Prospective study of variables associated with nonadherence to psychotherapy.

Background: The identification of factors associated with nonadherence to psychotherapy would allow a better prevention of this problem.Aim: To investigate factors associated with nonadherence in psychotherapy, its possible effect on outcomes, and reasons for therapy dropout.Method: Prospective analytic observational study of patients who initiated psychotherapy (N = 144). Sociodemographic, general clinical, treatment-related, subjective, psychological, psychopathologic, and outcome variables were evaluated at baseline and 1, 3, 6, and 12 months later. Objective nonadherence (dropout and irregularity), subjective nonadherence (poor patient engagement), and global nonadherence (combination of both) were analyzed.Results: Global nonadherence was 66%. Global nonadherence was associated with substance use or abuse (OR = 2.64) and younger age (OR = 0.97). Objective nonadherence was associated with active working status (OR = 4.11), younger age (OR = 1.04) and substance use or abuse (OR = 2.35). Subjective nonadherence was associated with worse insight in psychotherapy (OR = 0.95) and poor pharmacologic adherence (OR = 0.55). Contextual reasons (25.8%) were the most commonly reported cause of dropout. Time in psychotherapy was associated with outcome variables.Conclusions: Nonadherence to psychotherapy is frequent. To reduce nonadherence in psychotherapy, specific interventions for reducing substance use and abuse, measures aimed at facilitating access to Community Mental Health Units, and enhancing insight in psychotherapy should be implemented.

Escherichia coli shigatoxigénica en animales relacionados con casos de diarreas sanguinolentas o síndrome urémico hemolítico y prevalencia en roedores de la Ciudad de Buenos Aires / Shiga toxin-producing escherichia coli in animals related to cases of bloody diarrhea

Escherichia coli shigatoxigénica (STEC) es un patógeno endémico en Argentina, responsable de diarrea aguda sanguinolenta (DAS) y/o síndrome urémico hemolítico (SUH). La correlación entre SUH y alimentos contaminados ha sido documentada, aunque no siempre se estableció la fuente de infección. La ruta de contagio persona-persona es relevante. Dados los registros previos de prevalencia de STEC en animales de compañía y los hábitos de convivencia humano-animal en centros urbanos, es necesario evaluar la ruta mascota-persona. A su vez, los roedores podrían tener un papel epidemiológico en la endemia. OBJETIVO: Estudiar posibles reservorios animales relacionados con casos de SUH/DAS en la Ciudad Autónoma de Buenos Aires y estimar la prevalencia de STEC en roedores. MÉ-TODOS: Se intervino en 28 casos de SUH y 49 de DAS. Se realizó rastrillaje de cepas STEC por PCR a partir de hisopados rectales de los animales vinculados a cada caso. La prevalencia en roedores se estimó por PCR de sus hisopados rectales. RESULTADOS: Se aislaron cepas STEC en 1/10 caninos y 1/3 felinos con vivientes con casos de SUH, y 1/9 felinos contacto con casos de DAS. Rattus rattus fue hospedero de cepas STEC en 33% de los animales capturados en focos de SUH. En roedores, la prevalencia fue de 3,1%. CONCLUSIONES: Las cepas STEC circulan en los animales que conviven o tienen al menos un hábitat compartido con la población en riesgo, quienes podrían participar en la transmisión del agente. Es necesario reevaluar las intervenciones sanitarias en focos y en programas de control de SUH/DAS

Shigatoxigenic Escherichia coli(STEC) is an endemic pathogen in Argentina, which causes bloody diarrhea (BD) and/or hemolytic uremic syndrome (HUS).The co-relation between HUS and contaminated food has been documented, although the source of infection was not always established. Person-to-person route of infection is relevant. Taking into account previous STEC prevalence data in companion animals and the habits of human-animal coexistence in urban centers, it is necessary to evaluate pet-to-person transmission. On the other hand, rodents may also play an epidemiologic role in the endemic transmission. OBJECTIVE: To study potential animal reservoirs related to HUS and BD cases in the City of Buenos Aires and to estimate the prevalence of STEC in rodents. METHODS: An intervention was conducted in 28 cases of HUS and 49 of BD. Screening for STEC was performed by PCR from rectal swabs of linked animals to each case. The prevalence in rodents was estimated by PCR from rectal swabs. RESULTS: STEC strains were isolated in 1/10 dogs and 1/3 cats cohabiting with HUS cases, and in 1/9 cats in contact with DAS cases. Rattus rattus was host of STEC strains in 33% of the animals captured in HUS areas. In rodents, the prevalence was 3.1%. CONCLUSIONS: STEC strains circulate in animals that live withor share at least the same habitat with the population at risk, and could participate in the transmission of the agent. It is necessary to re-evaluate health interventions both in outbreaks and in control programs of HUS/BD

