Molecular phylogeny of Cosmetocleithrum Kritsky, Thatcher & Boeger, 1986 (Monogenoidea: Dactylogyridae), gill parasites of Neotropical catfishes (Siluriformes).

Cosmetocleithrum Kritsky, Thatcher & Boeger, 1986 (Dactylogyridae) represents one of the most species-rich groups (22 species currently recognized as valid) of all dactylogyrid parasites infecting Neotropical catfishes. Species of Cosmetocleithrum exhibit a remarkable affinity towards catfishes of the Doradidae and the Auchenipteridae. However, phylogenetic relationships between members of this genus have not been yet analysed. This study analysed newly obtained partial sequences of the 28S ribosomal RNA gene of seven species of Cosmetocleithrum, including its type species C. gussevi Kritsky, Thatcher & Boeger, 1986, along with several other dactylogyrids infecting siluriform, gymnotiform, perciform and characiform fishes. Cosmetocleithrum appeared as an evolutionary recent group, composed of two well-defined lineages: lineage 1 includes parasites of doradids - namely, C. bulbocirrus, C. confusum, C. parvum and C. bifurcum - whereas lineage 2 is composed of species from doradids - that is, C. rarum, C. gussevi, C. gigas, C. trachydorasi and C. falsunilatum - together with parasites of auchenipterids - namely, C. laciniatum and C. baculum. The search for synapomorphies to characterize taxonomic groups within Cosmetocleithrum appears challenging, since the morphology of their haptoral elements is quite conservative, and that of the copulatory complex is highly variable between species. The results of the present study support the recent synonymization of Paracosmetocleithrum Acosta, Scholz, Blasco-Costa, Alves & Silva, 2018 with Cosmetocleithrum. Whereas the 28S ribosomal DNA data resolved Cosmetocleithrum as monophyletic, the statistical support for the lineage was low, rendering its phylogenetic position between other Neotropical dactylogyrids yet undefined.

Programa de atención integral a pacientes mayores de 65 años con fractura de cadera / Comprehensive care program for elderly patients over 65 years with hip fracture

Objetivos. Presentamos los resultados en salud de un programa de asistencia multidisciplinar a pacientes con fractura de cadera mayores de 65 años. Pacientes y métodos. Hemos desarrollado un modelo de coordinación asistencial para la atención integral del paciente con fractura de cadera, estableciendo qué, quién, cuándo, cómo y dónde intervienen traumatólogos, internistas, médicos de familia de urgencias, intensivistas, fisioterapeutas, anestesistas, enfermeros y trabajadores sociales. Se evaluaron retrospectivamente todos los pacientes mayores de 65 años que ingresaron con diagnóstico de fractura de cadera (años 2006 a 2010). Resultados. Se incluyen 1.000 episodios de fractura de cadera ocurridos en 956 pacientes. La edad media fue de 82 años y la estancia media de 6,7 días, reduciéndose 1,14 días en los 5 años del programa. Antes de las 72h se intervinieron el 85,1%, y el 91,2% a lo largo del programa. La incidencia de infección quirúrgica fue del 1,5% y la mortalidad intrahospitalaria del 4,5% (24,2% a los 12 meses). Al cabo de un año reingresaron el 14,9%, y el 40% de los enfermos consiguieron ser independientes para las actividades básicas de su vida diaria. Conclusiones. Este programa de atención multidisciplinar al paciente con fractura de cadera se asoció a resultados beneficiosos en salud, con un elevado porcentaje de pacientes intervenidos precozmente (más del 90%), una reducida estancia media (menos de 7 días), incidencia de infecciones quirúrgicas, reingresos y mortalidad intrahospitalaria y al año de seguimiento, así como una adecuada recuperación funcional (AU)

