Creutzfeldt-Jakob disease cluster in the health area of Meixoeiro Hospital

OBJECTIVE

Galicia is the Spanish region in which most bovine spongiform encephalopathy cases have been registered. Meixoeiro Hospital is included in the Galician Health Service (SERGAS). The aim of the study was to analyze the clinical and epidemiological characteristics of Creutzfeldt-Jakob disease (CJD) in the health area of Meixoeiro Hospital and to identify possible specific risk factors to the general public.

METHODS

All incident cases of CJD were identified in the health area of Meixoeiro Hospital (187,877 inhabitants) over a 14-year period, 1997-2010, and classified according to WHO diagnostic criteria. We obtained clinical detail and epidemiological information on all cases. Crude and age-specific incidence rates were calculated. A review of surgical or invasive medical procedures was undertaken.

RESULTS

We diagnosed 12 patients with CJD, 10 sporadic CJD (sCJD), and two genetic CJD (gCJD). No iatrogenic or variant CJD was detected. According to Poisson distribution, 3.9 CJD cases would be expected for our area over the 14 years researched. The average yearly mortality rate from CJD was 4.6 cases per million (3.8 from sCJD and 0.8 from gCJD). Eight patients (67%) underwent at least one surgical or invasive medical procedure. Sixteen of twenty-seven (59%) of these procedures were undertaken in Meixoeiro Hospital.

CONCLUSIONS

The incidence of CJD in the health area of Meixoeiro Hospital is three times higher than expected. The hypothesis that at least some cases of sCJD are apparently because of covert transmission or zoonosis events should not be formally refuted and might explain the high rate found.

Cultural aspects related to the health of Andean women in Latin America: a key issue for progress toward the attainment of the Millennium Development Goals

International declarations have affirmed that health is a universal right. In order for people to exercise their right to health, their social and cultural contexts need to be acknowledged. However, due to a number of barriers encountered at different levels of society and geographically this right is not yet fully exercised by a considerable number of women in Latin America. During the last decade progress has been made in the development of public health policies and programs that integrate and recognize the differences in culture that should be considered when addressing indigenous women's health issues. However, a biomedical health model, which discounts cultural influences, prevails globally over a more integrated approach. This leads to a lack of access and use of quality reproductive health services and care among indigenous people and is one of several important factors contributing to high levels of maternal mortality and poor reproductive health among indigenous women. It is important to ensure that an intercultural approach is included in health policies, programs and services. An intercultural strategy fosters dialogue and respect among women, men, and decision-makers and can contribute to the realization of reproductive health rights and improvement of health outcomes. The debate continues on how to accelerate progress in public policies, health programs and health services. An intercultural approach to assure the health of indigenous women should be a key part of this discussion. Specific efforts are critical for obtaining better health outcomes for indigenous women and other vulnerable populations, if not progress will stagnate in the middle of the 21st century, jeopardizing the attainment of the Millennium Development Goal (MDGs).

Prestroke dementia

OBJECTIVE

To determine the frequency, associated factors and outcome of dementia previous to a stroke.

DESIGN

Cross-sectional study of a cohort of 324 consecutive unselected stroke patients (mean age 70.9 years, range 20-98; 255 ischaemic, 46 haemorrhagic and 25 indefinite).

METHODS

Cognitive and functional status prior to stroke were assessed by means of an interview to a relative, a short version of the Informant Questionnaire on Cognitive Decline in the Elderly and the Barthel Index. The DSM-III-R criteria were used to establish the diagnosis of prestroke dementia. Clinical and CT features of patients with and without prestroke dementia were compared.

RESULTS

Forty-nine patients (15%) were demented before stroke; they were significantly older, less well educated, they had more frequently female gender, prior cerebrovascular disease, cerebral and medial temporal lobe atrophy and leukoaraiosis in the CT scan, and they had a higher mortality rate. Female sex (OR 3.7, CI 95% 1.2-12), low education (OR 2.1, CI 95% 1.1-4.2), previous stroke (OR 3.6, CI 95% 1.2-11), and cerebral atrophy (OR 3.8, CI 95% 1.7-8.3) were independently associated with prestroke dementia in the logistic regression analysis.

CONCLUSIONS

Fifteen percent of stroke patients have prestroke dementia and they have a worse outcome. Factors associated with prestroke dementia are reminiscent both of degenerative and vascular brain pathology.

