Non-convulsive status epilepticus as the initial manifestation in a family with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL)

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an autosomal dominant small-vessel disease caused by mutations of the NOTCH3 gene. It typically presents with migraine, recurrent brain ischaemia, and cognitive disorders. Seizures rarely present as the initial manifestation, with non-convulsive status epilepticus being even less frequent. We present a series of 3 related patients with this arteriopathy, 2 of whom presented status epilepticus as a manifestation of the disease.

Impact of an enhanced screening program on the detection of non-AIDS neoplasias in patients with human immunodeficiency virus infection

BACKGROUND

The incidence of non-AIDS defining cancer (NADC) is higher in people living with HIV (PLWH) than in the general population, and it is already one of the leading causes of death in the HIV-infected population. It is estimated that the situation will be aggravated by the progressive aging of PLWH. Early diagnosis through intensive cancer screening may improve the ability for therapeutic interventions and could be critical in reducing mortality, but it might also increase expenditure and harms associated with adverse events. The aim of this study is to evaluate an enhanced screening program for early diagnosis of cancer in PLWH compared to standard practice. The specific objectives are (1) to compare the frequency of cancer diagnosed at an early stage, (2) to analyze safety of the enhanced program: adverse events and unnecessary interventions, (3) to analyze the cost-utility of the program, and (4) to estimate the overall and site-specific incidence of NADC in PLWH.

METHODS

We will conduct a multicenter, non-blinded, randomized, controlled trial, comparing two parallel arms: conventional vs enhanced screening. Data will be recorded in an electronic data collection notebook. Conventional intervention group will follow the standard of care screening in the participating centers, according to the European AIDS Clinical Society recommendations, and the enhanced intervention group will follow an expanded screening aimed to early detection of lung, liver, anal, cervical, breast, prostate, colorectal, and skin cancer. The trial will be conducted within the framework of the Spanish AIDS Research Network Cohort (CoRIS).

DISCUSSION

The trial will evaluate the efficacy, safety, and efficiency of an enhanced screening program for the early diagnosis of cancer in HIV patients compared to standard of care practice. The information provided will be relevant since there are currently no studies on expanded cancer screening strategies in patients with HIV, and available data estimating cost effectiveness or cost-utility of such as programs are scarce. An enhanced program for NADC screening in patients with HIV could lead to early diagnosis and improve the prognosis of these patients, with an acceptable rate of unnecessary interventions, but it is critical to demonstrate that the benefits clearly outweigh the harms, before the strategy could be implemented.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04735445. Registered on 25 June 2019.

Music therapy and Sanfilippo syndrome: an analysis of psychological and physiological variables of three case studies

Introduction

Mucopolysaccharidosis type III (MPS III) or Sanfilippo syndrome is a neurodegenerative disease caused by the accumulation of mucopolysaccharides in the body. As the symptoms are wide ranging, it is a challenge to provide a diagnosis and psychological treatment for affected children.

Method

The main objective of this study was to describe a form of music therapy treatment applied to three children diagnosed with MPS III. The psychological variables were evaluated by an ad hoc observation recording template, and the physiological variables were measured with a digital meter before and after each session. The perception of the parents was also considered through a semi-structured interview.

Results

An improvement in the psychological variables was shown in all cases. Changes in the physiological variables were also noted, although they varied according to each child. The parents report some benefit of music therapy and they share difficulty in assessing the extent of benefits of the music therapy.

Discussion

Findings indicate that music therapy can be a useful form of treatment with multiple benefits for children with conditions such as MPS III or similar conditions. However, further research is needed in this area and in the development of specific ways of evaluating music therapy.

Ketogenic diet and cognition in neurological diseases: a systematic review

CONTEXT

In recent years, the ketogenic diet has gained special relevance as a possible therapeutic alternative to some neurological and chronic diseases.

OBJECTIVE

The aim of this systematic review was to answer the following question: Does a ketogenic diet improve cognitive skills in patients with Alzheimer's disease, Parkinson's disease, refractory epilepsy, and type 1 glucose deficiency syndrome? To define the research question, the PICOS criteria were used, following the guidelines of the PRISMA method.

DATA SOURCES

Medline/PubMed, Elsevier Science Direct, Dialnet, EBSCOhost, Mediagraphic, Sage Journals, ProQuest, and Wiley Online Library databases were used.

DATA EXTRACTION

After applying inclusion and exclusion criteria in accordance with the PRISMA method, a total of 63 entries published between 2004 and 2019 were used.

DATA ANALYSIS

The records extracted were analyzed from a qualitative approach, so no statistical analysis was carried out.

CONCLUSION

Although scientific literature on the subject is scarce and there has tended to be a lack of scientific rigor, the studies reviewed confirmed the effectiveness of this diet in improving the cognitive symptomatology of the aforementioned diseases.

