a pre-specified number of points based on abnormal findings and complexity. All ECG cases represented cardiovascular pathology in Haiti adapted from the Association of Program Directors in Internal Medicine evaluation list. The main intervention was sharing group performance and ECG solutions to all participants each week to promote competition and self-study without specific feedback or discussion by experts. To assess impact, pre- and post-intervention assessments measuring content knowledge and comfort for each participant were performed. RESULTS: Overall group participation was heterogeneous with groups participating a median of 54.5% of the weeks (range 0-100%). 22 residents completed the pre- and post-test assessments. The mean pre- and post-intervention assessment knowledge scores improved from 27.3% to 41.7% (p = 0.004). 70% of participants improved their test scores. The proportion of participants who reported comfort with ECG interpretation increased from 57.6% to 66.7% (p = 0.015). CONCLUSION: This study demonstrates improvement in ECG interpretation through a team-based, asynchronous ECG competition approach. This method is easily scalable and could help to fill gaps in ECG learning. This approach can be delivered to other hospitals both in and outside Haiti. Further adaptations are needed to improve weekly group participation.

Biofilms en instalaciones alimentarias militares. Comparación de técnicas rápidas de vigilancia y verificación / Biofilms in military food facilities. Comparison of rapid surveillance and verification techniques

Introducción:Los patógenos formadores de biofilms incrementan el riesgo de contaminación biológica de los alimentos en las industrias alimentarias, por lo que es necesario cuantificar y cualificar los peligros presentes en los mismos.Objetivo:Se pretende demostrar la presencia de biofilms bacterianos en las superficies de trabajo de instalaciones alimentarias militares (IAM) mediante distintas técnicas rápidas de control higiénico.Material y métodos:Se analizaron un total de 550 muestras entre las 10 IAM: Cada IAM contó con 5 puntos de muestreo (n = 50) y en cada uno de ellos se obtuvieron 11 muestras sobre una superficie de 100 cm2, para poner de manifiesto la presencia de biofilms y establecer la correlación entre las siguientes técnicas analíticas: determinación de adenosín trifosfato (ATP) mediante luminómetro 3M Clean-Trace™ NG3, valoración de residuos proteicos con hisopos Clean-Trace™ Surface Protein Plus, recuentos de microorganismos aerobios mesófilos (AC) mediante sistema TEMPO® y Petrifilm™, y visualización de biofilms mediante reacción enzimática con Biofinder®.Resultados:Se encontró correlación estadísticamente significativa (p < 0,05) entre las determinaciones de ATP y la presencia de biofilms y de residuos proteicos. También se halló linealidad con significación estadística (R2 0,422, p < 0,05) entre el ATP y el recuento de AC por TEMPO®. Se observó correlación y concordancia entre los recuentos de AC mediante el sistema TEMPO® y a través de Petrifilm™ (coeficiente de correlación intraclase 0,463, IC 95%: 0,179-0,673, p < 0,05). En ningún punto de muestreo (PM) se detectaron bacterias patógenas.Conclusión:Se detectaron biofilms en una tercera parte de los PM inspeccionados. Su monitorización combinando técnicas rápidas debe tenerse en consideración en los procedimientos de vigilancia del sistema de Análisis de Peligros y Puntos de Control Crítico (APPCC). (AU)

Introduction:Biofilm-forming pathogens increase the risk of biological food contamination in food industries, thus it is necessary to quantify and qualify the dangers present in them.Objective:To demonstrate the presence of bacterial biofilms on the work surfaces of military food facilities using different rapid hygienic control techniques.Materials and methods:An amount of 550 samples were analyzed among 10 military food facilities: Each one had 5 sampling points (n = 50) and in each of them 11 samples were obtainded on a surface of 100 cm2 to assess the presence of biofilms and to establish the correlation between different analytical techniques: determination of adenosin triphosphate (ATP) using 3M Clean-Trace ™ NG3 luminometer, protein residue titration with Clean-Trace ™ Surface Protein Plus swabs, mesophilic aerobic microorganism (AC) counts using TEMPO® and Petrifilm ™ system, and visualization of biofilms using enzymatic reaction with Biofinder®.Results:A statistically significant correlation (p <0.05) was found between ATP determinations and the presence of biofilms and protein residues. Linearity with statistical significance (R2 0.422, p <0.05) was also found between ATP and AC count by TEMPO®. Correlation and concordance between AC counts were observed using the TEMPO® system and through Petrifilm ™ (intraclass correlation coefficient 0.463, 95% CI: 0.179-0.673, p <0.05). At no sampling point (SP) were pathogenic bacteria detected.Conclusion:Combining quick techniques should be considered in surveillance procedures of Hazard Analysis and Critical Control Points (HACCP). (AU)