Immunohistochemical study of constitutive neuronal and inducible nitric oxide synthase in the central nervous system of goat with natural listeriosis

The expression of both constitutive and inducible forms of nitric oxide synthase (NOS) was investigated by immunohistochemical staining of formalin-fixed paraffin-embedded sections in normal and Listeria monocytogenes-infected brains of goats. In normal control goats, a small number of neurons showed immunoreactivity of both iNOS and nNOS, and the number of iNOS-positive neurons was higher than the number of nNOS-positive neurons. In natural listeriosis, listeria antigens were easily immunostained in the inflammatory cells of microabscesses. In this lesion, the immunoreactivity of iNOS in neurons was more intense than the control, but nNOS was not. In microabscesses, nNOS was weakly visualized in macrophages and neutrophils, while iNOS was expressed in macrophages, but not in neutrophils. These findings suggest that normal caprine brain cells, including neurons, constitutively express iNOS and nNOS, and the expressions of these molecules is increased in Listeria monocytogenes infections. Furthermore, inflammatory cells, including macrophages, expressing both nNOS and iNOS may play important roles in the pathogenesis of bacterial meningoencephalitis in goat.

Production and evaluation criteria of specific monoclonal antibodies to the hemagglutinin of the H7N2 subtype of avian influenza virus

To enhance the rapidity in diagnosing the spread of avian influenza virus (AIV) in chicken layer flocks, studies were initiated to develop more sensitive and specific immunological and molecular methods for the detection of AIV. In this study, the purification of the hemagglutinin protein (H) from field isolates of H7N2, the production of monoclonal antibodies (MAbs), and their evaluation as diagnostic reagents are reported. Hybridomas were generated by fusion of SP2/0-Ag14 myelomas and spleen cells from immunized mice. Hybridomas secreting antibodies specific for the H protein were assayed by an ELISA and cloned using limiting dilution. The MAbs produced were characterized by hemagglutination inhibition (HI), immunohistochemistry (IHC), indirect fluorescent antibody assay (IFA), Western blots, and IFA flow cytometry using various AIV subtypes (i.e., H4N2, H5N3, H7N2). Of the various MAbs assayed, 6 had consistent and reproducible results in each of the assays used. The results obtained in this investigation enhanced the usage of the MAbs to viral H protein in the surveillance of AIV in chickens.

[Vasopressin and brain death]

Brain death results in the breakdown of effective central regulatory mechanisms of cardiocirculatory stability, even in patients with artificial mechanical ventilation, correction of electrolytic and acid-basic disorders and maximal conventional pharmacological support of the circulation. Recent evidences have shown that the fall of vasopressin levels in the blood circulation significantly influences the cardiocirculatory stability of patients with brain death, and its exogenous administration is defended by many authors for the management of multiorgan donor patients. In this brief review we analyse and discuss some experimental and clinical relevant studies about the role of vasopressin in the control of cardiocirculatory stability in brain death, and its potential usefulness in the management of multiorgan donor. We conclude that the role of vasopressin in the pathophysiology of brain death and its usefulness as a pharmacological agent in the management of multiorgan donor are not well elucidated, deserving further investigations.

[Blood pressure in school children and adolescents - The Belo Horizonte study]

OBJECTIVE: To investigate epidemiological aspects of blood pressure (BP) levels, and the prevalence of arterial hypertension in a representative sample of the whole elementary and high school population of the city of Belo Horizonte (state of Minas Gerais, southeastern Brazil). To describe the blood pressure levels found and the prevalence of BP levels above the 90th and 95th percentiles in the first and second measurements. To evaluate prevalence using four different normality references separately to assess the impact of choice of reference. To study the frequency at which the studentś blood pressure has been evaluated.METHODS: In an observational cross-sectional epidemiological study, we studied a sample of 1005 students, aged 6 to 18 year, randomized from an universe of 486,166 students from the 521 public and private elementary and high schools in the city. Each student was evaluated by means of a personal interview, anthropometric measurements, and two blood pressure measurements in a single visit and at a 10-minute interval.RESULTS: The systolic and diastolic blood pressure levels, by age and gender, were slightly lower than those described by the Task Force Report (1987) and by Rosner et al. (1993). The prevalence of BP levels (systolic or diastolic) over the 95th percentile were, according to the reference used: 8.7% - Task Force Report (1987); 5.5% - Rosner et al. (1993); 6.5% - Update on the Task Force Report (1996); and 9.8% - the 95th percentile from our own study. In the second measurement these prevalence rates dropped to 4.9%; 2.4%; 3.5% and 5.8%, respectively.CONCLUSIONS: We present a detailed description (mean values and standard deviations, and the 90th, 95th and 99th percentiles by age and gender) of the BP levels found in both measurements. Mean values and upper percentiles found in this study are very close to those found in the American references, which validates the current use of these references in Brazil. The prevalence of 9.0% of BP levels above the 90th percentile in two measurements made at random hints at the number of children who should be monitored for hypertension, and reinforces the importance of routine evaluation of blood pressure at every pediatric examination.

