Risk assessment of Cryptosporidium intake in drinking water treatment plant by a combination of predictive models and event-tree and fault-tree techniques

Risk-informed decision making permits a more effective water safety management. In this framework, this article introduces the rationale and proposes a new approach to carry out a quantitative risk assessment along the water chain, from river source to tap water, by integrating predictive modelling combined with event-tree and fault-tree techniques. The model developed by this approach could not only account for normal but also for abnormal process conditions in the water treatment plant, as well as assess the real impact of the applied safety controls, such as turbidity control. A sensitivity study was conducted to determine the effect of considering a typical drinking water treatment plant (DWTP), i.e. coagulation, sedimentation and filtration with two turbidity controls (on intake and after filtration) on the risk of infection due to exposure to Cryptosporidium in tap water. The results showed that, with the current effectiveness of turbidity reduction in the DWTP, the first control did not minimise the annual risk of Cryptosporidium infection (3.6E-04) and only limiting turbidity after filtration to below 0.01NTU provided a clear reduction in risk (7.7E-05) at the cost of rejecting 60 % of the water after the control. The lowest risk was found when turbidity reduction was set at 4 logs (8.48E-06), although this means that the effectiveness of turbidity reduction should be greatly improved. It was therefore concluded that supplementing the current treatment with alternative barriers such as UV or ozone disinfection and/or implementing direct control of Cryptosporidium concentration should be considered.

Simplified risk-prediction for benchmarking and quality improvement in emergency general surgery. Prospective, multicenter, observational cohort study

BACKGROUND AND AIMS

Emergency General Surgery (EGS) conditions account for millions of deaths worldwide, yet it is practiced without benchmarking-based quality improvement programs. The aim of this observational, prospective, multicenter, nationwide study was to determine the best benchmark cutoff points in EGS, as a reference to guide improvement measures.

METHODS

Over a 6-month period, 38 centers (5% of all public hospitals) attending EGS patients on a 24-h, 7-days a week basis, enrolled consecutive patients requiring an emergent/urgent surgical procedure. Patients were stratified into cohorts of low (i.e., expected morbidity risk <33%), middle and high risk using the novel m-LUCENTUM calculator.

RESULTS

A total of 7258 patients were included; age (mean ± SD) was 51.1 ± 21.5 years, 43.2% were female. Benchmark cutoffs in the low-risk cohort (5639 patients, 77.7% of total) were: use of laparoscopy ≥40.9%, length of hospital stays ≤3 days, any complication within 30 days ≤ 17.7%, and 30-day mortality ≤1.1%. The variables with the greatest impact were septicemia on length of hospital stay (21 days; adjusted beta coefficient 16.8; 95% CI: 15.3 to 18.3; P < .001), and respiratory failure on mortality (risk-adjusted population attributable fraction 44.6%, 95% CI 29.6 to 59.6, P < .001). Use of laparoscopy (odds ratio 0.764, 95% CI 0.678 to 0.861; P < .001), and intraoperative blood loss (101-500 mL: odds ratio 2.699, 95% CI 2.152 to 3.380; P < .001; and 500-1000 mL: odds ratio 2.875, 95% CI 1.403 to 5.858; P = .013) were associated with increased morbidity.

CONCLUSIONS

This study offers, for the first time, clinically-based benchmark values in EGS and identifies measures for improvement.

Mitosis-targeting therapies: a troubleshooting guide

Several mitotic kinases and kinesins are currently considered as cancer targets based on their critical role during the cell division cycle and their significant level of expression in human tumors. Yet, their use is limited by the lack of selectivity against tumor cells, the low percentage of mitotic cells in many human tumors, and dose-limiting side-effects. As a consequence, initial clinical trials have shown limited responses. Despite these drawbacks, inhibiting mitosis is a promising strategy that deserves further development. Future advances will benefit from more specific inhibitors with better pharmacodynamic properties, a clear physiological characterization and cell-type-specific requirements of old and new mitotic targets, and rational strategies based on synthetic lethal interactions to improve selectivity against tumor cells.

