Uric acid and acute kidney injury in high-risk patients for developing acute kidney injury undergoing cardiac surgery: A prospective multicenter study

PURPOSE

It is unclear whether preoperative serum uric acid (SUA) elevation may play a role in the development of acute kidney injury (AKI) associated with cardiac surgery (CSA-AKI). We conducted a cohort study to evaluate the influence of preoperative hyperuricemia on AKI in patients at high risk for developing SC-AKI.

DESIGN

Multicenter prospective international cohort study.

SETTING

Fourteen university hospitals in Spain and the United Kingdom.

PARTICIPANTS

We studied 261 consecutive patients at high risk of developing CSA-AKI, according to a Cleveland score ≥ 4 points, from July to December 2017.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

AKIN criteria were used for the definition of AKI. Multivariable logistic regression models and propensity score-matched pairwise analysis were used to determine the adjusted association between preoperative hyperuricemia (≥7 mg/dL) and AKI. Elevated preoperative AUS (≥7 mg/dL) was present in 190 patients (72.8%), whereas CSA-AKI occurred in 145 patients (55.5%). In multivariable logistic regression models, hyperuricemia was not associated with a significantly increased risk of AKI (adjusted Odds Ratio [OR]: 1.58; 95% confidence interval [CI]: 0.81-3; P = .17). In propensity score-matched analysis of 140 patients, the hyperuricemia group experienced similar adjusted odds of AKI (OR 1.05, 95%CI 0.93-1.19, P = .37).

CONCLUSIONS

Hyperuricemia was not associated with an increased risk of AKI in this cohort of patients undergoing cardiac surgery at high risk of developing CSA-AKI.

The EPICTER score: a bedside and easy tool to predict mortality at 6 months in acute heart failure

Aims

Estimating the prognosis in heart failure (HF) is important to decide when to refer to palliative care (PC). Our objective was to develop a tool to identify the probability of death within 6 months in patients admitted with acute HF.

Methods and results

A total of 2848 patients admitted with HF in 74 Spanish hospitals were prospectively included and followed for 6 months. Each factor independently associated with death in the derivation cohort (60% of the sample) was assigned a prognostic weight, and a risk score was calculated. The accuracy of the score was verified in the validation cohort. The characteristics of the population were as follows: advanced age (mean 78 years), equal representation of men and women, significant comorbidity, and predominance of HF with preserved ejection fraction. During follow‐up, 753 patients (26%) died. Seven independent predictors of mortality were identified: age, chronic obstructive pulmonary disease, cognitive impairment, New York Heart Association class III–IV, chronic kidney disease, estimated survival of the patient less than 6 months, and acceptance of a palliative approach by the family or the patient. The area under the ROC curve for 6 month death was 0.74 for the derivation and 0.68 for the validation cohort. The model showed good calibration (Hosmer and Lemeshow test, P value 0.11). The 6 month death rates in the score groups ranged from 6% (low risk) to 54% (very high risk).

Conclusions

The EPICTER score, developed from a prospective and unselected cohort, is a bedside and easy‐to‐use tool that could help to identify high‐risk patients requiring PC.

Importance of tissue sampling, laboratory methods, and patient characteristics for detection of Pneumocystis in autopsied lungs of non-immunosuppressed individuals

To understand the epidemiological significance of Pneumocystis detection in a lung tissue sample of non-immunosuppressed individuals, we examined sampling procedures, laboratory methodology, and patient characteristics of autopsy series reported in the literature. Number of tissue specimens, DNA-extraction procedures, age and underlying diagnosis highly influence yield and are critical to understand yield differences of Pneumocystis among reports of pulmonary colonization in immunocompetent individuals.

[Evolution of the intake and nutritional status of zinc, iron and copper in women undergoing bariatric surgery until the second year after surgery]

INTRODUCTION

Bariatric surgery allows a significant reduction in weight and improvement of comorbidities associated with obesity in the long term, but it can also adversely affect the nutritional status of some micronutrients.

OBJECTIVES

To evaluate changes in intake and parameters of nutritional status of zinc, iron and copper in patients undergoing Roux-en-Y gastric bypass (GBP) or sleeve gastrectomy (SG), until the second postoperative year.

