Telefarmacia como estrategia de dispensación coordinada entre Farmacia Hospitalaria y Atención Primaria / Telepharmacy as a strategy for co-ordinated dispensing between Hospital Pharmacy and Primary Care

A partir de la publicación de la Orden Ministerial SND/293/2020,del 25 de marzo, tras la declaración de la emergencia sanitariapor SARS-CoV-2 en España, se diseñaron una serie de medidasque garantizaran la restricción de movilidad de la población sinperjuicio del acceso a los medicamentos hospitalarios. Así, a raízde dicha publicación, en el Servicio de Farmacia Hospitalaria delHospital SAS La Línea se desarrolló un programa de Telefarmaciacon puntos de dispensación en los centros de Atención Primariaadscritos y una consulta telefónica de Atención Farmacéutica.Se realizaron un total de 1.007 dispensaciones en 301 pacientesdurante el periodo de estudio comprendido entre el 1 de julio al15 de noviembre de 2020. Así, al finalizar dicho periodo, 235fueron los pacientes que permanecieron incluidos en el programa de Telefarmacia con una edad media de 64 años y un54,5% (128) mujeres. A estos pacientes, se les enviaron por correo postal una encuesta de satisfacción que podrían devolvervoluntaria y anónimamente al Servicio de Farmacia. Se recibieronun total de 62 encuestas, mostrándose los pacientes satisfechosen un 96,77% (60) con el servicio de entrega, 90,32% (56) conel trato recibido, 87,10% (54) con la puntualidad y 98,39% (61)con las condiciones de conservación en el Centro de Salud.El alto grado de satisfacción de los pacientes encuestadosrefleja que el nuevo programa de Telefarmacia podrían responder a las necesidades individuales de los pacientes,siendo para ello fundamental la coordinación de todos losprofesionales implicados, así como la corresponsabilidad delos pacientes en el control de sus tratamientos.Con los resultados obtenidos en el presente estudio, parece justificado mantener en el futuro los centros de atención primariacomo punto de dispensación junto con un mayor desarrollo dela consulta no presencial de Atención Farmacéutica. (AU)

As of the publication of Ministerial OrderSND/293/2020, of March 25, after thedeclaration of the health emergency dueto SARS-CoV-2 in Spain, a series of measures were designed to guarantee therestriction of population mobility withoutprejudice to access to hospital medications. Thus, as a result of said publication,a telepharmacy program was developedat the clinical pharmacy service of theHospital SAS La Línea with dispensingpoints in the attached Primary Care centers and a Pharmaceutical Care Telephone Consultation.A total of 1,007 dispensations weremade in 301 patients during the studyperiod from July 1 to November 15,2020. Thus, at the end of that period,235 were the patients who remainedincluded in the Telepharmacy programwith a mean age 64 years and 54.5%(128) women. A satisfaction survey wassent to these patients by post, whichthey could return voluntarily and anonymously to the pharmacy service. A totalof 62 surveys were received, showing96.77% (60) satisfied patients with thedelivery service, 90.32% (56) with theattention received, 87.10% (54) withthe punctuality and 98.39% (61) withthe conditions of conservation in thehealth center.The high degree of satisfaction of thesurveyed patients reflects that the newTelepharmacy program could respondto the individual needs of the patients,being essential for this the coordinationof all the professionals involved, as wellas the co-responsibility of the patientsin the control of their treatments.With the results obtained in the present study, it seems justified in the future to maintain primary care centersas a dispensing point together with afurther development of the non-faceto-face consultation of PharmaceuticalCare. (AU)

A management algorithm for vertebral destruction syndrome by multiple myeloma and metastatic spinal cord compression.

