Detection of Antibodies for Pathogenic Leptospira in Wild Mammals and Birds from Southern Chile-First Record of Seropositivity in a Guiña (Leopardus guigna)

Leptospirosis is a neglected bacterial zoonotic disease of worldwide distribution that is present in different animal species. This epidemiological study determined the seroprevalence of pathogenic Leptospira spp. in animals at a wildlife rehabilitation center in Puerto Montt, southern Chile, by sampling 60 animals belonging to three classes (birds, mammals, and reptiles). Diagnosis was performed using the microscopic agglutination test with a panel of eight serovars and serogroups. The results showed that 15 animals had anti-Leptospira antibodies, obtaining a seroprevalence of 25.00%, with Leptospira borgpetersenii serogroup Tarassovi presenting reactivity in 13 of the seropositive animals. Among the classes of mammals, chilla foxes (Lycalopex griseus) and pudus (Pudu puda) were seropositive. A guiña (Leopardus guigna) was also seropositive, which was described for the first time in mammals. Among the classes of birds, choroy parrots (Enicognathus leptorhynchus), bandurrias (Theristicus melanopis), and Magellanic penguins (Spheniscus magellanicus) were seropositive. Routine examinations to diagnose leptospirosis, perform epidemiological surveillance, and apply prevention and control measures are necessary, and additional research focusing on the One Health approach to explore the epidemiological role of different wild animal species in the maintenance and transmission of leptospirosis at the local and global levels are recommended.

An Autologous Protein-Based Topical Ointment for Hard-to-Heal Skin Wounds: A Multiple Case Series

BACKGROUND

There is increasing evidence regarding the wound healing potential of platelet-derived autologous by-products. We provide preliminary data regarding the use of a new plasma rich in growth factors-derived autologous topical ointment for the management of hard-to-heal wounds.

CASES

Four patients suffering from difficult-to-heal wounds were treated with the autologous ointment. Within 2 to 8 weeks, all wounds healed completely with no signs of infection or functional impairment of the affected limbs. No adverse events were reported.

CONCLUSION

Randomized and controlled trials are needed to determine the clinical efficacy of the autologous ointment. Nevertheless, results from this multiple case series indicate that this approach may be useful for accelerating the re-epithelization of difficult-to-heal wounds.

In vitro and in vivo Effect of Platelet-Rich Plasma-Based Autologous Topical Serum on Cutaneous Wound Healing

INTRODUCTION

Skin injury and wound healing is an inevitable event during lifetime. However, several complications may hamper the regeneration of the cutaneous tissue and lead to a chronic profile that prolongs patient recovery. Platelet-rich plasma is rising as an effective and safe alternative to the management of wounds. However, this technology presents some limitations such as the need for repeated blood extractions and health-care interventions.

OBJECTIVE

The aim of this study was to assess the use of an endogenous and storable topical serum (ES) derived from plasma rich in growth factors promoting wound healing, and to obtain preliminary data regarding its clinical and experimental effect over ulcerated skin models and patient care.

METHODS

Human dermal fibroblast and 3D organotypic ulcerated skin models were used to assess ES over the main mechanisms of wound healing including cell migration, edge contraction, collagen synthesis, tissue damage, extracellular matrix remodeling, cell death, metabolic activity, and histomorphometry analysis. Additionally, 4 patients suffering from skin wounds were treated and clinically assessed.

RESULTS

ES promoted dermal fibroblast migration, wound edge contraction, and collagen synthesis. When topically applied, ES increased collagen and elastin deposition and reduced tissue damage. The interstitial edema, structural integrity, and cell activity were also maintained, and apoptotic levels were reduced. Patients suffering from hard-to-heal wounds of different etiologies were treated with ES, and the ulcers healed completely within few weeks with no reported adverse events.

CONCLUSION

This preliminary study suggests that ES might promote cutaneous wound healing and may be useful for accelerating the re-epithelization of skin ulcers.

