Impact on the incidence of gastrointestinal perforation during the COVID-19 pandemic in the Costa del Sol healthcare system area.

INTRODUCTION AND AIMS: Gastrointestinal perforation is a surgical emergency that is associated with a high mortality rate and requires special care. During the pandemic, there has been competition with COVID-19 patients for health resources, especially ICU bed availability. The primary aim of our study was to compare the incidence of gastrointestinal perforation during the COVID-19 pandemic, with cases registered before the pandemic. MATERIALS AND METHODS: A retrospective, observational, single center, cohort study was conducted that included patients that underwent emergency surgery for gastrointestinal perforation in the periods during the pandemic (6 months) and before the pandemic (12 months). Sociodemographic characteristics, comorbidities, duration of hospital and ICU stay, status at discharge, and perforation site were compared. RESULTS: The study included 67 subjects (33 in the pre-pandemic period and 34 in the pandemic period). There were no significant differences regarding sex, age, or comorbidity. The perforation rate per emergency intervention was 4-times higher during the pandemic. There was an increase in the number of patients that were foreigners (4 [11%]) and nonresidents (6 [17%]). ICU admissions decreased (6 [19%]) but ICU stay increased to 137 h. Hospital stay increased by 5 days and delay in care increased 4.5 h. The number of deaths was higher (from 5 [15.2%] to 10 [29.4%]). Four patients with perforations were positive for COVID-19, were admitted to the ICU, and died. CONCLUSIONS: During the COVID-19 pandemic there was an increase in the incidence of gastrointestinal perforations at our healthcare system area; symptoms were more advanced, and mortality was higher.

[Impact on the incidence of gastrointestinal perforation during the COVID-19 pandemic in the Costa del Sol healthcare system area]. / Impacto en la incidencia de perforación gastrointestinal durante la pandemia de COVID-19 en el área sanitaria Costa del Sol.

INTRODUCTION AND AIMS: Gastrointestinal perforation is a surgical emergency that is associated with a high mortality rate and requires special care. During the pandemic, there has been competition with COVID-19 patients for health resources, especially ICU bed availability. The primary aim of our study was to compare the incidence of gastrointestinal perforation during the COVID-19 pandemic, with cases registered before the pandemic. MATERIALS AND METHODS: A retrospective, observational, single center, cohort study was conducted that included patients that underwent emergency surgery for gastrointestinal perforation in the periods during the pandemic (6 months) and before the pandemic (12 months). Sociodemographic characteristics, comorbidities, duration of hospital and ICU stay, status at discharge, and perforation site were compared. RESULTS: The study included 67 subjects (33 in the pre-pandemic period and 34 in the pandemic period). There were no significant differences regarding sex, age, or comorbidity. The perforation rate per emergency intervention was 4-times higher during the pandemic. There was an increase in the number of patients that were foreigners (4 [11%]) and nonresidents (6, [17%]). ICU admissions decreased (6 [19%]) but ICU stay increased to 137 h. Hospital stay increased by 5 days and delay in care increased 4.5 h. The number of deaths was higher (from 5 [15.2%] to 10 [29.4%]). Four patients with perforations were positive for COVID-19, were admitted to the ICU, and died. CONCLUSIONS: During the COVID-19 pandemic there was an increase in the incidence of gastrointestinal perforations at our healthcare system area; symptoms were more advanced, and mortality was higher.

Canopy position affects photosynthesis and anatomy in mature Eucalyptus trees in elevated CO2.

Leaves are exposed to different light conditions according to their canopy position, resulting in structural and anatomical differences with consequences for carbon uptake. While these structure-function relationships have been thoroughly explored in dense forest canopies, such gradients may be diminished in open canopies, and they are often ignored in ecosystem models. We tested within-canopy differences in photosynthetic properties and structural traits in leaves in a mature Eucalyptus tereticornis canopy exposed to long-term elevated CO2 for up to three years. We explored these traits in relation to anatomical variation and diffusive processes for CO2 (i.e., stomatal conductance, gs and mesophyll conductance, gm) in both upper and lower portions of the canopy receiving ambient and elevated CO2. While shade resulted in 13% lower leaf mass per area ratio (MA) in lower versus upper canopy leaves, there was no relationship between leaf Nmass and canopy gap fraction. Both maximum carboxylation capacity (Vcmax) and maximum electron transport (Jmax) were ~ 18% lower in shaded leaves and were also reduced by ~ 22% with leaf aging. In mature leaves, we found no canopy differences for gm or gs, despite anatomical differences in MA, leaf thickness and mean mesophyll thickness between canopy positions. There was a positive relationship between net photosynthesis and gm or gs in mature leaves. Mesophyll conductance was negatively correlated with mean parenchyma length, suggesting that long palisade cells may contribute to a longer CO2 diffusional pathway and more resistance to CO2 transfer to chloroplasts. Few other relationships between gm and anatomical variables were found in mature leaves, which may be due to the open crown of Eucalyptus. Consideration of shade effects and leaf-age dependent responses to photosynthetic capacity and mesophyll conductance are critical to improve canopy photosynthesis models and will improve understanding of long-term responses to elevated CO2 in tree canopies.