Escherichia coli shigatoxigénica en animales relacionados con casos de diarreas sanguinolentas o síndrome urémico hemolítico y prevalencia en roedores de la Ciudad de Buenos Aires / Shiga toxin-producing escherichia coli in animals related to cases of bloody diarrhea

Escherichia coli shigatoxigénica (STEC) es un patógeno endémico en Argentina, responsable de diarrea aguda sanguinolenta (DAS) y/o síndrome urémico hemolítico (SUH). La correlación entre SUH y alimentos contaminados ha sido documentada, aunque no siempre se estableció la fuente de infección. La ruta de contagio persona-persona es relevante. Dados los registros previos de prevalencia de STEC en animales de compañía y los hábitos de convivencia humano-animal en centros urbanos, es necesario evaluar la ruta mascota-persona. A su vez, los roedores podrían tener un papel epidemiológico en la endemia. OBJETIVO: Estudiar posibles reservorios animales relacionados con casos de SUH/DAS en la Ciudad Autónoma de Buenos Aires y estimar la prevalencia de STEC en roedores. ME-TODOS: Se intervino en 28 casos de SUH y 49 de DAS. Se realizó rastrillaje de cepas STEC por PCR a partir de hisopados rectales de los animales vinculados a cada caso. La prevalencia en roedores se estimó por PCR de sus hisopados rectales. RESULTADOS: Se aislaron cepas STEC en 1/10 caninos y 1/3 felinos con vivientes con casos de SUH, y 1/9 felinos contacto con casos de DAS. Rattus rattus fue hospedero de cepas STEC en 33% de los animales capturados en focos de SUH. En roedores, la prevalencia fue de 3,1%. CONCLUSIONES: Las cepas STEC circulan en los animales que conviven o tienen al menos un hábitat compartido con la población en riesgo, quienes podrían participar en la transmisión del agente. Es necesario reevaluar las intervenciones sanitarias en focos y en programas de control de SUH/DAS (AU)

Shigatoxigenic Escherichia coli(STEC) is an endemic pathogen in Argentina, which causes bloody diarrhea (BD) and/or hemolytic uremic syndrome (HUS).The co-relation between HUS and contaminated food has been documented, although the source of infection was not always established. Person-to-person route of infection is relevant. Taking into account previous STEC prevalence data in companion animals and the habits of human-animal coexistence in urban centers, it is necessary to evaluate pet-to-person transmission. On the other hand, rodents may also play an epidemiologic role in the endemic transmission. OBJECTIVE: To study potential animal reservoirs related to HUS and BD cases in the City of Buenos Aires and to estimate the prevalence of STEC in rodents. METHODS: An intervention was conducted in 28 cases of HUS and 49 of BD. Screening for STEC was performed by PCR from rectal swabs of linked animals to each case. The prevalence in rodents was estimated by PCR from rectal swabs. RESULTS: STEC strains were isolated in 1/10 dogs and 1/3 cats cohabiting with HUS cases, and in 1/9 cats in contact with DAS cases. Rattus rattus was host of STEC strains in 33% of the animals captured in HUS areas. In rodents, the prevalence was 3.1%. CONCLUSIONS: STEC strains circulate in animals that live withor share at least the same habitat with the population at risk, and could participate in the transmission of the agent. It is necessary to re-evaluate health interventions both in outbreaks and in control programs of HUS/BD (AU)

Risk factors for Shiga toxin-producing Escherichia coli infections in preadolescent schoolchildren in Buenos Aires, Argentina.