Cuantificación de gluten en las raciones de combate españolas / Quantification of gluten in Spanish combat rations

Las personas con enfermedad celiaca pueden ingresar en los centros docentes militares de formación y su alimentacióndurante los ejercicios de instrucción se puede realizar mediante raciones de combate, individuales o colectivas. Objetivo: Cuantificar elgluten en las raciones de combate con etiquetado precautorio de alérgenos (EPA) o sin gluten en su composición. Material y Métodos:Se analizaron 39 muestras de raciones individuales de combate (23 con EPA y 16 sin cereales con gluten en su composición) y 6 racionescolectivas (sin cereales con gluten en su composición), mediante un kit comercial de inmunoabsorción ligada a enzimas (ELISA). Resultados: Los resultados de todas las muestras se encontraron por debajo del límite de cuantificación (< 5mg/kg de gluten). Conclusiones:Los resultados del contenido en gluten obtenidos sobre las muestras y los lotes analizados muestran un riesgo bajo de exposición. (AU)

People with celiac disease can join the military training centers and and their diet during training exercises can be donethrough combat rations, individual or collective rations. Objective: To quantify the gluten in the combat rations with precautionarylabeling of allergens (PAL) or gluten-free in its composition. Material and Methods: 39 individual operational rations samples (23with PAL and 16 without cereals with gluten in their composition) and 6 collective rations (without cereals with gluten in their composition) were analyzed using a commercial enzyme-linked immunosorbent assay (ELISA) kit. Results: All samples were below thelimit of quantification (< 5mg/kg of gluten) and the results met the quality criteria. Conclusions: The gluten results obtained on thesamples and batches analyzed show a low risk of exposure. (AU)

Evaluating resident involvement and the 'July effect' in parotidectomy.

OBJECTIVE: This study aimed to evaluate the effect of resident involvement and the 'July effect' on peri-operative complications after parotidectomy. METHOD: The American College of Surgeons National Surgical Quality Improvement Program database was queried for parotidectomy procedures with resident involvement between 2005 and 2014. RESULTS: There were 11 733 cases were identified, of which 932 involved resident participation (7.9 per cent). Resident involvement resulted in a significantly lower reoperation rate (adjusted odds ratio, 0.18; 95 per cent confidence interval, 0.05-0.73; p = 0.02) and readmission rate (adjusted odds ratios 0.30; 95 per cent confidence interval, 0.11-0.80; p = 0.02). However, resident involvement was associated with a mean 24 minutes longer adjusted operative time and 23.5 per cent longer adjusted total hospital length of stay (respective p < 0.01). No significant difference in surgical or medical complication rates or mortality was found when comparing cases among academic quarters. CONCLUSION: Resident participation is associated with significantly decreased reoperation and readmission rates as well as longer mean operative times and total length of stay. Resident transitions during July are not associated with increased risk of adverse peri-operative outcomes after parotidectomy.

Does distance from a clinic and poverty impact visit adherence for noncommunicable diseases? A retrospective cohort study using electronic medical records in rural Haiti.

