Development of a semi-structured questionnaire to analyse supply chain resilience in the post-COVID business era.

The COVID-19 pandemic has had and is having devastating effects on the health of the population, but also on the economic health of companies and their supply chains. The old paradigms of the commercial and industrial world have been inevitably disrupted: global supply chains have shifted from a system based on efficiency to one oriented towards resilience. To this regard, the present research paper aims at investigating how Supply Chain Resilience will evolve in the new paradigms of the post-COVID business era. In order to contribute to this investigation, a semi-structured questionnaire is developed, through a structured research approach. Future research lines will be based on conducting this questionnaire as a basis for a targeted survey, analysable through association rules.

¿Melanoma lentiginoso acral: metastásico,simultáneo, persistente? / Persistent, simultaneous, metastasic, acral lentiginous melanoma?

El melanoma lentiginoso acral (MLA) supone un 5% de todos los melanomas malignos, y presenta una frecuencia de metástasis loco-regionales mayoral resto de subtipos de melanoma. En la práctica clínica habitual observamos que existe un porcentaje significativo de casos de MLA que presentan recurrencias locales en zonas de piel aparentemente sanas, incluso después de haber realizado una extirpación con márgenes de seguridad adecuados, como en el caso clínico que presentamos. Esto podría estar generado por la presencia del denominado “campo de células de melanoma”, definido recientemente por Bastian (AU)

Acral lentiginous melanoma (MLA) represents 5% of all malignant melanomas, and has a frequency of loco-regional metastases greater than other subtypes of melanoma. In clinical practice we observed that a significant percentage of cases of MLA that recurrences in apparently healthy areas of skin, even after making excision with adequate safety margins, as in a case that we present. This could be generated by the presence of so-called“ melanoma field cells” recently defined by Bastian (AU)

Algunas considaraciones sobre la inserción de la máscara laríngea prose en decúbito prono / No disponible

No disponible

Studies on the safety and immunogenicity of the South African bluetongue virus serotype 2 monovalent vaccine: specific detection of the vaccine strain genome by RT-PCR.

In order to study the safety and the immunogenicity of the South African vaccine against the serotype 2 bluetongue virus, two groups of seven sheep were vaccinated with the vaccine used in the French island of Corsica. Vaccinated and non-vaccinated sheep were observed clinically and their rectal temperatures were recorded daily. The serological response in vaccinated animals confirmed the immunogenicity of the vaccine. Post-vaccinal viraemia was investigated and the vaccine genome was detected by reverse transcription polymerase chain reaction (RT-PCR). No viraemia was observed at post-vaccination days 4, 7 and 11 but the vaccine strain of virus was detected by RT-PCR throughout the experiment. The thermostability of the vaccine was also evaluated. The vaccine titre strongly decreased at temperatures higher than 35 degrees C.

Inoculation of lactating ewes by the intramammary route with Mycoplasma agalactiae: comparative pathogenicity of six field strains.

Contagious agalactia affects goats and sheep. In most infected sheep, the causal agent, Mycoplasma agalactiae, induces mastitis and/or agalactia, keratoconjunctivitis and arthritis. However, a few strains of M. agalactiae were isolated from tank milk from flocks without any clinical signs. The present study was undertaken to compare these apparently "asymptomatic" strains to classical virulent strains in order to assess the pathogenicity of four "asymptomatic" strains. Six groups of lactating ewes were inoculated by the intramammary route with 10(8) viable mycoplasmas of each strain. The clinical signs were regularly evaluated; the excretion of bacteria in milk and the serological response were measured. Ewes were necropsied 7 weeks after inoculation and the level of infection in retromammary lymph nodes was determined. Among the 4 apparently "asymptomatic" strains, 2 were fully virulent as were the strains isolated from discased animals, and the other 2 induced somewhat less severe clinical symptoms. The other parameters, in particular the level of excretion in milk and the level of infection of regional lymph nodes following necropsy were similar for all strains. Mean antibody response was also comparable between the apparently "asymptomatic" and virulent strains, in spite of great individual variability. This observation shows that flocks without any clinical sign from which M. agalactiae is isolated in bulk milk, must be kept under strict control since mycoplasmas may induce severe outbreaks later with changing conditions of breeding.

Pulsed-field gel electrophoresis is more efficient than ribotyping and random amplified polymorphic DNA analysis in discrimination of Pasteurella haemolytica strains.

