Relation between serologic response and pathologic findings in sheep with naturally acquired paratuberculosis

OBJECTIVE

To investigate the relation between lesions and serologic response in sheep with naturally acquired paratuberculosis and to evaluate the efficacy of agar gel immunodiffusion (AGID) and ELISA as diagnostic tests.

ANIMALS

134 adult sheep, culled by the owner from flocks with history of severe chronic weight loss.

PROCEDURE

Before euthanasia, blood samples were collected and serum was obtained. AGID and ELISA were performed, using a protoplasmic antigen of Mycobacterium paratuberculosis. Sensitivity and specificity of these techniques were evaluated, using histopathologic findings as a reference. Histologic studies were carried out focusing on specimens containing intestinal organized lymphoid tissue.

RESULTS

Of the sheep examined, 46.3% had lesions that were classified in 5 categories, according to their location, extension, cellular types, and presence of acid-fast bacilli. Regarding serologic test results, 37.1% of sheep with lesions had a positive AGID result, and all sheep without lesions had negative results. However, ELISA positivity was slightly greater--48.4% of sheep with lesions; however, by use of ELISA, 11.1% of sheep without lesions had positive results.

CONCLUSION

A close relation between pathologic findings and serologic response was determined, especially between presence of acid-fast bacilli (potentially heavily shedding sheep) in the intestinal lesions and positivity to serologic tests, especially AGID.

CLINICAL RELEVANCE

On the basis of these results, together with its high specificity, reliability, and the difficulty of fecal specimen culture in sheep, AGID is proposed as a useful tool for seeking evidence of paratuberculosis in live sheep, and therefore, is suggested as the basis for control programs in areas in which the disease is a serious threat to sheep production.

[Predictors of rehospitalization in schizophrenia]

OBJECTIVES

The aim of this study is to determine the predictive value on rehospitalization of sociodemographic variables, positive/negative symptoms and thought disorders. The results are part of research project founded by the Basque Health Department.

METHODS

A 18 month follow-up study of a cohort of 60 patients with acute exacerbation of schizophrenia was carried out. The assessment was performed with DSM III-R diagnostic criteria, PANSS and CGI rating scales, and SCID-P semistructured interview. All patients received antipsychotic treatment. The sociodemographic and disease data, the dimensional score of the PANSS subscales, the score of CGI scale, the items 2, 12, 13 and 14 of the PANSS as indicators of formal thought disorders; and the items 1, 5, 6, 17 and 23 of the PANSS as content thought disorders were established as predictors. The predictive value was determined by the Cox regression test (Lee 1992).

RESULTS

We did not find predictive value either in the PANSS scores or in the 9 thought disorders evaluated (Wald and RR tests were not significative). Nevertheless, considering the values of standard error obtained in the Cox regression we were not in a position to assure that they did not have an incidence in the hospitalizations. The CGI was the only scale that showed prognostic value (Wald test = 1.9945; RR = 1.7499). Our results indicated that the lower number of previous hospitalizations (Wald test = 1.1437; RR = 1.1437) and the high level of studies (Wald test = 2.4258; RR = 1.8052) diminished the risk of rehospitalization.

CONCLUSIONS

1 o The predictive value on rehospitalization for the positive/negative symptoms and thought disorders was not confirmed. 2 o CGI is the only scale with predictive value. That fact makes us consider the importance of what German psychiatrists called "smelling the schizophrenia" or "The smell of schizophrenia". 3 o Our results indicate that the lower number of previous hospitalizations, and the high level of studies diminish the risk of rehospitalization.

Cyproterone acetate displaces opiate binding in mouse brain

Drugs acting on androgen receptors modify opioid transmission in the central nervous system. To investigate a direct interaction, we studied whether the binding of [3H]diprenorphine to mouse brain membranes was modified by cyproterone acetate (progesterone derivative with antiandrogen activity), flutamide (non-steroidal antiandrogen), 5alpha-dihydrotestosterone and progesterone. Only cyproterone acetate inhibited [3H]diprenorphine binding (IC50 = (1.62 +/- 0.33) x 10(-6) M) without modifying its association rate. These results suggest that cyproterone acetate binds to opiate receptors independently of its classical androgenic intracellular receptor effect.

