Relation between pathologic findings and cellular immune responses in sheep with naturally acquired paratuberculosis

OBJECTIVE

To investigate the relation between lesions and cellular immune response-based tests in sheep with naturally acquired paratuberculosis and to evaluate efficacy of an interferon-gamma (IFN-gamma) assay and the intradermal skin test.

ANIMALS

110 and 88 adult sheep were used to evaluate the IFN-gamma assay and skin test, respectively.

PROCEDURE

Before euthanasia, heparinized blood was collected and incubated with avian purified protein derivative (PPD). Interferon-y production was assessed, using a commercial enzyme immunoassay. Skin testing in the caudal fold also was performed, using avian PPD. Sensitivity and specificity of these techniques were evaluated, using histopathologic findings as reference.

RESULTS

Of the sheep examined, 61 (55.4%) had lesions that were classified in 5 categories, according to location, extension, cellular types, and presence of acid-fast bacilli. Regarding cellular immunity test results, 55.4% of sheep with and 6.1 % without pathologic changes had positive results of the IFN-gamma assay. Skin test sensitivity (55.6%) and specificity (100%) were slightly greater.

CONCLUSION

Close association between pathologic findings and cellular immune response was apparent. Most sheep with focal (tuberculoid) and some with diffuse lesions (borderline tuberculoid), all with scant or no acid-fast bacilli in the intestine, had positive results of the IFN-gamma assay and skin test. Most sheep with diffuse lesions and high numbers of bacilli (borderline lepromatous) were test negative.

CLINICAL RELEVANCE

Cellular immune response-based and serologic tests are useful tools for seeking evidence of paratuberculosis. Each technique detects different types of immune-reacting sheep, and their simultaneous use may detect most infected animals.

Comparison of the effects of calmidazolium, morphine and bupivacaine on N-methyl-D-aspartate- and septide-induced nociceptive behaviour

We have recently shown that spinal calmodulin inhibitors (W-7 and calmidazolium) dose-dependently inhibit the nociceptive reaction (biting, scratching, licking, BSL) evoked by intrathecal N-methyl-D-aspartate (NMDA) and septide, an agonist of the neurokinin (NK) NK1 receptor. To compare this effect with that induced by standard analgesics, we now report a study of the effects of calmidazolium (14420 nmol), bupivacaine (29-582 nmol) and morphine (26-260 nmol) when coadministered intrathecally with either NMDA (4 microg) or septide (0.5 microg). Calmidazolium had the highest potency for inhibiting septide-induced nociceptive behaviour, acting over a dose range of 34-130 nmol (dose eliciting a half-maximal response, ED50, 67 nmol) lower than that of bupivacaine [ED50 234 (115-475) nmol]. Only the highest dose of morphine (260 nmol) inhibited septide-evoked BSL [ED50=133 (69-255) nmol]. Higher doses of morphine could not be tested due to the appearance of an excitatory aversive reaction. Both calmidazolium [ED50=232 (138-388) nmol] and bupivacaine [ED50=123 (59-256) nmol] dose-dependently reduced NMDA-induced BSL reaching an almost maximal inhibition at the highest doses assayed (420 and 291 nmol, respectively). In contrast, morphine had less effect on NMDA-induced behaviour, inducing only a partial reduction of BSL even with the highest dose assayed (260 nmol). Overall, it can be concluded that the calmodulin inhibitor calmidazolium inhibits septide- and NMDA-evoked nociceptive behaviour with a potency and efficacy at least as high as those of morphine and bupivacaine.

Different types of steroids inhibit [3H]diprenorphine binding in mouse brain membranes

1. The binding of 60 drugs, mainly steroids, to opioid receptors was studied in crude membrane fractions from mouse brains. 2. Competition assays with the different drugs (5 x 10(-7)-10(-4)M) were performed by labeling opiate receptors with [3H]diprenorphine (0.3-0.4 nM). 3. Only 7 drugs (alpha,5beta-tetrahydrodeoxycorticosterone, megestrol acetate, mifepristone, 17alpha-ethynylestradiol, diethylstilbestrol, clomiphene citrate and tamoxifen citrate) inhibited [3H]diprenorphine binding more than 50% at the highest concentration assayed (10(-4) M). The IC50 values ranged between 6x10(-5) M. 4. Thus, the present results show that only a limited number of steroids, from diverse classes, bind to opiate receptors.

