Guidelines for the management of coagulation disorders in patients with cirrhosis.

Coagulation management in the patient with cirrhosis has undergone a significant transformation since the beginning of this century, with the concept of a rebalancing between procoagulant and anticoagulant factors. The paradigm that patients with cirrhosis have a greater bleeding tendency has changed, as a result of this rebalancing. In addition, it has brought to light the presence of complications related to thrombotic events in this group of patients. These guidelines detail aspects related to pathophysiologic mechanisms that intervene in the maintenance of hemostasis in the patient with cirrhosis, the relevance of portal hypertension, mechanical factors for the development of bleeding, modifications in the hepatic synthesis of coagulation factors, and the changes in the reticuloendothelial system in acute hepatic decompensation and acute-on-chronic liver failure. They address new aspects related to the hemorrhagic complications in patients with cirrhosis, considering the risk for bleeding during diagnostic or therapeutic procedures, as well as the usefulness of different tools for diagnosing coagulation and recommendations on the pharmacologic treatment and blood-product transfusion in the context of hemorrhage. These guidelines also update the knowledge regarding hypercoagulability in the patient with cirrhosis, as well as the efficacy and safety of treatment with the different anticoagulation regimens. Lastly, they provide recommendations on coagulation management in the context of acute-on-chronic liver failure, acute liver decompensation, and specific aspects related to the patient undergoing liver transplantation.

Evaluación del sangrado, dolor y tiempo quirúrgico del abordaje midvasto versus parapatelar medial en artroplastía total de rodilla primaria por osteoartrosis grado IV / Evaluation of bleeding, pain and operative time of the midvasto versus medial parapatellar approach in primary total knee arthroplasty for grade IV osteoarthrosis

Resumen: Introducción: la artroplastía total de rodilla es un procedimiento común en la cirugía ortopédica de tratamiento para gonartrosis grado IV. Este procedimiento disminuye el dolor y mejora la funcionalidad. Sin embargo, los resultados según el abordaje son distintos, no existe evidencia sobre qué abordaje quirúrgico sea claramente superior. El objetivo de este estudio es evaluar el tiempo y sangrado transquirúrgico, así como el dolor postquirúrgico del abordaje midvasto versus parapatelar medial en artroplastía total de rodilla primaria en gonartrosis grado IV. Material y métodos: se realizó estudio observacional, comparativo, retrospectivo del 01 de Junio de 2020 al 31 de Diciembre de 2020 incluyendo derechohabientes del Instituto Mexicano del Seguro Social, mayores de 18 años con diagnóstico de gonartrosis grado IV, programados para artroplastía total de rodilla primaria en ausencia de otra patología inflamatoria, osteotomías previas o coagulopatías. Resultados: noventa y nueve pacientes que fueron sometidos a abordaje midvasto (grupo M) y 100 pacientes a abordaje parapatelar medial (grupo T) con hemoglobina preoperatoria 14.7 g/l grupo M y 15.2 g/l grupo T, la reducción fue de 5.0 g/l grupo M y 4.6 g/l grupo T. Dolor en ambos grupos sin diferencia significativa; de 6.7 a 3.2 grupo M y de 6.7 a 3.1 grupo T. Tiempo quirúrgico mayor con el abordaje parapatelar medial (98.7 versus 89.2 minutos). Conclusiones: ambos abordajes representan excelente vía de acceso para realizar artroplastía total primaria de rodilla; sin embargo, no se encontraron diferencias significativas en el volumen de sangrado ni en la reducción del dolor, el abordaje midvasto se asoció con menor tiempo quirúrgico y menor afectación de la flexión de la rodilla, por lo que se recomienda el abordaje midvasto en pacientes sometidos a artroplastía total de rodilla primaria.

