Design of water reuse storage facilities in Sustainable Urban Drainage Systems from a volumetric water balance perspective.

This paper presents a methodology for designing water reuse storage facilities as part of Sustainable Urban Drainage Systems (SUDS) in urban catchments. The method analyzes the whole water balance of the catchment. The contributions to the balance are irrigation and precipitation; the outlets are evapotranspiration, seepage and discharge to the conventional sewage system. The internal system variations are the volume of water to be locally reutilized and the soil water content variation. A cost function that includes the costs of irrigation, discharge to the conventional sewer system and reuse of water locally is proposed to estimate the optimum volume of water to be reused. This approach for SUDS design goes beyond traditional events-based perspectives oriented to damage prevention. This method conceives stormwater as a resource and seeks its optimal use through the design of SUDS. Several types of urban catchments were studied, and the results show that the proposed methodology can be applied either for simulating SUDS behavior in urban catchments or for estimating the optimum volume of water to be locally reused.

Polymer-based materials modified with magnetite nanoparticles for enrichment of phospholipids.

A polymeric material modified with magnetic nanoparticles (MNPs) has been synthesized and evaluated as sorbent both for solid-phase extraction (SPE) and dispersive magnetic solid-phase extraction (MSPE) of phospholipids (PLs) in human milk samples. The synthesized sorbent was characterized by scanning electron microscopy and its iron content was also determined. Several experimental variables that affect the extraction performance (e.g. loading solvent, breakthrough volume and loading capacity) were investigated and a comparison between conventional SPE and MSPE modalities was done. The proposed method was satisfactorily applied to the analysis of PLs in human milk fat extracts in different lactation stages and the extracted PLs were determined by means of hydrophilic interaction liquid chromatography using evaporative light scattering detection.

Cambios organizativos en un Servicio de Medicina Interna. Caso de Gestión Clínica / Organisational changes in an Intrnal Medicine Service. A case of clinical management

El Servicio de Medicina Interna (SMI) forma el eje troncal de un hospital. Sus campos de actuación son la asitencia sanitaria centrada en la atención integral del paciente, el estudo de la epidemiología y la prevención y el aspecto docente e investigador. El presete estudio pretende por una parte, exponer el impacto de la implantaci´n d eun programa de prescripción electróica del medicamento sobre la organización de un SMI. Y por otra, y como consecuencia de la relación existente, entre la implantación de los procesos, analizar los indicadores de la actividad asitencial llevada a cabo en el servicio, para así poder detectar oportunidades de mejroa. Un cambio tan radical como es el paso del registro en papel al registro infroatizdo, comprota la redefinición delmodelo organizativo de la mayoría de las actividades que se llevan a término en un servicio por parte de los distintos estamentos profesionales. La monitorizción de la casuístia de un servicio aporta una importante informción, ya que los cambios advertidos en las patologías producen un gran impacto en el conjunto de toda la organización. Analizando la actividad asitencial, y estableciendo una comparativa entre e SMI y el Serviio de Medicina Infecciosa (SMINF) se observa una importante tendencia a la baja encuanto a los datos asitenciales de este último servicio. Por el contrario, si nos remitimos al SMI, el aumento de la actividad se hace patente en la elevación de número de altas totales y del procentaje de las esancias. Cabe destacar el incremento de la complejidad de la casuístca aendida en ambos servicios y puntualizar que los pacientes con patologías asociadas a aparato respiratorio son los que ingresas con una mayor frecuencia (AU)

This study aims,on the one had, to show te mpact of impementing an electronic drug prescription programme on the organizationof an IMS. Secondly,and as a result of the relationship between the indroduction of new tecnology and re-engineeringof processes, the purpose is to analyze the idicators of heathcare activity undertakenat the servce so as to dientifiy opportunities for mporvement. A change as radica as the transition from paper records to computerized records, involves the redefinition of the organizationalmodel of most activities performe at aservice by th various professionals (AU)

El papel de la interacción y la comunicación en las primeras adquisiciones lingüísticas de los niños con síndrome de Down / The role of interaction and communication in early language acquisition among children with DS

