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5-Fluorouracil (5-FU) and oral fluoropyrimidines, such as capecitabine, are widely used in the treatment of cancer, especially gastrointestinal tumors and breast cancer, but their administration can produce serious and even lethal toxicity. This toxicity is often related to the partial or complete deficiency of the dihydropyrimidine dehydrogenase (DPD) enzyme, which causes a reduction in clearance and a longer half-life of 5-FU. It is advisable to determine if a DPD deficiency exists before administering these drugs by genotyping DPYD gene polymorphisms. The objective of this consensus of experts, in which representatives from the Spanish Pharmacogenetics and Pharmacogenomics Society and the Spanish Society of Medical Oncology participated, is to establish clear recommendations for the implementation of genotype and/or phenotype testing for DPD deficiency in patients who are candidates to receive fluoropyrimidines. The genotyping of DPYD previous to treatment classifies individuals as normal, intermediate, or poor metabolizers. Normal metabolizers do not require changes in the initial dose, intermediate metabolizers should start treatment with fluoropyrimidines at doses reduced to 50%, and poor metabolizers are contraindicated for fluoropyrimidines.

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AIMS: This study aimed to evaluate in vitro individual and combined antifungal activity of propolis extract (PE) and oregano essential oil (OEO) against Penicillium allii, causal agent of blue mould disease. The chemical characterization of both products was also included. METHODS AND RESULTS: Chromatographic analysis of PE and OEO confirmed the presence of bioactive compounds. The antifungal susceptibility assays showed that PE and OEO were highly active against the mycelial growth and conidial germination of P. allii. PE and OEO MICs were 12·5 and 1·5 µl ml-1 , respectively. The MFCs of these products were 50 and 3·1 µl ml-1 , respectively. PE acted mainly through diffusion, while OEO acted by a mixed contribution of vapour and diffusion. Synergism and additive effect between both products were found in some combination ratios. CONCLUSION: PE and OEO, both natural products with different chemical composition, have a strong antifungal activity against P. allii and show a favourable interaction causing synergism. SIGNIFICANCE AND IMPACT OF THE STUDY: The results of this study indicated the potential use of PE combined with OEO as a non-conventional strategy towards the formulation of a biofungicide to control blue mould disease in garlic seed-cloves.

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The spatial distribution and temporal variation of 11 species of Tropisternus were analyzed in two permanent ponds located in the province of Corrientes, Argentina. Samples were collected every 15 days, between October 2010 and March 2011. The species recorded were Tropisternus collaris (Fabricius), Tropisternus ovalis Castelnau, Tropisternus laevis (Sturm), Tropisternus lateralis limbatus (Brullé), Tropisternus longispina Fernández & Bachmann, Tropisternus carinispina Orchymont, Tropisternus bourmeisteri Fernández & Bachmann, Tropisternus apicipalpis (Chevrolat), Tropisternus dilatatus Bruch, Tropisternus obesus Bruch, and Tropisternus ignoratus Knisch. The first four were present in higher proportions than the remaining during most of the study period. The spatial distribution of individuals was mostly related to the homogeneity or heterogeneity of the ecosystem in relation to microhabitats with aquatic vegetation: In ponds with different microhabitats, individuals were mainly aggregated, whereas in ponds with homogenous features, individuals were randomly distributed. However, when species were analyzed individually, the spatial distribution and the use of microhabitat by each species were different with respect to preference and behavior.

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The aim of this paper is to compare the spontaneous and induced with cyclophosphamide micronucleus indexes in bone marrow cells of the Sprague Dawley, Lewis and Wistar rat lines. Five experimental groups were formed (10 animals of each sex and of each line, in every group). The first group was used as the negative control (intact animals), the second one was exposed to oral administration of drugs; other conditions were the same as for the other groups. The third group was treated with 2% Tween 65 and the fourth group was treated with 0.9% NaCl. Both substances were administered by oral way to 2 ml/kg during 14 days. The fifth group was treated intraperitoneally with strong mutagen cyclophosphamide in the dose of 50 mg/kg (10 ml/kg in solution), on 48th and 24th hours before euthanasia. The Sprague Dawley line (both sexes) was significantly different from the other lines. Rats of this line had lower index of spontaneous formation of micronuclei, higher index of cyclophosphamide-induced micronucle formation, percent of micronucleated erythrocytes in bone marrow and the index of cytotoxicity. The results obtained make it possible to identify the most appropriate line of rats as model animals for studies of genotoxicity. It will allow also to obtain more accurate estimates of genotoxicity of various substances.

