Influence of Body Mass Index on Venous Thrombotic Complications of Liver Transplants.

OBJECTIVE: To analyze venous thrombotic complications in transplanted patients as a function of their body mass index (BMI). MATERIALS AND METHODS: This single-center, observational retrospective study of individuals undergoing liver transplantation between January 2008 and December 2014 analyzed the frequency of pretransplant portal thrombosis, post-transplant venous complications (early and late portal thrombosis), deep vein thrombosis, pulmonary thromboembolism and the survival outcomes as a function of World Health Organization BMI class. RESULTS: Liver transplantation was performed in 208 patients during the study period. No statistically significant differences in study variables were found as a function of BMI in bivariate analyses (P < .05), and Kaplan-Meier survival analysis results were also nonsignificant. CONCLUSION: No differences in the rate of venous thrombotic complications or survival were found as a function of the BMI class of these liver transplant recipients. These findings are in line with previous reports that complication rates are not higher in obese patients and support the proposal that obesity should not be considered a contraindication for liver transplantation based on the risk of venous complications.

[Experiences of the family living with severe mental illness: a qualitative study in Navarre]. / Experiencias de la familia que convive con la enfermedad mental grave: un estudio cualitativo en Navarra.

BACKGROUND: It is estimated that 1% of the general population suffers from severe mental illness (SMI). In most cases, families are the ones providing support and direct care to the ill relative, which in turn results in the family being the unit that lives with the mental illness. In Spain, two key aspects have been barely explored: the relationship between the family and the mental health system; and the knowledge of families and the possible transfer of such knowledge to other families. The aim of this paper is to contribute to exploring these two aspects. METHODS: A qualitative study with a narrative approach was implemented in the Foral Community of Navarre (Spain). The study consisted of in-depth interviews with families living with SMI. Two interviews were conducted with each family (which included the individual diagnosed with a mental illness). A multimodal analysis (structural, thematic and dialogical) was conduc-ted with each family. Comparative analyses between families were also performed. RESULTS: A total of 6 families were interviewed with a total of 18 participants. Findings were grouped around two central catego-ries: requirements of families and family to family. The first category includes improving relationships with mental health provi-ders, medications, psychosocial rehabilitation centers and supporting families. The second category includes recommendations from the perspective of the relative with a SMI and those without it. CONCLUSIONS: Families would like to receive a higher degree of support from mental-health providers. At the same time, families should be considered as important sources of knowledge and support for the treatment of other families living with SMI.

Assessing a quick monitoring method using rocky intertidal communities as a bioindicator: a multivariate approach in Algeciras Bay.

A multivariate approach was used to test the value of intertidal communities as a bioindicator of environmental conditions at Algeciras Bay, southern Spain. The study area is located in the Strait of Gibraltar and it is subjected to a variety of anthropic impacts. Eight localities (5 inside and 3 outside the bay) were selected, and four transects were undertaken in each locality to characterise the fauna and flora. The spatial distribution of the intertidal species reflected the physico-chemical conditions of Algeciras Bay. The stations located outside the bay, characterised by high hydrodynamism and dissolved oxygen and low sedimentation and turbidity, had a higher diversity and species richness than the inner stations. According to the BIO-ENV procedure and CCA, water turbidity was the factor which best correlated with the intertidal assemblages. SIMPER showed that the molluscs Chtamalus stellatus, Mytilus cf edulis, Littorina neritoides and Balanus perforatus, and the algae Gelidium pusillum, Corallina elongata, Asparagopsis armata, Colpomenia sinuosa and Fucus spiralis were the species that most contributed to the dissimilarity between internal and external sites. The present study, based on the spatial distribution of intertidal taxa, yielded similar results to those previously obtained in the area with costly physico-chemical analysis based on complex matrices of subtidal epifaunal communities. Consequently, the intertidal sampling method proposed in this study is presented here as a quick, effective alternative strategy, and can be useful in environmental monitoring programs, since these communities are easily accessible and amenable to sample, and the sessile nature of the majority of the species makes future, long-term monitoring relatively simple.

Prevalence of fetal resorption in stray dogs in Yucatan, Mexico.

