[Cost-effectiveness analysis of fracture liaison services in Catalonia]. / Análisis de coste-efectividad de las Unidades de Coordinación de Fracturas en Cataluña.

OBJECTIVE: To assess the cost-effectiveness of Fracture Liaison Service (FLS) compared to the standard of care for secondary prevention of fragility fractures form the perspective of the Catalan Health Service. METHODS: Cost-utility assessment through a Markov model that simulated disease progression of a patients' cohort candidates to initiate antiosteoporotic treatment after a fragility fracture. A time horizon of 10 years and a 6-month duration per cycle was established. Clinical, economics and quality of life parameters were obtained from the literature and derived from four Catalan FLS. The Catalan Health Service perspective was adopted, considering direct health costs expressed in 2022 euros. A 3% discount rate was applied on costs and outcomes. Uncertainty was assessed through multiple sensitivity analyses. RESULTS: Compared to the standard of care, FLS would promote antiosteoporotic initiation and persistence, reducing the incidence and mortality associated with subsequent fragility fractures. This incremental clinical benefit was estimated at 0.055 years and 0.112 quality-adjusted life years (QALYs) per patient. A higher cost (€1,073.79 per patient) was estimated, resulting into an incremental cost-utility ratio of €9,602.72 per QALYs gained. The sensitivity analyses performed were consistent, corroborating the robustness and conservative approach of the base-case. CONCLUSIONS: The introduction of FLS for the secondary prevention of FF would represent a cost-effective strategy from the Catalan Health Service perspective.

Spectrum and visual outcomes of Vogt-Koyanagi-Harada disease in Argentina.

AIM: To review all cases of Vogt-Koyanagi-Harada (VKH) disease in an Inflammatory Eye Disease Service in Argentina and to describe the clinical profile and outcomes of treatment. METHODS: The records from patients with VKH disease between January 1980 and December 2008 were retrospectively analyzed for clinical profile, complications, and treatment. Patients were classified according to their initial treatment in group 1: high corticosteroid dose [≥1 mg/(kg·d)] within 2wk of illness onset; group 2: high corticosteroid dose, 2 to 4wk of onset and group 3: patients who received the high dose after 1mo of illness onset, patients who received lower oral doses than 1 mg/(kg·d) without regarding the time of beginning of the disease. RESULTS: A total of 210 eyes of 105 patients were included. The mean age at presentation was 32.6±13y (range: 10-74y), and 86.7% were female. The mean duration of follow up was 144±96.6mo. Patients in the group 1 had significantly higher visual acuity than the other groups (P<0.0001), none had (loss of, or no) light perception at the end of follow up, whereas 24.7% patients in group 3 ended in light perception (P<0.004). CONCLUSION: Patients with early high dose corticosteroid treatment have better visual acuity and fewer complications. Proper timing in referral and treatment is critical for better visual outcome in VKH disease.

Aggression and prosocial behaviors in social conflicts mediating the influence of cold social intelligence and affective empathy on children's social preference.

This study proposes a model in which aggressive and prosocial behaviors exhibited in social conflicts mediate the influence of empathy and social intelligence to children's social preference by same-sex peers. Data were obtained from kindergarten to the end of the first grade. The sample yielded 117 Spanish children (64 girls and 53 boys) with a mean age of 62.8 months (SD = 3.3) at the beginning of the study. For boys, affective empathy contributed to boys' social preference through a decrease in physical aggression as responses to social conflict. For girls, affective empathy had an indirect effect on girls' preference by increasing assistance to others in their conflicts. No mediating effect in the contribution of social intelligence on girls' social preference was detected. Our results suggest that, only for girls, cold social intelligence can promote both indirect aggression (coercive strategic that do not leave social preference, at least at these ages) and behaviors that lead social preference (such as prosocial behaviors).

Factors associated with cortisol levels and health in 5-6-year-old children.

