Latent TB and depressive symptoms in household contacts of persons with active TB

BACKGROUND: Depression is common among persons with TB and is associated with poor clinical outcomes. However, little is known about the relationship between latent TB infection (LTBI) and depression. We assessed the association between LTBI and depressive symptoms among household contacts (HHCs) of patients receiving TB treatment.METHODS: We enrolled 1,009 HHCs of 307 patients receiving TB treatment in Lima, Peru, during 2016-2018. At enrollment, HHC LTBI status was assessed using the interferon-gamma release assay (IGRA). Depressive symptoms were assessed at baseline and 12 months later using the Patient Health Questionnaire-9 (PHQ-9) with a cut-off of ≥5. We used logistic regression to estimate the odds ratio (OR) for PHQ-9 ≥5, comparing HHCs with and without baseline LTBI.RESULTS: Among 921 HHCs, 374 (41.0%) had LTBI at baseline, and 69 (12.4%) of 567 HHCs had PHQ-9 ≥5. Compared to HHCs without LTBI at enrollment, those with LTBI had almost two times the odds of PHQ-9 ≥5 at follow-up after controlling for potential confounders (adjusted OR 1.93, 95% CI 1.09-3.39); this association was driven by greater severities of depressive symptoms.CONCLUSION: HHCs with LTBI had increased odds of depressive symptoms 1 year later. This population may benefit from mental health screening and interventions integrated into TB programs.

Culture-negative TB: clinical characteristics, risk factors and treatment outcomes

BACKGROUND: Although culture remains the standard for TB diagnosis, 15-20% of patients diagnosed and treated for TB are culture-negative. We explored clinical characteristics, risk factors and treatment outcomes for culture-negative TB in a Peruvian cohort.METHODS: We recruited 4,500 index TB patients and 10,160 household contacts in Lima, Peru, and enrolled 692 secondary patients diagnosed with TB during follow-up of household contacts. We analyzed smear and culture status, sociodemographic factors, clinical characteristics and TB treatment outcomes to compare culture-negative and positive patients.RESULTS: Of the 4,880 adult patients, 915 (18.8%) were culture-negative. Culture-negative patients were less likely to report symptoms of TB disease and disease of longer duration. A multivariate analysis showed no statistically significant difference in loss to follow-up, treatment failure or recurrence between the culture-negative and -positive groups but a higher rate of death among culture-negative patients with an adjusted OR of 1.65 (95% CI 1.05-2.60). In a multivariate analysis of determinants of culture negativity, older age, substance use and being a secondary case were associated with culture status.CONCLUSIONS: More recognition and awareness of culture-negative TB is key for early and correct diagnosis to reduce transmission and improve treatment outcomes.

Exploring the destiny and distribution of thiocyanate in the water-soil-plant system and the potential impacts on human health

Endocrine disruptors like thiocyanate are some of the principal causes of chronic disorders worldwide. Prenatal and postnatal exposure to thiocyanate can interfere with normal neurological development in both fetuses and newborns. Currently, little information regarding thiocyanate levels and potential sources of exposure is available. In this study, we evaluated thiocyanate uptake and accumulation in chard and spinach grown under greenhouse conditions. Both chard and spinach are commonly used to produce baby foods. Three thiocyanate concentrations were compared: Control, T1 (30 ng mL^-1), and T2 (70 ng mL^-1). Thiocyanate accumulation depended on the concentration and exposure time. Chard was found to accumulate more thiocyanate than spinach, with leaf accumulation > stem accumulation (p < 0.0194) and maximum concentrations of 76 ng g^-1 (control), 112 ng g^-1, (T1), and 134 ng g^-1 (T2). The estimated daily intake (EDI) of thiocyanate for chard and spinach (fresh) exceeded the subchronic reference dose of 200 ng^-1 kg^-1 day^-1 and the chronic reference dose of 600 ng^-1 kg^-1 day^-1. In addition, the EDI of thiocyanate for spinach in baby food exceeded twice the chronic reference dose in the vulnerable newborn-1 year age group. However, all EDIs were lower than the lowest observed adverse effect level (LOAEL) of 1.9 × 10⁵ ng kg^-1 day^-1. Further studies are needed that increase our knowledge of thiocyanate levels and potential environmental sources to reduce opportunities for exposure, especially in vulnerable groups.

Accumulation and distribution of perchlorate in spinach and chard growing under greenhouse: Implications for food safety in baby foods commodities

Very little information is available with regards to the bioavailability of perchlorate in spinach or chard used in the production of baby foods commodities. In the present study, the uptake and accumulation of perchlorate were compared under two different treatments (T1: 1 and T2: 10 mg L^-1 ClO₄^-). Our results indicate that spinach has a higher capacity to accumulate perchlorate than chard (p < 0.0185). Concentrations of perchlorate in leaves, stems and roots (leaves > stem > roots) all gradually increased (p < 0.0001) as vegetable growing and treatment (T2 > T1). No significant differences were found between the control and T1. The daily intake for perchlorate (control) is below the proposed international standard, however, it was exceeded in T1 and T2. The results suggested that perchlorate is actively accumulate in high concentrations in vegetables used in the production of baby food commodities and the exposure of perchlorate via the food consumption (baby foods) was evaluated as not safe.