Non-convulsive status epilepticus as the initial manifestation in a family with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL)

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an autosomal dominant small-vessel disease caused by mutations of the NOTCH3 gene. It typically presents with migraine, recurrent brain ischaemia, and cognitive disorders. Seizures rarely present as the initial manifestation, with non-convulsive status epilepticus being even less frequent. We present a series of 3 related patients with this arteriopathy, 2 of whom presented status epilepticus as a manifestation of the disease.

Fate of Mycobacterium avium subsp. paratuberculosis and changes in bacterial diversity populations in dairy slurry after chemical treatments

AIMS

A major drawback of using dairy slurry as fertilizer is that it may contains pathogens such as Mycobacterium avium subsp. paratuberculosis (MAP), and it could represent a risk to animal and public health. Thus, the aim of this study was to evaluate the fate of MAP and bacterial communities in dairy slurry after chemical treatments.

METHODS AND RESULTS

Cattle slurry, naturally contaminated with MAP, was collected from a dairy herd and divided into 32 glass bottles which were assigned to eight different treatments (control, 3·0% CaO, 0·5% NaOH; 0·087%, 0·11% and 0·14% H₂ SO₄ ; and 1·0 and 2·5% KMnO₄ ). Treated dairy slurry samples were evaluated at 0, 1, 3, 7, 15, 30 and 60-days following treatment application for viable MAP and dairy slurry pH, and in addition temperature in this material was monitored continuously. Bacterial counts were estimated at each sampling time. A Bayesian zero-inflated Poisson mixed model was fitted to assess the effect of each treatment on the count of MAP cells. Model results indicated that only the 3·0% CaO treatment had a statistically important negative effect on MAP counts during the study period. For most treatments, MAP was undetectable immediately after chemical treatment but re-appeared over time, in some replicates at low concentrations. However, in those cases MAP counts were not statistically different than the control treatment. Regarding the fate of the other bacterial populations, the Firmicutes phylum was the dominant population in the un-treated slurry while Clostridia class members were among the most prevalent bacteria after the application of most chemical treatments.

CONCLUSION

Only 3% CaO treatment had a statistically important negative effect on MAP viability in cattle slurry.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study provides evidence of MAP partial control in dairy slurry. This information should be considered as a best management practice to reduce MAP and other pathogens for slurry management on dairy farms.

A randomised controlled trial of a program based on the theory of planned behavior to promote fruit and vegetable intake among schoolchildren: PROFRUVE study protocol

BACKGROUND

The PROFRUVE study is a controlled intervention based on the Theory of Planned Behavior (TPB), which follows those behavioral theories that have proved to be the most effective at changing infant fruit and vegetable (FV) intake pattern. The main purpose of the study is to evaluate the effectiveness of an intervention program in increasing FV consumption in schoolchildren aged 8 to 10 and based on TPB.

METHODS

Eligible classrooms within schools from Vitoria-Gasteiz (Basque Country, Spain) will be randomly assigned to the intervention (classrooms n = 4; children n = 86) or control (classrooms n = 4; children n = 86) group. The intervention group will receive 14 sessions of 60 min during an academic year (October to June). These sessions, designed by a multidisciplinary team, are based on TPB and are directed at modifying determinants of behavior (attitudes, subjective norms, perceived behavioral control and intention of consumption), and intake of FV itself. Both the process and the evolution of consumption and determinants of behavior will be evaluated (before, during, shortly after and a year after) using validated surveys, 7 day food records, 24 h reminders and questionnaires.

DISCUSSION

This study will provide a valid and useful tool to achieve changes in the consumption of FV at school level. A negative result will be helpful in redefining new strategies in the framework of changing habits in the consumption of FV.

TRIAL REGISTRATION

This study has been retrospectively registered at ClinicalTrials.gov. Identifier: NCT03400891 . Data registered: 17/01/2018.

A decade of the Catalonian Arthroplasty Register (RACat): Variability, exhaustivity, and survival of prostheses between 2005 and 2014

BACKGROUND AND AIM

The Catalonian Arthroplasty Register (RACat) is a public health-based population register used to analyse and evaluate hip and knee replacements in Catalonia. The aim of this study is to present the outcomes after 10 years in operation (January 2005-December 2014).

METHODOLOGY

Using the information from the RACat and the minimum basic data set at hospital discharge, an analysis was made of the quality and exhaustivity of the data, as well as a descriptive analysis of the patients, prostheses, and care process. Survival was also analysed by calculating the accumulated incidence of revisions (according to the cause of intervention in hip replacements and conservation or sacrifice of the posterior cruciate ligament in knee replacement). The relationship between revision risk and the fixation technique of the prosthesis is also analysed, using competitive risk models adjusted for gender, age, and comorbidities.

RESULTS

The main reason for the primary hip and knee replacement surgery was arthrosis. The accumulated incidence of revisions at 10 years was 3.9% in hip replacements caused by arthrosis, and 2.3% in those caused by fracture. Conservation of the posterior cruciate ligament was achieved in 4.4% of knee replacements, with sacrifice in 5.1%.

DISCUSSION

The RACat is consolidated as a tool for the evaluation of joint replacements, with great potential in the analysis of medium and long-term efficacy, the study of the variability in clinical practice, and post-marketing surveillance.

