[Characteristics of cases of infectious syphilis diagnosed in prisons, 2007-2008]

OBJECTIVE

To describe the characteristics of cases of syphilis amongst prison inmates.

MATERIALS AND METHODS

Descriptive study. Confirmed cases of primary, secondary and early latent syphilis were identified in prisons in Spain during 2007-2008. Socio-demographic and clinical information, as well as variables related to transmission, was collected by the attending physicians in a standard form. Frequency distributions of each variable were performed. Annual incidence rates were calculated. To evaluate the association between qualitative variables, the χ² and Fisher's exact tests were used; the Mann-Whitney test was utilized to compare quantitative variables.

RESULTS

During the study period, 94 syphilis cases were identified (35.1% primary, 20.2% secondary and 44.7% early latent). The incidence rates were 0.9 cases/1000 prisoners in 2007 and 0.7 cases/1000 prisoners in 2008. Most cases were male (90.4%), between 31-40 years old (30.9%) and foreigners (52.1%). The majority of patients were diagnosed through screening (80.9%). Heterosexual contact was the most frequent transmission route (83.0%). Overall HIV prevalence was 5.3%, and 16.0% of the patients had a history of previous sexually transmitted infections (STI). Almost 40% of the cases reported being a client of a sex worker.

CONCLUSIONS

Incidence of syphilis in prison is high. Many syphilis patients were detected through screening, highlighting the role of the Spanish prison health service in STI control.

Epidemiologic trends of cancer diagnoses among HIV-infected children in Spain from 1997 to 2008

BACKGROUND

The introduction of highly active antiretroviral therapy (HAART) has influenced the incidence of cancer in people with human immunodeficiency virus (HIV) infection. The aim of this study was to evaluate changes in the pattern of cancer rates in HIV-infected children on HAART during over a decade of follow-up.

PATIENTS AND METHODS

We carried out a case-control study. Data were obtained from the records of the minimum basic data set of hospitals in Spain from 1999 to 2008. The epidemiologic trends of cancer diagnoses were evaluated through 3 calendar periods: early-period HAART: 1997-1999, midperiod HAART: 2000-2002, and late-period HAART: 2003-2008).

RESULTS

HIV-infected children had higher rates of cancer diagnosis than HIV-negative children (P < 0.001) for both acquired immunodeficiency disease syndrome (AIDS)-defining malignancies (ADM) and non-AIDS-defining malignancies (non-ADM). The highest rates of cancer diagnosis in HIV-positive children were for non-Hodgkin lymphoma, malignant neoplasm of bone and articular cartilage, and Hodgkin lymphoma. When we compared the 3 calendar periods, we found that the rate of ADM diagnoses decreased (from 9.1 to 3.6 to 1.0 cancers per 1000 HIV-children/yr; P < 0.05) and that the rate of non-ADM diagnoses increased (from 0.6 to 5.0 to 8.7 cancers per 1000 HIV-children/yr; P < 0.05). Moreover, the overall rate of cancer diagnoses (ADM plus non-ADM) did not change during the study period (9.7, 8.7, and 9.7 cancers per 1000 HIV-children/yr).

CONCLUSIONS

HIV-infected children had a dramatic decrease in the rate of ADM diagnoses and an increase in the rate of non-ADM diagnoses. The overall cancer diagnosis rate has not decreased during the past decade and the incidence of cancer still remains high in HIV-infected children in Spain.

[Acute viral infections in immunocompetent patients]

Los virus tienen un papel importante dentro de las infecciones graves en los pacientes adultos, que en algunas ocasiones llegan a necesitar hospitalización e ingreso en unidades de cuidados intensivos, especialmente en casos de síndrome de distrés respiratorio del adulto y encefalitis. Las infecciones por virus influenza y parainfluenza, virus sincitial respiratorio, herpes virus y adenovirus son las que más frecuentemente causan estos cuadros. Se ha realizado una revisión de la literatura pormenorizada y actualizada de epidemiología, patogénesis, manifestaciones clínicas y aproximación terapéutica de las infecciones virales en pacientes inmunocompetentes. Por otro lado, si bien la neumonía asociada a ventilación mecánica tiene como etiología más frecuente las infecciones bacterianas, recientemente el papel de los virus como patógenos en estas infecciones está en debate, por lo que se hace una breve revisión de su papel etiopatogénico en la neumonía asociada a ventilación mecánica.

[Role of viral infections in immunosuppressed patients]

Ser receptor de un trasplante de órgano sólido, así como recibir tratamiento quimioterápico para una enfermedad hematólógica maligna, predispone claramente a padecer infecciones virales tanto comunes como oportunistas, de origen tanto comunitario como procedentes del donante de órganos y/o de una reactivación de un virus latente endógeno. Herpes virus y más especialmente citomegalovirus y virus de Epstein-Barr son los que con más frecuencia afectan a estos enfermos, así como los virus respiratorios. El tratamiento consiste en la combinación de reducir la inmunodepresión inducida junto con tratamiento antiviral. Se ha realizado una revisión de la literatura pormenorizada y actualizada de la epidemiología, la patogenia, las manifestaciones clínicas y la aproximación terapéutica de las infecciones virales en estos enfermos.

Acute viral infections in immunocompetent patients

Viruses play a significant role in serious infections in adults and sometimes lead to the need for hospitalization and admission to intensive care units, especially in cases of severe respiratory distress or encephalopathy. Influenza and parainfluenza viruses, syncytial respiratory virus, herpes viruses and adenovirures are the most frequent causes of these severe infections. A review of the literature has been performed in order to update the epidemiology, pathogenesis and therapeutic approach of viral infections affecting immunocompetent patients. Furthermore, ventilator-associated pneumonia (VAP) is the most frequent nosocomial infection in intensive care units and has a high morbidity and mortality rate. It is mainly a bacterial disease, although the potential role of viruses as pathogens or copathogens in VAP is under discussion. Therefore, a brief review of the potential pathogenic role of viruses in VAP has also been performed.

