The Importance of Evaluating Frailty and Social-behavioral Factors for Managing Drugs and Dialysis Prescription in Elderly Patients.

Ageing is characterized by a progressive loss of complexity, which is an essential condition for making the organism capable of keeping homeostasis. Thus, senile loss of complexity makes old individuals frail: a syndrome characterized by the presence of shrinking (sarcopenia), weakness, poor endurance and energy, slowness, and low physical activity. Moreover, renal ageing progressively leads to a glomerular filtration rate (GFR) reduction, one of the main pharmacokinetic senile changes, which is not detectable by simply evaluating serum urea or creatinine values but measuring or calculating patient's GFR. Finally, current epidemiology has documented that detrimental social-behavioral factors such as low education level, poor financial-resource, depression, and isolation, also influence the onset and progression of chronic diseases, and even overall mortality, particularly in the elderly. Thus, we propose that these 3 variables: frailty phenotype, senile GFR, and detrimental social-behavioral factors, should be considered at time of prescribing drugs or medical procedures in the elderly. Additionally, they should also be considered for following patient's response to prescribed therapies in elderly patients suffering from chronic diseases (diabetes mellitus, chronic kidney disease, etc.), or on organ replacement treatments (dialysis and transplantation).

Estimated glomerular filtration rate (eGFR), 25(OH) D3, chronic kidney disease (CKD), the MYH9 (myosin heavy chain 9) gene in old and very elderly people.

It is known that the common physiological denominator of the ageing process is an attenuation of functional performance with respect to the situation of young people and adults. However, since the first cohort-based longitudinal studies, it has not been possible to establish a "linear" relationship between age and glomerular filtration in all cases. This does not mean that there is no physiological ageing process at all; in addition to those already elucidated, its mechanisms include cell senescence, podocyte dysfunction, a vitamin D deficiency, and homozygotic forms of the MYH9 gene. The aim of the present work was to analyse the prevalence of chronic kidney disease (CKD) and, where possible, the correlation between CKD, defined by an eGFR < 60 ml/min/1.73 m(2), plasma 25(OH)D3 levels and the MYH9 gene in a population of elderly and very elderly persons. These parameters have not been evaluated previously in populations of elderly and very elderly patients. It is concluded that a moderate decrease in the eGFR occurs with age. This does not imply the presence of CKD in elderly people, since in most individuals the reduced eGFR is not accompanied by anaemia, and no individuals show hypocalcaemia, hyperphosphataemia or a high Alb/Cr ratio. Here we observed a lower Hb level and an elevated Alb/Cr ratio in subjects heterozygotic for the MYH9 gene. This could be interpreted in the sense that the gene could exert some protective effect on renal function, whereas the heterozygotic form (allele A) of the MYH9 gene could be considered a very early marker, a new risk factor for the appearance of CKD, or a sign of renal frailty in elderly people.

The value of a formula including haematocrit, blood urea and gender (HUGE) as a screening test for chronic renal insufficiency.

INTRODUCTION: Despite increasing use in clinical practice, an estimated glomerular filtration rate value (eGFR) of <60 ml/min/1.73 m2 does not necessarily indicate the existence of chronic renal insufficiency (CRI) and this may lead to an over-estimate of CRI particularly in persons seventy years or older. AIM: To find a screening test able to differentiate CRI from the decrease in GFR normally associated with the renal ageing process. METHODS: Medical information of 487 individuals of both sexes aged 16-102 was obtained from nephrologists, internal medicine physicians, cardiologists, geriatricians, family and nuclear medicine doctors from Argentina, Portugal and Spain. Data were assessed and statistically analysed using logistic regression techniques. From the discriminative variables it was derived the HUGE formula. RESULTS: A formula including haematocrit , blood urea, and gender (HUGE), diagnoses CRI regardless of the variables of age, blood creatinine, creatinine clearance, or other eGFR. The HUGE formula is: L = 2.505458 - (0.264418 x Hematocrit) + (0.118100 x Urea) [+ 1.383960 if male]. If L is a negative number the individual does not have CRI; if L is a positive number, CRI is present. Our data demonstrate that the HUGE formula is more reliable than MDRD and CKD-EPI, particularly in persons aged over 70. CONCLUSIONS: Our HUGE screening formula offers a straightforward, easily available and inexpensive method for differentiating between CRI and eGFR < 60 ml/min/1.73 m2 that will prevent a considerable number of aged healthy persons, as much as 1.700.000 in Spain and 2.600.000 in U.K., to be excluded from clinical assays or treatments contraindicated in CRI.