Occurrence, distribution and dynamics of perchlorate in soil, water, fertilizers, vegetables and fruits and associated human exposure in Chile

Perchlorate (ClO₄^-) has been identified as a persistent environmental contaminant of concern. Perchlorate exposure is a potential health concern because it interferes with hormone production by thyroid gland. Food (fruits and vegetables) and drinking water are an important source of human exposure to perchlorate. However, little is known about the occurrence of perchlorate in Chile. The purpose of this study was to determine the occurrence of perchlorate in 145 samples (soil, drinking water, surface water, groundwater, fertilizers, fruits and vegetables) collected across Chile and estimate associated exposure to consumers. Our results show that perchlorate was detected in soil (median: 22.2 ng g^-1), drinking water (median: 3.0 ng mL^-1), fruits (median: 0.91 ng g^-1 fresh weight [FW]), lettuce (median: 5.0 ng g^-1 FW) and chard (median: 4.15 ng g^-1 FW). Interestingly, perchlorate concentrations detected in drinking water from three regions (Serena, Copiapo and Illapel) exceeded the USEPA interim drinking water health advisory level of 15 ng mL^-1. Median concentrations of perchlorate in non-nitrogenous fertilizers (3.1 mg kg^-1) were higher than those in nitrogenous fertilizers (1.3 mg kg^-1). Estimated daily intake (EDI) of perchlorate via drinking water was lower than the USEPA's reference dose (7000 ng kg^-1 bw day^-1). The EDI of perchlorate via vegetables (chard and lettuce) produced in northern Chile was three times higher than those produced in other regions. The results of this study provide information about perchlorate sources in Chile, which will be helpful in modifying current regulations.

Detection of Xylella fastidiosa in almond orchards by synergic use of an epidemic spread model and remotely sensed plant traits

The early detection of Xylella fastidiosa (Xf) infections is critical to the management of this dangerous plan pathogen across the world. Recent studies with remote sensing (RS) sensors at different scales have shown that Xf-infected olive trees have distinct spectral features in the visible and infrared regions (VNIR). However, further work is needed to integrate remote sensing in the management of plant disease epidemics. Here, we research how the spectral changes picked up by different sets of RS plant traits (i.e., pigments, structural or leaf protein content), can help capture the spatial dynamics of Xf spread. We coupled a spatial spread model with the probability of Xf-infection predicted by a RS-driven support vector machine (RS-SVM) model. Furthermore, we analyzed which RS plant traits contribute most to the output of the prediction models. For that, in almond orchards affected by Xf (n = 1426 trees), we conducted a field campaign simultaneously with an airborne campaign to collect high-resolution thermal images and hyperspectral images in the visible-near-infrared (VNIR, 400-850 nm) and short-wave infrared regions (SWIR, 950-1700 nm). The best performing RS-SVM model (OA = 75%; kappa = 0.50) included as predictors leaf protein content, nitrogen indices (NIs), fluorescence and a thermal indicator (Tc), alongside pigments and structural parameters. Leaf protein content together with NIs contributed 28% to the explanatory power of the model, followed by chlorophyll (22%), structural parameters (LAI and LIDFa), and chlorophyll indicators of photosynthetic efficiency. Coupling the RS model with an epidemic spread model increased the accuracy (OA = 80%; kappa = 0.48). In the almond trees where the presence of Xf was assayed by qPCR (n = 318 trees), the combined RS-spread model yielded an OA of 71% and kappa = 0.33, which is higher than the RS-only model and visual inspections (both OA = 64-65% and kappa = 0.26-31). Our work demonstrates how combining spatial epidemiological models and remote sensing can lead to highly accurate predictions of plant disease spatial distribution.

Field study on the uptake, accumulation and risk assessment of perchlorate in a soil-chard/spinach system: Impact of agronomic practices and fertilization

The application of excessive fertilizer represents a primary source of entry for perchlorate into crop systems and thus has raised widespread concern regarding food safety. Several studies have reported the occurrence of perchlorate in vegetables. However, limited information is available on the fate of perchlorate in the soil-plant system. In this study, we performed field experiments to evaluate the effects of the application rate of Chilean nitrate fertilizer and the type of fertilization (manual or fertigation) on the uptake of perchlorate by plants grown in open fields. Interestingly, in the control, chard and spinach accumulated 21.3 and 25.9 μg kg^-1, respectively. For both agronomic practices, the content of perchlorate in chard and spinach increased as the fertilizer application rate increased, with fertigation promoting more significant accumulations. Spinach accumulated almost two times more perchlorate than chard for all treatments; however, the concentrations generally remained below regulatory values. The intake of spinach and chard presented a low risk to human health for all age groups. These findings enhance our understanding of the environmental impact of the use of fertilizers in agriculture and food safety.

Interactive effects of aluminum and cadmium on phenolic compounds, antioxidant enzyme activity and oxidative stress in blueberry (Vaccinium corymbosum L.) plantlets cultivated in vitro

To evaluate the potential role of phenolic compounds in Al and Cd stress tolerance mechanisms, Vaccinium corymbosum cv. Legacy plantlets were exposed to different metal concentrations. The present study used an in vitro plant model to test the effects of the following treatments: 100μM Al; 100μMAl + 50μMCd; and 100μMAl + 100μMCd during periods of 7, 14, 21 and 30 days. The oxidative damage was determined by the accumulation of malondialdehyde (MDA) and hydrogen peroxide (H₂O₂). The antioxidant activity values were determined using 1,1-diphenyl-2-picrylhydrazine (DPPH) and the ferric reducing antioxidant power test (FRAP). Additionally, the phenolic compound concentrations were determined using HPLC-DAD. The exposure to Al and Cd increased the MDA and H₂O₂ contents differentially, while the antioxidant capacity values showed differences between DPPH and FRAP with the largest changes in FRAP relative to Cd. SOD had the highest activity in the first 7 days, leading to a significant increase in phenolic compounds observed after 14 days, and chlorogenic acid was the major compound identified. Our results revealed that phenolic compounds seem to play an important role in the response to ROS. Therefore, the mechanisms of tolerance to Al and Cd in V. corymbosum will be determined by the type of metal and time of exposure.