Mosquito vectors of West Nile virus during an epizootic outbreak in Puerto Rico

The purpose of this investigation was to identify the mosquito (Diptera: Culicidae) vectors of West Nile virus (WNV; family Flaviviridae, genus Flavivirus) during an epizootic WNV outbreak in eastern Puerto Rico in 2007. In June 2006, 12 sentinel chicken pens with five chickens per pen were deployed in six types of habitats: herbaceous wetlands, mangrove forests, deciduous forests, evergreen forests, rural areas, and urban areas. Once WNV seroconversion in chickens was detected in June 2007, we began trapping mosquitoes using Centers for Disease Control and Prevention (CDC) miniature (light/CO2-baited) traps, CMT-20 collapsible mosquito (CO2- and ISCA SkinLure-baited) traps, and CDC gravid (hay infusion-baited) traps. We placed the CDC miniature traps both 2-4 m and >30 m from the chicken pens, the collapsible traps 2-4 m from the pens, and the gravid traps in backyards of houses with sentinel chicken pens and in a wetland adjacent to an urban area. We found numerous blood-engorged mosquitoes in the traps nearest to the sentinel chickens and reasoned that any such mosquitoes with a disseminated WNV infection likely served as vectors for the transmission of WNV to the sentinels. We used reverse transcriptase-polymerase chain reaction and isolation (C636) on pools of heads, thoraxes/ abdomens, and legs of collected blood-engorged mosquitoes to determine whether the mosquitoes carried WNV. We detected WNV-disseminated infections in and obtained WNV isolates from Culex nigripalpus Theo (minimum infection rate [MIR] 1.1-9.7/1,000), Culex bahamensis Dyar and Knab (MIR 1.8-6.0/1,000), and Aedes taeniorhynchus (Wied.) (MIR 0.34-0.36/1,000). WNV was also identified in and isolated from the pool of thoraxes and abdomens of Culex quinquefasciatus Say (4.17/1,000) and identified in one pool of thoraxes and abdomens of Culex habilitator Dyar and Knab (13.39/1,000). Accumulated evidence since 2002 suggests that WNV has not become endemic in Puerto Rico.

Delayed ischemic preconditioning protects against liver ischemia-reperfusion injury in vivo

OBJECTIVES

Ischemic preconditioning (IP) affords resistance to liver ischemia-reperfusion (IR) injury, providing an early phase of protection. Development of delayed IP against IR injury was assessed using partial IR in rat liver.

METHODS

The IP manuver (10 minutes of ischemia and up to 72 hours of reperfusion) was induced before 1 hour of ischemia and 20 hours of reperfusion. At the end of the reperfusion period, blood and liver samples were analyzed for serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), haptoglobin and tumor necrosis factor-alpha (TNF-alpha) levels, hepatic histology, protein carbonyl and glutathione (GSH) contents as well as nuclear factor-kappaB (NF-kappaB), and activating protein-1 (AP-1) DNA binding.

RESULTS

The IP manuver significantly increased protein carbonyl/GSH ratios (275%), serum ALT (42%), and AST (58%); these changes normalized after 12 hours. Serum AST, ALT, and LDH levels were significantly increased by IR (4-, 5.6-, and 7.0-fold, respectively), with significant changes in liver histology, protein carbonyl/GSH ratio (481% enhancement), and serum TNF-alpha (6.1-fold increase). Delayed IP in IR animals reduced serum AST (66%), ALT (57%), and LDH (90%) and liver GSH depletion (89%), with normalization of protein carbonyl content, serum TNF-alpha levels, and liver histology. Enhanced AP-1/NF-kappaB DNA binding ratios and diminished haptoglobin expression induced by IR were normalized by IP.

CONCLUSION

These data support that delayed IP suppresses IR-induced liver injury, oxidative stress, and TNF-alpha response, which coincide with recovery of IR-altered signaling functions represented by normal AP-1/NF-kappaB DNA binding ratios and acute phase responses.

Prevalence of maternal hepatitis C infection according to HIV serostatus in six Spanish regions (2003-2006)

The objective of this article is to describe the prevalence of maternal Hepatitis C infection globally and by HIV serostatus. Unlinked anonymous testing on 474,539 samples from newborn babies was carried out, selected through stratified sampling by year and HIV status, in six Spanish Autonomous Regions, from 2003 to 2006. Results were 0.15% for global anti-hepatitis C virus (HCV), 29.69% and 0.10% for HIV(+) and HIV(-) women, respectively. Anti-HCV prevalence rate is low in these regions compared to Hospital cohorts. Although a high prevalence rate in HIV co-infected women is found, it tends to decrease along the period studied.

[Factors related to non-prescription of tuberculin skin testing in a cohort of HIV-infected people]

INTRODUCTION

Tuberculin skin testing (TST) for tuberculosis (TB) is recommended for all patients with HIV infection because of the known relationship between these two conditions. In this report we analyze the incidence and variables associated with non-prescription of TST in a cohort of HIV-infected people.

PATIENTS AND METHODS

Longitudinal study conducted between 2000 and 2002 at 10 HIV hospital-based clinics. All HIV-infected patients who had not been regularly followed-up previously in dedicated clinics were identified. Data about TST and other variables related to TB were obtained from the clinical records. We calculated the percentage of patients who did not undergo TST and the associated factors, using odds ratios (ORs) and the 95% CI to investigate associations. A multivariate logistic regression analysis was performed.

RESULTS

A total of 1242 patients met the inclusion criteria. TST was not performed in 185 patients (17.6% of those eligible). The fact of being an intravenous drug abuser was associated with a higher probability of TST non-prescription (OR: 2.6, 95% CI 1.1-6.5), whereas being unemployed (OR: 0.6, 95% CI 0.3-1.0), having a CD4 cell count >200 (CD4 200-499: OR 0.5, 95% CI 0.3-0.9. CD4> or =500: OR 0.3, 95% CI 0.2-0.6), and contact with persons with TB (OR 0.2, 95% CI 0.1-0.5) were associated with a lower probability.

CONCLUSIONS

In this study, the percentage of TST non-prescription was quite high. The results suggest that TST non-prescription in this population is related to the clinicians' expectations regarding the results of the test and the patients' adherence to treatment for latent TB infection.

Resultados de la plastia de oposición de Camitz en pacientes con atrofia tenar secundaria a síndrome de canal del carpo grave crónico

Objetivo. Evaluar los resultados funcionales de la trasferencia del palmar menor en los casos con atrofia tenar secundaria a síndrome del canal carpiano crónico.

Material y Método. Se revisan retrospectivamente 6 pacientes con una media de edad de 63 años e igual distribución en cuanto a género. En cuatro casos se trató de la mano dominante. Se registraron: el grado de atrofia, la movilidad del pulgar, y la fuerza. Se calcularon el DASH y el CTS y se registraron las complicaciones.

Resultados. Tras 45,7 meses de seguimiento medio, la abducción radial fue de 53,3º y todos lograron la oposición completa. Las pinzas pulpejo-pulpejo y pulpejo-lateral y la fuerza de puño fueron respectivamente del 75,1%, 96,6% y 96,8% respecto al lado contralateral. Se registró una mejoría significativa en los cuestionarios DASH y CTS siendo los valores del ES y SRM mayores de 0,8 en todos los casos.