Objectives. To report the health outcomes of a multidisciplinary care program for patients over 65 years with hip fracture. Patients and methods. We have developed a care coordination model for the comprehensive care of hip fracture patients. It establishes what, who, when, how and where orthopedists, internists, family physicians, emergency, intensive care, physiotherapists, anesthetists, nurses and workers social intervene. All elderly patients over 65 years admitted with the diagnosis of hip fracture (years 2006 to 2010) were retrospectively evaluated. Results. One thousand episodes of hip fracture, corresponding to 956 patients, were included. Mean age was 82 years and mean stay 6.7 days. This was reduced by 1.14 days during the 5 years of the program. A total of 85.1% were operated on before 72 yours, and 91.2% during the program. Incidence of surgical site infection was 1.5%. In-hospital mortality was 4.5%, (24.2% at 12 months). Readmissions at one years was 14.9%. Independence for basic activity of daily living was achieved by 40% of the patients. Conclusions. This multidisciplinary care program for hip fracture patients is associated with positive health outcomes, with a high percentage of patients treated early (more than 90%), reduced mean stay (less than 7 days), incidence of surgical site infections, readmissions and inpatient mortality and at one year, as well as adequate functional recovery (AU)

Comprehensive care program for elderly patients over 65 years with hip fracture.

OBJECTIVES: To report the health outcomes of a multidisciplinary care program for patients over 65 years with hip fracture. PATIENTS AND METHODS: We have developed a care coordination model for the comprehensive care of hip fracture patients. It establishes what, who, when, how and where orthopedists, internists, family physicians, emergency, intensive care, physiotherapists, anesthetists, nurses and workers social intervene. All elderly patients over 65 years admitted with the diagnosis of hip fracture (years 2006 to 2010) were retrospectively evaluated. RESULTS: One thousand episodes of hip fracture, corresponding to 956 patients, were included. Mean age was 82 years and mean stay 6.7 days. This was reduced by 1.14 days during the 5 years of the program. A total of 85.1% were operated on before 72 yours, and 91.2% during the program. Incidence of surgical site infection was 1.5%. In-hospital mortality was 4.5%, (24.2% at 12 months). Readmissions at one years was 14.9%. Independence for basic activity of daily living was achieved by 40% of the patients. CONCLUSIONS: This multidisciplinary care program for hip fracture patients is associated with positive health outcomes, with a high percentage of patients treated early (more than 90%), reduced mean stay (less than 7 days), incidence of surgical site infections, readmissions and inpatient mortality and at one year, as well as adequate functional recovery.

The follicular thyroid cell line PCCL3 responds differently to laminin and to polylaminin, a polymer of laminin assembled in acidic pH.

The extracellular-matrix protein laminin forms polymers both in vivo and in vitro. Acidification of pH leads to the formation of an artificial polymer with biomimetic properties, named polylaminin (polyLM). Follicle cells in the thyroid are in close contact with laminin, but their response to this important extracellular signal is still poorly understood. PCCL3 thyroid follicular cells cultured on glass, on regular laminin (LM) or on laminin previously polymerized in acidic pH (polyLM) showed different cell morphologies and propensities to proliferate, as well as differences in the organization of their actin cytoskeleton. On polyLM, cells displayed a typical epithelial morphology and radially organized actin fibers; whereas on LM, they spread irregularly on the substrate, lost cell contacts, and developed thick actin fibers extending through the entire cytoplasm. Iodide uptake decreased similarly in response to both laminin substrates, in comparison to glass. On both the LM and polyLM substrates, the expression of the sodium iodide symporter (NIS) decreased slightly but not significantly. NIS showed dotted immunostaining at the plasma membrane in the cells cultured on glass; on polyLM, NIS was observed mainly in the perinuclear region, and more diffusely throughout the cytoplasm on the LM substrate. Additionally, polyLM specifically favored the maintenance of cell polarity in culture. These findings indicate that PCCL3 cells can discriminate between LM and polyLM and that they respond to the latter by better preserving the phenotype observed in the thyroid tissue.

Record of Urocleidoides vaginoclaustrum Jogunoori, Kritsky and Venkatanarasaiah, 2004 (Monogenea: Dactylogyridae) from a freshwater fish in Mexico.

We describe herein the first occurrence of the monogenean Urocleidoides vaginoclaustrum in the wild. This monogenean was originally described from an aquarium neotropical fish examined in India. Worms were collected from the gills of Xiphophorus hellerii, a species native to tropical Mexico but introduced to the Los Berros Spring in the State of Durango, Northern Mexico. These specimens showed slight morphological differences in the sclerotized structures of the haptor with respect to the specimens described from India. A brief morphological characterization of this species is presented.

