Dialysis outcomes in Colombia (DOC) study: a comparison of patient survival on peritoneal dialysis vs hemodialysis in Colombia

The goal of the Dialysis Outcomes in Colombia (DOC) study was to compare the survival of patients on hemodialysis (HD) vs peritoneal dialysis (PD) in a network of renal units in Colombia. The DOC study examined a historical cohort of incident patients starting dialysis therapy between 1 January 2001 and 1 December 2003 and followed until 1 December 2005, measuring demographic, socioeconomic, and clinical variables. Only patients older than 18 years were included. As-treated and intention-to-treat statistical analyses were performed using the Kaplan-Meier method and Cox proportional hazard model. There were 1094 eligible patients in total and 923 were actually enrolled: 47.3% started HD therapy and 52.7% started PD therapy. Of the patients studied, 751 (81.3%) remained in their initial therapy until the end of the follow-up period, death, or censorship. Age, sex, weight, height, body mass index, creatinine, calcium, and Subjective Global Assessment (SGA) variables did not show statistically significant differences between the two treatment groups. Diabetes, socioeconomic level, educational level, phosphorus, Charlson Co-morbidity Index, and cardiovascular history did show a difference, and were less favorable for patients on PD. Residual renal function was greater for PD patients. Also, there were differences in the median survival time between groups: 27.2 months for PD vs 23.1 months for HD (P=0.001) by the intention-to-treat approach; and 24.5 months for PD vs 16.7 months for HD (P<0.001) by the as-treated approach. When performing univariate Cox analyses using the intention-to-treat approach, associations were with age > or =65 years (hazard ratio (HR)=2.21; confidence interval (CI) 95% (1.77-2.755); P<0.001); history of cardiovascular disease (HR=1.96; CI 95% (1.58-2.90); P<0.001); diabetes (HR=2.34; CI 95% (1.88-2.90); P<0.001); and SGA (mild or moderate-severe malnutrition) (HR=1.47; CI 95% (1.17-1.79); P=0.001); but no association was found with gender (HR=1.03, CI 95% 0.83-1.27; P=0.786). Similar results were found with the as-treated approach, with additional associations found with Charlson Index (0-2) (HR=0.29; Cl 95% (0.22-0.38); P<0.001); Charlson Index (3-4) (HR=0.61; Cl 95% (0.48-0.79); P<0.001); and SGA (mild-severe malnutrition) (HR=1.43; Cl 95% (1.15-1.77); P<0.001). Similarly, the multivariate Cox model was run with the variables that had shown association in previous analyses, and it was found that the variables explaining the survival of patients with end-stage renal disease in our study were age, SGA, Charlson Comorbidity Index 5 and above, diabetes, healthcare regimes I and II, and socioeconomic level 2. The results of Cox proportional risk model in both the as-treated and intention-to-treat analyses showed that there were no statistically significant differences in survival of PD and HD patients: intention-to-treat HD/PD (HR 1.127; CI 95%: 0.855-1.484) and as-treated HD/PD (HR 1.231; CI 95%: 0.976-1.553). In this historical cohort of incident patients, there was a trend, although not statistically significant, for a higher (12.7%) adjusted mortality risk associated with HD when compared to PD, even though the PD patients were poorer, were more likely to be diabetic, and had higher co-morbidity scores than the HD patients. The variables that most influenced survival were age, diabetes, comorbidity, healthcare regime, socioeconomic level, nutrition, and education.

Gas chromatographic-mass spectrometric study of the degradation of phenolic compounds in wastewater olive oil by Azotobacter Chroococcum

Compounds present in wastewater olive oil (WWOO) which can be used in metabolic pathways of Azotobacter chroococcum (A. chroococcum) have been investigated. Some compounds such as syringic acid, p-coumaric acid and syringaldehyde do not favour microorganism growing up. However, it has been shown that in batch culture, polyphenolic compounds (PCs) such as protocatetic acid and p-hydroxybenzoic acid do facilitate the growing up of microorganism. What is more, the maximum concentration in which bacteria can grow was 0.3% (w/v) for both polyphenols. At higher concentrations, substrate inhibition was observed; which is characterized by decreasing growth rates. Therefore, A. chroococcum can grow up using PCs as an individual source of carbon and energy supply but it is also dependent on the type of the compound and on its concentration. A gas chromatography coupled mass spectrometry method has been used for the study of the degradation of simple phenolic compounds.

