Sexually transmitted infections, the epidemic that persists after the COVID-19 pandemic: an analysis of the primary care electronic health records covering about 5 million people in Catalonia

BACKGROUND

The aim of our study is to analyse the trends in the diagnosis of sexually transmitted infections (STIs) during the COVID-19 pandemic.

METHODS

We conducted an observational retrospective population-based study using data from primary care electronic health records spanning from January 2016 to December 2022 (involving 5.1 million people older than 14 years). We described the daily number of new STI diagnoses from 2016 to 2022; as well as the monthly accumulation of new STI diagnoses for each year. We compared the monthly averages of new diagnoses in 2019, 2020, 2021 and 2022 using the T-test. Finally, we performed a segmented regression analysis of the daily number of STI diagnoses.

RESULTS

We analysed 200,676 new STI diagnoses. The number of diagnoses abruptly decreased coinciding with the lockdown. Overall in 2020, we observed a reduction of 15%, with higher reductions for specific STIs such as gonorrhoea (-21%), chlamydia (-24%), and HIV (-31%) compared to 2019. Following this drastic drop, which was temporarily associated with the lockdown, we observed a rapid rebound. In 2021, the number of STI diagnoses was similar to that of 2019. Notably, we found a considerable increase in 2022, particularly for non-specific STI, which lack laboratory confirmation (67% increase). HIV was the only STI with a reduction of up to -38% in diagnoses at the end of 2022 compared to 2019.

CONCLUSIONS

After a significant reduction in 2020, the number of STIs recorded in primary care rapidly rebounded, and the current trend is similar to that of 2019, except for HIV. These findings underscore the dynamic impact of the COVID-19 pandemic on STI diagnoses and highlight the importance of ongoing monitoring and public health interventions in the post-pandemic period.

Prevalence and Risk Factors for Colonization by Multidrug-Resistant Microorganisms among Long-Term Travelers and Recently Arrived Migrants

Multidrug-resistant (MDR) bacteria have become one of the most important health problems. We aimed to assess whether international travel may facilitate their spread through the colonization of asymptomatic travelers. A cross-sectional study was conducted (November 2018 to February 2022). Pharyngeal and rectal swabs were obtained from long-term travelers and recently arrived migrants from non-European countries, and an epidemiological survey was performed. Colonization by Gram-negative bacteria and methicillin-resistant Staphylococcus aureus (MRSA) was determined by chromogenic media and MALDI-TOF-MS. Resistance mechanisms were determined by the biochip-based molecular biology technique. Risk factors for colonization were assessed by logistic regression. In total, 122 participants were included: 59 (48.4%) recently arrived migrants and 63 (51.6%) long-term travelers. After their trip, 14 (11.5%) participants-5 (8.5%) migrants and 9 (14.3%) travelers-had rectal colonization by one MDR bacterium. Escherichia coli carrying the extended-spectrum beta-lactamase (ESBL) CTX-M-15 was the most frequent. No participants were colonized by MRSA or carbapenemase-producing Enterobacteriaceae. The only risk factor independently associated with MDR bacterial colonization was previous hospital attention [OR, 95% CI: 10.16 (2.06-50.06)]. The risk of colonization by MDR bacteria among recently arrived migrants and long-term travelers is similar in both groups and independently associated with previous hospital attention.

Final Measurement of the ^{235}U Antineutrino Energy Spectrum with the PROSPECT-I Detector at HFIR

This Letter reports one of the most precise measurements to date of the antineutrino spectrum from a purely ^{235}U-fueled reactor, made with the final dataset from the PROSPECT-I detector at the High Flux Isotope Reactor. By extracting information from previously unused detector segments, this analysis effectively doubles the statistics of the previous PROSPECT measurement. The reconstructed energy spectrum is unfolded into antineutrino energy and compared with both the Huber-Mueller model and a spectrum from a commercial reactor burning multiple fuel isotopes. A local excess over the model is observed in the 5-7 MeV energy region. Comparison of the PROSPECT results with those from commercial reactors provides new constraints on the origin of this excess, disfavoring at 2.0 and 3.7 standard deviations the hypotheses that antineutrinos from ^{235}U are solely responsible and noncontributors to the excess observed at commercial reactors, respectively.

STEREO neutrino spectrum of 235U fission rejects sterile neutrino hypothesis

Anomalies in past neutrino measurements have led to the discovery that these particles have non-zero mass and oscillate between their three flavours when they propagate. In the 2010s, similar anomalies observed in the antineutrino spectra emitted by nuclear reactors have triggered the hypothesis of the existence of a supplementary neutrino state that would be sterile, that is, not interacting by means of the weak interaction1. The STEREO experiment2-6 was designed to investigate this conjecture, which would potentially extend the standard model of particle physics. Here we present an analysis of the full set of data generated by STEREO, confirming observed anomalies while rejecting the hypothesis of a light sterile neutrino. Installed at the Institut Laue-Langevin (ILL) research reactor, STEREO accurately measures the antineutrino energy spectrum associated to the fission of 235U. The segmentation of the detector and its very short distance to the compact core are crucial properties of STEREO for our analysis. The measured antineutrino energy spectrum suggests that anomalies originate from biases in the nuclear experimental data used for the predictions7,8. Our result supports the neutrino content of the standard model and establishes a new reference for the 235U antineutrino energy spectrum. We anticipate that this result will allow progress towards finer tests of the fundamental properties of neutrinos but also to benchmark models and nuclear data of interest for reactor physics9,10 and for observations of astrophysical or geoneutrinos11,12.

Prospective associations between a priori dietary patterns adherence and kidney function in an elderly Mediterranean population at high cardiovascular risk

Purpose

To assess the association between three different a priori dietary patterns adherence (17-item energy reduced-Mediterranean Diet (MedDiet), Trichopoulou-MedDiet and Dietary Approach to Stop Hypertension (DASH)), as well as the Protein Diet Score and kidney function decline after one year of follow-up in elderly individuals with overweight/obesity and metabolic syndrome (MetS).

