[In vitro activity of fosfomycin against ESBL-producing enterobacteria of urinary origin]

In vitro activity of fosfomycin, compared with other antibiotics used for urinary tract infections (UTI), against extended spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae clinical isolates obtained from UTIs, was determined. The activity of fosfomycin, co-trimoxazole, ciprofloxacin, nitrofurantoin, amoxicillin/clavulanic acid and gentamicin against 71 ESBL-producing E. coli clinical isolates and 13 ESBL-producing K. pneumoniae clinical isolates obtained from UTI was studied by the agar-dilution method or E-test. E. coli isolates produced mainly CTX-M type ESBL (76.1%), especially CTX-M 14 (56.3%). K. pneumoniae isolates produced most predominantly SHV-type ESBL (92.3%), mainly SHV-2 (76.9%). Gentamicin (4.4%), fosfomycin (5.6%) and nitrofurantoin (5.6%) showed the lowest resistance proportions against E. coli. Co-trimoxazole and ciprofloxacin (7.7%) showed the lowest resistance proportions against K. pneumoniae.

Bilateral ovarian Burkitt's lymphoma

Primary ovarian lymphoma is a rare entity. We submit a case of a 34-year-old black patient presenting with a bilateral adnexal tumor. She underwent hysterectomy with double salpingo-oophorectomy followed by polychemotherapy treatment. Histology confirmed Epstein-Barr virus-positive bilateral Burkitt's lymphoma. The patient died from septic shock after a month of treatment. Endemic Burkitt's lymphoma has a predilection for the female genital tract, manifesting itself clinically as a pelvic mass and less frequently as a menstrual disorder. It is a rare entity in our environment but should be kept in mind when treating patients of African origin.

Temperature influences the expression of fimbriae and flagella in Hafnia alvei strains: an immunofluorescence study

Hafnia alvei, a Gram negative bacillus related to the Enterobacteriaceae family, is considered an opportunistic pathogen of several animal species and humans. In this communication, we describe fimbrial-like structures from different strains of H. alvei that cannot be easily ascribed to any of the previously reported fimbrial types in this species (type I or type III). Polymerase chain reaction (PCR) and immunofluorescence assays were carried out to study fimbriae and flagella in H. alvei strains isolated from different sources. No correlation between the results obtained by PCR and those obtained by phenotypic methods were found, and the antibodies used gave cross or different recognition patterns of the surface structures present in these strains. We report as well that strain and growth temperature influence fimbriation and expression of flagella in human and animal isolates of H. alvei. This study also indicates that the absence of fimbriae have a significant positive influence on the initial adhesion of H. alvei to human epithelial cells.

The orderly, in vitro emergence of DNA from bacteriophage phi29 particles

phi29 DNA-containing 12-13- particles (produced by infecting nonsuppressor hosts of Bacillus subtilis with phage containing suppressible mutations in cistrons 12 and 13) can be complemented with lysates containing proteins p12* and p13 to yield infectious phage. Complementation of these particles with lysates containing p12* but not p13 or complementation with purified p12* in the absence of p13 produces a structure (called complex) which has a markedly different organization. Electron microscopy and sedimentation analysis after digestion with DNase I or proteinase K indicate that complex is composed of an intact phage head with a genome-sized linear DNA molecule attached at the collar-tail region. EcoRI digestion establishes that the DNA molecule has a unique orientation. Gel electrophoresis indicates that p12*, the neck appendage protein, is transferred to the particles when complex is formed. Complex can also be produced by incubation of 12-13- particles at 42 degrees , by incubation at pH 6.0, or by incubation in the presence of 20 mM EDTA. Complex is also formed from DNA-containing 12- particles but to a lesser extent.