OBJECTIVES: This study assesses the relationships between social context (family and inter-peer context), stress, and illness in 5-6-year-old children. METHODS: To this end, data were collected on spontaneous social interpeer behavior; families provided data on stress, anxiety, and parental acceptance-rejection; and the children's pediatricians provided data relative to their health. Data on stress-related hormones (cortisol) were collected using saliva samples. RESULTS: The results revealed that none of the variables examined were significantly related to illness development in the subjects in the sample group. Cortisol levels, however, were positively associated with a record of chronic or congenital illnesses, the manifestation of behaviors related to the search for leadership status in the group and the presence of stressful events in the family environment. CONCLUSIONS: Despite finding no relationship between children's level of adrenocortical activity and the contracting or contingent development of diseases, we did find that chronic/congenital diseases may constitute a source of early stress in childhood. Certain conditions of uncertainty in the social context (family and interpeer) also seem to constitute different sources of stress.

Identification of the PTPN22 functional variant R620W as susceptibility genetic factor for giant cell arteritis.

OBJECTIVE: To analyse the role of the PTPN22 and CSK genes, previously associated with autoimmunity, in the predisposition and clinical phenotypes of giant cell arteritis (GCA). METHODS: Our study population was composed of 911 patients diagnosed with biopsy-proven GCA and 8136 unaffected controls from a Spanish discovery cohort and three additional independent replication cohorts from Germany, Norway and the UK. Two functional PTPN22 polymorphisms (rs2476601/R620W and rs33996649/R263Q) and two variants of the CSK gene (rs1378942 and rs34933034) were genotyped using predesigned TaqMan assays. RESULTS: The analysis of the discovery cohort provided evidence of association of PTPN22 rs2476601/R620W with GCA (PFDR=1.06E-04, OR=1.62, CI 95% 1.29 to 2.04). The association did not appear to follow a specific GCA subphenotype. No statistically significant differences between allele frequencies for the other PTPN22 and CSK genetic variants were evident either in the case/control or in stratified case analysis. To confirm the detected PTPN22 association, three replication cohorts were genotyped, and a consistent association between the PTPN22 rs2476601/R620W variant and GCA was evident in the overall meta-analysis (PMH=2.00E-06, OR=1.51, CI 95% 1.28 to 1.79). CONCLUSIONS: Our results suggest that the PTPN22 polymorphism rs2476601/R620W plays an important role in the genetic risk to GCA.

Treatment of high strength olive mill wastewater by Fenton's reagent and aerobic biological process.

The present work describes the application of a Fenton's reagent pretreatment combined with an aerobic biological process to remove the olive mill wastewater (OMW) pollutant load. Wastewater treatment was monitored by means of global parameters directly related to the concentration of organic compounds in OMW effluents: chemical oxygen demand (COD) and total phenolic content (TP). The biologic treatment itself allowed conversions from 67 to 83% of COD and 55 to 61% of TP. In the Fenton's reagent process a fixed H2O2/COD ratio of 0.20, a pH = 3.5 and a H2O2/Fe(2+) molar ratio of 15 were defined as optimal conditions to treat the OMW. For an initial COD load of 92.5 g/L(-1)) the Fenton reagent-biologic combined process allowed a global removal of 80.7% COD and 93.7% TP. A kinetic study was performed resorting to the Grau model. The application of this model allowed observing an increase in the kinetic constant of the combined process (kFB = 24.7 g/L(-1) day) when compared to the single aerobic process (kB = 19.4 g/L(-1) day).

Optimization of the synthesis of a new coagulant from a tannin extract.

The current article studies the optimization of a new coagulant agent for water purification and wastewater remediation. Design of experiments is used for optimizing the production of this new tannin-based coagulant by using Acacia mearnsii de Wild tannin extract, NH(4)Cl and formaldehyde. The effectiveness of this product was confirmed on dye-polluted wastewater and surfactant wastewater. This cationic coagulant seems to be sensitive to temperature and tannin-NH(4)Cl ratio (g of ammonium chloride per g of tannin extract). NH(4)Cl ratio was found to be more influent than temperature and no interaction is presented between these two parameters. For each system, an optimum combination NH(4)Cl ratio and temperature was found: 24.9°C and 2 g g(-1) for dye removal and 36.4°C and 1.87 g g(-1) for surfactant elimination. The optimal conditions were merged to produce a combined coagulant that was tested on dye, surfactant, surface river water and municipal wastewater. Predicted levels of remediation were experimentally confirmed.