¿Son modificables las actitudes hacia laspersonas mayores en estudiantes de medicina?Experiencia en la Universidad de Salamanca / Are the medical students’ attitudes towards older people modifiable? The University of Salamanca’s experience

Introducción. Los médicos y los estudiantes de medicina tienden a tener actitudes negativas hacia las personas mayores. En la Unión Europea, sólo el 50% de los estudiantes de medicina reciben formación en medicina geriátrica. Sujetos y métodos. Se evaluaron las actitudes hacia las personas mayores en la cohorte de estudiantes de medicina de 5.º del curso 2006-07 inscritos en la asignatura de geriatría, al comienzo y al fin de la misma. Se utilizó un cuestionario basado en la escala diferencial semántica de Rosencranz et al, donde las puntuaciones bajas indican actitudes más positivas. Resultados. Se obtuvieron datos de 93 estudiantes, 74% fueron mujeres y 26% varones. El promedio de edad fue 22,4 años. Se apreció una mejoría en la mayoría de las variables evaluadas, con diferencias significativas en 21 de las 32 variables analizadas. Sólo el15% declaró haber recibido un entrenamiento previo en el área del envejecimiento. Conclusiones. La exposición a conocimientos y prácticas basadas en la atención y cuidado de las personas mayores modificarían positivamente las actitudes de los estudiantes de medicina (AU)

Introduction. Both physicians and medical students show negative attitudes towards older people. In the European Union, only about 50% of the medical students receive geriatric medicine training. Subjects and methods. Attitudes towards elder people were evaluated in medical students in the fifth year of their studies during 2006-07 academical year, before and after receiving specific training in geriatric medicine. To measure attitudes we used the instrument developed by Rosencranz et al, which incorporates the Aged Semantic Differential; low scores show positives attitudes. Results. 93questionnaires were filled in correctly; 74% of the participants were women and 26% men. Average age was 22.4 years. Our results shows lower values in the majority of the 32 variables studied, with statistically significant differences in 21 of them. Only 15% of the participants declared to have received geriatric medicine training before our study. Conclusions. Medical students’ exposure to knowledge and practice in elderly care could positively modify their attitudes (AU)

Identificación de mayores con trastornos mentales y su relación con autopercepción de salud en medio comunitario rural. Estudio de corte transversal / Identification of elderly subjects with mental illness and its relationship with self-perception of health in a rural community setting. A cross-sectional study

INTRODUCCIÓN. El incremento de la carga de los trastornos mentales en la población de mayores y los pocos datos de prevalencia en medio rural comunitario son la razón de esta comunicación. Nuestro objetivo fue identificar adultos mayores con trastornos neuropsiquiátricos (ansiedad, depresión, distimia) en medio comunitario rural y su relación con la autopercepción del estado de salud. MATERIAL Y MÉTODOS. Estudiamos una cohorte de mayores de 65 años (n = 165) de Garcibuey (C1) y Villanueva del Conde (C2), dos pueblos de la provincia de Salamanca. Utilizamos un cuestionario realizado en base al de la Organización Panamericana de la Salud/Organización Mundial de la Salud (OPS/OMS) para el estudio SABE que revela aspectos en 4 dominios diferentes: datos demográficos, estado de salud, estado nutricional y aspectos sociales de los adultos mayores. Los datos se obtuvieron entre noviembre de 2006 y febrero de 2007 por entrevista directa y revisión sistemática de historias clínicas. Utilizamos para el tratamiento estadístico el paquete SPSS 12.0. RESULTADOS Y CONCLUSIONES. Cuarenta y una (25,2%) de las personas han sufrido o sufren un trastorno neuropsiquiátrico, 121 (74,2%) no. Nueve están bajo tratamiento médico farmacológico. El 63,4% vive solo o con su pareja; 22 (53,6%) perciben su estado de salud como malo o regular. El 65,8% consume psicofármacos. Las mujeres (28 [68,2%]) fueron las más afectadas (AU)