METHODS

We prospectively studied 45 women undergoing GBP or SG (mean age 35.2 ± 8.4 years, mean BMI 39.8 ± 4.0 kg/m²), every 6 months We measured intake and status indications nutritional zinc, iron and copper, and annually evaluated body composition. The contribution of minerals through supplements represented twice the recommended intake for a healthy woman in patients undergoing GT and three times for GBP.

RESULTS

20 women underwent GBP and 25 SG. In both groups there was a significant reduction in weight and body fat percentage, which was maintained until the second postoperative year. Women who have had a greater commitment GBP nutritional status of zinc, iron and copper, that patients undergoing SG.

CONCLUSIONS

Gastric bypass Roux-Y produces a greater commitment of nutritional status of zinc, iron and copper sleeve gastrectomy. It should evaluate whether administration of supplementation fractional improve the absorption of these nutrients.

[Epidural anesthesia for coronary revascularization in the conscious patient]

Thoracic epidural anesthesia has been widely used to complement general anesthesia in coronary artery bypass grafting. The main advantages of the combination are excellent pain control and a less pronounced stress response to surgery. The invasiveness of surgery to treat ischemic heart disease has been attenuated thanks to the use of the mini-sternotomy and coronary anastomosis without extracorporeal circulation. In 4 patients, coronary artery revascularization was carried out via a mini-sternotomy, grafting the anterior descending artery to the left internal thoracic artery under high thoracic epidural anesthesia (block of segments T1-T8) with a perfusion of 0.75% ropivacaine and fentanyl in a conscious patient. There were no hemodynamic or respiratory complications during surgery. The mean duration of stay in the intensive care unit was less than 18 hours and the mean hospital stay was less than 5 days. Postoperative coronary arteriograms demonstrated the patency of all grafts and all patients were asymptomatic at 1 month. Our initial experience suggests that the use of only high thoracic epidural anesthesia is feasible in coronary revascularization in selected, cooperative patients who require a single coronary bypass graft.

[Comparison of 2 techniques for inhaled anesthetic induction with sevoflurane in coronary artery revascularization]

OBJECTIVE

Our objective was to evaluate efficacy, side effects, and hemodynamic alterations during anesthetic induction with sevoflurane in patients undergoing coronary artery bypass surgery, comparing the techniques of administration with tidal volume breathing and with vital capacity breaths.

MATERIAL AND METHODS

This was a randomized controlled trial enrolling 30 patients scheduled for myocardial revascularization. Anesthetic induction with inhaled sevoflurane was performed with 2 techniques: sevoflurane administered with tidal volume breathing (n=15) and with vital capacity breaths (n=15). We assessed time until a bispectral index (BIS) of 50 or less was reached. We also recorded adverse effects and alterations in hemodynamic variables during induction.

RESULTS

The time to induction was significantly shorter in the tidal volume group. The time until reaching a BIS of 50 or less was significantly shorter in the vital capacity group. Hemodynamics were similar in both groups (no significant differences). In both groups mean arterial pressure decreased significantly from baseline (P<0.05) and systolic and diastolic blood pressures both decreased slightly, with no significant heart rate or ST segment changes. Adverse effects were few and not serious.

CONCLUSIONS

Mean arterial pressure decreased in both groups, with no significant differences. The results indicate that hemodynamic stability seems to be similar with both techniques for providing inhaled anesthetic induction with sevoflurane.

Occurrence of bacterial indicators and bacteriophages infecting enteric bacteria in groundwater in different geographical areas

AIMS

The aim of this research was to determine the suitability of coliphages (bacteriophages) for assessing the microbial quality of groundwater.

METHODS AND RESULTS

The number of several bacterial indicators (faecal coliforms, Escherichia coli, enterococci and spores of sulfite-reducing clostridia) and bacteriophages (somatic coliphages, F-specific RNA bacteriophages and bacteriophages infecting Bacteroides fragilis) were determined in groundwater of aquifers in various geographical areas. Results show that the relative abundance, determined as percentages of positive detections, of the bacterial indicators and bacteriophages varies depending on the aquifer.

CONCLUSIONS

A single bacterial indicator may not be enough to assess microbiological quality in certain aquifers. One bacterial indicator and a bacteriophage parameter provide more information than two bacterial indicators.

