[Withdrawal of benzodiazepines in the elderly]. / Retirada de benzodiacepinas en el anciano.

TITLE: Retirada de benzodiacepinas en el anciano.

[Cytochrome pharmacogenetics applied to the prescription of antidepressants: Instructions for use]. / Pharmacogénétique des cytochromes appliquée à la prescription des antidépresseurs : mode d'emploi.

CYP2D6 and CYP2C19 polymorphisms affect the exposure, efficacy, and safety of antidepressants. This article is an instruction manual and a guide for the deployment, in hospitals, of pharmacogenetics as an aid to the prescription of an antidepressant. It synthesizes the recommendations of two learned societies, the Clinical Pharmacogenetics Implementation Consortium (CPIC) and the Dutch Pharmacogenetics Working Group (DPWG), to produce a recommendation table adapted to a wide panel of antidepressants.

[Atypical purpuric oedema of the nose during granulomatosis with polyangiitis]. / Un œdème purpurique du nez atypique au cours d'une granulomatose avec polyangéite.

INTRODUCTION: Granulomatosis with polyangeitis or Wegener's disease is a necrotizing vasculitis of small and medium vessels associated with antineutrophil cytoplasmic autoantibodies (ANCA). The most frequent sites are lung, ear, nose and throat and kidney. PATIENTS AND METHODS: We report the case of a 47-year-old woman presenting purpuric oedematous plaque with bullous detachment of the nose and hospitalised for the assessment of two suspicious neoplastic lung lesions discovered as a result of a recent stroke and repeated seromucosal otitis. Granulomatosis with polyangeitis was suspected because of multiple systemic lesions. The histopathology of skin lesions and laboratory investigation results were consistent with this diagnosis. A favourable outcome was achieved with corticosteroids and rituximab. DISCUSSION: The diagnosis of GPA is based on criteria established by the American College of Rheumatology. The cutaneous clinical aspect described in our case confirms the polymorphism of the cutaneous lesions possibly associated with this disease. They are rarely isolated but, in some cases, allow early diagnosis with improved prognosis, which remains severe in the absence of treatment.

Raman spectra and structural peculiarities of TeO2-TeO3 mixed oxides.

Raman spectra of the mixed crystalline oxides of the (1 - x)TeO2 + xTeO3 (x = 0, », ½, 1) series were recorded and simulated by using the DFT calculations. Good agreement between observed and calculated Raman spectra makes it possible to establish unambiguous assignment for all prominent Raman lines. This result gives an insight into relations between structural peculiarities and observed spectral features for the crystals promising as nonlinear optical materials. Highlights • Several mixed TeO2-TeO3 crystals were synthesized by solid-state chemistry • DFT calculations well describe structures and phonon spectra of TeO2-TeO3 oxides • Raman lines can be assigned to internal vibrations of TeO4 and TeO6 polyhedrons • Observed Raman bands can be used as fingerprints of different structural units.

Influencia del hidrolizado de proteínas en el comportamiento bioproductivo en gallinas de la línea L1 White Leghorn / Influence of protein hydrolysates on bioproduction performance in L1 line White Leghorn hens

RESUMEN El objetivo de la presente investigación fue evaluar la influencia del hidrolizado de proteínas (HP) como suplemento nutricional en el comportamiento bioproductivo en gallinas White Leghorn. Se utilizaron gallinas de reproductores ligeros con 39 semanas de edad, durante seis semanas. Se realizó un diseño completamente aleatorizado con dos tratamientos de 320 gallinas cada uno (tres réplicas de 40 gallinas). El T1, recibió diariamente 2 mL de HP por ave y al T2, no se le ofertó el producto. Se controlaron las variables bioproductivas (producción total de huevos, porcentaje de postura, consumo total de pienso, conversión, viabilidad y la mortalidad por causas), los indicadores de la incubación (huevos a planta, los porcentajes de incubación, incubabilidad y pollitos de primera) y los de calidad (consumo de pienso por pollito de primera y pollitos de primera por gallina). Se observaron diferencias significativas en el porcentaje de postura y significativa para la conversión masal y en los huevos a planta, porcentaje de incubación y porcentaje de incubabilidad y con mejor comportamiento en los indicadores de calidad en las gallinas que recibieron HP. Se concluye que el empleo de HP mejora el porcentaje de postura y la conversión masal y los indicadores relativos a la incubación, porcentaje de huevos aptos a planta, porcentaje de incubación y de incubabilidad de gallinas de la línea ligera, adicionalmente, su uso reduce aproximadamente en 100 gramos el consumo de pienso necesario para obtener un pollito de primera.

