Substantial concordance between transient elastography and APRI and FIB-4 combination amongst hepatitis C inmates with non advanced liver fibrosis.

OBJECTIVES: To establish concordance between transient elastography (TE) and non invasive markers (NIM) APRI and FIB-4 combination in cronic hepatitis C (HC) patients with non-advanced liver fibrosis (NALF). MATERIAL AND METHOD: Multi-centre retrospective study carried out at two different Barcelona Prisons HC inmates who had the TE done at 2019. We compared the ET vs. NIM results. The NALF consideration was ≤2 (≤12.5 Kilopascal (kPa) in TE). In the NALF cases was calculated de NIM APRI and FIB-4 and the kappa index agreement was established between TE and NIM. RESULTS: 107 cases were included, but only 82 were assessable. The average age was 42 (DS: ±3.2) years. The 96.5% were men, 51.2% spanish, 70.7% drug users and 39% HIV co infected. The 45.1% of those HC infected had genotipe 1. The 90.2% of the evaluated patients by TE the ALD was not detected. The kappa index was 0.78. 65 (79.3%) studied inmates got HC treatment. The 20.7% could not be treated because the evaluation was not completed. CONCLUSION: Most of the HC infected inmates have no ALD, and in such cases concordance between NIM/TE is substantial. The NIM can be used to shorten the evaluation time and prescribe the treatment faster, especially if the length of stay in prison is short and risk of transmission is high.

Buena concordancia entre la elastografía de transición y las pruebas combinadas APRI y FIB-4 en presos con hepatitis C sin enfermedad hepática avanzada / Good agreement between transitional elastography and combined APRI and FIB-4 tests in hepatitis C prisoners without advanced liver disease

Objetivos: Determinar la concordancia entre la elastografía de transición (ET) y los métodos no invasivos (MNI) del índicede relación de niveles de plaquetas y aspartato-aminotransferasa (APRI, aspartate aminotransferase to platelet ratio index) y elíndice de fibrosis 4 (FIB-4) combinados en internos con Hepatitis C crónica (HCC) sin enfermedad hepática avanzada (EHA).Material y método: Estudio multicéntrico y retrospectivo realizado en reclusos con HC de dos prisiones de Barcelona con ETefectuada en 2019. Se comparó el resultado de la ET frente a MNI. Se consideró que no era EHA si la fibrosis era ≤2 (≤12,5 kilopascales [kPa], en ET). Se calculó el grado de fibrosis por métodos no invasivos (MNI) y, en los casos sin EHA, se determinóla concordancia entre ET y MNI mediante el índice kappa (κ).Resultados: Se incluyeron 107 casos, 82 evaluables. Edad media: 42 (desviación estándar [DE]: ±3,2) años. El 96,4% eranhombres, el 51,2% españoles, el 70,7% con antecedente de uso de drogas intravenosas (UDI) y el 39% infectados por VIH. El45,1% de los infectados presentaba genotipo 1. En el 90,2% de los evaluados mediante ET, no se detectó EHA. El índice κ fuede 0,78. Se prescribió tratamiento contra el virus de la hepatitis C (VHC) a 65 (79,3%). El 20,7% no pudo tratarse por falta detiempo para completar el estudio.Conclusiones: La mayoría de los infectados actuales no presentan EHA y, en estos casos, la concordancia MNI/ET es buena.Los MNI pueden utilizarse para acortar el tiempo de evaluación hepática y prescribir antes el tratamiento, sobre todo si el tiempo de estancia en prisión se prevé corto y el riesgo de transmisión es alto. (AU)

