Restoration of peristalsis in the esophagus of a patient diagnosed of achalasia

We report the case of a patient with dysphagia in whom a clinical and manometric follow-up was carried out. We initially observed a motor disorder of the esophageal spasm type. During manometric follow-up a progression to vigorous achalasia was observed. The patient was treated with pneumatic dilation, which obtained a good response to treatment. In manometries performed after treatment we observed a return of peristalsis in the distal esophageal body. Early treatment and short evolution of disease may allow peristalsis to recover in these cases. Peristalsis recovery casts new doubts on achalasia etiology.

Analysis of genetic heterogeneity of hepatitis C viruses in Central America reveals a novel genetic lineage. Brief report

Hepatitis C virus (HCV) has high genomic variability and at least six different types have been reported. The genotypes distribution is currently unknown among HCV strains circulating in Central America. In order to study the degree of genetic variability of strains isolated in Costa Rica, sequence data obtained from the 5' non coding region from 7 patients from Costa Rica were compared with published sequences from 57 strains of all types. The phylogenetic analysis revealed the existence of type 1 strains of a novel genetic lineage, recently described for some South American countries, and indicates an increasing diversification of HCV.

Malaria vectors in Bioko Island (Equatorial Guinea): PCR determination of the members of Anopheles gambiae Giles complex (Diptera: Culicidae) and pyrethroid knockdown resistance (kdr) in An. gambiae sensu stricto

Anopheles gambiae sensu lato Giles, 1902 and Anophelesfunestus Giles, 1900 are the main malaria vectors on the island of Bioko (Equatorial Guinea). This study was carried out to determine: a) members of the An. gambiae complex that may be present on the island of Bioko and, b) the sensitivity of An. gambiae sensu stricto to pyrethroids. The analysis by PCR detected the presence of An. gambiae s.s. as the major vector of the complex and the "forest chromosomal form" was demonstrated by cytogenetic analysis. The presence of Anopheles melas in the southwest, north and southeast of the island justifies its study as a vector. The molecular characterization of pyrethroid knockdown resistance (kdr) showed that the populations of An. gambiae s.s. were sensitive and no mutations were found. This fact justifies the implementation on a large scale of pyrethroid-impregnated bednets within the framework of the Malaria Control Program of Equatorial Guinea.

The initial inositol 1,4,5-trisphosphate response induced by histamine is strongly amplified by Ca(2+) release from internal stores in smooth muscle

We have studied the Ca(2+)-dependence and wortmannin-sensitivity of the initial inositol 1,4,5-trisphosphate (Ins(1,4,5)P(3)) response induced by activation of either histamine or muscarinic receptors in smooth muscle from guinea pig urinary bladder. Activation of H(1) receptors with histamine (100 microM) produced a significant elevation in Ins(1,4,5)P(3) levels with only 5s stimulation and in the presence of external Ca(2+). However, this response was abolished fully by either the prolonged absence of external Ca(2+) or the depletion of internal Ca(2+) stores with thapsigargin (100nM) or ryanodine (10 microM). In contrast, the same conditions only slightly reduced the initial Ins(1,4,5)P(3) response induced by carbachol. The prolonged incubation of smooth muscle in 10 microM wortmannin to inhibit type III PI 4-kinase abolished both the early histamine-evoked Ins(1,4,5)P(3) and Ca(2+) responses. Conversely, wortmannin did not alter Ca(2+) release induced by carbachol, despite a partial reduction of its Ins(1,4,5)P(3) response. Collectively, these data indicate that the detectable histamine-induced increase in Ins(1,4,5)P(3) is more the consequence of Ca(2+) release from internal stores than a direct activation of phospholipase C by H(1) receptors. In addition, the effect of wortmannin implies the existence of a Ca(2+)-dependent amplification loop for the histamine-induced Ins(1,4,5)P(3) response in smooth muscle.

