Effect of the apical ligand on the geometry and magnetic properties of copper(ii)/mesoxalate trinuclear units.

Three new heterometallic metal-organic frameworks, namely, {(Ph4P)2[MnCu3(Hmesox)3Br(H2O)]·H2O}n (1), {(Ph4P)2[CoCu3(Hmesox)3Br]}n (2) and {(Ph4P)2[ZnCu3(Hmesox)3Br]·2.5H2O}n (3) were prepared and their structure and magnetic properties were investigated (H4mesox = mesoxalic acid, Ph4P+ = tetraphenylphosphonium). The structure of all the compounds consist of two interpenetrating opposite-chirality supramolecular cationic and polymeric anionic 3-D (10,3)-a networks, which results in chiral compounds. The anionic network is formed from the polymerization of [Cu3(Hmesox)3Br]4- units, working as three connectors, and M(ii) cations, working as three-connecting nodes, M = Mn(ii), Co(ii) and Zn(ii). The Ph4P+ cations build the cationic chiral supramolecular network opposite to the anionic one. Compounds 1 and 2 exhibit long-range magnetic ordering with critical temperatures of 7.2 K and 6.9 K, respectively. However, compound 3 does not display long-range order, but shows ferromagnetic and antiferromagnetic coupling among the Cu(ii) ions. The magnetic interactions are studied by DFT calculations and compared with related Cu(ii)-mesoxalate compounds previously reported.

Fiebre, disnea e infiltrados pulmonares en pacientes con infección por VIH / Fever, dyspnea and infiltrated lungs in HIV patients

Las infecciones pulmonares en pacientes con infección por el VIH (virus de inmunodeficiencia humana) han sufrido variaciones desde la instauración de profilaxis para el Pneumocystis jiroveci y el tratamiento antirretroviral de gran actividad (TARGA), apareciendo infecciones por otros gérmenes resistentes a los antibióticos habitualmente utilizados y ocasionando problemas diagnósticos y terapéuticos. Presentamos el caso de un paciente varón de 59 años con infección por el VIH y en tratamiento con TARGA, que debutó con un cuadro febril e infiltrados pulmonares. Ante su falta de mejoría con tratamiento antibiótico empírico, se le realizó una broncoscopia y biopsia bronquial que permitió el diagnóstico del eishmaniosis visceral ante la visión directa de amastigotes intra y extracelulares debajo del epitelio bronquial (AU)

Lung infections in HIV (human immunodeficiency virus) patients have suffered variations since the establishment of prophylaxis treatment against Pneumocystis jiroveci with highly active antiretroviral therapy (HAART), with infections appearing due to other germs that are resistant to the antibiotics generally used and causing diagnostic and therapeutic problems. We present the case of a 59 year old male, HIV patient undergoing treatment with HAART, who suffered fever and pulmonary infiltration. Due to his lack of improvement with empiric antibiotic treatment, a bronchoscopy and bronchial biopsy were performed, which allowed the diagnosis of visceral leishmaniasis due to the direct vision of intra- and subcellular amastigotes under the bronchial epithelium (AU)

[Comparisons between clinical practice consultation in a prison and in community health centres: differences and repercussions]. / Actividad clínica en la consulta médica a demanda de un Centro Penitenciario frente a la de un Centro de Salud.

