Brief Telephonic Motivational Interviewing for People Living with HIV with Follow-up Problems.

Motivational interviewing (MI)-based interventions can be effective for people living with HIV (PLWHIV) with medical follow-up problems. This study aimed to assess the stage of motivation to attend medical appointments of PLWHIV with medical follow-up problems and to evaluate a single telephone session MI intervention directed to engage them in care. The change in stage was evaluated before and after the intervention, and attending medical appointments was monitored for six months. Thirty-nine PLWHIV participated; 51.3% were in precontemplation/contemplation and 49.7% in preparation/action stage. Most (excluding those in the action stage from the beginning) (n = 22, 71.0%) advanced to another stage after the intervention (z = - 4.235, p < .001), and most did not miss the following appointments. Brief and remote MI interventions could be useful in low-resource settings, especially for those in the early stages of change, to explore motivations related with missing medical appointments.

Improvement of the Pour Plate Method by Separate Sterilization of Agar and Other Medium Components and Reduction of the Agar Concentration.

Although the pour plate method is widely employed in microbiological quality control, it has certain drawbacks, including having to melt the culture medium before seeding. In this study, the preparation of the culture medium was modified by using a lower concentration of agar (10 g/L), which was separated from the nutrients during sterilization. The new protocol was assessed in media frequently used in microbiological quality control of food, cosmetics, and pharmaceutical products, with tryptic soy agar (TSA), Sabouraud 4% dextrose agar (SDA), and violet red bile glucose agar (VRBG). In comparison with the conventionally produced media, the modifications significantly improved the growth of Saccharomyces cerevisiae in SDA, Staphylococcus aureus, Salmonella enterica subsp. enterica serovar Typhimurium, and Candida albicans in TSA and Escherichia coli ATCC 8739 and ATCC 25922 and S. Typhimurium in VRBG. The modified VRBG was also more selective for Pseudomonas aeruginosa. Regarding physicochemical properties, a significantly lower pH was observed in TSA and VRBG and lower strength values in TSA. Sterilizing agar separately from the other components of the medium and reducing the agar concentration to 10 g/L can improve microorganism growth and enhance the selectivity of differential media in the pour plate method. These modifications could facilitate the automation of this culture technique. IMPORTANCE In the era of rapid microbiological methods, there is a need to improve long-established culture techniques. Drawbacks of the pour plate method include having to melt each medium separately before seeding. For this technique, we demonstrate that separating the agar from the other components of commonly used media during sterilization and reducing the agar concentration to 10 g/L can enhance microbial growth. The new protocol could have advantages in routine laboratory practice because less agar is required and the same molten agar suspension can be used to prepare different media. Moreover, these modifications could facilitate the automation of the pour plate method.

Trace elements in blood of Baltic gray seal pups (Halichoerus grypus) from the Gulf of Riga and their relationship with biochemical and clinical parameters.

Trace elements are pollutants of both natural and anthropogenic origin which can influence negatively on ecosystem and wildlife health. We evaluated trace element in blood samples of gray seal (Halichoerus grypus) stranded in the Gulf of Riga and their influence on their health status through hematological and biochemical profiles. Zn showed the highest levels followed by Cu > Se > Pb > THg > As. Cr and Cd were not detected. Most trace element levels were generally comparable to those reported in seal species; however, high Pb values were observed in those sample showing detectable concentrations (<0.046-257.6 µg/kg ww). Significant positive correlations were found between trace elements concentrations and various biochemical parameters, including Se-ASAT, Se:Hg-ASAT, Cu-TP, Cu-ALB, CuCa, Zn-ALAT, ZN-LDH, ZnP, Zn-Segment neutrophils, and Pb-CK. Nevertheless, most relationships were not strong enough (p > 0.04) to assume a toxicological implication. Despite its limitations, this information could serve as the baseline for future research.

Improvement of Mueller-Kauffman Tetrathionate-Novobiocin (MKTTn) enrichment medium for the detection of Salmonella enterica by the addition of ex situ-generated tetrathionate.

