Guidelines: basic principles of neurorehabilitation for patients with acquired brain injury. Recommendations of the Spanish Society of Neurorehabilitation

INTRODUCTION

We present the Spanish Society of Neurorehabilitation's guidelines for adult acquired brain injury (ABI) rehabilitation. These recommendations are based on a review of international clinical practice guidelines published between 2013 and 2020.

DEVELOPMENT

We establish recommendations based on the levels of evidence of the studies reviewed and expert consensus on population characteristics and the specific aspects of the intervention or procedure under research.

CONCLUSIONS

All patients with ABI should receive neurorehabilitation therapy once they present a minimal level of clinical stability. Neurorehabilitation should offer as much treatment as possible in terms of frequency, duration, and intensity (at least 45-60minutes of each specific form of therapy that is needed). Neurorehabilitation requires a coordinated, multidisciplinary team with the knowledge, experience, and skills needed to work in collaboration both with patients and with their families. Inpatient rehabilitation interventions are recommended for patients with more severe deficits and those in the acute phase, with outpatient treatment to be offered as soon as the patient's clinical situation allows it, as long as intensity criteria can be maintained. The duration of treatment should be based on treatment response and the possibilities for further improvement, according to the best available evidence. At discharge, patients should be offered health promotion, physical activity, support, and follow-up services to ensure that the benefits achieved are maintained, to detect possible complications, and to assess possible changes in functional status that may lead the patient to need other treatment programmes.

Improvement of Mueller-Kauffman Tetrathionate-Novobiocin (MKTTn) enrichment medium for the detection of Salmonella enterica by the addition of ex situ-generated tetrathionate

The detection of Salmonella in food is based on the use of a selective enrichment broth such as Muller-Kauffman Tetrathionate-Novobiocin (MKTTn), in which tetrathionate plays a key role by providing Salmonella with a growth advantage. As sodium tetrathionate is unstable, it is generated in situ by the addition of iodine (Lugol's solution) before seeding. This step is cumbersome as the solution is easily spilled, compromising the performance of the medium and hindering the work of technicians. The aim of this study was to optimize MKTTn broth by generating tetrathionate ex situ through an external reaction between iodine and thiosulphate followed by lyophilization. Quality control procedures were performed to compare the modified and original media, testing pure productivity (enrichment with 50-120 CFU of Salmonella Thyphimurim ATCC 14028 and Salmonella Enteritidis ATCC 13076 and plating on Xylose Lysine Deoxycholate agar, XLD), mixed productivity (50-120 CFU of Salmonella strains and Pseudomonas aeruginosa and Escherichia coli at ≥10⁴ CFU and XLD plating) and selectivity (≥10⁴ CFU of P. aeruginosa and Enterococcus faecalis and plating on Tryptone Casein Soy agar, TSA). The modified MKTTn medium (S/L) performed comparably with the original medium in terms of growth of both Salmonella strains (>300 colonies in XLD), alone or with P. aeruginosa and E. coli. Quantitative assays showed no statistically significant differences in the number of colonies grown on XLD after 10^-5 dilution (p = 0.7015 with S. Thyphimurim ATCC 14028 and p = 0.2387 with S. enteritidis ATCC 13076; ANOVA test). MKTTn medium (S/L) was also selective against E. coli (≤100 colonies) and E. faecalis (<10 colonies). These results suggest that adding tetrathionate as a lyophilisate (S/L) is a feasible alternative to the use of Lugol's solution for the preparation of MKTTn enrichment broth and does not affect the properties of the medium.

The effect of early experiences in Barn Owl (Tyto alba) behaviour. Acquisition-expression time of neophobia and filial imprinting. Implications for management and conservation

In birds, early experiences determine the later behavioural phenotype of individuals and their way of adapting to the challenges they encounter in their environment. We investigated how the degree of exposure of barn owl chicks to humans and their biological parents influenced their behavioural response to humans and different environments. Only the treatment groups raised by human beings, or those that remained for less time with their biological parents (15 days posthatching), learned to fly towards their trainer. However, the two groups of chicks that were raised the longest by their biological parents (20 and 25 days) never flew towards their trainer. In these last groups, the filial imprint was shown not to be able to be reversed. Neophobia was estimated to emerge between 17 and 19 days of age, as barn owls were able to recognize the environment in which they were habituated, showing fear of a new environment. Birds were able to recognize the person who raised them and objects with which they had been raised. The results obtained in this work can help to establish breeding protocols in this and other species of birds of prey, which improve their adaptability to the environment where they will live, whether in captivity or in the wild.