OBJECTIVES: To determine the prevalence of fetal resorption in 77 pregnant bitches and its association with the age, size and body condition score of the bitch and to determine the frequency of transuterine migration of embryos. METHODS: The number and position of embryos or fetuses and placental zones were registered postmortem. The prevalence of fetal losses was determined by comparing the number of corpora lutea with the number of embryos or fetuses in each bitch. The prevalence of transuterine migration of embryos was determined by correlating the number of fetuses in each horn and the number of corpora lutea in the ipsilateral ovary. RESULTS: Fetal resorption zones were demonstrated in 42.9 per cent of the bitches. However, pregnancy continued in 84.9 per cent of cases. Of the fetal losses, 25.9 per cent were determined by counting the number of corpora lutea and viable embryos or fetuses. Young bitches tended to have a higher probability of fetal resorption than adult bitches (P<0.06). The presence of fetal resorption zones was not associated with size or body condition. Transuterine migration of embryos had occurred in 15.8 per cent of the bitches. CLINICAL SIGNIFICANCE: This study demonstrated that embryo resorption is a normal event in the bitches, with a higher prevalence than previously thought.

Natural occurrence of hexavalent chromium in the Aromas Red Sands Aquifer, California.

To address increasing concerns of chromium contamination in the drinking water of Santa Cruz County, we designed a study to investigate the source(s) and spatial gradients of the chromium concentration and speciation in local aquifers. This study was catalyzed by a report (January 2001) bythe Soquel Creek Water District of elevated hexavalent chromium concentrations ranging from 6 to 36 microg L(-1), approaching the state's maximum concentration limit of 50 microg L(-1), in the Aromas Red Sands aquifer. To test the accuracy of those preliminary measurements, we collected groundwater using trace metal clean techniques from 11 sites in Santa Cruz County, including 10 from the aquifer with reportedly elevated chromium concentrations and 1 from an adjacent aquifer, the Purisima, and analyzed them fortotal chromium using inductively couple plasma mass spectrometry. Nine of the reportedly 10 contaminated sites had total chromium concentrations ranging from 5 to 39 microg L(-1), while one from the control site was below the limit of detection (0.01 microg L(-1)). We also measured the speciation of chromium at all sites using a solid supported membrane extraction coupled with graphite furnace atomic absorption spectrometry and determined that on average 84% of total chromium was Cr(VI). In addition to the groundwater analyses, a series of extractions were performed on sediment samples from both the Aromas Red Sands and Purisima aquifers. These tests were used to empirically characterize sediment trace metal (Cr, Fe, Mn) distributions in five phases providing information about the origin, availability, reactivity, and mobilization of these trace metals. Results from groundwater and sediment samples indicate that the chromium is naturally occurring in the Aromas Red Sands aquifer, possibly by Cr(III) mineral deposits being oxidized to Cr(VI) by manganese oxides in the aquifer.

Comparative study of the effectiveness of thyroxine and steroids on reduction of neonatal morbidity: outcome at 20 months follow-up

This study analyzes health, growth and neurodevelopmental outcome of infants who received prenatal corticosteroids with or without thyroxine for fetal lung maturation. During a 12 month period infants from a prospective double blind study who received either steroids or steroids combined with thyroxine for pulmonary maturation and who had reached 18 months of age were recalled for evaluation of health status, growth parameters and neurodevelopmental outcome using the Bayley Scales 2nd edition (BSID-II). Mental developmental index (MDI), psychomotor developmental index (PDI), language developmental age (LDA), cognitive developmental age (CDA), and behavioral rating scales (BRS) were compared for the two treatment groups. The Hollingshead Socioeconomic Status Index was determined for each infant. Of a total of 134 patients enrolled during the study period, 66 patients return for follow up. Data from 60 patients was included in the final analysis. Of these, 32 had received the combination regimen and 28 had solely received only steroids. Demographics and neonatal morbidity were similar in both groups. No statistical differences in growth parameters, hospital admissions, respiratory problems, surgical procedures or frequency of infections were found. Neurodevelopmental parameters (MDI, PDI) were similar in both treatment groups, although, below normal in both groups. Language delay was more common in infants who received prenatal corticosteroids. There were no difference in the incidence of neurologic abnormalities. The addition of thyroxine to steroids did not affect growth or neuro-developmental outcome of the infants at 18 to 22 postnatal age.

