A machine learning tool for the diagnosis of SARS-CoV-2 infection from hemogram parameters.

Monocytes and neutrophils play key roles in the cytokine storm triggered by SARS-CoV-2 infection, which changes their conformation and function. These changes are detectable at the cellular and molecular level and may be different to what is observed in other respiratory infections. Here, we applied machine learning (ML) to develop and validate an algorithm to diagnose COVID-19 using blood parameters. In this retrospective single-center study, 49 hemogram parameters from 12,321 patients with clinical suspicion of COVID-19 and tested by RT-PCR (4239 positive and 8082 negative) were analysed. The dataset was randomly divided into training and validation sets. Blood cell parameters and patient age were used to construct the predictive model with the support vector machine (SVM) tool. The model constructed from the training set (5936 patients) achieved an accuracy for diagnosis of SARS-CoV-2 infection of 0.952 (95% CI: 0.875-0.892). Test sensitivity and specificity was 0.868 and 0.899, respectively, with a positive (PPV) and negative (NPV) predictive value of 0.896 and 0.872, respectively (prevalence 0.50). The validation set model (4964 patients) achieved an accuracy of 0.894 (95% CI: 0.883-0.903). Test sensitivity and specificity was 0.8922 and 0.8951, respectively, with a positive (PPV) and negative (NPV) predictive value of 0.817 and 0.94, respectively (prevalence 0.34). The area under the receiver operating characteristic curve was 0.952 for the algorithm performance. This algorithm may allow to rule out COVID-19 diagnosis with 94% of probability. This represents a great advance for early diagnostic orientation and guiding clinical decisions.

An analysis of the cecum microbiome of three breeds of the guinea pig: Andina, Inti, and Peru.

This study investigated the effect of host genetics on the structure and composition of the cecum microbiota of three breeds of guinea pigs: Andina, Inti, and Peru. Fifteen guinea pigs were distributed into three groups according to their breed: Andina (5), Inti (5), and Peru (5). We discovered that four main phyla were shared between the three breeds: Bacteroidota, Firmicutes, Spirochaetota, and Synergistota. Although there were no significant differences in the alpha and beta diversity analysis, we found that the Linear discriminant analysis effect size and the heat tree analysis showed significant differences between the abundance of several taxa present in the cecum microbiome of the three breeds. These results suggest that host genetics could be a factor in the structure and composition of the guinea pig cecum microbiome. In addition, we found unique genera for each breed that have fermentation capacity and, therefore can be analyzed in further studies to determine if there is a functional relationship between them and the breed and its industrial profile.

Prevalence, coinfection, and risk factors associated with Fasciola hepatica and other gastrointestinal parasites in cattle from the Peruvian Amazon.

Background and Aim: Extensive cattle rearing is a major source of economy for the inhabitants of the Amazon region of Peru. Milk and meat production is generally affected by the prevalence of various parasites, including hepatic and gastrointestinal parasites, as these products provide ideal conditions for parasitic growth. This poses a serious public health threat. This study aimed to estimate the prevalence, coinfection, and risk factors associated with the liver fluke (Fasciola hepatica) and other gastrointestinal parasites in cattle from the Amazon region of Peru. Materials and Methods: Fecal samples obtained from 1450 bovine specimens were analyzed using flotation and sedimentation methods to identify parasites, including Eimeria spp., strongyle-type eggs (STEs), and F. hepatica. We collected information about the specimens, including age, sex, origin, breed, category, frequency of deworming, farm size, herd size, water sources, and rearing system by conducting simple inspections and interviewing owners. The data obtained were statistically evaluated using the Chi-square test (p < 0.05) to determine the association between the qualitative variables. We also calculated the odds ratio at a 95% confidence interval to identify the risk factors. Results: We observed that F. hepatica, Eimeria spp., and STEs were 45.6%, 39.8%, and 35.3% prevalent, respectively. We found risk factors related to distomatosis in the animals from Huambo, where the drinking water sources are mainly streams, ditches, and rivers, while the specimens from Valle Chico were predisposed to coccidiosis. Further, the risk factors related to the presence of STEs in feces were age (61-90 months), origin (Valle Chico), herd size (<50 animals), and type of extensive rearing. Furthermore, significant coinfection was observed between Eimeria spp. and STEs. Conclusion: The high percentages of parasites in cattle observed were related to epidemiological factors, such as the origin of the sample, water sources, age, herd size, and extensive breeding. Similarly, the presence of STEs was a risk factor for contracting coccidiosis. Our future goals include investigating these parasites using a larger sample size and identifying more risk factors using more sensitive and specific diagnostic tests.