Anionic selectivity sequence of the Cl(-)-H+ symporter in the synaptosomal preparation from rat brain cortex

The Na(+)/H(+) exchanger has been the only unequivocally demonstrated H(+)-transport mechanism in the synaptosomal preparation. We had previously suggested that a Cl(-)-H(+) symporter (in its acidifying mode) is involved in cytosolic pH regulation in the synaptosomal preparation. Supporting this suggestion, we now show that: (1) when synaptosomes are transferred from PSS to either gluconate or sulfate solutions, the Fura-2 ratio remains stable instead of increasing as it does in 50 mM K solution. This indicates that these anions do not promote a plasma membrane depolarization. (2) Based in the recovery rate from the cytosolic alkalinization, the anionic selectivity of the Cl(-)-H(+) symporter is NO(3)(-) > Br(-) > Cl(-) >> I(-) = isethionate = sulfate = methanesulfonate = gluconate. (3) PCMB 10 muM inhibits the gluconate-dependent alkalinization by 30 +/- 6%. (4) Neither Niflumic acid, 9AC, Bumetanide nor CCCP inhibits the recovery from the cytosolic alkalinization.

[Antimicrobial selection criteria evaluation by family doctors and general practitioners]

OBJECTIVE

This study has aimed to know the criteria used by the Spanish medical practitioners/family doctors (MP/FD) when choosing an antimicrobial agent in their daily practice and to compare it with that existing one decade ago.

MATERIAL AND METHODS

This is an observational, cross-sectional study performed with a structured personal interview to 450 MP/FDs randomly chosen with representativeness on the national level. The field work was made by specialized personnel in the last quarter of the year 2006. A 95.5% confidence interval margin was proposed, with a sample error = 4.7%, for maximum dispersion response (p=q=50).

RESULTS

The parameter considered most when choosing an antibiotic treatment (spontaneous response) is clinical efficacy (two out of every three doctors). Clinical efficacy is following by the dosage regime and tolerability/safety, which was the principal parameter expressed ten years ago. Following these are antibacterial spectrum, administration route, price and bacterial resistances. However, they considered that the latter significantly influence clinical efficacy and when they are not relativized with other parameters, the doctors state that they take them into account <<much/a lot>>. It seems that the opinion of the patient is usually considered and that the protocol, scientific information and expert's opinions are the principal sources of information considered when prescribing an antimicrobial agent. Amoxicillin/clavulanate is the antibiotic drug of choice in all upper and lower respiratory tract infections. There is overestimation of the bacterial etiology in throat infections and acute bronchitis and S. pyogenes to betalactamic antibiotics. It is concluded that knowledge of the Spanish MP/DF regarding antimicrobial therapy has improved in recent years and that clinical efficacy, related with bacterial eradication and not only with clinical remission, is the factor that should be considered when choosing an antibiotic.

[Behavior of the primary care physicians in the treatment of community infections]

This study aimed to evaluate the behavior of the physicians who attend to patients with community infections who are responsible for most of the antibiotic prescriptions made in the community setting. Furthermore, the evolution over the last 10 years in regards to the treatment habits of the most frequent infections in Primary Health Care (PHC) was studied and prescription behaviors were analyzed in relationship to the acquaintance and attitude of the participating physicians. A data collection sheet from 1,411 prescriptions made by 855 physicians from different specialties was used to conduct the study. This represents a statistically significant sample nationwide both from the point of view of the physicians involved in the treatment of infectious diseases in PHC as well as regarding to the prescriptions they have written. The study reveals the amplitude of respiratory and pararespiratory disease with oral antimicrobial agents, particularly beta-lactamics, and the significant advance in the last 10 years in the use of amoxicillin and clavulanic acid as treatment of choice. Treatment duration was somewhat longer while the number of containers prescribed was less than in the previous study. This would be related to the use of more spaced doses of the antimicrobial agents. Furthermore, the study reveals some discrepancies between attitudes and events of the physicians in the approach to certain diagnoses. Key words: Behavior. Primary care physicians. Prescription. Antimicrobials agents.

Protein value for ruminants of a sample of whole cottonseed

The effective ruminal degradability (ED) of dry matter (DM), crude protein (CP) and amino acids, and the effective intestinal digestibility (IED) of DM and CP of a sample of whole cottonseed was measured using in situ and rumen outflow rate techniques in three wethers cannulated in the rumen and duodenum. The microbial contamination of rumen incubated residues was corrected by a continuous rumen infusion of15NH3as microbial marker and rumen solid associated bacteria as reference sample. Microbial contamination resulted in an overestimation of the undegradable fraction of DM (0·291v. 0·275;P<0·05) and CP (0·071v. 0·037;P<0·01) and a small underestimation of ED of DM (0·500v. 0·512;P=0·09) and CP (0·755v. 0·779;P=0·052). A proportion of 0·1 of the ruminal undegraded CP was of microbial origin and for essential amino acids this proportion varied from 0·042 to 0·150. Differences in ED between amino acids modified the amino acid profile, with an important reduction (0·2;P<0·01) in the proportion of lysine. Apparent intestinal digestibility of the insoluble fraction of this food, measured with the mobile nylon bag technique, showed large reductions (P<0·001) with the increase of the ruminal incubation time between 0 and 72 h: from 0·392 to 0·026 for DM and from 0·851 to 0·099 for CP. These evolutions fitted an exponential function with a previous lag. The IED was estimated either by integration of these equations and those describing the ruminal degradation and rumen outflow or by incubation through the intestines of a sample pooled to be representative of rumen flow of the undegraded food. The two methods gave similar values for both DM (0·222v. 0·203) and CP (0·659v. 0·658).