ABSTRACT The objective of this study was to evaluate the influence of protein hydrolysates (PH), as a nutritional supplement, in the bioproduction performance of White Leghorn hens. Thirty-nine-week old light line hens were assessed during six weeks. Two treatments (T) were designed involving 320 hens each (three replications of 40 hens each). In T1, each bird received 2 ml of PH daily; the birds in T2 were not offered the product. The following variables were controlled: bioproduction (total egg production, egg-laying percentage, total feed intake, mass conversion, viability, and caused mortality); incubation indicators (eggs to plant, incubation percentage, hatchability, and top quality chicks) and; quality (feed intake by top quality chicks, and top quality chicks per hen). The hens that received the PH showed significant differences in the laying, incubation, and hatchability percentage, as well as mass conversion, and the egg to plant ratio. They showed better performance in quality indicators. It is concluded that the use of PH in light line hens improves their bioproduction performance, as well as the indicators of to incubation, egg to plant ratio, and hatchability; its use also reduces by approximately 100 grams the necessary food intake to obtain top quality chicks.

Assessment of Clinical Practices for Crushing Medication in Geriatric Units.

OBJECTIVES: To assess the modification of the form of medication and evaluate staff observance of good clinical practices. DESIGN: One-day assessment of clinical practices. SETTING: 17 geriatrics units in the 3 Teaching Hospitals of Paris-Sud (APHP), France. PARTICIPANTS: Elderly in-patients with difficulties swallowing capsules and tablets. MEASUREMENTS: Assessment of target-patient prescriptions and direct observation of nurses' medical rounds. RESULTS: 155/526 in-patients (29.5%) were unable to swallow tablets or capsules: 98 (40.3%) in long-term care, 46 patients (23.8%) in the rehabilitation unit and 11 (12.2%) in the acute care unit (p = .005). In thirty-nine (27.3%) of the 143 prescriptions studied all tablets were safe to crush and all capsules were safe to open. In 104 cases, at least one medication could not be safely modified, including 26 cases (18.2%) in which none of the prescribed drugs were safe to crush or open. In 48.2% of the 110 medications that were crushed, crushing was forbidden, and presented a potential threat in 12.7% of cases or a reduced efficacy in 8.2% of cases. Crushing methods were rarely appropriate: no specific protective equipment was used (81.8%), crushing equipment was shared between patients without cleaning (95.1%), medications were spilled or lost (69.9%). The method of administration was appropriate (water, jellified water) in 25% of the cases, questionable (soup, coffee, compote, juice, cream) in 55% of the cases and unacceptable (laxative) in 21% of the cases. CONCLUSION: Management of drug prescriptions in patients with swallowing difficulties is not optimal, and may even have iatrogenic effects. In this study, 12.7% of the modifications of the drug form could have been harmful. Doctors, pharmacists and nurses need to reevaluate their practices.

El peso corporal y su efecto sobre indicadores bioproductivos en gallinas white leghorn l33 / The corporal weight and its effect on bioproductive indicators in white leghorn l33 hens

El objetivo del presente estudio fue evaluar el efecto del peso corporal sobre indicadores bioproductivos en gallinas White Leghorn L33. Se estudiaron 192 gallinas ponedoras con 39 semanas de edad durante un período de seis semanas y con tres observaciones semanales. Se diseñaron dos grupos según peso vivo, con 96 gallinas cada uno (tres réplicas de 32 aves), teniendo el grupo 1 entre 1500-1600 g y el grupo 2 entre 1735-1820 g; este último correspondió al rango establecido para este híbrido con esa edad. Además de la viabilidad y mortalidad se determinaron las variables bioproductivas (producción, peso, tamaño, forma y grosor de la cáscara de los huevos), así como la proporción de sucios, manchados y cascados. En la última semana del estudio, se analizó la calidad interna del huevo (dimensión y color de clara y yema) y se calcularon los índices de yema, clara y Unidades Haugh. Se realizó una estadística descriptiva y se utilizaron las pruebas T de Student y Fisher (P < 0,05) para comparar las medias entre grupos. Se evidenciaron diferencias estadísticas significativas entre producción, peso y tamaño de los huevos para el grupo de mayor peso corporal. Asimismo, se comprobó mayor calidad interna del huevo (altura de clara y yema) en este segundo grupo. Sin embargo, no se evidenciaron diferencias significativas en la calidad externa de los huevos (sucios, manchados, cascados), pero sí en el grosor de la cáscara. Se concluye que el peso corporal influye directa y positivamente sobre los indicadores bioproductivos en gallinas White Leghorn L33.