The detection of Salmonella in food is based on the use of a selective enrichment broth such as Muller-Kauffman Tetrathionate-Novobiocin (MKTTn), in which tetrathionate plays a key role by providing Salmonella with a growth advantage. As sodium tetrathionate is unstable, it is generated in situ by the addition of iodine (Lugol's solution) before seeding. This step is cumbersome as the solution is easily spilled, compromising the performance of the medium and hindering the work of technicians. The aim of this study was to optimize MKTTn broth by generating tetrathionate ex situ through an external reaction between iodine and thiosulphate followed by lyophilization. Quality control procedures were performed to compare the modified and original media, testing pure productivity (enrichment with 50-120 CFU of Salmonella Thyphimurium ATCC 14028 and Salmonella Enteritidis ATCC 13076 and plating on Xylose Lysine Deoxycholate agar, XLD), mixed productivity (50-120 CFU of Salmonella strains and Pseudomonas aeruginosa and Escherichia coli at ≥104 CFU and XLD plating) and selectivity (≥104 CFU of P. aeruginosa and Enterococcus faecalis and plating on Tryptone Casein Soy agar, TSA). The modified MKTTn medium (S/L) performed comparably with the original medium in terms of growth of both Salmonella strains (>300 colonies in XLD), alone or with P. aeruginosa and E. coli. Quantitative assays showed no statistically significant differences in the number of colonies grown on XLD after 10-5 dilution (p = 0.7015 with S. Thyphimurium ATCC 14028 and p = 0.2387 with S. Enteritidis ATCC 13076; ANOVA test). MKTTn medium (S/L) was also selective against E. coli (≤100 colonies) and E. faecalis (<10 colonies). These results suggest that adding tetrathionate as a lyophilisate (S/L) is a feasible alternative to the use of Lugol's solution for the preparation of MKTTn enrichment broth and does not affect the properties of the medium.

Medicinal Plants in Traditional Herbal Wines and Liquors in the East of Spain and the Balearic Islands.

Homemade herbal preparations from the East of Spain are the witness of traditional medicine inherited from the ancient complex formulas of herbal teas and medicinal wines. In this study, we document the use of traditional alcoholic beverages, identify their ingredients, almost exclusively botanical, record the local medicinal uses of these mixtures, and discuss patterns of distribution of this knowledge in regions of eastern Spain, the Balearic Islands and Andorra. We determine marker species and relevant patterns of herbal formulas in the different regions of the territory. Homemade liquors and liqueurs are consumed for their digestive and tonic-restorative properties but they also play in some cases an important social role. The elderly remember other medicinal uses such as aperitif, emmenagogue, or antidiarrheal, for some of the most popular preparations. The herbal liqueur formulas include predominantly Lamiaceae, Asteraceae, Rosaceae, Rutaceae, and Apiaceae species. Herbs (58%), fruits (28%), and mixtures of both (12%) are ingredients of liquors and wines, being the aerial parts the most frequent in terms of species (30%) and records (49%). Dictamnus hispanicus, Santolina villosa, Salvia blancoana subsp. mariolensis, Rosmarinus officinalis, Thymus vulgaris, and Clinopodium serpyllifolium subsp. fruticosum are the species most frequently used. Others species used to a lesser extent as Polygonatum odoratum, Thymus moroderi, and Saxifraga longifolia are restricted to locally homemade preparations because their collection and uses require special knowledge of the rare or endemic flora. Sustainability of these practices is strongly limited by the overall loss of local traditional knowledge and by the limited availability of most of the wild species; some of them are endangered or threatened mainly by the loss of their natural habitats. Cultivation and domestication are a promising alternative to collecting from wild populations. The cultivation of Thymus moroderi in the province of Alicante and Polygonatum odoratum in the province of Teruel are good examples. There is a notable decrease in the complexity of the formulas registered throughout the nearly 15 years of the study. This is interpreted as a consequence of a loss of knowledge, less accessibility to wild resources, and changes in traditions and preferences.

Efficacy and safety of peri-procedural bridging therapy with low molecular weight heparin in atrial fibrillation patients under vitamin K antagonists.

