Interference of Dermatophagoides pteronyssinus sensitization in grass pollen allergy

Summary

Background. Climate conditions in the northwest of Spain are from the rest of the country, and the pollen sensitisation rates and allergens involved are different. The present study aimed to investigate the sensitisation profile of patients with grass pollen allergy and the interference of other sensitisations in respiratory symptoms. Methods. A total of 959 Spanish patients with seasonal respiratory symptoms and a positive skin prick test (SPT) to Phleum pratense pollen were studied. Patients were classified as having rhinitis and/or bronchial asthma. A battery of SPTs, including common weeds and tree pollens, profilin, polcalcin, moulds, Dermatophagoides pteronyssinus, Lepidoglyphus destructor, and cat and dog dander were performed. Serum specific IgE (sIgE) to Phl p 1 and Phl p 5, adding sIgE to Phl p 7, Phl p 12 and house dust mites (HDMs) or other pollens in selected cases were measured. Results.The majority (89.8%) of the patients were polysensitised according to SPT. HDM co-sensitisation was the most prevalent (62.3%). Profilin and polcalcin rendered a positive result in 25.9% and 18.7% of the patients, respectively. A higher proportion of patients recognized sIgE to Phl p 1 (88.7%) with respect to Phl p 5 (59%). Phl p 1-sIgE levels were higher than Phl p 5-sIgE levels, and no differences were found in patients with rhinitis and/or asthma. However, total serum IgE was higher in patients with asthma. Multivariate regression analyses revealed that only sIgE to Dermatophagoides pteronyssinus (after adjusting by sIgE to Phl p 1, Phl p 5 and Lepidoglyphus destructor) was associated with a greater risk of asthma. Conclusions. Phl p 1 is the most relevant allergen in patients with grass pollen allergy in the northwest of Spain. Sensitisation rates against panallergens are low. Even in patients with grass pollen allergy, HDM sensitisation plays a relevant role in asthma.

IgE antibodies to alpha-gal in the general adult population: relationship with tick bites, atopy, and cat ownership

BACKGROUND

The carbohydrate alpha-gal epitope is present in many animal proteins, including those of red meat and animal immunoglobulins, such as cat IgA. Systemic anaphylaxis to the alpha-gal epitope has recently been described.

OBJECTIVE

To investigate and compare the prevalence of alpha-gal-specific (s)IgE and its associated factors in the general adult population from two separated (Northern and Southern) European regions (Denmark and Spain, respectively).

METHODS

Cross-sectional study of 2297 and 444 randomly selected adults from 11 municipalities in Denmark and one in Spain. Alpha-gal sIgE was assessed by ImmunoCAP to bovine thyroglobulin. Additional assessments included a panel of skin prick test (SPT) to common aeroallergens and epidemiological factors, including the history of tick bites in the Danish series.

RESULTS

The prevalence of positive (≥ 0.1 kUA /L) sIgE to alpha-gal was 5.5% and 8.1% in the Danish and Spanish series, respectively. The prevalence of sIgE ≥ 0.35 kUA /L was 1.8% and 2.2% in Denmark and Spain, respectively. Alpha-gal sIgE positivity was associated with pet ownership in both series and, particularly, cat ownership (data available in the Danish series). Alpha-gal sIgE positivity was associated with atopy (SPT positivity) in both series, although it was not associated with SPT positivity to cat or dog dander. Alpha-gal sIgE positivity was strongly associated with a history of tick bites.

CONCLUSIONS AND CLINICAL RELEVANCE

The prevalence of alpha-gal sIgE antibodies in these general adult European populations is similarly low. The presence of alpha-gal sIgE antibodies is associated with a history of tick bites, atopy, and cat ownership.

Influence of experimental alcohol administration on serum immunoglobulin levels: contrasting effects on IgE and other immunoglobulin classes

In humans, alcoholic liver disease is associated with hypergammaglobulinemia, particularly with high serum concentrations of IgA. Furthermore, alcohol consumption is associated with high concentrations of IgE and low concentrations of IgG. However, there is little experimental evidence to corroborate these observational findings. The objective of the present study was to investigate the potential short-term effects of alcohol administration on serum immunoglobulin concentrations in mice, and the potential influence of sex and strain on these effects. Eight mouse groups were defined by strain (Swiss vs C57BL/6), sex (male vs female), and experimental procedure (alcohol administration vs control diet). Alcohol was administered in a semi-liquid diet (6.5%v/v); control animals received an isocaloric semi-liquid diet. Immunoglobulin concentrations (IgE, IgA, IgM, IgG1, IgG2a, IgG2b, and IgG3) were measured at baseline and weekly thereafter for 4 weeks. Serum Th1 (interferon-gamma) and Th2 (IL-4 and IL-13) cytokines were measured at week 4. We found significant variations in baseline immunoglobulin concentrations depending upon mouse sex and strain. Alcohol administration was quickly followed by an increase in serum IgE concentrations in all experimental groups. IgE increase was correlated with serum IL-13 increase. In contrast, alcohol administration was not associated with significant changes in serum IgA and IgM concentration, and appeared to decrease IgG subclass concentrations. Alcohol effects on immunoglobulin concentrations were independent of mouse strain and sex. In conclusion, alcohol administration in mice had contrasting effects on IgE and other immunoglobulin classes. This experimental evidence confirms observational results in humans.

Exploring the obesity-asthma link: do all types of adiposity increase the risk of asthma?

BACKGROUND

Obesity and risk of asthma are linked. Different distributions of adiposity, such as visceral, subcutaneous or ectopic adiposity, may affect asthma risk differently.

OBJECTIVE

To explore the association of different adiposity types with self-reported asthma, bronchial inflammation and lung function, accounting for possible effect modifiers, such as atopy and gender.

METHODS

In a general population sample of 3471 persons aged 19-72, visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were measured by ultrasound, and fat percentage by bio-impedance. Body mass index, waist circumference, waist-to-hip ratio (WHR), bronchial inflammation as fractional expiratory nitric oxide (FeNO), lung function [FEV(1) and forced vital capacity (FVC)], and atopy (specific IgE) were measured.

RESULTS

All adiposity measures were associated with a higher risk of asthma. The risk estimates (odds ratios, OR, with 95% confidence interval, CI) of current asthma were of similar magnitude for all six adiposity measures ranging between 1.17, CI = 0.98-1.40 (SAT) and 1.51, CI = 1.17-1.95 (WHR). The adiposity-asthma associations were significantly stronger in non-atopics than in atopics. In non-atopics the risk estimates of current asthma ranged between 1.35 CI = 1.08-1.72 and 1.82 CI = 1.34-2.46 for SAT and WHR respectively. Consistent results were obtained using dichothomized adiposity measures (obese vs. non-obsese). The FVC and FEV(1) decreased significantly with increasing adiposity in both atopics and non-atopics, e.g. FVC decreased between 36 mL (CI = 10, 62 mL) and 155 mL (CI = 124, 186 mL) for one unit (standard error) increase of SAT and VAT respectively. Adiposity measures were not associated with atopy and not consistently associated with FeNO levels.