Abstract: Introduction: total knee arthroplasty is a common procedure in orthopedic surgery for treating grade IV knee osteoarthritis. This procedure reduces pain and improves functionality. However, the results according to the approach are different, it is not clear which surgical approach is clearly superior. The objective of this study is to evaluate the time and post-surgical bleeding, as well as the postoperative pain of the midvasto versus medial parapatellar approach in primary total knee arthroplasty in grade IV gonarthrosis. Material and methods: an observational, comparative, retrospective study was carried out from June 1, 2020 to December 31, 2020, including beneficiaries of the Mexican Social Security Institute over 18 years of age with a diagnosis of grade IV knee osteoarthritis scheduled for primary total knee arthroplasty in the absence of other inflammatory pathology, previous osteotomies or coagulopathies. Results: of 99 patients who underwent the midvasto approach (group M) and 100 patients to the medial parapatellar approach (group T), there was preoperative hemoglobin 14.7 g/l group M and 15.2 g/l group T, reduction was 5.0 g/l group M and 4.6 g/l group T. Significant pain reduction in both groups without significant difference; from 6.7 to 3.2 group M and from 6.7 to 3.1 group T. The surgical time was significantly longer with the medial parapatellar approach (98.7 versus 89.2 minutes). Conclusions: both approaches represent an excellent access route to perform primary total knee arthroplasty; however, no significant differences were found in the volume of bleeding or in the reduction of pain, the midvaste approach was associated with shorter surgical time and less involvement of flexion of the knee. Therefore, the midvasto approach is recommended in patients undergoing primary total knee arthroplasty.

[Evaluation of bleeding, pain and operative time of the midvasto versus medial parapatellar approach in primary total knee arthroplasty for grade IV osteoarthrosis]. / Evaluación del sangrado, dolor y tiempo quirúrgico del abordaje midvasto versus parapatelar medial en artroplastía total de rodilla primaria por osteoartrosis grado IV.

INTRODUCTION: total knee arthroplasty is a common procedure in orthopedic surgery for treating grade IV knee osteoarthritis. This procedure reduces pain and improves functionality. However, the results according to the approach are different, it is not clear which surgical approach is clearly superior. The objective of this study is to evaluate the time and post-surgical bleeding, as well as the postoperative pain of the midvasto versus medial parapatellar approach in primary total knee arthroplasty in grade IV gonarthrosis. MATERIAL AND METHODS: an observational, comparative, retrospective study was carried out from June 1, 2020 to December 31, 2020, including beneficiaries of the Mexican Social Security Institute over 18 years of age with a diagnosis of grade IV knee osteoarthritis scheduled for primary total knee arthroplasty in the absence of other inflammatory pathology, previous osteotomies or coagulopathies. RESULTS: of 99 patients who underwent the midvasto approach (group M) and 100 patients to the medial parapatellar approach (group T), there was preoperative hemoglobin 14.7 g/l group M and 15.2 g/l group T, reduction was 5.0 g/l group M and 4.6 g/l group T. Significant pain reduction in both groups without significant difference; from 6.7 to 3.2 group M and from 6.7 to 3.1 group T. The surgical time was significantly longer with the medial parapatellar approach (98.7 versus 89.2 minutes). CONCLUSIONS: both approaches represent an excellent access route to perform primary total knee arthroplasty; however, no significant differences were found in the volume of bleeding or in the reduction of pain, the midvaste approach was associated with shorter surgical time and less involvement of flexion of the knee. Therefore, the midvasto approach is recommended in patients undergoing primary total knee arthroplasty.