INTRODUCTION: Multiple myeloma represents 1% of all cancers and 10% of hematological cancers. Up to 80-90% of cases will have skeletal involvement and the spine is the most frequently involved site. Any intervention must be aimed to improve the patients functional prognosis and will impact their quality of life. OBJECTIVE: To describe the clinical presentation of vertebral destruction syndrome due to multiple myeloma and to present the management algorithm used for the study and decision-making in treatment. MATERIAL AND METHODS: Study design: Retrospective cross-sectional. A search was made in the hospitals clinical file in search of patients with a histological diagnosis of multiple myeloma attended by the Spinal Surgery Service. Clinical characteristics of the initial presentation were obtained such as: presence of pain, ASIA scale and it was categorized according to the Durie-Salmon classification at diagnosis; the levels involved and type of surgery were described. RESULTS: The study included ten patients with an average age of 61.4 years, 70% were male subjects. All patients were approach according to the modified protocol for vertebral destruction syndrome and fluoroscopy-guided percutaneous biopsy. Most had pain at diagnosis, after neurologic examination only 30% were classified as ASIA A. Most of the patients were staged III according to Durie Salomon. The most frequently vertebral segment involved was thoracic. In only one patient more than two vertebrae were involved. After diagnosis of multiple myeloma, nine patients were managed according to a NOMS framework. In the majority they were treated with fusion by posterior approach, six of them were augmented with vertebroplasty. Only one patient of the total, was treated with vertebroplasty alone. CONCLUSIONS: The use of systematized management algorithms will allow better decisions to be made in conjunction with a multidisciplinary group for the care of multiple myeloma with vertebral involvement.

INTRODUCCIÓN: El mieloma múltiple representa 1% de todos los tipos de cáncer y 10% de los cánceres hematológicos. Hasta en 80-90% de los casos se involucrará el sistema esquelético, siendo la columna el sitio más frecuentemente afectado. Cualquier intervención planeada deberá ser dirigida a mejorar el pronóstico funcional del paciente e impactará en su calidad de vida. OBJETIVO: Describir la presentación clínica del síndrome de destrucción vertebral por mieloma múltiple y presentar el algoritmo de manejo empleado para el estudio y la toma de decisiones en el tratamiento. MATERIAL Y MÉTODOS: Diseño de estudio: Retrospectivo, transversal. Se realizó una búsqueda en el archivo clínico del hospital en búsqueda de pacientes con diagnóstico histológico de mieloma múltiple atendidos por el Servicio de Cirugía de Columna. Se obtuvieron características clínicas de la presentación inicial como: presencia de dolor, escala de ASIA y se categorizó de acuerdo con la clasificación de Durie-Salmon al diagnóstico; se describen los niveles involucrados y tipo de cirugía. RESULTADOS: El estudio incluyó 10 pacientes con una edad promedio de 61.4 años, 70% de los cuales fueron varones. Todos los pacientes se abordaron de acuerdo al protocolo de síndrome de destrucción vertebral y con biopsia percutánea guiada por fluoroscopía. La mayoría de los pacientes tenían dolor al diagnóstico, tras la exploración neurológica sólo el 30% fueron clasificados como ASIA A. La mayoría de los pacientes se estadificaron como III de acuerdo con Durie-Salmon. El segmento vertebral más comúnmente afectado fue el torácico. En sólo un paciente se involucraba más de dos vértebras. Tras el diagnóstico de mieloma múltiple, nueve pacientes fueron manejados de acuerdo con el marco de trabajo NOMS. La mayoría fueron tratados con fusión por un abordaje posterior, seis de ellos con aumentación con vertebroplastía. Sólo un paciente del total, fue tratado sólo con vertebroplastía. CONCLUSIONES: El empleo de algoritmos de tratamiento sistematizado permitirá la toma de mejores decisiones en conjunto con un grupo multidisciplinario para el tratamiento de mieloma múltiple con afección vertebral.

Safety of long-term treatment with Pegvisomant: analysis of Spanish patients included in global ACROSTUDY.

PURPOSE: To evaluate the long-term safety of Pegvisomant (PEG) in the Spanish cohort of ACROSTUDY. METHODS: As of July 2013, 199 Spanish patients were included in ACROSTUDY, a global non interventional safety PEG surveillance study. Patients were observed for safety, biochemical outcome and magnetic resonance imaging evaluations. RESULTS: PEG was administered during an average period of 6.7 ± 2.1 years and a mean daily dose of 15.5 ± 7.5 mg. 48.2% of patients received PEG monotherapy. 90.9% of patients had received other medical treatment before PEG start. 195 adverse events (AEs) were reported in 88 patients (44.2%), and serious AEs were described in 31 patients (15.6%). There were no cases of liver tests >10 ULN, or permanent liver damage. Tumor size changes were locally reported in 61 cases (33.5%), with increases observed in 11 patients (6%). In acromegalic patients with diabetes mellitus a decrease in fasting serum glucose value was reported, reaching statistical significance after 1 and 4 years of treatment (-24.6 and -25.9 mg/dl, p = 0.04). After 60 months, normal or lower limit of normal (LLN) IGF-I levels were found in 67.9% of patients. 85.5% of patients showed an IGF-I normal or

Adaptation of acidogenic sludge to increasing glycerol concentrations for biohydrogen production.