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One stage of honey production is extraction. Honey is a product with minimal types and levels of microorganisms; however it could be contaminated during its manipulation. The aim of this work was to evaluate the microbiological contamination of honey at different processing points. Mould and yeast, total coliform number as well as the presence of Salmonella spp. were determined in 50 samples. All comb and centrifugal honey-extractor samples showed low levels of mould and yeast (< or = 10 CFU/g of honey) and an absence of total coliforms. Contamination problems were observed at the uncapping stage of beeswax-capped honey separation, showing that the "unheated" honey process would imply more risks. Ten to fifty CFU/g of honey of mould and yeast were observed in four out of 30 samples from the honey pump and drums. The present work shows the importance of preventing contamination at the beeswax-honey separation stage, and also highlights the need to perform microbiological studies in the honeyhouse, which would contribute to determine critical points in control quality systems.

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La miel es un producto natural que presenta una carga microbiana muy baja. No obstante, durante el procesamiento empleado para transformarla en un producto comercial, que incluye una etapa de extracción, puede contaminarse. El objetivo de este trabajo fue evaluar la contaminación microbiológica en diferentes puntos del circuito dentro de las plantas de extracción de miel. En 50 muestras se cuantificó el número de hongos filamentosos y levaduras, así como el de coliformes totales, y se determinó la presencia de Salmonella spp. Todas las muestras provenientes de los panales y de los extractores centrífugos presentaron un recuento de hongos filamentosos y levaduras ≤ 10 UFC/g de miel, y ausencia de coliformes. Sin embargo, se evidenciaron problemas de contaminación en la etapa de separación cera-miel de los opérculos, con indicios de que el sistema "en frío" implicaría mayores riesgos. De un total de 30 muestras procedentes de la bomba o de los tambores, 4 presentaron recuentos de hongos filamentosos y levaduras entre 10 y 50 UFC/g de miel. El presente trabajo muestra la importancia de prevenir contaminaciones provenientes de la separadora cera-miel y también la necesidad de realizar estudios microbiológicos en las plantas de extracción, ya que éstos podrían contribuir a determinar los puntos críticos en los sistemas de control de calidad.

One stage of honey production is extraction. Honey is a product with minimal types and levels of microorganisms; however it could be contaminated during its manipulation. The aim of this work was to evaluate the microbiological contamination of honey at different processing points. Mould and yeast, total coliform number as well as the presence of Salmonella spp. were determined in 50 samples. All comb and centrifugal honey-extractor samples showed low levels of mould and yeast (≤10 CFU/g of honey) and an absence of total coliforms. Contamination problems were observed at the uncapping stage of beeswax-capped honey separation, showing that the "unheated" honey process would imply more risks. Ten to fifty CFU/g of honey of mould and yeast were observed in four out of 30 samples from the honey pump and drums. The present work shows the importance of preventing contamination at the beeswax-honey separation stage, and also highlights the need to perform microbiological studies in the honeyhouse, which would contribute to determine critical points in control quality systems.

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OBJECTIVE: To analyse the informal system of caring for people with neuro-degenerative disease: what it consists of and the characteristics of main carers, the type of care given, and the consequences for the main carer of assuming these functions. DESIGN: Descriptive cross-sectional study conducted by means of a home-filled questionnaire. SETTING: Autonomous Community of Andalusia. PARTICIPANTS: 72 main carers of someone with neuro-degenerative disease, chosen from a sub-sample of 1000 homes in which at least one dependent person lives and receives care from a member of his/her family or social network with whom he/she resides. This sub-sample was based on a random sample of 3160 Andalusian homes stratified proportionately according to province and size of dwelling. MAIN RESULTS: In 86.1% of the 72 homes polled, health care was provided only by the informal system network. In over half the homes, care was provided by just one person, the main carer. The main carer was usually a woman (87.4%), with an average age of 54.52, house-wife and close family member of the sick person. In our study the beneficiaries of care had an average age of 77.63, a low level of autonomy in daily activities, and had had a neuro-degenerative disease for an average of 8.16 years. The main kinds of care provided in the home for people with neuro-degenerative disease were help in instrumental activities, care related to daily activities, observation/company and supervision of medicines. Main carers believed that undertaking this work had seriously affected their health (72.2%), the use they made of their time (84.7%), their social life (83.3%) and their economic position (44.4%). CONCLUSIONS: People with neuro-degenerative disease make considerable demands on health care provision, which is mainly covered at home by the immediate family network. In most cases this network consists of just one person, the main carer, on whom falls the entire burden of care. The assumption of this role directly affects the health of a large number of carers, as well as other areas of their lives, in particular the possibility of conducting a social life and using their time for themselves or for activities other than caring.