New mutations in chronic lymphocytic leukemia identified by target enrichment and deep sequencing

Chronic lymphocytic leukemia (CLL) is a heterogeneous disease without a well-defined genetic alteration responsible for the onset of the disease. Several lines of evidence coincide in identifying stimulatory and growth signals delivered by B-cell receptor (BCR), and co-receptors together with NFkB pathway, as being the driving force in B-cell survival in CLL. However, the molecular mechanism responsible for this activation has not been identified. Based on the hypothesis that BCR activation may depend on somatic mutations of the BCR and related pathways we have performed a complete mutational screening of 301 selected genes associated with BCR signaling and related pathways using massive parallel sequencing technology in 10 CLL cases. Four mutated genes in coding regions (KRAS, SMARCA2, NFKBIE and PRKD3) have been confirmed by capillary sequencing. In conclusion, this study identifies new genes mutated in CLL, all of them in cases with progressive disease, and demonstrates that next-generation sequencing technologies applied to selected genes or pathways of interest are powerful tools for identifying novel mutational changes.

Food safety objectives for Listeria monocytogenes in Spanish food sampled in cafeterias and restaurants

To gain more insight into the context of food safety management by public administrations, food safety objectives must be studied. The Valencian administration quantified the prevalence of Listeria monocytogenes in cafeterias and restaurants in this region of Spain between 2002 and 2010. The results obtained from this survey are presented here for 2,262 samples of fish, salad, egg, cold meat, and mayonnaise dishes. Microbiological criteria defined for L. monocytogenes were used to differentiate acceptable and unacceptable samples; more than 99.9% of the samples were acceptable. These findings indicate that established food safety objectives are achievable, consumer health at the time of consumption can be safeguarded, and food safety management systems such as hazard analysis critical control point plans or good manufacturing practices implemented in food establishments are effective. Monitoring of foods and food safety is an important task that must continue to reduce the current L. monocytogenes prevalence of 0.1% in restaurant or cafeteria dishes, which could adversely affect consumer health.

Endoscopist experience as a risk factor for colonoscopic complications

AIM

We aimed to determine the incidence of colonic perforation (CP) following colonoscopy and postpolypectomy bleeding (PPB) in a teaching hospital, assessing the influence of endoscopist experience as a risk factor.

METHOD

All colonoscopies performed between 1995 and 2008 were reviewed. Demographic data, endoscopic procedure information, incidence of CP and PPB, and endoscopist experience were recorded.

RESULTS

In the 14-year period, 25,214 endoscopic colonic procedures were performed, and 3991 patients underwent polypectomy. The overall CP risk was 0.51/1000 procedures; and PPB 14.7/1000. The relative risk (RR) ratio of complications was 2.8/1000 procedures. The RR rate was highest for endoscopists performing less than 591 procedures per year (4.0/1000 [95% CI, 3.7-4.3] vs 2.9/1000 [95% CI, 2.6-3.2]), P < 0.001).

CONCLUSION

The complication rate after colonoscopy was comparable to that previously reported. Colonoscopy carried out by a low-volume endoscopist was independently associated with bleeding and perforation.

Age-related increase in xanthine oxidase activity in human plasma and rat tissues

This study assessed the role of xanthine oxidase in vascular ageing. A positive correlation between xanthine oxidase activity and age was found in human plasma. Similar results were found in rat plasma. Xanthine oxidase expression and activity in homogenates from the aortic wall were significantly higher in samples from old rats than in their young counterparts (p < 0.01). In rat skeletal muscle homogenates both xanthine oxidase expression and activity showed a similar age-related profile. Superoxide production by xanthine oxidase in aortic rings was higher in aged rats. Uric acid, the final product of xanthine oxidase has been proposed as a risk factor for coronary heart disease and an independent marker of worse prognosis in patients with moderate-to-severe chronic heart failure. These results give a possible explanation for this correlation and underscore the role of xanthine oxidase in ageing.

