Cardioembolic ischemic stroke associated with undertreated atrial fibrillation: an observational study / Accidente cerebrovascular isquémico cardioembólico asociado con fibrilación auricular no tratada: estudio observacional

Objectives: To describe the characteristics of patients and to determine the risk factors associated with second Emergency Department visits at 30 and 180 days in sick people admitted to the Emergency Department for cardioembolic stroke with a previous diagnosis of atrial fibrillation.Methods: Retrospective, observational study of adult patients admitted to the Emergency Department at our institution for cardioembolic stroke from January 1, 2019 to December 31, 2019. All study participants had a previous diagnosis of Atrial Fibrillation, CHADs2-VASc ≥2, and no contraindications for anticoagulants. The patients were retrospectively identified through a database search. A univariate analysis was performed to assess variables potentially associated with readmission (any cause) at 30 and 180 days. All variables with a p<0.2 were included in a multivariate analysis.Results: During the study period, 547 patients presented to the ED with ischemic stroke and 113 (20.6%) met the study inclusion criteria. Of these, 53 patients (46.9%) did not receive anticoagulant therapy before the stroke and 28 (24.7%) were taking doses lower than recommended in the technical data sheet. The pharmacological stroke prevention strategy was modified in 44 patients (38.9%) at discharge. On the multivariate analysis, diabetes was the only risk factor significantly associated with early readmission to the ED.Conclusions: Most patients (71.6%) with a previous diagnosis of AF who presented to the emergency department for cardioembolic stroke had not received optimal anticoagulant preventive treatment before the event. Diabetes was the only risk factor associated with early readmission to the Emergency Department. (AU)

Objetivos: Describir las características de los pacientes y determinar los factores de riesgo asociados a las segundas visitas al Servicio de Urgencias a los 30 y 180 días en los enfermos ingresados en el Servicio de Urgencias por ictus isquémico cardioembólico con diagnóstico previo de fibrilación auricular.Métodos: Estudio retrospectivo y observacional de pacientes adultos ingresados en el Servicio de Urgencias del Hospital de la Santa Creu i Sant Pau (HSP) por un ictus cardioembólico desde el 1 de enero de 2019 hasta el 31 de diciembre de 2019. Todos los participantes en el estudio tenían un diagnóstico previo de fibrilación auricular, CHADs2-VASc ≥2, y no tenían contraindicaciones para los anticoagulantes. Los pacientes fueron identificados retrospectivamente mediante una búsqueda en una base de datos del hospital. Se realizó un análisis univariante para evaluar las variables potencialmente asociadas al reingreso (cualquier causa) a los 30 y 180 días. Todas las variables con una p <0,2 se incluyeron en un análisis multivariante.Resultados: Durante el periodo de estudio, 547 pacientes acudieron a urgencias con ictus isquémico y 113 (20,6%) cumplieron los criterios de inclusión del estudio. De ellos, 53 pacientes (46,9%) no recibían tratamiento anticoagulante antes del ictus y 28 (24,7%) tomaban dosis inferiores a las recomendadas en la ficha técnica. La estrategia de prevención farmacológica del ictus se modificó en 44 pacientes (38,9%) al alta. En el análisis multivariante, la diabetes fue el único factor de riesgo que se asoció significativamente con el reingreso temprano en urgencias.Conclusiones: La mayoría de los pacientes (71,6%) con diagnóstico previo de FA que acudieron a urgencias por ictus cardioembólico no habían recibido un tratamiento preventivo anticoagulante óptimo antes del evento. La diabetes fue el único factor de riesgo asociado al reingreso temprano en el servicio de urgencias. (AU)

Environmental status of marine plastic pollution in Spain.

