Strong hydroclimatic controls on vulnerability to subsurface nitrate contamination across Europe.

Subsurface contamination due to excessive nutrient surpluses is a persistent and widespread problem in agricultural areas across Europe. The vulnerability of a particular location to pollution from reactive solutes, such as nitrate, is determined by the interplay between hydrologic transport and biogeochemical transformations. Current studies on the controls of subsurface vulnerability do not consider the transient behaviour of transport dynamics in the root zone. Here, using state-of-the-art hydrologic simulations driven by observed hydroclimatic forcing, we demonstrate the strong spatiotemporal heterogeneity of hydrologic transport dynamics and reveal that these dynamics are primarily controlled by the hydroclimatic gradient of the aridity index across Europe. Contrasting the space-time dynamics of transport times with reactive timescales of denitrification in soil indicate that ~75% of the cultivated areas across Europe are potentially vulnerable to nitrate leaching for at least one-third of the year. We find that neglecting the transient nature of transport and reaction timescale results in a great underestimation of the extent of vulnerable regions by almost 50%. Therefore, future vulnerability and risk assessment studies must account for the transient behaviour of transport and biogeochemical transformation processes.

Informe especial: Transmisión vertical de Chagas: situación epidemiológica de Chagas en embarazo y Chagas congénito en la maternidad Sardá: Primer semestre de 2018 / Special report: Vertical transmission of Chagas: epidemiological situation of Chagas in pregnancy and congenital Chagas in Sardá Maternity: first semester of 2018

Hasta la Semana Epidemiológica 36 de 2018 se notificaron en la Ciudad de Buenos Aires 104 casos de Chagas congénito, de los cuales se confirmaron 6 (5,8%), se descartaron 6 y el 88% restante aún no cuenta con el cierre de caso. Las comunas del sur de la Ciudad acumulan el 56% de los casos. Durante el primer semestre de 2018 se diagnosticaron en la Maternidad Sardá 67 mujeres con Chagas en el embarazo, de un total de 2972 partos realizados en la institución en ese periodo, lo que representa una prevalencia de 22,54 por cada mil embarazadas En este informe se busca describir la situación de la transmisión vertical de la enfermedad de Chagas en el primer semestre de 2018, entre SE 1 y 26; describir la modalidad de notificación de los casos por la Unidad de Promoción y Protección de la Salud (P y P); y reforzar la importancia de la notificación de Enfermedades de Notificación Obligatoria debido a su relevancia en la Salud Pública. Se presentan los casos de Chagas en embarazo por grupo etario, y según provincia de residencia, y se detallan propuestas para la optimización de resultados.

Integrated Care Models for Managing and Preventing Frailty: A Systematic Review for the European Joint Action on Frailty Prevention (ADVANTAGE JA).

Frailty requires concerted integrated approaches to prevent functional decline. Although there is evidence that integrating care is effective for older people, there is insufficient data on outcomes from studies implementing integrated care to prevent and manage frailty. We systematically searched PubMed and Cochrane Library database for peer-reviewed medical literature on models of care for frailty, published from 2002 to 2017. We considered the effective and transferable components of the models of care and evidence of economic impact, where available. Information on European Union-funded projects or those registered with the European Innovation Partnership on Active and Healthy Ageing, and grey literature (including good practices) were also considered. We found 1,065 potential citations and 170 relevant abstracts. After excluding reports on specific diseases, processes or interventions and service models that did not report data, 42 full papers met the inclusion criteria. The evidence showed that few models of integrated care were specifically designed to prevent and tackle frailty in the community and at the interface between primary and secondary (hospital) care. Current evidence supports the case for a more holistic and salutogenic response to frailty, blending a chronic care approach with education, enablement and rehabilitation to optimise function, particularly at times of a sudden deterioration in health, or when transitioning between home, hospital or care home. In all care settings, these approaches should be supported by comprehensive assessment and multidimensional interventions tailored to modifiable physical, psychological, cognitive and social factors.

Schizotypal traits and cognitive performance in siblings of patients with psychosis.

