Malnutrition in an elderly population without cognitive impairment living in nursing homes in Spain: study of prevalence using the Mini Nutritional Assessment test.

BACKGROUND: The prevalence of malnutrition in institutionalized elderly people is generally high. A good nutritional status is related to a decrease in mortality and costs of morbidity treatments. Therefore, it is essential to know the nutritional status in order to establish action policies. However, there are not enough studies about malnutrition in institutionalized elderly in Spain. OBJECTIVES: The objectives of this survey were to assess the prevalence of malnutrition and risk of malnutrition in elderly people living in nursing homes in the province of Albacete (Spain) using the Mini Nutritional Assessment (MNA®) test, to analyze their distribution according to age, gender and different nursing home features, and to identify the MNA items that best predict the MNA total score. METHODS: A cross-sectional study was conducted with data collected from 895 elders living in 34 nursing homes all over the province of Albacete, including facilities located in the main city, towns and villages. Prevalence of malnutrition and risk of malnutrition were assessed using the MNA full form test. Groups of malnutrition were compared by using mean MNA scores. Stepwise linear regression analyses were used to identify the items in the MNA which best predicted the MNA total scores. RESULTS: According to the MNA, the prevalence of malnutrition among elderly people staying in Albacete province nursing homes was 2.8%, and the prevalence of being at risk of malnutrition was 37.3%. MNA total score was significantly higher in men (24.3 ± 2.9) than in women (23.7 ± 3.3) and significantly higher in residents living in nursing homes located in towns and villages (24.2 ± 2.8) than in those who were living in institutions placed in the main city (23.7 ± 3.4). The MNA score was found to decrease with increasing age, except for individuals aged 90 years or older. CONCLUSIONS: The prevalence of malnutrition and risk of malnutrition was 40.1%. Female gender and living in institutions located in the main city were identified as malnutrition risk factors. In general, an increase in malnutrition with age was detected, except for people in the last years of their lives. The MNA questions that best predicted the nutritional status were the ones relating to the anthropometrical and self-assessments.

Validation of the revised mini nutritional assessment short-forms in nursing homes in Spain.

OBJECTIVE: To contribute to the validation of the revised BMI-MNA-SF and CC- MNA-SF with regard to association and agreement with the full-MNA, considered as gold standard, in nursing homes in Spain. DESIGN: Prospective analysis. SETTING: Nursing homes. PARTICIPANTS: Eight hundred ninety five subjects aged 65 or older meeting inclusion criteria. MEASUREMENTS: Correlation, diagnostic accuracy and agreement between the revised MNA short forms and the MNA full form. RESULTS: The MNA-SFs correlated strongly with the full MNA version (Pearson's correlation coefficient r=0.904; p<0.001). High values of sensitivity, specificity and predictive values were obtained for the BMI- MNA-SF and CC-MNA-SF against the full-MNA when the dichotomized categorizations "malnourished-at risk of malnutrition" vs. "well nourished" and "malnourished" vs "at risk of malnutrition-well nourished" were considered (Youden's index at least 0.695 in all cases). Areas under the ROC curves also reached high values (BMI-SF: 0.950 and CC-SF: 0.923 for the first categorization; BMI-SF: 0.979 and CC-SF: 0.978 for the second one) showing both tests excellent accuracy with the full-MNA. The agreement between the MNA-SFs and the full-MNA was quantified as the percentage of correct classifications. The BMI-MNA-SF classified 83.80% correctly and the CC-MNA-SF classified 78.55% correctly. Significant proportions of subjects were underestimated by both MNA-SFs. Just about 6% of overestimations were found in both cases. CONCLUSION: The revised BMI-MNA-SF and CC-MNA-SF are rapid, easy and reliable tools capable to identify malnourished individuals and those who are at risk of malnutrition with minimal misclassifications with potential harm in nursing home residents. Due to the special characteristics of elderly staying in these institutions, the CC-MNA-SF is a good option to replace the BMI-MNA-SF when BMI is not available.

Selection of antagonistic bacteria isolated from the Physalis peruviana rhizosphere against Fusarium oxysporum.

