Prevalencia de acidosis metabólica en derivaciones ileales tras más de un año de la cistectomía radical y repercusiones metabólicas secundarias asociadas / Prevalence of metabolic acidosis in ileal diversions more than one year after radical cystectomy and associated secondary metabolic effects

Introducción y objetivo La acidosis metabólica (AM) es una alteración conocida en pacientes con derivaciones ileales. Es más frecuente en etapas tempranas postoperatorias y disminuye con el tiempo. Nuestro objetivo es determinar su prevalencia tras más de un año de seguimiento, analizar sus factores de riesgo y evaluar su impacto en diferentes perfiles metabólicos. Materiales y métodos Realizamos un estudio observacional entre enero de 2018 y septiembre de 2022 siguiendo las normas STROBE. La AM fue definida con valores de bicarbonato venoso <22mEq/l. Analizamos 133 pacientes con una media de seguimiento de 55,24±42,36 meses. Resultados Se identificaron 16 (12%) pacientes con AM. Los pacientes con y sin AM fueron comparables en edad, sexo y tiempo de seguimiento. El grupo con AM presentó una mayor tasa de anemia (68,75 vs. 19,65%; p<0,001) e insuficiencia renal (100 vs. 45,29%; p<0,001) y niveles venosos estadísticamente significativos mayores de creatinina, cloro, potasio, hormona paratiroidea y fósforo, pero menores valores de hemoglobina, filtrado glomerular, colesterol total, vitamina D, calcio y albúmina (todos p<0,05). El filtrado glomerular fue el único factor de riesgo independiente relacionado con la AM (OR: 0,914; IC 95%: 0,878-0,95; p<0,0001), demostrando una estrecha correlación con los valores de bicarbonato venoso (r=0,387; p<0,001). Conclusiones La AM es una alteración poco prevalente en derivaciones urinarias ileales transcurrido más de un año de la cistectomía, pero tiene implicaciones en el metabolismo hematológico, renal, proteico, lipídico y óseo. Aconsejamos su monitorización en pacientes con insuficiencia renal para poder realizar un diagnóstico y tratamientos precoces (AU)

Introduction and objective Metabolic acidosis (MA) is a well-known complication in patients with ileal urinary diversions. It is common in the early postoperative stages and decreases over time. Our objective is to investigate the prevalence of MA after more than one year of follow-up, identify the associated risk factors, and analyze its secondary metabolic consequences. Materials and methods We conducted an observational study between January 2018 and September 2022 following the STROBE guidelines. MA was defined as a serum bicarbonate level <22mEq/L. Finally, we analyzed 133 patients with a mean follow-up of 55.24±42.36 months. Results MA was observed in 16 (12%) patients. Patients with and without MA were comparable in age, sex, and follow-up time. The group with MA presented a higher rate of anemia (68,75% vs 19.65%, P<.001) and renal failure (100% vs 45.29%, P<.001), statistically significant higher levels of serum creatinine, chloride, potassium, parathyroid hormone, and phosphorus but lower serum values of hemoglobin, renal glomerular filtration rate, total cholesterol, vitamin D, calcium, and albumin (all P<.05). Renal glomerular filtration rate was the only independent risk factor related to the development of MA (OR: 0.914; 95% CI: 0.878-0.95; P<.0001), proving a close correlation with venous bicarbonate values (r=.387, P<.001). Conclusions MA is a little prevalent disorder in ileal urinary diversions more than one year after radical cystectomy is performed but it has secondary consequences on hematologic, renal, protein, lipid, and bone metabolism. We recommend to a close follow-up in patients with renal failure for early diagnosis and treatment (AU)

Prevalence of metabolic acidosis in ileal diversions more than one year after radical cystectomy and associated secondary metabolic effects.