Inbreeding in Southeastern Spain : The Impact of Geography and Demography on Marital Mobility and Marital Distance Patterns (1900-1969)

In this paper, the structure of a southeastern Spanish population was studied for the first time with respect to its inbreeding patterns and its relationship with demographic and geographic factors. Data on consanguineous marriages (up to second cousins) from 1900 to 1969 were taken from ecclesiastic dispensations. Our results confirm that the patterns and trends of inbreeding in the study area are consistent with those previously observed in most non-Cantabrian Spanish populations. The rate of consanguineous marriages was apparently stable between 1900 and 1935 and then sharply decreased since 1940, which coincides with industrialization in Spain. A marked departure from Hardy-Weinberg expectations (0.25) in the ratio of first cousin (M22) to second cousin (M33) marriages in the study population (0.88) was observed. The high levels of endogamy (>80%) and its significant steadiness throughout the twentieth century is noteworthy. Accordingly, our results show that exogamous marriages were not only poorly represented but also that this reduced mobility (<6 km) suggests that the choice of a mate was preferentially local. We found higher mobility in M22 with respect to M33 cousin mating. The relationships between population size and consanguinity rates and inbreeding fit power-law distributions. A significant positive correlation was observed between inbreeding and elevation. Many Spanish populations have experienced a prolonged and considerable isolation across generations, which has led to high proportions of historical and local endogamy that is associated, in general, with high [Formula: see text] values. Thus, assessing genomic inbreeding using runs of homozygosity (ROH) in current Spanish populations could be an additional pertinent strategy for obtaining a more refined perspective regarding the population history inferred from the extent and frequency of ROH regions.

A review of perchlorate (ClO4-) occurrence in fruits and vegetables

Since the 1990s, a large number of studies around the world have reported the presence of perchlorate in different types of environmental matrices. In view of their inherent characteristics, such as high solubility, mobility, persistence, and low affinity for the surface of soil, perchlorates are mobilized through the water-soil system and accumulate in edible plant species of high human consumption. However, the ingestion of food products containing perchlorate represents a potential health risk to people due to their adverse effects on thyroid, hormone, and neuronal development, mainly in infants and fetuses. At present, research has been centered on determining sources, fates, and remediation methods and not on its real extension in vegetables under farming conditions. This review presents a comprehensive overview and update of the frequent detection of perchlorate in fruits and vegetables produced and marketed around the world. Additionally, the impact of fertilizer on the potential addition of perchlorate to soil and its mobility in the water-soil-plant system is discussed. This review is organized into the following sections: sources of perchlorate, mobility in the water-soil system, presence in fruits and vegetables in different countries, international regulations, and toxicological studies. Finally, recommendations for future studies concerning perchlorate in fruits and vegetables are presented.

Perchlorate levels in soil and waters from the Atacama Desert

Perchlorate is an anion that originates as a contaminant in ground and surface waters. The presence of perchlorate in soil and water samples from northern Chile (Atacama Desert) was investigated by ion chromatography-electrospray mass spectrometry. Results indicated that perchlorate was found in five of seven soils (cultivated and uncultivated) ranging from 290 ± 1 to 2,565 ± 2 μg/kg. The greatest concentration of perchlorate was detected in Humberstone soil (2,565 ± 2 μg/kg) associated with nitrate deposits. Perchlorate levels in Chilean soils are greater than those reported for uncultivated soils in the United States. Perchlorate was also found in superficial running water ranging from 744 ± 0.01 to 1,480 ± 0.02 μg/L. Perchlorate water concentration is 30-60 times greater than levels established by the United States Environmental Protection Agency (24.5 μg/L) for drinking.

Cytomegalovirus ileitis in an immunocompetent patient

Cytomegalovirus (CMV) is a virus that belongs to the family of Herpesviridae. Infection can cause a serious disease in immunocompromised patients, but it can also affect immunocompetent patients, creating generally self limiting symptoms. However, in some cases it can be fatal. We present a case of CMV ileitis with serious clinical symptoms that led to an operation in an immunocompetent patient.

Inbreeding coefficients for X-linked and autosomal genes in consanguineous marriages in Spanish populations: the case of Guipúzcoa (Basque Country)

Inbreeding patterns over the past two centuries have been studied more extensively in Spain and Italy than anywhere else in Europe. Consanguinity studies in mainland Spain have shown that populations settled along the Cantabrian cornice share inbreeding patterns that distinguish them from other populations further south. A visual representation of spatial variations of two key inbreeding variables is presented here for the first time via contour maps. This paper also analyzes time trends of mean inbreeding coefficients for X-linked (F(x)) and autosomal genes (F) (1862-1995) together with variations in F(x)/F ratios in Guipúzcoa, the most autochthonous Spanish Basque province. Because close cousin marriages are a mark of identity of the study population, we evaluated the contribution of uncle-niece/aunt-nephew (M12) and first cousin (M22) marriages to F(x) and F values and compared the frequencies of M12 and M22 pedigree subtypes and their corresponding F(x)/F ratios to those found in other Spanish populations. The mean Fx and F inbreeding levels in Guipúzcoa for the 134-year period analyzed were 1.51 x 10(-3) and 1.04 x 10(-3), respectively, and the F(x)/F ratio was seen to be very stable over time. Our findings show that major similarities exist for close consanguineous marriage subtypes between Basque and non-Basque Spanish populations, despite significant geographic variability in terms of first cousin pedigrees. The distortion seems to be caused by Guipúzcoa. The F(x)/F ratios for first cousins in Spanish populations were higher than expected (1.25), with values ranging from 1.34 to 1.48. The findings of the present study may be useful for advancing knowledge on the effects of the interaction between biology and culture and for exploring associations between mating patterns and the prevalence of certain diseases.

