Development of a new tool for assessing health-related quality of life in patients with primary hyperparathyroidism.

BACKGROUND Several studies in recent years have evaluated Health Related Quality of Life (HRQoL) of patients with primary hyperparathyroidism (PHPT). No disease specific questionnaires are available to assess the impact of the disease. The aim of this research is to describe the development of a new disease specific Quality of Life (QoL) questionnaire for use specifically with PHPT patients. METHODS A conceptual model was developed describing the impact of the disease and its symptoms on QoL domains. A literature review was conducted to identify the most relevant domains. A focus group with experts was used to validate the domains; 24 patients were also interviewed to complement the information from the patient's perspective. A content analysis of the interviews was performed to identify items related with the impact of the disease, leading to PHPQoL-V.1 which was presented to a sample of 67 patients. Reliability was assessed by Cronbach's coefficient alpha and item-total score correlations. Validity was assessed by a factor analysis performed to determine the number of domains. Rasch analysis was carried out in order to refine the questionnaire items. RESULTS 259 items were extracted from the interviews that were subsequently reduced to 34 items. Cronbach's coefficient alpha was 0.92. The factor analysis extracted two domains (physical and emotional). After Rasch analysis the questionnaire PHPQoL-V.2 kept 16 items (9 physical and 7 emotional). The questionnaire was developed in a Spanish population and the final version was translated to English through translation and back-translation. CONCLUSION The first disease specific HRQoL questionnaire for PHPT patients (PHPQoL-16) has been developed. Validation studies designed to assess measurement properties of this tool are currently underway.

Funció gonadal en pacients obesos abans i després de cirurgia bariàtrica

Estudio observacional en 33 hombres obesos mórbidos sometidos a cirugía bariátrica con objetivo de analizar cambios del perfil gonadal tras pérdida de peso. La prevalencia de hipogonadismo basal (TT & 300 ng/dL y TL & 65 ng/dL) era 78,8% y 51,5%; y un año tras cirugía 6% y 15%. Al año de la cirugía se observó incremento de TT, TL, SHBG y FSH y disminución de estradiol y prolactina. La edad y PPP se asociaban significativa e independientemente al porcentaje de cambio de TT. El hipogonadismo asociado a hombres con obesidad mórbida es muy prevalente y reversible con pérdida ponderal.

A novel ABCG-like transporter of Trypanosoma cruziis involved in natural resistance to benznidazole

Benznidazole (BZ) is one of the two drugs used for Chagas disease treatment. Nevertheless therapeutic failures of BZ have been reported, which were mostly attributed to variable drug susceptibility among Trypanosoma cruzistrains. ATP-binding cassette (ABC) transporters are involved in a variety of translocation processes and some members have been implicated in drug resistance. Here we report the characterisation of the first T. cruzi ABCG transporter gene, named TcABCG1, which is over-expressed in parasite strains naturally resistant to BZ. Comparison ofTcABCG1 gene sequence of two TcI BZ-resistant strains with CL Brener BZ-susceptible strain showed several single nucleotide polymorphisms, which determined 11 amino acid changes. CL Brener transfected with TcI transporter genes showed 40-47% increased resistance to BZ, whereas no statistical significant increment in drug resistance was observed when CL Brener was transfected with the homologous gene. Only in the parasites transfected with TcI genes there was 2-2.6-fold increased abundance of TcABCG1transporter protein. The analysis in wild type strains also suggests that the level of TcABCG1transporter is related to BZ natural resistance. The characteristics of untranslated regions of TcABCG1genes of BZ-susceptible and resistant strains were investigated by computational tools.

Co-administration of plasmid-encoded granulocyte-macrophage colony-stimulating factor increases human immunodeficiency virus-1 DNA vaccine-induced polyfunctional CD4+ T-cell responses