OBJECTIVES: To describe and quantify clinical practice consultancy in a prison health care unit so as to evaluate likely differences from a community Health Care Centre. To identify possible training needs when transferring health care staff from one system to another in the light of probable integration of Prison Health Care into the Public Health System. METHODS: A transversal descriptive study was used for three Primary Health Care teams: an urban health centre with a high work load, a rural health centre with a low work load, and the health care unit of a provincial prison (not a mega-prison). Ransom sequential sampling was used to include all the medical activity generated in the consultancy. All activity programmed by the health professional and administrative consultancy was excluded, while efforts were made to locate troubled consultations. Comparisons were made by contrasting differences in proportions. RESULTS: The Prison Health Care Unit showed higher statistically significant clinical activity in mental health, drug abuse, HIV and HCV infection management and specific Primary Health Care problems (biopsychosocial integration is a therapeutic priority). In both community Health Centres there is more statistically significant activity in Internal Medicine and Geriatrics. In the prison environment there is significantly higher troubled consultation. CONCLUSIONS: In a future context of integration of prison health care services into the Public Health Service, training in mental health care (especially addictive disorders) and in HIV-HCV infection management may be necessary for community health centre professionals wishing to transfer to prison health care units. The prison health care professional who wants to work in a public health centre may need training in Internal Medicine (especially Geriatrics). The statistically significant results for health care in prison, Primary Health Care and troubled consultation suggest that the GP plays a more active role in prison than in the community health centre. This should also be borne in mind when the intended integration of Prison Health Care into the Public Health Service takes place.

Actividad clínica en la consulta médica a demanda de un Centro Penitenciario frente a la de un Centro de Salud / Comparisons between clinical practice consultation in a prison and in community health centres: differences and repercussions

Objetivos: Describir y cuantificar la actividad clínica en las consultas de demanda de un Centro Penitenciario (CP) para valorar las posibles diferencias respecto a un Centro de Salud (CS). Identificar los posibles requerimientos de formación específica ante eventuales traslados de profesionales entre uno y otro medio, resultantes de una supuesta integración de la Sanidad Penitenciaria (SP) en el conjunto del Sistema Público de Salud (SPS). Método: Estudio descriptivo transversal. Se aplica en tres equipos de Atención Primaria (AP): un Centro de Salud Urbano de alta carga asistencial (CSU), un Centro de Salud Rural de baja carga asistencial (CSR) y un CP provincial -no tipo macro cárcel-. Muestreo aleatorio secuencial que incluye toda la actividad médica generada en la consulta de demanda. Se excluye toda la actividad programada por el profesional sanitario y las consultas administrativas. Se realiza un intento de reconocimiento de consultas conflictivas para el profesional. Las comparaciones se realizan mediante el test estadístico de Contraste de Diferencia de Proporciones. Resultados: En el CP se halla significación estadística (SE) de mayor actividad clínica en las áreas de salud mental, toxicomanías, manejo de infección VIH-VHC y de problemas específicos de AP (integración biopsicosocial prioritaria en su tratamiento). En ambos CS hay SE de mayor actividad en el conjunto del área de Medicina Interna (MI) y de Geriatría (G). En el medio penitenciario hay SE de mayor conflictividad en la consulta. Conclusiones: En un futuro contexto de integración de derecho de la SP, puede ser necesaria formación en salud mental, particularmente en trastornos adictivos, y en manejo de infección VIH-VHC para ejercer en un CP. Puede ser necesaria formación en el conjunto de Medicina Interna, particularmente en Geriatría, de médicos de CP para que se trasladen a CS. La significación obtenida, en la asistencia sanitaria de una prisión, de la AP y de la conflictividad, sugiere un papel más relevante del médico general en un CP que en el conjunto del SPS y puede ser un dato a tener en cuenta en la planificación de la anunciada integración de la SP en el SPS (AU)

Objectives: To describe and quantify clinical practice consultancy in a prison health care unit so as to evaluate likelydifferences from a community Health Care Centre. To identify possible training needs when transferring health carestaff from one system to another in the light of probable integration of Prison Health Care into the Public Health System. Methods: A transversal descriptive study was used for three Primary Health Care teams: an urban health centre witha high work load, a rural health centre with a low work load, and the health care unit of a provincial prison (not a mega-prison).Ransom sequential sampling was used to include all the medical activity generated in the consultancy. All activity programmedby the health professional and administrative consultancy was excluded, while efforts were made to locate troubledconsultations. Comparisons were made by contrasting differences in proportions. Results: The Prison Health Care Unit showed higher statistically significant clinical activity in mental health, drugabuse, HIV and HCV infection management and specific Primary Health Care problems (biopsychosocial integration is atherapeutic priority).In both community Health Centres there is more statistically significant activity in Internal Medicine and Geriatrics.In the prison environment there is significantly higher troubled consultation.Conclusions: In a future context of integration of prison health care services into the Public Health Service, trainingin mental health care (especially addictive disorders) and in HIV-HCV infection management may be necessary for communityhealth centre professionals wishing to transfer to prison health care units. The prison health care professional whowants to work in a public health centre may need training in Internal Medicine (especially Geriatrics). The statistically significant results for health care in prison, Primary Health Care and troubled consultation suggest that the GP plays a more active role in prison than in the community health centre. This should also be borne in mind when the intended integration of Prison Health Care into the Public Health Service takes place (AU)

