Myoglobinuria and COX deficiency in a patient taking cerivastatin and gemfibrozil

The authors describe a patient who presented with myoglobinuria after starting cerivastatin-gemfibrozil therapy. Muscle histochemistry revealed ragged-red fibers and cytochrome c oxidase negative (COX) fibers, and biochemistry showed a defect of COX activity. Immunoblot analysis showed a 60% reduction of COX I and COX II polypeptides. Cerivastatin myotoxicity might be related to a depletion of essential metabolites needed to anchor COX subunit I to mitochondrial membrane.

Urinary analysis of nephrolithiasis markers

Renal stone disease is an ancient and common affliction, common in industrialised nations. The causes and incidence of nephrolithiasis are presented. Afterwards, the promoters and inhibitors of renal stone formation analysis in urine are described including enzymatic methods, chromatography, capillary electrophoresis and other techniques. Aspects such as sample collection and storage are also included. The review article includes referenced tables that provide summaries of methodology for the analysis of nephrolithiasis related compounds.

Aerosol orgotein (Ontosein) for the prevention of radiotherapy-induced adverse effects in head and neck cancer patients: a feasibility study

Orgotein is an anti-inflammatory superoxide dismutase agent successfully used in treating several inflammatory diseases. It is also used in treating radiation-induced adverse effects in difference malignancies, notably breast, lung, bladder, prostate, cervix, and head and neck cancers. It is administered either topically or parenterally. To our knowledge, it has never been used before for prophylaxis of radiation-induced adverse effects or in aerosol form. Here we report on the results from a feasibility study on aerosol orgotein (Ontosein) for prevention of acute and deferred radiation-induced adverse effects in patients treated for head and neck malignancies. Our results show that aerosol orgotein administered before each radiation therapy session may impart some benefits in both incidence and severity of acute and deferred radiation-induced adverse effects in head and neck cancer patients, when compared with historical controls. In addition, aerosol orgotein administration is easy and convenient for both the patient and the radiotherapist.

Hospitalization of patients with anorexia nervosa: a therapeutic proposal

Anorexia nervosa is an eating disorder that primarily affects young women and has a high morbidity and mortality rate. Hospitalization effectively overcomes the acute phase, prevents progression to chronicity and promotes lasting changes. Our aim is to establish a prior therapeutic contract and systematize hospitalization in three stages comprising: clinical and nutritional approaches, individual and group psychotherapy, family therapy, occupational therapy, body therapy and pharmacotherapy. Because of the multiple determination of anorexia nervosa and the risk involved, treatment must be carried out by a multidisciplinary team.

[Characteristics of bleeding from esophageal-gastric varices in patients with HIV infection]

AIMS

Coinfection with human immunodeficiency virus (HIV) and hepatotropic viruses (hepatitis B and C) is frequent because the routes of infection are similar. Liver disease appears earlier in these patients and progression to cirrhosis and its complications is faster. The aim of this study was to determine the incidence and clinical characteristics of bleeding from esophageal-gastric varices in patients with HIV.

METHODS

We retrospectively analyzed 258 consecutive episodes of bleeding from esophageal-gastric varices in cirrhotic patients between January 1996 and January 2001, of which 20 episodes occurred in patients with HIV (7.8%).

RESULTS

The mean age was significantly lower in patients with HIV infection and all presented hepatitis C infection. The hepatic venous pressure gradient was higher in patients with HIV (22.8 3.4 mmHg vs 19.6 5,4 mmHg; p = 0.05). No differences in the severity of liver disease (Child-Pugh), transfusion requirements, treatment performed, initial hemostasis, early recurrence, or rescue treatment with dipeptidyl peptidase I (DPPI) were found. The development of complications (bacterial infections, hepatic encephalopathy and ascites), hospital stay and mortality were also similar. Mortality was not influenced by HIV stage. Bleeding from esophageal-gastric varices in patients with HIV infection has a similar form of presentation and clinical course with treatment to that in non-cirrhotic patients, despite a higher degree of portal hypertension.

CONCLUSIONS

The presence of HIV infection should not modify diagnostic or therapeutic attitudes to bleeding from esophageal-gastric varices.