Objectives: To establish concordance between transient elastography (TE) and non invasive markers (NIM) APRI and FIB-4combination in hepatitis C (HC) patients with non-advanced liver fibrosis (NALF).Material and method: Multi-centre retrospective study carried out at two different Barcelona Prisons HC inmates whohad the TE done at 2019. We compared the ET vs. NIM results. The NALF consideration was ≤2 (≤12.5 Kpa in TE). In theNALF cases was calculated de NIM APRI and FIB-4 and the kappa index agreement was established between TE and NIM.Results: 107 cases were included, but only 82 were assessable. The average age was 42 (DS: ±3.2) years. The 96.5% were men,51.2% spanish, 70.7% drug users and 39% HIV co infected. The 45.1% of those HC infected had genotipe 1. The 90.2%of the evaluated patients by TE the ALD was not detected. The kappa index was 0.78. 65 (79.3%) studied inmates got HCtreatment. The 20.7% could not be treated because the evaluation was not completed. Conclusion: Most of the HC infected inmates have no ALD, and in such cases concordance between NIM/TE is substantial.The NIM can be used to shorten the evaluation time and prescribe the treatment faster, especially if the length of stay inprison is short and risk of transmission is high. (AU)

Estado de salud periodontal de pacientes trasplantados renales y calidad de vida asociada. Estudio exploratorio / Periodontal health of renal patients and quality of life associated. Exploratory study

Objetivo. Determinar el estado de salud periodontal del paciente trasplantado renal, mediante la revisión de las historias clínicas diligenciadas por odontólogos generales o especialistas así como por la percepción de calidad de vida post-transplante, en relación con la salud bucal. Métodos. Estudio descriptivo transversal con 30 participantes de una unidad de transplante renal de la ciudad de Medellín, Colombia. Se exploraron antece- dentes médico-odontológicos personales y familiares, examen bucal y periodontograma completo, por un solo examinador (Kappa= 0,79). Se aplicó la encuesta Oral Health Impact Profile (OHIP-14). Resultados . Edad promedio de 35 años (d.s±20,5), 50% hombres y 70% residentes en Medellín. El 46,7% tuvo falla renal de carácter idiopático. Del 44,3% que presentaron problemas periodontales, el 73% tuvo periodontitis locali- zada, 31,8% bolsas periodontales de 4 mm. El cuestionario de calidad de vida aplicado mostró dos dimensiones afectadas: dolor físico y malestar psicológico (23,4% y 20% res- pectivamente). Conclusiones. Los pacientes trasplantados renales tuvieron compromiso periodontal. La severidad medida por la pérdida de inserción, mostró un resultado poco satisfactorio, considerando que los pacientes deben estar libres de factores irritativos e inflamatorios en la boca. El OHIP-14 es un instrumento amigable y sencillo para valorar la calidad de vida asociada a salud bucal.

Objective. Determine the periodontal health status of the renal transplantation patient, by reviewing the medical records filled out by general dentists or specialists as well as the perception of post-transplantation quality of life, in relation to oral health. Methods . Cross-sectional descriptive study with 30 participants from renal transplantation unit in the city of Medellín, Colombia. Personal and family medical-dental history, oral exam and complete periodontogram were explored by a single examiner (Kappa = 0.79). The Oral Health Impact Profile (OHIP-14) survey was applied. Results. Average age: 35 years (d.s ± 20.5), 50% men and 70% residents in Medellín. 46.7% had idiopathic renal failure. From the 44.3% who presented periodontal problems, 73% had localized peri- odontitis, 31.8% periodontal pockets of 4 mm. The quality of life applied questionnaire showed two affected dimensions: physical pain and psychological distress (23.4% and 20% respectively). Conclusions. The kidney transplantation patients had periodontal involvement. The severity measured by the loss of insertion, showed an unsatisfactory result, considering that patients should be free of irritating and inflammatory factors in the mouth. The OHIP-14 is a friendly and simple instrument to assess the quality of life associated with oral health

Predictive value of hypoxia in advanced head and neck cancer after treatment with hyperfractionated radio-chemotherapy and hypoxia modification

