[Prevalence of anti-HAV antibodies and efficacy of pre-vaccine detection at institutions for mentally retarded of the city of Alicante]

OBJECTIVE

The aim of this study was to investigate the prevalence and efficacy of the anti-HAV antibodies detection in institucions for mentally retarded people in the city of Alicante.

DESIGN

Prevalence study.

SETTING

Two institucions for mentally retarded people in the city of Alicante.

PARTICIPANTS

One hundred and seven residents and seventy seven in care of them.

MEASUREMENTS AND MAIN RESULTS

We have investigated the anti-HAV antibodies prevalence by enzymeinmunoanalysis of microparticle test. The efficacy of the anti-HAV antibodies detection before the vaccination has been studied by calculating the threshold of prevalence with the following formula: unit cost of detection + (1 - X) x unit cost vaccination anti-HAV negative subjects = unit cost vaccination.

RESULTS

The global prevalence of anti-HAV antibodies was 56.5% (95% CI, 49-63.7). The prevalence of the residents was 55.1% (95% CI, 45.2-64.7) and 58.4% in care of them (95% CI, 46.6-69.5). Among the sociodemographic variables evaluated only the age was associated with the prevalence of anti-HAV antibodies (p < 0.001). The unit cost of prevaccination detection of anti-HAV antibodies was calculated as 998 pesetas and the unit cost of the vaccination as 3595, obtaining a prevalence anti-HAV threshold of 27.8%.

CONCLUSIONS

The prevalence of anti-HAV antibodies in this collective studied is similar to the prevalence of anti-HAV antibodies of the spaniard population. The direct vaccination without a previous marker study is recommended to people under the age of 31 in this population group.

[Carbohydrate metabolic changes in cystic fibrosis]

OBJECTIVES

To assess the prevalence of impaired glucose tolerance and diabetes mellitus in a group of patients with cystic fibrosis and to compare insulin secretion, haemoglobin A1c, age, gender, genotype, and clinical status related variables between the groups with abnormal (impaired glucose tolerance and diabetes mellitus) and normal carbohydrate metabolism.

PATIENTS AND METHODS

66 patients with cystic fibrosis (age 1-38 years). Plasma glucose, insulin and C peptide determinations during an oral glucose tolerance test (OGTT) in 65 patients (one was previously known as diabetic). Based on the Expert Committee from the American Diabetes Association (1997), patients were classified as having impaired glucose tolerance and diabetes mellitus. Haemoglobin A1c, presence of delta F508 mutation, date of diagnosis and first sputum colonization, scores of National Institutes of Health, Schwachman and Chrispin-Norman, pancreatic enzyme intake, weight, body mass index, forced expiratory volume in one second and forced vital capacity determinations in every patient. Comparative analysis of these variables in both groups of patients was performed by Student test.

RESULTS

Nine patients (13.6%) showed impaired tolerance glucose and one diabetes mellitus following OGTT, so we have two diabetics in our cystic fibrosis group (3.0%). When compared to cystic fibrosis patients with normal glucose tolerance, tolerance glucose and diabetes mellitus patients had significantly reduced basal insulin levels (8.6 [3.8] vs 15.0 [22.2] microU/ml; p < 0.0001), increased glucose stimulated insulin and C peptide levels (50.2 [19.3] vs 21.4 [19.3] microU/ml; p < 0.0001, and 9.0 [5.9] vs 4.4 [3.2] ng/ml; p < 0.0001), they were older (18.0 [7.5] vs 12.7 [7.3] years old; p < 0.05) and had longer time since diagnosis and since first sputum colonization. The remaining variables did not differ between the two groups. All patients with exocrine pancreatic sufficiency showed normal glucose tolerance.

CONCLUSIONS

Abnormalities in carbohydrate metabolism were present in 16.6% of cystic fibrosis patients. These patients had reduced basal but increased glucose stimulated insulin levels. Age, time since diagnosis of cystic fibrosis, time since first sputum colonization and exocrine pancreatic insufficiency are the variables being associated with carbohydrate metabolism abnormalities.

