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Biomedical subjects

A Hernández

Publications and source records attributed to A Hernández.

At least 19 recordsLinked to original sources

Plasticity of photoprotective mechanisms of Buxus sempervirens L. leaves in response to extreme temperatures.

Summer 2003 was unusually hot in Western Europe, with local droughts and an intense heatwave, that led to a massive damage in vegetation. Since high temperatures are supposed to generate photooxidative stress, we analysed photoprotective responses in leaves of the evergreen boxtree (Buxus sempervirens L.) during summer 2003. All the photoprotective compounds analysed (alpha-tocopherol, beta-carotene, and xanthophylls cycle pigments) were simultaneously induced in parallel with a reduction in photochemical efficiency (Fv/Fm). To characterise these responses, we compared these data with other data obtained during cold stress periods (2003, 2005) and with an unstressful summer (2002). Photoprotective responses observed during the heatwave were also induced by low temperature stress, and in both situations, this effect was exacerbated by light. In parallel with such induction the accumulation of red retro-carotenoids and xanthophyll esters was also observed under unfavourable conditions, suggesting a photoprotective role for both groups of carotenoids. This is the first report showing that in any species (Buxus sempervirens L.), the same retro-carotenoids can be induced in response to winter and summer stress. Present results demonstrate that the same mechanisms are induced as response to sub- and supraoptimal temperatures and the plasticity of such responses plays a critical role in plant acclimation to extreme temperatures, an ability that is specially important in the context of any future climate warming.

Acclimatization↗

Analysis of body fluid mixtures by mtDNA sequencing: An inter-laboratory study of the GEP-ISFG working group.

The mitochondrial DNA (mtDNA) working group of the GEP-ISFG (Spanish and Portuguese Group of the International Society for Forensic Genetics) carried out an inter-laboratory exercise consisting of the analysis of mtDNA sequencing patterns in mixed stains (saliva/semen and blood/semen). Mixtures were prepared with saliva or blood from a female donor and three different semen dilutions (pure, 1:10 and 1:20) in order to simulate forensic casework. All labs extracted the DNA by preferential lysis and amplified and sequenced the first mtDNA hypervariable region (HVS-I). Autosomal and Y-STR markers were also analysed in order to compare nuclear and mitochondrial results from the same DNA extracts. A mixed stain prepared using semen from a vasectomized individual was also analysed. The results were reasonably consistent among labs for the first fractions but not for the second ones, for which some laboratories reported contamination problems. In the first fractions, both the female and male haplotypes were generally detected in those samples prepared with undiluted semen. In contrast, most of the mixtures prepared with diluted semen only yielded the female haplotype, suggesting that the mtDNA copy number per cell is smaller in semen than in saliva or blood. Although the detection level of the male component decreased in accordance with the degree of semen dilution, it was found that the loss of signal was not consistently uniform throughout each electropherogram. Moreover, differences between mixtures prepared from different donors and different body fluids were also observed. We conclude that the particular characteristics of each mixed stain can deeply influence the interpretation of the mtDNA evidence in forensic mixtures (leading in some cases to false exclusions). In this sense, the implementation of preliminary tests with the aim of identifying the fluids involved in the mixture is an essential tool. In addition, in order to prevent incorrect conclusions in the interpretation of electropherograms we strongly recommend: (i) the use of additional sequencing primers to confirm the sequencing results and (ii) interpreting the results to the light of the phylogenetic perspective.

Blood↗

Nosocomial and community-acquired meticillin-resistant Staphylococcus aureus infections in hospitalized patients (Spain, 1993-2003).