[Epidemiological study of hepatitis A and E viruses in different populations in Uruguay]

The hepatitis A and E virus (HAV and HEV) share the fecal-oral mechanism. Hepatitis A is an endemo-epidemic disease in Uruguay but no data on the epidemiologic pattern of the HEV is available. The aims of this study were to update the epidemiologic behavior of the HAV in Montevideo and demonstrate the circulation of the HEV in Uruguay. Two hundred fourteen patients who consulted in the Policlínica de Nutrición y Digestivo were studied, 185 (86%) of whom were anti HAV (HAVAB, Abbot) positive. 81.8% (117/143) of those residents in Montevideo and 95.7% (68/71) of those who were from the inland were anti-HAV positive. From the Montevideo population 55.8% cases under the age of 40 years were anti-HAV positive and occurred in 97.6% of those older (p < 0.001). Considering the health care conditions of the positive patients in Montevideo, 95.6% (43/45) had septic chambers and 75.5% (74/98) disposed of toilet facilities (p < 0.001). It is concluded that although the global prevalence has been maintained since 1982, there is a change in the epidemiologic pattern with greater risk of infection in patients under the age of 40 years proceeding from areas without toilet facilities. The prevalence of total antibodies for HEV (EIA, Abbot) was 2.8% in this population. An association was observed with HAV in 2.2% (4/185). Moreover, a sample of 252 blood donors from the National Blood Service was analyzed with 5 being found to be anti HEV positive, with only 3 (1.2%) being confirmed in the Center for Disease Control in the United States. Although no definitive conclusions may be drawn from the present study, from an epidemiologic point of view, it has been shown that there is evidence of the circulation of HEV in Uruguay, in both the out patient and in blood donor populations.

Molecular characterization of beta-thalassemia genes in an Argentine population

This study was designed to identify the beta-thalassemia mutations in an Argentine population. Seventy-one pediatric patients and 101 available relatives were studied (85 chromosomes). Diagnosis of beta-thalassemia was made by conventional hematological procedures. Molecular studies were carried out by dot-blot and restriction endonuclease analysis on amplified DNA to detect the eight most frequent mutations in the Mediterranean area. We were able to identify 95.3% of the beta-thalassemia mutations in the subjects under study. The four common defects (C-39, 47%; IVS-I nt 110, 22.4%; IVS-I nt 1, 9.4%; and IVS-I nt 6, 5.9%) account for 84.7% of the beta-thalassemia alleles. The alleles and their distributions showed a close similarity to the spectrum of alleles in Italy. The differences might represent the influence of other immigrations, especially from Spain. We conclude that beta-thalassemia in Argentina originated mainly from Italian immigrants. This study will enable us to design an adequate approach to genetic counseling and/or prenatal diagnosis for couples at risk.

Significance of indeterminate reactivity to human T-cell lymphotropic virus in western blot analysis of individuals at risk

Current tests to confirm human T-cell lymphotropic virus (HTLV) infection in individuals at risk of retroviral infection commonly yield indeterminate results. To assess the significance of HTLV-seroindeterminate reactivities in a high-risk population, 16 at-risk individuals who had this serologic pattern by Western blot were studied using a polymerase chain reaction (PCR) assay. Human T-cell lymphotropic virus type II infection was confirmed by the presence of virus-specific nucleic acid in four patients. However, PCR analysis was negative in the remaining 12 individuals. These results indicate strongly that all specimens from at-risk individuals with nondiagnostic HTLV reactivity by current Western blot assay should continue to be considered inconclusive, requiring further testing by more sensitive tests.

[Serotonergic function in endogeneity of depression]

OBJECTIVE

This study employed an alternative method for assessing serotonergic function in depression. The neuroendocrine responses to acute intravenous administration of the serotonin (5-HT) reuptake inhibitor clomipramine were assessed in patients with Major Depression with Melancholia (DMM) and matched subjects with Major Depression (DM) (without Melancholia) and Dysthimic disorder (TD).

METHOD

10 patients who met DSM III-R criteria of DMM, 10 patients with DM and 10 with DD matched for age and sex received 12.5 mg of intravenously administered clomipramine. Prl, Cortisol and GH were measured during the next 135 minutes. We divided the samples using the Newcastle Scale.

RESULTS

The DMM patients had significant blunting prolactin responses to clomipramine compared with the other patients. Most of the major depression patients without melancholia were neurotic depressions according to the Newcastle Scale. There was a negative correlation between endogeneity and prolactin response.

CONCLUSIONS

These data support the hypothesis that DMM patients have abnormal neuroendocrine responses to the intravenous administration of the 5-HT reuptake inhibitor clomipramine, and that there is an association between endogeneity and prolactin response.

