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As critical language pedagogies are being implemented in heritage language (HL) settings, there is an increasing need to examine the impact of critical approaches in Spanish HL speakers. The present study examines how the development of HL learners’ critical language awareness (CLA) influences ethnic identity formation in a university-level course that adopts a critical approach to HL instruction. As part of the curricular content, a CLA instructional intervention, consisting of a 4-week unit (10 h), was implemented. First, to measure ethnic identity, at the beginning (pre) and at the end of the semester (post), students completed the Ethnic Identity Scale (EIS) and provided comments with their answers. Additionally, in order to examine CLA development before and after the intervention, participants completed an existing questionnaire, which addresses topics such as language variation, language ideologies, and bilingualism. Overall, the results show that students’ CLA levels increased from “somewhat high” to “high”. Furthermore, participants reported different ethnic–racial identity statuses, which moved toward ethnic identity achievement. Higher CLA levels were associated with an achieved positive status. These findings can contribute to a better understanding of the link between students’ CLA and ethnic identity in HL educational settings, where a critical language pedagogy is applied.

Objectives The objective of this study was to highlight the role of the clinical laboratory and the relevance of reporting the case immediately to the unit of hematology for the diagnosis and early administration of treatment in the presence of such an urgent hematologic disease as thrombotic thrombocytopenic purpura (TTP). Case presentation An elderly patient was referred to the emergency department of our hospital by his general practitioner for speech difficulty, facial asymmetry and weakness in the upper limb. Stroke code was activated. However, laboratory findings (anemia, thrombocytopenia, elevated creatinine, total bilirubin and LDH, negative direct Coombs test) and presence of schistocytes in the peripheral blood smear test were consistent with a completely different diagnosis: TTP thrombotic microangiopathy. Conclusions The first diagnostic approach of left hemispheric stroke was not confirmed in the laboratory, with findings of nonautoimmune hemolytic anemia, thrombocytopenia without apparent cause and presence of schistocytes. We should not forget that the clinical manifestations of this condition are widely variable and may include multiorganic dysfunction. Although confirmation of diagnosis is based on ADAMTS-13, its associated high mortalitiy requires immediate treatment on mere suspicion.

Resumen Objetivos Resaltar el papel del laboratorio clínico y la pronta comunicación con el servicio de Hematología en el diagnóstico y la rapidez en la instauración del tratamiento de una patología hematológica tan urgente como la Púrpura Trombótica Trombocitopénica (PTT). Caso clínico Varón de edad avanzada derivado a Urgencias hospitalarias por su médico de Atención Primaria por trastorno de emisión del lenguaje, asimetría facial y disminución de fuerza en extremidad superior, por lo que se activa el código ictus. Sin embargo, los hallazgos de laboratorio (anemia y trombocitopenia, creatinina, bilirrubina total y LDH elevadas, test de Coombs directo negativo) y presencia de esquistocitos en el frotis de sangre periférica, acaban derivando en un diagnóstico completamente diferente: microangiopatía trombótica tipo PTT. Conclusiones La primera orientación diagnóstica de ictus hemisférico izquierdo fue rechazada ante los signos de anemia hemolítica no autoinmune, trombocitopenia sin causa aparente y presencia de esquistocitos. No debemos olvidar que esta patología puede cursar con afectación multiorgánica y características clínicas muy variables. Aunque su diagnóstico definitivo se basa en la determinación de actividad de ADAMTS-13, debido a la elevada mortalidad es necesario instaurar tratamiento de forma inmediata tras su sospecha.

Resumen Antecedentes y objetivos La diabetes supone un importante factor de riesgo para el desarrollo de enfermedad cardiovascular, principal causa de muerte. El proposito de este estudio fue conocer el grado de control glucemico de los pacientes con diabetes tipo 2 sin enfermedad cardiovascular en Espana, segun la determinacion mas reciente de hemoglobina glucosilada, asi como el patron de tratamiento antidiabetico, la incidencia de episodios de hipoglucemia grave en los ultimos 6 meses y el grado de control de los factores de riesgo cardiovascular, en funcion del genero. Pacientes y metodos Estudio epidemiologico nacional, multicentrico y transversal. Participaron 800 medicos asociados a la redGDPS. Resultados Se incluyeron 1.059 pacientes, 57% varones. Edad media: 62,7 anos en varones vs. 65,2 en mujeres (p Conclusiones El control glucemico es peor en las mujeres incluso si ajustamos por edad y tiempo de evolucion de la diabetes (p = 0,043) y por el numero de hipoglucemiantes (p = 0,015). El grado de control es tambien peor en mujeres para la dislipidemia, obesidad abdominal y filtrado glomerular. Desde Atencion Primaria es esencial una estrategia preventiva promocionando estilos de vida saludables y controlando todos los factores de riesgo vascular.