AIMS: Cape gooseberries (Physalis peruviana) have become increasingly important in Colombia for both domestic consumption and the international export market. Vascular wilting caused by Fusarium oxysporum is the most damaging disease to P. peruviana crops in Colombia. The control of this pathogen is mainly carried out by chemical and cultural practices, increasing production costs and generating resistance. Therefore, the objectives of this study were to test rhizobacteria isolates from P. peruviana rhizosphere against F. oxysporum under in vitro and in vivo conditions. METHODS AND RESULTS: Over 120 strains were isolated, and five were selected for their high inhibition of F. oxysporum growth and conidia production under in vitro conditions. These strains inhibited growth by 41-58% and reduced three- to fivefold conidia production. In the in vivo assays, all the tested isolates significantly reduced fungal pathogenicity in terms of virulence. Isolate B-3.4 was the most efficient in delaying the onset of the first symptoms. All isolates were identified as belonging to the genus Pseudomonas except for A-19 (Bacillus sp.). CONCLUSIONS: Our results confirmed that there are prospective rhizobacteria strains that can be used as biological control agents; some of them being able to inhibit in vitro F. oxysporum growth and sporulation. SIGNIFICANCE AND IMPACT OF THE STUDY: Incorporating these bacteria into biological control strategies for the disease that causes high economical losses in the second most exported fruit from Colombia would result in a reduced impact on environment and economy.

IgG monitoring to identify the risk for development of infection in heart transplant recipients.

Infectious complication represents a significant source of morbidity and mortality in heart transplant recipients. To assess humoral immunity markers that can predict the development of infection, 38 consecutive recipients of heart transplants performed at a single center were prospectively studied. Induction therapy included daclizumab. Immunoglobulin (IgG, IgA, IgM) and complement factors (C3, C4, and factor B) were performed by nephelometry in peripheral blood samples obtained before transplantation, and 7 days and 1 month after transplantation. During a mean follow-up of 16.9 months, 13 patients had at least one episode of infection (34.2%). Eight of these were cytomegalovirus (CMV) infections treated with intravenous ganciclovir, 2 were bacterial pneumonia, 1 patient had bacterial septicemia, 1 patient had urinary tract infection, and 1 patient had pulmonary nocardiosis. No significant association was found between infection and age, sex, immunosuppression, CMV serostatus of donor and recipient, or treated rejection episodes. Pre-transplant IgG (below median value=1140 mg/dL; relative risk [RR] 3.69; 95% confidence interval [CI] 1.01-13.54; P=0.04) and post-transplant IgG levels at day 7 (below median value=679 mg/dL; RR 11.21; CI 1.04-89.48; P=0.022) were associated with an increase in the risk for developing infections. Early monitoring of immunoglobulin levels might help to identify the risk for developing infection in heart transplantation.

Prevalence of IgG anti-{alpha}-fodrin antibodies in Sjogren's syndrome.

The objective of this study was to determine the prevalence of antibodies against alpha-fodrin (alpha-fodrin) of the immunoglobulin G (IgG) isotype in Sjögren's syndrome (SS), as defined by European Community Study Group (ESG) and ESG-modified criteria. We arrived at the prevalence and mean concentrations of IgG anti-alpha-fodrin antibodies using enzyme-linked immunosorbent assay (ELISA) in 507 patients with SS, primary SS (pSS), and secondary SS (sSS), classified according to either the ESG or the ESG-modified criteria. IgG anti-alpha-fodrin antibodies were detected in 6/507 (1.2%) and 4/228 (1.7%) of the SS group, according to the ESG or ESG-modified criteria, respectively. Similar prevalence was found for patients with pSS or sSS. Anti-Ro/SSA antibodies were present in 151/409 (36.9%) vs. 149/213 (70.0%) of the SS group, 85/195 (43.6%) vs. 83/101 (82.2%) of the pSS group, and 66/214 (30.8%) vs. 66/112 (58.9%) of the sSS group. Anti-La/SSB antibodies were detected in 77/403 (19.1%) vs. 73/212 (34.4%) of the SS group, 47/194 (24.2%) vs. 45/101 (44.5%) of the pSS group, and 30/209 (14.3%) vs. 28/111 (25.2%) of the sSS group. No clinical associations were found. Only two IgG anti-alpha-fodrin-positive sera were anti-Ro/SSA-negative. We conclude that IgG antibodies against alpha-fodrin are present in a small percentage of people with SS, pSS, and sSS. The lower prevalence in patients classified according to the ESG criteria reflects the lower specificity of these criteria. IgG anti-alpha-fodrin antibodies can be detected in some SS patients whose sera do not contain anti-Ro/SSA antibodies.