Telemedicine as a tool for intensive management of diabetes: the DIABTel experience

This paper presents the current features of the DIABTel telemedicine system and the evaluation outcomes of its use in clinical routine. This telemedicine system is designed to complement the daily care and intensive management of diabetic patients through telemonitoring and telecare services. The system comprises a patient unit (PU) used by patients in their day-to-day activities and a Medical Workstation used by physicians and nurses at hospitals. Both applications offer tools to collect, manage, view and interpret data and to exchange data and messages. The system was evaluated for usability, telemedical protocols, metabolic control and quality of life. This evaluation consisted in a 6-month cross-over pilot study with ten Type I diabetic patients. The results of the evaluation allowed assessment of the telemedicine protocols in terms of the number of communications/patient (21.6+/-7.7); days between communications (5.4+/-2.66); messages sent by physicians (118 text messages); and data and messages transmitted by patients (3524 blood glucose readings, 1649 day-to-day insulin adjustments, 24 exercise reports, ten diet modifications and 63 text messages). Physicians performed more therapeutic changes during the DIABTel period than in the control period. There was a trend towards HbA1c improvement during DIABTel use with no incidence in the number of hypoglycaemias. This pilot study demonstrates the feasibility of the DIABTel system in clinical routine use and its potential benefits for diabetes care: improving the availability of information necessary for therapy adjustments; offering new physician-patient communication tools; increasing patient empowerment and education; and showing a positive trend towards improving the metabolic control of patients. Further studies are needed to validate these findings and to promote telemedicine as an opportunity to better diabetes care.

Validation of a HPLC quantification of acetaminophen, phenylephrine and chlorpheniramine in pharmaceutical formulations: capsules and sachets

Acetaminophen, phenylephrine and chlorpheniramine are frequently associated in pharmaceutical formulations against the common cold. Their quantification presents several problems. A HPLC method for the simultaneous determination of these compounds in pharmaceutical formulations such as capsules and sachets, including the separation of impurities and excipients has been developed and validated. The selectivity of the method was also tested to be used if phenylpropanolamine hydrochloride were employed instead of phenylephrine. Final chromatographic conditions were a gradient elution, being solvent A: phosphate buffer 40 mM at pH 6.0 and solvent B: acetonitrile. At t=0, the mobile phase consisted of 92% A and 8% B and it changed with a linear gradient during 8 min to 75% A and 25% B. At min 8, it changed to 30% A and 70% B for 5 min and at t=15 min, it returns to the initial conditions (92% A and 8% B) during 1 min remaining at this composition until t=20 min. UV detection was performed at 215 nm for phenylephrine and chlorpheniramine, because at this wavelength sensitivity was higher than in other more characteristic wavelengths and it was necessary for the detection of minor compounds. For acetaminophen 280 nm was employed. Validation parameters permit to consider the method adequate.

Clear cells carcinoma of fallopian tubes associated with tubal endometriosis. Case report and review

Our case report describes a patient with clear cell fallopian tube carcinoma (histological grade 3; stage (FIGO): III c.) associated with an endometrial cyst of the tube wall.

Association of NRAMP1 promoter gene polymorphism with the susceptibility and radiological severity of rheumatoid arthritis

The natural resistant-associated macrophage protein 1 (NRAMP1) has been proposed as a candidate gene for the susceptibility to autoimmune diseases. In this study, the possible role of the functional polymorphism located at the promoter region of NRAMP1 gene in the susceptibility and clinical outcome of rheumatoid arthritis (RA) was investigated. A total of 141 Spanish RA patients and 194 controls previously typed for HLA-DRB1* were genotyped for the NRAMP1 polymorphism. No significant differences in the distribution of frequencies among RA patients and controls were observed. Nevertheless, when patients and controls were stratified according to their HLA shared epitope (SE) status, an increase of 2/2 genotype among SE-negative (SE-) patients with respect to SE- controls was observed (23% vs 7%, OR = 3.74, 95% CI 1.31-10.72). In addition, the possible role of this polymorphism in the clinical course of RA was investigated in a subgroup of 82 patients who were prospectively followed during a mean of 9 years. After follow-up, an increase of patients with the homozygous 2/2 genotype was detected among those with severe small joint radiological involvement: 73% of patients 2/2 had a severe form in contrast to 37% of patients with the genotype 2/3 and 30% of patients bearing 3/3 OR = 5.45, 95% CI 1.14-34.24). In conclusion, NRAMP1 gene promoter polymorphism could influence the radiological severity of rheumatoid arthritis and disease susceptibility, particularly in individuals lacking HLA-linked risk factors.