Simultaneous determination of chlorthalidone and spironolactone with univariate and multivariate calibration: wavelength range selection

Chlorthalidone and spironolactone were determined simultaneously with the aid of univariate and multivariate calibration methods. Univariate calibration was performed by the zero-crossing and derivative ratio spectrum methods. Extensive spectral overlap and the scarcity of wavelengths in derivative spectra allowing one analyte to be distinguished and quantitated in the presence of the other gave rise to poor results that called for multivariate calibration. Partial least-squares regression was used in combination with a suitable method for selecting the optimum wavelength range and number of factors for analysis. The ensuing method was applied to simultaneous determination of chlorthalidone and spironolactone in a commercially available pharmaceutical preparation. The results were validated by high-performance liquid chromatography.

Allogeneic bone marrow transplantation vs chemotherapy for the treatment of childhood acute lymphoblastic leukaemia in second complete remission (revisited 10 years on)

In 1989 we carried out a trial comparing allogeneic BMT to chemotherapy (CT) in 76 children with relapsed acute lymphoblastic leukaemia (ALL). Ten years on we have clinically revised outcome to firmly establish the role of each treatment, to analyse the importance of length of first remission and to provide long-term actuarial results for disease-free survival (DFS) and relapse rate in each group. For 21 patients within the transplantation group, probability of DFS and relapse are 42.8 +/- 10.8% and 40.2 +/- 11.7% (s.e.), respectively. In the chemotherapy group, probability of DFS is 10.0 +/- 4.74% (P = 0.001) and probability of relapse 87.5 +/- 5.2% (P = 0.0004). These results strongly reflect those at initial analysis, confirming a key role of BMT in the management of ALL in second remission. Moreover, on univariate analysis only two factors influenced DFS: treatment group and length of first complete remission (less or more than 30 months from first CR). Thus, it seems clear that the best therapeutic option in early relapse is BMT, whereas DFS in late relapse is at the limit of significance (P = 0.07), with a higher relapse rate in the CT group. Although encouraging results using intensified rotational combination chemotherapy have been published, prospective randomised studies are needed to assess with certainty the best therapeutic option in these patients.

[Multiple progressive occlusions of intracranial arteries]

OBJECTIVES

We present a case of multiple progressive occlusions of intracranial arteries, a variety of Taveras' syndrome, without smoke spirals, which may be confused with other multifocal disorders.

PATIENT

A 30 year old woman was admitted to hospital with a clinical picture of fluctuating paresia of her left limbs, blurred vision and urgency of micturition which partially recovered. On examination there was paresia of the left arm, generalized increased reflexes and facial asymmetry.

RESULTS

On MRI there were areas of marked hyperintensity at T2. Some of these took up gadolinium at T1 and had a serpiginous pattern, compatible with vasculopathy. On angiography, stenosis and filling defect were seen in the left carotid artery. The anterior cerebral and left Sylvian arteries were filled by the vertebrobasilar system via the posterior communicating artery and an anomalous trigeminal artery.

CONCLUSIONS

The clinical picture of multiple progressive occlusions of intracranial arteries is a variety of moya-moya disease, without the typical smoke spirals, which may lead to confusion with clinical pictures of arteritis and demyelinating disorders if angiography is not done, since this is essential for diagnosis.

