Simplification of Complex Insulin Regimens with IdegLira in People with Type 2 Diabetes: Literature Review and Clinical Recommendations

INTRODUCTION

This study developed a simple algorithm based on clinical results described in medical literature and which allows one to simplify complex insulin regimes with IdegLira to avoid adverse events related to the complexity of some insulin treatments.

METHODS

We conducted a systematic review of the literature that allowed us to identify studies that evaluated the clinical result of simplifying complex insulin regimes. The authors reviewed the common factors these simpler regimes had, including the type of patients who used them.

RESULTS

We found nine clinical studies published between 2017 and 2022, eight performed in Europe and one in Latin America. The monitoring time of the studies ranged between 3 and 18 months. The size of the study populations was between 61 and 611 patients (the latter was in five countries). In all studies, HbA1c decreased by 0.6-1.7% and the weight decreased by 0.1-3.11 kg.

CONCLUSIONS

On the basis of the findings of these studies, we made some recommendations for clinical practice to simplify treatment. The results of these studies support an algorithm that simplifies the treatment of complex insulin regimens.

AB0527 DIFFUSE ALVEOLAR HEMORRHAGE IN LATIN AMERICAN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: A CASE-CONTROL STUDY

Background

Diffuse alveolar hemorrhage (DAH) is an uncommon and life-threatening complication of systemic lupus erythematosus (SLE) with a high mortality rate (estimated average 50%). The presence of respiratory symptoms (dyspnea, cough, hemoptysis), a new drop in hemoglobin levels, and diffuse infiltrates on chest imaging should raise suspicion of this complication.

Objectives

We aimed to describe DAH-SLE patients and compare them with non-DAH SLE patients.

Methods

We conducted a single-center, case-control study that enrolled hospitalized patients between 2012 and 2020 in Colombia. Twenty-three DAH-SLE patients (cases) were matched by age and sex with 23 non-DAH-SLE patients (controls). Descriptive, comparative, and logistic regression analyses were performed.

Results

In seven (30.4%) patients, DAH was the initial manifestation of SLE; 69.5% of DAH-SLE patients were females with a mean age of 35 years. Lupus nephritis was present in 65% of cases, mean hemoglobin decrease was 2.22 g/l [standard deviation (SD) 0.92 g/L], and 78% had hemosiderophages in bronchoalveolar lavage. All patients received intravenous (IV) pulses of methylprednisolone followed by high-dose steroids, 87.0% IV cyclophosphamide pulses, 60.8% plasmapheresis, 21.7% IV immunoglobulin, and 8.7% rituximab. Comparisons between DAH and non-DAH groups are shown in Table 1. Bivariate logistic regression analysis showed that male sex (OR 9.625 CI95% 1.07 - 86.17; p=0.043), higher SLEDAI-2K score (OR 1. 28 CI95% 1.10 - 1.48; p=0.001), and higher C-reactive protein (CRP) levels (OR 1.09 CI95% 1.01 - 1.18; p=0.016) were independently associated with the occurrence of DAH, whereas prior use of corticosteroids (OR 0.029 CI95% 0.003 - 0.25; p=0.001) and antimalarials (OR 0.121 CI95% 0.03 - 0.45; p=0.002), higher hemoglobin levels (OR 0.457 CI95% 0.29 - 0.71; p=0.001), higher C3 (OR 0.94 CI95% 0.91 - 0.97; p<0.0001) and higher C4 levels (OR 0.87 CI95% 0.80 - 0.95; p=0.002) were negatively associated with DAH occurrence (Graph).

Table 1.

Demographic, clinical, serological, and therapeutic characteristics in DAH-SLE patients and non-DAH-SLE patients

VariableNon-DHA SLE (n = 23)DHA SLE (n = 23)Female95.6%69.5%Age (years)27.9 (SD 12.8)34.82 (SD 17.3)Hospital stay (days)*20.7 (SD 29.1)34.39 (24.4)SLEDAI-2K*6.17 (SD 5.9)21.77 (12.5)Creatinine (mg/dL)*2.5 (SD 3.7)4.23 (SD 5.2)Leucocyte (cell/mm3)8907 (5668)9408 (5477)Neutrophil (cell/mm3)7112 (5595)8063 (5456)Lymphocyte (cell/mm3)1236 (759)952 (425)Hemoglobin (g/L)10.5 (2.6)6.9 (1.5)Ureic nitrogen (mg/dL)*33.79 (SD 28.87)45.73 (SD 25.64)ESR (mm/Hour)51.5 (35.72)64.65 (47.50)CPR (mg/dL)*5.21 (SD 8.16)12.42 (9.63)Ferritina (ng/mL)509 (526)891 (856)Lactate dehydrogenase (U/L)*314 (SD 114)503 (SD 357)C3 (mg/dL)*84.8 (SD 23.07)44.84 (SD 27.91)C4 (mg/dL)*20.5 (10.3)9.5 (8.2)Anti-dsDNA42.8%71.4%Anti-Ro38.8%38.8%Anti-La11.1%10.5%Anti-RNP44.4%47.3%Anti- Sm38.8%35%IgG ACL09%IgM ACL10.5%13.6%Lupus anticoagulant33.3%33.33%Mucocutaneous involvement78.2%69.5%Articular involvement73.9%60.8%Hematological involvement86.9%69.5%Renal involvement91.3%86.9%Serosal involvement34.7%26.1%Prior glucocorticoid*95.6%39.1%Prior antimalarial*69.5%21.7%Dead4.3%21.7%