BACKGROUND: The clinical effect of peri-operative bridging therapy in atrial fibrillation (AF) patients remains unclear given that it may increase bleeding risk without providing significant benefits. We aimed to investigate peri-procedural events in relation to peri-operative use of bridging therapy in AF patients under Vitamin K Antagonists (VKAs). METHODS: We included AF patients stable the previous 6 months on VKAs. During a median follow-up of 6.5 years (IQR 4.3-7.9), we recorded all invasive procedures and the peri-operative clinical management. All peri-procedural events (ischaemic stroke/transient ischaemic attack/systemic embolism, clinically relevant non-major bleeding and major bleeding) and severe peri-procedural events (ischaemic stroke/transient ischaemic attack/systemic embolism and major bleeding) suffered until the 30-days post-intervention period were recorded. RESULTS: We included 1361 patients (48.7% male, median age 76 [IQR 71-81] years). There were 1100 (70.9%) procedures performed using bridging therapy. The rate of any (4.5% vs. 0.7%, P < 0.001) and severe (2.3% vs. 0.0%, P = 0.002) peri-procedural events were higher in patients receiving bridging therapy. Adjusted logistic regressions demonstrated that the bleeding risk of the procedure was related with higher risk of severe peri-procedural events (OR 3.51, 95% CI 1.54-8.01) and peri-procedural events (OR 2.77, 95% CI 1.56-4.91). Importantly, the use of bridging therapy was also independently associated with higher risk of any peri-procedural events (OR 4.32, 95% CI 1.28-14.51). CONCLUSIONS: In this study including AF patients under VKA therapy, the use of bridging therapy as part of the clinical management during an invasive procedure was independently associated with higher risk of any peri-procedural event.

Trastorno de identidad de género. Parte II: terapia endocrinológica en el proceso de readecuación corporal / Gender identity disorder. Part II: endocrine therapy in the process of body readjustment

Endocrinology step of transgender readjustment therapy is made according to previously published in the part 1 of article: “gender identity disorder in rev. chil. endocrinol. diabetes 2015, 8 (4): 167-173.During started puberty in Tanner stage 2-3, the persistence of the experience that their identity male or female gender is not coherent with its bodily, authorize to start the endocrinological therapy, as an important step of body readjusting. In the process of transition from male to female or female to male, should stop pubertal development, what we do with GNRH analogues: intramuscle leuprolideor triptorelin 11.25 mg. every 12 weeks or with medroxyprogesterone acetate 150 mg. monthly. This process continues until 16 years, adding antiandrogen, preferably spironolactone in the process of body readjusting of male to female. At 16 years old, starts the cross hormonal therapy to masculinizing or feminizing. Maintaining gonadotrophin suppression, female to male, testosterone undecanoate or other injectable testosterone esters is administered, customizing the date of administration and inMale to female, daily use of oral estradiol valerate or transdermal gel. Plasma levels of estradiol andtestosterone should not be located in high or supraphysiological range to avoid thromboembolism or polycythemia risk in those who receive testosterone. Should to be explained the time to obtain the bodily effects, achieving a realistic attitude of the goals and the need for regular checks. Attendance to emotional changes, mainly to meet the social gender role. The laboratory, metabolic, hormonal, hemogram and electrolytic changes are evaluated. To be indicated bone densitometry and study images of internal genitals and breasts are necesary...

An ethnopharmacological and historical analysis of "Dictamnus", a European traditional herbal medicine.

ETHNOPHARMACOLOGICAL RELEVANCE AND BACKGROUND: "Dictamnus" was a popular name for a group of medicinal herbaceous plant species of the Rutaceae and Lamiaceae, which since the 4th century have been used for gynaecological problems and other illnesses BCE and still appear in numerous ethnobotanical records. AIMS: This research has as four overarching aims: Determining the historical evolution of medical preparations labelled "Dictamnus" and the different factors affecting this long-standing herbal tradition. Deciphering and differentiating those medicinal uses of "Dictamnus" which strictly correspond to Dictamnus (Rutaceae), from those of Origanum dictamnus and other Lamiaceae species. Quantitatively assessing the dependence from herbal books, and pharmaceutical tradition, of modern Dictamnus ethnobotanical records. Determining whether differences between Western and Eastern Europe exist with regards to the Dictamnus albus uses in ethnopharmacology and ethnomedicine. METHODS: An exhaustive review of herbals, classical pharmacopoeias, ethnobotanical and ethnopharmacological literature was conducted. Systematic analysis of uses reported which were standardized according to International Classification of Diseases - 10 and multivariate analysis using factorial, hierarchical and neighbour joining methods was undertaken. RESULTS AND DISCUSSION: The popular concept "Dictamnus" includes Origanum dictamnus L., Ballota pseudodictamnus (L.) Benth. and B. acetabulosa (L.) Benth. (Lamiaceae), as well as Dictamnus albus L. and D. hispanicus Webb ex Willk. (Rutaceae), with 86 different types of uses. Between 1000 and 1700 CE numerous complex preparations with "Dictamnus" were used in the treatment of 35 different pathologies. On biogeographical grounds the widespread D. albus is a far more likely prototypical "Dictamnus" than the Cretan endemic Origanum dictamnus. However both form integral parts of the "Dictamnus" complex. Evidence exists for a sufficiently long and coherent tradition for D. albus and D. hispanicus, use to treat 47 different categories of diseases. CONCLUSIONS: This approach is a model for understanding the cultural history of plants and their role as resources for health care. "Dictamnus" shows how transmission of traditional knowledge about materia medica, over 26 centuries, represents remarkable levels of development and innovation. All this lead us to call attention to D. albus and D. hispanicus which are highly promising as potential herbal drug leads. The next steps of research should be to systematically analyse phytochemical, pharmacological and clinical evidence and to develop safety, pharmacology and toxicology profiles of the traditional preparations.