Hydrogen is a promising alternative as an energetic carrier and its production by dark fermentation from wastewater has been recently proposed, with special attention to crude glycerol as potential substrate. In this study, two different feeding strategies were evaluated for replacing the glucose substrate by glycerol substrate: a one-step strategy (glucose was replaced abruptly by glycerol) and a step-by-step strategy (progressive decrease of glucose concentration and increase of glycerol concentration from 0 to 5 g L(-1)), in a continuous stirred tank reactor (12 h of hydraulic retention time (HRT), pH 5.5, 35 °C). While the one-step strategy led to biomass washout and unsuccessful H2 production, the step-by-step strategy was efficient for biomass adaptation, reaching acceptable hydrogen yields (0.4 ± 0.1 molH2 mol(-1) glycerol consumed) around 33 % of the theoretical yield independently of the glycerol concentration. Microbial community structure was investigated by single-strand conformation polymorphism (SSCP) and denaturing gradient gel electrophoresis (DGGE) fingerprinting techniques, targeting either the total community (16S ribosomal RNA (rRNA) gene) or the functional Clostridium population involved in H2 production (hydA gene), as well as by 454 pyrosequencing of the total community. Multivariate analysis of fingerprinting and pyrosequencing results revealed the influence of the feeding strategy on the bacterial community structure and suggested the progressive structural adaptation of the community to increasing glycerol concentrations, through the emergence and selection of specific species, highly correlated to environmental parameters. Particularly, this work highlighted an interesting shift of dominant community members (putatively responsible of hydrogen production in the continuous stirred tank reactor (CSTR)) according to the gradient of glycerol proportion in the feed, from the family Veillonellaceae to the genera Prevotella and Clostridium sp., putatively responsible of hydrogen production in the CSTR.

Evaluación nutricional e indicadores de grasa visceral y subcutánea en niños con síndrome de Down / Nutrition assessment and indicators of fat visceral and fat subcutaneous in children with Down syndrome

Antecedentes. Existen pocas publicaciones en relación a la composición corporal en niños con síndrome de Down (SD). Objetivos. Evaluar la relación entre los indicadores del estado nutricional (EN) -utilizando referencias catalanas y del CDC/NCHS- y los indicadores de la composición corporal, y comparar la concordancia entre los índices peso/talla (IP/T), índice de masa corporal/edad (IMC/E), y peso/edad (P/E) para evaluar el estado nutricional en niños con SD. Materiales y métodos. Estudio analítico de corte transversal en el que se estudiaron 40 niños con SD, 20 niñas y 20 niños de edades comprendidas entre 3 y 13 años. Se realizaron mediciones antropométricas para obtener indicadores del estado nutricional tales como IP/T, IMC/E y P/E, e indicadores de grasa visceral y subcutánea y del compartimiento muscular. Se evaluaron las pruebas de correlación y el índice de Kappa para establecer relación y concordancia, respectivamente. Resultados. La evaluación nutricional realizada en niños con SD muestra que el 60% presenta sobrepeso y obesidad, según el indicador IMC/E, porcentaje que alcanza el 75% según el índice IP/T. El análisis de correlación indica que la circunferencia de la cintura, el área de grasa braquial, y el % de masa grasa según Slaughter y Weststrate y Deurenberg, muestran una alta correlación positiva con el IMC/E (p < 0,05). Un modelo de regresión logística reflejó que ningún indicador de la masa grasa es clínicamente significativo para predecir el incremento del indicador P/E. Se determinó que los indicadores IMC/E e IP/T tienen una mayor concordancia (Kappa = 0,59; p = 0,0000). Conclusión. Determinamos una alta correlación entre el diagnóstico nutricional (IMC/E e IP/T) y los indicadores de las grasas visceral (circunferencia de la cintura) y subcutánea (porcentaje de masa grasa y de área grasa braquial) en niños con SD. Se encontró una mayor concordancia entre los indicadores de IMC/E e IP/T, lo que sugiere que estos son óptimos para evaluar el estado nutricional (AU)