Purpose. Hypoxia has predictive value in head and neck cancer (HNC). It has been well described, albeit in a small number of clinical Centres. The aim of this study was to describe our experience using the polarographic probe technique to assess the predictive value of tumour oxygenation in patients with advanced HNC treated with hyperfractionated radio-chemotherapy. Hypoxia modification was induced using percutaneous spinal cord stimulation (SCS). Methods/patients. Male patients (n = 12; stage IVb n = 8; IVa n = 4; mean age 58: range 46-70 years) with advanced HNC were evaluated. Planned therapy was hyperfractionated-radiotherapy, oral tegafur (precursor of 5-fluorouracil) and hypoxia modification using SCS. Pre-treatment analyses included: haemoglobin levels and tumour oxygenation (using the Eppendorf polarographic probe device). Oxygenation was expressed as median-pO2 (in mmHg) and hypoxia as the percentage of pO2 values ≤5 mmHg (HP5) and ≤2.5 mmHg (HP2.5). Results. Lower haemoglobin levels were directly correlated with median pO2 (p = 0.017) and inversely correlated with HP5 (p = 0.020) and more advanced stages (IVb vs. IVa; p = 0.028). Patients who subsequently developed systemic metastasis had tumours that were more hypoxic, with lower median pO2 (p = 0.036) and higher HP5 (p = 0.036). The subgroup of patients with HP2.5 above the median (the most hypoxic tumours) had lower loco-regional control (p = 0.027), cause-specific survival (p = 0.008), and overall survival (p = 0.008). Conclusions. Higher tumour hypoxia showed predictive value in HNC in our study, and was significantly associated with lower overall survival, cause-specific survival, and loco-regional control. Tumour hypoxia determination could be used to select patients who would most benefit by hypoxia modification during chemo-radiotherapy of HNC (AU)

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Predictive value of hypoxia in advanced head and neck cancer after treatment with hyperfractionated radio-chemotherapy and hypoxia modification.

PURPOSE: Hypoxia has predictive value in head and neck cancer (HNC). It has been well described, albeit in a small number of clinical Centres. The aim of this study was to describe our experience using the polarographic probe technique to assess the predictive value of tumour oxygenation in patients with advanced HNC treated with hyperfractionated radio-chemotherapy. Hypoxia modification was induced using percutaneous spinal cord stimulation (SCS). METHODS/PATIENTS: Male patients (n = 12; stage IVb n = 8; IVa n = 4; mean age 58: range 46-70 years) with advanced HNC were evaluated. Planned therapy was hyperfractionated-radiotherapy, oral tegafur (precursor of 5-fluorouracil) and hypoxia modification using SCS. Pre-treatment analyses included: haemoglobin levels and tumour oxygenation (using the Eppendorf polarographic probe device). Oxygenation was expressed as median-pO2 (in mmHg) and hypoxia as the percentage of pO2 values ≤5 mmHg (HP5) and ≤2.5 mmHg (HP2.5). RESULTS: Lower haemoglobin levels were directly correlated with median pO2 (p = 0.017) and inversely correlated with HP5 (p = 0.020) and more advanced stages (IVb vs. IVa; p = 0.028). Patients who subsequently developed systemic metastasis had tumours that were more hypoxic, with lower median pO2 (p = 0.036) and higher HP5 (p = 0.036). The subgroup of patients with HP2.5 above the median (the most hypoxic tumours) had lower loco-regional control (p = 0.027), cause-specific survival (p = 0.008), and overall survival (p = 0.008). CONCLUSIONS: Higher tumour hypoxia showed predictive value in HNC in our study, and was significantly associated with lower overall survival, cause-specific survival, and loco-regional control. Tumour hypoxia determination could be used to select patients who would most benefit by hypoxia modification during chemo-radiotherapy of HNC.

[Prevalence of latent tuberculosis infection amongst immigrants entering prison]. / Prevalencia de infección tuberculosa latente en población inmigrante que ingresa en prisión.