[Recommendations for the prevention of respiratory syncytial virus infection]

Premature babies < or = 35 weeks gestation, with or without chronic lung disease (CLD), and infants affected by severe congenital heart disease should be considered high risk population for RSV infection and hospitalization. Hygienic measures and RSV monoclonal antibodies (palivizumab) have been found useful in decreasing rates of RSV hospitalization in these patients. Guidelines for their administration include: a) strongly recommended use in premature babies < or = 28 weeks gestation, or born between 29-32 weeks gestation and less than 6 months at start of RSV station or discharged along it, or affected by CLD in treatment during last 6 months or by severe congenital heart disease. Last two groups could be prophylaxed for two RSV seasons. b) Recommended use among premature babies between 32-35 weeks gestation and less than 6 months of age and presenting two or more risk factors: chronologic age < 10 weeks at start of RSV station, breastfeeding < or = 2 months (physician prescription), sibling < 14 years old, day-care assistance, family history of wheezing, > or = 4 adults at home, airways malformation or neuromuscular disease.

Occult liver involvement by polyarteritis nodosa

The diagnosis of panarteritis nodosa is usually difficult because of the variability of clinical manifestations. Herein is presented a case of occult liver involvement by polyarteritis nodosa. Several biopsies were performed but the diagnosis was made with the contribution of a hepatic arteriography.

Zinc and perinatal growth

AIM

To study the relationship between zinc, insulin-like growth factor (IGF-I), osteocalcin and perinatal growth.

MATERIALS AND METHODS

Anthropometric variables, serum levels of IGF-I, osteocalcin and zinc were measured in preterm (PT) appropriate for gestational age (AGA), full term (FT) small for gestational age (SGA) and FT AGA newborns at birth (n=52), at first week (n=38) and at third week (n=38) of postnatal age.

RESULTS

At birth, the FT SGA had lower levels of IGF-I. At the first week after birth, both FT SGA and PT AGA infants had less deposits of subcutaneous fat; FT SGA infants also showed significantly lower osteocalcin and zinc levels. At 3 weeks of postnatal life, FT SGA infants continued to show significantly lower zinc levels. They had increased their fat deposits so that differences between groups in skinfold measurements failed to be significant. The highest levels of osteocalcin were found in PT AGA infants at the third week after birth.

CONCLUSIONS

Perinatal nutrition influences the IGF-I levels. The low concentration of osteocalcin found in SGA infants at first week of life probably reflects decreased bone turnover. During the first weeks of life, there is a progressive decrease in the serum levels of zinc, accentuated in the FT SGA group.

Cord blood levels of cytokines as predictors of early neonatal sepsis

AIM

To investigate whether cord blood levels of C-reactive protein, interleukin-1beta, interleukin-6, interleukin-8, tumour necrosis factor-alpha and the soluble receptor of interleukin-2, are useful markers in the diagnosis of early neonatal sepsis.

DESIGN

Umbilical cord blood samples were obtained at birth from 261 neonates, but 5 of these newborns were excluded from the study. Group I included 10 newborns that developed early neonatal sepsis with a positive blood culture; Group II included 11 newborns with non-infectious perinatal diseases; Group III, which served as the control group, included 10 randomly selected patients, matched for gestational age, among the 235 healthy newborn babies.

RESULTS

There were no differences among the three study groups in levels of C-reactive protein. interleukin-1beta, tumour necrosis factor-alpha and the soluble receptor of interleukin-2. Interleukin-6 was significantly elevated in Group I (360.4+/-157.8 pg/ml) and Group II (158.8+/-122.3 pg/ml), when compared with Group III (8.6+/-3.12 pg/ml) (p < 0.01), whereas interleukin-8 was significantly elevated in Group I (389.3+/-115.9 pg/ml) compared with Groups II (30.2+/-5.1 pg/ml) (p < 0.05) and III (33.9+/-8.6 pg/ml) (p < 0.05). A cut-off of 100.8 pg/ml for interleukin-6 obtained by the ROC (receiver operating characteristic) method gave a sensitivity of 50% and a specificity of 87%, and a cut-off of 111.7 pg/ml for interleukin-8 showed a sensitivity of 78% and a specificity of 91%.