Comparative analysis of fasting effects on the cecum microbiome in three guinea pig breeds: Andina, Inti, and Peru.

Guinea pigs have historically been used as a food source and are also an important model for studying the human intestines. Fasting is the act of temporarily stopping the intake of food. This process can alter the microbiota of various animals. This study is the first to investigate the impact of fasting on the cecum microbiome of three guinea pig breeds. We investigated the impact of fasting on the microbiome population structure in the cecum of three guinea pig breeds. This was done by sequencing and analyzing the V4 hypervariable region of the 16S rRNA gene in bacterial communities found in cecum mucosa samples. To achieve this, we established two treatment groups (fasting and fed), for each of the three guinea pig breeds: Andina, Inti, and Peru. The study involved twenty-eight guinea pigs, which were divided into the following groups: Andina-fed (five), Andina-fasting (five), Inti-fed (four), Inti-fasting (five), Peru-fed (five), and Peru-fasting (four). The results indicated a significant difference in beta diversity between the treatment groups for the Peru breed (P-value = 0.049), but not for the treatment groups of the Andina and Inti breeds. The dominant phyla across all groups were Firmicutes and Bacteroidetes. We observed variations in the abundance of different taxa in the cecum microbiota when comparing the treatment groups for each breed. Additionally, there was a higher number of unique taxa observed in the fasting groups compared to the fed groups. We discovered that the genus Victivallis was the only one present in all fasting groups across all breeds. Despite the findings, the resilience of the gut microbiome was not challenged in all three breeds, which can lead to disruptive changes that may affect the overall maintenance of the cecum microbiome. Based on the observed differences in the treatment groups of the Peru breed, it can be suggested that fasting has a greater impact on this particular breed.

Turbulent Drag Reduction Using Anisotropic Permeable Substrates.

The behaviour of turbulent flow over anisotropic permeable substrates is studied using linear stability analysis and direct numerical simulations (DNS). The flow within the permeable substrate is modelled using the Brinkman equation, which is solved analytically to obtain the boundary conditions at the substrate-channel interface for both the DNS and the stability analysis. The DNS results show that the drag-reducing effect of the permeable substrate, caused by preferential streamwise slip, can be offset by the wall-normal permeability of the substrate. The latter is associated with the presence of large spanwise structures, typically associated to a Kelvin-Helmholtz-like instability. Linear stability analysis is used as a predictive tool to capture the onset of these drag-increasing Kelvin-Helmholtz rollers. It is shown that the appearance of these rollers is essentially driven by the wall-normal permeability Ky+ . When realistic permeable substrates are considered, the transpiration at the substrate-channel interface is wavelength-dependent. For substrates with low Ky+ , the wavelength-dependent transpiration inhibits the formation of large spanwise structures at the characteristic scales of the Kelvin-Helmholtz-like instability, thereby reducing the negative impact of wall-normal permeability.

Pelvic MRI findings in relapsed prostate cancer after radical prostatectomy.

PURPOSE/OBJECTIVE: Little is known about the clinical impact of using multiparametric MRI to plan early salvage radiotherapy after radical prostatectomy. We aimed to evaluate the incidence and location of recurrence based on pelvic multiparametric MRI findings and to identify clinical variables predictive of positive imaging results. MATERIALS AND METHODS: We defined radiological criteria of local and lymph node malignancy and reviewed records and MRI studies of 70 patients with PSA recurrence after radical prostatectomy. We performed univariate and multivariate analysis to identify any association between clinical, pathological and treatment-related variables and imaging results. RESULTS: Multiparametric MRI was positive in 33/70 patients. We found local and lymph node recurrence in 27 patients and 7 patients, respectively, with a median PSA value of 0.38 ng/ml. We found no statistically significant differences between patients with positive and negative multiparametric MRI for any variable. Shorter PSADT was associated with positive lymph nodes (median PSADT: 5.12 vs 12.70 months; p: 0.017). CONCLUSIONS: Nearly half the patients had visible disease in multiparametric MRI despite low PSA. Positive lymph nodes incidence should be considered when planning salvage radiotherapy, particularly in patients with a short PSADT.

Hemolytic disease of the newborn due to anti-jkb: case report and review of the literature.