[Posttraumatic pseudoaneurysm of the posterior cerebral artery]

We present the case of a traumatic posterior cerebral artery pseudoaneurysm of a 29-year-old man due to a penetrating stab wound to the brain. The patient was brought to the emergency room in coma. The neurological examination revealed a Glasgow Coma Scale Score of 8 and left hemiplegy. The initial CT scan showed right temporal lobe haemorrhage with penetration in the lateral ventricle and subarachnoid haemorrhage. The cerebral angiography performed after three weeks, revealed a high PCA pseudoaneurysm. After surgery, a pseudoaneurysm was demonstrated in the histological study.

Successful Kidney Transplantation Reduces Hyperplastic Parathyroid Gland

INTRODUCTION

In dialysis patients, the parathyroid glands (PTGs) may increase progressively, producing abnormal bone metabolism. Changes in PTG volume among patients with hyperplastic PTGs are not well known after kidney transplantation. This study investigated PTG volume by ultrasound (US).

METHODS

US of PTG was performed immediately (US-0) and 12 months after (US-12) transplantation to identify glands in all recipients. We calculated the percentage reduction in PTG volume (R%PTG). We declared it significant when it was > or =35%. Bone biochemical markers and renal function were recorded sequentially.

RESULTS

Among engrafted patients, parathyroid US-0 was performed in 47 and US-0 and US-12 in 36. Some visible gland was observed upon US-0 in 13 recipients, a group that showed higher pretransplantation parathyroid hormone (PTH) levels than the remaining 34 patients with no visible glands (627 +/- 360.0 vs 280 +/- 240.9 pg/mL; P < .05). Of 36 recipients with US-0 and US-12, the baseline study identified PTGs in 12 patients (p+ group), while the remaining 24 had no identified glands (p- group). In the p+ group, no PTG, at US-12 were visible in four patients, and a significant R%PTG was observed in three at this time, representing a reduction in gland volume after transplantation among 58.3% of p+ patients. There was a progressive reduction in PTH among both groups. Patients with glandular volume reduction displayed better renal function: serum creatinine 1.7 +/- .79 versus 2.9 +/- .74 mg/dL (P < .05).

CONCLUSIONS

Transplantation reversed hyperparathyroidism and PTG volume among recipients who achieved nearly normal renal function.

[Heparin immune thrombocytopenia in a hemodialysis patient. A case report. Literature review]

Heparin-induced thrombocytopenia (HIT) is an important side effect of heparin therapy associated with significant morbidity and mortality if unrecognized. The platelet count typically falls below 150,000/ll 5-14 days after heparin is started. Thrombosis is the major clinical complication. We present the case gives a patient that develops a deep vein thrombosis ilio-femoral left, with trombocytopenia, one week after beginning treatment with haemodialysis in which Ac anti heparin is detected by test PaGIA (Particle Gel Inmuno Assay.

Analysis of accident inequality of the Spanish fishing fleet

There is at present a clear tendency to consider safety as a vital factor in the running of a country's fishing sector. However, the planning of the necessary resources and their adequate distribution according to the sector's needs is only possible if detailed information is available about the degree of concentration of the accidentality of that sector. In this context, the aim of this work is two-fold: firstly, to formalise a methodology for the fishing sector of a country which allows the inequality in the concentration of accidents to be analysed; and secondly, to apply this methodology to the Spanish fishing fleet for the period 1994-2002. Thus, indices are built by regions and by types of vessel for two variables: fishermen and vessels. Results are obtained both for the inequality in the concentration of accidents and their associated Lorenz curves and for the rates and elasticities of fishing sector accidents.