Conserving evolutionary history does not result in greater diversity over geological time scales

Alternative prioritization strategies have been proposed to safeguard biodiversity over macroevolutionary time scales. The first prioritizes the most distantly related species—maximizing phylogenetic diversity (PD)—in the hopes of capturing at least some lineages that will successfully diversify into the future. The second prioritizes lineages that are currently speciating, in the hopes that successful lineages will continue to generate species into the future. These contrasting schemes also map onto contrasting predictions about the role of slow diversifiers in the production of biodiversity over palaeontological time scales. We consider the performance of the two schemes across 10 dated species-level palaeo-phylogenetic trees ranging from Foraminifera to dinosaurs. We find that prioritizing PD for conservation generally led to fewer subsequent lineages, while prioritizing diversifiers led to modestly more subsequent diversity, compared with random sets of lineages. Importantly for conservation, the tree shape when decisions are made cannot predict which scheme will be most successful. These patterns are inconsistent with the notion that long-lived lineages are the source of new species. While there may be sound reasons for prioritizing PD for conservation, long-term species production might not be one of them.

Efecto del tipo genético y la maduración sobre la retención de agua en carne de toros castrados

La capacidad de retención de agua en crudo (CRAr) y en cocinado (CRAc) fue determinada en carne madurada a 7, 14 y 21 días post mórtem. Los músculos Longissimus dorsi (LD) y Semitendi-nosus (ST) de 164 machos castrados provenientes del cruce de machos de las razas Simmental, Normanda, Blanco Orejinegro, Braunvieh, Guzerat, Brahman Blanco, Brahman Rojo, Limousin y Romosinuano con hembras Brahman blanco. Para el parámetro CRAr en LD se presentó significancia de los factores tipo genético y maduración y en ST del factor maduración. Para el parámetro de CRAc en LD fue significativo el factor tipo genético y para ST ninguno de los dos factores fue significativo. No existieron interacciones significativas de los dos factores evaluados. Lo ideal es someter a tiempos cortos de maduración ambos músculos y tener en cuenta el tipo genético al cual pertenece el individuo con el fin de minimizar las pérdidas de exudado.

In vitro study of microleakage of fissure sealant with different previous treatments

The purpose of this work was to evaluate microleakeage of a sealant after using three different techniques for conditioning the surface to be sealed. Twenty-four caries-free upper and lower premolars were used, which were preserved in distilled water at room temperature. The structural faults were enlarged using a cylindrical conical diamond (ISO 007). Teeth were randomly assigned into three groups of eight. Group I (control) was conditioned with 37% phosphoric acid (Vivadent) for 15 seconds after which the sealant Helioseal F (Vivadent) was applied and cured for 40 seconds. Group II was conditioned in the same way, after which one-step adhesive Te-econom (Vivadent) and the sealant were applied. Group III was conditioned using a self-etching adhesive, Go (SDI), after which the sealant was applied. Adhesive was applied according to the manufacturer's instructions. The samples were thermocycled for 300 cycles between 5 degrees and 55 degreesC and immersed in a 2% methylene blue solution for 48 hs. at standardized temperature of 37 degreesC +/- 1 degree. Then they were rinsed with tap water and ground longitudinally in V-P direction with silica carbide rotatory disks of decreasing grit. The amount of leakage was evaluated under stereoscopic microscope at 40X magnification. The longitudinal penetration of dye into the tooth-sealant interface was scored on a scale of 0 to 3. The results were analyzed by a Kruskal-Wallis non-parametric test. In Group II, 100% of the samples showed low (50%) or no (50%) leakage. Both the other groups had a higher percentage of specimens with high leakage (scores 2 and 3) (P = 0.000). Group II had the best performance, with significant differences (P = 0.0028) compared to the other experimental groups. Marginal leakage was lowest when the tooth was conditioned with phosphoric acid and subsequent application of an adhesive, prior to sealant.

Thyrotropin levels and their relationship with cardiovascular risk factors in the island of Gran Canaria, Spain. Implications of lowering the upper reference limit of thyrotropin stimulating hormone

OBJECTIVE

To characterize the cardiovascular risk profile of subjects with high and normal-high concentrations of serum TSH in a sample of adult Spanish subjects from the island of Gran Canaria.

DESIGN

Cross-sectional population-based study.

SUBJECTS

After excluding 28 individuals on current treatment with levothyroxine and 9 others with TSH levels below the range of normality (0.3-4.9 mU/l), 704 randomly selected subjects (412 women; age range: 30-82 yr) belonging to the Telde Study were assessed.