Cathodoluminescence study of Mg activation in non-polar and semi-polar faces of undoped/Mg-doped GaN core-shell nanorods

Spectrally and spatially resolved cathodoluminescence (CL) measurements were carried out at 80 K on undoped/Mg-doped GaN core-shell nanorods grown by selective area growth metalorganic vapor phase epitaxy in order to investigate locally the optical activity of the Mg dopants. A study of the luminescence emission distribution over the different regions of the nanorods is presented. We have investigated the CL fingerprints of the Mg incorporation into the non-polar lateral prismatic facets and the semi-polar facets of the pyramidal tips. The amount of Mg incorporation/activation was varied by using several Mg/Ga flow ratios and post-growth annealing treatment. For lower Mg/Ga flow ratios, the annealed nanorods clearly display a donor-acceptor pair band emission peaking at 3.26-3.27 eV and up to 4 LO phonon replicas, which can be considered as a reliable indicator of effective p-type Mg doping in the nanorod shell. For higher Mg/Ga flow ratios, a substantial enhancement of the yellow luminescence emission as well as several emission subbands are observed, which suggests an increase of disorder and the presence of defects as a consequence of the excess Mg doping.

Modelling and kinetics studies of a corn-rape blend combustion in an oxy-fuel atmosphere

A kinetic oxy-combustion study of a previously optimized lignocellulose blend is proposed. Kinetic and diffusion control mechanism are considered. The proposed correlations fit properly with the experimental results and diffusion effects are identified as be important enough to be taken into account. Afterwards, with the results obtained in the kinetic study, a detailed consecutive and parallel kinetic scheme is proposed for modelling the oxy-combustion of the blend. A discussion of the temperature and concentration profiles are included. Variation of products final distribution is considered. Smaller particles than 0.001 m are proposed for reducing temperature and concentration profiles and obtaining a good final product distribution. CO2-char reaction is identified as one of the most important step to be optimized for obtaining the lowest final residue. In this study, char is mainly oxidised at 950 K and this situation is attributed to an optimized blending of the bioresidues.

Assessment of stigma associated with tuberculosis in Mexico

BACKGROUND

Stigma is a major barrier to health care access and impacts the quality of life for individuals affected by tuberculosis (TB). Assessing TB stigma is essential to addressing health disparities. However, no such instrument was available in Mexico at the time of our study. This study examined the adaptability of the TB and human immunodeficiency virus (HIV) stigma scales previously used in Thailand.

METHODS

The original scale, developed in English, was linguistically adapted to Spanish and administered to 217 individuals affected by TB in five states in Mexico. The TB-HIV stigma subscales were designed to assess individual and community perspectives. Additional data collected included general information and socio-demographics. Assessment of psychometric properties included basic statistical tests, evaluation of Cronbach's alpha and factor analysis.

RESULTS

We found no significant statistical differences associated with higher stigma scores by location, age, marital status, education and stigma scores. Factor analysis did not create any new factors. Internal consistency reliability coefficients were satisfactory (Cronbach α = 0.876-0.912).

CONCLUSION

The use of the stigma scales has implications for 1) health improvements, 2) research on stigma and health disparities, and 3) TB and HIV stigma interventions. Further research is needed to examine transferability among larger and randomly selected Spanish-speaking populations.

[Quality of life-associated factors at one year after total hip and knee replacement: a multicentre study in Catalonia]

AIMS

To assess the health related quality of life (HRQOL) and associated factors of patients before, and one year after, total knee (TKA) and hip (THA) arthroplasty.

METHODS

A quasi-experimental prospective study conducted in hospitals with different levels of complexity and volume in Catalonia, and on patients with an indication of a TKA or THA. Demographic and psychosocial variables were recorded, and the SF-36 and WOMAC, and a question on perception of change after surgery were administered to patients by telephone interview. The standardised differences (effect size) of perceived change using the SF-36 and WOMAC scores before and after surgery were calculated. The factors associated with HRQOL one year after surgery were analysed using adjusted general linear models.

RESULTS

Although there was an overall improvement in most HRQOL domains of patients (n=672), 9% saw little improvement after surgery, with their scores at baseline and follow-up being very similar (small size effect: 0.0-0.4). Women, patients with low social support, with lower scores (worse) in perceived mental health and baseline HRQOL, and who declared that their condition was more severe, perceived a poorer HRQOL one year after surgery (P<.05).

CONCLUSIONS

Factors associated to a worse prognosis one year after an arthroplasty have been identified and are consistent with other published studies. The assessment of HRQOL can be a key instrument for identifying possible patients without improvement, in order to assess alternatives to an intervention, or apply other interventions in order to improve the efficiency of the healthcare process.

[Arthroplasty registers as post-marketing surveillance systems: the Catalan Arthroplasty Register]

OBJECTIVE

The aim is to present the functioning and results of the Catalan Arthroplasty Registry (RACat).

