Persistence of the insecticide Dimilin 45 ODC on conifer forest foliage in an Atlantic-climate ecosystem

The oil formulation of diflubenzuron (Dimilin 45 ODC) persisted for 10-12 weeks on the foliage of a conifer forest in an Atlantic-climate ecosystem. Within 22-30 days following treatment, 55-80% of the insecticide had been removed from the foliage. During this period, the concentration of diflubenzuron was higher than 370 ng g(-1). Aerial application at 56.3 g of Al ha(-1) resulted in deposition levels of the insecticide ranging from 867.5 to 1824.4 ng g(-1), depending upon forest characteristics. The results showed that aerial application is only a suitable technique for the treatment of forest areas with dense foliage and/or high tree density and no more than 15% of tree-free area. The only metabolite detected was 2,6-difluorobenzamide, and this persisted on foliage until the first rainfalls occurred. An empirical mathematical correlation was found to express the influence of meteorological variables--rainfall, solar radiation and temperature--on the persistence of the insecticide. These results suggested that degradation of diflubenzuron on foliage could be due to photodegradation. Some recommendations were made to optimize the deposition of the insecticide on foliage and to minimize its persistence and the off-site spray drift.

Role of an essential acyl coenzyme A carboxylase in the primary and secondary metabolism of Streptomyces coelicolor A3(2)

Two genes, accB and accE, that form part of the same operon, were cloned from Streptomyces coelicolor A3(2). AccB is homologous to the carboxyl transferase domain of several propionyl coezyme A (CoA) carboxylases and acyl-CoA carboxylases (ACCases) of actinomycete origin, while AccE shows no significant homology to any known protein. Expression of accB and accE in Escherichia coli and subsequent in vitro reconstitution of enzyme activity in the presence of the biotinylated protein AccA1 or AccA2 confirmed that AccB was the carboxyl transferase subunit of an ACCase. The additional presence of AccE considerably enhanced the activity of the enzyme complex, suggesting that this small polypeptide is a functional component of the ACCase. The impossibility of obtaining an accB null mutant and the thiostrepton growth dependency of a tipAp accB conditional mutant confirmed that AccB is essential for S. coelicolor viability. Normal growth phenotype in the absence of the inducer was restored in the conditional mutant by the addition of exogenous long-chain fatty acids in the medium, indicating that the inducer-dependent phenotype was specifically related to a conditional block in fatty acid biosynthesis. Thus, AccB, together with AccA2, which is also an essential protein (E. Rodriguez and H. Gramajo, Microbiology 143:3109-3119, 1999), are the most likely components of an ACCase whose main physiological role is the synthesis of malonyl-CoA, the first committed step of fatty acid synthesis. Although normal growth of the conditional mutant was restored by fatty acids, the cultures did not produce actinorhodin or undecylprodigiosin, suggesting a direct participation of this enzyme complex in the supply of malonyl-CoA for the synthesis of these secondary metabolites.

Impact of mild pulmonary hypertension on mortality and pulmonary artery pressure profile after heart transplantation

BACKGROUND

Pulmonary hypertension is a risk factor for early mortality after transplantation, but the risk threshold is debated. Also, little is known about the evolution of pulmonary circulation after transplantation. The aim of this study was to determine the influence of current risk pulmonary pressure parameters on early post-operative mortality and to assess the time-related changes in pulmonary pressure after surgery.

METHODS

One hundred twelve consecutive transplanted patients were studied retrospectively to determine the influence of trans-pulmonary gradient of >12 mm Hg and pulmonary vascular resistance of >2.5 Wood units, at baseline or after vasodilator test, on early mortality. A multivariate analysis was used to study the hemodynamic parameters associated with early mortality. The pulmonary pressures of all surviving patients were studied for up to 3 years after surgery.

RESULTS

Early mortality in the groups with and without pulmonary hypertension were 24.4% and 5.6%, respectively (p =.009). The only variable that was independently associated with early mortality was the pulmonary vascular resistance index (odds ratio = 1.459). Mild pulmonary hypertension disappeared 1 year after heart transplantation.