Los niños pequeños con síndrome de Down (SD) son niños en proceso de crecimiento, con intereses, necesidades y deseos, como los de los demás niños de su edad cronológica. Su desarrollo lingüístico presenta especificidades. Aunque algunas de ellas están relacionadas con el síndrome, debido al retraso mental (RM), no pueden tratarse de forma aislada, porque confluyen con otras adquisiciones del desarrollo global. Se plantea reflexionar sobre la importancia de la interacción y la comunicación en los inicios de la adquisición del lenguaje desde un enfoque funcional, teniendo en cuenta la complejidad del sistema lingüístico y las interconexiones entre los aspectos cognitivos, emocionales y sociales durante ese proceso de adquisición, así como las especificidades que presentan los niños con SD en su desarrollo general. Tratándose de la primera infancia, más que un trabajo concreto con los niños, la propuesta de intervención está dirigida a ayudar a los padres a encontrar estrategias comunicativas para favorecer las interacciones con sus hijos (AU)

Children with Down Syndrome (DS) are children who grow and have interests, desires and needs just like any other child in their age group. Although mental retardation(MR) does give rise to certain syndrome-specific characteristics in their language development, these must not be treated in isolation because they have a bearing on other global development acquisitions. This paper advocates that we consider the importance of interaction and communication in early language acquisition from a functional perspective, bearing in mind the complexity of the language system and the interconnections between cognitive, emotional and social aspects in the acquisition process, in addition to the specificities of children with DS in their overall development. As the focus in this case is early childhood, rather than working directly with the child the proposed intervention seeks to help parents find communicative strategies that enhance the interactions they have with their children (AU)

[Episodic hypertension in postural orthostatic tachycardia syndrome]. / Hipertensión arterial episódica asociada al síndrome de taquicardia postural ortostática.

We report the case of a 17-year-old woman who presented to the emergency department on several occasions due to palpitations, tachycardia, syncope, short spells of dizziness and light-headedness with complete spontaneous recovery, and hypertension. The patient had been evaluated by several specialists, and multiple complementary examinations had revealed no abnormalities that could explain the symptoms. Due to suspicion of orthostatic intolerance or postural orthostatic tachycardia syndrome with hypertension, the patient underwent a 60-degree tilt table test, which confirmed the diagnosis. The patient was successfully treated with bisoprolol. The physiopathological mechanisms, diagnosis, and treatment of this syndrome are reviewed.

Hipertensión arterial episódica asociada al síndrome de taquicardia postural ortostática / Episodic hypertension in postural orthostatic tachycardia syndrome

Se presenta el caso clínico de una mujer de 17 años de edad que acude en reiteradas ocasiones a urgencias por palpitaciones, taquicardia, síncope, reacción vegetativa de escasa duración, con recuperación espontánea y completa y detección de cifras elevadas de presión arterial. Estudiada en diversas consultas de especialidades y tras múltiples exploraciones complementarias no se encontró patología que justificase el cuadro. Ante la sospecha de intolerancia ortostática o síndrome de taquicardia postural ortostática con hipertensión se realizó la prueba de estimulación con cama basculante a 60°, confirmándose el diagnóstico y comprobando la desaparición de los síntomas al iniciar tratamiento con bisoprolol. Se revisan los mecanismos fisiopatológicos, así como el diagnóstico y el tratamiento del mismo

We report the case of a 17-year-old woman who presented to the emergency department on several occasions due to palpitations, tachycardia, syncope, short spells of dizziness and light-headedness with complete spontaneous recovery, and hypertension. The patient had been evaluated by several specialists, and multiple complementary examinations had revealed no abnormalities that could explain the symptoms. Due to suspicion of orthostatic intolerance or postural orthostatic tachycardia syndrome with hypertension, the patient underwent a 60-degree tilt table test, which confirmed the diagnosis. The patient was successfully treated with bisoprolol. The physiopathological mechanisms, diagnosis, and treatment of this syndrome are reviewed

[Are the Spanish hypertensive children therapeutic orphans?]. / Son los niños hipertensos españoles huérfanos terapéuticos?