SIGNIFICANCE AND IMPACT OF THE STUDY

Coliphages (CPH) provide different information from that provided by bacterial indicators on the microbial quality of groundwater in different geographical areas. Easy, fast and inexpensive methods for the detection of CPH are feasible in both industrialized and developing countries.

Reduction of bacterial indicators and bacteriophages infecting faecal bacteria in primary and secondary wastewater treatments

AIMS

To compare the suitability of various bacterial and viral indicators to assess the removal of faecal micro-organisms by primary and secondary wastewater treatment processes.

METHODS AND RESULTS

The numbers of several bacterial indicators [faecal coliforms (FC), enterococci (ENT) and sulphite-reducing clostridia (SRC)] and bacteriophages (somatic coliphages, F-specific RNA phages and bacteriophages infecting Bacteroides fragilis strain RYC2056) were determined in incoming raw sewage and effluents from various primary and secondary wastewater treatment processes in several geographical areas. Reductions in the numbers of indicators were calculated as log10 reductions. Processes based on removal and mild disinfection, showed no significant differences in the elimination of any of the indicators tested or between geographical areas. In contrast, treatment processes that include strong microbial inactivation, such as lime-aided flocculation and lagooning, showed significant differences between the log10 reductions of the various micro-organisms studied, FC showing the highest reduction and spores of SRC and phages infecting B. fragilis the lowest.

CONCLUSIONS

The microbial elimination performance of treatment processes based principally on removal and mild disinfection can be evaluated with a single indicator. In contrast, processes with additional disinfecting capabilities require more than one indicator for accurate evaluation of the treatment; bacteriophages are good candidates for use as second indicators.

SIGNIFICANCE AND IMPACT OF THE STUDY

Bacteriophages provide additional information for the evaluation of microbial elimination in some treatment plants. The easy, fast and cheap methods available for phage determination are feasible both in industrialized and developing countries.

[The specific cox-2 inhibitor valdecoxib provides effective analgesia after inguinal hernia surgery]

OBJECTIVE

To compare 3 oral analgesic doses--valdecoxib 20 mg, valdecoxib 40 mg and controlled-release diclofenac 75 mg--to placebo in the treatment of pain after inguinal herniorrhaphy.

METHOD

An international multicenter double-blind placebo-controlled trial comparing parallel groups receiving oral valdecoxib 20 or 40 mg, controlled-release diclofenac 75 mg, or placebo every 12 hours over a period of 36 hours. The study enrolled 269 patients undergoing inguinal herniorrhaphy with spinal anesthesia. Pain intensity difference, the sum pain intensity difference, need for rescue medication, and overall patient satisfaction were compared.

RESULTS

Valdecoxib 40 mg and controlled-release diclofenac 75 mg take every 12 hours provided similar analgesia that was significantly more efficacious than placebo as shown by the sum pain intensity difference at 12 hours. Both treatments decreased pain intensity in comparison with baseline throughout the study. Differences were significant in comparison with placebo at 8-10 hours through 24 hours of administration of the first dose. No significant differences between valdecoxib 20 mg and placebo were observed. The percentage of patients needing rescue medication was significantly lower in the valdecoxib 40 mg group (30% in that group vs. 52% for placebo), and that difference was not seen for any of the other groups. All treatments were well tolerated.

CONCLUSIONS

Valdecoxib 40 mg and diclofenac 75 mg provided similar quality of analgesia for treating pain after inguinal herniorrhaphy.

Pneumocystis jiroveci isolates with dihydropteroate synthase mutations in patients with chronic bronchitis

Since mutations in the dihydropteroate synthase (DHPS) gene possibly associated with sulfonamide resistance have been reported in patients with Pneumocystis jiroveci (previously carinii) pneumonia, and since P. jiroveci colonization has been recently demonstrated in patients with chronic pulmonary diseases, the present study aimed to investigate the possible occurrence of P. jiroveci DHPS mutations in patients with chronic bronchitis. P. jiroveci colonization was detected in 15 of 37 non-selected patients with chronic bronchitis by amplifying the large subunit of the mitochondrial gene of the ribosomal RNA using nested PCR. DHPS mutations were demonstrated using touchdown PCR and restriction enzyme analysis in two of eight patients with chronic bronchitis and in two of six patients from the same region who had AIDS-associated Pneumocystis pneumonia. In all cases, mutations were observed in subjects with no prior exposure to sulfonamides. These data could have important implications for public health, since (i) P. jiroveci colonization could speed the progression of chronic bronchitis, and (ii) these patients, who are customary sputum producers, could represent a reservoir for sulfonamide-resistant strains with the potential ability to transmit them to immunocompromised hosts susceptible to Pneumocystis pneumonia.

