Adequacy of medical referrals to hospital emergency service

OBJECTIVE: To assess the correctness and diagnostic concordance in referrals of patients to hospital Casualty Departments (CD); and the possible differences between rural and urban health centres (HC) as well as between general practitioners (GP) and family and community medicine (FCM) specialists. DESIGN: Observational study of a crossover nature. SETTING: Health area 1 in the province of Badajoz. PATIENTS AND OTHER PARTICIPANTS: 800 patients, referred to their local hospital Casualty Department. MEASUREMENTS AND MAIN RESULTS: 50.5% of all referrals were considered justified. 15.1% of the patients referred were admitted to hospital. 50.7% of referrals from GPs were found to be correct, against 47% from FCM specialists; and 49% of those referred from rural HCs were correct, as against 45.9% of those referred from urban HCs (no significant differences). Only 54% of referrals had a diagnostic hypothesis, with diagnostic concordance at 50%. There was diagnostic concordance in 28.1% of GP referrals, against 33.3% of FCM specialists; and in 27.5% of those from rural HCs against 26.1% from urban HCs (no significant differences). CONCLUSIONS: We found no differences in the correctness of referrals or diagnostic concordance of patients seen in the CD of our city's health area, neither between patients referred from rural and urban HCs, nor between patients referred by GPs and FCM specialists.     

Lipid damage in farmed rainbow trout (Oncorhynchus mykiss) after slaughtering and chilled storage

The flow ice system including ozone (OFI condition) was tested for slaughtering and storage (up to 16 days) of farmed rainbow trout (Oncorhynchus mykiss). Lipid damage analyses were carried out and compared to sensory acceptance and instrumental colour changes. Comparison to individuals processed with the flow ice system in the absence of ozone (FI condition) was undertaken. Rainbow trout slaughtered and chilled under FI and OFI conditions showed a low lipid damage development, according to lipid oxidation and hydrolysis events and lipid composition (polyunsaturated fatty acids, phospholipids and endogenous antioxidants) changes. Additionally, both icing conditions led to largely good quality and shelf life times and to the absence of changes in colour properties. It is concluded that flow ice as such, or including the presence of ozone, can be considered as ideal strategy to be employed as slaughtering and storage system during the commercialisation of the actual farmed species. The ozone presence has shown some profitable effects as leading to an extended shelf life time by quality retention of several sensory parameters; in contrast, some negligible negative effects could be observed on the secondary and tertiary lipid oxidation development. However, the oxidation values reached by individuals kept under OFI conditions cannot be considered as particularly high.     

Basal ganglia organization in amphibians: catecholaminergic innervation of the striatum and the nucleus accumbens

The aim of the present study was to determine the origin of the catecholaminergic inputs to the telencephalic basal ganglia of amphibians. For that purpose, retrograde tracing techniques were combined with tyrosine hydroxylase immunohistochemistry in the anurans Xenopus laevis and Rana perezi and the urodele Pleurodeles waltl. In all three species studied, a topographically organized dopaminergic projection was identified arising from the posterior tubercle/mesencephalic tegmentum and terminating in the striatum and the nucleus accumbens. Although essentially similar, the organization of the mesolimbic and mesostriatal connections in anurans seems to be more elaborate than in urodeles. The present study has also revealed the existence of a noradrenergic projection to the basal forebrain, which has its origin in the locus coeruleus. Additional catecholaminergic afferents to the striatum and the nucleus accumbens arise from the nucleus of the solitary tract, where catecholaminergic neurons appear to give rise to the bulk of the projections to the basal forebrain. In other regions, such as the olfactory bulb, the anterior preoptic area, the suprachiasmatic nucleus, and the thalamus, retrogradely labeled neurons (after basal forebrain tracer-applications) and catecholaminergic cells were intermingled, but none of these centers contained double-labeled cell bodies. It is concluded that the origin of the catecholaminergic innervation of the striatum and the nucleus accumbens in amphibians is largely comparable to that in amniotes. The present study, therefore, strongly supports the existence of a common pattern in the organization of the catecholaminergic inputs to the basal forebrain among tetrapod vertebrates.     

Immunohistochemical expression of p53 and c-erbB-2 in breast carcinoma: relation with epidemiologic factors, histologic features and prognosis

We have performed immunohistochemical staining for p53 and c-erbB-2 on formaldehyde-fixed, paraffin-embedded primary invasive ductal carcinomas from 112 patients, with a minimal follow-up time of 60 months. All of them had received postoperative chemoradiation therapy. We have analyzed the association of these factors with epidemiologic risk factors, histopathologic features and hormonal receptor status and the influence on prognosis. Our results indicate that the expression of c-erbB-2 protein defines a group of node-negative patients with poor prognosis. The overexpression of c-erbB-2 has shown a significant association with estrogen receptor status (those tumors expressing c-erbB-2 are usually estrogen receptor negative), presence of fibrosis and lymphoplasmacytoid infiltrates. P53 expression has shown no relation either with prognosis or with any other histopathologic or clinical feature. The only factors with prognostic influence in our series have been tumor size, the presence of node metastases, TNM stage and the prognostic morphometric index (Baak's index), apart from c-erbB-2 in node-negative patients. However, only the TNM stage showed an independent association with prognosis after a multivariate analysis. In summary, in our experience the expression of p53 protein has no prognostic influence on breast carcinoma, and TNM stage remains to be as the most powerful prognostic factor in these patients.     