In situ study of the relevance of bacterial adherence to feed particles for the contamination and accuracy of rumen degradability estimates for feeds of vegetable origin

An in situ study was conducted on four rumen-cannulated wethers to determine (using (15)N infusion techniques) the microbial contamination (mg bacterial DM or crude protein (CP)/100 mg DM or CP) and the associated error on the effective degradability of fourteen feeds: barley and maize grains, soyabean and sunflower meals, full-fat soyabean, maize gluten feed, soyabean hulls, brewers dried grains, sugarbeet pulp, wheat bran, lucerne and vetch-oat hays, and barley and lentil straws. The DM or CP contamination in residues (M) fitted to single exponential or sigmoid curves. A general model (M=m (1-e(-ft) ) (j)) was proposed to match this fit. Asymptotic values (m) varied from 2.84% to 13.3% and from 2.85% to 80.9% for DM and CP, respectively. Uncorrected results underestimated the effective degradability of both DM (P<0.05) and CP (P<0.01). For CP, this underestimation varied from 0.59 % to 13.1%, with a higher but unascertainable error for barley straw. Excluding maize grain, the microbial contamination of both DM and CP, and the associated underestimation of the effective degradability of CP, were positively related to the cellulose content of the feed. The error in the effective degradability of CP was also negatively related to the CP content and its apparent effective degradability (R(2) 0.867). This equation allows easier and more accurate estimates of effective degradability, needed to improve protein-rationing systems.

[Degree of public awareness regarding intensive care units (ICUs) and intensive care physicians in Castilla y León]

AIM

To determine degree of public awareness regarding the activities and health care professionals that comprise intensive care units (ICUs) in the autonomous community of Castilla y León.

DESIGN

Questionaire in the form of a true-false test dealing with a) description of an ICU; b) description of ICU patients, and c) degrees and qualifications held by ICU physicians.

LOCATION

Waiting rooms of outpatient clinics and ICUs of 9 hospitals in Castilla y León.

SUBJECTS AND METHODS

During the period from 1 October 2003 to 29 February 2004, there were surveyed a group of those persons accompanying outpatients arriving for appointments (OP, n = 2,293), and a group comprised of relatives of ICU patients (ICU, n = 727) upon discharge from the ICU.

RESULTS

The average age of those subjects surveyed was 45.6 years old. 62.1% were women and 52.8% had received education through secondary level or higher. Of the 1,354 analyzed OP questionnaires, 27.7%, 25.5% and 48.4% responded correctly to questions A, B and C, respectively. Of the 284 analyzed ICU questionnaires, 38.6%, 41.0%, and 63.5% responded correctly to questions A, B and C, respectively. Differences between results from the two surveyed groups were statistically significant, and the best results from the ICU group were found among those subjects whose family members had remained in ICU for 2 days or more.

CONCLUSIONS

In the described scope, of the citizens of Castilla y León, 27.7% know as it is a ICU, 25.5% know what type of patients usually is entered there, and 48.4% recognize their doctors like ICU specialists specifically. These knowledge improve significantly after having some relative entered in ICU for more than 2 days.

[Storage of antibiotics in Spanish households]

This study aimed to determine how many antibiotics were stored in Spanish households, analyzing their origin and characteristics (number, antibiotic type and pharmaceutical form). In addition, some general characteristics of the "home medicine cabinet" were investigated. The study was conducted by telephone interviews with one of the heads of the family in 1,000 randomly chosen Spanish homes, but in accordance with a territorial distribution proportional to the Spanish population and to the urban and rural setting. According to the results obtained, there was at least one antibiotic packet in 37% of Spanish households, mostly corresponding (96.5%) to broad-spectrum semisynthetic penicillin (amoxycillin or clavulanic-amoxycillin). A total of 59.2% of the packets found corresponded to solid oral forms (tablets, capsules, etc.) and 40.4% corresponded to liquid oral forms (syrup, suspension, sachet). The antibiotics were mostly obtained by medical prescription (84.9%), self-medication being the origin in almost 15% of them. There was a member of the family under antibiotic treatment at the time of the study in only 30% of the households that had one or more containers. The financial evaluation of the "leftover" antibiotic doses makes it possible to estimate a cost of about 18 million euros, more than 12 million of which would have been financed by the Health Care Administration. The results show that storing of antibiotics continues to be important in Spain, even though a considerable decrease has been observed in the last 10 years. This could be related to a progressive abandonment of self-medicating attitudes.

Epidemiology of transfusion-transmitted infections among multi-transfused patients in seven hospitals in Peru

BACKGROUND

Transfusion-transmitted infections (TTIs) constitute a major health problem worldwide where routine screening of blood or blood products is improperly done, and where non-medical injecting medications and/or drug use are prevalent. Prevalence and risk factors vary by geographic location and by the specific TTI (including HIV-1, HBV, HCV and HTLV-I).

OBJECTIVE

To determine the prevalence and risk factors associated with TTIs among a sample of multi-transfused adult patients in Peru.