Surface water and wastewater treatment using a new tannin-based coagulant. Pilot plant trials.

A new tannin-based coagulant-flocculant (Tanfloc) was tested for water treatment at a pilot plant level. Four types of water sample were treated: surface water (collected from a river), and municipal, textile industry (simulated by a 100 mg L(-1) aqueous solution of an acid dye), and laundry (simulated by a 50 mg L(-1) aqueous solution of an anionic surfactant) wastewaters. The pilot plant process consisted of coagulation, sedimentation, and filtration. The experiments were carried out with an average coagulant dosage of 92.2 mg L(-1) (except in the case of the surface water for which the dosage was 2 mg L(-1)). The efficacy of the water purification was notable in every case: total turbidity removal in the surface water and municipal wastewater, about 95% dye removal in the case of the textile industry wastewater, and about 80% surfactant removal in the laundry wastewater. Filtration improved the removal of suspended solids, both flocs and turbidity, and slightly improved the process as a whole. The efficiency of Tanfloc in these pilot studies was similar to or even better than that obtained in batch trials.

Comparison of single-step and two-step purified coagulants from Moringa oleifera seed for turbidity and DOC removal.

The coagulant proteins from Moringa oleifera purified with single-step and two-step ion-exchange processes were used for the coagulation of surface water from Meuse river in The Netherlands. The performances of the two purified coagulants and the crude extract were assessed in terms of turbidity and DOC removal. The results indicated that the optimum dosage of the single-step purified coagulant was more than two times higher compared to the two-step purified coagulant in terms of turbidity removal. And the residual DOC in the two-step purified coagulant was lower than in single-step purified coagulant or crude extract.

Glomerulosclerosis segmentaria y focal asociada a policitemia vera / No disponible

No disponible

Novel tannin-based adsorbent in removing cationic dye (Methylene Blue) from aqueous solution. Kinetics and equilibrium studies.

Natural tannin-based adsorbent has been prepared on the basis of the gelification of Quebracho bark extract. The resulting product, Quebracho Tannin Gel (QTG) was tested as cationic dye adsorbent with Methylene Blue (MB). Kinetics of adsorption process were studied out and a period of 15 days was determined for reaching equilibrium. The influences of pH and temperature were evaluated. As pH or temperature raise q capacity of QTG increases. Theoretical modelization of dye-QTG adsorption was carried out by multiparametric adjustment according to Langmuir's hypothesis. Values of the k(l1), k(l2) and activation energies were calculated.

Improvement of water treatment pilot plant with Moringa oleifera extract as flocculant agent.

Moringa oleifera extract is a high-capacity flocculant agent for turbidity removal in surface water treatment. A complete study of a pilot-plant installation has been carried out. Because of flocculent sedimentability of treated water, a residual turbidity occured in the pilot plant (around 30 NTU), which could not be reduced just by a coagulation-flocculation-sedimentation process. Because of this limitation, the pilot plant (excluded filtration) achieved a turbidity removal up to 70%. A slow sand filter was put in as a complement to installation. A clogging process was characterized, according to Carman-Kozeny's hydraulic hypothesis. Kozeny's k parameter was found to be 4.18. Through fouling stages, this k parameter was found to be up to 6.36. The obtained data are relevant for the design of a real filter in a continuous-feeding pilot plant. Slow sand filtration is highly recommended owing to its low cost, easy-handling and low maintenance, so it is a very good complement to Moringa water treatment in developing countries.

Removal of Alizarin Violet 3R (anthraquinonic dye) from aqueous solutions by natural coagulants.