Predictive capacity of prodromal symptoms in first-episode psychosis of recent onset

BACKGROUND

Both the nature and number of a wide range of prodromal symptoms have been related to the severity and type of psychopathology in the psychotic phase. However, at present there is an incomplete picture focused mainly on the positive pre-psychotic dimension.

AIM

To characterize the prodromal phase retrospectively, examining the number and nature of prodromal symptoms as well as their relationship with psychopathology at the onset of first-episode psychosis.

METHODS

Retrospective study of 79 patients experiencing a first-episode psychosis of less than 1 year from the onset of full-blown psychosis. All patients were evaluated with a comprehensive battery of instruments including socio-demographic and clinical questionnaire, IRAOS interview, PANSS, stressful life events scale (PERI) and WAIS/WISC (vocabulary subtest). Bivariate associations and multiple regression analysis were performed.

RESULTS

Regression models revealed that several prodromal dimensions of IRAOS (delusions, affect, language, behaviour and non-hallucinatory disturbances of perception) predicted the onset of psychosis, with positive (22.4% of the variance) and disorganized (25.6% of the variance) dimensions being the most widely explained.

CONCLUSION

In addition to attenuated positive symptoms, other symptoms such as affective, behavioural and language disturbances should also be considered in the definitions criteria of at-high-risk people.

Outcomes and prognostic factors in intermediate-risk prostate cancer: multi-institutional analysis of the Spanish RECAP database

PURPOSE

To retrospectively assess outcomes and to identify prognostic factors in patients diagnosed with intermediate-risk (IR) prostate cancer (PCa) treated with primary external beam radiotherapy (EBRT).

MATERIALS AND METHODS

Data were obtained from the multi-institutional Spanish RECAP database, a population-based prostate cancer registry in Spain. All IR patients (NCCN criteria) who underwent primary EBRT were included. The following variables were assessed: age; prostate-specific antigen (PSA); Gleason score; clinical T stage; percentage of positive biopsy cores (PPBC); androgen deprivation therapy (ADT); and radiotherapy dose. The patients were stratified into one of three risk subcategories: (1) favourable IR (FIR; GS 6, ≤ T2b or GS 3 + 4, ≤ T1c), (2) marginal IR (MIR; GS 3 + 4, T2a-b), and (3) unfavourable IR (UIR; GS 4 + 3 or T2c). Biochemical relapse-free survival (BRFS), disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS) were assessed.

RESULTS

A total of 1754 patients from the RECAP database were included and stratified by risk group: FIR, n = 781 (44.5%); MIR, n = 252 (14.4%); and UIR, n = 721 (41.1%). Mean age was 71 years (range 47-86). Mean PSA was 10.4 ng/ml (range 6-20). The median radiotherapy dose was 74 Gy, with mean doses of 72.5 Gy (FIR), 73.4 Gy (MIR), and 72.8 Gy (UIR). Most patients (88%) received ADT for a median of 7.1 months. By risk group (FIR, MIR, UIR), ADT rates were, respectively, 88.9, 86.5, and 86.9%. Only patients with ≥ 24 months of follow-up post-EBRT were included in the survival analysis (n = 1294). At a median follow-up of 52 months (range 24-173), respective 5- and 10-year outcomes were: OS 93.6% and 79%; BRFS 88.9% and 71.4%; DFS 96.1% and 89%; CSS 98.9% and 94.6%. Complication rates (≥ grade 3) were: acute genitourinary (GU) 2%; late GU 1%; acute gastrointestinal (GI) 2%; late GI 1%. There was no significant association between risk group and BRFS or OS. However, patients with favourable-risk disease had significantly better 5- and 10-year DFS than patients with UIR: 98.7% vs. 92.4% and 92% vs. 85.8% (p = 0.0005). CSS was significantly higher (p = 0.0057) in the FIR group at 5 (99.7% vs. 97.3%) and 10 years (96.1% vs. 93.4%). On the multivariate analyses, the following were significant predictors of survival: ADT (BRFS and DFS); dose ≥ 74 Gy (BRFS); age (OS).