CONCLUSION

While cord blood levels of interleukin-6 appear to be related to pathological conditions in the perinatal period (infectious and non-infectious), interleukin-8 seems to be a good predictor of early bacterial neonatal infection.

Rehospitalization because of respiratory syncytial virus infection in premature infants younger than 33 weeks of gestation: a prospective study. IRIS Study Group

OBJECTIVE

To collect data on hospitalization for respiratory syncytial virus (RSV) infections and presumptive risk factors for rehospitalization among premature infants in Spain.

DESIGN

Observational, prospective, longitudinal, multicenter study.

SETTING

Fourteen Spanish neonatal units with an annual birth cohort of 57,000 infants.

PATIENTS

All children (n = 680) born < or =32 weeks of gestational age between April 1, 1998, and March 31, 1999, and discharged from the hospital before March 31, 1999, were included in the study. A total of 96 were excluded because of administration of prophylactic treatment (n = 55) or were lost to follow-up (n = 41). Five children died during the study period, but death was related to RSV in only 1 case.

METHODS AND MAIN OUTCOME MEASURES

Neonatal and demographic data were recorded at the initial visit. Infants were prospectively followed at monthly intervals up to March 31, 1999. In patients rehospitalized for respiratory disorders, further data about RSV status and morbidity were collected. A comparison was made between children rehospitalized for RSV infection and those who were not. The influence of factors on the probability of rehospitalization for RSV infection was assessed by logistic regression analysis.

RESULTS

Of the 584 evaluable patients 118 (20.2%) were rehospitalized for respiratory disease during the study period. The causative pathogen was identified in 89 (75.4%) hospital admissions. Of these 59 (66.3%) were a result of RSV infection in 53 children; 6 were reinfections. In a logistic regression model significant independent prognostic variables included: lower risk of RSV hospitalization with increase gestational age [odds ratio (OR), 0.85; 95% confidence interval (CI), 0.72 to 0.99; P < 0.047]; higher risk with chronic lung disease (OR = 3.1; 95% CI 1.22 to 7.91; P < 0.016); and living with school age siblings (OR = 1.86; 95% CI 1.01 to 3.4; P < 0.048).

CONCLUSION

This large descriptive study has enabled us to define the influence of specific risk factors that increase the risk of rehospitalization for RSV infection in preterm infants. Such studies help to define the appropriate role of available prophylactic interventions and establish treatment guidelines.

[High-frequency oscillatory ventilation as salvage strategy in the newborn infant. Spanish multicenter study. I]

OBJECTIVE

The aim of this study was to evaluate the results of high frequency ventilation (HFV) used as a rescue strategy in newborn infants with severe lung disease who either failed conventional mechanical ventilation (CMV) or had an air block.

PATIENTS AND METHODS

From April 1995 to June 1998, 241 infants with severe lung disease and managed according to a common protocol of HFV used as a rescue strategy were prospectively evaluated in the nine participating level III Spanish Neonatal Intensive Care Units. The most frequent diagnoses were respiratory distress syndrome (119), meconium aspiration (24), pneumonia (19) and congenital diaphragm hernia (18).

RESULTS

Mean +/- SD gestational age and birth weight were 32.0 +/- 5.5 weeks and 1,187 +/- 1,071 g, respectively. All babies were previously manages with CMV for a mean of 59 hours. HFV was started at a mean postnatal age of 82 hrs, with a mean oxygenation index (OI) of 28.3 +/- 15.3 and an a/A DO2 of 0.10 +/- 0.08. Initial mean HFV settings were: mean airway pressure 12.8 +/- 3.4 mbar, frequency 8.3 +/- 1.4 Hz, amplitude 53 +/- 20 percent, tidal volume 2.2 +/- 0.7 ml/kg and FiO2 0.88 +/- 0.2. At two hours of HFV there was a significant increase in the mean PaO2 (from 48 to 80 mmHg), with a concomitant decrease in FiO2 (from 0.88 to 0.79), PaCO2 (from 60 to 46 mmHg) and OI (from 28 to 18). Mean a/A DO2 increased from 0.10 to 0.19; these changes remained similar thereafter. HFV was suspended after a mean of 95 hrs because of improvement in 70%, death in 19% and failure to improve the clinical condition in the remaining 19%. Intrahospital death rate was 32%. The following complications were observed: pneumothorax (10%), interstitial emphysema (4%), intraventricular hemorrhage grades III and IV (14.5%) and bronchopulmonary dysplasia (35%).