Revalidation of the isobaric multiplet mass equation

We have determined the energy of the J(pi) = 1/2(+), T = 3/2 resonance in 32S(p,p) to be E(p) = 3374.7+/-0.8 keV. This disagrees with the previously accepted value of E(p) = 3370+/-1 keV by Abbondanno et al. [Nuovo Cimento 70A, 391 (1970)] and solves a problem raised by recent observations of unexpected deviations from the isobaric multiplet mass equation. This resonance is also important in calibrating the beta-delayed proton spectra from 33Ar and 32Ar, and our findings may modify previous conclusions.

Hepatobiliary inflammation, neoplasia, and argyrophilic bacteria in a ferret colony

Hepatobiliary disease was diagnosed in eight of 34 genetically unrelated cohabitating pet ferrets (Mustela putorios furo) during a 7-year period. The eight ferrets ranged in age from 5 to 8 years and exhibited chronic cholangiohepatitis coupled with cellular proliferation ranging from hyperplasia to frank neoplasia. Spiral-shaped argyrophilic bacteria were demonstrated in livers of three ferrets, including two with carcinoma. Sequence analysis of a 400-base pair polymerase chain reaction product amplified from DNA derived from fecal bacteria from one ferret demonstrated 98% and 97% similarity to Helicobacter cholecystus and Helicobacter sp. strain 266-1 , respectively. The clustering of severe hepatic disease in these cohabitating ferroes suggests a possible infectious etiology. The role of Helicobacter species and other bacteria in hepatitis and/or neoplasia in ferrets requires further study.

[Percutaneous intrahepatic portosystemic shunting as a treatment for refractory hepatic hydrothorax]

Hepatic hydrothorax is an infrequent complication of portal hypertension in liver cirrhosis. Treatment with saline restriction and diuretics is usually effective but when this fails, the therapeutic approach is difficult and multiple complications occur. Transjugular percutaneous intrahepatic portosystemic shunt (IPS) is associated with a marked decrease in portal pressure and consequently this technique has been used in the treatment of refractory ascites. The aim of this study was to analyze the efficacy, safety and outcome of refractory hepatic hydrothorax treated by IPS. The procedure was performed in 5 patients who were all grade B or C in the Child-Pugh classification. Three patients showed complete response to the treatment, of whom 1 underwent transplantation 20 days later. The fourth patient showed partial response with a reduction in the need to perform thoracocentesis and the fifth patient showed no response to IPS and died after 17 days of follow-up. Albumin levels and Child classification remained unchanged. Two patients presented recurrence with reappearance of hydrothorax due to shunt dysfunction and 2 patients presented hepatic encephalopathy that responded to medical treatment. Refractory hepatic hydrothorax can be controlled by IPS in a large number of patients but its efficacy is restricted by shunt dysfunction, the risk of encephalopathy and by its limited effect on survival.

Acrosome reaction in fertile and subfertile boar sperm

The main purpose of sperm evaluation is to predict its fertilizing ability. However, basic sperm test results show a low correlation with fertilizing ability. The purpose of this study was to determine whether there is an association between acrosome reaction (AR) and the incidence of subfertility of normal sperm boar. The production records of 22 farms were analyzed to identify boars with low fertility and/or prolificity, classified as subfertile. Twenty-two subfertile boar semen samples were analyzed and compared with 51 samples of fertile boars. Sperm were capacitated during 4 h at 39 degrees C. viability was determined by bisbenzimide (Hoechst-33258) staining. Acrosome reaction was assessed with fluorescein isothiocyanate conjugated Pisum sativum agglutinin. The percentage of spontaneous acrosome reaction (SAR) was not significantly different in fertile (4.5%) and subfertile boars (4.75%) (p > .05). Nevertheless, the percentage of progesterone-induced acrosome reaction (IAR) was significantly lower in subfertile boars (5.75%) as compared with fertile boars (10%) (p < .01). These results suggest that assessment of IAR in vitro may be a useful parameter to identify subfertility in boars.

