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Resumen Objetivo: generar recomendaciones sobre el diagnóstico y el tratamiento de la alergia a la proteína de la leche de vaca (APLV), que sirvan de referencia y consulta para los médicos pediatras y de cuidado primario. Materiales y métodos: el presente documento de posición de expertos fue desarrollado por un grupo de médicos, especialistas en diferentes áreas terapéuticas y con experiencia en APLV. Se definieron los temas más relevantes y se realizó una revisión de la literatura científica disponible, a fin de elaborar una propuesta de recomendaciones que fue discutida por los autores. Resultados: se elaboró un documento de posición que propone un enfoque práctico sobre la definición, el diagnóstico y el tratamiento de la APLV en el paciente pediátrico. Conclusiones: el diagnóstico temprano y el manejo adecuado de la APLV pueden contribuir a una disminución de la carga de esta enfermedad y sus complicaciones.

Abstract Objective: The objective of this paper is to develop and present recommendations for diagnosis and treatment of Cow's Milk Protein Allergy (CMPA) which can serve as a reference for pediatric and primary care physicians to consult. Materials and methods: This expert position document was developed by a group of doctors who are specialists in several therapeutic areas who have experience in CMPA. The most relevant topics were defined and a review of the available scientific literature was carried out to prepare a proposal for recommendations that was then discussed by the authors. Results: A position paper was developed that proposes a practical approach to definition, diagnosis and treatment of CMPA in pediatric patients. Conclusions: Early diagnosis and proper management of CMPA can help decrease the burden of this disease and its complications.

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BACKGROUND: Infants conceived from IVF are at increased risk for low birthweight. Animal studies suggest that embryo culture medium influences birthweight but it is unknown whether this association exists in humans. This study examines the relationship between culture medium and birthweight following IVF. METHODS: We identified all IVF cycles with start dates between 1 January 1999 and 31 December 2008 that used autologous oocytes with resulting embryos cultured in G1.3, Global or G1.5 medium. The population was restricted to singleton deliveries following Day 3, fresh single embryo transfer, or twin deliveries following Day 3, fresh double embryo transfer, at a gestational age of ≥ 34 weeks. Only the first cycle during the study period was included for each woman. Women were excluded if the number of gestational sacs on ultrasound differed from the number of infants born. Variables were evaluated with the χ²-test or analysis of variance. Multiple linear regressions controlled for potential confounders. RESULTS: Of the 198 women with singleton deliveries, 102 embryos were cultured in G1.3, 53 in Global and 43 in G1.5 medium. Of the 303 twin deliveries, 172 pairs of embryos were cultured in G1.3, 58 in Global and 73 in G1.5 medium. No significant association between culture medium and birthweight was observed, even when controlling for potential confounders. CONCLUSIONS: This retrospective study demonstrated no significant association between embryo culture medium and birthweight following IVF. Although our careful selection of patients minimized the influence of potential confounders, further research is required to elucidate this issue with larger numbers of patients.

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On 5 August 1968, publication of the Harvard Committee's report on the subject of "irreversible coma" established a standard for diagnosing death on neurological grounds. On the same day, the 22nd World Medical Assembly met in Sydney, Australia, and announced the Declaration of Sydney, a pronouncement on death, which is less often quoted because it was overshadowed by the impact of the Harvard Report. To put those events into present-day perspective, the authors reviewed all papers published on this subject and the World Medical Association web page and documents, and corresponded with Dr A G Romualdez, the son of Dr A Z Romualdez. There was vast neurological expertise among some of the Harvard Committee members, leading to a comprehensible and practical clinical description of the brain death syndrome and the way to diagnose it. This landmark account had a global medical and social impact on the issue of human death, which simultaneously lessened reception of the Declaration of Sydney. Nonetheless, the Declaration of Sydney faced the main conceptual and philosophical issues on human death in a bold and forthright manner. This statement differentiated the meaning of death at the cellular and tissue levels from the death of the person. This was a pioneering view on the discussion of human death, published as early as in 1968, that should be recognised by current and future generations.

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We studied an 8-year-old boy after a near-drowning left him in a vegetative state (VS) for 4 years before the study. Findings fulfilled all clinical criteria for the diagnosis of VS. The purpose of this study was to investigate whether there was significant differential activation of the brain in response to hearing his mother's voice compared with the voices of unknown women. The data were assessed using quantitative electric tomography (QEEGt), a technique that combines anatomical information of the brain by MRI with EEG patterns to estimate the sources of the EEG within the brain. We found significant differences for EEG frequencies from 14-58 Hz, with a peak at 33.2 Hz (gamma band). The 3D reconstruction showed that these statistical differences were localized in the lateral and posterior regions of the left hemisphere. No significant differences were found between unknown women vs. basal conditions. These results demonstrate recognition of the mother's voice and indicate high-level residual linguistic processing in a patient meeting clinical criteria for VS. These findings launch new ethical and practical implications for the management of VS patients.