INTRODUCTION: According to current guidelines, hypertension in children should be treated with the same drugs as those used in adults, with adjustment of the dose to their body size. The term therapeutic orphans refers to the lack of information on how to use drugs in children. The aim of this study was to investigate whether the information in the International Vademecum (I-V) is sufficient for the correct use of antihypertensive drugs in children. MATERIAL AND METHOD: We reviewed the data on pediatric dosages of antihypertensive drugs in the I-V (44th and 45th editions). When there were several drugs for the same molecule, the last one marked with the Spanish Ministry of Health and Consumption's logo was selected. When information on a particular drug was not available, the entries for other drugs with the same active principle were reviewed. The information was compared with that provided by the Fourth Report of the National High Blood Pressure Education Program Working Group (NHBPEP). RESULTS: A total of 111 entries for 41 antihypertensive drugs were reviewed. Information on use in children is available for only 3 diuretics and 2 angiotensin converting enzyme inhibitors. The remaining entries either contain no information or indicate that the effectiveness and safety in children has not been evaluated. Some drugs are contraindicated in children. The Fourth Report of the NHBPEP includes pediatric dosages for 28 antihypertensive drugs. The Food and Drug Administration has authorized 10 antihypertensive drugs for use in children. CONCLUSIONS: The information in the V-I can be used to determine the correct dosage of only 5 antihypertensive drugs in children, making this age group authentic therapeutic orphans.

Systemic lupus erythematosus in Europe at the change of the millennium: lessons from the "Euro-Lupus Project".

The "Euro-Lupus Cohort" is composed by 1000 patients with systemic lupus erythematosus (SLE) that have been followed prospectively since 1991. These patients have been gathered by a European consortium--the "Euro-Lupus Project Group". This consortium was originated as part of the network promoted by the "European Working Party on SLE", a working group created in 1990 in order to promote research in Europe on the different problems related to this disease. The "Euro-Lupus Cohort" provides an updated information on the SLE morbidity and mortality characteristics in the present decade as well as defines several clinical and immunological prognostic factors.

¿Son los niños hipertensos españoles huérfanos terapéuticos? / Are the Spanish hypertensive children therapeutic orphans?

Introducción: Según las guías, la hipertensión en los niños debe tratarse con los mismos fármacos usados en adultos ajustando las dosis al tamaño corporal. El término huérfano terapéutico se refiere a la falta de información sobre el uso de medicamentos en niños. El objetivo es investigar si el Vademécum Internacional (V-I) contiene información para el uso correcto de antihipertensivos en niños. Material y método: Revisión en el V-I de la posología pediátrica de antihipertensivos. Si existen varias especialidades para un fármaco se selecciona el del logotipo del Ministerio de Sanidad y Consumo más reciente. Si en una monografía no hay información, se revisan las de otras especialidades del mismo principio activo. La información se compara con la del 4.º informe del National High Blood Pressure Education Program Working Group (NHBPEP). Resultados: Se revisan 111 monografías de 41 fármacos con indicación de antihipertensivo. Sólo para 3 diuréticos y 2 inhibidores de la enzima conversora de angiotensina (IECA) hay información pediátrica. Las otras advierten de que no se ha establecido la eficacia y seguridad o no hacen referencia a niños. En algunos casos se contraindican. El 4.º informe del NHBPEP incluye dosificación pediátrica de 28 antihipertensivos. La Food and Drug Administration (FDA) tiene autorizados 10 antihipertensivos para uso en niños. Conclusiones: Con la información del V-I sólo es posible dosificar correctamente 5 antihipertensivos en niños, lo que los convierte en auténticos huérfanos terapéuticos

Introduction: According to current guidelines, hypertension in children should be treated with the same drugs as those used in adults, with adjustment of the dose to their body size. The term therapeutic orphans refers to the lack of information on how to use drugs in children. The aim of this study was to investigate whether the information in the International Vademecum (I-V) is sufficient for the correct use of antihypertensive drugs in children. Material and method: We reviewed the data on pediatric dosages of antihypertensive drugs in the I-V (44th and 45th editions). When there were several drugs for the same molecule, the last one marked with the Spanish Ministry of Health and Consumption's logo was selected. When information on a particular drug was not available, the entries for other drugs with the same active principle were reviewed. The information was compared with that provided by the Fourth Report of the National High Blood Pressure Education Program Working Group (NHBPEP). Results: A total of 111 entries for 41 antihypertensive drugs were reviewed. Information on use in children is available for only 3 diuretics and 2 angiotensin converting enzyme inhibitors. The remaining entries either contain no information or indicate that the effectiveness and safety in children has not been evaluated. Some drugs are contraindicated in children. The Fourth Report of the NHBPEP includes pediatric dosages for 28 antihypertensive drugs. The Food and Drug Administration has authorized 10 antihypertensive drugs for use in children. Conclusions: The information in the V-I can be used to determine the correct dosage of only 5 antihypertensive drugs in children, making this age group authentic therapeutic orphans

