[Severe child abuse admitted to paediatric ICU]

OBJECTIVE

To describe cases of severe child abuse admitted to PICU.

METHODS AND PATIENTS

It is a retrospective study (2000-2008) in which patients diagnosed with physical child abuse admitted to PICU were included. Other abuse patterns were excluded (severe negligence, sexual abuse or scalding).

RESULTS

There were 8 patients included (3 boys and 5 girls). The median age was 5.2 months, with 6 patients were less than 7 months old. The most frequent sign was neurological symptoms: seizures (4 patients), subdural haematoma (2 patients), traumatic brain injury (1 patient). Other: haemothorax (1 patient) and cardiac arrest of no known aetiology (1 patient). The CT showed a subdural haematoma in 5 patients, 3 of which needed surgical drainage. Child abuse was confirmed using the social history and the presence of inflicted injuries. There were long bones fractures (tibia, ulna and radius, bilateral rib fractures) in 3 patients and 4 patients had retinal haemorrhages. There was one death and 3 had severe neurological after effects.

CONCLUSION

Severely abused children can be falsely diagnosed with a casual neurological disease. The most frequent injury is subdural haematoma with or without another injury associated to child abuse. It very important to diagnose child abuse in order to prevent recurrent injuries.

Plasma and tissue depletion of florfenicol and florfenicol-amine in chickens

Chickens were used to investigate plasma disposition of florfenicol after single intravenous (i.v.) and oral dose (20 mg kg-1 body weight) and to study residue depletion of florfenicol and its major metabolite florfenicol-amine after multiple oral doses (40 mg kg-1 body weight, daily for 3 days). Plasma and tissue samples were analyzed using a high-performance liquid chromatography (HPLC) method. After i.v. and oral administration, plasma concentration-time curves were best described by a two-compartment open model. The mean [ +/- standard deviation (SD)] elimination half-life (t1/2beta) of florfenicol in plasma was 7.90 +/- 0.48 and 8.34 +/- 0.64 h after i.v. and oral administration, respectively. The maximum plasma concentration was 10.23 +/- 1.67 microg mL-1, and the interval from oral administration until maximal concentration was 0.63 +/- 0.07 h. Oral bioavailability was found to be 87 +/- 16%. Florfenicol was converted to florfenicol-amine. After multiple oral dose (40 mg kg-1 body weight, daily for 3 days), in kidney and liver, concentrations of florfenicol (119.34 +/- 31.81 and 817.34 +/- 91.65 microg kg-1, respectively) and florfenicol-amine (60.67 +/- 13.05 and 48.50 +/- 13.07 microg kg-1, respectively) persisted for 7 days. The prolonged presence of residues of florfenicol and florfenicol-amine in edible tissues can play an important role in human food safety, because the compounds could give rise to a possible health risk. A withdrawal time of 6 days was necessary to ensure that the residues of florfenicol were less than the maximal residue limits or tolerance established by the European Union.

Attitude of Scottish residents living in southeastern Spain toward organ donation

BACKGROUND

Southeastern Spain is a habitual area of residence for the native population of Scotland.

OBJECTIVE

To assess the attitude toward donation in the immigrant population in our regional community who were born in Scotland and to analyze the variables that influence this attitude.

MATERIALS AND METHODS

A random sample was taken (n = 350) of the population group born in Scotland and living in southeastern Spain. The instrument used to measure attitude was a previously validated questionnaire, which was self-administered and completed anonymously between December 2005 and March 2006. For a control group, we used a sample of the autochthonous population (n = 2000). Statistical analysis included Student t test, the chi(2) test, Fisher exact test, and logistical regression analysis.

RESULTS

The attitude toward donation was favorable among 73% of respondents (n = 237), with 7% (n = 22) against and 21% (n = 68) undecided. The attitude was more favorable than among the Spanish control group (73% vs 63%; P = .002). The following variables were related to this attitude: an understanding of the concept of brain death (P = .025); having discussed the matter within the family unit (P < .001); a partner's attitude toward donation (P < .001); being in favor of donating a family member's organs (P < .001); attitude toward cremation (P < .001); attitude toward autopsy (P = .002); and concern about mutilation after donation (P < .001).

CONCLUSIONS

The attitude of Scottish residents in southeastern Spain is more favorable than that of the Spanish population. It is mainly affected by factors related to the family and to the attitude toward manipulation of the cadaver.

Hemodynamic changes during reperfusion of the graft in an animal model of liver xenotransplantation

Our goal was to determine the hemodynamic changes that are witnessed during the initial minutes of reperfusion of the graft in liver xenotransplantation from pig to baboon.

