The potential for quality assurance systems to save costs and lives: the case of early infant diagnosis of HIV.

OBJECTIVES: Scaling up of point-of-care testing (POCT) for early infant diagnosis of HIV (EID) could reduce the large gap in infant testing. However, suboptimal POCT EID could have limited impact and potentially high avoidable costs. This study models the cost-effectiveness of a quality assurance system to address testing performance and screening interruptions, due to, for example, supply stockouts, in Kenya, Senegal, South Africa, Uganda and Zimbabwe, with varying HIV epidemics and different health systems. METHODS: We modelled a quality assurance system-raised EID quality from suboptimal levels: that is, from misdiagnosis rates of 5%, 10% and 20% and EID testing interruptions in months, to uninterrupted optimal performance (98.5% sensitivity, 99.9% specificity). For each country, we estimated the 1-year impact and cost-effectiveness (US$/DALY averted) of improved scenarios in averting missed HIV infections and unneeded HIV treatment costs for false-positive diagnoses. RESULTS: The modelled 1-year costs of a national POCT quality assurance system range from US$ 69 359 in South Africa to US$ 334 341 in Zimbabwe. At the country level, quality assurance systems could potentially avert between 36 and 711 missed infections (i.e. false negatives) per year and unneeded treatment costs between US$ 5808 and US$ 739 030. CONCLUSIONS: The model estimates adding effective quality assurance systems are cost-saving in four of the five countries within the first year. Starting EQA requires an initial investment but will provide a positive return on investment within five years by averting the costs of misdiagnoses and would be even more efficient if implemented across multiple applications of POCT.

OBJECTIFS: L'intensification du dépistage au point des soins (DPS) pour le diagnostic précoce du VIH chez le nourrisson (DPVN) pourrait réduire le grand écart dans le dépistage des nourrissons. Cependant, un DPVN DPS sous-optimal pourrait avoir un impact limité et des coûts évitables potentiellement élevés. Cette étude modélise la rentabilité d'un système d'assurance qualité pour traiter les performances des tests et les interruptions de dépistage, dues par exemple à des ruptures de stock, au Kenya, au Sénégal, en Afrique du Sud, en Ouganda et au Zimbabwe, avec des épidémies variables du VIH et des systèmes de santé différents. MÉTHODES: Nous avons modélisé une qualité de DPVN soulevée par le système d'assurance qualité à partir de niveaux sous-optimaux: c'est-à-dire des taux d'erreurs de diagnostic de 5%, 10% et 20% et des interruptions des tests de DPVN en mois, à des performances optimales ininterrompues (sensibilité de 98,5%, spécificité de 99,9%). Pour chaque pays, nous avons estimé l'impact sur un an et la rentabilité (en USD/DALY évitée) de scénarios améliorés pour éviter les infections à VIH manquées et les coûts inutiles de traitement du VIH pour les diagnostics faux positifs. RÉSULTATS: Les coûts modélisés sur un an d'un système national d'assurance qualité DPS vont de 69.359 USD en Afrique du Sud à 334.341 USD au Zimbabwe. Au niveau des pays, les systèmes d'assurance de la qualité pourraient potentiellement éviter entre 36 et 711 infections manquées (c'est-à-dire des faux négatifs) par an et des coûts de traitement inutiles entre 5.808 et 739.030 USD. CONCLUSIONS: Le modèle estime que l'ajout de systèmes d'assurance qualité efficaces permet de réaliser des économies dans quatre des cinq pays au cours de la première année. Le lancement de l'assurance qualité nécessite un investissement initial, mais fournira un retour sur investissement positif dans les cinq ans en évitant les coûts des diagnostics erronés et serait encore plus efficace s'il était mis en œuvre dans plusieurs applications de DPS.

A new combined operative technique using crossed inguinal lymphatic rescue for pediatric patients with mixed lymphatic and venous malformations.