CONCLUSIONS AND CLINICAL RELEVANCE

The effect of adiposity on asthma was mainly seen in non-atopics and did not appear to depend on the distribution of adiposity as reflected by the adiposity measures used in the present study. Increasing adiposity was associated with lower lung function independent of atopic status.

Prevalence of pinguecula and pterygium in a general population in Spain

PURPOSE

To determine the prevalence of pinguecula and pterygium and to investigate their associations in a general adult population in North-Western Spain.

METHODS

An age-stratified random sample of 1155 subjects ≥ 40 years was selected in O Salnés (Spain). From 937 eligible subjects, 619 (66.1%) participated (mean age (SD): 63.4 (14.5) years, range: 40-96 years, 37.0% males). An interview to collect history of systemic diseases and lifestyle details and a comprehensive ophthalmic evaluation in which pinguecula and pterygium were recorded was carried out. The prevalence of pinguecula and pterygium and their relationship with lifestyle factors and ocular and systemic diseases was investigated.

RESULTS

The prevalence of pinguecula was 47.9% (95% confidence interval (CI): 43.9-51.9). This prevalence increased significantly with aging (P = 0.002) and was higher in men (56.4%; 95% CI: 50.0-62.7) than in women (42.7%; 95% CI: 37.8-47.8) (P=0.001). The prevalence of pterygium was 5.9% (95% CI: 4.3-7.9). This prevalence also increased significantly with aging (P = 0.005) and was 4.8% (95% CI: 2.6-8.4) in men and 6.5% (95% CI: 4.5-9.3) in women (P = 0.346). After controlling for age and sex, pinguecula was associated with alcohol intake (adjusted odds ratio (OR(a)): 3.08; 95% CI: 1.60-5.95), pterygium with fluorescein staining (OR(a): 2.64; 95% CI: 1.08-6.46) and both disorders with outer activity (OR(a): 2.07; 95% CI: 1.36-3.15 and 2.28; 95% CI: 1.04-4.98, respectively).

CONCLUSIONS

Pinguecula is far more common than pterygium. Alcohol consumption is strongly associated with pinguecula. Fluorescein staining is highly prevalent in subjects with pterygium. Both disorders increase with age and are associated with outer activity.

HIF expression and Max-SUV-18F-FDG-PET in non-small cell lung cancer (NSCLC) patients

e22010

Background: Tumor hipoxia induces the up-regulation of several genes via the hipoxia-inducible transcription factors (HIF) 1 and 2. HIF-2 alpha (HIF-2 α) and HIF-1 alpha (HIF-1α) are associated with the prognosis of operable NSCLC patients. We studied the immunohistochemical expression of HIF-1α and HIF-2 α in patients with NSCLC and the possible correlation with the maximum standardised uptake value (max SUV) of 18F-FDG as well as other biological parameters. Methods: We used a Tissue Arrayer device (Beecher Instruments. WI) to construct a TMA block, according to conventional protocols for the study of immunohistochemical expression of HIF-1α, HIF-2 α, EGFR, bcl-2, MIB1, p16, p63 and cyclins A, B1, D1 and D3. Sections were scored as positive if >10% of cells stained positively. Staining patterns were correlated to clinical variables. Results: HIF- 1α expression was observed in 84/96 patients (34/39 adenocarcinomas and 50/57 squamous cell carcinomas), however it did not correlate with clinical stage (I-II: 41/45 vs III-IV: 44/51). HIF-1α correlated positively with HIF-2 α (p:0,001) and EGFR (p:<0,001) expressions. The maxSUV values of 18F-FDG-PET were higher (p:0,039) in HIF-1α -positive (17,1±8,6) than in negative tumors (11,8±4,4). HIF-2 α expression was observed in 60/103 cases (27/42 adenocarcinomas and 33/61 squamous cell carcinomas) and it did not correlate with clinical stage ((I-II: 28/45 vs III-IV: 32/57). HIF-2 α correlated positively with HIF-1α (p:0,001), MIB1 (p:0,045) and EGFR (p:0,091) expressions. After multivariate analysis, only the clinical stage (RR: 2,2) was a prognostic factor. Conclusions: 1) HIF-1α and HIF-2 α expressions are frequent in patients with NSCLCs and it did not correlate with clinical stage; 2) maxSUVs FDG-PET values were higher in HIF1alpha positive than in HIF-1α negative patients; 3) HIF-1α was correlated with EGFR expression, while HIF-2 α was correlated with MIB1 expression.

No significant financial relationships to disclose.

[The immunohistochemical expression of cyclin B1 is associated with higher SUV in 18F-FDG-PET in non-small cell lung cancer patients. Initial results]

AIM

to study the expression of cyclin B1 and its possible relationship with the maximum SUV in FDG-PET and MIB1 expression in patients with NSCLC.

MATERIALS AND METHODS

49 patients (15 adenocarcinomas, 27 squamous cell carcinomas and 7 bronchoalveolar carcinomas) were included in this study; the immunohistochemical expression of cyclin B1 was determined using the tissue-array technique. Each PET was performed 60 minutes after the i.v. administration of 350-518 MBq of FDG on an Advance system (GE) in 2D acquisition mode.

RESULTS

cyclin B1 expression was detected in 40 out of 45 cases. The SUV values were higher (p=0.04) in the cyclin B1+ cases than in the negative cases (16.4+/-8.1 vs 10.9+/-6.2). Cyclin B1 expression and SUV values were not correlated with the clinical stage. The expression of cyclin B1+ correlated positively (p<0.0001) with that of MIB1. After univariate analysis, only the cellular proliferation was a prognostic factor (p=0.037).

CONCLUSIONS

our results suggest that there is a direct correlation between cyclin B1 expression and max-SUV values in the PET of NSCLC patients. When the association of cyclin B1 with positive MIB1 is also considered, our results support the role of cell proliferation in FDG uptake by the tumour.

[The immunohistochemical expression of cyclooxygenase 2 is inversely associated with (18)F-FDG-PET SUV values in non-small-cell lung cancers. Initial results]

OBJECTIVE

To study the expression of COX-2 and its possible relationship with the maximum standardized uptake value (SUV) in FDG-PET, and EGFR, p16 and MIB1 expression in patients with NSCLC.

MATERIAL AND METHOD

45 patients (12 adenocarcinomas and 33 squamous cell carcinomas) were included in this study; the immunohistochemical expression of COX-2, MIB-1, p16 and EGFR was determined using tissue-array. Each PET was performed 60 minutes after the i.v. administration of 350-518 MBq of FDG on an Advance system (GE) in 2D acquisition mode.

RESULTS

COX-2 expression was detected in 35 out of 45 cases, and was very significant (> ++) in 12 of them. SUV values were lower in the COX-2 > ++ cases that in the remaining cases (13.4 +/- 1.2 vs. 12.9 vs. 17.1 +/- 1.5; p = 0.059). COX-2 > ++ expression and maxSUV values were not correlated with the clinical stage. The expression of COX-2 > ++ was correlated positively with p16 (r = 0.36; p = 0.014) and negatively with MIB1 (r = -0.32; p = 0.041) expression, whereas the SUV was correlated positively with EGFR (r = 0.44; p = 0.004) and negatively with p16 (r = -0.29; p = 0.041) expression.