The excessive use of plastic in our society is causing a massive accumulation, since it is a non-biodegradable product and with still poor recycling rates. This effect can be observed in the seas, which more and more plastic waste are accumulating. The present work is a critical review, based on all currently available literature, that reports environmental status of marine plastic pollution, especially microplastic pollution, in Spain. The three Spanish water areas with the highest presence of plastics are the Alboran Sea, the Gulf of Alicante and the vicinity of Barcelona probably related to fishing and industrial activities and high population densities. With regard to microplastic contamination on beaches in Spain, annual monitoring by the Spanish government shows contamination along the entire coast of the country, with particularly high concentrations in the Canary Islands (between 800 and 8800 particles/m2 in spring). Between 40 and 50% of the particles analyzed were pellets and the main factors postulated for the distribution of these particles are marine currents and the geomorphological characteristics. With regards to biota, ingestion of microplastics by fish has been intensely confirmed and, important differences were observed between the locations of the sampling, being bogues (Boops boops) one of the fish species more studied in Spain. Finally, the work includes a revision of European and Spanish legislation about plastics and marine pollution and some strategies to reduce this kind of contamination in Spain.

The potential of microplastics as carriers of metals.

Microplastics can adsorb chemical pollutants such as metals or pharmaceuticals, and transferred them along the food chain. In this work, an investigation of the adsorption of Cd, Co, Cr, Cu, Ni, Pb and Zn by five different types of microplastics was performed in Milli-Q water and natural waters (seawater, urban wastewater and irrigation water) via a series of batch adsorption experiments. The effects of concentration of metals and physicochemical characteristics of polymers were particularly studied. Results revealed a significant adsorption of lead, chromium and zinc on microplastics, especially on polyethylene and polyvinyl chloride. In the case of polyethylene terephthalate, it showed little adsorption capacity. Specific surface, porosity and morphology are characteristics that affect the molecular interactions. The adsorption isotherms were better described by Langmuir model, which indicates that the main adsorption mechanism might be chemical adsorption. Finally, results obtained in natural waters indicated that dissolved organic matter may play a major role on metal adsorption on microplastics. Results showed an enhancement of metal adsorption in waters with high chemical and biological oxygen demands as urban wastewater and irrigation water.

Kinetic study of thermal degradation of olive cake based on a scheme of fractionation and its behavior impregnated of metals.

This research aims to provide a better knowledge of the thermal decomposition of the olive cake as well as this lignocellulosic material loaded, in a previous stage of biosorption, with heavy metals for its use in processes of energy recovery. Firstly, isolation of constituents of the olive cake was carried out. Then, experiments were performed by thermogravimetric analysis (TGA) and differential thermogravimetry (DTG) under inert and oxidative atmosphere at a heating rate of 15 K/min for each isolated fraction. Next, adequate reactions schemes were proposed to find kinetic parameters. Validation of these schemes were verified by the goodness of fitting between experimental and simulated data. Also, some important combustion characteristics such as ignition and burnout temperatures were determined. With regard to the effect of metals, cadmium, copper, chromium, nickel and lead present in metal-loaded olive cake did not modify values of kinetic parameters which described the thermal decomposition processes.

Escoliosis idiopática / Idiopathic scoliosis

La escoliosis idiopática es motivo de consulta tanto en Atención Primaria como en Atención Especializada, por las connotaciones que supone el tratamiento tanto ortopédico como quirúrgico. Se define como la deformidad de la columna vertebral en el plano anteroposterior superior a 10º. Tiene una prevalencia aproximada del 2%. Los estudios más recientes hablan a favor de una predisposición genética en el desarrollo de las curvas. Los cribados para su diagnóstico se han demostrado caros e ineficaces. El adecuado conocimiento de una exploración básica y de la historia natural de la enfermedad evita la exposición radiológica excesiva. La escoliosis idiopática más frecuente es la del adolescente, por lo que hay que prestar especial atención en la exploración a los niños de 10-11 años. El tratamiento está muy estandarizado, teniendo en cuenta el tipo y la magnitud de la curva, el sexo y el estado madurativo del paciente. La indicación del corsé es para las curvas inmaduras de 25 a 45º y la cirugía para las que superen los 45º. Los actuales sistemas de instrumentación hacen innecesario esperar a la edad madura para realizar la cirugía (AU)