Methods

We prospectively analyzed 5675 participants (55–75 years) from the PREDIMED-Plus study. At baseline and at one year, we evaluated the creatinine-based estimated glomerular filtration rate (eGFR) and food-frequency questionnaires-derived dietary scores. Associations between four categories (decrease/maintenance and tertiles of increase) of each dietary pattern and changes in eGFR (ml/min/1.73m²) or ≥ 10% eGFR decline were assessed by fitting multivariable linear or logistic regression models, as appropriate.

Results

Participants in the highest tertile of increase in 17-item erMedDiet Score showed higher upward changes in eGFR (β: 1.87 ml/min/1.73m²; 95% CI: 1.00–2.73) and had lower odds of ≥ 10% eGFR decline (OR: 0.62; 95% CI: 0.47–0.82) compared to individuals in the decrease/maintenance category, while Trichopoulou-MedDiet and DASH Scores were not associated with any renal outcomes. Those in the highest tertile of increase in Protein Diet Score had greater downward changes in eGFR (β: − 0.87 ml/min/1.73m²; 95% CI: − 1.73 to − 0.01) and 32% higher odds of eGFR decline (OR: 1.32; 95% CI: 1.00–1.75).

Conclusions

Among elderly individuals with overweight/obesity and MetS, only higher upward change in the 17-item erMedDiet score adherence was associated with better kidney function after one year. However, increasing Protein Diet Score appeared to have an adverse impact on kidney health. Trial Registration Number: ISRCTN89898870 (Data of registration: 2014).

Supplementary Information

The online version contains supplementary material available at 10.1007/s00394-022-02838-7.

Joint Measurement of the ^{235}U Antineutrino Spectrum by PROSPECT and STEREO

The PROSPECT and STEREO collaborations present a combined measurement of the pure ^{235}U antineutrino spectrum, without site specific corrections or detector-dependent effects. The spectral measurements of the two highest precision experiments at research reactors are found to be compatible with χ^{2}/ndf=24.1/21, allowing a joint unfolding of the prompt energy measurements into antineutrino energy. This ν[over ¯]_{e} energy spectrum is provided to the community, and an excess of events relative to the Huber model is found in the 5-6 MeV region. When a Gaussian bump is fitted to the excess, the data-model χ^{2} value is improved, corresponding to a 2.4σ significance.

Searching for Hidden Neutrons with a Reactor Neutrino Experiment: Constraints from the STEREO Experiment

Different extensions of the standard model of particle physics, such as braneworld or mirror matter models, predict the existence of a neutron sterile state, possibly as a dark matter candidate. This Letter reports a new experimental constraint on the probability p for neutron conversion into a hidden neutron, set by the STEREO experiment at the high flux reactor of the Institut Laue-Langevin. The limit is p<3.1×10^{-11} at 95% C.L. improving the previous limit by a factor of 13. This result demonstrates that short-baseline neutrino experiments can be used as competitive passing-through-walls neutron experiments to search for hidden neutrons.

Accurate Measurement of the Electron Antineutrino Yield of ^{235}U Fissions from the STEREO Experiment with 119 Days of Reactor-On Data

We report a measurement of the antineutrino rate from the fission of ^{235}U with the STEREO detector using 119 days of reactor turned on. In our analysis, we perform several detailed corrections and achieve the most precise single measurement at reactors with highly enriched ^{235}U fuel. We measure an IBD cross section per fission of σ_{f}=(6.34±0.06[stat]±0.15[sys]±0.15[model])×10^{-43}  cm^{2}/fission and observe a rate deficit of (5.2±0.8[stat]±2.3[sys]±2.3[model])% compared to the model, consistent with the deficit of the world average. Testing ^{235}U as the sole source of the deficit, we find a tension between the results of lowly and highly enriched ^{235}U fuel of 2.1 standard deviations.

The Role First-Day Readings Play in a 3-Day Schedule of Self-Monitoring Home Blood Pressure Based on Prognostic Data. VAMPAHICA Study

BACKGROUND

The optimal schedule for self-monitoring home BP (SMHBP) readings is enormously important in the diagnosis of different phenotypes related to hypertension. The aim of this study was to determine the prognostic capacity of a 3-day SMHBP schedule when using or suppressing the first-day measurements in compiling the results.

METHODS

A total of 767 newly diagnosed, nontreated patients with no history of cardiovascular disease (CVD) were followed for 6.2 years. As a baseline, office BP measurements were taken for all the patients who then went on to follow a 3-day SMHBP schedule, taking 2 readings in the morning and 2 in the evening. The prognostic calculation was performed with CVD variables. The prognostic capacity of the 3-day schedule was evaluated with and without the first-day readings (12 and 8 readings).

RESULTS

A total of 223 normotensive subjects (NT), 271 subjects with sustained hypertension (SHT), and 184 white-coat hypertensive subjects (WCH) were followed. The distribution of 98 (14.4%) nonfatal CV events during the follow-up was as follows: WCH 21 (11.4%), NT 9 (4.0%), and SHT 68 (25.1%). No statistically significant differences were observed in the risk of CV events (OR) for the 2 groups of hypertensives, irrespective of the schedule of readings used (SHT with vs. without first-day readings: 8.81 (4.28-18.15) vs. 8.61 (4.15-17.85) and WCH with vs. without first-day readings: 2.71(1.13-6.47) vs. 3.40 (1.49-7.78)).

CONCLUSIONS

Our findings show that first-day readings do not need to be discarded in order to calculate the final value of an SMHBP schedule.