*P value < 0.05

Conclusion

In about one-third of patients diagnosed with DAH, this life-threatening complication was the initial presentation of SLE. Male sex, higher SLEDAI-2K scores, and higher CRP levels were associated with DAH occurrence, whereas higher hemoglobin levels, elevated complement levels, prior use of glucocorticoids, and antimalarial treatment were negatively associated with the occurrence of DAH.

Figure 1.

Forest plot of factors associated with DHA-SLE patients. *

*The Forest plot graph does not include the male sex variable due to its wide confidence intervals.

Disclosure of Interests

None declared

Utilizing optical spectroscopy and 2',7'-difluorofluorescein to characterize the early stages of cement hydration

The increasingly sophisticated nature of modern, more environmentally friendly cementitious binders requires a better understanding and control particularly of the complex, dynamic processes involved in the early phase of cement hydration. In-situ monitoring of properties of a constantly changing system over a defined period of time calls for simple, sensitive, fast, and preferably also non-invasive methods like optical spectroscopy. Here, we exploit the time-dependent changes in the absorbance and fluorescence features of the negatively charged optical probe 2',7'-difluorofluorescein (DFFL) for the study of the hydration processes in pastes of white cement (WC), cubic tricalcium aluminate (C₃A), and tricalcium silicate (C₃S), the main phases of cement, and in pastes of quartz (Q) over 24 h after addition of the dye solution. For comparison, also conventional techniques like isothermal heat flow calorimetry were applied. Based upon the time-dependent changes in the spectroscopic properties of DFFL, that seem to originate mainly from dye aggregation and dye-surface interactions and considerably vary between the different pastes, molecular pictures of the hydration processes in the cement pastes are derived. Our results clearly demonstrate the potential of optical spectroscopy, i.e., diffuse reflectance, steady state and time-resolved fluorometry in conjunction with suitable optical reporters, to probe specific hydration processes and to contribute to a better understanding of the early hydration processes of cement at the molecular scale.

POS0770 DIFFERENTIAL CLINICAL PRESENTATION BETWEEN SLE RUPHUS PATIENTS AND SLE NON-RHUPUS PATIENTS: A CASE-CONTROL STUDY

Background:

Rhupus is a term that describe the coexistence of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). Rhupus patients have symmetrical, erosive arthritis, characteristic SLE manifestations and an array of autoantibodies including rheumatoid factor (RF), anti-cyclic citrullinated peptides (anti-CCP), anti-dsDNA, and anti-Sm.1 Joint involvement is common in SLE patients (90%), but only 1% to 9,7% have rhupus.2 Due to its low prevalence, there is still a lack of evidence on its presentation and differences with other SLE patients without rhupus.

Objectives:

To examine the rhupus prevalence and to compare the clinical and serological characteristics between rhupus, and non-rhupus SLE patients (SLE with arthritis (SLEa), and SLE without arthritis (SLEwa)).

Methods:

We performed a case-control study. Rhupus patients (cases) were matched 1:1 with non-rhupus SLE patients (controls). Descriptive statistics were calculated and rhupus, SLEa, and SLEwa were compared.

Results:

A total of 72 patients were included, 24 patients in each group; most were female (87.5%). The median age at rhupus onset was 36.5 years (IQR 30-42.5). RA preceded rhupus in half of the patients, 29% were initially diagnosed as SLE, and 21% were initially diagnosed as rhupus. The median duration of RA was 66 months (IQR 30-144).

In the descriptive analysis of rhupus patients, the most affected joints were the proximal interphalangeal and metacarpophalangeal joints (87.5%), followed by the wrists (79.1%). Regarding immunological findings, RF and anti-CCP were positive in 87.5% and 50% of the patients, respectively. As to radiographic findings, the median number of erosions in the hands and wrists was 2 (IQR 0-5) and the median number of joints with narrowed joint space was 7 (IQR: 1.5 - 13.5). In terms of treatment, 95.8% received corticosteroids (median 10 mg/day), 91.6% antimalarials, 79.1% methotrexate, 41.6% leflunomide, and 25.0% rituximab.

Patients with rhupus were older and had less renal and hematological involvement than patients with SLEa and SLEwa. SLEa patients had higher seropositivity for anti-RNP and anti-Sm, higher neurological involvement, and higher SLEDAI-2K scores than rhupus patients. Comparisons of other clinical and serological variables between SLE rhupus and non-ruphus patients are shown in table 1 and figure 1.