METHOD

We studied a group of 12 baboons undergoing transplantation of a pig liver via the classic technique with arterial anastomosis to the aorta. The anesthesia technique was similar to that used in humans. Hemodynamic monitoring, due to the size of the recipient, consisted of heart rate (HR), mean arterial pressure (MAP), and central venous pressure (CVP) recorded at the beginning and end of each of the three phases: preanhepatic (A1, A2), anhepatic (B1, B2), and neohepatic (C1 and C2). We aimed to maintain the following values by means of crystalloids, colloids, and blood derivates: HR >50 beats/minute; MAP >60 mm Hg; and CVP >10 mm Hg.

RESULTS

Both HR and CVP remained unchanged throughout the procedure. MAP droped briefly after vascular clamping (B1) but not on reperfusion (C1).

CONCLUSION

In cirrhotic patients there is an autonomic dysfunction, demonstrated as cardiovascular instability at times like the clamping of major vessels and reperfusion of the graft. On the other hand, the intact baboon has an intact nervous system. After vascular clamping, the sharp decrease in venous return lead to an adequate vasopressor response. Likewise, the extreme vasodilatation involved with reperfusion managed to maintain MAP above 70 mm Hg.

Hospital Personnel in Surgical Services in a Transplant Hospital Faced With Living Liver Donation: An Attitudinal Survey

Living liver donation is becoming a more widely accepted practice given the decrease in donor morbidity and mortality and the beneficial results in the recipient. Use of this technique is unusual in Spain. There are a number of workers against its use within the health care system. The objective of this study was to analyze attitudes toward and the variables that affect them concerning living liver donation among surgical services in a transplant hospital.

MATERIALS AND METHODS

A random survey was stratified by surgical area and job category in a Spanish third-level hospital with an ongoing solid organ transplant program. Attitudes toward living liver donation were assessed using a questionnaire about organ donation and transplantation that evaluated various psychosocial variables. Student's t test and the chi square test were used.

RESULTS

A total of 263 workers were surveyed (mean age as 40 +/- 9 years). Regarding attitudes toward living liver donation, the level of acceptance was 80% (n = 211) of respondents, whereas 10% were undecided (n = 26), and another 10% were against (n = 26), assuming that the donations were related. When we asked about unrelated living donation, the percentage in favor decreased to 10% (n = 27). No differences were found with respect to job category or type of service. The variables that are related to such an attitude are the following: (1) possibility of respondent needing an organ (P = .001); (2) favorable attitude toward living kidney donation (P < .000); and (3) a belief that medical errors exist (P = .004). An important finding was that attitudes toward living liver donation were not more favorable according to whether the respondent was in favor or against cadaveric organ donation (P = .175).

CONCLUSION

There was a highly favorable attitude toward living liver donation among hospital personnel in surgical services, which is an important factor to take into account if this type of donation is to be encouraged in Spain.

Irish Residents in Southeastern Spain: In Search of Favorable Groups to Encourage Living Kidney Donation in Spain

INTRODUCTION

There has been an increase in the population resident in southeast Spain originating from the British Isles, among them Irish citizens. Living kidney donation rates are currently low in Spain. In an attempt to increase these rates, a search is underway to find groups who are favorable toward this type of donation especially from those countries with high levels of living kidney donation. The objective of this study was to analyze the attitudes toward living kidney donation among the population group originating from Ireland (including Northern Ireland) and who live in southeast Spain.

MATERIALS AND METHODS

A random sample (n = 325) of the population in southeast Spain (Autonomous Community of Murcia) who were born in Ireland completed a validated questionnaire to measure attitudes. The questionnaire was self-administered and was completed anonymously between November 2005 and March 2006. Spanish citizens from an urban and a rural area were used as control groups (n = 500).

RESULTS

The questionnaire completion rate was 81% (n = 262) including 87% (n = 229) of respondents in favor of living related donation and 13% (n = 94) against it. The attitude was similar to that of the urban Spanish control group (87% vs 89%; P = .5832) and more favorable than that of the rural area (87% vs 29%; P < 0.001). With respect to living donation for monetary incentives, 7% (n = 16) reported that they would donate an organ while alive for money, although this would depend on the quantity of money offered; 4% (n = 10) would need to think about it; while the vast majority (81%; n = 212) would never donate an organ in life for money. The following variables influenced attitudes toward living kidney donation: respondent sex (P = .023); previous experience with the donation and transplantation process (P = .004); participation in prosocial activities (P = .016); religion (P = .003); partner's attitude toward the matter (P = .020); concern about "mutilation" after donation (P < .001); and belief that living kidney donation is a risk for the patient (P = .003).