Truncular venous malformations and acquired functional or anatomical venous occlusions (or sub-occlusions) can be the cause of secondary lymphedema and even the cause of primary lymphedema when they are associated with lymphatic malformations (lymphangiodysplasia - LAD I, lymphadenodysplasia - LAD II, or a combination of both) in pediatric patients. This understanding recognizes the shared and successive embryogenesis of both systems. These conditions can exhibit hypertension in the venous pedicles intended for lymph-venous anastomosis, and this finding would be a formal contraindication to the procedure. However, this hypertension is a rarely considered condition and is not commonly identified. As a technique to solve this problem, we have combined Nielubowicz, Olszewski, Campisi, and Palma's proposals and created a lymph-venous anastomosis from the side with lymphedema and venous hypertension (lymphatic donor and venous recipient) with an internal suprapubic saphenous venous bridge (from the normal side to the lymphedematous side with venous hypertension) to enable a crossed inguinal lymphatic/venous rescue. We believe this newly synthesized approach will allow better clinical care of pediatric patients with complex and combined lymphatic-venous malformations and is worthy of further investigation.

Motivations and values associated with combining sex and illicit drugs ('chemsex') among gay men in South London: findings from a qualitative study.

OBJECTIVES: There is considerable public health concern about the combining of sex and illicit drugs (chemsex) among gay men. With a view to inform supportive therapeutic and clinical interventions, we sought to examine the motivations for engaging in chemsex among gay men living in South London. METHODS: Community advertising recruited 30 gay men for qualitative semi-structured interview. Aged between 21 and 53 years, all lived in South London in the boroughs of Lambeth, Southwark and Lewisham and all had combined crystal methamphetamine, mephedrone and/or γ-hydroxybutyric acid/γ-butyrolactone with sex in the past 12 months. Transcripts were subjected to a thematic analysis. RESULTS: We broadly distinguished two groups of reasons for combining sex and drugs, within which we described eight distinct motivations. The first major group of motivations for combining drugs with sex was that drugs provide the means by which men can have the sex they desire by increasing libido, confidence, disinhibition and stamina. The second major group of motivations for chemsex was that drugs enhance the qualities of the sex that men value. Drugs made other men seem more attractive, increased physical sensations, intensified perceptions of intimacy and facilitated a sense of sexual adventure. CONCLUSION: Analysis revealed that sexualised drug use provides both motivation and capability to engage in the kinds of sex that some gay men value: sex that explores and celebrates adventurism. Those services providing (talking) interventions to men engaging in chemsex should consider these benefits of sexualised drug use alongside the harms arising.

Illicit drug use in sexual settings ('chemsex') and HIV/STI transmission risk behaviour among gay men in South London: findings from a qualitative study.

BACKGROUND: 'Chemsex' is a colloquial term used in the UK that describes sex under the influence of psychoactive substances (typically crystal methamphetamine, mephedrone and gamma-hydroxybutyric acid (GHB)/gamma-butyrolactone (GBL)). Recently, concern has been raised as to the impact of such behaviour on HIV/sexually transmitted infection (STI) transmission risk behaviour, which this qualitative study aimed to explore via semistructured interviews with gay men living in three South London boroughs. METHODS: Interviews were conducted with 30 community-recruited gay men (age range 21-53) who lived in the boroughs of Lambeth, Southwark and Lewisham, and who had used crystal methamphetamine, mephedrone or GHB/GBL either immediately before or during sex with another man during the previous 12 months. Data were subjected to a thematic analysis. RESULTS: Chemsex typically featured more partners and a longer duration than other forms of sex, and the relationship between drug use and HIV/STI transmission risk behaviour was varied. While some men believed that engaging in chemsex had unwittingly led them to take risks, others maintained strict personal rules about having safer sex. Among many participants with diagnosed HIV, there was little evidence that the use of drugs had significantly influenced their engagement in condomless anal intercourse (primarily with other men believed to be HIV positive), but their use had facilitated sex with more men and for longer. CONCLUSIONS: Analysis revealed that, within this sample, chemsex is never less risky than sex without drugs, and is sometimes more so. Targeted clinic-based and community-based harm reduction and sexual health interventions are required to address the prevention needs of gay men combining psychoactive substances with sex.