A combination of scGOS/lcFOS with Bifidobacterium breve M-16V protects suckling rats from rotavirus gastroenteritis.

PURPOSE: Rotavirus (RV) is the leading cause of severe diarrhoea among infants and young children, and although more standardized studies are needed, there is evidence that probiotics can help to fight against RV and other infectious and intestinal pathologies. On the other hand, the effects of prebiotics have not been properly addressed in the context of an RV infection. The aim of this study was to demonstrate a protective role for a specific scGOS/lcFOS 9:1 prebiotic mixture (PRE) separately, the probiotic Bifidobacterium breve M-16V (PRO) separately and the combination of the prebiotic mixture and the probiotic (synbiotic, SYN) in a suckling rat RV infection model. METHODS: The animals received the intervention from the 3rd to the 21st day of life by oral gavage. On day 7, RV was orally administered. Clinical parameters and immune response were evaluated. RESULTS: The intervention with the PRO reduced the incidence, severity and duration of the diarrhoea (p < 0.05). The PRE and SYN products improved clinical parameters as well, but a change in stool consistency induced by the PRE intervention hindered the observation of this effect. Both the PRE and the SYN, but not the PRO, significantly reduced viral shedding. All interventions modulated the specific antibody response in serum and intestinal washes at day 14 and 21 of life. CONCLUSIONS: A daily supplement of a scGOS/lcFOS 9:1 prebiotic mixture, Bifidobacterium breve M-16V or a combination of both is highly effective in modulating RV-induced diarrhoea in this preclinical model.

Cocoa intake attenuates oxidative stress associated with rat adjuvant arthritis.

Cocoa contains flavonoids with antioxidant properties. The aim of this study was to ascertain the effect of cocoa intake on oxidative stress associated with a model of chronic inflammation such as adjuvant arthritis. Female Wistar rats were fed with a 5% or 10% cocoa-enriched diet or were given p.o. a quercetin suspension every other day for 10 days. Arthritis was induced by a heat-killed Mycobacterium butyricum suspension. Reactive oxygen species (ROS) produced by macrophages, and splenic superoxide dismutase (total, cytoplasmic and mitochondrial) and catalase activities were determined. Clinically, joint swelling in arthritic rats was not reduced by antioxidants; however, the 5% cocoa diet and quercetin administration reduced ROS production. Moreover, the 5% cocoa diet normalized the activities of superoxide dismutase and catalase. In conclusion, a cocoa diet reduces the oxidative stress associated with a chronic inflammatory pathology, although it was not enough to attenuate joint swelling.

Effects of cooling and freezing storage on the stability of bioactive factors in human colostrum.

Breast milk constitutes the best form of newborn alimentation because of its nutritional and immunological properties. Banked human milk is stored at low temperature, which may produce losses of some bioactive milk components. During lactation, colostrum provides the requirements of the newborn during the first days of life. The aim of this study was to evaluate the effect of cooling storage at 4°C and freezing storage at -20°C and -80°C on bioactive factors in human colostrum. For this purpose, the content of IgA, growth factors such as epidermal growth factor, transforming growth factor (TGF)-ß1 and TGF-ß2, and some cytokines such as IL-6, IL-8, IL-10, and tumor necrosis factor (TNF)-α, and its type I receptor TNF-RI, were quantified. Some colostrum samples were stored for 6, 12, 24, and 48 h at 4°C and others were frozen at -20°C or -80°C for 6 and 12 mo. We quantified IgA, epidermal growth factor, TGF-ß1, and TGF-ß2 by indirect ELISA. Concentrations of IL-6, IL-10, and TNF-α cytokines, IL-8 chemokine, and TNF-RI were measured using the BD Cytometric Bead Array (BD Biosciences, Erembodegem, Belgium). Bioactive immunological factors measured in this study were retained in colostrum after cooling storage at 4°C for at least 48h, with the exception of IL-10. None of the initial bioactive factor concentrations was modified after 6 mo of freezing storage at either -20°C or -80°C. However, freezing storage of colostrum at -20°C and -80°C for 12 mo produced a decrease in the concentrations of IgA, IL-8, and TGF-ß1. In summary, colostrum can be stored at 4°C for up to 48 h or at -20°C or -80°C for at least 6 mo without losing its immunological properties. Future studies are necessary to develop quality assurance guidelines for the storage of colostrum in human milk banks, and to focus not only on the microbiological safety but also on the maintenance of the immunological properties of colostrum.