Background: There are only few publications related to body composition in Down syndrome (DS). Objective: Evaluate the relationship between indicators of nutrition assessment by Catalan references and CDC/NCHS and indicators of body composition, and compare the concordance between weight/height index (IW/H), body mass index/age (BMI/A) and weight/age (W/A) to evaluate nutritional status in children with DS. Materials and methods: Analytical cross-sectional study in which 40 children with DS, 20 girls and 20 boys between 3 and 13 years old were studied. Anthropometric measurements were performed to obtain indicators of nutrition assessment as IW/H, BMI/A and W/A and indicators of subcutaneous and visceral fat and muscular compartment. Correlation tests and Kappa index were evaluated to establish relationship and agreement respectively. Results: The nutrition assessment in children with DS shows that 60% presents overweight and obesity according to BMI/A, and 75% according to IW/H. Correlation analysis indicates that waist circumference, fat brachial area, % fat mass by Slaughter and Weststrate and Deurenberg have a high positive correlation with BMI/A (p-value < 0.05). A logistic regression model showed that no indicator of fat mass is clinically significant in predicting an increase of the indicator W/A. It was determined that the BMI/A and IW/H indicators have a higher concordance (Kappa = 0.59; p =.0000). Conclusions: We determined a high correlation between nutritional diagnosis (BMI/A and IW/A) with indicators of visceral fat (waist circumference) and subcutaneous (% fat mass and fat brachial area) in children with DS. A greater agreement was found between indicators of BMI/A and IW/A suggesting that they are optimal for assessing the nutritional status (AU)

Cunaxidae (Acari: Prostigmata) diversity and population dynamics in garlic (Allium sativum) crop fields.

Agroecosystems are altered systems whose soil structure has changed affecting the dynamics of soil organisms. This paper aims at evaluation of the effects of garlic farming practices on phenology, richness, abundance, composition and diversity of soil-dwelling Cunaxidae. Ten pilot plots in Guanajuato State were sampled from August 2002 to July 2005, every month, 8 months per year. Ten soil samples (1 kg) were taken from each plot and extracted in Berlese-Tullgren funnels. A total of 108 cunaxids were found, belonging to 11 species. Neocunaxoides andrei was the most abundant, and Cunaxa evansi and Armascirus sp. were least abundant. Relative abundance was highest after harvesting and during plant growth, and lowest during planting. Dactyloscirus nicobarensis and D. candylus were present from planting to harvesting. According to Sörensen's similarity coefficient between cultivation stages, Cunaxidae communities were similar during plant growth and harvesting, sharing 80 % of the species. The highest abundance and diversity were found in 2004, during and after harvesting. Cunaxid species increased over 100 % from planting to the harvesting phase, suggesting that they play an important role in the soil agrosystems food web. Species composition and diversity in cunaxid communities present in garlic crop fields varied with agricultural phase, but little change was observed among the years studied. All species found in this study are new records for the state of Guanajuato and for the garlic crop fields.

Object-oriented modeling and simulation of the closed loop cardiovascular system by using SIMSCAPE.

The modeling of physiological systems via mathematical equations reflects the calculation procedure more than the structure of the real system modeled, with the simulation environment SIMULINK™ being one of the best suited to this strategy. Nevertheless, object-oriented modeling is spreading in current simulation environments through the use of the individual components of the model and its interconnections to define the underlying dynamic equations. In this paper we describe the use of the SIMSCAPE™ simulation environment in the object-oriented modeling of the closed loop cardiovascular system. The described approach represents a valuable tool in the teaching of physiology for graduate medical students.

Estado del conocimiento de los Cynipini (Hymenoptera: Cynipidae) en México: perspectivas de estudio / Status of the knowledge of the Cynipini (Hymenoptera: Cynipidae) in Mexico: perspectives for future studies

The knowledge status of the gall-former cynipids in the Mexican oaks is commented herein. For each of the 157 cited species from 33 oak species, the most important biological and ecological information is included. Andricus championi (Cameron), a species described only from the gall, is considered as 'incertae sedis'. Andricus tumeralis Pujade-Villar nom. nov. is proposed to denominate the species Andricus ashmeadi Dalla Torre & Kieffer for being a homonymy of Andricus ashmeadi Basset. Atrusca dugesi (Mayr) n. comb. (formery in Cynips) and Antron sagata (Kinsey) n. comb. (formery in Sphaeroteras) are proposed. The reasons of these changes are commented as well as the need for further studies on Mexican cynipids.

