Newly developed Learning and Verbal Memory Test (TAMV-I): Normative data for Spanish-speaking pediatric population.

OBJECTIVE: To generate normative data for the Learning and Verbal Memory Test (TAMV-I) in Spanish-speaking pediatric populations. METHOD: The sample consisted of 4,373 healthy children from nine countries in Latin America (Chile, Cuba, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, and Puerto Rico) and Spain. Each participant was administered the TAMV-I as part of a larger neuropsychological battery. Free recall, memory delay and recognition scores were normed using multiple linear regressions and standard deviations of residual values. Age, age2, sex, and mean level of parental education (MLPE) were included as predictors in the analyses. RESULTS: The final multiple linear regression models indicated main effects for age on all scores, such that scores increased linearly as a function of age. Age2 had a significant effect in all countries except Cuba, and Puerto Rico for free recall score; a significant effect for memory delay score in all countries except Cuba and Puerto Rico; and a significant effect for recognition score in in all countries except Guatemala, Honduras, and Puerto Rico. Models showed an effect for MLPE in Chile (free recall), Honduras (free recall), Mexico (free recall), Puerto Rico (free recall, memory delay, and recognition), and Spain (free recall and memory delay). Sex affected free recall score for Cuba, Ecuador, Guatemala, Mexico, Paraguay, Peru, and Spain, memory delay score for all countries except Chile, Paraguay, and Puerto Rico, and recognition score for Ecuador, Mexico, Peru, and Spain, with girls scoring higher than boys. CONCLUSIONS: This is the largest Spanish-speaking pediatric normative study in the world, and it will allow neuropsychologists from these countries to have a more accurate way to interpret the TAMV-I with pediatric populations.

Verbal fluency tests: Normative data for Spanish-speaking pediatric population.

OBJECTIVE: To generate normative data for the phonological and semantic verbal fluency tests (VFT) in Spanish-speaking pediatric populations. METHOD: The sample consisted of 4,373 healthy children from nine countries in Latin America (Chile, Cuba, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, and Puerto Rico) and Spain. Each participant was administered the VFT as part of a larger neuropsychological battery. Scores for letters F, A, S, and animals and fruit categories were normed using multiple linear regressions and standard deviations of residual values. Age, age2, sex, and mean level of parental education (MLPE) were included as predictors in the analyses. RESULTS: The final multiple linear regression models showed main effects for age on all scores, such that scores increased linearly as a function of age. Age2 had a significant effect in Chile (animals), Cuba (A letter, fruits), Ecuador (animals, fruits), Honduras (F letter), Mexico (animals, fruits), Peru (fruits), and Spain (S letters, animals, fruits). Models showed an effect for MLPE in Chile (A letters, animals, fruits), Ecuador (S letter, animals, fruits), Guatelama (F, S letter, animals), Honduras (animals), Mexico (F, A, S letters, animals, fruits), Puerto Rico (A, letters, animals), and Spain (all scores). Sex scores were found significant in Chile (animals), Ecuador (A letter, fruits), Mexico (F letter, fruits), Paraguay (F, A, S letters, fruits), Puerto Rico (F letter, animals, fruits), and Spain (F letter, fruits). CONCLUSIONS: This is the largest multi-national Spanish speaking-pediatric normative study in the world, and as such it will allow neuropsychologists from these countries to have a more accurate way to interpret the phonological and semantic VFT in pediatric populations.