Early and/or immediately full caloric diet versus standard refeeding in mild acute pancreatitis: a randomized open-label trial.

UNLABELLED: Refeeding after acute pancreatitis (AP) is traditionally started in a successively increasing manner when abdominal pain is absent and pancreatic enzymes are decreasing. We aimed to evaluate length of hospital stay (LOHS) and refeeding tolerance for early refeeding and/or immediately full caloric intake in patients recovering from AP. METHODS: In this randomized, open-label trial, patients with AP were randomized into four different refeeding protocols. Group 1 and 2 received a stepwise increasing diet during three days while 3 and 4 received an immediately full caloric, low fat diet. Group 2 and 4 started refeeding early (once bowel sounds returned) and 1 and 3 started at standard time (bowel sounds present, no abdominal pain, no fever, leucocytes and pancreatic enzymes decreasing). Main outcomes measurements were LOHS and tolerance (ability to ingest >50% of meals without severe pain, nausea or AP relapse). RESULTS: Eighty patients were evaluated and 72 randomized (median age 60 years, range 24-85, 33 male). LOHS was significantly reduced after early refeeding (median 5 versus 7 days (p = 0.001)) but not in patients receiving immediately full caloric diet, compared to standard management (6 versus 6 days (p = 0.12)). There was no difference in refeeding tolerance comparing immediately full caloric diet versus stepwise increasing diet (31/35 (89%) versus 33/37 (89%) patients tolerating the treatment, p = 1.00) or early versus standard time for refeeding (33/37 (89%) versus 31/35 (89%), (p = 1.00)). CONCLUSIONS: Refeeding after AP when bowel sounds are present with immediately full caloric diet is safe and well tolerated. Early refeeding shortens LOHS.

Biorefinery concept in a microalgae pilot plant. Culturing, dynamic filtration and steam explosion fractionation.

A 53 m(3) microalgae pilot plant with semi-closed photobioreactors has been operated in batch mode at Tarragona, where proper climatic conditions exist. Operations carried-out were microalgae culturing, concentration, cell disruption and lipid extraction. Culturing was performed with and without CO2 fertilization. pH was used to control CO2 dosing. With CO2 fertilization best microalgae concentrations were obtained. Productivities up to 19.9 g/m(2)/day were reached. Although sedimentation and centrifugation was performed, studies focused on dynamic membrane filtration as improved technique compared with conventional one. Significant fouling reduction was obtained by using a vibrational membrane setup. Cell disruption including product pre-extraction was performed by using steam explosion at moderate conditions, as novel technique for this application. Lipid extraction was performed by using conventional techniques with and without exploded material. The amount of lipids obtained from exploded material was higher than with non-exploded material, which shows that steam explosion provides a clear enhancement.

Upconversion emission obtained in Yb(3+)-Er(3+) doped fluoroindate glasses using silica microspheres as focusing lens.