STUDY DESIGN

A cross-sectional multi-center study was conducted across seven major hospitals in Peru from February 2003 to September 2004. Self-reported behavior information (medical procedures, number of sexual partners, and drug use history) was analyzed, along with a review of exposure history from hospital medical records. Prevalences were calculated by TTI for different exposures, along with unadjusted and adjusted odds ratios for infection risk.

RESULTS

Overall, 192 (54.7%) of 351 multi-transfused patients were found infected with one or more TTIs. Number of transfusion units, years of transfusion history (6 or more), and number of treatment facilities (2 or more) were associated with HCV infection. Hemodialysis history was a common risk factor associated with HBV, HCV and HTLV-I infection. HIV infection was associated only with total number of transfusion units received.

CONCLUSIONS

High prevalences of HBV and HCV infection were found among Peruvian multi-transfused patients and were associated with a past history and number of blood transfusions, as well as with past hemodialysis procedures. TTIs continue to represent a significant public health problem in Peru. Continued vigilant attention to blood safety procedures, including universal screening and health care provider education, is recommended.

Acute and persistent iatrogenic Cushing's syndrome after a single dose of triamcinolone acetonide

Iatrogenic Cushing's syndrome is a well-known adverse effect of glucocorticoids. It usually develops after prolonged exposure to excessive amounts of synthetic glucocorticolds. The development of iatrogenic Cushing's syndrome (ICS) after a single and low dose of synthetic glucocorticoid is an exceptional event. Up to now, only a few number of cases have been associated with triamcinolone acetonide and they have always been related to local administration. We report, for the first time, a patient who developed ICS after a single low dose of parenterally (im) administered triamcinolone acetonide. She was a 45-yr-old woman who referred to us because of cushingoid appearance, whose hormonal determinations were suggestive of secondary adrenal insufficiency. Clinical features were developed one month after the administration of a 40 mg single-dose of im triamcinolone acetonide because of acute laryngitis. Endocrinological evaluation confirmed the hypothalamic-pituitary-adrenal (HPA) axis suppression. Eight months later, cushingoid phenotype had completely disappeared and HPA function had spontaneously recovered. We review clinical features and comment on the possible pathogenic mechanisms of this particular and new form of ICS.

Crossover from the Luttinger-liquid to Coulomb-blockade regime in carbon nanotubes

We develop a theoretical approach to the low-energy properties of one-dimensional electron systems aimed to encompass the mixed features of Luttinger-liquid and Coulomb-blockade behavior observed in the crossover between the two regimes. For this aim, we extend the Luttinger-liquid description by incorporating the effects of a discrete single-particle spectrum. The intermediate regime is characterized by a power-law behavior of the conductance, but with an exponent oscillating with the gate voltage, in agreement with recent experimental observations. Our construction also accounts naturally for the existence of a crossover in the zero-bias conductance, mediating between two temperature ranges where the power-law behavior is preserved but with a different exponent.

Abnormalities in the bone mineral metabolism in HIV-infected patients

OBJECTIVE

To evaluate bone mineral metabolism in HIV infected and asymptomatic patients receiving highly active antiretroviral therapy (HAART) containing protease inhibitors (PI) and naïve patients.

METHODS

We studied 30 asymptomatic HIV infected male patients, 13 in the naive group and 17 in the IP group, both without differences in demographics characteristics. We excluded women and patients with any known factor associated to osteopenia. We did a nutritional questionnaire, a DEXA scan in lumbar spine and femur, a study of CD4 lymphocytes, viral load and an analysis of bone formation and resorption markers in all patients. We compared vitamin D and PTH levels with a control group of healthy male volunteers age-pareated. For the statistical analysis we used the SPSS program.

RESULTS

Osteopenia was present in 17/30 (57%), 8/13 (61.5%) in the naïve group and 9/17 (53%) in the PI group (not significant differences). We found a vitamin D deficiency in 86% of patients, with mean serum levels that was found to be significantly lower than those from a healthy control group (p=0.04). Testosterone level was significantly related to bone mineral density in lumbar spine (p</=0.05).

CONCLUSIONS

HIV may be an individual risk factor in bone disorders, requiring calcium and vitamin D supplementation.

Infección bacteriémica por Nocardia otitidiscaviarum: revisión a propósito de un caso

We present a case of bacteremic pneumonia caused by Nocardia otitidiscaviarum in a corticodependent COPD. Blood and sputum cultures on Mycobacterial media were positives and identification was done using 16S rDNA sequencing. In this article we review the most relevant communications about Nocardia spp infection and study the strain susceptibility using E-test.