INTRODUCTION: Schizotypy has been proposed to be the expression of genetic vulnerability to schizophrenia. The available literature shows cognitive similarities between schizotypy and schizophrenia, with mildly impaired performance being associated with schizotypy. This study aims to determine the relationship between schizotypy and cognitive performance in siblings of patients with psychosis. METHODS: Schizotypal features and cognitive performance on a neuropsychological battery were compared between 48 siblings of patients with psychosis and 44 healthy controls. The relationships between schizotypy and cognitive performance were analysed by controlling the condition of being a sibling. RESULTS: Siblings showed poorer performance on vigilance/sustained attention (M = 37.6; SD = 7.1) and selective attention/interference control/working memory (M = 23.28; SD = 2.7) tasks. The variance in vigilance/sustained attention performance was explained, at 30%, by the interpersonal factor of schizotypy on the suspiciousness dimension and the condition of being a sibling. CONCLUSIONS: Interpersonal features of schizotypy in siblings of patients with psychosis are associated with deficits in vigilance/sustained attention performance.

Impacto de la Atención Farmacéutica en la calidad de vida de pacientes con Diabetes Mellitus Tipo 2 / Impact of pharmaceutical care in clinical outcomes and quality of life of patients with type 2 diabetes mellitus

Introducción: La calidad de vida relacionada a la salud, agrupa elementos propios del individuo y otros externos al mismo, pero que interaccionan con él y pueden llegar a cambiar su estado de salud. Abarca áreas de función física, somática, estado psicológico y relación social. Objetivo: Evaluar los parámetros clínicos y la calidad de vida de pacientes con Diabetes Mellitus Tipo 2, que forman parte de un programa de Atención Farmacéutica. Metodología: Ensayo Clínico Aleatorizado, con medición de variables antes y después. No probabilístico. De conveniencia. Participaron 32 pacientes del grupo intervenido y 32 en grupo control. Se realizaron entrevistas mensuales durante 6 meses (desde octubre 2011 hasta junio 2012). Resultados: La edad promedio de los pacientes fue 55,6±10,6 años. En su mayoría mujeres. La evolución de la enfermedad fue 8,96±8,13 años. La patología asociada más frecuente fue en 82% hipertensión arterial. Los pacientes intervenidos mejoraron la glicemia en 35% donde 24 pacientes tenían el valor (≤ 130 mg/dL); la hemoglobina glicosilada mejoró 22% donde 15 pacientes lograron los parámetros deseados (≤ 6,5%). La calidad de vida del grupo intervenido aumento de (56,3 a 71,3 %), mejorando en todas las dimensiones y registrando una disminución en dolor corporal del grupo intervenido, en cambio en el grupo control disminuyó de (57,4 a 46,1 %), registrándose un aumento en la dimensión de dolor corporal. Conclusión: Los parámetros clínicos y la Calidad de vida del paciente diabético se ve influenciada positivamente por la intervención del farmacéutico en Atención Farmacéutica

Introduction: The relationship between quality of life and health combines elements intrinsic of the individual as well as external ones that interact with him. They possess the ability of changing the state of health. It includes such areas as physical, somatic, psychological and social. Objective: To evaluate the clinical parameters and quality of life of patients with Type 2 Diabetes Mellitus, within a program of Pharmaceutical Care. Methodology: Randomized Clinical Trial with measurement of variables before and after the evaluation. Non probabilistic. Convenience. 32 patients participated in the intervention group; 32 in the control group. Monthly interviews were conducted for 6 months, from October 2011 to June 2012. Results: The average age of the patients was 55,6±10,6 years. They were mostly women. The evolution of the condition was 8,96±8,13 years. The most frequent associated pathology was high blood pressure in 82% of them. The glycemia levels of the patients improved 35%, where 24 of the patients showed an index ≤ 130 mg/dL; glycosylated hemoglobin level improved 22%, where 15 patients achieved desired parameters (≤ 6,5%). The quality of life of the intervened group improved from 56.3 % to 71.3% in all dimensions showing a decrease in body pain for the intervened group. Body pain levels for the control group decreased from 57.4 to 46.1 % showing an increase in the body pain dimension. Conclusion: Clinical parameters and quality of life of diabetic patients is positively influenced by the intervention of the pharmacist in pharmaceutical care

Management of liver transplantation waiting list for decompensated cirrhosis in a Spanish tertiary hospital: differences between hepatitis C virus recipients and other etiologies.