Endovascular treatment of hemoptysis by abnormal systemic pulmonary artery supply

We report the case of a 29-year-old man with hemoptysis. The patient came to the emergency department, where a laboratory test and chest radiograph were reported as normal. The following day the patient again had hemoptysis, though less than previously. He reported no chest pain, dyspnea, fever, catarrh, changes in urine or feces, contact with patients with bacillus disease or constitutional symptoms. Doppler ultrasound of the chest showed right basal parenchymatous condensation containing a vessel with arterial flow (in the opposite direction to the aortic flow) compatible with an aberrant vessel, possibly a sequestration, leaving the aorta above the celiac trunk. Because of the findings of the chest echogram and magnetic resonance study, thoracoabdominal computed tomography angiography was undertaken; this showed right basal condensation and an anomalous vessel originating 1 cm above the celiac trunk, supplying the right lower lobe. An aortic and pulmonary arteriogram via an arterial and right femoral vein approach confirmed the findings. The patient was treated successfully with percutaneous embolization with coils. The relevant literature is reviewed.

High temporal resolution measurements of ozone precursors in a rural background station. A two-year study

We present a very complete database of individual non-methane hydrocarbon (NMHC) measurements with high temporal resolution (hourly) in a rural background atmosphere. We show their use to characterize the biogenic NMHC as well as to identify the transport and impact of anthropogenic NMHC on rural areas. In January 2003 an automatic GC-FID analyzer of volatile organic compounds between 2 and 10 carbon atoms (C2-C10 VOCs) was placed in the centre of the Valderejo Natural Park in northern Iberia (42.87 degrees N, 3.22 degrees W), far away from important cities. The system operated continuously until December 2004. Data coverage was higher than 70% for a total of 59 VOC of both anthropogenic and biogenic origin, with detection limits in the range of pptv. Our results allow for the description of the behaviour of these compounds, in order to identify external impacts arriving to the sampling site which has been recognized to be highly representative of a rural background atmosphere. Biogenic VOC concentrations have been compared also with the calculated emissions, using Guenther's algorithm, and the discrepancies interpreted in terms of the different reactivity of such compounds.

Identification of Plum pox virus pathogenicity determinants in herbaceous and woody hosts

Plum pox virus (PPV) is a member of the genus Potyvirus that is able to infect a large variety of plant species, including trees of the genus Prunus, its natural host. When some PPV isolates are propagated for an extended time in herbaceous plants, their ability to infect trees is reduced. The molecular basis of this change in host infectivity is poorly understood. We report the construction of hybrid viruses from cDNA clones of two D-strain isolates of PPV, PPV-D and PPV-R, which differ in their host range. PPV-D can infect GF305 peach seedlings efficiently, however, it is unable to infect Nicotiana clevelandii plants. Conversely, PPV-R infects N. clevelandii, but not GF305 peach seedlings. The analyses of the hybrid viruses showed that, although determinants of PPV pathogenicity are extensively spread throughout the PPV genome, the 3' terminal region of the PPV-R genome, including the 3' noncoding region and the coding regions for the coat protein (CP), NIb, and part of NIa protein, is sufficient to confer infectivity of N. clevelandii in a PPV-D background. Our data demonstrate a high concentration of amino acid substitutions in the CP and a host-specific effect of a deletion at the N terminus of this protein in PPV pathogenicity in peach and N. clevelandii infectivity experiments. These results suggest that relevant host specificity determinants are located in the N-terminal region of the CP. The analyses of the PPV-R and PPV-D chimeras also showed that key host-specific pathogenicity determinants lie in the 5' terminal third of the PPV genome, a region that spans proteins P1, HCPro, and P3. The selection of mutations in only a few specific residues in proteins P1, P3, and 6K1 after partial adaptation of a chimeric virus (BD-GFP) to N. clevelandii further suggests a relevant role for these proteins in host adaptation.

Melatonin administration prevents cardiac and diaphragmatic mitochondrial oxidative damage in senescence-accelerated mice

Cardiac and diaphragmatic mitochondria from male SAMP8 (senescent) and SAMR1 (resistant) mice of 5 or 10 months of age were studied. Levels of lipid peroxidation (LPO), glutathione (GSH), GSH disulfide (GSSG), and GSH peroxidase and GSH reductase (GRd) activities were measured. In addition, the effect of chronic treatment with the antioxidant melatonin from 1 to 10 months of age was evaluated. Cardiac and diaphragmatic mitochondria show an age-dependent increase in LPO levels and a reduction in GSH:GSSG ratios. Chronic treatment with melatonin counteracted the age-dependent LPO increase and GSH:GSSG ratio reduction in these mitochondria. Melatonin also increased GRd activity, an effect that may account for the maintenance of the mitochondrial GSH pool. Total mitochondrial content of GSH increased after melatonin treatment. In general, the effects of age and melatonin treatment were similar in senescence-resistant mice (SAMR1) and SAMP8 cardiac and diaphragmatic mitochondria, suggesting that these mice strains display similar mitochondrial oxidative damage at the age of 10 months. The results also support the efficacy of long-term melatonin treatment in preventing the age-dependent mitochondrial oxidative stress.