Aplicación del anticuerpo c-kit (CD 117) para diferenciación inmunohistoquímica en tumores estromales gastrointestinales / C-kit (CD 117) antibody application for immunohistochemistry differentiation in gastrointestinal stromal tumours

La interpretación diagnóstica de las lesiones del estroma gastrointestinal, basada en los significativos avances de la inmunohistoquímica, parece indicar que estos tumores previamente considerados como leiomiomas o leiomiosarcomas, tienen un origen y expresión distinta que contrasta con los caracteres histopatológicos de estos. La incorporación del anticuerpo c-kit (CD-117) permitiría efectuar esa diferenciación y darles la designación de tumores estromales gastrointestinales (GIST). En el presente estudio se analizaron 5 casos de tumores gástricos y 3 de origen muscular de otras ubicaciones anatómicas, previamente diagnosticados, a los cuales se aplicaron anticuerpos primarios para Desmina, CD34, ENE y c-kit. Las muestras fueron posteriormente reveladas con complejo avidina-biotina y se evaluaron según su reacción a la inmunotinción como positivas o negativas. Los resultados obtenidos se expresan cualitativamente de acuerdo a la marcación e intensidad de la reacción con los distintos anticuerpos, observándose una manifiesta diferenciación entre los tumores que son de origen gástrico con aquellos provenientes de músculo liso. En consecuencia, la aplicación del anticuerpo c-kit(CD117) en procedimientos inmunohistoquímicos de rutina, es útil y recomendable para definir un diagnóstico diferencial

Hierro y cobre en Plagioscion squamosissimus (Piscis: Sciaenidae) del río Orinoco, Venezuela / Iron and copper in Plagioscion squamosissimus (Piscis: Sciaenidae) from the Orinoco river, Venezuela

Bauxite explotation of the Orinoco River in recent years is an important source of heavy metals discharge in the ecosystem, changing the natural biochemical flow of these elements and their concentrations in water, sediment and organisms. Iron and copper concentrations were measured in the fish Plagioscion squamosissimus in the Orinoco river, by sampling the fish population for three months (September-November 1998) in the main channel of the middle Orinoco (07 degrees 38' 21.2[quot ] N; 66 degrees 19' 10.9" W) and in Castillero lagoon (7 degrees 39' 09" N; 66 degrees 09' 00" W) with 2 and 4 cm mesh sizes. The internal organs of 30 fishes per month and site were stove-dried at 80 degrees C, pulverized and dried in disecator for 30 min to use as indicators with the acid digestion method for predicting the effect of heavy metals. We found relatively high values of iron and copper concentrations in fishes of the lagoon, and high seasonal variations in the iron concentration.

Diagnosis of pneumococcal pneumonia by polymerase chain reaction (PCR) in whole blood: a prospective clinical study.

BACKGROUND: Streptococcus pneumoniae is the leading cause of community acquired pneumonia; however, only a small proportion of cases can be detected by conventional methods. The ability of the polymerase chain reaction (PCR) test performed on whole blood samples to identify patients with pneumococcal pneumonia was investigated. METHODS: One hundred and fourteen consecutive adult patients with community acquired pneumonia were evaluated by a wide battery of diagnostic tests in order to determine the aetiology. Blood samples from these patients and 50 controls were also tested by the nested PCR test to detect selected pneumolysin gene fragments of S pneumoniae. RESULTS: The patients were divided into four groups: (1) 40 patients with pneumococcal pneumonia in 22 of whom (55%) the PCR was positive (eight of 11 with bacteraemia and 14 of 29 without); (2) 30 with pneumonia due to other pathogens in all of whom the PCR was negative; (3) 44 with pneumonia of unknown aetiology in 14 of whom (32%) PCR was positive, and (4) 50 controls in whom the PCR test was positive in two (4%). Thus, the sensitivity of the test was 55% and the specificity 100% (81% if positive PCR tests among undiagnosed patients are considered as false positive results). CONCLUSION: PCR applied to whole blood samples appears to be a sensitive and very specific diagnostic test for identifying patients with pneumococcal pneumonia with a potential application in clinical practice.