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The use of immobilized yeast technology and its advantages in sparkling wine production was chosen for rose and white sparkling wine production, aiming at the study and brand development of a traditional local sparkling wine, mainly rose, which is produced from grape varieties cultivated at a local scale with the "rural" method, in Zitsa region, Ioannina, Greece. In all cases the double-layer immobilization method was used. Sodium alginate was used in the same concentration in all cases, for the external layer of the beads. Preliminary comparison of sodium alginate, carrageenan, and glycerine used for the internal core, showed that with 2% concentration of sodium alginate loaded with 2.10(9) cells/g of gel and 2,65 g of beads in each bottle cell release was not observed and the wine remained absolutely free of yeast cells even one month after fermentation completion. Organoleptic properties of the sparkling wine produced with immobilized yeast compared with sparkling wine produced with free yeast were found similar.

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Dentro de las enfermedades profesionales y, debido al ruido industrial, la sordera era, hasta hace poco tiempo, infradeclarada, sufriendo un boom en su reconocimiento al ser utilizada como vía de salida "no traumática" para redimensionar las plantillas de empresas en crisis. Hemos realizado un estudio descriptivo con el objetivo de relacionar la exposición a ruido industrial con las alteraciones auditivas detectadas en una población laboral, estableciendo comparación entre trabajadores expuestos y no expuestos. Se han encontrado diferencias significativas entre estos grupos, siendo las audiometrías patológicas por ruido del 79 y del 25 por ciento, respectivamente (p < 0,05) (AU)

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The helminthological fauna of the cotton rat, Sigmodon hispidus in a tropical environment varies according to habitat and feeding behavior. Six species of nematodes (Longistriata adunca, Trichostrongylus sigmodontis, Strongyloides sigmodontis, Litomosoides carinii, Monodontus sp. and Protospirura sp.) and two species of cestodes (Hymenolepis diminuta and Raillietina sp.) were found in rats from extensive dry lands in Guanacaste where hot temperatures and heterogeneous diet are the rule. Only two species of nematodes (Longistriata adunca and Angiostrongylus costaricensis) were found in rats collected in a humid pineapple plantation in the Central Plateau (Alajuela) where mild temperatures predominate. A. costaricensis, a metastrongylid of medical importance, was found in 42% of them.

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We describe a 15-month-old eutrophic immunocompetent male who presented with fever, hepatosplenomegaly, pancytopenia, and hypergammaglobulinemia. Leishmania amastigotes were identified in spleen and bone marrow specimens. In addition, tissue culture, animal inoculation, and isoenzyme analysis identified the parasite as Leishmania donovani infantum or Leishmania donovani chagasi. The infant was successfully treated with an antimonial drug. These findings represent the first case of visceral leishmaniasis reported in Costa Rica.

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Peritoneal macrophages from Wistar rats, inoculated and non-inoculated with 10(6) T. lewisi trypomastigotes, were cultured and infected with 10(6) T. gondii tachyzoites. Multiplication rates of this parasite were studied after 1, 24 and 48 h of infection but there were not significant differences between the number of parasites found inside of macrophages coming, either from T. lewisi infected or non infected rats. On the other hand, in vivo studies of Toxoplasma multiplication inside peritoneal macrophages, showed that there is an increase of parasite number in cells from T. lewisi infected rats, as compared with those macrophages from non infected rats. This effect was statistically significant and was more evident after four days of infection. Therefore, it has been demonstrated that in vivo, but not in vitro T. lewisi infections, causes an important decrease of the natural resistance to T. gondii of the white rats, which is manifested by the major invasion and multiplication of the parasite inside of peritoneal macrophages.

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An in vivo model to study the antimalaric effect of plant extracts is described. White mice (25-30 g body weight) are treated subcutaneously with 0.6 ml of the diluted extract starting seven days before P. berghei infection; treatment continues until death or for 30 days. Simultaneously 0.2 ml of the extract are applied per os starting three days before infection. In a test of the model, treated and non-treated animals differed in body weight, survival time, haematocrite, parasitemia development, and spleen or liver weight of recent dead or killed mice.

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The effects of a modified natural porcine surfactant (Curosurf) on phagocytosis and killing of Cryptococcus neoformans by alveolar macrophages and on the production of superoxide anions were investigated in vitro. Attachment and ingestion were evaluated separately by a fluorescent quenching technique. The nitroblue tetrazolium reduction test was used as an indirect measurement of superoxide anion production. Killing was assessed by a colony-forming assay. Surfactant induced increased ingestion of C. neoformans, unopsonized as well as opsonized with fresh serum or anticryptococcal polyclonal IgG. Surfactant had, however, no effect on the attachment or killing of unopsonized or opsonized C. neoformans by the alveolar macrophages. In addition, the enhancement of the oxidative metabolism of the macrophages after stimulation with opsonized yeast was impaired, although the killing was not affected. This study indicates that in vitro Curosurf can influence the alveolar macrophage defence against C. neoformans by enhancing its ingestion and by interacting with the superoxide anions release from alveolar macrophages stimulated with fresh serum or anticryptococcal polyclonal IgG opsonized yeast cells.