OBJECTIVE: To study the prevalence of latent tuberculosis infection (LTBI) and the predictive factors amongst immigrants entering prison. METHODS: prospective study conducted in May and June of 2009. The tuberculin skin test (TST) was performed, with induration of ≥ 10 mm being regarded as positive. Variables collected were: age, origin, number of incarcerations, length of time living in Spain, heroin and cocaine consumption, intravenous drug use and HIV infection. The rate of LTBI was calculated and the overall infection rate (ITL and history of TB). To study predictable factors, a bivariant and multivariant analysis were carried out using logistic regression. RESULTS: 152 male immigrants. Average age: 31.9 years ± 7.8; 37.2% of them with heroin or cocaine consumption and 7.5% IDU. 12 patients were previously TST positive and 6 patients had history of TB. TST was performed on 134 people, 63 with positive results and 71 with negative ones. ITL rate: 49.3. Overall infection rate: 53.3%. Bivariate associated with LTBI: more than one incarceration (67.4% vs. 36.4% in primary, p=0.001), age (76% ≥ 40 vs. 40.4% under this age and heroin and cocaine consumption (60% consumers vs. 39.3% non consumers; p=0.02. Multivariate analysis only confirmed the association with age (p=0.001; OR: 2.34, IC=1.39-3.94). CONCLUSIONS: The LTBI rate amongst immigrants entering prison is very high. A complete study is recommended for all of them, with special attention being paid to the most vulnerable ones, such as older people.

Prevalence of latent tuberculosis infection in inmates recently incarcerated in a men's prison in Barcelona.

OBJECTIVE: To study the prevalence of latent tuberculosis infection (LTBI) in prisoners. METHODS: Among inmates admitted to a men's preventive detention prison in Barcelona during May-June 2009, without a previous positive tuberculin skin test (TST), a ≥ 10 mm TST was considered positive (5 mm in human immunodeficiency virus [HIV] infected persons). A multivariate logistic regression was performed, calculating odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: A total of 221 individuals were included. The average age was 33.5 years (± 8.9 SD); 61.6% were foreigners and 45.2% were heroine and/or cocaine users; 40.3% had LTBI. The infection was associated with age >40 years (OR 3.10, 95%CI 1.51-6.35) and having been born in Eastern Europe (OR 4.3, 95%CI 1.4-12.8), North Africa (OR 2.2, 95%CI 1.01-4.7), sub-Saharan Africa (OR 7.6, 95%CI 1.3-44) or Latin America (OR 3.8, 95%CI 1.5-9.3). Subjects infected with HIV had a lower risk of a positive TST (OR 0.22, 95%CI 0.04-1.07). Only 31 (14%) did not present any of these risk factors, and 8 (25.8%) had LTBI. CONCLUSIONS: The prevalence of LTBI was very high in this study, and systematic screening of all inmates at the time of entry into the prison is therefore recommended. Excluding those who do not fall in any of the high-risk prevalence groups from the evaluation complicates the screening and is not very effective.

Prevalencia de infección tuberculosa latente en población inmigrante que ingresa en prisión / Prevalence of latent tuberculosis infection amongst immigrants entering prison

Objetivo: Estudiar la prevalencia de infección tuberculosa latente (ITL) y sus factores predictivos en población reclusa inmigrante. Métodos: Estudio prospectivo realizado en mayo y junio de 2009. Se realizó intradermorreacción de Mantoux (IDRM), considerándose positiva la induración >= 10 mm. Se recogen las variables: edad, origen, reincidencia, tiempo en España, consumo de heroína y/o cocaína, uso de drogas intravenosas e infección VIH. Se calcula la tasa de ITL y la tasa global de infección (ITL más antecedente de tuberculosis). Para estudiar factores predictivos, se realizó un análisis bivariante y multivariante mediante regresión logística. Resultados: Se estudiaron 152 varones inmigrantes al ingreso en prisión. Edad media: 31,9 años ± 7,8. El 37,3% consumidor de heroína y/o cocaína y el 7,5% usuarios de drogas por vía intravenosa (UDI). 12 tenían IDRM previa positiva y 6 antecedente de TB. Se realizó IDRM a 134, 63 con resultado positivo y 71 con resultado negativo. Tasa de ITL: 49,3%. Tasa global de infección: 53,3%. Bivariadamente, se asoció a la ITL: la reincidencia (67,4% vs 36,4% en primarios, p=0,001), la edad (76% en los >= 40 años vs 40,4% en menores de esa edad; p=0,002) y el consumo de heroína y/o cocaína (60% en consumidores vs 39,3% en no consumidores; p= 0,02). El análisis multivariante sólo confirmó la asociación con la edad (p=0,001; OR: 2,34, IC= 1,39-3,94). Conclusiones: La tasa de ITL en inmigrantes que ingresan en prisión es muy elevada. Se recomienda en todos un completo estudio, con especial dedicación a los más vulnerables como los inmigrantes de mayor edad(AU)