A series of annual surveys on the prevalence of infections in hospitalized patients in Spain was undertaken from 1993 to 2003 to describe clinical and demographic characteristics, trends and geographical variations in the proportion of meticillin-resistant Staphylococcus aureus (MRSA). A total of 8312 S. aureus infections in patients from 296 acute care hospitals pertaining to 17 regions in Spain were observed during the study period. Overall, 23.8% of these organisms were reported as meticillin resistant. The proportion of MRSA varied widely across regions and during the study period. Patients with nosocomial infections (NIs) had a two-fold higher prevalence of MRSA (31%) than patients with community-acquired infections (CAIs) (14%; P<0.001). Nevertheless, there was an increasing trend in the prevalence of MRSA isolates, both in patients with NI (from 22% to 41%; P<0.001) and with CAI (from 7% to 28%; P<0.001) throughout the 11-year period. Geographical variations over the last three years (2001-2003) show a centripetal gradient, with the lowest MRSA prevalence in south-west Spain and the highest MRSA prevalence in the central regions. Almost five-fold differences in MRSA proportions were seen between regions (range 10.3-54.5%). Compared with bloodstream infections, infections in other sites were more likely to be caused by MRSA (adjusted odds ratios for surgical site, urinary tract, skin and respiratory infections of 1.2, 1.2, 1.5 and 2.1, respectively).

Community-Acquired Infections↗

Is an emergency heart transplantation justified?

INTRODUCTION: Emergency heart transplantation remains an important controversy due to the shortage of donors and the previously demonstrated results inferior to other patients. These recipients display a worse clinical status and their donors are more often considered suboptimal. Nevertheless, it is the only therapeutic option for patients with advanced cardiomyopathy and acute decompensation with no response to other therapies. We compared results among the emergency indication with those of elective transplants. METHODS: We analyzed the 213 patients who underwent cardiac transplantation in our center up to December 2004 to compare emergency with elective heart transplantations for preoperative and surgical variables as well as outcomes. RESULTS: A higher percentage of emergency patients were New York Heart Association class IV, displayed renal dysfunction, and were women. Regarding donors, a higher percentage were over 40 years of age. No differences were observed in the early and first-year mortality or morbidity rates, although we noted a greater 5-year mortality rate among emergency cases. CONCLUSIONS: In our center emergency heart transplantation was associated with only slightly worse results compared with elective transplantations. Both donors and recipients should be carefully selected to improve results.

Adult↗

Is it possible to reduce the number of endomyocardial biopsies with new immunosuppressive drugs?

INTRODUCTION: Using previous immunosuppressive regimens the considerable number of rejections of heart transplantations required routine surveillance myocardial biopsies, particularly during the early months. More effective immunosuppressive regimens would probably allow routine biopsies to be reduced. Our objectives were to assess the incidence of and the time to rejection with a new immunosuppressive protocol, considering the possibility of reducing the number of routine biopsies. MATERIALS AND METHODS: We undertook a retrospective study of patients who had undergone heart transplantation from January 2002 to August 2005 and who received induction therapy with Daclizumab (two doses) and maintenance therapy with tacrolimus + mycophenolate + low doses of steroids. RESULTS: Among 42 patients, 13 (31%) showed myocardial rejection in the first 3 months. All episodes were grade 3A and none had hemodynamic consequences. After 3 months, three patients (7.1%) experienced 3A rejection and 1 (2.4%), grade 4 acute rejection after ceasing medical treatment. Each episode of rejection was predictable, either owing to reduction in immunosuppression therapy or to a previous history of rejection. CONCLUSIONS: The majority of rejection episodes occur in the first 3 months posttransplantation. After that time, the incidence of rejection is less and clinically predictable. Therefore, surveillance biopsies should be limited to the first 3 months, and performed later either in symptomatic patients (with a history of previous rejection) or in those whose immunosuppressive therapy needs to be reduced.

Biopsy↗

Sirolimus experience in heart transplantation.