INTRODUCTION AND OBJECTIVE: Metabolic acidosis (MA) is a well-known complication in patients with ileal urinary diversions. It is common in the early postoperative stages and decreases over time. Our objective is to investigate the prevalence of MA after more than one year of follow-up, identify the associated risk factors, and analyze its secondary metabolic consequences. MATERIALS AND METHODS: We conducted an observational study between January 2018 and September 2022 following the STROBE guidelines. MA was defined as a serum bicarbonate level ​​<22mEq/L. Finally, we analyzed 133 patients with a mean follow-up of 55.24 ± 42.36 months. RESULTS: MA was observed in 16 (12%) patients. Patients with and without MA were comparable in age, sex, and follow-up time. The group with MA presented a higher rate of anemia (68,75% vs 19,65%, p < 0.001) and renal failure (100% vs 45,29%, p < 0.001), statistically significant higher levels of serum creatinine, chloride, potassium, parathyroid hormone, and phosphorus but lower serum values ​​of hemoglobin, renal glomerular filtration rate, total cholesterol, vitamin D, calcium, and albumin (all p < 0.05). Renal glomerular filtration rate was the only independent risk factor related to the development of MA (OR 0.914; 95% CI 0.878-0.95; p < 0.0001), proving a close correlation with venous bicarbonate values ​​(r = 0.387, p < 0.001). CONCLUSIONS: MA is a little prevalent disorder in ileal urinary diversions more than one year after radical cystectomy is performed but it has secondary consequences on hematologic, renal, protein, lipid, and bone metabolism. We recommend to a close follow-up in patients with renal failure for early diagnosis and treatment.

Immunization with thiol-binding proteins from Haemonchus contortus adult worms partially protects goats against infection during prepatency.

To contribute of the knowledge of the immune mechanisms underlying the response to the immunization of goats with thiol-binding proteins fractions (PBS-TSBP) from Haemonchus contortus (H. contortus) adult worms, this study analyzed the degree of protection and the immune responses developed against the parasite after vaccination with this antigenic complex during the time-elapsing between challenge with L3 of the parasite and the development of adult worms, evidenced by the appearance of first faecal eggs (prepatent period or prepatency). Goat kids immunized with PBS-TBSP generated an immune response during the prepatency which translates into a reduction in the number of worms, as well as a lower reduction on packed cell volume and plasma protein levels in relation to the non-vaccinated animals. As previously described in other studies carried out after the prepatent period, this protection was associated with a systemic humoral response. At the local level, a specific humoral response was also observed, together with an immune-inflammatory infiltrate in the gastric mucosa of MCH-II + cells and CD4+ lymphocytes, whose number was associated with a reduction in the number of worms and an increase in plasma proteins. A high peripheral eosinophilia was detected, but no corresponding increased infiltration of the gastric mucosa by eosinophils or globular leukocytes was observed. In agreement with previous data on the immunolocalization of the antigens used here, the results obtained contribute to the idea that these may be excretion/secretion (E/S) products necessary for parasite survival, whose inactivation during the larval and/or pre-adult stages may have contributed to immunoprotection.

Ligation of intersphincteric fistula tract (LIFT) for the treatment of anal fistula: a prospective observational study

Background: The ligation of intersphincteric fistula fract (LIFT) technique avoids postoperative anal continence disturbances and preserves quality of life. Methods: A total of 70 patients with anal fistula (AF) were treated in the Day Surgery Unit. The LIFT technique was the primary treatment in 63 patients. The other had previously undergone placement of a loose seton (two-step approach). The mean follow-up was 66.8 months. Statistical analysis was performed using contingency tables, the chi-square test, and the Student T-test. Results: The use of LIFT was successful in 40 patients (57.1%). However, 6 patients (8.6%) presented persistence of postoperative intersphincteric fistula, being successfully treated by fistulotomy. There were no differences in this technique's success rate between high and low AF (p = 0.45). The success rate of one-step LIFT, however, was significantly higher (p = 0.03). No disturbances of continence were observed. Conclusions: The LIFT technique has a role in the treatment of AF, is suitable for ambulatory surgery, and has a low complications rate. A two-step approach is not always needed. (AU)

Protective immune responses during prepatency in goat kids experimentally infected with Eimeria ninakohlyakimovae.