Se comenta cual es el estado del conocimiento de los cinípidos que producen agallas en los encinos mexicanos. Para cada una de las 157 especies citadas en 33 especies de encinos, se mencionan los aspectos biológicos y ecológicos más importantes. Se considera a Andricus championi (Cameron), especie descrita solamente a partir de la agalla, como 'incertae sedis'. Se propone Andricus tumeralis Pujade-Villar nom. nov. para denominar a la especie Andricus ashmeadi Dalla Torre & Kieffer por ser homonimia de Andricus ashmeadi Basset. Se propone Atrusca dugesi (Mayr) n. comb., (antes incluida en el género Cynips) y Antron sagata (Kinsey) n. comb., (antes incluida en el género Sphaeroteras). Se exponen las razones de estos cambios taxonómicos y se señala lo mucho que queda por hacer en el estudio de los Cynipidae mexicanos.

[Status of the knowledge of the Cynipini (Hymenoptera: Cynipidae) in Mexico: perspectives for future studies]. / Estado del conocimiento de los Cynipini (Hymenoptera: Cynipidae) en México: perspectivas de estudio.

The knowledge status of the gall-former cynipids in the Mexican oaks is commented herein. For each of the 157 cited species from 33 oak species, the most important biological and ecological information is included. Andricus championi (Cameron), a species described only from the gall, is considered as 'incertae sedis'. Andricus tumeralis Pujade-Villar nom. nov. is proposed to denominate the species Andricus ashmeadi Dalla Torre & Kieffer for being a homonymy of Andricus ashmeadi Basset. Atrusca dugesi (Mayr) n. comb. (formery in Cynips) and Antron sagata (Kinsey) n. comb. (formery in Sphaeroteras) are proposed. The reasons of these changes are commented as well as the need for further studies on Mexican cynipids.

[Incidence of severe rotavirus gastroenteritis among Chilean children under three years of age]. / Impacto de gastroenteritis severa por rotavirus en niños chilenos menores de 3 años de edad.

BACKGROUND: Rotavirus infections account every year in Chile, for approximately 53,000 emergency consultations and 8,000 hospital admissions among children under three years of age. AIM: To estimate incidence rates of severe rotavirus gastroenteritis in children <3 years of age, living in the V and VIII Regions and to identify the predominant viral serotypes. MATERIAL AND METHODS: A prospective hospital-based surveillance for severe gastroenteritis was implemented in public and private hospitals of Viña del Mar and Valparaiso (Region V) and of Chiguayante, Concepción, Penco, San Pedro de la Paz, Talcahuano and Tomé (Region VIII). All children <3 years of age residing in the districts, who consulted for severe gastroenteritis requiring oral or intravenous rehydration (equivalent to WHO plan B or C), or who were admitted to the hospital, were enrolled. Demographic and clinical information and a stool sample were obtained. Rotavirus was detected by ELISA and positive samples were serotyped by ELISA or real time PCR. RESULTS: Between January 23 and June 30, 2003, a total of 760 children were recruited. Among these, 343 (45%) were admitted to the hospital. Stool samples were collected from 433 children. Among these, 214 were positive for rotavirus (49.4%). Overall, monthly disease incidence rates were 124/100,000 in V Region, and 114/100,000 in VIII Region. The predominant serotype was G4. CONCLUSIONS: Rotavirus was responsible for nearly half of the severe gastroenteritis episodes among children <3 years, during a predominantly G4 serotype season. Every year, approximately one every 70 children <3 years will have a severe rotavirus gastroenteritis episode.

Impacto de gastroenteritis severa por rotavirus en niños chilenos menores de 3 años de edad / Incidence of severe rotavirus gastroenteritis among Chilean children under three years of age