CONCLUSIONS

This is the first nationwide study in Spain to report long-term outcomes of patients with intermediate-risk PCa treated with EBRT. Survival outcomes were good, with a low incidence of both acute and late toxicity. Patients with unfavourable risk characteristics had significantly lower 5- and 10-year disease-free survival rates. ADT and radiotherapy dose ≥ 74 Gy were both significant predictors of treatment outcomes.

Determining personalized treatment by gene expression profiling in metastatic breast carcinoma patients: a pilot study

PURPOSE

The present study evaluates the massive study of gene expression in metastatic breast carcinoma (MBC) patients using microarray gene expression profiling (MAGE) complemented with conventional sequencing, immunohistochemistry (IHC) and fluorescent "in situ" hybridization (FISH), seeking to optimize the treatment in a subset of heavily pretreated patients and with limited life expectancy.

PATIENTS, MATERIAL AND METHODS

MBC patients in hormone therapy progression with survival expectancy of at least 3 months (m) have been included. The MAGE contains gene probes representing genes known to potentially interact with available drugs as cited in the literature.

RESULTS

Thirty-nine procedures were performed from October 2010 to April 2016. Within the 30 evaluable procedures, considering all hormonal manipulations as a single line, the patients had received a median of 4 treatment lines prior to MAGE (range 1-7). Progression was observed in 6 cases, stable disease (SD) in 7 cases and partial response (PR) in 16 cases, which implies a clinical benefit rate (SD + PR) of 76%. Actuarial median progression-free survival (PFS) was 6 m (95% CI 2.5-9.5) in patients with clinical benefit. The median overall survival (OS) for the entire series was 11 m (95% CI 2.2-19.8).

CONCLUSION

Data presented here indicate that the use of MAGE provides relevant information to establish personalized treatment in frail patients with limited life expectancy in which therapeutic futility is a particularly difficult burden to assume.

Hematological complications in children subjected to extracorporeal membrane oxygenation

OBJECTIVES

To analyze the hematological complications and need for transfusions in children receiving extracorporeal life support (ECLS).

DESIGN

A retrospective study was carried out.

SETTING

A pediatric intensive care unit.

PATIENTS

Children under 18 years of age subjected to ECLS between September 2006 and November 2015.

INTERVENTIONS

None.

VARIABLES OF INTEREST

Patient and ECLS characteristics, anticoagulation, hematological and coagulation parameters, transfusions and clinical course.

RESULTS

A total of 100 patients (94 with heart disease) with a median age of 11 months were studied. Seventy-six patients presented bleeding. The most frequent bleeding point was the mediastinum and 39 patients required revision surgery. In the first 3days, 97% of the patients required blood transfusion (34.4ml/kg per day), 94% platelets (21.1ml/kg per day) and 90% plasma (26.6ml/kg per day). Patients who were in the postoperative period, those who were bleeding at the start of ECLS, those requiring revision surgery, those who could not suspend extracorporeal circulation, and those subjected to transthoracic cannulation required a greater volume of transfusions than the rest of the patients. Thromboembolism occurred in 14 patients and hemolysis in 33 patients. Mortality among the children who were bleeding at the start of ECLS (57.6%) was significantly higher than in the rest of the patients (37.5%) (P=.048).

CONCLUSIONS

Children subjected to ECLS present high blood product needs. The main factors related to transfusions were the postoperative period, bleeding at the start of ECLS, revision surgery, transthoracic cannulation, and the impossibility of suspending extracorporeal circulation. Children with bleeding suffered greater mortality than the rest of the patients.