Sterile Neutrino Constraints from the STEREO Experiment with 66 Days of Reactor-On Data

The reactor antineutrino anomaly might be explained by the oscillation of reactor antineutrinos toward a sterile neutrino of eV mass. In order to explore this hypothesis, the STEREO experiment measures the antineutrino energy spectrum in six different detector cells covering baselines between 9 and 11 m from the compact core of the ILL research reactor. In this Letter, results from 66 days of reactor turned on and 138 days of reactor turned off are reported. A novel method to extract the antineutrino rates has been developed based on the distribution of the pulse shape discrimination parameter. The test of a new oscillation toward a sterile neutrino is performed by comparing ratios of cells, independent of absolute normalization and of the prediction of the reactor spectrum. The results are found to be compatible with the null oscillation hypothesis and the best fit of the reactor antineutrino anomaly is excluded at 97.5% C.L.

Development of a construct-based risk assessment framework for genetic engineered crops

Experience gained in the risk assessment (RA) of genetically engineered (GE) crops since their first experimental introductions in the early nineties, has increased the level of familiarity with these breeding methodologies and has motivated several agencies and expert groups worldwide to revisit the scientific criteria underlying the RA process. Along these lines, the need to engage in a scientific discussion for the case of GE crops transformed with similar constructs was recently identified in Argentina. In response to this need, the Argentine branch of the International Life Sciences Institute (ILSI Argentina) convened a tripartite working group to discuss a science-based evaluation approach for transformation events developed with genetic constructs which are identical or similar to those used in previously evaluated or approved GE crops. This discussion considered new transformation events within the same or different species and covered both environmental and food safety aspects. A construct similarity concept was defined, considering the biological function of the introduced genes. Factors like environmental and dietary exposure, familiarity with both the crop and the trait as well as the crop biology, were identified as key to inform a construct-based RA process.

[Prior health advice to immigrants who travel to visit family and friends]

Objetivo

Los inmigrantes que realizan o proyectan viajes para visitar a sus familiares en sus países de origen (inmigrantes-visiting friends and relatives [I-VFR]) tienen un riesgo superior a adquirir enfermedades relacionadas con el viaje que otros viajeros. El objetivo principal de este estudio es analizar los conocimientos de la población inmigrante sobre la necesidad de recibir consejo sanitario (CS) antes de realizar viajes internacionales en general y, específicamente, antes de viajar a sus países de origen.

Diseño

Estudio observacional y multicéntrico.

Emplazamiento

Participaron 10 médicos de familia de 10 Centros de Salud de Cataluña y Aragón.

Participantes

Quinientos cincuenta y cinco inmigrantes ≥ 15 años de edad, que consultaron a su médico de familia y accedieron a responder un cuestionario. Se realizó un muestreo oportunista.

Resultados

Consideraban necesario recibir CS antes de realizar un viaje internacional 389 (70,1%) personas; 406 (73,2%) eran I-VFR y 145 (35,7%) habían solicitado CS previamente al viaje, con mayor frecuencia a su médico de familia (n = 60; 41,1%).

No habían solicitado CS 261 (65,2%) sujetos, siendo el motivo más frecuente por considerarlo innecesario 173 (42,6%).

Conclusiones

Los I-VFR no suelen solicitar CS previo a viajar, fundamentalmente por considerarlo innecesario. Cuando lo solicitan, con gran frecuencia se dirigen en primera instancia a su médico de familia.

Chagas disease among the Latin American adult population attending in a primary care center in Barcelona, Spain

Background/Aims

The epidemiology of Chagas disease, until recently confined to areas of continental Latin America, has undergone considerable changes in recent decades due to migration to other parts of the world, including Spain. We studied the prevalence of Chagas disease in Latin American patients treated at a health center in Barcelona and evaluated its clinical phase. We make some recommendations for screening for the disease.

Methodology/Principal Findings

We performed an observational, cross-sectional prevalence study by means of an immunochromatographic test screening of all continental Latin American patients over the age of 14 years visiting the health centre from October 2007 to October 2009. The diagnosis was confirmed by serological methods: conventional in-house ELISA (cELISA), a commercial kit (rELISA) and ELISA using T cruzi lysate (Ortho-Clinical Diagnostics) (oELISA). Of 766 patients studied, 22 were diagnosed with T. cruzi infection, showing a prevalence of 2.87% (95% CI, 1.6–4.12%). Of the infected patients, 45.45% men and 54.55% women, 21 were from Bolivia, showing a prevalence in the Bolivian subgroup (n = 127) of 16.53% (95% CI, 9.6–23.39%).

All the infected patients were in a chronic phase of Chagas disease: 81% with the indeterminate form, 9.5% with the cardiac form and 9.5% with the cardiodigestive form. All patients infected with T. cruzi had heard of Chagas disease in their country of origin, 82% knew someone affected, and 77% had a significant history of living in adobe houses in rural areas.

Conclusions

We found a high prevalence of T. cruzi infection in immigrants from Bolivia. Detection of T. cruzi–infected persons by screening programs in non-endemic countries would control non-vectorial transmission and would benefit the persons affected, public health and national health systems.

Chagas disease is a parasitic infection caused by the protozoan Trypanosoma cruzi, and is becoming an emerging health problem in non-endemic areas because of growing population movements. The clinical manifestations of chronic T. cruzi infection include the latent form (the indeterminate chronic form), the cardiac form, the digestive or cardiodigestive form, and sudden death. Therefore, many diagnoses of Chagas disease are based on epidemiological suspicion rather than on clinical signs and symptoms. This study showed that the prevalence of Chagas disease in Latin American patients attending at a health center in Barcelona is 2,87% and the highest prevalence was found among Bolivian patients (16,53%). All the infected patients were in a chronic phase of Chagas disease. Detection of T. cruzi–infected persons by screening programs in non-endemic countries would control non-vectorial transmission and would benefit the persons affected, public health and national health systems. The data obtained in this study and the experiences described elsewhere suggest that it is advisable to perform Chagas disease screening in non-endemic countries on all patients from continental Latin America who: (1)have a suggestive epidemiologic history, (2)are pregnant, (3)are immunosuppressed, (4)have symptoms suggestive of Chagas disease, or (5)request screening.