INTRODUCTION. This paper aims to deal with the increaseof the burden of mental disorders in the elderly populationand scarce prevalence data in the rural communitysetting and the poor evidence in rural settings. Our aim wasto identify elderly adults with neuropsychiatric morbidity(anxiety, depression and dysthymia) in rural communityarea, and their relationship to self-perception of one’s healthcondition.MATERIAL AND METHODS. A cohort made up of subjectsover 65 years (n = 165) from Garcibuey (C1) and Villanuevadel Conde (C2), Salamanca, was studied. We used aquestionnaire based on the SABE study from Pan-AmericanHealth Organization/World Health Organization (PAHO/WHO) to evaluate personal data, health and nutritionalstatus and social issues in elderly subjects. Data was collectedbetween November 06 - February 07 by direct personalinterview and systematic review of medical record.RESULTS AND CONCLUSIONS. Forty-one (25.2%) ofthe cohort have suffered or are suffering a neuropsychiatricdisorder, 9 of whom are currently under medical treatment.A total of 63.4% live alone or with a partner; 22 (53.6%) perceivetheir health status as fair or bad. A total of 65.8% consumepsychodrugs. Neuropsychiatric disorders are more frequentin women (28 [68.2%]) (AU)

[Left atrial myxoma presenting as angor pectoris]. / Mixoma auricular izquierdo como forma de presentación de una angina de esfuerzo.

A 73 years old woman without cardiovascular risk factors presented physical exercise angina and dyspnea since 8 months ago. The caused of the disease was a left atrial myxoma which entering in left ventricle. The patient was free of coronary injured.

Estudio de farmacovigilancia para evaluar la seguridad y la efectividad del tratamiento con losartán: efectos a largo plazo de losartán solo o en combinación sobre la uricemia / Pharmacovigilance study of the safety and effectiveness of losartan therapy: long-term effects of losartan alone or in combination on uricemia

Introducción: se evalúa la acción del tratamiento con losartán sobre la uricemia, en pacientes hipertensos en el medio comunitario. Material y método: estudio de farmacovigilancia, observacional, prospectivo, multicéntrico, no aleatorizado, abierto, de 1 año de seguimiento. Centros de atención primaria de Ávila, Burgos, León, Palencia, Salamanca, Valladolid y Zamora. Se incluyó a 275 pacientes de 67,5 años, con hipertensión arterial, no diabéticos y diabéticos (n = 19), a los que se trató con losartán, 50 mg/día. A las 8 semanas se aumentaba a 100 mg/día si era preciso. Si a las 24 semanas la presión arterial (PA) persistía elevada, se añadía hidroclorotiazida, 25 mg. Se procedió a la toma de sangre para uricemia, creatinina, electrolitos, glucemia, colesterol y triglicéridos al comienzo y a las 48 semanas de tratamiento. Resultados: la uricemia disminuyó significativamente en el grupo de pacientes tratados con losartán y losartán + tiazidas. El 30% de los pacientes recibió 50 mg de losartán, el 14%, 100 mg y el 56%, losartán + tiazida. La PA media ± desviación estándar varió desde 166 ± 29 mmHg de sistólica y 96 ± 19 mmHg, al comienzo del estudio, a 145 ± 23 mmHg de sistólica y 83 ± 18 mmHg de diastólica al finalizarlo. La creatinina, el sodio, el potasio, la glucemia, el colesterol y los triglicéridos no sufrieron deterioro durante el año de seguimiento. Conclusiones: el losartán es un fármaco seguro, con pocos efectos secundarios y que, tras 1 año de seguimiento, disminuye la uricemia sin deterioro del perfil lipídico, hidrocarbonato ni renal. Se postula como fármaco de primera elección en hipertensos mayores con hiperuricemia

