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Puntos para una lectura rapida • Cualquier acto asistencial es un momento adecuado para repasar y actualizar el calendario vacunal. • La administracion simultanea de varias vacunas reduce el numero de visitas y aumenta la cobertura. • Para mejorar registros vacunales deberia haber un sistema centralizado a nivel nacional y un calendario vacunal unico. • Argumentar la importancia de la vacunacion por parte del personal sanitario es una buena estrategia para aumentar coberturas.

This study presents the development and validation of a new analytical method for the simultaneous determination of fifteen analytes classified as halogenated flame retardants (HFRs) – nine brominated diphenyl ethers (BDEs) and six novel HFRs – in different kinds of mollusks using matrix solid-phase dispersion (MSPD) followed by gas chromatography coupled to negative chemical ionization-mass spectrometry (GC–NCI-MS). The proposed method is the first one developed for such a broad range of HFRs in aquatic biota, featuring several advantages, including low solvent and sample intake, simplicity of operation, reduced cost and integration of extraction and clean-up into a single step. Under optimal conditions, 0.5 g of freeze-dried sample, 0.5 g of a primary-secondary amine (PSA) as solid support, a sorbent combination of 1.75 g of florisil (deactivated with 5% Milli-Q water), 1.75 g of acidified silica (10% (w/w) H2SO4) and 0.5 g of silica, and 10 mL dichloromethane as elution solvent were used. Standard addition over the extract was required however for the correct quantification due to matrix effects in the GC system, particularly for novel HFRs, that could not be compensated with the internal standards. The method afforded LODs in the range of 0.003–0.07 ng g−1 dry weight (0.0006–0.014 ng g−1 on a wet weight basis, assuming an 80% sample water content), except for decabromodiphenyl ethane (DBDPE) (0.6 ng g−1 dry weight, 0.12 ng g−1 wet weight). The accuracy of the method was evaluated with three different types of spiked mollusk species using surrogate standards and standard addition over the extract for quantification and the recoveries were in the 70–120% range, except for bis(2-ethylhexyl)-3,4,5,6-tetrabromo-phthalate (DEHTBP) in clam (Ruditapes philippinarum) samples (46% recovery). Moreover, the method was successfully validated with standard reference materials (SRMs) of salmon and mussel tissues for BDEs. Finally, the method was applied to the determination of HFRs in different kind of freeze-dried mollusks: mussel (Mytilus galloprovincialis), cockle (Cerastoderma edule) and clam (R. philippinarum). Raft cultured mussels showed the highest concentrations of HFRs (up to 0.8 ng g−1 wet weight of BDE-209).

To evaluate deoxypyridinoline as a resorption marker in phenylketonuria (PKU) and to search for a relationship between deoxypyridinoline, calcium/creatinine index (Ca/Cr I), osteocalcin and bone alkaline phosphatase (BAP).This was a transversal analytical study of 46 PKU patients [17.5 (4-38) years]. Deoxypyridinoline and osteocalcin were measured with a chemiluminescent assay and BAP was measured with an immunoradiometric assay.Deoxypyridinoline was significantly increased in patients aged 7-14 and18 years old, being associated with age (r=-0.724, P0.001). Adult patients showed significantly higher Ca/Cr I, which correlates with Phe values for the year prior to the study (P=0.014). Serum BAP was significantly increased in pediatric patients (9-13 years), while it was decreased in adult patients (P=0.003). Decreased osteocalcin levels were found in patients15 years (P=0.028). Altered deoxypyridinoline and BAP values were related (P=0.042).PKU patients excreted increased D-Pyr, suggesting high bone resorption. Bone formation seems active in childhood but deteriorates in adult PKU patients. Periodic measurement of D-Pyr and BAP may be useful in the prevention of osteopenia in PKU patients.