T-cell based vaccines against human immunodeficiency virus (HIV) generate specific responses that may limit both transmission and disease progression by controlling viral load. Broad, polyfunctional, and cytotoxic CD4+T-cell responses have been associated with control of simian immunodeficiency virus/HIV-1 replication, supporting the inclusion of CD4+ T-cell epitopes in vaccine formulations. Plasmid-encoded granulocyte-macrophage colony-stimulating factor (pGM-CSF) co-administration has been shown to induce potent CD4+ T-cell responses and to promote accelerated priming and increased migration of antigen-specific CD4+ T-cells. However, no study has shown whether co-immunisation with pGM-CSF enhances the number of vaccine-induced polyfunctional CD4+ T-cells. Our group has previously developed a DNA vaccine encoding conserved, multiple human leukocyte antigen (HLA)-DR binding HIV-1 subtype B peptides, which elicited broad, polyfunctional and long-lived CD4+ T-cell responses. Here, we show that pGM-CSF co-immunisation improved both magnitude and quality of vaccine-induced T-cell responses, particularly by increasing proliferating CD4+ T-cells that produce simultaneously interferon-γ, tumour necrosis factor-α and interleukin-2. Thus, we believe that the use of pGM-CSF may be helpful for vaccine strategies focused on the activation of anti-HIV CD4+ T-cell immunity.

When to initiate combined antiretroviral therapy to reduce mortality and AIDS-defining illness in HIV-infected persons in developed countries: an observational study.

BACKGROUND: Most clinical guidelines recommend that AIDS-free, HIV-infected persons with CD4 cell counts below 0.350 × 10(9) cells/L initiate combined antiretroviral therapy (cART), but the optimal CD4 cell count at which cART should be initiated remains a matter of debate. OBJECTIVE: To identify the optimal CD4 cell count at which cART should be initiated. DESIGN: Prospective observational data from the HIV-CAUSAL Collaboration and dynamic marginal structural models were used to compare cART initiation strategies for CD4 thresholds between 0.200 and 0.500 × 10(9) cells/L. SETTING: HIV clinics in Europe and the Veterans Health Administration system in the United States. PATIENTS: 20, 971 HIV-infected, therapy-naive persons with baseline CD4 cell counts at or above 0.500 × 10(9) cells/L and no previous AIDS-defining illnesses, of whom 8392 had a CD4 cell count that decreased into the range of 0.200 to 0.499 × 10(9) cells/L and were included in the analysis. MEASUREMENTS: Hazard ratios and survival proportions for all-cause mortality and a combined end point of AIDS-defining illness or death. RESULTS: Compared with initiating cART at the CD4 cell count threshold of 0.500 × 10(9) cells/L, the mortality hazard ratio was 1.01 (95% CI, 0.84 to 1.22) for the 0.350 threshold and 1.20 (CI, 0.97 to 1.48) for the 0.200 threshold. The corresponding hazard ratios were 1.38 (CI, 1.23 to 1.56) and 1.90 (CI, 1.67 to 2.15), respectively, for the combined end point of AIDS-defining illness or death. Limitations: CD4 cell count at cART initiation was not randomized. Residual confounding may exist. CONCLUSION: Initiation of cART at a threshold CD4 count of 0.500 × 10(9) cells/L increases AIDS-free survival. However, mortality did not vary substantially with the use of CD4 thresholds between 0.300 and 0.500 × 10(9) cells/L.

Health risk behaviors in adolescents with chronic conditions

OBJECTIVE: The objective of this study was to compare the frequency of risk behaviors and to measure the extent of co-occurrence of these behaviors in chronically ill and healthy adolescents. METHODS: Data were drawn from the 2002 Swiss Multicenter Adolescent Survey on Health database, a nationally representative survey of 7548 adolescents in postmandatory school aged 16 to 20 years. There were 760 subjects who reported a chronic illness and/or a disability. The comparison group consisted of 6493 subjects who answered negatively to both questions. We defined 8 risk behaviors: daily smoking, alcohol misuse, current cannabis use, current use of any other illegal drug, early sexual debut, eating disorder, violent acts, and antisocial acts. We analyzed each behavior and the sum of behaviors, controlling for age, gender, academic track, parents' education level, depression, and health status. Results are given as adjusted odds ratios using the comparison group as the reference category. RESULTS: Youth with a chronic condition were more likely to smoke daily, to be current cannabis users, and to have performed violent or antisocial acts. Youth with a chronic condition were also more likely to report 3 or >or=4 risk behaviors. CONCLUSIONS: These results indicate that having a chronic condition carries additional risks for engaging in health risk behaviors and emphasize the importance of health risk screening and preventive counseling for young people in general and among those suffering from chronic conditions in particular.