Relationship among color development, anthocyanin and pigment-related gene expression in 'Crimson Seedless' grapes treated with abscisic acid and sucrose

'Crimson Seedless' is one of the most important table grape varieties in Chile, but under certain environmental conditions, the fruit exhibits inadequate red color development, causing economic losses due to lower product quality. The use of plant growth regulators, such as abscisic acid (ABA) and ethylene, during development increases the anthocyanin content of the skin, improving the color of the berry. Recently, sucrose has been identified as a signaling molecule capable of regulating the expression of genes of the anthocyanin biosynthesis pathway. The aim of this study was to analyze the effect of application of ABA and/or sucrose on color development and their relationship with anthocyanin metabolism. Applications of ABA (400 ppm or 200 ppm) and/or sucrose (90 mM) were performed close to the véraison stage. During development and at harvest, quality attributes such as berry firmness, total soluble solids and titratable acidity were not affected by these treatments. Increased red color development was observed in fruits treated with ABA and/or sucrose, due to accumulation of anthocyanins. Fruits subjected to sucrose treatment showed higher levels of anthocyanins than untreated fruits but lower levels than fruits treated with ABA. Increased expression of genes involved in anthocyanin biosynthesis was observed in ABA- and sucrose-treated fruits compared to untreated fruits. Based on these findings, we demonstrated that sucrose improved fruit color development by increasing synthesis and accumulation of anthocyanins, thus allowing earlier harvests and improving table grape quality.

Psychotherapeutic Iinterventions in Transition Unit

Introduction.

The In-patient units are very closed and highly controlled healthcare resource and then patients have to join the community rapidly, and in sometimes feeling unprotected and with their needs non covered. We created a transition unit with a program of psychotherapeutic intervention, to offer an adequate transition between the acute episode and the incorporation to the community.

Objective.

We describe the characteristics of the psychotherapeutic group, the aims and the results of the interventions.

Methods.

Psychotherapeutic transition unit was created to offer intensive attention and control demand that is not possible to control in the community. The objects are to prevent re-admissions and relapse because of abandonment of treatment in patient with personality disorder and suicide attempts, and first episode, affective or psychotic. Patients are selected from the in-patients unit with inclusion criteria, and start going from the unit before discharge. The intervention is once per week, with a duration between 60–90 minutes. There is not a number of sessions, and we have approximately 10 patients per sessions.

Results.

Since the beginning of the psychotherapeutic interventions, re-admissions have been decreased in patients with diagnosis of personality disorder (most histrionic and borderline disorder) with multiple admissions because of suicide attempt, some had been discharged. In another group of patient we have prevented relapses.

Conclusions.

Psychotherapeutic interventions will be effective in patients with high risk of re-admissions and relapses. It is early to have solid conclusions, but the preliminary results encourage the continuation of the program.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Long-term inyectable antipsychotics in adolescents. A case report

Introduction

Actually psychiatrists around the world are treating children and adolescents (despite limited medical indications in this age group) with atypical antipsychotics at increasing rates for a range of psychiatric illnesses (schizophrenia, bipolar disorder, behavioral changes…). Over the last few years, a number of new long-term injectable treatments (ILD) have emerged, the advantages of which are found in adult (adherence, functionality, consistent blood level without daily peaks…) but we do not have enough data in minors.

Objectives

Discuss utility of ILD in adolescents.

Methods

We expose a case report about a 17-year-old man, when he was a child he was diagnosed with attention deficit disorder and autism spectrum disorder and also he had a story of disrupted behavioural and aggressively. After been hospitalized in our hospital we remake his clinic history and he was diagnosed with schizophrenia. Before the injectable treatment (ABILIFY MAINTENA®) this patient tried various treatments (mood stabilizers, antidepressants…) and many hospitalizations.

Results

After the ILD, our patient has good functionality, he is now living with his parents and studying in the high school. He has not needed another hospitalization after the last one.