Resumen Introduccion y objetivos Con la implementacion de la Estrategia de Promocion de la Salud y Prevencion en Espana, el escenario reflejado en estudios previos de infracontrol de los factores de riesgo cardiovascular (FRCV) en pacientes con diabetes tipo 2 (DM2) y enfermedad cardiovascular (ECV) puede haberse modificado, por lo que nos planteamos conocer el grado de control glucemico y de otros FRCV en los pacientes con DM2 y ECV atendidos actualmente en nuestro medio, el patron de tratamiento antidiabetico y las diferencias en funcion del genero. Materiales y metodos Estudio epidemiologico, observacional, transversal, de ambito nacional en pacientes de ambos generos diagnosticados de DM2 y ECV establecida. Resultados Se incluyeron 3.143 pacientes. Edad media: 69,0 ± 10 anos. La HbA1c media fue mayor en mujeres que en varones (7,4 ± 1,1% vs. 7,3 ± 1,2%; p Conclusiones El grado de control glucemico de los pacientes con DM2 y ECV en Espana es mejorable. El perfil de tratamiento no se ajusta a las recomendaciones de las guias de practica clinica en general. Las diferencias en el control de los FRCV son peores en mujeres para lipidos y obesidad.

Ovarian cancer is the third most frequent gynaecological malignancy worldwide and in Mexico, with a high mortality rate, due to that in many cases its diagnosis is made in advanced stages. Prognosis is important for determining the subtype and the degree of evolution. During lasts years, the management of ovarian cancer has undergone an important evolution with the incorporation of new therapeutic options, which in turn represent an increase in the survival of these patients. We present recommendations for the management of ovarian cancer developed by an expert panel Mexican based on available evidence so far and the characteristics of health care in the country.El cáncer de ovario es la tercera neoplasia maligna ginecológica más frecuente globalmente y también en México, con una elevada tasa de mortalidad debido a que en muchos casos su diagnóstico se realiza en etapas avanzadas. Para establecer su pronóstico es importante la determinación del subtipo y del grado de evolución. En los últimos años, el manejo del cáncer de ovario ha sufrido una importante evolución con la incorporación de nuevas opciones terapéuticas, que a su vez representan un incremento en la supervivencia de estas pacientes. Se presentan las recomendaciones para el manejo del cáncer de ovario elaboradas por un panel de expertos mexicanos basadas en la evidencia disponible hasta el momento y en las características de la atención sanitaria del país.

SUMMARY The complex Moho topography beneath the northwestern Andes is the result of multiple geodynamic processes during the Cenozoic. To contribute to our understanding of the Moho depth distribution beneath this region, we inverted gravity data from two widely used satellite-derived data sets (EGM2008 and EIGEN-6C4) and one regional airborne Bouguer gravity anomaly map (ANH2010). Their inversion allowed choosing the ANH2010, based on lower residual gravity and a higher agreement with seismic estimations, as the most suitable data set to gain insights into the Moho depth beneath the northwestern Andes and its relationship with previously identified tectonic features. The inverted Moho argues for a 40–50 km depth beneath the Central and Eastern cordilleras, reaching depths beyond 50 km below the Eastern Cordillera, and shallower depths between 30 and 40 km mainly along the foreland region to the east, the Western Cordillera and the coastal plains. Three main thickened crust features of regional extent were identified: (1) a deep Moho expression with a crustal thickness greater than 40 km in the northwesternmost foreland region, which we consider a direct consequence of the adjacent thickened Eastern Cordillera involving the fold and thrust deformation migration from the range towards the foreland, and the flexural deformation proposed for the eastern foothills; (2) a regional deep Moho expression (50–60 km) along the axis of the Eastern Cordillera, related to its shortening history including multiple phases of Cenozoic thick-skinned deformation and magmatic underplating; and (3) a Moho deeper than 60 km in a southern latitude (1°S–1°N) beneath the modern magmatic arc, whose interpretation is more complex, likely a combined result of mafic addition to the base of the crust, foundering tectonics, and lateral displacement of the lower crust prompted by the subducting Carnegie ridge.