Conclusiones. Creemos que la plastia de oposición de Camitz es una intervención simple, segura y efectiva que ayuda a mejorar la función de la mano en los casos de SCC crónicos graves, especialmente en pacientes mayores.

Tratamiento de los encondromas de la mano con cerámicas biorreabsorbibles

Objetivos: Aunque el tratamiento estándar de los encondromas es el curetaje más relleno con hueso autólogo, hay autores que recomiendan la utilización de material sintético para evitar morbilidad en la zona dadora. En este sentido presentamos nuestra experiencia de 12 casos tratados con curetaje y relleno con cerámicas biorreabsorbibles.

Material y Método: Nueve encondromas estaban localizados en las falanges y 3 en los metacarpianos. Tras su curetaje, 10 se rellenaron con hidroxiapatita de origen natural, 1 con fosfato tricálcico y otro con sulfato cálcico.

Resultados: Tras un seguimiento medio de 26,3 meses, no se encontraron complicaciones postquirúrgicas, fracturas ni recidivas. Se objetivó la incorporación de la cerámica en todos los casos aunque sólo en uno de ellos se produjo su reabsorción completa.

Conclusiones: Las ventajas de los materiales sintéticos son: disponibilidad ilimitada, disminución de la duración de la intervención y ausencia de complicaciones en la zona donante. No obstante el resultado final va a depender más de la técnica quirúrgica que del material de relleno, ya que un curetaje exhaustivo y una reposición de la ventana cortical son fundamentales a la hora de evitar recidivas y prevenir complicaciones.

Rizartrosis y síndrome del canal carpiano: tratamiento simultáneo a través de una misma vía de abordaje

Objetivo: La asociación de rizartrosis y síndrome del canal carpiano es frecuente. El objetivo de este estudio es valorar el resultado de la descompresión del canal carpiano a través de la vía utilizada para realizar la artroplastia de resección-suspensión del trapecio, así como discutir las ventajas e inconvenientes encontrados con esta técnica.

Material y método: Entre 2002 y 2006 se realizaron 16 artroplastias de resección-suspensión que presentaban un síndrome del canal carpiano asociado. Se valoró la resolución de la sintomatología mediante escala analógica visual, la recuperación de la fuerza de agarre de puño y las pinzas pulgar-índice, y la mejoría producida por la intervención en la calidad de vida de los pacientes utilizando la versión española de los cuestionarios DASH (Disabilities of the Arm, Shoulder, and Hand) y CTS (Carpal Tunnel Syndrome).

Resultados: Se revisaron 14 pacientes con un seguimiento medio de 23,7 meses (rango: 10-52). La sintomatología mejoró 8 puntos de media tras la intervención. La fuerza final de agarre de puño y de las pinzas pulpejo-lateral y pulpejo-pulpejo fueron 54,5%, 71,8% y 73,5% de los valores de referencia según edad, género y lado afecto.

El cuestionario DASH mejoró 34,8 puntos, y el CTS 0,8 puntos para la valoración funcional y de 2,5 puntos para la gravedad de síntomas.

Discusión y conclusiones: Aunque el tratamiento del canal carpiano puede realizarse antes, durante o después de la cirugía de la artrosis trapecio-metacarpiana, para disminuir la morbilidad postoperatoria y la persistencia de síntomas se recomienda que ambas patologías sean tratadas en el mismo acto quirúrgico, y si fuera posible a través de la misma incisión. No alarga significativamente la intervención, permite una descompresión efectiva con mínima morbilidad y evita algunas de las complicaciones asociadas a la técnica tradicional.

[Evolution of the human immunodeficiency virus seroprevalence in mothers of newborns from 8 autonomous regions (Spain), 1996-2005]

BACKGROUND AND OBJECTIVE

To asses the human immunodeficiency virus (HIV) seroprevalence evolution of newborns' mothers.

POPULATION AND METHOD

Unlinked anonymous study of HIV antibodies in blood spots for congenital metabolic disorders detection in newborns, from 1996 to 2005; in Baleares, Canarias, Castilla-La Mancha, Castilla y León, Galicia, Melilla and Murcia Regions, including Valencia from 2003 on. HIV-antibodies screening was performed through ELISA and results were confirmed using immunoblot.

RESULTS

Global prevalence rates were stable through the period in the 7 initially enrolled regions, near to 1 per thousand; however, during the first 5-year period the prevalence tended to increase (p < 0.05), while a reverse trend was observed in the following 5 years (p < 0.05). Baleares and Valencia showed the highest rates, although Baleares showed a declining trend. Canarias is the only region that displays an increasing trend.

CONCLUSIONS

HIV prevalence in newborns' mothers remained steady during the 10-year period, but after a phase of significant increase the tendency has reverted. Data presented in this paper show the importance of monitoring HIV prevalence among women who give birth, and emphasise the need of improving antenatal prophylaxis programmes to prevent mother-to-child transmission.

Dialysis outcomes in Colombia (DOC) study: a comparison of patient survival on peritoneal dialysis vs hemodialysis in Colombia

The goal of the Dialysis Outcomes in Colombia (DOC) study was to compare the survival of patients on hemodialysis (HD) vs peritoneal dialysis (PD) in a network of renal units in Colombia. The DOC study examined a historical cohort of incident patients starting dialysis therapy between 1 January 2001 and 1 December 2003 and followed until 1 December 2005, measuring demographic, socioeconomic, and clinical variables. Only patients older than 18 years were included. As-treated and intention-to-treat statistical analyses were performed using the Kaplan-Meier method and Cox proportional hazard model. There were 1094 eligible patients in total and 923 were actually enrolled: 47.3% started HD therapy and 52.7% started PD therapy. Of the patients studied, 751 (81.3%) remained in their initial therapy until the end of the follow-up period, death, or censorship. Age, sex, weight, height, body mass index, creatinine, calcium, and Subjective Global Assessment (SGA) variables did not show statistically significant differences between the two treatment groups. Diabetes, socioeconomic level, educational level, phosphorus, Charlson Co-morbidity Index, and cardiovascular history did show a difference, and were less favorable for patients on PD. Residual renal function was greater for PD patients. Also, there were differences in the median survival time between groups: 27.2 months for PD vs 23.1 months for HD (P=0.001) by the intention-to-treat approach; and 24.5 months for PD vs 16.7 months for HD (P<0.001) by the as-treated approach. When performing univariate Cox analyses using the intention-to-treat approach, associations were with age > or =65 years (hazard ratio (HR)=2.21; confidence interval (CI) 95% (1.77-2.755); P<0.001); history of cardiovascular disease (HR=1.96; CI 95% (1.58-2.90); P<0.001); diabetes (HR=2.34; CI 95% (1.88-2.90); P<0.001); and SGA (mild or moderate-severe malnutrition) (HR=1.47; CI 95% (1.17-1.79); P=0.001); but no association was found with gender (HR=1.03, CI 95% 0.83-1.27; P=0.786). Similar results were found with the as-treated approach, with additional associations found with Charlson Index (0-2) (HR=0.29; Cl 95% (0.22-0.38); P<0.001); Charlson Index (3-4) (HR=0.61; Cl 95% (0.48-0.79); P<0.001); and SGA (mild-severe malnutrition) (HR=1.43; Cl 95% (1.15-1.77); P<0.001). Similarly, the multivariate Cox model was run with the variables that had shown association in previous analyses, and it was found that the variables explaining the survival of patients with end-stage renal disease in our study were age, SGA, Charlson Comorbidity Index 5 and above, diabetes, healthcare regimes I and II, and socioeconomic level 2. The results of Cox proportional risk model in both the as-treated and intention-to-treat analyses showed that there were no statistically significant differences in survival of PD and HD patients: intention-to-treat HD/PD (HR 1.127; CI 95%: 0.855-1.484) and as-treated HD/PD (HR 1.231; CI 95%: 0.976-1.553). In this historical cohort of incident patients, there was a trend, although not statistically significant, for a higher (12.7%) adjusted mortality risk associated with HD when compared to PD, even though the PD patients were poorer, were more likely to be diabetic, and had higher co-morbidity scores than the HD patients. The variables that most influenced survival were age, diabetes, comorbidity, healthcare regime, socioeconomic level, nutrition, and education.