Deficiency of CB2 cannabinoid receptor in mice improves insulin sensitivity but increases food intake and obesity with age

AIMS/HYPOTHESIS

The endocannabinoid system has a key role in energy storage and metabolic disorders. The endocannabinoid receptor 2 (CB2R), which was first detected in immune cells, is present in the main peripheral organs responsible for metabolic control. During obesity, CB2R is involved in the development of adipose tissue inflammation and fatty liver. We examined the long-term effects of CB2R deficiency in glucose metabolism.

METHODS

Mice deficient in CB2R (Cb2 ( -/- ) [also known as Cnr2]) were studied at different ages (2-12 months). Two-month-old Cb2 (-/-) and wild-type mice were treated with a selective CB2R antagonist or fed a high-fat diet.

RESULTS

The lack of CB2R in Cb2 (-/-) mice led to greater increases in food intake and body weight with age than in Cb2 (+/+) mice. However, 12-month-old obese Cb2 (-/-) mice did not develop insulin resistance and showed enhanced insulin-stimulated glucose uptake in skeletal muscle. In agreement, adipose tissue hypertrophy was not associated with inflammation. Similarly, treatment of wild-type mice with CB2R antagonist resulted in improved insulin sensitivity. Moreover, when 2-month-old Cb2 (-/-) mice were fed a high-fat diet, reduced body weight gain and normal insulin sensitivity were observed.

CONCLUSIONS/INTERPRETATION

These results indicate that the lack of CB2R-mediated responses protected mice from both age-related and diet-induced insulin resistance, suggesting that these receptors may be a potential therapeutic target in obesity and insulin resistance.

[Utility of an immunochromatographic test for Chagas disease screening in primary healthcare]

INTRODUCTION

Chagas disease is a common condition among Latin American immigrants living in Spain.

MATERIAL AND METHODS

An immunochromatographic test was used for Chagas disease screening in 148 patients from Latin America and the results were compared with those of 2 ELISA techniques.

RESULTS

The test had a sensitivity of 92.5%, a specificity of 96.8%, and a coefficient of agreement with the 2 ELISA techniques of 0.9.

CONCLUSIONS

The specificity of the test assayed suffices for Chagas disease screening, but the sensitivity needs to be improved before it can be used for this purpose.

Biogeographical origin and varicella risk in the adult immigration population in Catalonia, Spain (2004-2006)

Immigrants to the European Union may have a higher susceptibility to varicella-zoster virus primo-infection than the indigenous population. There is no evidence as yet that this is caused by genetic or social factors. Therefore, susceptibility could be due to a lesser transmission of the virus in their ecosystems of origin. A multicentre observational study was performed from July 2004 to June 2006 in four primary healthcare centres in Catalonia, Spain, monitoring varicella incidences and comparing standardised incidence rates and standardised rate ratios among different populations classified according to their biogeographical origin (holarctic, Asian paleotropical, African paleotropical or neotropical). Overall, 516 varicella cases were recorded. The standardised incidence rates per 1,000 inhabitants per year were: holarctic: 2.17 (95% confidence interval (CI): 1.95-2.39); autochthonous 2.26 (95% CI: 2.03-2.49); immigrants 3.59 (95% CI: 2.92-4.26); neotropical 4.50 (95% CI: 3.28-5.71); non-holarctic 5.38 (95% CI: 4.27-6.14); Asian paleotropical 7.03 (95% CI: 4.77-9.28); and African paleotropical 7.05 (95% CI: 1.12-23.58). The difference to the autochthonous population was greatest in immigrants of neotropical origin (standardised rate ratio = 2.07 (95% CI: 1.61-2.64) or 4.5 excess cases per 1,000 inhabitants per year) and Asian paleotropical origin (standardised rate ratio = 3.24 (95% CI: 2.47-4.11) or 9.6 excess cases per 1,000 inhabitants per year). Biogeographical origin may therefore account for the vulnerability of certain immigrant populations to varicella, in particular those from Asian paleotropical (Indostan and Southest Asia) and neotropical (South America and the Caribbean) ecosystems. Vaccination of immigrants at high risk (fertile women, healthcare workers) could be recommendable.

Antioxidant response and oxidative damage in brain cortex after high dose of pilocarpine

Pilocarpine is a cholinergic agonist capable to induce seizures and an epilepticus-like state in rodents. This status epilepticus (SE) is an useful animal model to study the development and understanding of the neuropathology, behavioural and electroencephalographic alterations of human temporal lobe epilepsy. It has been suggested a relationship between SE and reactive oxygen species (ROS) that can result in seizure-induced neurodegeneration. The aim of this study was to evaluate the existence of oxidative damage and the changes in the antioxidant system in cortex after administration of a high pilocarpine dose. Rats were injected with pilocarpine (350 mg/kg i.p.) or with saline as control and 2h after the animals were sacrificed. Malondialdehyde (MDA) levels, as marker of lipid peroxidation, significantly increased (64%) after pilocarpine treatment evidencing oxidative damage. Antioxidant enzyme activities--catalase (CAT), glutathione peroxidase (GP) and superoxide dismutase (SOD)--significantly increased in response to pilocarpine (28%, 28% and 21%, respectively). GP and Mn-SOD gene expression were induced by pilocarpine treatment. Vitamin E concentration in brain cortex decreased (15%) as result of pilocarpine administration. In conclusion, the high dose of pilocarpine, used in the present study, induces oxidative damage and increases antioxidant enzyme activities and expression in brain cortex. Moreover, increased lipid peroxidation produces the consumption of Vitamin E.