During the first schizogony, the goat coccidia Eimeria ninakohlyakimovae develops macroschizonts in lacteal duct endothelial cells, whose rupture leads to severe ileal damage and clinical signs during the prepatent period. The immune response elicited against early stages of the parasite development still requires to be investigated. In the present study we have evaluated immune reactions in goat kids primary- and challenged-infected with Eimeria ninakohlyakimovae, and sacrificed during prepatency (7days after challenge). The oocyst output during the primary infection, body weight and clinical condition of all the animals were examined and, at the end of the experiment, all the goat kids were euthanized and subjected to necropsy. Samples were taken from different sections of the ileum, colon and mesenteric lymph nodes (MLN) of primary- and challenged E. ninakohlyakimovae-infected animals. Intestinal leukocyte subpopulations were characterized in E. ninakohlyakimovae-infected mucosa and counts of lymphocytes, eosinophils, polymorphonuclear neutrophils (PMN), globular leukocytes and mast cells were recorded. Additionally, gene expression of caprine IL-2, IL-4, IL-10 and INFγ of ileal, colonic and MLN tissues were performed, as well as the immunohistochemical characterization of immune cells. The E. ninakohlyakimovae primary infection resulted in moderate to severe enteritis with different degrees of diarrhoea and was accompanied by high OPG counts and an increase of most immune cells analyzed when compared to uninfected control animals. Furthermore, eosinophil-, lymphocyte-, globular leukocyte- and mast cell-counts were significantly higher in the challenge group compared to the primary infected animals, whilst the opposite was true for PMN counts. The challenge infection was also associated with moderate increased levels of local mucosal IgA. Interestingly, the number of immature schizonts found at the ileal mucosa was statistically higher in the challenge infected group compared to the challenged control animals. Furthermore, in the challenged E. ninakohlyakimovae-infected animals a significantly higher number of mucosal CD4+ and CD8+ lymphocytes were observed, indicating that these T cell subpopulations might be involved in protective host immune response elicited against early stages of parasite development. The immune response was however very complex, as antigen presenting cells and other effector cell populations of the innate immune system, as well as certain cytokines, were involved. In summary, the results of this study contribute to the better understanding of local cellular and humoral immune responses against caprine E. ninakohlyakimovae, particularly during the prepatency.

Reverse osmosis membrane composition, structure and performance modification by bisulphite, iron(III), bromide and chlorite exposure.

Reverse osmosis (RO) membrane exposure to bisulphite, chlorite, bromide and iron(III) was assessed in terms of membrane composition, structure and performance. Membrane composition was determined by Rutherford backscattering spectrometry (RBS) and membrane performance was assessed by water and chloride permeation, using a modified version of the solution-diffusion model. Iron(III) dosage in presence of bisulphite led to an autooxidation of the latter, probably generating free radicals which damaged the membrane. It comprised a significant raise in chloride passage (chloride permeation coefficient increased 5.3-5.1 fold compared to the virgin membrane under the conditions studied) rapidly. No major differences in terms of water permeability and membrane composition were observed. Nevertheless, an increase in the size of the network pores, and a raise in the fraction of aggregate pores of the polyamide (PA) layer were identified, but no amide bond cleavage was observed. These structural changes were therefore, in accordance with the transport properties observed.

Selective non-antibiotic treatment in sigmoid diverticulitis: is it time to change the traditional approach?

BACKGROUND: A growing body of knowledge is calling into question the use of antibiotics in acute diverticulitis (AD). Moreover, recent studies provide evidence regarding the security of treating patients with AD as outpatients. The aim of this study was to evaluate a restrictive antibiotic outpatient protocol for the treatment of mild-to-moderate episodes of AD. METHODS: All patients with symptoms of AD presenting to our emergency department were assigned a modified Neff stage. Patients with mild AD received outpatient treatment without antibiotics. Patients with mild AD and comorbidities were admitted to receive the same treatment. Patients with moderate AD were admitted for 48 h and were then managed as outpatients until they had completed 10 days of antibiotic treatment. RESULTS: Between April 2013 and November 2014, we attended 110 patients with a diagnosis of AD, 77 of whom we included in the study: 45 patients with mild AD and 32 with moderate AD. Of the patients with mild AD, 88.8 % successfully completed the non-antibiotic, non-admission treatment regime and 95.5 % benefited from a non-antibiotic regime, whether as outpatients or inpatients. A total of 88 % of patients with mild AD and 87.5 % of patients with moderate AD who met the inclusion criteria completed treatment as outpatients without incident. No major complications (abscess, emergency surgery) or deaths were recorded. CONCLUSIONS: Outpatient treatment without antibiotics for patients with mild AD is safe and effective. Patients with moderate AD can be safely treated with antibiotics in a mixed regime as inpatients and outpatients.

Influence of immunoprotection on genetic variability of cysteine proteinases from Haemonchus contortus adult worms.