CONCLUSIONS

Mild pulmonary hypertension is a risk factor for early postoperative mortality. The hemodynamic parameter most closely associated with early mortality is pulmonary vascular resistance index. The hemodynamic profile of pulmonary circulation after heart transplantation is partially dependent on the level of pulmonary hypertension before transplantation, at least during the first year after surgery.

Complications of thoracentesis in cirrhotic patients with pleural effusion

OBJECTIVE

To study the complications of thoracentesis, either diagnostic or therapeutic, in cirrhotic patients with pleural effusion.

EXPERIMENTAL DESIGN

A cohort prospective study. A diagnostic thoracentesis was performed at admission or when spontaneous bacterial empyema was suspected; a therapeutic thoracentesis was conducted in patients with dyspnea that did not improve with medical treatment. A chest radiography and a careful clinical follow up were performed in all patients within 24 hours after the procedure. We studied the risk factors for developing pneumothorax and the actuarial probability of pneumothorax after consecutive therapeutic thoracentesis.

PATIENTS

All cirrhotic patients admitted with pleural effusion over a 4-year period. The study included 69 patients.

RESULTS

During the study period, we performed 245 thoracentesis, 150 diagnostic and 95 therapeutic ones. The most severe complication was pneumothorax in 10 cases (4%), after 2 out of 150 (1.3%) diagnostic thoracentesis and after 8 out of 95 (8.4%) therapeutic thoracentesis (RR, 95% CI 6.8, 1.41-32.77, p < 0.01). The actuarial risk of pneumothorax after the first, second and fourth therapeutic thoracentesis was 7.7%, 25.3% and 34.7%, respectively.

CONCLUSIONS

Diagnostic thoracentesis in cirrhotic patients is associated to a low morbidity. Therapeutic thoracentesis is a risk factor for pneumothorax and the risk increases after consecutive thoracentesis. A chest radiograph is not justified after a diagnostic thoracentesis, but should be done after a therapeutic thoracentesis.

A sustained increase in intracellular Ca(2+) is required for the acrosome reaction in sea urchin sperm

The acrosome reaction (AR), necessary for fertilization in many species, requires an increase in intracellular Ca(2+) ([Ca(2+)](i)). In sea urchin sperm, the AR is triggered by an egg-jelly factor: the associated [Ca(2+)](i) elevation lasts minutes and involves two Ca(2+) permeable channels. Both the opening of the second channel and the onset of the AR occur approximately 5 s after treatment with egg factor, suggesting that these events are linked. In agreement, removal of Ca(2+) from sea water or addition of Ca(2+) channel blockers at the time when opening of the second channel is first detected inhibits AR and causes a "rapid" (t(1/2) = 3--15 s) decrease in [Ca(2+)](i) and partial inhibition of the intracellular pH change associated with the AR. Simultaneous addition of NH(4)Cl and either EGTA, Co(2+), or Ni(2+) 5 s after egg factor prevents the partial inhibition of the evoked pH(i) change observed but does not reverse AR inhibition. Therefore, the sustained increase in [Ca(2+)](i) caused by the second Ca(2+) channel is needed for the sperm AR. Experiments with agents that induce capacitative Ca(2+) uptake (thapsigargin and cyclopiazonic acid) suggest that the second channel opened during the AR could be a store-operated Ca(2+) channel.

[Flavonoid drugs as antioxidant in intraocular irrigating solution]

PURPOSE

To study the protective effect for vitrectomy of intraocular irrigating solutions containing different concentrations of two antioxidants: Meralop and Activadone and compare them with saline solutions and BSS plus.

MATERIAL AND METHODS

Seventy-five pigmented rabbits were divided into 8 groups: I. Control (n=8); II. Gas-vitrectomy (n=15); III. Vitrectomy + saline solution (n=6); IV. Vitrectomy + BSS plus (n=9); V. Vitrectomy + Activadone 90 mg/l (n=8); VI. Vitrectomy + Activadone 180 mg/l (n=9); VII. Vitrectomy + Meralop 16 mg/l (n=10); VIII. Vitrectomy + Meralop 64 mg/l (n=10). Antioxidant activity in lens and retina was measured evaluating the levels of lipoperoxides malondyaldehide (MDA) and 4-hydroxynonenal (4-HNE) by spectrophotometry.