Idiopathic scoliosis is a reason for consultation in both Primary Care and in Specialized Care because of the connotations that implies both orthopaedic and surgical treatment. It is defined as the coronal plane deformity greater than 10 degrees. It has a prevalence of approximately 2%. The most recent studies speak in favour of a genetic predisposition in the development of the curves. The scoliosis screening programs for diagnosis have proved expensive and ineffective. An adequate knowledge of basic exploration and natural history of the disease prevents excessive radiation exposure to children. Idiopathic scoliosis is most common in the adolescent. We need to pay special attention to the exploration of children aged 10-11. The treatment is very standardized, taking into account the type and magnitude of the curve, sex and skeletal maturity of the patient. Given these factors, an indication of the back brace is for immature curves 25 to 45 º and surgery for curves that exceed 45 degrees. Current instrumentation systems allow surgery before skeletal maturity (AU)

La bacteriemia asociada al catéter venoso central: implementación de un nuevo protocolo de consenso / Catheter-associated bloodstream infections: Implementation of a new consensus protocol

Introducción: La bacteriemia asociada al catéter venoso central (BA-CVC) es altamente prevalente y a menudo está asociada a complicaciones fatales. Algunos estudios han demostrado que la aplicación de intervenciones preventivas podría ayudar a reducir y a controlar este tipo de infección. Objetivos: Determinar si la puesta en marcha de un nuevo protocolo de consenso sobre la manipulación y el mantenimiento del catéter venoso central (CVC) puede reducir la BA-CVC en pacientes pediátricos. Evaluar su cumplimiento en las unidades de cuidados intensivos (UCI). Método: Estudio prospectivo en las UCI pediátricos (UCIP) y neonatales (UCIN), hematología, oncología y plantas de hospitalización de un hospital materno-infantil de tercer nivel de Barcelona. El estudio se divide en 2 períodos: antes (primer semestre) y después (segundo semestre) de la puesta en marcha del nuevo protocolo en el año 2007. Los cambios más relevantes han sido colocar una conexión hermética en la parte proximal y distal (entre la línea y la jeringa) del catéter, y etiquetar la línea de medicación y el apósito con la fecha de colocación del catéter. Evaluación del cumplimiento mediante check-list en las UCIP y en las UCIN en el segundo período del estudio. Cálculo de la tasa de bacteriemia por 1.000 catéteres al día. Resultados: Las tasas de bacteriemia por 1.000 catéteres al día antes y después de la puesta en marcha del nuevo protocolo han sido de 5,7 y 4,9 en la UCIP; de 24,6 y 18,0 en la UCIN; de 7,6 y 4,6 en hematología y oncología, y de 11,9 y 10,3 y en plantas de hospitalización. En relación con el cumplimiento del protocolo, en más del 95% de los casos la conexión hermética proximal estaba colocada y formaba parte del CVC, y hasta en el 85% de los casos el catéter estaba etiquetado con la fecha de colocación en las 2 UCI. Conclusiones: Un protocolo consensuado de manipulación y de mantenimiento del CVC y la formación del personal sanitario permiten controlar la BA-CVC en unidades de alto riesgo. Se ratifica la importancia de la vigilancia epidemiológica como medida de control de la infección nosocomial (AU)