Conclusions

The ILD in adolescents must be a therapeutic option in mental disease, in this group is very difficult the complementation of the treatment, it's frequent the comorbid use of substances, this population are not used to take medications… so every treatment that facility this kind of problems must be a perfect weapon to improve their mental health and to prevent relapse and hospitalization.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

An oxidative burst and its attenuation by bacterial peroxidase activity is required for optimal establishment of the Arachis hypogaea-Bradyrhizobium sp. symbiosis

AIMS

The main purpose of this study was to determine whether the Arachis hypogaea L. root oxidative burst, produced at early stages of its symbiotic interaction with Bradyrhizobium sp. SEMIA 6144, and the bacterial antioxidant system are required for the successful development of this interaction.

METHODS AND RESULTS

Pharmacological approaches were used to reduce both plant oxidative burst and bacterial peroxidase enzyme activity. In plants whose H2 O2 levels were decreased, a low nodule number, a reduction in the proportion of red nodules (%) and an increase in the bacteroid density were found. The symbiotic phenotype of plants inoculated with a Bradyrhizobium sp. SEMIA 6144 culture showing decreased peroxidase activity was also affected, since the biomass production, nodule number and percentage of red nodules in these plants were lower than in plants inoculated with Bradyrhizobium sp. control cultures.

CONCLUSIONS

We demonstrated for the first time that the oxidative burst triggered at the early events of the symbiotic interaction in peanut, is a prerequisite for the efficient development of root nodules, and that the antioxidant system of bradyrhizobial peanut symbionts, particularly the activity of peroxidases, is counteracting this oxidative burst for the successful establishment of the symbiosis.

SIGNIFICANCE AND IMPACT OF THE STUDY

Our results provide new insights into the mechanisms involved in the development of the symbiotic interaction established in A. hypogaea L. a legume infected in an intercellular way.

Role of reactive oxygen species generation and Nod factors during the early symbiotic interaction between bradyrhizobia and peanut, a legume infected by crack entry

AIMS

We evaluated whether reactive oxygen species (ROS) production and the plant antioxidant system are involved in the symbiotic interaction between bradyrhizobia and legumes infected by crack entry, without intracellular infection threads (IT) formation, such as Arachis hypogaea L. (peanut). The role of bradyrhizobial Nod factors (NF) in modulating the plants' oxidative burst was also analysed.

METHODS AND RESULTS

Histochemical and quantitative procedures were used to detect ROS levels in inoculated and in NF-treated peanut roots. Increase in root H2O2 production was determined at 10 min postinoculation with Bradyrhizobium sp. SEMIA 6144 or after NF addition. ROS production was modulated by NF. From 15 to 30 min postinoculation, the compatibility of Bradyrhizobium sp.-peanut interaction depends mostly on the H2O2 detoxification via catalase.

CONCLUSIONS

We demonstrated for the first time that the early events of the symbiotic interaction in legumes invaded by crack entry trigger an increase in ROS production (represented exclusively by a higher H2O2 content) in which NADPH-oxidase seems not to be involved. NF modulate this response by enhancing the plant antioxidant machinery, contributing to the creation of adequate conditions for symbiosis development.

SIGNIFICANCE AND IMPACT OF THE STUDY

Our data provide new insights into the mechanism involves in the symbiotic interaction that establish legumes infected by crack entry and suggest that ROS response shows differences compared with legumes invaded by IT formation.

Solar wind thermally induced magnetic fluctuations

A kinetic description of Alfvén-cyclotron magnetic fluctuations for anisotropic electron-proton quasistable plasmas is studied. An analytical treatment, based on the fluctuation-dissipation theorem, consistently shows that spontaneous fluctuations in plasmas with stable distributions significantly contribute to the observed magnetic fluctuations in the solar wind, as seen, for example, in [S. D. Bale et al., Phys. Rev. Lett. 103, 211101 (2009)], even far below from the instability thresholds. Furthermore, these results, which do not require any adjustable parameters or wave excitations, are consistent with the results provided by hybrid simulations. It is expected that this analysis contributes to our understanding of the nature of magnetic fluctuations in the solar wind.