Although anti-Jkb is a well-defined cause of severe acute or delayed hemolytic transfusion reactions, it is rarely associated with severe Hemolytic Disease of the Newborn (HDN), even with high antibody titer. To date, only 13 cases have been reported, so the possible reasons for that still remain unclear. Most of HDN due to anti-Jkb are mild-to-moderate, and usually have a good prognosis. A 41-years-old woman, who had a positive antibody screening test in her 13th week of pregnancy, was sent to the blood bank for study before an amniocentesis. Antibody identification and red blood cell (RBC) phenotyping of the patient and his husband were performed, plus arrays study in the amniotic fluid. An anti-Jkb was identified in the patient's serum with a titer of 1:1, and her RBC phenotype was O Rh(D) positive, C(+), c(+), E(-), e(+), K(-), Jka(+), Jkb(-). The RBC genotype of the fetus was B Rh(D) positive, Jka(+), Jkb(+). Antibody titer remained stable and the pregnancy was uneventful. At birth, there was no need of phototherapy or exchange transfusion for the newborn and her Jk(b+) typing result was confirmed in a cord blood sample. Although most of HDN cases due to anti-Jkb have a good outcome, monitoring antibody titer should be done to prevent fatal complications. Furthermore, antenatal antibody screening should be performed in every pregnant woman irrespective of her Rh(D) antigen status in order to detect red cell alloimmunization to other clinically significant blood group antigens.

[Effect of a multidisciplinar protocol on the clinical results obtained after bariatric surgery]. / Comparación de resultados previos y posteriores a la aplicación de un protocolo de actuación en cirugía bariátrica.

INTRODUCTION: Bariatric surgery has been shown to be an effective therapy for weight loss in patients with severe obesity, and the implementation of a multidisciplinar management protocol is recommended. OBJECTIVES: To assess the usefulness of the implementation of a management protocol in obesity surgery based on the Spanish Consensus Document of the SEEDO. METHODS: Retrospective comparative study of the outcomes in patients previously operated (51 patients) and after the implementation of the protocol (66 patients). The following data were gathered: anthropometry, pre-and post-surgery comorbidities, post-surgical nutritional and surgical complications, validated Quality of Life questionnaire, and dietary habits. RESULTS: Withdrawals (l7.6%) and alcoholism (5.8%) were higher in patients pre- versus post-implementation of the protocol (4.5% vs. 3%, respectively), the differences being statistically significant. The mortality rate was 2% in the pre-protocol group and 0% in the postprotocol group. The dietary habits were better in the post-protocol group, the pre-protocol group presenting a higher percentage of feeding-behavior disorders (5.1%) although not reaching a statistical significance. The improvement in quality of life was higher in the post-protocol group for all items, but only reaching statistical significance in sexual activity (p = 0.004). In the pre-protocol group, 70.5% of the patients had more than one nutritional complication vs. 32.8% in the post-protocol group (p < 0.05). There were no differences regarding the percentage of weight in excess lost at two years (> 50% in 81.3% in the pre-protocol group vs. 74.8% in the pos-protocol group) or the comorbidities. CONCLUSIONS: Bariatric surgery achieves excellent outcomes in weight loss, comorbidities, and quality of life, but presents nutritional, surgical, and psychiatric complications that require a protocol-based and multidisciplinary approach. Our protocol improves the outcomes regarding the withdrawal rates, feeding-behavior disorders, dietary habits, nutritional complications, and quality of life.

Comparación de resultados previos y posteriores a la aplicación de un protocolo de actuación en cirugía bariátrica / Effect of a multidisciplinar protocol on the clinical results obtained after bariatric surgery

Introducción: La cirugía bariátrica ha demostrado ser un tratamiento eficaz para la pérdida de peso en pacientes con obesidad severa, recomendándose la aplicación de un protocolo de actuación multidisciplinar. Objetivos: Evaluar la utilidad de la implantación de un protocolo de actuación en cirugía de la obesidad basado en el Documento de consenso español de la SEEDO. Métodos: Estudio restrospectivo comparativo de resultados de pacientes intervenidos previamente (51 pacientes) y tras la implantación del protocolo (66 pacientes). Se recogieron datos de: antropometría , comorbilidades pre y postcirugía, complicaciones nutricionales y quirúrgicas postcirugía, test de Calidad de Vida validado, y hábitos alimentarios. Resultados: Los abandonos (17,6%) y el alcoholismo (5,8%) fueron mayores en pacientes preprotocolo frente postprotocolo (4,5% y 3% respectivamente) con diferencias estadísticamente significativas. La mortalidad fue del 2% en los preprotocolo y del 0% en los postprotocolo. Los hábitos alimentarios fueron mejores en los postprotocolo, presentando mayor porcentaje de trastornos de conducta alimentaria los preprotocolo (5,1%) aunque sin significación estadística. La mejoría de la calidad de vida fue superior en los postprotocolo en todos los items, pero solo con significación estadística en la actividad sexual (p 0,004). El 70,5% de los pacientes preprotocolo tenían más de una complicación nutricional frente al 32,8% de los postprotocolo (p < 0,05). No hubo diferencias en cuanto a porcentaje de sobrepeso perdido a los dos años (superior al 50% en el 81,3% de los casos preprotocolo y en el 74,8% de los postprotocolo) ni evolución de comorbilidades. Conclusiones: La cirugía bariátrica consigue excelentes resultados en: pérdida de peso, comorbilidades y calidad de vida, pero presenta complicaciones nutricionales, quirúrgicas y psiquiátricas que exigen un abordaje multidisciplinar y protocolizado. Nuestro protocolo mejora resultados de tasa de abandonos, trastornos de conducta alimentaria, hábitos alimentarios, complicaciones nutricionales y mejoría de calidad de vida (AU)