Evaluación de la conciliación de la medicación en una Unidad de Traumatología / Evaluation of medication reconcilliation in a Trauma Unit

Introducción: El objetivo del estudio fue evaluar la tasa de discrepancias en la conciliación de la medicación realizada al ingreso de los pacientes en una Unidad de Traumatología, identificando los posibles factores de riesgo asociados a los errores de conciliación. Material y métodos: Se trata de un estudio observacional transversal realizado en un hospital de tercer nivel durante el periodo comprendido entre el 1 de mayo y el 16 de julio del 2012, en el que se elaboró un listado del tratamiento domiciliario del paciente contrastándose con la historia farmacoterapéutica recogida al ingreso en dicha unidad, para identificar los errores de conciliación. Estos se clasificaron en función del tipo y la relevancia de la discrepancia. Se realizó un análisis estadístico por regresión logística, utilizando como variable dependiente la existencia de discrepancias. Resultados: Ciento sesenta y cuatro pacientes fueron incluidos en el estudio, hallándose errores de conciliación en el 48,8%, de las cuales el 14,4% fueron considerados muy relevantes. De los pacientes ingresados de forma urgente, el 66,7% presentó discrepancias frente al 44,8% en pacientes programados. En total, se identificaron 153 errores de conciliación, siendo el tipo más frecuente el de omisión de algún medicamento (72%). Se detectó que por cada fármaco añadido al tratamiento domiciliario habitual el riesgo de presentar discrepancias aumenta en un 33%. Conclusión: Este estudio pone en evidencia la falta de exhaustividad en la recogida de la historia farmacoterapéutica de los pacientes al ingreso en la Unidad de Traumatología (AU)

Introduction: The aim of this study was to assess the rate of discrepancies in medication reconciliation on admission patients in a trauma unit, and identifying potential risk factors associated with these discrepancies. Material and methods: A cross-sectional, observational study was carried out to identify reconciliation errors in a tertiary hospital during the period from May 1 to July 16 of 2012. Medication history of the patient was compared with home medication data collected on admission, to identify reconciliation errors. These were classified according to the type and severity of the discrepancies. Statistical analysis by logistic regression was performed, using the presence of discrepancies as dependent variable. Results: The study included 164 patients, and reconciliation errors were found in 48.8%, of which 14.4% were considered highly relevant. Around two-thirds (66.7%) of the patients admitted to the emergency department showed unjustified discrepancies compared to 44.8% in scheduled patients. In total, 153 reconciliation errors were identified, being omitted drug the most frequent type of discrepancie (72%). The risk of discrepancies increases by 33% for each drug added to the usual home treatment. Conclusion: This study demonstrates the lack of quality in home medication recording in patients admitted to the trauma unit (AU)

Evaluation of medication reconcilliation in a Trauma Unit.

INTRODUCTION: The aim of this study was to assess the rate of discrepancies in medication reconciliation on admission patients in a trauma unit, and identifying potential risk factors associated with these discrepancies. MATERIAL AND METHODS: A cross-sectional, observational study was carried out to identify reconciliation errors in a tertiary hospital during the period from May 1 to July 16 of 2012. Medication history of the patient was compared with home medication data collected on admission, to identify reconciliation errors. These were classified according to the type and severity of the discrepancies. Statistical analysis by logistic regression was performed, using the presence of discrepancies as dependent variable. RESULTS: The study included 164 patients, and reconciliation errors were found in 48.8%, of which 14.4% were considered highly relevant. Around two-thirds (66.7%) of the patients admitted to the emergency department showed unjustified discrepancies compared to 44.8% in scheduled patients. In total, 153 reconciliation errors were identified, being omitted drug the most frequent type of discrepancie (72%). The risk of discrepancies increases by 33% for each drug added to the usual home treatment. CONCLUSION: This study demonstrates the lack of quality in home medication recording in patients admitted to the trauma unit.

Multispecies coexistence of trees in tropical forests: spatial signals of topographic niche differentiation increase with environmental heterogeneity.

Neutral and niche theories give contrasting explanations for the maintenance of tropical tree species diversity. Both have some empirical support, but methods to disentangle their effects have not yet been developed. We applied a statistical measure of spatial structure to data from 14 large tropical forest plots to test a prediction of niche theory that is incompatible with neutral theory: that species in heterogeneous environments should separate out in space according to their niche preferences. We chose plots across a range of topographic heterogeneity, and tested whether pairwise spatial associations among species were more variable in more heterogeneous sites. We found strong support for this prediction, based on a strong positive relationship between variance in the spatial structure of species pairs and topographic heterogeneity across sites. We interpret this pattern as evidence of pervasive niche differentiation, which increases in importance with increasing environmental heterogeneity.

