Cytotoxicity on human cells of Cry1Ab and Cry1Ac Bt insecticidal toxins alone or with a glyphosate-based herbicide.

The study of combined effects of pesticides represents a challenge for toxicology. In the case of the new growing generation of genetically modified (GM) plants with stacked traits, glyphosate-based herbicides (like Roundup) residues are present in the Roundup-tolerant edible plants (especially corns) and mixed with modified Bt insecticidal toxins that are produced by the GM plants themselves. The potential side effects of these combined pesticides on human cells are investigated in this work. Here we have tested for the very first time Cry1Ab and Cry1Ac Bt toxins (10 ppb to 100 ppm) on the human embryonic kidney cell line 293, as well as their combined actions with Roundup, within 24 h, on three biomarkers of cell death: measurements of mitochondrial succinate dehydrogenase, adenylate kinase release by membrane alterations and caspase 3/7 inductions. Cry1Ab caused cell death from 100 ppm. For Cry1Ac, under such conditions, no effects were detected. The Roundup tested alone from 1 to 20 000 ppm is necrotic and apoptotic from 50 ppm, far below agricultural dilutions (50% lethal concentration 57.5 ppm). The only measured significant combined effect was that Cry1Ab and Cry1Ac reduced caspases 3/7 activations induced by Roundup; this could delay the activation of apoptosis. There was the same tendency for the other markers. In these results, we argue that modified Bt toxins are not inert on nontarget human cells, and that they can present combined side-effects with other residues of pesticides specific to GM plants.

[The National Institute for Clinical Excellence (NICE)]. / Das National Institute for Clinical Excellence (NICE) - Staatsmedizinisches Rationierungsinstrument oder Vorbild für die evidenzbasierte Bewertung medizinischer Leistungen?

In discussions on the development of the institutional framework for decisions on the benefit package of social health insurance in Germany, the English National Institute for Clinical Excellence (NICE) is considered as either a good or a bad example for reform. According to this study, the procedures and criteria applied by NICE for making health care coverage decisions are legitimate. Procedures are transparent and interest groups are broadly represented. Decision criteria include cost effectiveness of services - albeit only if information on cost effectiveness is available and highly evident. Furthermore, cost effectiveness is not the only criteria for coverage decisions. NICE very rarely induces strong direct rationing, but rather leaves room for discretion. However, the trade-off between maximising allocative efficiency and avoiding distributional consequences becomes apparent.

Evaluation of clinical, electrophysiologic, and computed tomographic parameters in replanted hands.

OBJECTIVE: To compare clinical, electrophysiologic, and computed tomography (CT) imaging correlates of reinnervation in replanted limbs. DESIGN: Patients were assessed between 8 and 194 months after replantation of completely severed hands. SETTING: University hospital, departments for neurology and for plastic and reconstructive surgery. PARTICIPANTS: Thirteen patients, 10 with total and 3 with subtotal type V amputation, whose hands had been reattached. INTERVENTIONS: Clinical assessment of function of hand and finger muscles; electromyographic tests of sensory nerve action potentials (SNAPs) of median, ulnar, and radial nerves; and compound motor action potentials (CMAPs) of abductor pollicis brevis, first dorsal interosseus, and abductor digiti minimi muscles. CT assessment of motor unit action potentials. Measurements of both replanted and normal hands. MAIN OUTCOME MEASURES: Medical Research Council scale of force; sensory functions of anatomic areas of nerves; SNAP and CMAP amplitudes; CT area, mean absorption, standard deviation (SD) from mean absorption, and root mean square SD of absorption. RESULTS: Correlates of reinnervation were evidenced by all methods, except by surface recordings of SNAPs, which could not be elicited even in hands with good sensory function. CMAP amplitudes were the electrophysiologic parameter that correlated best with the clinical restoration. Of the CT measures, the cross-sectional area was the most useful parameter for the detection of denervation, but no CT parameter was sufficiently sensitive to detect reinnervation. In cases with good functional recovery, CMAP amplitudes were superior to clinical rating in showing incomplete reinnervation. CONCLUSION: The combination of clinical and electrophysiologic methods supplied sufficient data for a reliable evaluation of reinnervation. Usually, CT parameters did not add useful information.