Introduction: Bariatric surgery has been shown to be an effective therapy for weight loss in patients with severe obesity, and the implementation of a multidisciplinar management protocol is recommended. Objectives: To assess the usefulness of the implementation of a management protocol in obesity surgery based on the Spanish Consensus Document of the SEEDO. Methods: Retrospective comparative study of the outcomes in patients previously operated (51 patients) and after the implementation of the protocol (66 patients). The following data were gathered: anthropometry, pre-and post-surgery comorbidities, post-surgical nutritional and surgical complications, validated Quality of Life questionnaire, and dietary habits. Results: Withdrawals (l7.6%) and alcoholism (5.8%) were higher in patients pre- versus post-implementation of the protocol (4.5% vs. 3%, respectively), the differences being statistically significant. The mortality rate was 2% in the pre-protocol group and 0% in the postprotocol group. The dietary habits were better in the post-protocol group, the pre-protocol group presenting a higher percentage of feeding-behavior disorders (5.1%) although not reaching a statistical significance. The improvement in quality of life was higher in the post-protocol group for all items, but only reaching statistical significance in sexual activity (p = 0.004). In the pre-protocol group, 70.5% of the patients had more than one nutritional complication vs. 32.8% in the post-protocol group (p < 0.05). There were no differences regarding the percentage of weight in excess lost at two years (> 50% in 81.3% in the pre-protocol group vs. 74.8% in the pos-protocol group) or the comorbidities. Conclusions: Bariatric surgery achieves excellent outcomes in weight loss, comorbidities, and quality of life, but presents nutritional, surgical, and psychiatric complications that require a protocol-based and multidisciplinary approach. Our protocol improves the outcomes regarding the withdrawal rates, feeding-behavior disorders, dietary habits, nutritional complications, and quality of life (AU)

Control nutricional en pacientes de traumatología / Nutritional control in orthopedic surgery patients

Objetivos: Establecer la incidencia y evolución de malnutrición en una cohorte de pacientes ingresados en un servicio de traumatología. Ámbito: Es un estudio observacional y prospectivo, realizado en un hospital terciario que dispone de Unidad de Nutrición Clínica. Pacientes: Se estudian 107 pacientes (56,1% mujeres, 43,9% hombres, edad 62,1 ± 20,4 años) al ingreso en el Servicio de Traumatología y la evolución en la primera consulta externa de los pacientes intervenidos para colocar una prótesis de cadera o rodilla. Intervenciones: Se realizó una historia clínica, recogida de datos antropométricos y tres tests de cribado nutricional: Mini-Nutritional Assessment (MNA), Malnutrition Universal Screening Tool (MUST) y Valoración Global Subjetiva (VGS). Con ellos se calcula la prevalencia de malnutrición al ingreso, comparando las diferencias entre los métodos y la posible existencia de asociación entre la malnutrición y otros factores, tales como úlceras por presión o dependencia para las actividades de la vida diaria. Resultados: Según el MNA el 22% tiene riesgo de malnutrición, en la VGS es un 24% (un 4% están malnutridos) y en el MUST un 80% presenta alto riesgo de malnutrición. Un 1,7% de los pacientes tienen un Índice de Masa Corporal (IMC) menor que 18,5. Existe una relación significativa entre la malnutrición y estado neuropsicológico (p = 0,001), dependencia para las actividades de la vida diaria (p = 0,002) y entre el MUST de alto y medio riesgo con la aparición de úlceras por presión (p = 0,003). Hay empeoramiento del estado nutricional postquirúrgico con 2 tests: MNA y VGS (p = 0,000). Conclusión: En las condiciones del estudio la prevalencia de malnutrición al ingreso en el Servicio de Traumatología es elevada, los pacientes con cirugía protésica de rodilla y cadera muestran al mes un claro empeoramiento de su estado nutricional, así como una mayor incidencia de úlceras por presión (AU