[Continuity of medical care. Evaluation of a collaborative program between hospital and Primary Care]. / Continuidad asistencial. Evaluación de un programa de colaboración entre Atención Hospitalaria y Atención Primaria.

The patients being treated in our health care system are becoming increasingly older and have a greater prevalence of chronic diseases. Due to these factors, these patients require greater and easier accessibility to the system as well as continuity of medical care. Collaboration between the different levels of health care has been instrumental in the success of the system and has produced changes in the hospital medical care protocol. Our hospital has developed a care model oriented towards the patient's needs, resulting in a higher grade of satisfaction among the medical professionals. In this paper, we have given a detailed description of part of our medical model, illustrating its different components and indicating several parameters of its evaluation. We have also reviewed the current state of the various models published on this topic. In summary, we believe that this medical care model presents a different approach to management that benefits patients, medical professionals and the health system alike.

Continuidad asistencial. Evaluación de un programa de colaboración entre Atención Hospitalaria y Atención Primaria / Continuity of medical care. Evaluation of a collaborative program between hospital and Primary Care

Los pacientes atendidos en nuestro sistema sanitario tienen cada vez más edad y mayor prevalencia de enfermedades crónicas. Estas características de salud han condicionado que entre las expectativas de mayor relevancia de los pacientes, se indiquen la accesibilidad al sistema y la continuidad en los cuidados. La colaboración entre los distintos niveles asistenciales ha sido una herramienta reconocida que facilita la consecución de estas expectativas, provocando cambios en la organización del trabajo. Nuestro hospital ha desarrollado un modelo de atención sanitaria que ­en su orientación al enfermo­ facilita la colaboración entre los distintos niveles asistenciales, consiguiendo un grado de satisfacción de los profesionales elevado. En este trabajo se describe detalladamente parte del modelo, mostrando los elementos que lo caracterizan, indicando algunos parámetros de la evaluación de resultados y revisando la situación de los modelos de continuidad asistencial publicados. En resumen, consideramos que este sistema asistencial está dotado de elementos de gestión que permiten atender las expectativas de los usuarios, aportando beneficios para el paciente, el profesional y el sistema sanitario (AU)

The patients being treated in our health care system are becoming increasingly older and have a greater prevalence of chronic diseases. Due to these factors, these patients require greater and easier accessibility to the system as well as continuity of medical care. Collaboration between the different levels of health care has been instrumental in the success of the system and has produced changes in the hospital medical care protocol. Our hospital has developed a care model oriented towards the patient's needs, resulting in a higher grade of satisfaction among the medical professionals. In this paper, we have given a detailed description of part of our medical model, illustrating its different components and indicating several parameters of its evaluation. We have also reviewed the current state of the various models published on this topic. In summary, we believe that this medical care model presents a different approach to management that benefits patients, medical professionals and the health system alike (AU)

Efecto agudo del litio en el control de la crisis tirotoxica: reporte de un caso / Acute effect of lithium in the management of thyrotoxic storm: report of a case

La terapeutica de la crisis tirotoxic aexige una disminucion rapida de las concentraciones sericas de hormonas tiroideas para lo cual se requieren tratamiento adyuvantes a los antitiroideo. El acido iopanoico ha sido ampliamente utilizado por su capacidad de inhibir la conversion periferica de T4 a T3, sin embargo no se comercializa actualmente en nuestro pais. El litio actua inhibiendo la liberacion de T4 y T3 a la circulacion general, por lo cual puede utilizarse como droga adyuvante en el hipertiroidismo severo. Objetivo: desccribir los efectos agudos del litio en la tirotoxicosis severa. Se trata de una mujerde 39 años con antecedentes de hipertiroidismo de larga data y abandono de la medicacion, que se interno en terapia intensivapor un cuadro de neumonia severa con insuficiencia respiratoria y crisis tirotoxica. Se inicio tratamiento con hidrocortisona, metimazol y litio 600mg/dia. Las hormonas tiroideas disminuyeron mas de un 50 por ciento a las 48h y se normalizaron a los 6 dias de iniciada la terapeutica, con valores de litemia por debajo del rango terapeutico para su uso en patologia psiquiatrica. A la semana las hormonas entraron en rango subnormal coincidiendo con una desconpensacion hemodinamica de la paciente. Este efecto fue atribuido al litio y no exclusivamente a un sindrome T3 y T4 bajas dado que al suspender dicho compuesto las hormonas se elevaron nuevamente en rango de hipertirodismo sin que hubiera cambiado el cuadro clinico de la paciente. En conclusion, el uso de litio permitio en esta pciente un control rapido y reiterado de las hormonas tiroideas, a una dosis baja y alejada del rango de toxicidad. Por lo tanto consideramos que se trata de una alternativa terapeutica muy ventajosa para el control agudo del hipertiroidismo y que a su vez no posterga el tratamiento con I131