INTRODUCTION: Shiga toxin-producing Escherichia coli (STEC) infections are the leading cause of hemolytic uremic syndrome (HUS). STEC is the most common cause of acute kidney disease, responsible for 20% of renal transplants in Argentina. METHODOLOGY: In 2007, an epidemiological survey was conducted among 883 students from the fifth and sixth years of elementary education in the public schools of San Martin City, Buenos Aires, Argentina. Degree of exposure to the known risk factors previously detected in the region as primary causes of STEC infections was evaluated. Risk factors assessed included consumption of hamburgers, poor personal hygiene, and exposure to various types of drinking and recreational water. The study was designed to evaluate exposure to risk factors for STEC infections among different socioeconomic groups. RESULTS: Ninety-five percent of children surveyed reported consumption of hamburgers. Most of these hamburgers were precooked. Children of high and medium strata attended private swimming-pools, while children from the low stratum attended public pools. Only 30.2% of students washed their hands after going to the toilet and only 43.5% reported hand-washing before eating. CONCLUSIONS: Students demonstrated high levels of exposure to identified risk factors for STEC infections. Reduction of these risks will require cultural changes aimed at decreasing morbidity caused by food-borne infections. Institutional framework must provide the necessary resources to implement these changes and emphasize the importance of good personal hygiene. Health education must be implemented to increase food safety awareness of the consumers.

Spatial-specific action of serotonin within the leech midbody ganglion.

Serotonin is a conspicuous neuromodulator in the nervous system of many vertebrates and invertebrates. In previous experiments performed in the leech nervous system, we compared the effect of the amine released from endogenous sources [using selective serotonin reuptake inhibitors (SSRIs), e.g. fluoxetine] with that of bath-applied serotonin. The results suggested that the amine does not reach all its targets in a uniform way, but produces the activation of an interneuronal pathway that generated specific synaptic responses on different neurons. Taking into account that the release of the amine is often regulated at the presynaptic level, we have investigated whether autoreceptor antagonists mimic the SSRIs effect. We found that methiothepin (100 microM) produced similar effects than fluoxetine. To further test the hypothesis that endogenous serotonin produce its effect by acting locally at specific sites, we analyzed the effect of iontophoretic applications of serotonin. We found a site in the neuropil of the leech ganglia where serotonin application mimicked the effect of the SSRIs and the 5-HT antagonist. The results further support the view that the effect of serotonin exhibits a spatial specificity that can be relevant to understand its modulatory actions.

Inducible nitric oxide synthase polymorphism is associated with susceptibility to Henoch-Schönlein purpura in northwestern Spain.

OBJECTIVE: To assess the contribution of 2 polymorphisms within the inducible nitric oxide (NOS2A) promoter region to the susceptibility to Henoch-Schönlein purpura (HSP), and to determine if implications exist with severe systemic complications of HSP, in particular with severe renal involvement and permanent renal dysfunction (renal sequelae). METHODS: Fifty-eight patients from Northwest Spain with primary cutaneous vasculitis classified as HSP were studied. All patients were required to have had at least 2 years' followup. Patients and ethnically matched controls (n=251) were genotyped by PCR based techniques for a multiallelic (CCTTT)n and for the biallelic TAAA repeat in the promoter region of the NOS2A gene. RESULTS: HSP patients exhibited a significantly increased frequency of the NOS2A short (8-11) CCTTTn alleles (OR 1.64, 95% CI 1.09-2.47, p=0.017) and genotypes (OR 3.59, 95% CI 1.79-7.20, p=0.0002) compared to controls, particularly when patients with nephritis were compared with controls. However, when the NOS2A TAAA repeat polymorphism was assessed, no differences were found. CONCLUSION: Significant differences in the NOS2A promoter polymorphism allele and genotype frequency between HSP patients and controls suggest a potential role for this gene in the susceptibility to HSP and in the development of nephritis.

Selective serotonin reuptake inhibitors induce spontaneous interneuronal activity in the leech nervous system.