Fibrolipoma del nervio cubital. A propósito de un caso

Introducción: Los fibrolipomas de los nervios periféricos, o hamartomas lipofibromatosos, son tumores benignos que infiltran el espacio entre los fascículos neurales. Son más frecuentes en el territorio nervio mediano. La resonancia magnética ofrece un diagnóstico patognomónico. El tratamiento debe ser descompresivo cuando la escisión microquirúrgica no sea posible sin ocasionar secuelas funcionales.

Caso clínico: Varón de 30 años, trabajador manual, sin alteraciones morfológicas en sus manos con clínica de hipoestesia en 4º y 5º dedos, pérdida de fuerza en mano, atrofia hipotenar e interósea y principio de garra cubital de 8 meses de evolución. La electromiografía realizada indicó compresión del nervio cubital a nivel del canal de Guyon. En el acto quirúrgico se comprobó la existencia de un fibrolipoma del nervio cubital que comprometía a sus ramas terminales sensitiva y motora. Al no ser posible la exéresis microquirúrgica sin dañar al nervio, se realizó biopsia y descompresión amplia del nervio, mejorando la sintomatología del paciente.

Resistance of the Echinococcus granulosus cyst wall to complement activation: analysis of the role of InsP6 deposits

The larva of the cestode Echinococcus granulosus (hydatid cyst) is protected by the acellular laminated layer (LL). The mechanisms that make this thick coat a poor activator of host complement are incompletely understood. The structure binds, through unknown motifs, the host regulator of the alternative complement pathway (ACP), factor H. A second potential mechanism of ACP regulation, the inhibition of factor B activation, was detected in assays employing purified components (Immunopharmacology 42 : 91). The inhibitor was subsequently identified as myo-inositol hexakisphosphate (InsP(6)), which in the form of nano-deposits is a major component of the LL (Biochem J 362 : 297; J Cell Biochem 93 : 1272; FEBS J 273 : 3192). In this report we show that colloidal InsP(6 )solids inhibit factor B activation, through adsorption and associated impairment of C3b binding. However, this interaction is not relevant in the presence of serum proteins. In serum, InsP(6) deposits instead bind C1q, and initiate complement activation. This activation is curtailed through efficient C3b inactivation, previously shown to be entirely factor H-dependent, and now observed to be independent of the InsP(6) deposits. Therefore the complement resistance of the LL must be based on functional factor H binding sites present on the mucin-based meshwork that is its other major constituent.

[Quality of care for the dying in a hospital]

Aim. To analyse the accounts of the relatives of patients who died during one year in a hospital in Navarre, within a study of the quality of care for the dying. Method. A telephone interview was conducted with the person dearest to the patients who had died in the course of one year in the hospital. The TOOLKIT survey, previously validated, was used to this end. In all cases a maximum of three calls was made to establish contact with the person to be interviewed. The calls were made between three and six months following the death of the patient. The first part of the interview was aimed at providing information about the aim of the study and informed consent was requested. Four fields were analysed: physical and emotional comfort, shared decision making, respect and dignity, and care of the carers. The interview ended with an open question: Do you wish to add anything else? Results. The number of persons interviewed was 327. For the 712 deceased in the hospital who met the requirements, 320 persons could not be located and another 65 refused to be interviewed. Many complaints were gathered concerning the quantity and quality of information and the manner and time of its provision. There were also complaints concerning respect for the wishes of the patient, the management of pain, dyspnoea and personal treatment received. The lack of emotional support perceived by the relatives is also important. Conclusions. Besides the numerical variables contained in the survey, we believe that the narrative that a survey can contain provides key information for the analysis of care quality.

Gene expression patterns in brain cortex of three different animal models of depression

Animal models represent a very useful tool for the study of depressive-like behavior and for the evaluation of the therapeutic efficacy of antidepressants. Nevertheless, gene expression patterns of these different animal models and whether genes classically associated with human major depression are present in these genetic profiles remain unknown. Gene expression was evaluated in three animal models of depression: acute treatment with reserpine, olfactory bulbectomy and chronic treatment with corticosterone. Gene expression analysis was carried out using the Affymetrix GeneChip technology. The results were evaluated using the GeneChip Operating software (Gcos 1.3) and analyzed with the GeneSpring GX v7.3 bioinformatics software (Agilent) and dChip 2005 software. Expression changes were validated with quantitative real-time polymerase chain reaction (RT-PCR) assays. Many transcripts were differentially expressed in the cortex of depressed-like animals in each model. Gene ontology analysis showed that significant gene changes were clustered primarily into functional neurochemical pathways associated with apoptosis and neuronal differentiation. When expression profiles were compared among the three models, the number of transcripts differentially expressed decreased and only two transcripts (complement component 3 and fatty acid-binding protein 7) were differentially expressed in common. Both genes were validated with RT-PCR. Moreover, five (Htr2a, Ntrk3, Crhr1, Ntrk2 and Crh) of the genes classically related to human major depression were differentially expressed in at least one of these models. The different animal models of depression share relevant characteristics although gene expression patterns are different among them. Moreover, some of the classical genes related to human major depression are differentially expressed in these models.

