A method to reproduce pH and Eh environmental changes due to sediment resuspension.

During the last decades, metals have been released into coastal areas increasing the environmental and human health risks, however, resuspension events of trace metals polluted sediment could represent even more severe risks. Anoxic condition in the sediment is capable to stabilize the trace metals, due to the bonding with reduced anions. Although, the sediment resuspension can alter the potential redox and pH characteristics resulting in metals released from the water column. The climate change advance would impact directly on ocean chemistry, is expected the spatial increase of anoxic sites, mainly in coastal areas. Furthermore, it is mandatory and urgent to expand the knowledge over the process of sediment metals releasing in order to develop prediction and remediation tools for possible environmental impacts. This is a simple method of manipulating and simulating physicochemical alterations. The creation of microcosmos without oxygen allows the formation of a very reducible environment, common in coastal areas with low energy and high organic matter input. And further oxidation allows the assessment of the trace metals released to the water column and/or the new arrangement of these metals in different geochemical fractions. • The experimental procedure to assess trace metals mobility to potential redox and pH changes in sediment and water. • A method is suitable for a wild range of sediment characteristics.

Posicionamiento SEMERGEN en el abordaje de la insuficiencia cardíaca crónica en atención primaria / SEMERGEN positioning on approaching chronic heart failure in primary care

La insuficiencia cardíaca (IC) es un problema de salud pública que genera una gran carga asistencial tanto hospitalaria como en atención primaria (AP). La publicación de numerosos estudios sobre IC durante los últimos años ha supuesto un cambio de paradigma en el abordaje de este síndrome, en el que la labor de los equipos de AP va adquiriendo un protagonismo mayor. Las recientes guías publicadas por la Sociedad Europea de Cardiología han introducido cambios fundamentalmente en el manejo del paciente con IC. La nueva estrategia propuesta, con fármacos que reducen las hospitalizaciones y frenen la progresión de la enfermedad, debe ser ya una prioridad para todos los profesionales implicados. En este documento de posicionamiento se analiza una propuesta de abordaje basada en equipos multidisciplinares con el liderazgo de los médicos de familia, clave para proporcionar una atención de calidad a lo largo de todo el proceso de la enfermedad, desde su prevención hasta el final de la vida (AU)

Heart failure (HF) is a public health problem that generates a large healthcare burden both in hospitals and in Primary Care (PC). The publication of numerous studies about HF in recent years has led to a paradigm shift in the approach to this syndrome, in which the work of PC teams is gaining greater prominence. The recent guidelines published by the European Society of Cardiology have fundamentally introduced changes in the management of patients with HF. The new proposed strategy, with drugs that reduce hospitalizations and slow the progression of the disease, should now be a priority for all professionals involved. This position document analyzes a proposal for an approach based on multidisciplinary teams with the leadership of family doctors, key to providing quality care throughout the entire process of the disease, from its prevention to the end of the life (AU)

Evaluation of prophylaxis in primary prevention with acetylsalicylic acid in people with diabetes: A scoping review.

BACKGROUND: The efficacy and safety of acetylsalicylic acid (ASA) prophylaxis for the primary prevention of atherosclerotic cardiovascular disease (ACVD) remain controversial in people with diabetes (DM) without ACVD, because the possible increased risk of major bleeding could outweigh the potential reduction in the risk of mortality and of major adverse cardiovascular events (MACE) considered individually or together. OBJECTIVE: To evaluate the overall risk-benefit of ASA prophylaxis in primary prevention in people with DM and to compare the recommendations of the guidelines with the results of the meta-analyses (MA) and systematic reviews (SR). MATERIAL AND METHODS: We searched Medline, Google Scholar, Embase, and the Cochrane Library for SR and MA published from 2009 to 2020 which compared the effects of ASA prophylaxis versus placebo or control followed up for at least one year in people with DM without ACVD. Heterogeneity among the randomized clinical trials (RCT) included in the SR and MA was assessed. Cardiovascular outcomes of efficacy (all-cause mortality [ACM], cardiovascular mortality [CVM], myocardial infarction [MI], stroke and MACE) and of safety (major bleeding events [MBE], major gastrointestinal bleeding events [MGIBE], and intracranial and extracranial bleeding) were shown. RESULTS: The recommendations of 12 guidelines were evaluated. The results of 25 SR and MA that included a total of 20 RCT were assessed. None of the MA or SR showed that ASA prophylaxis decreased the risk of ACM, CVM or MI. Only two of the 19 SR and MA that evaluated ischemic stroke showed a decrease in the stroke risk (mean 20.0% [SD±5.7]), bordering on statistical significance. Almost half of the MA and SR showed, bordering on statistical significance, a risk reduction for the MACE composite endpoint (mean 10.5% [SD±3.3]). The significant increases in MGIBE risk ranged from 35% to 55%. The significant increases in the risk of MBE and extracraneal bleeding were 33.4% (SD±14.9) and 54.5% (SD±0.7) respectively. CONCLUSION: The overall risk-benefit assessment of ASA prophylaxis in primary prevention suggests that it should not be applied in people with DM.