INTRODUCCIÓN: la artroplastía total de rodilla es un procedimiento común en la cirugía ortopédica de tratamiento para gonartrosis grado IV. Este procedimiento disminuye el dolor y mejora la funcionalidad. Sin embargo, los resultados según el abordaje son distintos, no existe evidencia sobre qué abordaje quirúrgico sea claramente superior. El objetivo de este estudio es evaluar el tiempo y sangrado transquirúrgico, así como el dolor postquirúrgico del abordaje midvasto versus parapatelar medial en artroplastía total de rodilla primaria en gonartrosis grado IV. MATERIAL Y MÉTODOS: se realizó estudio observacional, comparativo, retrospectivo del 01 de Junio de 2020 al 31 de Diciembre de 2020 incluyendo derechohabientes del Instituto Mexicano del Seguro Social, mayores de 18 años con diagnóstico de gonartrosis grado IV, programados para artroplastía total de rodilla primaria en ausencia de otra patología inflamatoria, osteotomías previas o coagulopatías. RESULTADOS: noventa y nueve pacientes que fueron sometidos a abordaje midvasto (grupo M) y 100 pacientes a abordaje parapatelar medial (grupo T) con hemoglobina preoperatoria 14.7 g/l grupo M y 15.2 g/l grupo T, la reducción fue de 5.0 g/l grupo M y 4.6 g/l grupo T. Dolor en ambos grupos sin diferencia significativa; de 6.7 a 3.2 grupo M y de 6.7 a 3.1 grupo T. Tiempo quirúrgico mayor con el abordaje parapatelar medial (98.7 versus 89.2 minutos). CONCLUSIONES: ambos abordajes representan excelente vía de acceso para realizar artroplastía total primaria de rodilla; sin embargo, no se encontraron diferencias significativas en el volumen de sangrado ni en la reducción del dolor, el abordaje midvasto se asoció con menor tiempo quirúrgico y menor afectación de la flexión de la rodilla, por lo que se recomienda el abordaje midvasto en pacientes sometidos a artroplastía total de rodilla primaria.

Incidence of pre-eclampsia and other perinatal complications among pregnant women with congenital heart disease: systematic review and meta-analysis.

OBJECTIVE: It has been proposed recently that pre-eclampsia (PE) may originate from maternal cardiac maladaptation rather than primary placental insult. As congenital heart disease (CHD) is associated with reduced adaptation to the hemodynamic needs of pregnancy, it is hypothesized that women with CHD have an increased risk of PE. The aim of this systematic review was to investigate the risk of PE in pregnant women with CHD. METHODS: A systematic search was performed to identify relevant studies published in English, Spanish, French, Italian, Chinese or German, with no time restrictions, using databases such as PubMed, Web of Science and SCOPUS. Randomized controlled trials and observational studies (prospective or retrospective cohorts) of pregnant women with a history of CHD were sought. The main outcome was the incidence of PE (including eclampsia and HELLP syndrome). For quality assessment of the included studies, two reviewers assessed independently the risk of bias. For the meta-analysis, the incidence of PE in pregnancies (those beyond 20 weeks' gestation) was calculated using single-proportion analysis by random-effects modeling (weighted by inverse variance). Heterogeneity between studies was assessed using the χ2 (Cochran's Q), tau2 and I2 statistics. Subgroup analysis was performed, and meta-regression was used to assess the influence of several covariates on the pooled results. RESULTS: A total of 33 studies were included in the meta-analysis, including 40 449 women with CHD and a total of 40 701 pregnancies. The weighted incidence of PE was 3.1% (95% CI, 2.2-4.0%), with true-effect heterogeneity of 93% according to I2 , and no publication bias found. No difference was found in the weighted incidence of PE between studies including cyanotic CHD vs those excluding (or not reporting) cyanotic CHD (2.5% (95% CI, 1.6-3.4%) vs 4.1% (95% CI, 2.4-5.7%); P = 0.0923). Meta-regression analysis showed that the only cofactor that significantly influenced the incidence of PE in each study was the reported incidence of aortic stenosis; studies with a higher incidence of aortic stenosis had a higher incidence of PE (estimate: 0.0005; P = 0.038). CONCLUSIONS: We failed to demonstrate an incidence of PE above the expected baseline risk in women with CHD. This observation contradicts the theory of the cardiac origin of PE. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Contrasting energy allocation strategies of two sympatric Merluccius species in an upwelling system.