Lung function and symptoms among indigenous Mayan women exposed to high levels of indoor air pollution

SETTING

Indoor air pollution from burning of biomass fuel in open fires is a known risk factor for chronic obstructive pulmonary disease (COPD) in developing countries.

OBJECTIVE

To estimate the prevalence of respiratory symptoms and lung function among women in rural Guatemala and to describe the methods and practical issues associated with the assessment of respiratory health.

DESIGN

Information about respiratory symptoms, lung function and individual measurement of exposure was collected cross-sectionally among 350 Mayan-Indian women aged 15-50 years who used traditional open fires.

RESULTS

These women, exposed to indoor air pollution since birth, had a relatively high prevalence of cough (22.6%), phlegm (15.1%), wheeze (25.1%) and tightness in the chest (31.4%). Respiratory symptoms were positively associated with exposure levels. Lung function was higher than the most feasible reference population (average above predicted forced expiratory volume in 1 s [FEV(1)] +4.5% and forced vital capacity [FVC] +4.2%). Only one woman had a FEV(1)/FVC ratio lower than 70%.

CONCLUSIONS

According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, almost one third of these young non-smoking women were at risk (stage 0) of developing COPD. The methodological issues encountered during the study highlight the importance of standardising approaches to local adaptation of established questionnaires to study respiratory health in rural areas of developing countries.

Tenosinovitis, de origen vegetal, de los flexores de muñeca y dedos. A propósito de un caso

Introducción: Las tenosinovitis de origen vegetal son poco frecuentes. El grupo de edad más afectado son niños y adolescentes. La realización de una correcta historia clínica es fundamental para el diagnóstico del proceso. La mayoría producen una reacción aséptica de cuerpo extraño al material retenido. La ecografía y la resonancia magnética son de inestimable ayuda para la localización del cuerpo extraño, y la mayoría de los casos se solucionan adecuadamente con la intervención quirúrgica.

Caso clínico: Varón de 17 años de edad que sufrió caída en el campo sobre su mano derecha, atendido en el Servicio de Urgencias por presentar herida volar en muñeca. A las 8 semanas de la lesión, el paciente fue remitido a la Unidad de Cirugía de la Mano del Hospital por presentar inflamación fría de muñeca y dificultad para la activación del pulgar. Se realizó resonancia magnética que identificó tumoración reactiva con cuerpos extraños en el seno de los flexores de muñeca y mano. Se intervino quirúrgicamente realizando exéresis de la reacción a cuerpo extraño con varios fragmentos de tallo de planta y sinovectomía. La recuperación fue completa.

Resultados del tratamiento de la rizartrosis mediante sección de los tendones accesorios del Abductor pollicis longus

Objetivo: Valoración de los resultados obtenidos en pacientes con rizartrosis, en estadios iniciales, tratados mediante la tenotomía de los tendones accesorios del abductor pollicis longus, según técnica de Zancolli.

Material y Método: Entre 2002 y 2006 se han intervenido 23 casos: 13 tipo I, 7 tipo II y 3 tipo III de la clasificación de Zancolli. La edad media fue de 50,3 años, siendo el 95,7% mujeres; el 60,9% de los casos afectaba a la mano derecha. En un 82,6% de los casos la tenotomía de los tendones accesorios se realizó en el contexto del tratamiento de otra patología asociada. Se midió el dolor mediante la escala analógica visual, la movilidad del pulgar, la fuerza de prensión y de las pinzas pulgar-índice mediante dinamómetros Jamar y B&L, la progresión radiológica de la artrosis, la existencia de complicaciones y la mejoría de la calidad de vida mediante la versión española del cuestionario DASH.

Resultados: Tras un seguimiento medio de 46 meses se valoraron 18 pacientes. El dolor disminuyó 2,8 puntos, la abducción radial media fue de 41,2º, la fuerza media de la pinza pulpejo-pulpejo fue del 52,7% de la esperada, la pulpejo-lateral del 64,2%, y la de puño del 36,5%. En el estudio radiológico final encontramos una progresión radiológica de la enfermedad en 8 casos (44,4%), obteniendo una mejoría de 16,7 puntos en el DASH.

Discusión y Conclusiones: Con esta técnica se consigue una mejoría del dolor, pero no parece existir una disminución significativa en la progresión radiológica de la enfermedad a medio-largo plazo, salvo para algunos estadios muy iniciales. Puede ser útil en estadios prerradiológicos en los que ha fracasado el tratamiento conservador, o como gesto quirúrgico asociado cuando se vaya a intervenir al paciente por otra patología de la mano.

SNP-based markers for discriminating olive (Olea europaea L.) cultivars

A set of 11 polymorphic markers (1 cleaved amplified polymorphic sequence (CAPS), 2 sequence-characterized amplified regions (SCARs), and 8 single-nucleotide polymorphism (SNP)-derived markers) was obtained for olive cultivar identification by comparing DNA sequences from different accessions. Marker development was more efficient, using sequences from the database rather than cloning arbitrary DNA fragments. Analyses of the sequences of 3 genes from 11 diverse cultivars revealed an SNP frequency of 1 per 190 base pairs in exons and 1 per 149 base pairs in introns. Most mutations were silent or had little perceptible effect on the polypeptide encoded. The higher incidence of transversions (55%) suggests that methylation is not the major driving force for DNA base changes. Evidence of linkage disequilibrium in 2 pairs of markers has been detected. The set of predominantly SNP-based markers was used to genotype 65 olive samples obtained from Europe and Australia, and was able clearly to discriminate 77% of the cultivars. Samples, putatively of the same cultivar but derived from different sources, were revealed as identical, demonstrating the utility of these markers as tools for resolving nomenclature issues. Genotyping data were used for constructing a dendrogram by UPGMA cluster analysis using the simple matching similarity coefficient. Relationships between cultivars are discussed in relation to the route of olive's spread.

A review of taste and odour events in Barcelona's drinking water area (1990-2004)

The main, relevant, solved problems associated with taste and odour incidents in Barcelona's drinking water area in the last 14 years are reviewed. Events produced by creosote, dioxanes and dioxolanes, dicylopentadiene, and diacetyl, among the anthropogenic compounds; geosmin, MIB and iodinated trihalomethanes and chlorobromoanisoles as examples of compounds of natural origin are exemplified. The determination of the odour threshold concentrations of selected odorous compounds is also shown as a tool to gain a better knowledge of future taste and odour events.