Endothelial function in hypertensive obese patients: 1 year after surgically induced weight loss.

The aim of this study was to describe the effect of surgically induced weight loss on vascular function measured by flow-mediated dilatation (FMD) in hypertensive obese patients. This prospective study included 33 patients (78 % females, mean age 53 (9) years) undergoing bariatric surgery (BS). Before and 12 months postoperatively, the BMI, 24-h ambulatory BP, high-sensitivity C-reactive protein (hs-CRP), leptin, homeostasis model assessment (HOMA IR), and abdominal fat were measured. Endothelial function was assessed by FMD. After BS, the excess body weight loss was 71 %; the 24-h [systolic 18(11)//diastolic 7(7) mmHg] BP values, hs-CRP, leptin, HOMA, and abdominal fat significantly decreased, with no changes in endothelial function. Weight loss achieved by BS was associated with a significant improvement in BP and metabolic and inflammation parameters, but FMD did not improve.

[Forced spirometry in healthy preschool children]. / Espirometría forzada en preescolares sanos bajo las recomendaciones de la ATS/ERS: estudio CANDELA.

INTRODUCTION: Reference values for spirometry in healthy preschool children have not yet been obtained in accordance with American Thoracic Society (ATS) and the European Respiratory Society (ERS) guidelines. The objective was to establish reference values for spirometry in healthy preschoolers under the ATS/ERS 2007 statement. MATERIAL AND METHOD: Children of at least 2 and under 7 years of age were tested in 9 pediatric pulmonary function laboratories. The technicians were trained to apply a standardized protocol to perform spirometry. RESULTS: Valid spirometry results were obtained in 455 (81.54%) out of 558 children: 242 boys (53.2%) and 213 girls (46.8%). Ages were as follows: 31 at least 2 and under 3 years old; 96, at least 3 and under 4; 108, at least 4 and under 5; 122, at least 5 and under 6 years, and 98, at least 6 and under 7 years. Formulas were used to calculate the reference values for all the spirometry variables in preschoolers. CONCLUSIONS: Spirometry is feasible in the majority of preschool children under the new guidelines. The availability of the reference values presented is an important step, both for the care of preschoolers and for further research on pulmonary function.

Health inequalities among the elderly in western Europe.

BACKGROUND: This paper analyses gender inequalities in health status and in social determinants of health among the elderly in western Europe. METHODS: Data came from the first wave of the "Survey of Health, Ageing and Retirement in Europe" (2004). For the purposes of this study a subsample of community-residing people aged 65-85 years with no paid work was selected (4218 men and 5007 women). Multiple logistic regression models separated by sex and adjusted for age and country were fitted. RESULTS: Women were more likely to report poor health status, limitations in mobility and poor mental health. Whereas in both sexes educational attainment was associated with the three health indicators, household income was only related to poor self-rated health among women. The relationship between living arrangements and health differed by gender and was primarily associated with poor mental health. In both sexes, not living with their partner but living with other people and being the household head was related to poor mental health status (adjusted odds ratio (aOR) 2.14; 95% CI 1.11 to 4.14 for men and aOR 1.75; 95% CI 1.12 to 2.72 for women). In addition, women living with their partner and other(s) and those living alone were more likely to report poor mental health status (aOR 1.67; 95% CI 1.17 to 2.41 and aOR 1.58; 95% CI 1.26 to 1.97, respectively). CONCLUSIONS: Health inequalities persist among the elderly. Women have poorer health status than men and in both sexes the risk of poor health status increases among those with low educational attainment. Living arrangements are primarily associated with poor mental health status with patterns that differ by gender.