This study investigated the somatic growth and energy allocation strategy of two sympatric hake species (Merluccius polli and Merluccius senegalensis), coexisting under the strong influence of the Mauritanian upwelling. The results revealed that ontogeny, bathymetry, geography and reproduction shaped the differences found between the condition dynamics of the two species. Aside from species-specific differences, individuals were observed in better condition in the northernmost area (more influenced by the permanent upwelling) and in the deepest waters, probably the most favourable habitat for Merluccius spp. Both species also displayed contrasting trade-offs in energy allocation probably due to the dissimilarity of their habitats, which favours the existence of divergent adaptive strategies in response to different ontogenic requirements. It was hypothesized that M. polli invests in mass and energy reserves while sacrificing growth, as larger sizes may not provide an ecological advantage in a deeper and more stable environment. Moreover, M. senegalensis capitalizes on a steady growth without major disruptions, enabling earlier spawning at the expense of a lower somatic mass, which is fitting to a less stable shallower environment. This study sheds new light on differences in the biological traits and life strategies of Merluccius spp., which permit their overlap in a complex upwelling system and may contribute to the long-lasting scientific-based management of these species.

Asociación entre síntomas depresivos satisfacción corporal y estado nutricional en niños y adolescentes / The relationschip between depressive symptoms, nutricional stratus and corporal dissatisfaction in adolescents

El objetivo de este trabajo es estudiar la relación entre síntomas depresivos, estado nutricional e insatisfacción corporal en adolescentes. Nuestra hipótesis es que el estado nutricional esta asociado a sintomatología depresiva y que esta asociación puede estar mediada por el grado de insatisfacción corporal. La muestra corresponde a adolescentes, de ambos sexos, de 10 a 19 años, entre 5° básico y 4° medio, de Liceos Municipalizados de Hombres y de Mujeres de la comuna de Independencia. Obtenido su asentimiento y el consentimiento de sus padres, se procedió a la medición de peso y talla de 285 sujetos, a fin de obtener su índice de masa corporal (IMC), clasificándose en bajo peso, peso normal, riesgo de obesidad y obesidad, de acuerdo a las curvas de IMC para la edad del CDCNCHS. Se aplicó el Cuestionario de Depresión Infantil (CDI) considerándose los puntos de corte 14, 15 a 18 y 19, y el Cuestionario de Insatisfacción Corporal de la Universidad de Dallas, modificado por Rubén Zukerfeld (CIC) que clasifica a la muestra según insatisfacción corporal ausente, estándar, intensa y muy intensa. Los resultados muestran una prevalencia de síntomas depresivos superior que en estudios internacionales para el tramo etario, 15,8 por ciento considerando punto de corte 19, y 31,2 por ciento si consideramos punto de corte 15 (especificidad de 90 por ciento). Se encontraron cifras de obesidad (12,3 por ciento) y riesgo de obesidad (19,6 por ciento) acordes a la realidad nacional en este periodo evolutivo. No se observó una relación, directa y significativa, entre estado nutricional y síntomas depresivos, sin embrago si se encuentra una asociación entre insatisfacción corporal y sintomatología depresiva, lo que plantea el desafío de comprender mejor el significado de la corporalidad para el sujeto en este periodo evolutivo.

