[Retinopathy of prematurity in the Murcia region of Spain. Incidence and severity]

OBJECTIVE

To determine the incidence and severity of Retinopathy of Prematurity (ROP) in the Murcia region of Spain.

METHODS

This was a retrospective study of all infants born preterm in the Murcia region during 2004, who were screened for ROP. Our screening criteria were: Infants with a gestational age <or= 32 weeks (GA) or with a birth weight <or= 1500 g (BW). We evaluated sex, GA, BW, parity and ophthalmologic evaluation. We then performed a descriptive study and a statistical analysis.

RESULTS

The study sample involved 115 infants with an average GA of 29.67 weeks and BW of 1325 g. The incidence of ROP and severe ROP was 32.1% and 15.6% respectively. The likelihood of the premature infant developing severe ROP was found to be 88.8% if it was born before 29 weeks GA or weighed less than 1000 g BW. Significant differences (p < 0.001), in terms of GA and BW between infants with and without ROP, were found.

CONCLUSIONS

A third of the preterm infants screened for ROP in the Murcia region developed the disease, and the 50% of these required treatment. The current screening criteria used in our region are appropriate. If more restrictive criteria were used, some severe ROP cases would not be detected. In order to be able to modify the current guidelines for screening for ROP, further studies are required.

Quantification and confirmation of anionic, cationic and neutral pesticides and transformation products in water by on-line solid phase extraction-liquid chromatography-tandem mass spectrometry

Two on-line SPE-LC-ESI-MS/MS methods have been developed for the rapid determination and confirmation of 18 polar pesticides and nine transformation products (TPs) in water samples. Given the very different physico-chemical characteristics of the analytes, it was not feasible the simultaneous determination of all selected compounds in only one method. Thus, it was necessary to use heptafluorobutyric acid and formic acid in order to obtain good retention in the SPE cartridge for basic and acidic analytes, respectively. The developed analytical methodology based on the direct injection of 2 mL of water sample in the system allowed the quantification of all analytes at the 25 ng/L level (LOQ) with limits of detection normally lower than 5 ng/L. Satisfactory recoveries (70-110%) were obtained for most compounds in ground and surface water samples. Some exceptions were found mainly in surface water, due to the ion suppression produced by the higher amount of matrix interferents in these samples. The acquisition of two MS/MS transitions for each compound allowed the reliable confirmation of positive findings even at the LOQ level. The developed methodology was applied to real ground and surface water samples showing the interest of including TPs in monitoring methods, as several of them were found at concentrations higher than that of parent compounds.

Study of different atmospheric-pressure interfaces for LC-MS/MS determination of acrylamide in water at sub-ppb levels

A rapid, sensitive and selective method based on LC-MS/MS has been developed for the direct determination of acrylamide residues in water in compliance with the current European Union (EU) 98/83 Drinking Water Directive. Given the high polarity of acrylamide, the application of a rapid on-line solid phase extraction step, commonly used for preconcentrating low analyte levels, was not found to be completely satisfactory. Therefore, an alternative approach based on the use of direct large-volume injection into the LC-MS/MS system has been used. Three atmospheric-pressure interfaces (ESI, APCI and Ion Sabre APCI) were checked to reach the required sensitivity (0.1 microg/l). All three interfaces were tested by analysis of six different water samples (surface water, groundwater, drinking water and three treated water samples) spiked at three concentration levels each (0.1, 1 and 10 microg/l). When using ESI, poor sensitivity and high matrix effects were observed. This situation improved when APCI was used as the interface because no matrix effect was found, although sensitivity was not completely satisfactory. The best results were obtained by interfacing the Ion Sabre APCI; its higher sensitivity for acrylamide (LOD 0.03 microg/l) and the absence of matrix effects recommended its selection. Using this approach, satisfactory recoveries (90-97%) and precision (<12%) were obtained for all water samples studied. Besides, the acquisition of two different MS/MS transitions allowed not only the quantification but also the confirmation of acrylamide in water at concentration levels around 0.1 microg/l.

Tongue-Base Suspension in Conjunction with Uvulopalatopharyngoplasty for Treatment of Severe Obstructive Sleep Apnea: Long-Term Follow-Up Results

OBJECTIVES/HYPOTHESIS

To evaluate the usefulness of tongue-base suspension (TBS) in addition to uvulopalatopharyngoplasty (UPPP) in the treatment of obstructive sleep apnea syndrome (OSAS).