Resumen Objetivo Comprender las actitudes, comportamientos, creencias y conocimiento de la enfermedad en las personas diagnosticadas de diabetes tipo 2, asi como comprender que esperan de los profesionales sanitarios respecto al soporte y ayuda en el control de su enfermedad Diseno Estudio cualitativo, con un diseno interpretativo de tipo hermeneutico Emplazamiento La investigacion fue realizada en el primer semestre del ano 2001 y la poblacion estudiada procedia de Sabadell, poblacion urbana de la provincia de Barcelona Participantes Un total de 21 pacientes diagnosticados de diabetes tipo 2, atendidos en centros de atencion primaria Metodo Analisis de contenido de 21 entrevistas semiestructuradas realizadas en el domicilio. La validez del analisis fue asegurada mediante su revision por varios miembros del equipo investigador Resultados La diabetes es una enfermedad socialmente aceptada. Los pacientes se sienten mas o menos diabeticos segun sean tratados o no con insulina. La perdida que consideran mas importante es no poder comer ciertas cosas. Los diabeticos diferencian entre los conocimientos que ellos necesitan y los que han de tener los profesionales. El principal apoyo del diabetico es la familia, seguido del de los profesionales sanitarios Conclusiones os planes educativos han de ir muy relacionados con las demandas reales de las personas diabeticas. Estas esperan de los profesionales sanitarios, ademas de los conocimientos propios de la enfermedad, ser atendidas con valores eticos y de apoyo

The aim of the study was to observe the influence of carbamazepine and valproic acid on plasma total homocysteine and B-vitamin status and the gene-drug interaction with the 677C--T mutation of the methylenetetrahydrofolate reductase (MTHFR) gene. Plasma total homocysteine concentrations were determined in 136 epileptic children taking anti-epileptic drugs as monotherapy. Nutritional (folate, B12 and B6 vitamins) and genetic (MTHFR 677 C--T) determinants of plasma homocysteine were studied in a random sample of 59 of the 136 epileptic children. Total homocysteine concentrations were significantly increased (p0.05) and folate and vitamin B6 levels were significantly decreased (p0.01) in the children taking anti-epileptic drugs compared with our reference ranges. In the carbamazepine-treated group, significantly positive correlation was found between duration of treatment and homocysteine concentration (p0.01). Homocysteine concentrations showed a significantly negative correlation with vitamin levels (folate: p = 0.002, and vitamin B12: p = 0.017) only in the carbamazepine treated group. In children treated with carbamazepine up to 3 years, total homocysteine concentration correlated negatively only with folate (p = 0.003), while in patients treated for more than 3 years, total homocysteine correlated negatively only with vitamin B12 values (p = 0.007). The lowering action of carbamazepine treatment on folate levels seems to be associated with hyperhomocysteinaemia, which seems to be related to the homozygous condition for the MTHFR 677C--T mutation. Valproic acid treatment, although also associated with hyperhomocysteinaemia, only shows a lowering effect on vitamin B6 levels, which seems to be independent of the MTHFR genotype.

Objective: To assess the recovery, maintenance, and quality of ovarian function by comparing the success of autotransplantation in intraperitoneal (IP) and SC locations over a 6-month period in syngeneic Lewis rats. Design: Experimental animal study. Setting: Unit of Experimental Research at the Barcelona University School of Medicine. Animal(s): Female syngeneic Lewis rats. Intervention(s): The animals were randomized to one of three groups: group A, control group with ovariectomy (n = 15); group B, ovariectomy and IP autologous heterotopic transplant of ovarian tissue without vascular pedicle (n = 14); and group C, ovariectomy and SC autologous heterotopic transplant (n = 15). Main Outcome Measure(s): Serum levels of FSH and 17β-E 2 and vaginal cytology. Result(s): In groups B and C, E 2 serum concentrations from day 7 and day 10 onward remained comparable to basal levels, and significantly higher than in group A, throughout the 6-month period. In group B from day 7 after surgery onward, and in group C from day 10 after surgery onward, FSH concentrations remained low (comparable to basal levels) throughout the follow-up period. Vaginal cytology of groups B and C showed trophic maturation between days 4 and 10 after ovariectomy and insertion of the ovarian tissue implant, whereas the control group remained atrophic. There were no statistically significant differences between IP and SC implants. Conclusion(s): A heterotopic autotransplant of ovarian tissue without vascular pedicle in syngeneic Lewis rats is successful for ≥6 months.