First Report of Fusarium Wilt of Flue-Cured Tobacco Caused by Fusarium oxysporum f. sp. batatas in Spain

Tobacco (Nicotiana tabaccum L.) is among the most important crops in La Vera Region (Cáceres, west-central Spain) where, since 2001, flue-cured tobacco plants showing typical symptoms of a vascular disease associated to the cyst nematode (Globodera tabacum) complex have been frequently observed (2). Symptoms observed were wilting, yellowing, and drying of the leaves, usually on one side of the plant; stunted and distorted leaves with curved midribs due to the unequal growth; and brown vascular discoloration of stems and midribs. Several diseased plants were collected during the summers of 2003 and 2004, and F. oxysporum was consistently isolated from sections of necrotic midribs. To confirm the pathogenicity of F. oxysporum isolates, plants of flue-cured tobacco (cv. Ct-681) were inoculated. Since Fusarium wilt of tobacco may be caused by F. oxysporum f. sp. vasinfectum or F. oxysporum f. sp. batatas (1), plants of cotton (cv. Acala) and sweet potato (cvs. Nemagold and Nancy Hall) were also inoculated to determine the forma specialis designation. Twenty plants per cultivar and isolate were inoculated with six isolates at the two to four true-leaf stage by pouring into the substrate 200 ml of a conidial suspension (1 × 10⁵ CFU/ml). After inoculation, plants were incubated in a growth chamber at 28°C (day) and 24°C (night) with a 16-h photoperiod. All six F. oxysporum isolates were pathogenic to tobacco and sweet potato, but there were differences among isolates in time from inoculation to appearance of first disease symptoms (7 to 15 days after inoculation in tobacco and sweet potato) and also in disease severity 30 days after inoculation (60 to 100% wilt or mortality in tobacco and 50 to 100% in sweet potato). F. oxysporum was reisolated from stems of inoculated plants. No disease symptom was observed in cotton plants 60 days after inoculation, and F. oxysporum was not reisolated from them. Results of inoculation on the differential hosts indicated that disease symptoms in tobacco were caused by F. oxysporum f. sp. batatas. To our knowledge, this is the first report of F. oxysporum f. sp. batatas causing disease in flue-cured tobacco in Spain. References: (1) G. M. Armstrong and J. K. Armstrong. Phytopathology 58:1242, 1968. (2) G. Espárrago and I. Blanco. Plant Dis. 86:1402, 2002.

Differentially expressed genes between high-risk human papillomavirus types in human cervical cancer cells

Cervical carcinoma (CC) is one of the most common cancers among women worldwide and the first cause of death among the Mexican female population. Human papillomavirus (HPV) infection is the most important etiologic factor for CC. Of the oncogenic types, HPV16 and HPV18 are found in 60-70% of invasive CCs worldwide. HPV18 appears to be associated with a more aggressive form of cervical neoplasia than HPV16 infection. At present, there are no studies on differentially expressed cellular genes between transformed cells harboring HPV16 and HPV18 sequences. Based on previous complementary DNA microarray data from our group, 13 genes were found to be differentially overexpressed between HPV16- and HPV18-transformed cells. These genes were as follows: E6BP, UBE4A, C20orf14, ATF7, ABCC8, SLC6A12, WASF3, SUV39H1, SPAG8, CCNC, E2FFE, BIRC5, and DEDD. Differential expression of six selected genes was confirmed by real-time reverse transcription-polymerase chain reaction (RT-PCR). All real-time RT-PCRs confirmed differential expression between HPV18 and HPV(-) samples. The present work identifies genes from signaling pathways triggered by HPV transformation that could be differentially deregulated between HPV16(+) and HPV18(+) samples.