Invasive pneumococcal disease among children in a health district of Barcelona: early impact of pneumococcal conjugate vaccine

This study evaluated the impact of heptavalent pneumococcal conjugate vaccine (HPCV) on invasive pneumococcal disease (IPD) in children aged < or = 5 years in Barcelona, Spain. The incidence of IPD, vaccine uptake and prevalence of nasopharyngeal colonisation were analysed in two different periods: 1999-2001 (pre-licence period), and 2002-2004 (post-licence period). In total, 121 cases of IPD were identified. The overall incidence of IPD decreased from 96.9 cases/100,000 to 90.6 cases/100,000 (OR 0.93, 95% CI 0.69-1.26, p 0.71) between the two periods. The proportion of cases caused by non-vaccine-related serotypes (NVS) increased from 21% to 43.7% (OR 2.9, 95% CI 1.2-7, p 0.01). IPD was diagnosed in seven vaccinated children, six of whom were infected by NVS. There was a trend of diminishing prevalence of resistance to penicillin and macrolides in 2002-2004. The incidence of empyema increased from 1.7 to 8.5/100,000 (OR 4.5, 95% CI 0.91-18, p 0.06). The rate of vaccination ranged from 4.8% to 34%. It was concluded that the rates of IPD in this area did not decrease following the introduction of HPCV. The low uptake of vaccine and the greater proportion of colonisation/infection by NVS probably explain these findings. A trend of increasing empyema was also apparent. A decrease in the prevalence of penicillin and macrolide resistance paralleled the progressive uptake of vaccine.

Further evaluation of the synthetic peptide vaccine S3Pvac againstTaenia soliumcysticercosis in pigs in an endemic town of Mexico

Taenia soliumcysticercosis is a parasitic disease frequently affecting human health and the pig industry in many developing countries. A synthetic peptide vaccine (designated S3Pvac) against porcine cysticercosis has been developed previously as an aid to interrupt transmission and has been shown to be effective. The results of the present study support the effectiveness of the vaccine under endemic field conditions. However, given the time-frame of the vaccination trial, no changes in the local levels of transmission were detectable before and after vaccination using sentinel pigs. Thus, this investigation shows the limited usefulness of single vaccination as the sole means of interruptingTaenia soliumtransmission in an endemic region.

[A naturalistic study: 100 consecutive episodes of acute agitation in a psychiatric emergency department]

INTRODUCTION

Psychomotor agitation is a common event in psychiatric emergency services (PES) with a prevalence of approximately 10 %. There is no general consensus on to how to manage psychomotor agitation; benzodiazepines, typical antipsychotics and now atypical antipsychotics have demonstrated similar efficacy. The aim of our study was to describe the epidemiology and clinical management of agitation in "real-life" in a psychiatric emergency service.

METHODS

A naturalistic study was performed in acutely agitated patients recruited consecutively in a psychiatric emergency service. Demographics, clinical and therapeutic characteristics were analyzed. Efficacy was assessed by the Excitement Component of the Positive and Negative Syndrome Scale (PANSS-EC) and the Agitation-Calmness Evaluation Scale (ACES). Pragmatic variables such as the need for second pharmacological intervention and the need for physical restraints were assessed.

RESULTS

The study included 100 patients with psychomotor agitation. Mean age was 36.2 % and 54% were women. The most prevalent diagnoses were psychotic disorder (48 %) and personality disorder (24 %). Physical restraint was required in 39 % of patients and 52 % accepted oral treatment. Haloperidol was the most frequent oral treatment and olanzapine was the most frequent intramuscular treatment.

CONCLUSIONS

A naturalistic approach provides data based on clinical reality in psychiatric emergency services. Strict research designs of clinical trials of efficacy imply sample selection biases and are generally distanced from the clinical reality. Atypical antipsychotics have become the first-line treatment in acute agitation

Sensorineural hearing loss in insulin-like growth factor I-null mice: a new model of human deafness

It has been reported that mutations in the gene encoding human insulin-like growth factor-I (IGF-I) cause syndromic hearing loss. To study the precise role of IGF-I in auditory function and to hypothesize the possible morphological and electrophysiological changes that may occur in the human inner ear, we have analysed the auditory brainstem response in a mouse model of IGF-I deficiency. We show here that homozygous Igf-1(-/-) mice present an all-frequency involved bilateral sensorineural hearing loss. Igf-1(-/-) mice also present a delayed response to acoustic stimuli; this increases along the auditory pathway, indicating a contribution of the central nervous system to the hearing loss in Igf-1(-/-) mice. These results support the use of the Igf-1(-/-) mouse as a new model for the study of human syndromic deafness.

Abel inversion applied to a small set of emission data from a microwave plasma

In this work we propose a criterion to apply the Abel inversion in the case of a small set of experimental data to be used in laboratory plasmas. The Nestor-Olsen method, spline interpolation, and Fourier transform Abel inversion have been compared in order to study the influence of statistical noise and the number of sampled data. The application of this criterion permits us to obtain a radial distribution of the plasma parameters (densities and temperatures) from the spectral line profiles emitted by the discharge. The proposed criterion has been tested using the lateral intensities of several lines emitted by a microwave helium plasma column generated at atmospheric pressure.

Growth of hydroxyapatite in a biocompatible mesoporous ordered silica

A novel biomaterial (HA-SBA-15) has been developed based on the growth of calcium phosphate hydroxyapatite (HA) nanoparticles within an organized silica structure (SBA-15). Characterization of the material was carried out using a combination of X-ray diffraction, X-ray fluorescence, transmission electron microscopy, N2 adsorption-desorption isotherms and nuclear magnetic resonance. Transmission electron microscopy observations and N2 porosimetry revealed the crystallization of hydroxyapatite nanoparticles inside the mesopore cavities of the silica structure. Specific surface areas of 760 m2 g(-1) and 260 m2 g(-1) were measured for the SBA-15 and the HA-SBA-15 material, respectively. The hydroxyl groups present in the silica nanostructure surface have brought about cationic defects in the silicium sites, mainly with those of tetrahedral symmetry, and promoted the formation of siloxanes. 29Si MAS-NMR analysis shows a significant reduction of the silanol groups concentration with HA growing within the base (SBA-15) material. Studies and brain tissue biocompatibility tests were carried out. Histopathological studies on the SBA-15 implant material showed no changes to the tissue nearby. The results confirmed the synthesis of a silica-based composite containing HA nanoparticles with the potential for biomedical applications.

[Perception of difficulties in family medicine in the delivery of health to economic immigrants]

OBJECTIVES

To find the problems, as seen by family doctors, in care for immigrants, with description of proposed solutions.

DESIGN

Transversal and descriptive.

PARTICIPANTS

262 doctors from 18 health centres in a district.