This work aims to explore the relationship between depressive symptoms, nutritional status and corporal dissatisfaction in adolescents. Our hypothesis is that the nutritional state this associated with depressive symptomatology and that this association can be mediated by the degree of corporal dissatisfaction. The sample is adolescents of both sexes, 10 to 19 years, between 5 th. To 12th, grade in mixed (female and male), public school at the Independencia’s neighborhood. Obtained their consent and the consent of their parents, we proceeded to the measurement of weight and height of 285 students to obtain their Body Mass Index (BMI), BMI classifying into low weight, normal weight, risk of obesity and obesity, according to the IMC curves for the age of CDC-NCHS. Was applied the questionnaire child depression (CDI) whereas the 14, 15 and 18 and 19, breakpoints and the Dissatisfaction Body Questionnaire (DBQ) of the University of Dallas, questionnaire amended by Rubén Zukerfeld that classifies the sample according to body dissatisfaction absent, standard, intense and very intense. The results show a higher prevalence of depressive symptoms that in international studies for the installment age, 15.8 percent whereas breakpoint 19 and 31.2 percent considering breakpoint 15 (90 percent specificity). Found obesity’s figures (12.3 per cent) and obesity’s risk (19.6 percent) according to the national reality in this evolutionary period. The study show that not observed a direct and significant relationship between nutritional status and depressive symptoms, however, was founding an association between body dissatisfaction and depressive symptomatology. These conclusion, posed the challenge to obtain a better understanding the meaning of the body image for the peoples in this evolutionary period.

[Nutritional planning of menus of public schools of the community of Madrid]. / Planificación nutricional de los menús escolares para los centros públicos de la Comunidad de Madrid.

Some nutritional unbalances have been observed in menus served at dining rooms of schools from the Community of Madrid (CM): small portions, inter-day variations up to 50% of energy intake, unbalances in caloric and lipidic profiles, little variety, lack of parental information, etc. The Education Council of the CM considered necessary to plan and regulate the basic conditions that menus of these dinning rooms should meet. The Spanish Nutrition Foundation (FEN) and the Nutrition Department of the Complutense University of Madrid (UCM) were put in charge of elaborating the bases to develop the Regulation (BOCM 24-05-01, 10-09-02). Collective catering companies were called for a tender to provide menus adapted to such Regulation. This work describes the adaptation of programmed dietary schemes of officially approved companies and mainly the impact on energy and nutritional content of menus and their adaptation to the recommended caloric and lipidic profiles. So far, a random sample of 171 schools with dining rooms (more than 37,000 schoolboys) has been visited by nutritionists, with no previous announcement, to control served menus. For this, at each centre a duplicate of the portion served that day was gathered. The energy and nutrient content was determined and the fatty acid composition was analysed. The adaptation to the Regulation by catering companies has substantially improved the menus as compared to previous times: more presence of vegetables, better quality of fat and less amount of fat and proteins at the expense of carbohydrates.

Planificación nutricional de los menús escolares para los centros públicos de la Comunidad de Madrid / Nutritional planning of menus of public schools of the Community of Madrid

En los menús servidos en los comedores de los colegios públicos de la Comunidad de Madrid (CM) se venían detectando algunos desequilibrios nutricionales: cantidades insuficientes, desviaciones interdías de hasta el 50% de energía, desequilibrio en los perfiles calórico y lipídico, poca variedad, desinformación de los padres, etc. La Consejería de Educación de la CM, consideró necesario planificar y regular las condiciones básicas que deben reunir los menús para dichos comedores. La Fundación Española de la Nutrición (FEN) junto con el Departamento de Nutrición de la UCM, fueron los encargados de elaborar las bases para desarrollar la Normativa (BOCM 24-05-01, 10-09-02). Se convocó a las empresas de restauración colectiva a un concurso para el suministro de menús adaptados a dicha Normativa. En este trabajo se describe la adaptación a las pautas dietéticas programadas de las empresas homologadas y, principalmente, su repercusión en el aporte energético y nutricional de los menús así como la adecuación a los perfiles calórico y lipídico recomendados. Además, y hasta el momento, una muestra aleatoria de 171 centros, con servicio de comedor (más de 37.000 escolares), han sido visitados, sin anuncio previo de la fecha, por nutriólogos para llevar a cabo el control de los menús servidos. Para ello, en cada centro se recogió la porción duplicada del menú servido ese día. Se determinó su contenido en energía y nutrientes y se analizó su composición en ácidos grasos. La adaptación por parte de las empresas de restauración a la normativa fijada ha mejorado sustancialmente los menús respecto a periodos anteriores: mayor presencia de verduras y hortalizas, mejor calidad de la grasa y menor cantidad de grasas y proteínas a expensas de hidratos de carbono (AU)