Antioxidant response analysis in the brain after pilocarpine treatments

Cholinergic and gabaergic systems play an important role generating electroencephalographic activity and regulating vigilance states. Pilocarpine is a cholinergic agonist commonly used to induce seizures and an epilepticus-like state in rodents. A relationship between status epilepticus and reactive oxygen species has been also suggested which could result in seizure-induced neurodegeneration. The aim of this study was to evaluate the existence of oxidative damage as well as the antioxidant enzyme response in cortex and hippocampus after the administration of an intraperitoneal (350 mg/kg) and an intracerebroventricular (360 microg, 1 microl) pilocarpine injection in rats. The GABA agonist muscimol (1 mg/kg, i.p.), with described neuroprotective properties, was used as a negative control. Only systemic pilocarpine induced oxidative damage. Malondialdehyde levels, as a marker of lipid peroxidation (LP), increased in both regions (55-56%). Catalase (52-80%) and superoxide dismutase (53-60%) activities also rose in both regions but glutathione peroxidase activity only increased in cortex (45%). Glutathione reductase and caspase-3 activity did not change. In conclusion, systemic pilocarpine produced oxidative brain damage, whereas local pilocarpine brain injection had no effects. Moreover, the enzymatic determinations performed in this study are a good tool to study brain injury in pharmacological manipulations such as the ones used in short recording EEG studies.

Home blood pressure self-monitoring: diagnostic performance in white-coat hypertension

OBJECTIVE

To determine the diagnostic performance of home blood pressure self-monitoring in white-coat hypertension using a 3-day reading program.

MATERIAL AND METHODS

One hundred and ninety nontreated patients recently diagnosed with mild-moderate hypertension, selected consecutively at four primary healthcare centers in the city of Barcelona, were included. Each patient underwent morning and night home blood pressure self-monitoring with readings in triplicate for three consecutive days, followed by 24-h ambulatory blood pressure monitoring. The normality cut-off point value for home blood pressure self-monitoring and daytime ambulatory blood pressure monitoring was 135/85 mmHg.

RESULTS

Sixty-three patients were diagnosed with white-coat hypertension with home blood pressure self-monitoring (34.8%; 95% confidence interval: 27.9-42.2) and 74 with ambulatory blood pressure monitoring (41.6%; 95% confidence interval: 33.7-48.4). No statistically significant differences were observed between home blood pressure self-monitoring values and those of diurnal ambulatory blood pressure monitoring [137.4 (14.3)/82.1 (8.3) mmHg vs. 134.8 (11.3)/81.3 (9.5) mmHg]. Home blood pressure self-monitoring diagnostic performance parameters were sensitivity 50.0% (95% confidence interval: 38.3-61.7), specificity 75.7% (95% confidence interval: 66.3-83.2), positive and negative predictive values 58.7% (95% confidence interval: 45.6-70.8) and 68.6% (95% confidence interval: 59.4-76.7), respectively, and positive and negative probability coefficients 2.05 and 0.66, respectively. Analysis of different normality cut-off points using a receiver operating characteristic curve failed to produce significant improvement in the diagnostic performance of home blood pressure self-monitoring.

CONCLUSIONS

The diagnostic accuracy of a 3-day home blood pressure self-monitoring reading program in white-coat hypertension was poor. Ambulatory blood pressure monitoring continues to be the test of choice for this indication.

[Imported diseases in immigrants: myth and reality]

In recent years, with the growth of immigration from low income countries, in certain health spheres and in civil society itself through the mass media, there has been speculation about the risk to the health of the receptor community brought by immigration. This article attempts to conceptualise the terminology that is used to deal with the diseases of immigrants, to serve as a common denominator in the description and interpretation of the data provided by the medical journals, avoiding the confusions that arise in non-specialised health settings or in those that are remote from this. It aims to reflect on the reality of these diseases, both those that are imported and those that are transmissible, and to clarify the risks for the receptor community and their determinants.

High-risk travel abroad overtook low-risk travel from 1999 to 2004: characterization and trends in 2,622 Spanish travelers

BACKGROUND

Travel medicine in Spain is provided by a few specialized centers that do not come under the auspices of the main health system. Some kind of reform is required to avoid common summer collapses and postponements of the service. In contrast to other European countries, neither the exact role nor the responsibilities of general practitioners and primary health care in travel medicine are clearly defined.

METHODS

An observational study was performed with retrospective data concerning 2,622 travelers from 1999 to 2004. Although the study was performed at a third-level travel medicine center, continuous contact with and support to general practitioners was maintained throughout the period.

RESULTS

International travel was a steadily increasing reality between 1999 and 2004 despite well-known tragic events involving world safety. The number of high-risk travels (53.4%) also increased and even overtook low-risk ones (46.6%). This trend was explained as the result of an increasing number of journeys to sub-Saharan Africa (14.9%) and those made by traveling immigrants (64.1% of those journeys), which represented a significantly higher proportion of high-risk travels compared with those made by autochthonous subjects (52.1%; p < .001). Moreover, traveling immigrants tend to consult more frequently in periods < 15 days prior to travel than do autochthonous travelers (p < .0001). A substantial number of highly vulnerable travelers, such as pregnant women, infants, elderly people, and immunosuppressed subjects, was found (1.8%). Low-risk travelers who could have been advised and vaccinated by general practitioners were 1,139 (43.4%).

CONCLUSIONS

Given the increasing number of travelers undertaking high-risk travels abroad, any kind of reinforcement of travel medicine provision in Spain should be considered essential. General practitioners could attend to a significant proportion of low-risk travelers.

Engineering of carbon catabolite repression in recombinant xylose fermenting Saccharomyces cerevisiae

Two xylose-fermenting glucose-derepressed Saccharomyces cerevisiae strains were constructed in order to investigate the influence of carbon catabolite repression on xylose metabolism. S. cerevisiae CPB.CR2 (Delta mig1, XYL1, XYL2, XKS1) and CPB.MBH2 (Delta mig1, Delta mig2, XYL1, XYL2, XKS1) were analysed for changes in xylose consumption rate and ethanol production rate during anaerobic batch and chemostat cultivations on a mixture of 20 g l(-1) glucose and 50 g l(-1) xylose, and their characteristics were compared to the parental strain S. cerevisiae TMB3001 ( XYL1, XYL2, XKS1). Improvement of xylose utilisation was limited during batch cultivations for the constructed strains compared to the parental strain. However, a 25% and 12% increased xylose consumption rate during chemostat cultivation was achieved for CPB.CR2 and CPB.MBH2, respectively. Furthermore, during chemostat cultivations of CPB.CR2, where the cells are assumed to grow under non-repressive conditions as they sense almost no glucose, invertase activity was lower during growth on xylose and glucose than on glucose only. The 3-fold reduction in invertase activity could only be attributed to the presence of xylose, suggesting that xylose is a repressive sugar for S. cerevisiae.