Objective: To study the prevalence of latent tuberculosis infection (LTBI) and the predictive factors amongst immigrants entering prison. Methods: prospective study conducted in May and June of 2009. The tuberculin skin test (TST) was performed, with induration of >= 10 mm being regarded as positive. Variables collected were: age, origin, number of incarcerations, length of time living in Spain, heroin and cocaine consumption, intravenous drug use and HIV infection. The rate of LTBI was calculated and the overall infection rate (ITL and history of TB). To study predictable factors, a bivariant and multivariant analysis were carried out using logistic regression. Results: 152 male immigrants. Average age: 31.9 years ± 7.8; 37.2% of them with heroin or cocaine consumption and 7.5% IDU. 12 patients were previously TST positive and 6 patients had history of TB. TST was performed on 134 people, 63 with positive results and 71 with negative ones. ITL rate: 49.3. Overall infection rate: 53.3%. Bivariate associated with LTBI: more than one incarceration (67.4% vs. 36.4% in primary, p=0.001), age (76% >= 40 vs. 40.4% under this age and heroin and cocaine consumption (60% consumers vs. 39.3% non consumers; p=0.02. Multivariate analysis only confirmed the association with age (p=0.001; OR: 2.34, IC=1.39-3.94). Conclusions: The LTBI rate amongst immigrants entering prison is very high. A complete study is recommended for all of them, with special attention being paid to the most vulnerable ones, such as older people(AU)

DBS-relevant electric fields increase hydraulic conductivity of in vitro endothelial monolayers.

Deep brain stimulation (DBS) achieves therapeutic outcome through generation of electric fields (EF) in the vicinity of energized electrodes. Targeted brain regions are highly vascularized, and it remains unknown if DBS electric fields modulate blood-brain barrier (BBB) function, either through electroporation of individual endothelial cells or electro-permeation of barrier tight junctions. In our study, we calculated the intensities of EF generated around energized Medtronic 3387 and 3389 DBS leads by using a finite element model. Then we designed a novel stimulation system to study the effects of such fields with DBS-relevant waveforms and intensities on bovine aortic endothelial cell (BAEC) monolayers, which were used as a basic analog for the blood-brain barrier endothelium. Following 5 min of stimulation, we observed a transient increase in endothelial hydraulic conductivity (Lp) that could be related to the disruption of the tight junctions (TJ) between cells, as suggested by zonula occludens-1 (ZO-1) protein staining. This 'electro-permeation' occurred in the absence of cell death or single cell electroporation, as indicated by propidium iodide staining and cytosolic calcein uptake. Our in vitro results, using uniform fields and BAEC monolayers, thus suggest that electro-permeation of the BBB may occur at electric field intensities below those inducing electroporation and within intensities generated near DBS electrodes. Further studies are necessary to address potential BBB disruption during clinical studies, with safety and efficacy implications.

La tridimensionalidad del concepto de nutrición: su relación con la educación para la salud / The three-dimensionality of the nutrition concept: its realtionship with health education

The evolution of the nutrition concept is described until arriving to the concept of three-dimensionality, analyzing it from at the world level, in Latin America and México. Nutrition used to be considered an exclusively biological process; nevertheless, now it involves social and ecological aspects. The convergence between the health concept and nutrition from the biosocial conception of the individual is analyzed, emphasizing the importance of education as a promotional tool, which includes not only includes the informative aspect but also the modification of behavior to change the individual's lifestyle.