Increasing the amount of n-3 fatty acid in meat from young Holstein bulls through nutrition1

Fifty-four Holstein bulls were blocked by initial BW (301 +/- 7.4 kg) and randomly assigned to 6 treatments following a 3 x 2 factorial arrangement, with 3 concentrate lipid levels (5, 8, and 11% of DM) and 2 lipid sources (whole canola seed and whole linseed), with the objective of evaluating the possibility of increasing the content of n-3 fatty acids in meat. Concentrates (mostly corn meal) were isonitrogenous and isocaloric. Concentrate and straw were both fed ad libitum. Animal BW was recorded every 2 wk, and feed consumption was recorded weekly. Ruminal pH and VFA concentrations were determined monthly. Bulls were transported to the slaughterhouse when they achieved the target slaughter weight of 443 kg (after 105 +/- 4 d of fattening). After slaughter, a sample of LM from the sixth to the eighth ribs was dissected and analyzed for intramuscular fat content and fatty acid profile. Dietary lipid source did not affect overall animal performance, rumen fermentation, or carcass quality. Rumen pH was >6.0 despite consumption by the bulls of large amounts of concentrate. In bulls fed linseed, the percentage of n-3 fatty acids in LM increased linearly with lipid level, whereas in bulls fed canola seed it remained constant. The ratio of n-6:n-3 fatty acids was lower (P < 0.01) in the LM of bulls fed linseed (10.0) than in those fed canola seed (26.0). The content of cis-9, trans-11-CLA in the LM tended (P = 0.06) to be greater in the bulls fed linseed than in those fed canola seed (62.9 vs. 49.2 mg/kg of LM, respectively). Concentration of n-3 fatty acids in meat of bulls fed high-concentrate diets can be enhanced by whole linseed supplementation without affecting animal performance, ruminal fermentation, or carcass quality.

Bronchiolitis obliterans organizing pneumonia simulating progression in bronchioloalveolar carcinoma

Bronchiolitis obliterans organizing pneumonia (BOOP) is a clinicopathologic syndrome with characteristic features. The diagnosis of BOOP requires the presence of a combination of pathological, clinical, and radiological features. We report the case of a lung cancer patient with bronquiloalveolar carcinoma (BAC) presenting with BOOP after chemotherapy with docetaxel and gemcitabine producing severe respiratory insufficiency, and simulating a progression of the tumor.

Multiple resistance traits control Plum pox virus infection in Arabidopsis thaliana

Twelve Arabidopsis accessions were challenged with Plum pox potyvirus (PPV) isolates representative of the four PPV strains. Each accession supported local and systemic infection by at least some of the PPV isolates, but high variability was observed in the behavior of the five PPV isolates or the 12 Arabidopsis accessions. Resistance to local infection or long-distance movement occurred in about 40% of all the accession-isolate combinations analyzed. Except for Nd-1, all accessions showed resistance to local infection by PPV-SoC; in the Landsberg erecta (Ler) accession, this resistance was compromised by sgt1 and rar1 mutations, suggesting that it could be controlled by an R gene-mediated resistance pathway. While most of the susceptible accessions were symptomless, PPV induced severe symptoms on inflorescences in C24, Ler, and Bay-0 as early as 15 days after inoculation. Genetic analyses indicated that these interaction phenotypes are controlled by different genetic systems. The restriction of long-distance movement of PPV-El Amar and of another member of genus Potyvirus, Lettuce mosaic virus, in Col-0 requires the RTM genes, indicating for the first time that the RTM system may provide a broad range, potyvirus-specific protection against systemic infection. The restriction to PPV-PS long-distance movement in Cvi-1 is controlled by a single recessive gene, designated rpv1, which was mapped to chromosome 1. The nuclear inclusion polymerase b-capsid protein region of the viral genome appears to be responsible for the ability of PPV-R to overcome rpv1-mediated resistance.