[Imported hookworm infection in African immigrants in Spain: study of 285 patients]

BACKGROUND AND OBJECTIVE

Hookworm infection is a worldwide intestinal parasitic disease affecting more than one billion people. It represents an important public health problem in rural areas of developing countries. In our environment, it is generally considered an imported disease due to the immigration process.

PATIENTS AND METHOD

Retrospective observational study of African immigrants diagnosed with hookworm infection at the Immigration and Tropical Medicine Unit of the Hospital of Mataró over the period 1984-1999.

RESULTS

We identified 285 patients, mainly young males, from Gambia or Senegal, with a precarious job who had arrived in Spain 3 years earlier or less. Abdominal pain was the commonest reason for consultation (28.8%) cases. Non digestive symptoms were 35.6% and 4.6% remained assymptomatic. 60% had a concomitant infectious disease. Laboratory tests showed iron-deficiency anemia in 28.4% and eosinophilia in 52.3%. 70% of patients did not come to visit after treatment.

CONCLUSIONS

Microbiologic stool examination is recommended as part of the health assessment of immigrants from countries where hookworm infection is highly prevalent, even in the absence of abdominal symptoms or abnormalities of the red and white blood series.

Increasing ethanol productivity during xylose fermentation by cell recycling of recombinant Saccharomyces cerevisiae

The influence of cell recycling of xylose-fermenting Saccharomyces cerevisiae TMB3001 was investigated during continuous cultivation on a xylose-glucose mixture. By using cell recycling at the dilution rate ( D) of 0.05 h(-1), the cell-mass concentration could be increased from 2.2 g l(-1) to 22 g l(-1). Consequently, the volumetric ethanol productivity increased ten-fold, from 0.5 g l(-1) h(-1) to 5.35 g l(-1) h(-1). By increasing the biomass concentration, the xylose consumption rate increased from 0.75 g xylose l(-1) h(-1) without recycling to 1.9 g l(-1) h(-1) with recycling. The specific ethanol productivity was in the range of 0.23-0.26 g g(-1) h(-1) with or without cell recycling, showing that an increased cell-mass concentration did not influence the efficiency of the yeast.

[Imported diseases in African immigrants in Spain: study of 1,321 patients]

BACKGROUND

Immigrants can carry diseases characteristic from their countries of origin. These are known as imported diseases (ID) and can be classified into tropical diseases (TD) or cosmopolitan diseases (CD). The aim of this study was to analyse the ID in African immigrants and evaluate their repercussion in the Spanish Public Health.

PATIENTS AND METHOD

Observational study, retrospective protocol, carried from 1984 to 1994 in African immigrants seen in a reference Hospital. Not infectious chronic ID were excluded. The repercussion in public health was divided in 3 categories according to transmission risk to the host population: a) ID without current risk; b) ID with potential risk and, c) ID of risk.

RESULTS

1,321 African immigrants were considered. Most of them were from Sub-Saharan Africa. The most frequent TD were helminthiases and among CD, tuberculosis, sexually transmitted diseases and parasitoses. ID without transmission risk were 26.7% (2.4% CD and 24.3% TD), ID with potential risk 35.2% (33.6% CD and 1.6% TD) and ID with risk 38% (all CD).

CONCLUSIONS

The CD and their association with poverty suppose a higher risk of transmission to the host country population. Global policies of helping social and economic insertion of immigrant populations, combined with international health collaboration, will rebound positively in the general population's health.

Comparative, clinico-epidemiologic study of Schistosoma mansoni infections in travellers and immigrants in Spain

The study presented here aimed to contrast the marked clinical differences in the presentation of Schistosoma mansoni-induced infection between immigrants and travellers entering Spain from endemic regions, and to elucidate the therapeutic implications of these infections. A total of 200 African immigrants and 80 travellers with schistosomiasis were included in the study. Among the immigrants, 25 patients were diagnosed with Schistosoma mansoni infection; 15 presented with nonspecific symptoms, and 10 were asymptomatic. Hepatosplenomegaly was observed in nine. Among the travellers, 14 were diagnosed with Schistosoma mansoni infection; four were asymptomatic, four had Katayama syndrome, four had diarrhoea, and two had prostatitis. All of the patients were treated with praziquantel. Patients diagnosed with Katayama syndrome received praziquantel and dexamethasone for 3 days, with the praziquantel treatment being repeated at 3-4 weeks. The significant differences observed in the clinical presentation of Schistosoma mansoni-induced infection, indicate that a well-differentiated therapeutic strategy is required when this infection is diagnosed in a non-immune (traveller) or a semi-immune (immigrant) patient.

On-line bioprocess monitoring with a multi-wavelength fluorescence sensor using multivariate calibration

Cultivations of Pseudomonas fluorescens were monitored with a multi-wavelength on-line fluorescence sensor. The multi-wavelength fluorometer used excitation light from 270 to 550 nm with 20 nm steps and measured fluorescence emission from 310 to 590 nm. The fluorescence, on-line exhaust gas measurements and off-line analysis of nitrate, succinate, optical density and protein were compared chemometrically by multivariate calibration, i.e. computing partial least square (PLS) regression models. Based on the multivariate regression models, it was possible to determine CO2 and O2 composition in the exhaust gas (the correlation coefficients, R2 between the predicted values by the PLS model and the measured values was 0.97 for CO(2) and 0.97 for O2, respectively). Also to make quantitative determinations of succinate (R(2) = 0.97), protein (R(2) = 0.94), optical density (R(2) = 1.0) and nitrate (R(2) = 0.98) in the medium based on the fluorescence spectra. Only a limited data set was available but the results indicated that the sensor could indirectly determine non-fluorescent compounds, i.e. nitrate and succinate, which probably is due to the stoichiometric relationship between fluorescent cellular components and non-fluorescent compounds. Consequently multi-wavelength fluorescence is an interesting technique for a wide range of applications.