[Mammary reconstruction in Poland's syndrome]

Poland's syndrome is considered to be a polimalformative entity with different degrees of severity. We retrospectively reviewed our patients with Poland's syndrome diagnosis, treated between 2000 and 2006. The aim of our study is to assess the different choices of surgical treatment for mammary reconstruction according to the importance of malformation and taking into account our own experience and literature references. A total o f 13 patients (5 males and 8 females) were studied and only 6 of them (1 male and 5 females) underwent surgery. Surgical indication was based on Foucras's classification, considering 3 grades of severity. We propose a surgical approach adapted to each stage, as well as surgical refinements to improve the aesthetic aspect. Most of our patients were very satisfied with final results even though they underwent complex procedures with a considerable rate of complications.

[Complications and sequelae after nasal trauma]

Septal haematoma after nasal trauma is a complication that can lead to septal abscess if unrecognized or early intervention is not performed. It can cause compression and thereby necrosis that evolve to a septal abscess in which cultures reveal saprophyte bacteria. Cartilage necrosis and destruction can produce impaired breathing and aesthetic deformities with collapse of the dorsum and the tip of the nose. We present a 10 year old masculine infant, that suffered a nasal fracture with a septal haematoma that remained undiagnosed. The patient developed a septal abscess that required drainage and resulted in nasal sequelae with collapse of dorsum and cranial displacement of tip and columella. Functional and aesthetic reconstruction was performed using rib cartilage grafts. No complications occurred. Functional and aesthetic improvement was observed. Result after 2 months of follow-up is considered favourable.

Genetic Position of Andalusians from Huelva in Relation to Other European and North African Populations: A Study Based on GM and KM Allotypes

An understanding of population relationships in the Mediterranean region is crucial to the reconstruction of recent human evolution. Andalusia, the most southern region of Spain, has been continuously and densely occupied since ancient times and has a rich history of contacts with many different Mediterranean populations. Thus, to understand the Mediterranean peopling process, investigators should analyze the population relationships between the Iberian peninsula and northern Africa based on an assessment of genetic diversity that takes Andalusia into consideration. The aim of this study was to address the extent of genetic variation in the Iberian peninsula between its geographic extremes (Huelva and the Basque area) and to explain the intensity of the phylogenetic relationships between Andalusians and other neighboring populations, such as those from North Africa. We present, for the first time, results on allotype markers (GM and KM) of human immunoglobulins in the Andalusian population from Huelva. The most frequent GM haplotypes in Andalusia correspond to those that are also the most common in Europe. A sub-Saharan haplotype was found at a relatively high frequency compared to other Iberian samples, and a North Asian marker did not reach polymorphic frequencies in the study sample. A hierarchical cluster analysis based on the first two principal components (94.1% of the total genetic variance) revealed an interesting geographic structure for the 49 populations selected from the literature. The Huelva sample showed a central position in the multivariate space--despite being geographically located at one of the extremes of the Mediterranean basin--and clustered with most Western European populations. Western Europe and Eastern Europe (the latter group paradoxically including Italy and the major islands of the western Mediterranean) were differentiated. North African populations were grouped in two clusters that did not separate either Arabs and Berbers or their present-day countries. Analysis of immunoglobulin allotype markers shows that gene flow among human populations should generally be interpreted in terms of complex patterns, with the observed frequencies being the consequence of the entire genetic and demographic history of the population. Single historical events rarely determine gene frequencies in large human populations. Analysis of the GM system has shown that the Andalusian population from Huelva, as a result of its complex history, is not simply an outstanding part of the Mediterranean world but rather the genetic center of gravity of that world.

Genetic polymorphism and linkage disequilibrium of the HLA-DP region in Basques from Navarre (Spain)

In this work, a sample of 116 individuals from an autochthonous Basque population (northern Navarre, Spain) was typed at the DNA level for HLA-DPA1 and HLA-DPB1 loci, with the aim of analysing the genetic polymorphism and the linkage disequilibrium (LD) of the HLA-DP region. In this Basque subpopulation, the most frequent alleles were *0103 (0.767) and *0201 (0.185) for DPA1 locus, whereas for DPB1 locus the *0401 allele was predominant (0.307). Accordingly, the most frequent haplotype was DPA1*0103-DPB1*0401 (0.300), which showed a significant LD. However, the haplotypes that most differentiated the sample of Navarre from other worldwide populations already analysed were DPA1*0105-DPB1*1901 (0.011) and DPA1*0201-DPB1*7601 (0.021), both of which showed a strong LD. Analysis of the relationships between populations based on data provided by HLA-DPA1 and HLA-DPB1 loci revealed a high genetic affinity between the Basque samples (North Navarre and Guipúzcoa), which, in turn, tend to plot separately from the remaining European populations. Gene frequency clines for DPB1*01, DPB1*04 and DPB1*11 alleles among European populations are reported for the first time. These alleles showed maximum values of F(ST) (0.033, 0.034 and 0.025, respectively). Various evolutionary forces were considered in discussing the origin of the spatial structuring of the gene frequencies: (i) gene flow, argued from the hypotheses of Post-glacial recolonization from southern Europe or the demic diffusion of farmers from the Near East into Europe, and (ii) the existence of selective pressures that could have generated genetic microdifferentiation.