Table 1.

Clinical and serological manifestations in rhupus, articular SLE, and non-articular SLE

VariablesRHUPUSM (IQR)SLE with arthritisM (IQR)SLE without arthritisM (IQR)P value RHUPUS vs. SLE with arthritisp value RHUPUSvs. SLE without arthritisAge (years) M (IQR)40 (31.5 – 49)29 (21.5 – 45)33 (19.5 – 37.5)0.0430.013CPR M (IQR)2.3 (1– 8.5)1.6 (0.3– 3.6)0.9 (0.2– 2.5)0.3370.032Positive anti-RNP N (%)7 (29.1%)14 (58.3%)7 (29.1%)0.0421.000Positive anti-Sm N (%)5 (20.8%)15 (62.5%)6 (25%)0.0030.500SLEDAI – 2K score M (IQR)4.5 (1 – 7)9 (2 – 18)7 (3.5 – 15)0.0450.082Figure 1.

Differences in the frequencies of organic alterations. w/o: without.

Conclusion:

Patients with rhupus were older and had lower SLEDAI-2K scores compared with those non-rhupus. Furthermore, renal, neurological, and hematological manifestations were more common in non-rhupus patients than in rhupus patients.

References:

[1]Antonini L, et al. Rhupus: a systematic literature review. Autoimmun Rev. 2020;19(9):102612.

[2]Tani C, et al. Rhupus syndrome: Assessment of its prevalence and its clinical and instrumental characteristics in a prospective cohort of 103 SLE patients. Autoimmun Rev. 2013; 12:537–41.

Disclosure of Interests:

None declared

The Many Faces of Carbohydrate Metabolism in Male Germ Cells: From Single Molecules to Active Polymers

Spermatogenesis is a complex physiological process that involves cell proliferation, meiotic division and a final cell differentiation of post-meiotic cells into spermatozoa. During this process male germ cells also undergo a metabolic differentiation process, in which post-meiotic spermatogenic cells (spermatids) but not meiotic spermatogenic cells (spermatocytes) respond differentially to D-glucose metabolism, glucose transporters (GLUTs) distribution and utilization of non-hexose substrates, such as lactate/pyruvate or dihydroxyacetone. These differences might be explained by the requirement for a specific metabolic process to support cell differentiation or in some cases, cell viability. In addition, though glycogen is considered to be the main glucose store, in male germ cells this polymer may play a novel role in cell proliferation, acting as a new marker for apoptotic events in testicular tissue via a yet unknown mechanism. In this article, we summarize the main metabolic changes that occur during male germ differentiation, with a specific focus on metabolic sources during spermatocyte to spermatid transition. The latter considering that these cells come from the same cell linage as specialized cells, but are not isolated from their environment, describing the roles from single molecules to polymers on the viability of male germ cells.

Lack of subclinical myocardial ischaemia in Mexican patients with systemic lupus erythematosus without traditional risk factors for coronary artery disease

The objective of this study was to analyse whether patients with systemic lupus erythematosus (SLE) without traditional risk factors for coronary artery disease (CAD) develop subclinical myocardial ischaemia in the first years after diagnosis. A cross-sectional analysis of a cohort of 200 female SLE patients was conducted. We selected those patients who fulfilled the American College of Rheumatology (ACR) SLE criteria and had no traditional risk factors for CAD, including diabetes mellitus, hypertension, obesity, hyperlipidemia, and smoking. After an initial clinical and laboratory examination, patients were evaluated using a baseline echocardiogram and a dobutamine and atropine stress echocardiogram to search for subclinical myocardial ischaemia. Forty-one patients were included in the study. The mean age at the time of the study was 34.5 ± 9.56 years (mean ± SD). The mean age at diagnosis was 30.3 ± 9.39 years. The mean time from diagnosis was 3.9 ± 3.3 years. Baseline disease activity index (MEX-SLEDAI score) showed that 92.6% of patients had disease activity, although most patients had mild activity. A dobutamine and atropine stress echocardiogram was performed in 40 patients. All 40 patients had negative tests for subclinical myocardial ischaemia. Patients without traditional risk factors for CAD do not have an increased risk for subclinical myocardial ischaemia in the first years after diagnosis. A longitudinal follow-up study of these patients is needed to confirm our findings and assess if additional non-traditional risk factors for CAD increase the risk for myocardial ischaemia. Lupus (2007) 16, 298—301.