[Percutanous dilation tracheotomy: our experience]. / Traqueotomía percutánea por dilatación: nuestra experiencia.

UNLABELLED: Percutaneous dilation Tracheotomy (PDT) is becoming a popular alternative to surgical tracheotomy. In our hospital, we recently adopted the use of the PDT in intensive care unit patients. OBJECTIVE: The objective [corrected] of this investigation is to characterize and quantify the rate of complications for PDT. MATERIALS AND METHODS: A prospective study of 60 PDT performed at different intesive care units, betweem September 2002 to July 2003. RESULTS: The intraoperative time for PDT was 8 minutes. Complications included 6 cases of mild intraoperative hemorrhage, 1 case of moderate intraoperative hemorrhage, 4 cases of mild postoperative hemorrhage and 1 case of subcutaneous emphysema. CONCLUSIONS: PDT is a good alternative to surgical tracheotomy and should be added to the otolaryngologists armamentarium of surgical airway procedures.

Traqueotomía percutánea por dilatación: nuestra experiencia / Percutanous dilation tracheotomy: our experience

La traqueotomía percutánea por dilatación (TPD) viene siendo una popular alternativa a la traqueotomía quirúrgica. En nuestro hospital ha sido integrada recientemente en la Unidad de Cuidados Intesivos. Objetivo: El objetivo de nuestro estudio es el de analizar las complicaciones de la TPD. Material y métodos: Realizamos un estudio prospectivo de 60 TPD, realizadas en diferentes unidades de cuidados intensivos, entre septiembre de 2002 y julio de 2003. Resultados: El tiempo intraoperatorio parala TPD fue de unos 8 minutos. Hubo 7 casos de hemorragia intraoperatoria, 6 leves y uno moderado, 4 casos de hemorragia postoperatoria y un caso de enfisema subcutáneo. Conclusiones: La TPD es una buena alternativa a la traqueotomía quirúrgica que debería añadir el otorrinolaringólogo a su repertorio quirúrgico de vía aérea (AU)

Percutaneous dilation Tracheotomy (PDT) is becoming a popular alternative to surgical tracheotomy. In our hospital, we recently adopted the use of the PDT in intensive care unit patients. OBJECTIVE: The objective [corrected] of this investigation is to characterize and quantify the rate of complications for PDT. MATERIALS AND METHODS: A prospective study of 60 PDT performed at different intesive care units, betweem September 2002 to July 2003. RESULTS: The intraoperative time for PDT was 8 minutes. Complications included 6 cases of mild intraoperative hemorrhage, 1 case of moderate intraoperative hemorrhage, 4 cases of mild postoperative hemorrhage and 1 case of subcutaneous emphysema. CONCLUSIONS: PDT is a good alternative to surgical tracheotomy and should be added to the otolaryngologists armamentarium of surgical airway procedures (AU)

Evaluación de un programa de educación de tratamiento intensivo en adolescentes con diabetes tipo 1. Seguimiento por dos años / Evaluation of an intensive treatment education program for type 1 diabetes in a group of adolescents. A two year follow up