One hundred thirty-three strains of Pasteurella haemolytica of both biotypes (90 and 43 strains of biotypes A and T, respectively) and almost all the serotypes were subjected to ribotyping, random amplified polymorphic DNA (RAPD) analysis, and pulsed-field gel electrophoresis (PFGE) analysis for epidemiological purposes. A total of 15 patterns recorded as ribotypes HA to HO were found for the P. haemolytica biotype A strains, with ribotypes HA, HC, and HD being encountered most often (66 strains [74%]); and 20 ribotypes, designated HA' to HT', that were clearly distinct from those observed for biotype A strains were observed for strains of biotype T. RAPD analysis generated a total of 44 (designated Rp1 to Rp44) and 15 (designated Rp1' to Rp 15') unique RAPD patterns for biogroup A and biogroup T, respectively. Analysis of the data indicated that a given combined ribotype-RAPD pattern could be observed for biotype A strains of different serotypes, whatever the zoological or geographic origin, whereas this was not the case for biotype T strains. PFGE appeared to be more efficient in strain discrimination since selected strains from various zoological or geographical origins harboring the same ribotype-RAPD group were further separated into unique entities.

[Papillary transitional cell carcinoma of the frontal sinus]. / Carcinoma papilar de células transicionales del seno frontal.

INTRODUCTION: A case is reported of primary transitional-cell carcinoma in the frontal sinus of a 54-year-old woman, which was interesting because of the histological type, evolution, and difficulty of follow-up. CLINICAL CASE: A 54-year-old woman with no history of exposure to risk factors presented swelling of the frontal area of 3 months duration. Fine needle aspiration biopsy revealed an adenoma but TAC showed an intrasinusal tumor with destruction of the inner and outer walls. Surgical exeresis revealed the correct histological diagnosis. Local recurrence at 12 months, without cervical lymph nodes or distant metastases, was treated surgically and the patient remained asymptomatic and disease-free 24 months later. DISCUSSION: Malignant tumors of the frontal sinus are rare in the literature. We describe the histological features of transitional-cell tumor and emphasize its similarity with papilloma, benign behavior and management options, in which surgery is of choice. Prognostic and survival factors in the literature are reviewed.

Salmonella abortusovis, strain Rv6, a new vaccinal vehicle for small ruminants.

Salmonella abortusovis strain Rv6 (Sao Rv6) is a live attenuated vaccine used for a few years to protect ewes against abortive salmonellosis. As Salmonellae, particularly Salmonella aro mutants, have considerable potential as vehicles for the presentation of heterologous vaccine antigens, Sao Rv6 was tested in order to develop a vaccinal vehicle for small ruminants. Five vector plasmids were tested in Sao Rv6; these plasmids, which carry Maltose Binding Protein (MBP) expressed as protein, but differ in their promotors, had been previously tested in S. typhimurium strain SL3261, and were transferred into Sao Rv6. The five plasmids were stable in vitro, and the recombinant Sao Rv6 expressed MBP at various levels. Intraperitoneal infection of OF1 mice with the recombinant bacteria did not modify the characteristics of Sao Rv6; dissemination and infection levels were similar in all groups and all mice developed antibodies to Salmonella antigens as measured by ELISA. In contrast, only animals immunized with Sao Rv6 carrying the pNTE plasmid developed a serum antibody response to MBP. This plasmid was then tested in sheep; following subcutaneous immunization with Sao Rv6-pNTE, dissemination and infection levels were not modified in comparison with sheep immunized with Sao Rv6 lacking plasmid. Antibodies specific to MBP were detected in sera of sheep immunized with Sao Rv6-pNTE, purified MBP, and with S. typhimurium SL3261-pNTE as positive controls. These results demonstrate that Sao Rv6 can be used as a vehicle for heterologous antigens in sheep with pNTE as plasmid vector.

[Validity of the protocol for evaluating the inappropriate use of hospitalization]. / Validez del protocolo de evaluación del uso inapropiado de la hospitalización.

BACKGROUND: The study was carried out in order to assess the inter-observer reliability and validity in respect of clinical appraisal given by the Appropriateness Evaluation Protocol (AEP), in the context of the Spanish Public Hospital System. MATERIAL AND METHOD: In order to assess the reliability a total of 614 hospital stays chosen at random from 56 hospital admissions were independently analysed by three reviewers (two doctors and one nurse). In order to assess the validity, the findings obtained by the nurse were compared with the majority opinion given by the 7 hospital specialists in respect of each of hospital stays under evaluation. As part of the analytical procedure, indices for observed agreement, and specific agreement were calculated, as well as the Kappa statistic, all forming of various random samples of 614 hospital stays. In order to assess the predictive validity of the AEP, its sensitivity, specificity and predictive values were all measured against the majority clinical judgement. RESULTS: The study exhibited a high degree of inter-observer reliability (specific agreement > 64%, kappa > 0.75) and a reasonable validity in comparison with the consensus of opinions formed by a least 4 or 5 of its 7 clinical reviewers (specific agreement > 61%, kappa > 0.64), these values decreasing notably when the consensus of 6 or 7 of the reviewers was required. The AEP revealed a high degree of sensitivity and a low degree of specificity in comparison with the majority clinical assessment, thus minimising the occurrence of false results when the stay was regarded as appropriate, and producing false negatives (appropriate hospital stays regarded as inappropriate) varying in degree from moderate to very high. CONCLUSIONS: The results showing high reliability and moderate validity regarding clinical assessment shows the AEP to be a useful instrument in the sifting-out of inappropriate use of hospitalisation, although they do not allow a definitive judgement to be made concerning the efficiency of hospital services nor judgements regarding individual cases.