Colgajo sural en úlceras venosas crónicas de piernas / Sural flap in chronic venous leg ulcer

Las úlceras venosas de las piernas son una patología frecuente, constituyendo un verdadero problema de salud pública. Tradicionalmente en nuestro medio los pacientes han sido manejados conservadoramente con curaciones de las úlceras y comprensión elástica de las extremidades inferiores. Sin embargo, esta conducta implica controles por largos períodos de tiempo causando un deterioro en la calidad de vida del enfermo y una significativa carga económica. En algunos pacientes hemos empleado injertos de piel, no obstante los resultados han sido decepcionantes debido a la alta recidiva. Por estos motivos presentamos la experiencia preliminar del Hospital de Punta Arenas, con el manejo quirúrgico de estas úlceras. Realizamos la resección de la úlcera y de tejido lipodermatoesclerótico, ligadura de las venas perforantes insuficientes y cobertura inmediata con un colgajo sural a pedículo distal. Hemos manejado 4 pacientes portadores de úlceras venosas crónicas de las piernas con este enfrentamiento, presentándose como una alternativa válida de tratamiento. Se discuten algunos aspectos relacionados al tipo de cirugía, evolución, complicaciones y resultados.

Bleomycin-induced chronic lung damage does not resemble human idiopathic pulmonary fibrosis.

Administration of bleomycin into the lungs of experimental animals has been utilized as a model to understand human pulmonary fibrosis. Most of the studies, however, have focused on early stages of the lung reaction. We hypothesized that chronic stages of the model may not mimic idiopathic pulmonary fibrosis, since in preliminary studies, lung volume and compliance were not decreased. Eight male Sprague-Dawley rats receiving intratracheal bleomycin (0.5 U/100 g body weight) underwent measurement of FRC, inspiratory capacity, and lung compliance 120 d later. Lung histologic changes were evaluated using light microscopy. Eight rats without intervention served as controls. Results show that our model, in early stages, has histologic changes no different from those previously described elsewhere. In chronic stages, however, the model does not behave as a restrictive syndrome: FRC is normal or increased, whereas lung compliance is normal. Focal peribronchiolar inflammation and fibrosis associated with paracicatricial emphysematous changes are the main histologic features of long-term lung remodeling after bleomycin. We conclude that while the chronic stages of the model may be informative in understanding mechanisms of fibrosis, care should be taken not to extrapolate to human idiopathic pulmonary fibrosis. We speculate that the model might resemble a particular subgroup of human interstitial lung disease, namely, those involving peribronchiolar structures.

Species differences in the intracellular distribution of ciprofibroyl-CoA hydrolase. Implications for peroxisome proliferation.

Peroxisomal proliferators (HPP), such as ciprofibrate and clofibric acid, are species-specific drugs. Since HPP-coenzyme A derivatives might be involved in their action, we studied the subcellular distribution of liver ciprofibroyl-CoA hydrolase in rat and in two HPP-unresponsive species, humans and guinea pig. Total activity was similar in the three species and was not induced by clofibric acid treatment. In guinea pig, as in humans, the enzyme is localized in the mitochondrial and soluble fractions and no changes are observed after drug treatment. In the rat, the enzyme has a microsomal localization, but upon clofibric acid treatment it changes to a mitochondrial and soluble distribution, as in unresponsive species. These results raise the possibility that drug-induced hydrolases in rats might be normally expressed in humans and guinea pigs.

Versatilidad de la cardioplejía anterógrada/retrógrada en cirugía cardiaca / Versality of antegrade and retrograde cardioplegia in heart surgery

Desde marzo de 1990 hasta marzo de 1992, se operaron 80 pacientes de corazón por diversas patologías. Se usó como medida de protección miocárdica la combinación de las vías anterógrada por la raíz aórtica y la retrógrada por el seno venoso coronario (SVC) para el paso de la solución cardiopléjica. La cánula de retroplejía fue introducida al SVC de dos maneras: en 67 pacientes se canuló vía transatrial (método ciego) con cánula única para el retorno venoso; a los 13 restantes se les canuló bajo visión directa por atriotomía derecha con canulación bicava para el retorno venoso total. Los procedimientos quirúrgicos realizados fueron variados y prolongados en la mayoría y sólo se usó cardioplejía cristaloide fría a 4 grados centígrados con potasio, excepto en un paciente con daño ventricular severo en el cual, por ser cirugía de rescate, se administró cardioplejía sanguínea caliente. No se presentaron complicaciones en lo tocante a la canulación del SVC (bloqueo A-V, ruptura del seno venoso), no hubo dificultades técnicas para canular el SVC ni para el paso de la solución cardiopléjica que fue monitorizado en forma continua manteniendo una presión en el SVC por debajo de los 40 mm Hg. La mortalidad hospitalaria (30 días de postoperatorio) fue de 3.75 por ciento (3 casos): por sepsis en 2 casos y uno por accidente vascular cerebral. La mayoría de los pacientes no recibieron inotrópicos para sostén ventricular en el postoperatorio inmediato y sólo algunos recibieron dabutamina o dopamina para mantener la función renal. Concluimos, con base en este estudio, que la cardioplejía combinada anterógrada/retrógrada puede ser aplicada en forma rutinaria en la mayoría de los pacientes que son sometidos a cirugía de corazón abierto

A high molecular weight proteoglycan is differentially expressed during development of the mollusc Concholepas concholepas (Mollusca; Gastropoda; Muricidae).