Resumen: Introducción: Las terapias respiratorias no invasivas (TRNI) fueron ampliamente utilizadas en la primera ola de la pandemia de COVID-19, en escenarios distintos según los medios disponibles. El objetivo fue presentar la supervivencia a 90 días y los factores asociados a esta de los pacientes tratados con TRNI en un centro de tercer nivel sin Unidad de Cuidados Respiratorios Intermedios. Como objetivo secundario comparar los resultados obtenidos de las distintas terapias. Métodos: Estudio observacional de pacientes tratados con TRNI fuera de un ambiente de Cuidados Intensivos o Unidad de Cuidados Respiratorios Intermedios, diagnosticados de COVID-19 y con síndrome de distrés respiratorio agudo por criterios radiológicos y de ratio SpO2/FiO2. Se desarrolló un modelo multivariante de regresión logística para determinar las variables independientemente asociadas, y se compararon los resultados de la terapia de alto flujo con cánula nasal y la presión positiva continua en la vía aérea. Resultados: Se trataron 107 pacientes y sobrevivieron 85 (79,4%) a los 90 días. Antes de iniciar la TRNI el ratio medio de SpO2/FiO2 fue de 119,8 ± 59,4. Un mayor score de SOFA se asoció significativamente a la mortalidad (OR 2,09; IC95% 1,34 – 3,27), mientras que la autopronación fue un factor protector (OR 0,23; IC95% 0,06 – 0,91). La terapia de alto flujo con cánula nasal fue utilizada en 63 sujetos (58,9%), y la presión positiva continua en la vía aérea en 41 (38,3%). No se encontraron diferencias entre ellas. Conclusión: Aproximadamente cuatro de cada cinco pacientes tratados con TRNI sobrevivieron a los 90 días, y no se encontraron diferencias significativas entre la terapia de alto flujo con cánula nasal y la presión positiva continua en la vía aérea. Abstract: Introduction: Non-invasive respiratory therapies (NRT) were widely used in the first wave of the COVID-19 pandemic in different settings, depending on availability. The objective of our study was to present 90-day survival and associated factors in patients treated with NRT in a tertiary hospital without an Intermediate Respiratory Care Unit. The secondary objective was to compare the outcomes of the different therapies. Methods: Observational study of patients treated with NRT outside of an intensive care or intermediate respiratory care unit setting, diagnosed with COVID-19 and acute respiratory distress syndrome by radiological criteria and SpO2/FiO2 ratio. A multivariate logistic regression model was developed to determine independently associated variables, and the outcomes of high flow nasal cannula and continuous positive airway pressure were compared. Results: In total, 107 patients were treated and 85 (79.4%) survived at 90 days. Before starting NRT, the mean SpO2/FiO2 ratio was 119.8 ± 59.4. A higher SOFA score was significantly associated with mortality (OR 2,09; 95% CI 1.34-3.27), while self-pronation was a protective factor (OR 0.23; 95% CI 0.06-0.91). High flow nasal cannula was used in 63 subjects (58.9%), and continuous positive airway pressure in 41 (38.3%), with no differences between them. Conclusion: Approximately 4 out of 5 patients treated with NRT survived to 90 days, and no significant differences were found between high flow nasal cannula and continuous positive airway pressure.

Background: The heterogeneity and lack of validation of existing severity scores for food allergic reactions limit standardization of case management and research advances. We aimed to develop and validate a severity score for food allergic reactions. Methods: Following a multidisciplinary experts consensus, it was decided to develop a food allergy severity score (FASS) with ordinal (oFASS) and numerical (nFASS) formats. oFASS with 3 and 5 grades were generated through expert consensus, and nFASS by mathematical modeling. Evaluation was performed in the EuroPrevall outpatient clinic cohort (8232 food reactions) by logistic regression with request of emergency care and medications used as outcomes. Discrimination, classification, and calibration were calculated. Bootstrapping internal validation was followed by external validation (logistic regression) in 5 cohorts (3622 food reactions). Correlation of nFASS with the severity classification done by expert allergy clinicians by Best-Worst Scaling of 32 food reactions was calculated. Results: oFASS and nFASS map consistently, with nFASS having greater granularity. With the outcomes emergency care, adrenaline and critical medical treatment, oFASS and nFASS had a good discrimination (receiver operating characteristic area under the curve [ROC-AUC]>0.80), classification (sensitivity 0.87–0.92, specificity 0.73–0.78), and calibration. Bootstrapping over ROC-AUC showed negligible biases (1.0 × 10−6–1.23 × 10−3). In external validation, nFASS performed best with higher ROC-AUC. nFASS was strongly correlated (R 0.89) to best-worst scoring of 334 expert clinicians. Conclusion: FASS is a validated and reliable method to measure severity of food allergic reactions. The ordinal and numerical versions that map onto each other are suitable for use by different stakeholders in different settings. © 2021 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.

