Epidemiological and clinical characteristics of occult bacteremia in an adult emergency department in Spain: influence of blood culture results on changes in initial diagnosis and empiric antibiotic treatment

A prospective study was carried out to analyze the usefulness of blood culture results for adult patients who were discharged from the emergency department with bacteremia. Over a 29-month period, 110 patients with significant bacteremia who were seen in the emergency department and discharged home were studied. The mean age of the patients was 61.8 years. The most frequent initial major diagnosis was urinary tract infection (UTI) (n=63; 57.3%). Gram-negative organisms were isolated in 79 (71.8%) cases. A change in diagnosis (44.5% cases) was more common when the initial diagnosis was something other than UTI or when empiric antimicrobial therapy was ineffective or was not given (P<0.001). The significant predictors of modification of the initial empiric antibiotic therapy were ineffective empiric antimicrobial therapy and transfer of the patient from the emergency department to an infectious diseases outpatient clinic (P=0.01). Blood culture results may be useful for achieving the correct diagnosis in adult patients with bacteremia and for guiding treatment in the subsequent management of outpatients.

Characterization of Candida albicans orthologue of the Saccharomyces cerevisiae signal-peptidase-subunit encoding gene SPC3

The Candida albicans orthologue of the SPC3 gene, which encodes one of the subunits essential for the activity of the signal peptidase complex in Saccharomyces cerevisiae, was isolated by complementation of a thermosensitive mutation in the S. cerevisiae SEC61 gene. The cloned gene (CaSPC3) encodes a putative protein of 192 amino acids that contains one potential membrane-spanning region and shares significant homology with the corresponding products from mammalian (Spc22/23p) and yeast (Spc3p) cells. CaSPC3 is essential for cell viability, since a hemizygous strain containing a single copy of CaSPC3 under control of the methionine-repressible MET3 promoter did not grow in the presence of methionine and cysteine. The cloned gene could rescue the phenotype associated with a spc3 mutation in S. cerevisiae, indicating that it is the true C. albicans orthologue of SPC3. However, in contrast with results previously described for its S. cerevisiae orthologue, CaSPC3 was not able to complement the thermosensitive growth associated with a mutation in the SEC11 gene. The heterologous complementation of the sec61 mutant suggests that Spc3p could play a role in the interaction that it is known to occur between the translocon (Sec61 complex) and the signal peptidase complex, at the endoplasmic reticulum membrane.

Striatal dopamine D2 receptor density in neuroleptic-naive and in neuroleptic-free schizophrenic patients: an 123I-IBZM-SPECT study

Most post-mortem autoradiographic studies have described striatal dopamine D(2) receptor up-regulation due to chronic neuroleptic exposure. The aim of our study was to compare in-vivo striatal D(2) receptor density in neuroleptic-naive and neuroleptic-free schizophrenic patients. We included 28 young (mean age: 28+/-8 years) acute psychotic patients meeting DSM-IV criteria for schizophrenia or schizophreniform disorder. Enrolled patients were either first-episode neuroleptic-naive (n=12) or neuroleptic-free (n=16) after a minimum washout period of 7 days. All neuroleptic-free subjects had previously received neuroleptic treatment for a median period of 3.5 years. Both groups were evaluated using standard clinical scales. In-vivo striatal D(2) receptor binding was assessed by basal ganglia/frontal cortex ratios using (123)I-IBZM SPECT. No statistically significant differences were found in age or clinical assessment between neuroleptic-naive and neuroleptic-free schizophrenic patients. No differences were found in the basal ganglia/frontal cortex ratios of neuroleptic-naive (1.78+/-0.11) and neuroleptic-free (1.81+/-0.15) patients. No striatal uptake laterality was observed in either group. No correlation was demonstrated between BG/FC ratios and duration of illness, period of neuroleptic exposure or time of drug washout. We conclude that our neuroleptic-naive and neuroleptic-free schizophrenic patients did not show differences in striatal D(2) receptor binding, suggesting that IBZM-SPECT fails to detect D(2) receptor up-regulation induced by chronic exposure to neuroleptic drugs.

