Heart disease education and prevention program targeting immigrant Latinos: using focus group responses to develop effective interventions

Although research has provided considerable knowledge concerning the positive effects of behavioral change on morbidity and mortality from heart disease and related risk factors, some segments of the population have not benefited equitably from this information. In April 1995, the National Heart, Lung, and Blood Institute (NHLBI) conducted seven focus groups to determine knowledge and attitudes about heart disease and associated risk factors, identify media usage and preferences, and assess publications usage and preferences among Spanish-speaking Latino immigrants residing in the Washington, D.C., metropolitan area. This information was gathered to assist in the development of key messages and strategies for the NHLBI Latino Community Cardiovascular Disease Prevention and Outreach Initiative, Salud para su Corazón--a heart disease prevention and education campaign. Findings from these focus groups indicate that Latinos may not benefit from heart disease prevention messages developed for the general population because of language and cultural differences. The researchers concluded that health education and disease prevention programs targeting the Latino community should develop educational materials and interventions that address language preferences and cultural values. Furthermore, to be effective, these programs should show people how to make positive behavioral changes based on their current circumstances, while remaining sensitive to the fact that Latino immigrants face major life adjustments and many are still greatly influenced by their country of origin.

Blood bank leukocyte infusions as remission induction therapy in a case of acute lymphoblastic leukemia

A 15-year-old female with pre-pre B ALL in third relapse was treated with administration of eight blood bank leukocyte concentrates per day for 5 days. The total number of mononuclear cells per kilogram of weight was 4.89 x 10(8). On the fifth day of infusions the patient was in complete remission (CR), asymptomatic and with a normal CBC. No secondary effects were found. The patient remained in CR without treatment for 10 weeks before relapsing again. The possibility of reaching a short-lived, clinically relevant response, using blood bank leukocyte infusions, is a promising new approach for the treatment of leukemia.

[Internal ophthalmoplegia: a rare complication of varicella]

INTRODUCTION

Internal ophthalmoplegia complicating Chickenpox is rare. Fifteen cases have been reported so far.

CLINICAL CASE

We reported a new case of this neurological complication in a 3 1/2 year old girl that 6 days after the onset of the typical rash, the right pupil was dilated and fixed to light and accommodation. Pupillary dilatation and accommodative paralysis persist after five years, but spectacle correction has restored the visual acuity.

Community panel discussions: from research to community action

HYPERTENSION AND CARDIOVASCULAR DISEASE are increasing among minorities. Participants at the workshop on the Epidemiology of Hypertension in Hispanic Americans, Native Americans, and Asian/Pacific Islander Americans voiced a need to intensify a systemic approach for community-based strategies to guide prevention, treatment, and control. To answer this need, a panel addressed recommended community-based strategies from inclusion of community members in the research process to implementation and application of findings for community action. Recommended strategies include encouraging close cooperation and data sharing between investigators and community groups; including differences in culture, heritage, and local influences in hypertension research; training and working with minority researchers and health care professionals; and intensifying comprehensive and culturally appropriate education programs that focus on prevention, treatment, and control of hypertension. This article contains a summary of key areas of emphasis, as well as implementation strategies to decrease hypertension and other cardiovascular diseases in specific ethnic groups.

Influence of lobular development on breast epithelial-cell proliferation and steroid-hormone receptor content

The development of the breast evolves through progressive formation of lobular structures. Lobules type 1 (Lob 1) are the most undifferentiated ones; they evolve to lobules type 2 (Lob 2), and those to type 3 (Lob 3), in response to mainly ovarian hormones. Although estradiol and progesterone act by binding to their specific receptors, their content in these structures and how they correlate with proliferative activity are not known. Normal breast tissues obtained from 40 reduction mammoplasties performed for cosmetic reasons in women free of mammary pathology were processed for light microscopy. Paraffin sections were immunoreacted with antibodies against estrogen receptor (ER), progesterone receptor (PgR), and proliferating cell nuclear antigen (PCNA). The number of cells positively labeled with each one of the three antibodies was quantitated in Lob 1, 2 and 3, and expressed as a percentage of the total number of cells. ER were positive in Lob 1 (21%) and Lob 2 (10%), but negative in Lob 3. PgR were positive in Lob 1 (66%) and 2 (68%), decreasing in Lob 3 (31%). The highest percentage of PCNA positive cells were found in Lob 1 (40%), decreasing in Lob 2 (33%) and Lob 3 (11%). These results indicate that the normal breast epithelium contains ER and PgR, but the former is at higher levels in Lob 1, which also expresses greater proliferative activity as demonstrated with PCNA.