Occurrence and densities of bacteriophages proposed as indicators and bacterial indicators in river waters from Europe and South America

AIMS

To evaluate the feasibility of bacteriophages as a complementary tool for water quality assessment in surface waters from different parts of the globe.

METHODS AND RESULTS

Faecal coliform bacteria, enterococci, spores of sulphite-reducing clostridia, somatic coliphages, F-specific RNA bacteriophages and bacteriophages infecting Bacteroides fragilis were determined by standardized methods in raw sewage and in 392 samples of river water from 22 sampling sites in 10 rivers in Argentina, Colombia, France and Spain, which represent very different climatic and socio-economic conditions. The results showed that the indicators studied maintained the same relative densities in the raw sewage from the different areas. Classifying the river water samples according to the content of faecal coliform bacteria, it can be observed that the relative densities of the different bacterial indicators and bacteriophages changed according to the concentration of faecal coliform bacteria. There was a relative increase in the densities of all groups of bacteriophages and sulphite-reducing clostridia with respect to faecal coliforms and enterococci in the samples with low counts of faecal coliform bacteria.

CONCLUSIONS

The numbers of bacterial indicators and bacteriophages were similar in the different geographical areas studied. Once released in rivers, the persistence of the different micro-organisms differed significantly. Bacteriophages and spores of sulphite-reducing clostridia persisted longer than faecal coliforms and enterococci.

SIGNIFICANCE AND IMPACT OF THE STUDY

Bacteriophages in river water samples provide additional information to that provided by bacteria about the fate of faecal micro-organisms in river water. The easy, fast and cheap methods for phage determination are feasible both in industrialized and developing countries.

[Analgesia and sedation in the subarachnoid anesthesia technique: comparative study between remifentanil and fentanyl/midazolam]

OBJECTIVE

To assess the efficacy and safety of remifentanil in comparison with fentanyl-midazolam for analgesia and sedation during subarachnoid anesthesia.

MATERIAL AND METHODS

Sixty ASA I-III patients between 25 and 75 years old and scheduled for inguinal hernia repair were enrolled. Before the subarachnoid block, the patients were randomly assigned to receive an intravenous infusion of 0.1 microgram.Kg-1.min.-1 of remifentanil (group R) or 1 microgram.Kg-1 of fentanyl and 0.02 mg.Kg-1 of midazolam (group F). Ten minutes later a subarachnoid block to L3-L4 was performed with 10 mg of hyperbaric bupivacaine. We recorded intensity of pain during performance of the block on a simple verbal scale, the observer's assessment of alertness/sedation (OAA/S), hemodynamic variables, respiratory frequency and SpO2, level of comfort and side effects.

RESULTS

Over 70% of patients had no pain or slight pain during the subarachnoid puncture and absence of pain was significantly greater in group R than in group F (37% vs. 16%, p < 0.05). Sedation was adequate during surgery in both groups (OAA/S 2-3). There were no differences in level of comfort between the two groups. The incidences of hypoxemia, hypoventilation and excessive sedation were significantly higher in group R (40%, 20% and 16%, respectively; p < 0.05).

CONCLUSIONS

Remifentanil is more effective for treating pain associated with a subarachnoid block and provides cardiovascular stability with a limited level of sedation per dose, but its use is associated with a high incidence of respiratory depression.

[Acute selective tolerance to remifentanil after prolonged infusion]

We describe the cases of 3 patients who received anesthesia with remifentanil continuously infused at rates of 0.8 to 1.25 micrograms.kg-1.min-1 for at least 3 hours. Upon emergence from anesthesia, after withdrawal of the anesthetic gas, satisfactory levels of consciousness, spontaneous breathing and absence of pain were achieved under maintenance doses of remifentanil greater than 0.8 microgram.kg-1.min-1; such doses are related to the development of ventilatory depression, apnea and significant sedation. Acute tolerance to remifentanil is under debate at present. Such tolerance involves decreased efficacy of an opiate or the need for higher doses to maintain an effect after exposure. The development of tolerance is related mainly to the pharmacokinetics of an opiate, a short half-life and infusion periods exceeding 3 hours, and in the case of remifentanil, to the use of high doses. The most likely explanation for de phenomena described would be the development of selective acute tolerance to ventilatory depression and to sedation, with no effect on the antinociceptive effects of remifentanil. Clinical trials should be carried out to assess the development of acute tolerance to remifentanil and its possible perioperative repercussions.