MEASUREMENTS

Participants underwent physical examination and fasting blood analyses to determinate TSH, serum lipids, homocysteine, fibrinogen, von Willebrand factor, plasminogen activator inhibitor- 1, C-reactive protein, and insulin.

RESULTS

Twenty-nine participants had serum TSH concentrations above the normal range of normality. Among all the studied variables, only female sex and diastolic blood pressure were significantly associated with TSH levels > or =5 mU/l in a multivariate logistic regression analysis. If the upper normal limit of TSH was reduced up to 2.4 mU/l, an additional group of 106 subjects would be considered to have elevated TSH levels. A serum TSH > or =2.5 mU/l was positive and independently associated with female sex, body mass index, total cholesterol, and homocysteine, and negatively associated with smoking.

CONCLUSIONS

Although the impact of serum TSH levels on cardiovascular risk cannot be established from these findings, TSH values within the upper part of the usually accepted normal range were demonstrated to be associated with well-recognized risk factors for cardiovascular disease.

Genital sensory stimulation shifts estradiol intraoviductal signaling from nongenomic to genomic pathways, independently from prolactin surges

Estradiol (E2) accelerates oviductal egg transport through nongenomic pathways involving oviductal protein phosphorylation in non-mated rats, and through genomic pathways in mated rats. Here we investigated the ability of cervico-vaginal stimulation (CVS) to switch the mode of action of E2 in the absence of other male-associated components. Pro-estrous rats were subjected to CVS with a glass rod and 12 hours later were injected subcutaneously with E2 and intrabursally with the RNA synthesis inhibitor Actinomycin D or the protein phosphorylation inhibitor H-89. The number of eggs in the oviduct, assessed 24 h later, showed that Actinomycin D, but not H-89 blocked the E2-induced egg transport acceleration. This clearly indicates that CVS alone, without other mating-associated signals, is able to shift E2 signaling from nongenomic to genomic pathways. Since mating and CVS activate a neuroendocrine reflex that causes iterative prolactin (PRL) surges, the involvement of PRL pathway in this phenomenon was evaluated. Prolactin receptor mRNA and protein expression in the rat oviduct was demonstrated by RT-PCR and Western blot, but their levels were not different on day 2 of the cycle (C2) or pregnancy (P2). Activated ST AT 5a/b (phosphorylated) was detected by Western blot on P2 in the ovary, but not in the oviduct, showing that mating does not stimulate this PRL signalling pathway in the oviduct. Other rats subjected to CVS in the evening of pro-estrus were treated with bromoergocriptine to suppress PRL surges. In these rats, H-89 did not block the E2-induced acceleration of egg transport suggesting that PRL surges are not essential to shift E2 signaling pathways in the oviduct. We conclude that CVS is one of the components of mating that shifts E2 signaling in the oviduct from nongenomic to genomic pathways, and this effect is independent of PRL surges elicited by mating.

Epidemiological, biological and histological characterization of patients with indeterminate third-generation recombinant immunoblot assay antibody results for hepatitis C virus

We studied the epidemiological, laboratory and histological characteristics of a group of patients with positive antibodies against hepatitis C virus (HCV) as determined by third-generation enzyme-linked immunosorbent assay (ELISA), and with indeterminate HCV antibody positivity as established by third-generation recombinant immunoblot assay (RIBA-3). The results obtained were compared with those recorded in a group of RIBA-3-positive patients. Both groups correspond to blood donors in whom the prevalence of hepatitis C is low. There were no statistically significant intergroup differences in mean age, or in the presence of infection risk factors. RNA positivity was much more frequent in the RIBA-positive group (71%vs 10%; P < 0.05), as was transaminase elevation during the 3 years of follow-up (54%vs 13%; P < 0.05). In 46% of the RIBA-indeterminate patients the liver biopsy proved normal, or only liver steatosis or minimal changes were detected, while 33% had persistent chronic hepatitis, and 21% showed active chronic hepatitis. A mean Knodell index score of 2.28 was recorded; 50% of the subjects showed no fibrosis, 46% grade 1 fibrosis (fibrous portal expansion), 4% grade 2 fibrosis (bridging fibrosis), and none grade 3 fibrosis (liver cirrhosis). In the RIBA-positive group, a greater percentage of patients had active chronic hepatitis, a greater Knodell index, and increased-grade fibrosis. It can be concluded that the RIBA-3-indeterminate group is epidemiologically similar to the RIBA-3-positive series, although with a lesser prevalence of laboratory test alterations, a lower viral replication index, and more likely to have benign disease - particularly in subjects without viral replication.