Maintenance of breast milk Immunoglobulin A after high-pressure processing.

Human milk is considered the optimal nutritional source for infants. Banked human milk is processed using low-temperature, long-time pasteurization, which assures microbial safety but involves heat denaturation of some desirable milk components such as IgA. High-pressure processing technology, the subject of the current research, has shown minimal destruction of food macromolecules. The objective of this study was to investigate the influence of pressure treatments on IgA content. Moreover, bacterial load was evaluated after pressure treatments. The effects of high-pressure processing on milk IgA content were compared with those of low-temperature, long-time pasteurization. Mature human milk samples were heat treated at 62.5 degrees C for 30min or pressure processed at 400, 500, or 600MPa for 5min at 12 degrees C. An indirect ELISA was used to measure IgA in human milk whey obtained after centrifugation at 800xg for 10min at 4 degrees C. All 3 high-pressure treatments were as effective as low-temperature, long-time pasteurization in reducing the bacterial population of the human milk samples studied. After human milk pressure processing at 400MPa, 100% of IgA content was preserved in milk whey, whereas only 72% was retained in pasteurized milk whey. The higher pressure conditions of 500 and 600MPa produced IgA retention of 87.9 and 69.3%, respectively. These results indicate that high-pressure processing at 400MPa for 5min at 12 degrees C maintains the immunological protective capacity associated with IgA antibodies. This preliminary study suggests that high-pressure processing may be a promising alternative to pasteurization in human milk banking.

Leaf physiological versus morphological acclimation to high-light exposure at different stages of foliar development in oak.

We investigated light acclimation in seedlings of the temperate oak Quercus petraea (Matt.) Liebl. and the co-occurring sub-Mediterranean oak Quercus pyrenaica Willd. Seedlings were raised in a greenhouse for 1 year in either 70 (HL) or 5.3% (LL) of ambient irradiance of full sunlight, and, in the following year, subsets of the LL-grown seedlings were transferred to HL either before leaf flushing (LL-HLBF plants) or after full leaf expansion (LL-HLAF plants). Gas exchange, chlorophyll a fluorescence, nitrogen fractions in photosynthetic components and leaf anatomy were examined in leaves of all seedlings 5 months after plants were moved from LL to HL. Differences between species in the acclimation of LL-grown plants to HL were minor. For LL-grown plants in HL, area-based photosynthetic capacity, maximum rate of carboxylation, maximum rate of electron transport and the effective photochemical quantum yield of photosystem II were comparable to those for plants grown solely in HL. A rapid change in nitrogen distribution among photosynthetic components was observed in LL-HLAF plants, which had the highest photosynthetic nitrogen-use efficiency. Increases in mesophyll thickness and dry mass per unit area governed leaf acclimation in LL-HLBF plants, which tended to have less nitrogen in photosynthetic components and a lower assimilation potential per unit of leaf mass or nitrogen than LL-HLAF plants. The data indicate that the phenological state of seedlings modified the acclimatory response of leaf attributes to increased irradiance. Morphological adaptation of leaves of LL-HLBF plants enhanced photosynthetic capacity per unit leaf area, but not per unit leaf dry mass, whereas substantial redistribution of nitrogen among photosynthetic components in leaves of LL-HLAF plants enhanced both mass- and area-based photosynthetic capacity.

[The bowel: a key component of the immune system]. / El intestino: pieza clave del sistema inmunitario.

The gut is constantly exposed to a high antigenic load coming from the diet and commensal bacteria. The Gut-Associated Lymphoid Tissue (GALT) constitutes the most extensive and complex part of the immune system and is capable of efficiently distinguishing invasive pathogens from innocuous antigens. The knowledge of its unique structure consisting on organised tissue, inductor of the immune response (Peyer's patches and mesenteric lymph nodes), and diffused tissue, effector of the immune response (intraepithelial lymphocytes and lamina propria lymphocytes), allow us to understand the development and regulation of the immune response in the gut and how this one can be extended to the rest of the organism.

Spleen lymphocyte function modulated by a cocoa-enriched diet.

Previous studies have shown the down-regulating in vitro effect of cocoa flavonoids on lymphocyte and macrophage activation. In the present paper, we report the capacity of a long-term rich cocoa diet to modulate macrophage cytokine secretion and lymphocyte function in young rats. Weaned rats received natural cocoa (4% or 10% food intake), containing 32 mg flavonoids/g, for 3 weeks. Spleen immune function was then evaluated through the analysis of lymphocyte composition, their proliferative response and their ability to secrete cytokines and Ig. In addition, the status of activated peritoneal macrophages was established through tumour necrosis factor (TNF)-alpha secretion. The richest cocoa diet (10%) caused a reduction of TNF-alpha secretion by peritoneal macrophages showing anti-inflammatory activity. Similarly, although a 10% cocoa diet increased lymphocyte proliferation rate, it down-regulated T helper 2 (Th2)-related cytokines and decreased Ig secretion. These changes were accompanied by an increase in spleen B cell proportion and a decrease in Th cell percentage. In summary, these results demonstrate the functional activity of a cocoa-high dosage in down-regulating the immune response that might be beneficial in hypersensitivity and autoimmunity.