Intracellular calcium movements of boar spermatozoa during 'in vitro' capacitation and subsequent acrosome exocytosis follow a multiple-storage place, extracellular calcium-dependent model

This work analysed intracellular calcium stores of boar spermatozoa subjected to 'in vitro' capacitation (IVC) and subsequent progesterone-induced acrosome exocytosis (IVAE). Intracellular calcium was analysed through two calcium markers with different physico-chemical properties, Fluo-3 and Rhod-5N. Indicative parameters of IVC and IVAE were also evaluated. Fluo-3 was located at both the midpiece and the whole head. Rhod-5N was present at the sperm head. This distribution did not change in any of the assayed conditions. Induction of IVC was concomitant with an increase in both head and midpiece Ca(2+) signals. Additionally, while IVC induction was concurrent with a significant (p < 0.05) increase in sperm membrane permeability, no significant changes were observed in O2 consumption and ATP levels. Incubation of boar spermatozoa in the absence of calcium showed a loss of both Ca(2+) labellings concomitantly with the sperm's inability to achieve IVC. The absence of extracellular calcium also induced a severe decrease in the percentage of spermatozoa exhibiting high mitochondrial membrane potential (hMMP). The IVAE was accompanied by a fast increase in both Ca(2+) signalling in control spermatozoa. These peaks were either not detected or much lessened in the absence of calcium. Remarkably, Fluo-3 marking at the midpiece increased after progesterone addition to sperm cells incubated in a medium without Ca(2+) . The simultaneous addition of progesterone with the calcium chelant EGTA inhibited IVAE, and this was accompanied by a significant (p < 0.05) decrease in the intensity of progesterone Ca(2+) -induced peak, O2 consumption and ATP levels. Our results suggest that boar spermatozoa present different calcium deposits with a dynamic equilibrium among them and with the extracellular environment. Additionally, the modulation role of the intracellular calcium in spermatozoa function seems to rely on its precise localization in boar spermatozoa.

DRESS syndrome due to antibiotic therapy of osteoarticular infections in children: two case reports

Osteoarticular infection in children frequently occurs before 10 years of age. Surgical drainage is sometimes required, whereas acute osteomyelitis can be treated with antibiotic therapy alone. The duration of antibiotic therapy varies, 2 weeks is sufficient for septic arthritis, whereas 6 weeks is often required for complicated cases. Some of these antibiotic drugs present direct complications with low clinical impact in certain individuals. Hypersensitivity to these drugs causes different reactions in children. DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) is a severe and potentially life-threatening drug reaction. It is characterised by high fever, malaise, lymphadenopathy and skin rash. From a clinical perspective, these symptoms can lead to an exacerbation of the initial infectious process for which treatment was commenced. The liver is the organ most often affected in DRESS syndrome associated with haematological changes, potentially similar to sepsis. We present two cases of children with osteoarticular infections who developed DRESS syndrome after antibiotic therapy. Both patients made a complete recovery after cessation of the antibiotic drugs used.

Follow-up of loci from the International Genomics of Alzheimer's Disease Project identifies TRIP4 as a novel susceptibility gene

To follow-up loci discovered by the International Genomics of Alzheimer's Disease Project, we attempted independent replication of 19 single nucleotide polymorphisms (SNPs) in a large Spanish sample (Fundació ACE data set; 1808 patients and 2564 controls). Our results corroborate association with four SNPs located in the genes INPP5D, MEF2C, ZCWPW1 and FERMT2, respectively. Of these, ZCWPW1 was the only SNP to withstand correction for multiple testing (P=0.000655). Furthermore, we identify TRIP4 (rs74615166) as a novel genome-wide significant locus for Alzheimer's disease risk (odds ratio=1.31; confidence interval 95% (1.19-1.44); P=9.74 × 10(-)(9)).

KCNH1 potassium channels are expressed in cervical cytologies from pregnant patients and are regulated by progesterone

Potassium voltage-gated channel, subfamily H (eag-related), member 1 (KCNH1) potassium channels are potential tumour markers and cancer therapeutic targets and are up-regulated by oestrogens and human papilloma virus (HPV) oncogenes. However, the role of KCNH1 in normal tissues is poorly understood, and its expression in pregnancy is unknown. We wondered whether KCNH1 channels are expressed in cervical cells from pregnant patients and whether progesterone (P4) regulates KCNH1. The association with HPV was also investigated. KCNH1 protein expression was studied by immunocytochemistry in liquid-based cervical cytologies; 93 samples were obtained from pregnant patients at different trimesters, and 15 samples were obtained from non-pregnant women (controls). The presence ofHPVwas studied by PCR with direct sequencing and nested multiplex PCR. HeLa cervical cancer cells were transfected with human progesterone receptor-B (PR-B) and treated with P4.KCNH1mRNA expression in these cultures was studied by real-time PCR. KCNH1 protein was detected in 100% of the pregnancy samples and in 26% of the controls. We found 18 pregnant patients infected with HPV and detected 14 types ofHPV. There was no association between the percentage of cells expressing KCNH1 and either the presence or type of HPV. P4induced KCNH1 mRNA and protein expression in cells transfected with human PR-B. No regulation of KCNH1 by P4was observed in non-transfected cells. We show for the first time the expression of an ion channel during human pregnancy at different trimesters and KCNH1 regulation by P4in human cells. These data raise a new research field for KCNH1 channels in human tissues.