Background: Rotavirus infections account every year in Chile, for approximately 53,000 emergency consultations and 8,000hospital admissions among children under three years of age. Aim: To estimate incidence rates of severe rotavirus gastroenteritis in children <3 years of age, living in the V and VIII Regions and to identify the predominant viral serotypes. Material and methods: A prospective hospital-based surveillance for severe gastroenteritis was implemented in public and private hospitals of Viña del Mar and Valparaiso (Region V) and of Chiguayante, Concepción, Penco, San Pedro de la Paz, Talcahuano and Tomé (Region VIII). All children <3 years of age residing in the districts, who consulted for severe gastroenteritis requiring oral or intravenous rehydration (equivalent to WHO plan B or C), or who were admitted to the hospital, were enrolled. Demographic and clinical information and a stool sample were obtained. Rotavirus was detected by ELISA and positive samples were serotyped by ELISA or real time PCR. Results: Between January 23 and June 30, 2003, a total of 760 children were recruited. Among these, 343 (45 percent) were admitted to the hospital. Stool samples were collected from 433 children. Among these, 214 were positive for rotavirus (49.4 percent). Overall, monthly disease incidence rates were 124/100,000 in V Region, and 114/100,000 in VIIIRegion. The predominant serotype was G4. Conclusions: Rotavirus was responsible for nearly half of the severe gastroenteritis episodes among children <3 years, during a predominantly G4 serotype season. Every year, approximately one every 70 children <3 years will have a severe rotavirus gastroenteritis episode.

Vacunas en desarrollo: Helicobacter pylori / Vaccines under development: Helicobacter pylori

La infección con Helicobacter pylori es la causa de patologías gastrointestinales como úlcera péptica y cáncer gástrico. Una vacuna contra H. pylori es relevante debido a la alta prevalencia de la infección y a la morbi-mortalidad asociada a ésta en nuestro país. El uso masivo de terapias antimicrobianas actuales no es una estrategia factible, especialmente en países en desarrollo, en parte debido al alto costo, los múltiples efectos adversos, el riesgo de reinfección y la emergencia de resistencia a los antimicrobianos. Numerosos modelos animales han sido utilizados durante años para determinar el curso de la infección por H. pylori y explorar la factibilidad de una vacuna, ya sea para erradicar o prevenir la infección. Dichos modelos, con la posible excepción de los monos, no son suficientes para responder preguntas fundamentales debido a resultados contradictorios. Un modelo humano de infección por H. pylori debe ser desarrollado con el principal propósito de seleccionar vacunas óptimas. El objetivo final es el desarrollo de estudios de campos de vacunas candidatas, pero el estado actual del conocimiento no proporciona una metódica adecuada para seleccionar tales vacunas candidatas promisorias. Dichos estudios pueden ser diseñados para proporcionar información relevante sobre la inmunidad y patogénesis de la infección por H. pylori.

[Vaccines under development: Helicobacter pylori]. / Vacunas en desarrollo: Helicobacter pylori.

Helicobacter pylori causes gastrointestinal disease including peptic ulcer and gastric cancer. An H. pylori vaccine is relevant because of the high prevalence of the infection and its associated complications. Extensive use of traditional antimicrobial therapies to eradicate H. pylori is not feasible, specially in developing countries, in part because of their high cost, associated adverse effects, the risk of reinfection, and the emergence of antimicrobial drug resistance. Numerous animal studies have been performed to determine infection outcomes and to explore the feasibility of a vaccine eradication or prevention of infection. These animal models with the possible exception of monkeys, have not been sufficient to address fundamental issues due to controversial results. A human model of H. pylori infection needs to be developed aimed to select an optimum vaccine candidate. The ultimate scientific goal will be to develop field studies using advanced vaccine candidates, but the current state of knowledge does is insufficient and has provided such candidates. These studies need to be designed in order to provide relevant information on immunity and pathogenesis associated to H. pylori.

[Oral nutritional supplements. Are they useful?]. / Suplementos nutricionales orales. Son útiles?

Oral nutritional supplements are products included in enteral nutrition, preferably used in hospital settings, although their use in the community is gradually increasing and in the United Kingdom has doubled in the last seven years, with prescriptions covering a wide range of the population from children to the elderly, and different pathologies affecting their nutritional status. There is, however, no consensus on the usefulness of oral nutritional supplements among these patients, so we do not have any recommendations for use. In this paper we have reviewed the various studies available in the literature in order to clarify the usefulness of these supplements in different contexts or pathologies.

[Prevalence of infections by hepatitis B, C, D and E viruses in Bolivia]. / Prevalencia de las infecciones por virus de las hepatitis B, C, D y E en Bolivia.