During the past decade several reports were published showing that intensive treatment of type 1 diabetes can prevent and delay disease-related microvascular complications. However, several problems were reported in children and adolescents such as frequent hypoglycemic episodes and weight gain. The aim of this study was to describe the results of intensified treatment for type 1 diabetes in a group of Argentinean adolescents after a follow-up of two years. Twenty five adolescents with type 1 diabetes older than 10 years with at least one year from diagnosis were selected. All patients received a one-week teaching program during admission to our center. All patients were followed-up monthly during two years. Treatment schedule included 4-5 controls in fasting conditions, two doses of NPH insulin and four doses of regular insulin according to glycemia and the amount of calculated carbohydrate intake. Median age was 13.5 years (range 10 to 19 years). Mean time from diagnosis to inclusion in the study was 3.8 years (range 1.25 to 9 years). Mean total dose of NPH insulin decreased significantly when measured at the inclusion in the study (0.9 IU/kg) and after a year of follow-up 0.8 IU/kg (p 0.04). However, there were no changes in NPH insulin dose after two years follow-up (0.85 IU/kg). On the contrary, the dose of regular insulin administered on fasting conditions with normal glycemia increased from 0 to 0.21/kg after a year (p 0.0001) and to 0.69 after two years (non significant). Median HbA1C showed a significant reduction from 10 +/- 1.62% to 8.53 +/- 1.04% after a year (p 0.03) and to 8.72 +/- 0.81% after two years. BMI Z score increased from significantly from 0.7 +/- 0.9 to 1.06 +/- 1.15 after a year (p 0.03) with a further reduction without a significant difference from the basal value after two years. We found no significant differences in the frequency of hypoglycemia or other metabolic features. Our results show that intensive treatment of type 1 diab...

Durante la década pasada, se publicaron numerosos trabajos demostrando que el tratamiento intensivo de la diabetes tipo 1 puede prevenir y retrasar el desarrollo de las complicaciones microvasculares asociadas a la misma. Sin embargo en el grupo de niños y adolescentes se hallaron algunos problemas como el incremento de la frecuencia de los episodios de hipoglucemia y el excesivo aumento de peso. El propósito del presente estudio fue describir los resultados del tratamiento intensificado llevado a cabo durante 2 años en una población de niños y adolescentes argentinos con diabetes tipo 1. Fueron seleccionados 25 pacientes mayores de 10 años de edad con diabetes de más de 1 año de evolución. Todos ellos realizaron un programa de educación durante una semana de internación. El seguimiento posterior fue mensual durante los siguientes dos años. El esquema de tratamiento insulínico consistió en 4 a 5 controles preprandiales diarios, dos dosis de insulina NPH cubriendo requerimientos basales y cuatro dosis de insulina regular preprandial ajustadas de acuerdo al cálculode hidratos de carbono a ingerir, la actividad física y el valor de glucemia. La media de edad fue de 13.5años (r: 10-19 años). El tiempo medio transcurrido desde el diagnóstico hasta la intensificación del tratamientofue de 3.8 años ( r: 1.2 –9 años). La dosis media total de NPH disminuyó significativamente desde 0.9 U/kg en elinicio a 0.8 U/kg al año de seguimiento (p = 0.04), sin diferencias al segundo año de seguimiento (0.85 U/kg). Porel contrario, la dosis de insulina regular administrada en forma preprandial en normoglucemia aumentó de 0 a0.21 U/kg en el primer año (p 0.0001) y a 0.69 U/kg a los dos años (p NS). La media de HbA1C mostró unasignificativa reducción desde 10±1.62% a 8.53±1.04% en el primer año (p = 0.03) y 8.72± 0.81% a los dos años.El Z score de IMC aumentó significativamente de 0.7 ± 0.9 a 1.06 ± 1.15 luego de un año (p = 0.03) descendiendo a valores no...

Evaluación de un programa de educación de tratamiento intensivo en adolescentes con diabetes tipo 1. Seguimiento por dos años / Evaluation of an intensive treatment education program for type 1 diabetes in a group of adolescents. A two year follow up