Efficacy and safety of dipyrone versus tramadol in the management of pain after hysterectomy: a randomized, double-blind, multicenter study

BACKGROUND AND OBJECTIVES

We assessed the efficacy and safety of dipyrone in comparison with tramadol in the relief of early postoperative pain following abdominal hysterectomy.

METHODS

A total of 151 women between 18 and 60 years of age undergoing abdominal hysterectomy during general anesthesia participated in a randomized, double-blind, controlled, multicenter study. Seventy-three patients received dipyrone and 78 received tramadol. Patients received an intravenous loading dose of the study drug immediately after operation followed by intravenous (IV) maintenance infusion and IV on-demand boluses up to a maximum number of predetermined doses/day of 8 g dipyrone and 500 mg tramadol. The duration of the study was 24 hours.

RESULTS

The mean (SD) number of boluses in the dipyrone group was 3.8 (2.4) and 3.5 (2.5) in the tramadol group (95% confidence interval, -0.455 to 1.175), and the percentage of patients requiring rescue IV morphine (dipyrone 26.9%, tramadol 26.8%) was not statistically significant. Other analgesic efficacy parameters, such as pain intensity differences, sum of pain intensity differences, pain relief assessed by the patient, or patients who required the maximum number of demand doses, were not different between treatment groups. A significantly higher percentage of adverse gastrointestinal effects was found in patients given tramadol (42.1%) than in patients given dipyrone (20.2%) (P <.05). Also, a significantly higher number of tramadol-treated patients required ondansetron to control nausea and vomiting at 1 hour (19% v 7%), 2 hours (26% v 11%), and 24 hours (46% v 29%) (P <.05) after surgery. Patients and the investigators reported similar tolerability for both study arms.

CONCLUSIONS

Dipyrone and tramadol showed similar efficacy for early pain relief after abdominal hysterectomy. Nausea and vomiting, possibly caused by the tramadol, occurred more frequently in those patients. In this group, the need of the antiemetic drug ondansetron was also higher.

A comparison of two constant-dose continuous infusions of remifentanil for severe postoperative pain

We evaluated the analgesic efficacy and safety of two continuous constant-dose infusions of IV remifentanil, without infusion rate increments or the addition of boluses, in patients with severe postoperative pain during the first 4 h after general anesthesia with IV propofol-remifentanil. Thirty patients were randomly assigned to two groups of 15 subjects each according to the remifentanil dose administered: 0.1 microg. kg(-1). min(-1) IV (Group A) or 0.05 microg. kg(-1). min(-1) IV (Group B). Rescue analgesia was provided with meperidine (0.5 mg/kg IV) when pain intensity on the simple verbal scale (SVS) > or =2. The criteria for adequate analgesia (SVS 0-1, respiratory frequency >8/min. and SpO(2) >90%) after 4 h were met by 78% and 75% of the patients in Groups A and B, respectively (P = ns). "Meperidine rescue" analgesia was significantly more in Group B (26%) than in Group A (6%) (P < 0.05). There were no cases of respiratory depression, and nausea and emesis occurred in one patient in each group (6.5%). We conclude that IV remifentanil is an effective and safe opioid for the treatment of postoperative pain at a constant dose of 0.1 microg. kg(-1). min(-1) with a need for rescue analgesia 4 times less than a constant dose of 0.05 microg. kg(-1). min(-1).

IMPLICATIONS

Our study suggests that the use of a constant continuous infusion of remifentanil 0.1 microg.kg(-1).min(-1)IV is an effective alternative in the treatment of severe postoperative pain.

[Comparative study of inhalation induction by vital capacity breath in adults using 6% sevoflurane with oxygen or 4.5%sevoflurane in 50% nitrous oxide]

OBJECTIVE

To evaluate the efficacy, side effects and hemodynamic characteristics of induction by vital capacity breath in adults using 6% sevoflurane and oxygen versus 4.5% sevoflurane and 50% nitrous oxide.