Objectives: to evaluate the effect of losartan therapy on uricemia in patients with hypertension in the community setting. Design: observational, prospective, multicenter, nonrandomized, open-label pharmacovigilance study with a 1-year follow-up. Setting: primary care centers in Avila, Burgos, Leon, Palencia, Salamanca, Valladolid, and Zamora (Spain). Patients and method: two hundred seventy-five men and women (mean age 67.5 years), without diabetes (n = 256) and with diabetes (n = 19), treated with 50 mg/day of losartan were included. If high blood pressure (BP) (> 140/90 mmHg) was uncontrolled at 8 weeks, the dose was increased to 100 mg/day. If BP continued to be high at 24 weeks, hydrochlorothiazide (25 mg) was added. BP was measured after the patient had been sitting for 7 minutes with a mercury manometer and phase V Korotkoff's sound as the reference point. Blood samples were drawn for analysis of uricemia, creatinine, electrolytes, glycemia, cholesterol, and triglycerides at the beginning of the study and after 48 weeks' treatment. Results: uricemia significantly decreased in the group of patients treated with losartan and losartan + thiazides. Thirty percent of the patients received 50 mg of losartan, 14% received 100 mg and 56% received losartan + thiazide. Systolic BP was reduced from 166 (SD 29) mmHg at the beginning of the study to 145 (SD 23) at the end of the study. Diastolic BP was reduced from 96 (SD 19) mmHg to 83 (SD 18) mmHg. No negative effects on creatinine, sodium, potassium, glycemia, cholesterol or triglyceride values were found during the 1-year follow-up. Conclusions: losartan is a safe drug with few adverse effects. After a 1-year follow-up, it reduces uricemia without producing negative effects on lipid, carbohydrate or renal profiles. Therefore, it could be used as a first-line drug in elderly patients with hypertension and hyperuricemia

Inmunogenicidad y capacidad protectora en hamsters de vacunas antileptospirósicas monovalentes de células enteras del serogrupo Ballum / Immunogenicity and protective capacity of leptospiral whole-cell monovalent serogroup Ballum vaccines in hamsters

El serogrupo Ballum de Leptospira constituye en la actualidad la primera causa de leptospirosis humana en Cuba. Vacunas de células enteras químicamente inactivadas fueron formuladas a partir de dos cepas clínicas de Leptospira interrogans serogrupo Ballum empleando como adyuvante hidróxido de aluminio. Los niveles de aglutininas inducidos en hamsters por una u otra preparación vacunal fueron estimados mediante aglutinación microscópica y la actividad IgG específica fue cuantificada mediante ELISA. La capacidad de protección homóloga y heteróloga contra la infección letal y subletal se determinó mediante el desafío con 100 y 10 000 DL50 de cinco cepas virulentas pertenecientes a los serogrupos Ballum, Canicola, Icterohaemorrhagiae y Pomona. Las evaluaciones realizadas demostraron que ambas vacunas fueron inmunogénicas e indujeron una completa protección homóloga en el modelo animal empleado. La protección cruzada frente a serogrupos heterólogos solo fue significativa en una de las preparaciones monovalentes frente al desafío con 100 DL50 de Canicola. Como resultado de este estudio se pudo comprobar la alta inmunogenicidad y capacidad protectora en hamsters de vacunas monovalentes de células enteras formuladas a partir de dos cepas candidatas vacunales del serogrupo de Leptospira de mayor circulación en humanos en Cuba no incluido en la vacuna actualmente disponible.

Leptospira serogroup Ballum is at present the first cause of human leptospirosis in Cuba. Killed whole-cell vaccines were formulated with two clinical isolates of Leptospira interrogans serogroup Ballum using aluminum hydroxide as adjuvant. Agglutinins levels induced by each vaccine in hamsters were estimated by microscopic agglutination test and specific IgG activities were quantified by a whole cell-based enzyme-linked immunosorbent assay. Homologous and cross protective capacity against lethal and sublethal infection were determined in vaccinated animals by challenge with 100 and 10 000 LD50 of five virulent strains belonging to serogroups Ballum, Canicola, Icterohaemorrhagiae and Pomona. Both monovalent serogroup Ballum vaccines were immunogenic and induced complete homologous protection in the animal model. Cross-protection was only significant in one of the two vaccines against challenge with 100 LD50 of serogroup Canicola. The results of this study demonstrate the high immunogenicity and protective capacity in hamsters of whole-cell monovalent vaccines formulated with two vaccine candidate strains belonging to the most prevalent serogroup of Leptospira in Cuba.