[Influence of secretory otitis media on mastoid pneumatization. Multiple regression analysis]. / Influencia de la otitis media secretoria en la neumatización mastoidea. Análisis mediante regresión múltiple.

The influence of secretory otitis media (SOM) on mastoid pneumatization was studied in 122 ears of 61 children under 15 who were seen at our clinic two times. Age, tympanometry, mastoid size, and time between visits were analyzed. Multiple regression analysis yielded and equation relating age and SOM with mastoid size at first examination. Another regression equation explained the contribution of SOM resolution or persistence and age on mastoid size at the time of the second examination. This equation explained 76.14% of the variability in mastoid size and showed that normal ears had better mastoid growth than children with SOM. Even thought inflammation resolved with medical or surgical treatment, mastoid pneumatization was more developed in normal subjects.

[Retropharyngeal lipoma]. / Lipoma del espacio retrofaríngeo.

Although ordinary lipoma is the most common neoplasm of mesenchymal origin, retropharyngeal lipoma is a very rare tumour and only about 20 cases have been reported. We present a further case of this kind and discuss its most important clinical features, diagnosis and treatment. Updated theories on the lipoma's etiology and their evolutive course are reviewed.

[Giant dermoid cyst of the floor of the mouth]. / Quiste dermoide gigante de suelo de boca.

Report the case of a young feminine patient, 17, presenting since the first year of her life, a swelling of few milimeters diameter, close to the frenulum of the tongue, with progressive enlargement. At examination is verified a swelling about 10 cms. diameter filling the whole ground of the mouth and pulling backwards the tongue and producing a clear protrusion in the suprahyoid region. After lateral X-ray of the neck, echography and cervical TAC, surgery is advised with the suspicion of ranula sublingualis. Removal of the tumor through medial cervictomy, finding, besides the main mass, a second one about 3 cms. diameter. The histopathological diagnosis of a cyst of the thyroglossal duct, its sitting place and the clinical course, compelled the AA. to review the slides and being obvious the presence of sebaceus glands, they change the prior diagnosis for that of dermoid cyst.

Alcohol intake effects on the dorsal vagal complex of the rat: a cellular morphometric study.

We have analyzed the morphometric effects on the dorsal vagal complex (DVC) of the rat of alcohol exposure and/or hypoproteic diet intake during 8 weeks. In the area postrema (AP), alcohol treatment (combined with normal isoproteic or hypoproteic diet) caused a significant decrease in karyometric parameters. In the dorsal motor nucleus of the vagus (DMV) and nucleus tractus solitari (NTS), the alcohol isoproteic intake (AI) produced an increase in neuron size (expressed by an increase in the neuronal nuclear area and the cell/neuropil coefficient). The hypoproteic diets produced a reduction in the global volume of each structure of the DVC which was accompanied by a decrease in global brain volume. These results indicate that after 8 weeks of treatment, alcohol is the main cause of the morphometric alteration found in the DVC, while variations in the amount of protein intake appear to produce global effects on the whole brain.

[Solitary nasal plasmocytoma]. / Plasmocitoma solitario nasal.

Report of the case of one patient diagnosed of a nasal extramedullary solitary plasmacytoma, starting as an suppurated panophtalmia. Biopsy of the mass inside the nose led to diagnosis. Comments about the difficulties of histopathological differential diagnosis, underlying the need to rule out any other systemic process (multiple myeloma). The subject was treated with inductive chemotherapy and radiotherapy, being free of the illness after 4 years follow up.

Subcutaneous and conjunctival vaccination with a live attenuated strain of Salmonella Abortusovis: effect of gestation on serological response of ewes.

Annual serological testing of flocks vaccinated by the subcutaneous route with a live, attenuated strain of Salmonella Abortusovis has previously demonstrated the persistence of agglutinating antibodies. It has however been impossible to determine whether the antibodies originated from the vaccination or from an enzootic infection. The serological response, as measured by a microtechnique of seroagglutination using a stained antigen, was studied in an isolated flock of 30 adult ewes. The trial period after the subcutaneous vaccination was 34 months, which included 3 lambings. Ten female offspring of these ewes were also studied. They were vaccinated by the conjunctival route and were studied for 18 months, which included 1 lambing. As is common for natural or experimental infection, high antibody titers were obtained 10-15 d after vaccination in both groups. The values then decreased and rose again to significant levels at each subsequent pregnancy. The vaccinal strain was never isolated from vaginal swabs taken at each lambing and there was no suggestion of stimulation by an external antigen. Gestation may therefore stimulate the antibody response. This suggests that the immunity conferred by this vaccination may last for at least 3 lambing periods. The consequences of these observations on vaccination protocols and serological diagnosis are discussed.