[Brain SPECT with 201-thallium in AIDS patients]

Brain lymphoma is a late complication in AIDS. Lymphoma incidence is increasing in AIDS patients due to the introduction of HAART and prolongation of these patients' life expectancy. This work aims to evaluate the usefulness of brain SPECT with 201Tl in patients with AIDS who present focal brain lesions in computed tomography (CT).

METHODS

Seventeen patients with neurologic symptoms and focal neurologic lesions in the CNS (central nervous system) were studied. The images were interpreted as positive when the intensity of the focal deposit of the tracer was greater than that of the adjacent tissue. The SPECT results were compared with serologic data, clinical evolution and/or radiologic follow-up and cerebral biopsy.

RESULTS

SPECT images showed focal uptake of radiotracer in 3 patients. All three died shortly after the SPECT was performed. All of them had negative serology for toxoplasmosis. Four patients were diagnosed of progressive multifocal leukoencephalopathy and the ten remaining cases had a good clinical and/or radiologic response.

CONCLUSIONS

Brain SPECT with 201Tl is a very useful non-invasive technique for the differential diagnosis of cerebral focal lesions in AIDS patients.

Disparate effects of estradiol on egg transport and oviductal protein synthesis in mated and cyclic rats

Previously, we found that the dose of estradiol (E2) required to accelerate egg transport increases 5- to 10-fold, in mated compared to cyclic rats. Here we examined protein synthesis in the oviduct of mated and cyclic rats following a single injection of E2 known to accelerate oviductal egg transport or after concomitant treatment with progesterone (P4) known to block this acceleration. On Day 1 of the cycle or pregnancy, E2, P4, or E2 + P4 were injected s.c., and 4 h later oviducts were removed and incubated for 8 h in medium with 35S-methionine. Tissue proteins were separated by SDS-PAGE, and protein bands were quantitated by fluorography and densitometry. In mated rats, E2 and P4 increased different protein bands and P4 did not affect the fluorographic pattern induced by E2. In contrast with mated rats, none of these treatments changed the fluorographic pattern of the oviductal proteins in cyclic rats. Estradiol-induced egg transport acceleration was then compared under conditions in which oviductal protein synthesis was suppressed. Mated and cyclic rats treated with equipotent doses of E2 for accelerating egg transport also received actinomycin D (Act D) locally. Estradiol-induced oviductal egg loss was partially blocked by Act D in mated but had no effect in cyclic rats. We conclude that the oviduct of mated and cyclic rats differs in that only the former responds with increased protein synthesis to a pulse of exogenous E2 and P4 and requires an intact protein synthesis machinery in order to accelerate egg transport in response to E2.

[Meningococcal disease in Spain: seasonal nature and recent changes]

BACKGROUND

In this study we built a time series model in the time domain based on the cases of meningococcal disease declared every four weeks in Spain between 1972 and 1998 With the model we analyzed the incidence of the disease and examined whether an epidemic really took place at the beginning of 1997, or whether the values were in the range of expectations. At this time there was widespread social alarm in Spain, because there was considered to be an outbreak of meningitis. We also examined whether the incidence of the disease diminished during 1997 following the measures introduced by the Comisión Interterritorial del Sistema Nacional de Salud.

METHOD

The data on the incidence of the meningococcal disease in Spain were obtained from the Boletín Epidemiológico Semanal, published by the Instituto de Salud Carlos III, declared from 1972 to 1998 and grouped every four weeks. The method corresponds to the time series model in the domain of time: the Box-Jenkins method.

RESULTS

In order to explain the behaviour of the disease during the years of the study we chose a model ARIMA(0,1,1) (0,1,1)13 that shows annual seasonal behaviour, with higher incidence in the winter and the beginning of spring, and lower incidence in summer. An intervention analysis showed that in March 1996 there was a level shift in the incidence of the illness. This lasted until September 1997, at which time the incidence returned to pre-1996.

CONCLUSIONS

The measures of sanitary monitoring against the meningitis in the months of greater incidence, winter and beginning of spring must be intensified. Between spring 1996 and autumn 1997 the incidence of meningitis increased. Thereafter, until the end of 1998, there was a significant decrease in incidence, attributable to the performance of the health authorities.

[Prevalence of enterohemorrhagic Escherichia coli in a cattle area of Argentina. Genotypic characterization of the strains of animal origin]

BACKGROUND

There is a high prevalence of infection by Enterohemorrhagic Escherichia coli (EHEC) and patients with hemolytic uremic syndrome (HUS) in Argentina.