Characterization of 10 microsatellite markers for the understorey Amazonian herb Heliconia acuminata.

We characterized 10 microsatellite loci for the plant Heliconia acuminata from the Biological Dynamics of Forest Fragments Project (Manaus, Brazil). Markers were screened in 61 individuals from one population and were found to be polymorphic with an average of eight alleles per locus. We found moderate to high levels of polymorphic information content, and observed and expected heterozygosities. All 10 markers are suitable for spatial genetic structure and parentage analyses and will be used for understanding H. acuminata dynamics across a fragmented landscape.

Duration of dysphagic symptoms and swallowing outcomes after thermal burn injury.

Levels of swallowing disability, patterns of dysphagia rehabilitation and swallowing outcomes on discharge were retrospectively reviewed for 30 patients with thermal burn injury (with or without inhalation injury), referred to speech pathology services for dysphagia management. The average total surface burn area of the group was 50%. All patients were mechanically ventilated for an average of 24 days, with 80% of patients requiring subsequent tracheostomy. Initial dysphagia assessment occurred approximately 20 days after admission, whereas first safe oral intake was achieved by approximately 30 days. Supplementary nutrition and hydration was necessary for all patients. The time to achieve oral intake without supplementation was 53 days. Outcome measures revealed a significant improvement in swallowing function throughout the duration of inpatient stay, with 90% of patients discharged safely tolerating a normal diet, 6.7% of patients managing soft diet consistencies, and 3.3% managing soft puree consistencies on discharge.

Simultaneous PML/RARalpha and AML1/ETO expression with t(15;17) at onset and relapse with only t(8;21) in an acute promyelocytic leukemia patient.

We report a patient with acute promyelocytic leukemia with the common translocation (15;17) and PML-RARAalpha fusion gene. In relapse, blasts showed typical FAB M2 morphologic features, and the karyotype was 45,X, -Y,t(8;21). A reexamination of the leukemic cells at diagnosis revealed that an AML1-ETO fusion gene was also present at that time without cytogenetic evidence of t(8;21). In relapse, only t(8;21) was detected. Two different clones were identified by cytogenetic standard techniques. The association of two common translocations supervening in the same time in the same cells could not be established.

[Spanish version of the new World Health Organization Disability Assessment Schedule II (WHO-DAS-II): initial phase of development and pilot study. Cantabria disability work group]. / Versión en lengua española de un nuevo cuestionario de evaluación de discapacidades de la OMS (WHO-DAS-II): fase inicial de desarrollo y estudio piloto. Grupo Cantabria en Discapacidades.

The aim of the present paper is to present the initial phases of the development of the Spanish version of the "World Health Organization Disablement Assessment Schedule II" WHO-DAS-II and also to describe the quantitative and qualitative methodological strategies used in the elaboration process of an instrument: i) compatible with the new International Classification of Functioning and Disability -ICIDH-2- of the World Health Organisation; ii) with criteria of cross-cultural applicability and; iii) to allow us to assess the disability in all its dimensions.

The 1.5 A resolution crystal structure of the carbamate kinase-like carbamoyl phosphate synthetase from the hyperthermophilic Archaeon pyrococcus furiosus, bound to ADP, confirms that this thermostable enzyme is a carbamate kinase, and provides insight into substrate binding and stability in carbamate kinases.