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Cotton rats (Sigmodon hispidus) were collected from Ojo de Agua, Alajuela (N = 74) and Cañas, Guanacaste (N = 29). Feces had 31 E. sigmodontis, nine E. tuskegeensis, eight E. roperi, three E. webbae and two Eimeria sp. This is the first report of these coccidian parasites for Costa Rica.

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Phagocytosis, oxidative metabolism and phagolysosomal pH of rat alveolar macrophages (AM) were studied at different points of time after challenge with Cryptococcus neoformans. Phagocytosis was evaluated using a fluorescent quenching technique which distinguishes between attached and ingested organisms. The nitroblue tetrazolium (NBT) test was used as an indirect measurement of the oxidative metabolism of the phagocytes. The pH of the phagolysosomes was measured using a cytofluorometric technique. Both the attachment and ingestion of serum opsonized C. neoformans by AM were slow during the first hours of incubation, but were considerable after 24 h. The oxidative metabolism of Am challenged with the yeast was insignificant during the first hour, but reached high levels after 24 h. Most phagolysosomes in AM with ingested cryptococci had a pH < 5.5. Our results indicate that these AM defence mechanisms, although poor during the first hours after exposure to the yeast, are of significance after 24 h. Thus, in the immunocompetent host the AM should prevent the dissemination of C. neoformans from the lungs.

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To demonstrate that T. lewisi infection increases T. gondii multiplication in white rats, groups of five Wistar or Sprague Dawley rats were inoculated with 10(6) T. lewisi trypomastigotes and four or seven days later infected with Toxoplasma tachyzoites. Host survival time was monitored, and the presence of T. gondii was confirmed in all dead rats by studying peritoneal exudate smears and lung tissue sections stained with haematoxylin-eosin. The presence of Toxoplasma cysts or antibodies was checked in the brain of surviving rats. The increase is observed four days after trypanosome inoculation and is dependent on rat strain, but not on inoculum size or rat age. Humoral and cellular factors may have a role in the increase as has been reported for other experimental infections with African trypanosomes and T. cruzi.

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Differences in Toxoplasma gondii dissemination in white rats (Sprague Dowley) and mice (Wistar) after oral oocyst inoculation are described. Groups of five animals (both hosts) were infected per os with oocysts of the TCR-2 avirulent strain and the dissemination pattern was compared in brain tissue or by serology. Early dissemination was similar in both species. One hr after infection the parasite was present in blood and peritoneal exudate as well as in heart, lung, liver, spleen, lymph nodes and brain. However, after five days there were important differences between both hosts and after 30 days, the parasite was detected only in rat heart and brain, while in mice it persisted in fluids and all organs.

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Presence of T. gondii in meat from several sources was determined by traditional methods and by a new simplified method in which animals are fed meat directly without any previous treatment with artificial gastric fluid. Tissues are ground and the animals ingest them naturally. Determination of Toxoplasma in lungs or brain (as well as by specific antibody test), showed no statistically significant differences between both methods.

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Extracts from thirteen species of plants were evaluated by "in vivo" antimalarial test against plasmodium berghei effects. Significant activities were observed in the ethyl acetate and aqueous extracts, elaborated of Cedrela tonduzii leaves, Trichilia havanensis and Trichilia americana barks, Neurolaena lobata and Gliricidia sepium leaves and Duranta repens fruits. Compounds identified include flavanoids, coumarins, mellilotic acid and iridoids which some kind of biodynamic activity has previously been reported. The flavone quercetin 1 purified from C. tonduzii gave strong antimalarial activity, however, its respective glucosides (quercetin 3-glucoside 2 y robinine 7) showed little significant activity.

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In Costa Rica, a total of 640 samples from eight different vegetables used for raw consumption, were analyzed for the presence of intestinal parasites and fecal coliforms. Eighty samples of each vegetable were analyzed, forty during the dry season and forty in the rainy. A greater, but unsignificant (p > 0.05) level of fecal coliforms was found during the dry season. Levels of Escherichia coli, were higher (p < 0.05) during the dry season in lettuce (Latuca sativa) and cilantro (Coleandrum sativum) leaves. Cysts of Endolimax nana, Entamoeba coli, Entamoeba histolytica, Giardia intestinalis and Cryptosporidium sp. were found in all vegetables. The greater percentage of positive samples was found during the dry season, although these relation was only corroborated (p < 0.05) in radish (Raphanus sativus) and cilantro leaves. Only lettuce and cilantro levels showed a positive linear correlation (p < 0.05) between occurrences of intestinal parasites and fecal coliforms.

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