BACKGROUND: Decompensated cirrhosis due to hepatitis C virus (HCV) is one of the main indications for liver transplantation (LT) in Spain. Recurrence of HCV after LT is the main cause of graft loss and death in HCV-positive recipients. Advanced donor age determines a more aggressive recurrence of HCV and a shorter survival. In this setting, in our liver unit, grafts from younger donors are allocated to HCV-positive recipients. The aim of this study was a comparative analysis of allocation of grafts in HCV-positive recipients versus other etiologies and the impact on waiting list time, Model for End-Stage Liver Disease (MELD) score progression until LT, need of admission in a hospital, survival until LT. METHODS: This was a retrospective study from the cohort of patients included in the waiting list for LT owing to decompensated cirrhosis in the Hospital Gregorio Marañón from January 2008 to June 2013. RESULTS: A total of 91 patients were included; 63 patients (69.23%) received LT; 19 (20.88%) retired from the waiting list: 6 because of improvement, 11 (12.08%) because of death. In both groups, the age of recipients was similar (HCV 52 y vs other 53 y; P = .549). HCV patients were included in the waiting list with lower MELD score than other etiologies (HCV 16.1 vs other 19.4; P = .010); nevertheless, MELD score was similar at the time of LT in both groups (HCV 18.9 vs other 19.4; P = .675). Time on waiting list was significantly longer in HCV patients (198 d vs 86 d; P = .002) and they were admitted in hospital more days (30 d vs 12 d; P = .03). Donor age in the HCV group was significantly lower (64.3 y vs 54.7 y; P = .006). The intention-to-treat survival analysis did not show differences between the groups (log rank = 0.504). CONCLUSIONS: HCV patients with decompensated cirrhosis receive grafts from younger donors. HCV patients remain waiting longer for an optimal organ and suffer MELD deterioration and more days admitted in hospital. These differences in allocation of grafts did not affect final survival. In our experience, designating younger organs to HCV-positive patients does not penalize neither HCV recipients nor recipients with other etiologies.

Peritonitis bacteriana espontánea por Listeria monocytogenes / Spontaneous Listeria monocytogenes bacterial peritonitis

No disponible

Microorganimos de agua dulce como indicadores de salud ambiental en el Paraguay / Sweet water microorganismo as enviromental health indicators in Paraguay

Presenta sobre la contaminación microbiana de las aguas continentales es una grave amenaza a la salud pública y el desarrollo de los paìses de América Latina y el Caribe

Immunogenicity of herpes simplex virus type 1 mutants containing deletions in one or more alpha-genes: ICP4, ICP27, ICP22, and ICP0.

Replication defective mutants of HSV have been proposed both as vaccine candidates and as vehicles for gene therapy because of their inability to produce infectious progeny. The immunogenicity of these HSV replication mutants, at both qualitative and quantitative levels, will directly determine their effectiveness for either of these applications. We have previously reported (Brehm et al., J. Virol., 71, 3534, 1997) that a replication defective mutant of HSV-1, which expresses a substantial level of viral genes without producing virus particles, is as efficient as wild-type HSV-1 in eliciting an HSV-specific cytotoxic T-lymphocyte (CTL) response. In this report, we have further evaluated the immunogenic potential of HSV-1-derived replication defective mutants by examining the generation of HSV-specific CTL following immunization with viruses that are severely restricted in viral gene expression due to mutations in one or more HSV alpha genes (ICP4, ICP27, ICP22, and ICP0). To measure the CTL responses induced by the HSV alpha-mutants, we have targeted two H-2Kb-restricted CTL epitopes: an epitope in a virion protein, gB (498-505), and an epitope in a nonvirion protein, ribonucleotide reductase (RR1 822-829). The HSV mutants used in this study are impaired in their ability to express gB while a majority of them still express RR1. Our findings demonstrate that a single immunization with these mutants is able to generate a strong CTL response not only to RR1 822-829, but also to gB498-505 despite their inability to express wild-type levels of gB. Furthermore, a single immunization with any individual mutant can also provide immune protection against HSV challenge. These results suggest that mutants which are restricted in gene expression may be used as effective immunogens in vivo.

Persistence and expression of the herpes simplex virus genome in the absence of immediate-early proteins.

The immediate-early (IE) proteins of herpes simplex virus (HSV) function on input genomes and affect many aspects of host cell metabolism to ensure the efficient expression and regulation of the remainder of the genome and, subsequently, the production of progeny virions. Due to the many and varied effects of IE proteins on host cell metabolism, their expression is not conducive to normal cell function and viability. This presents a major impediment to the use of HSV as a vector system. In this study, we describe a series of ICP4 mutants that are defective in different subsets of the remaining IE genes. One mutant, d109, does not express any of the IE proteins and carries a green fluorescent protein (GFP) transgene under the control of the human cytomegalovirus IE promoter (HCMVIEp). d109 was nontoxic to Vero and human embryonic lung (HEL) cells at all multiplicities of infection tested and was capable of establishing persistent infections in both of these cell types. Paradoxically, the genetic manipulations that were required to eliminate toxicity and allow the genome to persist in cells for long periods of time also dramatically lowered the level of transgene expression. Efficient expression of the HCMVIEp-GFP transgene in the absence of ICP4 was dependent on the ICP0 protein. In d109-infected cells, the level of transgene expression was very low in most cells but abundant in a small subpopulation of cells. However, expression of the transgene could be induced in cells containing quiescent d109 genomes weeks after the initial infection, demonstrating the functionality of the persisting genomes.