CONCLUSION

Irish citizens living in southeast Spain showed a favorable attitude toward related living kidney donation. Therefore, they are a priority group to whom the option of living kidney donation should be offered when a kidney transplant is needed by an Irish person.

Emigration from the British Isles to southeastern Spain: a study of attitudes toward organ donation

Southeastern Spain is a cosmopolitan area where there is a growing British and Irish population. The objective is to analyze the attitude toward organ donation among British and Irish citizens living in southeastern Spain. A sample was taken stratified according to a respondent's country of origin (n = 1700) between November 2005 and April 2006. Attitude was evaluated using a validated questionnaire, which was self-administered and completed anonymously. A sample of 2000 Spanish citizens was used as a control group. The survey completion rate was 95% (n = 1611). Attitude toward donation is favorable in 72% (n = 1155) of respondents with 8% (n = 122) against and 20% (n = 334) undecided. Attitude is more favorable than in the control group (72% vs. 63%; p < 0.0001). The following factors influence this attitude: (1) attitude toward the donation of a family member's organs (OR = 4.891); (2) having discussed the matter of organ donation within the family (OR = 2.513); (3) a willingness to accept an autopsy if it were necessary (OR = 1.706); (4) having no concern about the mutilation of the deceased donor (OR = 3.294); (5) having a partner who is in favor of donation (OR = 2.786) and (6) a respondent's belief that he or she might need a transplant in the future (OR = 2.243). The attitude of this population is more positive than in the native Spanish population and is determined by many psychosocial factors.

Attitude of hospital personnel faced with living liver donation in a Spanish center with a living donor liver transplant program

In Spain, despite its high rate of cadaveric donation, death while on the liver transplant waiting list is high. For this reason, living liver donation is being encouraged despite of the risk of morbidity for the donor. The objective of this study was to analyze attitudes toward living liver donation among hospital personnel in a hospital with a recently authorized living donor liver transplantation program. A random sample was taken and was stratified by type of service and job category (n = 1,262). Attitude was evaluated by means of a validated psychosocial questionnaire. The questionnaire was completed anonymously and was self-administered. Statistical analysis included the Student t test, the chi(2) test, and logistical regression analysis. The questionnaire completion rate was 93% (n = 1,168). Only 15% (n = 170) of respondents were in favor of living liver donation if it were unrelated. An additional 65% (n = 766) were in favor if this donation, but only for relatives. Of the rest, 9% (n = 107) did not agree with living liver donation, and the remaining 11% (n = 125) were undecided. The variables related to this attitude were age (P = 0.044); job category (P = 0.002); type of service (according to whether it is related to organ donation and transplantation) (P = 0.044); participation in prosocial activities (P = 0.026); attitude toward cadaveric organ donation (P <0.001); attitude of a respondent's partner toward organ donation (P = 0.010); a respondent's belief that in the future, he or she may need a transplant (P < 0.001); and a willingness to receive a donated living liver organ if one were needed (P < 0.001). There is also a close relationship between attitude toward living kidney donation and living liver donation (P < 0.001). In the multivariate analysis, the only common independent variable from the bivariate analysis was a willingness to receive a living donor liver transplant if one were needed (odds ratio = 9.3). Attitude toward living liver donation among hospital personnel in a hospital with a solid organ transplant program is favorable and is affected by factors related to cadaveric donation, altruistic activity, and feelings of reciprocity. Physicians and the youngest hospital workers are those who are most in favor, which leads us to think that there is a promising future for living liver transplantation, which is essential given the cadaveric organ deficit and the high mortality rate while on the waiting list.

Benefit of a Hospital Course About Organ Donation and Transplantation: An Evaluation by Spanish Hospital Transplant Personnel

A considerable percentage of hospital personnel are against organ donation, which at a crucial time could act as an obstacle to donation. Moreover, there is often a lack of training of personnel necessary for them to provide accurate information about organ donation and transplantation. Our objective was to determine the acceptability of a training course about organ donation among hospital workers in a center with an ongoing solid organ transplant program.

MATERIALS AND METHODS

A random sample (n = 1168) was stratified by type of service and job category among workers in hospital services within an organ transplant program. An evaluation was made of attitudes toward donation and acceptance of a training course using a validated psychosocial questionnaire. Distribution of the survey was made by the head of each service and job category. The survey was completed anonymously and self-administered.