A multiplex PCR for detection of poxvirus and papillomavirus in cutaneous warts from live birds and museum skins

Viral cutaneous lesions are frequent in some bird populations, though we are generally ignorant of the causal agent. In some instances, they represent a threat to livestock and wildlife health. We present here a multiplex PCR which detects and distinguishes infection by two such agents, avipoxviruses and papillomaviruses, in avian hosts. We assayed biopsies and superficial skin swabs from field and preserved museum skin specimens. Ninety-three percent of samples from symptomatic specimens tested positive for the presence of avipox (n = 23) or papillomavirus (n = 5). Sixteen and five sequences, corresponding to the P4b and L1 genes, were obtained from avipox and papillomavirus, respectively. One museum specimen, of Fringilla coelebs (chaffinch), was apparently infected with both viruses. Although papillomavirus sequences proved identical to previously published sequences, four novel avipox sequences were generated and used to build a neighbor-joining phylogenetic tree. Our tree recovered a similar topology to that of several recent authors; however, we also propose here two new minor avipox clades (B1b and B3). This multiplex PCR technique shows improved sensitivity compared to other avipox and papillomavirus assays, is able to detect a wide range of avipox and papillomavirus types (it amplifies all three avian-derived papillomavirus genera described thus far and sequences from both major avipox clades), and was even able to detect ancient viral DNA contained in museum specimens of greater than 75 years antiquity for both viruses.

[Adjuvant treatment with phenol of aggressive benign and low grade malignant bone tumors in patients with immature skeleton]

INTRODUCTION

The surgical treatment of aggressive benign bone tumors is based on intralesional resection associated with local adjuvant treatment to avoid local relapses. The purpose of this study is to assess the effectiveness of adjuvant treatment with phenol in aggressive, low grade, malignant and benign bone tumors in young patients.

MATERIAL AND METHODS

We conducted a descriptive retrospective study of 37 patients, 13 girls and 24 boys, with bone tumors. They were treated with curettage and intralesional phenol between January 1989 and January 2006. The study included 35 Campanacci grade III benign tumors and 2 low grade malignant tumors, Enneking IA.

RESULTS

Minimum follow-up was 5 years. The local relapse rate was 13.5%. Mean age at the time of surgery was 10.7 years (SD +/- 4.4). Mean patient follow-up was 104.9 months (SD +/- 41.9). Mean time between surgery and relapse was 18.8 months (SD +/- 11.81). Complications during the follow-up period occurred in 18.9% of the patients. The MSTS score was 28.7 points (SD +/- 1.7).

DISCUSSION

The treatment of bone tumors with phenol shows low relapse and complication rates, so it is indicated for the management of locally aggressive bone tumors.

Identification and genomovar assignation of clinical strains of Pseudomonas stutzeri

The identification of Pseudomonas stutzeri clinical isolates through conventional phenotypic methods was compared with identification through partial rpoD gene sequencing. We observed that commercial phenotypic systems easily confuse P. stutzeri with other Pseudomonas species. We also demonstrated that most of the clinical strains of P. stutzeri herein studied (79%) belonged to genomovar 1 of the species. We propose the use of partial rpoD gene sequence analysis as a complementary molecular tool for the precise routine identification and genomovar assignation of P. stutzeri clinical isolates, as well as for typing and epidemiological studies.

Usefulness of consecutive biomarkers measurement in the management of community-acquired pneumonia

The aim of this study was to investigate whether procalcitonin (PCT), neopterin, C-reactive protein (CRP), and mid regional pro-atrial natriuretic peptide (MR-proANP) levels at admission and during the clinical course can be useful for the management of patients with pneumonia. The study population consisted of 75 patients with clinical and radiological diagnosis of pneumonia. Serum samples were collected at admission and during hospitalization. Complications were defined as intensive care unit (ICU) admission or death. The levels of PCT were significantly higher in pneumonia of definite bacterial origin in comparison to probable bacterial or unknown origin. The PCT levels were higher in pneumococcal pneumonia. The PCT and MR-proANP levels increased significantly according to the Pneumonia Severity Index (PSI). All biomarkers levels are higher in patients developing complications and who were dying. The serial levels of MR-proANP remain significantly elevated in patients developing complications and in patients classified in PSI and CURB-65 risk groups. In patients not developing complications, there is a significant decrease in the PCT levels. PCT can be useful for identifying pneumonia etiology. PCT and MR-proANP levels correlate with pneumonia severity rules. PCT and MR-proANP serial measurements can be useful for predicting short-term prognosis. Systemic biomarkers can provide additional information regarding clinical evolution, because these are dynamic and can be measured daily.