Remnants of the Caribbean Large Igneous Plateau (C-LIP) are found as thicker than normal oceanic crust in the Caribbean Sea that formed during rapid pulses of magmatic activity at ∼91–88 and ∼76 Ma. Strong geochemical evidence supports the hypothesis that the C-LIP formed due to melting of the plume head of the Galápagos hotspot, which interacted with the Farallon (Proto-Caribbean) plate in the eastern Pacific. Considering plate tectonics theory, it is expected that the lithospheric portion of the plume-related material migrated within the Proto-Caribbean plate in a north–north-eastward direction, developing the present-day Caribbean plate. In this research, we used 3D lithospheric-scale, data-integrative models of the current Caribbean plate setting to reveal, for the first time, the presence of positive density anomalies in the uppermost lithospheric mantle. These models are based on the integration of up-to-date geophysical datasets from the Earth's surface down to 200 km depth, which are validated using high-resolution free-air gravity measurements. Based on the gravity residuals (modelled minus observed gravity), we derive density heterogeneities both in the crystalline crust and the uppermost oceanic mantle ( km). Our results reveal the presence of two positive mantle density anomalies beneath the Colombian and the Venezuelan basins, interpreted as the preserved fossil plume conduits associated with the C-LIP formation. Such mantle bodies have never been identified before, but a positive density trend is also indicated by S-wave tomography, at least down to 75 km depth. The interpreted plume conduits spatially correlate with the thinner crustal regions present in both basins; therefore, we propose a modification to the commonly accepted tectonic model of the Caribbean, suggesting that the thinner domains correspond to the centres of uplift due to the inflow of the hot, buoyant plume head. Finally, using six different kinematic models, we test the hypothesis that the C-LIP originated above the Galápagos hotspot; however, misfits of up to ∼3000 km are found between the present-day hotspot location and the mantle anomalies, reconstructed back to 90 Ma. Therefore, we shed light on possible sources of error responsible for this offset and discuss two possible interpretations: (1) the Galápagos hotspot migrated (∼1200–3000 km) westward while the Caribbean plate moved to the north, or (2) the C-LIP was formed by a different plume, which – if considered fixed – would be nowadays located below the South American continent.

En este artículo se presentan los resultados del análisis de un corpus (n=15) de presentaciones académicas orales (PAO) en español realizadas por estudiantes universitarios hablantes de herencia y de ELE estadounidenses. El objetivo es determinar la manera en la que se manifiesta la postura a través del metadiscurso. Con este fin se identificaron las marcas metadiscursivas de actitud, su frecuencia de uso y función retórica según las categorías en la taxonomía de Hyland. Los resultados muestran que el grupo de herencia hace mayor uso de estos recursos y que los adjetivos evaluativos en ambos grupos es la forma lingüística más empleada para codificar las muestras de actitud.

Objective: To evaluate the appropriateness of magnetic resonance imaging (MRI) of the knee requested by primary care physicians. Design: Retrospective observational study. Setting: Six primary care centres in the Elche Department of Health of the Valencian Community, Spain. Participants: Three hundred patients with knee pain who were prescribed MRI. Main Outcome Measures: Data were collected from the electronic clinical history, which allowed us to assess the appropriateness and inappropriateness of the MRI requests for the knee based on the American College of Radiology (ACR) criteria. A multivariate logistic regression model was used to identify factors associated with an inappropriate request. Results: About 45% (41-49%) of knee MRI prescriptions were assessed as inappropriate. The frequency was higher in female patients (odds ratio, OR = 1.96; P = 0.03). A history of knee trauma and urgent use of MRI were associated with a lower frequency of inappropriate requests (OR = 0.14, P < 0.001 and OR = 0.32, P = 0.03, respectively). In 82% of cases, the request for MRI was deemed inappropriate because it was used as the initial imaging test. The availability of a previous radiograph of the knee significantly reduced the rate of inappropriate requests (OR = 0.05, P < 0.001); only 47% of the patients had a previous radiograph. Conclusions: The percentage of inappropriate knee MRI prescriptions is high. Protocols should be put in place to improve the appropriateness of MRI requests by promoting understanding of the appropriate use of MRI among primary care physicians.