INTRODUCTION: Sirolimus is a potent, nonnephrotoxic immunosuppressant with antiproliferative activity in nonimmune cells. Recent data support the conversion in late renal failure secondary to calcineurin inhibitors (CNIs), with limited experience in de novo regimens in patients with predictive factors of postoperative renal impairment. OBJECTIVE: We evaluated our experience of sirolimus-based immunosuppression administered to 25 heart transplant recipients. METHODS: A retrospective analysis of 25 heart transplant recipients who received sirolimus included 17 conversions due to late CNI-related chronic renal dysfunction, six patients with a de novo regimen, and two patients who developed posttransplant pulmonary neoplasms. The conversion from CNI to sirolimus was started with 2 mg, with an average time after transplantation of 78 +/- 43 months and a mean baseline serum creatinine level of 2.1 +/- 0.45 mg/dL. The mean clinical follow-up was 17 +/- 9 months postconversion, and included echocardiography and laboratory studies. In the de novo group successive endomyocardial biopsies were performed during the first semester. RESULTS: Serum creatinine fell from 2.1 +/- 0.45 mg/dL to 1.8 +/- 0.51 mg/dL (P = .012). Mean sirolimus levels were 15 +/- 9 ng/mL (doses 2.2 +/- 0.4 mg). This improvement continued until 3 months (creatinine 1.5 +/- 0.35 P < .01)/sirolimus levels 11.7 +/- 5 ng/mL [1.9 +/- 0.7 mg]), with maintenance at 6 months (1.58 +/- 0.3 mg/dL/14 +/- 4 ng/mL [1.85 +/- 0.7 mg]) and 1-year postconversion (1.53 +/- 0.39 mg/dL; P = .019/10.7 +/- 2.5 ng/mL [1.5 +/- 0.7 mg]). De novo, after a mean follow-up of 13 months (range 3 to 35), sirolimus appeared to increase the incidence of a moderate histological grade of rejection without hemodynamic compromise. Side effects were common (63%), including peripheral edema, skin eruptions, and pericardial effusion. Only one patient discontinued treatment, due to intestinal intolerance. Four patients died during follow-up: two because of lung neoplasms and two because of progressive graft vessel disease. CONCLUSION: Sirolimus improved late CNI-related chronic renal dysfunction. Kidney function was preserved using a de novo CNI-free immunosuppressive regimen for recent cardiac transplant recipients.

Adult↗

Infections in cardiac transplant recipients: clinical and microbiological characteristics and consequences.

INTRODUCTION: Infections are one of the main complications that cause morbidity and mortality in cardiac transplant recipients. We sought to establish the incidence of infections, identify the predisposing factors and determine their consequences. PATIENTS: A prospective study of 30 patients who received cardiac transplantations in our hospital from July 2003 to May 2005. RESULTS: Of the 30 transplant recipients, 93.3% were men (average age, 48 years); the average age of the women was 53 years. The incidence of infection was 70%: 21 episodes of infection. The main clinical symptoms were bacteriemia (28%), pneumonia (19%), and surgical wound infections (14%). The etiology of the infection, as established in 12 cases (57%), was bacterial (66%), viral (25%), or fungal (9%). The most common microorganisms were cytomegalovirus and coagulase-negative staphylococcus. None of the donors had a history of infection. There was a higher frequency of serious complications, such as renal failure (12.9%), respiratory insufficiency (9.6%), and multiorgan failure (9.6%) among patients with versus without infections (P < .05). The 1-year survival rate of patients with infections was similar to that of patients with no infections (83% vs 88%, P = NS). CONCLUSIONS: The incidence of infections was 70%. Bacteremia, pneumonia, and surgical wound infections occurred most frequently. Cytomegalovirus and coagulase-negative staphylococcus were the most frequent microorganisms. Patients with infections had the most serious complications, but their survival rate was similar to that of patients free of this complication.

Bacteremia↗

Pulmonary arteriole remodeling in hypoxic broilers expressing different amounts of endothelial nitric oxide synthase.

Lung samples from 30 pulmonary hypertensive chickens expressing low nitric oxide (NO) synthase activity in endothelial arteriolar cells were compared with samples taken from 30 nonhypertensive animals expressing high activity to investigate a possible relationship between the just-mentioned expressions and pulmonary vascular remodeling. The external diameter and media muscular thickness in 20 arterioles of 50- to 200-microm external diameter were measured in lung samples from 17-, 30-, and 42-d-old broilers to calculate %T (medial wall width divided by external vessel diameter x 100). The %T was higher in hypertensive chickens than in nonhypertensive (P < 0.01) chickens and was inversely related to NO synthase enzyme (P < 0.01). It can be inferred from this study that NO is involved in the remodeling process in broilers with hypoxic pulmonary hypertension syndrome.

Aging↗

Determination of the maximum tolerated dose and the safety index of an experimental fasciolicide in cattle.