Se describe la evolución del concepto de nutrición hasta llegar a la concepción de la tridimensionalidad del mismo. Analizándolo desde el nivel mundial, América Latina y México. Se consideraba a la nutrición como un proceso exclusivamente biológico, sin embargo actualmente involucra aspectos sociales y ecológicos. Se destaca la convergencia entre el concepto de salud y nutrición, a partir de la concepción biopsicosocial del individuo, motivo por el que se enfatiza la importancia de la educación para la salud como herramienta preventiva y promocional que no solo incluye el aspecto informativo sino también la modificación de conductas con el objetivo de que el individuo adquiera estilos de vida saludables. Se concluye con la manera como la educación para la salud se articula con las tres dimensiones de la nutrición.

Isomerización dll 1-ciclohexiloctano en zeolitas h-zsm-22 y h-y / 1-cyclohexyloctane isomerizationinto h-zsm-22 and h-yzeolites / Isoerizacáo de 11-ciclohexiloctano na zeólitas h-zsm-22 yh-y

En este trabajo se presentan los resultados de la evaluación energética de los intermediarios de la isomerización del 1-ciclohexiloctano en dos etapas. La primera etapa corresponde a la isomerización del 1-ciclohexiloctano en fase gaseosa vía carbocationes clásicos, usando el nivel de teoría DFT/B3LYP y conjunto de funciones base 6-31G. En la segunda etapa se desarrolló la coordenada de reacción de la isomerización del 1-ciclohexiloctano en presencia de zeolitas acidas H-ZSM-22 y H-Y empleando el método ONIOM, usando los niveles de teoría B3LYP/ 6-31G:UFF. Los resultados muestran diferencias significativas entre las reacciones en fase gaseosa y condensada. Estas diferencias ponen de manifiesto la influencia del confinamiento cuántico que sufren las moléculas al interior de los sistemas microporosos del tipo zeolitas.

We studied the isomerization mechanism of 1-cycle-hexyloctane either in gas phase or inside zeolites using quantum models. In the gas phase the reaction was simulated following the classical scheme via carbocations. On the other hand, the isomerization reaction was modeled with 1-cycle-hexyloctane inside HZSM-22 and H-Y acid zeolites (condensed phase). We used the ONIOM(B3LYP/6-31G: UFF) hybrid method to study such behavior in both zeolites. Our results show that the reaction follows different pathways when the simulations are performed either in gas phase or within the zeolites pores. Such differences show the importance of quantum confinement inside microporous materials.

Neste trabalho foram desenvolvidos os mecanismos das reacção de isomerização de 1-ciclo-hexil-octano através de duas etapas. Na primeira etapa, a reação foi realizada como carbocátions clasicos, utilizando-se o método DFT/B3LYP e as funções básicas 6-31G. Na segunda, a reação de isomerização de 1-ciclo-he-xil-octano foi estudou em zeolites ácido H-ZSM-22 e H-Y utilizando-se o método híbrido ONIOM o nível B3LYP e funções básicas 6-31G.

Gender differentials of pulmonary tuberculosis transmission and reactivation in an endemic area.

BACKGROUND: In most low income countries there are twice as many cases of tuberculosis (TB) reported among men than among women, a difference commonly attributed to biological and epidemiological characteristics as well as socioeconomic and cultural barriers in access to health care. The World Health Organization has encouraged gender specific comparisons in TB rates to determine whether women with TB are less likely than men with TB to be diagnosed, reported, and treated. A study was undertaken to identify gender based differences in patients with pulmonary TB and to use this information to improve TB control efforts. METHODS: Individuals with a cough for more than 2 weeks in southern Mexico were screened from March 1995 to April 2003. Clinical and mycobacteriological information (isolation, identification, drug susceptibility testing and IS6110 based genotyping, and spoligotyping) was collected from those with bacteriologically confirmed pulmonary TB. Patients were treated in accordance with official norms and followed to ascertain treatment outcome, retreatment, and vital status. RESULTS: 623 patients with pulmonary TB were enrolled. The male:female incidence rate ratio for overall, reactivated, and recently transmitted disease was 1.58 (95% CI 1.34 to 1.86), 1.64 (95% CI 1.36 to 1.98), and 1.41 (95% CI 1.01 to 1.96), respectively. Men were more likely than women to default from treatment (adjusted OR 3.30, 95% CI 1.46 to 7.43), to be retreated (hazard ratio (HR) 3.15, 95% CI 1.38 to 7.22), and to die from TB (HR 2.23, 95% CI 1.25 to 3.99). CONCLUSIONS: Higher rates of transmitted and reactivated disease and poorer treatment outcomes among men are indicators of gender differentials in the diagnosis and treatment of pulmonary TB, and suggest specific strategies in endemic settings.