Experimental inoculation of conventional pigs with porcine reproductive and respiratory syndrome virus and porcine circovirus 2

Postweaning multisystemic wasting syndrome (PMWS) is a disease of nursery and fattening pigs characterized by growth retardation, paleness of the skin, dyspnea, and increased mortality rates. Porcine circovirus 2 (PCV2) has been demonstrated to be the cause of PMWS. However, other factors are needed for full development of the syndrome, and porcine reproductive and respiratory syndrome virus (PRRSV) infection has been suggested to be one of them. Twenty-four conventional 5-week-old pigs were distributed in four groups: control (n = 5), PRRSV inoculated (n = 5), PCV2 inoculated (n = 7), and PRRSV and PCV2 inoculated (n = 7). The two groups inoculated with PRRSV showed growth retardation. Pigs inoculated with both PRRSV and PCV2 had increased rectal temperature. One of these pigs developed wasting, had severe respiratory distress, and died. The most important microscopic lesion in pigs inoculated with PCV2 was lymphocyte depletion with histiocytic infiltration of the lymphoid organs, more severe and in a wider range of tissues in doubly inoculated pigs. Interstitial pneumonia was observed in the three inoculated groups. PCV2 nucleic acid was found by in situ hybridization in larger amounts and in a wider range of lymphoid tissues in PRRSV- and PCV2-inoculated than in PCV2-inoculated pigs. TaqMan PCR was performed to quantify the PCV2 loads in serum during the experiment. PCV2 loads were higher in doubly inoculated pigs than in pigs inoculated with PCV2 alone. These findings indicate that severe disease can be reproduced in conventional 5-week-old pigs by inoculation of PRRSV and PCV2. Moreover, these results support the hypothesis that PRRSV infection enhances PCV2 replication.

Treatment with the insulin analogue lispro in children and adolescents with type 1 diabetes mellitus: evaluation over a 3-year period

The aim of the present study was to evaluate the degree of metabolic control obtained with the use of the insulin analogue lispro compared to the previous regimen with classical regular insulin in children and adolescents with Type 1 diabetes mellitus. HbA1c, lipid metabolism, body mass index (BMI), frequency of severe hypoglycaemia, carbohydrate intake, total daily insulin requirements and its distribution during the day were analysed in 44 diabetics patients (57% males and 43% females) throughout a 3-yr period. The mean age of the patients at the beginning of the study was 15.6 +/- 2.7 yr with a mean duration of the disease of 8.01 +/- 3.4 yr. All data were evaluated for the year before the change of treatment, and 1 yr (44 patients), 2 yr (19 patients) and 3 yr (13 patients) after the change. HbA1c levels did not significantly change (6.6 +/- 1.1% with regular insulin, 6.32 +/- 1.05% in the 1st year with lispro, 6.6 +/- 1.1% in the 2nd yr with lispro, 6.33 +/- 0.9% in the 3rd yr with lispro). However, significant differences (p = 0.03) were found after 3 yr of treatment in those patients who changed to insulin lispro therapy due to a bad glycaemic control. The total daily insulin dose (U/kg/d) remained unchanged. The total short-acting/intermediate-acting insulin ratio significantly decreased (45.9 +/- 0.1% regular insulin; 37.2 +/- 0.1% 1st yr lispro (p < 0.001); 33.6 +/- 0.1% 2nd yr lispro (p < 0.05); 35.5 +/- 0.1% 3rd yr lispro (p < 0.05). BMI and lipid profile remained unchanged. The self-reported daily carbohydrate in take significantly decreased due to a reduction of snacks. Total number of episodes of severe hypoglycaemia did not change significantly. In conclusion insulin lispro treatment did not modify the daily insulin dose, but reduced the short-acting/intermediate acting insulin ratio. The metabolic control remained unchanged. The number of patients reporting severe hypoglycaemia was similar despite the treatment schedule. After this 3-yr duration trial all patients decided to continue the treatment with lispro insulin.

Study of Ligmed-A, an antidiarrheal drug based on lignin, on rat small intestine enzyme activity and morphometry

This study aimed to determine the potential toxic effect of 4-day oral treatment with a lignin-based formulation on the enzymatic activity and morphology of the small intestine of rat. Ligmed-A is collected from sugarcane and is used to treat diarrhea in weaning pigs. The compound is about 90% lignin, an insoluble polyphenolic constituent of plants and a component of dietary fiber. The duodenal, jejunal and ileal mucosa of control rats and those receiving 2 g/kg Ligmed-A showed similar protein contents of about 100 mg/g. The sucrase and alkaline phosphatase activities of the three intestinal segments were unaltered after administration of the compound. Nonhistological alterations were observed after treatment. Our results, together with those of previous studies which found no toxicological effects, indicate that Ligmed-A could provide a potent antidiarrheal treatment in the veterinary area. However, further studies are required to examine its use in humans.