The limitations associated with the use of anthelmintic drugs in the control of gastrotintestinal nematodosis, such as the emergence of anthelmintic resistance, have stimulated the study of the immunological control of many parasites. In the case of Haemonchus contortus, several vaccination trials using native and recombinant antigens have been conducted. A group of antigens with demonstrated immunoprotective value are cathepsin B - like proteolytic enzymes of the cysteine proteinase type. These enzymes, which have been observed in both excretory-secretory products and somatic extracts of H. contortus, may vary among different geographic isolates and on strains isolated from different hosts, or even from the same host, as has been demonstrated in some comparative studies of genetic variability. In the present study, we evaluated the genetic variability of the worms that fully developed their endogenous cycle in immunised sheep and goat in order to identify the alleles of most immunoprotective value. To address these objectives, groups of sheep and goats were immunised with PBS soluble fractions enriched for cysteine proteinases from adult worms of H. contortus from either a strain of H. contortus isolated from goats of Gran Canaria Island (SP) or a strain isolated from sheep of North America (NA). The results confirmed the immunoprophylactic value of this type of enzyme against haemonchosis in both sheep and goats in association with increased levels of specific IgG. The genetic analysis demonstrated that the immunisation had a genetic selection on proteinase-encoding genes. In all the immunised animals, allelic frequencies were statistically different from those observed in non-immunised control animals in the four analysed genes. The reduction in the allelic frequencies suggests that parasites expressing these proteases are selectively targeted by the vaccine, and hence they should be considered in any subunit vaccine approach to control haemonchosis in small ruminants.

Direct ultrafiltration performance and membrane integrity monitoring by microbiological analysis.

The feasibility of substituting a conventional pre-treatment, consisting of dioxi-chlorination, coagulation/flocculation, settling and sand filtration, of a drinking water treatment plant (DWTP) by direct ultrafiltration (UF) has been assessed from a microbiological standpoint. Bacterial indicators, viral indicators and human viruses have been monitored in raw river, ultrafiltered and conventionally pre-treated water samples during two years. Direct UF has proven to remove bacterial indicators quite efficiently and to a greater extent than the conventional process does. Nevertheless, the removal of small viruses such as some small bacteriophages and human viruses (e.g. enteroviruses and noroviruses) is lower than the current conventional pre-treatment. Membrane integrity has been assessed during two years by means of tailored tests based on bacteriophages with different properties (MS-2, GA and PDR-1) and bacterial spores (Bacillus spores). Membrane integrity has not been compromised despite the challenging conditions faced by directly treating raw river water. Bacteriophage PDR-1 appears as a suitable microbe to test membrane integrity, as its size is slightly larger than the considered membrane pore size. However, its implementation at full scale plant is still challenging due to difficulties in obtaining enough phages for its seeding.

Does stapled anopexy for bleeding haemorrhoids cure associated anaemia?

AIM: The aim of this study was to evaluate the effectiveness of stapled anopexy (SA) in patients with chronic bleeding haemorrhoids and secondary anaemia. METHOD: Our department performed 340 SA procedure per patient for haemorrhoids between January 1999 and December 2011. Fifty (14.7%) of these patients (25 male patients and 25 female patients) had anaemia (haemoglobin concentration < 13 g/dl in male patients and < 12 g/dl in female patients) secondary to chronic haemorrhoidal bleeding. Patients with colorectal bleeding and anaemia not caused by haemorrhoids were excluded. The mean (SD) age was 56.4 (13.9) years and the mean (SD) haemoglobin concentration was 9.2 (1.6) g/dl for male patients and 10.4 (1.2) g/dl for female patients. Five (10%) patients with anaemia had Grade II, 22 (44%) had Grade III and 23 (46%) had Grade IV haemorrhoids. The median (range) duration of postoperative follow-up was six (1-12) years. RESULTS: None of the patients required early postoperative admission or experienced early or late complications related to SA. The procedure was successful (normal haemoglobin concentration and no bleeding at 6 months postsurgery) in 45 (90%) patients. Of the five (10%) patients in whom SA was ineffective, one had Grade II, three had Grade III and one had Grade IV haemorrhoids. All these patients underwent Milligan-Morgan haemorrhoidectomy 3 months after SA. CONCLUSION: SA is an effective treatment for patients with bleeding haemorrhoids and subsequent anaemia. In our experience, the success rate was satisfactory and there were no serious complications.