Antimalarial activity of imidazo[2,1-a]isoindol-5-ol derivatives and related compounds

The synthesis of several series of imidazo[2,1-a]isoindol-5-ol derivatives and the results of their evaluation against Plasmodium falciparum are presented and discussed. The effects of electron-withdrawing or-donating substituents on different parts of the molecule, as well as those produced by the incorporation of an additional fused ring, were analyzed. Several compounds showed significant antimalarial activity in vitro with IC(50) values as low as 60 nM and a certain efficacy in vivo by reducing parasitemia in Plasmodium berghei mouse models.

Cryptosporidium parvum in diarrheic calves detected by microscopy and identified by immunochromatographic and molecular methods

Cryptosporidium is an important protozoan parasite that causes diarrhea in neonates and young bovines. The objective of the present study was to determine the frequency of Cryptosporidium infection in animals of dairy farms of the Metropolitan Region (Santiago), Chile. Fecal samples of 205 newborn calves with diarrhea were studied and used for comparing the efficiency of two microscopic staining methods for diagnosis of the parasite, the auramine (AU) and a modified Ziehl-Neelsen (ZN) procedure. Out of the 205 fecal samples, we detected oocysts in 115 (56.1%) with AU and 102 (49.8%) with ZN. Comparison of results obtained with the two microscopic techniques showed significant difference (p<0.05), AU being more sensitive. On the other hand, concordance between the two methods was almost perfect (kappa value of 0.83). The results with these two operator dependent methods were confirmed using an operator independent immunochromatographic (IC) method. The IC method also enabled us to determine the identity of the parasite species as that of Cryptosporidium parvum. Identification of the parasite species was further corroborated by performing a Cryptosporidium species-specific polymerase chain reaction (PCR) test on few samples taken at random. Overall, the results showed a high number of infected animals suggesting the parasite C. parvum as a major parasitic disease agent of neonatal calves with diarrhea in dairy farms of the Metropolitan Region (Santiago) of Chile.

Characterization of the nontrivial and chaotic behavior that occurs in a simple city traffic model

We explore in detail the nontrivial and chaotic behavior of the traffic model proposed by Toledo et al. [Phys. Rev. E 70, 016107 (2004)] due to the richness of behavior present in the model, in spite of the fact that it is a minimalistic representation of basic city traffic dynamics. The chaotic behavior, previously shown for a given lower bound in acceleration/brake ratio, is examined more carefully and the region in parameter space for which we observe this nontrivial behavior is found. This parameter region may be related to the high sensitivity of traffic flow that eventually leads to traffic jams. Approximate scaling laws are proposed.

From the limits of the classical model of sensitometric curves to a realistic model based on the percolation theory for GafChromic EBT films

PURPOSE

Modern radiotherapy uses complex treatments that necessitate more complex quality assurance procedures. As a continuous medium, GafChromic EBT films offer suitable features for such verification. However, its sensitometric curve is not fully understood in terms of classical theoretical models. In fact, measured optical densities and those predicted by the classical models differ significantly. This difference increases systematically with wider dose ranges. Thus, achieving the accuracy required for intensity-modulated radiotherapy (IMRT) by classical methods is not possible, plecluding their use. As a result, experimental parametrizations, such as polynomial fits, are replacing phenomenological expressions in modern investigations. This article focuses on identifying new theoretical ways to describe sensitometric curves and on evaluating the quality of fit for experimental data based on four proposed models.

METHODS

A whole mathematical formalism starting with a geometrical version of the classical theory is used to develop new expressions for the sensitometric curves. General results from the percolation theory are also used. A flat-bed-scanner-based method was chosen for the film analysis. Different tests were performed, such as consistency of the numeric results for the proposed model and double examination using data from independent researchers.