Publication of European Union Research on Infectious Diseases (1991?2001): A Bibliometric Evaluation

The study presented here analyzed the contents of 36 international infectious diseases journals from 1991 to 2001 to determine the number of reports prepared by authors in the European Union and to compare the per country scientific productivity. Articles included in the study were identified using the PubMed website. The number of publications in infectious disease journals produced by authors in the European Union experienced an exponential growth from 461 (19.2% of world production) in 1991 to 2,401 (35.9%) in 2001. The mean impact factor increased from 2.259 in 1991 to 3.001 in 2001. The leading countries in the total number of publications were the UK, France, and Germany. After taking population figures into account, Sweden, Denmark, and Finland headed the list, and after correcting for gross domestic product, the greatest producers were Sweden, Finland, and the UK. Overall, the scientific production and repercussion index of European Union research on infectious diseases experienced a notable rise during the last decade of the 20th century.

Successful use of tissue plasminogen activator in catheter-related intracardiac thrombus of a premature infant

The incidence of clinically apparent neonatal thrombosis is about 0.1 to 0.2% in the neonatal intensive care unit (NICU). The optimal treatment modalities for neonates with thromboses are not known. We report on our experience with recombinant tissue type plasminogen activator (rt-PA) in a premature infant with an intracardiac thrombus.

Measuring the core features of personality disorders in substance abusers using the Temperament and Character Inventory (TCI)

Personality disorders (PDs) are still classified through categorical taxonomies that are at odds with current research findings. Dimensional models provide a suitable alternative for measuring individual differences. However, as they have traditionally lacked a clear definition of the "disorder" construct, the clinical utility of these models has been limited. This study tests whether Cloninger's dimensional model is able to capture two domains: the features that differentiate PD subtypes from each other and the common core features underlying all PDs. Seventy-four drug dependent patients were independently assessed using the SCID-II and Cloninger's TCI. There was a slight relationship between TCI temperament dimensions and the DSM personality disorder subtypes, but the association was not specific enough to allow differential diagnosis. The character dimension Self-Directedness was strongly associated with the presence and severity of all PDs, irrespective of subtype, correctly classifying 77% of subjects. Character dimensions are a reliable, valid and low-cost tool for detecting PDs in drug abusers and may help to provide an operational definition of the common core features underlying all PDs.

Determinant parameters and components in the storage of virgin olive oil. Prediction of storage time beyond which the oil is no longer of "extra" quality

This work studies the changes in the quality indices standardized by the European Union, together with the evolution of the oxidative stability and sterols, polyphenols, alpha-tocopherol, pigments, and fatty acids contents throughout the storage of Picual and Hojiblanca olive cultivar "extra" virgin olive oils at 2 degrees C + darkness and 30 degrees C + illumination. Only two quality indices (K(270) and sensory evaluation) indicate the loss of the extra quality of the oil during storage, and there is an excellent correlation between initial stability and the time to reach the limit of K(270) > 0.25 (after which the oil quality is no longer of "extra" quality). This time can be predicted with an error of <10%, which is of great commercial interest and previously unknown. Also unknown until now is that the changes in polyphenols, pigments, and alpha-tocopherol with storage time follow first-order kinetics.

Cloning and sequence analysis of the LEU2 homologue gene from Pichia anomala

The Pichia anomala LEU2 gene (PaLEU2) was isolated by complementation of a leu2 Saccharomyces cerevisiae mutant. The cloned gene also allowed growth of a Escherichia coli leuB mutant in leucine-lacking medium, indicating that it encodes a product able to complement the beta-isopropylmalate dehydrogenase deficiency of the mutants. The sequenced DNA fragment contains a complete ORF of 1092 bp, and the deduced polypeptide shares significant homologies with the products of the LEU2 genes from S. cerevisiae (84% identity) and other yeast species. A sequence resembling the GC-rich palindrome motif identified in the 5' region of S. cerevisiae LEU2 gene as the binding site for the transcription activating factor encoded by the LEU3 gene was found at the promoter region. In addition, upstream of the PaLEU2 the 3'-terminal half of a gene of the same orientation, encoding a homologue of the S. cerevisiae NFS1/SPL1 gene that encodes a mitochondrial cysteine desulphurase involved in both tRNA processing and mitochondrial metabolism, was found. The genomic organization of the PaNFS1-PaLEU2 gene pair is similar to that found in several other yeast species, including S. cerevisiae and Candida albicans, except that in some of them the LEU2 gene appears in the reverse orientation.