CONCLUSIONS

Our results suggest that: a) the expression of COX-2 > ++ is often found in this kind of lung cancer and is not associated with the clinical stage; b) the maxSUVs were not related to the stage and were lower in COX-2 > ++ tumours than in the other cases; and c) the different behaviour of both parameters can be explained by their correlation with cell proliferation (MIB1), EGFR and p16 expression.

Serum levels of immunoglobulins (IgG, IgA, IgM) in a general adult population and their relationship with alcohol consumption, smoking and common metabolic abnormalities

The present study investigated serum immunoglobulin (Ig) concentrations in relation to demographic factors, common habits (alcohol consumption and smoking) and metabolic abnormalities in an adult population-based survey including 460 individuals. Serum levels of interleukin (IL)-6, a marker of inflammation, were also determined. After adjusting for confounders, male sex was associated positively with IgA levels and negatively with IgM levels. Age was associated positively with IgA and IgG levels. Smoking was associated negatively with IgG levels. Heavy drinking was associated positively with IgA levels. Metabolic abnormalities (obesity and metabolic syndrome) were associated positively with IgA levels. Abdominal obesity and hypertriglyceridaemia were the components of metabolic syndrome associated most strongly with serum IgA. Heavy drinkers with metabolic syndrome showed particularly high serum IgA levels. Serum IL-6 levels were correlated positively with IgA and IgG concentrations. It is concluded that sex, age, alcohol consumption, smoking and common metabolic abnormalities should be taken into account when interpreting serum levels of IgA, IgG and IgM.

Sensitization to cross-reactive carbohydrate determinants in relation to alcohol consumption

BACKGROUND

Alcohol consumption is associated with increased serum IgE of unknown specificity.

OBJECTIVE

To investigate the prevalence of specific IgE to cross-reactive carbohydrate determinants (CCDs) in adults, and its relation to alcohol consumption.

METHODS

Population-based survey of 457 adults (218 abstainers, 195 light-to-moderate drinkers, 44 heavy drinkers). Specific IgE determinations included a CCD (MUXF(3), the N-glycan of bromelain), pollens (Lolium perenne and Olea europaea), Hymenoptera venoms (Apis mellifera and Vespula spp.), and a mite (Dermatophagoides pteronyssinus). We replicated these studies in an additional sample of alcoholics (n=138). Inhibition assays were performed in selected cases.

RESULTS

In the general population, 5.6% of individuals (95% confidence interval 3.5-7.6%) showed positive (>/=0.35 kU/L) CCD-specific IgE. The levels of CCD-specific IgE were particularly high in heavy drinkers, who also showed a high prevalence of positive IgE to pollens and Hymenoptera venoms, doubling (at least) the prevalence found in alcohol abstainers and light-to-moderate drinkers. The presence of IgE to pollens and Hymenoptera venoms was closely correlated with the presence of CCD-specific IgE. These features were confirmed in the additional sample of alcoholics. Inhibition studies indicated a role of CCD interference in IgE positivity to pollen and Hymenoptera allergens in alcoholics.

CONCLUSIONS

CCD-specific IgE is prevalent in heavy drinkers, and is associated with positive IgE to pollens and Hymenoptera venoms. Specific IgE results should be interpreted with caution in heavy drinkers.

Toxocara infection seroprevalence and its relationship with atopic features in a general adult population

BACKGROUND

The relationship of helminth infection with atopy is controversial. Toxocariasis is the most common helminth infection in industrialized countries. The study aimed to investigate the association between Toxocara exposure and atopic features.

METHODS

The study is based on a cross-sectional survey of 463 subjects, randomly selected (stratified by decades of age) from a general adult population. Toxocara exposure was defined by the presence of serum Toxocara antibodies. Main outcome measures included total serum IgE levels, skin prick tests (SPT) to a panel of 13 relevant aeroallergens, specific IgE to aeroallergens (Phadiatop test), and respiratory symptoms evaluated by means of a questionnaire.

RESULTS

A total of 134 subjects (weighted proportion 28.6%, 95% CI 26.5-30.7%) showed Toxocara exposure. Pet ownership, rural habitat, farming, and low educational level were associated with Toxocara exposure. Toxocara exposure was associated with both positive SPT (particularly to mites) and positive specific IgE (Phadiatop test) after adjusting for potential confounders. The effect of Toxocara exposure on total serum IgE levels and blood eosinophil count was different in SPT-positive subjects and SPT-negative individuals. In SPT-negative individuals, Toxocara exposure was associated with an increase in both serum IgE levels and eosinophil counts, whereas an opposite trend was observed in SPT-positive individuals. Toxocara exposure was not associated with respiratory symptoms.

CONCLUSIONS

In this adult population, Toxocara exposure is associated with allergic sensitization, particularly to mites. There is evidence of an intriguing interaction between Toxocara exposure and allergic sensitization for both total serum IgE levels and blood eosinophil counts.

Cell-cycle-associated markers and clinical outcome in human epithelial cancers: a tissue microarray study

The development and progression of epithelial cancers are the result of an imbalance in signals promoting and inhibiting cellular proliferation and apoptosis. The aim of this study is to evaluate the expression of cell-cycle and apoptosis regulators and correlate them with clinical outcome in the most frequent carcinomas, in order to establish common prognostic biomarkers independent of cancer origin. Using tissue microarrays (TMAs), we have analysed the immuno-expression of Ki-67, Bcl-2, Bax, cyclin D1, cyclin D3, CDK1, CDK2, CDK6, p16, p21, and p27 in a series of 205 carcinomas of the large bowel, breast, lung and prostate (80, 73, 37 and 15 cases, respectively). By univariate analysis, positivity for p27, p16 and Bcl-2 was associated with better overall survival (P<0.0135, P<0.0442 and P<0.0001, respectively). The risk of mortality was 2.3-fold greater in patients without Bcl-2 expression. TMA immunohistochemical analysis identified a subset of epithelial cancers with overlapping alterations in cell-cycle checkpoints, apoptosis regulators and tumour suppressor pathways. We found that in most common epithelial cancers, regardless of origin, Bcl-2 appears to be the key biological factor influencing clinical behaviour.

[Renal transplantation in the northwest of Spain: analysis of the activity in the region of Galicia]

BACKGROUND

Spain is the world leader in organ transplant rates, and the national average is maintained in the northwestern Spanish region of Galicia. However, there is no official registry recording transplantation results in this region. In this paper we report a study of patient and graft survival and risk factors among kidney transplant patients in Galicia between January 1996 and December 2000.

METHODS

Patients receiving kidney transplants in Galicia in the above period were monitored up to the end of 2001, deaths and graft losses were recorded and analysed by actuarial and Kaplan-Meier methods, and possible risk factors for death and graft loss were evaluated using Cox's proportional hazards model.