The objective of this study was to evaluate the effect of the corporal weight on bioproductive indicators in White Leghorn L33 hens. They were studied 192 egg-laying hens with 39 weeks of age during a period of six weeks and with a frequency of three weekly observations. Two groups according to the alive weight with 96 hens each one (three replies of 32 birds) were designed, having the group 1 (1500-1600 g) and group 2 (17351820 g), and being this last group the established range for this crossbreed with that age. Besides of viability and mortality bioproductive variables (production, weight, size, form and nutshell thickness of the eggs) were determined, as well as the proportion of dirty, stained and cracked eggs. In the last week of study the internal quality (dimension and color of egg white and yolk) was analyzed and the yolk and white index and Haugh Units were calculated. Descriptive statistics was realized and the Student's t and Fisher tests (P < 0.05) were used to compare means between groups. Significant statistical differences among production, weight, and size of eggs for group of bigger corporal weight were evidenced. Likewise, bigger internal quality of the egg (height of the egg white and yolk) in this second group was demonstrated. However, significant differences in the external quality of the eggs (dirty, stained and cracked) were not evidenced, unlike in the nutshell thickness. It is concluded that corporal weight influences direct and positively on bioproductive indicators in White Leghorn L33 hens.

Solid-state dye-sensitized solar cells based on ZnO nanocrystals.

We report on the development of solution-processed ZnO-based dye-sensitized solar cells. We fabricate mesoporous ZnO electrodes from sol-gel processed nanoparticles, which are subsequently sensitized with conventional ruthenium complexes and infiltrated with the solid-state hole transporter medium 2, 2', 7, 7'-tetrakis-(N, N-di-p-methoxyphenylamine)-9, 9'-spirobifluorene (spiro-OMeTAD). Starting from ZnO nanorods synthesized from solution, we investigate the porous ZnO film morphology using various precursor formulations. The nature of the polymeric additive used in the initial ZnO formulation, as well as the ZnO electrode sintering treatment, is varied and its influence on device performance and charge dynamics, probed by transient perturbation techniques, is discussed. We show that using ethyl-cellulose in the initial ZnO formulation is responsible for an improved dye loading on the ZnO porous electrode, while a gradual sintering step at 350 degrees C is suitable for the proper removal of the organic phases that can be found in the ZnO films after their deposition by spin-coating. Using only 800 nm thick porous ZnO electrodes sensitized by N719, the best performing device exhibits a short-circuit current density of 2.43 mA cm(-2) under simulated solar emission of (100 mW cm(-2)), associated with an overall power conversion efficiency of 0.50%.

Skin lesions in broiler chickens measured at the slaughterhouse: relationships between lesions and between their prevalence and rearing factors.

1. This slaughterhouse-based study was to evaluate correlations between cutaneous lesions which are linked to animal welfare. The relationships between these lesions and various rearing factors were investigated. 2. The percentage of lesions in each flock was determined by observation at the slaughterhouse. Fifty-five flocks slaughtered between May 2005 and May 2006 in 8 slaughterhouses were investigated. 3. Data relating to farm management and housing factors during the rearing period were collected retrospectively from 36 of the 55 flocks scored for lesions. 4. A negative correlation was observed between (i) presence of breast blisters and deep hock burns, (ii) presence of breast blisters and deep footpad dermatitis, and (iii) presence of breast burns and scratches. 5. We proposed an assessment of broiler chicken welfare at the slaughterhouse on the basis of several criteria: (i) footpad dermatitis, hock burns and breast burns, (ii) scratches, and (iii) breast blisters. 6. The presence of contact dermatitis was related to litter quality and several management factors. Only scratches and breast blisters were related to high stocking density. The type of lesion was related to genotype. Genotype A (fast-growing) had fewer breast blisters but deeper footpad lesions than B (slower-growing).

Differential regulation of Th1/Th2 in relevant tissues for sepsis pathogenesis with a Limulus anti-LPS factor-derived peptide increases survival in Gram-positive sepsis.