Histopathological Classification of Lesions associated with Natural Paratuberculosis Infection in Cattle

Paratuberculosis-associated lesions in 116 naturally infected adult cows, with or without clinical signs, were classified histopathologically. Tissue samples obtained focused on gut-associated lymphoid tissue. Lesions were divided into five categories. Focal lesions (n=68 cases), consisted of small granulomas in the ileal and jejunal lymph nodes or the ileocaecal lymphoid tissue. In the multifocal type (n=13 cases), small granulomas or scattered giant cells appeared in some intestinal villi, as well as in the lymph nodes. Diffuse multibacillary lesions (n=15 cases), associated with severe granulomatous enteritis affecting different intestinal locations and lymph nodes, were formed by macrophages containing large numbers of acid-fast bacilli. In diffuse lymphocytic lesions (n=3 cases), lymphocytes were the main inflammatory cells, with some macrophages or giant cells containing few if any mycobacteria. In diffuse intermediate forms (n=17 cases), the infiltrate was formed by abundant lymphocytes and macrophages, and mycobacteria were present to varying degrees related to the number of macrophages. Clinical signs and gross lesions were mainly associated with diffuse forms. Thickening of the intestinal wall, which was the most common macroscopical finding, was related to the degree of submucosal change. Mycobacterium avium subsp. paratuberculosis was identified by culture or PCR in all cows with diffuse lesions, and in 55.5 and 37% of those with multifocal or focal forms, respectively. The importance of sampling the ileal and caudal jejunal lymph nodes to find histological lesions of paratuberculosis in cattle is emphasized.

[Clinical and epidemiologic analysis of intestinal tract colonization with vancomycin-resistant enterococci in an intensive care unit]

Intestinal tract colonization with vancomycin resistant enterococci (VRE) was studied during five months and 25 days. Out of 171 patients hospitalized in the intensive care unit, 124 (73%) were included in this study. Thirty five of them (28%) were recognized as colonized with VRE. VRE isolates (n = 35) were identified as Enterococcus faecium (n = 18), Enterococcus gallinarum (n = 16), and Enterococcus raffinosus (n = 1). All of them were resistant to vancomycin (MIC90 = 512 microg/ml) and to teicoplanin (MIC90 = 32 microg/ml), having the vanA gene. By means of molecular methods a high homology was found among E. faecium and E. gallinarum isolates, respectively, suggesting their spread as a kind of outbreak. No significant differences in age or sex were found among colonized and non-colonized patients (p > 0.05). On the other hand, the hospitalization time and the use of broad-spectrum antibiotics were associated with colonization. From this study we highlight the importance of enhancing all measures of control and prevention of hospital infections, carefully analyzing the empiric antimicrobial schemes, trying to reduce the hospital stage, and following the surveillance to evaluate the efficacy of such procedures.

GMR effect in CuCo annealed melt-spun ribbons

A thorough microstructural and magnetic analysis has been performed on as-quenched and annealed (475 and 525 degrees C, 1 hour) melt-spun Cu100-xCox (x = 10 and 15) granular alloys, presenting a giant magnetoresistance (GMR) effect. The annealed samples are inhomogeneous with respect to the Co-particle sizes and interparticles distances and, therefore, these particles present superparamagnetic and ferromagnetic behaviours, which determine the GMR response. The samples x = 15, treated at 525 degrees C during 1 hour, presented the best GMR ratio (approximately 5% at room temperature to be the highest value approaching roughly to the saturation under an applied magnetic field of 15 KOe), with the coexistence of Co-particles with both kinds of magnetic behaviour.

Estudio de injertos óseos vascularizados en el tratamiento de pseudoartrosis de escafoides, mediante RMN tras inyección de gadolinio

Se presenta la experiencia obtenida con injerto óseo vascularizado dependiente de la arteria del cuarto compartimento extensor de radio distal en siete pacientes con pseudoartrosis de escafoides. 5 de ellos presentaban necrosis avascular del polo proximal. Se realiza un RMN con inyección de gadolinio en 6 casos, comprobándose revascularización del escafoides en 5 casos. Se describe la técnica quirúrgica y se discuten las indicaciones.