Serotonin [5-hydroxytryptamine (5-HT)] is a conspicuous neuromodulator of sensory-motor networks that affects a variety of neurons at different levels of the network hierarchy. Because of its many possible targets, it has been difficult to obtain a comprehensive picture of how 5-HT achieves its final modulatory output on any given network. Our hypothesis is that the profile of 5-HT actions is dictated by its pattern of release from endogenous sites. We tested this hypothesis in the leech nervous system by means of a selective serotonin reuptake blocker (SSRI), fluoxetine. Fluoxetine evoked barrages of synaptic potentials in identified sensory, motor, and interneurons. This effect was mimicked by the tricyclic antidepressants imipramine and clomipramine, and by the SSRI citalopram, with relative efficacies that matched their known relative selectivities for the 5-HT transporter. The synaptic responses evoked by fluoxetine in different neurons were temporally correlated, suggesting that they had a common origin. The profile of the synaptic responses matched that expected from the activation of the mechanosensory pressure cells, known to act by polysynaptic pathways. The results suggest that endogenous 5-HT acted on cord spanning interneurons. On the other hand, bath-applied 5-HT evoked an effect different from that of the SSRI. Taken together, the results evidenced that the pattern of action of the monoamine is dictated by the spatial distribution of the 5-HT release sites.

Interleukin 1beta gene polymorphism association with severe renal manifestations and renal sequelae in Henoch-Schönlein purpura.

OBJECTIVE: To assess the influence of the interleukin (IL)-1beta gene (-511 C/T) in the incidence of Henoch-Schönlein purpura (HSP) and determine its possible implication in severe systemic complications of HSP, in particular severe renal involvement and permanent renal dysfunction (renal sequelae). METHODS: Patients from Northwest Spain with primary cutaneous vasculitis classified as HSP according to proposed criteria were studied. All patients were required to have had at least 2 years' followup. Patients and ethnically matched controls were genotyped for IL-1beta gene (-511 C/T) polymorphism by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). RESULTS: Forty-nine Caucasian patients (38 of them younger than 21 years) who fulfilled classification criteria for HSP and 148 controls were examined. No allele or genotype differences between the whole group of HSP and controls were observed. However, all 5 patients who developed severe nephropathy during the course of disease carried the rare T allele compared with only 16 of the remaining 44 patients (pcorr = 0.01). A significant association between carriage of the -511(IL-1beta) T allele and renal sequelae (pc = 0.02; OR: 3.6, 95% CI: 1.3-10.0) was also found. CONCLUSION: In unselected patients with cutaneous vasculitis who fulfill classification criteria for HSP, carriage of IL-1beta (-511) T allele appears to influence severity of renal involvement.

Lack of association between endothelial nitric oxide synthase polymorphisms and Henoch-Schönlein purpura.

OBJECTIVE: To assess the influence of endothelial nitric oxide synthase (eNOS) polymorphisms in the susceptibility and clinical expression of patients with cutaneous vasculitis fulfilling classification criteria for Henoch-Schönlein purpura (HSP). METHODS: Fifty patients from Northwest Spain with primary cutaneous vasculitis classified as HSP were studied. Patients and ethnically matched controls (n = 117) were genotyped by polymerase chain reaction techniques for a variable-number tandem-repeat polymorphism in intron 4, a T/C polymorphism at position -786 in the promoter region, and a polymorphism in exon 7 (298Glu/Asp or 5557G/T) of the eNOS gene. RESULTS: No differences in allele or genotype frequencies for any of the individual eNOS polymorphisms were observed between patients fulfilling HSP classification criteria and controls, or when patients were stratified for the presence of nephritis or joint or gastrointestinal manifestations. In the HSP group no linkage disequilibrium between these polymorphisms was found. No significant difference in haplotype frequencies was observed between patients and controls. CONCLUSION: Our results do not support a role for these polymorphisms in the susceptibility to HSP.

Interleukin 8 gene polymorphism is associated with increased risk of nephritis in cutaneous vasculitis.

OBJECTIVE: To assess the influence of interleukin-8 (IL-8), epithelial cell-derived neutrophil-activating peptide (ENA-78), and regulated upon activation normal T cell expressed and secreted (RANTES) gene polymorphisms in the susceptibility and clinical expression of patients fulfilling classification criteria for Henoch-Schönlein purpura (HSP). METHODS: Fifty patients (25 men) from Northwest Spain with primary cutaneous vasculitis classified as HSP according to proposed criteria were studied. All patients were required to have had at least 2 years' followup. Patients and ethnically matched controls were genotyped for IL-8, ENA-78, and RANTES gene polymorphisms. RESULTS: No allele or genotype differences between patients fulfilling HSP classification criteria and controls were observed for any of the chemokines. However, a significantly increased frequency of allele A of the IL-8 gene polymorphism was found in patients with HSP who developed renal manifestations compared with patients without renal involvement (p = 0.02; pcorr = 0.036). Moreover, the genotype distribution in HSP patients with and without renal involvement showed statistically significant differences (p = 0.02). CONCLUSION: In unselected patients with cutaneous vasculitis, carriage of IL-8 allele A influences the susceptibility to renal involvement.