Objective: To assess the nutritional status of orthopaedic patients. Design: Prospective observation study. Setting: Tertiary hospital, Clinical Nutrition Unit. Patients: 107 patients (56,1% women, 43,9% men, 62,1± 20,4 years) are studied at admission to the orthopaedic unit and it is observed the evolution of orthopaedic surgery patients with hip or knee prosthesis. Material and methods: Medical history, anthropometric data and three nutritional screening tools were considered: Mini-Nutritional Assessment (MNA), Malnutrition Universal Screening Tool (MUST) y Valoración Global Subjetiva (VGS). It was assessed the prevalence of malnutrition in patients on admission to hospital, using different methods and determining if a correlation exists between malnutrition and other factors, such as the development of pressure sores of the dependence in activities of daily living. Results: The risk of malnutrition is 22 and 24/100 patients admitted at hospital, if MNA and SGA are used, respectively (SGA caregorized 4% of the group as "malnourished"). 80% patients are considered to be at high risk of malnutrition using MUST. 1,7% patients presented a Body Mass Index (BMI) lower than 18,5. There is a strong agreement between malnutrition and neropsychological status (p = 0,001), and the dependence in activities of daily living (p = 0,002), and between medium and high risk of malnutrition and the development of pressure sores (p = 0,003). If MNA and SGA (p = 0,000) are used, post-surgical patients presents a deteriorating nutritional status. Conclusions: The prevalence of malnutrition in patients on admission to hospital is elevated. Orthopaedic surgery patients with hip and knee prosthesis presented a deteriorating nutritional status, and a higher incidence of pressure sores in a month (AU)

[Nutritional control in orthopedic surgery patients]. / Control nutricional en pacientes de traumatología.

OBJECTIVE: To assess the nutritional status of orthopaedic patients. DESIGN: Prospective observation study. SETTING: Tertiary hospital, Clinical Nutrition Unit. PATIENTS: 107 patients (56.1% women, 43.9% men, 62.1 +/- 20.4 years) are studied at admission to the orthopaedic unit and it is observed the evolution of orthopaedic surgery patients with hip or knee prosthesis. MATERIAL AND METHODS: Medical history, anthropometric data and three nutritional screening tools were considered: Mini-Nutritional Assessment (MNA), Malnutrition Universal Screening Tool (MUST) y Valoración Global Subjetiva (VGS). It was assessed the prevalence of malnutrition in patients on admission to hospital, using different methods and determining if a correlation exists between malnutrition and other factors, such as the development of pressure sores of the dependence in activities of daily living. RESULTS: The risk of malnutrition is 22 and 24/100 patients admitted at hospital, if MNA and SGA are used, respectively (SGA caregorized 4% of the group as "malnourished"). 80% patients are considered to be at high risk of malnutrition using MUST. 1.7% patients presented a Body Mass Index (BMI) lower than 18.5. There is a strong agreement between malnutrition and neropsychological status (p = 0.001), and the dependence in activities of daily living (p = 0.002), and between medium and high risk of malnutrition and the development of pressure sores (p = 0.003). If MNA and SGA (p = 0.000) are used, post-surgical patients presents a deteriorating nutritional status. CONCLUSIONS: The prevalence of malnutrition in patients on admission to hospital is elevated. Orthopaedic surgery patients with hip and knee prosthesis presented a deteriorating nutritional status, and a higher incidence of pressure sores in a month.

Induction chemotherapy with paclitaxel plus carboplatin followed by paclitaxel with concurrent radiotherapy in stage IIIB non-small-cell lung cancer (NSCLC) patients: a phase II trial.

PURPOSE: We conducted a prospective phase II trial to evaluate the efficacy and toxicity of induction chemotherapy with paclitaxel plus carboplatin followed by concurrent radiotherapy with weekly paclitaxel in stage IIIB non-small-cell lung cancer (NSCLC) patients. PATIENTS AND METHODS: Patients with stage IIIB NSCLC received two 3-week cycles of paclitaxel 200mg/m(2) combined with carboplatin (target area under the plasma concentration curve (AUC) of 6 mg/ml) followed by weekly paclitaxel 50mg/m(2) concurrently with radiotherapy consisted of 2 Gy daily, 5 days per week (60 Gy total dose in 6 weeks). The median follow-up period was 5 years. RESULTS: Between March 1999 and January 2002, 21 patients were enrolled and analyzed. Ninety percent of patients completed the planned treatment schedule. The overall response rate was 76% (24% complete response and 52% partial response). The median overall survival time was 15 months and the 1-year, 2-year and 5-year overall survival rates were 57, 33 and 24%, respectively. The disease progression rate at 1 year was 43% and the median progression-free survival was 8 months. During the chemoradiation period, grade 3-4 oesophagitis and pneumonitis were observed in 24 and 14% of patients, respectively. CONCLUSIONS: Induction chemotherapy with carboplatin and paclitaxel followed by weekly paclitaxel with concurrent radiotherapy was found to be active and tolerable in selected stage IIIB NSCLC patients. Further studies are needed to improve the safety profile and outcome in this setting.