RESULTS

MDA + 4-HNE concentrations in lens and retina of each group (mean and standard deviation in nmol/g) were: Group I= 3.806DE1.043, 38.787DE10.404. Group II= 4.353DE3.626, 41.554DE18.520. Group III= 297.306DE103.73, 156.69DE6.82. Group IV= 29.39DE15.38, 112.02DE50.12. Group V= 42.31DE20.82, 55.44DE42.21. Group VI= 27.66DE9.29, 181.061DE79.39. Group VII= 134.93DE133.52, 76.89DE36.02. Group VIII= 112.91DE60.30, 79.97DE38.005.

CONCLUSIONS

All intraocular irrigation solutions containing antioxidant substances produced lower MDA + 4-HNE levels than saline solution. In the retina, Activadone 90 mg/l produces less MDA concentration than BSS plus.

CT and MR findings in a calcified myocardial tuberculoma of the left ventricle

Tuberculosis can involve a multitude of organ tissues but generally affects the respiratory tract. Heart tuberculosis is rare, and the pericardium is the most common location reported in the literature, accounting for 0.5% of extrapulmonary tuberculosis. Isolated myocardial tuberculosis is a very unusual occurrence, with only a few case reports in the literature, usually diagnosed at necropsy. Findings of myocardial tuberculoma on cross-sectional images previously have not been reported. We present computed tomography and magnetic resonance imaging findings of an isolated calcified myocardial tuberculoma.

Sexual dimorphism in the adrenergic control of rat brown adipose tissue response to overfeeding

Gender-related differences in the brown adipose tissue (BAT) response to overfeeding rats on a cafeteria diet were studied by assessing the balance between the expression of beta-adrenoceptors (beta1-, beta2-, beta3-AR) and alpha2A-AR and their relation to the expression of uncoupling proteins (UCP1, UCP2, UCP3). Cafeteria diet feeding for 15 days, which involved a similar degree of hyperphagia in both sexes, led to a greater body weight excess in females than in males and a lower activation of thermogenesis. Gender-related differences were found for different adrenoceptor expression and protein levels, which might explain, in part, sex differences in the thermogenic parameters. The lower expression of alpha2A-AR in females than in males could be responsible for the higher expression of UCP1 and thermogenic capacity under non-hyperphagic conditions. However, in a situation of high adrenergic stimulation--as occurs with overfeeding--as there is a preferential recruitment of the beta3-AR by noradrenaline compared with other adrenergic receptors, the higher levels of beta3-AR in males rats than in females could be responsible for the greater thermogenic capacity and the lesser weight gain in males. Thus, the alpha2/beta3 balance in BAT could be a key in the thermogenic control.

Steady state responses to multiple amplitude-modulated tones: an optimized method to test frequency-specific thresholds in hearing-impaired children and normal-hearing subjects

OBJECTIVE

To evaluate, using statistical methods, the usefulness of the binaural multiple frequency auditory steady state responses (MF SSRs) for objective, frequency-specific audiometry in a large sample of hearing-impaired children and normal-hearing subjects.

DESIGN

The MF SSRs were recorded in a sample of 43 hearing-impaired children (86 ears) and 40 normal-hearing young adults (80 ears). Simultaneous carrier tones (0.5, 1, 2, and 4 kHz) modulated in amplitude at different rates (77 to 105 Hz) were presented binaurally (TDH 49 earphones) at variable intensities (110 to 20 dB SPL). For each subject the response thresholds (RTHs) at 0.5, 1, 2, and 4 kHz, were determined automatically (F test) and compared with the corresponding behavioral thresholds (BTHs).

RESULTS

In the normal-hearing subjects, RTHs were detectable, on average, between 11 and 15 dB above the BTH. These differences were significantly smaller in the hearing-impaired (5 to 13 dB). Also a close correspondence was found between the subjective and objective audiogram curves in both groups. The within subject Spearman correlation coefficients calculated between the two curves, were in most cases above the significance cut off point (p < 0.05). Also in 1-way repeated measures analysis of variance, the overall error in the estimation of the audiogram (vector across frequency of absolute distances between the curves) did not differ significantly from zero.