Effect of litter size and sex in the birth weight of newborn kids and in the behaviour of primiparous goats before, during and after the parturition

The objective of this study was to determine the effect of litter size (46 single birth and 32 double birth) and sex (44 male and 66 female) of newborn kids on the puerperal behaviour of primiparous Murciano-Granadina goats (N = 78). The highest frequencies were grunting, with 124.9 ± 166.5, and butting conspecific, with 7.0 ± 8.7. Frequencies of the remaining variables considered (standing, kicking, moving head and neck, licking their back and pawing the earth) were lower than 3.0. The majority of variables were significantly greater for single births than for twin births (P < 0.01). Goats that gave birth to twins spent more time lying down, and less time walking than those that gave birth to one kid (10.1 ± 6.7 min vs. 6.8 ± 7.0 min, P < 0.05 and 2.9 ± 1.1 min vs. 6.0 ± 5.5 min, P < 0.01, respectively). Parturition was longer and birth weight heavier for singleton than twin-born kids (64.5 ± 15.7 min vs. 41.9 ± 10.7 min and 2.9 ± 0.2 kg vs. 2.3 ± 0.1 kg, respectively). In conclusion, primiparous goats showed objective signs of discomfort that were more evident for singleton than twin birth kids.

[25 hydroxyvitamin D levels and cardiovascular risk in a cohort of patients with advanced chronic kidney disease]

BACKGROUND

Decreased 25 hydroxyvitamin D serum levels have been related to an increase in cardiovascular morbility and mortality in both general population and chronic kidney disease patients. The aim of this study was to evaluate the relationship between 25 hydroxyvitamin D serum level, cardiovascular risk factors and previous established cardiovascular disease in a group of patients with advanced chronic kidney disease.

MATERIAL AND METHODS

We performed a cross-sectional observational study in a cohort of 171 stage 4 and 5 chronic kidney disease outpatients seen in our predialysis clinic, mean age 64.16 +/- 13 years, 59.6% were men, 64.3% had diabetes, 47.3% had obesity, 46.8% had previous cardiovascular disease. 25 hydroxyvitamin D and 1-25 dihydroxyvitamin D were measured, we also determined other routine biochemical parameters. All subjects underwent an echocardiogram and 24 hours ambulatory blood pressure monitoring was also performed.

RESULTS

Mean 25 hydroxyvitamin D levels were 22.1 +/- 13 ng/mL, only 18.7% of the patients had adequate levels, levels were insufficient in 58.5% of the patients and deficient in 22.8% of them. Low 25 hydroxyvitamin D levels were significantly related with age, diabetes, female gender, obesity, MDRD glomerular filtration rate and previous cardiovascular disease. Pulse pressure was the Ambulatory Blood Pressure Monitoring parameter that was better correlated with 25 hydroxyvitamin D levels. We could not find any association between vitamin D levels and other bone and mineral metabolism parameters. No relationship was seen between low vitamin D levels and left ventricular hypertrophy. On multivariate analysis lower levels of 25 hydroxyvitamin D were independently associated with female gender, previous cardiovascular disease, MDRD4-GFR and higher pulse pressure.

CONCLUSIONS

Our study confirm a high prevalence of 25 hydroxyvitamin D insufficiency and deficiency in advanced chronic kidney disease patients, this was associated with the presence of cardiovascular risk markers and previous established cardiovascular disease. However we could not see any relationship with left ventricular hypertrophy which is a known predictor of future cardiovascular events in this population.

[What people mean by constipation? A general population based-study.]

INTRODUCTION

The word "constipation" is used by people to refer multiple symptoms such as infrequent stools, hard stools, excessive straining and feeling of incomplete evacuation. This variability is a confounding factor and may induce discrepancies between doctors and patients.

AIM

to evaluate among the general population of 6 different cities of Mexico, what is meant by constipation.

MATERIAL AND METHODS

A cross-sectional study was performed in the cities of Veracruz, Tampico, Tuxtepec, Colima, Puebla and San Luis Potosi (representing 4 geographical areas of Mexico). All subjects answer a questionnaire that assesses self-perception of constipation with the question: Do you consider yourself constipated? Frequency and stool form (Bristol), symptoms and associated factors to constipation were also evaluated. Rome III criteria for functional constipation (FC) and irritable bowel syndrome with constipation (IBS-C) were applied.

RESULTS

One thousand and forty one subjects were evaluated (mean age 35 +/- 15 years), 657 (63%) women. In our study, 87% (n = 907) had a bowel movement at least every 48 hours and most of them (67%) have stools type 3-4. Thirty four percent (n = 356) of subjects considered to have constipation, of whom 73 (21%) met criteria for FC, 65 (18%) for IBS-C and 218 subjects (61%) did not meet diagnostic criteria. The symptom that best defines constipation was straining (47%). Correlation and concordance between self-perception and the Rome criteria was 0.14 (p = 0.61).

CONCLUSIONS

In our population, 61% of subjects who perceived symptoms of constipation are not really constipated according to the criteria of Rome.