RESULTS

Results show that the percolation-theory-based model provides the best theoretical explanation for the sensitometric behavior of GafChromic films. The different sizes of active centers or monomer crystals of the film are the basis of this model, allowing acquisition of information about the internal structure of the films. Values for the mean size of the active centers were obtained in accordance with technical specifications. In this model, the dynamics of the interaction between the active centers of GafChromic film and radiation is also characterized by means of its interaction cross-section value.

CONCLUSIONS

The percolation model fulfills the accuracy requirements for quality-control procedures when large ranges of doses are used and offers a physical explanation for the film response.

Resonance, criticality, and emergence in city traffic investigated in cellular automaton models

The complex behavior that occurs when traffic lights are synchronized is studied for a row of interacting cars. The system is modeled through a cellular automaton. Two strategies are considered: all lights in phase and a "green wave" with a propagating green signal. It is found that the mean velocity near the resonant condition follows a critical scaling law. For the green wave, it is shown that the mean velocity scaling law holds even for random separation between traffic lights and is not dependent on the density. This independence on car density is broken when random perturbations are considered in the car velocity. Random velocity perturbations also have the effect of leading the system to an emergent state, where cars move in clusters, but with an average velocity which is independent of traffic light switching for large injection rates.

Optimal control in a noisy system

We describe a simple method to control a known unstable periodic orbit (UPO) in the presence of noise. The strategy is based on regarding the control method as an optimization problem, which allows us to calculate a control matrix A. We illustrate the idea with the Rossler system, the Lorenz system, and a hyperchaotic system that has two exponents with positive real parts. Initially, a UPO and the corresponding control matrix are found in the absence of noise in these systems. It is shown that the strategy is useful even if noise is added as control is applied. For low noise, it is enough to find a control matrix such that the maximum Lyapunov exponent lambda(max)<0, and with a single non-null entry. If noise is increased, however, this is not the case, and the full control matrix A may be required to keep the UPO under control. Besides the Lyapunov spectrum, a characterization of the control strategies is given in terms of the average distance to the UPO and the control effort required to keep the orbit under control. Finally, particular attention is given to the problem of handling noise, which can affect considerably the estimation of the UPO itself and its exponents, and a cleaning strategy based on singular value decomposition was developed. This strategy gives a consistent manner to approach noisy systems, and may be easily adapted as a parametric control strategy, and to experimental situations, where noise is unavoidable.

[Not Available]

OBJECTIVE

To evaluate changes in quality over a 5-year period from the perspective of patients, in an attempt to meet their expectations in a new hospital.

METHOD

The procedure takes as a reference the results of an opinion survey carried out in the hospital in 2001 and compares these results with those of annual surveys and completes them with information from written complaints and demands for accountability.

RESULTS

During the period studied, 821 surveys (a response rate of 22.3%), 3,756 complaints and 105 demands for administrative accountability were received and processed. The surveys revealed a degree of satisfaction of 96%, and study of the changes detected significant differences in comfort and response capacity. The most common reasons for complaints were medical transport (15.3%), delays in receiving care (12.6%), and waiting lists (9.3%). The main reasons for demands for accountability (only 20% of which were accepted) were death or serious secondary outcomes (59%), and the principal causes were related to omissions (42.9%) or malpractice (22.9%).

DISCUSSION

Patients' opinions tended to worsen slightly over the 5-year period studied, related to their increased expectations. Although the reasons for making complaints and demands were independent of the problems identified in patients' opinions and showed different dimensions, there were certain areas of overlap. Greater efforts are required in the area of emergency services and, of course, in problems related to comfort, improvement of which is easily achievable and evident with the inauguration of the new hospital.

Universal and nonuniversal features in a model of city traffic

The complex behavior that occurs when traffic lights are synchronized is studied. Two strategies are considered: all lights in phase, and a "green wave" with a propagating green signal. It is found that traffic variables such as traveling time, velocity, and fuel consumption, near resonance, follow critical scaling laws. For the green wave, it is shown that time and velocity scaling laws hold even for random separation between traffic lights. These results suggest the concept of transient resonances, which can be induced by adaptively changing the phase of traffic lights. This may be important to consider when designing strategies for traffic control in cities, where short trajectories, and thus transient solutions, are likely to be relevant.