Sedation is necessary in the management of critically ill patients, both to alleviate suffering and to cure patients with diseases that require admission to the intensive care unit. Such sedation should be appropriate to the patient needs at each timepoint during clinical evolution, and neither too low (undersedation) nor too high (oversedation). Adequate sedation influences patient comfort, safety, survival, subsequent quality of life, bed rotation of critical care units and costs. Undersedation is detected and quickly corrected. In contrast, oversedation is silent and difficult to prevent in the absence of management guidelines, collective awareness and teamwork. The Zero Oversedation Project of the Sedation, Analgesia and Delirium Working Group of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units aims to offer a practical teaching and collective awareness tool for ensuring patient comfort, safety and management with a view to optimizing the clinical outcomes and minimizing the deleterious effects of excessive sedation. The tool is based on a package of measures that include monitoring pain, analgesia, agitation, sedation, delirium and neuromuscular block, keeping patients pain-free, performing dynamic sedation according to clinical objectives, agreeing upon the multidisciplinary protocol to be followed, and avoiding deep sedation where not clinically indicated.

WOS: 000468732700018, PubMed ID: 31054483, Background and aims: One of the objectives of the ESC-EORP EUROASPIRE V survey is to determine how well European guidelines on the management of dyslipidaemias are implemented in coronary patients. Methods: Standardized methods were used by trained technicians to collect information on 7824 patients from 130 centers in 27 countries, from the medical records and at a visit at least 6 months after hospitalization for a coronary event. All lipid measurements were performed in one central laboratory. Patients were divided into three groups: on high-intensity LDL-C-lowering-drug therapy (LLT), on low or moderate-intensity LLT and on no LLT. Results: At the time of the visit, almost half of the patients were on a high-intensity LLT. Between hospital discharge and the visit, LLT had been reduced in intensity or interrupted in 20.8% of the patients and had been started or increased in intensity in 11.7%. In those who had interrupted LLT or had reduced the intensity, intolerance to LLT and the advice of their physician were reported as the reason why in 15.8 and 36.8% of the cases, respectively. LDL-C control was better in those on a high-intensity LLT compared to those on low or moderate intensity LLT. LDL-C control was better in men than women and in patients with self-reported diabetes. Conclusions: The results of the EUROASPIRE V survey show that most coronary patients have a less than optimal management of LDL-C. More professional strategies are needed, aiming at lifestyle changes and LLT adapted to the need of the individual patient., ESC - EORP; AmgenAmgen; Eli LillyEli Lilly; PfizerPfizer; SanofiSanofi-Aventis; Ferrer; Novo NordiskNovo Nordisk, The EUROASPIRE V survey was carried out under the auspices of the ESC - EORP. Since the start of EORP, the following companies have supported the programme: Amgen, Eli Lilly, Pfizer, Sanofi, Ferrer and Novo Nordisk. The sponsors of the EUROASPIRE surveys had no role in the design, data collection, data analysis, data interpretation, decision to publish, or writing the manuscript.

To encourage development of negative attitudes toward alcohol use and thus prevent early onset of alcohol use, an intersectoral intervention was conducted from 2014 to 2015 among Cuban adolescents in 14 schools in Havana. The intervention included 312 students (189 girls and 123 boys) aged 14 to 15 years in 10th grade of high school or vocational school. Workshops were conducted using participatory techniques and group dynamics. Qualitative methods were applied, including narrative, desiderative and projective techniques. Indicators included attitudes, motivation, interests and perception of risk. Following the intervention, 82.7% (258/312) of participants reported healthy cultural and recreational interests and 61.9% (193/312) reinforced negative attitudes toward drinking. Such interventions can help prevent early onset of alcohol use in school settings. Given the positive results, the intervention is slated to be reproduced in other Cuban provinces. KEYWORDS Adolescents, prevention, alcoholism, attitudes, Cuba.