[Effects of estrogens and progestogens on the lipid profile in postmenopausal hypogonadism]

It is known that postmenopausal hypogonadism is associated to an increase of low density lipoproteins (LDL) and a decrease of high density lipoproteins (HDL) that increases the risk of cardiovascular disease. The hormonal replacement therapy of estrogen with or without a progestin reduces such risk in approximately 50%. This study of a retrospective clinical design was longitudinal, descriptive and comparative of 172 patient grouped for treatment received: a) with estrogen and progestin (E + P: 59.1%, n = 122), and b) estrogen alone (E: 40.9%, n = 50), in whom was determined: lipid profile and aterogenic risk initially and each year until 5 years of follow up. Results obtained were: 172 with average age of 51.5 +/- SD 9.2 years with average 5.5 duration years of postmenopause, in both groups the aterogenic risk was reduced as well as concentrations of serum LDL, while HDL increased. It is concluded that hormonal replacement therapy exerted a substantial effect upon main lipoproteins (HDL, LDL) modifying sensitively the aterogenic risk and consequently ameliorating the risk of cardiovascular disease and atherosclerosis.

Sedation for gastrointestinal endoscopy. Analysis of tolerance and complications

OBJECTIVE

To analyse tolerance and complications in patients undergoing a gastrointestinal endoscopy.

PATIENTS AND METHODS

One hundred forty three patients were prospectively studied: 44.8% underwent a diagnostic upper endoscopy; 13.3%, a therapeutic upper endoscopy; 37%, a diagnostic colonoscopy and 4.9%, a therapeutic colonoscopy. Midazolam or midazolam combined with meperidine were used. Tolerance, level of sedation and complications were studied. Chis quare and ratio comparison tests were used for the statistical analysis. P-values less than 0.05 were considered as statistically significant.

RESULTS

In the diagnostic upper endoscopy group, tolerance was better with midazolam plus meperidine vs midazolam only (83.8% and 59.3% respectively); p < 0.05. In the therapeutic upper endoscopy group, tolerance was also better when both drugs were combined; p < 0.05. In the diagnostic and therapeutic colonoscopy groups, tolerance was good in 63.5% and 85.7% of patients, respectively. Men had better tolerance for upper endoscopy; p < 0.05. Tolerance was worse in patients under 40 years of age for upper endoscopy; p < 0.05. Mild desaturation occur in 27.3% of patients, being more severe in therapeutic procedures; p < 0.05.

CONCLUSIONS

Tolerance was good in a high percentage of patients, and better in men and in patients older than 40 years of age. The main problem is desaturation, that increases in therapeutic procedures.

Diversification of hepatitis C viruses in South America reveals a novel genetic lineage

Hepatitis C virus (HCV) has high genomic variability and, since its discovery, at least six different types and an increasing number of sub-types have been reported. Genotype 1 is the most prevalent genotype found in South America. Recent phylogenetic analysis of strains isolated in Uruguay revealed the presence of a different genetic lineage from major sub-types 1a and 1b. In order to study if type 1 HCV strains circulating in the South American region can be associated with this genetic lineage, sequence data obtained from the 5' non-coding region from 6 type 1 patients from Chile, were compared with sequences obtained from 12 type 1 Uruguayan and 9 type 1 Brazilian patients as well as 17 different strains of all types isolated elsewhere. The phylogenetic analysis revealed the existence of type 1 strains of this novel genetic lineage in all South American countries studied, and indicates a diversification of HCV viruses in the South American region.

Panic disorder in a Spanish sample of 89 patients with pure alcohol dependence

High rates of anxiety disorders, including panic disorder (PD), have been found in patients suffering from alcohol dependence (AD). It has been suggested that alcoholic subjects with PD represent a more severe subgroup of patients. Eighty-nine patients with 'pure' AD (without abuse of other drugs) were examined and compared for the presence of PD. Several clinical scales were administered to assess symptomatology and severity. Twenty-three patients (25.8%) met the criteria for PD. The mean age at onset for alcohol use was 18.7 versus 28.5 years for PD onset. Our finding of an earlier onset for alcoholism than for PD in a sample of Spanish patients illustrates the potential importance of transcultural factors. These patients were more likely to be women and to have first-degree relatives with PD. Overall, alcoholic patients with comorbid PD showed greater clinical severity. They were found to have more comorbidity with axis I disorders (major depression and dysthymia), greater clinical severity, and a history of more suicide attempts.