Infecciones víricas y gestación (excepto VIH) / Viric infections and pregnancy (excepting HIV)

Las infecciones víricas durante la gestación, son un problema de salud pública, debido a los riesgos fetales que algunas de ellas pueden comportar. Resulta fundamental su conocimiento tanto para el especialista en Obstetricia como para el Médico de Familia y el personal sanitario encargado del seguimiento de la embarazada. Esta revisión pretende dar un repaso y actualizar conocimientos, tanto en el diagnóstico clínico como de laboratorio, diagnóstico prenatal y medidas de prevención primaria y secundaria que hacen disminuir sus graves consecuencias

Viric infections during pregnancy, are a public health trouble, because of the fetal risks associated with them. Their knowledge is very important for Obstetricians and General Practitioners and also for Midwives and Nurses who take care of pregnant women. This review studies and actualizes the understanding of clinical and laboratory diagnosis, prenatal diagnosis, primary and secundary prevention in order to reduce the severe effects of viric infections during pregnancy

Pielonefritis aguda en la gestación / Acute pyelonephritis in pregnancy

La pielonefritis aguda es la complicación médicagrave mas común durante la segunda mitaddel embarazo. La presencia de una bacteriuriaasintomática no diagnosticada en el primertrimestre de gestación es un factor predisponentede primer orden. Los cambios anatómicosy funcionales que el embarazo y su ambientehormonal ocasionan sobre el aparato urinariotambién facilitan el desarrollo de infeccionesurinarias y potenciales pielonefritis.Las pielonefritis agudas no complicadas de lamujer gestante están mayoritariamente ocasionadaspor enterobacterias gram negativas queascienden desde el tracto urinario inferior.Un diagnóstico certero, fundamentado en parámetrosclínicos y analíticos, junto con un eficaztratamiento antibioterápico disminuyen lascomplicaciones maternas y fetales que se ocasionanen un 20% de las pielonefritis agudasgraves

The acute pyelonephritis is the medical serious complication commonly during the second half of the pregnancy. The presence of an asymtomatic bacteriuria not diagnosed in the first trimester of gestation is a predisposition factor of the first order. The anatomical and functional changes that the pregnancy and his hormonal environment cause on the urinary device also facilitate the development of urinary infections and potential pyelonephritis. The acute pyelonephritis not complicated of the pregnancy woman are caused for the most part for negative gram enterobacterias that ascend from the lowest urinary tract. An accurate diagnosis based on clinical and analytical parameters, together with an effective antibiotic treatment they diminish the mother and foetal complications that are caused in 20% of the acute serious pyelonephritis

Aproximación al efecto del programa de desayunos escolares sobre el rendimiento intelectual en alumnos de educación inicial y primaria del Perú / Aproach to the effect of the school breakfast program on the intellectual performace in elementary and primary school students in Peru

Objetivos: Evaluar el efecto de Programas de Desayunos Escolares (PDE), sobre el rendimiento intelectual en alumnos pertenecientes al nivel inicial y primario, atendidos por el PDE en el año 2001. Materiales y métodos: En este estudio transversar descriptivo se evaluaron mediante las pruebas cognitivas Catell 1 (4-8 años) y Catell 2 (9-13 años) escolares de 4 a 13 años (seleccionados por muestreo probabilístico multietápico) de los distritos atendidos por el PDE, calculándose los promedios del puntaje total y puntaje de cada uno de los subtests incluidos en estas pruebas. Para identificar a los niños que recibieron la intervención, se usó dos modalidades: el testumonio del profesor de "consumo usual" del desayuno escolar y la observación del consumo el día de la evaluación. Resultados: Fueron evaluados 1787 escolares: 922 de inicial y 865 de primaria. La proporción de niñas y niños fue similar. El consumo reciente del desayuno mostró efectos positivos en el puntaje total y su test específico en escolares de inicial de Lima, la costa y la selva con el Catell 1 y en escolares de primaria de la costa con el Catell 2. El consumo usual mostró efectos positivos en el puntaje total y su test específicos en escolares de inicial de la costa y la selva con el Catell 1. Conclusiones: Existen efectos positivos del consumo reciente y consumo regular de la ración del PDE con el rendimiento intelectual, siendo en este efecto mayor en escolares del nivel inicial y en lugares de la costa y la selva

