Incidence and care-related costs of severe hypoglycaemia requiring emergency treatment in Andalusia (Spain): the PAUEPAD project

AIMS

Hypoglycaemia is a serious medical emergency. The need for emergency medical service care and the costs of hypoglycaemic emergencies are not completely known.

METHODS

This was a retrospective observational study using Public Company for Health Emergencies (EPES) data for hypoglycaemia in 2012. The EPES provides emergency medical services to the entire population of Andalusia, Spain (8.5 million people). Data on event type, onsite treatments, emergency room visits or hospitalization were collected. Medical costs were estimated using the public rates for healthcare services.

RESULTS

From a total of 1 137 738 emergency calls that requested medical assistance, 8683 had a primary diagnosis of hypoglycaemia (10.34 per 10 000 person-years). The incidence of severe hypoglycaemic episodes requiring emergency treatment in the estimated population with diabetes was 80 episodes per 10 000 person-years. A total of 7479 episodes (86%) required an emergency team to visit the patient's residence. The majority of cases (64%) were addressed in the residence, although 1784 (21%) cases were transferred to hospital. A total of 5564 events (65%) involved patients aged > 65 years. Overall mortality was 0.32% (28 cases). The total annual cost of attending a hypoglycaemic episode was €6 093 507, leading to an estimated mean direct cost per episode of €702 ± 565. Episodes that required hospital treatment accounted for 49% of the total costs.

CONCLUSIONS

Hypoglycaemia is a common medical emergency that is associated with high emergency medical service utilization, resulting in a significant economic impact on the health system.

Amyophatic dermatomyositis presenting as a flagellated skin eruption with positive MDA5 antibodies and thyroid cancer: a real association?

Amyopathic dermatomyositis (ADM) is characterized clinically by typical skin lesions with hypomyopathy or no muscular involvement. ADM has been recently reported to be complicated by rapidly progressive interstitial lung disease (ILD), especially in patients with positive antibodies against melanoma differentiation-associated gene 5 (MDA5). These patients may have a low risk of cancer, but no clinical, histological or laboratory markers completely specific for paraneoplastic DM have been identified to date. We report a case of flagellate erythema as the initial presentation of ADM associated with ILD, positive MDA5 antibodies and a concomitant diagnosis of thyroid cancer. We discuss the unusual clinical features and associations that make this case particularly interesting.

Role of Angiotensin II type 1 receptor on renal NAD(P)H oxidase, oxidative stress and inflammation in nitric oxide inhibition induced-hypertension

AIMS

Activation of the renin-angiotensin system (RAS), renal oxidative stress and inflammation are constantly present in experimental hypertension. Nitric oxide (NO) inhibition with N(w)-nitro-L-arginine methyl ester (L-NAME) has previously been reported to produce hypertension, increased expression of Angiotensin II (Ang II) and renal dysfunction. The use of Losartan, an Ang II type 1 receptor (AT1R) antagonist has proven to be effective reducing hypertension and renal damage; however, the mechanism by which AT1R blockade reduced kidney injury and normalizes blood pressure in this experimental model is still complete unknown. The current study was designed to test the hypothesis that AT1R activation promotes renal NAD(P)H oxidase up-regulation, oxidative stress and cytokine production during L-NAME induced-hypertension.

MAIN METHODS

Male Sprague-Dawley rats were distributed in three groups: L-NAME, receiving 70 mg/100ml of L-NAME, L-NAME+Los, receiving 70 mg/100ml of L-NAME and 40 mg/kg/day of Losartan; and Controls, receiving water instead of L-NAME or L-NAME and Losartan.

KEY FINDINGS

After two weeks, L-NAME induced high blood pressure, renal overexpression of AT1R, NAD(P)H oxidase sub-units gp91, p22 and p47, increased levels of oxidative stress, interleukin-6 (IL-6) and interleukin-17 (IL-17). Also, we found increased renal accumulation of lymphocytes and macrophages. Losartan treatment abolished the renal expression of gp91, p22, p47, oxidative stress and reduced NF-κB activation and IL-6 expression.

SIGNIFICANCE

These findings indicate that NO induced-hypertension is associated with up-regulation of NADPH oxidase, oxidative stress production and overexpression of key inflammatory mediators. These events are associated with up-regulation of AT1R, as evidenced by their reversal with AT1R blocker treatment.