Carbamoyl phosphate (CP), an essential precursor of arginine and the pyrimidine bases, is synthesized by CP synthetase (CPS) in three steps. The last step, the phosphorylation of carbamate, is also catalyzed by carbamate kinase (CK), an enzyme used by microorganisms to produce ATP from ADP and CP. Although the recently determined structures of CPS and CK show no obvious mutual similarities, a CK-like CPS reported in hyperthermophilic archaea was postulated to be a missing link in the evolution of CP biosynthesis. The 1.5 A resolution structure of this enzyme from Pyrococcus furiosus shows both a subunit topology and a homodimeric molecular organization, with a 16-stranded open beta-sheet core surrounded by alpha-helices, similar to those in CK. However, the pyrococcal enzyme exhibits many solvent-accessible ion-pairs, an extensive, strongly hydrophobic, intersubunit surface, and presents a bound ADP molecule, which does not dissociate at 22 degrees C from the enzyme. The ADP nucleotide is sequestered in a ridge formed over the C-edge of the core sheet, at the bottom of a large cavity, with the purine ring enclosed in a pocket specific for adenine. Overall, the enzyme structure is ill-suited for catalyzing the characteristic three-step reaction of CPS and supports the view that the CK-like CPS is in fact a highly thermostable and very slow (at 37 degrees C) CK that, in the extreme environment of P. furiosus, may have the new function of making, rather than using, CP. The thermostability of the enzyme may result from the extension of the hydrophobic intersubunit contacts and from the large number of exposed ion-pairs, some of which form ion-pair networks across several secondary structure elements in each enzyme subunit. The structure provides the first information on substrate binding and catalysis in CKs, and suggests that the slow rate at 37 degrees C is possibly a consequence of slow product dissociation.

Versión en lengua española de un nuevo cuestionario de evaluación de discapacidades de la OMS (WHO-DAS-II): fase inicial de desarrollo y estudio piloto / Spanish version of the new World Health Organization Disablement Assessment Schedule II (WHO-DAS-II): Initial phase of development and pilot study

El objetivo del presente trabajo es presentar las fases iniciales del desarrollo de la versión en lengua española del Cuestionario de Evaluación de Discapacidades de la OMS -WHO-DAS-II ('World Health Organization Disablement Assessment Schedule II'), así como realizar una descripción de las estrategias metodológicas, tanto cualitativas como cuantitativas, utilizadas para garantizar que dicho instrumento sea: i) compatible con el nuevo sistema de Clasificación de discapacidades de la OMS (Clasificación Internacional del Funcionamiento y de la Discapacidad- CIDDM-2); ii) aplicable transculturalmente, y; iii) adecuado para evaluar la discapacidad de un modo fiable y en todas sus dimensiones (AU)

La discapacidad: modelos interpretativos y su influencia en el nuevo sistema de clasificación de discapacidades de la Organización Mundial de la Salud (CIDDM-2) / Disability: Interpretative Models and their Influence in the New Classification System of Disabilities from the World Health Organisation (ICIDH-2)

Este artículo presenta los aspectos esenciales relativos a los modelos de discapacidad más significativos desarrollados hasta la fecha, así como su impacto sobre el proceso de revisión del sistema de Clasificación Internacional de Deficiencias, Discapacidades y Minusvalías -CIDDM- desarrollado por la Organización Mundial de la Salud. Se revisan, fundamentalmente, los modelos "Médico-Biológico" y "Social" para de esta forma introducir los modelos "Universal" y "Bio-Psico-Social" adoptados en dicho proceso de revisión. Este artículo describe, además, la estructura, contenidos y nuevas conceptualizaciones de la nueva Clasificación Internacional de Deficiencias, Discapacidades y Minusvalías de la OMS, que ha pasado a denominarse, al menos de forma provisional, Clasificación Internacional del Funcionamiento y la Discapacidad, -CIDDM-2. (AU)

Interactions between goldenrod (Solidago altissima L.) and its insect herbivore (Trirhabda virgata) over the course of succession.