During the past decade several reports were published showing that intensive treatment of type 1 diabetes can prevent and delay disease-related microvascular complications. However, several problems were reported in children and adolescents such as frequent hypoglycemic episodes and weight gain. The aim of this study was to describe the results of intensified treatment for type 1 diabetes in a group of Argentinean adolescents after a follow-up of two years. Twenty five adolescents with type 1 diabetes older than 10 years with at least one year from diagnosis were selected. All patients received a one-week teaching program during admission to our center. All patients were followed-up monthly during two years. Treatment schedule included 4-5 controls in fasting conditions, two doses of NPH insulin and four doses of regular insulin according to glycemia and the amount of calculated carbohydrate intake. Median age was 13.5 years (range 10 to 19 years). Mean time from diagnosis to inclusion in the study was 3.8 years (range 1.25 to 9 years). Mean total dose of NPH insulin decreased significantly when measured at the inclusion in the study (0.9 IU/kg) and after a year of follow-up 0.8 IU/kg (p 0.04). However, there were no changes in NPH insulin dose after two years follow-up (0.85 IU/kg). On the contrary, the dose of regular insulin administered on fasting conditions with normal glycemia increased from 0 to 0.21/kg after a year (p 0.0001) and to 0.69 after two years (non significant). Median HbA1C showed a significant reduction from 10 +/- 1.62% to 8.53 +/- 1.04% after a year (p 0.03) and to 8.72 +/- 0.81% after two years. BMI Z score increased from significantly from 0.7 +/- 0.9 to 1.06 +/- 1.15 after a year (p 0.03) with a further reduction without a significant difference from the basal value after two years. We found no significant differences in the frequency of hypoglycemia or other metabolic features. Our results show that intensive treatment of type 1 diab...(AU)

Durante la década pasada, se publicaron numerosos trabajos demostrando que el tratamiento intensivo de la diabetes tipo 1 puede prevenir y retrasar el desarrollo de las complicaciones microvasculares asociadas a la misma. Sin embargo en el grupo de niños y adolescentes se hallaron algunos problemas como el incremento de la frecuencia de los episodios de hipoglucemia y el excesivo aumento de peso. El propósito del presente estudio fue describir los resultados del tratamiento intensificado llevado a cabo durante 2 años en una población de niños y adolescentes argentinos con diabetes tipo 1. Fueron seleccionados 25 pacientes mayores de 10 años de edad con diabetes de más de 1 año de evolución. Todos ellos realizaron un programa de educación durante una semana de internación. El seguimiento posterior fue mensual durante los siguientes dos años. El esquema de tratamiento insulínico consistió en 4 a 5 controles preprandiales diarios, dos dosis de insulina NPH cubriendo requerimientos basales y cuatro dosis de insulina regular preprandial ajustadas de acuerdo al cálculode hidratos de carbono a ingerir, la actividad física y el valor de glucemia. La media de edad fue de 13.5años (r: 10-19 años). El tiempo medio transcurrido desde el diagnóstico hasta la intensificación del tratamientofue de 3.8 años ( r: 1.2 ¹9 años). La dosis media total de NPH disminuyó significativamente desde 0.9 U/kg en elinicio a 0.8 U/kg al año de seguimiento (p = 0.04), sin diferencias al segundo año de seguimiento (0.85 U/kg). Porel contrario, la dosis de insulina regular administrada en forma preprandial en normoglucemia aumentó de 0 a0.21 U/kg en el primer año (p 0.0001) y a 0.69 U/kg a los dos años (p NS). La media de HbA1C mostró unasignificativa reducción desde 10±1.62% a 8.53±1.04% en el primer año (p = 0.03) y 8.72± 0.81% a los dos años.El Z score de IMC aumentó significativamente de 0.7 ± 0.9 a 1.06 ± 1.15 luego de un año (p = 0.03) descendiendo a valores no...(AU)

Lessons from the "Euro-Lupus Cohort".

The "Euro-Lupus Cohort" is composed by 1,000 patients with systemic lupus erythematosus (SLE) that have been followed prospectively since 1991. These patients have been gathered by a European consortium - the "Euro-Lupus Project Group". This consortium was originated as part of the network promoted by the "European Working Party on SLE", a working group created in 1990 in order to promote research in Europe on the different problems related to this disease. The "Euro-Lupus Cohort" provides an updated information on the SLE morbidity and mortality characteristics in the present decade as well as defines several clinical and immunological prognostic factors.

[The Vaccination Program of Andalucía: the identification of evaluation indicators in the framework of quality assurance]. / Programa de Vacunaciones de Andalucía: identificación de indicadores de evaluación en el marco de garantía de calidad.