Efecto agudo del litio en el control de la crisis tirotoxica: reporte de un caso / Acute effect of lithium in the management of thyrotoxic storm: report of a case

La terapeutica de la crisis tirotoxic aexige una disminucion rapida de las concentraciones sericas de hormonas tiroideas para lo cual se requieren tratamiento adyuvantes a los antitiroideo. El acido iopanoico ha sido ampliamente utilizado por su capacidad de inhibir la conversion periferica de T4 a T3, sin embargo no se comercializa actualmente en nuestro pais. El litio actua inhibiendo la liberacion de T4 y T3 a la circulacion general, por lo cual puede utilizarse como droga adyuvante en el hipertiroidismo severo. Objetivo: desccribir los efectos agudos del litio en la tirotoxicosis severa. Se trata de una mujerde 39 años con antecedentes de hipertiroidismo de larga data y abandono de la medicacion, que se interno en terapia intensivapor un cuadro de neumonia severa con insuficiencia respiratoria y crisis tirotoxica. Se inicio tratamiento con hidrocortisona, metimazol y litio 600mg/dia. Las hormonas tiroideas disminuyeron mas de un 50 por ciento a las 48h y se normalizaron a los 6 dias de iniciada la terapeutica, con valores de litemia por debajo del rango terapeutico para su uso en patologia psiquiatrica. A la semana las hormonas entraron en rango subnormal coincidiendo con una desconpensacion hemodinamica de la paciente. Este efecto fue atribuido al litio y no exclusivamente a un sindrome T3 y T4 bajas dado que al suspender dicho compuesto las hormonas se elevaron nuevamente en rango de hipertirodismo sin que hubiera cambiado el cuadro clinico de la paciente. En conclusion, el uso de litio permitio en esta pciente un control rapido y reiterado de las hormonas tiroideas, a una dosis baja y alejada del rango de toxicidad. Por lo tanto consideramos que se trata de una alternativa terapeutica muy ventajosa para el control agudo del hipertiroidismo y que a su vez no posterga el tratamiento con I131(AU)

Retinochoroiditis associated with congenital toxoplasmosis in children: IgG antibody profiles demonstrating the synthesis of local antibodies.

PURPOSE: Retinochoroiditis is generally diagnosed after the first year of life and the association with congenital toxoplasmosis presents a diagnostic dilemma. The detection of local intraocular specific antibodies could be useful for diagnosis. METHODS: We studied six patients (mean age 7 +/- 5 years) with retinochoroiditis which appeared after the first year of life. Aqueous and serum were analysed by immunoblotting for anti T. gondii IgG to diagnose toxoplasmosis. RESULTS: All serum samples were positive only for anti T. gondii IgG. The retinochoroiditis was active in three patients and inactive in the others. Immunoblot analysis of serum and aqueous from the patients with active lesions showed IgG versus the specific antigen of T. gondii. In the patients with inactive lesions the pattern was the same in the two compartments. In active forms, aqueous and serum Western blot patterns differed in proteins lower than 16kDa and higher than 116kDa: in aqueous the findings were typically positive for 30kDa. CONCLUSIONS: Aqueous humour analysis by the Western blot technique may be useful in the diagnosis of congenital toxoplasmosis. In the present small series, we nevertheless detected different patterns for inactive and active retinochoroiditis, confirming the diagnosis in the latter. Aqueous humour paracentesis may be indicated in a child with active retinochoroiditis with unusual clinical features, appearing after the first year of life, and with no clinical or serological evidence of congenital infection.