The aim of the present study was to determine the maximum tolerated dose (MTD) and the safety index (SI) of 5-chloro-2-methylthio-6-(1-napthyloxy)1H-benzimidazole, called compound alpha, in cattle. In addition, to search for possible adverse effects after treatment, the measurement of some biochemical, haematological and physiological parameters were also analysed. Eighteen crossbred heifers were divided into six groups of three animals each. Groups 1-5 received a single oral dose of 12, 36, 60, 120 and 180 mg/kg of body weight (bw) of compound alpha. Group 6 served as an untreated control. To determine the biochemical, haematological and enzymatic parameters, sera and blood samples were individually taken at 0, 4, 8, 16, 32, 128, and 720 h after treatment. Physiological parameters such as rectal temperature, heart rate (HR), respiration rate (RR) and ruminal motility were measured at the time intervals mentioned above. Estimation of the MTD and SI was obtained by using the formula reported by the Food and Drug Administration (FDA), the results showing an MTD of 180 mg/kg/bw and an SI of 15 times the recommended clinical dose. Some statistical differences were observed in a few of the biochemical, haematological and enzymatic parameters, the adverse effects being not highly representative. Alterations on HR and RR were statistically different (P<0.05) only in heifers treated with 180 mg.

Administration, Oral↗

Paraventricular-coerulear interactions: role in hypertension induced by prenatal undernutrition in the rat.

Rats submitted to fetal growth retardation by in utero malnutrition develop hypertension when adult, showing increased hypothalamic mRNA expression for corticotropin-releasing hormone (CRH) and increased central noradrenergic activity. As hypothalamic CRH serves as an excitatory neurotransmitter within the locus coeruleus (LC) and coerulear norepinephrine plays a similar role within the paraventricular nucleus (PVN) of the hypothalamus, we studied, in both normal and prenatally undernourished 40-day-old anesthetized rats, the effects of intra-LC microinjection of CRH and intra-PVN microinjection of the alpha(1)-adrenoceptor antagonist prazosin on multiunit neuronal activity recorded simultaneously from the two nuclei, as well as the effects on systolic pressure. Undernutrition was induced during fetal life by restricting the diet of pregnant mothers to 10 g daily, whereas mothers of control rats received the same diet ad libitum. At day 40 of postnatal life: (i) undernourished rats showed increased neuronal activity in the PVN and LC, as well as increased systolic pressure; (ii) intra-LC CRH stimulated LC and PVN neurons and increased systolic pressure only in normal rats; (iii) intra-PVN prazosin decreased LC and PVN neuronal activity and systolic pressure only in undernourished rats; and (iv) in normal rats, prazosin prevented the stimulatory effect of CRH only in PVN activity; in undernourished rats, prazosin allowed CRH to regain its stimulatory effects. The results point to the existence of an excitatory PVN-LC closed loop, which seems to be hyperactive in prenatally undernourished rats as a consequence of fetal programming; this loop could be responsible, in part, for the hypertension developed by these animals.

Animals↗

Optimization of phosphate removal in anodizing aluminium wastewater.

The wastewater produced after brightening and anodizing aluminium has high concentrations of phosphates and sulphates. The addition of MgO in a first physico-chemical wastewater treatment step makes the selective recovery of phosphates in the form of magnesium phosphates feasible, which may be reused as fertilizer. The proposed wastewater treatment process allows manufacturers to reduce more than 70% of the volume of the precipitate in the sedimentation reactor and more than 50% of the weight of the final disposal sludge. In this study, the use of an alternative low-grade MgO (LG-MgO) as a source of magnesium, which is cheaper than pure MgO, is investigated. The phosphate concentration and pH of the treated wastewater is controlled by the formation and precipitation of newberyite or bobierrite as a function of the magnesium source added. According to experimental data, a reaction mechanism is proposed. Although LG-MgO reacts more slowly than pure MgO and it is necessary to add 3-4 times the stoichiometric amount, this procedure has considerable economic and technical advantages.

Aluminum↗

Persistence of invertebrate iridescent virus 6 in tropical artificial aquatic environments. Brief report.