An intensity enhancement of the green upconversion emission from a codoped Er(3+)-Yb(3+) fluoroindate glass has been obtained by coating the glass surface with silica microspheres (3.8 µm diameter). The microspheres focus an incoming beam (λ ≈ 950 nm) on the surface of the fluoroindate glass. The green emission (λ ≈ 545 nm) of the Er(3+) ions located in the microsphere focus was measured with a microscope in reflection mode, being the peak intensity 4.5 times the emission of the bare substrate. The transversal FWHM of the upconversion spot was experimentally determined by deconvolution with the experimental Point Spread Function of the system, obtaining a value of 309 nm. This value is in good agreement with Finite-Difference Time-Domain simulations taking into account the magnification of the image due to the microsphere.

Cognitive representations of obligation and prohibition signs when they provide the same amount of semantic information

Esta investigación pretende investigar si existe una dificultad inherente en la comprensión de las señales de prohibición respecto a las señales de obligación. En este estudio los participantes decidían si las maniobras realizadas por un vehículo esquemático, presentando en una pantalla de ordenador, estaban permitidas o no de acuerdo con las señales mostradas. Se utilizaron diversas escenas, tales como intersección en T. En estas situaciones, una señal de "obligación a la izquierda" indica también que girar a la derecha no está permitido, es decir, es equivalente a la señalización "no girar a la derecha". Ambas señalizaciones aunque diferentes, determinan igualmente que una de las carreteras está "permitida" y la otra no. Sin embargo, los estudios de razonamiento sugieren diferencias comportamentales ante ambas situaciones. Investigaciones previas mostraron ventaja global para las señales de obligación. En este estudio se controló el número de carreteras alternativas referidas por cada tipo de señal, usando distintos tipos de intersecciones de carreteras. En estas condiciones particulares, los resultados no mostraron ventaja global para las señales de obligación o prohibición, sino que dependió de la maniobra. Las respuestas más rápidas se dieron con maniobra permitida ante señales de obligación y con maniobra no permitida ante señales de prohibición. Estos resultados, usando situaciones esquemáticas, son consistentes con las predicciones de teorías como la de los modelos mentales sobre razonamiento con proposiciones deónticas(AU)

The aim of this research was to test whether there is an inherent difficulty in understanding prohibition signs rather than obligation signs. In the experiment conducted, participants decided whether simple car movements presented on a computer screen were allowed or not according to either obligation or prohibition traffic signs. The information provided by obligation and prohibition signs at a T-junction can be understood as messages in the form: A "mandatory left turn" sign indicates that turning right is not allowed, the same as a "no right turn" sign. Both statements mark each of the relevant roads as "allowed" and "not-allowed" in exactly the same way. However, reasoning studies suggest dramatic differences in behaviour. Previous research showed a general advantage for obligation signs. In this study, the number of alternative roads indicated by these two kinds of traffic sign was controlled using different crossroad junctions. In those particular conditions, our results showed that there is no overall advantage for either obligation or prohibition signs. It depends on the manoeuvre performed by the vehicle. Obligation signs produce faster responses when the manoeuvre is allowed, whereas prohibition signs show faster reaction times when the manoeuvre is not allowed. Those results obtained with diagrammatic information are consistent with some cognitive theories, such as the mental model theory about reasoning with deontic propositions(AU)

Test de toxicidad sobre la especie Atriplex lampa, su aplicación para la evaluación de riesgo asociado a derrames de petróleo en suelos de la Patagonia / The application of toxicity test on the specie Atriplex lampa in the risk assessment of oil spills in Patagonian soils

Se estudiaron suelos contaminados con hidrocarburos del petróleo, en cercanías de la ciudad de Comodoro Rivadavia (Chubut, Argentina). Además de cuantificar el contenido de hidrocarburos totales en suelo (TPH), se realizaron bioensayos, utilizando especies vegetales como organismos de prueba. Los índices utilizados fueron: el porcentaje de germinación (G), la elongación de la radícula (R) y del hipocotilo (H) en Lactuca sativa L y dos especies autóctonas de la región patagónica, Atriplex lampa y Prosopis denudans. Se consideró, además, el efecto de la salinidad sobre los bioensayos, en base a la medición de la conductividad eléctrica del suelo (CE). Los resultados obtenidos del análisis por componentes principales, muestran que la primera componente explica el 58,3 % de la variabilidad total con un gradiente de toxicidad al cual contribuyen, principalmente, el porcentaje de germinación de Lactuca sativa L (GL) y Atriplex lampa (GA), en este orden de significancia. La segunda componente explica el 16,9 % y la misma está caracterizada por TPH y CE. Además, no se ha encontrado una correlación simple y directa entre TPH y toxicidad, lo cual sugiere que TPH, en conjunción con ensayos ecotóxicos, parece ser una herramienta más adecuada para definir el punto final de una remediación. La especie autóctona Atriplex lampa mostró tener una sensibilidad similar a la especie Lactuca sativa L por lo que podría considerarse su utilidad como una especie fitoindicadora en las evaluaciones de riesgo ambiental (AU)