Identification of a plum pox virus CI-interacting protein from chloroplast that has a negative effect in virus infection

The cylindrical inclusion (CI) protein of potyviruses is involved in virus replication and cell-to-cell movement. These two processes should rely on multiple plant-virus interactions; however, little is known about the host factors that are involved in, or that may interfere with, CI functions. By using a yeast two-hybrid system, the CI protein from Plum pox virus (PPV) was found to interact with the photosystem I PSI-K protein, the product of the gene psaK, of Nicotiana benthamiana. Coexpression of PPV CI was shown to cause a decrease in the accumulation level of PSI-K transiently expressed in N. benthamiana leaves. To test the biological relevance of this interaction, we have analyzed the infection of PPV in N. benthamiana plants in which psaK gene expression has been silenced by RNA interference, as well as in Arabidopsis thaliana psaK knockout plants. Our results show that downregulation of the psaK gene leads to higher PPV accumulation, suggesting a role for the CI-PSI-K interaction in PPV infection.

Anti-CD25 Monoclonal Antibody Sequential Immunosuppressive Induction Therapy in Renal Transplants With High Risk of Delayed Graft Function

There is little experience on the use of monoclonal antibodies that block the high-affinity interleukin-2 receptor (basiliximab and daclizumab) in sequential therapy in renal transplants with risk of delayed graft function. This study sougth to test the efficacy and safety of the substitution of anticalcineurins with two doses of basiliximab or daclizumab in the immediate posttransplant period for recipients at risk of delayed renal graft function. Immunosuppression consisted of steroids, mycophenolate mofetil, and two doses of basiliximab (20 mg/day) on days 0 and 4 posttransplant or daclizumab (1 mg/kg per day) on days 0 and 15 posttransplant. Anticalcineurins were not administered until the beginning of graft function. Among 49 recipients (mean age 63.5 +/- 10.5 years), 40 received a kidney from a donor over 60 years of age, three from a non-heart-beating donor, and six from donors with an acute elevation of serum creatinine to 2.4 +/- 0.86 (1.7-3.7). At a mean follow-up of 14.2 +/- 8.4 months, five patients experienced acute rejection episodes. Only 15 patients needed posttransplant dialysis (2.7 +/- 1.6). In 11 patients, cyclosporine (CsA) was introduced at 6 +/- 2.9 days posttransplant and in 37, tacrolimus on 8.6 +/- 3.6 days posttransplant. The incidence of kidney graft loss was 16.3%. Patient survival was 96%. Thirty-nine recipients are alive with functioning grafts, with mean serum creatinine of 1.4 mg/dL. In conclusion, substitution for anticalcineurins with interleukin-2-receptor blockade in the immediate posttransplant period for patients at risk of delayed graft function minimizes nephrotoxicity and reduces tubular necrosis, without increasing the risk of an acute rejection episode.

Trypanosoma vivax: A novel method for purification from experimentally infected sheep blood

Trypanosoma vivax is the principal etiological agent of bovine trypanosomosis, a widely disseminated disease in tropical and subtropical regions. Here, we present a simple and reproducible method for the purification of T. vivax from experimentally infected and immunosuppressed sheep, using an isopycnic Percoll gradient, followed by DEAE-cellulose chromatography, with an estimated yield of 11-15%. This method could be used for the purification of T. vivax geographical isolates from various locations and from different natural hosts.

Secondary signet-ring cell tumour of the prostate derived from a primary gastric malignancy

Primary signet-ring cell carcinoma of the prostate is infrequent and even more so as secondary spread of this pathologic sub-type to the prostate. We describe the sixth reported case with a diagnosis of a secondary signet-ring cell tumour of the prostate secondary to a gastric cancer. Five years post-gastrectomy to resect signet-ring cell carcinoma, we detected a secondary intra-prostatic spread with urinary tract obstruction. The physical appearance of the tumour cells was similar to that of the previously-resected signet-cell carcinoma of the stomach. There were no metastases in other sites and the patient was treated with radiotherapy. When confronted with intra-prostatic signet-ring cell adenocarcinoma it is necessary to distinguish between primary and secondary aetiology since this would reflect in the choice of treatment and prognosis.