[Hepatitis caused by virus C. Risk factors]

To establish the risk factors to hepatitis C virus (HCV) infection, we studied 120 patients divided in 2 groups: A first group of 40 patients with HCV infection, 24 (60%) with past medical history of blood transfusion, 14 (35%) of them also had hemodialysis and 3 Kidney transplant. 10 patients (25%) had mayor surgery without transfusion, 3 had frequent visits to the dentist and 3 month baby whose mother was HCV positive. In 4 patients we found no risk factors. A second group of 80 patients who visit our clinic for the first time, 2 were found positive for HCV (1.6%). 13 of them had blood transfusion, one was HCV+ (OR: 5.5, P = 0.73). 41 had history of mayor surgery, one HCV+ (OR: 0.95, P = 1.000). The risk factors related to HCV infection in our population were blood transfusion, hemodialysis and mayor surgery. The use of EV drugs, tatoos, sexual behavior, interfamiliar or vertical transmission were not risk factor in our population.

MEM-59 monoclonal antibody detects a CD43 epitope involved in lymphocyte activation

Previous studies on T cell activation via CD43 antigen stimulation were limited to the use of L10, a monoclonal antibody (mAb) recognizing a sialic acid-independent epitope on the CD43 molecule. Here we study the CD43 mAb MEM-59, which recognizes a neuraminidase-sensitive epitope on the CD43 molecule, for its ability to activate T lymphocytes. The antibody by itself is able to stimulate proliferation of peripheral blood mononuclear cells (PBMC) in a monocyte-dependent fashion, and to act synergistically with the mitogen phorbol 12-myristate 13-acetate. It is demonstrated that the monocyte dependence of MEM-59-induced proliferation of peripheral blood lymphocytes (PBL) cannot be attributed to cross-linking via Fc receptors on monocytes alone: F(ab')2 fragments of MEM-59 are at least as effective as intact IgG in the induction of PBMC proliferation. The effects of MEM-59 reported here are distinct in important ways from those reported for L10. Our proliferation data are extended by the observation that MEM-59 mAb induces mobilization of intracellular Ca2+ in PBMC and in the T cell line Jurkat, while the CD3/TcR-negative Jurkat derived-mutant J.TR3-T3.5 exhibits defective signaling compared to the parent cell line. Moreover, CD3 and CD43 are shown to be present jointly in a large complex in a mild detergent lysate of the T cell line HPB-ALL. These data indicate a physical and functional association between CD3/TcR and CD43 pathways, suggesting a role for CD43 as a co-stimulatory molecule in CD3/TcR signaling, especially in T cell-antigen-presenting cell interactions.

[Clinical, laboratory, and ultrasonography features of acute viral hepatitis]

We review the charts of the hospital with diagnostic of acute viral hepatitis. We classified them using serologic markers in hepatitis B (60 patients), hepatitis A (27 patients) and C (4 patients). Fatigue, anorexia, fever, chills and lymphadenopathy where more common in hepatitis A. Arthralgias, pruritus and rash where more common in hepatitis B. Bilirubin levels where higher in patients with hepatitis B (10.3 = -6.04 S.E:0.80) and C (9.7 +/- 4.09 S.E:1.24) compared with hepatitis A (6.7 +/- 6.04 S.E:0.80) p < 0.01 and p < 0.05. Alamine-Aminotransferase (ALT) levels where higher in patients with hepatitis B (1.918 +/- 1.099 S.E:215.5) and hepatitis A (1879 +/- 1.099 S.E:215.5) and lower in hepatitis C (988 +/- 764 E.E:382) p < 0.05. Abdominal Ultrasound reveal splenomegaly in 45% and 50% of patients with hepatitis A and C and only in 15% of patients with hepatitis B. Changes in gallbladder wall where found in 50% of patients with hepatitis A. 3.3% of patients with hepatitis B and 75% of patients with hepatitis C developed chronic infection.

[Gastric schwannoma. Report of a case]

Gastric schwannoma is a rare and benign neurogenic tumor. Diagnosis of this entity is uncertain previous to surgery, being this tumor localized in the sub-mucosa. Final diagnosis is achieved by surgical removal and histological examination.