MTT assays of the different extracts of D. bicolor on MDA-MB-231 breast cancer cell line. The graphics represent the MTT assays of the different extracts (aqueous, ethanolic, acetonic and hexanic) of D. bicolor on breast cancer cells MDA-MB-231. The ethanolic, acetonic and hexanic extracts demonstrated a cytotoxic effect in a doses and time dependent manner, obtaining IC50 values of 128.20 ± 2.035, 203.2 ± 2.3 and 450.7 ± 2.657 μg/mL, respectively. However, the aqueous extract didn’t showed any cytotoxic activity at any concentration or time. The experiments were performed at least in triplicate and the values are reported as mean ± SE, *P

Existe una preocupación sobre el nivel de competencia coordinativa de los escolares en la Educación Secundaria Secundaria (ESO) española y su impacto en sus actividades cotidianas y en su salud. El objetivo de este estudio fue evaluar la coordinación de una muestra de escolares de primero de la ESO. Participaron 120 escolares, 65 chicos y 55 chicas, de cuatro institutos de Educación Secundaria de la Comunidad de Madrid, de edades comprendidas entre 12 y 14 años. Todos los participantes llevaron a cabo el test de coordinación corporal (KKTK) diseñado para detectar los problemas de coordinación motriz en las edades escolares. Los resultados permitieron el establecimiento de tres grupos de coordinación: normal (38,3%), sintomático (31,35%) y problemático (30%). Estos resultados indicaron que un 61,7% de los escolares participantes en este estudio presentaban algún tipo de dificultad de coordinación, al encontrarse en los niveles sintomático y problemático. La presencia de las chicas en el nivel sintomático y problemático fue predominante. Los resultados confirman que los problemas de coordinación motriz existen en la población escolar y que no solo suponen un problema educativo sino también de salud, ya que impiden estilos de vida más activos entre los adolescentes, especialmente entre las chicas. Palabras clave: Estilos de vida. Educación Secundaria. Adolescencia. Trastornos evolutivos de la coordinación. Desarrollo motor.

c t r i Aunque el bocio intratoracico y el vertigo periferico son enfermedades relativamente frecuentes, no lo es tanto el verlas asociadas. Presentamos un caso de bocio intratoracico, que por sus caracteristicas clinicas ha podido ser la causa de un sindrome vertiginoso de repeticion, lo que hasta ahora no hemos encontrado descrito en la literatura medica. Se trata de una mujer de 61 anos con antecedente de hipoacusia en oido derecho secundaria a sarampion en la infancia y en tratamiento por hipertension arterial. Diagnosticada desde hace 10 anos de bocio multinodular intratoracico con funcion tiroidea normal. Comienza hace 6 meses con episodios repetidos de mareo con giro de objetos y nauseas de varias horas de duracion. En el primer episodio presento vomitos. No acufenos. Los episodios son tan frecuentes que la incapacitan para su actividad habitual. En todas las ocasiones en que se realizan la exploracion neurologica y ORL resultan normales. Durante uno de los episodios uno de sus hijos filma con su movil un claro nistagmo hacia la derecha. Con el diagnostico de posible vertigo episodico no posicional se le realizan los siguientes estudios complementarios en el hospital de referencia: RM craneal y CAI, TAC de penascos y Doppler de troncos

We aimed at assessing the clinical significance of the levels of acute lymphoblastic leukemia (ALL) cells in samples of cerebrospinal fluid (CSF) during therapy. We studied 990 CSF samples from 108 patients, at the time of diagnosis (108) and at each time of intrathecal therapy (882). The proportions of leukemic cells in CSF samples were assessed by flow cytometry (FCM). Patients with central nervous system (CNS) involvement at diagnosis (FCM+) showed predominantly a T-ALL, and higher percentages of known negative prognostic factors: high risk group, higher white blood cell counts, normal karyotype, and the BCR-ABL fusion gene. No differences in relapse free survival (RFS) and overall survival (OS) were observed between FCM+ versus FCM- at diagnosis. Patients with CNS involvement during therapy showed significantly older age, and higher frequencies of T-cell leukemia. We found a significantly higher RFS in patients with FCM+ during therapy. The detection of subclinical CNS disease by FCM during maintenance was associated with significantly lower 3-years RFS and 3-years OS. A sensitive methodology like FCM can be applied for a close follow-up of the levels of ALL in CFS samples, and may identify a group of patients at high risk for relapse.