RESULTS

Sixty-nine percent (n = 808) of respondents were in favor of donating their own organs. With respect to the benefit of a training course about organ donation and transplantation, 50% (n = 584) of respondents considered it to be a useful idea, whereas 15% (n = 176) did not, and 35% (n = 408) were not sure. An important finding was that 56% (n = 452) of those who are in favor of donation would take part in the course compared to only 37% (n = 132) of those who were against or undecided. There was a significant relationship between those workers who believed that the training course will be of use and the following factors: younger age (P = .000); women (P = .000); single (P = .000); nursing job category (P = .000); a temporary contract (P = .012); a worker in nonsurgical services (P = .000); prior understanding of the concept of brain death (P = .003); favoring cadaveric organ donation (P = .000); performing pro-social voluntary type activities (P = .000); discussions of organ donation and transplantation within the family (P = .022); Catholic religion (P = .001); a partner in favor of organ donation and transplantation (P = .001); and a belief that he may need a transplant (P = .000).

CONCLUSIONS

A training course about organ donation and transplantation might be useful given that only half of the workers would be prepared to take part and with respect to the target population, only 37% of them stating that they would participate. Its main use would be to reinforce the positive attitude of those who are already in favor and increase their knowledge about the subject. What is more, if these workers received adequate training they would serve to promote donation both directly and indirectly to the general public and other hospital personnel.

Personnel in cadaveric organ transplant-related hospital units faced with living liver donation: an attitudinal study in a Spanish hospital with a cadaveric and living liver transplant programme

INTRODUCTION

The attitude of health-care personnel is fundamental for the procurement of transplant organs, especially in those services that are related to transplantation. The objective of this study is to find out the attitude towards living liver donation among personnel who work in transplant-related services in a hospital with a cadaveric and living organ transplant programme.

MATERIALS AND METHODS

A random sample was taken and stratified by type of service and job category (N=330), in services related to transplantation (procurement units, transplant units and follow-up units). Attitude was evaluated using a validated psychosocial questionnaire.

CONTROL GROUP

a random sample of personnel in clinical services that do not have any direct contact with solid organ transplantation. Student's t-test and the chi(2) test complemented by a logistical regression analysis were applied in the statistical analysis.

RESULTS

The questionnaire completion rate was 94% (N=309). Only 10% (N=31) of respondents are in favour of living liver donation if it is unrelated, but another 67% (N=207) are in favour if donation were for a relative. Of the rest, 11% (N=33) do not agree with living liver donation and the remaining 12% (N=38) are undecided. In the control group, attitude towards living liver donation is favourable in 82% (N=344) (P=0.0908). An analysis of the variables that influence attitude shows that the following factors are significantly related: (1) age (P=0.037); (2) a respondent's belief that he or she may need a transplant in the future (P=0.013); and (3) if it were necessary, a willingness to receive a donated living liver organ (P=0.000). Of the variables that have the most influence on attitude towards living liver donation in the bivariate analysis, there are two variables that are statistically significant in the multivariate analysis: (1) age and (2) willingness to accept a donated living liver organ from a relative if it were needed (OR=14.19). There is also a close relationship between attitude towards living liver donation and attitude towards living kidney donation (P=0.000) CONCLUSIONS: There is a favourable attitude towards living liver donation among personnel in units related to the transplantation and donation process, although it is less favourable than expected. Therefore, it will be necessary to increase this level of acceptance and to improve information about the matter if we want to encourage living liver donation. The youngest workers in these units are those who are most in favour, which leads us to believe that there is a hopeful future for this type of liver donation that is so necessary given the cadaveric organ deficit.

Self-assembled monolayer-based piezoelectric flow immunosensor for the determination of canine immunoglobulin

A simple, highly sensitive immunosensor for the direct determination of immunoglobulin (Ig) in canine serum based on a piezoelectric crystal accommodated in a flow-cell was developed and optimized. The new biosensor is also useful for discriminating between Ig subclasses present in canine serum by using specific monoclonal antibodies binding to the coated crystal. Various canine monoclonal anti-IgG were deposited onto the surface of the gold-coated crystal resonator using the self-assembly technique to form a receptor layer. The highly ordered self-assembled monolayers thus obtained provide a well-controlled surface structure and many advantages as regards sensing performance. The results obtained with the proposed immunosensor were compared with those provided by a protein A-based orientation-controlled immobilization method for the same monoclonal antibodies and also with direct physical adsorption of the antibodies. The crystal was accommodated in a flow-cell that was inserted into a buffer flowing stream in order to make resonant frequency measurements.