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OBJECTIVE: To find and analyse the views of both health centre users and users of private insurance companies on the quality of services offered. DESIGN: Descriptive, crossover study using qualitative methodology. The views of health centre and private insurance company users on the quality of services delivered were gathered through 8 focus groups. The variables of opinion analysed were defined according to the SERVQUAL model of Parasuraman on perceived quality. SETTING: Three health districts in a health area in Andalusia. PARTICIPANTS: 70 users took part. RESULTS: Accessibility (prior appointment, information and reception service, hours open), capacity for response (speed and efficiency of processing) and internal organisational coordination were considered by health centre users weak-points of the primary care services, which affected negatively their credibility. These variables were identified by private insurance users as the main advantages of the care model for which they had opted. Reliability was valued positively by health centre users, but received a higher valuation from private insurance users. However, the courtesy and friendliness of health centre professionals was seen as an outstanding point of the service, and no different from that of private professionals. The use of clinical records, the competence of the professionals and the tangible aspects of health centres were identified by their users as strong points of the primary care services and give the public care model an advantage over the private one.

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AIMS: The chronic urticaria and the angioedema affect to the population's wide sectors and up to now their cause is ignored. MATERIAL AND METHOD: They were studied during one year 50 mature patients with chronic urticaria coming from the ambulatory consultation of the service of alergología of the Hospital CQ Hermanos Ameijeiras. The diagnosis of chronic urticaria settled down clinically for observation of the lesions and for the time of its evolution that should exceed six weeks. It was included as group witness to 26 healthy individuals. RESULTS: They were high levels for the IgE seric in the patients' 70%; you even normal of IgA, IgG and IgM in the great majority of the cases. The determination of circulating immunocomplexs gave negative in 88% of the sick and only positive in 12%. The tests for cutirreacción with extracts alergénicos micóticos, in reading at the 48 hours, were not negative in a significant way, among the group of sick and in the group witness.

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OBJECTIVE: To identify in Health Centres (HC), doctors' offices and out-patient clinics the variables among the use, the doctor and organisation, which most affect satisfaction of the Primary Care (PC) user. DESIGN: A descriptive crossover study. SETTING: PC level in three Andalusian cities. PATIENTS AND OTHER PARTICIPANTS: A sample of groups of 460 users of out-patient clinics and doctors' offices and 400 from HCs, all in an urban environment. MEASUREMENTS AND MAIN RESULTS: Three questionnaires were used to gather the independent variables of organisation, doctor and use, and also the dependent variable, or satisfaction, in three dimensions: professional competence, personal qualities and accessibility. The reliability of the scale of satisfaction was analysed using Crombach's alpha; and discriminative capacity, using the Edwards test. The effect of the variables of doctor, user and organisation on HCs and doctors' offices / out-patient clinics was analysed separately with multiple regression. The determination coefficient of the variables for the user at doctors' offices / out-patient clinics was higher than the same variables in HCs (p < 0.0001), age being the variable which most affected satisfaction, both in HCs and doctors' offices / out-patient clinics. The determination coefficients for the regressions of the variables of doctor and organisation were higher in HCs than in doctors' offices / outpatient clinics (p < 0.001) in both cases - with the use of the clinical records being the primary variable in both organisations. CONCLUSIONS: It appears that the organisational model of HCs offers more possibilities of increasing user satisfaction by modifying determined features of the doctor and the organisation.

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A study comparing two pretreatment protocols to prevent adverse reactions to iodinated radiocontrast media (IRCM) was performed in 45 adults patients. They followed inclusion and exclusion criteria. Pretreatment protocol A was within 12 hours before using the IRCM and pretreatment protocol B was for 72 hours before. A corticosteroid and two H2 receptor antagonists were given on both protocols. We managed these protocols by an aleatory way, so 22 patients received protocol A and 23 patients received protocol B. Excellent results were found in 63.6% and good results were found in 36.4% for protocol A. Excellent results were found in 78.2% and good results were found in 21.8% for protocol B. However, no statistically differences were detected for both protocols (p = 0.451).

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OBJECTIVE: To identify the defining characteristics of Primary (PC) and Specialist Care (SC), along with the level of concordance between managers in both sectors in the definition of these characteristics. SETTING: Intermediate course in Administration of the Andalucian School of Public Health, Granada. DESIGN: By means of the Philips 66 technique, followed by consensus construction, the enumeration of the characteristics of care sectors was requested of the managers, who had been previously selected for an Administration course. The procedure was repeated on five different occasions between 1991 and 1993. For each technique four groups were created (two formed by PC and two by SC professionals), in order to obtain self-referred (PC professionals assess PC and the SC ones, SC) and crossed assessments (PC professionals assess SC and vice versa). PARTICIPANTS: 116 professionals in all took part, 55 from the PC sphere, 45 SC and 16 in provincial and/or central services. RESULTS: There was dissonance in the expectations that managers placed in each sector of the health care system. PC managers' views of SC and SC managers' of PC did not coincide with the views of each group of managers on their own health care sector. CONCLUSIONS: When designing activities to coordinate between sectors, a period of clarification, both on the characteristics of each sector and on the expectations placed on each one, should be included. The subsequent negotiation of these can assist the development and maintenance of joint activities to improve coordination.