Reliability of a new recombinant immunoblot assay (RIBA HIV-1/HIV-2 SIA) as a supplemental (confirmatory) test for HIV-1 and HIV-2 infections

The diagnosis of HIV infection is usually determined using serological methods. Positive results in a screening test should be confirmed with more specific supplementary assays, and the Western blot (WB) is the most frequently used. However, problems of WB, particularly in regard to the significance of indeterminate results, still remain. We evaluate a new recombinant HIV-1/2 antigen-based immunoblot (RIBA) as confirmatory assay in a panel of 190 clinical samples. The RIBA was much more sensitive and specific than WB. In particular, the test allows for a significant reduction in the number of indeterminate results and for more accurate distinction between HIV-1 and/or HIV-2 infections. Thus, these results make tests such as the RIBA instead of WB particularly attractive for validating anti-HIV EIA reactivity.

[Serotypes of the human immunodeficiency virus type 1 in Madrid]

BACKGROUND

HIV-1 shows high genetic variability, mainly in the genomic region codifying the envelope proteins, which are the most immunogenic. This fact explains the high heterogeneity of antibodies against HIV-1 epitopes. Both genetic and serologic diversity has allowed to classify HIV-1 variants in several subtypes (genotypes and serotypes, respectively). The clinical and epidemiological significance of infection caused by each subtype remains to be clarified.

PATIENTS AND METHODS

Serum samples from 154 HIV-seropositive individuals living in Madrid were studied. Serotyping was performed using 4 peptides belonging to the V3 env region. Epidemiological and clinical variables examined in these patients were the route of infection, the year in which HIV infection occurred, the country of birth, and the rate of disease progression (rapid versus slow).

RESULTS

148 (96.2%) samples could be serotyped, and the B class was recognized in 131 (88.5%) of them. Serotype A/C was found in 9 (6.1%). Two samples (1.3%) reacted to peptide E; however, both were also reactive against the B peptide, suggesting co-infection with B and E subtypes. Six samples were EIA-reactive for HIV-1/2 but were typed as HIV-2 alone. Infection with serotypes A/C was more frequent amongst immigrants, mainly in Africans. There was not association between any subtype and the route of infection neither a different rate of disease progression.

CONCLUSION

HIV-1 serotype B is the most frequently found in HIV-seropositive individuals living in Madrid, without association with the route of infection or the clinical course of the disease. Serotypes A/C and E were found sporadically, mainly among immigrants.

[Rapid and slow progression of the infection by the type 1 human immunodeficiency virus in a population of seropositive subjects in Madrid]

BACKGROUND

The rate of progression to AIDS in HIV-1 infected subjects is variable, and circumstances associated with more rapid or slow development of severe immunodeficiency might be grouped in three categories; environmental cofactors, host features, and particular virulence of the virus itself. Currently, it is not yet clear the the relative impact of each one.

PATIENTS AND METHODS

A cross-sectional study was done in a cohort of 1,783 IV-1 infected persons from three centers located in Madrid, mainly devoted to attend persons at risks for HIV infection. Long-term nonprogressors (LTNP) were defined as those with more than 8 years of confirmed HIV seropositivity, and CD4+ T-cell count above 500 x 10(6)/I in the absence of antiretroviral therapy or symptoms suggesting immunodeficiency. Rapid progressors (RP) were those with less than 5 years from seroconversion and repeatedly current CD4+ T-cell count below 200 x 10(6)/I. An analysis of different epidemiological, immunological and virological features was performed comparing LTNP and RP.

RESULTS

Among 1,783 HIV (+) subjects studied, 100 (5.6%) fulfilled criteria for LTNP and 12 (0.7%) for RP. Among LTNP, stabilized CD4 slope was seen in 16 (33%) out of 48 after more than 8 years of infection. Variables statistically associated with LTNP were: past history of intravenous drug addiction (80% of them), male gender (79% of them), high alcohol intake (48% of them), HIV-1 non-syncitium inducing viral phenotype, and very low or undetectable HIV-1 plasma viremia. In contrast, variables associated with RP were: infection by sexual contact (75% of cases), female gender (50% of them), syncitium-inducing viral plenotype, and high titers of plasma viremia. The CD4/CD8 ratio below 1 was seen in all RP and in 88% of LTNP. However, a preferent depletion of CD4+ cell occurred in the first group, instead of an enhancement of the CD8 T-cell count in LTNP. The prevalence of serological markers for hepatotropic viruses and other potential infectious cofactors was not higher in RP.

CONCLUSIONS

Multiple factors seems to account for the different rate of disease progression observed in HIV-1 infected persons. The dynamic equilibrium between the immune system and the virulence of the virus seem to be influenced--but not determined--by environmental infectious or non infectious cofactors.