Skin and soft-tissue infections after injury in the ocean: culture methods and antibiotic therapy for marine bacteria

Isolated organisms from two common Indo-Pacific marine animals (Echinometra mathaei urchins and Acanthaster planci sea stars) likely to cause puncture wounds to recreational beachcombers, diverse, or operational military forces during amphibious assaults demonstrate why practitioners should consider their first choice for potential antibiotic therapy differently from their usual favorite antibiotics. The effects of thiosulfate-citrate-bile-sucrose (TCBS) agar, varying salt concentrations in the standard media, and comparison of room temperature incubation versus use of the 30 degrees C (86 degrees F) incubator are reviewed. The yield of pathogenic marine bacteria is increased if TCBS agar is used and more than one temperature is used for incubation. A potentially significant human pathogen, Vibrio vulnificus, appears to be ubiquitous.

Neosporosis-associated bovine abortion in Pennsylvania

Neospora caninum was found in fetal tissues of 34 of 688 cases of bovine abortion submitted to the Pennsylvania Animal Diagnostic Laboratory System during the period from May 1994 to November 1996. The aborted fetuses ranged in gestational age from 3 to 8 months. Microscopic lesions consisted primarily of encephalitis and myocarditis. A labeled (strept) avidin-biotin staining procedure using anti-N. caninum polyclonal rabbit serum revealed N. caninum organisms within the fetal brain (27 of 27), heart (10 of 13), placenta (5 of 6), kidney (2 of 2), liver (1 of 4) and skeletal muscle (1 of 1).

Aneurysmal bone cyst of the patella

Aneurysmal bone cysts are uncommon lesions accounting for less than 1% of reported primary bone tumors. This case study reports the ninth primary aneurysmal bone cyst of the patella, and the second to be reported in a white male patient. The scarcity of reports in this vulnerable site may refute trauma as the cause. If the articular surface is spared, this lesion can be treated successfully by curettage and bone grafting, once a definitive diagnosis is made.

Bovine platelets contain a 280 kDa microtubule-associated protein antigenically related to brain MAP 2

Resting bovine platelets contain a microtubule coil which reorganizes into linear arrays upon thrombin activation. Microtubule arrays in both resting and activated platelets are extensively cross-linked. In an effort to determine the proteins responsible for this cross-linking, we have developed a method to isolate taxol-stabilized microtubule coils directly from platelet-rich plasma. Negatively stained coils are still cross-linked, and fine filamentous projections are seen between adjacent microtubules. Critical-point-dried rotary shadowed replicas of these coils most clearly demonstrate the projections radiating from individual microtubules as well as along the microtubule coil. Sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) analysis of isolated coils shows many microtubule-associated proteins (MAPs) present in addition to tubulin. One of these proteins, a 280 kDa MAP, cross-reacts with an antibody to bovine brain MAP 2 by immunoblot analysis. Immunofluorescence localization of this protein with both monoclonal and polyclonal antibodies demonstrates that it is associated with the microtubule coil in resting platelets and with the linear microtubule array present after thrombin activation. Immunoelectron microscopic localization demonstrates that projections from individual microtubules are labeled by the antibodies. We suggest that this MAP, along with several other potential MAPs, is responsible for the cross-linking and stability of bovine platelet microtubules.

The application of Miller's elastic stain to glycol methacrylate tissue sections

The application of Miller's dilute elastic stain followed sequentially by Gill's III hematoxylin and a fast green counterstain produced a reliable and consistent method for differentially staining elastic fibers, nuclei, muscle and collagen in glycol methacrylate tissue sections. Evaluation of different methods of fixation and conditions of staining on animal tissue sections showed that elastic fibers in both perfusion and immersion fixed tissues can be intensely stained. The stability of Miller's elastic stain offers the potential of a commercially available histological stain reagent for coarse and fine elastic fibers in glycol methacrylate tissue sections.