Interleukin 1 receptor antagonist gene polymorphism is associated with severe renal involvement and renal sequelae in Henoch-Schönlein purpura.

OBJECTIVE: To assess the influence of interleukin 1 receptor antagonist gene polymorphism (IL1RN) in the incidence of Henoch-Schönlein purpura (HSP) and cutaneous leukocytoclastic angiitis (CLA) and to determine if implications exist with severe systemic complications of HSP, in particular with severe renal involvement and permanent renal dysfunction (renal sequelae). METHODS: Patients from Northwest Spain with primary cutaneous vasculitis classified as HSP or hypersensitivity vasculitis (HV) according to proposed criteria were studied. Patients with HV were included if they had a biopsy proven small size blood vessel leukocytoclastic vasculitis limited to skin and also fulfilled the Chapel Hill Consensus Conference on the Nomenclature of Systemic Vasculitis definitions for CLA. All patients were required to have had at least 2 years' followup. Patients and ethnically matched controls were genotyped for IL-1 receptor antagonist intron 2 VNTR polymorphism. RESULTS: We examined 96 Caucasian patients (58 HSP and 38 CLA) and 109 controls. No allele or genotype differences between the whole group of HSP or CLA patients and controls were observed. We found a significant association between carriage of IL-1 receptor antagonist allele 2 (ILRN*2) and severe renal involvement, manifested as nephrotic syndrome and/or renal insufficiency (p = 0.016), and permanent renal involvement (renal sequelae) (p = 0.012). CONCLUSION: In unselected patients with cutaneous vasculitis, carriage of ILRN*2 alleles influences disease severity rather than susceptibility.

HLA-B35 association with nephritis in Henoch-Schönlein purpura.

OBJECTIVE: To investigate the implications of the HLA-B locus in the susceptibility to Henoch-Schönlein purpura (HSP) and determine if there are associations with renal and gastrointestinal (GI) manifestations of the disease. METHODS: A retrospective study was performed on an unselected population of patients with HSP from Northwest Spain. Forty-eight Caucasian patients (24 women), 11 of them older than 20 years, were studied. Patients and ethnically matched controls were HLA-B genotyped from DNA using molecular based methods. RESULTS: When patients with HSP were compared with matched controls, no differences in HLA-B frequencies were observed. No HLA-B associations with GI manifestations were observed. In contrast, an increased frequency of HLA-B35 was observed in patients with renal manifestations (10 of 31) compared to those without (0 of 17). No significant distortions in frequency were seen for any other HLA-B alleles with HSP subgroups. CONCLUSION: Our results support a role of HLA-B35 in the susceptibility for nephritis in unselected patients with HSP.

Henoch-Schönlein purpura and cutaneous leukocytoclastic angiitis exhibit different HLA-DRB1 associations.

OBJECTIVE: To examine the HLA-DRB1 genotype of patients with cutaneous leukocytoclastic angiitis (CLA), a small-sized blood vessel vasculitis limited to skin, and determine if differences exist with Henoch-Schönlein purpura (HSP), a small-sized blood vessel vasculitis with cutaneous and systemic complications. METHODS: A retrospective study was performed on an unselected population of patients from Northwest Spain with primary cutaneous vasculitis classified according to proposed criteria. Patients who fulfilled classification criteria for hypersensitivity vasculitis were included in this study if they had a biopsy proven leukocytoclastic vasculitis limited to skin and, due to this, they also met the Chapel Hill Consensus Conference on the Nomenclature of Systemic Vasculitis definitions for CLA. Patients were included in this study if they had at least 2 years' followup. We studied 96 Caucasian patients (58 HSP, 38 CLA). Patients and ethnically matched controls (n = 145) were HLA-DRB1 genotyped from DNA using molecular based methods. RESULTS: No HLA-DRB1 genotype differences between patients with CLA and controls were seen. HLA-DRB1*01 was increased and HLA-DRB1*07 reduced in HSP patients compared to controls. When HLA-DRB1 genotypes of patients with CLA and HSP were compared a significant increase of HLA-DRB1*15/16 and especially of HLA-DRB1*07 was observed in the patients fulfilling definitions for CLA compared to those with HSP. CONCLUSION: HSP and CLA exhibit different HLA-DRB1 genotype associations.