First Report of Fusarium solani Causing Crown and Root Rot on Strawberry Crops in Southwestern Spain

Spain is the fourth largest strawberry (Fragaria × ananassa) producing country in the world. Since April 2010, stunted and dead strawberry plants have been detected in four strawberry fruit production fields in Huelva (southwestern Spain) affecting less than 1% of plants. Symptoms consisted of foliage wilt, plant stunting and drying, and death of older leaves. Internal vascular and cortical tissues of plant crowns showed an orange to brown discoloration. Crowns and roots of symptomatic plants were surface sterilized in 1% sodium hypochlorite for 2 min, rinsed in sterile distilled water for 2 min, and air-dried in a laminar flow cabinet. Small disinfested pieces were transferred to petri dishes containing potato dextrose agar (PDA) and incubated for 10 days at 25°C with a 12-h photoperiod. Cultures derived from single spores were obtained, and morphological characterization was performed by microscopic examination. White to pale cream colonies developed after 10 days of incubation. Unbranched monophialides with microconidia in false heads, micro- (0 to 3 septa) and macroconidia (5 to 7 septa) wide and robust in shape, and chlamydospores were consistent with descriptions of Fusarium solani (Martius) Appel & Wollenweber emend. Snyder & Hansen (2). In addition, the fungus was isolated from asymptomatic runner plants from nurseries by the same method described above, and from soil samples from six fruit-producing fields. Soil samples were analyzed by dilution plating on Fusarium-selective agar medium (1). Genomic DNA from three isolates (FPOST-81 from dead plant 'Sabrina,' TOR-11 from runner plant 'Camarosa,' and TOR-1 from soil) was obtained with a DNA extraction kit (Isolate Plant DNA MiniKit, Bioline). A portion of the translation elongation factor-1 alpha (EF-1α) gene was sequenced using EF-1/-2 primers (3) (GenBank Accession Nos. KF275032, KF275033, and KF275034). The sequence comparison revealed a 99 to 100% match with F. solani sequences in GenBank and Fusarium-ID databases. To confirm the pathogenicity of the fungi, runner strawberry plants 'Camarosa' were inoculated by dipping crowns and roots into a conidial suspension (10⁶ to 10⁷ conidia per ml) for 30 min (8 plants per F. solani isolate) or into sterile distilled water for the controls. Plants were potted in 13-cm diameter pots with peat and maintained at 25/18°C and 70/40% relative humidity (day/night) in a growth chamber with a daily 16-h photoperiod of fluorescent light. Three plants inoculated with isolates TOR-11 and FPOST-81, and four plants inoculated with isolate TOR-1, died within 10 days after inoculation. After 8 to 12 weeks, all of the remaining inoculated plants were stunted and developed symptoms similar to those observed in the field. Production of new feeder roots was lacking or scarce. Control plants remained healthy and formed feeder roots. All plants inoculated with isolates TOR-1 and FPOST-81, and 50% of plants inoculated with TOR-11, showed brown discoloration in the crown. F. solani was re-isolated from symptomatic plants at frequencies of 100% and 80 to 100% from root and crown tissues, respectively. Although F. solani has been reported as a pathogen in other crops, to our knowledge, this is the first report of the occurrence of F. solani causing disease in strawberry plants in Spain. References: (1) D. Bouhot and F. Rouxel. Ann. Phytopathol. 3:251, 1971. (2) J. F. Leslie and B. A. Summerell. The Fusarium Laboratory Manual, Blackwell Publishing, London, 2006. (3) K. O'Donnell et al. Proc. Natl. Acad. Sci. USA 95:2044, 1998.

Analysis of genetic diversity in Bolivian llama populations using microsatellites

South American camelids (SACs) have a major role in the maintenance and potential future of rural Andean human populations. More than 60% of the 3.7 million llamas living worldwide are found in Bolivia. Due to the lack of studies focusing on genetic diversity in Bolivian llamas, this analysis investigates both the genetic diversity and structure of 12 regional groups of llamas that span the greater part of the range of distribution for this species in Bolivia. The analysis of 42 microsatellite markers in the considered regional groups showed that, in general, there were high levels of polymorphism (a total of 506 detected alleles; average PIC across per marker: 0.66), which are comparable with those reported for other populations of domestic SACs. The estimated diversity parameters indicated that there was high intrapopulational genetic variation (average number of alleles and average expected heterozygosity per marker: 12.04 and 0.68, respectively) and weak genetic differentiation among populations (FST range: 0.003-0.052). In agreement with these estimates, Bolivian llamas showed a weak genetic structure and an intense gene flow between all the studied regional groups, which is due to the exchange of reproductive males between the different flocks. Interestingly, the groups for which the largest pairwise FST estimates were observed, Sud Lípez and Nor Lípez, showed a certain level of genetic differentiation that is probably due to the pattern of geographic isolation and limited communication infrastructures of these southern localities. Overall, the population parameters reported here may serve as a reference when establishing conservation policies that address Bolivian llama populations.