Performance of VITEK-2 Compact and overnight MicroScan panels for direct identification and susceptibility testing of Gram-negative bacilli from positive FAN BacT/ALERT blood culture bottles

We describe the reliability of the VITEK-2 Compact and overnight MicroScan panels for direct identification and susceptibility testing from the BacT/ALERT blood culture system when using FAN (FA and FN) bottles. A simple procedure, in two centrifugation steps, was designed to remove the charcoal particles present in FA and FN bottles. A total of 113 positive blood cultures showing Gram-negative rods were investigated. Enterobacteriaceae were isolated in 104 cases, and Pseudomonas aeruginosa in nine. The MicroScan system correctly identified 106 (93.8%) of the 113 isolates. The seven identificaction errors included P. aeruginosa (three), Enterobacter cloacae (one), Escherichia coli (one), Klebsiella oxytoca (one), and Klebsiella pneumoniae (one). The VITEK-2 system correctly identified 109 (96.5%) of the 113 samples obtained directly from the blood culture bottles. The four unidentified isolates were Enterobacter cloacae (two), Escherichia coli (one), and P. aeruginosa (one). MicroScan yielded 4/779 (0.5%) very major errors and 28/2825 (0.9%) minor errors. VITEK-2 yielded 2/550 (0.36%) very major errors, 1/1718 (0.05%) major error, and 32/2373 (1.3%) minor errors. Both systems provided excellent identification (correlation of >90%) and susceptibility (correlation of >98%) results. The average times required to obtain identification and susceptibility results using the direct test applied to the VITEK-2 Compact system were 4.57 +/- 1.37 h and 6.52 +/- 1.64 h, respectively. The VITEK-2 compact system provided results on the same day that the blood culture was found to be positive.

Variability in the behavior of kids born of primiparous goats during the first hour after parturition: effect of the type of parturition, sex, duration of birth, and maternal behavior

The aim of the study was to determine the effect of the type of birth, the sex of the kids, the duration of the birth (categorized as short, medium, or long), and the level of maternal care (categorized as low, medium, or high) on the behavioral variables of kids during the first hour after birth. The parturitions of 78 primiparous goats of Murciano-Granadina breed (46 single-birth and 32 twin-birth) along with the behavior of the kids (44 males and 66 females) during the first hour of life were studied. Birth weight and duration of parturition were greater in single-birth kids (2.94 kg and 60.5 min, respectively) than in twin-birth kids (2.27 kg and 43.2 min, respectively). Birth weight and duration of parturition was greater in males (2.74 kg and 54.61 min) than in females (2.43 kg and 47.70 min). All the kids attempted to stand during the first hour of life, but only 83% attempted to suckle with 65% succeeding. Single-birth kids attempted to stand earlier than twin-birth kids (7.05 vs. 9.08 min), although they achieved this later (16.87 vs. 13.21 min). Compared with twin-birth kids, single-birth kids attempted to suckle later (22.45 vs. 34.76 min, respectively) and achieved it later (25.69 vs. 37.32 min). In the single-birth kids the duration of the first suckling was shorter (16.11 vs. 22.26 s), although total suckling time was greater (5.86 min) than in the twin-birth kids. Males tried to stand sooner than females (7.41 vs. 8.78 min), but took longer (16.12 vs. 13.81 min). The sex factor had no significant effect on suckling-related variables. Compared with medium- and long-duration-birth kids, short-duration-birth kids attempted to suckle earlier, (29.34, 34.23, and 12.82 min, respectively), achieved suckling earlier (31.75, 37.00, and 16.70 min, respectively), and suckled longer at first attempt (0.32, 0.17, and 0.45 min, respectively). Total suckling time was longer in long-duration-birth kids than in medium- and short-duration birth (9.07, 2.63, and 3.86 min, respectively). These results suggest that heavier kids suffer more during birth and are slower to achieve suckling; however, they appear to recover quickly because the total suckling time observed during the first hour was greater.

[Gender-related differences in functional assessment of serotonergic system in healthy young subjects]

INTRODUCTION

Prolactin stimulation test with serotonergic stimulants has been widely used in the study of diverse psychiatric disorders. However, the characterization of this response in normal subjects is still incomplete.

OBJECTIVE

To compare the response to serotonin stimulation using dexfenfluramine, a specific serotonergic agent, in young healthy men and women, controlling the menstrual cycle.

METHODS

A total of 10 women and 9 men, who were given 30 mg of dexfenfluramine orally, were studied and their levels of prolactin were measured on an hourly basis for a five-hour period. Baseline, maximum and delta values of prolactin were compared for both groups.

RESULTS

According to the age groups studied (mean age for men: 19.9 +/- 2.5 years old; mean age for women: 20 +/- 1.5 years old), the prolactin maximum level and the response to prolactin (DPRL) were significantly higher in women (p-values: 0.02 and 0.04, respectively).

CONCLUSIONS

Young healthy women show a greater response to stimulation with dexfenfluramine than young healthy men. Clinical and biological implications of this observation are discussed in the context of the currently available research papers.