Moratoria para el test de Kveim / Moratorium on Kveim test

No disponible

Genetic variation in the beta-3-adrenergic receptor in essential hypertension.

We investigated the role of the beta-3-adrenergic receptor polymorphism in membrane lipid composition and erythrocyte membrane sodium transport in essential hypertensive patients. We studied 87 essential hypertensive patients determining: The Trp64Arg mutation of the beta-3-adrenergic receptor by PCR, lipoprotein profile by standard laboratory methods, membrane lipid composition by IATROSCAN and erythrocyte sodium lithium countertransport by Canessa technique. Patients with the mutation as compared with those without it showed lower membrane cholesterol, membrane cholesterol phospholipids ratio and erythrocyte sodium lithium countertransport, however blood pressure and the other studied variables were similar in both groups of patients. After adjusting by sex sodium lithium countertransport activity remained significant. These data suggest that although the Trp64Arg mutation of the beta-3-adrenergic receptor is related with a different membrane lipid composition and erythrocyte sodium lithium countertransport values it does not contribute to blood pressure levels in essential hypertensive patients.

[The effect of the angiotensinogen M235T and the angiotensin-converting enzyme I/D polymorphisms on arterial hypertension and other cardiovascular risk factors]. / Influencia de los polimorfismos M235T del angiotensinógeno e I/D de la enzima conversiva de la angiotensina sobre la hipertensión arterial y otros factores de riesgo cardiovascular.

BACKGROUND: It has been reported the association between M235T angiotensinogen (AGT) and I/D angiotensin converting enzyme (ACE) gene polymorphisms and hypertension and other cardiovascular risk factors. However there are few data about Spanish population. So that we have studied the relationship among the aforementioned polymorphisms and hypertension and the possibility of association between any polymorphism and a worse cardiovascular risk profile. PATIENTS AND METHODS: 251 hypertensive and 245 control normotensive subjects were studied. The M235T AGT and the I/D ACE gene polymorphisms were determined by polymerase chain reaction (PCR). Family and personal history of cardiovascular disease, lipoprotein profile, microalbuminuria and left ventricular hypertrophy (LVH) by Sokolow index were analyzed in hypertensive patients. RESULTS: The distribution of the different polymorphisms was similar among hypertensive and normotensive subjects. There was not any relationship among AGT nor ACE genotypes and target organ damage. The II ACE genotype was associated with higher lipoprotein (a) (Lp[a]) levels and greater cerebrovascular disease family history and the MT AGT genotype with lower total cholesterol (TC) and triglycerides (TG) levels. CONCLUSIONS: In our study there was not any relationship between arterial hypertension and M235T AGT or I/D ACE gene polymorphisms. None specific genotype was associated with worse cardiovascular risk profile. The II ACE genotype was a predictor of cerebrovascular disease risk through higher levels of Lp(a) and the MT AGT genotype was associated with a better lipid profile.

Emerging microorganisms in cystic fibrosis.

Pseudomonas aeruginosa is the most common bacterial isolate obtained from patients with cystic fibrosis of the lungs. Recently, however, new multiresistant organisms have emerged, whose identification may be difficult and whose pathogenic role proves hard to define. Of the 71 strains isolated from 24 patients with cystic fibrosis during acute flareups of pulmonary symptoms, 48 turned out to be Pseudomonas aeruginosa (67.6%); 11 were Pseudomonas non-aeruginosa (15.5%); and 12 were Achromobacter xylosoxidans (16.9%). Each bacterial isolate was tested for sensitivity to nine antibiotics (ceftazidime, azlocillin, piperacillin, aztreonam, cefsulodin, cefoperazone, amikacin, tobramycin, and sisomycin) in terms of minimum inhibitory concentration and minimum bactericidal concentration values. In this series, Achromobacter xylosoxidans proved the species least responsive to treatment, and ceftazidime the most active antibiotic both against Achromobacter and against strains of the genus Pseudomonas. Twenty-three different associations of ceftazidime with aminoglycosides, tested for activity on the multiresistant strains, failed to show synergism of action.