Manejo de agua y sodio por el riñón senescente. Interpretación de una técnica de aclaramiento para su estudio funcional / Handling of water and sodium by the senescent kidney. Interpretation of a clearance technique for functional study

Los trastornos hidroelectrolíticos, particularmente las hiponatremias, son frecuentes en personas ancianas y, en general, achacadas a un síndrome de secreción inapropiada de hormona antidiurética. Si bien esto es lo más frecuente en adultos jóvenes, no es el caso en los ancianos, cuya causa más frecuente es una depleción real del sodio motivada por cierto grado de incompetencia de la parte gruesa de la rama ascendente del asa de Henle. La localización se hizo mediante una sobrecarga hiposalina y un estudio de aclaramientos utilizando la técnica de Chaimowitz, que describimos y comentamos en este trabajo

Hydroelectrolytic disorders, especially hyponatremias, are frequent in the elderly and are generally due to a syndrome of inappropriate antidiuretic hormone secretion. Although this is the most common cause in young adults, the most frequent cause in the elderly is Na depletion due to impaired competence of the thick ascending limb of Henle's loop. Localization was performed through hyposaline loading and clearance study using Chaimowitz's technique, which we describe and discuss in the present article

[Immunogenicity and protective capacity of leptospiral whole-cell monovalent serogroup Ballum vaccines in hamsters]. / Inmunogenicidad y capacidad protectora en hamsters de vacunas antileptospirósicas monovalentes de células enteras del serogrupo Ballum.

Leptospira serogroup Ballum is at present the first cause of human leptospirosis in Cuba. Killed whole-cell vaccines were formulated with two clinical isolates of Leptospira interrogans serogroup Ballum using aluminum hydroxide as adjuvant. Agglutinins levels induced by each vaccine in hamsters were estimated by microscopic agglutination test and specific IgG activities were quantified by a whole cell-based enzyme-linked immunosorbent assay. Homologous and cross protective capacity against lethal and sublethal infection were determined in vaccinated animals by challenge with 100 and 10,000 LD50 of five virulent strains belonging to serogroups Ballum, Canicola, Icterohaemorrhagiae and Pomona. Both monovalent serogroup Ballum vaccines were immunogenic and induced complete homologous protection in the animal model. Cross-protection was only significant in one of the two vaccines against challenge with 100 LD50 of serogroup Canicola. The results of this study demonstrate the high immunogenicity and protective capacity in hamsters of whole-cell monovalent vaccines formulated with two vaccine candidate strains belonging to the most prevalent serogroup of Leptospira in Cuba.

Inmunogenicidad y capacidad protectora en hamsters de vacunas antileptospirósicas monovalentes de células enteras del serogrupo Ballum. / [Immunogenicity and protective capacity of leptospiral whole-cell monovalent serogroup Ballum vaccines in hamsters]

Leptospira serogroup Ballum is at present the first cause of human leptospirosis in Cuba. Killed whole-cell vaccines were formulated with two clinical isolates of Leptospira interrogans serogroup Ballum using aluminum hydroxide as adjuvant. Agglutinins levels induced by each vaccine in hamsters were estimated by microscopic agglutination test and specific IgG activities were quantified by a whole cell-based enzyme-linked immunosorbent assay. Homologous and cross protective capacity against lethal and sublethal infection were determined in vaccinated animals by challenge with 100 and 10,000 LD50 of five virulent strains belonging to serogroups Ballum, Canicola, Icterohaemorrhagiae and Pomona. Both monovalent serogroup Ballum vaccines were immunogenic and induced complete homologous protection in the animal model. Cross-protection was only significant in one of the two vaccines against challenge with 100 LD50 of serogroup Canicola. The results of this study demonstrate the high immunogenicity and protective capacity in hamsters of whole-cell monovalent vaccines formulated with two vaccine candidate strains belonging to the most prevalent serogroup of Leptospira in Cuba.

Inmunodeficiencia común variable: descripción de un caso asociado a síndrome antifosfolípido / Variable common immunodeficiency: description of a case associated with antiphospholipid syndrome

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Effect of ham protein substitution on oxidative stress in older adults.