Incorporation of radioactive sulfate to hatched veliger larvae of the gastropod muricid Concholepas concholepas indicated that over 87% of the sulfated macromolecules were found in the detergent insoluble fraction, rich in extracellular matrix (ECM) components. The sulfated material was solubilized with guanidine salt followed by urea dialysis and fractionated by DEAE-Sephacel chromatography. Three sulfated compounds eluting at 0.7, 1.1, and 3.0 M NaCl, called peaks I, II, and III, respectively, were obtained. The sulfated compound present in peak I was degraded by pronase or sodium alkaline treatment to a small sulfated resistant material, suggesting the presence of a proteoglycan (PG). Filtration analysis on Sephacryl S-500 and SDS-PAGE of the intact PG indicates that it has a high molecular weight (360,000 to over 1 x 10(6)). Monoclonal antibodies (mAb) against this PG were produced. The specificity of one mAb, the 6H2, was demonstrated by size chromatography and ELISA analysis. The epitope recognized by this mAb seems to be present in the core protein of the PG. Both the extent of sulfation and the presence of different sulfated species of PGs were evaluated during the development of this mollusc. A twelvefold increase in the incorporation of sulfate to PGs per milligram of protein was found in veliger larvae compared to blastula-glastula stages. This change correlated well with the differential expression of the sulfated PG present in peak I. Biochemical and immunological analysis indicate that high levels of this PG are found in veliger and trocophore larvae in comparison with blastula-gastrula and early juveniles.(ABSTRACT TRUNCATED AT 250 WORDS)

Isolation of proteoglycans synthesized by rat heart: evidence for the presence of several distinct forms.

1. The proteoglycans (Ps) synthesized by auricle and ventricle from adult rat heart were studied. 2. Auricle tissue incorporated over two times radioactive sulfate compared to ventricle tissue and the Ps were mainly found in the detergent insoluble fraction. 3. The Ps from both tissues were isolated by ion-exchange chromatography on DEAE-Sephacel, followed by gel filtration on Sepharose CL-6B and SDS-PAGE electrophoresis. 4. Enzymatic and chemical degradation of these Ps suggest that at least three and probably four different species of Ps can be observed in heart tissue. 4. A high molecular weight chondroitin sulfate-P, a high molecular weight heparan sulfate-P, a chondroitin/dermatan sulfate-P of 240-200 kDa and a dermatan sulfate of 115 kDa. 5. This latter P was specifically immunoprecipitated using rat decorin antiserum.

A Mr 46,000 human milk fat globule protein that is highly expressed in human breast tumors contains factor VIII-like domains.

The human milk fat globule has proved to be a good source of antigenic material for production of antibodies against surface components of breast epithelial cells. Monoclonal antibodies against one of the major components of the human milk fat globule, which identify a glycoprotein with an apparent molecular weight of 46,000, have been found to be useful for both breast cancer diagnosis and therapy. In order to characterize this Mr 46,000 glycoprotein, specific monoclonal antibodies were used to select complementary DNAs from a lambda gt11 expression library from lactating breast. The largest complementary DNA insert (BA46-1) was 1270 base pairs and encoded 217 amino acids. A single 2.2-kilobase RNA was specifically detected in a variety of carcinoma cell lines, using this complementary DNA probe, and it was overexpressed in some carcinoma lines. The mRNA levels correlated with the level of expression of the antigen in these cell lines as detected by Western blot analysis. Sequence analysis revealed strong homology of the Mr 46,000 glycoprotein with serum factors VIII and V, in the region implicated in phospholipid binding.

Cloning and sequencing of a complementary DNA encoding a Mr 70,000 human breast epithelial mucin-associated antigen.