MATERIAL AND METHOD

The RACat arose by the initiative of the Catalan Society of Orthopaedic Surgery and Traumatology, the Catalan Health Service (CHS) and the Catalan Agency for Health Information Assessment and Quality. Publicly funded hospitals sent information through the Internet (CHS Applications website) on knee and hip arthroplasties: patient identification, hospital, joint (hip/knee), type (primary/revision), side of operation, date of surgery and prosthesis (manufacturer's name and reference number). The quality of the data is analysed regularly. We estimate the risk of replacement by the Kaplan-Meier method.

RESULTS

A total of 52 hospitals out of 62 send data to RACat, and information on 36,951 knee and 26,477 hip arthroplasties is available. Data quality improved between 2005 and 2010. In 2010 coverage exceeded 70%, with side of operation 97%, and prostheses identification of 80%. The risk of replacement at three years was 3.3% (95% CI:3.1-3.6) for knee, 2.9% (95% CI:2.5-3.3) for total hip, and 2.5% (95% CI:2.0-3.1) for partial hip.

DISCUSSION

Risk of replacement is higher than that observed in other registers, although data quality and its improvement over time should be taken into account.

CONCLUSIONS

The information available in the RACat will help to establish a standard that will enable hospitals to compare results.

Detection of markers of cardiovascular and renal risk in Cuba: Isle of Youth Study (ISYS)

Chronic vascular diseases constitute a growing global health problem.

OBJECTIVES

To (a) determine marker positivity for renovascular damage in the total adult population of the Isle of Youth, Cuba; (b) describe marker association with common risk factors for renal and related chronic vascular conditions, and (c) identify best predictors of renovascular damage.

METHODS

Previous informed consent was obtained, the population studied was 55,646, and subjects were aged ≥20 years. Blood pressure, weight and height were measured and a questionnaire applied. Urine markers for renovascular damage (hematuria, proteinuria and microalbuminuria) were also determined.

RESULTS

Positive markers were detected in 21.3%: hematuria (12.6%), microalbuminuria (6.8%), proteinuria (0.9%), and proteinuria + hematuria (0.9%). Risk factors were highly prevalent: 15.1% were aged ≥60 years; 32.3% overweight, 13.9% obese, and 25.1% smokers. Prevalence of high blood pressure (30%), diabetes mellitus (5.4%) and cardiovascular disease (5%) was also high, while cerebrovascular disease registered 0.9%. Markers were more prevalent in older people and in those suffering from diabetes mellitus, high blood pressure, cardiovascular and cerebrovascular disease, overweight or obesity. Risk factor regression tree analysis identified hypertension as the best predictor of renovascular damage.

CONCLUSIONS

Adult population-wide screening revealed hidden morbidity and permitted better risk stratification. Results serve to inform community-based multidisciplinary and intersectoral disease prevention and management.

Foodborne and indicator bacteria in farmed molluscan shellfish before and after depuration

Galicia's coast (northwestern Spain) is a major producer of bivalve molluscs. Over an 18-month period, the presence of Salmonella, Aeromonas, Plesiomonas shigelloides, Vibrio parahaemolyticus, and Clostridium botulinum was determined by PCR methods in mussels (22 batches) and infaunal bivalves (31 batches of clams and cockles) before and after depuration. All batches were harvested from Galician class B harvesting areas where bivalve molluscs must not exceed 4,600 Escherichia coli per 100 g of flesh and liquor in 90% of the samples. Virulence-associated genes of Salmonella (invA), Aeromonas (aerA, hlyA, alt, ast, and laf), P. shigelloides (hugA), V. parahaemolyticus (tdh and trh), and C. botulinum (BoNT) were not detected. The pR72H chromosomal DNA fragment, which is conservative in V. parahaemolyticus strains, was detected in five (4.7%) samples. A number of 192 suspect isolates did not fit the description of clinical Aeromonas phenospecies, pathogenic Vibrio spp., or P. shigelloides. The effectiveness of commercial depuration in reducing bacterial indicators was also examined. E. coli was reduced to < or = 230/100 g of flesh and liquor in 90.9% of mussel lots but in only 70.9% of infaunal bivalve lots. For total coliform elimination, mussels were also more effective. Total counts significantly (P < 0.005) correlated with numbers of Pseudomonas, Aeromonas, and Vibrio. Our data indicate that Salmonella and pathogenic bacteria indigenous to estuarine environments do not appear to be significant hazards in Galician molluscan shellfish. A reason for concern, however, is that clearance of E. coli to acceptable levels was not always achieved especially in infaunal bivalves.

Continuous and Localized Mn Implantation of ZnO

We present results derived from continuous and localized 35 keV (55)Mn(+) ion implantations into ZnO. Localized implantations were carried out by using self-ordered alumina membranes as masks leading to ordered arrays of implanted volumes on the substrate surfaces. Defects and vacancies in the small implantation volumes of ZnO were generated due to the implantation processes besides the creation of new phases. Rapid thermal annealing was applied in the case of continuous implantation. The samples were characterized by HRSEM, GIXRD, Raman spectroscopy and RBS/C. Magnetic characterization of the samples pointed out appreciable differences among the samples obtained by the different implantation methods. This fact was mainly attributed to the different volume/surface ratios present in the implanted zones as well as to the increase of Mn atom concentrations along the grain frontiers in the nanostructured surfaces. The samples also showed a ferromagnetic transition phase at temperature value higher than room temperature.