The rate of loss of activity of invertebrate iridescent virus 6 (IIV-6, family Iridoviridae) was determined in two artificial aquatic habitats in southern Mexico, using a sensitive insect bioassay technique. IIV-6 placed in trays of water in direct sunlight suffered rapid loss of activity (99.99% reduction) over a period of 36 h, during which water temperatures fluctuated between 24 and 41 degrees C. No significant deactivation occurred during the hours of darkness. In contrast, IIV-6 placed in trays of water in the shade lost 97% of original activity over a 60 h period, during which water temperatures fluctuated from 24 to 31 degrees C. Longitudinal analysis involving mixed effects models of time (shade) and cumulative exposure to ultraviolet radiation (sunlight) indicated that the rate of deactivation was best described by third order polynomial equations in both cases. We conclude that the likelihood of transmission of IIVs in aquatic habitats will be mediated by the intensity of UV radiation and water temperature.

Animals↗

Potential impact of American Diabetes Association (2000) criteria for diagnosis of gestational diabetes mellitus in Spain.

AIMS/HYPOTHESIS: This study was carried out to determine the impact of American Diabetes Association (ADA) 2000 criteria for the diagnosis of gestational diabetes mellitus (GDM) in the Spanish population. METHODS: Pregnant women were assigned to one of four categories: negative screenees, false-positive screenees, ADA-only-GDM (untreated) and GDM according to National Diabetes Data Group (NDDG) criteria (treated). Fetal macrosomia and Caesarean section were defined as primary outcomes, with seven additional secondary outcomes. RESULTS: Of 9,270 pregnant women screened for GDM, 819 (8.8%) met NDDG criteria. If the threshold for defining GDM had been lowered to ADA criteria, an additional 2.8% of women would have been defined as having the condition (relative increase of 31.8%). Maternal characteristics of women with ADA-only-GDM were between those of false-positive screenees and women with NDDG-GDM. The risk of diabetes-associated complications was slightly elevated in the individuals who would have been classified as abnormal only after the adoption of ADA criteria. In addition, the ADA-only-GDM contribution to morbidity was lower than that of other variables, especially BMI. CONCLUSIONS/INTERPRETATION: Use of the ADA criteria to identify GDM would result in a 31.8% increase in prevalence compared with NDDG criteria. However, as the contribution of these additionally diagnosed cases to adverse GDM outcomes is not substantial, a change in diagnostic criteria is not warranted in our setting.

Adolescent↗

Mycobactericidal and tuberculocidal activity of Korsolex AF, an amine detergent/disinfectant product.

The mycobactericidal and tuberculocidal activities of Korsolex AF against Mycobacterium tuberculosis, Mycobacterium avium-Mycobacterium intracellulare (MAI), Mycobacterium kansasii and Mycobacterium chelonae were determined using quantitative suspension and carrier tests. The effects of organic load and hard water were also considered. A clinical isolate of MAI was the most resistant of the four test organisms. A 2% solution had good mycobactericidal and tuberculocidal activities after 30 min of exposure. Although further evaluation using European standard tests is necessary, we conclude that Korsolex AF appears to be a promising product for the disinfection of hospital instruments contaminated with mycobacteria.

Amines↗

Use of oral sildenafil in patients with irreversible pulmonary hypertension not eligible for heart transplantation.

Heart transplantation is contraindicated in patients with acute irreversible pulmonary hypertension (PH), but new drugs are opening up therapeutic possibilities. Sildenafil citrate is a nonselective pulmonary vasodilator that is being used in our hospital to treat several patients with PH and which has allowed the inclusion of 1 patient on the waiting list for heart transplantation. A 20-year-old man with Becker muscular dystrophy was diagnosed at the age of 19 years with dilated cardiomyopathy with severe pulmonary artery systolic pressure (PH = 60 mm Hg). A pretransplantation study, including a right hemodynamic analysis with an acute vasodilator test using intravenous epoprostenol, revealed the irreversible character of the PH. Inasmuch as the administration of dobutamine did not achieve an adequate reduction of PH, oral sildenafil was started (25 mg every 12 hours) as salvage therapy. An echocardiogram obtained 2 months after starting sildenafil therapy showed normal right cavities, previously dilated, as well as minimal protosystolic tricuspid regurgitation without PH. A new right hemodynamic study performed after 4 months showed a reduction in pulmonary vascular resistance, from 8 U to 3.5 U Woods. As a result, the patient has now been included on the waiting list for heart transplantation. The promising example of this patient confirms the necessity to carry out controlled trials to establish definitively the indications for the use of sildenafil in patients with irreversible PH.