Modeling traffic through a sequence of traffic lights

We introduce a microscopic traffic model, based on kinematic behavior, which consists of a single vehicle traveling through a sequence of traffic lights that turn on and off with a specific frequency. The reconstructed function that maps the state of the vehicle from light to light displays complex behavior for certain conditions. This chaotic behavior, which arises by the discontinuous nature of the map, displays an essential ingredient in traffic patterns and could be of relevance in studying traffic situations.

Variation of leishmanicidal activity in four populations of Urechites andrieuxii

Urechites andrieuxii Muell.-Arg. (Apocynaceae) is widely used in the Yucatan Peninsula for the treatment of cutaneous leishmaniasis. The influence of the environment in the variability of the leishmanicidal activity of the plant was evaluated using crude methanol extracts of roots from individuals belonging to four natural populations growing in the Yucatan Peninsula. The results of the growth inhibition test using three Leishmania spp. promastigotes showed a stronger leishmanicidal activity in populations of U. andrieuxii growing in more humid environments. Further evaluation against four human cancer cell lines and in the brine shrimp bioassay of both extracts from various parts of the plant and from the most active methanol root extracts, suggested that while the leaf extract appears to have selective toxicity against Leishmania parasites, the strong leishmanicidal activity detected in the root extracts of the plant might be due to its cytotoxicity.

Natural products as trypanocidal, antileishmanial and antimalarial drugs

Parasitic diseases caused by protozoa as Leishmania, Trypanosome or Plasmodium are responsible for more than three millions deaths annually throughout the developing countries. This review covers recent studies on plant-secondary metabolites isolated from medicinal plants and that have demonstrated moderate to high activity in in vitro and in vivo bioassays against these protozoa. The biological activity of the last promising antiparasitic leads are described.

A new diterpene from Tanaecium jaroba

One new diterpene, 2 alpha-hydroxy-12beta-hydroxy-isopimara-8(14), 15-diene, and six known compounds as triterpenes, sterols and fatty acid, were isolated from the stem bark of Tanaecium jaroba (Bignoniaceae), a Bolivian plant used in traditional medicine. Their structures were established mainly by 1D and 2D NMR (COSY, HMQC, HMBC, ROESY) and their antiplasmodial activities were evaluated in vitro against Plasmodium falciparum.

Antiprotozoal activities of Colombian plants

In our search for therapeutical alternatives for antiprotozoal chemotherapy, we collected a selection of 44 plants from western Colombia upon ethnopharmacological and chemotaxonomic considerations. Polar and apolar extracts of these species were examined for antimalarial activity using in vitro tests with two clones of Plasmodium falciparum. Leishmanicidal and trypanocidal activity were determined in vitro using promastigote and amastigote forms of several strains of Leishmania sp. and epimastigotes of Trypanosoma cruzi. Among the selected plants, the 15 following species showed good or very good antiprotozoal activity in vitro: Aspidosperma megalocarpon, Campnosperma panamense, Conobea scoparioides, Guarea polymera, Guarea guidonia, Guatteria amplifolia, Huberodendron patinoi, Hygrophila guianensis, Jacaranda caucana, Marila laxiflora, Otoba novogranatensis, Otoba parviflora, Protium amplium, Swinglea glutinosa and Tabernaemontana obliqua. Cytotoxicity was assessed in U-937 cells and the ratio of cytotoxicity to antiprotozoal activity was determined for the active extracts. Ten extracts from eight species showed selectivity indexes > or = 10. Among the extracts that showed leishmanicidal activity, the methylene chloride extract of leaves from C. scoparioides showed a selectivity index in the same range that the one of the Glucantime control. Several of the active leishmanicidal plants are traditionally used against leishmaniasis by the population of the concerned area.