STUDY DESIGN

Long-term prospective case series.

SETTING

University tertiary care medical center.

METHODS

Fifty-five consecutive patients with severe OSAS (apnea-hypopnea index [AHI] 52.8+/-14.9 events/hr) with multilevel upper airway obstruction who refused treatment with continuous positive airway pressure underwent UPPP plus TBS with the Repose system. All patients were evaluated before surgery by clinical history, Epworth Sleepiness Scale (ESS), fiberoptic nasopharyngoscopy with Müller maneuver, and nocturnal polysomnography (PSG). After 3 years of surgery, all patients were re-evaluated at the clinic and had ESS test and full PSG. Surgical success was defined when the ESS dropped bellow 11, and the AHI decreased below the threshold of 20 events per hour of sleep and at least 50% from the preoperative value

RESULTS

There were 42 (78%) patients in which the AHI score decreased more than 50%, the AHI was lower than 20 events/hr in the PSG, and the ESS was lower than 11 after 3-years of follow-up (surgical success index). Logistic regression analysis demonstrated that body mass index at baseline was the only variable with significant statistical power to predict surgical success (odds ratio 0.85; 0.73-0.95, 95% confidence interval, P<.01)

CONCLUSION

When associated with UPPP, the TBS technique performed with the Repose system demonstrates a surgical success of up to 78% for patients with severe OSA who refused nasal continuous positive airway pressure.

An ion-pairing liquid chromatography/tandem mass spectrometric method for the determination of ethephon residues in vegetables

A rapid, sensitive and selective method has been developed for the direct determination of ethephon residues in vegetables (apple, cherry and tomato). Given the anionic character of ethephon, the use of ion-pairing liquid chromatography (LC) in combination with tandem mass spectrometry (MS/MS, triple quadrupole) allowed its direct determination in these matrices avoiding a derivatisation step and favouring the automation of the method. Samples were extracted with a mixture of dichloromethane/aqueous formic acid (pH 3) (1:1). Then, tetrabutylammonium acetate (TBA) was added as an ion-pairing reagent, and an aliquot of the aqueous extract was directly injected into the LC/MS/MS system. Quantification was performed with matrix-matched standards prepared from blank sample extracts. MS/MS measurements were made in the selected reaction monitoring (SRM) mode, using the most sensitive transition (m/z 107 > 79) for quantification, and up to four additional transitions for confirmation. Quantitative recoveries were obtained for all matrices (between 83% and 96%) at two concentration levels tested (0.05 and 0.5 mg/kg), with relative standard deviations lower than 9% in all cases. The addition of TBA directly into the sample extract contained in the injection vial was found sufficient to obtain satisfactory LC retention for the analyte. Under these conditions, the absence of ion-pairing reagent in the mobile phase minimised the ionisation suppression for ethephon in the MS source, leading to an increase in the sensitivity of the method and reaching limits of detection of 0.02 mg/kg for all matrices investigated. The acquisition of five specific MS/MS transitions for ethephon allowed the simultaneous and reliable quantification and confirmation of the analyte in the samples.

[Dyspnea in COPD: relation to the MRC scale with dyspnea induced by walking and cardiopulmonary stress testing]

OBJECTIVE

Exercise-related dyspnea is the main symptom of chronic obstructive pulmonary disease (COPD), yet its relation to lung function deterioration is weak. The aim of this study was to evaluate the relation between the patients' usual level of dyspnea and dyspnea caused by a maximum cardiopulmonary stress test or a 6-minute walking test.

METHODOLOGY

Thirty-six consecutive patients with stable COPD (age 66 7 years post-bronchodilator FEV1 47 14% of predicted) were studied. In addition to full baseline function testing, all patients underwent stress testing on a cycle ergometer and a 6-minute walking test in a corridor 50 m long. Exercise-induced dyspnea was assessed by the patient on a Borg scale before beginning and after completing each test. Chronic dyspnea during activities of daily living was quantified on the Medical Research Council (MRC) scale.