Increased vasopressin and adrenocorticotropin responses to stress in the midluteal phase of the menstrual cycle

Accumulating evidence indicates that gonadal steroids modulate functioning of the hypothalamic-pituitary-adrenal (HPA) axis, which has been closely linked to the pathophysiology of anxiety and depression. However, the effect of the natural menstrual cycle on HPA axis responsivity to stress has not been clearly described. In nine healthy women, metabolic and hormonal responses to treadmill exercise stress during the early follicular phase of the menstrual cycle, when gonadal steroid levels are low, were compared with responses in the midluteal phase of the cycle, when both progesterone and estrogen levels are relatively high. Exercise intensity was gradually increased over 20 min to reach 90% of each subject's maximal oxygen consumption during the final 5 min of exercise. Basal plasma lactate, glucose, ACTH, vasopressin, oxytocin, and cortisol levels were similar in the two cycle phases. However, in response to exercise stress, women in the midluteal phase had enhanced ACTH (P < 0.0001), vasopressin (P < 0.01), and glucose (P < 0.001) secretion. These findings suggest that relatively low levels of gonadal steroids during the early follicular phase of the menstrual cycle provide protection from the impact of stress on the HPA axis.

Dynamic responses of Pseudomonas fluorescens DF57 to nitrogen or carbon source addition

Cultures of Pseudomonas fluorescens DF57 were grown on different carbon and nitrogen sources. Glucose, succinate and acetate were used as carbon source and pulsed to an aerobic steady-state cultivation of P. fluorescens DF57 at D = 0.1 h(-1) with citrate as limiting carbon source. Glucose was utilised with the fastest uptake rate (19.4 C mmol l(-1) h(-1)) compared to succinate (8.8 C mmol l(-1) h(-1)) and acetate (4.3 C mmol l(-1) h(-1)). Acetate triggered an inhibition of cellular metabolism, which resulted in 2-h long growth arrest after its addition to the steady-state culture. The influence of the nitrogen source was investigated in an aerobic cultivation on a mixture of ammonium and nitrate as limiting nitrogen sources and citrate as non-limiting carbon source. When ammonia and nitrate were pulsed to the steady-state culture, they were mainly assimilated into biomass with a maximum uptake rate of 111 and 33 mg N l(-1) h(-1), respectively. Nitrate uptake was never complete as the residual concentration in the chemostat cultivation was 30 mg N l(-1) nitrate. A pulse of nitrite in the cultivation broth resulted in an inhibition of the growth but not of the primary metabolism, as nitrite was taken up at 38 mg N l(-1) h(-1), citrate was consumed and cofactors were produced continuously. In all experiments, oxygen was used as electron acceptor.

Human endothelial cells expressing polyoma middle T induce tumors

The middle T oncogene of murine polyomavirus (PymT) rapidly transforms and immortalizes murine embryonic endothelial cells (EC), leading to the formation of vascular tumors in newborn mice, by recruitment of host, non-transformed EC. These tumors are reminiscent of human vascular tumors like cavernous hemangioma, Kaposi's sarcoma or those characterizing Kasabach-Merrit syndrome. Here we investigate the in vitro and in vivo behavior of human primary umbilical cord vein EC expressing PymT. While PymT has been unable to transform human fibroblasts in earlier experiments or controls done here, mT expressing EC (PymT-EC) derived by infection with pLX-PymT retrovirus induce hemangiomas in nu/nu mice. These tumors contain not only human cells but also recruited mouse EC as shown by the presence of human and murine CD31 positive EC. In vitro analysis shows that PymT-EC retain endothelial specific markers like CD31, Von Willebrand factor, and VE-cadherin, and reach the confluence without signs of overgrowth. They are also responsive to vascular endothelial growth factor-A. However, their proliferation rate is increased. The balance between urokinase-type plasminogen activator and plasminogen activator inhibitor-1 is modified; RNA and catalytic activity for the former are elevated while PAI-1 RNA is reduced. In contrast with murine model, where the PymT EC cells become immortal, the effects induced by PymT in human EC are transient. After 12-15 passages, human PymT EC stop proliferating, assume a senescent phenotype, and lose the ability to induce hemangiomas. At the same time both the amount of middle T protein and the level of activation of pp60c-src lower.

Physiological studies in aerobic batch cultivations of Saccharomyces cerevisiae strains harboring the MEL1 gene

Physiological studies of Saccharomyces cerevisiae strains harboring the MEL1 gene were carried out in aerobic batch cultivations on glucose-galactose mixtures and on the disaccharide melibiose, which is hydrolyzed by the enzyme melibiase (Mel1, EC 3.2.1.22) into a glucose and a galactose moiety. The strains examined (T200, T256, M24, and TH1) were all derived from the bakers' and distillers' strain of S. cerevisiae, DGI 342. All the strains showed a significant higher ethanol yield when growing on glucose, and half the biomass yield, compared with growth on galactose. The maximum specific uptake rates were 2.5-3.3-fold higher on glucose than on galactose for all the strains examined, and hence, ethanol production was pronounced on glucose due to respiro-fermentative metabolism. The T256 strain and the T200 strain having the MEL1 gene inserted in the HXK2 locus and the LEU2 locus, respectively, hydrolyzed melibiose with low specific hydrolysis rates of 0.03 C-mol/g/h and 0.04 C-mol/g/h, respectively. This resulted in high biomass yields on melibiose in the order of 10 g/C-mol compared with 3.7 g/C-mol for M24 and 1.6 g/C-mol for TH1. The M24 strain, constructed by classical breeding, and the mig1/gal80 disrupted and melibiase-producing strain TH1, were superior in their ability to hydrolyze melibiose into glucose and galactose showing specific melibiose hydrolysis rates of 0.17 C-mol/g/h and 0.24 C-mol/g/h, respectively. Hence, high ethanol yields on melibiose were obtained with these two strains. Growth on the glucose-galactose mixtures showed a reduction of glucose control successfully obtained in the M24 strain and the TH1 strain.