Fully automated liquid culture system compared with Löwenstein-Jensen solid medium for rapid recovery of mycobacteria from clinical samples

The aim of this study was to compare the rate of recovery of mycobacteria and the time to detection in 5208 samples using the MB/BacT culture system (Organon Teknika, USA) and Löwenstein-Jensen medium. Mycobacteria were recovered from 301 (5.7%) samples. Two hundred fifty-seven (85.3%) isolates from 114 patients were Mycobacterium tuberculosis [135 (52.5%) smear-positive, 122 (47.4%) smear-negative], and 44 (14.6%) were potentially pathogenic environmental mycobacteria. The yield with the MB/BacT was higher than that with Löwenstein-Jensen [287 (95.3%) vs. 200 (66.4%), P<0.001] for both Mycobacterium tuberculosis [247 (96.1%) vs. 187 (72.7%), P<0.001] and potentially pathogenic environmental mycobacteria [40 (90.9%) vs. 13 (29.5%), P<0.001], mainly at the expense of the smear-negative samples. Moreover, 70 (27.2%) samples were positive only in the MB/BacT, whereas ten (3.8%) samples were positive only in Löwenstein-Jensen. The number of patients with tuberculosis detected by the MB/BacT was higher than that detected by Löwenstein-Jensen medium [111 (97.3%) vs. 89 (78%), P<0.001]. In 25 (21.9%) patients the diagnosis was established solely by means of the MB/BacT. In smear-positive and smear-negative samples, the mean times to detection of Mycobacterium tuberculosis were 16.7 and 26.3 days, respectively, with Löwenstein-Jensen and 11.5 and 19.3 days, respectively, with the MB/BacT. These results indicate that the MB/BacT is more efficient and faster than Löwenstein-Jensen for the recovery of mycobacteria.

The crystalline pattern of calcium in different topographical regions of the otoconial membrane. An electron probe and spectroscopic diffraction study

Quantitative electron probe microanalysis and electron spectroscopic diffraction analysis was used to determine the gradient of distribution of calcium and its crystalline pattern at different levels (lower gelatinous membrane, upper gelatinous membrane and otoliths) in the otoconial membrane of adult OF1 mice. Our quantitative electron probe microanalytical data, obtained with scanning-transmission electron microscopy, indicated that there was a gradient in calcium concentration which increased from the vestibular surface towards the otoliths. Differences between the three regions of the otoconial membrane were statistically significant in both the utricle and saccule. Our results with electron spectroscopic diffraction revealed an increasing crystalline development from the lower gelatinous membrane towards the otoliths. Our findings with both techniques suggest that the gelatinous membrane is involved in the maturation and crystallization of the otoliths.

[Round Table: Urticaria in relation to infections]

OBJECTIVES

1) To study the clinical and analytic features of infectious disease associated to urticaria in children. 2) To look into the probable etiology of the infectious disease. 3) To determine atopic predisposition and previous urticarial episodes and to rule out the involvement of antibiotics.

DESIGN

Transversal and observational study.

SETTING

Pediatric Allergy Outpatient Clinic of a tertiary Hospital.

PATIENTS

Forty-four children, aged 1 to 12 years with acute urticaria associated to clinically infectious or febrile illness attending an Emergency Pediatric Department.

INTERVENTION

Symptoms evaluation and physical examination in the seventh first days and follow over 3-6 weeks by the same physician.

MEASUREMENTS

Clinical features of urticaria (duration, angioedema associated); Clinic diagnosis of illness infectious (acute respiratory infection, gastroenteritis, febrile syndrome); white blood cells count, C-reactive protein, aminotransferases (AST, ALT), L-Y-glutamyl transferase; viral culture and antigen detection: enterovirus (EV), adenovirus, respiratory syncytial virus (RSV), parainfluenza 1, 2 and 3, influenza A y B and cytomegalovirus (CMV); serological assay: CMV, enterovirus, mycoplasma pneumoniae, Epstein-Barr, parvovirus B19.