Severe sepsis and septic shock are important causes of death in intensive care units. Although Gram-negative infections were predominant in the 1960s, Gram-positive infections have increased in the past two decades and now account for about half of the cases of severe sepsis. In this study, we examined the effect of a Limulus anti-LPS factor (LALF)-derived peptide on lung and liver Th1/Th2 cytokine mRNA levels during a Gram-positive sepsis. We also examined the morphopathological changes observed in these organs during the disease. Mice challenged with a high dose of Staphylococcus haemolyticus showed severe damage in lung. In contrast, the liver of challenged mice showed an accumulation of bacterial particles in the sinusoids, associated with a severe inflammatory response due to high levels of tissue mRNA proinflammatory cytokines. Treatment with the peptide LALF(32-51) ameliorated the sepsis-induced effects in the lung and liver and increased the survival of mice in a dose- and time-dependent manner. Pretreatment with the peptide LALF(32-51) differentially regulates TNF-alpha, IFN-gamma, IL-12p40, IL-2 and IL-10 mRNA levels in lung and liver of peptide-treated mice, and limits the systemic inflammatory response. These findings support for the first time the effectiveness of an LALF-derived peptide in the treatment of a Gram-positive sepsis. Modulation of the Th1/Th2 pattern in tissues relevant for sepsis correlates with an improved outcome of the disease as denoted by increased survival.

Infección por el virus de la hepatitis C, crioglobulinemia y enfermedades linfoproliferativas

No disponible

The SiBI connector: a new medical device to facilitate preoxygenation and reduce waste anesthetic gases during inhaled induction with sevoflurane.

IMPLICATIONS: The SiBI connector is a new medical device used for vital capacity inhaled induction with sevoflurane. It allows efficient preoxygenation of patients and reduces waste anesthetic gases in the operation room during induction.

[Tuberculosis management unit: 7-year experience]. / Unidad monográfica de tuberculosis: experiencia de 7 años de funcionamiento.

Between January 1992 and December 1998 we collected clinical, epidemiological and treatment data on all patients diagnosed of tuberculosis in our specialized unit. Five hundred sixty-seven patients (70% male and 30% female) were studied prospectively. The rate of new cases increased until 1995 and decreased during the last three years of study. Mean patient age was 38.8 years, with nearly 64% of patients under 45 years of age. Predisposing disease, mainly chronic alcoholism, was present in 36%. Fifteen percent belonged to a high-risk social group (6.5% were drug addicts and 6.3% lived inside secure institutions). The mean time elapsing from the appearance of symptoms until referral to our service was 80.4 days and the most common clinical picture at presentation was general unwellness with cough and expectoration (46%) followed by hemoptysis (18%). Cavitation was visible in 48.5% of x-rays, while alveolar infiltrates were seen in 33%, pleural effusion in 12% and lymph node involvement in 10%. Adult tuberculosis was diagnosed in 80% of cases, 10% were reactivations and 9% were primary. Bacteriological diagnosis was available for 85%. Therapy usually involved six months with hydrazide, rifampicin and pyrazinamide (81%). Therapy was generally well-tolerated, although analyses revealed some anomalies, such as transaminase alteration (18%) and hyperuricemia (19%). Therapy was changed because of toxicity in only 2.6%. Follow-up after therapy was strict and the rate of successful cure was 97.5%. We conclude that diagnosis was not prompt enough and believe that knowledge of epidemiological, clinical and evolutionary data, as well as monitoring of real rates of cure of treated patients justifies the existence of specialized centers for managing tuberculosis.

Unidad monográfica de tuberculosis: experiencia de 7 años de funcionamiento / Tuberculosis management unit: 7 years experience