[SEMERGEN positioning on approaching chronic heart failure in primary care]. / Posicionamiento SEMERGEN en el abordaje de la insuficiencia cardíaca crónica en atención primaria.

Heart failure (HF) is a public health problem that generates a large healthcare burden both in hospitals and in Primary Care (PC). The publication of numerous studies about HF in recent years has led to a paradigm shift in the approach to this syndrome, in which the work of PC teams is gaining greater prominence. The recent guidelines published by the European Society of Cardiology have fundamentally introduced changes in the management of patients with HF. The new proposed strategy, with drugs that reduce hospitalizations and slow the progression of the disease, should now be a priority for all professionals involved. This position document analyzes a proposal for an approach based on multidisciplinary teams with the leadership of family doctors, key to providing quality care throughout the entire process of the disease, from its prevention to the end of the life.

[Positioning for the management of arterial hypertension in Primary Care from the critical analysis of the American (2017) and European (2018) guidelines. Spanish Society of Primary Care Physicians (SEMERGEN)]. / Posicionamiento para el manejo de la hipertensión arterial en atención primaria a partir del análisis crítico de las guías americana (2017) y europea (2018). Sociedad Española de Médicos de Atención Primaria (SEMERGEN).

The Scientific Societies of Primary Care, being the area in which there is a considerable prevalence of Arterial Hypertension (AHT), need to periodically evaluate the international guidelines for its management. This is particularly relevant when disparate guidelines make it difficult to make decisions in daily clinical practice. The present document has as its aim to analyse the changes and new developments proposed in the guidelines of the American College of Cardiology and the American Heart Association (ACC/AHA 2017), as well as in the guidelines of the European Society of Cardiology and European Society of Hypertension (ESC/ESH 2018). An analysis will be made of any differences, limitations, and their applicability to Primary Care in Spain. Finally, the most relevant available and appropriate information is extracted and integrated in order to homogenise the care of the hypertensive patient, from a critical, but also a reasoned, perspective. The discrepancies between the recommendations in such essential aspects as the management of the disease, require the compiling and critical analysis of the information that enables us as scientific society, interested in providing all PC physicians with the most relevant, and at the same time, sensible, recommendations of all the guidelines.

Efectividad y seguridad de la terapia de rescate en pacientes VIH / Safety and effectiveness of salvage therapy in HIV patients

Introducción: En pacientes VIH el tratamiento aplicado tras el fracaso de al menos dos líneas de tratamiento antirretroviral se denomina pauta de rescate. El estudio pretende describir las características de pacientes VIH a los que se aplica pauta de rescate, y conocer la efectividad y seguridad del tratamiento con tipranavir (TPV), darunavir (DRV), enfuvirtida (ENF) y etravirina (ETR) combinados con un régimen antirretroviral optimizado. Pacientes y método Pacientes VIH en tratamiento con ENF, TPV, DRV o ETR, en el servicio de infecciosas de un hospital de tercer nivel, que han estado al menos 12semanas en tratamiento. Se describen las características de los pacientes y se analiza la efectividad, durabilidad y adherencia a los tratamientos. Resultados Se estudian 28 pacientes, con una media de 10 pautas de tratamiento antes del inicio con pauta de rescate (DE=3,5) (IC 95%: 8,9-11,1). En el 85,7% de las pautas los pacientes presentaron una adherencia del >90%. El 70,8% de las líneas con ENF se suspendieron durante el seguimiento. Tras la pauta de rescate se duplicó el porcentaje de casos con carga viral (CV)<400copias/ml y casi se triplicaron los casos con CV indetectable (<50copias/ml). Los tratamientos empleados no produjeron alteraciones a nivel hepático o renal, pero alteraron el perfil lipídico y aumentó el porcentaje de pacientes con hiperglucemia. Conclusiones Las pautas de rescate estudiadas han sido efectivas. La buena adherencia del paciente al tratamiento es primordial para la efectividad del mismo (AU)