[Spectroscopic magnetic resonance in hemimegalencephalus]

INTRODUCTION

Hemimegalencephalus (HM) is a disorder of cerebral migration characterized by the overdevelopment of one cerebral hemisphere. It is usually associated with pachygyria, gliosis and neurone loss. We present a study using stereoscopic magnetic resonance (SMR) in a case of HM confirmed by the pathologist.

CLINICAL CASE

A girl with right HM had hemigeneralized crisis since birth. A selective right temporoccipital cortectomy was done when she was two and a half years old. The resected piece showed thickening and absence of cortical striation, neurone loss, gliosis, giant neurones and heterotopias. After a symptom-free period the crises reappeared as right fronto-parietal epileptiform anomalies. When she was four years old SMR was done to compare this area with the corresponding area of the radiologically normal left hemisphere. Comparative study showed a marked drop in N-acetyl-aspartate (NAA), glutamate (Glu) and Gaba, and increased choline (Col) and inositol (Ino). We found no difference in the creatinine levels.

CONCLUSIONS

The histological findings are in concordance with the levels of metabolites found in the affected hemisphere. The drop in NAA and Glu is related to neurone loss and the increase in glial cells, and the increase in Col and Ino with increase in membranes metabolism, as is observed in the gliosis. SMR is an advance in the identification and grading of changes seen on conventional MR, when establishing the prognosis and choice of treatment in HM.

Spasmolytic activity of a lipidic extract from Sabal serrulata fruits: further study of the mechanisms underlying this activity

The mechanisms involved in the spasmolytic effect of a lipidic extract from Sabal serrulata fruits were investigated. The extract relaxed vanadate-induced contractions on rat uterus incubated in a calcium free solution (EC50 = 11.41 +/- 1.38 micrograms/ml). The modification of the effect by a cyclooxygenase inhibitor (indomethacin), a protein kinase A inhibitor (TPCK), calcium modifying drugs, and drugs interfering with transcription and protein synthesis has been assayed. The effect was unmodified by a 3 microM concentration of indomethacin, (EC50 = 8.77 +/- 1.28 vs 11.41 +/- 1.38 micrograms/ml) and a 5 micrograms/ml concentration of the transcription inhibitor, actinomycin D, (EC50 = 8.23 +/- 2.19 vs 11.41 +/- 1.38 micrograms/ml). The inhibitor of intracellular calcium mobilization TMB-8 (0.1 mM), the Na+/Ca+2 exchanger inhibitor amiloride (0.1 mM), the calcium chelator BAPTA-AM (50 microM), the PKA inhibitor TPCK (10 microM), and the protein synthesis inhibitor cycloheximide (10 micrograms/ml) significantly shifted to the right the dose-response curve of the extract (EC50 = 17.83 +/- 1.87 micrograms/ml, 18.61 +/- 2.50 micrograms/ml, 35.28 +/- 9.13 micrograms/ml, 33.99 +/- 3.07 micrograms/ml, and 27.31 +/- 4.93 micrograms/ml, respectively, vs 11.41 +/- 1.38 micrograms/ml). These results suggest that the effect of the lipidic extract from S. serrulata fruits could be partially due to Na+/Ca+2 exchanger activation and interference with intracellular calcium mobilization, and point to cAMP as a possible mediator. Moreover, protein synthesis seems to be involved in the spasmolytic activity.

Epidemiology of human T-lymphotropic virus type II (HTLV-II) infection in Spain. HTLV Spanish Study Group

The human T-lymphotropic virus type II (HTLV-II) has recently been associated with the genesis of some subacute neurological syndromes and, rarely, with atypical T-lymphoid malignancies. The virus is endemic in some Amerindian and African tribes, and among intravenous drug users (IDUs) in North America and Europe. Given that HTLV-II is transmitted by the same routes as other human retroviruses, the screening of antibodies to HTLV-II in blood donors has became a matter of controversy in some countries. Herein, we describe the clinical, epidemiological and virological features of 113 individuals with HTLV-II infection identified in Spain up to September 1995. Most of them (94/113; 83%) were male, and all but seven were natives. Four were African immigrants living in Madrid and 3 had been born in other European countries. All but six subjects were IDUs, and sexual transmission of HTLV-II and transfusion were involved in five and one individual, respectively. Eighty-four percent of the IDUs infected with HTLV-II were co-infected by HIV-I (93/107). Clinical manifestations potentially linked to HTLV-II were absent, although an IDU male co-infected by HIV-1 and HTLV-II developed a severe non-inflammatory proximal myopathy. In conclusion, HTLV-II infection is present in Spain, mainly among IDUs, with a growing incidence and a current overall prevalence of 2.0 percent.

