[Frequency of molecular alterations in heterozygous beta-thalassemia in southern Spain and their relation to the hematologic phenotype]

INTRODUCTION

Heterozygous beta-thalassemia manifests hematologically with microcytosis, reduced red blood cell hemoglobin concentration and high hemoglobin A2 levels. Almost all molecular alterations are due to point mutations. We attempt to determinate the frequency of that mutations in the Oriental Andalusia Area, and its relationship with the hematological phenotype.

PATIENTS AND METHODS

We have studied 45 heterozygous patients. DNA samples were amplified by PCR, using the printers CD7 and HI1. A 16 Kb fragment corresponding to beta globin gene was obtained and analyzed by Dot Blot assay and hybridized with allelic specific oligonucleotide (ASO) probes to detect the 6 more frequent mutations found in the South of Spain.

RESULTS

Codon 39 nonsense mutation (31.1%) was the most frequent finding followed by IVS-1 NT 110 (26.7%). The relationship between hematological parameters and molecular mutations concluded that IVS-I NT 6 mutation developed a minimal anemia.

DISCUSSION

From the practical point of view, this study indicates that we were able to detect more than 90% of heterozygous beta-tal. with 5 out of 6 ASO probes used in this work. Thus, our data also provides a further implication in prenatal diagnosis.

[Health education for mothers in the catchment area of the El Llano ambulatory center, Merida, Venezuela]

OBJECTIVE

To determine whether it is possible to achieve substantial changes in mother's knowledge and attitude, with respect to breast feeding, to feeding during the first year of life, to immunisation and other aspects that have to do with the normal growth and overall development of the child.

DESIGN

Controlled, non-random, forward-looking study.

SETTING

Primary Health Care.

PATIENTS AND OTHER PARTICIPANTS

Study group of 20 mothers, and control group of 17 mothers.

INTERVENTIONS

Monthly meetings were held with the study group for 7 months, in which they were given leaflets and talks on health education, with the respective questionnaires before and after the talks. The same questionnaires were given to the control group, when their children were a year old.

MEASUREMENTS AND MAIN RESULTS

All the children of the mothers in the study group were having their children at the right time, compared with 70.6% of those in the control group, a statistically very significant result (chi 2 = 6.8 p < 0.01). The study group gave correct answers 85% out of total, compared with the control group's 37.5%, which is statistically significant (chi 2 = 8.6 p < 0.01).

CONCLUSIONS

There was a significant change of attitude with regard to immunisation and feeding in the first year of life and a change in knowledge regarding breast feeding, immunisation and other aspects, in the study group as compared to the control group.

Changes in white blood cells during parturition in mothers and newborn

Following spontaneous delivery (n = 12) a pronounced increase in the maternal total white blood cell count was found (to [mean +/- SD]: 20 +/- 6 x 10(9) total leukocytes/l), which would be considered highly 'pathological' in nonpregnant women. The alteration was predominantly due to an increase in polymorphnuclear cells and band forms. Simultaneously, a drastic decrease in the percentage and the absolute number of lymphocytes was noticed in venous blood (from 32 to 5%, or [mean +/- SD]: from 2.7 +/- 0.7 to 1.1 +/- 0.3 x 10(9) total lymphocytes/l). In this decrease nearly all lymphocyte subtypes were involved, although to differing extents. Following elective caesarean delivery (n = 6), no leukocytosis was found, however the percentage and absolute number of lymphocytes was also decreased, although not as pronounced as after spontaneous delivery. Again not all the lymphocyte subpopulations were affected to the same degree, and the effect was especially obvious for the suppressor T cells and B cells. Following emergency caesarean delivery (n = 5), no obvious effect on the absolute number of lymphocytes or on the pattern of lymphocyte subpopulations was observed. However, the total number of white blood cells was clearly increased, as after spontaneous deliveries. The possible significance of these findings, also for therapeutic consequences during the perinatal period, is discussed.

Chlorinated dibenzo-p-dioxins and dibenzofurans and the human immune system. 1. Blood cell receptors in volunteers with moderately increased body burdens

Using monoclonal antibodies (mAbs) and flow cytometry, we studied a variety of surface receptors on lymphocyte subpopulations of workers with moderately increased body burdens of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and of other polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/PCDF), expressed here as International-Toxicity Equivalencies (I-TE). The hypothesis to be tested was whether or not humans exhibit a similar susceptibility to PCDDs/PCDFs with respect to the surface receptors found previously to respond to small doses of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) in Callithrix jacchus. These are: helper-inducer (memory) T cells (CD4+CD45R0+CD45RA-CD29highCD11a+), CD20+ B cells, and cytotoxic T cells (CD8+CD56+/CD57+). Furthermore, 68 triple-labellings with mAbs were performed on the cells of each volunteer to possibly generate further hypotheses. It was evaluated whether any of the variables might be used as a biomarker of effects for this class of compounds. There were two main goals: (1) to evaluate whether workers with a moderately increased PCDD/PCDF-body burden [25-140 ppt TCDD or 104-522 ppt I-TE in blood fat] exhibit changes in the surface receptors of white blood cells, as observed in previous studies in non-human primates, and (2) to clarify whether persons at the upper range [10-23 ppt TCDD or 30-90 ppt I-TE in blood fat] of the body burden reference values of a not particularly exposed population show detectable deviations in these immunological variables, when compared with persons at the lower and medium range [1-3 ppt TCDD or 9-29 ppt I-TE] of these body burden reference values. Regression analysis of our data revealed slight trends for some of the biomarkers (e.g. CD45R0+). With one exception, these were all increases. None of the alterations observed are of medical relevance. The slight increase in the percentage of CD4+CD45R0+ cells remained significant even after covariant analysis taking age-related changes into account. Altogether, the data do not provide any evidence to support an assumption that moderately increased body burdens of PCDDs/PCDFs in adults induce decreases in the cellular components of the human immune system. Adult humans certainly are less susceptible to this action of PCDDs/PCDFs than adolescent Callithrix jacchus.