Introduction: The treatment used after failure of at least two lines of antiretroviral treatment in HIV patients is called salvage therapy. The study aims to describe the characteristics of HIV patients subjected to such a regimen, and determine the safety and effectiveness of treatment with tipranavir (TPV), darunavir (DRV), enfuvirtide (ENF) and etravirine (ETR) combined with an optimised antiretroviral regimen. Patients and methods: HIV patients treated with ENF, TPV, DRV or ETR in a tertiary hospital infectious diseases department subjected to at least 12 weeks treatment. The patient characteristics are described and the effectiveness, durability and adherence to the treatment analysed. Results: There were 28 patients studied, with an average of 10 treatment regimens prior tostarting salvage therapy (SD = 3.5; 95 % CI, 8.9-11.1). A total of 85.7 % patients had treatment adherence > 90 %. For ENF, 70.8 % of the treatment lines were suspended during follow-up. After salvage therapy, the percentage of patients with viral load (VL) < 400 copies/ml doubled, and cases with undetectable CV (< 50 copies/ml) almost tripled. The treatments used did not change the liver or kidney profiles; however, they changed the lipid profile and increased the percentage of patients with hyperglycaemia. Conclusions: The salvage therapy studied was effective. Good adherence to the therapy is critical for its effectiveness (AU)

[Safety and effectiveness of salvage therapy in HIV patients]. / Efectividad y seguridad de la terapia de rescate en pacientes VIH.

INTRODUCTION: The treatment used after failure of at least two lines of antiretroviral treatment in HIV patients is called salvage therapy. The study aims to describe the characteristics of HIV patients subjected to such a regimen, and determine the safety and effectiveness of treatment with tipranavir (TPV), darunavir (DRV), enfuvirtide (ENF) and etravirine (ETR) combined with an optimised antiretroviral regimen. PATIENTS AND METHODS: HIV patients treated with ENF, TPV, DRV or ETR in a tertiary hospital infectious diseases department subjected to at least 12 weeks treatment. The patient characteristics are described and the effectiveness, durability and adherence to the treatment analysed. RESULTS: There were 28 patients studied, with an average of 10 treatment regimens prior to starting salvage therapy (SD=3.5; 95% CI, 8.9-11.1). A total of 85.7% patients had treatment adherence >90%. For ENF, 70.8% of the treatment lines were suspended during follow-up. After salvage therapy, the percentage of patients with viral load (VL) <400 copies/ml doubled, and cases with undetectable CV (<50 copies/ml) almost tripled. The treatments used did not change the liver or kidney profiles; however, they changed the lipid profile and increased the percentage of patients with hyperglycaemia. CONCLUSIONS: The salvage therapy studied was effective. Good adherence to the therapy is critical for its effectiveness.

Molecular breeding in developing countries: challenges and perspectives.

Molecular breeding (MB) holds great promise for developing countries. However, the developing countries are hardly homogeneous in its implementation. Whilst newly industrialised countries routinely use several MB applications and are exploring the latest approaches, developing countries with mid-level economies are testing marker applications and taking initial steps towards adopting MB in day-to-day breeding. Various bottlenecks still impede adoption in these countries. Limited human resources and inadequate field infrastructure remain major challenges, although through virtual platforms aided by the information and communication technology revolution, breeders now have better access to genomic resources, advanced laboratory services, and robust analytical and data management tools. These developments are bound to have impact crop improvement in developing countries.

A new area multidetector dosemeter for mixed n-gamma fields.

A new instrument to assess neutron ambient doses has been designed and constructed. In its design, spectrometric capabilities have been implemented that allow to take into account the energy spectrum of the neutron field in the evaluation of the operational magnitude, ambient dose equivalent, H*(10). This dosemeter is based on the moderation-absorption technique and can be employed over a wide range of energies from thermal to 20 MeV. It consists of a spherical shaped polyethylene moderator with a set of thermoluminescence dosemeters (TLDs) inserted in different positions of its interior to evaluate the external neutron energy spectrum. At this moment the system uses pairs 6LiF:Mg,Ti (TLD-600) and 7LiF:Mg,Ti (TLD-700) thermoluminescence dosemeters for a better gamma discrimination. The dosemeter response matrix was calculated using the MCNP4C Monte Carlo code (MC). The viability of the dosemeter for area dosemetry has been examined experimentally showing its capabilities over a wide range of energies.