BACKGROUND: Adherence to regular outpatient visits is vital to managing noncommunicable diseases (NCDs), a growing burden in low and middle-income countries. We characterized visit adherence among patients with NCDs in rural Haiti, hypothesizing higher poverty and distance from the clinic were associated with lower adherence. METHODS: We analyzed electronic medical records from a cohort of adults in an NCD clinic in Mirebalais, Haiti (April 2013 to June 2016). Visit adherence was: 1) visit constancy (≥1 visit every 3 months), 2) no gaps in care (> 60 days between visits), 3) ≥1 visit in the last quarter, and 4) ≥6 visits per year. We incorporated an adapted measure of intensity of multidimensional poverty. We calculated distance from clinic as Euclidean distance or self-reported transit time. We used multivariable logistic regressions to assess the association between poverty, distance, and visit adherence. RESULTS: We included 463 adult patients, mean age 57.8 years (SE 2.2), and 72.4% women. Over half of patients had at least one visit per quarter (58.1%), but a minority (19.6%) had no gaps between visits. Seventy percent of patients had a visit in the last quarter, and 73.9% made at least 6 visits per year. Only 9.9% of patients met all adherence criteria. In regression models, poverty was not associated with any adherence measures, and distance was only associated with visit in the last quarter (OR 0.87, 95% CI [0.78 to 0.98], p = 0.03) after adjusting for age, sex, and hardship financing. CONCLUSIONS: Visit adherence was low in this sample of adult patients presenting to a NCD Clinic in Haiti. Multidimensional poverty and distance from clinic were not associated with visit adherence measures among patients seen in the clinic, except for visit in the last quarter. Future research should focus on identifying and addressing barriers to visit adherence.

Review of effectiveness criteria in the application of Telemedicine

Telemedicine is a very useful tool and resource for medical diagnosis and treatment. Since its inception in the 70s it has developed progressively, demonstrating the clinical benefit it brings to patients and being increasingly present in the daily activities of clinicians. Different studies have tried to define and limit its effectiveness at the time of application versus face-to-face assistance, this being an important variable to clarify. This article reviews the different variables that have been coined to define the effectiveness when trying to demonstrate the cost-effectiveness of including telemedicine in daily healthcare activity

La telemedicina es una herramienta y recurso de gran utilidad para el diagnóstico y tratamiento médico. Desde su inicio en la década de los 70 se ha desarrollado de forma progresiva, demostrando el beneficio clínico que aporta a los pacientes y estando cada vez más presente en la actividad diaria de los clínicos. Diferentes estudios han tratado de definir y acotar su efectividad a la hora de aplicarse versus la asistencia presencial, siendo esta una variable importante a despejar. Este artículo realiza una revisión de las diferentes variables que se han acuñado para definir efectividad a la hora de tratar de demostrar la rentabilidad de incluir la telemedicina en la actividad asistencial diaria

High Poverty and Hardship Financing Among Patients with Noncommunicable Diseases in Rural Haiti.

Background: Poverty is a major barrier to healthcare access in low-income countries. The degree of equitable access for noncommunicable disease (NCD) patients is not known in rural Haiti. Objectives: We evaluated the poverty distribution among patients receiving care in an NCD clinic in rural Haiti compared with the community and assessed associations of poverty with sex and distance from the health facility. Methods: We performed a cross-sectional study of patients with NCDs attending a public-sector health center in rural Haiti 2013-2016, and compared poverty among patients with poverty among a weighted community sample from the Haiti 2012 Demographic and Health Survey. We adapted the multidimensional poverty index: people deprived ≥44% of indicators are among the poorest billion people worldwide. We assessed hardship financing: borrowing money or selling belongings to pay for healthcare. We examined the association between facility distance and poverty adjusted for age and sex using linear regression. Results: Of 379 adults, 72% were women and the mean age was 52.5 years. 17.7% had hypertension, 19.3% had diabetes, 3.1% had heart failure, and 33.8% had multiple conditions. Among patients with available data, 197/296 (66.6%) experienced hardship financing. The proportions of people who are among the poorest billion people for women and men were similar (23.3% vs. 20.3%, p > 0.05). Fewer of the clinic patients were among the poorest billion people compared with the community (22.4% vs. 63.1%, p < 0.001). Patients who were most poor were more likely to live closer to the clinic (p = 0.002). Conclusion: Among patients with NCD conditions in rural Haiti, poverty and hardship financing are highly prevalent. However, clinic patients were less poor compared with the community population. These data suggest barriers to care access particularly affect the poorest. Socioeconomic data must be collected at health facilities and during community-level surveillance studies to monitor equitable healthcare access. Highlights: Poverty and hardship financing are highly prevalent among NCD patients in rural Haiti.Patients attending clinic are less poor than expected from the community.People travelling farther to clinic are less poor.Socioeconomic data should be collected to monitor healthcare access equity.