Oil spills near of the Comodoro Rivadavia city (Chubut, Argentina) were studied. Total petroleum hydrocarbon (TPH) is used to characterize the samples and bioassays were carried out using plants as test organisms. The percentage germination (G), the root elongation (R) and the hypocotyls elongation (H) in Lactuca sativa L and two native species to Patagonian region, Atriplex lampa and Prosopis denudans were used as toxicological indexes. It was considered the effect of salinity on the bioassays, based on the measurement of the electrical conductivity of soil (EC). Application of principal component analysis to experimental data showed that the first component accounted for more than 58.3 % of variance. The 1st PC is largely influenced by the germination percentage of Lactuca sativa L (GL) and Atriplex lampa (GA), in that order of significance. The second component accounted 16.9 % of variance. The 2nd PC is largely influenced by TPH and EC. A simple and direct correlation between TPH and toxicity was not found suggesting that TPH in conjunction with ecotoxicity test would be more successfully tool to define the end point of a remediation. The native specie Atriplex lampa showed to have a similar sensibility to the Lactuca sativa L suggesting that it could be used as a phytoindicator in assessement of environmental risk (AU)

Vigilancia de tuberculosis en el Servicio de Salud Viña del Mar-Quillota entre los años 1999-2008: estudio longitudinal de tendencia / Surveillance of Tuberculosis in Health Service of Viña del Mar-Quillota, Chile from 1999 to 2008

Trend in Tuberculosis (TB) rates and association of factors affecting the outcome of this disease were assessed in the Health Service of Viña del Mar-Quillota, Chile from 1999 to 2008. Study of 1291 TB patients by the years 1999 to 2008. We evaluated incidence and mortality rate per 100,000 inhabitants, pulmonary / extrapulmonary ratio, presence of HIV, death and site of infection. It was found a decreasing trend in the incidence rate (p < 0.001 R² = 0.97) and association between the presence of HIV and case fatality rate (p < 0.001). It was not found association between site of disease and mortality rate (p = 0.3) nor a decreasing trend in mortality (p = 0.116) and pulmonary/extrapulmonary ratio (p = 0.194). There is a decreasing trend in the incidence rate of TB patients which reflects a well-functioning system of control and surveillance; the presence of HIV is associated with death because of this it should be considered in clinical management of TB.

Se evalúa la tendencia de las tasas de incidencia de tuberculosis (TBC) y de factores asociados al desenlace de esta enfermedad, en el Servicio de Salud Viña del Mar-Quillota durante los años 1999 2008. Estudio de 1.291 pacientes con TBC entre los años 1999-2008. Se evalúa tasa de incidencia y mortalidad por 100.000 habitantes, razón de casos pulmonares/extrapulmonares, presencia de VIH, tasa de letalidad y localización de la infección. Se observa una tendencia decreciente en la tasa de incidencia (p <0,001; R² = 0,97) y asociación entre presencia de VIH y fallecer (p < 0,001). No se observa asociación entre localización de la enfermedad y fallecimiento (p = 0,3), ni tendencia decreciente en la tasa de mortalidad (p = 0,116) ni en la razón de casos pulmonares/extrapulmonares (p = 0,194). La tendencia decreciente de la tasa de incidencia de TBC refleja un buen funcionamiento del sistema de control y vigilancia. La infección por VIH se asocia con mayor riesgo de muerte por lo que debe considerarse en el enfrentamiento clínico de la TBC.