In Bolivia, no studies have been carried out specifically on hepatitis viruses. Thus, their prevalence and circulation patterns are virtually unknown. A seroepidemiologic study was performed from 1992 to 1996 to generate a preliminary idea of the overall prevalence of infection from hepatitis B, C, D, and E viruses (HBV, HCV, HDV, and HEV, respectively) in different Bolivian population groups. Prompted by the data obtained in other areas of Latin America, the study focused on indigenous communities in the Amazon region. In rural areas of the high Andean plateau, HBV infection showed an overall prevalence compatible with medium to low endemicity (11.2%), and no carriers of HCV or HDV antibodies were found. In two high-risk groups in the city of Cochabamba (homeless children and sexual workers), the prevalence of HBV infection was similar (11.6%) and could be considered low by comparison to that of similar population groups in Latin American urban centers. The prevalence of HCV (one positive case, or 0.5%) was similar to that found in similar population groups, although the small number of samples precludes drawing more definite conclusions. As has been noted previously with similar communities in tropical areas of South America, HBV infection is highly endemic in indigenous populations of the Bolivian Amazon (with an overall prevalence of 74.0%), but circulation of HCV has not been detected. It is a well-known fact that HBV is horizontally transmitted and that transmission can take place very early in life, but the mechanisms involved are unknown. By 10 years of age, more than half the population has already had the natural infection that, in approximately 10 more years will have affected virtually the entire population. The very low rate of positivity to HBsAg (1.6%), the absence of viral DNA in samples showing isolated positivity to anti-HBc, and the high prevalence of anti-HBs among individuals who show markers for natural infection (92.4%) suggest vertical transmission plays no role in persistent endemicity. So far, no outbreak of HDV infection has been documented in these communities, but the high endemicity shown by HBV points to the possibility of future outbreaks. Results obtained with tests for the detection of antibodies against HEV suggest that this virus is circulating widely in Bolivia and that it could have caused recent outbreaks in Cochabamba state. Vaccination against HBV in endemic populations is recommended as a short-term measure. Also recommended are actively searching for outbreaks and sporadic cases of hepatitis E in the entire country and performing additional research that will help in assessing the public health consequences of the situation described in this article.

Conception after iodine-131 therapy for differentiated thyroid cancer.

We reviewed the medical history of 26 women with differentiated thyroid cancer who became pregnant after receiving therapeutic doses of radioactive iodine (131I) in order to document the possibility of a greater risk for disorders in these pregnancies. There were a total of 39 pregnancies, 6 of which occurred during the first year after therapy. In 3 cases the following anomalies were encountered: a male suffering Trisomy 18 (Edward's syndrome), a female with constitutional aplastic anemia, and a male with a congenital hip dysplasia. Of the 33 pregnancies that occurred after the first year post-therapy, there were 2 spontaneous abortions and a male effected by ureteral stenosis. Based on these data, although it cannot be confirmed that these congenital disorders are due to the 131I therapy, we recommend that pregnancy be avoided for the first year after therapy.

Enhanced growth hormone (GH) responsiveness to GH-releasing hormone after dietary restriction in patients with Cushing's syndrome.

OBJECTIVE: In patients with Cushing's syndrome, decreased growth hormone (GH) secretion is observed although the basic mechanism is not yet understood. A short-term hypocaloric diet is known to increase both spontaneous and GHRH-stimulated GH secretion in normal subjects. In order to gain further insight into the altered GH secretion in patients with Cushing's syndrome, we assessed the effect of a short-term hypocaloric diet on GH responses to GHRH in these patients. DESIGN: Two GHRH tests (1 microgram/kg i.v.) were performed, the first under basal conditions (normocaloric diet) and the second after a 3-day hypocaloric diet (650 cal/day). PATIENTS: Six female patients with untreated Cushing's disease. MEASUREMENTS: Plasma GH levels were measured by immunoradiometric assay. RESULTS: GHRH-induced GH release was impaired in patients with Cushing's disease on a normal diet (mean peak 12.4 +/- 6.4 mU/l, area under the curve (AUC) 744 +/- 332 mU/l/120 min). Following a hypocaloric diet, GH responses to GHRH were markedly enhanced in the same group of patients (mean peak 46.2 +/- 14.8 mU/l, AUC 3142 +/- 1032 mU/l/120 min, P < 0.05). CONCLUSIONS: This study demonstrates that in patients with Cushing's disease the somatotroph hyporesponsiveness to growth hormone releasing home is improved after a short-term hypocaloric diet. Therefore, blunted growth-hormone secretion in chronic hypercortisolism is a potentially reversible state and the secretory capacity of the somatotroph appears not to be severely compromised in patients with Cushing's disease.