The ability to draw is a complex perception and cognition function, which is acquired in infancy and is not usually investigated in the neuropaediatric clinic.To validate the Pascual graphomotor test (PGT) in 5 to 11 year-old Cuban school children.The PGT was performed on a total of 172 children from the city of Havana Círculo Infantil del Municipio Plaza nursery school and from the 1st to 5th year of a primary school in the same area. The sample was systematic. The test was repeated the following day. All the drawings were scored blind by a neurologist and neurology resident.For the validation of the test the differentiation with age and school year was taken as a validation criterion. A high correlation was obtained between the ages of the children and the scores obtained. The Spearman coefficient was -0.78 (P=0.01), and a there was a similar inverse correlation between the school year and the test scores (Spearman coefficient=-0.79, P=0.01). The test was very reliable, with an intraclass correlation coefficient (ICC) of 0.99 for inter-observer agreement and 0.97 for the test-retest.The test was valid according to the criterion employed, differentiation with age and school year. The PGT demonstrated good temporal and inter-observer stability. We believe that it is a very useful tool in the neurological examination of Cuban school children.

Aims: This work focuses on the development of a method for the identification of pathogenic yeast. With this aim, we target the nucleotide sequence of the RPS0 gene of pathogenic yeast species with specific PCR primers. PCR analysis was performed with both the genomic DNA, whole cells of clinical isolates of Candida species and clinical samples. Methods and Results: A single pairs of primers, deduced from the nucleotide sequence of the RPS0 gene from pathogenic yeast, were used in PCR analysis performed with both the genomic DNA and whole cells of clinical isolates of Candida species and clinical samples. The primers designed are highly specific for their respective species and produce amplicons of the expected sizes and fail to amplify any DNA fragment from the other species tested. The set of primers was tested successfully for the identification of yeast from colonies, blood cultures and clinical samples. These results indicate that genes containing intron sequences may be useful for designing species-specific primers for the identification of fungal strains by PCR. The sensitivity of the method with genomic DNA was evaluated with decreasing DNA concentrations (200 ng to 1 pg) and different cell amounts (10 7 –10 5 cells). Conclusion: The results obtained show that the amplification of RPS0 sequences may be suitable for the identification of pathogenic and other yeast species. Significance and Impact of the Study: Identification of Candida species using molecular approaches with high discriminatory power is important in determining adequate measures for the interruption of transmission of this yeast. The approach described in this work is based on standard technology, and it is specific, sensitive and does not involve complex and expensive equipment. Furthermore, the method developed in this work not only can be used in eight yeast species, but also provides the basis to design primers for other fungi species of clinical, industrial or environmental interest.

Kikuchi-Fujimoto disease or necrotizing histiocytic lymphadenitis is a self-limited process of lymphatic system that affects more frequently young women. Fever and adenopathy, often cervical, are typical. Diagnosis is fundamentally based on the affected lymph node biopsy, since laboratory data are often normal. It's a very rare entity in Spain, being more frequent in Oriental countries. It's a benign evolution process, with a spontaneous healing in some weeks or months. This is the reason because of this disease could be infradiagnosed. It's very important the differential diagnosis with malignant lymphomas, because Kikuchi-Fujimoto disease doesn't need any treatment.

La enfermedad de Kikuchi-Fujimoto o linfadenitis necrotizante histiocitaria es un proceso autolimitado del sistema linfático que afecta con más frecuencia a mujeres jóvenes. Clínicamente se caracteriza por la presencia de fiebre y de adenopatías, sobretodo cervicales. El diagnóstico se basa fundamentalmente en la biopsia del ganglio afectado, ya que a menudo los datos de laboratorio son normales. Es una enfermedad rara en España, siendo más frecuente en países orientales. Se trata de un proceso de evolución benigna, con resolución espontánea en semanas o meses, razón por la cual esta enfermedad podría estar infradiagnosticada. Es fundamental su distinción de los linfomas, dado que la enfermedad de Kikuchi no necesita tratamiento.

Eosinophilic gastroenteritis is rare. Fewer than 30 cases have been published in the Spanish literature, although Kaijser first described this entity in 1937. Its etiology is still unknown and it has frequently been reported to involve the stomach and small bowel, with characteristic eosinophilic infiltration of the bowel wall. The colon has rarely been reported as a site of this condition, which manifests as acute abdominal pain due to intestinal obstruction. We report the case of a 38-year-old woman who presented eosinophilic gastroenteritis. Onset was acute colitis causing acute abdomen. The patient received conservative treatment and responded well to steroids. To our knowledge, such a case has not previously been reported.