HLA-DQA1 polymorphism in autochthonous Basques from Navarre (Spain): genetic position within European and Mediterranean scopes

In this work, a sample of 112 individuals from an autochthonous Basque population (Northern Navarre, Spain) were typed at the DNA level for the HLA-DQA1 locus, with the aim of characterizing its polymorphism and analyzing the genetic relationships of Basque Navarrese with other Caucasian populations. Northern Navarre is a neighboring area with Guipúzcoa, a province located in the core of the Basque territory having the highest proportion of Basque-speakers. In Navarrese population, the most frequent alleles were DQA1*01 (0.375) and DQA1*02 (0.259). Frequency clines for both DQA1*0103 allele and DQA1*04* allele cluster (including DQA1*0401, DQA1*0501 and DQA1*0601) among the European and Mediterranean populations considered are reported for the first time. Furthermore, a spatial structuring previously described for DQA1*02 allele is corroborated. The information provided by the highly polymorphic HLA-DQA1 locus was stressed by using genetic distances and non-metrical multidimensional scaling (MDS). The analysis of genetic relationships among populations showed a high genetic affinity between the Basque subpopulations of Northern Navarre and Guipúzcoa, which in turn tended to plot separately from the remaining European and Mediterranean populations. In the same way, the Basques showed no clear relationship to North African populations, as postulated in several previous HLA studies. The observed genetic heterogeneity seems to be conditioned by the high frequencies of the DQA1*02 allele in Basques from Guipúzcoa and North Navarre. These two subpopulations seem to show low levels of admixture with other non-Basque neighboring populations, probably because of their deeply rooted ethnicity and the existence of a linguistic barrier to random mating.

Allele variation of DYS19 and Y-Alu insertion (YAP) polymorphisms in Basques: an insight into the peopling of Europe and the Mediterranean region

Two Y-chromosome DNA polymorphisms, the DYS19 microsatellite and the YAP (at locus DYS287), were tested in males from two autochthonous Basque populations from France and northern Navarre (Spain). The results are compared to those obtained for the same genetic markers in 32 populations from Europe, northern Africa, and western Asia. The high predominance of the DYS19*11 (190-base-pair) allele in Basques indicates that their genetic diversity for microsatellite DYS19 is around half that observed in Europeans, North Africans, and western Asians. The Y-Alu insertion (YAP+) was not detected in the Basque samples. This study attempts to throw some light on the importance of historically recent migratory movements, the main corridors of gene flow, and demographic sizes and their variations in shaping gene frequency patterns in contemporary human populations, particularly in the Mediterranean region. Historical processes may have had more significant effects on the genetic make-up of current human populations than those of prehistoric times.

Inbreeding and demographic transition in the Orozco Valley (Basque Country, Spain)

Inbreeding in the Orozco Valley (Basque Country, Spain) between the 18th and 20th centuries was investigated on the basis of ecclesiastical dispensations and surname lists. The variations over time are very similar to those observed elsewhere in Europe, with a major increase in the coefficient of inbreeding in the late 19th and early 20th centuries. This is due mainly to an increase in marriages between first cousins. A highly marked decrease in inbreeding is observed during the 20th century. The secular trends described by the coefficient calculated on the basis of dispensations and by that calculated on isonymy are very similar. The nonrandom component of isonymy reveals a selective search for a related spouse during the period of maximum inbreeding. These results are associated with the process of demographic transition which affected European populations as a whole in the 19th century, resulting in a greater availability of kin among potential mates and thus enabling inbreeding to increase to levels far higher than those observed for earlier centuries.

[Recurrent Bell's facial palsy: our experience]

Recurrent facial palsy is noted infrequently in the literature. We present a comparative study of recurrent Bell's palsy (RBP) with regard to non-recurrent Bell's palsy (NRBP). Afterwards we compare among RBP cases those of ipsilateral recurrence (RRBP) to those of contralateral one (ARBP). We constate that non-recurrent Bell'palsy formes behave similarly to the contralateral recurrent forms.

[Anesthesia for the patient with cancer]

Surgery and radiotherapy provide the basis for local and regional control of cancer. The cancer patient has special characteristics that have implications for anesthesia. Tumors may involve the airways and affect ventilation, hemodynamics and intracranial pressure. Remote tumors can occur in endocrine cancer and in paraneoplastic syndromes. Other systemic complications of the cancer patient include hemostatic changes, immunosuppressant anemia and altered metabolism. Radiotherapy causes changes with anesthetic implications when treatment is directed at the head and neck, mediastinum, lung or surgical area. Chemotherapy is associated with non-specific toxic effects such as mucositis, aplasia and immunosuppression, alopecia and vascular injury; in addition, each chemical has other more specific toxic effects. Chemicals that are toxic for the heart and lungs have the greatest implications for anesthesia. Preoperative assessment should ascertain the effects caused by both the tumor and its treatment. Preparation for surgery includes improving nutrition and possibly inserting a venous port. Management during surgery depends on type of intervention and the patient's physical status, as they will determine the need for invasive monitoring and vessel access. The patient can be given antiemetic and antithrombotic prophylaxis. Important issues in postoperative care are the need for adequate analgesia; provision of early nutrition; antibiotic, antithrombotic and antiemetic prophylaxis; and prevention of ulcers caused by pressure.

A worldwide analysis of AG molecular diversity inferred from serology

Ten population samples from different geographic origins were tested serologically for the AG polymorphism of human beta-lipoproteins. Their haplotype frequencies were used with previously published data to perform a wide analysis of AG genetic differentiations throughout the world. Coancestry coefficients were computed from weighted F(ST)s among populations by using a matrix of molecular distances among AG haplotypes, which is here determined on the basis of DNA studies. Coancestry coefficients derived from unweighted F(ST)s and more classical Prevosti distances were computed on the same data and used for a comparison. In all cases a highly significant correlation was found between genetics and geography on a worldwide scale, while the significance of the correlation with linguistics differed. A test of significance of the pairwise F(ST)s among populations also gave different results depending on whether the molecular distance matrix among AG haplotypes was included. Globally, this study shows that in spite of being highly significantly correlated to each other, different genetic distance measures can lead to different interpretations of the same data set. Moreover, the elucidation of the molecular models related to the presently known serological polymorphisms may represent an additional tool for analyzing such polymorphisms in human population genetics studies.