Valoración del sistema telemático Medical Guard Diabetes® en pacientes con diabetes tipo 1 / Evaluation of the telematic system Medical Guard Diabetes™ in patients with type 1 diabetes

El control de la diabetes tipo 1 requiere la interacción entre lospacientes y el equipo de salud. En esta línea, los sistemas telemáticospodrían ser de utilidad. El objetivo de este trabajo fue evaluarla eficacia y seguridad del sistema telemático Medical Guard Diabetes® (MGD), que fue modificado para poder enviar glucemias yotros datos. Se incluyeron 20 pacientes con diabetes tipo 1 y malcontrol metabólico, que fueron aleatorizados a control presencialmensual (CP) o envío de información (glucemias, dosis de insulina,raciones de carbohidratos) con MGD (MG) y respuesta mensualmediante SMS (short message system). La intervención duró 6meses. Se evaluaron la hemoglobina glucosilada (HbA1c), el númerode hipoglucemias, los conocimientos sobre la diabetes, la calidadde vida y el coste de la intervención. Las características basalesde ambos grupos fueron similares. Un paciente del grupo MGabandonó el estudio. Sólo los pacientes del grupo MG presentaronuna disminución significativa en el número de hipoglucemias alfinal del estudio respecto del inicio (p= 0,027). En el grupo CP, lavariación de la HbA1c durante el seguimiento fue del –0,66% (p=0,102), y en el grupo MG fue del 0,16% (p= 0,666). En ambosgrupos se observó una mejoría en los test de conocimientos (CP:p= 0,025; MG: p= 0,023) al final de la intervención. No hubodiferencias en los tests de calidad de vida. La duración de las visitasfue menor en el grupo MG (p= 0,025), al igual que los costes totalesde la intervención (CP= 119,20 euros frente a MG= 82,70euros). En conclusión, el sistema MGD es eficaz y seguro para elenvío de datos, y la visita telemática resulta menos costosa que lasconvencionales

The control of type 1 diabetes requires interaction between patientsand the healthcare team. To achieve this, telematic systemsmay be useful. The aim of this study was to assess the efficacy andsafety of the telematic system Medical Guard Diabetes® (MGD),which was modified for sending glycaemia and other data. In thisstudy, 20 type 1 diabetic patients with poor metabolic control wererandomized to either carry out hospital appointments (CP) or tosend information (glycaemia, insulin, carbohydrate intake) with theMGD (MG) and monthly contact by SMS. The study period was 6months evaluating HbA1c, number of hypoglycaemias, patientknowledge on diabetes, quality of life and costs. Both groups werecomparable at baseline. One patient in the MG group left the study.On comparing basal and final values only the MG group showed asignificant decrease in the number of hypoglycaemias (p= 0.027).During the follow-up, the change in HbA1c was –0.66% (p= 0.102)in the CP group and 0.16% (p= 0.666) in the MG group. Bothgroups showed an improvement in the knowledge test at the endof study (CP: p= 0.025; MG: p= 0.023). There was no significantdifference in the quality of life tests. The length of the visits wasshorter in the MG group (p= 0.025) as was the intervention totalcost (CP=119.20 € vs. MG= 82.70 €). In conclusion, the MGDsystem is effective and safe for sending information and thetelematic appointment is less expensive than hospital appointments

Tratamiento de la nefropatía diabética / Treatment of diabetic neuropathy

La nefropatía diabética es una complicación muy prevalente de la diabetes. Su abordaje exige un diagnóstico temprano, así como la reducción del impacto de los factores de riesgo implicados en su aparición y progresión: hiperglucemia, hipertensión, dislipemiay tabaquismo. Los objetivos que se deben conseguir son hemoglobina glucosilada < 7%, presión arterial < 130/80 mmHg, lipoproteínas de baja densidad < 100 mg/dl y abstinencia tabáquica. El abordaje de la hipertensión arterial exige el bloqueo del sistema renina-angiotensina, y el de la insuficiencia renal debe ser multidisciplinario y efectuarse de forma planificada, especialmente cuando se llega a la etapa terminal. En la actualidad se están estudiando diversas opciones terapéuticas, entre las que destacan la inhibición de la formación de productos avanzados de la glucosilación, el bloqueo de la proteincinasa Cy el uso de glucosaminoglucanos (AU)