RESULTS

In the study period, 672 kidneys were transplanted, all from deceased donors. Graft and patient survival rates were respectively 80% and 94% after 1 year, and 67% and 83%, after 5 years. Two-thirds of graft losses occurred within the first year and the most common cause was vascular thrombosis (44%). Independent risk factors for graft loss were donor asystole (relative risk [RR] = 3.41, 95% confidence interval [CI]: 1.73-6.73), donor age (RR = 1.54, CI: 1.05-2.27 for 40-60-year-olds, RR = 2.59, CI: 1.66-4.07 for over-60s, relative to under-40s), donation from outside the institution in which implant was performed (RR = 1.43, CI: 1.02-2.02), acute rejection (RR = 2.32, CI: 1.63-3.22), and retransplantation (RR = 1.56, CI: 1.03-2.37). The main causes of death were infections (38%), followed by cardiovascular pathologies (30%) and tumours (11%).

CONCLUSIONS

The kidney transplant rate varies excessively within Galicia; the global rate is 50 per million inhabitants per year. Patient survival is similar to those recorded in national registers, but graft survival is deficient, apparently due to a high incidence of vascular thrombosis.

[Risk factors for refusing kidneys in Galicia. Is it possible to increase its use?]

INTRODUCTION

Demographic changes along with an increase in the demand of organs and an increase in the expertise of transplantation teams, lead to a constant modification of donors' characteristics and, accordingly, of the supply of the organs used and refused.

OBJECTIVE

Analyze the use and refusal of kidneys generated in Galicia. Subjects and method. A follow-up of kidney donors was carried out between 1996 and 2000, studying the reasons for non extraction and refusal of kidneys and analyzing the influence that donors' characteristics have on them. In order to evaluate the risk factors of not using grafts, multiple logistic regression patterns were made, assessing odds ratios with confidence intervals at 95%.

RESULTS

836 kidneys were recovered from 433 donors, and 697 were implanted out of them. 17% of the organs extracted, a percentage approaching 25% in the two latest years, were discarded, due to the biopsy findings (27%), donor's previous conditions (22%), anatomical disorders (16%), prolonged cold ischemia (12%) or recipient not located or unsuitable (14%). The average age of refused grafts was significantly higher than that of implanted ones, in such a way that having more than 45 years old was an independent risk for refusing kidneys (OR = 1.76 and p = 0.05, for 45-59 years old; OR = 6.1 and p = 0.000, for older than 60 years old). The same happened with history of hypertension (OR = 1.59 and p = 0.044), high serum creatinine level (OR = 1.83 and p = 0.005) and positive serology for HCV (OR = 5.65 and p = 0.001) and anti-HBc (OR = 2.91 and p = 0.017).

CONCLUSIONS

Elderly donors and donors with concomitant diseases enable us to increase the number of grafts, although they also lead to an increase in refusals, which nearly amounts to 20% of the ones generated. However, more than the half were refused due to pontentially avoidable reasons and therefore these could have been valued for transplantation to limit recipients.

Evaluation of the phadiatop test in the diagnosis of allergic sensitization in a general adult population

BACKGROUND

Phadiatop is a commercially available qualitative serological test employed for screening of allergic sensitization in patients with suspected allergic diseases.

AIM

The study evaluated the diagnostic accuracy of Phadiatop for the diagnosis of allergic sensitization in a general adult population.

METHODS

A total of 469 subjects from the population of A-Estrada (Spain) were selected by age-stratified random sampling (age range, 18-92 years). Phadiatop test (Uni-CAP method) was performed in serum samples from 465 of these subjects. Skin prick tests to a panel of 13 relevant aeroallergens in the studied area (including mites, pollens, moulds, and animal dander) were employed as the reference diagnostic procedure. Subjects with at least a positive skin prick test (> or =4 mm, n= 120) were considered to have allergic sensitization.

RESULTS

Phadiatop sensitivity was 70.8% (95% CI 61.7-78.6%), specificity 90.7% (95% CI 87.0-93.5%), positive predictive value 72.6% (95% CI 63.5-80.3%), negative predictive value 89.9% (95% CI 86.2-92.8%), global accuracy 85.6% (95% CI 82.0-88.6%), negative likelihood ratio 0.3 (95% CI 0.2-0.4), and positive likelihood ratio 7.6 (95% CI 5.4-10.8). A high proportion of false-positive Phadiatop cases showed (a) increased total serum IgE levels, (b) significant alcohol consumption, and (c) small-sized (below the diagnostic cut-off) wheal reactions on SPT. A high proportion of false-negative Phadiatop cases showed exclusive storage mite sensitization. Sensitivity and positive predictive value of Phadiatop were somewhat higher among individuals with a history of nasal or bronchial symptoms.

CONCLUSIONS

Phadiatop is a valuable tool for the diagnosis of allergic sensitization in a general adult population. However, limitations of the test should be taken into account in similar surveys.

Association of hepatitis A virus infection with allergic sensitization in a population with high prevalence of hepatitis A virus exposure

BACKGROUND

An inverse association between allergic sensitization and markers of exposure to food-borne and orofecal infections (particularly hepatitis A virus, HAV) has been reported. The prevalence of HAV exposure and allergic sensitization vary widely in different areas, and vary along with age within a given area.

AIM

To investigate the association between HAV exposure and allergic sensitization in adults from a mostly rural area of Spain.

METHODS

An age-stratified random sample of 720 subjects was drawn from the population older than 18 years of A-Estrada, Spain. From 697 eligible subjects, 469 (67.2%, median age 54 years, range: 18-92) participated in the study. Positive skin prick tests to a panel of aeroallergens defined allergic sensitization. Positive serum HAV antibodies (assayed in 465 subjects) defined HAV exposure.

RESULTS

The prevalence of HAV exposure was 83.6% (95% CI: 80.7-86.5). The prevalence of allergic sensitization was lower in subjects with HAV exposure than in patients without it (25.0%vs 40.0%, OR 0.44, 95% CI: 0.25-0.77, P=0.004), but this association became substantially altered after adjusting for age, which was closely linked to both allergic sensitization and HAV exposure (adjusted OR 1.15, 95% CI: 0.60-2.19, P=0.66).

CONCLUSIONS

In a population with high prevalence of HAV exposure, no significant association between HAV exposure and allergic sensitization is observed after controlling for the confounding effect of age.

High prevalence of storage mite sensitization in a general adult population

BACKGROUND AND AIM

Occupational and nonoccupational storage mite (SM) allergy has received considerable attention in recent years. The study aimed to evaluate both the prevalence and factors associated with sensitization to SMs in a general adult population from a warm and humid area where mites are the predominant allergens.

PATIENTS AND METHODS

An age-stratified random sample of 720 subjects was drawn from the population older than 18 years of A-Estrada (Galicia, Spain). From 697 eligible subjects, 469 (67%, median age 54 years, range 18-92 years, 44% males, 75% of cases from a rural environment) agreed to participate. Skin prick tests to SMs (Lepidoglyphus destructor and Tyrophagus putrescentiae), house dust mite (Dermatophagoides pteronyssinus), pollens, moulds and animal danders were performed in all cases. Wheals >or= 4 mm were considered positive. Epidemiological data were assessed by questionnaire. A design-based analysis was performed and all calculations were weighted to give unbiased estimates.