RESULT

22 children (50%) are between 1-2 years old. 40 patients (90,9%) had symptoms of respiratory tract infection and only four patients had a pneumonia. The other 4 children had a gastroenteritis. The analytic was suggestive of viral infection in 35 (79.5%) and unknown on seven patients. In 20 children (45.4%) was identified a probable infection. The viral detection was positive in 3 patients: CMV, herpes simplex 1 and influenza A. Twenty microbiological findings for seventeen patients was found by serological criterion of probable infection: enterovirus (10); parvovirus B19 (4); Epstein-Barr (3) y mycoplasma (3). Evidence of a double serologic infection was found in three patients. In comparison with a serological control group encountered that acute urticaria during a infectious disease is significantly associated (p = 0.0054) to high titer to enterovirus by complement-fixation. The urticaria was associated with angioedema in 38.6% and 9 children (20.4%) related an previous similar episode. Twenty-one (47.7%) had been treated with antibiotics before development the urticaria. All patients was given the suspected antibiotic and no patient developed any adverse reaction.

CONCLUSIONS

The clinically infectious associated to urticarial rash in children, usually is a viral respiratory infections. Is more frequent at infant. In spite of antibiotic therapy is often related to development the urticaria, the subsequent challenge with the same antibiotic is good tolerated.

Effect of dietary (n-9), (n-6) and (n-3) fatty acids on membrane lipid composition and morphology of rat erythrocytes

Studies focused on the intake of different dietary fats have shown changes in membrane lipid composition and, as a result, alterations in membrane physical properties. These changes affect erythrocyte morphology, receptor activity and oxygen transport, among others. Here, we compare the effects of diets exclusively differing in the type of fat (olive oil rich in monounsaturates, sunflower oil rich in n-6 polyunsaturates and fish oil rich in n-3 polyunsaturates) on fatty acid composition of plasma and erythrocyte membranes and erythrocyte morphology under scanning electron microscopy in rats. Monounsaturates are highest in animals fed olive oil diets; as are linoleic and arachidonic acids in sunflower oil-fed animals and n-3 PUFAs in fish oil-fed animals. The lowest levels of arachidonic acid are found in fish oil-fed animals and so are n-3 PUFAs in sunflower oil-fed animals. Our results show that sunflower oil-fed animals present lower discocyte, the major cell shape related to tissue oxygen supply, and higher codocyte percentages than olive oil- and fish oil-fed groups. Echinocyte percentage is higher in fish oil-fed animals with respect to the other two groups. The collective data indicate that olive oil elevates monounsaturates and the number of discocytes, pointing out a possible beneficial aspect of this dietary fat.

Electron probe microanalysis of permanent human enamel and dentine. A methodological and quantitative study

Sample preparation of dental tissues for quantitative electron microprobe analysis has not been critically examined because of the highly mineralized nature of these structures. The present study was designed to establish the most suitable method for the electron probe quantitative determination of calcium in human permanent enamel and dentine while preserving the morphological features. Comparisons of quantitative data obtained with air-drying and freeze-drying methods showed that calcium in enamel was more accurately measured in specimens prepared with cryopreservation and freeze-drying. No significant differences between the methods tested were found in dentine although cryopreservation and freeze-drying yielded less statistical variability. Moreover this approach did not modify morphological features of interest. We recommend this combination of processing techniques for human permanent teeth not only because it was found the most accurate and least variable in determining calcium concentration, but also because of its potential usefulness in studies of alterations in tooth mineralization.