Diagnosis of Helicobacter pylori infection in patients with bleeding ulcer disease: rapid urease test and histology.

INTRODUCTION: The endoscopic diagnosis of Helicobacter pylori infection in patients with bleeding peptic ulcer is limited by a decreased sensitivity in standard invasive tests, rapid urease test and histology. There is controversy about the convenience of using one, neither, or both diagnostic tests. AIMS: To evaluate the results of simultaneously performed rapid urease test and histology in the diagnosis of Helicobacter pylori infection (H. pylori) in patients with bleeding peptic ulcer. PATIENTS AND METHODS: We included 173 patients, 98 male and 75 female, with an average age of 62 years (18-88), with upper gastrointestinal bleeding secondary to duodenal ulcer (115) or gastric ulcer (58), diagnosed within 24 hours after hospital admission. None of the patients had received treatment for H. pylori, proton pump inhibitors or antibiotics in the two weeks prior to the upper gastrointestinal bleeding episode. H. pylori infection was investigated in all patients by two antral biopsy samples for histological study (hematoxilin-eosin) and one or two antral biopsies for rapid urease test (Jatrox-H.p.-test). In cases with a negative urease test and histology, a 13C urea breath test was performed. Infection was considered present when at least one invasive test or the breath test was positive, whereas both invasive tests and the breath test had to be negative to establish an absent infection. RESULTS: 152 patients (88%) showed H. pylori infection, 104 patients (90%) with duodenal ulcer and 48 patients (83%) with gastric ulcer. In all 119 cases (78%) were diagnosed by the urease test and 112 cases (74%) by histology. Both methods were used to diagnose 134 of 152 cases (88%) (p < 0.05), these being positive in 97 cases and negative in 39 cases. In 18 of these 39 cases, the breath test was positive. CONCLUSIONS: Histology and urease test have similar diagnostic values for the identification of H. pylori in patients with bleeding peptic ulcer. Due to its rapid results, the urease test should be the method of choice. However, additional biopsies should be performed, and, when negative, a histological study should be carried out, since a combination of both methods allows a more precise diagnosis.

Etiología y resistencia bacteriana de las infecciones urinarias extrahospitalarias / Aetiology and bacterial resistance in urinary infections of outpatiens

Fundamento. El conocimiento de los agentes etiológicos de las infecciones del tracto urinario y del mapa de sensibilidad antimicrobiana de cada zona geográfica es una práctica recomendada para mejorar el uso de antibióticos y para facilitar la elección del tratamiento empírico. El objetivo de este trabajo es proporcionar información actualizada de la flora patógena de las infecciones urinarias extrahospitalarias y su sensibilidad a antimicrobianos en nuestra área de salud, a partir de los urocultivos realizados en el laboratorio de Microbiología del Ambulatorio General Solchaga durante los últimos cuatro años. Material y métodos. Entre 1996 y 1999 realizamos 92.816 urocultivos de pacientes extrahospitalarios. Las orinas se sembraron en placas de agar chocolate y agar MacConkey con asa calibrada. El antibiograma se realizó por el método de Kirby-Bauer. Resultados. El porcentaje de urocultivos positivos fue del 17 por ciento. Los bacilos gram-negativos representaron el 88,9 por ciento de los aislamientos, los cocos gram-positivos el 11 por ciento y las levaduras el 0,1 por ciento. Escherichia coli fue el germen aislado con más frecuencia (71 por ciento). Los estudios de sensibilidad muestran que amoxicilina-ac.clavulánico, cefalosporinas de primera generación y fosfomicina mantienen una sensibilidad superior al 80 por ciento. Conclusiones. El conocimiento actualizado de la flora patógena más común y su sensibilidad a antimicrobianos permite hacer una selección más adecuada del tratamiento antibiótico cuando no se dispone del patrón de sensibilidad del germen responsable. A la vista de los resultados podemos concluir que amoxicilina-ac.clavulánico, cefalosporinas de primera generación y fosfomicina presentan una buena actividad in vitro y se deberían considerar como tratamientos empíricos de las infecciones de tracto urinario. (AU)