RESULTS

Tyrophagus putrescentiae and L. destructor were the leading causes of allergic sensitization throughout all ages. SM sensitization was found in 104 cases (weighted value 24.4%, 95% CI 20.6-28.2). SM sensitization was inversely associated with age. Multivariate analysis showed that SM sensitization was not significantly associated with sex, smoking, educational level, farming profession, rural environment, indoor humidity, presence of pets, livestock or grain storage facilities near home.

CONCLUSIONS

SMs (T. putrescentiae and L. destructor) are major aeroallergens in adults in the region studied, even in subjects without occupational exposure.

Liver Disease in Heavy Drinkers With and Without Alcohol Withdrawal Syndrome

BACKGROUND

Withdrawal syndrome is a hallmark of alcohol dependence. The characteristics of alcohol consumption, closely related to dependence, could influence the development of alcoholic liver disease. The study aimed to investigate if patients with severe alcohol withdrawal syndrome have a peculiar profile of liver disease.

METHODS

The study included 256 heavy drinkers (aged 19-75 years, 70.3% males) admitted to an Internal Medicine Department. Patients admitted for complications of liver disease were not included. Severe alcohol withdrawal syndrome (seizures, disordered perceptions, or delirium) developed in 150 patients (58.6%). Alcohol consumption (daily quantity, duration, and pattern [regular or irregular]) was assessed by questionnaire. Liver biopsy was performed in all cases.

RESULTS

Patients with alcohol withdrawal syndrome showed a lower prevalence of liver cirrhosis and a higher prevalence of alcoholic hepatitis than patients without it. The negative association of alcohol withdrawal syndrome with liver cirrhosis persisted after we adjusted for sex, daily intake, duration, and pattern of alcohol consumption. Alcoholic hepatitis was independently associated with the irregular pattern of alcohol consumption, which was closely associated with severe alcohol withdrawal syndrome.

CONCLUSIONS

The profile of liver injury is different in heavy drinkers who develop and who do not develop a severe alcohol withdrawal syndrome when admitted to the hospital.

Association of alcohol consumption with total serum immunoglobulin E levels and allergic sensitization in an adult population-based survey

BACKGROUND

Chronic alcoholism is associated with increased total serum IgE levels.

OBJECTIVE

The study aimed to investigate the relationship between alcohol intake and both total serum IgE levels and allergic sensitization in a general adult population.

MATERIALS AND METHODS

A total of 720 subjects was randomly selected (stratified by age) from the population older than 18 years of A-Estrada (Spain) and invited to participate in the study. From 697 eligible subjects, 469 (67%, median age 54 years, range 18 to 92 years, 44% males, 75% of cases from a rural environment) agreed to participate. A battery of 13 skin prick tests to common aeroallergens was performed in all subjects. Cases with at least one positive test (n = 121, 26%) were considered to have allergic sensitization. The most frequent sensitisers were mites and pollens (24% and 10% of subjects, respectively). Total serum IgE was measured in 465 subjects (99%). Alcohol consumption was registered as the number of standard (approximately 10 g) drinking units habitually consumed per week. A total of 244 subjects (52%) were alcohol consumers (median intake, 14 units/week, range 1 to 147 units/week). Abstainers (n = 225, 48%) constituted the reference category.

RESULTS

Alcohol consumption of more than 14 units/week was associated with an increase in serum IgE levels after adjusting for age, gender, allergic sensitization and smoking (P = 0.02). Alcohol consumption was not significantly associated with either overall allergic sensitization or mite sensitization after adjusting for age, gender and smoking. However, alcohol consumption of more than 14 units/week was associated with an increased prevalence of pollen sensitization (adjusted OR 3.15, 95% CI 1.19 to 8.34, P = 0.02).

CONCLUSION

Alcohol consumption above a certain threshold is associated with an increase in total serum IgE levels. Alcohol consumption may also be associated with an increased prevalence of pollen sensitization.

[A population study of the efficacy of pulsioxymetry in diagnosing obstructive sleep apnoea syndrome]

OBJECTIVES

To evaluate the use at home of night-time pulsioxymetry to diagnose obstructive sleep apnoea syndrome in the general population.

DESIGN

Cros-sectional study of diagnostic tests.

PARTICIPANTS

Random sample of 70 individuals chosen from a Health Centre´s appointment records.

MAIN MEASUREMENTS

Anamnesis concerning sleep and respiratory disorders during sleep, anthropometric measurements, Epworth´s sleepiness scale, home night-time pulsioxymetry and polysomnography.

RESULTS

Visual inspection by oxymetry gave 82% sensitivity (95% CI, 62-93) and 69% specificity (95% CI, 53-82) for the diagnosis of obstructive sleep apnoea syndrome. Other indices such as the time with oxygen saturation below 90% and the number of desaturations above 4% gave a sensitivity of 82% and 86% and specificity of 63% and 65%, respectively. All the cases of clinically significant obstructive apnoea were diagnosed by pulsioxymetry.

CONCLUSIONS

Night-time pulsioxymetry is a useful test for general screening of obstructive sleep apnoea.

Clinical characteristics and prognosis of hospitalised inpatients with heart failure and preserved or reduced left ventricular ejection fraction

OBJECTIVE

To determine the clinical and prognostic differences between patients with heart failure who had preserved or deteriorated systolic function, defined as a left ventricular ejection fraction of > 50% or < 50%, respectively, within two weeks of admission to hospital.

METHODS

The records of 229 patients with congestive heart failure were studied. There were 95 women and 134 men, mean (SD) age 66.7 (11.7) years, who had been admitted to a cardiology department for congestive heart failure in the period 1991 to 1994, and whose left ventricular systolic function had been evaluated echocardiographically within two weeks of admission. Data were collected on the main clinical findings, supplementary investigations, treatment, and duration of hospital admission. Follow up information was obtained in the spring of 1998 by searching the general archives of the hospital and by a telephone survey.

RESULTS

Left ventricular systolic function was preserved in 29% of the patients. The preserved and deteriorated groups differed significantly in the sex ratio (more women in the preserved group) and in the presence of a third heart sound, cardiomegaly, alveolar oedema, ischaemic cardiomyopathy, and treatment with angiotensin converting enzyme (ACE) inhibitors (all more in the deteriorated group). There were no significant differences in age, New York Heart Association functional class, rhythm disturbances, left ventricular hypertrophy, treatment with drugs other than ACE inhibitors, or survival. In the group as a whole, the survival rates after three months, one year, and five years were 92.6%, 80%, and 48.4%, respectively.

CONCLUSIONS

In view of the unexpectedly poor prognosis of patients with congestive heart failure and preserved left ventricular systolic function, controlled clinical trials should be carried out to optimise their treatment.