MEASUREMENTS

Each professional received a questionnaire containing social and demographic variables, number of immigrants seen per day, their place of origin, 6 items on accessibility, 5 on barriers to care, 6 on clinic, and 7 on solutions.

RESULTS

159 doctors, 57.2% women, replied. Average age was 41.1; 64% saw 2-3 immigrants a day. 52.3% (95% CI, 45.0%-61.4%) recognised that care for immigrants posed professional problems. They said that immigrants attended as an emergency more often (81.1%); they more often had no clinical records (74.7%); and they had difficulties obtaining a health card (53%). 67% expressed no difficulties for getting to the hospital. Perceived barriers were the mobility of immigrants (82.9%), language (82.3%), and culture (71.3%). Solutions suggested were translators (95.6%) or cultural intermediary (82.7%). Clinically, doctors saw no differences of pathology in immigrants (56.7%), and no greater psychiatric pathology (66%). Lack of skill in contagious pathologies hampered care (60.3%). 82.8% affirmed that specific protocols were needed. 80.3% argued for a unit of imported diseases. Among care priorities were information on health circuits and making the health card easier to obtain.

CONCLUSIONS

The difficulties sustained by a broad range of professionals are diverse, with access and linguistic-cultural questions standing out. To palliate them, sensitivity from health staff and action from management are needed.

[Influence of the nasogastric tube in the pathology of the maxillary sinus]

INTRODUCTION

Nasoesophageal tube (NT) is very often used by the ear, nose and throat specialists in head and neck oncological surgery. It is well known the irritative effect that it has on the nasosinusal mucosa. The aim of this study is to analyze the relationship between the use of the NT and the pathology of the maxillary sinuses.

MATERIAL AND METHOD

The study was carried out in 25 patients treated in our department who had been fed by NT, after surgery. A plain sinus X-ray was performed in the pre-operatory period and a control radiograph in the post-operatory period, and the results have been analyzed.

RESULTS AND CONCLUSIONS

No sinusitis had been observed whatever length of time the NT remained in situ.

[Clinical picture and prognostic factors for severe community-acquired pneumonia in adults admitted to the intensive care unit]

OBJECTIVE

In Chile very little information is available on severe community-acquired pneumonia treated in intensive care units. This study describes the clinical picture, prognostic factors, and treatment of adult patients admitted to the intensive care unit for severe community-acquired pneumonia.

PATIENTS AND METHODS

A total of 113 consecutive patients were included in this prospective, descriptive study.

RESULTS

The mean (SD) age of the 113 patients was 73 (15). Of these, 95% had associated comorbidity, and 81% were in the high-risk classes of the Pneumonia Severity Index. Etiology was identified in 31%, and the most common pathogens were Streptococcus pneumoniae (40%), gram negative bacilli (17%), and Mycoplasma pneumoniae (6%). The main complications were the need for mechanical ventilation (45%), septic shock (26%), heart failure (24%), and arrhythmias (15%). Mortality at 30 days was 16.8%, and multivariate analysis revealed the following factors to be associated with a greater risk of death: acute renal failure (odds ratio: 5.1), and glycemia above 300 mg/dL (odds ratio: 7.2).

CONCLUSIONS

The patients with severe pneumonia admitted to the intensive care unit are elderly, with a high level of comorbidity and complications, but most survive.

[Behaviour of vancomycin with the new techniques in haemodialysis]

When using high convection dialysis techniques it arouses the necessity of considering the suitability of the regular protocols when administrating drugs, such as vancomycin.

OBJECTIVES

To confirm if the usual guideline of vancomycin is efficient in patients undergoing treatments with acetate free biofiltration (AFB) and haemodiafiltration on-line (on-line). To propose an alternative guideline of administration.

MATERIAL AND METHODS

13 patients treated with AFB or On-line. 10 of them used filters of polysulfone and 3 of them of AN69. First part: 6 patients were administered 1 g iv during the last hour of dialysis. Second part: 7 patients were given a loading dose of 30 mg/kg iv with a reinforcement of 500 mg post-dialysis. The blood levels of the antibiotic were monitorized during the week following the administration.

OUTCOMES

During the first phase it was noticed a decrease of 41% in the serum level of vancomycin during dialysis, conditioning subtherapeutic levels in the 83% of the patients until the end of the study. As for the second phase, therapeutic non-toxic levels were maintained during the whole study. The existence of a post-dialysis rebound of the 21 % was confirmed. A bigger clearance of vancomycin was obtained with the On-line technique rather than with AFB (176 vs 135 ml/min). We find a strong correlation between the decrease of the antibiotic and the volume ultrafiltrated with the On-line technique.

CONCLUSIONS

The usual guideline of vancomycin may not be enough with the new convective dialysis techniques. A guideline based on a loading dose of 30 mg/kg and a reinforcement of 500 mg at the end of each dialysis could be adequate. The antibiotic clearance with the On-line technique is probably made by convective transport.

Scorpion envenoming in two regions of Colombia: clinical, epidemiological and therapeutic aspects

To determine clinical and epidemiological features of scorpion stings in two departments of Colombia, a descriptive study was performed in the hospitals of 10 towns from Antioquia (2 256 071 inhabitants) and five from Tolima (630 424 inhabitants). One hundred and twenty-nine cases were admitted during one year, 51 in Antioquia, 78 in Tolima and 41 were children less than 15 years old. Most stings (70.5%) occurred inside the house; 27.9% were on the hands and 26.4% on the feet. The scorpion species involved were Tityus pachyurus (51), Centruroides gracilis (31), T. fuehrmanni (29), T. asthenes (7) and Chactas spp. (1). In 10 cases the scorpion involved was not identified. Systemic envenoming signs (e.g. vomiting, tachypnea) were significantly more frequent in children than in adults (P < 0.05). Four children had hypertension, but none developed pulmonary oedema. One 3-year-old girl, stung by T. asthenes, had acute oedematous pancreatitis. Ninety-eight patients had mild envenoming. Moderate (27 patients) and severe (four patients) envenoming was significantly more frequent in children than in adults (P = 0.003; relative risk = 2.97). A pepsin-digested anti-Centruroides spp. antivenom was administered to 19 of 31 patients presenting systemic envenoming signs. No adverse reactions to antivenom were observed.