Some nutritional unbalances have been observed in menus served at dining rooms of schools from the Community of Madrid (CM): small portions, inter-day variations up to 50% of energy intake, unbalances in caloric and lipidic profiles, little variety, lack of parental information, etc. The Education Council of the CM considered necessary to plan and regulate the basic conditions that menus of these dinning rooms should meet. The Spanish Nutrition Foundation (FEN) and the Nutrition Department of the Complutense University of Madrid (UCM) were put in charge of elaborating the bases to develop the Regulation (BOCM 24-05-01, 10-09-02). Collective catering companies were called for a tender to provide menus adapted to such Regulation. This work describes the adaptation of programmed dietary schemes of officially approved companies and mainly the impact on energy and nutritional content of menus and their adaptation to the recommended caloric and lipidic profiles. So far, a random sample of 171 schools with dining rooms (more than 37,000 schoolboys) has been visited by nutritionists, with no previous announcement, to control served menus. For this, at each centre a duplicate of the portion served that day was gathered. The energy and nutrient content was determined and the fatty acid composition was analysed. The adaptation to the Regulation by catering companies has substantially improved the menus as compared to previous times: more presence of vegetables, better quality of fat and less amount of fat and proteins at the expense of carbohydrates (AU)

Systemic antibody response to diarrheagenic Escherichia coli and LPS O111, O157 and O55 in healthy Brazilian adults.

Enterohaemorrhagic Escherichia coli (EHEC) can cause a variety of human illnesses ranging from uncomplicated diarrhoea to haemorrhagic colitis and haemolytic uremic syndrome. The serotype O157:H7 has been associated with numerous outbreaks worldwide, but in Brazil the infection is rare. Brazilian adults present antibodies reactive with the principal virulence factors of enteropathogenic E. coli (EPEC) that have many genetic and antigenic similarities with EHEC. Lipopolysaccharides (LPS) are components of outer membranes and important virulence factors of Gram-negative bacteria. LPS O111 is present in EPEC and EHEC strains. LPS O157 is found only in EHEC strains, but it has some structural similarities with LPS O55 present in EPEC strains. This study investigates the levels of IgG and IgM seric antibodies reactive with EHEC O157:H7, EHEC O111:H-, EPEC O111:H- and the levels of anti-LPS O111, LPS O157 and LPS O55 antibodies in healthy adults living in São Paulo, Brazil. The antibody levels were determined by an enzyme-linked immunosorbent assay for 100 individual serum samples, and the presence of anti-bacterial and anti-LPS seric antibodies was confirmed. Positive correlations were found among the three kinds of antibodies. The concentrations of IgM anti-LPS were significantly higher than those of IgG, and surprisingly, the concentrations of anti-LPS O157 were high in view of the infrequent isolation of O157 bacteria in Brazil. Our results suggest that there is a cross-reacting immunity to EHEC in the Brazilian population, which may be a result of the immunity to EPEC antigens. Alternatively, Brazilians may be exposed to EHEC more frequently than has previously been thought.

Cloning and characterization of a FAD-monooxygenase gene ( cadA) involved in degradation of chloranilic acid (2,5-dichloro-3,6-dihydroxybenzo-1,4-quinone) in Pseudomonas putida TQ07.

A bacterium culture was isolated on the basis of its ability to degrade chloranilic acid, and was later identified as Pseudomonas putida (TQ07). Several transposon insertion mutants unable to degrade chloranilic acid were selected. The characterization of the site of insertion of one of these mutants led to the identification of the cadA gene encoding an enzyme with significant homology with FAD-monooxygenases involved in the degradation of aromatic and chloroaromatic compounds. The finding that, after replacing the mutant allele with the wild-type one, the strain recovered the wild-type pattern of "halo" formation (a zone of clearing color on agar plates around TQ07 colonies that degrade chloranilic acid) and degradation of chloranilic acid, unequivocally assigned cadA a function in the metabolism of this compound. We also found that most of the transposon insertion mutants unable to degrade chloranilic acid are clustered in a 10-kb region of the P. putidagenome that is encoded in a megaplasmid or in an unstable chromosomal region.