Introduction: Catheter-associated bloodstream infection is highly prevalent and often associated with fatal complications. Some studies have shown that applying preventive interventions could help to reduce and control this type of infection. Objective: To determine whether a new consensus protocol for the manipulation and maintenance of central venous catheters would decrease catheter-associated bloodstream infections (CA-BSIs) in paediatric patients. To evaluate its compliance in intensive care units. Method: Prospective study in the paediatric (PICU) and neonatal (NICU) intensive cares units, haematology, oncology and hospital wards in a Maternal and Paediatric reference Hospital in Barcelona. The study period is divided into two periods: before (first semester) and after the start of the new protocol (second semester) in 2007. The most important changes have been the insertion of the hermetic connection in the proximal and distal site (between the line and the syringe) of the central venous catheter (CVC), the labelling of the medication line and the CVC with the date of placement. A check-list to evaluate compliance was introduced in both intensive care units (paediatrics and neonatal) during the second study period. The rates of bloodstream infection per 1000 catheter-days were assessed. Results: The rate of bloodstream infections per 1000 catheter-days before and after the start of the new protocol was 5.7 and 4.9 in PICU; 24.6 and 18.0 in NICU; 7.6 and 4.6 in haematology-oncology, and 11.9 and 10.3 in hospital wards. As regards compliance to the protocol, we found that proximal sealed connectors were used in more than 95% of the cases and up to 85% of the central venous catheter were labelled with the insertion date in both intensive care units. Conclusions: A consensus protocol for the use and maintenance of central venous catheters and healthcare worker training helped to control the rate of CA-BSIs. We reaffirm the importance of epidemiological surveillance as a measure for controlling nosocomial infections (AU)

[Catheter-associated bloodstream infections: implementation of a new consensus protocol]. / La bacteriemia asociada al catéter venoso central: implementación de un nuevo protocolo de consenso.

INTRODUCTION: Catheter-associated bloodstream infection is highly prevalent and often associated with fatal complications. Some studies have shown that applying preventive interventions could help to reduce and control this type of infection. OBJECTIVE: To determine whether a new consensus protocol for the manipulation and maintenance of central venous catheters would decrease catheter-associated bloodstream infections (CA-BSIs) in paediatric patients. To evaluate its compliance in intensive care units. METHOD: Prospective study in the paediatric (PICU) and neonatal (NICU) intensive cares units, haematology, oncology and hospital wards in a Maternal and Paediatric reference Hospital in Barcelona. The study period is divided into two periods: before (first semester) and after the start of the new protocol (second semester) in 2007. The most important changes have been the insertion of the hermetic connection in the proximal and distal site (between the line and the syringe) of the central venous catheter (CVC), the labelling of the medication line and the CVC with the date of placement. A check-list to evaluate compliance was introduced in both intensive care units (paediatrics and neonatal) during the second study period. The rates of bloodstream infection per 1000 catheter-days were assessed. RESULTS: The rate of bloodstream infections per 1000 catheter-days before and after the start of the new protocol was 5.7 and 4.9 in PICU; 24.6 and 18.0 in NICU; 7.6 and 4.6 in haematology-oncology, and 11.9 and 10.3 in hospital wards. As regards compliance to the protocol, we found that proximal sealed connectors were used in more than 95% of the cases and up to 85% of the central venous catheter were labelled with the insertion date in both intensive care units. CONCLUSIONS: A consensus protocol for the use and maintenance of central venous catheters and healthcare worker training helped to control the rate of CA-BSIs. We reaffirm the importance of epidemiological surveillance as a measure for controlling nosocomial infections.

[Cognitive evoked potentials in uncomplicated hypertensive patients]. / Potenciales evocados cognitivos en pacientes con hipertensión arterial no complicada.

INTRODUCTION: One of the most frequent complications of vascular encephalopathies is the onset of cognitive disorders that lead the patient to a progressive decay of his abilities and useful life. Being high blood pressure (HBP) one of the most important causes of brain vascular disorders, we studied some aspects of cognition in HBP patients without neurological manifestations and with normal scores in Mini Mental State Examination. PATIENTS AND METHODS: There were studied 84 uncomplicated hypertensive patients, with a normal neurological physical examination and a group of 35 functionally healthy subjects. The patients were divided into three groups: slight high blood pressure (SLHBP, n = 24 age, 49 +/- 4) with diastolic blood pressure (DBP) between 90 and 100 mmHg, moderate high blood pressure (MHBP, n = 40, age 51 +/- 6) with DBP between 101 and 114 mmHg, and severe high blood pressure (SHBP, n = 20, age 49 +/- 8) with DBP of 115 mmHg or higher. All subjects underwent visual and auditory P300 evoked potentials. RESULTS: Visual and auditory P300 wave showed global latency delay, and amplitude decrease and absence of response in different leads, especially in frontal regions, higher in SHBP patients. This absence of response was more evident in auditory P300 in all patient groups. CONCLUSION: It is remarkable that neurologically asymptomatic HBP patients have P300 alterations with regional focalization, possibly due to a functional disorder related to hemodynamic changes in the central nervous system.