[Comparison of three genotyping methods for the detection of HIV-1 resistance to antiretroviral drugs]

Highly active antiretroviral therapy has dramatically improved the life expectancy of human immunodeficiency virus (HIV)-infected patients, but mutations in the HIV-1 reverse transcriptase (RT) and protease (P) genes confer drug failure. Evaluation of drug resistance genotyping in HIV-1 has proven to be useful for the selection of drug combinations with maximum antiretroviral activity. The aim of this study was to evaluate the optimal procedure to determine the resistance profile in the laboratory. Plasma from 90 antiretroviral-treated patients was analyzed by reverse hybridization, which identifies the presence of wild-types or mutations at the 19 key codons for protease and RT regions, and was compared with two other methods of direct cDNA sequencing. A total of 408 mutations were detected by InnoLiPA HIV-1, (Line Probe Assay, Innogenetics, Belgium), 572 by TrueGene HIV-1 Genotyping System (Visible Genetics, Canada), and 721 by ViroSeq HIV-1 Genotyping System (Perkin Elmer/Applied Biosystems, California). Hybridization detected a significantly higher number of primary mutations which are associated with a high level of drug resistance (p <0.001). Hybridization also detected a higher number of mixtures of wild-type and mutant viruses. There was a good concordance among the three methods, although it was higher between the two sequencing methods. Sequencing determines a higher number of mutations, but hybridization better identifies primary mutations correlated with a high level of drug resistance. Hybridization is more suitable for detecting mixed populations and is easier to implement in clinical laboratories but does not eliminate the need for sequence analysis for detection of drug-resistant HIV.

Cosegregation of the mitochondrial DNA A1555G and G4309A mutations results in deafness and mitochondrial myopathy

We report a patient with progressive external ophthalmoplegia (PEO), exercise intolerance, and deafness after aminoglycoside exposure, harboring two pathogenic mutations in her mtDNA: an A1555G in the 12S rRNA gene and a G4309A in the tRNA(Ile) gene. Muscle histochemistry showed abundant ragged-red fibers, and biochemistry revealed normal respiratory chain function. The A1555G mutation was homoplasmic in blood from the proband and from all maternal relatives. The G4309A mutation was abundant in the proband's muscle, less abundant in her blood, still less abundant in the mother's blood, and absent in blood from other maternal relatives. Family members were asymptomatic. Our data suggest that the former mutation resulted in aminoglycoside-induced deafness and the latter caused PEO plus exercise intolerance.

[Helicobacter pylori: cagA analysis and vacA genotyping in Chile. Detection of a s2/m1 strain]

BACKGROUND

The genes cagA and vacA encode H pylori virulence factors.

AIM

To genotype these genes in H pylori strains isolated from patients with upper gastrointestinal symptoms.

MATERIAL AND METHODS

We studied 50 patients who underwent an upper gastrointestinal endoscopy, with positive culture for H pylori. Detection of cagA and vacA genotyping was done using polymerase chain reactions.

RESULTS

The gene cagA was detected in 19 samples (38%). Signal sequences s1 and s2 of vacA gene were detected in 16 samples each (32%). There was simultaneous amplification of s1 and s2 in 6 samples and they were not detected in 9 samples. The middle region of vacA was m1 in 9 samples, m2 in 29 samples and there was simultaneous amplification of m1 and m2 in 12 samples. In 16 samples (32%), more than one type of signal sequence or medial region was detected. Of those patients in whom vacA was the only genotype detected, 15 were s2/m2, 7 were s1/m1, 4 were s1/m2 and 1 was s2/m1.

CONCLUSIONS

In these patients, the infection with cagA- H pylori strains, predominates, the prevalence of infection with s1 or s2 strains is similar and the predominant medial region is m2.