Comparación en la incidencia de prurito en las primeras 24 horas del postoperatorio cuando se utiliza morfina e hidromorfona peridurales como analgésicos para operación cesárea / Comparison of the morphine and hydromorphone epidural analgesia on incidence of the pruritus during postoperative period in cesarean section patients

PROPÓSITO: Comparación en la incidencia de prurito en las primeras 24 horas del postoperatorio en las pacientes sometidas a operación cesárea cuando se les administra hidromorfona o morfina peridural. ANTECEDENTES: Se conoce que el efecto analgésico de la morfina y la hidromorfona son comparables, la literatura reporta en forma controvertida, la aparición del prurito como un efecto adverso más pronunciado con el uso de la morfina. MÉTODOS: Entre Abril y Diciembre de 1.997, en nuestra institución, se realiza un ensayo clínico, doble ciego, con 59 pacientes embarazadas programadas para cesárea, las cuales recibieron anestesia peridural lumbar con inserción de catéter. Como anestésico local se aplicó xilocaína simple o con epinefrína, adicionando 50 - 75 mcr. de Fentanyl, hasta adquirir un nivel sensitivo de T4. Fueron aleatorizados en dos grupos: El grupo 1 (n=28) recibió 1.5 mgrs de Morfina diluidos en 10cc de solución salina normal. El grupo 2 (n=31) recibió 0.5 mgrs de hidromorfona diluidos en 10cc de solución salina normal. Ambas mezclas se administraron una vez se clampeó el cordón umbilical. Se realizo el seguimiento desde el ingreso a sala de recuperación, 2, 6, 12 y 24 horas después; evaluando EVA, aparición de efectos adversos, uso de dosis de rescate de dipirona, uso de clemastina parenteral. Se utilizaron pruebas de chi cuadrado, de Fisher y análisis de varianza de las variables a medir. RESULTADOS: Se encontró una diferencia estadísticamente significante entre la aparición de los efectos adversos en cada uno de los grupos: el prurito moderado se presento en forma predominante en el grupo Hidromorfona (p=0.006) durante las primeras 24 horas del postquirúrgico. Mientras que otros efectos colaterales, tales como mareo y náuseas, se reportaron en el grupo de la Morfina (p=0.0014 y 0.002 respectivamente). CONCLUSIÓN: Este estudio demuestra que la incidencia de prurito en las 24 primeras horas del postoperatorio es mayor cuando se utiliza Hidromorfona que Morfina peridurales

[Radiotherapy for the treatment of testicular seminomas]. / Radioterapia para el tratamiento de los seminomas testiculares.

OBJECTIVE: Conventional treatment of testicular seminoma has been orchiectomy followed by adjuvant lymph node irradiation. Over the last 10 years the role of postoperative elective radiotherapy has been questioned. This paper reviews the role of radiotherapy in the treatment of seminoma of the testis. METHODS: The literature is reviewed with special reference to the results achieved in the treatment of testicular seminoma with and without radiotherapy. The advantages and disadvantages of postoperative radiotherapy, the techniques and dose administered are discussed. RESULTS/CONCLUSIONS: The results obtained with radiotherapy postorchidectomy in stage I seminoma of the testis are excellent, with a disease free survival of 95%-100%. The use of more limited fields of irradiation and lower dose has reduced the radiation-induced toxicity. Currently, many centers have opted for clinical surveillance after orchiectomy. Their experience have permitted identification of the risk factors and there have been attempts to identify the group of patients that benefit from adjuvant therapy. The low incidence of stage II tumors has not permitted performing randomized studies to determine the benefits of adjuvant therapy and its comparison with chemotherapy. Consolidation radiotherapy for bulky stage II and stage III and IV tumors continues to be a controversy, although its potential value in carefully selected patients is recognized.

Small cell carcinoma of the urinary bladder treated with chemotherapy and radiotherapy: results in five cases.

Small cell carcinoma of the bladder is a rare and highly aggressive tumor. We report our experience with 5 consecutive patients treated with systemic chemotherapy and adjuvant radiotherapy. TNM stages were T2N0M0 (1 patient), T3aN0M0 (3 patients) and T3bN1M0 (1 patient). The chemotherapy protocol was the one used with small cell lung cancer patients at our hospital: six cycles of alternating PE/CAV (PE: cisplatin, etoposide; CAV: cyclophosphamide, doxorubicin, vincristine). Cystoscopy was performed after the third cycle. Four out of 5 patients were free of macroscopic disease. The fifth patient had persistent lesions and was treated by cystectomy. This patient developed a local-regional recurrence 4 months later and died shortly afterwards. Four patients completed the planned six cycles. Cystoscopy with bladder biopsy was then performed on each, and all had complete remission. They were treated with external radiotherapy (45 Gy pelvis, 60 Gy bladder). One patient had invasive bladder recurrence 12 months later and cystectomy was performed. At the last follow-up 42 months later, he was alive and well. The other 3 patients were alive and free of disease 60, 48 and 27 months after diagnosis, respectively. These results are clearly more favorable than previous reports. Cystectomy might, therefore, be unnecessary in some patients.