[Cardiovascular risk in subjects with high probability of metabolic syndrome and insulin resistance. DESIRE study]

INTRODUCTION AND OBJECTIVES

The metabolic syndrome is an association of closely related alterations. The main objective of this study is to know the frequency of the metabolic syndrome and insulin resistance, and their role as cardiovascular risk indicators in an adult population assigned to Primary Care centers in Spain.

METHODS

Subjects > or = 45 years with basal glycemia > or = 90 mg/dl and abdominal circumference > or = 94 cm (men) or > or = 80 cm (women). ATP III modified-criteria were used for the metabolic syndrome and HOMA index > 3.29 was used for insulin resistance. Cardiovascular risk was estimated by the Framingham and SCORE models.

RESULTS

A total of 2,341 subjects (62 +/- 10 years; 44.6% males) were included. Frequency of metabolic syndrome and insulin resistance was 54.6% (52.5; 56.8) and 56.6% (54.5; 58.7) respectively. Metabolic syndrome was associated to a higher cardiovascular risk score with both Framingham (16 [15; 16] vs 11 [11; 12] p < 0.0001) and SCORE (2.7 [2.4; 3] vs 2.4 [2.1; 2.8]; p = 0.006) models. The results were similar for the presence of insulin resistance.

CONCLUSIONS

Metabolic syndrome and insulin resistance are cardiovascular risk predictors. Early identification of metabolic syndrome by the use of simple clinical measures (basal glycemia and waist circumference) would make the intervention on the different disorders of metabolic syndrome possible.

Pyrolysis of mixtures of sewage sludge and manure: a comparison of the results obtained in the laboratory (semi-pilot) and in a pilot plant

A pilot-scale pyrolysis process was carried out for the treatment of a mixture of two types of waste, sewage sludge and cattle manure, comparing the results with others obtained under laboratory conditions (semi-pilot scale). The aim of this study was to obtain the energetic valorization of the products. Owing to the specific characteristics of the plant, two products were obtained from the process: gas and carbonized solid. As no liquid fraction was obtained, the gas fraction is a greater percentage made up of both condensable and non-condensable compounds, which were obtained separately at the laboratory scale. The pilot plant was designed so that the gases produced by thermolysis were burnt continuously in a combustion chamber, while the carbonized fraction was fed in batches for co-combustion. To determine composition and combustion ability, the gas and solid products from the pilot process were characterized by chromatographic analysis of the gaseous fraction and chemical analysis and programmed-temperature combustion of the carbonized solid. The composition of the combustion gases, rich in light hydrocarbons, and the carbon present in the carbonized fraction enable the energetic valorization of these products. The combustion gases were subjected to a cleaning process and their composition analysed twice: before and after the gas cleaning treatment. The study led to a positive assessment of the possible use of the process products as fuel, provided that the combustion gases are treated. As most of the sulphur and chlorine from the original waste are mainly concentrated in the solid fraction, the use of char as a fuel will depend on the effectiveness of clean-up techniques for combustion gases. During gas cleansing, neutralizing with sodium bicarbonate proved effective, especially for the acidic compounds HCl, HF and SO(2).

Influence of the application of sewage sludge on the degradation of pesticides in the soil

A study was made of the influence of the application of sewage sludge on the degradation of pesticides in the soil. Two kinds of sludge were used, with different characteristics, one from an urban treatment plant and one from a food processing plant. Three organophosphorus insecticides, fenitrothion, diazinon and dimethoate, were studied. The relative importance was determined of the chemical and biological degradation processes, which involved experiments on soil and sterile soil samples. A comparative study was also made of the degradation of pesticide residues and the evolution of the microbial population. The application of sludge seems to have a complex effect on the degradation of pesticides, determined by the bioavailability and biodegradability of their active ingredient. The biodegradation of pesticide residues brings about alterations in the microorganism population of the soil.

Application of vernier thinning techniques to segmented annular arrays

Due to the aperture periodicity, the inter-element spacing of two-dimensional squared arrays is maintained near lambda/2 in order to avoid grating lobes. This condition gives rise to severe problems derived from the huge number of array elements and from their little size that causes the signal to noise ratio to bring down. Vernier techniques have been proposed to lower the number of active elements, but the drastic reduction of the ultrasonic energy is still a great problem for the image contrast. In this work, vernier techniques for segmented annular (SA) arrays are theoretically studied. SA arrays produce lower grating lobes than squared arrays and, therefore, allow the element size to be increased beyond the lambda/2 constraint. Using larger elements, SA arrays have advantage to squared arrays because they have larger active area and smaller thinning order for the same complexity (number of channels) of the image system. Theoretical results of the vernier techniques applied to SA arrays in both radial and tangential directions are presented and compared with the equivalent squared array.