Brote de tuberculosis multirresistente / Outbreak of Multiresistant Tuberculosis

Fundamento. Se estudian seis casos de tuberculosis multirresistente diagnosticados en el Hospital de Navarra durante el año 1996.Material y métodos. Las pruebas de sensibilidad se realizaron utilizando el sistema BACTEC 460TB frente a cuatro fármacos antituberculosos mayores: isoniacida, estreptomicina, rifampicina y etambutol. En el estudio epidemiológico se utilizaron técnicas de "fingerprinting" mediante RFLP con IS 6110.Resultados.Cuatro de los pacientes estaban coinfectados con el VIH. Todos ellos tuvieron un pronóstico fatal a corto plazo. Los cuatro presentaban resistencia a todos los fármacos estudiados; en tres la resistencia fue primaria, y en el cuarto secundaria. El estudio molecular puso de manifiesto que tres pacientes VIH+ tenían patrones idénticos de polimorfismo en la longitud de los fragmentos de restricción (RFLP). Dos eran hermanos y en el tercero se demostró la contaminación nosocomial. Por otra parte, el patrón de RPLF de estos pacientes, presentaba gran similitud con el de una de las pacientes VIH-, lo que sugiere un origen clonal de las cepas, no habiéndose encontrado otra relación epidemiológica. El patrón de RPLF del otro paciente VIH+ era idéntico al de otra cepa suya, aislada 14 meses antes, siendo la primera sensible. Las otras dos pacientes eran mujeres VIH-, y evolucionaron favorablemente, En una, que era diabética, se había diagnosticado una tuberculosis multirresistente hacía 7 años, habiendo permanecido asintomática hasta la actualidad. La otra, se trataba de una resistencia secundaria por un tratamiento deficiente. Conclusiones. La aparición de tuberculosis multirresistente se plantea como un problema muy grave entre los pacientes VIH+, especialmente en un momento en que su esperanza de vida se ha visto notablemente mejorada gracias a las nuevas terapias. En los pacientes VIH-, la tuberculosis multirresistente tiene mejor pronóstico. La tipificacion mediante polimorfismo en la longitud de los fragmentos de restricción es muy útil para poder esclarecer el origen de los casos (AU)

Ferromagnetism in malonato-bridged copper(II) complexes. Synthesis, crystal structures, and magnetic properties of [[Cu(H2O)3][Cu(mal)2(H2O)]]n and [[Cu(H2O)4]2[Cu(mal)2(H2O)]][Cu(mal)2(H2O)2][[Cu(H2O)4][Cu(mal)2(H2O)2][(H2mal = malonic acid).