Anopexia mucosa grapada para el tratamiento de hemorroides y prolapso mucoso rectal en régimen de cirugía mayor ambulatoria / Stapled mucosal anopexy for the treatment of haemorrhoids and rectal mucose prolapse in day surgery

Introducción: El tratamiento quirúrgico de las hemorroides y del prolapso mucoso rectal mediante anopexia mucosa grapada disminuye el dolor postoperatorio respecto a las técnicas resectivas clásicas. Objetivo: Demostrar que la anopexia mucosa grapada es una técnica segura y efectiva para ser utilizada en cirugía mayor ambulatoria. Pacientes y métodos: Estudio observacional de 327 anopexias mucosa grapada (enero de 2000 a diciembre de 2011) para cirugía hemorroidal. Se evalúa el dolor postoperatorio mediante escala verbal numérica de 0 a 10, los eventos adversos, el grado de satisfacción postoperatoria mediante escala categórica verbal y los resultados del seguimiento (cifra de recidiva global). Asimismo, se analizan los índices principales de cirugía ambulatoria, ingresos no planeados, reingreso y tasa de ambulatorización. Resultados: La edad media de la muestra fue de 48,1 años (rango 21-85). La estancia postoperatoria media en los pacientes ambulatorios fue de 2,25 horas. El índice de ambulatorización fue de 79,8 % (261 pacientes), con un porcentaje de ingresos no planeados de 6,9 % (18 pacientes) y una tasa de reingresos de 1,1 % (3 casos). En cuanto al dolor, el 81,3 % de los pacientes experimentó dolor igual o inferior a 2 y referente a la situación postoperatoria inmediata, el 90 % de los pacientes la expresaron como excelente o buena. La cifra de recidiva global fue del 8,8 % (23 pacientes).Conclusiones: La anopexia mucosa grapada es una técnica segura y efectiva para el tratamiento de las hemorroides en régimen de cirugía sin ingreso. La cifra de recidivas es mayor a la observada con técnicas resectivas. Se puede conseguir una implementación progresiva de esta técnica en régimen ambulatorio con facilidad, con adaptación a los indicadores de calidad (AU)

Background: Stapled mucosal anopexy decreases postoperative pain for the treatment of haemorrhoids and rectal mucose prolapse when comparing with classical resective techniques. Aim of the study: To prove that stapled mucosal anopexy is a save and effective procedure to be performed in ambulatory surgery. Patients and method: From january 2000 to december 2011, 327 stapled mucosal anopexy procedures were performed, 261 cases (79.8 %) were done in ambulatory surgery. The mean age of the series was 48.1 (range 21-85), 165 men and 96 women. Preoperative preparation included phosphate enemas, and antibiotic prophylaxis. Progressive implementation in ambulatory surgery, postoperative pain, admissions, late admissions, early postoperative situation and recurrence were considered for the study. Results: Overall rate for stapled mucosal anopexy for ambulatory surgery was 79.8%. Postoperative pain was measured by a visual analogic scale (1-10), and 81.3 % of the patients expressed pain under 2. Eighteen patients (6.9 %) required admission on the day of surgery and late admission was needed in 3 patients (1.1 %). Ninety per cent of the patients expressed their situation as excellent or good. Overall recurrence of symptoms was 23 cases (8.8 %).Conclusions: Stapled mucosal anopexy is a safe and effective procedure for prolapsing haemorrhoids in ambulatory surgery. Recurrence rate is higher than that observed in resective techniques. Progressive implementation subject to normal day case criteria is easily achievable (AU)

Immunoprotective effect of cysteine proteinase fractions from two Haemonchus contortus strains adapted to sheep and goats.

A preliminary analysis of the significance of genetic diversity in cysteine proteinase genes has been performed simultaneously in sheep and goats, with regard to the immunological control using these enzymes against haemonchosis. For this purpose, we have studied the cross-immunoprotective effect of cysteine protease-enriched protein fractions (CPFs) in adult worms of two Haemonchus contortus strains from North America and Spain that are adapted to sheep and goats, respectively. Previous genetic analysis of cysteine proteinase genes in both strains has shown that some of loci are polymorphic and these differences are translated into changes in the amino acid sequences. However, our results show that CPFs from H. contortus adult worms have a protective effect against the parasite in both sheep and goats. These results are similar regardless of whether they were obtained from sheep or goat-adapted H. contortus strains, which could be very important in case H. contortus CPFs were commercially used in different countries, as vaccines to prevent the negative effects of this parasite. Interestingly, this experimental inoculation of both species with a heterologous strain of H. contortus contributes to the idea shown in previous studies about how difficult is the interpretation and the comparison of vaccination where strains not adapted to a specific host are used. Therefore, the challenger of using heterologous strains could provide similar results to those observed in immunised animals. This study suggests the possibility of exploring the mechanisms involved in natural protection against non-adapted strains, in order to develop strategies to control haemonchosis.