Towards the Improvement of Fruit-Quality Parameters in Citrus under Deficit Irrigation Strategies

Water shortage is becoming a severe problem in arid and semiarid regions worldwide, reducing the availability of agricultural land and water resources. In Spain, citrus is one of the most economically important crops, with 74,000 ha devoted to its cultivation. Since water resources are increasingly more insufficient, the efficient use of water is becoming more essential. Deficit irrigation in many agricultural crops has frequently proved to be an efficient tool for improving water-use efficiency. This paper examines the effects a deficit irrigation during the ripening period on yield and the most representative fruit quality properties. The study was conducted during two consecutive years (2009-2010) in a commercial 12-year-old orange orchard (Citrus sinensis L. Osb. cv. Navelina) grafted onto Carrizo citrange (Citrus sinensis L. Osb. × Poncirus Trifoliata L. Osb.). A regulated deficit irrigation (DI) was applied, which was fully irrigated during the flowering and fruit-growth stage, and during the ripening period it was subjected to a water-stress ratio of 0.75. A control treatment was established, this being irrigated at 100% of crop evapotranspiration. Along the water stress period, it was tested the temporal evolution of the main organoleptic and nutraceutical fruit properties (color index, the total soluble solids, titrable acidity, maturity index, rind weight, juice weight, the ratio of juice weight versus fruit weight, and the total C vitamin and flavonoids). It was not observed a descend in juice content, or fruit weight, or in the final yield. In terms of fruit organoleptic and nutraceutical properties, there were not detected negative effects in the studied properties. Furthermore, DI treatment showed higher values of maturity index than control treatment, which can be considered as a positive aspect in the fruit quality. Considering these results, we can affirm that a moderate water stress applied during the maturity period is a sustainable strategy for saving water, increasing the irrigation productivity and obtaining fruits with similar properties to those without deficit irrigation.

Value of matrix-assisted laser desorption ionization-time of flight for routine identification of viridans group streptococci causing bloodstream infections

Phenotypic tests do not always unequivocally identify some species of viridans group streptococci (VGS). sodA sequence analysis is the most accurate method for identification, although it requires specialized personnel and has not been applied systematically in clinical microbiology laboratory routines. Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) is emerging as a rapid alternative for bacterial identification. This study assesses the ability of MALDI-TOF and the API 20 Strep system to identify VGS isolates recovered from blood cultures using sodA sequence analysis as the reference method. All clinically significant VGS isolates recovered from blood cultures between January 2007 and January 2010 were identified by sodA sequence analysis and API 20 Strep. The strains were then tested by MALDI-TOF. Agreement between API 20 Strep/MALDI-TOF and sodA sequence analysis was determined. We examined 124 clinical isolates. Sensitivities of API 20 strep and MALDI-TOF for the species level identification of VGS isolates were, respectively, as follows: 60.5% and 73.4%. Sensitivities of API 20 strep and MALDI-TOF for the group level identification were, respectively, as follows: 70% and 94.3%. The turnaround times to identify VGS isolates by sodA sequence analysis, API 20 Strep and MALDI-TOF were 12-24, 24-48 h and 15 min, respectively. API 20 Strep cannot accurately identify all isolates of VGS. MALDI-TOF appeared to be a rapid and reliable alternative for identification of VGS strains to group level, but was not able to discriminate closely related species of certain groups.

Effect of aracnotoxin from Latrodectus mactans on bovine sperm function: modulatory action of bovine oviduct cells and their secretions

Latrodectus mactans' aracnotoxin (Atx) induces changes in sperm function that could be used as a co-adjuvant in male contraceptive barrier methods. This effect includes the suppression of intracellular reactive oxygen species (ROS), an event necessary for capacitation, chemotaxis and acrosome reaction (AR). The sperm that are not trapped by the barrier method can reach the oviduct before fertilisation and be exposed to the secretions of the oviducts. This study evaluated the effect of bovine tubal explants (TU) and conditioned media (CM) from the ampullar and isthmal regions on spermatozoa exposed to Atx. Thawed bovine sperm were incubated with Atx, TU and CM from the ampullar and isthmal regions for 4 h and then DNA integrity, intracellular ROS and lysophosphatidylcholine-induced AR were determined. Spermatozoa exposed to Atx and co-incubated with TU and CM for 4 h produced an increase in sperm DNA damage, a decrease in ROS production and a decrease in %AR, compared with the control. A similar result was obtained from the co-incubation of spermatozoa with Atx. In conclusion, the effect of Atx is not modified by tubal cells or their secretions and this opens the door to future studies to evaluate the application of synthetic peptides obtained from Atx as a co-adjuvant of contraceptive barrier methods.