[Influenza vaccination of human immunodeficiency virus-infected patients with severe immunodepression. Impact on CD4 lymphocytes and plasma viral load]

BACKGROUND

The aim of this study was to assess the effect of influenza vaccination on plasma HIV viral load and CD4 T-lymphocytes in patients with advanced HIV disease.

PATIENTS AND METHOD

Observational study carried out in HIV-infected patients with a CD4 cell count < 200 X 10(6)on highly active antiretroviral therapy(HAART). Influenza vaccine was voluntarily offered and plasma viral load and CD4 cell counts were measured at baseline, 4 weeks and 12 weeks in vaccinated and control subjects.

RESULTS

Sixteen patients were analysed, 10 of them being immunized with the influenza vaccine. A significant decline in CD4 cell counts at 4 and 12 weeks and an increasing trend of viral load were seen in all immunized patients who had a high viral load at the time of vaccination (n = 6), but not in those with an undetectable viral load. The mean decrease of CD4 T-lymphocytes in these 6 patients was 49.8%. Three patients showed a huge drop of the CD4 cell count (over 60% of baseline).

CONCLUSIONS

Influenza vaccination of severely immunocompromised HIV-infected patients who are failing to HAART might be associated with an immunological impairment.

Double-blind olanzapine vs. haloperidol D2 dopamine receptor blockade in schizophrenic patients: a baseline-endpoint

The aim of this study was to compare in vivo striatal D2 dopamine receptor occupancy induced by olanzapine and haloperidol in schizophrenic patients using a baseline-endpoint [(123)I]IBZM single photon computed emission tomography (SPECT) design. The relationships of striatal D2 receptor occupancy with clinical efficacy and extrapyramidal symptoms (EPS) were also assessed. Twenty-seven inpatients with schizophrenia or schizophreniform disorder were included in a 4-week prospective, randomized, double-blind, parallel and comparative clinical trial. Thirteen patients were treated with haloperidol (10 mg/day) and 14 with olanzapine (10 mg/day). Ratings of clinical status and EPS were obtained weekly. The percentage of D2 receptor occupancy was estimated by using basal ganglia (striatum)/frontal cortex IBZM uptake ratios obtained from each patient before and after 4 weeks of maintained antipsychotic treatment. Olanzapine led to a mean striatal D2 receptor occupancy of 49% (range 28-69%), which was significantly lower than that induced by haloperidol (mean 64%, range 46-90%). The baseline-endpoint SPECT design used in this study revealed lower antipsychotic D2 occupancy percentage values than those reported in the literature, using other approaches. The degree of striatal D2 receptor occupancy correlated to the EPS, which predominantly appeared in patients on haloperidol. No relationship was found between the striatal D2 receptor occupancy and clinical improvement. Olanzapine induced a lower striatal D2 occupancy than haloperidol. This low striatal D2 occupancy, together with the lower incidence of EPS in olanzapine-treated patients, contributed to confirm the atypical behavior of this new antipsychotic drug. Nevertheless, conclusions based on SPECT-estimated percentages of antipsychotic D2 occupancy should be cautious, since the SPECT design could influence the results. In this regard, SPECT studies including baseline and endpoint examinations should be encouraged.

Peroxisomal proliferation induced by treatment with clofibrate in a patient with a peroxisomal disease

The induction of peroxisomal proliferation in liver parenchymal cells of rats fed a diet containing clofibrate, a hypolipidemic drug, is a well-established event. However, the available data on human hepatocytes in vivo and in vitro indicate that agents that induce peroxisomal proliferation in rats and mice have no effect on human liver cells. The authors are reporting the case of a patient with clinical and laboratory diagnosis of X-linked-adrenoleukodystrophy. In an initial liver biopsy, a reduced volume fraction of peroxisomes was found (Vv. = .012) after a morphometric analysis, initiating treatment with clofibrate at a dose of 1.5 g/d. The administration of clofibrate was maintained for 7 yr. Liver biopsies were taken after 2, 4, and 7 yr, to follow the peroxisomal response. Results demonstrated a 500% increase in peroxisomal Vv. (.060) after 2 yr of treatment, compared with the pretreatment Vv. In subsequent biopsies, the peroxisomal Vv. value was maintained at 225 and 183% increases above the pretreatment biopsy (.027 and .022, respectively).