Salmonella Abortusovis experimental infection induced by the conjunctival route: clinical, serological and bacteriological study of the dose effect in female lambs.

The aim of this work was to explore the first stages of infection with Salmonella Abortusovis after a mucosal inoculation, and to establish an experimental model limiting the bacteriological investigations to the inoculation site. Four groups of 6 ewe-lambs were infected by the conjunctival route with decreasing doses of Salmonella Abortusovis. The clinical and serological survey was completed by a daily bacteriological examination of nasal swabs and faeces. Enumeration of viable bacteria was performed on liver, spleen, lungs and lymph nodes harvested 1, 8, and 22 d after inoculation. A rapid colonization of the cephalic lymph nodes was observed, associated with a transient spreading to prescapular and subiliac lymph nodes without dissemination to the liver and spleen. An irregular and low level faecal excretion was associated with the colonization of mesenteric lymph nodes. The infection by the conjunctival route may either systemically propagated or be locally restricted by the lymphoid system in relation to doses administered. This model uses low infective doses similar to those occurring in field conditions and offers the possibility of limiting the bacteriological control to the regional lymph nodes. It confirms that live attenuated Salmonella strains may be used as vaccinal vectors by the mucosal route.

[The demand for specialized care in otorhinolaryngology]. / Estudio de la demanda asistencial especializada en otorrinolaringologiá.

BACKGROUND: The specialized medical assistance knowledge improved in hospitals since the introduction of Clinical Documentation Services, but hardly anything is known about outpatient assistance, specially in otolaryngology. METHODS: In order to find out this information, during 1992 last quarter, we sampled 20 days of outpatient consult, studying the following variables in patients visited: age, sex, diagnosis, diagnostic-therapeutic procedures and motives for hospital attention. RESULTS: In the sample first visits are 63% and second visits 37%. Only 7.5% of patients were sent to hospital and we refer the diagnosis cause. In 5.6% of cases we couldn't establish any diagnosis, the 47% of cases presented otologic pathology and the rest 47% belonged to rhinologic pathology, pharyngeal and laryngeal troubles. The frequency of diagnosis were different in age groups. In 25% of patients diagnostic-therapeutic procedures were done. CONCLUSIONS: This study supplies us interesting information about the features of ENT outpatient assistance respect sex and age, more frequent diagnostics, procedures and causes for hospital attention.

Abortion and serological reaction of ewes after conjunctival instillation of Salmonella enterica subsp enterica ser abortusovis.

The aim of the experiment was to evaluate in pregnant ewes the clinical, bacteriological and serological effects of conjunctival instillation of S abortusovis. An individual dose of 1 x 10(10) viable S abortusovis were administered to 20 ewes 92 d after mating. Among 18 pregnant ewes, 8 aborted 110 +/- 13 d after mating, 4 had stillborn lambs and 6 a clinically normal lambing (114 +/- 1.3 d). S abortusovis was isolated from placentas, swabs and foetuses of the 12 lambings. Evolution of "H" agglutination titers measured by means of a microtechnique using a coloured antigen was found to be independent of the clinical results. Instillation by conjunctival route could constitute an experimental model closer to a natural mode of infection than the subcutaneous route.

Experimental ovine salmonellosis (Salmonella abortusovis): pathogenesis and vaccination.

Salmonella enterica subsp. enterica ser. Abortusovis, a sheep-adapted serotype, causes a contagious disease. Abortion is the major symptom and the main source of contamination. Research on this ovine disease may aid farmers, but may also contribute to comparative biological knowledge. Innate resistance partly controlled by the Ity locus, increased resistance to reinfection and humoral and T-cell-mediated immunity were observations gained with a murine model. In ewes, abortion regularly occurs following subcutaneous challenge carried out from the third month of gestation onwards. This ovine model was used to evaluate prevention methods for Salmonella Abortusovis infection. One subcutaneous injection of a live attenuated lyophilized vaccine containing a selected streptomycin-independent reverse mutant was shown to protect ewes against abortion and excretion of Salmonella Abortusovis. This vaccine could be administered simultaneously with other commercial live vaccines such as Brucella melitensis Rev. 1 vaccine. In sheep, application of the vaccine to the conjunctiva (an easy, individual and hygienic route of mucosal vaccination) was followed by lymph node bacterial colonization and a serological response without local or general clinical reactions. The early events of natural infection remain to be explored, as do the mechanisms underlying the host specificity of Salmonella Abortusovis.