[Spanish translation and validation of the Neuromuscular Module of the Pediatric Quality of Life Inventory (PedsQL): evaluation of the quality of life perceived by 5-7 years old children with neuromuscular disorders and by their parents]. / Traducción y validación al español del módulo neuromuscular de la escala Pediatric Quality of Life Inventory (PedsQL): evaluación de la calidad de vida autopercibida por niños de 5-7 años con enfermedades neuromusculares y sus padres.

INTRODUCTION: The recent advances in the therapies for some neuromuscular disorders imply a better prognosis. As a consequence, health-related quality of life has emerged as a core outcome. It is particularly important to know both the self-perceived health-related quality of life by children, as soon as possible, as well as the parental perception. Therefore, it is essential to have valid and specific scales for proper assessment. AIM: To assess the validity and reliability of the Spanish version of Pediatric Quality of Life Inventory (PedsQL) Neuromuscular Module for self-perceived and parent perceived quality of life of children aged 5-7 with neuromuscular disorders. SUBJECTS AND METHODS: Cross-cultural validity of the Spanish version was carried out with the permission of the Mapi-Research-Trust. Subsequently, a test-retest was administered to 27 children aged 5-7 and 37 parents in order to evaluate internal consistency, intra-observer reliability and construct validity. RESULTS: The Cronbach alpha coefficient showed good internal consistency for children and was rated as excellent by parents. Furthermore, the intra-observer correlation indicated an excellent reliability for both. Construct validity analysis suggested that a new scale structure with more dimensions might be more adequate. Moreover, said structure will also explain a greater percentage of variability. CONCLUSION: The Spanish version of PedsQL Neuromuscular Module for the self-perceived and parent-perceived quality of life of children aged 5-7 showed good internal consistency and reliability.

TITLE: Traducción y validación al español del módulo neuromuscular de la escala Pediatric Quality of Life Inventory (PedsQL): evaluación de la calidad de vida autopercibida por niños de 5-7 años con enfermedades neuromusculares y sus padres.Introducción. Los recientes avances en el abordaje terapéutico de las enfermedades neuromusculares pediátricas han permitido un mejor pronóstico y, en consecuencia, surge la necesidad de medir la calidad de vida relacionada con la salud como parte de un abordaje integral. Es importante disponer de instrumentos válidos y específicos para su correcta valoración que contemplen la calidad de vida relacionada con la salud tanto autopercibida por los niños como por los padres. Objetivo. Evaluar la validez y la fiabilidad de la versión española del módulo neuromuscular de la Pediatric Quality of Life Inventory (PedsQL) para la medición de la calidad de vida autopercibida por niños de 5 a 7 años con enfermedades neuromusculares y la de sus padres. Sujetos y métodos. Con autorización de Mapi-Research-Trust, se procedió a la adaptación transcultural de la versión española de la escala. Posteriormente, se realizó un test-retest a 27 niños de 5 a 7 años y a 37 padres para evaluar la consistencia interna, la fiabilidad y la validez de constructo. Resultados. El coeficiente alfa de Cronbach mostró una consistencia interna buena para los niños y excelente para los padres. La correlación intraobservador indicó una excelente fiabilidad para ambos. La validez de constructo sugirió que una estructura de más dimensiones podría ser más adecuada y explicaría un mayor porcentaje de variabilidad. Conclusiones. La versión española del módulo neuromuscular de la PedsQL para evaluar calidad de vida de niños de 5 a 7 años con enfermedades neuromusculares y de sus padres tiene buena consistencia interna y fiabilidad.

Salbutamol tolerability and efficacy in patients with spinal muscular atrophy type II.

Spinal muscular atrophy (SMA) is an autosomal recessive disease caused by homozygous deletions or loss-of-function mutations in SMN1, which result in a degeneration of motor neurons in the spinal cord and brain stem. Even without a randomized placebo-controlled trial, salbutamol has been offered to patients with SMA in the neuromuscular clinics of most of hospitals for many years. We describe the response to salbutamol in 48 patients with SMA type II who were not taking any other medication. We investigate the changes over an eighteen-month period in motor functional scales and we analyze side effects and subjective response to treatment. Our results suggest that oral administration of salbutamol might be helpful in the maintenance of motor function in patients with SMA type II. An apparent beneficial effect was observed in functional scales of children under the age of 6, especially during the first 6 months of therapy. The majority of patients of all ages referred some kind of subjective positive effect associated with therapy intake. Salbutamol seemed safe and was well tolerated without serious side effects.