AIM

To study cattle and pigs as a possible reservoir of EHEC in Argentina.

MATERIAL AND METHODS

One hundred two healthy animals (68 cattles and 31 pigs) from a livestock in Argentina, were studied. Stool samples were obtained with a rectal swab. The strains were identified by DNA hybridization with specific gene probes detecting Shiga-like toxin 1 and 2 (Stx1, Stx2), and hly gen related to fimbrial adhesin-associated plasmid. EHEC strains were serogrouped using commercial antisera.

RESULTS

EHEC was isolated from 30 out of 68 bovines cultures (44.1%) and from 25 out of 31 pigs (58.1%). Isolates carrying genes codifying both Stx1 and Sxt2, were observed in 50% of cattle and 63.9% of pigs. The gene which codifies for hemolysin (associated to fimbrial adhesin) was observed in about 41% of EHEC isolates. Strains belonging to serogroups O26, O111, and O157 were isolated from cattle, and O111, and O157 from pigs.

CONCLUSIONS

The high percentage of EHEC in both cattle and pigs and the presence of human infection-associated serogroups, suggests that these animals are a reservoir of EHEC associated with disease in humans.

[Prevalence of the Chlamydia trachomatis in neonatal conjunctivitis determination by indirect fluorescence and gene amplification]

BACKGROUND

Chlamydia trachomatis is one of the most common identifiable infectious agents in neonatal conjunctivitis. It also causes pneumonitis, that is preceded by conjunctivitis in one third of cases.

AIM

To asses the prevalence of Chlamydia trachomatis in newborns with conjunctivitis.

PATIENTS AND METHODS

In 162 newborns, coming from 14 Primary Health Centers from Santiago de Chile, C. trachomatis was detected by indirect fluorescence and two polymerase chain reaction (PCR 1 and 2), which amplified different sequences from the common endogenous plasmid. Those patients with positive indirect fluorescence and PCR 2 were defined as infected:

RESULTS

The prevalence of C. trachomatis was 8%, and the distribution of the positive cases was similar in the different Health Centers. Other isolates were: S. aureus (9.8%), S. pneumoniae (8%), S. viridans (6.2%) y H. influenzae (5.5%).

CONCLUSIONS

The prevalence of C. trachomatis in neonatal conjunctivitis in Chile is similar to that of developed countries. Therefore, C. trachomatis should be considered in the election of antimicrobials for the treatment of neonatal conjunctivitis, to avoid ocular and respiratory complications.

A statistical analysis of the seasonality in pulmonary tuberculosis

The present study examines whether pulmonary tuberculosis (PTB) has an annual seasonal pattern. A mathematical model is also obtained to forecast the pattern of incidence. The data for the study are the cases of PTB reported throughout Spain, published in the Epidemiology Bulletin by the Carlos III Health Center of the Spanish Ministry of Health in a 26-year period, 1971-1996. The analytical results show that the low rates in tuberculosis notifications over the period 1971-1981 have changed, halting in 1982 and reversing with high incidence from 1983 onwards. An annual seasonal pattern was also shown with higher incidence during summer and autumn. With the mathematical model we predicted the disease behaviour in 1997 and the results were compared to the reported cases. In Spain, as in several industrialised countries, the reason for this recent increase in the number of reported cases is, mainly, the human immunodeficiency virus (HIV) infection. The seasonal trend, with higher incidence in winter, can be attributed to the increase in indoor activities, much more common than in a warm climate. The tubercle bacilli expelled from infected persons in a room with closed windows may remain infectious for a long time, increasing the risk of exposure of healthy persons to the bacilli. As the preclinical period, from exposure to clinical onset, may be of several weeks, the high incidence in spring would be explained. Moreover, in winter and spring the infections of viral aetiology, like flu, are more frequent and cause immunological deficiency which is another reason for the seasonal trend observed. An incidence greater than that foreseen by the mathematical model would express a failure in epidemiologic surveillance, and thus the results of this study may be used to assess a quality of the preventive measures.