Potenciales evocados cognitivos en pacientes con hipertensión arterial no complicada / Cognitive evoked potentials in uncomplicated hypertensive patients

Introducción. Una de las complicaciones más frecuentes de las encefalopatías vasculares es la aparición de trastornos cognitivos que llevan al paciente a un progresivo deterioro de sus capacidades y vida útil. La hipertensión arterial (HTA) es una de las causas más frecuentes de alteraciones vasculares cerebrales, por lo que estudiamos las características de la onda P300 en etapas de la HTA en las que no había alteraciones clínicas neurológicas y con resultados normales en el Mini Mental State Examination. Pacientes y métodos. Se estudiaron 84 pacientes hipertensos sin complicaciones, con examen físico neurológico normal, y un grupo de 35 sujetos funcionalmente sanos. Los pacientes se clasificaron en hipertensión arterial ligera (HTAL, n 24, edad 49 4), con una tensión arterial diastólica (TAD) entre 90 y 100 mmHg, hipertensión arterial moderada (HTAM, n 40, edad 51 6), con TAD entre 101 y 114 mmHg; hipertensión arterial grave (HTAG, n 20, edad 49 8), con TAD igual o mayor a 115 mmHg. A todos los sujetos se les registraron los potenciales evocados cognitivos P300 visuales y auditivos. Resultados. La onda P300 (visual y auditiva) presentó retraso de latencia y disminución de amplitud de forma global, y ausencia de respuesta en diferentes derivaciones con predominio frontal, mayor en pacientes con HTAG. Esta ausencia de repuesta fue más notable para la P300 auditiva en todos los grupos de pacientes. Conclusión. Se aprecia que los pacientes hipertensos neurológicamente asintomáticos presentan alteraciones en la P300 con focalización regional, posiblemente por un trastorno funcional desarrollado en relación con cambios hemodinámicos en el sistema nervioso central

Introduction. One of the most frequent complications of vascular encephalopathies is the onset of cognitive disorders that lead the patient to a progressive decay of his abilities and useful life. Being high blood pressure (HBP) one of the most important causes of brain vascular disorders, we studied some aspects of cognition in HBP patients without neurological manifestations and with normal scores in Mini Mental State Examination. Patients and methods. There were studied 84 uncomplicated hypertensive patients, with a normal neurological physical examination and a group of 35 functionally healthy subjects. The patients were divided into three groups: slight high blood pressure (SLHBP, n = 24 age, 49 ± 4) with diastolic blood pressure (DBP) between 90 and 100 mmHg, moderate high blood pressure (MHBP, n = 40, age 51 ± 6) with DBP between 101 and 114 mmHg, and severe high blood pressure (SHBP, n = 20, age 49 ± 8) with DBP of 115 mmHg or higher. All subjects underwent visual and auditory P300 evoked potentials. Results. Visual and auditory P300 wave showed global latency delay, and amplitude decrease and absence of response in different leads, especially in frontal regions, higher in SHBP patients. This absence of response was more evident in auditory P300 in all patient groups. Conclusion. It is remarkable that neurologically asymptomatic HBP patients have P300 alterations with regional focalization, possibly due to a functional disorder related to hemodynamic changes in the central nervous system

Pan-African polyspecific antivenom produced by caprylic acid purification of horse IgG: an alternative to the antivenom crisis in Africa.