The potent anti-HIV protein cyanovirin-N contains two novel carbohydrate binding sites that selectively bind to Man(8) D1D3 and Man(9) with nanomolar affinity: implications for binding to the HIV envelope protein gp120.

Cyanovirin-N (CVN) is a monomeric 11 kDa cyanobacterial protein that potently inactivates diverse strains of human immunodeficiency virus (HIV) at the level of cell fusion by virtue of high affinity interactions with the surface envelope glycoprotein gp120. Several lines of evidence have suggested that CVN-gp120 interactions are in part mediated by N-linked complex carbohydrates present on gp120, but experimental evidence has been lacking. To this end we screened a comprehensive panel of carbohydrates which represent structurally the N-linked carbohydrates found on gp120 for their ability to inhibit the fusion-blocking activity of CVN in a quantitative HIV-1 envelope-mediated cell fusion assay. Our results show that CVN specifically recognizes with nanomolar affinity Man(9)GlcNAc(2) and the D1D3 isomer of Man(8)GlcNAc(2). Nonlinear least squares best fitting of titration data generated using the cell fusion assay show that CVN binds to gp120 with an equilibrium association constant (K(a)) of 2.4 (+/- 0.1) x 10(7) M(-1) and an apparent stoichiometry of 2 equiv of CVN per gp120, Man(8)GlcNAc(2) D1D3 acts as a divalent ligand (2 CVN:1 Man(8)) with a K(a) of 5.4 (+/- 0.5) x 10(7) M(-1), and Man(9)GlcNAc(2) functions as a trivalent ligand (3 CVN:1 Man(9)) with a K(a) of 1.3 (+/- 0.3) x 10(8) M(-1). Isothermal titration calorimetry experiments of CVN binding to Man(9)GlcNAc(2) at micromolar concentrations confirmed the nanomolar affinity (K(a) = 1.5 (+/- 0.9) x 10(8) M(-1)), and the fitted data indicated a stoichiometry equal to approximately one (1 Man(9):1 CVN). The 1:1 stoichiometry at micromolar concentrations suggested that CVN has not only a high affinity binding site-relevant to the studies at nM concentrations-but a lower affinity site as well that facilitates cross-linking of CVN-oligomannose at micromolar concentrations or higher. The specificity of CVN for Man(8) D1D3 and Man(9) over the D1D2 isomer of Man(8) indicated that the minimum structure required for high affinity binding comprises Manalpha1 --> 2Manalpha. By following the (1)H-(15)N correlation spectrum of (15)N-labeled CVN upon titration with this disaccharide, we unambiguously demonstrate that CVN recognizes and binds to the disaccharide Manalpha1 --> 2Manalpha via two distinct binding sites of differing affinities located on opposite ends of the protein. The high affinity site has a K(a) of 7.2 (+/- 4) x 10(6) M(-1) and the low affinity site a K(a) of 6.8 (+/- 4) x 10(5) M(-1) as determined by isothermal titration calorimetry. Mapped surfaces of the carbohydrate binding sites are presented, and implications for binding to gp120 are discussed.

Actuación de Enfermería para mejorar el control de la tuberculosis en prisión

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Nipple care, sore nipples, and breastfeeding: a randomized trial.