An insight into recent consanguinity within the Basque area in Spain. Effects of autochthony, industrialization and demographic changes

BACKGROUND

The importance of studying the genetic kinship of those human groups characterized by a deeply rooted ethnicity has traditionally been and still is an interesting goal of anthropological and population genetic studies. However, only a few surveys have aimed to learn about the impact of industrial development on the consanguinity of these populations and even those have concentrated on industrialized regions. This approach is worth analysing in Spain, where industrialization was late in relation to other western European countries.

AIM

In this work we analyse the characteristics of inbreeding in Guipúzcoa from 1951 to 1995. This Basque province underwent industrial and tourist development earlier than other Spanish regions. It has the highest density of Basque speakers and has always occupied a central position within the map of distribution of the Basque language. Guipúzcoa is geographically placed in the core of the Basque area. SUDJECTS AND METHODS: Data on consanguineous marriages recorded in the province of Guipúzcoa between 1951 and 1995 were taken from Roman Catholic dispensations stored in the Diocesan Archives of San Sebastián, the province's capital city. Over the whole time period, a total of 1152 consanguineous marriages were registered.

RESULTS

The high frequencies of first cousin (M22) (F = 1/16) and uncle-niece, aunt-nephew (M12) (F = 1/8) consanguineous marriages distinguish Guipúzcoa from the rest of Iberian populations. The M22/M33 ratio (with M33 being second cousins) has never dropped below 0.67, which represents a significant deviation from the expectation value of 0.25. When consanguineous marriages are classified according to marriage partner birthplaces interesting results emerge. Provincial endogamy shows the highest consanguinity rates (57%) and the proportion of M22/M33 is also rather high (0.63). However, a major contribution to the consanguinity levels and mean inbreeding coefficient recorded in Guipúzcoa over recent decades has been made by immigrant relative groups coming from other geographical areas of Spain. In this segment of population the observed M22/M33 rates are 1.44.

CONCLUSIONS

This study shows again how important preferentiality (or avoidance) is in human consanguinity, and also how human groups, in spite of being spatially settled in the same territory, present differential attitudes for given consanguinity patterns.

[Morphological changes in adenotonsillar tissue as early manifestation of asymptomatic HIV patient]

The HIV virus induces in the host several changes in your immunological system, which heads to the AIDS. We report two cases diagnosed by pathological studies after adenotonsilectomy for adenotonsilar hypertrophy. The diagnosis of HIV patients is suspected by epidemiologic (risk groups) or clinical features (opportunist diseases). But, it exists a early diagnosis, the histological findings in the extranodal lymphoid tissues, unusual on the literature. These phenomenons re-enforce the contamination way by means of the superior aerodigestive tract mucosis.

The genetic position of the autochthonous subpopulation of Northern Navarre (Spain) in relation to other basque subpopulations. A study based on GM and KM immunoglobulin allotypes

GM and KM immunoglobulin (Ig) allotypes were tested in 118 autochthonous Basques from northern Navarre. The results are compared to those obtained for the same genetic markers in 6 other Basque subpopulations, 3 from Spain (Guipúzcoa, Vizcaya, and Alava) and 3 from France: Macaye, Saint-Jean Pied de Port, and Mauleon. The northern Navarrese appear genetically closer to the Alava and Saint-Jean Pied de Port subpopulations. The Basques present 3 GM haplotypes that are uncommon in Caucasian populations, suggesting that they have not been completely isolated either from Asian or African populations. The GM*1,17 23' 10,11,13,15,16 north Asian haplotype was probably the first to be introduced into the Basque area. The GM*1,17 23' 5* haplotype, considered an African genetic marker although also detected in Central Asia, would have reached the Iberian Peninsula through consecutive historic migrations from North Africa. The rare haplotype GM*1,17 23 21,28 results probably from a genetic recombination or crossing-over between the 2 common haplotypes GM*1, 17 23' 21,28 and GM*3 23 5*. It is also found with a low frequency in other neighboring regions and countries; but the possibility of its having been introduced through the main passage connecting western France and Spain during the Roman Empire and Middle Ages cannot be ruled out.

[A superior vena cava syndrome due to a surgical retractor]

A 56-year-old male diagnosed of epidermoid carcinoma of the right lung (T4 N0 M0, stage IIIb) is described. He had earlier received chemotherapy and radiotherapy and was scheduled for removal of the right lung. During surgery the need to resect tumor infiltration of the right atrium became evident. During weaning from by-pass sudden deterioration of hemodynamics occurred with poor response to volume and inotropic drugs. Superior vena cava syndrome due to traction of the innominate trunk from a surgical retractor was diagnosed; the crisis resolved when the retractor was withdrawn. We discuss the pathophysiology of this clinical picture and relevant intraoperative aspects.

[Common variable immunodeficiency associated with autoimmune thrombocytopenia: anesthetic management]

A 44-year-old man diagnosed of common variable immunodeficiency associated with thrombopenia due to autoimmunity required anesthesia for anal fissure repair and hemorrhoidectomy. Hemostatic complications developed after surgery, with extreme thrombopenia (1,000 platelets/pl) and analytical changes that necessitated administration of six units of platelets from apheresis, as well as immunoglobulins, antifibrinolytic agents (e-aminocaproic acid) and granulocytic colony stimulating factors. Anesthesia for such patients is reviewed, with emphasis on careful management of the airways, preparation of sufficient material for surgery (rapid transfusion equipment, large caliber intravenous catheters, sterile material) and orientation of anesthetic technique toward general anesthesia through a laryngeal mask.

Cerebral thrombosis associated with active Crohn's disease

An increased incidence of cerebral thromboembolic events has been reported in young patients with inflammatory bowel disease (IBD). It has been suggested that a hypercoagulable state is associated with clinical activity of the disease, with elevation of factors V, VIII, fibrinogen and platelets and a lowering of anti-thrombin III. We present the case of a 35 y/o male with refractory Crohn's disease who complained of headaches, blurred vision and tonic-clonic seizures. The studies demonstrated an ischemic stroke of the left cerebral hemisphere, without vascular abnormalities. Elevation of factor VIII, platelets, and antithrombin III were found. The symptoms were relieved with medical treatment and the patient has continued in good health after resection of the diseased terminal ileum.