RESULTS

The MRC value was only weakly related to percent of predicted FEV1 (r = 0.34, p = 0.04). Parameters obtained during exercise tests that were associated with the MRC were SaO2 at the end of the 6-minute walking test (r = 0.49, p = 0.004) and change in dyspnea on the Borg scale during the 6-minute walking test (deltaBorg-6mWT, r = 0.54, p = 0.0008) and during the stress test (r = 0.35, p = 0.04). Multiple regression analysis, with the MRC result as the dependent variable, showed that deltaBorg-6mWT and SaO2 at the end of the walking test explained 29% of the variance.

CONCLUSION

Severity of chronic dyspnea in COPD patients assessed on the MRC scale is more related to dyspnea triggered by the walking test than with dyspnea induced by cycle ergometer stress testing.

[Strengthening of the steering role of health++ authorities in health care reforms]

Strengthening the ability of health authorities to provide leadership and guidance, now and in the future, is an important issue within the context of health sector reform. It means, among other things, redefining the role of health in light of leading social and economic trends seen in the world at the beginning of the 21st century, increasing participation in health by nongovernmental entities, moving toward participatory democracy in many countries, and modifying concepts of what is considered "public" and "private." Within this scenario, it is necessary to redirect the role of the health sector toward coordinating the mobilization of national resources, on a multisectoral scale, in order to improve equity and social well-being and to channel the limited available resources to the most disadvantaged groups in society. The liberalization of the production and distribution of health-related goods and services, including insurance, challenges the exercise of authority in the area of health. Furthermore, the formation of regional economic blocks and the enormous weight wielded by multinational companies in the areas of pharmaceuticals and other medical supplies and technologies are forcing the health sector to seek ways of harmonizing health legislation and international negotiations. According to many experts, all of these demands surpass the ability of Latin American ministries of health to effectively respond, given most countries' current organizational, legal, and political conditions and technical infrastructure. The countries of the Americas must make it a priority to strengthen their health officials' ability to provide leadership and guidance in order to meet present and future challenges.

Spontaneous regression of Elschnig pearl posterior capsule opacification

After extracapsular cataract extraction with in-the-bag intraocular lens implantation, a 72-year-old woman had reduced visual acuity from posterior capsule opacification (PCO) resulting from Elschnig pearl proliferation. No capsulotomy was performed, and the PCO decreased spontaneously over time, improving visual acuity and leaving a clear capsule.

Minimum distance estimation of mutational parameters for quantitative traits

Individual spontaneous mutations affecting the expression of quantitative traits cannot be systematically identified and, therefore, their effect on the trait cannot be measured. Thus, the rate of occurrence of such mutations and the moments of the probability distribution of the corresponding effects, which are important in evolutionary studies, remain unknown. Here we propose a method to estimate those mutational properties from the observed distribution of the trait mean in a set of independent inbred lines (all derived from the same homozygous base population) in which mutations had been allowed to accumulate randomly. It is based on the use of the well-known minimum distance method, i.e., on the minimization of a distance between the observed distribution and that expected on the basis of a genetic model. We analyze data for three morphological traits (wing length and abdominal and sternopleural bristle number) in Drosophila melanogaster. The method appears to be powerful, giving evolutionary coherent estimates of relevant mutational properties that had not been estimated previously. For all traits, mutational rates were low (smaller than 0.05). Most mutations affecting wing length or abdominal bristle number and negative effect, while almost half of those affecting sternopleural bristle number had positive effect. For each trait, results obtained from data on different generations are in qualitative agreement, although mutational effects seem to depend on generation-specific environmental factors. The method detected between-trait differences in the kurtosis coefficient of the distribution of mutational effects, which varied from values close to that of the normal distribution (wing length) to relatively high values (sternopleural bristle number). It reveals that an important proportion of the mutational input variance of each trait is due to mutations with absolute effect smaller than 0.5 environmental standard deviation units. For morphological traits undergoing weak direct selection, this suggests that large amounts of genetic variance due to genes segregating at intermediate frequencies can be present at the equilibrium.