The herpes simplex virus immediate-early protein ICP0 affects transcription from the viral genome and infected-cell survival in the absence of ICP4 and ICP27.

ICP4, ICP0, and ICP27 are the immediate-early (IE) regulatory proteins of herpes simplex virus that have the greatest effect on viral gene expression and growth. Comparative analysis of viral mutants defective in various subsets of these IE genes should help elucidate how these proteins affect cellular and viral processes. This study focuses on the mutant d97, which is defective for the genes encoding ICP4, ICP0, and ICP27 and expresses the bacterial beta-galactosidase (beta-gal) gene from the ICP0 promoter. Together with the d92 virus (ICP4- ICP27-) and the ICP0-complementing cell line L7, d97 provided a unique opportunity to evaluate ICP0 function in the absence of the regulatory activities specified by ICP4 and ICP27. The pattern of protein synthesis in d97-infected cells was unique relative to other IE gene mutants in that it was similar to that seen in the absence of prior viral protein synthesis, possibly approximating the effect of cellular factors and virion components alone. Inactivation of ICP0 in the absence of ICP4 produced a significant decrease in the levels of the early mRNAs ICP6 and thymidine kinase (tk). There was also a marginal reduction in the levels of the IE ICP22 mRNA, and this was most notable at low multiplicity of infection (MOI). In d97-infected L7 cells, the levels of the viral mRNAs were mostly restored to those observed in infections with d92. Nuclear runoff transcription analysis demonstrated that the presence of ICP0 resulted in an increase in the transcription rates of the analyzed genes. The transcription rates of the early genes were dramatically reduced in the absence of ICP0. At low MOI, the transcription rates of ICP6 and tk were comparable to the rate of transcription of a cellular gene. Relevant to the potential use of d97 as a transfer vector, it was also determined that the absence of ICP0 reduced the cellular toxicity of the virus compared to that of d92. The beta-gal transgene expressed from an IE promoter was detected for up to 14 days postinfection; however, the level of beta-gal expression declined dramatically after 1 day postinfection. In the presence of ICP0, the level of expression of beta-gal was increased; however the infected monolayer was destroyed by 3 days postinfection. Therefore, deletion of ICP0 in the absence of ICP4 and ICP27 reduces toxicity and lowers the level of expression of genes from the viral genome.

Reduction of Acute Low Back Injuries by Use of Back Supports.

The objective of this study was to determine the effect of a change in back-support-use policy on the occurrence of work-related low back injuries among a large cohort of employees in the retail-trade home improvement industry. Working hours of exposure, back support use, and intensity of materials-lifting requirements were collected from 1989 through 1994. Records of injury-related claims were reviewed for all documented injuries to the lower back among members of the cohort during the same period. Over 101,000,000 working hours were recorded by nearly 36,000 employees; 2,152 employees reported an acute low back injury occurring during working hours as a first report of episode, with medical-physician diagnosis and acute/abrupt onset. Incidence density rates were calculated for persons wearing and not wearing the back support. Rate ratios and prevented fractions were evaluated. Before implementation of a company-wide back-support policy, the employees had a rate of acute low back injuries of 30.6 per million working hours. After implementation, this rate fell to 20.2 per million working hours, a significant reduction of 34.0%. This effect was seen in both genders, in younger workers and in those aged 55+, with low levels of lifting as well as high lifting intensities, and in persons with one to two years of employment with the company. The authors conclude that uniform mandatory implementation of a back-support-use policy significantly reduces the incidence of acute low back injuries incurred in the workplace.

Functional interactions between herpes simplex virus immediate-early proteins during infection: gene expression as a consequence of ICP27 and different domains of ICP4.