A polyspecific Pan-African antivenom has been produced from the plasma of horses immunized with a mixture of the venoms of Echis ocellatus, Bitis arietans and Naja nigricollis, the three most medically important snakes in sub-Saharan Africa. The antivenom is a whole IgG preparation, obtained by caprylic acid precipitation of non-IgG plasma proteins. The antivenom effectively neutralizes the most important toxic activities of the three venoms used in the immunization in standard assays involving preincubation of venom and antivenom before testing. This antivenom compares favourably with other antivenoms designed for use in Africa with respect to neutralization of the toxins present in the venom of E. ocellatus. Caprylic acid fractionation of horse hyperimmune plasma is a simple, convenient and cheap protocol for the manufacture of high quality whole IgG antivenoms. It constitutes a potentially valuable technology for the alleviation of the critical shortage of antivenom in Africa.

[Early functional disorders of the brain in uncomplicated hypertensive patients]. / Alteraciones funcionales cerebrales tempranas en pacientes con hipertensión arterial no complicada.

OBJECTIVE: To detect the presence of changes in brain electrical activity that might be used as early markers in patients with risk factors for developing vascular encephalopathy. PATIENTS AND METHODS: There were studied 84 uncomplicated hypertensive patients, with a normal neurological physical examination and mean age of 49 years compared to 35 functionally healthy subjects. The patients were divided into three groups: slight high blood pressure (SLHBP, n = 24) with diastolic blood pressure (DBP) between 90 and 100 mmHg, moderate high blood pressure (MHBP, n = 40) with DBP between 101 and 114 mmHg, and severe high blood pressure (SHBP, n = 20) with TAD of 115 mmHg or higher. All subjects underwent digital electroencephalogram (dEEG) with quantitative analysis (QEEG). RESULTS: The patients showed focal, especially frontal paroxysms, and diffuse polymorphic theta activity in these areas, mainly those with SLHBP. Posterior alpha rhythm disorganization, inter-hemispheric asymmetries and frontal monomorphic activity were more often found in SHBP patients. In QEEG was observed an increase in absolute and relative power of slow activities, and a decrease in power of alpha and beta activities. All these findings were more frequent in the left hemisphere. CONCLUSION: The hemodynamic characteristics of the Central Nervous System and the changes caused by HBP alter the functional organization of the brain cortex, especially in frontal and midline regions, irrigated by the anterior cerebral artery.

Alteraciones funcionales cerebrales tempranas en pacientes con hipertensión arterial no complicada / Early functional disorders of the brain in uncomplicated hypertensive patients

Objetivo. Detectar la presencia de cambios en la actividad eléctrica cerebral que puedan utilizarse como marcadores biológicos tempranos en pacientes con factores de riesgo para desarrollar encefalopatías vasculares. Pacientes y métodos. Se estudiaron 84 pacientes hipertensos sin complicaciones, con examen físico neurológico normal, y una edad media de 49 años, y un grupo de 35 sujetos funcionalmente sanos. Los pacientes se clasificaron en hipertensión arterial ligera (HTAL, n 24), con una tensión arterial diastólica (TAD) entre 90 y 100 mmHg; hipertensión arterial moderada (HTAM, n 40), con TAD entre 101 y 114 mmHg, e hipertensión arterial grave (HTAG, n 20), con TAD igual o mayor a 115 mmHg. A todos los sujetos se les realizó un electroencefalograma digital (EEGd) con análisis cuantitativo (QEEG). Resultados. Los pacientes presentaron paroxismos focales predominantemente frontales y actividad θ polimorfa difusa en esas áreas, principalmente los que tenían HTAL. La desorganización del ritmo posterior, las asimetrías interhemisféricas y la actividad θ monomorfa frontal fue mayor en los pacientes con HTAG. En el QEEG predominó el incremento de energía absoluta y relativa de la actividad lenta y la disminución de la energía de las actividades θy . Las alteraciones fueron más frecuentes en el hemisferio izquierdo. Conclusión. Las características hemodinámicas propias del sistema nervioso central y los cambios producidos por la HTA alteran la organización funcional de la corteza cerebral, principalmente en las regiones frontales y la línea media lo que corresponde a las áreas de irrigación de la arteria cerebral anterior