Fenticonazole nitrate for treatment of vulvovaginitis: efficacy, safety, and tolerability of 1-gram ovules, administered as ultra-short 2-day regimen

Because of its potential as a low cost first-line monotherapy for the most common vulvovaginal infections, we evaluated fenticonazole nitrate in a prospective, open-label, multicenter pilot study with 101 sexually active women (per-protocol; 16 to 61 years of age) with vulvovaginitis involving single or mixed infections with Candida albicans, Trichomonas vaginalis, and/or Gardnerella vaginalis. Fenticonazole nitrate (1 g) was administered as vaginal ovules, once daily on days 1 and 3. Eradication (direct phase-contrast microscopy of vaginal swabs and/or microbiological culture) on day 8 was 90% (C. albicans, 26/29, p < 0.001), 70% (T. vaginalis, 7/10, p = 0.161), 67% (G. vaginalis, 22/33, p < 0.009), and 45% (mixed infection, 13/29, p = 0.001). After 28 days, relapse was 0% for candidiasis and trichomoniasis, 27% (6/22) for G. vaginalis, and 23% (3/13) for mixed infection. Overall, eradication of all offending pathogens was achieved in 67% of the total per-protocol population, with a relapse rate of only 16%. Score sums for symptoms improved from 7.0 (baseline) to 1.7 (day 8), and 0.71 (day 28), (p < 0.001). Treatment was safe and well tolerated. The results of our pilot study suggest that application of fenticonazole nitrate 1 g intravaginal ovules on 2 alternate days is a suitable first-line treatment of vulvovaginitis with acceptable broad-spectrum efficacy against the most commonly involved pathogens and with a low rate of early relapse, reserving antibiotics for patients with treatment failure or relapse of infection. Our results should encourage further examination of this approach in larger and well controlled clinical trials.

Policosanol prevents bone loss in ovariectomized rats

Osteoporosis is characterized by reduced bone mass, abnormal bone architecture and increased fracture risk. Ovariectomy impairs bone mass and metabolism in rats and ovariectomized rats are considered as a suitable model of postmenopausal osteoporosis. Mevalonate is required for producing lipoids that are important in osteoclast activity and thus drugs affecting mevalonate production can prevent bone loss in rodents. Policosanol is a cholesterol-lowering drug isolated from sugar cane wax that inhibits cholesterol biosynthesis through an indirect regulation of hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase activity. The purpose of this study was to determine whether policosanol could prevent bone loss in the bones of ovariectomized rats by comparing its effects with those induced by estradiol. Sprague Dawley female rats were randomly distributed in four groups: a sham-operated group treated with Tween/H2O vehicle and three groups of ovariectomized rats treated with 17beta-estradiol (30 microg/kg/day) or policosanol (50 and 200 mg/kg/day), respectively, for 3 months. At treatment completion the rats were sacrificed, their bones removed and variables of bone resorption and formation were investigated by histomorphometry. Ovariectomy increased trabecular separation but diminished the number and thickness of trabecules. Estradiol and policosanol prevented these effects compared with ovariectomized controls. Both treatments also prevented an increase in the number of osteoclasts and their surface area induced by ovariectomy. Estradiol, but not policosanol, significantly prevented an increase of osteoblast surface area compared with ovariectomized controls. In conclusion, policosanol prevented bone loss and decreased bone resorption in ovariectomized rats, suggesting that it should be potentially useful in preventing bone loss in postmenopausal women.

Effects of chronic administration of D-003, a mixture of sugar cane wax high molecular acids, in beagle dogs

D-003 is a mixture of high molecular weight aliphatic primary acids purified from sugar cane wax (Saccharum officinarum, L) with cholesterol-lowering and antiplatelet effects. Previous studies, including a 6-month study conducted in rats, have shown no D-003-related toxicity. The present study was undertaken to investigate the effects of D-003 orally administered for 9 months in beagle dogs. The animals were randomly distributed in three groups: a control group receiving the vehicle only and two groups orally administered D-003 (200 and 400 mg/kg). Body weight gain, food consumption and clinical signs were controlled throughout the study. The effects of D-003 on collagen-induced platelet aggregation, bleeding time (BT) and coagulation parameters (prothrombin time and kaolin-activated thromboplastin time) were also investigated. Most blood biochemistry and hematological parameters were assessed at baseline and after 6 and 9 months of treatment, while total cholesterol (TC), triglycerides, platelet aggregation, BT and coagulation parameters were determined at baseline and after 9 months of treatment. At study completion, the animals were sacrificed. D-003 at a dose of 200 and 400 mg/kg significantly reduced TC (p < 0.05), significantly inhibited platelet aggregation and increased BT compared with levels in controls. Data analyses of body weight gain, food consumption, clinical observations, the remaining blood biochemistry and hematology indicators (including coagulation parameters, organ weight ratios and histopathological findings) showed no trends with D-003 doses or significant differences between control animals and treated groups. In conclusion, D-003 administered for 9 months to beagle dogs induced the expected effects with no evidence of drug-related toxicity.