Administration, Oral↗

Myocardial preservation using Celsior: clinical results in high-risk cardiac transplantation.

Graft failure during the first few days posttransplantation remains one of the main unresolved complications. The objective of this study was to evaluate the influence of Celsior preservation solution on the incidence of early graft failure in high-risk cardiac transplant recipients. A retrospective study was carried out evaluating the cardiac transplants in 179 heart recipients. The patients were divided into 2 groups: (1) Celsior preservation solution (n = 37), and (2) Control solution (n = 142). To evaluate the efficacy of the Celsior solution, a subgroup of transplants from older donors or with ischemia times greater than 4 hours was compared with the other cases. The incidence of early graft failure was lower among the Celsior subgroups with longer ischemia times or of older donors compared with the control groups. We conclude that preservation with Celsior solution in cardiac transplantation is safe and effective. It even has advantages to reduce early graft failure compared with conventional solutions, a benefit that may be more evident in subgroups at high risk for myocardial dysfunction.

Disaccharides↗

Preliminary results of the effect of treatment of hyperhomocysteinemia and its relationship with inflammation, coagulation status, and endothelial function after renal transplantation.

The aim of this study was to assess the relationship between total plasma homocysteine (tHC) and several markers of endothelial function, coagulation, and pro-inflammatory status in renal transplant recipients. Our own previous study demonstrated the efficacy of folic acid (FA) and vitamin B(12) (B(12)) treatment to reduce tHC. Using 70 stable recipients, 56 of whom showed hyperhomocisteinemia (HHC) (tHC > or = 14 micromol/L) and a control group (n = 14, tHC < 14 micromol/L), we treated 29 patients in the HHC group (10 mg FA and 500 mg B(12) daily) and determined their endothelial function, inflammatory activity, and coagulation status. We assessed plasma levels of von Willebrand Factor and fibrinogen as the prothrombotic profile and C-reactive protein and plasma albumin as inflammation markers. We performed Doppler sonography of the brachial artery to assess endothelial function. The mean value of plasma tHC of 19.05 +/- 3.70 micromol/L before treatment decreased to 13.45 +/- 3.25 micromol/L after 3 months of treatment (P < .001). The vWF was significantly correlated with tHC (P < .05) and was higher in the HHC patients (P < .05). The fibrinogen mean level was also significantly higher in HHC patients (P < .05). The C-reactive protein level was significantly higher and the albumin level was lower among patients with HHC. The endothelium-dependent dilation (EDD) correlated with baseline tHC (P < .05). In preliminary data we observed that homocysteine-lowering therapy may provide cardiovascular protection by enhancing endothelial function, limiting oxidative stress, and reducing procoagulation status.

Adult↗

Cystic echinococcosis: analysis of the serological profile related to the risk factors in individuals without ultrasound liver changes living in an endemic area of Tacuarembó, Uruguay.

Cystic echinococcosis (CE) is a high prevalence zoonosis among the rural population of Tacuarembó (Uruguay). The correlation between serological data and the incidence of risk factors was studied in a survey carried out in 1998 among rural communities where 480 individuals were examined by means of abdominal sonography (local prevalence = 0.8%). Serum samples (305) were analysed by ELISA to determine specific IgG against crude antigens from Echinococcus granulosus. A total of 27 individuals exhibiting no detectable changes in abdominal sonographic examination were found to be seropositive ('ultrasound normal group'). Of these individuals 9 were seroreactive against purified antigen B. A significant degree of correlation was found between seroreactivity and the incidence of some risk factors (CE antecedent in the family, P < 0.005 and use of rural water, P < 0.0001) among this group. Follow-up of individuals of the 'ultrasound normal group' was carried out after 2 years to evaluate the implications of this serological reactivity. No predictive value for cyst development was assessed with complementary image study; in contrast transient antibodies were observed with both crude and purified antigen as approximately 60% of individuals became negative when re-sampled.

Adult↗