Control microbiológico de las comidas servidas en centros de educación infantil del Ministerio de Defensa durante el año 2017 / Microbiological control of the food served in children's education centres of the Ministry of Defense in 2017

Introducción: La población infantil es más vulnerable a las enfermedades de transmisión alimentaria que otros grupos demográficos. En los últimos años se han notificado brotes de enfermedades de origen alimentario en guarderías causados por agentes patógenos como Salmonella spp., Listeria monocytogenes o Cronobacter sakazakii. Objetivos: Determinar la calidad microbiológica de las comidas servidas en los comedores de las guarderías en relación con los criterios de seguridad alimentaria y de higiene de los procesos. Materiales y Métodos: Se analizaron 241 muestras del menú de iniciación y del menú completo en 13 guarderías. Se investigó la presencia de Salmonella spp. y Cronobacter spp. y se realizó el recuento de L. moncytogenes y de los microorganismos indicadores de la higiene de los procesos (aerobios mesófilos, enterobacterias totales, coliformes totales, Escherichia coli ß-glucuronidasa positivos y Staphylococcus aureus). Resultados: Salmonella spp. y L. monocytogenes no se detectaron en ninguna de las muestras analizadas. Cronobacter spp. se aisló en la guarnición de ensalada de un segundo plato. E. coli no se detectó en ninguna muestra y para el resto de indicadores de higiene las prevalencias fueron las siguientes: aerobios mesófilos 36,10 %, enterobacterias 13,28 %, coliformes totales 7,47 % y S. aureus 4,14 %. El grupo de frutas fue siempre el que presentó mayor prevalencia en todos los parámetros, seguido por los segundos platos debido principalmente a la presencia de ensaladas en la guarnición. Conclusiones: Conforme a los resultados microbiológicos obtenidos, se considera que las comidas servidas tienen un alto grado de calidad microbiológica

Introduction: Infants and children are more vulnerable to foodborne illnesses than other demographic population. In recent years, foodborne outbreaks have been reported in kindergartens because of the presence of pathogenic agents like Salmonella spp., Listeria monocytogenes and Cronobacter sakazakii. Objective: To determine the microbiological quality of foods ready for consumption in kindergarten foodservices regarding food safety and process hygiene criteria. Materials and Methods: 241 food samples from the initiation menu and full menu were analyzed in 13 kindergartens. Salmonella spp. and Cronobacter spp. were investigated and an enumeration of L. monocytogenes and of the hygiene indicator microorganisms (mesophilic aerobes, enterobacteriaceae, ß-glucuronidase positive Escherichia coli, total coliforms and Staphylococcus aureus) was carried out. Results: No Salmonella spp. or L. monocytogenes were isolated from any of the samples. Cronobacter spp. was isolated in the fresh salad of a second plate. E. coli was not detected in any sample and the results shown in the rest of the hygiene indicators were the following: mesophilic aerobes 36,10 %, enterobacteriaceae 13,28 %, total coliforms 7,47 % and S. aureus 4,14 %. The fruits group was always the one that showed the highest prevalence in all the parameters, followed by the second courses mainly due to the presence of fresh salads. Conclusions: According to the microbiological results obtained, it is considered that the meals served have a high level of microbiological quality

Neumomediastino y neumotórax bilateral en paciente con fibrosis pulmonar idiopática / Pneumomediastinum and Bilateral Pneumothorax in Patients with Idiopathic Pulmonary Fibrosis

Los pacientes con fibrosis pulmonar idiopática (FPI) presentan un mayor riesgo de desarrollar complicaciones pulmonares agudas, incluyendo entre ellas el neumotórax y el neumomediastino. Describimos los hallazgos en la radiografía y el TAC de tórax en un paciente con diagnóstico de FPI. El examen radiológico realizado por dos radiólogos especialistas de tórax reveló hallazgos de aire extra alveolar. La disnea, disfagia, afonía y dolor torácico fueron los síntomas más llamativos que presentó el paciente. En la Rx de tórax se apreció neumotórax bilateral y neumomediastino. El paciente falleció a los 22 días de iniciado el deterioro clínico por insuficiencia respiratoria