The human milk fat globule (HMFG) membrane contains several glycoproteins that have been referred to as breast differentiation antigens and that are expressed in normal breast, breast tumors, breast tumor-derived cell lines, and are found in breast cancer patient serum. These antigens include a high molecular weight mucin and several smaller components including Mr 150,000; 70,000; and 46,000 glycoproteins. We have used 2 monoclonal antibodies (McR2 and Mc13) that bind the Mr 70,000 component of HMFG to immunoscreen a lambda gt11 expression library prepared from human lactating breast tissue. We report here the sequence of a complementary DNA clone (BA70-1) that codes for a peptide that binds both McR2 and Mc13 but not monoclonal antibodies to the breast mucin or other components of HMFG.A 1.8-kilobase RNA was detected in 9 of 9 breast tumor cell lines using 32P-labeled BA70-1 as probe. The BA70-1 RNA was highly expressed in 6 of 9 cells lines of breast and several other carcinomas lines compared with a lymphoblastoid cell line (Raji). The BA70-1 complementary DNA sequence has no extensive homology with previously reported sequences including the high-molecular weight mucin complementary DNA. Since the Mr 70,000 molecule appears to be associated with the breast mucin by disulfide bonds, its study could help elucidate the structure of this latter complex and how it is organized in the cell membrane, and prove useful in diagnosis and therapy of breast cancer.

[A combination of ampicillin and sulbactam: effect on aerobic and anaerobic gram-negative bacteria]. / Asociación ampicilina y sulbactam: actividad sobre bacilos gram negativos aerobios y anaerobios.

The antibacterial activity of the association of ampicillin and sulbactam (2:1) upon strains of aerobic and anaerobic Gram negative agents was assayed. Inhibition of B-lactamases from intact and disrupted cells of some selected strains by sulbactam was also determined. Susceptibility was found in 34% and partial inhibition in 48%; 18% were fully resistant. Synergy between ampicillin and sulbactam was found upon ampicillin susceptible strains. This effect might reflect higher degree of binding of the inhibitor to PBP's in the absence of a trapping effect produced by B-lactamases. Anaerobic microorganisms were found to be highly susceptible to this association of B-lactams. Adequate penetration of the inhibitor into periplasmic space of Gram negative bacilli was deduced by the similar decrease of B-lactamase activity observed in intact and disrupted cells treated with sulbactam.

Racionalización del drenaje en la colecistectomía / Rationalization of drainage in cholecystectomy

Se analiza en forma prospectiva y randomizada, la evolución postoperatoria de 138 pacientes colecistectomizados con y sin drenaje. Fueron colecistectomizados sin drenaje 79 y con drenaje 59 pacientes. La morbilidad para el grupo sin drenaje fue de 7,6% y para el grupo con drenaje de 13,6%, cifra que no alcanzó significación estadística. La estada postoperatoria promedio fue de 3,98 días para el grupo con drenaje y de 3,65 para el grupo sin drenaje. Respecto a la convalescencia, esta fue significativamente más confortable para los pacientes sin drenaje (14% contra 3,4%). Se discuten las bases para racionalizar el uso del drenaje en ésta cirugía

Bacteriological studies with ampicillin/sulbactam on selected strains of gram-negative bacteria.

Antibacterial activity of sulbactam or ampicillin alone and in combination on ampicillin-resistant, beta-lactamase-producing Gram-negative bacteria (Citrobacter freundii and Escherichia coli) was studied. Inhibition of beta-lactamase activity by sulbactam was investigated using intact and disrupted cells. Minimal inhibitory concentrations of ampicillin were high but decreased significantly in the presence of sulbactam. Similar enzyme inhibition was observed with intact and disrupted bacterial cells, thus indicating efficient penetration by sulbactam into the periplasmic space. Bacterial killing was achieved in approximately 4 hrs with ampicillin/sulbactam at concentrations that neither killed nor inhibited the same strains when the drugs were used alone. Sulbactam was more effective against plasmid-cured strain of E. coli than the same plasmid-containing organism.

La anestesia: medio para conservar la homeostasis en la cirugía de aneurisma de aorta abdominal / Anesthesia: it's influence in the corporal homeostasis during abdominal aortic aneurysm surgery

Revisamos retrospectivamente los expedientes de pacientes sometidos a cirugía de aeurisma de aorta abdominal, encontrando 8 pacientes en un periodo de 5 años. El objetivo de este trabajo fue el analizar los camibos que sufre la homeostasis corporal en el periodo transoperatorio y sus complicaciones, así como la influencia de la anestesia como mecanismo conservador de la misma. La mortalidad atribuida a la anestesia fue nula, y la quirúrgica electiva fue comparable a la de otros centros. Las alteraciones observadas en el perfil hemodinámino durante el pinzamiento aórtico, mostraron el riesgo que tienen estos pacientes de sufrir un infarto agudo al miocardio. La protección renal resultó ser indispensable, independientemente del tiempo de pinzamiento aórtico.