[Microepidemics of tuberculosis; apropos of 2 school outbreaks in the area 15 of the Valencia community]

Schools are settings with high concentrations of young people with little exposure to Mycobacterium tuberculosis and greater risk of developing disease when infection occurs as the result of sporadic localized outbreaks. We studied two outbreaks in two elementary schools (A and B) after two cases of bacilliferous pulmonary tuberculosis were detected in teachers in 1990 and 1994. Contacts were trace din school A by the primary care physician and in school B by the pneumologist and public health authorities. Contacts were classified as belonging to the risk group (RG) or the low risk group (LRG). The RG was composed of 187 contacts in school A and 59 in school B. Individuals in the LRG numbered 429 and 116 respectively. Mantoux positives numbered 108 in the RG and 45 in the LRG in school A (p < 0.001). In school B 50 RG individuals and 29 LRG individuals were positive (p < 0.001). The proportion of Mantoux positives was greater in the RG of school B than in the RG of school A (p < 0.01), probably owing to longer time of evolution of disease and possible laryngeal involvement in the index case. Likewise, tuberculin positives were fewer in the LRG of school A than in the LRG of school B (p < 0.001), owing to the small size of the LRG in school A. Thirteen cases of tuberculosis were seen in school A, six of which called for drug prophylaxis after contacts were traced. The nature of the index case and the conditions of exposure are both important in such outbreaks, demonstrating the need to act appropriately to trace contacts, preferably under the supervision of a pneumologists.

Comparative study of inhaled amiloride and inhaled furosemide in exercise-induced asthma

BACKGROUND

Certain diuretics such as furosemide, when inhaled, have been found to be useful in preventing Exercise-Induced Asthma (EIA).

STUDY OBJECTIVE

To assess the possible preventive effect of inhaled amiloride in EIA.

DESIGN

A double blind, randomized, cross-over study comparing the effect of inhaled amiloride, inhaled furosemide and placebo in EIA.

PATIENTS

Sixteen asthmatic patients (8 males and 8 females) with an average age of 21 years (range 9-31) who presented a FEV1 decrease of over 15% in a previous free-running exercise test.

INTERVENTIONS

Solutions were inhaled with a Hudson nebulizer connected to an oxygen source in different days before exercise testing. A Vitalograph Compact (Ohmeda, England) spirometer was used and FEV1 was obtained at baseline, three minutes after solution inhalation, immediately after exercise and then every 5 min. until 20 minutes post-exercise. The changes in FEV1 percentages (FEV1%) and the mean FEV1 decreases expressed as percentages for each solution were compared.

RESULTS

Inhaled furosemide diminished the fall in the FEV1 at every time after exercise. The maximum decrease in mean FEV1 was at 5 minutes post-exercise and was 11 +/- 7% with furosemide, 24 +/- 14% (p < 0.01) with amiloride and 19 +/- 12% (p < 0.05) with placebo. Amiloride administration resulted in a slight but significative increase in the FEV1 fall (p < 0.01 when compared with placebo).

CONCLUSIONS

Amiloride is not useful to protect EIA whereas Furosemide does it. These differences results may be related to the differents mechanisms of action of the two diuretics.

[Neurological education of general practitioners. Results of a survey carried out among 196 general practitioners]

We have carried out a survey among professional general practitioners in our province with the aim of getting to know their opinion concerning their own training in Neurology. The survey included questions about the adequacy of training, the nature of any deficiency therein (be it theoretical and/or practical) and ability to analyse and attend a neurological patient. The percentage of replies was 78% out of a total of 196 surveys. 78.8% of those questioned consider that their neurological training has not been sufficient either for clinical or general practice; while 43.8% believe that this insufficiency is due to a lack of practical training, 1.8% think the fault lies in a lack of theoretical training, and 54.32% consider that it is due to a lack of both practical and theorectical training. 61.2% of those questioned claim to have difficulties with neurological explorations, and 55.6% claim they have greater difficulties attending a neurological patient than other patients classified within other internal medical specialties. 76% consider that it is either partially or totally false to claim that these difficulties are unimportant due to the lack of treatment for neurological illnesses, although 69.4% consider it to be partially or totally true that they will never be able to achieve diagnosis of a neurological patient due to a lack of the required complementary investigations. 43.9% consider that continued training in Neurology is not useful because it is a repetition of training received at university. As a consequence, there is an imbalance between neurological training and the need to attend the patient at the level of general practice, which should be set right by making the theoretical training given during graduation more suitable, and by increasing and improving practical credits.