PATIENTS AND METHODS

We assigned 50 ASA I-II patients aged 20 to 70 years old randomly to two groups of 25 to receive either 6% sevoflurane in oxygen or 4.5% sevoflurane in nitrous oxide. All patients were premedicated with oral bromazepam (1.5 to 3 mg). Induction was by vital capacity breath using a Mapleson A circuit (8 l. min-1) for 5 min. We recorded induction time, side effects, hemodynamic variables and patient opinion after surgery.

RESULTS

Induction time was significantly faster for the sevoflurane-oxygen group (60 +/- 10 s) than for the sevoflurane-nitrous oxide group (71 +/- 8 s) (p < 0.001). Complications were minor and hemodynamic variables stable in both groups, with no statistically significant differences. The patients expressed satisfaction with both induction techniques.

CONCLUSIONS

A vital capacity breath of 6% sevoflurane provided rapid induction. Induction was no more rapid when 50% nitrous oxide was added and the incidence of side effects did not decrease. Hemodynamic variables are stable during induction with sevoflurane with or without nitrous oxide, making this a well-tolerated alternative technique that is positively evaluated by patients.

Analysis of herpes simplex virus 1 and 2 infection in women with high risk sexual behaviour in Mexico

BACKGROUND

This paper describes the seroprevalence and risk factors of Herpes simplex virus (HSV) infection in a group of female prostitutes from Mexico City.

METHODS

Women who consented to participate in the study voluntarily attended a sexually transmitted disease (STD) clinic during 1992. A standardized questionnaire was administered and a blood sample was obtained from each participant. Type-specific Western blot serology was performed to determine the serostatus of HSV-1 and HSV-2 for participants. Bivariate and multivariate analyses were applied to identify variables associated with an increased risk for HSV infection.

RESULTS

Prevalences of infection among the 997 prostitutes studied were 93.9% for HSV-1 and 60.8% for HSV-2. Only 1.8% of the women were seronegative for both viruses. The only variable associated with HSV-1 seropositivity was crowding index. The following variables were associated with an increased risk for infection with HSV-2: age, level of education, working site, born outside Mexico City and increasing time as a prostitute.

CONCLUSIONS

This is the first assessment of HSV infection in Mexico and may be useful for the development and application of control and preventive measures among the prostitute population at risk of acquiring and transmitting human immunodeficiency virus (HIV) and other STD.

[Remifentanyl. Indications in anesthesia]

Remifentanil is a new opioid in the fentanyl family. Developed and marketed by Glaxo Wellcome Inc., it was approved by the U.S. Food and Drug Administration in July 1996 and has been available for use in Spain since the end of 1997. Remifentanil is an analog of fentanyl (4-piperidyl anilide) with a methyl-ester group that allows the molecule to be hydrolyzed by esterases in plasma and tissues. Rapid onset and metabolism make it an easy drug to control for achieving the desired depth of anesthesia, although these aspects are also the drug's main drawbacks given that the anesthesiologist must plan and initiate postoperative analgesia before surgery ends. Rapid onset and potency also mean that the use of this drug for either postoperative analgesia or monitored sedation in awake state with spontaneous breathing needs further study to assess safety.

Low prevalence of hepatitis B markers among Mexican female sex workers

OBJECTIVES

To estimate the prevalence and associated risk factors of hepatitis B virus (HBV) serological markers in female sex workers (FSW) in Mexico City.

METHODS

The study population consisted of 1498 FSW who attended a detection centre for human immunodeficiency virus (HIV) in Mexico City, between January and October 1992. Study participants responded to a standardised questionnaire and provided a blood sample for serology of syphilis, HIV, and HBV.

RESULTS

A total of 0.2% (95% CI 0.1-0.3) of the population were hepatitis B surface antigen (HBsAg) carriers. The general prevalence of antibodies to hepatitis B core antigen (anti-HBc) was 6.3% (95% CI 5.5-7.1). This marker of previous exposition to HBV, was independently associated by logistic regression multivariate analysis with age, working in the street, and history of blood transfusion (BT) before 1987 (OR 4.8, 95% CI 2.1-11.3). Syphilis prevalence was 7.6% (95% CI 6.2-8.9) and HIV prevalence was 0.1% (95% CI 0-0.3).