Consumers can mediate the composition of plant communities and alter ecosystem processes. Although herbivores usually increase N availability in the short term, they might decrease it in the long term. I investigated the long-term effect of insect herbivores on leaf tissue quality and soil N availability in goldenrod (Solidago altissima) fields using two approaches: (1) I compared plots from which herbivores had been excluded for 17 years with adjacent plots that had experienced normal levels of herbivory, and (2) I examined a chronosequence of nine goldenrod fields representing three successional stages: early, middle, and late. These parallel approaches showed that, in the long term, herbivores decrease the quality of leaf litter and soil N availability in goldenrod fields. These long-term effects appear to compensate for various short-term effects that increase N availability in the soil (e.g., added frass, increased light penetration). Furthermore, herbivores decrease leaf litter quality and N availability by reducing the quality of leaf tissue within the same species. This pattern may result from insect herbivores preferentially grazing on plants with a high N content thereby increasing the amount of recalcitrant litter over the course of succession.

The carbamoyl-phosphate synthetase of Pyrococcus furiosus is enzymologically and structurally a carbamate kinase.

The hyperthermophiles Pyrococcus furiosus and Pyrococcus abyssi make pyrimidines and arginine from carbamoyl phosphate (CP) synthesized by an enzyme that differs from other carbamoyl-phosphate synthetases and that resembles carbamate kinase (CK) in polypeptide mass, amino acid sequence, and oligomeric organization. This enzyme was reported to use ammonia, bicarbonate, and two ATP molecules as carbamoyl-phosphate synthetases to make CP and to exhibit bicarbonatedependent ATPase activity. We have reexamined these findings using the enzyme of P. furiosus expressed in Escherichia coli from the corresponding gene cloned in a plasmid. We show that the enzyme uses chemically made carbamate rather than ammonia and bicarbonate and catalyzes a reaction with the stoichiometry and equilibrium that are typical for CK. Furthermore, the enzyme catalyzes actively full reversion of the CK reaction and exhibits little bicarbonate-dependent ATPase. In addition, it cross-reacts with antibodies raised against CK from Enterococcus faecium, and its three-dimensional structure, judged by x-ray crystallography of enzyme crystals, is very similar to that of CK. Thus, the enzyme is, in all respects other than its function in vivo, a CK. Because in other organisms the function of CK is to make ATP from ADP and CP derived from arginine catabolism, this is the first example of using CK for making rather than using CP. The reasons for this use and the adaptation of the enzyme to this new function are discussed.

Carbamate kinase: New structural machinery for making carbamoyl phosphate, the common precursor of pyrimidines and arginine.

The enzymes carbamoyl phosphate synthetase (CPS) and carbamate kinase (CK) make carbamoyl phosphate in the same way: by ATP-phosphorylation of carbamate. The carbamate used by CK is made chemically, whereas CPS itself synthesizes its own carbamate in a process involving the phosphorylation of bicarbonate. Bicarbonate and carbamate are analogs and the phosphorylations are carried out by homologous 40 kDa regions of the 120 kDa CPS polypeptide. CK can also phosphorylate bicarbonate and is a homodimer of a 33 kDa subunit that was believed to resemble the 40 kDa regions of CPS. Such belief is disproven now by the CK structure reported here. The structure does not conform to the biotin carboxylase fold found in the 40 kDa regions of CPS, and presents a new type of fold possibly shared by homologous acylphosphate-making enzymes. A molecular 16-stranded open beta-sheet surrounded by alpha-helices is the hallmark of the CK dimer. Each subunit also contains two smaller sheets and a large crevice found at the location expected for the active center. Intersubunit interactions are very large and involve a central hydrophobic patch and more hydrophilic peripheral contacts. The crevice holds a sulfate that may occupy the site of an ATP phosphate, and is lined by conserved residues. Site-directed mutations tested at two of these residues inactivate the enzyme. These findings support active site location in the crevice. The orientation of the crevices in the dimer precludes their physical cooperation in the catalytic process. Such cooperation is not needed in the CK reaction but is a requirement of the mechanism of CPSs.

Antimicrobial effectiveness of 2% glutaraldehyde versus other disinfectants for hospital equipment, in an in vitro test based on germ-carriers with a high microbial contamination.