Identification of secret agent as the O-GlcNAc transferase that participates in Plum pox virus infection

Serine and threonine of many nuclear and cytoplasmic proteins are posttranslationally modified with O-linked N-acetylglucosamine (O-GlcNAc). This modification is made by O-linked N-acetylglucosamine transferases (OGTs). Genetic and biochemical data have demonstrated the existence of two OGTs of Arabidopsis thaliana, SECRET AGENT (SEC) and SPINDLY (SPY), with at least partly overlapping functions, but there is little information on their target proteins. The N terminus of the capsid protein (CP) of Plum pox virus (PPV) isolated from Nicotiana clevelandii is O-GlcNAc modified. We show here that O-GlcNAc modification of PPV CP also takes place in other plant hosts, N. benthamiana and Arabidopsis. PPV was able to infect the Arabidopsis OGT mutants sec-1, sec-2, and spy-3, but at early times of the infection, both rate of virus spread and accumulation were reduced in sec-1 and sec-2 relative to spy-3 and wild-type plants. By matrix-assisted laser desorption ionization-time of flight mass spectrometry, we determined that a 39-residue tryptic peptide from the N terminus of CP of PPV purified from the spy-3 mutant, but not sec-1 or sec-2, was O-GlcNAc modified, suggesting that SEC but not SPY modifies the capsid. While our results indicate that O-GlcNAc modification of PPV CP by SEC is not essential for infection, they show that the modification has a role(s) in the process.

An improved outdoor calibration procedure for broadband ultraviolet radiometers

This article aims at improving the broadband ultraviolet radiometer's calibration methodology. For this goal, three broadband radiometers are calibrated against a spectrophotometer of reference. Three different one-step calibration models are tested: ratio, first order and second order. The latter is proposed in order to adequately reproduce the high dependence on the solar zenith angle shown by the other two models and, therefore, to improve the calibration performance at high solar elevations. The proposed new second-order model requires no additional information and, thus, keeps the operational character of the one-step methodology. The models are compared in terms of their root mean square error and the most qualified is subsequently validated by comparing its predictions with the spectrophotometer measurements within an independent validation data subset. Results show that the best calibration is achieved by the second-order model, with a mean bias error and mean absolute bias error lower than 2.2 and 6.7%, respectively.

[Digestive haemorrhage due to angiodysplasia in dialysis patients. Treatment with conjugated estrogens]

Gastrointestinal angiodysplasia is a very common cause of digestive hemorrhage among elderly patients with chronic renal insufficiency. Therapeutic possibilities are scarce, as well as information available. Here we present our experience with 8 cases of dialysis patients that were treated with conjugated estrogens because of digestive hemorrhage due to angiodysplasia. Dissapearance of bleeding was observed after the onset of estrogen therapy, with a significant decrease of blood transfusions. This type of non-invasive treatment can avoid aggressive therapeutic interventions in patients with a high prevalence of co-morbid conditions (old patients undergoing chronic dialysis).

Statistical normal values of visual parameters that characterize binocular function in children

A wide range of visual parameters used to evaluate binocular function were evaluated in a paediatric population (1056 subjects aged 6-12 years). Mean values are provided for these ages in optometric tests that directly assess the vergence system, horizontal phorias for near and far vision (measured by a modified version of the Thorington method), negative and positive vergence amplitude for near and far vision (step vergence testing), vergence facility (flippers 8 Delta BI/8 Delta BO), and near-point of convergence (penlight push-up technique and red-lens push-up technique), as well as stimulus accommodative convergence/accommodation ratio and stereoacuity (Randot test) which provide an overall evaluation of the vergence, accommodative and oculomotor systems. A statistical comparison (anova and Bonferroni post hoc test) of these values between ages was performed. The differences, although statistically significant, were not clinically meaningful, and therefore we identified two trends in the behaviour of these parameters. For all parameters, except for vergence facility, we established a single mean reference value for the age range studied. The difference between the means for vergence facility indicated the need to divide the population into two age ranges (6-8 and 8-12 years). This study establishes statistical normal values for these parameters in a paediatric population and their means are a valuable instrument for separating children with binocular anomalies from those with normal binocular vision.

[Antiproteinuric effect of renin-angiotensin system blockade in patients with normal/lower than 115 mmHg systolic blood pressure]

The renoprotective effect of renin-angiotensin system (RAAS) blockade by ACE inhibitors (ACEI) or AT1 receptor antagonists (ARA) in chronic proteinuric nephropathies is well known. Most studies have related this beneficial effect with the antihypertensive and antiproteinuric properties of these drugs, but this aspect has not been extensively analyzed in patients with normal/low values of blood pressure. We studied nineteen patients with different chronic proteinuric nephropathies that started ACEI or ARA because of proteinuria and despite systolic blood pressure (SBP) < or = 115 mmHg. Short and long-term tolerance to treatment as well as evolution of renal function parameters were recorded.