Day case stapled anopexy for the treatment of haemorrhoids and rectal mucosal prolapse.

AIM: Stapled anopexy (SA) gives better early postoperative results than classical haemorrhoidectomy. The aim of this study is to demonstrate that SA is a safe and effective procedure for the treatment of haemorrhoids and rectal mucose prolapse in a day-case surgery programme. METHOD: From January 2000 to December 2008, 297 SA procedures were performed; 230 (77.4%) were performed in the Day Surgery Unit (DSU). Third- and fourth-degree haemorrhoids, second-degree haemorrhoids with no response to conservative treatment and several cases of rectal prolapse were included. The mean age of the patients in the series was 48.1 years (range 21-85). Preoperative preparation included phosphate enemas and antibiotic prophylaxis. Patients were operated on mainly under spinal anaesthesia. Day-case rate, postoperative pain (measured by a visual analogic scale, 1-10), admissions, re-admissions, early postoperative situation and recurrence were evaluated in the study. RESULTS: The overall DSU rate was 78%, with a progressive increase from 46% to 99% in 2008. One hundred and eighty-five patients (80%) had pain scores under 2; no patient had a pain score over 7. Eighteen (8%) patients required admission on the day of surgery. Late admission was needed for 3 (3%) patients. Thirty-three patients reported their situation as excellent, 174 as good, 20 as acceptable and three as bad when they answered a phone questionnaire 24 h after surgery. Overall, 20 (9%) patients had recurrence of symptoms. CONCLUSION: SA is a safe and effective procedure for prolapsing haemorrhoids in the day case setting. The recurrence rate is higher than that observed in classical haemorrhoidectomy. Most patients can be managed as day-cases.

Presence of C. albidus, C. laurentii and C. uniguttulatus in crop and droppings of pigeon lofts (Columba livia).

Columba livia is an important reservoir and carrier of Cryptococcus neoformans, Cryptococcus uniguttulatus, Cryptococcus laurentii and Cryptococcus albidus. Upper digestive tract of this species is also known as a habitat for Cryptococcus neoformans. Given the increasing clinical interest of this microorganism, 331 swabs from crop and 174 dropping samples from pigeon lofts in Grand Canary Island have been studied. The obtained results show an extensive presence samples 81 positive (24.47%) of Cryptococcus spp. in analysed crops: 32 (9.66%) for C. neoformans, 24 (7.2%) for C. uniguttulatus, 23 (6.9%) for C. albidus and 2 (0.6%) for C. laurentii. In the same way, Cryptococcus spp was also isolated in 82 (47.13%), dropping samples: C. neoformans in 59 (33.9%), C. uniguttulatus, in 9 (5.17%), C. laurentii in 8 (4.59%) and C. albidus in 6 (3.44%) of the investigated samples, respectively. The cryptococcosis produced by species of cryptococci other than C. neoformans has become more important during the last decade, supporting the study on the role of pigeon in the epidemiology of this disease.

Preliminary study on the use of a Teladorsagia circumcincta bulk milk ELISA test in dairy goats under experimental conditions.

An ELISA test for the detection of anti-Teladorsagia circumcincta antibodies in goat milk samples (both individual and bulk milk samples) has been developed in dairy goats experimentally infected with a trickle infection. The results observed were compared with those obtained when some other standard methods for the detection of animals infected with gastrointestinal nematodes (GIN), such as faecal egg counts (FEC) and serum pepsinogen levels. Some factors that could affect the final results of the test (dilution and nature of samples as well as their preservation at 4 degrees C for 0-10 days) were also monitored. The results show that the proposed test could allow the detection of infected herds using bulk milk samples. The levels of anti-T. circumcincta antibodies in milk and serum samples and the concentrations of serum pepsinogen showed a similar pattern over time. Refrigeration of milk samples for less than 5 days or its preservation with potassium dichromate for 10 days did not significantly affect the ability of the test to detect infected animals. Finally, when a commercial Ostertagia ostertagi ELISA kit was used to assay milk samples from goats infected with T. circumcincta, the results suggest that it may be possible to use a crude O. ostertagi antigen-based ELISA for the detection of goats infected with T. circumcincta.