Non-enzymatic glycosylation of alkaline phosphatase alters its biological properties.

Hyperglycaemia in poorly controlled diabetic patients induces non-enzymatic glycosylation (glycation) of proteins, altering their structure and physiological bioactivity. Alkaline phosphatase (ALP) is a membrane-bound exoenzyme which faces the extracellular compartment. We have investigated the glycation of intestinal alkaline phosphatase in vitro and the consequences of such molecular modifications on certain structural and functional characteristics. The effect of glycation on alkaline phosphatase specific activity was determined after incubation of the enzyme with different sugars for various periods of time. The formation of early reversible glycation products was determined by the measurement of fructosamine levels, while the appearance of advanced glycation end products was estimated by spectrofluorometric analysis. A decrease in the specific activity of ALP was associated both with an increase in fructosamine levels and with the appearance of AGE-characteristic fluorescence. Changes in these parameters were found to depend on the incubation time, and on the concentration and glycating capability of the sugar employed. Co-incubation with aminoguanidine slowed down the appearance of protein-linked fluorescence, and additionally curbed the decrease in enzymatic specific activity. A significant correlation between the levels of ALP-fructosamine and ALP-advanced glycation end product was observed. Patterns of protein bands fractionated by SDS-PAGE were essentially identical for the nonglycated controls and the glycated samples. The electrophoretic mobility of the band of alkaline phosphatase on cellulose acetate gels increased as a function of the incubation time and the glycosylating power of the carbohydrate used. The present study provides evidence for the in vitro glycation of alkaline phosphatase, and for the consecutive alteration of its activity and structure.

Midplane dose determination during total body irradiation using in vivo dosimetry.

BACKGROUND AND PURPOSE: During TBI techniques an accurate determination of the dose distribution is very difficult when using commercial treatment planning systems. In order to determine the midplane dose, an algorithm was developed based on the use of in vivo dosimetry. MATERIALS AND METHODS: Scanditronix EDP-30 diodes were placed at the entrance and the exit surface for in vivo dosimetry. The proposed algorithm was validated firstly in a regular and homogeneous phantom of different thickness with an ionization chamber and TL dosimeters and secondly in an Alderson anthropomorphic phantom with TL dosimeters. In this study, in vivo measurements were evaluated in 60 patients and furthermore, in 20 of them, the midplane dose calculated with this algorithm was compared with the method described by Rizzotti A, Compri C, Garusi GF. Dose evaluation to patients irradiated by 60Co beams, by means of direct measurement on the incident and on the exit surfaces. Radiother. Oncol. 1985;3:279-283. RESULTS: No differences were found between the two methods. The differences between dose values calculated with both methods and dose values measured with the ionization chamber and TL dosimeters were within +/-22% and +/-4%, respectively, in the regular and homogeneous phantom and within +/-2% in the Alderson phantom. The algorithm was useful in calculating the midplane dose when heterogeneities as lungs were present. Even when partial transmission blocks were used to reduce the dose to the lungs, the algorithm with modified correction factors gave a midplane lung dose in the Alderson phantom within 1.3% of the measurements with TL dosimeters. For 360 patients' measurements in each A-P and P-A field, the relative deviations were analyzed between the measured and calculated entrance, exit dose and midplane dose and the prescribed dose, always applying the temperature correction factor. These deviations at the entrance dose were within +/-4%. Greater deviations were found for the exit dose measurements. Deviations larger than +/-10% corresponded in general to obese patients, with a thickness over 25 cm. The relative deviations between the total received and prescribed midplane doses in 60 patients were within +/-3%. CONCLUSIONS: The results indicate excellent correspondence between the total prescribed and calculated midplane doses using this algorithm while also no significant differences were found when the Rizzotti method was used. Comparison between doses measured with TL dosimeters in the core of Alderson phantom lungs and doses calculated from in vivo measurements showed that the proposed algorithm could be used in the presence of heterogeneities even when partial transmission blocks were used. The temperature correction factor must be applied in order to avoid a 2-3% dose overestimation.