Physiological studies in aerobic batch cultivations of Saccharomyces cerevisiae strains harboring the MEL1 gene

Physiological studies of Saccharomyces cerevisiae strains harboring the MEL1 gene were carried out in aerobic batch cultivations on glucose-galactose mixtures and on the disaccharide melibiose, which is hydrolyzed by the enzyme melibiase (Mel1, EC 3.2.1.22) into a glucose and a galactose moiety. The strains examined (T200, T256, M24, and TH1) were all derived from the bakers' and distillers' strain of S. cerevisiae, DGI 342. All the strains showed a significant higher ethanol yield when growing on glucose, and half the biomass yield, compared with growth on galactose. The maximum specific uptake rates were 2.5-3.3-fold higher on glucose than on galactose for all the strains examined, and hence, ethanol production was pronounced on glucose due to respiro-fermentative metabolism. The T256 strain and the T200 strain having the MEL1 gene inserted in the HXK2 locus and the LEU2 locus, respectively, hydrolyzed melibiose with low specific hydrolysis rates of 0.03 C-mol/g/h and 0.04 C-mol/g/h, respectively. This resulted in high biomass yields on melibiose in the order of 10 g/C-mol compared with 3.7 g/C-mol for M24 and 1.6 g/C-mol for TH1. The M24 strain, constructed by classical breeding, and the mig1/gal80 disrupted and melibiase-producing strain TH1, were superior in their ability to hydrolyze melibiose into glucose and galactose showing specific melibiose hydrolysis rates of 0.17 C-mol/g/h and 0.24 C-mol/g/h, respectively. Hence, high ethanol yields on melibiose were obtained with these two strains. Growth on the glucose-galactose mixtures showed a reduction of glucose control successfully obtained in the M24 strain and the TH1 strain.

[Taeniasis and primary care]

OBJECTIVE

To evaluate the therapeutic guidelines used in evaluating taeniasis in primary care (mebendazole, pyrantel pamoate) and to show the low availability of first choice drugs (niclosamide, praziquantel).

DESIGN

A retrospective, descriptive study.

SETTING

A clinic for travellers abroad in the Tropical Medicine section (Infectious Diseases Service) of the Hospital Clínic, Barcelona.

PARTICIPANTS

68 medical histories of cases of Taeniasis seen at this clinic between 1984 and 1994.

RESULTS

72.3% had not travelled to the tropics (autochthonous Taeniasis). The most common symptoms were epigastralgia, anal pruritus, diarrhoea, weight loss and bulimia. 71.2% had previously attended other medical services and all had been correctly diagnosed. 91.8% had received ineffective treatment (the most common treatment was with mebendazole and pyrantel pamoate), sometimes on different occasions. Time elapsed between diagnosis and correct treatment varied from 1 day to 36 months.

CONCLUSION

Taeniasis is an easily diagnosed infestation. Its treatment is comfortable and effective, with an average cure period of 24 hours. However, the particular medicines are not available in primary care, which hampers and delays treatment.

Effect of zinc or S-adenosyl-l-methionine on long term administration of low doses of lead to rats

Two alternatives for the treatment of lead intoxication, administration of zinc or a thiol donor, S-adenosyl-L-methionine (SAM), were analysed. Rats were exposed to lead (Pb)-acetate (60 mg/l) in drinking water during 90 days; one group also received SO4Zn in water (40 mg/l), while another received both Pb and SAM (5 mg/24 hr intraperitoneally. Erythrocytic delta-aminolaevulinic dehydratase (ALA-D) activity was significantly reduced (P < 0.001) both in rats receiving Pb alone and in rats receiving Pb and each of the other two treatments. The high erythrocytic uroporphyrinogen synthetase (URO-S) activity noticed in Pb administered rats, was significantly (P < 0.001) reduced in animals treated either with zinc or with SAM. Hepatic ALA-D activity tended to decrease while renal enzyme activity was not modified by the low level Pb exposure used in this work. Interestingly, SAM treated rats in both tissues exhibited significantly (P < 0.01) higher activities of the enzyme. It is argued that SAM treatment causes a surplus of thiols that allows the full expression of ALA-D catalytic activity.

Survival in carcinoma of the uterine cervix correlated to primary treatment results

Survival data in 1 106 patients with cervical carcinoma treated between 1967 and 1972 are presented. Survival figures decrease when doubtful or evident activity of the tumor persists at the end of the irradiation.

Complications from irradiation of carcinoma of the uterine cervix

The types and frequency of complications in 2248 patients irradiated for carcinoma of the cervix using different techniques are reported. Proctitis was the most frequent complication. Severe complications, such as fistulas, ureteral stenosis with hydronephrosis, enterocolitis, sigmoiditis, intestinal obstruction and skin necrosis occurred in 81 patients (3.6%). Only 36 patients (1.6%) developed fistulas.

Carcinoma of the uterine cervix. Results of treatment in 2 248 cases

Data on the survival of 2 248 patients with cervical carcinoma, treated between1966 and 1972 at 3 oncologic centers in Cuba, are presented. Intracavitary radium application combined with external 60Co irradiation was the main treatment method. The most frequent complication was radiation proctitis, but fistulas occurred only in 1.6 per cent.