CONCLUSIONS

The binaural MF SSR was proven to be a valid technique for the estimation of an objective audiogram, in a large sample of hearing-impaired children and normal-hearing subjects. With this method, frequency-specific thresholds at 0.5, 1, 2, and 4 kHz could be determined in all subjects (and both ears) with no appreciable loss in accuracy and a considerable reduction in testing time (average recording time = 21 minutes) when compared with other frequency-specific techniques.

The dispersed cell culture as model for functional studies of the subcommissural organ: preparation and characterization of the culture system

The subcommissural organ (SCO) is an enigmatic secretory gland of the brain, which is believed to be derived from ependymal (glial) precursor cells. We here developed a dispersed cell culture system of the bovine SCO as an approach to functional analyses of this brain gland. Tissue of the bovine SCO obtained from the slaughterhouse was papain dissociated either directly after dissection or after preparation of SCO explants. The latter had been maintained for 4-6 weeks in organ culture. The dispersed cells were cultured for up to 14 days and continuously tested for their secretory state by immunostaining of their secretory product. With respect to the morphology of the SCO cells (shape, processes, nucleus), no difference was found between the culture of freshly dissociated SCOs and that of dissociated SCO explants. In all cases, the dissociation caused a dedifferentiation; typical elongated cells were formed increasingly after 1 day of culture. Thereafter, only the cellular size increased, whereas the shape and the viability of the cells remained unchanged. Proliferating SCO cells were never observed. The culture obtained from fresh SCO tissue contained more glia cells and fibrocytes than the culture prepared from SCO explants. The proliferation of glia cells and fibrocytes was suppressed by blocking the mitotic activity with cytosine-beta-D-arabino furanoside (CAF). The cytophysiological features of the cultured dispersed cells of both origins did not differ as demonstrated by classical histology, by immunocytochemistry for the secretory products of the SCO, by the characteristics of calcium influx into the cytoplasm ([Ca2+]i) and cyclic adenosine monophosphate (cAMP) after stimulation with adenosine-5-triphosphate, substance P or serotonin, and by the activation of the transcription factor cAMP-responsive element-binding protein. Because of the maintenance of their viability, their capacity to release the secretory product into the culture medium, their receptive capacity, and their signal transduction pathways, we conclude that the dispersed cell culture system, especially that obtained from SCO explants, represents an appropriate and useful model for functional studies of the mammalian SCO.

Homogenous catalyzed ozonation of simazine. Effect of Mn(II) and Fe(II)

Simazine, [2-chloro, 4,6-bis(ethylamino)-1,3,5-s-triazine], a common herbicide typically found in surface and ground water was ozonised by using catalytic amounts of Mn(II) and Fe(II). An optimum value for metal concentration was found in the process. Some inhibition of the simazine degradation rate was observed when these metals were added above the optimum concentration. The pH of the reaction media played a significant role in the simazine oxidation rate. Thus, an increase in simazine conversion was observed when the pH was raised from 5 to 9. However, the catalytic effect of added manganese was negligible at the highest pH used in this study (pH 9). The beneficial influence of Fe(II) was also observed when utilising the combination of ozone and hydrogen peroxide. Contrarily, Mn(II) presented a negative influence on simazine conversion when using this oxidation technology.

Serum manganese concentrations in a representative sample of the Canarian population

Serum manganese (Mn) concentrations of 368 individuals 6-75 yr of age (179 males and 189 females) living in the Canary Islands were determined by graphite furnace atomic absorption spectrometry. The mean manganese concentration was 1.06+/-0.62 microg/L, ranging between 0.19 and 3.33 microg/L. Most of the analyzed samples (63.3% of the samples) fall within the reference interval (0.54-1.76 microg/L) for apparently healthy people. Individuals from Fuerteventura presented with mean Mn concentrations significantly higher than individuals from the rest of the islands. This could be attributed to differences in the Mn content of soil and/or differences in dietary habits of the population. Serum Mn concentration did not vary with gender, and individuals younger than 18 yr old had the highest mean Mn concentration, compared to the rest of the age groups considered. No relation to socioeconomic status, educational level, and tobacco or alcohol consumption was found. However, the serum Mn concentration tended to decrease when increasing the consumption of wine or beer. Sportsmen presented significantly higher serum Mn concentrations than the rest.