Pancreatic Trauma in Children

Objectives and Study: To document the demographics, mechanisms and outcome of traumatic pancreatitis in children at a single large tertiary referral centre in Australia. Methods: We undertook a 10-year retrospective audit of children admitted to the Royal Children's Hospital [RCH], Melbourne, Australia with a hospital coded diagnosis which included pancreatic injury between 1993 and 2002. Data included patient demographics, source of admission, mechanism of injury, pancreatic complications, associated injuries, Intensive Care Unit [ICU] admission, results of any operative findings, results of any acute computed tomography (CT) and/or ultrasound (US) imaging of pancreas, selected laboratory findings and length of stay. Results: We identified two distinct groups of patients in the 91 documented cases of pancreatic trauma (median age 8.0 yr, range 0.6-15.8 yr; M:F 2.5:1.0). Fifty-nine had a history of abdominal trauma and elevated serum lipase but no CT or ultrasound evidence of pancreatic injury (Group A). Thirty-two had a history of abdominal trauma, elevated serum lipase but also had CT scan and/or ultrasound evidence of pancreatic injury[Group B]. Patients with ''less severe'' injury based on normal imaging had a lower initial lipase level [Group A, median 651 U/L (interquartile range 520 - 1324) vs, Group B, 1608 U/L (interquartile range 680-3526); P = 0.005] and shorter admission time [Group A, 9.0 days (interquartile range 5.5-15.5) vs Group B, 13.4 days (interquartile range 6.8 - 23.8), P = 0.04]. There were no differences with respect to mortality [Group A, 13.5 % vs Group B, 12.5 %] but patients with evidence of injury on imaging were more likely to have surgical intervention [P = 0.0001]. The single most important overall cause of pancreatic trauma was involvement in a motor vehicle accident as a passenger or pedestrian. However, in children with high-grade ductal injury, bicycle handlebar injuries were most common. Associated injuries were common in both groups. Conclusion: Significant pancreatic injury can occur in the absence of abnormality on medical imaging. Pancreatic trauma commonly occurs in the context of multiple injuries after motor vehicle accidents in children and bicycle handlebar injuries, especially in boys. Most children can be treated conservatively, with surgical intervention being limited to high-grade ductal injury.

Protocolo para la evaluación de concha de abanico Argopecten purpuratus (LAMARCK, 1819)

La Unidad de Investigaciones de Invertebrados Marinos en conjunto con las sedes descentralizadas del Instituto del Mar del Perú, IMARPE, con fines de establecer y estandarizar los procedimientos para la estimación de la población y biomasa de concha de abanico (Argopecten purpuratus) en áreas silvestres, elaboró este protocolo que describe los pasos a seguir desde la planificación en escritorio, la ejecución a bordo de embarcaciones, pasando por los cálculos estadísticos, hasta la elaboración del informe ejecutivo. La estimación de la población y biomasa de concha de abanico, en áreas silvestres se realiza dentro del contexto de evaluación poblacional, que involucra este primer aspecto e incorpora: estructura poblacional por tallas y madurez gonadal, relaciones biométricas y biológicas, y las condiciones ambientales predominantes del ambiente marino. La correcta aplicación de estos procedimientos conducirá a la obtención de información confiable.

Sosiologinen väitöskirja suomalaisessta kirkostaeroamisliikkeestä

Juha Seppo

Evaluación poblacional de Ensis macha (Molina, 1782) en bahía Independencia-Pisco, 2010

Entre octubre y noviembre 2010 se realizó una evaluación poblacional de la concha navaja (Ensis macha) para determinar distribución, abundancia y estructura poblacional en los bancos naturales de bahía Independencia, empleando el muestreo al azar. Se colectó 672 individuos, la longitud valvar fluctuó entre 9 y 186 mm, promedio 126,2 mm, el 20,2% de ejemplares presentaron tallas menores a la mínima de extracción (≥120 mm). Las concentraciones variaron entre 0,5 y 76,5 ind.m-2, el área con mayor densidad promedio fue Balsero (12,5 ind.m-2), seguido de Canastones (3,6 ind.m-2), Morro Quemado (1,9 ind.m-2) y Tunga (1,5 ind.m-2). La biomasa relativa osciló entre 6,6 y 2.210,2 g.m-2, la mayor biomasa promedio se registró en Balsero con 359,7 g.m-2. La población y biomasa total fueron estimadas en 17,55 millones (±35,3%), y 498,65 t (±37,5%), respectivamente. En Morro Quemado, el recurso no se ha recuperado a pesar de la veda establecida en el litoral de Pisco (R.M. Nº 661-2008-PRODUCE); mientras que en Balsero se observaron signos de recuperación