[Iron and copper in Plagioscion squamosissimus (Piscis: Sciaenidae) from the Orinoco river, Venezuela]. / Hierro y cobre en Plagioscion squamosissimus (Piscis: Sciaenidae) del río Orinoco, Venezuela.

Bauxite explotation of the Orinoco River in recent years is an important source of heavy metals discharge in the ecosystem, changing the natural biochemical flow of these elements and their concentrations in water, sediment and organisms. Iron and copper concentrations were measured in the fish Plagioscion squamosissimus in the Orinoco river, by sampling the fish population for three months (September-November 1998) in the main channel of the middle Orinoco (07 degrees 38' 21.2" N; 66 degrees 19' 10.9" W) and in Castillero lagoon (7 degrees 39' 09" N; 66 degrees 09' 00" W) with 2 and 4 cm mesh sizes. The internal organs of 30 fishes per month and site were stove-dried at 80 degrees C, pulverized and dried in disecator for 30 min to use as indicators with the acid digestion method for predicting the effect of heavy metals. We found relatively high values of iron and copper concentrations in fishes of the lagoon, and high seasonal variations in the iron concentration.

Seroepidemiological studies of cutaneous leishmaniasis in the Campeche state of México.

Seroepidemiological studies of cutaneous leishmaniasis were carried out in 169 individuals in a rural area of the Campeche state of México. Fifty showed cutaneous lesions suggestive of leishmaniasis, 70% were parasite positive and 96% skin test positive. An overall 40% positivity to skin test with Montenegro's antigen was found. Most of the affected individuals were males from 11 to 30 years-old. Antibodies were determined by immunofluorescent antibody test (IFA) and by Western blot. Two antigen preparations were used, one from a Leishmania mexicana strain which produced localized cutaneous leishmaniasis (LCL) and the other from a diffuse cutaneous leishmaniasis (DCL). In the general population from the area of study 19% gave positive IFA tests with DCL antigen and 20% with LCL antigen while for the patients 67% gave positive IFA tests with DCL and 71% with LCL. By Western blot analysis most of the patients recognized more antigens in the DCL than in the LCL strain. In the DCL strain 78% of patients recognized a 105 kDa, 34% a 139 kDa, 28% a 117 kDa and 26% a 205 kDa MW antigen. In the LCL strain 40% of patients recognized a 205 kDa and 22% a 175 kDa antigens.

Anoplasty for stenosis and other anorectal defects.

Anorectal strictures have been a serious problem for many years. The aim of this study was to determine the experience with anoplasty in our institution. A group of 17 patients, (six males and 11 females) were evaluated between May 1989 and February 1994, with an age range of 20 to 78 (mean 61 years). The main symptoms were difficulty to pass stool or constipation in 10 patients (58.8 per cent), rectal bleeding in eight patients (47 per cent), and anorectal pain in seven patients (41.1 per cent). The patients underwent clinical examination and the findings were anal stenosis in 13 patients (76.4 per cent), perianal fistula in two patients (11.8 per cent), key hole deformity in one patient (5.9 per cent), and unhealed chronic fissure in one patient (5.9 per cent). The technical procedure was S plasty in six patients (35.2 per cent) and advancement flaps in 11 (64.8 per cent). The follow-up period was between 3 and 59 (mean 18) months. In 16 patients, surgery had good results with improvement of their preoperative symptoms and preservation of continence. There was one septic complication; mean hospital stay was 3 days. In conclusion, anoplasty appears to be a safe and successful alternative for the treatment of anal stenosis.

Fryns syndrome: neurologic findings in a survivor.