Sore and cracked nipples are common and may represent an obstacle to successful breastfeeding. In Italy, it is customary for health professionals to prescribe some type of ointment to prevent or treat sore and cracked nipples. The efficacy of these ointments is insufficiently documented. The incidence of sore and cracked nipples was compared between mothers given routine nipple care, including an ointment (control group), and mothers instructed to avoid the use of nipple creams and other products (intervention group). Breastfeeding duration was also compared between the two groups. Eligible mothers were randomly assigned, after informed consent, to one of the two groups. No difference was found between the control (n = 96) and the intervention group (n = 123) in the incidence of sore and cracked nipples and in breastfeeding duration. However, several factors were associated with sore nipples and with breastfeeding duration. The use of a pacifier and of a feeding bottle in the hospital were both associated with sore nipples at discharge (p = 0.02 and p = 0.03, respectively). Full breastfeeding up to 4 months postpartum was significantly associated with the following early practices: breastfeeding on demand, rooming-in at least 20 hours/day, non-use of formula and pacifier, no test-weighing at each breastfeed. The incidence of sore and cracked nipples and the duration of breastfeeding were not influenced by the use of a nipple ointment. Other interventions, such as providing the mother with guidance and support on positioning and latching, and modifications of hospital practices may be more effective in reducing nipple problems.

Métodos de aglutinación con partículas de látex y rantz-randall para el diagnóstico de las infecciones estreptocócicas / Agglutination and rantz-randall methods for the diagnosis of streptococcal infections

En el presente trabajo se compararon los métodos de aglutinación con partículas de látex (AL) y Rantz-Randall (RR) para investigar anticuerpos antiestreptolisina "O" en 72 muestras de sueros sanguíneos. Este estudio reveló un mayor porcentaje de positividad, por el método RR (55,5 por ciento) que por AL (16,6 por ciento). Cuando evaluamos la discordancia en nuestros datos, se observa que un suero positivo por AL (título 400 UI/ml) fue negativo para RR, lo cual pudo ser un falso positivo por la presencia de anticuerpos inespecíficos. En el caso de las 19 muestras de suero que resultaron positivas por RR a diluciones superiores a 1:240 y negativas por AL, podría explicarse por la mayor sensibilidad de la primera técnica y/o la presencia de falsos negativos por la técnica de AL, debido al fenómeno de prozona. El análisis estadístico mediante el Chi cuadrado, determinó que entre los métodos de RR y AL, hubo diferencia significante, lo cual reveló la importancia de este estudio ya que demuestra que el método de RR constituye una alternativa superior al de AL, como complemento del diagnóstico clínico y bacteriológico de las infecciones estreptocócicas

Kangaroo mother care for low birthweight infants: a randomized controlled trial in different settings.

A randomized controlled trial was carried out for 1 y in three tertiary and teaching hospitals, in Addis Ababa (Ethiopia), Yogyakarta (Indonesia) and Merida (Mexico), to study the effectiveness, feasibility, acceptability and cost of kangaroo mother care (KMC) when compared to conventional methods of care (CMC). About 29% of 649 low birthweight infants (LBWI; 1000-1999 g) died before eligibility. Of the survivors, 38% were excluded for various reasons, 149 were randomly assigned to KMC (almost exclusive skin-to-skin care after stabilization), and 136 to CMC (warm room or incubator care). There were three deaths in each group and no difference in the incidence of severe disease. Hypothermia was significantly less common in KMC infants in Merida (13.5 vs 31.5 episodes/100 infants/d) and overall (10.8 vs 14.6). Exclusive breastfeeding at discharge was more common in KMC infants in Merida (80% vs 16%) and overall (88% vs 70%). KMC infants had a higher mean daily weight gain (21.3 g vs 17.7 g) and were discharged earlier (13.4 vs 16.3 d after enrolment). KMC was considered feasible and presented advantages over CMC in terms of maintenance of equipment. Mothers expressed a clear preference for KMC and health workers found it safe and convenient. KMC was cheaper than CMC in terms of salaries (US$ 11,788 vs US$ 29,888) and other running costs (US$ 7501 vs US$ 9876). This study confirms that hospital KMC for stabilized LBWI 1000-1999 g is at least as effective and safe as CMC, and shows that it is feasible in different settings, acceptable to mothers of different cultures, and less expensive. Where exclusive breastfeeding is uncommon among LBWI, KMC may bring about an increase in its prevalence and duration, with consequent benefits for health and growth. For hospitals in low-income countries KMC may represent an appropriate use of scarce resources.