[A model for resource allocation in primary health care]. / Modelo de asignación de recursos en atención primaria.

Resource allocation in primary health care is a worldwide issue. In Chile, the state allocates resources to city halls using a mechanism called "per capita". However, each city hall distributes these resources according to the historical expenses of each health center. None of these methods considers the epidemiological and demographic differences in demand. This article proposes a model that allocates resources to health centers in an equitable, efficient and transparent fashion. The model incorporates two types of activities; those that are programmable, whose demand is generated by medical teams and those associated to morbidity, generated by patients. In the first case the health promotion, prevention and control activities are programmed according to the goals proposed by health authorities. In the second case, the utilization rates are calculated for different sociodemographic groups. This model was applied in one of the most populated communities of Metropolitan Santiago and proved to increase efficiency and transparency in resource allocation.

Modelo de asignación de recursos en atención primaria / A model for resource allocation in primary health care

Resource allocation in primary health care is a worldwide issue. In Chile, the state allocates resources to city halls using a mechanism called "per capita". However, each city hall distributes these resources according to the historical expenses of each health center. None of these methods considers the epidemiological and demographic differences in demand. This article proposes a model that allocates resources to health centers in an equitable, efficient and transparent fashion. The model incorporates two types of activities; those that are programmable, whose demand is generated by medical teams and those associated to morbidity, generated by patients. In the first case the health promotion, prevention and control activities are programmed according to the goals proposed by health authorities. In the second case, the utilization rates are calculated for different sociodemographic groups. This model was applied in one of the most populated communities of Metropolitan Santiago and proved to increase efficiency and transparency in resource allocation.

[Hepatitis B in children with cancer]. / Hepatitis B en niños con cáncer.

INTRODUCTION: Cancer patients can be asymptomatic carriers of the hepatitis B virus (HBV), which can be reactivated by chemotherapy. Our aim was to identify the serological markers of HBV in children with cancer who were asymptomatic carriers of the virus. Fifty two (52) children with cancer treated at the Maracaibo University Hospital in Venezuela were studied, 28 of these children (53.8%) were HBV positive, despite no clinical or biochemical signs or symptoms of hepatitis. The type of serological markers present in each of these children.were investigated. We found 7 cases (25%) with hepatitis B surface antigen (HBsAg) and 2 (7.1%) with anticore as the only markers. Multiple markers were found in the other children: 9 (32.1%) HBsAg and anticore; 7 (25%) HBsAg, e-antigen (HBeAg) and anticore; 3 (10.7%) HBsAg, HBeAg antibody and anticore. In total, of the 28 positive children 20 (71.4%) showed positive anticore and of these 4 (20%) were of the IgM type. Our results show a high level of positivity for HBV in the children with cancer studied. In spite of being asymptomatic carriers of the HBV, it is noticeable the presence of serological markers for acute disease. We recommend testing for HBV serological markers before starting chemotherapy. Should the test results be negative, vaccination is indicated and should they be positive, specialized care is indicated.

Rehabilitación foniátrica en pacientes sometidos a laringectomías parciales por cáncer de laringe / Rehabilitation foniatrica in subjected patients to partial laryngectomy for larynx cancer