Immunoglobulin allotypes (GM and KM) in Basques from Spain: approach to the origin of the Basque population

GM and KM immunoglobulin (Ig) allotypes have been tested in 310 autochthonous Basques from the three subpopulations of Vizcaya, Guipúzcoa, and Alava, Spain. They are compared with allotypes occurring in autochthonous French Basques, some Pyrenean subpopulations in France, and European populations. The analysis suggests that the Basque subpopulations show noticeable genetic distances between them and with other European populations. The genetic similarity between Basques and European populations is greater in the Basques from France than in the Basques from Spain. The genetic distances between Basque subpopulations in Spain fit well with the different historical levels of the spatial implantation of the Basque language. Guipúzcoa, the Basque province with the highest number of Basque-speaking people, shows the most genetic distinctiveness. The main underlying cause of this spatial genetic pattern seems to be admixture with surrounding populations. Our results do not support the hypothesis that Basques are a relict population of ancient Europeans. They might be a consequence of the colonization of the Basque area by a long-distance migrating group, probably a small Neolithic North Caucasian population that introduced agriculture in the region. They experienced early, rapid demographic growth, and they did not breed with the few hunter-gatherers wandering throughout the area. The North Caucasian migrants could have admixed with North Asian groups dating from many centuries before. Furthermore, Basques present polymorphic frequencies of a common African haplotype, suggesting that they have not been completely isolated from populations of Africa. However, another focus of the African haplotype has been detected in Central Asia, and the Basque frequencies alternatively might be due to North Asian groups.

Multiple kinship in two Spanish regions: new model relating multiple and simple consanguinity

The structure of the different categories of multiple consanguineous marriages (MCMs) and their historical variation patterns are analyzed in the Spanish dioceses of Alava (Basque Country) and Sigüenza-Guadalajara (Castile). Consanguineous marriages, up to third cousins, were taken from ecclesiastical dispensations, and the periods studied were 1831-1980 for Alava and 1861-1980 for Sigüenza-Guadalajara. Significant differences exist in the MCM rates in the two Spanish areas. In this study a model is proposed to prove that in a general population there may be dependence between MCM rates for specific relationships and the frequencies of those types of relationships in the form of simple consanguineous marriages (SCMs). The effects of avoidance and preferentiality and of underreporting are discussed to explain the deviations between observed and expected consanguineous marriage frequencies. A limit to the weight of remote consanguinity on the population inbreeding coefficient F is determined. The relationship between FT/FS and ms values from our two Spanish populations are fitted to curvilinear regressions. FT is the total population inbreeding coefficient, FS is the contribution to FT from SCMs, and ms is the relative observed frequency of SCMs in the general population.

New method for comparing levels of microdifferentiation: application to migration matrices of two populations from the Basque Country (Spain)

Population microdifferentiation rates can be obtained by various coefficients. Despite differences in the formulations of these coefficients, the obtained values lead to convergent empirical interpretations. One of the most widely used coefficients is Wright's FST. Insofar as all these statistics depend on the number of subpopulations r and their effective size Ne, they are far from easy to compare and interpret. Here, we propose a new method for comparing microdifferentiation rates: a measurement referred to as -log(p), inferred from the relationship between the statistics FST and chi 2. The most interesting quality of -log(p) is that it is independent of r and Ne so that its use facilitates comparisons between populations with different characteristics. Using parent-offspring migration matrices, we estimated the values of -log(p) for two populations in the Basque Country: Lanciego and Orozco. The obtained values were compared with the -log(p) for other world populations whose microdifferentiation rates had already been calculated by other researchers using different data sources. Both Basque populations showed low -log(p) values, as did most of the considered continental populations, whereas island and nonmodern populations showed higher values. This implies microdifferentiation only in island and nonmodern populations, although the secular trend of this process in some populations, such as the Aland Islanders and the Papago, leads to isolation breakdowns.

[Single photon emission computer tomography in the differential diagnosis of the paroxysmal clinical events in newborns]

Conventional computerized cranial tomography by single photon emission (TLCESF) is a nuclear medicine technique which makes use of a radioactive chemical complex to obtain a qualitative image of cerebral, cerebellar and brain-stem vascularization. This technique shows the changes in vascularization which occur between (decrease) and during (increase) the clinical events of paroxysmal epilepsy (ECP) in the area of origin. This technique is indicated in neonates with ECP which does not disappear on etiological treatment, where a non-epileptic cause cannot be ruled out on clinical grounds and where there are no associated encephalographic epileptic changes during the ECP.

Sex linked versus autosomal inbreeding coefficient in close consanguineous marriages in the Basque country and Castile (Spain): genetic implications

Pedigree structures of 161 uncle/niece-aunt/nephew and 4420 first cousin consanguineous marriages registered during the 19th and 20th centuries in two large and very different Spanish regions have been analysed and their genetic consequences evaluated. The frequencies of the different pedigree subtypes within each degree of relationship were quite similar in both populations despite significant heterogeneity in inbreeding patterns. The mean X-linked inbreeding coefficient (Fx) for each type of cousin mating was calculated and compared to that expected for autosomal genes (F). The effect of genealogical structure on the Fx/F ratio was compared to different cultural populations worldwide. Preferentiality and avoidance of close consanguinity along with specific types of pedigrees are discussed on the basis of premarital migration and sociocultural rules still deeply rooted in certain human groups. By admitting that the observed Fx coefficient is usually higher than F in most human populations some remarks have been made in terms of population genetic risk.