Serum selenium concentration in a representative sample of the Canarian population

The concentration of serum selenium in 395 individuals (187 males + 218 females) living in the Canary Islands, Spain was determined by hydride generation atomic absorption spectrometry. The mean selenium concentration was 74.7 +/- 25.2 microg/l ranging between 7.86 and 182.3 microg/l. Twenty-two adults (7.2% of the total) had serum selenium concentrations under 45 microg/l. It is widely accepted that below this selenium serum concentration (45 microg/l) there is an increased risk of cardiovascular disease and cancer. Our results fall within data recently published in other Spanish and European regions and are much lower than data observed in USA or seleniferous regions. The estimated Se intakes of our population were lower than the Recommended Dietary Allowances for American people. Individuals from Lanzarote had a mean Se concentration significantly higher than individuals from the other islands. This could be attributed to differences in Se content of soil and/or differences in dietary habits of the populations. Serum selenium concentration did not vary with the sex of the subjects. Individuals younger than 14 years old had a serum selenium concentration significantly lower than the rest of the individuals. No relationship with socio-economic status, educational level, smoking habits, physical exercise or beer consumption was found. However, individuals who consume wine more than three times a week showed higher selenium concentrations than individuals with lower consumption. Also, individuals with consumption above seven units of spirit drinks a week had the highest mean selenium concentration.

The structure, function, and origin of the microcin H47 ATP-binding cassette exporter indicate its relatedness to that of colicin V

Microcin H47, a gene-encoded peptide antibiotic produced by a natural Escherichia coli strain, was shown to be secreted by a three-component ATP-binding cassette exporter which was revealed to be strongly related to that of colicin V. The results of sequence and gene fusion analyses, as well as heterologous complementation assays, are presented.

[Surgical reconstruction of intervalvular fibrous body in active infective endocarditis]

INTRODUCTION AND OBJECTIVES

Surgery for infective endocarditis with paravalvular abscesses and fibrous body destruction has the highest mortality and morbidity rates in this disease with high surgical risk. We report a new approach of radical resection of the abscess and affected tissues and reconstruction of the heart with pericardium as an alternative to conventional surgery.

METHODS

In the last two years six patients with infective endocarditis, paravalvular abscesses and fibrous body destruction underwent surgery (five prostheses with infective endocarditis). The main indication for surgery was persistent sepsis despite adequate antibiotic treatment in five patients and congestive heart failure in one. After wide resection of the abscesses and fibrous body the heart was reconstructed with glutaraldehyde-fixed bovine pericardium.

RESULTS

There was no hospital mortality. The median bypass and clamp times were 198 and 174 minutes, respectively. One patient presented complete AV block and a permanent transvenous pacemaker was implanted. Doppler echocardiographic studies performed in all the patients prior to discharge indicated that no patient had patch dehiscence or paravalvular leaks. Patients were followed a mean of 15 months with no deaths or other complications being reported.

CONCLUSIONS

Resection of the abscesses and fibrous body, and reconstruction of the heart with glutaraldehyde-fixed bovine pericardial patch is a radical, feasible technique with all infected tissues being resected to thereby prevent reinfection or paravalvular leaks.

MRI of musculoskeletal extraspinal tuberculosis

PURPOSE

The aim of this study was to describe the MR findings in extraspinal musculoskeletal tuberculosis (EMT).

METHOD

A retrospective review was conducted of the MR findings of 18 patients with microbiologically and/or pathologically proven EMT. All MR studies were performed using T1-and T2-weighted spin echo sequences. T1-weighted spin echo sequences after Gd-DTPA injection were obtained for 12 patients. The MR images were evaluated for abnormalities in joints, bones, and soft tissues, and the results were grouped by anatomic localization, frequency distribution of structures affected, and morphologic patterns of involvement.