Diabetic nephropathy is a highly prevalent complication of diabetes, requiring early diagnosis and reduction of the impact of the risk factors involved in its pathogenesis and progression: hyperglycemia, hypertension, dyslipidemia and smoking. The targets areHbA1c < 7%, blood pressure < 130/80 mmHg,LDL-cholesterol < 100 mg/dl, and smoking cessation. Blood pressure control impliesrenin-angiotensin system blockade. A multidisciplinary and planned approach is mandatory in renal failure, especially in end stage disease. Currently, several therapeutic options are being investigated, most importantly those involving inhibition of advanced glycosylated end products, proteinkinase C blockade, and the use of glycosaminoglycans (AU)

Opresión cervical anterior como síntoma inicial en un caso de siringomielia / Anterior cervical pressure as an initial symptom in a Syringomyelia case

Presentamos el caso de una mujer joven que consulta por opresión cervical anterior como síntoma inicial. Tras persistencia de sintomatología y una exploración neurológica que muestra alteración de la sensibilidad térmica en el miembro superior derecho, se le realiza una resonancia magnética nuclear cráneo-cervical y se diagnostica una malformación de Arnold-Chiari con siringomielia cervical asociada. La paciente es intervenida y posteriormente dada de alta hospitalaria con control ambulatorio

We present the case of a young woman who consulted due to anterior cervical pressure. Due to persistence of the symptoms and after a neurological examination that showed thermal sensitivity alteration in the right arm, a cranial-cervical magnetic nuclear resonance was performed, diagnosing Arnold-Chiari's malformation with associated cervical syringomyelia. The patient was operated on and then discharged to out-patient care

Patient support and education for promoting adherence to highly active antiretroviral therapy for HIV/AIDS.

BACKGROUND: Adherence to prescribed regimens is required to derive maximal benefit from many highly active antiretroviral therapy (HAART) regimens in people living with HIV/AIDS. OBJECTIVES: To conduct a systematic review of the research literature on the effectiveness of patient support and education to improve adherence to HAART. SEARCH STRATEGY: A systematic search of electronic databases was performed from January 1996 to May 2005. SELECTION CRITERIA: Randomized controlled trials examining the effectiveness of patient support and education to improve adherence to HAART were considered for inclusion. Only those studies that measured adherence at a minimum of six weeks were included. DATA COLLECTION AND ANALYSIS: Study selection, quality assessments and data abstraction were performed independently by two reviewers. MAIN RESULTS: Nineteen studies involving a total of 2,159 participants met criteria for inclusion. It was not possible to conduct a meta-analysis due to study heterogeneity with respect to populations, interventions, comparison groups, outcomes, and length of follow-up. Sample sizes ranged from 22 to 367. The populations studied ranged from general HIV-positive populations to studies focusing exclusively on children, women, Latinos, or adults with a history of alcohol dependence, to studies focusing almost exclusively on men. Study interventions included cognitive behavioral therapy, motivational interviewing, medication management strategies, and interventions indirectly targeting adherence, such as programs directed to reduce risky sexual behaviours. Ten studies demonstrated a beneficial effect of the intervention on adherence. We found that interventions targeting practical medication management skills, those administered to individuals vs groups, and those interventions delivered over 12 weeks or more were associated with improved adherence outcomes. We also found that interventions targeting marginalized populations such as women, Latinos, or patients with a past history of alcoholism were not successful at improving adherence. We were unable to determine whether effective adherence interventions were associated with improved virological or immunological outcomes. Most studies had several methodological shortcomings leaving them vulnerable to potential biases. AUTHORS' CONCLUSIONS: We found evidence to support the effectiveness of patient support and education interventions intended to improve adherence to antiretroviral therapy. Interventions targeting practical medication management skills, those interventions administered to individuals vs groups, and those interventions delivered over 12 weeks or more were associated with improved adherence outcomes. There is a need for standardization and increased methodological rigour in the conduct of adherence trials.