Objetivos: La mayor supervivencia en el cáncer infantil condiciona una mayor preocupación por los efectos tardíos del cáncer y su tratamiento. El objetivo es ampliar el conocimiento de las secuelas sobre la pubertad y la función gonadal en los supervivientes del cáncer infantil. Pacientes y métodos: Se definieron un grupo de estudio y un grupo control. Grupo de estudio: pacientes con antecedente de cáncer infantil, con 2 años o más en remisión y sin tratamiento y edad entre 7 y 18 años al iniciar el estudio. Se seleccionaron 126 pacientes (72 niños y 54 niñas). Grupo control: niños sanos de 7 a 18 años (58 niños y 56 niñas). Métodos clínicos: curva de crecimiento, desarrollo puberal según Tanner, volumen testicular y ciclo menstrual. Métodos analíticos: determinación de concentración sérica basal de FSH, LH, testosterona, estradiol e inhibina B. En varones del grupo de estudio menores de 15 años se propuso un seminograma, y ecografía pélvica para niñas puberales. Resultados: Grupo de estudio: edad media al diagnóstico 4,93 años, media de 6,53 años desde el fin del tratamiento. Diagnósticos: leucemia (43 %), HCL (10%), LNH (8 %), Wilms (7 %), tumores SNC (6 %). Tratamientos: quimioterapia 97,6% de los pacientes, radioterapia 26 %, neurocirugía 6%, corticoides 75 %. Desarrollo puberal: 6% de varones con retraso puberal y 15% de niñas con pubertad adelantada (13 %) o precoz (2 %). Seminograma: efectuado en 10 varones (2 azoospermias, 2 astenozoospermia, 1 aspermia). Ecografía pélvica normal en 35 de 38 niñas. Comparando grupo de estudio frente a grupo control: los varones en estadio I y II tenían una edad significativamente mayor. En el estadio II FSH, LH y testosterona fueron significativamente mayores (2,71 UI/l frente a 1,55 UI/l, 2,00 UI/l frente a 0,90 UI/l y 6,2 nmol/l frente a 1,6 nmol/l), y en el estadio III se mantenían las diferencias significativas para LH (3,20 UI/l frente a 1,68 UI/l) y testosterona (12,9 nmol/l frente a 4,7 nmol/l). En las niñas no había diferencias en las variables de perfil, pero en el estadio I la inhibina B era significativamente menor en el grupo de estudio (< 10 pg/ml frente a 21 pg/ml). En 19 varones (26,4%) existía insuficiencia tubular, asociada significativamente con la edad al inicio del tratamiento (×1,226 por año) y con el trasplante de médula ósea (TMO), y en 5 (7 %) insuficiencia de células de Leydig, asociada significativamente con la radioterapia (×5,663) y TMO. Entre las niñas, 11 (20,4%) tenían insuficiencia ovárica parcial, asociada significativamente con la radioterapia (×13,407), la quimioterapia gonadotóxica (×9,096), el TMO y los tumores del SNC. Conclusiones: La edad prepuberal al inicio del tratamiento no protege del daño gonadal. Todos los niños tratados de un cáncer deben ser vigilados durante la pubertad, ya que desde la prepubertad y etapas precoces del desarrollo pueden aparecer hallazgos clínicos y analíticos sugestivos de insuficiencia gonadal. No hay un marcador clínico, hormonal o ecográfico que sea suficiente para determinar si existe insuficiencia gonadal, lo que obliga a que el seguimiento de estos niños se prolongue a la edad adulta.