Consensus conference on chronic viral hepatitis and HIV infection: updated Spanish recommendations

Chronic hepatitis B and C represent a leading cause of morbidity and mortality among human immunodeficiency virus (HIV)-infected patients worldwide. New treatment options against both hepatitis B (HBV) and C (HCV) viruses have prompted us to update previous recommendations for the management of coinfected individuals. Fifteen topics (nine related to HCV, five to HBV and one to both viruses) were selected for this purpose. A panel of Spanish experts in the field was invited to review these areas and propose specific recommendations, which were scored according to the Infectious Disease Society of America (IDSA) grading system. These guidelines represent a comprehensive and updated overview on the management of hepatitis B and C in HIV-infected patients.

Study of resistance to anti-tuberculosis drugs in five districts of Equatorial Guinea: rates, risk factors, genotyping of gene mutations and molecular epidemiology

SETTING

Five districts in Equatorial Guinea, March 1999 to February 2001.

OBJECTIVES

To determine tuberculosis drug resistance among new and previously treated cases, the risk factors associated with resistance, and the mutations associated with isoniazid and rifampicin (katG, inhA and rpoB genes) resistance, and to genotype resistant strains.

RESULTS

A positive culture identified as Mycobacterium tuberculosis complex was obtained in 240/499 patients. Susceptibility testing was performed in 236 strains. The overall resistance rate in new cases was 16.9% compared to 41.6% in previously treated cases. Isoniazid resistance was the most frequent (respectively 12.5% and 16.6%) in the two groups, while multidrug resistance was observed in 1.7% and 25% of new and previously treated cases, respectively. Female sex was statistically associated with resistance in new cases. Of 41 isoniazid-resistant strains, 33 (80.5%) had mutations in the inhA gene; none had mutations in the katG gene and eight had no mutations in either gene. All strains had low-level isoniazid resistance. Of eight strains resistant to rifampicin, six had mutations in the rpoB gene. Genotyping defined seven clusters.

CONCLUSIONS

Moderate resistance was found in new cases. Low-level isoniazid resistance predominated among mutations in the inhA gene, with a high percentage of clustering in resistant strains.

[Spontaneous spinal epidural hematomas: review of 8 cases]

INTRODUCTION

Spontaneous spinal epidural hematoma is a rarely occurring condition. The clinical importance of compressive spinal hematoma is due to its acute and progressive course that can lead to permanent and irreversible neurological deficits if not treated early. Clinical presentation is characterized by acute radicular pain followed by cord compression syndrome.

METHODS

We review eight cases of spontaneous spinal epidural hematomas diagnosed in our neurosurgical service in the last 16 years. Attention was focused on gender, age, medical history, level of the hematoma, preoperative neurological condition, operation interval and postoperative results.

RESULTS

The median age of patients was 63.5 years. A total of five patients were female and three male. The most frequently described symptoms before admission were acute vertebral pain followed by cord compression syndrome. In the MRI, six cases were isointense in T1-weighted images and hyperintense in T2-weighted images. In seven patients a laminectomy with clot removal was performed.

CONCLUSIONS

The most important prognostic factors for recovery after spontaneous spinal epidural hematoma are the level of preoperative neurological deficit and the time to surgical operation.

[Clinical complications in a series of patients with anticardiolipin antibodies]

An analysis was made of clinical complications, determined with objective methods, in 68 patients at the University Clinic of Navarra with the clinical suspicion of antiphospholipid syndrome (APS) and presence of anticardiolipin antibodies (ACA). Patients with IgG higher than 23 GPL were considered for the study. The most prevalent pathology was thrombosis: venous thrombosis (42.6%) and arterial thrombosis (22%). Other complications were abortions (23.8% of the 42 women) and thrombocytopenia (12.1%). With respect to the localisation of venous thrombosis, predominance corresponded to lower extremities (51.7%), followed by superficial thrombophlebitis (27.5%) and pulmonary thromboembolism (20.6%). Among the arterial complications, the most frequent were cerebrovascular disease (86.6 %) and coronary disease (13.4%). There was no correlation between the presence of high values of ACA and the prevalence or severity of clinical manifestations. In the series of patients with ACA IgG>23 GPL, we appreciated a high percentage of venous and arterial thrombosis detected with objective methods. The presence of ACA constitutes a prothrombotic risk factor

Insulating, superconducting, and large-compressibility phases in nanotube ropes

The superconducting properties of carbon nanotube ropes are studied using a new computational framework that incorporates the renormalization of intratube interactions and the effect of intertube Coulomb screening. This method allows one to study both the limits of thin and thick ropes ranging from purely one-dimensional physics to the setting of 3D Cooper-pair coherence, providing good estimates of the critical temperature as a function of the rope physical parameters. We discuss the connection of our results with recent experiments.