The quantitive chlorioallantoic membrane test using trypan blue stain to predict the eye irritancy of liquid scintillation cocktails

The chorioallantoic membrane-trypan blue staining assay (CAM-TBS) is used to evaluate the potential ocular irritation caused by liquid scintillation cocktails constituted by complex mixtures, including surfactants and other potential irritants. The harmful effect of these substances is determined by the amount of trypan blue adsorbed by the CAM. In the membrane previously treated with the scintillation liquids this amount was concentration dependent only in certain cases, irrespective of the water solubility of the mixtures. In general, it showed a high correlation (r=0.986) with the scores obtained in the Draize eye irritation test. In the present study, only two cocktails presented values of trypan blue adsorption higher than those recorded for their eye irritation in vivo, irrespective of the solvent nature. Unlike the classical HET-CAM procedure, this assay is objective and allows the evaluation of opaque and coloured substances without interfering in the determination of irritancy. Despite these advantages, the method is not suitable for complex mixtures of products that induce ocular irritation in small quantities.

[Technology for the whole utilization of brewer's yeast in food industry]

A flexible scheme for the fractionation of brewer's yeast was developed. The procedure allows the production of different products such as: dry yeast flakes, dry yeast pills, yeast-extract based table sauce, yeast protein concentrates and soy-like sauce. The investment required for the processing of one ton per day is below 2 million dollars with an overall profitability higher than 53%. Investment is recovered in 0.75 years. The production of food ingredients from yeast upgrades its biomass about 25 fold. Present procedure is compared with other biomass fractionation processes taking into account the utilization of all technological streams where the process becomes environmentally friendly since effluent production significantly lower than similar technologies.

Construction and characterization of a nonproliferative El Tor cholera vaccine candidate derived from strain 638

In recent clinical assays, our cholera vaccine candidate strain, Vibrio cholerae 638 El Tor Ogawa, was well tolerated and immunogenic in Cuban volunteers. In this work we describe the construction of 638T, a thymidine auxotrophic version of improved environmental biosafety. In so doing, the thyA gene from V. cholerae was cloned, sequenced, mutated in vitro, and used to replace the wild-type allele. Except for its dependence on thymidine for growth in minimal medium, 638T is essentially indistinguishable from 638 in the rate of growth and morphology in complete medium. The two strains showed equivalent phenotypes with regard to motility, expression of the celA marker, colonization capacity in the infant mouse cholera model, and immunogenicity in the adult rabbit cholera model. However, the ability of this new strain to survive environmental starvation was limited with respect to that of 638. Taken together, these results suggest that this live, attenuated, but nonproliferative strain is a new, promising cholera vaccine candidate.

Passive protection of serum from volunteers inoculated with attenuated strain 638 of Vibrio cholerae O1 in animal models

As part of the studies to obtain an oral vaccine against cholera disease, the protective effect of serum from volunteers inoculated in a controlled trial with a candidate live attenuated vaccine of Vibrio cholerae O1, El Tor Ogawa (638; CTX&phi; mutant, hap::celA), was tested. It was confirmed that the serum, as well as the purified IgG and IgA from the volunteers had a protective effect in both of the animal models used, although the purified antibodies needed the presence of complement to be protective. These results emphasize the expectations about the protective potential of the candidate in challenge studies in humans to be conducted very soon.

Systemic lupus erythematosus: mortality and survival in Argentina. A multicenter study

OBJECTIVE

To analyze the factors associated with mortality, survival and causes of death in patients with systemic lupus erythematosus (SLE) in Argentina.

PATIENTS AND METHOD

A series of 366 patients with SLE (45 men and 321 women), mean age 29 y (range 11-70 y) and mean disease duration 6 y, was evaluated from 1990 to 1998. A total of 57 clinical, serological and therapeutic variables were studied.

RESULTS

Five- and 10-year survival was 91% and 85% respectively. Forty four patients died (12%): 54% due to sepsis and 32% due to active SLE. Mortality risk factors included heart involvement CRR 3.82), hyperlipidemia (RR 2.72), renal damage (RR 2. 62), infections (RR 2.44), lung disease (RR 2.20) and myositis (RR 2. 07). High-dose prednisone (RR 3.4) or cyclophosphamide (RR 9.19) treatments increased the risk of sepsis (P=0.003) as a cause of death. However, corticosteroids, antimalarial agents and accumulated cyclophosphamide doses proved to be protective factors in overall mortality figures (RR <1).