[Value of touch in the diagnosis of fever and of paleness in the diagnosis of anemia. Observational study in adults]

Estimation of fever by touch and of pallor as a sign of anemia are common practices during physical examination. The diagnostic value of these procedures has been extensively studied in children, but there are fewer studies in adults.

OBJECTIVE

To evaluate the diagnostic value of physician's estimation of fever and anemia by touch and pallor, respectively.

PATIENTS AND METHODS

The study included 600 patients (mean age 66 years, range 14-94 years, 58% males) admitted to a hospital (n = 300) or seen at its Emergency Department (n = 300). Two physicians independently estimated the presence of fever by touch, as well as the presence of anemia by pallor (in the skin, nail or conjunctiva). Axillary temperature and peripheral blood hemoglobin were employed as standards for comparison.

RESULTS

Specificity of touch was higher than 90%, both for the diagnosis of axillary temperatures > or = 37.2 degrees C and > or = 38 degrees C, with a lower sensitivity. Interobserver concordance was fair (Kappa index, 0.47). Negative predictive value of touch was also high (99%) for the observed prevalence of fever (5%), with a very much lower positive predictive value. Similarly, specificity of pallor was high, particularly for hemoglobin values lower than 10 g/dL, with a substantially lower sensitivity. The best diagnostic values were obtained with conjunctival pallor. The Kappa index of concordance for the various types of pallor (skin, nail or conjunctiva) ranged between 0.39 and 0.44. Negative predictive value of pallor was high (98%) for the observed prevalence (9%) of significant anemia (hemoglobin < 10 g/dL), with a lower positive predictive value.

CONCLUSIONS

In adult patients of a hospital, physi-cian's estimation of fever by touch and anemia by pallor have a relatively low diagnostic value. Nevertheless, the estimation that the patient is afebrile or not pale make very improbable the presence of fever and significant anemia, respectively.

Influence of alcohol consumption on serum immunoglobulin E levels in atopic and nonatopic adults

BACKGROUND

Total and specific serum immunoglobulin E (IgE) are routinely used as diagnostic tools in allergy clinics. Several studies have demonstrated an increase of total serum IgE concentrations in alcoholics, but the possible influence of lower quantities of ethanol intake on serum IgE values has not been fully evaluated. This study was aimed at analyzing the influence of alcohol intake on both total and specific serum IgE concentrations in patients studied in an allergy clinic.

METHODS

A total of 460 patients were included in the study. According to skin-prick tests to common aeroallergens, 325 were classified as atopics and 135 as nonatopics. Most atopic patients (253; 78%) were allergic to mites. Alcohol consumption was recorded as the number of standard (10-g) drinking units regularly consumed per week. Two hundred subjects (43%) were abstainers, and 260 (57%) were regular consumers of a median of 30 g of alcohol per week. Total serum IgE was measured in all patients by latex-enhanced nephelometry. Serum-specific IgE was assayed by fluoroenzymeimmunoassay.

RESULTS

Total serum IgE increased along with ethanol consumption. On multivariate analysis, regular alcohol consumption greater than 70 g per week was associated with increased total serum IgE levels, even when adjusting for age, sex, atopy, and smoking. Among house-dust mite-allergic patients, specific serum IgE values against the house dust mite Dermatophagoides pteronyssinus were higher in regular alcohol consumers than in abstainers. This difference was not observed among patients allergic to grass pollen (Lolium perenne).

CONCLUSIONS

Alcohol consumption, even in moderate quantities, is associated with increased total and specific IgE concentrations in subjects studied in an allergy clinic. Alcohol intake should be taken into account in epidemiological studies of total serum IgE levels.

Influence of prosthesis size and left ventricular mass on left ventricular diastolic reserve in patients with aortic valve prostheses

BACKGROUND AND AIM OF THE STUDY

The study aim was to determine the influence of valve size and left ventricular (LV) mass on long-term LV diastolic reserve in patients subjected to aortic valve replacement for stenosis.

METHODS

Seventy-four patients (33 women, 41 men; mean age 64 years) after aortic valve replacement with 40 pericardial bioprostheses and 34 bileaflet mechanical prostheses were studied. All valves were of nominal size 19, 21 or 23 mm. The patients were studied by Doppler echocardiography, at rest and during peak effort, between 12 and 47 months after valve replacement.

RESULTS

All patients achieved significantly increased heart rate, blood pressure and cardiac output in response to effort. Effort also significantly modified transvalvular pressure drops and valve areas. The mean diastolic reserve was 29.3 ml, and mean stroke volume reserve 23.2 ml; in neither case were there any significant differences between valve types, or among valve sizes.

CONCLUSION

At about one year after surgery, the diastolic reserve of patients subjected to aortic valve replacement on account of stenosis was considerable, and independent of valve size. Despite the persistence of LV hypertrophy after valve replacement, LV diastolic function during effort was similar to that of the normal heart.

Screening of obstructive sleep apnoea: heart rate spectral analysis of nocturnal pulse oximetric recording

Using heart rate spectral analysis of nocturnal pulse oximetry, we prospectively evaluated the utility of this methodology in patients clinically suspected of having obstructive sleep apnoea (OSA). A hundred and ninety-seven outpatients referred with symptoms compatible with the diagnosis of OSA were studied. All participants had nocturnal pulse oximetry performed simultaneously with conventional polysomnography. Power density of heart rate obtained by nocturnal pulse oximetry was analysed using fast Fourier transformation of a Hamming-windowed signal. Recording test results were classified as abnormal (suspicion of OSA) in the presence of a peak in the periodogram between period boundaries 30-70 sec. A normal test result was defined as the absence of the 30-70 sec peak in the periodogram. The total area of the periodogram (S(TOT)), the area enclosed in the periodogram between the period boundaries 30-70 sec (S(30-70)), the area enclosed in the period boundaries 30-70 sec with respect to the total area of the periodogram (S) and the peak amplitude 30-70 sec (PA) were measured. The presence of a peak in the periodogram has a sensitivity of 81.3%, a specificity of 91.5% a positive predictive value of 89.1% and a negative predictive value of 85.1% for OSA diagnosis. The OSA patients were found to have higher values of S(TOT), S(30-70), S and PA than the non OSA patients. Receiver operating characteristics (ROC) curve was constructed at different thresholds of S(TOT), S(30-70) S and PA. For a PA threshold of 10(%)2, heart rate spectra analysis sensitivity for OSA was 58% and specificity was 92%. Furthermore, the positive and negative predictive values for diagnosis of OSA were 87 and 72% respectively. Apnoea hypopnea index (AHI) correlated significantly with S(TOT) (r=0.44; P<0.001), S(30-70) (r=0.59: P<0.001), S (r=0.58; P<0.001) and PA (r=0.58; P<0.001). According to our results, heart rate spectral analys s obtained by nocturnal pulse oximetry and identification of peak in the periodogram between period boundaries 30-70 sec could be useful as a diagnostic technique for OSA patients.