CONCLUSIONS

The prevalence of HBV infection in this group of Mexican FSW is lower than previously reported in other countries. In addition, the frequency of HBsAg carriers is similar to that in the general Mexican population. The absence of two major risk factors for HBV transmission in this group of FSW--that is, injecting drug use and anal intercourse, could help to explain this finding. However, the positive association between anti-HBc and history of blood transfusion demonstrated here, highlights the need to reinforce strict control of blood supplies in Mexico.

[Comparative study of sevoflurane and nitrous oxide versus halothane and nitrous oxide in pediatric anesthesia: efficacy and hemodynamic characteristics during induction]

OBJECTIVES

To study the efficacy, side effects and hemodynamics of anesthetic induction in pediatric patients using sevoflurane and nitrous oxide or halothane and nitrous oxide.

PATIENTS AND METHODS

We studied 80 pediatric ASA I-II patients aged between 1 and 10 years old scheduled for infraumbilical surgery of short duration. The patients were randomly assigned to two groups of 40 to receive one of the two drug combinations. All the children were premedicated with nasal midazolam 0.2 mg.kg-1. Induction was by inhalation of increasing concentrations of sevoflurane or halothane. The maximum inspired concentration during induction was 7% for sevoflurane and 3% for halothane. We analyzed induction time, side effects and hemodynamic variables.

RESULTS

The induction time was 2.06 +/- 0.5 min for halothane and 1.6 +/- 0.6 min for sevoflurane (p < 0.01). We observed no differences between the groups in coughing, laryngospasm, bronchospasm, secretions, apnea, nausea, vomiting, agitation or hiccoughing. Supraventricular beats appeared in 22.5% of patients in the halothane group and in 5% of the sevoflurane group. Induction with both anesthetics caused significant decreases from baseline blood pressure levels but no significant changes in heart rate.

CONCLUSIONS

Inhaled sevoflurane in 60% nitrous oxide provides rapid but gentle anesthetic induction, with hemodynamic stability and a low incidence of airway complications. Sevoflurane is therefore a reasonable alternative to halothane for pediatric surgery.

Specific immunoglobulins to soybean hull allergens in soybean asthma

Soybean asthma, which occurred as an epidemic among patients in Barcelona, Spain, is associated with specific IgE to soybean hull allergens. The purpose of this study was to investigate the possible role of specific IgG, IgG subclasses, IgA, and IgM in the pathogenesis of soybean asthma. We studied 3 groups of subjects from Barcelona: group 1, 12 asthmatic epidemic patients; group 2, 23 asthmatic nonepidemic patients; and group 3, 32 nonallergic subjects. Specific IgE was determined by radioimmunoassay and specific IgG, IgG subclasses (1, 2, 3, and 4), IgA, and IgM by amplified enzyme-linked immunosorbent assay. Cross-inhibition studies were performed for specific IgE and IgG4. We partially characterized the soybean hull allergens that bind specific IgE, IgG, and IgG4 by sodium dodecyl sulfate-polyacrylamide gel electrophoresis/Western blot. Percentage of positive results for the assays of the 8 Igs are as follows: for group 1, 100% (IgE), 75% (IgG), 16.6% (IgG1), 8.3% (IgG2), 0% (IgG3), 66.6% (IgG4), 25% (IgA), and 25% (IgM); for group 2, 4.3% were positive for specific IgE only; and for group 3, 0% (IgE), 0% (IgG), 6.2% (IgG1), 9.4% (IgG2), 9.4% (IgG3), 9.4% (IgG4), 6.2% (IgA), and 6.2% (IgM). The correlation between the specific IgE and the other specific Igs was significant between IgE and IgG4 in group 1 only (r = 0.752, p < 0.01). Cross-inhibition studies demonstrated a higher inhibitory capacity for IgG4 than for IgE. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis/ Western blot demonstrates three low molecular weight protein bands that bind specific IgE, IgG, and IgG4. This study suggests that specific IgG4 to soybean hull allergens plays a role in the pathogenesis of soybean asthma and corroborates the role of specific IgE in the same disease.