[Hypercoagulability status previous to total hip and knee arthroplasty: the contribution of rheumatoid arthritis]

PURPOSE

Starting from a status hypercoagulability previous to substitutive hip and knee surgery, the aim of this work was to investigate the influence of different osteoarthropatic pictures for which arthroplasty is indicated in the activation of the clotting cascade, rheumatoid arthritis (RA) being one of such pictures.

PATIENTS AND METHODS

Of 79 patients suitable for prosthetic surgery of hip (53) and knee (26), the preoperative values of several markers, namely, D dimers (D-D), thrombin-antithrombin (TAT) complex, and F1 + 2 prothrombin fragment (F1 + F2) were assessed by enzymoimmunoasay. The mean age of the patients was 65.5 years, and their sex distribution was 50 women and 29 men. The indications for arthroplasty were as follows: osteoarthrosis (62), aseptic necrosis (11), RA (9), articular gout (2), previous fracture (2), more than one diagnosis overlapped in some cases. The results attained were compared with a control group comprised of 33 subjects (16 women and 17 men) with mean age similar to the patient's group (68.06 years).

RESULTS

The D-D values in the patients suitable for hip arthroplasty and the TAT values in patients suitable for both types of surgery were significantly higher than those found in the control group (p = 0.012 and 0.01, respectively). The preoperative TAT levels of the RA patients were significantly higher (p = 0.025) than those found in the patients with the other surgical indications.

CONCLUSIONS

Previously to the performance of arthroplasty, the patients show hypercoagulative marker values higher than those of age-matched controls. The significant rising of TAT found in RA patients is concordant with the literature, and this fact makes it advisable to include RA among the pathologic situations associated with hypercoagulability, as this is a common indication for substitutive hip and knee surgery with high risk of venous thromboembolic disease.

[7 new cases of HIV-2 infection recognized in Madrid in 1996 and 1997]

The infection with human immunodeficiency virus type-2 (HIV-2) is endemic in Western Africa, where it is responsible for many of AIDS cases. In Spain, 72 cases with HIV-2 until December 1997 had been reported, mainly in African immigrants. Seven of these cases (4 males and 3 females) were identified during 1996 and 1997. Five came from Western Africa and other two were Spanish, one from Alicant and the other from Vigo. Only one out of the seven patients presented clinical manifestations (Pneumocystis carinii pneumonia); the remaining patients were asymptomatic. Viral isolates from six of these patients were genetically characterized: three were subtype A, whereas those from Equatorial Guinea patients corresponded to HIV-2 subtype B.

Evaluation of cellular and serological diagnostic tests for the detection of Mycobacterium bovis-infected goats

We have evaluated the comparative intradermal skin (CID) test, the interferon gamma (IFN-gamma) assay, two ELISAs with bovine PPD antigen, the standard and the anamnestic using sera obtained, respectively, at the time of the tuberculin injection and 15 days later, for the diagnosis of caprine tuberculosis (TB). The sensitivity and specificity results were high for the CID test (83.7%, 100%), the IFN-gamma assay (83.7%, 96%) and the anamnestic ELISA (88.6%, 95.8%). In contrast, they were comparatively low for the standard ELISA (54.9%, 88%). However, test results with the standard ELISA were positive in a group of goats with cavitating TB (100%). A combination of the CID test and the IFN-gamma assay offered the highest sensitivity, 95.8%, and also high specificity, 96%. In spite of this, the evidence that the serological tests were most sensitive for the detection of goats with severe lesions (100% positivity) suggested that a combination of CID test and anamnestic ELISA may be most useful as part of an eradication campaign against caprine TB.

[Intradural anesthesia with a 27-gauge Sprotte needle for arthroscopic knee surgery in ambulatory patients under 40 years of age]

OBJECTIVE

To assess the clinical usefulness of intradural anesthesia through a 27 gauge Sprotte ("pencil point") needle for arthroscopic knee surgery in outpatients under 40 years of age.

PATIENTS AND METHOD

A retrospective study of 116 patients under 40 scheduled for arthroscopic knee surgery, analyzing the incidence of post-dural puncture headache and backache after anesthesia provided with a 27 gauge (0.4 mm) Sprotte needle. Follow-up assessments were performed 24, 48 and 72 hours after surgery. We also studied technical difficulty and failure rate encountered in achieving blockade with this type of needle.

RESULTS

We recorded one case of headache (0.86%) that resolved within 48 hours with conservative treatment. Backache was reported by eight patients (6.8%) and was described as slight in all cases. The small caliber and design of the spinal needle caused no technical difficulties and anesthesia was successfully provided for all patients. Time of hospital stay ranged from 330 to 420 minutes (mean 360 +/- 45 minutes). No patient had to stay overnight.