Mediterranean diet has been related to a low risk of coronary hearth disease. In the present study, we have evaluated the effect of substituting 120 g of meat by 120 g of acorn-fed Iberian ham (one of the meat components of the Mediterranean diet) on body weight, blood pressure (MAP), plasma lipids and oxidant-antioxidant equilibrium in 13 males and 8 females with an average age of 71. Study was performed in three periods: basal diet evaluations (BD1), ham diet for 6 weeks (HD), and basal diet again for 6 weeks (BD2). MAP significantly diminished from 96 mmHg in BD1 to 89 mmHg after HD. After BD2, MAP remained in the same value. Plasma total antioxidant substances increased from 0.791 mmol/L in BD1, to 1.525 in HD, and to 1.213 in BD2. Glutathione reductase significantly increased from 49.5 U/L in BD1 to 57 in HD and decreased to 49.2 in BD2. Glutathione peroxidase rose from 33 U/gHb in BD1 to 72 in HD and decreased to 52 in BD2. Superoxide dismutase increased from 401 U/gHb in BD1 to 723 in HD and decreased to 433 in BD2. Plasma thiobarbituric acid reacting substances (TBARS) fall from 1.65 mmol/l in BD1 to 1.38 in HD and to 1.47 in BD2. TBARS in erythrocyte membranes also diminished but only in BD2. It can be concluded that including acorn-fed Iberian ham in the diet increased the antioxidant substances and decrease lipid peroxidation, with its subsequent beneficial effects on the atherogenic risk factors.

Levofloxacino frente a betalactámicos en el tratamiento de la neumonía adquirida en la comunidad con ingreso hospitalario / Levofloxacin versus betalactamic therapy in commu nity-acquired pneumonia that requires hospitaliza tion

Objetivo: Comparar la eficacia y seguridad de levofloxacino frente al tratamiento estándar con betalactámicos en pacientes con Neumonía Adquirida en la Comunidad que cumplen criterios de ingreso hospitalario (NACH). Pacientes y métodos: Estudio prospectivo de un año de duración de 49 pacientes (ptes.) ingresados en el Servicio de Medicina Interna, diagnosticados de NACH con asignación aleatoria a recibir.- I: cefotaxima o ceftriaxona, II: amoxicilina-clavulánico, (las dos previas asociadas o no a un macrólido) o, III: levofloxacino. Se realizó Rx. tórax a los 7 -10 días, al mes y, posteriormente si era necesario. Resultados: 29 ptes. recibieron pauta estándar (I o II) y 20 ptes. levofloxacino. Eran varones el 84%, con edad media de 70,9 años, 57% con enfermedad de base moderada o grave, y 55% con criterios de gravedad inicial. En el 47% de los casos se llegó a diagnóstico etiológico, siendo en un tercio de los casos bacilos gramnegativos. Se produjo la curación en el 94% de los pacientes y éxitus en 2 pacientes (5%). No se observaron diferencias entre los dos grupos en las características demográficas, enfermedad de base ni gravedad inicial. No se detectaron diferencias en los efectos secundarios, complicaciones, estancia hospitalaria o porcentaje de curaciones. La necesidad de prolongar el tratamiento fue mayor en el grupo estándar que en el tratado con levofloxacino (52 vs 15%, p: 0,02). Conclusiones: En población mayor y con gravedad inicial el tratamiento con levofloxacino puede ser una alternativa válida al tratamiento estándar (AU)

Objective: To compare the effectiveness and security of levofloxacin treatment in front betalactamic therapy in patient with community-acquired pneumonia that require hospitalization (CAPH). Patient and methods: A prospective and randomized study along a year from 49 patients diagnosed of (CAPH) that were admitted in the Internal Medicine Service. The patients were assigned randomly to receive.- I: cefotaxime or ceftriaxone, II: amoxicillin/ clavulanate (both could be associated or not with a macrolide) or III: levofloxacin. It was accomplished Rx. thorax to 7 -10 days, to the month and, other reviews if was necessary. Results: 29 cases were in standard therapy (I or II) and 20 cases received levofloxacin therapy. Male 84 %, half age 70,9 years old, 57 % with moderate or severe underlying disease, and 55 % with approaches of initial severity criteria. In 47 % of the cases we arrived to etiologic diagnosis, in the third of the cases were BGN. The cure took place in 94 % of the patients and 2 patients died (5%). No differences were observed regarding demographic characteristics, underlying disease and severity. No differences were detected in: the secondary effects, complications, hospital stay or, mean stay or percentage of cures. The necessity to prolong the therapy was bigger in the standard group in front of the group tried with levofloxacin (52 % vs. 15 %, p:0.02). Conclusions: In bigger population and with initial severity the treatment with levofloxacin can be a valid alternative to the standard therapy (AU)