Síndrome de carcinoide con manifestación inicial a nivel valvular cardíaco: a raíz de un caso clínico / Carcinoid syndrome presenting as valvular diseas: report of one case

Carcinoid syndrome is observed in one third of carcinoid tumors and usually appears when there are liver metastases. One of the main complications of this syndrome is the appearance of tricuspid or pulmonary valvular disease. We report a 56 years old male presenting with malaise and a weight loss of 10 kg. On physical examination, a heart murmur suspicious of a double tricuspid lesion was found. The echocardiogram was suggestive of a carcinoid valvular disease. The abdominal CAT scan showed a small bowel tumor. Urinary 5-hydroxy-indol- acetic acid values were highly elevated. The patient was subjected to excision of the distal ileum, liver metastasectomy and hemicolectomy. The pathological study of the surgical piece confirmed the diagnosis of carcinoid tumor. Two years after surgery, the patient is in stable conditions.

Asociación entre infección por virus de la Hepatitis B y Poliarteritis nodosa / Association between Hepatitis B virus infection and Polyarteritis Nodosa

Introducción: la Poliarteritis nodosa (PAN) se define como una vasculitis necrotizante que compromete a las arterias de mediano calibre, y causa un compromiso sistémico. Existe una asociación entre la PAN y la infección por el virus de la Hepatitis B, en relación principalmente con el depósito de inmunocomplejos virales circulantes. Las manifestaciones clínicas son inespecíficas y requiere un alto índice de sospecha. Se han usado varios regímenes de inmunosupresores (corticoides-ciclofosfamida) plasmaféresis y drogas antivirales, con respuestas variables. Objetivo: presentación de un caso clínico de PAN asociado con infección por virus de Hepatitis B, y revisión de la literatura. Caso clínico: paciente masculino de 40 años, con manifestaciones severas de Poliartritis nodosa, asociado con infección por Hepatitis B. Conclusiones: la PAN es una enfermedad poco frecuente, la asociación con infección por Hepatitis B está bien documentada y las estrategias terapéuticas difieren de las de la PAN clásica. Es una patología potencialmente fatal cuando no se reconoce y trata adecuadamente

Backgraound: Polyarteritis nodosa (PAN) is defined by a necrotizing vasculitis of medium sized arteries that causes a systemic inflammatory disease. There is an association between PAN and hepatitis B virus (HBV) infections, related mostly with viral circulting immune complexes. Clinical manifestations are not specific and require a high index of suspicion. Several immunosuppressive regimens (corticoids-ciclophosphamide), plasmapheresis and antiviral drugs have been used with varying response. Objective: Report of a clinical case of PAN associated with Hepatitis B virus infection and review of the literature. Case-reporte: A 40 year old man with severe manifestations of Polyarteritis nodosa, associated with Hepatitis B infection. Conclusions: PAN is uncommon disease, the association with hepatitis B virus infection is well documented, and the treatment strategies differs from the classic PAN. It is a potentially fatal disease when unrecognized and untreated

The interpretation of indicative and subjunctive concessives.

Using a priming paradigm in the context of a reading comprehension task, the possibilities that people keep in mind in order to understand indicative and subjunctive concessive sentences were examined and compared to those from factual and counterfactual 'if A, not-B' conditionals. The length of time it took people to read conjunctive descriptions (i.e., A and B, A and not-B, not-A and B, not-A and not-B) after they had been primed by the different types of linguistic form was measured. The results suggest that, whereas indicative 'even though' concessives and 'if, not' conditionals are understood by keeping in mind just a single possibility ('A and B' and 'A and not-B', respectively), the initial representations of subjunctive 'even if' concessive-conditionals and 'if, not' counterfactuals are compatible with a multiple-model representation. The implications of these results are discussed within the mental models framework.

Osteomalacia hipofosfatémica secundaria a sarcoma de muslo: caso clínico / Hypophosphatemic osteomalacia secondary to a sarcoma: report of one case

Tumor induced osteomalacia is uncommon and is characterized by an isolated and not PTH dependent reduction in tubular phosphate reabsorption. This alteration is produced by phosphaturic factors, such as fibroblast growth factor-23 (FGF-23) that are secreted by tumors. We report a 41 years old female presenting with joint pain and progressive loss of muscle strength in the lower limbs. Initial laboratory assessment showed hypophosphatemia, elevated alkaline phosphatases, normal intact parathormone levels, low levels of 25 hydroxy vitamin D and an elevated 24 h phosphaturia. Bone mineral density showed spine and femoral neck osteopenia. A positron emission tomography (PET) revealed a right thigh tumor with lung metastases. Its biopsy disclosed a fibrosarcoma. FGF-23 levels, measured by ELISA were markedly elevated. The patient was discharged with palliative measures.