CONCLUSIONS

The results confirm that intradural anesthesia with 27 gauge Sprotte needles is an acceptable anesthetic technique for outpatient surgery in young patients given that the rate of complications is low.

[Characteristics of sleep in deafness]

INTRODUCTION, MATERIAL AND METHODS: We studied a profoundly deaf population, in order to evaluate the zeitgeber sleep role of the ambient sound. A closed questionnaire was given to 36 students at a special college for the profoundly deaf and to 321 controls of similar age and sex.

RESULTS

We do not find total upset of sleep, but a good sleep quality, probably due to the noise isolation of the deafness. We find some traces of insecurity in falling asleep.

CONCLUSION

The ambient sound do not seem to play an important role as a sleep-wake zeitgeber.

[Risperidone in the treatment of acute exacerbation of schizophrenia symptoms]

A total of 439 schizophrenic patients according to ICD-10 criteria was included in an open label postmarketing surveillance study to evaluate the efficiency of resperidone as maintenance treatment of the schizophrenic acute exacerbation. The efficiency of risperidone was assessed according the number of patients who responded to treatment, the duration of the hospitalization period an the decrease in the total score as well as in the different clusters of the Brief Psychiatric Rating Scale (BPRS) during the study period. A patient was considered as responder to treatment when a decrease of, at least, a 20% was achieved in the total BPRS score while being treated in monotherapy with risperidone. Safety was evaluated by the UKU subscale for neurological side effects and spontaneous reports. Patients were evaluated at baseline and weeks 1, 2, 6 and 12. Forty patients (9.1%) were excluded from the statistical analysis due to protocol violation. Eighty one patients (20.3%) dropped out due to lost for follow-up (n = 25; 6.3%), new hospitalization (n = 23; 5.8%), inefficacy (n = 12; 3%), side effects (n = 7; 1.8%) and others (n = 14; 3.5%). Risperidone was used at doses between 1.5 and 19 mg daily (mean dosage: 7.66 +/- 3.07 mg daily). The duration of the hospitalization when dosages of risperidone of less than 6 mg daily were used was 32.1 days. However, when higher dosages were used, the number of days in-hospital decreased (26.6 days at dosages between 6 and 9 mg daily and 25.3 days when dosages higher than 9 mg daily were used). There was a significant reduction, versus baseline, in the BPRS mean total scores as well as in it's different clusters. (positive symptoms, negative symptoms, anxiety/depression) from week one onwards. At week 1, 66.9% of the patients had an improvement (20% versus baseline in their BPRS total score. At the end of the study period, 93.2% of the patients had an improvement (20% in their BPRS total score. There was a significant reduction in the total UKU subscale for neurological side effects scores (p < 0.005) from week 1 onwards, as well as for the total score of the following symptoms: rigidity, hypokinesia, hyperkinesia tremor and akatysia.

Allele-specific PCR method based on pncA and oxyR sequences for distinguishing Mycobacterium bovis from Mycobacterium tuberculosis: intraspecific M. bovis pncA sequence polymorphism

An allele-specific amplification method based on two genetic polymorphisms to differentiate Mycobacterium tuberculosis from Mycobacterium bovis was tested. Based on the differences found at position 169 in the pncA genes from M. tuberculosis and M. bovis, a PCR system which was able to differentiate most of the 237 M. tuberculosis complex isolates tested in one of the two species was developed. All 121 M. tuberculosis strains showed the expected base (cytosine) at position 169. Most of the M. bovis isolates had a guanine at the cited position. Nevertheless, 18 of the 116 M. bovis isolates, all of them goat isolates, showed the pncA polymorphism specific to M. tuberculosis. These results suggest that goat M. bovis may be the nicotinamidase-missing link at the origin of the M. tuberculosis species. Based on the polymorphism found at position 285 in the oxyR gene, the same system was used to differentiate M. tuberculosis from M. bovis. In this case, DNAs from all 121 M. tuberculosis isolates had the expected base (guanine) at this position. In addition, all 116 M. bovis isolates, including those from goats, showed the identical polymorphism (adenine). The oxyR allele-specific amplification method can differentiate M. bovis from M. tuberculosis, is rapid (results can be obtained in less than 3 h), and is easy to perform.