Desde enero de 1992 hasta diciembre de 1998 y de forma prospectiva hemos recogido los datos clínicos, epidemiológicos y terapéuticos de todos los pacientes diagnosticados de tuberculosis (TBC) en nuestra unidad monográfica. Controlamos 567 pacientes (70 por ciento varones y 30 por ciento mujeres). Su número aumentó progresivamente hasta 1995 para ir descendiendo en los últimos 3 años. La edad media fue de 38,8 años, y un 64 por ciento de los pacientes eran menores de 45 años. El 36 por ciento presentaban alguna patología predisponente, principalmente etilismo crónico. Un 15 por ciento de los pacientes pertenecían a un grupo de riesgo social, especialmente adictos a drogas (6,5 por ciento) e ingresados en instituciones cerradas (6,3 por ciento). El tiempo medio transcurrido desde el comienzo de la sintomatología hasta ser remitidos a nuestra consulta fue de 80,4 días y la presentación clínica más frecuente consistió en sintomatología general junto a tos y expectoración (46 por ciento), seguida de hemoptisis (18 por ciento). Radiológicamente, un 48,5 por ciento de casos presentaron imágenes cavitadas, frente a un 33 por ciento de infiltrados alveolares, un 12 por ciento de derrames pleurales y un 10 por ciento de formas adenopáticas. Respecto a la forma patogénica inicial, un 80 por ciento de casos se consideraron tuberculosis inicial del adulto, un 10 por ciento recidivas y el 9 por ciento primoinfecciones TBC. Se consiguió un diagnóstico bacteriológico en el 85 por ciento de casos. La pauta más utilizada fue la de 6 meses con hidracida, rifampicina y piracinamida (81 por ciento), en general bien tolerada, aunque resultaron frecuentes algunos trastornos analíticos como la alteración de las transaminasas (18 por ciento) o la hiperuricemia (19 por ciento). Únicamente en el 2,6 por ciento de los casos hubo que modificarla por toxicidad. Se realizó un seguimiento estricto tras la finalización del tratamiento con un 97,5 por ciento de curaciones. Como conclusión encontramos excesiva la demora diagnóstica y creemos que el conocimiento de datos epidemiológicos, clínicos y evolutivos, así como un control de los porcentajes reales de curación de los pacientes tratados justifica la existencia de unidades monográficas de control de la tuberculosis. (AU)

Investigation of tuberculosis contacts in a nonhospital pneumology practice.

The aim of this study was to analyze the results of the tuberculosis contact tracing carried out in an outpatient pneumology setting and to assess its performance with regard to the detection of new cases of tuberculosis and infected contacts. One thousand two hundred and twenty-eight contacts of 302 tuberculosis patients were evaluated in the Tuberculosis Unit of the Dr. Fleming Specialities Center between 1992 and 1996. Contacts were categorized into groups with regard to bacteriological status of the index case (Group A, smear-positive; Group B, culture-positive only; Group C, smear- and culture-negative) and intimacy of exposure to the index case (close or casual). The possible association between the existence of infection or disease and the bacteriological status of the index case and degree of intimacy of exposure was analyzed. There were 582 infected contacts (47.4%) and 42 new cases of tuberculosis (3.4%), six of which were smear-positive. The proportion of infected and diseased contacts was significantly higher for those who had contact with smear-positive patients and those who had close contact with the index case. Chemoprophylaxis was completed in 431 (35.1%) of the contacts evaluated. Systematic investigation of contacts represents an efficient means of discovering new cases of tuberculosis and infection, especially among contacts of smear-positive index cases and among those who are closer to the index case. The administration of appropriate treatment to these contacts will contribute to controlling the transmission of tuberculosis within the community.

[Prospective study with auditory evoked potentials of the brain stem in children at risk]. / Estudio prospectivo con potenciales evocados auditivos de tronco cerebral en niños de riesgo.

OBJECTIVE: The aim of this study was to evaluate methods of hypoacusis screening. PATIENTS AND METHODS: The early detection of audition problems is vital for quick rehabilitation. For this reason, resting on the criteria of the Comisión Española para la Detección Precoz de la Hipoacusia (Spanish Commission for the Early Detection of Hypoacusis), we have carried out a prospective study, from January to May 1998, evaluating patients at risk of suffering from hypoacusis. The study included 151 patients with ages between birth and 14 years. Medical records and brainstem auditory evoked responses (BAER) were carried out. RESULTS: The most common reason for requesting a consultation for the 151 patients included in our study was the suspicion of hypoacusis. Seventy-one (47%) presented pathological BAER, 37 of them were bilateral. In most cases the loss of audition was of cochlear origin, with 11 patients having a serious deafness, 4 with bilateral affection (3 suspicious of hypoacusis and 1 of hyperbilirubinemia) and 7 unilateral deafness. CONCLUSIONS: BAER is a good screening method for children at risk. It is an innocuous, objective and specific test that does not require the patient's collaboration. The level of positives is high (47%).