A new approach using tissue alkaline phosphatase histochemistry to identify Crohn's disease

In the present study, we investigate intestinal alkaline phosphatase activity in mucosal biopsies in patients with inflammatory bowel disease. Crohn's disease influences the alkaline phosphatase activity in the intestine, increasing its activity. We present a histochemistry-based method for alkaline phosphatase that is useful for the identification of Crohn's disease and the differentiation of ulcerative colitis.

British citizens in a regional community of southeastern Spain with a pre-clinical organ xenotransplantation program. A study of attitude toward xenotransplantation

BACKGROUND

It is important to find out about the social acceptance of xenotransplantation, especially in populations where there are pre-clinical xenotransplantation projects, and therefore the possibility of xenotransplantation to humans. In the native population of southeastern Spain this situation is well-known, but in recent years there has been an important social change because of a considerable migrational flow into Spain, especially from the British Isles.

OBJECTIVE

To analyze the attitude toward xenotransplantation among the population living in southeastern Spain born in the British Isles and to determine the variables that affect this attitude.

METHOD

A random sample was taken of British and Irish citizens resident in southeast Spain and stratified according to a respondent's nationality (n = 1700). The data were obtained between November 2005 and April 2006. Attitude was evaluated using a validated questionnaire that was completed anonymously and self-administered. The control group comprised a random sample (n = 250) of the native population. Student's t-test, the chi-squared test, Fischer's exact test and a logistic regression analysis were used in the statistical analysis.

RESULTS

The questionnaire completion rate was 91% (n = 1546), with 69% of respondents in favor of xenotransplantation, 8% against and 23% unsure, an attitude that is similar to that of the control group (P = 0.1616). These attitudes were based on the assumption that transplanted animal organs had the same outcomes and involved the same risks as human ones. This attitude is related to the following factors: (i) being of male sex (P = 0.0477); (ii) level of education (P = 0.012); (iii) being natives from England or Wales (P = 0.016); (iv) participation in voluntary pro-social activities (P = 0.035); (v) the respondent's religion (P < 0.001); (vi) knowing that one's religion has a favorable attitude toward transplantation (P < 0.001); (vii) having discussed the subject of organ donation and transplantation within the family (P < 0.001); (viii) a partner's favorable attitude toward transplantation (P < 0.001); (ix) previous experience of donation or transplantation (P = 0.024); (x) the belief that in the future one might need a transplant (P = 0.007) and (xi) a favorable attitude toward human donation, both deceased and living (P < 0.001). In the multivariate analysis, the following are significant independent variables: sex [odds ratio (OR) = 2.206], a favorable attitude toward deceased donation (OR = 1.977), and attitude toward living donation (OR = 2.097).

CONCLUSIONS

Attitude toward xenotransplantation among British residents who usually live in the southeast of Spain is similar to that of the native Spanish population, and is determined by many psychosocial factors, mainly related to previous attitude toward the different types of human organ donation and the respondent's sex.

Tryptophan metabolism and indoleamine 2,3-dioxygenase expression in coeliac disease

We have investigated the possible role of the metabolism of tryptophan and activity of the enzyme indoleamine 2,3-dioxygenase (IDO) in the immune regulation of coeliac disease (CD). Serum concentrations of tryptophan and its metabolites kinurenines were determined by high performance liquid chromatography in 24 patients with CD, seven patients with Crohn's disease and five healthy patients. We detected an increase of kynurenine (4.2 micromol/l +/- 0.27 versus 2.6 micromol/l +/- 0.54, P < 0002) and of the kynurenine/tryptophan ratio in supernatants of coeliac patients (11.5 micromol/l +/- 1.01 versus 6.5 micromol/l +/- 1.57, P < 0005) in comparison with healthy patients, respectively, and we found no differences with Crohn's disease patients. Immunohistochemistry analysis of intestinal biopsies from CD patients showed an increased expression of IDO, interferon-gamma, interleukin-10 and transforming growth factor-beta. Our data suggest that a mechanism(s) dependent on tryptophan catabolism might regulate the immune responses in CD.

New aspects in celiac disease

Celiac disease (CD) is a common autoimmune disorder characterized by an immune response to ingested gluten and has a strong HLA association with HLA-DQ2 and HLA-DQ8 molecules, but human HLA-DQ risk factors do not explain the entire genetic susceptibility to gluten intolerance. CD is caused by the lack of immune tolerance (oral tolerance) to wheat gluten. In this sense, the expression of soluble HLA-G in CD is of special interest because the molecule plays an important role in the induction of immune tolerance. The enhanced expression of soluble HLA-G found in CD may be part of a mechanism to restore the gluten intolerance. In this editorial, we review recent progress in understanding CD in relation to its prevalence, diagnosis and possible mechanisms of pathogenesis.