RESULTS

Isolated soft tissue tuberculosis was found in 10 (55.5%) patients and involvement of more than one structure in 8 (44.4%). Pyomyositis (n = 6) and arthritis with involvement of adjacent soft tissues (n = 7) were the most common forms of presentation. One patient presented with isolated fascial superficial tissue involvement in one leg. Isolated pyomyositis involving one (n = 3) or two (n = 3) muscles was homogeneous in six cases and showed intermediate (n = 6), low (n = 2), or high (n = 1) signal intensity on T1-weighted images and a high and very hyperintense signal on T2-weighted images. The tenosynovitis synovial fluid was homogeneous (n = 1) or heterogeneous with multiple tiny hypointense nodules (n = 1) on T2-weighted images. The subdeltoid bursitis fluid was characterized by homogeneous low signal intensity with a hyperintense rim (n = 2) on T1-weighted images and homogeneous (n = 1) or heterogeneous hyperintense signals with areas of low signal intensity (n = 1) on T2-weighted images. In tuberculous arthritis, the synovial joint fluid (n = 7) showed heterogeneous (n = 4) or homogeneous (n = 3) low signal intensity on T1-weighted images and high or very high signal intensity on T2-weighted images. Where involved, the adjacent muscle(s) (n = 8) were usually hypointense on T1-weighted images and very hyperintense on T2-weighted images. Associated cellulitis was found in arthritis with involvement of neighboring soft tissues (n = 5), pyomyositis (n = 2), and tenosynovitis (n = 1). The images obtained after Gd-DTPA showed peripheral (n = 10) or heterogeneous (n = 1) enhancement or no enhancement (n = 1).

CONCLUSION

The MR findings for EMT are variable. Although diagnosis is dependent largely on prior presumption and clinical context, MRI provides valuable guidelines in defining the extent of the lesions to select the appropriate treatment and for follow-up of abnormalities.

[Seroepidemiology of Herpes simplex virus type 2 in the Amerindian Yukpa population of Zulia state, Venezuela]

BACKGROUND

Yukpa aborigines start early in life their sexual activity and promiscuity with native and foreign individuals is common among women. This behavior allows the installation and propagation of Herpes simplex virus type 2 (HSV-2).

AIM

To determine the presence of antibodies to HSV-2 in a Yukpa Amerindian community at Zulia State, Venezuela.

SUBJECTS AND METHODS

We studied 96 natives, between 13 and 49 years old (62.3% of the whole population, 100% of individuals in fertile age). Control population consisted of 76 individuals, with similar sex and age range distribution, of the urban population from Maracaibo, Zulia State, Venezuela. HSV-2 serologic status was determined by an indirect fluorescent antibody test.

RESULTS

Antibodies to HSV-2 were detected in 53.1% of Yukpa population and 21.1% of urban population. Aboriginal women aged 21 to 40 years old had a prevalence of antibodies against HSV-2 of 66.7%. Among pregnant native women, the prevalence of antibodies against HSV-2 was 54.6%.

CONCLUSIONS

There is a high prevalence of antibodies against HSV-2 among Yukpa natives in Venezuela.

Control of Listeria monocytogenes by bacteriocins and monitoring of bacteriocin-producing lactic acid bacteria by colony hybridization in semi-hard raw milk cheese

The ability of Listeria monocytogenes to grow at low temperatures and increase to hazardous levels during storage of dairy products is of great concern to the dairy industry. List. monocytogenes was detected in 3·6% of 774 cows' milk samples from 114 farms in Central Spain (Gaya et al. 1998). Ewes' and goats' milks produced in Spain had contamination levels of 2·2 and 2·6% respectively (Rodríguez et al. 1994; Gaya et al. 1996). List. monocytogenes may survive during the manufacture and ripening of most cheese varieties, with higher risk in soft surface-ripened cheeses owing to the rise in pH during ripening (Maisnier-Patin et al. 1992; Giraffa & Carminati, 1997).