Effect of iodine supplementation on a pediatric population with mild iodine deficiency

A cross-sectional study in two stages consisted of healthy children to assess the effect of iodine supplementation on a pediatric population with mild iodine deficiency in an ongoing program in the Province of Pontevedra, northwestern Spain. In the first survey (1984), 1565 schoolchildren and in the second survey (1995) 907 schoolchildren were randomly selected from the population. In January 1985, a mandatory consumption of iodized salt in our region was begun. In both surveys we studied prevalence of goiter, urinary iodine excretion, and prevalence of thyroid dysfunction. Similar prevalences of goiter were observed in both surveys, 3.7% versus 3.9%; however, significantly lower prevalence of Ib and II degree goiters were observed in the second survey. The mean iodine excretion was 88.6 +/- 73 microg/L (median 66.3) and 146.4 +/- 99 microg/L (median 115.7), p < 0.01 for the first and second surveys, respectively. Finally, the overall prevalence of thyroid dysfunction was similar in both surveys, 9.2% versus 7.0%; however, significantly lower prevalence of suppressed serum thyrotropin (TSH), considered as a marker of subclinical hyperthyroidism, was observed in the second survey when compared to the first, 0.1% versus 2%, p < 0.01. Our results are in agreement with the recent data from Denmark, where the prevention of subclinical hyperthyroidism occurring in the elderly as a consequence of longstanding mild iodine deficiency is the reason that the Danish finally started iodine supplementation on a national basis. In conclusion, long-term correction of mild iodine deficiency in a pediatric population has beneficial effects on the prevalence of high-degree goiters, and this correction reduces significantly the prevalence of subclinical hyperthyroidism. The present observation constitutes a strong argument for correcting even mild iodine deficiency.

Numerical taxonomy of heavy metal-tolerant nonhalophilic bacteria isolated from hypersaline environments

A total of 232 metal-tolerant bacterial strains were isolated from water and sediment samples collected in different hypersaline environments located in Cádiz, Huelva and Morón de la Frontera (Spain). They were isolated on a medium containing mercury, chromium, cadmium, copper or zinc. These halotolerant isolates were analyzed by numerical taxonomy techniques by using the simple matching (SSM) and Jaccard (SJ) coefficients; clustering was achieved using the unweighted pair group method with averages (UPGMA) algorithm. At the 81% and 83% similarity level, different numbers of phenons were obtained for Gram-negative and Gram-positive halotolerant microorganisms. Most of the 48 Gram-negative metal-tolerant strains studied were grouped into nine phenons, representing the genera Pseudoalteromonas, Alteromonas, Xanthomonas, Pseudomonas, Alcaligenes and Enterobacteria. The 72 Gram-positive metal-tolerant strains grouped into eight phenons, with only 15 strains left unassigned. Most of the isolates were assigned to the genus Bacillus (seven phenons), and one phenon comprised microorganisms with phenotypic characteristics similar to those of the genus Celullomonas.

Intraoviductal administration of ribonucleic acid from estrogen-treated rats mimics the effect of estrogen on ovum transport

In order to determine whether or not ovum transport acceleration induced by estradiol (E2) requires RNA and protein synthesis in the oviduct, inhibitors of RNA and protein synthesis were injected locally in rats treated with E2. We also tested whether administration of oviductal RNA from E2-treated rats could mimic the effect of E2 on ovum transport. Rats on Day 2 of pregnancy were given a single s.c. injection of 10 microg E2 and an intraoviductal (i.o.) injection of actinomycin D, alpha-amanitin, or cycloheximide (Chx). In control groups, either the steroid or the inhibitor or both were replaced by the respective vehicle. RNA obtained from oviduct or ileum of E2-treated rats or from the oviduct of propylene glycol-treated rats was injected into the oviducts of recipient rats on Day 1 of pregnancy. Animals were autopsied 24 h later to determine the number and distribution of eggs in the genital tract. All three inhibitors partially blocked the E2-induced ovum transport acceleration, whereas administration of inhibitors alone did not affect oviductal egg recovery. Only oviductal RNA obtained from E2-treated rats decreased the number of oviductal eggs (active extract). To interpret this finding, the active extract was preincubated with RNase or DNase before i.o. administration. Other groups of recipient rats also treated with active extract were injected s.c. with Chx, or their uterine horns were ligated to disclose the fate of the missing oviductal eggs. Active extract treated with RNase did not decrease the number of oviductal eggs; Chx blocked the effect of the active extract; and eggs missing from the oviduct were partially recovered in the uteri of ligated recipient rats. It is concluded that protein synthesis in the oviduct is required for the full effect of E2 on ovum transport and that one or more RNA species induced by E2 in the oviduct are by themselves able to mimic, and therefore mediate, the effect of E2 on ovum transport.

[Time series in the epidemiology of typhoid fever in Spain]

BACKGROUND

The incidence of typhoid fever in Spain from January 1982 to December 1993 was studied with the aim of analyzing how the disease has evolved over these years and predict its future behavior in order to facilitate prevention by the public health care organizations and centers.