RESULTS

At baseline, SBP was 110.2 +/- 2.6 mmHg (105-115) an diastolic blood pressure (DBP) 68.6 +/- 4.3 (60-75). Initial low doses of ACEI or ARA were well tolerated. After 6 months of treatment, proteinuria decreased by 46% of baseline, from 2.1 +/- 1.8 g/day to 1.1 +/- 0.8 g/day, without significant changes in BP or renal function. After a 48 +/- 27 months follow up, proteinuria decreased to 0.7 +/- 0.6 g/day (68% of basal values). Renal function and BP did not show significant changes during follow up.

CONCLUSIONS

RAAS blockade by ACEI/ARA induces a significant antiproteinuric and renoprotective effect in proteinuric patients with normal/low levels of BP Initial doses of ACEI/ARA were well tolerated.

[Acute hyperphosphatemia secondary to phosphate administration for bowel preparation]

We report a 75-years-old woman, stable on a three-weekly hemodialysis program over a period of 3 years, who develop acute hyperphosphatemia secondary to phosphate administration for bowel preparation. The quick clinical diagnosis and the treatment with intensive hemodialysis resulted in a correction of hyperphosphatemia, hypocalcemia, acidemia and other electrolyte abnormalities. The phosphate cathartics are contraindicated in patients with severe renal insufficient or in dialysis program. Our case shows the severe side effects secondary to injudicious use of sodium phosphate cathartics.

Evolution of accommodative function and development of ocular movements in children

The evolution of the accommodative function and development of ocular movement are evaluated in a non-clinical paediatric population (1056 subjects) aged 6-12 years, providing means for each age in the optometric tests that evaluate the accommodative amplitude, accommodative facility, accommodative response (lag), and saccadic movements. A comparison of these values between ages (anova) established three distinct trends in the behaviour of these parameters. The accommodative amplitude, measured by modified dynamic retinoscopy, and the evaluation of the saccadic movements by the development of ocular movements [developmental eye movement (DEM)] test showed continuous change with age. The values for monocular and binocular accommodative facility, measured by +/-2.00 D flippers, indicated the need to divide the population into two age groups (6-7 and 8-12 years). Finally, the means of accommodative response, measured by monocular estimation model (MEM) retinoscopy, and the direct observation of saccadic movement revealed no significant differences between ages, establishing a single mean reference value for the age group studied.

The service patterns of a racially, ethnically, and linguistically diverse housestaff

PURPOSE

To explore whether racial and ethnic concordance in the service patterns of residents is as disproportionate as it is among practicing physicians, and to examine the effect of residents' second-language proficiencies on these patterns.

METHOD

The authors conducted a cross-sectional study of billing data from 13,681 patient visits to resident continuity clinics at a Northern California pediatric medical center between May 1998 and October 1999. For each racial or ethnic group of patients, the proportion of patient visits to race-concordant residents was compared with the proportion of visits to all residents of other races or ethnicities. Multivariate logistic regression analyses (adjusted for confounders and residents' second-language proficiency) were used to measure the concordance of race or ethnicity in patient-resident pairs.

RESULTS

For all visits made to African-American, Asian, and Latino residents, the percentage of race-concordant visits exceeded the percentage of race-discordant visits for each patient group. In adjusted regression models, African-American, Asian, and Latino patients were more likely to visit residents of the same race or ethnicity. White patients were not more or less likely to visit white residents. When adjusted for residents' second-language proficiencies, Latino patients remained more likely to visit Latino residents and Asian patients remained more likely to see Asian residents. In analyses restricted to residents reporting fluency in Spanish, Latino patients were more likely to visit Latino residents.

CONCLUSION

African-American, Asian, and Latino pediatric residents disproportionately served more patients from their own racial or ethnic backgrounds. This service pattern was not completely explained by physicians' second-language proficiencies. A resident's race or ethnicity may reflect a unique set of skills that is highly valued by patients or health care systems.