Comparison of MB-check and Löwenstein-Jensen media for recovery of mycobacteria

We have compared the rate of recovery of mycobacteria with the MB-Check culture system (liquid phase) and the Löwenstein-Jensen (LJ) medium in 2,907 clinical specimens obtained from 830 patients submitted for mycobacterial culture during 1-year period. Direct smear examination was carried out by auramine-rhodamine staining. All primary isolates from the culture media were confirmed by Ziehl-Neelsen staining and identified by acridinium-ester-labeled DNA probes specific for Mycobaterium tuberculosis complex. A total of 214 isolates were of the M. tuberculosis complex (88 patients) and 54 of "potentially pathogenic environmental mycobacteria" (45 patients). A total of 117 (54.7%) samples were smear-positive and the remaining 97 (45.3%) were smear-negative. There was a significant difference in the percentage of positive cultures obtained by the MB-Check method (99.1%) as compared with the LJ medium (73.8%) (P < 0.05). This difference, however, occurred almost exclusively at the expense of the 97 smear-negative samples (positive cultures 97.95% by the MB-Check method vs. 42.3% by the LJ culture, P < 0.05). The number of patients diagnosed of tuberculosis by the MB-Check was significantly higher as compared with LJ medium (88 [100%] vs. 77 [87.5%], P < 0.05). In 11 (12.5%) patients, the diagnosis was only established by the MB-Check system. In smear-positive samples, the mean (+/-SD) detection time for M. tuberculosis complex was 14.8 +/- 8 days with MB-Check and 19.9 +/- 7 days with LJ medium. The corresponding figures in smear-negative samples were 22.8 +/- 3 days and 27.8 +/- 6 days, respectively. DNA probes directly applied to MB-Check liquid medium showed a sensitivity of 98.8% and specificity of 100%. These results indicate that the MB-Check system is more efficient for the recovery of mycobacteria than LJ medium.

[General convulsive crisis related to pneumocephalus after inadvertant dural puncture in an obstetric patient]

We report a case of iatrogenic pneumocephalus in an obstetric patient after accidental dural puncture during repeated attempts to locate the epidural space by the technique of loss-of-resistance to air. Analgesia was provided throughout labor. Two days after puncture, typical spinal headache developed and was treated with bed rest, oral analgesics and hydration. The patient was released four days after delivery but returned to the hospital emergency service after suffering general convulsions and loss of consciousness which resolved spontaneously. A computerized tomography (CT) scan revealed pneumocephalus, to which the convulsions were attributed. No further convulsions occurred in spite of the fact that anticonvulsives were not prescribed. A CT scan one month later was normal.

Spontaneous pregnancy in couples waiting for artificial insemination donor because of severe male infertility

OBJECTIVE

To assess the spontaneous fertility in couples with severe seminal conditions while waiting for artificial insemination donor.

STUDY DESIGN

Prospective follow-up during a period of 24 months.

SETTING

University Medical School.

PARTICIPANTS

There were 285 couples in which the male had a very severe seminal pathology: 166 azoospermia, 86 oligozoospermia and 33 severe asthenozoospermia.

OUTCOME MEASURES

Pregnancy rates after being included on waiting list.

RESULTS

The spontaneous pregnancy rate was 3.2% (9/285), per month spontaneous pregnancy rate being 0.13%. Spontaneous pregnancy rate was 0% in azoospermia (0/166). versus 7.6% (9/119) in non-azoospermia cases. Spontaneous pregnancy rate was 8.5% (4/47) in the group with less than 0.1 million motile sperm/cc, 6.5% (3/46) in the group between 0.1 and 1 million/cc and 7.7% (2/26) in the group with 1-2 million/cc.

CONCLUSION

In a 2-year follow-up, pregnancy rate among non-azoospermic couples before undergoing artificial insemination was 7.6%. Extramatrimonial pregnancy (based on anamnesis and sperm analysis) seemed to be uncommon. Even in cases with less than 0.1 million of motile sperm/cc there was not a negligible spontaneous pregnancy rate.

Late recurrence and endocranial metastasis caused by giant cell tumor

A case of giant cell tumor localized in the proximal end of the right tibia, initially treated by simple curettage is described. After 11 years there was local recurrence, confirmed anatomopathologically, observed during wide resection and reconstruction by arthroplasty plus homoplastic grafting. After a few months there were metastatic lesions in the left parietooccipital and right retroorbitary area. Biopsy of the parietooccipital lesion showed giant cells in a sarcomatous stroma. The patient died after several attempts at chemotherapy. Even if only sporadic cases have been described of late recurrences and of extrapulmonary metastases for giant cell tumors, the case presented here is exceptionally rare. The factors that influence recurrence of these tumors and their ability to metastasize is discussed.