[Travelling immigrants]

OBJECTIVES

To characterise travelling immigrants and the international movements they undertake. To identify the risk journeys that this population makes and to assess the international preventive activities for them compared with those for autochthonous travellers.

DESIGN

Retrospective, observational study.

SETTING

Unit of International Health (UIH) Santa Coloma de Gramenet (Barcelona), in the Barcelonès Nord i Maresme Health Area, Primary Care Division of the Catalan Institute of Health.

PARTICIPANTS

Patients seen between June 1999 and June 2002 (n=1163) at the UIH. They were divided into two groups, depending on their origins: those born inside (autochthonous group; no=1019) or outside (immigrant group; n1=144) the European Union.

MAIN MEASUREMENTS

Age, country of origin, length of residence in Spain, interval between consultation and journey, reason for journey, destination, duration of the journey, kind of journey, stay in rural or isolated area, exposure to malaria, vaccinations and anti-malaria chemoprophylaxis prescribed, and overall risk of journey.

RESULTS

Immigrants spent more time abroad than autochthonous people (mean 43.5 days; 95% CI, 37.9-49.1; and 15.8 days, 95% CI, 14.9-16.7, respectively; P<.0001). Periods between the journey and the consultation at the UIH were generally similar in the two groups (mean of 26.8 days for immigrants and 30.41 days for autochthonous people; ns), although the immigrants consulted more often in periods of less than 15 and 7 days (P<.005). 31.9% of immigrants stayed in areas of high malaria transmission (95% CI, 24.4%-39.6%) vs 21.3% (95% CI, 18.8%-23.8%) of autochthonous people (P=.04). Overall, immigrants made more risk journeys than autochthonous people (54.8% vs 43.1%; P<.01). No significant differences between the two groups were found in terms of quality in the administration of the international vaccinations prescribed. Compliance with the guidelines for anti-malaria chemoprophylaxis was less in the immigrant group than in the autochthonous one (36% vs 84%; P<.005).

CONCLUSIONS

The immigrant group in our environment needs to be thought of as a risk group for catching and importing tropical diseases during their international movements. They form a population for whom international preventive measures should be prioritized.

Current Status and Newly Discovered Natural Hosts of Tomato infectious chlorosis virus and Tomato chlorosis virus in Spain

Tomato chlorosis virus (ToCV) and Tomato infectious chlorosis virus (TICV) are emergent whitefly-transmitted criniviruses. ToCV and TICV were detected in Spain in 2000 (2) and 2001 (1), respectively. Both viruses infect tomato (Lycopersicon esculentum Mill) crops and cause symptoms of foliar chlorosis. ToCV is prevalent along the southern and eastern regions of Spain (provinces of Sevilla, Málaga, Almería, Murcia, Alicante, and Castellón), Balearic (Mallorca), and the Canary Islands (Tenerife and Gran Canaria). However, TICV only has been detected in the provinces of Murcia, Alicante, and Castellón in Spain. During the summer and autumn of 2002, abnormal interveinal reddening, yellowing symptoms, or both, were observed in plants of Chenopodium album L., C. murale L., and Solanum nigrum L. growing in or around tomato fields in Murcia and Almería provinces. To study the alternative hosts that may serve as virus reservoirs in areas where these viruses are prevalent, 62 samples of 42 common weed species were analyzed by reverse transcription-polymerase chain reaction using specific primers for ToCV and TICV (1). The 439-bp ToCV-specific DNA fragment was amplified in two S. nigrum samples from Alicante and Murcia provinces, and the 501-bp TICV-specific DNA fragment was amplified in one C. murale sample from Murcia, as well as in three C. album samples from Murcia and Alicante provinces. The DNA fragment amplified from the ToCV isolate was sequenced and showed 99 to 98% identity with the ToCV isolates (GenBank Accession Nos. AY048854 and AF234029) from Italy and Portugal, respectively. The DNA fragment amplified from TICV isolates were sequenced and showed 98% identity with the TICV isolate from Spain (GenBank Accession No. AF479662), confirming the diagnosis. Although the number of samples is not sufficient to conclude that we know, in a precise way, the role of weed reservoirs in TICV and ToCV epidemics in Spain, this study might contribute to a better understanding of the epidemiology of these viruses. To our knowledge this is the first report of these weeds as natural hosts of ToCV and TICV in Spain. References: (1) M. I. Font et al. Plant Dis. 86:696, 2002. (2) J. Navas-Castillo et al. Plant Dis. 84:835, 2000.