Patients with idiopathic pulmonary fibrosis (IPF) have a higher risk of developing acute pulmonary complications, including pneumothorax and spontaneus pneumomediastinum. We describe the findings in the xray and CT scan of the thorax in a patient diagnosed with IPF. The radiography examination by two thoracic specialist radiologists revealed evidenced extravascular air in the thorax. Disnea, disphagia, aphonia, thoracic pain were the most concerning symptom presented in the patient. The thoracic radiology display air in the pleural cavity along bilateral pneumothorax and pneumomediastinum. The patient died 22 days after the start of clinical deterioration due to respiratory failure

[Knowledge and attitudes of health care professionals in advance healthcare directives]. / Conocimientos y actitudes sobre voluntades anticipadas en profesionales sanitarios.

BACKGROUND AND OBJECTIVE: The advanced healthcare directive is a new style of health care relationship, based on the respect of the patients autonomous decisions: as well as a valuable tool that enables a proper management of the decisions made at the end of life. The objective of this study was to explore the knowledge and attitudes of the health care professionals regarding the advance directives, as well as the resources for advanced care planning in a municipality of Madrid during 2016-2017. MATERIAL AND METHODS: A cross-sectional descriptive study was carried out on a population of Health care professionals of Primary and Specialised Care. The knowledge and attitudes questionnaire about the advance directives was used. Sociodemographic and knowledge variables related to resources for the advanced care planning. Statistical-descriptive analysis was performed. RESULTS: A total of 431 professionals were included, with a mean age of 44.55 years (SD: 11.1). As regards knowledge about advance directives, the mean score was 5.08 (SD 2.4), with statistically significant differences being found between professional groups. A small percentage (4.6%) of the professionals had their document of Advance directives ready, and 42% of professionals did not know if they were regulated by the Community of Madrid. Less than half (41.5%) of the professionals knew the palliative resources of their institution. CONCLUSIONS: The health care professional's knowledge about advance directives, as well as the resources for the advanced care planning, show deficiencies at training and information level. Almost half of the professionals did not know if these are regulated in the Community of Madrid. They also believe that it would be useful to plan, and very useful to have the Advance directives document ready.

High throughput method to characterize acid-base properties of insoluble drug candidates in water.

In drug design experimental characterization of acidic groups in candidate molecules is one of the more important steps prior to the in-vivo studies. Potentiometry combined with Yasuda-Shedlovsky extrapolation is one of the more important strategy to study drug candidates with low solubility in water, although, it requires a large number of sequences to determine pKa values at different solvent-mixture compositions to, finally, obtain the pKa in water (pwwKa) by extrapolation. We have recently proposed a method which requires only two sequences of additions to study the effect of organic solvent content in liquid chromatography mobile phases on the acidity of the buffer compounds usually dissolved in it along wide ranges of compositions. In this work we propose to apply this method to study thermodynamic pwwKa of drug candidates with low solubilities in pure water. Using methanol/water solvent mixtures we study six pharmaceutical drugs at 25 °C. Four of them: ibuprofen, salicylic acid, atenolol and labetalol, were chosen as members of carboxylic, amine and phenol families, respectively. Since these compounds have known pwwKa values, they were used to validate the procedure, the accuracy of Yasuda-Shedlovsky and other empirical models to fit the behaviors, and to obtain pwwKa by extrapolation. Finally, the method is applied to determine unknown thermodynamic pwwKa values of two pharmaceutical drugs: atorvastatin calcium and the two dissociation constants of ethambutol. The procedure proved to be simple, very fast and accurate in all of the studied cases.

Molecular characterization of congenital myasthenic syndromes in Spain.

Congenital myasthenic syndromes (CMS) are a heterogeneous group of genetic disorders, all of which impair neuromuscular transmission. Epidemiological data and frequencies of gene mutations are scarce in the literature. Here we describe the molecular genetic and clinical findings of sixty-four genetically confirmed CMS patients from Spain. Thirty-six mutations in the CHRNE, RAPSN, COLQ, GFPT1, DOK7, CHRNG, GMPPB, CHAT, CHRNA1, and CHRNB1 genes were identified in our patients, with five of them not reported so far. These data provide an overview on the relative frequencies of the different CMS subtypes in a large Spanish population. CHRNE mutations are the most common cause of CMS in Spain, accounting for 27% of the total. The second most common are RAPSN mutations. We found a higher rate of GFPT1 mutations in comparison with other populations. Remarkably, several founder mutations made a large contribution to CMS in Spain: RAPSN c.264C > A (p.Asn88Lys), CHRNE c.130insG (Glu44Glyfs*3), CHRNE c.1353insG (p.Asn542Gluf*4), DOK7 c.1124_1127dup (p.Ala378Serfs*30), and particularly frequent in Spain in comparison with other populations, COLQ c.1289A > C (p.Tyr430Ser). Furthermore, we describe phenotypes and distinguishing clinical signs associated with the various CMS genes which might help to identify specific CMS subtypes to guide diagnosis and management.