Design and control of porosity in oxide thin films grown by PECVD

This work presents a series of results about the synthesis and characterization of porous oxide thin films (thicknesses ∼ ∼300 nm) prepared at low temperature by PECVD. Two different experimental strategies are described. A first one, used for the preparation of porous SiO₂ thin films, consists of the use of a polymeric sacrificial layer that is removed during deposition of the oxide thin film. A second one, used for the preparation of TiO₂ thin films, relies on the modification of some critical deposition parameters (i.e., temperature, Ar/O₂ ratio in the plasma mixture, etc.). Thin films with a large variation of pore structures as evidenced by Scanning Electron Microscopy (SEM) have been prepared by the two methodologies. The thin films have been characterised by different techniques and some of their properties related with their microstructure assessed by ellipsometry (optical behaviour) or water contact angle measurements (hydrophobic/hydrophilic character). A quartz crystal monitor has been used to measure water vapour adsorption/desorption isotherms in the films. From the shape of these isotherms it is possible to estimate the type of pores existing in the different thin films. Examples of the potential use of these porous thin films as humidity sensors or hydrophilic surfaces are reported.     

Seasonal differences in neonatal jaundice

Cytomegalovirus is the main agent of congenital viral infections. The aim of this study was to compare the incidence of congenital cytomegalovirus infections of two groups of newborns of differing socioeconomic status. Cytomegalovirus was isolated from urine or oropharingeal secretions in 218 children born in a private clinic and 471 born in a public hospital. Positive viral isolates were confirmed with indirect immunofluorescence using monoclonal antibodies. Infection was detected in 12 children (1.82%), four coming from the private clinic (1.86%) and 8 coming from the public hospital (1.81%). Ninety two percent of infected children were asymptomatic. Urine and oropharingeal secretion samples had the same yield for viral isolation. It is concluded that the incidence of congenital cytomegalovirus infection is similar to that described in developed countries.     

Calcium additional to that bound to the transport sites is required for full activation of the sarcoplasmic reticulum Ca-ATPase from skeletal muscle

The sarcoplasmic reticulum Ca-ATPase is fully activated when approximately 1 microM [Ca2+] saturates the two transport sites; higher [Ca] inhibits the ATPase by competition of Ca-ATP with Mg-ATP as substrates. Here we describe a novel effect of EGTA and other chelators, raising the possibility of an additional activating effect of Ca in the sub- or low microM range. Sarcoplasmic reticulum membranes were isolated from rabbit skeletal muscles. The ATPase activity was measured after incubation at 37 degreesC in 3 mM ATP, 3 mM MgCl2, 50 mM MOPS-Tris (pH 7.2), 100 mM KCl, and variable CaCl2, EGTA and calcimycin. In the absence of added EGTA and Ca the ATPase activity is high due to contaminant Ca. The determination of the ATPase activity in the presence of increasing amounts of EGTA, without added Ca, yields a decreasing sigmoidal function. Ki ranged between 20 and 100 microM, depending on the enzyme concentration. Pi production is linear with time for several [EGTA] yielding suboptimal ATPase activities, which are inhibited by thapsigargin. These suboptimal Ca-ATPase activities are inhibited by preincubation of the enzyme in EGTA, at pH 7.2. This effect increases upon increasing EGTA concentration and preincubation time. The inhibitory effect of the previous exposure of the enzyme to EGTA is partially but significantly reverted by increasing [Ca2+] during incubations. Calcimycin and EDTA have similar effects as EGTA when added in preincubations. The effect of calcimycin is fully reverted by optimal [Ca2+] in incubations. The effects of EGTA, EDTA and calcimycin in preincubation are not additive. The results suggest that an additional calcium, lost during preincubations from a site with affinity near 1 microM, is necessary for full activation of the ATPase.     

Plasma and erythrocyte alpha-tocopherol and plasma retinol concentrations in term infants fed formula enriched with long-chain polyunsaturated fatty acids

OBJECTIVE: To assess the effect of long-chain polyunsaturated fatty acids (LCPUFA)- and vitamin E-supplemented formula feeding on erythrocyte and plasma alpha-tocopherol (VE), and plasma retinol (VA) concentrations in neonates and to compare these values with those found in infants feeding on infant formula without LCPUFA or breast milk SETTING: University Hospital of Granada, Spain. SUBJECTS: 49 full-term infants. DESIGN AND INTERVENTION: Subjects who chose not to breast feed were fed either (i) unsupplemented infant formula (F) or (ii) infant formula supplemented with LCPUFA and vitamin E (FL). Alpha-tocopherol and retinol were measured at 7 days, 1 month and 3 months. RESULTS: Plasma and erythrocyte VE concentrations and plasma VE/total lipids ratio increased significantly in all groups at 1 month of life (P < 0.05), but did not change significantly between 1 month and 3 months in any group (P > 0.05). Erythrocyte VE and VA retinol concentrations were higher in infants fed an infant formula than in breast milk-fed infants at 1 month of life (P < 0.05). Finally, there were no significant differences in plasma or erythrocyte VE levels, plasma VA or plasma VE/total lipid ratio between any groups at 3 months of life (P > 0.05). CONCLUSION: Infants fed on LCPUFA- and vitamin E-supplemented infant formula for 3 months have similar vitamin E and A status to infants fed on breast milk or infant formula without LCPUFA supplementation.