Epidural washout with high volumes of saline to accelerate recovery from epidural anaesthesia

BACKGROUND

Prolonged postoperative blockade can follow neuraxial blocks for short surgical procedures. We investigated whether washout with a high volume of saline through an epidural catheter could provide a faster recovery after epidural anaesthesia.

METHODS

Thirty patients were randomly assigned to a control group (no washout), to group 2x (epidural washout with twice the volume of 2% mepivacaine) and group 4x (epidural washout with four times that volume).

RESULTS

Recovery times from sensory blockade at L2 were 151+/-24, 122+/-29 and 116+/-24 min for control, 2x and 4x groups respectively. Significant differences were found in both saline groups when compared with control group, but not between group 2x and group 4x. No differences were found concerning motor blockade. One patient in group 4x demonstrated signs of intracranial hypertension. Mepivacaine plasma concentrations were increased by saline washout in group 4x.

CONCLUSIONS

Epidural washout with a high volume of saline can not be recommended since no clinically significant reduction in the recovery time can be achieved without risk.

Airway disorders and pulmonary function in snorers. A population-based study

The aim of our study was to determine the relationship between snoring, airway disorders and pulmonary function in the general population. We performed a stratified random sampling from the population (n = 92,364). Four hundred subjects agreed to participate and were invited to the clinic, where a detailed medical history, physical examination, spirometric test and maximal respiratory pressures measurements were carried out. Snoring was reported by 152 subjects (38%). Nasal obstruction and the presence of abnormal pharynx exploration were more frequent in subjects with snoring. Age, body mass index and neck circumference were significantly higher in the snorer group. In addition, we found that the non-snoring group had a significantly higher frequency of tonsillectomy during infancy and adolescence than the snorer group. We did not detect any significant difference in spirometric test values or in maximal respiratory pressure values between snorer group and non-snorer group. In conclusion, in the general population snoring is associated with nasal obstruction and abnormal pharynx exploration. Furthermore, snoring appears not to be associated with modifications in spirometric or in maximal respiratory pressure tests.

[Self-perception of health and mortality in elderly from a rural community]

OBJECTIVE

To assess the relationship between self-perception of their health and mortality in a representative sample of persons over 65 in a rural community.

DESIGN

Survival study of population with three years observance.

SETTING

A non-coastal and rural borough in Galicia.

PARTICIPANTS

408 people over 65, chosen by random sampling.

MEASUREMENTS AND MAIN RESULTS

The demographic, social and health (objective and subjective) parameters were determined through an initial survey, with subsequent follow-up to find the date and cause of death should this have occurred. Of the 404 elderly people observed, 67 (16%) died. The main causes of death were diseases of the circulatory apparatus (48%) followed by tumours. Mortality was higher in people who were older, unmarried, didn't drink alcohol, were seriously ill, had restricted mobility, consumed more medicines and had a perception of their health as poor. We found an association between self-perceived health and mortality, after adjustment for age, sex, marital status, educational level and consumption of medicines, only when we looked at the elderly without restricted mobility (RR = 2.3; 95% CI = 1.0-5.3).

CONCLUSIONS

We think that self-perception of health status can be an overall indicator of health, linked to mortality, and that in the elderly with good mobility, this association can be independent of age, sex, educational level, marital status and consumption of medicines.

The predictive value of inguinal herniography for the diagnosis and treatment of cryptorchidism

PURPOSE

We evaluated the role of a patent processus vaginalis for cryptorchidism as well as inguinal herniography as a predictor of the efficacy of human chorionic gonadotropin (HCG) treatment.

MATERIALS AND METHODS

We studied 244 boys with unilateral and 66 with bilateral cryptorchidism. All patients underwent inguinal herniography and received HCG. Nonresponders to treatment subsequently underwent orchiopexy, when processus vaginalis status, testicular position and epididymal characteristics were assessed.

RESULTS

HCG was effective for 139 of 281 testes (49.5%) with an obliterated and 0 of 95 with a patent processus vaginalis on herniography. We further evaluated herniography in accordance with orchiopexy findings of persistent unilateral and bilateral cryptorchidism in 206 boys (237 testes) after HCG. Herniography findings of processus vaginalis morphology revealed a close correlation with that reported by the surgeon after orchiopexy (p<0.000005). The incidence of a patent processus vaginalis increased as testicular position became more caudal. The processus vaginalis was obliterated in all cases of anorchia. The incidence of more severe epididymal anomalies decreased as the testicular position became more caudal. Epididymal abnormalities were more common when the processus vaginalis was patent.

CONCLUSIONS

Pretreatment herniography assessment of processus vaginalis morphology is of prognostic value for predicting the efficacy of hormone treatment, the presence or absence of testes when they are nonpalpable and future fertility.

Atherosclerosis profile and microalbuminuria in essential hypertension

Whether microalbuminuria (MA) is the result of intrarenal hemodynamic changes induced by increased systemic blood pressure (BP) or a marker of capillary leakiness at the glomerular level that reflects more generalized atherosclerotic vascular damage is still debated. To address this question, 319 patients without diabetes, 154 men and 165 women aged 57 +/- 8.6 years (range, 37 to 73 years), but with essential hypertension (EH) never treated with drugs were enrolled onto the study. Using a multiple linear regression analysis, we analyzed the prevalence of MA and its relationship with BP level as well as with other risk factors for the development of atherosclerosis. MA was present in 40% of the population studied. A univariable analysis of ambulatory BP monitoring measurements showed that only 24-hour systolic BP (P = 0.04), daytime systolic BP (P = 0. 02), and 24-hour daytime and nighttime systolic BP load (P < 0.01) predicted the presence of MA, whereas all BP variability parameters significantly predicted it. Multivariable analysis showed that only a positive family history of hypertension (P < 0.001), BMI (P < 0. 001), glucose (P < 0.001), and 24-hour systolic BP coefficient of variation (P < 0.001) independently predicted MA. In summary, the prevalence of MA in our group of patients with EH was high, presumably as a consequence of the older mean age of the population and the selection criteria. Besides being a marker of concomitant cardiovascular damage, MA was associated with a worse pattern of atherosclerotic risk factors. Although its pathophysiological meaning remains to be completely clarified, MA seems to be more related to other atherosclerosis risk factors and presumably reflects a more diffuse vascular injury.

Oximetry spectral analysis in the diagnosis of obstructive sleep apnoea

Using spectral analysis of oximetry data, we prospectively evaluated the validity of this methodology in patients clinically suspected of suffering from obstructive sleep apnoea (OSA). A total of 233 outpatients were studied. Nocturnal oximetry was performed simultaneously with conventional polysomnography for all participants. The power density of oxygen saturation was analysed using Fast-Fourier transformation of the oximetric signal. Nocturnal oximetry test results were considered as abnormal (suspicion of OSA) if a peak in the spectrum between the period boundaries 30 and 70 s was observed. A normal test result was defined as the absence of the 30-70 s peak from the spectrum. Single-blind evaluation was performed by three independent observers, and agreement of two or more of these was considered definitive. The peak amplitude and the ratio of the area enclosed in the 30-70 s peak to the total area of the spectrum (r(S)) were measured. The presence of a peak has a sensitivity of 78%, a specificity of 89%, a positive predictive value of 89% and a negative predictive value of 78%. Apnoea-hypopnoea indexes were correlated significantly with peak amplitude (r=0.74; P<0.001) and with r(S) (r=0.69; P<0.001). For a peak amplitude threshold of 0.7%(2), the sensitivity was 94% and the specificity was 65% for OSA diagnosis. Using a threshold for r(S) of 0.15, the sensitivity was 91% and the specificity was 67%. Thus the spectral analysis of nocturnal oximetry and identification of a peak at 30-70 s could be useful as a diagnostic technique for OSA subjects.