Association of the CTLA4 3' untranslated region polymorphism with the susceptibility to rheumatoid arthritis

Cytotoxic T-lymphocyte antigen 4 (CTLA4) gene polymorphism located in the 3' untranslated region (UTR) was investigated in 141 Spanish patients (38 men and 103 women) with rheumatoid arthritis (RA) and in 194 ethnically-matched healthy controls. Twenty alleles having different numbers of (AT) repeats (from 7 to 32) were found in this population. (AT)7 and (AT)16 were the most frequent alleles, and accounted for almost two-thirds of the allelic frequency in the control population. Consequently, alleles were assigned as L (large: 16 or more AT repeats) or S (short: less than 16 AT repeats). When the L/S distribution in patients and controls were compared, an increase of L alleles was observed among patients (49.9% vs. 39.7%; p = 0.02; p(c) = 0.04, odds ratio [OR] = 1.46; 95% confidence interval [CI], 1.06-2.01). Hence, the frequency of S alleles was decreased among patients (51.1% vs. 60.3%; p = 0.02; p(c) = 0.04; OR = 0.69; 95%CI, 0.50-0.95). Moreover, a statistically significant decrease in the frequency of S/S individuals was observed among RA patients (27.7% versus 40.7%; p = 0.01; p(c) = 0.03; OR = 0.56; 95%CI, 0.34-0.91). These differences were irrespective of the HLA "shared epitope" (SE) status, and were observed similarly among SE+ as well as among SE- patients. After combining these data with other reported previously by us, from studies of CTLA4 49 (A/G) and -318 (C/T) polymorphisms, we conclude that the strongest association between CTLA4 gene polymorphisms and RA susceptibility occurs with the 3' UTR polymorphism.

Evaluation of a Triatoma infestans elimination program by the decrease of Trypanosoma cruzi infection frequency in children younger than 10 years, Chile, 1991-1998

Chagas disease is widespread in Chile, distributed in rural and periurban areas in the 7 most northern regions of the country. The principal vector of Trypanosoma cruzi is Triatoma infestans. The interruption of the domestic cycle of transmission of T. cruzi has been attempted by health education, human housing improving, and elimination of the vector by means of systematic insecticide spraying of human dwellings. Spraying with insecticides has been supported by Chile's health authorities and has been carried out for the last 12 years. A total of 13,280 children (aged up to 10 years) were randomly selected from 47 counties in the area of Chile endemic for Chagas disease, and blood samples were collected to determine the levels of antibodies to T. cruzi by indirect hemagglutination and enzyme-linked immunosorbent assay tests. The results of the tests were analyzed to determine the changes that occurred after 12 years of insecticide spraying of dwellings to eliminate T. infestans infestation. A total of 142 (1.1%) samples of children showed antibodies to T. cruzi. This rate is significantly lower than the data generated in similar studies conducted in 1982-1985. The following reduction in prevalence rates were observed in each of the 7 endemic regions of the country: region I, 5.5-0.3%; region II, 6.6-0.3%; region III, 9.8-1.0%; region IV, 7.2-2.0%; region V, 5.2-1.9%, Metropolitan region, 1.4-0.6%; and region VI, 1.4-0.4%. Serovigilance of T. cruzi antibodies level represents a novel approach that may allow the evaluation of the impact of the vector elimination program. The results identify regions that need to strengthen the efforts to reduce the insect infestation of dwellings.

[Can sural nerve biopsy be used to orientate the treatment of chronic inflammatory demyelinating polyneuropathy?]

INTRODUCTION

Chronic inflammatory demyelinating polyneuropathy (CIDP) is an acquired neuropathy characterized by demyelination of the peripheral nerves and roots. The course of the illness is progressively chronic or of relapses and remissions. Biopsy of the sural nerve is not essential for diagnosis. It is therefore not necessary to carry it out on all occasions, but probably permits a more rational approach to treatment.

OBJECTIVE

To show whether biopsy of the sural nerve is useful for orientation of the treatment required in cases of CIDP.

PATIENTS AND METHODS

We studied a total of 16 patients admitted to hospital with a diagnosis of CIDP. They had neurophysiological studies, sural nerve biopsy and other studies to rule out other diagnoses. The patients were assigned to the therapeutic protocols recommended. During 8 years of follow up we compared the response to treatment with intacglobin/plamapheresis, steroids and cytostatic drugs.

RESULTS

It was highly significant (p< 0.001) that the patients with axon lesions on sural nerve biopsy did not respond to treatment with intac globin/plasmapheresis or steroids but did respond to cyclophosphamide, without any serious adverse effects being seen.

CONCLUSIONS

Axonal histopathological lesions of CIDP at the onset of the disease may require cytostatic treatment since they do not usually improve on standard treatment. Sural biopsy is usually invaluable in such cases.