Evaluación poblacional de Argopecten purpuratus (Lamarck, 1819) en bahía Independencia. Pisco, diciembre 2010

En diciembre 2010, se realizó una evaluación poblacional de la concha de abanico (Argopecten purpuratus) con la finalidad de determinar la distribución, abundancia y estructura poblacional en los bancos naturales de bahía Independencia, se empleó el muestreo al azar estratificado por profundidad. Las tallas fluctuaron entre 4 y 101 mm de altura valvar, media en 61,4 mm y se registró el 58,2% de ejemplares con tallas mayores a la mínima de extracción (≥65 mm). Predominaron ejemplares desovantes (92,1%). Se distribuyó formando agregaciones con concentraciones entre 1 y 5 ind.m-2. La población y biomasa total se estimó en 12,47 millones (±25,6%) y 948,2 t (±27,7%), respectivamente. Tunga y La Pampa se constituyeron como las áreas más importantes en población y biomasa.

Evaluación poblacional de Gari solida (Gray, 1828) en bahía Independencia-Pisco, junio 2010

En junio 2010, se efectuó la evaluación poblacional de almeja Gari solida en los principales bancos naturales de bahía Independencia: El Ancla, Pan de Azúcar y La Pampa para determinar su distribución, concentración, estructura por tamaños y magnitud poblacional. Los resultados evidenciaron una disminución de la biomasa y población, respecto a agosto del 2008, en 44,9% y 56,2%, respectivamente. La densidad por unidad de muestreo fluctuó entre 1 y 47 ind.m-2, las mayores densidades medias se encontraron en Pan de Azúcar (5,06 ind.m-2), La Pampa (2,42 ind.m-2) y menor densidad en El Ancla (0,57 ind.m-2). La biomasa total se calculó en 336,96 t (± 19,9%) y la población en 8,48 millones de individuos (± 19,85%), el 22,1% de la biomasa correspondió a ejemplares con tamaño mínimo de extracción (TME ≥75 mm). Las tallas de 792 ejemplares analizados fluctuaron entre 4 y 95 mm de longitud valvar, con moda en 65 mm y media en 57,5 mm. El rendimiento promedio del pie con respecto al peso total fue de 1: 9,5.

Evaluación poblacional de Chondracanthus chamissoi (C. Agardh 1820) en las bahías de Pisco y Paracas, Otoño 2010.

Entre mayo y junio 2010, se desarrolló la evaluación poblacional de la macroalga Chondracanthus chamissoi “yuyo” de las praderas en las bahías de Pisco y Paracas. Las biomasas medias fluctuaron entre 2,2 y 67,0 g.m-2, con promedio de 43,6 g.m-2. Se estimó una biomasa total de 211,96 toneladas (±56,8%); de los cuales 179,74 t correspondieron a Atenas; 30,1 t a Puerto Nuevo y 2,1 t a Playa Lobería. El sustrato de fijación estuvo compuesto, principalmente, por piedras, conchuela y arena media. En las praderas de Atenas ocupó la mayor parte del área evaluada, en las praderas de Puerto Nuevo y Playa Lobería se encontraron reducidas, respecto al 2007. Se encontró ejemplares entre 1 y 25 cm de longitud. El peso total individual varió de 0,1 a 94,6 g. Se registró biodiversidad asociada conformada por moluscos. Las condiciones oceanográficas se registraron normales, lo que permite suponer que la disminución poblacional respondería a las actividades de extracción.

Evaluación poblacional de Lessonia trabeculata Villouta y Santelices, 1986 en San Juan de Marcona, Marzo 2010

IMARPE, en marzo del 2010 realizó la evaluación poblacional de la macroalga Lessonia trabeculata en 2 sectores de San Juan de Marcona: Carro Caído (sector 1) y San Nicolás (sector 4). El diámetro mayor del rizoide (DMR) se registró en el sector 1 (59,1%), en el sector 4 solo el 30,3% presentó tamaño >20 cm (tamaño mínimo de extracción). En el sector 1 se estimó la biomasa en 38.070 t y en el sector 4 fue 3.279 t; en base a la biomasa se proyectó un rendimiento de 4.166 t para el año 2010. Se consideró evitar la extracción en la estación de otoño.