The tropicamide test in patients with dementia of Alzheimer type and frontotemporal dementia

The tropicamide test was applied to 30 patients with probable Alzheimer's disease (pAD), 12 with frontotemporal dementia (FTD) and 46 healthy subjects. One drop of 0.01% tropicamide was instilled in one eye and one drop of saline solution in the other. The pupil diameter was measured with a Goldmann pupillometer in its basal condition and 10, 15, 20, 25, 30, 35, 45 and 55 minutes afterwards. The results do not show differences between pupil dilation observed in pAD and in FTD; in both groups, from the beginning of the test, the pupil dilated more than in healthy people. A high interindividual variability was observed. The best cutoff point is 38% of interpupillary difference at minute 25 (sensitivity = 63%, specificity = 80%). If we consider the prevalence of AD in a population over 40 years old to be 1.4%, the adjusted positive predictive value of the test would be 4.2%. According to these results, the test is not a true diagnostic marker of AD.

Prevalence of sleep disordered breathing and sleep apnea in 50- to 70-year-old individuals. A survey

PURPOSE

To determine the prevalence of sleep disordered breathing (SDB) and sleep apnea syndrome (SAS) in a general population aged from 50 to 70 years.

SUBJECTS AND METHODS

We recruited 76 individuals aged between 50 and 70 years, chosen at random from the electoral census. They were invited to the clinic where a detailed medical history was taken and physical examination, ENT examination, pulmonary function tests and night time recording of respiratory variables performed.

RESULTS

The prevalence of SDB (apnea-hypopnea index >/= 5) was 28.9%, and there were no differences between men (28%) and women (30%). However, the prevalence of SAS was 6.8%, and there were differences between men (5 cases) and women (0 cases) (p = 0.0521). Subjects in the SDB group had higher systolic blood pressure than in the non-SDB group (p < 0.05).

CONCLUSIONS

SDB and SAS are common among 50- to 70-year olds. The prevalence of SDB was 28.9% and the prevalence of SAS was 6.8%.

Serum cytokines and increased total serum IgE in alcoholics

BACKGROUND

It has been reported that total serum IgE is increased in alcohol abusers, but the mechanisms responsible are not known. Production of IgE depends on B-cell stimulation by both antigens and some cytokines, particularly IL-4 and IL-13. Chronic alcoholism and alcoholic liver disease are accompanied by changes in cytokine production.

AIM OF THE STUDY

To evaluate if IgE increase in alcoholics could be associated to a ethanol-induced imbalance of the cytokine profile.

PATIENTS AND METHODS

A total of 65 patients (53 males and 12 females, aged 47 +/- 12 years), admitted to the hospital because of ethanol abstinence symptoms entered the study. On admission, total serum IgE was measured by chemiluminescent EIA and serum IL-4, IL-5, IL-6, IL-8, IL-10, IL-12, IL-13, and interferon-gamma were measured by ELISA. Data were compared with those of 40 healthy control subjects.

RESULTS

Serum IgE, IL-6, IL-8, IL-10, IL-12, and IL-13 were found to be high in alcoholic patients compared with healthy volunteers. Some parallelism was observed between serum IgE and both serum IL-10 and IL-13 were increased in alcoholics.

CONCLUSIONS

Total serum IgE elevation in alcoholics with abstinence syndrome is accompanied by an increase of some type 2 cytokines. Ethanol-induced alterations in the cytokine profile may contribute to increased IgE levels in alcoholics.

Snoring and myocardial infarction: a 4-year follow-up study

The association between snoring and myocardial infarction was studied in 1453 people of both sexes aged 20-70 years. The study was carried out in a population of 92,364 residents and the subjects were recruited using the Electoral Census. A questionnaire was sent to all participants, asking about snoring and cardiovascular risk factors. Hospital records were checked for the next 4 years to establish how many of them developed myocardial infarction. At the beginning of the follow-up study 39 patients were diagnosed with ischaemic heart disease. Of the other 1414 participants, 571 (40.4%) were snorers and 843 (59.6%) non-snorers. Twenty-one developed myocardial infarction in the snorer group and four in the non-snorer group. The snorer group presents an adjusted relative risk of myocardial infarction of 3.08 (95% CI 1.01-9.46) with respect to non-snorers. We conclude that snoring seems to be a potential risk factor for myocardial infarction.

Myoelectric activity during unilateral chewing in healthy subjects: cycle duration and order of muscle activation

STATEMENT OF PROBLEM

Craniomandibular disorders, unilateral mastication, and asymmetry of masticatory muscles appear to be related to each other. Thus, it is of interest to investigate masticatory muscle activity during unilateral mastication in healthy subjects.

PURPOSE

This study monitored contractile activity of the right and left masticatory muscles during right- and left-side gum chewing.

MATERIAL AND METHODS

Electromyographic techniques were used to determine chewing cycle duration and duration of contractile activity of the masticatory muscles (right and left masseter and anterior temporalis muscles) during unilateral chewing in 40 subjects without orofacial pain. The time-course of activation of the 4 muscles was also investigated.

RESULTS

Electromyographic traces showed extensive interindividual variation. In both right- and left-side chewing tests, and regardless of whether the masseter or the temporalis muscles were considered, mean duration of the contraction phase did not differ significantly between the working and nonworking sides. The working side temporalis contracted first, whether alone or at the same time as the other muscles.

CONCLUSIONS

In healthy subjects, no significant differences in masticatory muscle activity should be expected between either the right and left or the working and nonworking sides.

[Symptoms of sleep apnea syndrome in the general population]

The aim of this study was to determine the clinical features of patients with sleep apnea syndrome (SAS) in the general population. One hundred ten individuals were selected randomly from the census and given hospital appointments. Case histories were taken and complete physical examinations were made. Nighttime respiratory polysomnograms were performed. Twenty-two (20%) of the 110 subjects presented SAS. In the SAS group, 59.1% were habitual snorers and 22.7% reported daytime hypersomnolence. The SAS patients has a mean age of 59.6 +/- 8.8 years and 45.4% showed alterations of the pharynx. No differences in spirometric variables were observed. Only age and daytime hypersomnolence predicted SAS in the multivariate analysis. We conclude that the prevalence of snoring, daytime hypersomnolence, pharyngeal alterations are higher in patients with SAS. The patients are also older. Only age and daytime hypersomnolence predicted of SAS.