Infusión subcutánea continua de insulina y diabetes tipo 2 / Continuous subcutaneous insulin infusion and type 2 diabetes

El tratamiento mediante bomba o infusión subcutánea continua de insulina (ISCI) representa hoy en día una alternativa terapéutica en aquellos pacientes con diabetes tipo 1 en los que el tratamiento convencional intensivo con múltiples dosis de insulina se muestra ineficaz. Aunque es de suponer que los beneficios del tratamiento con ISCI, tales como la obtención de un perfil glucémico menos variable y una adaptación más flexible al estilo de vida, deberían ser similares en pacientes con diabetes tipo 1 y tipo 2, la información referente al uso de la ISCI en estos últimos es muy escasa. En este artículo, revisamos la información disponible sobre el uso de ISCI en pacientes con diabetes tipo 2 y su posible indicación y aplicación clínica en el futuro

Insulin pump therapy or continuous subcutaneous insulin infusion (CSII) has become an increasingly popular mode of insulin therapy for patients with type 1 diabetes mellitus. It is now considered as an alternative to conventional multiple doses insulin therapy after the failure of the last one. Although the benefits of therapy with CSII, such as less glycaemic variability and a more flexible lifestyle, should be similar for patients with type 1 and type 2 diabetes, data on the use of CSII in patients with type 2 diabetes are scarce and limited. In this article, we review the available information concerning the use of CSII, as well as the clinical situations where it may be considered as a treatment in the future, in subjects with type 2 diabetes mellitus

Favismo en un niño de 2 años y medio de edad / Favism in a two-and-a-half-year-old boy

El déficit de glucosa 6-fosfato deshidrogenasa (G6PD) es la enfermedad más importante de la vía de derivación de las pentosas y puede ser responsable de una anemia hemolítica inducida por fármacos oxidantes o por ciertas infecciones. El déficit de G6PD es frecuente en grupos étnicos afroamericanos y de la cuenca del mediterráneo. Presentamos el caso de un niño de 2 años y medio de edad de origen sirio que tras haber comido habas, presentó un cuadro de anemia hemolítica grave con 2,6 g de hemoglobina y hematócrito del 6,8 por ciento, que precisó tratamiento con un concentrado de hematíes (AU)

Penetration of diltiazem into breast milk and its pharmacokinetics in the lactating rabbit.

1. The aim was to investigate the milk transfer and pharmacokinetics of diltiazem (DTZ) in the lactating rabbit following DTZ intravenous (i.v.) administration. In addition, DTZ metabolism in mammary tissue and milk was also studied. 2. The pharmacokinetic parameters that largely determine drug disposition (AUC, VD, CL) showed no significant differences between the non-lactating and lactating rabbit. 3. When DTZ was administered to the lactating rabbit, the observed DTZ milk-to-blood AUC ratio (M/B) closely correlated with the calculated ratio, as predicted by a diffusional model, suggesting that DTZ passes into milk via non-ionic diffusion and that other factors which may affect the milk transfer seem to have limited relevance. 4. After a single intravenous dose of DTZ to the lactating rabbit, deacetyldiltiazem (M1) and demethyldiltiazem (MA) were observed in blood, but only M1 could be detected in milk. 5. In conclusion, DTZ seems to diffuse freely into milk after its i.v. administration to the lactating rabbit and should not be given to nursing mammals because of the potential risk for their young. This risk may be even higher because of the presence of M1 (a pharmacologically active metabolite) in milk after administration of the parent drug.

Escherichia coli FtsZ polymers contain mostly GTP and have a high nucleotide turnover.