Topographic distribution of CD18 integrin on human neutrophils as related to shape changes and movement induced by chemotactic peptide and phorbol esters

The acquisition of high-affinity ligand binding may result from a topographical redistribution of beta2 integrins (CD11/CD18) in the plane of the membrane in response to agonist-induced neutrophil stimulation. We examined the topographical distribution of CD18 on human neutrophils in relation with shapes changes and movements induced by stimulation with 10(-8) M N-formylmethionyl-leucyl-phenylalanine (fMLP) and 10(-7) M phorbol myristate acetate (PMA). To localize CD18, we used immunogold-labeling methods and backscattered electron images obtained with scanning electron microscopy. On unstimulated neutrophils, CD18 integrin was randomly distributed on the nonvillous planar cell body. Stimulation of neutrophils with 10(-8) M fMLP and 10(-7) M PMA for 10 min induced distinctive shape changes, i.e., polar and nonpolar ruffled shapes, and upregulation of the surface membrane content of CD18. These changes were accompanied by a specific topographic distribution of CD18. fMLP-stimulated (10(-8) M) cells accumulated CD18 on the ruffled plasma membrane at the frontal pole of polar neutrophils. PMA-stimulated (10(-7) M) cells displayed CD18 aggregates on all plasma membrane domains, mainly on ruffles of nonpolar ruffled neutrophils. We conclude that the motile neutrophil responses elicited by chemotactic peptide and phorbol ester are associated with distinct patterns of topographic distribution of CD18 integrin. These features of CD18 expression may influence adhesive interactions mediated by human neutrophils.

Comparison of solid and liquid culture media with polymerase chain reaction for detection of Mycobacterium tuberculosis in clinical samples

The aim of this study was to determine the sensitivity of different methods--two commercial polymerase chain reaction (PCR) kits (a protocol of nested PCR and a protocol of amplification of the IS6110 insertion element), the radiometric Bactec system, the Septi-Chek AFB culture system, and culture in Löwenstein-Jensen (LJ) solid medium--for the detection of Mycobacterium tuberculosis. One hundred clinical samples from 51 patients with culture-positive tuberculosis (81 specimens) and 19 controls (19 specimens) were used. Eighty-nine percent of the samples were smear negative. In the 81 specimens obtained from patients with tuberculosis, the frequency of positivity was 66.6% for nested PCR, 63% for culture in liquid media, 38.3% for IS6110 assay, and 28.4% for culture in LJ medium. In 18 samples obtained by invasive procedures in patients with tuberculosis, mycobacterial DNA was detected by nested PCR in 83.3% (including all samples positive by culture on liquid media), by culture in liquid media in 77.7% by culture on LJ medium in 27.7%, and by the IS6110 assay in 11.1%. No false-positive results were obtained from the negative control specimens with any of the techniques tested. The sensitivity of the reamplification protocol appears to be superior to that of the IS6110 assay and similar to that of the Bactec system.

[Time series in the epidemiology of typhoid fever in Spain]

BACKGROUND

The incidence of typhoid fever in Spain from January 1982 to December 1993 was studied with the aim of analyzing how the disease has evolved over these years and predict its future behavior in order to facilitate prevention by the public health care organizations and centers.

MATERIAL AND METHODS

The Box-Jenkins temporary series theory was used. The data corresponded to the declared disease cases throughout Spain published in the Epidemiology Bulletin by the Carlos III Health Center and the Department of Health and Welfare.

RESULTS

The ARIMA (0,1,1) (0,1,1)12 model was selected to report the data obtained. The analytical results demonstrated a exponential decreasing tendency with an annual seasonal pattern in incidence observed in this disease peaking in the months of July, August and September and decreasing in the declared cases in December, January and February. A mathematical expression was also obtained to allow the prediction of the disease behavior in the future.

CONCLUSIONS

Prophylactic measures should be taken in the summer months. A disease incidence greater than that foreseen by the mathematical formula obtained would express a failure in epidemiologic surveillance, and thus the results of this study may be used as a quality control of the preventive measures.