[Splenic pseudocystic. Report of a case]

Splenic pseudocysts represent 70 to 80% of the non parasitic cysts of this organ. Malaria, infectious mononucleosis, tuberculosis and t. pallidum infection are predisposing factors. Cystic characteristics are determined by CT-SCAN and ultrasound. Final diagnosis is achieved by hystological examination. This is a case report.

[Glucose-6-phosphate dehydrogenase deficiency: report of 2 cases]

Glucose 6 phosphate dehydrogenase (G6PD) is an enzyme related to the metabolism of glutation, an antioxidant agent. Its deficiency causes hemolisis, generally well tolerated. However there are some factors including, exercise, infections and oxidants drugs that stimulate the hemolisis of the older red blood cells. We report two patients with G6PD deficiency, that were initially diagnosed as acute viral hepatitis. Although this pathology is not frequent it should be recognized, for the implication of giving profilactic antimalaric drugs in endemic areas. The diagnosis should be suspected in patients with unconjugated jaundice, always investigating the previous ingestion of oxidants drugs.

Miller-Dieker syndrome. Detection of a cryptic chromosome translocation using in situ hybridization in a family with multiple affected offspring

OBJECTIVE

To describe a family in whom fluorescence in situ hybridization allowed for accurate diagnosis of Miller-Dieker syndrome in an at-risk pregnancy and determination of parental carrier status.

DESIGN

Retrospective case analysis and application of a new molecular tool to evaluate the family.

SETTING

Health maintenance organization. The family was followed up by the Departments of Medical Genetics, Pediatrics, and Obstetrics and Gynecology, Kaiser Permanente Medical Center, Panorama City, Calif.

PARTICIPANTS

Members of a single family.

INTERVENTIONS

Clinical evaluation and neuroimaging studies of the proband. Prenatal diagnosis via ultrasonography and amniocentesis. Chromosomal evaluation of the couple and their offspring. In situ hybridization studies in both parents and an affected fetus.

MEASUREMENTS/MAIN RESULTS

We describe a family in whom fluorescence in situ hybridization detected a submicroscopic deletion of the Miller-Dieker syndrome critical region 17p13.3 arising from a cryptic translocation in one of the parents. The proband was determined at birth owing to the presence of multiple congenital anomalies, including low birth weight, microcephaly, agenesis of the corpus callosum, lissencephaly, cerebral atrophy, unilateral ptosis, polydactyly, and omphalocele. High-resolution chromosome-banding analysis findings were normal in the parents and proband, who died at age 4 years. There were four subsequent pregnancies: two ended in first-trimester spontaneous abortion, and in the other two, large omphaloceles were detected in fetuses at 15 and 13 weeks' gestation. Both pregnancies were terminated. Fluorescence in situ hybridization probes for 17p13.3 had become available before the most recent pregnancy and were used to study parental and fetal cells. As a result, a balanced cryptic translocation between chromosome 17 and chromosome 19 was identified in the father: 46,XY,t(17;19)(p13.3q13.33). An unbalanced form of the translocation, involving a deletion of 17p13.3, was detected with fluorescence in situ hybridization in the fetus. This finding was in accordance with a clinical diagnosis of Miller-Dieker syndrome.

CONCLUSIONS

Molecular cytogenetic technology should be used in cases of suspected Miller-Dieker syndrome when high-resolution cytogenetic analysis fails to detect del(17) (p13.3). Positive findings should be followed up with parental studies. In addition, omphalocele should be included among the list of malformations that make up the Miller-Dieker syndrome.

P-lacW insertional mutagenesis on the second chromosome of Drosophila melanogaster: isolation of lethals with different overgrowth phenotypes

A single P-element insertional mutagenesis experiment was carried out for the second chromosome of Drosophila melanogaster using the P-lacW transposon. Out of 15,475 insertions on the second chromosome, 2,308 lethal and 403 semilethal mutants (altogether 2,711) were recovered. After eliminating clusters, 72% of the mutants represent independent insertions. Some of the mutants with larval, prepupal or pupal lethal phases have a prolonged larval period and show gradual overgrowth of the imaginal discs, brain and/or the hematopoietic organs (lymph glands). In this paper, 16 overgrowth mutants are described. As revealed by in situ hybridization, none of the mutations corresponds to any of the previously known overgrowth mutations on the second chromosome.