MATERIAL AND METHODS

The Box-Jenkins temporary series theory was used. The data corresponded to the declared disease cases throughout Spain published in the Epidemiology Bulletin by the Carlos III Health Center and the Department of Health and Welfare.

RESULTS

The ARIMA (0,1,1) (0,1,1)12 model was selected to report the data obtained. The analytical results demonstrated a exponential decreasing tendency with an annual seasonal pattern in incidence observed in this disease peaking in the months of July, August and September and decreasing in the declared cases in December, January and February. A mathematical expression was also obtained to allow the prediction of the disease behavior in the future.

CONCLUSIONS

Prophylactic measures should be taken in the summer months. A disease incidence greater than that foreseen by the mathematical formula obtained would express a failure in epidemiologic surveillance, and thus the results of this study may be used as a quality control of the preventive measures.

Discriminant analysis algorithm based on a distance function and on a Bayesian decision

We propose a new algorithm for the allocation of an individual to one of several possible groups or populations. The algorithm enables us to define a finite partition over the sample space, based on distance function. This partition is used, jointly with the application of a standard Bayesian decision rule, to allocate individuals to the populations. The algorithm also provides a measure of the allocation confidence for each individual, in a similar manner to that of logistic regression. The error rates for classification are also computed using the leave-one-out method. Results are compared with those obtained with other discriminant analysis techniques previously reported: Fisher's linear discriminant function, the quadratic discriminant function, logistic discrimination, and others.

Antiviral activity of phosphonoformate on rotavirus transcription and replication

The antiviral effect of foscarnet (PFA) on the replication of rotavirus, a member of the Reoviridae, was studied. The pyrophosphate analogue is an effective inhibitor of several viral polymerases acting on the enzyme pyrophosphate binding site. Replication of rotavirus in MA104 cells using different u.o.i. was inhibited by PFA in a concentration dependent manner, due to the inhibition of both plus- and minus-strand RNA synthesis. The addition of PFA to infected cells was specific for the inhibition of viral replication since uninfected cell incubated at the same PFA concentrations did not exhibit any cytotoxic effect. The 50% inhibitory effect of PFA on in vitro mRNA synthesis was obtained at a concentration of 150 microM. Over 80% of the in vitro minus-strand RNA synthesis was inhibited at a concentration of 320 microM, when PFA was assayed using replicase-enriched cell infected fraction. The results suggest that the effect may be due to an interaction of PFA with the viral polymerase, since this protein catalyses both plus- and minus-strand RNA synthesis. The results of experiments using the temperature-sensitive viral polymerase mutant show that the mutant is less sensitive to PFA, suggesting that this polypeptide is the target for PFA.

Effect of interferon and 2',5'-oligoadenylates on rotavirus RNA synthesis

Based on the antiviral effect of interferon on rotavirus replication the inhibitory effect of 2',5'-oligoadenylates on MRNA and double-stranded RNA synthesis was studied using an in vitro assay. The chemically synthesized oligonucleotides were used to determine several characteristics of the inhibitory effect, such as chain length, presence of phosphate residues at the 5'-end, and the 2',5'-phosphodiester bond itself. In vitro transcription was inhibited by oligos with 5 or more adenine residues at a final concentration of 100 microM or greater. This result makes rotavirus transcriptase different from other viruses in which the inhibitory effects are associated with dinucleotides and trinucleotides. The inhibitory effect was increased when the oligo contained a phosphate residue at the 5'-end; in this case, inhibition was also seen at lower oligo concentrations as well as at shorter oligo chain length. The study of the kinetics of inhibition showed that the inhibition by p(A2'p5')(3)3A was competitive with a Ki value of 256 microM. The effect of the oligonucleotides on the in vitro viral RNA replication showed that the 2',5'-oligoadenylates were not able to significantly inhibit the in vitro rotavirus RNA synthesis. The lack of inhibition in the in vitro assay was very peculiar since RNA transcription and replication involves the viral RNA polymerase, VP1.