Fryns syndrome, a multiple congenital anomaly syndrome associated with diaphragmatic defects, craniofacial dysmorphism, distal digital hypoplasia, and neurologic abnormalities, was first described in 1979. This autosomal recessive disorder is usually associated with stillbirth or death immediately after birth. Detailed neurologic findings in the third survivor beyond the neonatal period are reported, and neurologic abnormalities in other cases are reviewed. Initially, hypotonia, areflexia, and weakness were seen. Myoclonus developed immediately after birth and was well controlled with high-dose valproate. Electroencephalography revealed slowing and irregular paroxysmal discharges with spikes and sharp waves that disappeared with time and treatment. Magnetic resonance imaging demonstrated partial agenesis of the corpus callosum, a Dandy-Walker malformation, and progressive cerebral and brainstem atrophy. This syndrome should be considered in patients with unusual facial features and digital abnormalities associated with frequent early myoclonus.

Effects of estrogen-progestin replacement therapy on plasma beta-endorphin levels in menopausal women.

Serum beta-endorphin, LH, FSH, estradiol (E2) and progesterone (P) were measured in postmenopausal women before and after four different estrogen-progestin replacement therapies. Our result showed that serum E2 increased significantly and serum LH and FSH decreased significantly after all treatments. Serum P levels were similar before and after all treatments. Serum beta-endorphin levels increased significantly after cyclic administration of estrogen-progestin, but not after continuous administration of E2. We conclude that the frequently observed beneficial effects of estrogen-progestin replacement therapy on behavior and mood in postmenopausal women may be related to changes in peripheral opioid levels.

Changes in subcellular accumulation of contractile proteins in myocardiocyte cultures: effects of fibric acid derivatives.

We analyzed the influence of 6 and 24 h of treatment with the fibric acid derivatives bezafibrate (10 micrograms/ml), gemfibrozil (23 micrograms/ml), and fenofibrate (30 micrograms/ml) on alpha-actinin, troponin-T, and tropomyosin proteins in the cytoplasmic and cytoskeletal fractions of cultured chick myocardiocytes. The findings with sodium dodecyl sulfate-gel electrophoresis and immunoblotting showed that all three drugs modified cellular and subcellular protein levels in different ways: bezafibrate and fenofibrate produced the most significant alterations in both fractions, modifying alpha-actinin, troponin T, and tropomyosin compartmentalization in myocardiocytes, whereas gemfibrozil altered these proteins less notably. Given the role of these proteins in heart muscle contraction, fibric acid derivative-induced changes may be related with the secondary effects of these drugs on heart rhythmicity.

Protection of mice from herpes simplex virus-induced retinitis by in vitro-activated immune cells.

A form of acute retinal necrosis occurred in the contralateral eyes of susceptible mice 1 week after each received a uniocular injection of live herpes simplex virus type 1 (HSV-1) in the anterior chamber. Although these mice did not develop systemic delayed hypersensitivity to virus antigens, their sera contained virus-specific antibodies at the time contralateral retinitis occurred. These findings suggest that systemic immunity might not be able to protect against contralateral retinitis. To explore this possibility further, we examined lymph nodes and spleens of intraocularly infected mice to determine whether their lymphoid tissues contained primed HSV-1-specific cytotoxic T cells. Virus-specific cytotoxic T cells were readily identified in these mice. We wondered why successful immune priming did not confer protection against HSV-1 retinitis. We examined this issue by evaluating the capacity of in vitro-generated, HSV-1-specific effector T cells to prevent retinitis by infusing these cells by various routes and at various times into mice that received an intracameral injection of HSV-1. The results revealed that virus-specific effector cells could prevent contralateral retinitis if injected intravenously or into the anterior chamber of the contralateral eye at the same time that virus was injected into one eye. However, the effector cells failed to prevent retinitis if they were injected into the same eye that received HSV-1 or if their intravenous administration was delayed until 24 h after the HSV-1 injection into the eye. We concluded that immune T cells can protect against contralateral retinal necrosis caused by uniocular injection of HSV-1 into the anterior chamber but only if they are administered during the first 24 h after virus infection. We propose that a retinitis-inducing process is set in motion during this early time interval postinfection. Once the process has been initiated and established, it is no longer susceptible to immune intervention. It would appear that mice that are susceptible to contralateral retinitis fail to mobilize a protective response quickly enough to ward off the establishment of the retinitis-inducing process and its disastrous eventuality.

Plasma volume, umbilical artery Doppler flow, and antepartum fetal heart testing in high-risk pregnancies.