The cell division protein FtsZ is a GTPase structurally related to tubulin and, like tubulin, it assembles in vitro into filaments, sheets and other structures. To study the roles that GTP binding and hydrolysis play in the dynamics of FtsZ polymerization, the nucleotide contents of FtsZ were measured under different polymerizing conditions using a nitrocellulose filter-binding assay, whereas polymerization of the protein was followed in parallel by light scattering. Unpolymerized FtsZ bound 1 mol of GTP mol(-1) protein monomer. At pH 7.5 and in the presence of Mg(2+) and K(+), there was a strong GTPase activity; most of the bound nucleotide was GTP during the first few minutes but, later, the amount of GTP decreased in parallel with depolymerization, whereas the total nucleotide contents remained invariant. These results show that the long FtsZ polymers formed in solution contain mostly GTP. Incorporation of nucleotides into the protein was very fast either when the label was introduced at the onset of the reaction or subsequently during polymerization. Molecular modelling of an FtsZ dimer showed the presence of a cleft between the two subunits maintaining the nucleotide binding site open to the medium. These results show that the FtsZ polymers are highly dynamic structures that quickly exchange the bound nucleotide, and this exchange can occur in all the subunits.

Role of the carboxy terminus of Escherichia coli FtsA in self-interaction and cell division.

The role of the carboxy terminus of the Escherichia coli cell division protein FtsA in bacterial division has been studied by making a series of short sequential deletions spanning from residue 394 to 420. Deletions as short as 5 residues destroy the biological function of the protein. Residue W415 is essential for the localization of the protein into septal rings. Overexpression of the ftsA alleles harboring these deletions caused a coiled cell phenotype previously described for another carboxy-terminal mutation (Gayda et al., J. Bacteriol. 174:5362-5370, 1992), suggesting that an interaction of FtsA with itself might play a role in its function. The existence of such an interaction was demonstrated using the yeast two-hybrid system and a protein overlay assay. Even these short deletions are sufficient for impairing the interaction of the truncated FtsA forms with the wild-type protein in the yeast two-hybrid system. The existence of additional interactions between FtsA molecules, involving other domains, can be postulated from the interaction properties shown by the FtsA deletion mutant forms, because although unable to interact with the wild-type and with FtsADelta1, they can interact with themselves and cross-interact with each other. The secondary structures of an extensive deletion, FtsADelta27, and the wild-type protein are indistinguishable when analyzed by Fourier transform infrared spectroscopy, and moreover, FtsADelta27 retains the ability to bind ATP. These results indicate that deletion of the carboxy-terminal 27 residues does not alter substantially the structure of the protein and suggest that the loss of biological function of the carboxy-terminal deletion mutants might be related to the modification of their interacting properties.

Neumopatía en pacientes intervenidos de atresia de esófago tipo III / Pulmonary dysfunction in esophageal atresia witii tracheoesophageal fistula

Los pacientes intervenidos de atresia de esófago (AE) y fístula traqueoesofágica presentan una difícil infancia debido a las complicaciones respiratorias que se han asociado a la dislnotilidad esofágica, al reflujo gastroesofágico (RGE) y a la disfunción pulmonar. Material y Inétodos. Diez pacientes intervenidos de AE tipo 111 fueron evaluados según un protocolo consistente en: I. Revisión de la historia clínica. 2. Entrevista que valoró la evolución digestiva y respiratoria anual durante los tres primeros años. 3. Actualización del estudio digestivo. 4. Pruebas de función pulmonar (PFP) (espirometría basal). 5. Situación clínica actual. Resultados. El tiempo medio de seguimiento ha sido (le 7,3 ñ 4,45 años con un rango de 8 meses a 15 años. Durante el primer año, 7 de los 10 pacientes (70 por ciento) presentaron episodios de dificultad respiratoria con fatiga y/o sibilancias. Se evidenció RGE en tres pacientes precisando fundoplicatura de Nissen uno de ellos por esofagitis severa. La espirometría realizada a los pacientes por encima de los 4 años de vida (6 pacientes) mostró en la mitad de ellos una disminución de la capacidad vital forzada (FVC) (< 80 por ciento) en relación al volumen espiratorio forzado en el primer minuto (FEV 1), correspondiéndose con la existencia de un patrón pulmonar restrictivo. Conclusión. Los episodios de dificultad respiratoria en estos niños son muy frecuentes durante el primer año (70 por ciento en nuestra serie); sin embargo, sólo en un 25 por ciento tienen una clara relación con la existencia de RGE. La evaluación neumológica nos ayuda a conocer mejor el pronóstico de esta malformación, ya que estas neumopatías pueden ser tratadas precozmente y con otro fundamento fisiopatológico (AU)