Pyrolysis of tyres. Influence of the final temperature of the process on emissions and the calorific value of the products recovered

A study was made of the pyrolysis of tyre particles, with the aim of determining the possibilities of using the products resulting from the process as fuel. Three final temperatures were used, determined from thermogravimetric data. The design of the experiment was a horizontal oven containing a reactor into which particles of the original tyre were placed. After the process, a solid fraction (char) remained in the reactor, while the gases generated went through a set of scrubbers where most of the condensable fraction (oils) was retained. Finally, once free of this fraction, the gases were collected in glass ampoules. Solid and liquids fractions were subjected to thermogravimetric analyses in order to study their combustibility. The gas fraction was analysed by means of gas chromatography to establish the content of CO, CO2, H2 and hydrocarbons present in the samples (mainly components of gases produced in the pyrolysis process). A special study was made of the sulphur and chlorine content of all the fractions, as the presence of these elements could be problematic if the products are used as fuel. Tyre pyrolysis engenders a solid carbon residue that concentrates sulphur and chorine, with a relatively high calorific value, although not so high as that of the original tyre. The liquid fraction produced by the process has a high calorific value, which rises with the final temperature, up to 40 MJ/kg. The chlorine content of this fraction is negligible. Over 95% of the gas fraction, regardless of the final temperature, is composed of hydrocarbons of a low molecular weight and hydrogen, this fraction also appearing to be free of chlorine.

Beamforming with a reduced sampling rate

The beamforming process requires a high delay resolution to avoid the deteriorating effects of the delay quantization lobes on the image dynamic range and signal to noise ratio. Wideband transducers require delay resolutions in the order of 1/16 the signal period. If oversampling is used to achieve this timing resolution, a huge data volume has to be acquired and processed in real time. This is usually avoided by sampling just above the Nyquist rate and interpolating to achieve the required delay resolution. However this increases the hardware complexity. Baseband sampling has been alternatively proposed with sampling rates as low as the transducer frequency or even lower. This approach uses two A/D converters and processing chains for every channel, thus doubling the hardware requirements. Quadrature sampling can be used instead with a single A/D converter, but the sampling rate must be a multiple of four times the transducer frequency, decreasing the application flexibility. Furthermore, it produces relatively high errors in the detected envelope if wideband transducers are used. This work presents a new approach, the selective sampling technique (SST), which keeps the lowest sampling rate required by the imaging process or the signal bandwidth (whatever is larger) and, at the same time, provides a high delay resolution to keep the highest image dynamic range. The SST is based on a second order sampling process which, differently from the mentioned approaches, does not pose any constraints in the time interval between samples and produce lower errors in the detected envelope. The hardware requirements are low (a single A/D converter and processing chain for every transducer element), working at the lowest data rate compatible with the Nyquist criterion, thus reducing the data bandwidth. Furthermore, the sampling points can be also freely chosen, so that the SST simplify the usually required scan conversion process to a simple linear interpolation easily carried out by software in real-time.

3D beamforming with ultrasonic divided-ring arrays

Conventional 2D arrays have a set of squared elements whose inter-element spacing is around lambda/2. This arrangement requires an excessive amount of electronic resources for the generation and processing of ultrasonic signals. In this work, the beam properties of a single divided-ring array are analysed theoretically with the goal of producing volumetric images. Divided-ring arrays are based on a circular pattern, which has a lower periodicity than square arrays, and this property allows increasing the element size while keeping the amplitude of the grating lobes at a reasonably low level. The paper emphasises several advantages of ring arrays, suggesting that these apertures are useful for 3D ultrasonic imaging. First, as the element size may increase, the number of elements can be reduced with little loss of emitting area. Second, ring arrays produce beams of large depth of field in both transmission and reception. This can be used to avoid the complexity associated with dynamic focusing.

The Aspergillus nidulans carnitine carrier encoded by the acuH gene is exclusively located in the mitochondria

The location of the Aspergillus nidulans carnitine/acyl-carnitine carrier (ACUH) was studied. ACUH with a His-tag at its N-terminus was over-expressed in Escherichia coli and purified by Ni(2+) affinity chromatography. The purified protein was utilised to raise polyclonal antibodies which were characterised by Western blotting. For localisation studies A. nidulans T1 strain, that contains the acuH gene under control of the strong promoter alcA(p), was derived. Results obtained demonstrate the exclusively mitochondrial localisation of ACUH and therefore exclude the targeting of the acuH gene product to the peroxisomal membrane.

Development of a homologous transformation system for the opportunistic human pathogen Aspergillus fumigatus based on the sC gene encoding ATP sulfurylase

The development of a homologous transformation system for the opportunistic human pathogenic fungus Aspergillus fumigatus is described. The system is based on the sC gene encoding ATP sulfurylase. Several A. fumigatus sC mutant strains were readily isolated by strong selection for selenate resistance. The coding region plus upstream and downstream regulatory sequences of the A. fumigatus sC gene were cloned by inverse PCR and then sequenced. Sequencing of the sC cDNA revealed the presence of five introns located within the first half of the gene. The A. fumigatus sC gene encodes a protein of 574 amino acids which is highly similar to ATP sulfurylases from the filamentous fungal species Aspergillus nidulans, Aspergillus terreus and Penicillium chrysogenum. By contrast, ATP sulfurylases from the yeasts Saccharomyces cerevisiae and Schizosaccharomyces pombe lack the C-terminal adenosine-5'-phosphosulfate kinase-like domain present in the filamentous fungal orthologues. A 3.8-kb DNA fragment amplified by PCR and containing the sC gene plus 5' and 3' flanking regions was cloned into pUC19 to give the vector pSCFUM. Transformation of two different sC mutant isolates with the plasmid pSCFUM established the functionality of this new homologous transformation system. Molecular analysis of sC+ transformants showed that up to 44% of transformed clones contained one or more copies of the entire plasmid integrated at the sC locus. This result also demonstrates the utility of the sC marker for targeting specific genetic constructs to the A. fumigatus sC locus, facilitating studies of gene regulation and function.