Effect of vitamin B6 supplementation on gentamicin nephrotoxicity in rabbits

Therapeutic use of gentamicin (GM) in a clinical setting may result in nephrotoxicity, most commonly presenting as acute tubular necrosis (ATN). We have previously observed decreased plasma pyridoxal 5'-phosphate (PLP) levels in rabbits given therapeutic doses of GM and endeavor in this study to determine if vitamin B6 supplementation (B6S) could protect against the nephrotoxicity of GM. Twenty-one rabbits were randomly assigned to 1 of 7 treatment groups of 3 rabbits each. Three of the groups received 10 mg GM/kg with either 10 mg B6S, 100 mg B6S or 0.9% saline. Three of the groups received 40 mg GM/kg with either 10 mg B6S, 100 mg B6S, or normal saline. The control group only received 100 mg B6S. All treatments were administered im once daily for 5 d. Blood was drawn for chemical assays on day 0 prior to any treatments and 2 h after each respective treatment on days 1, 3 and 5. After 5 d, the rabbits were euthanatized and kidneys were excised for histological evaluation by light microscopy. At the 40 mg GM/kg/d dose, significant mild to moderate ATN was observed in the saline controls, which was prevented by either dose of B6S. Only a few animals given 10 mg GM/kg/d showed any renal pathology and that was minimal. Unexpectedly, 1 rabbit given only 100 mg B6S/d but no GM had interstitial nephritis with focal ATN. We conclude that vitamin B6 can protect against the nephrotoxicity of GM in rabbits, but that further study is needed on the possible nephrotoxicity of high doses of B6S.

Supplementation of cows grazing tropical grass swards with concentrates varying in protein level and degradability

Twelve Holstein and Brown Swiss cows participated in a replicated and balanced 3 x 3 Latin square experiment with 4-wk periods to test three commercial concentrate feeds as supplements to grazing at 4 cows/ha on mixed grass herbage of 6.94% mean CP. Available herbage DM was estimated at 27.5, 21.7, and 15.1 kg/cow per d in successive periods. Excessive rainfall had adverse effects in periods 2 and 3. Treatments were concentrates with 18, 15, or 15% CP with Protek (protein treated by a propietary process) as fed. Mean overall results were daily concentrate intake, 7.44 +/- 1.37 kg; daily milk yield, 17.3 +/- 4.8 kg: percentages of milk fat, SNF, and protein, 3.18 +/- .80, 8.58 +/- .28, and 2.94 +/- .27; FCM per concentrate DM, 2.33 +/- .41; and daily BW loss, .28 +/- .53 kg. Differences among treatments were small and unimportant. Concentrate allowances were intended to satisfy NE1 needs, but the anticipated contribution from pasture was overestimated. Energy rather than protein was deemed first limiting to animal performance, and neither CP higher than 15% in the concentrate nor protein protection was useful under these conditions.

Intestinal angiodysplasia: retrospective study of 18 cases

Eighteen patients operated on for intestinal angiodysplasia are reported. Visceral angiography was the diagnostic procedure of choice, providing evidence in most cases of lesions in the right colon. Right hemicolectomy was the surgical treatment normally provided. Mortality in our series was nil. This report looks at the main clinical features of these lesions, paying particular attention to their etiopathogenesis.

Operative choledochoscopy in biliary surgery

Forty-six patients submitted to operative choledochoscopy during biliary surgery are presented. Forty-two had benign diseases, principally calculi (38 cases), with only four patients presenting with malignant neoplasms. Our results bear out the effectiveness of operative choledochoscopy as a complement to cholangiography and conventional exploration of the bile duct, in significantly reducing the number of retained stones found, and in aiding other surgical procedures in the biliary tract.

Obstruction of the bile duct by a papillary adenoma of the gallbladder

A case of papillary adenoma of the gallbladder unassociated with cholelithiasis and showing detachment of part of the growth with obstruction of the common bile duct is described. One the basis of a search of the literature, it would appear that this is the first time such a case has been reported. The bibliography is discussed and a distinction drawn between this kind of adenoma and other benign tumors of the gallbladder.

Popliteal artery entrapment syndrome

Three cases of popliteal artery entrapment syndrome, one of them bilateral, are presented with a review of the literature, with special reference to the embryological development of the popliteal space and the diagnostic and therapeutic problems presented by this syndrome.

Failure of mianserin to affect autonomic function in the pupils of depressed patients

The autonomic effects of mianserin were tested in seven depressed patients by comparing pupillary responses to adrenergic and cholinergic agonists before and after treatment. Mianserin failed to affect pilocarpine-evoked miosis and tyramine- or phenylephrine-evoked mydriasis, despite adequate plasma levels of the drug. There was, however, a significant reduction in resting pupillary size after 1 and 3 weeks of treatment: this could result either from a central action, or from interactions at receptors other than cholinergic or adrenergic ones in the pupil of the eye. It is concluded that in clinical dosage mianserin is devoid of effects upon muscarinic receptors, alpha 1 adrenoceptors and noradrenaline uptake in the pupil.