Identification of the PTPN22 functional variant R620W as susceptibility genetic factor for giant cell arteritis

OBJECTIVE

To analyse the role of the PTPN22 and CSK genes, previously associated with autoimmunity, in the predisposition and clinical phenotypes of giant cell arteritis (GCA).

METHODS

Our study population was composed of 911 patients diagnosed with biopsy-proven GCA and 8136 unaffected controls from a Spanish discovery cohort and three additional independent replication cohorts from Germany, Norway and the UK. Two functional PTPN22 polymorphisms (rs2476601/R620W and rs33996649/R263Q) and two variants of the CSK gene (rs1378942 and rs34933034) were genotyped using predesigned TaqMan assays.

RESULTS

The analysis of the discovery cohort provided evidence of association of PTPN22 rs2476601/R620W with GCA (PFDR=1.06E-04, OR=1.62, CI 95% 1.29 to 2.04). The association did not appear to follow a specific GCA subphenotype. No statistically significant differences between allele frequencies for the other PTPN22 and CSK genetic variants were evident either in the case/control or in stratified case analysis. To confirm the detected PTPN22 association, three replication cohorts were genotyped, and a consistent association between the PTPN22 rs2476601/R620W variant and GCA was evident in the overall meta-analysis (PMH=2.00E-06, OR=1.51, CI 95% 1.28 to 1.79).

CONCLUSIONS

Our results suggest that the PTPN22 polymorphism rs2476601/R620W plays an important role in the genetic risk to GCA.

[The objective structured clinical evaluation of teaching in anaesthesiology and resuscitation]

OBJECTIVES

To find out the acquirement of professional competencies of Anaesthesiology and Resuscitation medical residents at the end of their training period using the Objective Structured Clinical Evaluation (OCSE) tool.

MATERIAL AND METHODS

Six competency components to evalúate were defined as follows: clinical interview (communication), technical ability and relationship abilities (leadership, decision making, work in a team), diagnostic assessment, therapeutic management, and medical records. Different methodologies were determined depending on the knowledge and skills to evaluate. Twelve clinical cases were developed that were performed in 12 stations. A total of 107 Ítems, specified within the stations, evaluated the competency components. A total of 43 residents were invited to participate in the last 4 months of their training in hospitals in Andalusia and Extremadura.

RESULTS

A total of 33 residents participated. The overall mean of the classifications obtained in the 12 stations was 64.2 out of a maximum of 100. The medical residents demonstrated higher competency in obstetrics, paediatric anaesthesia, and that associated with difficult airway. The main competency gaps were detected in the area of one-day surgery, chronic pain, and literature management, in which approximately half passed the test.

CONCLUSIONS

We believe that training evaluations, such as the OCSE, help in determining the skill levels of the medical resident, making it easier to continually improve the training of the future anaesthesiologist.

Removing heavy metals from polluted surface water with a tannin-based flocculant agent

Many environmental and health problems come from the presence of metals in surface water. Effectiveness of a new commercial tannin-based flocculant has been tested in order to remove Zn(2+), Ni(2+) and Cu(2+) by coagulation-flocculation process. pH has been adjusted in order to evaluate the real heavy metal removal due just to flocculant effect and not to hydroxide precipitation. At least a 75% of metal removal has been reported in every case, depending on pH value. Flocculant doses have been reported to be about 100-150 ppm.

[Clinical and radiological characteristics of primary pulmonary tuberculosis in adolescents]

OBJECTIVE

The aim of this study was to investigate the incidence, clinical and radiological particularities of primary pulmonary tuberculosis in children between 10 to 16 year-old in our community.

PATIENTS AND METHODS

The medical records and chest X-ray of all children under 16 years old diagnosed of primary pulmonary tuberculosis between 1982 to 1996, and a similar characteristics control group diagnosed of bacterial pneumonia were reviewed. The difference between teenager with tuberculosis and pneumonia and between patients with tuberculosis under 10 years and order were analysed.

RESULTS

Between January 1982 and December 1996, 83 children with age range from 10 to 16 years were diagnosed of primary pulmonary tuberculosis. The incidence has been 15,5 cases/100000 h < 16 years/year. The primary pulmonary tuberculosis whole incidence in children under 16 year-old has been 17 cases/100000 h/year (182 cases). The adolescents fits to 40.5% of the hold group. 51.2% were girls and 49.8% were boys. Middle age has been 14.2+/-0.18 years with a progressive increased with the age. Anorexia (38% vs. 16.6%) and asthenia (38% vs 19.4%) have been more frequents in teenagers with tuberculosis. Cough has been the most frequent symptom in both groups (61.9% and 77.7%), and respiratory distress has been the most characteristic of tuberculosis (17.8% vs 2.7%). Thoracic pain was more frequent in patients with tuberculosis 10 years or older (57.8% and 7.8%). Laboratory values are not specific. Pleural effusion (46.4% vs 22.2%) and mediastinal lymphadenophaty (60.1% vs. 40.4%) were the most characteristic X-ray finding in teenagers and children under 10 years with primary pulmonary tuberculosis respectively.

CONCLUSIONS

Primary pulmonary tuberculosis has a high incidence in the teenager population in our community with a progressive increased with the age. The clinical and laboratory values are unspecific in this age group. The most characteristic X-ray finding is pleural effusion (46.4% of the patients).

[Nontraumatic hemorrhagic stroke in children after the neonatal period]

OBJECTIVE

The aim of this study was to determine the incidence, clinical features and outcome of nontraumatic hemorrhagic stroke in children.

PATIENTS AND METHODS

We performed a retrospective study of children with nontraumatic hemorrhagic stroke (codes 430-432 of the International Classification of Disease, 9th revision).

RESULTS

Between January 1982 and December 1995, twenty-one children less than 16 years of age with nontraumatic hemorrhagic stroke were admitted to our hospital. The incidence rate for hemorrhagic stroke was 2.3 cases per 100,000 per year which constituted 67.7% of all strokes in children. There was a slight predominance of males (1.62:1). Onset of symptoms was sudden in 61.9% of cases and gradual in 38%. The most commo symptoms were altered consciousness (71.4%) and hemiparesis (61.9%). Vascular malformations constituted the largest etiological group (42.8%) followed by the hemorrhages into cerebral tumors (9.5%). In 28.5% of the cases no cause could be found. Surgery was carried out in 38% of the cases. There was an overall mortality of 19% and a post-operative mortality of 25%.

CONCLUSIONS

Hemorrhagic stroke is a rare event in childhood. Prompt surgical management decreases the mortality rate and improves the outcome of these patients.