Development of a method for the determination of danofloxacin in plasma by HPLC with fluorescence detection.

A simple and sensitive HPLC method has been developed for the determination of danofloxacin (DAN) in plasma. Sample preparations were carried out by adding phosphate buffer (pH 7.4, 0.1 M), followed by extraction with trichloromethane. DAN and the internal standard, sarafloxacin (SAR), were separated on a reversed-phase column, and eluted with aqueous solution-acetonitrile (80:20 v/v). The fluorescence of the column effluent was monitored at lambda(ex) = 338 and lambda(em) = 425 nm. The retention times were 2.80 and 4. 40 min for DAN and SAR, respectively. The method was shown to be linear from 1 to 1500 ng/mL (r(2) = 0.999). The detection and quantitation limit were 1 and 5 ng/mL, respectively. Mean recovery was determined as 80% by the analysis of plasma standards containing 150, 750 and 1500 ng/mL. Inter- and intra-assay precisions were 4.0% and 2.4%, respectively.

Pharmacokinetics of verapamil in lactating rabbits. Prediction of verapamil distribution into rabbit milk.

In this work, we have studied the pharmacokinetics and milk penetration of verapamil following intravenous administration in lactating rabbits. Milk-to-serum drug concentration ratios (M/B(obs)) have been determined using area under the milk and serum concentration-time profiles, and the resulting values have then been compared with those obtained by theoretical classical diffusion milk transfer models that were described by Fleishaker et al. [J. Pharm. Sci. 76 (1987) 189.], Atkinson and Begg [Br. J. Clin. Pharmacol. 25 (1990) 495.], and Stebler and Guentert [Pharm. Res. 9 (1992) 1299.]. The pharmacokinetic profile of verapamil in lactating rabbits following endovenous administration is described in the form of a two-compartment model. Moreover, we detected an important milk transfer after endovenous administration of verapamil in lactating rabbits. M/B(obs) was near 15. The classical diffusional models mentioned were not able to predict this extensive transfer of verapamil into rabbit milk. However, when the classical Fleishaker equation was modified and a stepwise regression was carried out, we found that the M/B(obs) value could be predicted using the plasma and milk protein binding.

[Pneumopathy in patients surgically treated for type III esophageal atresia]. / Neumopatía en pacientes intervenidos de atresia de esófago tipo III.

UNLABELLED: Patients following esophageal atresia with tracheoesophageal fistula (EA-TEF) treatment have several long-term respiratory complications during infancy. They are associated with esophageal dismotility and gastroesophageal reflux (GER) as well as lung dysplasia. MATERIAL AND METHODS: Ten patients were evaluated as follow: 1. Review of medical record. 2. An annual interview was performed concerning respiratory and digestive symptoms. 3. Phmetric score and radiologic studies of the digestive tract. 4. Functional respiratory test. 5. Update symptoms. RESULTS: Mean follow-up was 7.3 +/- 4.45 years (8 months-15 years). Seven cases (70%) had respiratory distress during the first postoperative year. Two of them had middle GER, performing a Nissen procedure in another patient with severe GER. Spirometry was underwent in 6 cases, showing a restrictive pattern in three. CONCLUSION: Respiratory distress were common during the first postoperative year (70% of cases in our serie) but only 25% were GER related. Pulmonary function test can be performed in long-term evolution of patients following operation for EA-TEF in order to have early treatment for respiratory complications.