Three malonato-bridged copper(II) complexes of the formulas [[Cu(H2O)3][Cu(C3H2O4)2(H2O)]]n (1), [[Cu(H2O)4]2[Cu(C3H2O4)2(H2O)]] [Cu(C3H2O4)2(H2O)2][[Cu(H2O)4][Cu(C3H2O4)2(H2O)2]] (2), and [Cu(H2O)4][Cu(C3H2O4)2(H2O)2] (3) (C3H2O4 = malonate dianion) have been prepared, and the structures of the two former have been solved by X-ray diffraction methods. The structure of compound 3 was already known. Complex 1 crystallizes in the orthorhombic space group Pcab, Z = 8, with unit cell parameters of a = 10.339(1) A, b = 13.222(2) A, and c = 17.394(4) A. Complex 2 crystallizes in the monoclinic space group P2/c, Z = 4, with unit cell parameters of a = 21.100(4) A, b = 21.088(4) A, c = 14.007(2) A, and beta = 115.93(2) degrees. Complex 1 is a chain compound with a regular alternation of aquabis(malonato)copper(II) and triaquacopper(II) units developing along the z axis. The aquabis(malonato)copper(II) unit acts as a bridging ligand through two slightly different trans-carboxylato groups exhibiting an anti-syn coordination mode. The four carboxylate oxygens, in the basal plane, and the one water molecule, in the apical position, describe a distorted square pyramid around Cu1, whereas the same metal surroundings are observed around Cu2 but with three water molecules and one carboxylate oxygen building the equatorial plane and a carboxylate oxygen from another malonato filling the apical site. Complex 2 is made up of discrete mono-, di-, and trinuclear copper(II) complexes of the formulas [Cu(C3H2O4)2(H2O)2]2-, [[Cu(H2O)4] [Cu(C3H2O4)2(H2O)2]], and [[Cu(H2O)4]2[Cu(C3H2O4)2(H2O)]]2+, respectively, which coexist in a single crystal. The copper environment in the mononuclear unit is that of an elongated octahedron with four carboxylate oxygens building the equatorial plane and two water molecules assuming the axial positions. The neutral dinuclear unit contains two types of copper atoms, one that is six-coordinated, as in the mononuclear entity, and another that is distorted square pyramidal with four water molecules building the basal plane and a carboxylate oxygen in the apical position. The overall structure of this dinuclear entity is nearly identical to that of compound 3. Finally, the cationic trimer consists of an aquabis(malonato)copper(II) complex that acts as a bismonodentate ligand through two cis-carboxylato groups (anti-syn coordination mode) toward two tetraaqua-copper(II) terminal units. The environment of the copper atoms is distorted square pyramidal with four carboxylate oxygens (four water molecules) building the basal plane of the central (terminal) copper atom and a water molecule (a carboxylate oxygen) filling the axial position. The magnetic properties of 1-3 have been investigated in the temperature range 1.9-290 K. Overall, ferromagnetic behavior is observed in the three cases: two weak, alternating intrachain ferromagnetic interactions (J = 3.0 cm-1 and alpha J = 1.9 cm-1 with H = -J sigma i[S2i.S2i-1 + alpha S2i.S2i+1]) occur in 1, whereas the magnetic behavior of 2 is the sum of a magnetically isolated spin doublet and ferromagnetically coupled di- (J3 = 1.8 cm-1 from the magnetic study of the model complex 3) and trinuclear (J = 1.2 cm-1 with H = -J (S1.S2 + S1.S3) copper(II) units. The exchange pathway that accounts for the ferromagnetic coupling, through an anti-syn carboxylato bridge, is discussed in the light of the available magneto-structural data.

[Hepatic mesenchymal hamartoma]. / Hamartoma mesenquimal hepático.

A case is presented of a 10-year-old female twin with a cystic liver mass that debuted as a painless epigastric mass. The lesion was excised by hepatectomy of segments II and III, confirming in the review of the cavity the presence of a common mesentery with cecocolonic malposition. The postoperative course was normal and clinical and echographic study of her twin sister disclosed no anomalies. The anatomopathologic study of the lesion revealed a tumor of difficult filiation that presented features of mesenchymal hamartoma together with others of biliary cystadenoma. The amount and nature of the stromal component, together with the patient's age at appearance, made us classify the case as mesenchymal hamartoma. The morphologic findings observed seem to support the histopathologetic theory of a congenital origin.