Two of the five immediate-early gene products, ICP4 and ICP27, expressed by herpes simplex virus type 1 have profound effects on viral gene expression and are absolutely essential for virus replication. Functional interactions between ICP4 and ICP27 may contribute to establishing the program of viral gene expression that ensues during lytic infection. To evaluate this possibility, viral mutants simultaneously deleted for ICP27 and defined functional domains of ICP4 were constructed. These mutant viruses allowed a comparison of gene expression as a function of different domains of ICP4 in the presence and absence of ICP27. Gene expression in the absence of both ICP4 and ICP27 was also examined. The results of this study demonstrate a clear involvement for ICP27 in the induction of early genes, in addition to its known role in enhancing late gene expression during viral infection. In the absence of both ICP4 and ICP27, viral early gene expression, as measured by the accumulation of thymidine kinase and ICP6 messages was dramatically reduced relative to the amounts of these messages seen in the absence of only ICP4. Therefore, elevated levels of early gene expression as a consequence of ICP27 occurred in the absence of any ICP4 activity. Evidence is also presented regarding the modulation of the ICP4 repression function by ICP27. When synthesized in the absence of ICP27, a mutant ICP4 protein was impaired in its ability to repress transcription from the L/ST promoter in the context of viral infection and in vitro. This defect correlated with the loss of the ability of this mutant protein to bind to its recognition sequence when produced in infected cells in the absence of ICP27. These observations indicate that ICP27 can regulate the activity of at least one domain of the ICP4 protein as well as contribute to elevated early gene expression independently of ICP4.

The human cytomegalovirus 86-kilodalton immediate-early 2 protein: synthesis as a precursor polypeptide and interaction with a 75-kilodalton protein of probable viral origin.

The immediate-early 2 (IE2) 86-kDa polypeptide, a major immediate-early gene product of human cytomegalovirus, regulates transcription both positively and negatively. We report two new properties of the IE2 86-kDa polypeptide in infected cells. Immunoprecipitation of infected cell proteins from human embryonic lung cells by antipeptide or monoclonal antibodies specific for IE2 epitopes revealed three closely migrating polypeptide species. The slowest, p86, behaved as expected for the mature 86-kDa IE2 polypeptide. The middle species, p80, was immunoprecipitated from denatured as well as native samples and labeled to steady state rapidly. Pulse-chase analysis demonstrated directly that p80 was a metabolic precursor to p86. The fastest-migrating species, p75, was not detected by probing blots of the immunoprecipitated proteins with IE2-specific antisera; p75 was not precipitated from denatured protein samples; and the products of partial proteolysis of p75 were distinct from those of p86. These properties established p75 as an unrelated coprecipitated polypeptide complexed with p86. The p75 proteins coprecipitated from cells infected with two different strains of human cytomegalovirus, AD169 and Towne, had different mobilities. p75 was detected as early as 6 h and as late as 72 h after infection, but it was not synthesized in cells released from a cycloheximide block. Thus, it is likely that p75 is an early viral protein.

[Amebic liver abscess in Tarapoto-Peru]. / Absceso hepático amebiano en Tarapoto-Perú.

UNLABELLED: In order to know the incidence and epidemiologic features of the Amebic Hepatic Abscess we realized this study in the medicine service. 86.67% were males, the average age was 41.38 +/- 18.60 years old being more frequent between 30 and 69 years old (74.48%). The more affected were farmers (60%), students (10%) and Housekeepers (6.67%). The average time of the disease was 12.12 +/- 6.35 dias. The most frequent symptoms were abdominal pain in the upper right quadrant (96.66%), Hepatomegaly (83.33%), Fever (82.22%), Diarrhea (37.77%), Nausea (36.66%), Jaundice (33.33%). The initial diagnosis was AHA (45.55%), acute cholecystitis (14.44%), generalized infectious syndrome (7.77%), acute hepatitis (6.66%). The most frequent studies was: echography (98.85%). AHA alone was in the right lobe (84.05%), left lobe (14.49%). The bigger abscess was of 12 cm in diameter. The treatment was metronidazole + antibioticos (37.78%), metronidazole + antibiotico+percutaneous drainage (24.45%), Metronidazole + surgical drainage (3.33%). The complications were right pleural effusion (8.89%), peritonitis (5.56%) and pioneumothorax (1.11%). The hospitalization time was 14 +/- 8.02 days. There was one death (1.11%). CONCLUSION: The AHA was ones of each 76 deliveries in our medicine service.

Exploring the physically ill child's self-perceptions and the mother's perceptions of her child's needs: insights gained from the FIRO-BC--a behavior test for use with children.

When dealing with the management of the dying patient and his family, systematic research has been very limited. Understanding the dying child's needs, as well as his family's, is important for approprirate therapy programs. The present study investigated the mother's awareness of her child's expressed and wanted needs in three areas of interpersonal relationships. It also studied the dying child's self-perceived needs and desires as compared with those of children with a non-life-threatening illness and with those of well children.