[Current status of congenital myasthenic syndromes]. / Estado actual de los sindromes miastenicos congenitos.

Since Engel reported the first case of congenital myasthenia in 1977 and the first pathogenic gene was found in 1995, knowledge about congenital myasthenic syndromes has continued to grow. Over the years, the pathogenic basis, its clinical features, the phenotype-genotype correlations that have been established and its therapeutic management have all been described. In this group of diseases the safety margin of neuromuscular transmission is altered by different mechanisms: in the synthesis or storage of acetylcholine quanta in the synaptic vesicles, in the calcium-mediated release of acetylcholine in the nerve terminal or in the efficiency of the quantum released to generate a post-synaptic depolarisation. Increased knowledge about them has enabled a number of different therapeutic strategies to be established. In this review the main updates on these syndromes are reported, including: the genes described as classifying 50% of cases, their current classification based on the localisation of the proteins that alter neuromuscular transmission, including a new group of congenital myasthenias, glycosylation disorders, the main key diagnoses and the therapeutic management of this group of under-diagnosed patients.

TITLE: Estado actual de los sindromes miastenicos congenitos.Desde la descripcion de Engel del primer caso de miastenia congenita en 1977 y el hallazgo en 1995 del primer gen patogeno, el conocimiento de los sindromes miastenicos congenitos se ha ido desarrollando, y se han descrito la base patogena, sus caracteristicas clinicas, las correlaciones fenotipo-genotipo establecidas y su abordaje terapeutico. En este grupo de enfermedades se altera el margen de seguridad de la transmision neuromuscular por distintos mecanismos: en la sintesis o almacenamiento de los quantum de acetilcolina en las vesiculas sinapticas, en la liberacion de acetilcolina en el nervio terminal mediada por calcio o en la eficiencia de la cuanta liberada para generar una despolarizacion postsinaptica. Su conocimiento ha permitido establecer distintas estrategias terapeuticas. En esta revision se describen las principales actualizaciones de estos sindromes: los genes descritos que clasifican un 50% de los casos, su clasificacion actual basandose en la localizacion de las proteinas que alteran la transmision neuromuscular, incluyendo un nuevo grupo de miastenias congenitas, los trastornos de la glicosilacion, las principales claves diagnosticas y el abordaje terapeutico de este grupo de pacientes infradiagnosticados.

Seguridad alimentaria en operaciones de mantenimiento de la paz del Ejército de Tierra: experiencia en Libre Hidalgo IX, ASPFOR XXIX y BPC III / Food safety in Spanish Army international operations: experience in Libre Hidalgo IX, ASPFOR XXIX and BPC III

Una correcta alimentación en campana siempre ha sido una preocupación del mando militar, con el fin de mantener la operatividad y preservar la salud de las unidades. El presente articulo pretende mostrar los pilares fundamentales de la seguridad alimentaria en operaciones de mantenimiento de la paz del Ejercito de Tierra (Libano, Afganistan e Irak). El veterinario militar es el encargado de realizar el control oficial, apoyándose en varias normativas y en el material veterinario desplegado. Supervisa la correcta implantación del sistema de autocontrol basado en el análisis de peligros y puntos de control critico, creado por una Unión Temporal de Empresas para las bases permanentes. Además, existen posiciones avanzadas ocupadas por tropas españolas. En la misión del Líbano, el mayor desafío fue el suministro por parte de Naciones Unidas de productos alimenticios de origen extracomunitario y la explotación local de frutas y verduras. En Afganistán el origen de los alimentos era principalmente nacional, por lo que el gran reto fue la alimentación en las posiciones, bien solventada con las raciones de combate, equipos de campana y la profesionalidad del personal. Por el contrario, en Irak fue necesario adaptarse a la dificultad en el suministro de alimentos desde España y al incendio ocurrido en las instalaciones alimentarias. Se concluye que la seguridad alimentaria en las operaciones de mantenimiento de la paz que desarrolla el Ejercito de Tierra, esta garantizada con los procedimientos de autocontrol implantados por la empresa contratada y el control oficial llevado a cabo por el veterinario militar. En situaciones tácticas de mayor riesgo, es necesario recurrir a medios militares (raciones, equipos y personal) (AU)