[Esophageal varices sclerosis in portal hypertension caused by portal thrombosis secondary to protein C deficiency]

Portal thrombosis is a rare entity classified as idiopathic in 50% of the cases, being protein C deficiency a known cause. We present two cases complicated with portal hypertension diagnosed through sonography and protein C determined though laboratory technics. Complicating esophageal varices sclerosed and follow up at seven months and ten years respectively, satisfactory clinical evolution observed.

Cysticercosis as a major cause of epilepsy in Peru. The Cysticercosis Working Group in Peru (CWG)

In countries where cysticercosis is endemic, the proportion of epilepsy due to cysticercosis is not well documented. To investigate the association between cysticercosis and epilepsy, we used the enzyme-linked immunoelectrotransfer blot (EITB) assay to detect serum antibodies to Taenia solium in 498 consecutive outpatients at a neurology clinic in Lima, Peru. Every patient was classified as epileptic (n = 189) or non-epileptic (n = 309) after neurological, and where possible electroencephalographic, examination. A substantially higher proportion of epileptic than non-epileptic patients was seropositive in the EITB (22 [12%] vs 8 [3%], p < 0.001). 19% of epileptic patients born outside Lima, 20% of those with late-onset epilepsy, and 29% of patients with both these characteristics were seropositive. Thus, in Peru, cysticercosis is an important aetiological factor for epilepsy.

[Prolonged total parenteral nutrition in surgery. A case report of severe malnutrition]

We present a 15-years-old female patient severely malnourished due to complications of abdominal surgery, who received total parenteral nutrition during 118 days. The clinical and laboratory parameters are analyzed and a photographic sequence is presented. During the treatment period nitrogen balance was positive and her weight increased in 50%.

[Gastroduodenitis and Helicobacter pylori in uremic patients]

We studied 26 patients (p) with end stage renal failure (RF) and 26 healthy volunteers (HV) to investigate the prevalence of Helicobacter pylori (Hp) and its relation with chronic gastritis (CG) and chronic duodenitis (CD). We analyzed 312 gastric and duodenal mucosal biopsies stained with H & E and Giemsa. Categorical data were assessed by the X2 and Fisher's exact test. Probability values of p < 0.05 were considered significant. Endoscopic lesions correlated with histological gastritis and duodenitis and Hp was positive in antrum of 6/8p (75%) (p < 0.05). The prevalence of Hp was 54.5% (15/26p) in RF and 47.2% (12/26s) in HV. Hp was found more frequently in pathological mucosa (p < 005.). CG of the antrum and CD were more commonly in RF (88.5% vs 69.5% and 42.3% vs 23.1% respectively). HP was more frequently located in the antrum than in body and duodenum in both groups (p < 0.05). Chronic gastritis of the body was more frequently in HV (p < 0.05). Active chronic antral gastritis and superficial gastritis were more frequently associated to Hp. Hp was associated to chronic inflammatory gastroduodenal diseases in both groups and may be a cofactor in its pathogenesis. We recommended Hp treatment before renal transplantation.

Diagnosis of paroxysmal nocturnal haemoglobinuria using immunophenotyping of peripheral blood cells

Paroxysmal nocturnal haemoglobinuria (PNH) is now generally accepted as a disease in which bone marrow derived cells are deficient in phosphatidylinositolglycan (PIG)-anchored surface molecules. A series of new monoclonal antibodies detecting PIG-anchored surface structures on human leucocytes (CD48, CD55, CD59) has recently been described. In the present study 12 patients with the diagnosis PNH and a positive Ham test were examined for PIG-anchored surface antigen expression on various cell lineages using immunofluorescence. In all patients deficient cells were detected in erythrocyte, granulocyte and monocyte analysis. A deficient lymphocyte subset was also observed in all but one of these patients. Using two-colour analysis, all lymphocyte subpopulations such as T, B and NK cells were found to be affected. In addition, peripheral blood cells of 22 patients with severe aplastic anaemia (SAA) were tested for the PIG-anchoring defect. In five of these patients the defect was detected, and in four of the five the lack of PIG-anchored molecules was confined to the granulocyte and monocyte lineages apparently without affecting the erythrocytes. The results of these studies demonstrate that cytofluorographic testing of peripheral blood cells provides a simple and reliable method for establishing the diagnosis of PNH. Furthermore, especially in the case of aplastic anaemia patients, the sensitivity of immunophenotyping might be superior to conventional laboratory tests.