CONCLUSIONS

HFV is an effective rescue strategy that improves pulmonary gas exchange within two hours of its initiation.

Smoking and trait anxiety

Smoking behavior was not associated with trait anxiety scores for a sample of 290 Spanish youth of 18 years.

[Pseudotumorous hyperplasia of the caudate lobe of the liver in a patient with Alagille syndrome]

The Alagille's syndrome consists in hypoplasia of the intrahepatic biliary ducts associated to congenital abnormalities of different organs. It is usually diagnosed in infancy due to cholestasis with good prognosis. The case of a 31-year old women who presented prominent chin, micrognathia, flattening of the nasal bone, infundibular stenosis of the pulmonary artery and cholestasis is reported. Ultrasonography demonstrated a lesion in the space of the hepatic caudate lobe with punction showing sinusoidal dilatation and infiltration of some portal spaces by lymphocytes, eosinophils and neutrophils. Samples of liver tissue obtained during laparotomy showed an absence of intrahepatic biliary ducts in the right and left lobes and preservation of those of the caudate lobe, which was also increased in size with a pseudotumoral appearance. The patients was asymptomatic with slight anicteric cholestasis at 16 months of diagnosis. The rarity of these forms of Alagille's syndrome with areas free of hypoplasia of the intrahepatic biliary ducts are of note.

Short-term prognosis of cirrhotics with spontaneous bacterial peritonitis: multivariate study

In order to identify the predictive factors of hospital mortality in cirrhotics with spontaneous bacterial peritonitis (SBP), we studied 64 patients who fulfilled the accepted diagnostic criteria. All cases were treated with cefotaxime up to 2 days after the infection was considered cured (7.7 +/- 2.9 days). Eleven patients (17%) died while in hospital, six of them before SBP was cured. After uni- and multivariate analyses, only seven routine clinical, biological, and bacteriological variables studied were independently associated with hospital mortality. These were: the presence of upper gastrointestinal bleeding at admission (beta = 2.01), the absence of abdominal pain as presenting symptom (beta = -1.29), the polymorphonuclear count (%) in the ascites (beta = 0.48), prothrombin rate (beta = -0.22), and serum Na (beta = -0.64), creatinine (beta = 0.50), and cholesterol (beta = -0.68). When the equation obtained was computed in a randomly selected sample of the patients studied, it correctly predicted the outcome in 92.3% of the cases. We conclude that short-term outcome of SBP patients depends on the existence of recent gastrointestinal bleeding, the severity of SBP, and the degree of liver and renal failure. The prognostic value of this model needs prospective validation in a new series of patients.

Sustained attention deficit in young schizophrenic and schizotypic men

We studied groups of 39 schizophrenic subjects, 35 schizotypic subjects, and 33 control subjects, comparing them on a standard sustained attention task called the Continuous Performance Test (identical pairs version). The expected negative relationship between performance on sustained attention and psychopathology was confirmed by differences among the three groups which were in the direction predicted, although only the difference between the schizophrenic group and the other two groups was significant. This finding adds evidence to the view from research on high risk and attention with schizophrenic subjects that subtle attention deficits are present among subjects within the schizophrenia spectrum. Consequently, our results can be understood as supporting a dimensional theory of psychopathology.

[Hepatic changes in patients with isolated immunodeficiency virus infection and AIDS]

BACKGROUND

The aim of the present study was to describe the spectrum of liver disease in isolated infection by the human immunodeficiency virus and in the acquired immunodeficiency syndrome as well as evaluate whether clinical and/or biological data exist to permit specific diagnosis in liver biopsy.