Partial contribution of polyamines to the relaxant effect of 17 alpha-estradiol in rat uterine smooth muscle

1. The effects of 17 alpha-estradiol on KCl (60 mM), CaCl2 (30 microM to 10 mM) and vanadate (0.3 mM)-induced contractions in rat uterus have been assayed. Furthermore, the effect of 17 alpha-estradiol on calmodulin-stimulated cAMP-phosphodiesterase activity was also studied. 2. 17 alpha-estradiol relaxed the tonic contraction induced by KCl (60 mM) in a concentration-dependent way (IC50, 8.3 +/- 0.7 microM), and CaCl2 (0.1 to 10 mM) counteracted it. 3. CaCl2 (30 microM to 10 mM) produced concentration-dependent contraction of rat uterus in a calcium-free medium supplemented with 60 mM of KCl (EC50: 0.2 +/- 0.01 mM). 17 alpha-estradiol (8 microM) antagonized the contraction induced by CaCl2, increasing the EC50 value up to 0.7 +/- 0.1 mM (P < 0.01). 4. 17 alpha-estradiol (0.1 to 1 mM) relaxed in a concentration-dependent way the tonic contraction induced by vanadate in rat uterus incubated in a calcium-free medium and EDTA supplemented. The maximal relaxation achieved with 1 mM of 17 alpha-estradiol was 52.2 +/- 2.8%. 5. 17 alpha-estradiol (1 to 100 microM) did not modify the basal activity of cAMP-phosphodiesterase but inhibited the calcium plus calmodulin stimulated activity. The maximal inhibition achieved was 43 +/- 5.4%. 6. The relaxing effect of 17 alpha-estradiol on KCl (60 mM)-induced tonic contraction was unmodified with the antioestrogen tamoxifen (0.1 and 1 microM), the inhibitor of tirosine kinase (genistein, 10 microM) and the cAMP-dependent protein kinase inhibitor (Rp-adenosine 3',5'-monophosphothioate, triethylamine salt, 100 microM). However, the effect was antagonized with the inhibitor of transcription (actinomycin D, 5 micrograms/ml,), the inhibitor of protein synthesis (cycloheximide, 10 and 100 micrograms/ml), and the inhibitor of ornithine decarboxilase (alpha-difluoromethyl-ornithine, 10 mM). 7. Our results suggest that polyamines contribute to the relaxant effect of 17 alpha-estradiol in rat uterine smooth muscle behaving, presumably, as mediators of the transcriptional component involved in the effect of 17 alpha-estradiol.

[Smoking in a psychiatric population]

The relationship between tobacco consumption and psychiatric disorders is a widely discussed topic that is generating a considerable yet controversial bibliography, that can be approached from different points of view. The authors make a revision and critical evaluation about smoking prevalence on psychiatric population, in the different psychiatric disorders and discussing the theories implicated.

Identification by spoligotyping of a caprine genotype in Mycobacterium bovis strains causing human tuberculosis

We have used spoligotyping to characterize 18 Mycobacterium bovis strains isolated from cattle and 23 M. bovis strains isolated from goats. The spoligotypes revealed that caprine strains form a separate and well-differentiated group that we refer to hereafter in this abstract as the caprine genotype. To evaluate the importance of this genotype as a cause of tuberculosis in other animal species, including humans, we applied the spoligotyping method to 112 strains, including to all isolates identified as M. bovis by a Mycobacterial National Reference Laboratory (Majadahonda, Madrid) from 1994 to 1996. Eighty-three of these strains were identified in human isolates. In addition to being identified in three goat isolates and two sheep isolates, the caprine genotype was also found in three isolates causing human tuberculosis. Evidence to support the argument that there is a zoonotic risk of caprine tuberculosis was presented by the identification of the caprine genotype in an isolate from a veterinary worker with a recent history of contact with tuberculous goats.

The density of monoamine oxidase B sites is not altered in the postmortem brain of alcoholics

The status of the enzyme monoamine oxidase B (MAO-B) was directly evaluated in the postmortem brain from 20 alcoholics and 23 matched controls. The density of MAO-B sites was quantified by the specific binding of the selective inhibitor [3H]Ro 19-6327 (lazabemide) (8 nM) to cortical membranes. A positive correlation between age at death and MAO-B density was observed in the total sample (r = 0.37, p = 0.015). The density of MAO-B in alcoholics (Bmax = 1,263 +/- 131 fmol/mg of protein) was not different form that in control (Bmax = 1,131 +/- 96 fmol/mg of protein). Ethanol in vitro inhibited [3H]Ro 19-6327 binding, with similar potency in membranes form alcoholics (Ki = 280 +/- 13 mM) and controls (Ki = 338 +/- 84 mM). The present results in brain tissue contrast with previous reports of decreased MAO-B enzymatic activity in platelets of alcoholics, but strongly agree with recent genetic studies on MAO-B status in alcoholism.