Neutralization of the edema-forming, defibrinating and coagulant effects of Bothrops asper venom by extracts of plants used by healers in Colombia

We determined the neutralizing activity of 12 ethanolic extracts of plants against the edema-forming, defibrinating and coagulant effects of Bothrops asper venom in Swiss Webster mice. The material used consisted of the leaves and branches of Bixa orellana (Bixaceae), Ficus nymphaeifolia (Moraceae), Struthanthus orbicularis (Loranthaceae) and Gonzalagunia panamensis (Rubiaceae); the stem barks of Brownea rosademonte (Caesalpiniaceae) and Tabebuia rosea (Bignoniaceae); the whole plant of Pleopeltis percussa (Polypodiaceae) and Trichomanes elegans (Hymenophyllaceae); rhizomes of Renealmia alpinia (Zingiberaceae), Heliconia curtispatha (Heliconiaceae) and Dracontium croatii (Araceae), and the ripe fruit of Citrus limon (Rutaceae). After preincubation of varying amounts of each extract with either 1.0 microg venom for the edema-forming effect or 2.0 microg venom for the defibrinating effect, the mixture was injected subcutaneously (sc) into the right foot pad or intravenously into the tail, respectively, to groups of four mice (18-20 g). All extracts (6.2-200 microg/mouse) partially neutralized the edema-forming activity of venom in a dose-dependent manner (58-76% inhibition), with B. orellana, S. orbicularis, G. panamensis, B. rosademonte, and D. croatii showing the highest effect. Ten extracts (3.9-2000 microg/mouse) also showed 100% neutralizing ability against the defibrinating effect of venom, and nine prolonged the coagulation time induced by the venom. When the extracts were administered either before or after venom injection, the neutralization of the edema-forming effect was lower than 40% for all extracts, and none of them neutralized the defibrinating effect of venom. When they were administered in situ (sc at the same site 5 min after venom injection), the neutralization of edema increased for six extracts, reaching levels up to 64% for C. limon.

Cross-amplification and sequence variation of microsatellite loci in Eurasian hard pines

Microsatellite transfer across coniferous species is a valued methodology because de novo development for each species is costly and there are many species with only a limited commodity value. Cross-species amplification of orthologous microsatellite regions provides valuable information on mutational and evolutionary processes affecting these loci. We tested 19 nuclear microsatellite markers from Pinus taeda L. (subsection Australes) and three from P. sylvestris L. (subsection Pinus) on seven Eurasian hard pine species ( P. uncinata Ram., P. sylvestris L., P. nigra Arn., P. pinaster Ait., P. halepensis Mill., P. pinea L. and P. canariensis Sm.). Transfer rates to species in subsection Pinus (36-59%) were slightly higher than those to subsections Pineae and Pinaster (32-45%). Half of the trans-specific microsatellites were found to be polymorphic over evolutionary times of approximately 100 million years (ten million generations). Sequencing of three trans-specific microsatellites showed conserved repeat and flanking regions. Both a decrease in the number of perfect repeats in the non-focal species and a polarity for mutation, the latter defined as a higher substitution rate in the flanking sequence regions close to the repeat motifs, were observed in the trans-specific microsatellites. The transfer of microsatellites among hard pine species proved to be useful for obtaining highly polymorphic markers in a wide range of species, thereby providing new tools for population and quantitative genetic studies.

Cross-amplification and sequence variation of microsatellite loci in Eurasian hard pines

Microsatellite transfer across coniferous species is a valued methodology because de novo development for each species is costly and there are many species with only a limited commodity value. Cross-species amplification of orthologous microsatellite regions provides valuable information on mutational and evolutionary processes affecting these loci. We tested 19 nuclear microsatellite markers from Pinus taeda L. (subsection Australes) and three from P. sylvestris L. (subsection Pinus) on seven Eurasian hard pine species ( P. uncinata Ram., P. sylvestris L., P. nigra Arn., P. pinaster Ait., P. halepensis Mill., P. pinea L. and P. canariensis Sm.). Transfer rates to species in subsection Pinus (36-59%) were slightly higher than those to subsections Pineae and Pinaster (32-45%). Half of the trans-specific microsatellites were found to be polymorphic over evolutionary times of approximately 100 million years (ten million generations). Sequencing of three trans-specific microsatellites showed conserved repeat and flanking regions. Both a decrease in the number of perfect repeats in the non-focal species and a polarity for mutation, the latter defined as a higher substitution rate in the flanking sequence regions close to the repeat motifs, were observed in the trans-specific microsatellites. The transfer of microsatellites among hard pine species proved to be useful for obtaining highly polymorphic markers in a wide range of species, thereby providing new tools for population and quantitative genetic studies.

Synthesis and odour thresholds of mixed halogenated anisoles in water

Earthy-musty off-flavour compounds in water samples are usually associated with the presence of geosmin and 2-methylisoborneol. However, the presence of 2,3,6- and 2,4,6-trichloroanisoles or other halogenated anisoles can impart objectionable tastes and odours to the water even at very low trace levels. This paper shows the synthesis of non-commercial 2,3,6- and 2,4,6- mixed chloro/bromoanisoles which can be present in bromide rich waters and could also be suspected of imparting earthy-musty off-flavours to the water. All the synthesized compounds were subjected to the flavour profile analysis (FPA) method and their odour threshold concentrations (OTC) in water were carried out giving values in the low ng/L range.

[Intranasal approaches for pituitary area tumors. Our experience]

Transsphenoidal approach is the most commonly employed surgical technique for the resection of pituitary tumors. We present our experience in the transnasal-transsphenoidal approach in 30 patients undergoing pituitary surgery from 1998 to 2002. Ten patients underwent surgery via a sublabial-transeptal-transsphenoidal approach, 15 patients via a transeptal-transsphenoidal approach and 5 patients via a pure endoscopic transnasal-transsphenoidal. The pathological study showed 29 pituitary adenomas and 1 Rathe's cleft cyst. We conclude that the pure endoscopic transnasal-transsphenoidal approach guided by a navigator-system is safest and more effective approach. We reserved the transeptal-transsphenoidal approach for cases with obstructive septal deflection and poor pneumatized sphenoid sinuses. We do not recommend the use of the sublabial-trans-sphenoidal approach.

[Evaluation of osteodystrophy parameters in a pre-dialysis unit]

A cross-sectional study was developed with 100 of the first-time pre-dialysis patients visiting the Princesa University Hospital's Advanced Chronic Kidney Disease (ACKD) unit, with the aim of analysing various parameters of osteodystrophy at this time. Parameters evaluated were: age, gender, renal function, osteodystrophy serum parameters, comorbidity index (ICED) and the patients' origin to establish correlations between these parameters. Mean iPTH levels were higher irrespective of the patients' origin, and were significantly higher in men than in women, the former also having poorer renal function and higher comorbidity score. The mean levels of calcium, phosphorous, alkaline phosphatase and CO2 did not justify this rise in iPTH. Nutritional parameters NPNA and albumin were adequate in spite of ageing. At early stages of ESRD, iPTH could be elevated and ACKD units play an important part its early detection and subsequent treatment.