[Pneumonia in the aged patient: is the clinical presentation atypical?]. / Neumonía en el anciano: es atípica su presentación clínica?

OBJECTIVE: Some new studies have questioned the often atypical character of pneumonia in aged patients. Therefore to study the different clinical presentation of this pathology is our aim. MATERIAL AND METHODS: Retrospective analysis of 179 cases of pneumonia in patients aged older than 65 years who were admitted in our hospital during 1992. RESULTS: The average age of the patients was 78 years, being 65.9% of them men. 91% presented pneumonias acquired in the community. 73.1% showed a typical dominant clinical presentation (febrile-respiratory); respiratory (47.4%), febrile (25.7%). The rest presented atypical patterns; mental-neurologic or "cerebral dysfunction" (10.6%), perambulation-general state (6.15%) and digestive-abdominal (9.5%). The respiratory pattern was associated to the presence of respiratory antecedents (p < 0.001); the febrile pattern to the absence of cardiovascular antecedents (p < 0.05); the mental-neurologic to the presence of neurologic antecedents (p < 0.001) and the alteration of perambulation-general state to an evolution of more than 7 days (p < 0.05). CONCLUSIONS: The greatest number of our pneumonia patients older than 65 years follows a typical clinical pattern febrile-respiratory). The patient's prior pathology conditions the clinical presentation.

Construction of a reference linkage map for melon.

A map of melon (Cucumis melo L.) with 411 markers (234 RFLPs, 94 AFLPs, 47 RAPDs, 29 SSRs, five inter-SSRs, and two isozymes) and one morphological trait (carpel number) was constructed using the F2 progeny of a cross between the Korean accession P1161375 and the Spanish melon type 'Pinyonet Piel de Sapo'. RFLPs were obtained using 212 probes from different genomic and cDNA melon libraries, including 16 Arabidopsis ESTs, 13 Cucumis known genes, and three resistant gene homologues. Most loci (391) mapped to 12 major linkage groups, spanning a total genetic distance of 1197 cM, with an average map interval of 3 cM/marker. The remaining 21 loci (six RAPDs and 15 AFLPs) were not linked. A majority (66%) of the markers were codominant (RFLPs, SSRs, and isozymes), making them easily transferable to other melon crosses. Such markers can be used as a reference, to merge other melon and cucumber maps already constructed. Indeed, some of them (23 SSRs, 14 RFLPs, one isozyme, and one morphological trait) could act as anchor points with other published cucurbit maps.

A test battery for the ecotoxicological evaluation of pentachlorophenol.

Experimental bioassays are currently used in ecotoxicology and environmental toxicology to provide information for risk assessment evaluation of new chemicals and to investigate their effects and mechanisms of action; in addition, ecotoxicological models are used for the detection, control and monitoring of the presence of pollutants in the environment. As a single bioassay will never provide a full picture of the quality of the environment, a representative, cost-effective and quantitative test battery should be developed. The effects of pentachlorophenol were studied using a battery of ecotoxicological model systems, including immobilization of Daphnia magna, bioluminiscence inhibition in the bacterium Vibrio fischeri, growth inhibition of the alga Chlorella vulgaris, and micronuclei induction in the plant Allium cepa. The inhibition of cell proliferation and MTT reduction were investigated in Vero cells. Neutral red uptake, cell growth, MTT reduction, lactate dehydrogenase leakage and activity were studied in the salmonid fish cell line RTG-2, derived from the gonad of rainbow trout. Pentachlorophenol was very toxic for all biota and cells. The system most sensitive to pentachlorophenol, was micronuclei induction in A. cepa, followed by D. magna immobilization, bioluminescence inhibition in V. fischeri bacteria at 60 min and cell proliferation inhibition of RTG-2 cells at 72 h. Inhibition of cell proliferation and MTT reduction on Vero monkey cells showed intermediate sensitivity.

Neumonía en el anciano: ¿es atípica su presentación clínica? / Pneumonia in the aged patient: is the clinical presentation atypical?