Quality assurance constitutes a major element in the evaluation of health services and has recently been introduced into our field. From this perspective, we intend to identify indicators for the evaluation the Andalusian Vaccination Programme, following the scheme proposed by Donabedian. A group of experts with different training backgrounds agreed upon the techniques on which the methodology used was based. Panels of experts were formed and the nominal group technique was used to identify criteria and standards. Mail surveys were made in order to select the most relevant standards from a multiple perspective: importance, ease of measurement and intervention capability. The aspects to be evaluated were defined about structure process and result. A total of 175 criteria and standards were identified, 42 related to structure, 68 related to process and 65 to results. The aspects to be evaluated, selected according to the priority technique used, are proposed to be employed systematically. The possibility of using them in the different structural levels of the health services is discussed.

Evaluation of the immune response in symptomatic and asymptomatic human giardiasis.

To better understand the common association of Giardia lamblia infection and allergic reactivity, total and specific IgE values were evaluated and different manifestations of symptomatic and asymptomatic infected human hosts were analyzed. The humoral, cellular, and nonspecific immune responses were evaluated in Cuban adults. Increased total serum IgE levels were significantly higher (p < 0.01) in Giardia patients than in negative controls; cure of giardiasis was characterized by a decrease in IgE levels and some patients regained normal IgE values. The skin test was positive in 91% (103/123) of chronic patients and only in 23% (20/123) of negative controls (p < 0.05). A positive test was seen in patients with antecedents of recent giardiasis (< 4 months). Specific IgE was higher in patients than in control sera, and in the former it decreased with sera dilution. During the follow-up period of cured patients, the proportion of IgE decreased and the opposite occurred in noncured patients. The cellular response evaluated by LIF was positive in 92% (11/12) of carriers and significantly higher (p < 0.05) than in symptomatic patients 8% (1/12); the same occurred with IgG and IgA antibody response; titers mainly of IgA were higher in asymptomatic carriers than in patients; all carriers were negative to the skin test. These results indicate the presence of total and specific IgE responses in humans infected with Giardia, but the response in symptomatic cases (patients) is different from that in asymptomatic cases (carriers).(ABSTRACT TRUNCATED AT 250 WORDS)

Avascular necrosis of bone in human immunodeficiency virus infection and antiphospholipid antibodies.

We describe 3 cases of human immunodeficiency virus (HIV) infected patients with antiphospholipid antibodies (aPL) in serum who developed avascular necrosis (AVN), an association that to our knowledge, has rarely been described. Given that the 3 patients had stopped their intravenous drug addiction 2 years before the clinical picture appeared, and none had any known risk factors for developing AVN, there may be an association, perhaps fortuitous, between HIV infection, the presence of aPL and the development of AVN.

Systemic lupus erythematosus: clinical and immunologic patterns of disease expression in a cohort of 1,000 patients. The European Working Party on Systemic Lupus Erythematosus.

In the present study we have analyzed the prevalence and characteristics of the most relevant clinical and immunologic features in 1,000 patients with SLE. Several differences in the expression of the disease have been observed in relation to the patients' age at onset, sex, and autoantibody serology. The childhood-onset patients more often had malar rashes (55% vs 39%) and nephropathy (28% vs 15%) as presenting manifestations. During the evolution of the disease, these patients had an increased prevalence only of malar rash (79% vs 56%) and a lower prevalence of rheumatoid factor (6% vs 19%). The older-onset patients (age 50 or older) less often showed malar rash (21% vs 42%), arthritis (52% vs 71%), and nephropathy (3% vs 17%) as the first symptom. During the evolution of their disease, these patients had a decreased prevalence of malar rash (33% vs 60%), photosensitivity (29% vs 47%), arthritis (73% vs 85%), nephropathy (22% vs 41%), thrombosis (4% vs 15%), and anti-La antibodies (6% vs 20%), but an increased prevalence of sicca syndrome (33% vs 15%). Males more often had serositis (28% vs 16%) as a first symptom, but they presented with a lower prevalence of arthritis (74% vs 85%) during the evolution of the disease. The presence of ANA, a high titer of anti-dsDNA, rheumatoid factor, anti-ENA, and antiphospholipid antibodies also distinguished additional homogeneous SLE subsets of clinical significance.