[Diffuse lung involvement in primary amyloidosis as an infrequent cause of interstitial lung disease. Clinical case]

We report a 50 years old female, admitted to the hospital due to malaise lasting 7 months, with diffuse bilateral lung infiltrates and a progressive respiratory insufficiency, dying one month after admission. A transbronchial biopsy disclosed an extensive amyloid infiltration. The necropsy confirmed this finding and showed a systemic primary amyloidosis associated to a multiple myeloma.

[Prenatal molecular diagnosis of cystic fibrosis. Report of 3 cases]

Cystic Fibrosis (CF) is a severe and relatively common autosomic recessive disease caused by a variety of mutations in the CFTR gene. The most frequent mutation worldwide, consists of the deletion of the phenylalanine codon at position 508 (delta F508). Here we report the first cases of prenatal diagnosis of CF by DNA analysis in couples at risk in Venezuela. The study focused on the detection of delta F508 alleles analyzing DNA recovered directly from amniocytes or from their cultures, using the polymerase chain reaction (PCR) and polyacrylamide gel electrophoresis. Two of three fetuses resulted homozygotic for the delta F508 allele and the third one turned out to be a delta F508 carrier. This information sustained the genetic counseling of the couples and allowed them to take objective reproductive decisions, a direct consequence of the availability of gene analysis at the DNA level.

[Neuropsychological deficits, obstetric complications and premorbid adjustment in patients with the first psychotic episode]

In spite of the great number of studies that have proved the existence of cognitive disturbances in schizophrenic subjects, conflicting results have not allowed to glimpse a typical pattern of neuropsychological deficits in schizophrenia. On the contrary, these results have raised important controversies regarding the nature of such cognitive impairment. Thus, questions concerning the existence of generalized versus focal cognitive impairment or in relation lo the static versus progressive nature of these deficits remain unresolved. In the middle of these debates, the need for prospective research, which focuses on the neuropsychological deficits of schizophrenia and other psychotic disorders from the beginning of the illness, has been pointed out. In these lines we present the results obtained in our study in which 59 subjects, who were admitted in our hospital for presenting a first psychotic episode, were assessed. Measures of premorbid adjustment, obstetric complications and clinical symptoms were taken and correlated to measures of cognitive performance obtained by using a minibattery of neuropsychological tests at time of dismissal. Results showed, as in previous research, that neuropsychological deficits are already present in psychotic patients at the beginning of the illness. These deficits in our sample were related lo obstetric complications especially in males, and disturbances of premorbid adjustment occurred in early stages of development. These results support the neurodevelopmental hypothesis of schizophrenia.

[Positive and negative symptoms in schizophrenia: standards of change during acute exacerbation]

INTRODUCTION AND OBJECTIVES

The temporal stability of the positive and negative symptoms in schizophrenia deserves a special interest due to its consequences in the outcome and the treatment of the disease. This study determines the temporal stability of positive/negative subtypes in schizophrenia during the acute phase.

MATERIAL AND METHODS

This is a clinical, observational and prospective study of a dynamic cohort of patients with acute exacerbation of schizophrenia defined by DSM III-R criteria. Patients with severe and unstable organic pathology, substance dependence, mental organic disorder, mental retardation, depression, or medicamentous parkinsonism were excluded. Clinical assessment was performed with the PANSS scale. Schizophrenic subtypes were established according to inclusive and restrictive criteria of PANSS. All patients were treated with new antipsycotics and biperiden if necessary.

RESULTS

51 patients were assessed for 8 weeks. In the baseline, the negative subtype (63.3% and 52.5% by inclusive and restrictive system respectively) and paranoid form (45.1%) were predominant. Three types of analysis were performed to determine the temporal stability: 1. Concordance (Kappa index). The concordance of the inclusive and restrictive System, regarding to the baseline assessment, indicated that both criteria had a low temporal stability. 2. Mc Nemar Ji Square. This test showed that these changes were bi-directional except for the first visit, which was significant through the restrictive system (higher change from the negative to other subtypes). 3. Transition analysis among groups by First Order Morkov Chains analysis indicated that this change was stationary (the change was the same in all phases).

CONCLUSIONS

1o The variable "time" has to be considered for the definition of subtypes in schizophrenia. 2o The restrictive system is more specific. It allows to identify a subgroup of patients with "Negative" schizophrenia with a high specificity and validity in clinical and epidemiological studies. 3o The use of the baseline visit as a reference (gold standard) is recommended because it exits a higher concordance among criteria and a more florid psychopathology.