[Continuous domiciliary oxygen therapy in Zaragoza: a cross-sectional home study]

To assess use of long-term domiciliary oxygen therapy (LDOT) in Saragossa by means of home interviews. We conducted a cross-sectional study of patients undergoing LDOT, interviewing 312 of the 614 patients who used O2 at home in January 1993 (103/100,000 h). Health care workers visited the patients at home and collected all available information related to indications, pattern of use of O2 and complementary tests done. The interviewer also took spirometric readings, SaO2 readings breathing room air and after 30 min breathing O2, and administered a quality of life questionnaire (only to patients with pneumopathies). All patients selected were assessed; 195 (62.5%) suffered from chronic obstructive pulmonary disease (COPD), 33 (10.6%) from asthma, 31 (9.9%) from other pneumopathies, and 53 (17%) from a variety of conditions that were not primarily bronchopulmonary. Thirty-six (11.5%) were active smokers. Only 101 of the 184 patients for whom arterial gasometric readings were available met the criteria for prescribing LDOT. SaO2 without O2 was > or = 92% in 89 (28.5%) patients and > or = 90% in 193 (61.8%). Only 96 (31%) patients reported using O2 more than 15 hours/day and there was a weak inverse relation (p = 0.04) between hours of use and FEV1 in the COPD group. Quality of life for patients with pneumophaties depended entirely on degree of lung function deterioration and was unrelated to use of O2. The rate of use of LDOT Saragossa is one of the highest in Spain. In an estimated 28.5-46% of cases, the indications are inappropriate, mainly due to infrequent use of arterial gas measurement and the prescription of LDOT for patients without COPD. This situation largely explains why patients hardly ever use LDOT on a daily basis.

[Active pulmonary tuberculosis in the community. Current presentation]

OBJECTIVE

To discover how patients in a provincial general hospital, diagnosed as having pulmonary tuberculosis had first clinically and radiologically presented.

DESIGN

This was a retrospective observational study. SITE. The San Jorge de Huesca General Hospital. The period of study was between January, 1986, and December, 1989.

PATIENTS AND OTHERS PARTICIPANTS

Those studied were the 59 patients diagnosed as having active pulmonary tuberculosis during the study period.

MAIN MEASUREMENTS AND RESULTS

The average age of the patients was 45.6 +/- 19.25 SD. There was greater occurrence in males. The most common form in which the disease first appeared was thoracic symptomatology (59%), followed by constitutional syndrome (45.7%). 8 patients were addicted to drugs taken parenterally (ADVP), of whom 4 were HIV-positive (6.8%). The most common radiological pattern was ulcero-caseous.

CONCLUSIONS

We underline the importance of diagnostical awareness at the Primary Care level in order to rapidly begin the correct treatment; and thus fight the adverse epidemiological situation caused by tuberculosis today.

[Symptomatic right aortic arch in adults]

A 54-year-old female presented with dyspnea on exertion and wheezing, with a negative response to inhaled beta-2 stimulating drugs and intravenous glucocorticoids. The major values of basal spirometric study were normal; however, the morphology of the flow-volume curve showed intrathoracic obstruction of large airways, with negative response to beta stimulating drugs. The bronchial provocative test with histamine was normal. Chest radiographs only showed a mild widening of the median mediastinum with left anterior tracheal displacement. Nuclear magnetic resonance showed a right aortic arch with tracheal strangulation.

[A second drug in nonatopic asthma insufficiently controlled with beta 2-adrenergic stimulants: budesonide versus theophylline]

We assessed whether theophylline or budesonide (an inhaled corticosteroid) is the most adequate drug to be added to the treatment of patients insufficiently controlled with beta agonists (procaterol). Two comparable groups of nonatopic asthmatic adults (n = 24), aged between 16 and 66 years (42 +/- 17), were investigated in a crossed, randomized study. After 4 weeks with procaterol + 800 micrograms of budesonide, the forced expiratory flow improved (p less than 0.01), the degree of bronchial hyperreactivity to histamine was reduced (p less than 0.001), the daily recorded symptomatology almost disappeared in all and the number of procaterol inhalations was reduced (p less than 0.05). The combination of theophylline + procaterol during 4 weeks did not improve these parameters from their baseline values. It was concluded that inhaled steroids are the drugs of choice in patients with asthma which is not controlled only with beta agonists.

Nifedipine in exercise-induced asthma

The calcium entry blockers may inhibit EIA in patients with bronchial asthma, but it is not demonstrated that they produced bronchodilation once the crisis is established. Nine patients with exercise induced asthma were studied. We carried out an exercise test for ten minutes with constant load and the following were measured; FVC, PEF, MEF25 and sGaw before and after test. All the values fell 20% or more than the initial values. A 20 mg was administered without modifying the studied parameters and only the administration of 400 micrograms of metaproterenol by inhalation made the sensation of dyspnea recur in all patients.