CONCLUSIONS

The main risk factors of death in SLE were heart involvement, hyperlipidemia and renal damage. Treatment with steroids, antimalarial agents and cyclophosphamide improved survival. High-dose corticosteroids and cyclophosphamide were associated with sepsis as a cause of death.

Effects of infantile thymectomy on ovarian functions and gonadotrophin-induced ovulation in prepubertal mice: role of thymulin

The effects of thymectomy performed on 10-day-old (Tx-10) mice on spontaneous puberty and the ovulatory response induced by gonadotrophin treatment were analysed, together with the effects of thymulin replacement from 10 days of age. Infantile thymectomy induced a delay of puberty, a decrease in serum 17beta-oestradiol concentration and a reduced total number of follicles. Injection of thymulin (12 ng/g body weight) to Tx-10 mice resulted in an earlier onset of puberty, a decrease in the weights of ovaries and uterus, and an increase in serum 17beta-oestradiol concentrations. In control and Tx-10 mice, treatment with pregnant mare serum gonadotrophin (PMSG) (5 IU) at 25 days of age resulted in ovulation and the numbers of ova shed by ovulating animals were similar. When the animals were injected with 1 IU PMSG ovulation did not occur. In Tx-10 mice, both 1 and 5 IU PMSG increased the number of follicles to values similar to those observed in the controls. In Tx-10 mice the sequential injection of PMSG (1 IU) and human chorionic gonadotrophin (hCG) (3 IU) resulted in ovulation, but the number of ova shed was lower than in controls. When these animals were injected daily with thymulin, an increase in the number of ova shed and serum 17beta-oestradiol concentrations was observed. The uterine weight of Tx-10 mice was always significantly reduced in response to gonadotrophin treatment. Thymulin injection in PMSG-hCG-treated Tx-10 mice provoked a significant increase in uterine weight. The results suggest that the presence of the thymus after the neonatal period is necessary to normal ovarian development and function. The increase in gonadotrophin-induced ovarian response produced by thymulin replacement indicates that this peptide has a role in this process as one of the connecting signals between thymus and ovaries.

What predictive parameters best indicate the need for emergent gastrointestinal endoscopy after foreign body ingestion?

Our aim was to determine what parameters may be used to indicate an emergent endoscopy after foreign body (FB) ingestion and to ascertain how often FBs are found endoscopically. Demographic data, gastroesophageal antecedents, clinical and endoscopic data, and complications were obtained. We examined 122 patients endoscopically. The onset of symptoms was immediate after FB ingestion in 93% of patients. Dysphagia was the most frequent symptom (66%), with the pharynx the most frequent location of impaction (71%). Endoscopy confirmed the presence of FBs in 52% of patients. Extraction was performed in 78%. The immediate onset of symptoms, dysphagia, and the absence of pharynx localization of impaction were predictive indicators of a positive FB finding (p < 0.05), with diagnostic sensitivity of 86% and specificity of 63%. Upper endoscopy should be performed in all patients with FB ingestion, even though no FB was found in 48%.

[Relationship between iron stores and diabetes mellitus in patients infected by hepatitis C virus: a case-control study]

BACKGROUND

To investigate whether the high prevalence of diabetes observed in patients infected by the hepatitis C virus (HCV) is associated to iron stores.

PATIENTS AND METHODS

Serum ferritin levels were determined in 123 patients infected by HCV (55 diabetic and 68 non-diabetic).

RESULTS

Serum ferritin concentrations were higher in diabetic than in non-diabetic patients (205 ng/ml [14-861] vs. 58 ng/ml [15-494]; p < 0.0001).

CONCLUSIONS

Serum ferritin levels are related with the presence of diabetes in patients infected by HCV.

Modeling cyclooxygenase inhibition. Implication of active site hydration on the selectivity of ketoprofen analogues

Molecular modeling studies performed on the two cyclooxygenase isozymes (COXs) suggest that active site hydration is crucial for understanding inhibitor selectivity. In this work, models have been constructed considering some implicit water molecules, placed in the position suggested by GRID, that participate in the dynamic hydrogen-bonding network at the polar active site entrance together with protein residues 355, 524, 120, and 513. The selectivity observed for ketoprofen (1) and the structural analogues 2 and 3 may be rationalized in terms of such implicit hydration.