The efficacy with which actively growing bacteriocin-producing cultures inhibit List. monocytogenes in some cheese varieties has been demonstrated. Nisin-producing starters inhibited List. monocytogenes V7 in Camembert cheese (Maisnier-Patin et al. 1992) and List. innocua BL86/26 in raw ewes' milk Manchego cheese (Rodríguez et al. 1998). A lacticin 3147-producing starter culture (McAuliffe et al. 1999) reduced List. monocytogenes Scott A levels in cottage cheese. Inoculation of milk with enterocin AS-48-producing Enterococcus faecalis INIA 4 inhibited List. monocytogenes strains Ohio and Scott A during the manufacture and ripening of Manchego cheese (Nuñez et al. 1997).

Semi-hard cheese varieties from raw or pasteurized cows' milk mixed with different proportions of ewes' and/or goats' milk represent ∼ 50% of Spanish cheese production. The objective of the present work was to evaluate the antilisterial activity of three bacteriocin-producing lactic acid bacteria strains isolated from milk (Rodríguez et al. 2000) during the manufacture and ripening of a semi-hard cheese manufactured from raw milk.

Frequency and determinants of microalbuminuria in mild hypertension: a primary-care-based study

OBJECTIVE

To evaluate the frequency of microalbuminuria and its relationship with several risk factors and left ventricular mass in a population of mildly hypertensive subjects attended in a primary-care setting.

DESIGN

Cross-sectional study.

SETTING

Eight primary-care centres.

PATIENTS

Two hundred and twenty-three non-diabetic patients recently diagnosed with mild hypertension were included in the study. None of them had clinical evidence of target-organ damage or had received prior antihypertensive treatment.

INTERVENTIONS

Subjects included in the study underwent clinical interview, measurement of blood pressure (BP) on three visits, blood analysis, measurement of albumin by immunonephelometry in three overnight urine collections, 24 h BP monitoring and M-mode and Doppler echocardiography.

MAIN OUTCOME MEASURES

Tobacco habit, clinic BP, body mass index, serum lipids and uric acid, glycaemia, urinary albumin excretion (UAE), ambulatory BP and left ventricular mass index.

RESULTS

The frequency of microalbuminuria was 7.2%. Microalbuminuric patients were more likely to be men and to be characterized by higher ambulatory BP, body mass index and uric acid levels. Regression analysis demonstrated that male sex and 24 h systolic BP were determinants of UAE. Patients with white-coat hypertension showed lower UAE than did subjects with sustained hypertension. Although a certain relationship between UAE and left ventricular mass index was found, these variables were not significantly correlated.

CONCLUSIONS

A low proportion of mildly hypertensive patients attended in a primary care setting are microalbuminuric. In this population, UAE is an expression of BP values over 24 h and correlates with several risk factors.

[The "quality of life" concept in medical students and postgraduate residents in a university hospital]

We investigated the quality of life's concept and its uses by both residents and interns as well as last year medical students in the University Hospital in Caracas (HUC). A random sample by strata, without replacement of 123 persons, completed a self administered questionnaire which included a set of closed questions and one of open questions related to the quality of life's concept. The mean age was 29 years for both sexes (3.55 standard deviation or SD). There was not a statistically significant difference between males and females. More than 50% read about quality of life in either newspapers, journals and fiction literature. There was no difference among the groups (p = 0.25). Only 68% had heard in a different sort of academical institution the term "quality of life" such as in the school of medicine, highschool or in some discussion groups with no differences among the groups (p = 0.15). However, there was no agreement as from whom and where they learned about quality of life (p < 0.001). Although everybody considered that the quality of life was an important element in medical actions such as diagnostic or therapeutics, its importance was reduced for diagnosis compared to treatment (p < 0.0001). All the elements that were considered as part of the concept were also considered as important, regardless of the group and was statistically significant (p < 0.05). The open question analysis showed that the non-medical definitions represent 85.15% of the group, 50% out of them included terms of potentiality or condition. Among the elements included in the definition was the social in 27.65%, psychological in 23.53% and, the economical in 12.35% of the questionnaires. The great majority of the "quality of life" definitions did not include a clearly defined subject and in many cases it was exclusively related to ill persons. Finally, there is an informal and not well oriented form of learning about "quality of life" in residents, interns and last year medical students with a lack of a good applicability in the medical practice. Therefore, there is a need for a formal training on quality of life along the medical studies and its uses in the medical practice in general and with special emphasis on diagnosis and therapeutics.