In this paper the ability of two natural products in removing dyes has been tested. After a preliminary screening for dye removal capacity, a tannin-based coagulant called ACQUAPOL C-1 and a vegetal protein extract derived from Moringa oleifera seed have been fully studied. The influence of several parameters such as pH, temperature or initial dye concentration (IDC) have been tested and the behavior of both coagulants has been compared. pH results to be an interesting variable and dye removal decreases as pH increases. This effect is higher in ACQUAPOL C-1 than in M. oleifera seed extract. Temperature seems not to be so affecting parameter, while IDC appears to be a very important variable in q(c) capacity, which is higher as IDC increases. Langmuir isotherm model fits very well in both cases of ACQUAPOL C-1 and M. oleifera seed extract dye removal.

Removing heavy metals from polluted surface water with a tannin-based flocculant agent.

Many environmental and health problems come from the presence of metals in surface water. Effectiveness of a new commercial tannin-based flocculant has been tested in order to remove Zn(2+), Ni(2+) and Cu(2+) by coagulation-flocculation process. pH has been adjusted in order to evaluate the real heavy metal removal due just to flocculant effect and not to hydroxide precipitation. At least a 75% of metal removal has been reported in every case, depending on pH value. Flocculant doses have been reported to be about 100-150 ppm.

Removal of sodium lauryl sulphate by coagulation/flocculation with Moringa oleifera seed extract.

Among other natural flocculant/coagulant agents, Moringa oleifera seed extract ability to remove an anionic surfactant has been evaluated and it has been found to be very interesting. Sodium lauryl sulphate was removed from aqueous solutions up to 80% through coagulation/flocculation process. pH and temperature were found to be not very important factors in removal efficiency. Freundlich (F), Frumkin-Fowler-Guggenheim (FFG) and Gu-Zhu (GZ) models were used to adjust experimental data in a solid-liquid adsorption hypothesis. Last one resulted to be the most accurate one. Several data fit parameters were determined, as Freundlich order, which was found to be 1.66, Flory-Huggins interaction parameter from FFG model, which was found to be 4.87; and limiting Moringa surfactant adsorption capacity from GZ model, which was found to be 2.13 x 10(-3)mol/g.

Behavioral and neurochemical responses in mice bearing tumors submitted to social stress.

Through the proinflammatory cytokines secreted in response to inflammation or injury, the immune system produces physiological and behavioral alterations. This study analyzes the effects on behavior, mononuclear proliferative response and central monoamine activity in response to the inoculation of tumor cells in mice submitted to social stress. Two groups of male OF1 mice were used, one of which was inoculated with B16 melanoma cells. Both groups were subdivided into two new groups, with one being submitted to social stress through sensory contact model with a selected aggressive subject, and the other being handled without social interaction. Subjects were exposed to social stress for a 24-h period, with three 5 min intervals of direct physical interaction, where the behavior was recorded and assessed. One hour after the stress and/or handling, they were put down and samples taken for physiological assessment. Significant behavioral changes were found in subjects with implanted tumors, mainly characterized by an increase in avoidance behavior and a decrease in immobility, defense-submission and non-social exploration behavior, coupled with an increase in the spleen mononuclear cell proliferative response. Similarly, an increase was observed in the density of dopamine(2) (D(2))-receptors in the striatum (SRT) and an increase in dopaminergic (DOPAC/DA) and serotonergic (5HIAA/5HT) turnover in the hypothalamus. The increase in the density of D(2)-receptors in the SRT coincides with the decrease in some behaviors with a predominant motor component. The results indicate significant changes in the defensive strategy used to cope with situations of intense social stress in mice bearing tumors.

Social stress paradigms in male mice: Variations in behavior, stress and immunology.

Male OF1 strain mice were allocated, after 2 weeks of individual housing, to cohabitating (6 or 16 days), fixed dyadic interaction pairs (6 or 16 daily encounters) or control groups (6 or 16 days). These different social stress situations were assessed for their effects on splenic contents of NE, IL-1 and IL-2 and serum levels of corticosterone. Spleen NE contents showed no significant variations, but serum corticosterone titers were generally higher in interacting pairs and subordinates. Splenic IL-2 did not respond in the same way to the treatments as IL-1. The differences in splenic interleukin contents could not be simply related to observed changes in serum corticosterone levels. Different mechanisms appear to regulate changes in glucocorticoids and the measured cytokines. These physiological phenomena do not simply reflect in the animal's social status (dominant or submissive). The intensity and duration of the agonistic behavior displayed as well as the interaction experience accumulated may account for the observed differences between the paradigms.