En el Servicio de Otorrinolaringología del Hospital "Dr. Domingo Luciani", se reportan laringectomías parciales desde 1986, por lo que nos propusimos evaluar nuestra experiencia desde el punto de vista foniátrico en el manejo de estas intervenciones. La muestra consistió en 3 laringectomías glóticas hasta el 2000 y a partir de ese año: 3 cordectomías vía laringofisura, 4 laringectomías glóticas, 8 hemilaringectomías verticales, 2 laringectomías supraglóticas y 6 laringectomías supracricoideas. De éstas últimas, 5 reconstruidos mediante cricohioidoepiglotopexia (CHEP) y 1 mediante cricohioidopexia (CHP). Se revisó la evaluación de voz y respiración pre y postoperatoria, evolución de la deglución, grado de aspiración y la estrategia de rehabilitación, dieta, tiempo de decanulación (retiro del traqueostomo), retiro de sonda nasogástrica (SNG) y percepción de la voz por el examinador. Se le realizó evaluación foniátrica preoperatoria a 16 de los 23 pacientes operados a partir de 2000. En esta evaluación, todos los pacientes presentaron deterioro franco de los parámetros vocálicos: cualidades de voz, duración fonatoria y parámetros respiratorios: patrón respiratorio, tiempo de retención y emisión, coordinación fonorespiratoria y no se detectaron trastornos deglutorios. En la evaluación postoperatoria: se reportó aspiración en 14 pacientes, la cual se clasificó utilizando la escala de Leipzig y Pearson 7: 8 pacientes grado 1, 1 paciente grado 2, 5 pacientes grado 3. Se inició la rehabilitación foniátrica postoperatoria entre el día 1 y 18, con promedio de 8. La decanulación se realizó entre el día 3 y 78, con promedio de 16 días y el retiro de SNG entre el día 4 y 82, con un promedio de 21 días. Se reportó deglución sin aspiración, en un tiempo variable entre un mes y un año con media de 6 meses. Los resultados son los comparables con los reportados en la literatura.

Evaluación cromosómica en pacientes con enfermedad bipolar / Chromosomal evaluation in patients with bipolar disorder

Introducción: Hay pocas noticias sobre estudios de citogenética convencional en pacientes con enfermedad bipolar, no así de estudios moleculares donde se señala la ubicación de genes de susceptibilidad en diversos cromosomas. El objetivo del presente trabajo es evaluar la estructura cromosómica a través de estudios convencionales en pacientes con enfermedad bipolar. Materiales y métodos: Se estudió a 40 pacientes mujeres, con diagnóstico de enfermedad bipolar, con un promedio de edad de 42,65 años (20-67 años). Se utilizó como control a 40 individuos adultos con las mismas edades, sin enfermedad psiquiátrica. Se evaluó la estructura cromosómica mediante estudios convencionales. Resultados: No se observaron alteraciones citogenéticas en las pacientes con enfermedad bipolar, salvo una, en la que en una metafase se evidenció hiperdiploidía con ganancia de los cromosomas 8 y 9. En 26/40 pacientes (65%) y en 4/40 controles (10%) se observó una alta expresión de sitios frágiles (p < 0,05). La ubicación cromosómica de estas fragilidades identifican un patrón de distribución concentrado principalmente en las bandas 1(p32), 1(q21), 1(q22), 2(p12), 2(q31), 3(p14), 3(q21), 3(q25), 7(p14), 14 (q22) y 19(p13). Se apreció que los 54 puntos de ruptura expresados están distribuidos en 17 de los 22 pares de autosomas, y no se observa ninguno en el par de cromosomas sexuales. Conclusiones: Los resultados muestran una frecuencia inesperadamente alta de fragilidad cromosómica en pacientes con enfermedad bipolar, sin que se tenga hasta ahora una explicación lógica para tal alteración, sus consecuencias futuras y su posible relación con el pronóstico y el tratamiento. Se deben llevar a cabo nuevos estudios a fin de dilucidar estos interrogantes

Introduction: The studies on genetic changes are aimed at the molecular level of alterations and have identified the location of the disease susceptible genes, some of wich are shared with schizophrenia. In the bipolar disease, there is little evidence from conventional cytogenetic studies in comparison with other mental pathologies. The purpose of this research was to evaluate the chromosome structure through conventional studies. Materials and methods: This research is prospective and descriptive. 40 female patients with an average age of 42.65 years and 40 adult controls without psychiatric disease were examined. Results: No cytogenetic alterations were observed in the bipolar disorder (BPD) patients, except for one patient in whom one mataphase evidenced hyperdiploidy with a gain of chromosomes 8 and 9. An unexpected high fragile site expression was noted in 26/40 patients (65%) and 4 /40 controls (10%). The chromosomal location of the fragilities observed identifies a distribution pattern concentrated mainly in bands 1(p32), 1(q21), 1(q22), 2(p12), 2(q31), 3(p14), 3(q21), 3(q25), 7(p14), 14 (q22) y 19(p13). It was observed that the 54 breakage points expressed are distributed on 17 of the 22 autosome pairs, with none observed on the sex chromosome pair. Conclusions: The presents results evidence an unexpected high frecuence of chromosomal fragility in BPD patients, without a logic explanation thus far such alteration, its future consecuences and possible relationship with prognosisi and treatment. New studies must be conducted in order to elucidate these questions