Inbreeding patterns in the Basque Country (Alava Province, 1831-1980)

A considerable number of studies have shown that Spain is one of the countries on the European continent with a high level of inbreeding and that, in general, this level decreased more quickly and later than the levels in the rest of Europe. The types and frequencies of consanguineous marriages (up to third cousins), the mean inbreeding coefficient, and secular trends have been studied within the Basque Country (Alava Province) using information from ecclesiastic dispensations from 1831 to 1980. A total of 5583 consanguineous marriages were registered in Alava over the whole period (150 years), and 79 different categories of relationship were observed. The analysis of the structure of consanguinity has shown some appreciable levels of close consanguineous unions: 0.08% (uncle-niece or aunt-nephew marriages) and 0.96% (first-cousin marriages) of the total number of marriages. This seems to be a common phenomenon among provinces of northern Spain. The rates of total consanguinity and the mean coefficient of inbreeding in the population of Alava from 1861 to 1980 were 4.62% and 0.00124, respectively. The temporal trend pattern of inbreeding in Alava closely fits the pattern observed in other large European populations: France, Italy, and Belgium. This early fall in the level of inbreeding in Alava compared to the levels found in both large and small populations in central and western Spain might be due to the early industrial development of the Basque Country and the resulting loss of importance of landownership.

Incidence of red-green color blindness in the Basque population

The incidence of red-green colour vision defects was studied in a sample of 392 Basque students (174 males and 218 females), using the Ishihara test cards (1987). The frequency of red-green colour blindness was 4.02 percent in the males and 0.46 percent in the females. The colour blindness frequencies found among males are within the range of other Spanish samples. Nevertheless they are lower than the values reported in other European populations.

[An anthropologic reflection on genetic epidemiology. On the need of a multidisciplinary approach]

Historically, Epidemiology arose from the need to take steps in forming health care policy, and up until a few decades ago, its interest has centred on illnesses caused by infectious agents. Recent developments in Medicine and Biology have permitted the evaluation of the behaviour of genetic material in vital processes. From these advances arose Genetic Epidemiology which researches the relationship between heredity and illness among human populations defined by their biosocial characteristics. Its primary field of application is in complex aetiology illnesses in which the genotype and the environment interact. Its complexity has inevitably converted it into a multi-disciplinary science. The basic parametres of the population structures, such as parentage and consanguinity, which is what physical anthropologists have been researching in recent years in Spain, form an important data base which must be integrated into future Genetic Epidemiology studies; these studies will result in its natural progression. Significant success is being obtained in this direction in many advanced countries, therefore it is advisable for our health care authorities to do the same and encourage this type of multidisciplinary work which will serve as a basis for a modern and efficient health care policy.

Lewis phenotypes and secretor character in the "Castilla la Nueva"-region (Spain). ABH and Lewis antigen levels in salivary secretion

In 1980 blood and saliva samples were taken from Spanish students of the University of Madrid. Red cells were analysed for A1B2BO and Lewis blood groups. Saliva samples were tested to detect the specific group substances ABH, Lea and Leb. A slightly higher frequency of the "le" gene (0.419) was found in our sample as compared to other Spanish samples. The phenotype frequencies of ABH secretors (77.2%) and non-secretors (22.8%) are in the range of other European populations. The levels of A and B antigens of individuals belonging to these blood groups were similar, whereas the average titration of the H substance showed the relation O greater than A2 greater than A1 greater than A1B greater than B. Analysis of variance proved this heterogeneity to be statistically significant. The amount of Lea substance in non-secretors was higher than in secretors. This shows again that the ABH secretor status has some influence on the quantity of this antigen. The average titration of the Leb substance in secretors was higher than that of Lea in individuals belonging to O, A and AB blood groups, but not in those with blood group B.

What is your diagnosis? Gastric leiomyoma

Smooth muscle tumors are the second most common benign tumors of the stomach after adenomatous polyps. Most often they present as solitary submucosal lesion. Occassionally they may be multiple. They usually present as a smooth mass, although they may be pedunculated and rarely present as gastroduodenal intusuception, when they are located in the distal antrum and prolapse into the duodenum. Leiomyomas may be submucosal, intramural or subserosal. Because of this peculiarity they may grow predominantly intraluminal as well as extraluminally.

Acatalasia in two Peruvian siblings

The oral findings in two Peruvian brothers, 10- and 11-years-old, with acatalasia are presented. Gingival necrosis and severe alveolar bone destruction were the main oral manifestations. Otherwise the patients were in good health. Thirteen hypocatalasemic individuals, including both parents, were found among 29 relatives of the probands examined from four generations. No other acatalasemic individuals were found. Hypocatalectic relatives of the probands did not have oral lesions, and no other abnormalities were detected. The parents of the affected children were not known to be related; however, both parents and their families come from the same small rural community. The inheritance pattern in the kindred was compatible with an autosomal recessive disorder. It is postulated that the gingival lesions resulted from damage to tissue from hydrogen peroxide generated by organisms in gingival plaque. The hydrogen peroxide cannot be degraded by gingival tissue or by leukocytes genetically lacking the enzyme catalase.

Intravenous glucose tolerance test in pregnancy in women living in chronic hypoxia

Rapid intravenous glucose tolerance tests have been performed in women living at high altitude in an environment of chronic hypoxia (average values: barometric pressure 445 mm. Hg, alveolar p02 46.0 mm. Hg, arterial p02 45.1 mm. Hg). The hypoxic group had a curve of the same shape but with lower values when compared with that of women born and living at sea level.

At sea level pregnancy modified the curve obtained when compared with that of nonpregnant women, but at high altitude pregnancy did not modify the curve. As a possible explanation a higher basal level of insulin in the high altitude group is suggested.