[Clinical course and prognostic factors in lupus nephropathy]. / Evolución y factores pronósticos de la nefropatía lúpica.

BACKGROUND: The present study was designed to know the clinical course of lupus nephritis and the risk factors associated with the development of end stage renal disease. METHODS: This a retrospective study performed in a cohort of 154 patients with biopsy proven lupus nephritis that were seen in our hospital between 1984 and 1990. The clinical records of all patients were reviewed in order to collect the following information at the time of the biopsy: age, sex, number and type of lupus criteria according with the American College of Reumathology, mean arterial pressure, serum creatinine, BUN, and albumin, as well as urinary protein excretion. The follow up was registered from the day the biopsy was performed to one of the following end points: end stage renal disease (defined as requirement of chronic dialysis), death or the end of study. All biopsies were analyzed by light microscopy to obtain the hystological subtype of lupus nephritis (WHO classification) and when type IV was diagnosed, the activity and chronicity indexes were also assessed. Kaplan-Meier survival tables were constructed. The association of clinical and laboratory variables with the development of end stage renal disease was obtained by log rank analysis. Variables obtained as significant were used to evaluate their individual impact using either the Cox multivariate proportional hazard method. RESULTS: Follow up was complete in 144 patients with a follow up time of 68 +/- 38 months. Ninety three patients were female with mean age of 28 +/- 9 years. At the time of the biopsy, renal manifestations had been present for 35 +/- 38 months and the number of lupus criteria per patient were 4 +/- 1. The clinical picture at the time of the biopsy was: nephrotic syndrome in 60%, non nephrotic proteinuria in 40%, and nephritic syndrome in only 2%. The hystological type of lupus nephritis was: I in 2%, II in 8%, III in 6%, IV in 71% and V in 11%. At the end of the study 28 patients developed end stage renal disease. For the whole group the survival of renal function was 85% at 70 months and 70% at 140 months. All, but one patient that developed end stage renal disease exhibited type IV nephropathy. In this subpopulation the mean activity and chronicity indexes were 8.5 +/- 3.5 and 3.1 +/- 2.4, respectively. By multivariate analysis the strongest predictors of end stage renal disease were the serum creatinine at the time of the biopsy, chronicity index, and age. The higher the serum creatinine and chronicity index at the time of biopsy, the higher the probability of developing end stage renal disease. CONCLUSIONS: We conclude that the clinical course of lupus nephritis in our population is similar to that seen in other series. The variables indicating advanced renal disease, such as high serum creatinine and chronicity index, were the strongest predictors of end stage renal disease.

Dry fermented sausages elaborated with Lactobacillus plantarum-staphylococcus carnosus. Part II: Effect of partial replacement of NaCl with KCl on the proteolytic and insolubilization processes.

The effect of partial replacement of NaCl with KCl (3% NaCl by 1.5% NaCl + 1% KCl) on the proteolytic and insolubilization processes that affect the nitrogen fractions of dry fermented sausages produced with L. plantarum-S. carnosus as starter culture was analysed. The percentage of solubility was significantly lower in the modified product, which is consistent with its significantly higher percentage of insoluble fraction observed from the beginning of the process. The myofibrillar fraction was more affected by the proposed modification than the sarcoplasmic fraction: the loss of solubility for the modified and control products were 33.6 and 27.6% for myofibrillar fraction and 9.9 and 9.3% for the sarcoplasmic fraction, respectively. Also a higher intensity of the proteolytic process was observed. The modified product was found to be slightly less hard but had a better salted taste.