[Levofloxacin versus beta-lactamic therapy in community acquired pneumonia that requires hospitalization]. / Levofloxacino frente a betalactámicos en el tratamiento de la neumonía adquirida en la comunidad con ingreso hospitalario.

OBJECTIVE: To compare the effectiveness and security of levofloxacin treatment in front betalactamic therapy in patient with community-acquired pneumonia that require hospitalization (CAPH). PATIENT AND METHODS: A prospective and randomized study along a year from 49 patients diagnosed of (CAPH) that were admitted in the Internal Medicine Service. The patients were assigned randomly to receive.-I: cefotaxime or ceftriaxone, II: amoxicillin/clavulanate (both could be associated or not with a macrolide) or III: levofloxacin. It was accomplished Rx. thorax to 7-10 days, to the month and, other reviews if was necessary. RESULTS: 29 cases were in standard therapy (I or II) and 20 cases received levofloxacin therapy. Male 84%, half age 70.9 years old, 57% with moderate or severe underlying disease, and 55% with approaches of initial severity criteria. In 47% of the cases we arrived to etiologic diagnosis, in the third of the cases were BGN. The cure took place in 94% of the patients and 2 patients died (5%). No differences were observed regarding demographic characteristics, underlying disease and severity. No differences were detected in: the secondary effects, complications, hospital stay or, mean stay or percentage of cures. The necessity to prolong the therapy was bigger in the standard group in front of the group tried with levofloxacin (52% vs. 15%, p:0.02). CONCLUSIONS: In bigger population and with initial severity the treatment with levofloxacin can be a valid alternative to the standard therapy.

Mice immunization with gel electrophoresis-micropurified bacterial lipopolysaccharides.

Some evidence on the possible use of sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) to elicit antibodies against smooth- or rough-type bacterial lipopolysaccharides (LPS) is shown. Gel-separated LPS were negatively stained with zinc-imidazole to precisely localize the bands of interest under fully reversible conditions. Then the bands of interest were excised and the resulting gel slices washed in a solution of a zinc-complexing agent (e.g., 100 mM EDTA), after which they were extruded through a metal sieve of 32 microm average size contained in a 1 mL syringe, to generate homogeneous gel microparticles. The LPS-containing gel slurries were used directly to immunize female BALB/c mice. Using this procedure, positive mouse polyclonal antibody responses against gel-purified smooth- or rough-LPS forms from Escherichia coli K-235 or Bordetella pertussis were elicited, as tested by a dot-immunoblotting assay. Our results may encourage the use of SDS-PAGE-micropurified LPS to develop optimized immunization procedures for the generation of specific antibodies against LPS bands of defined sizes, and therefore they constitute an intermediate step toward that aim.

Effects of postnatal handling of rats on emotional, HPA-axis, and prolactin reactivity to novelty and conflict.

The present studies evaluated whether or not postnatal handling (PH) (administered during the first 21 days of life) could enduringly improve coping behavior with novel and/or conflict situations. To this purpose, different groups of naive male rats (control and PH-treated) were submitted in separate experiments to 1 of the 3 following situations: an emotional reactivity test (in 4-month-old animals), an open-field session followed by endocrine measurements (in 7-month-old animals) and a punished drinking test (in 11-month-old animals). PH effects were significant in the 3 situations: handled animals were less resistant to capture or to the handling manouvers involved in the emotional reactivity test: the hormonal responses (corticosterone, prolactin, and ACTH changes) during and after an open-field stress were less intense, and PH effects lasted up to 11 months in the punished drinking test, as measured by a higher number of punished responses and less time spent freezing by handled animals during the punished period. The results are discussed in relation to previous evidence showing a long-lasting reduction of fearfulness in rats due to postnatal handling.