Objective. To detect the presence of changes in brain electrical activity that might be used as early markers in patients with risk factors for developing vascular encephalopathy. Patients and methods. There were studied 84 uncomplicated hypertensive patients, with a normal neurological physical examination and mean age of 49 years compared to 35 functionally healthy subjects. The patients were divided into three groups: slight high blood pressure (SLHBP, n = 24) with diastolic blood pressure (DBP) between 90 and 100 mmHg, moderate high blood pressure (MHBP, n = 40) with DBP between 101 and 114 mmHg, and severe high blood pressure (SHBP, n = 20) with TAD of 115 mmHg or higher. All subjects underwent digital electroencephalogram (dEEG) with quantitative analysis (QEEG). Results. The patients showed focal, especially frontal paroxysms, and diffuse polymorphic theta activity in these areas, mainly those with SLHBP. Posterior alpha rhythm disorganization, inter-hemispheric asymmetries and frontal monomorphic activity were more often found in SHBP patients. In QEEG was observed an increase in absolute and relative power of slow activities, and a decrease in power of alpha and beta activities. All these findings were more frequent in the left hemisphere. Conclusion. The hemodynamic characteristics of the Central Nervous System and the changes caused by HBP alter the functional organization of the brain cortex, especially in frontal and midline regions, irrigated by the anterior cerebral artery

Opioid availability in Latin America: the Santo Domingo report progress since the Declaration of Florianopolis.

The World Health Organization (WHO) has indicated that opioid analgesics are insufficiently available, particularly in developing countries, due to a variety of reasons, including legislative, educational, and policy issues. In its effort to promote the rational use of medical opioids and the adequate treatment of patients with cancer, WHO has sponsored a meeting of Latin American representatives every 2 years, which includes health professionals and government regulators. During March 24-27, 1996, a group of 86 representatives of cancer pain relief and palliative care programs from nine Latin American countries met in Santo Domingo under the auspices of the WHO Palliative Care Program for Latin America. For the first time since the First Latin American Meeting, government regulators were present to help address the issue of opioid availability from their perspective. During the meeting, issues pertaining to cancer pain, opioid availability, and palliative care were discussed. This report summarizes some of the events and presents a summary of the conclusions of an earlier meeting in 1994, as described in the Declaration of Florianopolis, and presents its follow-up, The Santo Domingo Report, generated following the 1996 meeting.

Pupal and larval cuticle proteins of Drosophila melanogaster.

Proteins, soluble in 7 M urea, were extracted from third-instar larval and pupal cuticles of Drosophila melanogaster. Both extracts contain a limited number of polypeptides resolved by one- or two-dimensional electrophoresis. The five major larval proteins have low molecular weights (less than 20000) and are not glycosylated. The major pupal cuticle proteins fall into two size classes: two with apparent molecular weights of 56K and 82K and four with molecular weights between 15K and 25K. The proteins with high apparent molecular weights are glycosylated. In nondenaturing gels, no components of the larval and pupal cuticle extracts comigrate. One-dimensional "fingerprints" indicate that cuticle proteins from these two stages have unique primary structures. Immunological results indicate that the major low molecular weight larval and pupal cuticle proteins are comprised of two families of proteins that share antigenic determinants. The high molecular weight pupal cuticle proteins are immunologically unrelated to the low molecular weight components. We conclude that the pupal and larval proteins are encoded in part by multigene families that have arisen by gene duplication and evolutionary divergence.

[Corneal distrophy of Groenouw type I and chromosomic delection (22p-) in one family (author's transl)]. / Distrofia corneal Groenouw tipo I y alteración cromosómica estructural (22p-) en una familia.

Authors report a family in which three members presented a type I Corneal Distrophy of Groenouw; two of them also presented a delection of short arms of a 22 chromosome, while the third presented the delection but not the corneal distrophy. The absence of relationship between the corneal distrophy and the 22 delection in this family proves that the latter is a familial marker, not being the cause of the disease.