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Giardia lamblia is a protozoa that invades the high portions of human small bowel, as well the gall bladder and biliary passages. The absorption from the gut of extrinsic particles which have all properties occurs at full scale in the small bowel. Infections by this protozoa may lead to different clinical symptoms: departing free-symptom, urticarial manifestations of variable intensity and malabsorption syndromes, as well. In Cuba, Giardia lamblia parasitism constitutes a health problem because of its high incidence and prevalence. Investigators have showed allergic dermatological disorders and others, in patients with giardiasis, that may obey from two mechanisms: first, the parasite or its metabolic products might be antigenic for the host; second, the parasite may act as a hapten, that in successive sensitizations might lead to such manifestations, producing specific antibodies which have been found in patients' sera with giardiasis. We recently have elaborated an allergenic extract from Giardia lamblia (we called it giardine ), for demonstrating cutaneous sensitization to such protozoa. In other way, Prausnitz and Küstner, in 1921, showed that a dermal allergic reaction could be passively transferred by means of sensitized patient's serum to a non-sensitized subject. More recently, in 1967, Ishizaka and Ishizaka and Johansson and Benich, in separate studies, showed that skin sensitizing antibodies belonged to a different kind of immunoglobulin, IgE, and it could be measured in serum from sensitized patients. So, a study of sensitization to Giardia lamblia has been performed. Twenty-two patients have been studied suffering from giardiasis with at least 3 month evolution of this disease.(ABSTRACT TRUNCATED AT 250 WORDS)

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We studied two groups of pregnant women: 30 asthmatic and 20 non- asthmatic ones (as control), within a eleven-month period. We filled clinical data with inclusion and exclusion criteria for our investigation. We performed tests for determination of E, G, A and M immunoglobulins; and spontaneous rosettes tests and lymphocytic CD4+ and CD8+ subpopulations, as well. We found high IgE levels in the asthmatic pregnant women, in each pregnancy quarter. In relation to IgG and IgA we found a diminishing tendency from the beginning to the end of pregnancy, with statistical meaning, in beth groups of women. We didn't get significant variations for IgM, spontaneous rosettes and lymphocytic CD4+ and CD8+ subpopulations levels, in any of the two pregnant groups, in any of three pregnancy quarters, in our investigation.

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A study was completed to investigate if any differences are observed in user satisfaction with health care centres, polyclinics and solo-practice, furthermore to identify user, organizational characteristics and doctors as variables that relate to user satisfaction in health care. A sample of users was chosen from the Andalusian cities of Granada, Málaga and Sevilla with an alpha = 5%, beta = 10% and d = 11%. The variables were collected trough the use of three questionnaires. Greater satisfaction was found between health care centre users than with polyclinics and solo-practice, with values being 62.4, 58.2 and 60.6 with a p < 0.001. The variables more strongly associated with user satisfaction in health care centres are those related with doctors and organization characteristics. Therefore several are capable of improvement in order to increase user satisfaction. On the contrary in polyclinics and solo-practice the most influential variables are those related with the user characteristics, which are not modifiable by the health services intervention.

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Three strains of anemophilous fungi (Alternaria, Rhizopus and Monilia) from different genera were studied. We found that the liquid Sabouraud and culture media used in this study lost nutrients after seven days of strain growth, without affecting their viability. This was proven when the fungi were reseeded at 15 and 60 days. Extracts from supposedly sensible patients were developed using intradermoreaction skin tests, finding no significant differences among the results obtained from these tests. We recommended further studies with more prolonged growth periods (90, 120, 180 or more days) to see whether this incides on the viability and allergenicity of the anemophilous fungi.

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Thirty adult patients with a diagnosis of chronic urticaria were attended as outpatients at the Allergology Service, Clinical Surgical Hospital "Hnos. Ameijeiras". An accurate clinical history was made, humoral parameters such as erythrosedimentation, total eosinophil count, serum levels of immunoglobulins and complement fractions were measured, and a skin biopsy was done. Most of the patients with urticarial vasculitis showed almost permanent papulous reactions with fever and arthralgias. Duodenal smear was positive for Giardia lamblia in a high percentage of patients with urticarial vasculitis. Paraffin-embedded skin biopsy was very useful for measuring morphological variables, and it is recommended that this technique be used in recent reactions (< 24 h evolution).

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We studied 200 patients assisting at the Allergy Department and the Gastroenterology Department in "Hermanos Ameijeiras" Clinical-Surgical Hospital. They were clinically and immunologically tested for giardiasis through duodenal fortis or gall bladder drainage and total IgE serum levels. All patients underwent intradermal and skin prick tests with Giardine allergenic extract. These skin tests showed high sensitivity and increased specificity. Thus, our procedure in diagnosis is accurate, accessible and economical.

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