Epidemiology of human T-lymphotropic virus type II (HTLV-II) infection in Spain. HTLV Spanish Study Group

The human T-lymphotropic virus type II (HTLV-II) has recently been associated with the genesis of some subacute neurological syndromes and, rarely, with atypical T-lymphoid malignancies. The virus is endemic in some Amerindian and African tribes, and among intravenous drug users (IDUs) in North America and Europe. Given that HTLV-II is transmitted by the same routes as other human retroviruses, the screening of antibodies to HTLV-II in blood donors has became a matter of controversy in some countries. Herein, we describe the clinical, epidemiological and virological features of 113 individuals with HTLV-II infection identified in Spain up to September 1995. Most of them (94/113; 83%) were male, and all but seven were natives. Four were African immigrants living in Madrid and 3 had been born in other European countries. All but six subjects were IDUs, and sexual transmission of HTLV-II and transfusion were involved in five and one individual, respectively. Eighty-four percent of the IDUs infected with HTLV-II were co-infected by HIV-I (93/107). Clinical manifestations potentially linked to HTLV-II were absent, although an IDU male co-infected by HIV-1 and HTLV-II developed a severe non-inflammatory proximal myopathy. In conclusion, HTLV-II infection is present in Spain, mainly among IDUs, with a growing incidence and a current overall prevalence of 2.0 percent.

[Comparative study of recovery from general anesthesia with halothane or sevoflurane in pediatrics]

OBJECTIVES

To assess the clinical signs of awakening and recovery from anesthesia with sevoflurane and 60% nitrous oxide in comparison with halothane and nitrous oxide administered to children.

PATIENTS AND METHOD

A prospective study in 39 pediatric ASA I-II patients under 10 years of age scheduled for infraumbilical or otolaryngological surgery. The patients were randomly assigned to 2 groups to receive sevoflurane (n = 20) or halothane (n = 19). All the children received nasal doses of 0.2 mg/kg-1 midazolam before surgery. Induction was achieved by inhalation of a mixture of 40% oxygen and 60% nitrous oxide by face mask along with increasing concentrations of sevoflurane or halothane. Maintenance was with halogenated anesthetic at 1 MAC and 60% nitrous oxide-oxygen along with nerve blockade in the infraumbilical procedures or intravenous analgesia in the otolaryngological operations. We recorded time until awakening, orientation, score on the Aldrete scale and adverse effects during the recovery period.

RESULTS

The children who received sevoflurane awoke and were well oriented earlier than were those in the halothane group (10.7 +/- 5.8 versus 18.7 +/- 9.8 min until awakening and 15.4 +/- 8.6 versus 22.1 +/- 10 min for orientation); likewise the sevoflurane group children received higher scores on Aldrete's scale earlier than did those in the halothane group. There were no statistical differences between the 2 groups with respect to side effects during the period of awakening and recovery.

CONCLUSIONS

Awakening and recovery are significantly faster with sevoflurane than with halothane, while the incidence of side effects are similar with the 2 agents.

[HTLV-I infection in Spain. Analysis of 24 cases identified until November, 1994. Spanish Group for the Study of HTLV-I/II)]

BACKGROUND

HTLV-I is a human retrovirus which has been implicated in the genesis of tropical spastic paraparesia (TSP), adult T-cell leukemia (ATL) and some patients with uveitis, subacute arthropathies and lymphocytary alveolitis. The virus is endemic in some zones of the Caribbean countries, Japan, subsaharian Africa, Middle East and Melanesia. Given that HTLV-I is transmitted by similar routes as HIV, anti-HTLV-I antibody screening is carried out in blood donors in some countries.

METHODS

The clinical, epidemiologic and virologic characteristics of the patients with HTLV-I infection identified in Spain up to November 1994 are described.

RESULTS

Twenty-four Spanish residents have been identified with HTLV-I infection including 16 Spaniards and 8 immigrants from endemic areas. Thirteen (53%) are males and 11 (47%) females. Most of the persons born in Spain (12/16; 75%) have lived in endemic areas or have maintained sexual relations with natives of them. Four patients were diagnosed with TSP, three with ATL and another with lymphomatoid granulomatosis and angiocentric T-cell lymphoma. The remaining patients were asymptomatic at the time of diagnosis. Two HTLV-I carriers were identified on blood donation.

CONCLUSIONS

HTLV-I infection is present in Spain being found in Spanish natives and, to a lesser degree, in immigrants from endemic areas. It is therefore recommendable to analyze the cost-benefit of anti-HTLV-I screening in blood donors.