Social behavior, cortisol, and sIgA levels in preschool children.

OBJECTIVE: This study aims to explore the possible existence of behavioral states in early stages of development, which are associated with specific cortisol production profiles and consequently with changes in the immune response [secreted immunoglobulin A (sIgA)]. METHODS: The subjects were 27 boys and 21 girls of preschool age whose behavior was videotaped in free play interactions. Their behavior was then evaluated using an ethogram of the social behavior of the child. Cortisol levels were measured using a radioimmunoassay in saliva samples, and sIgA levels were measured by means of an ELISA, also in saliva samples. RESULTS: No correlation between cortisol and sIgA levels was found. Variance analysis revealed that the only behavioral pattern, which showed significant differences with regard to cortisol levels, was isolation. CONCLUSIONS: There seems to be a connection between cortisol levels and isolation behavior; we found no relation between high cortisol levels and a lower sIgA secretion.

Relating testosterone levels and free play social behavior in male and female preschool children.

This study assessed potential relationships between a series of behavioral measures seen in the interactions of preschool children with their peers (particularly aggressive behavior) and testosterone levels. 28 boys and 20 girls of preschool age were videotaped in free play interactions. Their behavior was then evaluated with particular emphasis on aggression and affiliation in play and social interactions. Testosterone levels were measured using radioimmunoassay in saliva samples. Correlation analysis revealed a positive relationship in boys between testosterone and giving and receiving aggression in the context of 'social interactions' (serious aggression), but not in the context of play (playful aggresstion). Testosterone can be a useful biological marker for serious aggression (and behavioral patterns reflecting different levels of sociability) in preschool boys.

[Clinical and radiological characteristics of primary pulmonary tuberculosis in adolescents]. / Características clínicas y radiológicas de la tuberculosis pulmonar primaria en el adolescente.

OBJECTIVE: The aim of this study was to investigate the incidence, clinical and radiological particularities of primary pulmonary tuberculosis in children between 10 to 16 year-old in our community. PATIENTS AND METHODS: The medical records and chest X-ray of all children under 16 years old diagnosed of primary pulmonary tuberculosis between 1982 to 1996, and a similar characteristics control group diagnosed of bacterial pneumonia were reviewed. The difference between teenager with tuberculosis and pneumonia and between patients with tuberculosis under 10 years and order were analysed. RESULTS: Between January 1982 and December 1996, 83 children with age range from 10 to 16 years were diagnosed of primary pulmonary tuberculosis. The incidence has been 15,5 cases/100000 h < 16 years/year. The primary pulmonary tuberculosis whole incidence in children under 16 year-old has been 17 cases/100000 h/year (182 cases). The adolescents fits to 40.5% of the hold group. 51.2% were girls and 49.8% were boys. Middle age has been 14.2+/-0.18 years with a progressive increased with the age. Anorexia (38% vs. 16.6%) and asthenia (38% vs 19.4%) have been more frequents in teenagers with tuberculosis. Cough has been the most frequent symptom in both groups (61.9% and 77.7%), and respiratory distress has been the most characteristic of tuberculosis (17.8% vs 2.7%). Thoracic pain was more frequent in patients with tuberculosis 10 years or older (57.8% and 7.8%). Laboratory values are not specific. Pleural effusion (46.4% vs 22.2%) and mediastinal lymphadenophaty (60.1% vs. 40.4%) were the most characteristic X-ray finding in teenagers and children under 10 years with primary pulmonary tuberculosis respectively. CONCLUSIONS: Primary pulmonary tuberculosis has a high incidence in the teenager population in our community with a progressive increased with the age. The clinical and laboratory values are unspecific in this age group. The most characteristic X-ray finding is pleural effusion (46.4% of the patients).