[Gastric emptying of fluids and gallbladder contraction in non-ulcer dyspepsia]

Non-ulcer dyspepsia is a frequent clinical entity characterized by chronic upper gastrointestinal symptoms without organic lesions by radiology, sonography or endoscopy. We studied simultaneously the rate of gastric emptying and gallbladder contraction in 10 patients with non-ulcer dyspepsia and in 10 healthy controls after ingestion of 500 cc of isotonic saline, and 500 cc of a liquid mixed meal, hypercaloric and hyperosmotic. The measurements were done by direct real-time ultrasonic imaging in fasting and were repeated at regular intervals (15-30 minutes) after the liquid meal, until complete gastric emptying was established. We found with the liquid mixed meal, the patients with non-ulcer dyspepsia had a significant delay in gastric emptying and gallbladder hypokinesis with faulty contraction and slow refilling. Dynamic ultrasonographic studies are useful in patients with non-ulcer dyspepsia.

[Antibodies against hepatitis C virus. Experience with a second generation test]

A second generation recombinant immunoblot assay to detect antibodies against Hepatitis C virus (RIBA II, Ortho Diagnostic Systems) was applied to 30 serum samples repeatedly reactive to ELISA anti-HCV c100-3, 11 from hemodialysis patients, 11 from patients with chronic hepatitis and 8 from patients with cirrhosis. The assay detects individual antibodies directed to 4 antigenic components of the C virus, 2 antigens, c100 and 5-1-1 contained in the original ELISA assay and 2 new antigens, c33c and c22-3 the latter structural in nature. From the total of 30 samples, 23 (77%) were reactive, 4 (13%) indeterminate and 3 (10%) non reactive to the RIBA II assay. Much variation was observed regarding the response to each individual antigen. c22-3 was the most frequently reactive with the highest intensity. RIBA II assay confirmed a high percentage of the reactive results with the ELISA c-100-3, serum samples that were non reactive to RIBA showed a low optical density with ELISA. c22-3 was the most sensitive antigenic component.

[Antibodies against hepatitis C virus in patients with liver diseases and in risk subjects. Preliminary report]

The recent discovery of an antigenic component of the causative agent of Non-A, Non-B hepatitis, has led to the characterization of this virus--Hepatitis C Virus (HCV)--and to the identification of an antibody present in infected subjects (anti-HCV) detected by means of the C-100 antigen derived from a nonstructural region of the viral genome. Using a commercial Kit (Ortho Diagnostic Inc.), the incidence of anti-HCV antibody was studied in the Military Hospital "Dr. Carlos Arvelo" of Caracas, Venezuela with the following results: Health personnel (doctors, nurses, laboratory staff): 102 persons studied, 2 positives (1.96%); 16 patients in chronic hemodialysis: 6 positives (33%); 20 subjects with antibodies against HIV virus, confirmed by Western Blot: 7 positives (35.4%). Of 10 patients with Surface Antigen negative Chronic Hepatitis, 7 (70%) positive for anti-HCV, of 25 patients with cirrhosis: 12 positive (48%), 2 patients with hepatocarcinoma 1 positive (50%). There was also a high incidence of total anti-core antibodies in the patients studied. The results suggest that the hepatitis C virus could be playing an important role as a causative factor of liver diseases in our Country.

[Gastric emptying of different liquid test meals measured by ultrasonography]

The rate of gastric emptying of different liquid solutions was measured in 80 voluntary normal young male subjects (mean age 19.9 +/- 1.6 years) by direct real-time ultrasonic imaging. Multiple US scans were repeated at regular intervals (15-30 minutes) until complete gastric emptying was established, after ingestion of 500 cc of 8 different liquid test meals: isotonic saline, 50% glucose, 5% glucose, 40 g of proteins, 20 g of protein, 40 g of fat, 20 g of fat and mixed (carbohydrates, proteins and fat). Eight groups of ten subjects were studied, each one with a different test meal. Three types of gastric emptying were identified: slow (177 +/- 12 minutes) in subjects receiving 50% glucose, 40 and 20 grs of proteins and mixed test meals; intermediate (83 +/- 9 minutes) with 5% glucose, 40 and 20 g of fat; rapid (40 +/- 6 minutes) with isotonic saline. The mixed diet had the slowest emptying time (210 +/- 6 min). Our results are in accordance with published data regarding gastric motor physiology and demonstrates the usefulness of ultrasound in the study of gastric emptying of fluids.