Glucagon-like peptide-1 secretion in women with gestational diabetes mellitus during and after pregnancy

Gestational diabetes mellitus (GDM) predisposes women to future development of Type 2 diabetes mellitus (DM2) and the two conditions share similar metabolic alterations. Recent observations suggest that a defective glucose stimulated insulin secretion by glucagon-like peptide-1 (GLP- 1) plays a role in the pathogenesis of DM2. Whether such a defect is impaired in GDM remains to be ascertained.

AIM

We have determined GLP-1 secretion in response to oral glucose tolerance test (OGTT) in GDM and normal glucose tolerance (NGT) during and after pregnancy.

MATERIALS AND METHODS

100-g-3h OGTT was performed in 12 GDM and 16 NGT women at 27.3 ± 4.1 weeks of gestation, for determination of plasma GLP-1, glucose, insulin, and C-peptide. Insulin sensitivity (ISI) and insulin secretion (first and second phase); as well as ISI-secretion index (ISSI) were also derived.

RESULTS

NGT and GDM women were comparable for age pre-pregnancy body mass index (BMI) and weight gain. GDM had higher glucose area under the curve (AUC): 27,575.5 ± 3448 vs 20,685.88 ± 2715 mg/dl min (p<0.01), but lower first-phase insulin secretion (993.12±367 vs 1376.61 ± 423, p<0.05) and ISSI compared to controls (3873.23 ± 1185 vs 6232.13 ± 1734, p<0.001). When we examined GLP-1 mean levels in relation to mean glycemic values, GLP-1 secretion was inappropriately low with respect to mean glycemic values in GDM compared to NGT. At follow-up, AUCGLP-1 was significantly lower in post-partum GDM compared to post-partum NGT women (2542 ± 273 vs 10,092 ± 7367 pmol·l-1·min-1, p<0.05, respectively).

CONCLUSIONS

Our study suggests that GLP-1 secretion in GDM women is inadequate for the prevailing glycemic levels both in pregnancy and post partum. Moreover, we cannot exclude that other important aspects of the incretin effect may be involved in GDM development.

Multiple sclerosis prevalence in Malaga, Southern Spain estimated by the capture–recapture method

Background: Although not definitively proven, there is commonly accepted to be a latitudinal gradient in the distribution of multiple sclerosis (MS), which is more frequent in temperate zones. The European Mediterranean countries are situated in a zone of median frequency, although ever increasing figures have been noted in the last decades.

Objective: The objective of this study was to assess the current prevalence rate of MS in the province of Malaga, Southern Spain.

Methods: The capture–recapture method (CRM) uses independent sources of data and permits the number of non-registered cases of a given disease to be estimated, and by doing so, to avoid ascertainment bias.

Results: Use of this method showed the estimated prevalence rate of MS in the province of Malaga, Southern Spain, to be 125/105 (95% confidence interval: 102/105–169/105), higher than the figures published previously.

Conclusions: Although we recognize that these data need to be confirmed in further studies and in other areas of the country using a similar method, we believe this study is the first to find such high figure of prevalence, being very similar to the figures reported in recent years in other southern European countries.

Polyphenolic profile and antiproliferative activity of bioaccessible fractions of zinc-fortified fruit beverages in human colon cancer cell lines

INTRODUCTION

Colorectal cancer risks could be reduced by polyphenol-rich diets that inhibit tumour cell growth.

AIMS

To determine the polyphenolic profile of four fruit beverages (FbZn, FbZnFe, FbZnM and FbZnFeM) as affected by the presence of Zn with/without Fe and with/without skimmed milk, and the digestion conditions. To evaluate the antiproliferative activity of bioaccessible fractions against Caco-2 and HT-29 cells. To clarify whether cell cycle arrest and/or apoptosis is involved in their possible antiproliferative activity.

METHODS

The polyphenolic profiles were analyzed by RP-HPLC-DAD before and after in vitro gastrointestinal digestion. Cell proliferation and viability were measured using Trypan blue test, mitochondrial enzyme activity by means MTT test, cell cycle distribution using flow cytometry and apoptosis by means Hoechst dye.

RESULTS AND DISCUSSION

The presence of zinc, iron and/or milk decreased the soluble extractable phenolic content before digestion probably by chelate formation, FbZn and FbZnFe being the samples with the highest soluble extractable phenolics. After digestion, a decrease in phenolics was observed in all zinc-fortified samples (up to 32% with respect to the original fruit beverages) - the FbZnFeM sample showing the lowest soluble extractable phenolic content, though with the lowest percentage decrease in phenolics (14%). FbZnM digest (approximately 50 microM total soluble extractable phenolics) was the sample that most inhibited Caco-2 and HT-29 cell proliferation after 24 h of incubation, without cytotoxicity. The specific combination of phytochemicals in FbZnM digest proved cytostatic and significantly suppressed proliferation through cell cycle arrest in the S-phase in both cell lines, without apoptosis.