[Determination of spirometric values in a normal Chilean population over 5 years old, at sea level]

BACKGROUND

The interpretation of spirometric results requires reference values. Up to the moment, the reference values used in Chile are those of Knudson et al, obtained in a white North American population studied in Tucson, USA.

AIM

To obtain reference spirometric values from a Chilean population.

SUBJECTS AND METHODS

Maximal expiratory flow-volume curves were obtained from a randomly selected population of 850 healthy non-smoking subjects living at sea level, in cities without atmospheric pollution. Equipment and techniques were used according to the recommendations of the American Thoracic Society.

RESULTS

Linear regression equations were obtained, using age and height as independent variables and spirometric values as dependent variables, for both sexes and ages from 6 to 70 years old. Our values for forced vital capacity and forced expiratory volume were 9 to 18% and 10 to 15% higher than those reported by Knudson et al.

CONCLUSIONS

Chilean spirometric reference values differ from those used abroad, emphasizing the need to use local standards to interpret spirometric results.

[The clomipramine test and subtypes of depression]

OBJECTIVE

Neuroendocrine challenge paradigms have been used to assess serotonergic system in depression but limitations in the specificity of many of these tests have been noted. In this study, the neuroendocrine responses to acute intravenous administration of the serotonin (5-HT) reuptake inhibitor clomipramine were assessed in patients with Major Depression with Melancholia (DMM) and matched subjects with Major Depression (DM) (without Melancholia) and Dysthimic disorder (TD).

METHOD

10 patients who met DSM III-R criteria of DMM, 10 patients with DM and 10 with DD matched for age and sex received 12.5 mg of intravenously administered clomipramine. Prl, Cortisol and GH were measured during the next 135 minutes.

RESULTS

The DMM patients had significant blunting prolactin responses to clomipramine compared with the other patients.

CONCLUSIONS

These data support the hypothesis that DMM patients have abnormal neuroendocrine responses to the intravenous administration of the 5-HT reuptake inhibitor clomipramine and that they are different from the DM and TD patients.

[Report of the first 2 cases of HIV-1 group O infection in Spain]

BACKGROUND

The wide genetic variability of HIV-1 isolates has allowed to classify them into several subtypes. Very high divergent strains have been isolated recently from West Africa patients with AIDS, and they have been called HIV-1 group O ("outlier").

PATIENTS AND METHODS

In April 1995 a couple of patients was referred for medical follow-up and definitive diagnosis of HIV-1 infection. Both were white and had been born in Spain. The husband had been working for 10 years in West Africa. CD4+ T-cell counts were below 250 x 10(6)/l in both subjects, and the wife had developed seborrheic dermatitis and mild pancytopenia. Serologic and genetic studies were performed to study the presence of HIV-1 group O infection in this couple.

RESULTS

Serological tests (enzyme immunoassays, Western blot, line immunoassay) yielded indeterminate results for HIV-1 testing serum from the wife, but the husband's specimen was positive. Serological test for HIV-2 were negative in both subjects. In contrast, a new test allowed recognition of specific antibodies to HIV-1 group O in these patients. Furthermore, this infection was confirmed using a discriminative PCR methodology, which demonstrated the presence of specific HIV-1 group O sequences and the absence of group M sequences.

CONCLUSIONS

The first two cases of HIV-1 group O infection in Spain are described. It is pointed that diagnostic tests and therapeutic strategies need to considers the presence of this new HIV variant outside endemic areas.

[Vasculitis caused by Pseudomonas: a case report]

Pseudomona vasculitis is an exceptional disease. Only a few cases have been reported, non with oropharyngeal involvement. The case of a 30-year-old, HIV-positive man who suddenly developed septicemia and necrotizing lesions with tissue destruction of the oropharynx is reported. Histological study confirmed vasculitis. Pseudomona aeruginosa was isolated in peripheral blood and in the biopsy of the palatal lesion. Antibiotic treatment produced satisfactory results.

Association of primary antiphospholipid syndrome with primary adrenal insufficiency

The association of primary adrenal insufficiency with antiphospholipid antibodies is usually reported in the context of adrenal thrombosis or hemorrhage. We describe a 35-year-old woman who developed a primary antiphospholipid syndrome (spontaneous abortion, thrombocytopenia, and cerebrovascular occlusion) in association with primary adrenal insufficiency without evidence of suprarenal hemorrhage or thrombosis.