Standard case management of pneumonia in hospitalized children in Uruguay, 1997 to 1998

OBJECTIVE

To report the results of the use of antimicrobial guidelines for the management of children with community-acquired bacterial pneumonia.

METHODS

Admittance and discharge criteria and algorithms for diagnosis and treatment were established. The decision to treat with antibiotics was based on radiologic findings in pneumonia with pulmonary consolidation and left to the attending physician's criteria in the remaining cases. The use of antibiotics was limited to penicillin and derivatives (ampicillin, amoxicillin) and macrolides.

RESULTS

Of the 1163 children treated as bacterial pneumonia, hospitalized in public and private health facilities in Montevideo from September, 1997, through September, 1998, standard case management was applied in 1082 (93%). Age distribution was: <1 month, 1%; between 1 and 11 months, 29%; between 1 and 5 years, 50%; >5 years, 20%. Chest radiography showed evidence of pulmonary consolidation in 843 children (73%). Bacteria were detected in blood culture and/or pleural fluid of 57 children (5%). In 51 the identified microorganism was Streptococcus pneumoniae, susceptible to penicillin in 30, intermediate in 6 and resistant in 5 (maximum MIC, 4 microg/ml); in 10 cases etiologic diagnosis was made by antigen detection. Empyema was present in 62 children (5.3%); 38 (3.27%) required treatment in an intensive care unit; and 5 (0.4%) died.

CONCLUSIONS

Compliance with standard case management was highly satisfactory. Outcome of children treated with penicillin and derivatives was good, including children with empyema and pneumatocele and two patients with penicillin-resistant S. pneumoniae. At the present time S. pneumoniae resistant to penicillin is not an important problem in children with pneumonia in Uruguay. Surveillance of identified microorganisms and their antimicrobial susceptibility must continue.

Genetic variability among populations of Lutzomyia (Psathyromyia) shannoni (Dyar 1929) (Diptera: Psychodidae: Phlebotominae) in Colombia

Polyacrylamide gel electrophoresis was used to elucidate genetic variation at 13 isozyme loci among forest populations of Lutzomyia shannoni from three widely separated locations in Colombia: Palambí (Nariño Department), Cimitarra (Santander Department) and Chinácota (Norte de Santander Department). These samples were compared with a laboratory colony originating from the Magdalena Valley in Central Colombia. The mean heterozygosity ranged from 16 to 22%, with 2.1 to 2.6 alleles detected per locus. Nei's genetic distances among populations were low, ranging from 0.011 to 0.049. The estimated number of migrants (Nm=3.8) based on Wright's F-Statistic, F ST, indicated low levels of gene flow among Lu. shannoni forest populations. This low level of migration indicates that the spread of stomatitis virus occurs via infected host, not by infected insect. In the colony sample of 79 individuals, the Gpi locus was homozygotic (0.62/0.62) in all females and heterozygotic (0.62/0.72) in all males. Although this phenomenon is probably a consequence of colonization, it indicates that Gpi is linked to a sex determining locus.

Thyrotoxic periodic paralysis in caucasians. Report of 8 cases

BACKGROUND

Periodic paralysis is a well known complication of thytotoxicosis in Chinese and Japanese patients, but has been considered extremely rare in caucasians.

PATIENTS AND METHODS

Between 1991 and 1996, we admitted 8 caucasian patients to our Hospital due to thyrotoxic periodic paralysis. We retrospectively analysed their clinical manifestations.

RESULTS

All the patients were males. Their attacks started at night or early after awakening, frequently triggered by a high carbohydrate diet and physical exertion. Myalgias and flaccid weakness predominated over proximal leg muscles, sparing bulbar and respiratory musculature. Reflexes were brisk at the onset of the attack and reduced or absent during the course of the episode. Prior to diagnosis patients presented 1-5 attacks of thyrotoxic periodic paralysis each lasting 1-96 hours. Hypokalemia was documented in 6 patients. The episodes of periodic paralysis led to the diagnosis of a previously unsuspected thyrotoxicosis in 6 patients. In the other 2 patients the diagnosis of the thyroid dysfunction preceded the periodic paralysis. Attacks resolved after treatment of the hyperthyroid state.

CONCLUSIONS

Thyrotoxic periodic paralysis is an under-diagnosed but probably frequent complication of hyperthyroidism in caucasians. Early recognition of the attacks is essential to investigate and treat the underlying thyroid dysfucntion whose symptoms are usually mild. The episodes of periodic paralysis resolve with the correction of the hyperthyroidism.