METHODS

Liver biopsy was performed in 39 patients with the human immunodeficiency virus (34 via parenteral drug addicts), 22 of whom had established acquired immunodeficiency syndrome.

RESULTS

In 29 cases (74%) a specific histologic diagnosis was obtained with the changes most frequently found being the presence of granulomas (11 patients), mainly in patients with stablished AIDS, and chronic active hepatitis non A non B (10 patients), specially in the cases with isolated infection by the human immunodeficiency virus. Obtaining of a specific diagnosis was associated with an increase in GOT and a decrease of the CD4 lymphocytes and the CD4/CD8 quotient (p = 0.002 in all cases). The existence of established AIDS or prolonged fever was associated with the finding of hepatic granulomas (p = 0.02 and p = 0.002, respectively). The increase in GPT, the absence of stablished AIDS and the absence of prolonged fever was associated to the presence of chronic active hepatitis (p = 0.01, p = 0.002 and p = 0.0002, respectively).

CONCLUSIONS

In patients with infection by the human immunodeficiency virus liver biopsy provides diagnostic information in a high percentage of cases. The presence of established AIDS, prolonged fever, and hypertransaminasemia may point towards possible histologic diagnosis.

[Abdominal tuberculosis in patients with acquired immunodeficiency syndrome]

BACKGROUND

In individuals with HIV infection, extrapulmonary forms of tuberculosis are considered as opportunistic infections and are included in the diagnosis of AIDS. They often have atypical clinical features. Abdominal participation is uncommon and its diagnosis may be difficult.

METHODS

The clinical, radiological and pathological features of patients with a diagnosis of AIDS with abdominal tuberculosis in a series of 254 AIDS cases in a general hospital from 1984 to October 1990 were reviewed.

RESULTS

Tuberculosis developed in 104 (41%) of AIDS patients. In 25 (24%) the disease was exclusively pleuropulmonary and in 79 (76%) extrapulmonary tuberculosis was present, either alone or in association. Extrapulmonary tuberculosis was the first opportunistic infection in 66 AIDS cases (26%). The abdominal participation was demonstrated in 19 patients, with the following localizations: lymph nodes (9), liver (8), spleen (5), ileum (1) and peritoneum (1). Four patients with splenic tuberculosis also had multifocal nodular lesions.

CONCLUSIONS

Abdominal participation was found in 19 of the 104 AIDS patients with tuberculosis (18%). Lymph node involvement was the most common type. Hepatosplenic tuberculosis had a miliary form or showed multifocal images in echography or computed tomography.

[Impact on the energetic-proteic nutritional status of total paracentesis combined with infusion of albumin or dextran-70 in the therapy of tension ascites in liver cirrhosis]

The aim of this study was to investigate the effect of total paracentesis plus albumin or dextran-70 infusion on the nutritional status in cirrhotics with tense ascites. Seventeen patients were studied. Eight patients (group I) were treated with total paracentesis and albumin infusion, and in 9 cases (group II) dextran-70 infusion was associated to total paracentesis. The nutritional status was assessed before and two days after the procedure by measuring triceps skinfold thickness, mid-arm muscle circumference and serum albumin. No changes in anthropometric parameters were observed in either group. Patients in group I showed a significant increase in serum albumin levels (from 26.6 +/- 1.4 to 28.9 +/- 1.3 g/l; p = 0.007), whereas this parameter decreased in group II (from 25.5 +/- 1.3 to 23.1 +/- 1.4 g/l; p = 0.005). However, serum albumin levels returned to initial values in both groups one month after total paracentesis. There were no differences between both groups regarding the appearance of complications and mortality rate during admission. These results suggest that total paracentesis plus either i.v. albumin or dextran-70 has no long-term effect on the protein-energy nutritional status.