[Descriptive epidemiology of hospital interconsultations carried out at the ORL Service for a year in the San Millan-San Pedro Hospital Complex]. / Epidemiología descriptiva de las interconsultas hospitalarias realizadas al Servicio de ORL durante un año en el Complejo Hospitalario San Millán-San Pedro.

UNLABELLED: 391 requests of collaboration to our ENT Department during 1996 have been collected. Twelve variables were analysed: number of request, age, sex, date of emission, type (ordinary, with priority, urgent), time elapsed from emission until valuation of the patient, source, reason's request, pathology, complementary tests, treatment and destination (discharge, re-examination during admission or as an outpatient and admission to ENT-Service). RESULTS: 1,58 request were attended per working day, 80 percent were resolved during the first 48 hours, the Internal Medicine Department was the most frequent source, fever without focus or recalcitrant was the most frequent reason from Paediatric Department. We report the epidemiologic features of the most frequent variables.

[Extramedullary plasmocytoma. Report of 5 cases]. / Plasmocitomas extramedulares. Presentación de cinco casos.

The extramedullary plasmacytoma account for 1-2% of the total number of plasma-cell growths. 80 percent are originated on head and neck, beginning on submucous layer of the upper airways. Male are more frequent affected at sixth-seventh decade. Roentgentherapy chemotherapy is only worldwide accepted in cases of scattered disease, but when the cases are localizated the method is under assessment. Long tern follow up of patients is recommended, because there are cases which after many years of calm can evolve into a multiple myeloma. We report 5 cases: 3 women and 2 men, diagnosed as extramedullary plasmocytoma. In one of them, considered as nasal plasmacytoma, three years later was discovered an other plasmacytoma on a tibial epiphysis. The whole group was surgically treated with complementary röntgentherapy 4 of them. Afterwards no one showed multiple myeloma.

[Variability in the digital voice analysis depending on the analyzed vocal, in normal patients and in patients with dysphonia]. / Variabilidad en el análisis digital de la voz según la vocal analizada, en pacientes normales y pacientes disfónicos.

UNLABELLED: The aim of this study is to decide which of Spanish's 5 vowels is the most suitable for the analysis of the voice by means of the program Dr. Speech 3.0. We assessed 98 patients: 51 normal subjects and 47 hoarse patients (34 polyps, 7 nodules, 2 hyperfunctional dysphonia, 4 other pathologies) before and after following a surgical and/or speech therapy. The methodology of the study included: protocolized questionnaire, ENT examination, perceptual evaluation of the hoarse voices and physical analysis of the 5 sustained vowels. Jitter, shimmer, NNE and HNR in the voice varied depending on the analyzed vowel and from normal subjects to hoarse patients. NNE and HNR for vowels [o] and [u] was higher than for [a], such differences were statistically significant (p < 0.001). Shimmer for vowels [o] and [u] was lower than shimmer for [a] in hoarse patients (p < 0.05). Jitter for [a] was higher than jitter for the other vowels in normal patients. All algorithms improveded with surgical and/or speech therapy. Especially levels of noise for vowels [a] [e] and [o] presented statiscally significant improvements (p < 0.001), shimmer for [a] and [e] (p < 0.001) and jitter for [e] (p < 0.01). The hoarse patients presented values more pathological than the normal subjects, especially jitter for vowels [a] [e] and [o] (p < 0.001), shimmer for [a] [e] [i] and [u] (p < 0.001) and level of noise for [a] [e] [o] and [u] (p < 0.001). CONCLUSION: The analysis of vowel [e] presented higher r than [a] when correlated with perceptual evaluation of voice or with voice quality that gave us Dr. Speech 3.0. Also, the [e] is the best vowel to express the improvements of jitter, shimmer and level of noise of hoarse patients after following surgical and/or speech therapy.

[Renal transplant and chronic rejection in pediatrics]. / Trasplante renal y rechazo crónico en pediatría.

The rapid advances in immunobiology, pharmacology and molecular biology have made successful renal transplantation the optimal therapeutic modality for adults and children, reaching a near--90% of patient-graft survival among the first years of transplant. But this knowledge also presents clinicians and scientists with difficult challenges, one of the most important remaining is the chronic rejection of the graft. A critical review of the immunobiology, clinical evolution and histopathology of chronic rejection is presented. Immunosuppressive agents with emphasis in their mechanism of action is also detailed.