[Rare diseases. Concept, epidemiology and state of the question in Spain]

Rare diseases are those whose prevalence is below 5 cases per 10,000 inhabitants in the European Community. Most cases are diagnosed during paediatric age due to their genetic origin, while some others are congenital malformations. Nevertheless, a higher prevalence is seen during adulthood as most of the former diseases are very severe and patients die during childhood. At the same time, higher survival rates are related to some chronic rare diseases in adults. The Spanish Network of Research Epidemiology for Rare Diseases (REpIER) developed the first atlas showing the geographical distribution of rare diseases in Spain, assessed the Spanish rare disease registries, contributed to the further development of regional plans on rare diseases, as well as to social and health actions, and established the real group of needs to be solved. These have been included in the Communication of the European Commission on Rare Diseases as well as in the Spanish Senate Presentation.

Molecular epidemiology of methicillin-resistant Staphylococcus aureus in Majorcan hospitals: high prevalence of the epidemic clone EMRSA-15

Clinical isolates (n = 389) of methicillin-resistant Staphylococcus aureus (MRSA) recovered from 371 patients between January 2003 and June 2004 at the three major public hospitals on the island of Majorca, Spain were studied. The clonal relatedness of MRSA isolates was determined by pulsed-field gel electrophoresis (PFGE) after digestion with SmaI. During the study period, MRSA was found in 31% of patients with S. aureus-positive cultures. PFGE analysis identified three predominant clones, affecting 94% of the patients. The three clones had been detected since 1999 in one hospital, and were designated as clones A, B and C. Whereas clones A and B (multidrug-resistant) were related to the two most prevalent clones in Spain at this time, clone C was identical to EMRSA-15, currently one of the most common MRSA clones in UK hospitals and also detected in other countries, but rarely in Spanish hospitals. This imported epidemic clone was detected in c. 10% of patients admitted to one of the three hospitals in 2002, but its prevalence has increased significantly (32% of the patients investigated in the three hospitals in the present study), and this clone also accounted for 44% of the isolates from non-hospitalised patients. Even though EMRSA-15 showed the least multidrug resistance of the three major clones, it was apparently more virulent, since it was associated significantly (p 0.001) with bacteraemia, and positive blood cultures were documented for 21% of the patients infected by this clone, compared with only 10% and 7% of patients infected with clones A and B, respectively.

Expression of the GM-CSF receptor in ovine spermatozoa: GM-CSF effect on sperm viability and motility of sperm subpopulations after the freezing–thawing process

The granulocyte-macrophage colony stimulating factor (GM-CSF) is a pleiotropic cytokine capable of stimulating proliferation, maturation and function of haematopoietic cells. Receptors for this cytokine are composed of two subunits, alpha and beta, and are expressed in myeloid progenitors and mature mononuclear phagocytes, monocytes, eosinophils and neutrophils, as well as in other non-haematopoietic cells. We have previously demonstrated that bull spermatozoa express functional GM-CSF receptors that signal for increased glucose and vitamin-C uptake and enhance several parameters of sperm motility in the presence of glucose or fructose substrates. In this study, we have analyzed the expression of GM-CSF receptors in ovine spermatozoa and studied the effect of GM-CSF on sperm viability and motility after the freezing-thawing process. Immunolocalization and immunoblotting analyses demonstrated that ovine spermatozoa (Xisqueta race) expressed GM-CSF receptors. In addition, GM-CSF partially counteracted the impairing action of freezing/thawing on the percentage of total motility, as well as on the specific motility patterns of each of the separate, motile sperm subpopulations of ram ejaculates subjected to this protocol. These results suggest that GM-CSF can play a role in the resistance of ram spermatozoa to environmental thermal stress.

Structural and functional characterization of a recombinant sticholysin I (rSt I) from the sea anemone Stichodactyla helianthus

Sticholysins I and II (Sts I and II) are two potent cytolysins from the sea anemone Stichodactyla helianthus. These isoforms present 13 substitutions, with three non-conservative located at the N-terminus. St II is considerably more hemolytic than St I in human red blood cells, a result explained by the smaller number of negatively charged groups present at St II's N-terminus. In the present work, we have obtained a recombinant St I (rSt I), differing from the wild type in a single amino acid residue (E16Q). This pseudo-wild type is structurally similar to St I and shows a similar capacity to interact with and form pores in model membranes. This was assessed by the intrinsic fluorescence increase in the presence of liposomes, their adsorption to bilayers (measured by SPR), their concentration at the air-water interface, their interaction with lipid monolayers and their capacity to promote the release of carboxyfluorescein entrapped in liposomes. In spite of these similarities, rSt I presents a larger hemolytic activity in human red blood cells than St I, being intermediate in activity between Sts I and II. The results obtained in the present work emphasize that even the change of one single E by Q at the N-terminal segment may modify the toxin HA and show that this functional property is the most sensitive to subtle changes in the protein primary structure.