Objetivo: Recientemente, varios estudios han puesto en duda el carácter frecuentemente atípico de la clínica en la neumonía del anciano. Por ello, estudiamos las formas de presentación clínica de esta patología en pacientes de mayor edad.Material y métodos: Revisión retrospectiva de 179 casos de neumonía en pacientes mayores de 65 años, ingresados en nuestro hospital en el año 1992. Resultados : Los pacientes presentaban una edad media de 78 años, siendo la proporción de varones del 65,9 por ciento. El 91 por ciento presentaban neumonías adquiridas en la comunidad. El 73,1 por ciento mostraron un presentación clínica dominante típica (febril-respiratoria); respiratoria (47,4 por ciento), febril (25,7 por ciento).El resto presentaron patrones atípicos; mental-neurológico o de "disfunción cerebral" (10,6 por ciento), deambulación-estado general (6,15 por ciento) y abdominal-digestivo (9,5 por ciento). El patrón respiratorio se asoció con la presencia de antecedentes respiratorios (p<0,001), el febril con la ausencia de antecedentes cardiovasculares (p<0,05), el mental-neurológico con la presencia de antecedentes neurológicos (p<0,001) y la alteración de la deambulación-estado general con un tiempo de evolución mayor de 7 días (p<0,05). Conclusión : La mayoría de nuestros pacientes mayores de 65 años con neumonía cursan con un patrón clínico típico (febril-respiratorio). La patología previa del paciente condiciona la forma de presentación clínica. (AU)

Development of a second generation linkage map for almond using RAPD and SSR markers.

Fifty-four RAPD (random amplified polymorphic DNA) markers and 6 SSRs (simple sequence repeats) were included in a molecular marker map with 120 RFLPs (restriction fragment length polymorphisms) and 7 isozyme genes previously constructed using the offspring of a cross between the almond (Prunus amygdalus) cultivars 'Ferragnès' and 'Tuono'. Only highly reproducible RAPDs segregating 1:1 were used. To identify these markers, a total of 325 primers were screened, from which 41 produced RAPDs useful for mapping. Polymorphism was detected in six of the eight Prunus SSRs (simple sequence repeats) studied, thus enabling these to be mapped. All markers were placed on the 8 linkage groups previously identified. The number of new markers included in the map of 'Ferragnès' was 33 for a total of 126, and 30 in the map of 'Tuono' for a total of 99. The sizes of the maps of 'Ferragnès' (415 cM) and 'Tuono' (416 cM) were similar, representing a 5% increase over the maps constructed solely with isozymes and RFLPs. The estimated total size of the almond map was of 457 cM. Some markers were placed in zones with low density of markers and others in the extreme of linkage groups. The use of RAPD markers to complete genetic maps constructed with transferable markers is discussed.

Developing SCAR markers to study predation on Trialeurodes vaporariorum.

DNA markers of Trialeurodes vaporariorum were developed to detect remains of these whitefly in the gut of the predator Dicyphus tamaninii. A 2400-bp DNA fragment of T. vaporariorum, absent in other closely related prey species and in the predator banding pattern, was identified by random amplified polymorphic DNA (RAPD) analysis. After cloning and sequencing this fragment, two pairs of sequence-characterized amplified region (SCAR) primers were developed, amplifying single bands of 2100 bp and 310 bp, respectively. Detection of T. vaporariorum DNA in the predator gut was only possible using the primers that amplified the shortest fragment. Specificity tests performed with this pair of primers showed the presence of the 310-bp band for T. vaporariorum in all stages.

A linkage map with RFLP and isozyme markers for almond.

Inheritance and linkage studies were conducted with seven isozyme genes and 120 RFLPs in the F1 progeny of a cross between almond cultivars 'Ferragnes' and 'Tuono'. RFLPs were detected using 57 genomic and 43 cDNA almond clones. Eight of the cDNA probes corresponded to known genes (extensin, prunin (2), α-tubulin, endopolygalacturonase, oleosin, actin depolymerizing factor and phosphoglyceromutase). Single-copy clones were found more frequently in the cDNA (65%) than in the genomic libraries (26%). Two maps were elaborated, one with the 93 loci heterozygous in 'Ferragnes' and another with the 69 loci heterozygous in 'Tuono'. Thirty-five loci were heterozygous in both parents and were used as bridges between both maps. Most of the segregations (91%) were of the 1∶1 or 1∶1∶1∶1 types, and data were analyzed as if they derived from two backcross populations. Eight linkage groups covering 393 cM in 'Ferragnes' and 394 in 'Tuono' were found for each map. None of the loci examined in either map was found to be unlinked. Distorted segregation ratios were mainly concentrated in two linkage groups of the 'Ferragnes' map.