Are conjunctive inferences easier than disjunctive inferences? A comparison of rules and models

We report four experiments investigating conjunctive inferences (from a conjunction and two conditional premises) and disjunctive inferences (from a disjunction and the same two conditionals). The mental model theory predicts that the conjunctive inferences, which require one model, should be easier than the disjunctive inferences, which require multiple models. Formal rule theories predict either the opposite result or no difference between the inferences. The experiments showed that the inferences were equally easy when the participants evaluated given conclusions, but that the conjunctive inferences were easier than the disjunctive inferences (1) when the participants drew their own conclusions, (2) when the conjunction and disjunction came last in the premises, (3) in the time the participants spent reading the premises and in responding to given conclusions, and (4) in their ratings of the difficulty of the inferences. The results support the model theory and demonstrate the importance of reasoners' inferential strategies.

Psychometric properties of the Temperament and Character Inventory (TCI) questionnaire in a Spanish psychiatric population

OBJECTIVE

The psychometric properties of the Spanish version of Cloninger's Temperament and Character Inventory (TCI) were examined in a psychiatric population.

METHOD

Internal consistency, factor structure and concurrent validity were studied in a sample of 416 psychiatric patients.

RESULTS

A moderate to high internal consistency for all personality dimensions was found, except for Persistence. A confirmatory factor analysis of the TCI performed at the subscale level revealed an uncertain factor structure. However, when analysed separately, both the 11 temperament subscales (plus Persistence) and the 13 character subscales shaped four and three factors, respectively, in agreement with the biosocial model of personality. Finally, concurrent validity analyses were conducted using EPQ, SPSR and SSS questionnaires showing results consistent with theory.

CONCLUSION

The Spanish version of the TCI is a reliable and valid instrument, although the Persistence dimension might require further revision.

[Genotypic resistance to antiretroviral drugs in patients with therapeutic failure to highly active antiretroviral therapy]

BACKGROUND

To assess genotypic resistance mutations in patients with virological failure with highly active antiretroviral therapy (HAART) METHODS: Genotyping of reverse transcriptase (RT) and protease (PRO) HIV-1 genes were carried out in 33 adherent patients failing on HAART.

RESULTS

Resistance mutations were found in 32 of the 33; 27 of them (81.8%) being primary mutations: 26 (78.8%) in the RT gene and 60 (60.6%) in the PRO gene. Overall, 66.6% had genotypic resistance to two drugs and 60.6% showed resistance to drugs belonging to the two main classes of antiretroviral drugs. At the time of treatment failure, 72.7% had on their therapeutic regimen one antiretroviral drug to which they had resistance mutations, 48.5% had genotypic resistance to two drugs of the therapeutic regimen and 21.2% to three drugs.

CONCLUSIONS

Most adherent patients failing on HAART carry drug resistant genotypes. These patients may constitute a reservoir of multidrug resistant HIV that may limit treatment options in the future.

Relation of acidity and sensory quality with sterol content of olive oil from stored fruit

Composition of the sterol fraction, fatty acid, acidity, and the sensorial evaluation of virgin olive oils were studied in two eastern Spanish varieties grown and processed under the same conditions. Fruits were stored at 5 degrees C and ambient temperature for different times. During fruit storage, there was no significant variation (P = 0.05) in fatty acid composition. However, the sterol composition of the oil varied markedly (in particular, there was an increase in stigmasterol), acidity increased, and there was a very significant decrease in sensorial quality. The stigmasterol content presented a high correlation with the acidity and sensory evaluation (P < 10(-)(6)). The total sterol content increased gradually with olive storage time. Oils with stigmasterol greater than campesterol are graded to a low level (lampant). It is of interest that sensorial quality is revealed by stigmasterol content, a fact unknown until now.