Laeshmaniasis cutánea: presentación de un paciente pedriatrico / Cutaneous Leishmaniasis: pediatric patient presentation

Presentamos una paciente de sexo femenino, de 16 años de edad, con leishmaniasis cutánea tipo esporotricoide. Mencionamos su buena evolución con el tratamiento sistémico indicado: antimoniato de meglumine a razón de 20 mg/kg/día, 45 dosis. Consideramos importante el diagnóstico temprano de la afección, para evitar las formas cutáneo-mucosas. La educación sanitaria es un recurso para prevenir la afección

Laeshmaniasis cutánea: presentación de un paciente pedriatrico / Cutaneous Leishmaniasis: pediatric patient presentation

Presentamos una paciente de sexo femenino, de 16 años de edad, con leishmaniasis cutánea tipo esporotricoide. Mencionamos su buena evolución con el tratamiento sistémico indicado: antimoniato de meglumine a razón de 20 mg/kg/día, 45 dosis. Consideramos importante el diagnóstico temprano de la afección, para evitar las formas cutáneo-mucosas. La educación sanitaria es un recurso para prevenir la afección(AU)

[Effect of competition-oriented reform in the Netherlands health care system on the relationship between primary care physicians, insurance groups and insured patients]. / Die Auswirkungen der wettbewerbsorientierten Reformen im niederländischen Gesundheitswesen auf die Beziehungen zwischen Hausärzten, Krankenkassen und Versicherten.

The German health care policy debate is affected by proposals demanding the introduction of competitive elements. Analysis of the effects of regulated competition in the Netherlands health care system shows that actual behavioural changes of the key actors of the system differ considerably from expected changes, although incentives within the system have been substantially changed. Sickness funds are not selectively linked with providers and insured patients do not change their insurance company very often. From the point of view of the original reform targets, this preliminary result is quite disappointing. It can be explained by the fact that the relations between sickness funds, general practitioners and insured persons or patients are within a broader framework of health care. Thus, competition does not seem attractive to either of them. If regulated competition became more dominant, several undesirable effects on the so far well-appreciated primary care may be expected.

Enfermedadf por igA lineal / Lineal igA disease

Presentamos dos pacientes con enfermedad por ig A lineal, de 2 y 3 años de edad respectivamente, ambos del sexo masculino, se llegó al diagnóstico por la clínica dermatológica, la histología y la inmunofluorescencia directa, donde se detectó ig A lineal en la zona de la membrana basal. Fueron tratados con diamino difenil sulfona (DAPS), con una rápida y efectiva respuesta y con antihistamínicos (difenhidramina) para mejorar el prurito. Los controles se realizaron periódicamente desde el comienzo de la afección hasta la actualidad. Consideramos que la enfermedad por igA lineal no es una dermatosis muy frecuente en la infancia, pero se debe tener presente. Loas diagnósticos diferenciales obligados so: la dermatitis herpetiforme y el penfigoide ampollar, sin dejar de tener en cuenta otras afecciones ampollares no geneticas como el impétigo ampollar, la epidermólisis ampollar adquirida de la infancia y el eritema poliformo ampollar

Enfermedadf por igA lineal / Lineal igA disease

Presentamos dos pacientes con enfermedad por ig A lineal, de 2 y 3 años de edad respectivamente, ambos del sexo masculino, se llegó al diagnóstico por la clínica dermatológica, la histología y la inmunofluorescencia directa, donde se detectó ig A lineal en la zona de la membrana basal. Fueron tratados con diamino difenil sulfona (DAPS), con una rápida y efectiva respuesta y con antihistamínicos (difenhidramina) para mejorar el prurito. Los controles se realizaron periódicamente desde el comienzo de la afección hasta la actualidad. Consideramos que la enfermedad por igA lineal no es una dermatosis muy frecuente en la infancia, pero se debe tener presente. Loas diagnósticos diferenciales obligados so: la dermatitis herpetiforme y el penfigoide ampollar, sin dejar de tener en cuenta otras afecciones ampollares no geneticas como el impétigo ampollar, la epidermólisis ampollar adquirida de la infancia y el eritema poliformo ampollar(AU)