[The IPPS questionnaire in patients and controls. Psychometric validation]

The translation into Spanish of the AUA/International Prostatic Symptom (AUA/IPS) Score hadn't been validated in spanish. METHODS. AUA/IPS questionnaire was self administered by 103 consecutive patients and by 24 healthy volunteers. An alternative formulation to question 4 (ALT-4) was added. RESULTS. 51 patients (49%) and 17 controls (79%) completed al questions (Feasibility). Reliability was measured by: a) Crohnbach's alpha (0.68 and 0.70 with ALT-4) b) Kendall's coefficient of concordance (0.097, significance < 0.001) and c) retesting 17 patients within 2 months. The relation of the AUA/IPS scores with quality of life (Construct validity) showed a Spearman's correlation coefficient of 0.57 (confidence = 0.0001), and 0.52/0.0004 with ALT-4. The relation with uroflowmetry (Concurrent empirical validity) was poor as shown in ROC curves. CONCLUSIONS. The Spanish version of the AUA/IPS questionnaire given in an easy format improves feasibility without alteration of reliability or validity. The relation of the AUA/IPS score with uroflowmetry is poor, although the questionnaire can be considered valid and reliable.

Increased incidence of thyrotoxicosis after iodine supplementation in an iodine sufficient area

The aim of this study was to determine the incidence rate of thyrotoxicosis (TT) before and during dietary-iodine supplementation in an iodine-sufficient area.

POPULATION

the study was carried out in Vigo, South Galicia (northwest of Spain), from January 1977 to December 1989. The mean population throughout the study period was 267,330 inhabitants (47% males and 53% females). From January 1985, a mandatory consumption of iodinized salt on the whole population started in Galicia. This region was considered as an iodine-deficient area but Vigo is an iodine-sufficient area.

MEASUREMENTS

all newly diagnosed TT cases in Vigo city within the study period were included in this study. Diagnosis of TT was based on the clinical manifestations, an elevated level of T4 and suppressed TSH values. The difference between diffuse and nodular forms of goiter was assessed by scintigraphy. The average incidence rate (AIR) was determined in two periods, before (period A, 1977-1984) and during (period B, 1985-1989) iodine supplementation.

RESULTS

the AIR throughout the whole study period was 4.89 new cases per 100,000 population, 95% confidence limits 4.16 to 5.63; AIR was 1.34 for males and 8.03 for females. AIR in period B was significantly higher with respect to period A, 7.68 and 3.10 per 100,000 respectively. The confidence interval for the difference was from -20.4 to 30.1, p < 0.05. The increase of the incidence of TT was comprised of both nodular and diffuse goiters.

CONCLUSIONS

dietary iodinesupplementation in iodine-sufficient areas may induce an increase of the incidence of TT.(ABSTRACT TRUNCATED AT 250 WORDS)

[Nutritional study of alcoholics with specific reference to calcium and phosphorus]

We performed a nutritional study of 80 alcoholic males at least 15 days after an acute episode of alcoholic intake. 43 patients were intermittent drinkers with mean age 37.9 years and 37 patients were continuous drinkers with mean age 440.30 healthy subjects were studied as controls. Body mass index was 23.7 (range 19.2-37.9) in intermittent drinkers compared to 23.1 (range 18.1-29.8) in continuous drinkers (NS). Wine was the main alcoholic beverage in 70% and 89%, respectively. Mean daily alcohol intake was 170 g for 17 years and 358 g for 23 years, respectively. Mean caloric intake and % of calories from alcohol were 3387 and 42% for intermittent compared to 4271 and 66% for continuous drinkers, respectively. Daily calcium intake was 757 g and 774 g in each group. Alcoholic beverages supplied 16% and 34% of calcium intake, respectively. The intake of phosphorus was adequate. Alcoholic subjects did not manifest anemia or hypoalbuminemia, compared to controls. The present study fails to disclose significant caloric and protein undernutrition in alcoholic subjects. However, the intake of calcium is inadequate and a high percentage of it is provided by alcoholic beverages. This deficiency in conjunction with alcoholic damage to intestinal mucosa may lead to osteopenia in alcoholic patients.

Hormonal modulation of the rat mammary gland gamma-glutamyltranspeptidase

1. The in vivo effect of estradiol and domperidone (a hypophysis stimulator of prolactin secretion) in immature ovariectomized-adrenalectomized and hypophysectomized rat mammary gland was studied. 2. gamma-Glutamyltranspeptidase activity was used to evaluate the role of estradiol in the specific response of the gland to prolactin. 3. Our results suggest that the activity of gamma-glutamyltranspeptidase, like casein and lactose synthetase, is part of the specific response of the gland to prolactin.

[Heterologous hormonal regulation in the mammary gland]

Mammary gland growth and differentiation are largely dependent on a complex and interrelated action of many different hormones which makes the mammary tissue a very suitable one for the study of heterologous hormonal regulation. This type of control is analyzed by two different approaches: 1. The participation of estradiol in prolactin action during lactation, and 2. The role of glucocorticoids and thyroid hormones in the control of functional activity of rat mammary gland beta-adrenergic receptors.