2% glutaraldehyde is the reference disinfectant for hospital instruments. However, its high environmental toxicity makes desirable to search for alternatives. We compare the antimicrobial activity of 2% glutaraldehyde with 0.44% N-duopropenide (NDP), 0.66% NDP in 48 degrees alcoholic solution (NDP-alc), 0.13% glutaraldehyde-phenate, 1% or 3% persulphate (Virkon) and 0.1% or 0.5% chlorhexidine, using a model that mimics non-regular surface instruments contaminated with microbial strains (44 bacteria, 6 of which were Mycobacterium). The contaminated carrier is soaked in the disinfectant solution. After 5 or 20 minutes contact the disinfectant is neutralized. The overall results on all microorganisms in 20 minutes, show similar antibacterial activity for 2% glutaraldehyde and 0.66% NDP-alc, followed by 0.44% NDP and after by the two concentrations of Virkon and 0.5% chlorhexidine. The 0.13% glutaraldehyde-phenate and 0.1% chlorhexidine exhibited significantly less effect than any other disinfectant. 0.66% NDP-alc was faster antimicrobial activity than 2% glutaraldehyde, destroying totally the inoculum in 5 minutes. Activity on Mycobacterium showed great differences between 2% glutaraldehyde and the rest of products (> 5 log versus < 3 log reduction in 20 minutes), with an exception: NDP-alc, with similar and faster activity (> 5 log in 5 minutes) than 2% glutaraldehyde. With human blood, the survival microorganisms increase 0.3 log (average) in all the disinfectants used. The aggressiveness on metallic devices was greater in Virkon than in the other disinfectants. We conclude that NDP (alone or in alcoholic solution) may be a good alternative to glutaraldehyde in hospital instruments disinfection.

Gonadotrophin and prolactin secretory dynamics in girls with normal puberty, idiopathic precocious puberty and precocious puberty due to hypothalamic hamartoma.

OBJECTIVE: This study was designed to test the hypothesis that hypothalamic hamartoma causes precocious puberty through a different neuroendocrine mechanism than that of normal puberty or of idiopathic precocious puberty. DESIGN AND PATIENTS: We compared the pattern of gonadotrophin secretion among 4 girls with precocious puberty due to hypothalamic hamartoma, 27 girls with idiopathic precocious puberty, and 14 girls with normal puberty. All subjects were breast stage 3 or 4. Blood samples were obtained every 20 min for 4 h during the day (1.000 hours to 1400 h) and night (22.00 hours to 0200 h). MEASUREMENTS: LH, FSH, and prolactin were measured in each blood sample. Girls also underwent LHRH-stimulation with measurement of LH and FSH before and after stimulation. RESULTS: There were no significant differences in mean LH level, LH peak amplitude, or LH or FSH peak frequency during either the day or the night among the three diagnostic groups. However, the mean +/- SD LHRH-stimulated peak LH levels were greater in girls with hypothalamic hamartoma than in girls with normal puberty or with idiopathic precocious puberty (194 +/- 142 vs 85 +/- 60 or 66 +/- 54 IU/l, respectively, P < 0.05). The LHRH-stimulated peak FSH level in girls with hypothalamic hamartoma exceeded the level for the normal pubertal girls (31 +/- 19 vs 17 +/- 7 IU/l, P < 0.05), but not the level for the girls with idiopathic precocious puberty (25 + 12 IU/l). The peak LH to peak FSH ratio in the girls with hypothalamic hamartoma exceeded the ratio for the girls with idiopathic precocious puberty (7.3 +/- 3.9 vs 2.6 +/- 3.0 IU/l, P < 0.05), but not the ratio for the normal pubertal girls (5.0 + 2.9). There were no significant differences in mean prolactin level, peak amplitude or frequency, or in the ratio of mean night to mean day prolactin, among the 3 diagnostic groups. CONCLUSIONS: We conclude that spontaneous gonadotrophin and prolactin secretion are similar among girls with hypothalamic hamartoma, idiopathic precocious puberty, or normal puberty. However, the increased LHRH-stimulated peak LH in the girls with hypothalamic hamartoma suggests subtle differences in neuroendocrine regulation that may underlie their more rapid pubertal maturation.