A proper feeding in campaign has always been a concern of the military command in order to keep the operability and to preserve the health of the units. The present article tries to show the fundamental pillars of food safety in Spanish Army peacekeeping operations (Lebanon, Afghanistan and Iraq). The military veterinarian is in charge of official control, based on several regulations and veterinarian material which is deployed. A civilian company sets up hazard analysis and critical control points self-system, which is monitored by the veterinary officer in permanent bases. Furthermore, there are forward combat posts. In Lebanon, the main challenge was extra European Union food delivered by the United Nations and the local use of fruit and vegetables. In Afghanistan, the origin of food was national, so the most demanding element in this operation was the feeding in the posts. The solution was the use of field rations, field equipment and the professionalism of the soldiers. On the contrary, in Iraq it was necessary to adapt to the difficulty in food supply from Spain and to the fire which took place in the food facilities. In conclusion, food safety in Spanish Army peacekeeping operations is guaranteed by both the implementation of a self-control system by a civilian company, and with veterinary official control. In higher risk tactic situations, military means (rations, equipment and personnel) are necessary (AU)

Neurofibromatosis de tipo 2 con inicio en la edad pediátrica: identificación de los primeros signos y síntomas / Neurofibromatosis type 2 in childhood: a clinical characterization

Introducción. La neurofibromatosis de tipo 2 (NF2) es un trastorno neuroectodérmico con patrón de herencia autosómico dominante que condiciona una predisposición para desarrollar tumores de varios tipos en el sistema nervioso central y periférico. Se asocia también con alteraciones oculares y cutáneas. Caso clínico. Varón de 12 años con diagnóstico de NF2 de acuerdo con los criterios de Baser et al e inicio en la infancia. Se realiza una revisión bibliográfica sobre la evolución de los criterios diagnósticos en los niños. Conclusiones. El modo de presentación de la NF2 en la infancia difiere de la presentación en los adultos. Las manifestaciones iniciales de NF2 en los niños son las alteraciones oculares y cutáneas, no las auditivas. La clínica de inicio más frecuente en la edad pediátrica es la tríada de cataratas subcapsulares posteriores, lesiones intracutáneas en forma de placa o tumores nodulares subcutáneos, y síntomas neurológicos secundarios a la afectación de pares craneales distintos al VIII par, tronco encefálico o médula espinal. Debido a que los criterios diagnósticos de NF2 son menos sensibles en los pacientes pediátricos, los niños con cataratas congénitas o de aparición precoz y manifestaciones cutáneas típicas de NF2 deben ser seguidos estrechamente (AU)

INTRODUCTION. Neurofibromatosis type 2 (NF2) is a dominantly inherited neuroectodermal syndrome that predispose to the development of tumors of the central and peripheral nervous system. Additional features include eye and skin abnormalities. CASE REPORT. A 12-year old male with diagnosis of MF2 according to Baser et al and presentation in childhood was included. A comprehensive bibliographic review of evolution of the diagnostic criteria for NF2 in children was performed. CONCLUSIONS. The pattern of presentation of NF2 in childhood differs from adulthood in many aspects. Ophthalmologic and skin manifestations, and not an auditory dysfunction, are the most common initial symptoms in prepuberal-onset NF2. The most frequent symptoms and signs at presentation are posterior subcapsular cataract, skin manifestations as NF2 plaques and/or peripheral nerve tumors, and neurological dysfunction related to isolated or multiple cranial nerve deficits (other than nerve VIII), brainstem masses or spinal masses. As sensitivity of diagnostic criteria in children is low, those prepuberal patients with congenital or early-onset cataracts and typical skin manifestations of NF2 should be systematically assessed (AU)