Influence of partial replacement of NaCl with KCl on lipid fraction of dry fermented sausages inoculated with a mixture of Lactobacillus plantarum and Staphylococcus carnosus.

The effect of partial replacement of NaCl (3% NaCl) with KCl (1.5% NaCl and 1% KCl) on the lipid fraction of dry fermented sausages inoculated with Lactobacillus plantarum and Staphylococcus carnosus as starter culture was analysed. The reduction in salt concentration did not affect the Micrococcaceae count. A positive effect on the intensity of lipolytic activity was observed as a consequence of the decrease in salt level. There was no decrease in the oxidative processes. The higher amounts of volatile fatty acids found suggest that the tested modification enhances some of their mechanisms of synthesis.

Dry fermented sausages elaborated with Lactobacillus plantarum-Staphylococcus carnosus part I: Effect of partial replacement of NaCl with KCl on the stability and the nitrosation process.

The effect of partial replacement of NaCl with KCl on the nitrosation process of dry fermented sausages elaborated with L. plantarum + S. carnosus as starter culture was analysed. The Na (+)K (+) ratio decreased from 4.38 in the control to 0.86 in the modified product. The nitrosation process happened in a quicker and more intense way from the beginning of the process onwards. The chemical conversion percentages (nitrosopigments/total pigments × 100) were higher during the whole ripening process in the modified product. This fact agrees with the highest acidification found in the modified products. Also, a reduced degree of pigment oxidation was found.

[7 cases of carcinoma of the distal choledochus]. / Siete casos de carcinoma del colédoco distal.

Seven patients with carcinoma of the lower third of the extrahepatic bile duct over a twenty year period, were analyzed with emphasis to the presentation, laboratory, surgical findings, histology and outcome. There were four males and three females. The mean age was 59 years (range 53 to 68). All patients presented jaundice, abdominal pain and weight loss. Serum bilirubin levels were over 5 mg/dL in six patients (86%). The most useful diagnostic studies were endoscopic cholangiography, percutaneous cholangiography and computed tomography. All patients underwent a Whipple procedure. There was no operative mortality. In the long term follow-up, three patients were free of disease, and four had died. Tumor recurrence was high (43%) in spite of the curative resection.

[Duodenal cancer]. / Cáncer de duodeno.

UNLABELLED: To analyze the general characteristics and outcome of a cohort of 6 patients with malignant duodenal tumors who underwent surgical radical resection. DESIGN: Longitudinal retrolective study. SETTING: A third level medical center. RESULTS: Mean age was 48 years. M/F ratio was 2:1. The most frequent symptom was duodenal obstruction. Mean time between the beginning of the symptoms and the correct diagnosis was 15 months. Five of six patients demonstrated abnormalities on gastrointestinal X rays. All patients underwent Whipple resection, this was curative in 2, palliative in 2 more and not evaluated in two cases due to operative mortality. Five tumors were adenocarcinomas and one a carcinoid tumor. The long-term mortality occurred in 2 patients. CONCLUSIONS: The diagnosis of primary duodenal carcinoma needs a deep clinical suspicion, some patients when treated by radical resection may experience long-term survival.

Partial replacement of sodium chloride with potassium chloride in dry fermented sausages: Influence on carbohydrate fermentation and the nitrosation process.

Two types of dry fermented sausages were manufactured: type A with traditional formulation and type B with reduced sodium content. pH and a(w) values and the counts of aerobic mesophiles, Enterobacteriaceae and lactobacilli micro-organisms during the ripening of both fermented sausages were similar. Final lactic acid contents were also similar, but carbohydrate content was significantly lower in type B sausage. Content of acetic, propionic and butyric acids were significantly higher in type B, suggesting a higher heterofermentative activity. Also type B sausage showed lower nitrate level and higher chemical conversion percentage, suggesting a higher nitrosation intensity.