Henoch-Schönlein purpura in children and adults: clinical differences in a defined population.

OBJECTIVE: To examine epidemiologic, clinical, and outcome differences between children and adults with Henoch-Schönlein purpura (HSP) in a well-defined population. PATIENTS AND METHODS: Retrospective study of unselected patients with HSP seen at the only referral hospital for the Lugo region of Northwest Spain between 1980 and 2000. Patients were classified according to the criteria proposed by Michel et al. Two well-differentiated age groups were established for comparison: children (under 14 years of age) and adults (over 20 years of age). Also, to assess possible differences in the outcome, only those patients with at least 1 year of follow-up were included in the study. RESULTS: Seventy-three children and 31 adults fulfilled the inclusion criteria described above. Unlike in children, HSP in adults was more common in males. While in children, HSP manifested more commonly in fall and winter, summer and winter were the most common seasons of onset in adults. The frequency of gastrointestinal manifestations was similar in both groups. However, during the course of the disease, 6 of the 31 adults (19%) had severe renal manifestations and another 4 (13%) renal insufficiency. In children, by contrast, the frequency of severe renal manifestations or renal insufficiency during the course of the disease was significantly reduced compared with adults. After 6 years' median follow-up in children, complete recovery was observed in most cases. However, after 5 years' median follow-up, almost 40% of adults had persistent hematuria and 3 of them (10%) renal insufficiency that required hemodialysis in 2 cases. CONCLUSIONS: HSP is generally benign and self-limited in children and more severe in adults.

Método rápido y sensible para detectar aminas primarias y secundarias no fenólicas en orina humana / A fast and sensitive method to detect primary and secondary non-phenolic amines in human urine

En este trabajo se desarrolló una metodología cromatográfica rápida y precisa para buscar aminas primarias y secundarias O-metiladas, típicas de ciertos desórdenes mentales, en muestras de orina humanas de 24 horas. La extracción de la orina fue llevada a cabo bajo condiciones alcalinas para evitar la interferencia de catecolaminas y ácidos urinarios. Después de la extracción alcalina, a cada muestra se la hizo reaccionar con cloruro de dansilo en acetonitrilo en presencia de bicarbonato de sodio en exceso, para formar las correspondientes dansilamidas. Las fenetilamidas y las indolalquilaminas O-metiladas fueron visualizadas en placas de fase reversa de alta resolución (HP-TLC), por cromatografía líquida de alta resolución (HPLC) y por cromatografía gas-líquido (CGL) y, además, fueron identificadas por cromatografía gas-líquido acoplada con espectrometría de masas (CGL-EM). Este método es lo suficientemente sensible para estos metabolitos en muestras de orina y, por lo tanto, resulta útil para investigaciones biomédicas y clínicas de aminas primarias y secundarias no fenólicas en orina (AU)

Método rápido y sensible para detectar aminas primarias y secundarias no fenólicas en orina humana / A fast and sensitive method to detect primary and secondary non-phenolic amines in human urine

En este trabajo se desarrolló una metodología cromatográfica rápida y precisa para buscar aminas primarias y secundarias O-metiladas, típicas de ciertos desórdenes mentales, en muestras de orina humanas de 24 horas. La extracción de la orina fue llevada a cabo bajo condiciones alcalinas para evitar la interferencia de catecolaminas y ácidos urinarios. Después de la extracción alcalina, a cada muestra se la hizo reaccionar con cloruro de dansilo en acetonitrilo en presencia de bicarbonato de sodio en exceso, para formar las correspondientes dansilamidas. Las fenetilamidas y las indolalquilaminas O-metiladas fueron visualizadas en placas de fase reversa de alta resolución (HP-TLC), por cromatografía líquida de alta resolución (HPLC) y por cromatografía gas-líquido (CGL) y, además, fueron identificadas por cromatografía gas-líquido acoplada con espectrometría de masas (CGL-EM). Este método es lo suficientemente sensible para estos metabolitos en muestras de orina y, por lo tanto, resulta útil para investigaciones biomédicas y clínicas de aminas primarias y secundarias no fenólicas en orina