Organisation of the tomato polyphenol oxidase gene family.

We report the isolation and characterization of seven nuclear genes encoding polyphenol oxidase (PPO) in tomato (Lycopersicon esculentum cv. VFNT Cherry). The seven genes (PPOs A, A', B, C, D, E and F) fall into three structural classes (I, II, and III) based on Eco RI and Hind III restriction fragment length polymorphisms (RFLP). RFLP mapping and PFGE analysis demonstrated that the genes reside on chromosome 8, and may be clustered within a 165 kb region. Phage insert mapping demonstrated PPO E and PPO F (both class III), and PPOs B, D and A (classes I, II and I respectively) are grouped within separate 12.4 kb clusters. The complete nucleotide sequence was determined for each gene. Comparison to cDNAs revealed that the PPOs lack introns. A transcript of about 2 kb is expected for each PPO. Each PPO possesses a region encoding a transit peptide characteristic of polypeptides targeted to the thylakoid lumen. Predicted precursor polypeptides range in mass from 66 to 71 kDa and predicted mature polypeptides range from 57 to 62 kDa. All the PPOs encode two putative copper-binding sites characteristic of bacterial, fungal and mammalian tyrosinases. Five of the seven PPOs possess divergent DNA sequences in their 5' promoter regions. These flanking sequence differences may regulate the differential expression of PPO genes.

High density molecular linkage maps of the tomato and potato genomes.

High density molecular linkage maps, comprised of more than 1000 markers with an average spacing between markers of approximately 1.2 cM (ca. 900 kb), have been constructed for the tomato and potato genomes. As the two maps are based on a common set of probes, it was possible to determine, with a high degree of precision, the breakpoints corresponding to 5 chromosomal inversions that differentiate the tomato and potato genomes. All of the inversions appear to have resulted from single breakpoints at or near the centromeres of the affected chromosomes, the result being the inversion of entire chromosome arms. While the crossing over rate among chromosomes appears to be uniformly distributed with respect to chromosome size, there is tremendous heterogeneity of crossing over within chromosomes. Regions of the map corresponding to centromeres and centromeric heterochromatin, and in some instances telomeres, experience up to 10-fold less recombination than other areas of the genome. Overall, 28% of the mapped loci reside in areas of putatively suppressed recombination. This includes loci corresponding to both random, single copy genomic clones and transcribed genes (detected with cDNA probes). The extreme heterogeneity of crossing over within chromosomes has both practical and evolutionary implications. Currently tomato and potato are among the most thoroughly mapped eukaryotic species and the availability of high density molecular linkage maps should facilitate chromosome walking, quantitative trait mapping, marker-assisted breeding and evolutionary studies in these two important and well studied crop species.

Red blood cell and total blood acetylcholinesterase and plasma pseudocholinesterase in humans: observed variances.

Although acetylcholinesterase is the target molecule of organophosphate poisoning, it is not always assayed in clinical evaluations which include only the determination of plasma or serum cholinesterase. In this paper we present observations on workers exposed to, or poisoned by, ethylparathion. Acetylcholinesterase decreased earlier and more intensely than cholinesterase, with the suggestion of an initial increase of acetylcholinesterase activity in newly exposed, workers. A simplified standard Ellman assay of total acetylcholinesterase activity of hemolyzed total blood correlated with that of washed erythrocyte acetylcholinesterase. All results were standardized to both red blood cell and hemoglobin concentration. Normal values in a group of unexposed subjects were acetylcholinesterase: 1225 +/- 181 nU x 10/RBC and 39.30 +/- 5.05 U/g Hb for men, 1321 +/- 234 nU x 10/RBC and 42.57 +/- 6.85 U/g Hb for women. Differences between total and erythrocyte acetylcholinesterase were not statistically significant. Plasma cholinesterase appeared to be decreased in pregnancy and increased in anesthesia, liver and kidney disease and neuropathologic conditions attributed to metal poisoning while total acetylcholinesterase was unaffected. The determination of both cholinesterase and acetylcholinesterase assists the evaluation of individuals exposed to or poisoned by organophosphate, the differentiation of other conditions affecting cholinesterase and the recognition of genetically atypical cholinesterase.