The purpose of this clinical study is to investigate the diagnostic value of plasma volume (PV), nonstress test (NST), contraction stress test (CST), and umbilical artery Doppler (UAD) in detecting fetal compromise in 81 patients (83 fetuses) at risk for fetal growth retardation. Neither PV nor UAD studies were used in the clinical management. There were two stillbirths and three neonatal deaths for a perinatal mortality of 6%. Twenty-seven infants (32.5%) were small for gestational age (SGA), seven (8.6%) had cord pH 7.20 or less, and five (6.2%) had 5-minute Apgar scores less than 7. Overall, PV had the highest sensitivity and NST the highest specificity regarding delivery of SGA infants. The positive and negative predictive values for infants with low cord pH and low Apgar scores were similar among the various tests. There were nine fetuses with zero or reverse diastolic flow: seven were SGA (four perinatal deaths) and all of them had both nonreactive NST and positive CST. The other two infants were appropriate for gestational age with all other tests being normal. Antepartum fetal heart rate testing appears to be similar to other tests in predicting poor fetal outcome in high-risk pregnancies.

A comparison of labetalol plus hospitalization versus hospitalization alone in the management of preeclampsia remote from term.

Two hundred primigravid women with mild preeclampsia at 26-35 weeks' gestation were randomly allocated to treatment with hospitalization alone or combined with labetalol. There were no differences between the two groups in mean systolic or diastolic pressures, mean gestational age, or initial laboratory findings at time of entry. Patients in the labetalol group demonstrated a statistically significant (P less than .005) decrease in blood pressure during treatment. No such decrease occurred in the hospitalization-alone group. Both groups exhibited significant deterioration in proteinuria, creatinine, and uric acid. The average days of pregnancy prolongation (mean +/- SD) were 21.3 +/- 13 and 20.1 +/- 14 days in the hospitalization and labetalol groups, respectively. There were no differences between the groups regarding any of the following: gestational age at delivery, birth weight, number of infants admitted to the special care unit, or cord blood gas measurements. However, the incidence of small-for-gestational-age infants was significantly higher in the labetalol group (19 versus 9%, P less than .05). There were no stillbirths, but one neonatal death in the labetalol group. Treatment of maternal blood pressure in preeclamptic pregnancies with labetalol did not improve perinatal outcome, and was associated with a higher frequency of fetal growth retardation.

Digoxin-like immunoreactive substance in pregnancy.

Our aims were to determine the potential usefulness of digoxin-like immunoreactive substances in the prediction of preeclampsia, to study the relationship between fetal production of these substances and maternal serum levels, and to evaluate the association between digoxin-like immunoreactive substances and plasma volume findings in preeclamptic pregnancies. Serum digoxin-like immunoreactive substance concentrations were measured in normotensive and preeclamptic pregnant women and in umbilical artery and vein blood samples. None of the patients in the first trimester (n = 53) and 11% of those in the second (n = 56) had detectable levels of this substance. However, 91% of the patients in the third trimester (n = 161) had positive results. The concentrations of digoxin-like immunoreactive substances in the preeclamptic group (n = 78) were significantly (p less than 0.005) lower than those of third-trimester (n = 83) normotensive patients (0.22 +/- 0.12 versus 0.32 +/- 0.15 ng/ml). However, there were no significant differences between the two groups regarding digoxin-like immunoreactive substance concentrations when matched for gestational age (41 patients in each group). Digoxin-like immunoreactive substance concentrations in umbilical vessels were significantly higher (p less than 0.001) than the corresponding maternal levels. Umbilical vessel digoxin-like immunoreactive substance levels demonstrated good correlation with fetal gestational age and birth weight in both normotensive and preeclamptic pregnancies. On the other hand, there was a poor (r = 0.02; p = 0.91) correlation between plasma volume findings and digoxin-like immunoreactive substance concentration. We conclude that the digoxin-like immunoreactive substance level may be of very little value in the prediction of preeclampsia. The presence of digoxin-like immunoreactive substance at greater concentrations in the umbilical cord blood samples suggests the possibility of the fetus as the source of this substance. Digoxin-like immunoreactive substances may not play a major role in plasma volume expansion during pregnancy.