Peer Nomination Inventory of Depression: characteristics in a Spanish sample

The Peer Nomination Inventory of Depression (PNID) was answered by 1,121 children from Barcelona in the fourth year of grammar school and by their teachers (n = 36) to analyze this questionnaire in a Spanish sample. The results indicated (1) high internal consistency; (2) discriminative power between depressed and nondepressed; (3) low concurrent validity; (4) convergent and discriminant validity; (5) a two-factor structure; and (6) that two discriminant functions could differentiate between depressed, dysthymic, and nondepressed subjects. The teacher's responses showed (1) moderate internal consistency; (2) discriminative power between depressed and nondepressed groups; (3) moderate concurrent validity; (4) and that two discriminant functions could differentiate between the diagnostic groups. The importance of the information given by the teacher to help detect severe depressive problems was pointed out.

[Electroencephalographic maturation in preterm newborn infants]

We have studied 51 preterm infants [gestational age (GE) less than 32 weeks] by: a neurologic examination at 40 weeks of postconceptional age, serial cranial ultrasonographies, weekly electroencephalograms (EEG) until 42 weeks of postconceptional age, and Brunet-Lezine test of psychomotor developmental at 1 year old. Our objective is the longitudinal study of EEG maturation in preterm infants with or without neurologic injury. In preterm infants with the less gestational age are present the EEG characteristics reported for the older infants, the typical EEG pattern is the "sawtooth" (27-30 weeks GE). If these infants are "normal", the EEG maturation get adjusted to the previous reported pattern, except for the earlier presentation of transitory acute frontal waves and the disappearance of the preterm's discontinuous trace. The EEG maturation of preterm infants with perinatal neurologic injury are significantly delayed in contrast with "normal" preterm infants until 40 weeks of postconceptional age; this fact have a poor prognosis for these infants.

[Serum zinc during labor and in the newborn infant at term]

A study of serum zinc by atomic absorption spectrophotometry was carried out in peripheral blood samples form a group of 30 full-term mothers and umbilical cord samples from their newborns. Peripheral blood samples from 15 non-pregnant healthy women and umbilical cord samples collected within the first 24 hours in 20 healthy newborns were also obtained. Serum zinc in non-pregnant women yielded higher values which were significant (p less than 0,01), any way, the level of significance was higher when authors compared full term pregnant women with full term newborns in the first day of life.

[Effects of the administration of a diet with a low content of calcium and vitamin D derivatives on mineralization in pregnant rats and their fetuses]

Calcemia and calcium content of femuri has been determined in 88 female adult Wistar rats, distributed in four groups: Group A was given a normocalcic diet, group B a hypocalcic diet and groups C and D were also given the same hypocalcic diet, but at the same time were administered DHT and vitamin D (CC) respectively (15 mcg 3 times weekly). They were all killed 21 days after having been with a male for 24 hours; four rats were pregnant in each group A, B and C with a total offspring of 26, 22 and 35 fetuses respectively. Three pregnant rats in group C, gave 19 fetuses. Rats on hypocalcic diet showed a lower bone calcium content referred to 100 mg as weight, in comparison with those on a normocalcic diet (F = 5.51; p less than 0.01). Administration of CC or DTH did not hinder bone calcium depletion, which was more noticeable in pregnant rats (p less than 0.05). Concerning to calcemia, no differences existed between pregnant and non pregnant rats, there was a significant lowering of calcemia (F = 14.3; p less than 0.01) in rats on the hypocalcic diet (group B), but when administration of vitamin D (group D) and DHT (group C) was done, calcemia remained respectively equal and higher (p less than 0.001) by comparison to group A. Total calcium content in the ashed fetuses was similar in all groups. Fetuses acted as parasites of their mothers in respect to quantities of calcium deposited in them.

[Anorexia nervosa. Presentation of two cases]

Two patients with anorexia nervosa were studied. One of them showed cerebral atrophy by computed tomography (CT) of the brain. This finding has been reported previously in three cases. No other reports have been found in Spanish literature. This data could be merely a CT finding. Etiopathogenic and therapeutic evolution is discussed. Behavior modification, based in experimental psychology was used in treatment. Hypercaloric and hyperproteic feeding was also used.