Inherited p40phox deficiency differs from classic chronic granulomatous disease

Biallelic loss-of-function (LOF) mutations of the NCF4 gene, encoding the p40phox subunit of the phagocyte NADPH oxidase, have been described in only 1 patient. We report on 24 p40phox-deficient patients from 12 additional families in 8 countries. These patients display 8 different in-frame or out-of-frame mutations of NCF4 that are homozygous in 11 of the families and compound heterozygous in another. When overexpressed in NB4 neutrophil-like cells and EBV-transformed B cells in vitro, the mutant alleles were found to be LOF, with the exception of the p.R58C and c.120_134del alleles, which were hypomorphic. Particle-induced NADPH oxidase activity was severely impaired in the patients' neutrophils, whereas PMA-induced dihydrorhodamine-1,2,3 (DHR) oxidation, which is widely used as a diagnostic test for chronic granulomatous disease (CGD), was normal or mildly impaired in the patients. Moreover, the NADPH oxidase activity of EBV-transformed B cells was also severely impaired, whereas that of mononuclear phagocytes was normal. Finally, the killing of Candida albicans and Aspergillus fumigatus hyphae by neutrophils was conserved in these patients, unlike in patients with CGD. The patients suffer from hyperinflammation and peripheral infections, but they do not have any of the invasive bacterial or fungal infections seen in CGD. Inherited p40phox deficiency underlies a distinctive condition, resembling a mild, atypical form of CGD.

Transfer factor and allergy

Although various mechanisms involving antibodies and various cell types participate, a Thl and Th2 cells imbalance seems to play a central role for allergy development. Other lymphocyte subpopulations, such as Th17, CD4 FOXP3, and Th9 positive regulatory T lymphocytes may also be involved in the allergic response. Regulatory processes are an appealing target for therapeutic approaches aiming to solve allergic reactions by restoring the delicate balance within the immune system. Transfer factor (TF) or dialyzable leukocyte extract is meant to transfer cell-mediated immunity from immune competent donors to unsensitized or deficient recipients. A PubMed search on the current knowledge on TF indicates that TF may restore the Th1/Th2 balance and improve immune regulatory mechanisms of patients receiving it. Our preliminary results demonstrate that TF induces mRNA expression of IFN-g, osteopontin, RANTES, and hBD-2 in human healthy subjects. TF has been used to treat a variety of immune dysfunction related-pathologies, such as allergy, autoimmunity, immunodeficiencies, infectious diseases and tumors. Patients receiving TF together with their conventional treatment often have better clinical evolution than without it, as we have witnessed, adding TF to the usual medical treatment of allergic diseases as an attempt to provide allergic patients with those regulatory elements that they apparently lack but require to achieve properly regulated immune responses and thus obtain a faster and better resolution of allergic reactions.

Prevalence of pain in the Spanish population: telephone survey in 5000 homes

Pain has become the most common accompanying symptom in patients seeking medical advice, and it is one of the main issues in public health. In Spain, there are no reliable data about the impact of pain in general population. The aim of the study was to estimate the prevalence of acute and chronic pain in the Spanish general population. An epidemiological observational population-based cross-sectional study was carried out by means of a telephone survey. Multistep stratified quota-adjusted sampling was performed with people aged 18-95 years. A computer-assisted questionnaire was administered, covering physical pain symptoms, site, frequency, perceived cause, therapeutic measures and interference with daily life activities. There were 11,980 useful contacts, with 5000 effective interviews (42% of useful sample). Of the interviewees, 29.6% (95% confidence interval, 28.3-30.8%) reported having had pain the day before (women, 37.6%; men, 20.9%) and 43.2% the week before. Most common pain sites were lower extremities (22.7%) and back (cervical and lumbar levels) (21.5%), followed by head (20.5%). Frequency of pain increased with age, reaching 42.6% for people older than 65 years. Among people complaining of pain during the last day or week, duration of symptoms was higher than 3 months in 54% (chronic pain), representing 23.4% of the Spanish general population; most common causes of chronic pain were arthritis, rheumatism and migraine. Regarding treatment, 61.7% of people complaining of pain said they were taking drugs. Source of drug treatment advice was a physician or a nurse in 66.4% of cases and self-prescription in 29%. It is concluded that pain, particularly chronic pain, has a high prevalence in the Spanish general population and a significant impact on occupational and social relationships.

An exploratory multivariate approach to drug consumption patterns in young people based on primary socialization theory

Drug consumption patterns and their psychosocial conditioning factors are explored on the basis of Primary Socialization Theory (PST), through the application of a questionnaire to a representative sample (N= 650) of the young population (age 15 to 29 years) in the Madrid Region. Cluster analysis identifies five consumption groups. Discriminant analysis, including indicators about subject's integration in primary socialization environments, beliefs about the effects of drugs, indicators of psychosocial wellbeing, and variables related to leisure time, allows 67.45% of correct consumption group prediction. Complex associations between drug use, socialization environments and psychosocial wellbeing are found, calling into question approaches establishing cumulative or unidimensional relationships between posited "risk factors" and drug consumption.

Organ donation and family decision-making within the Spanish donation system

This study analyses the variables associated with the decisions made by families of potential organ donors to give or deny consent for the extraction of organs. Different indicators were recorded in 68 cases of family interview for petition of consent carried out in 13 Spanish hospitals. Those variables showing the strongest relation with family decision (donation/refusal of consent) are knowledge shown by the family about the deceased's wishes with regard to donation (p<0.001), family relationship climate (p<0.01), expression of family's satisfaction level with medical attention received (p<0.01) and number of relatives present at the consent request interview (p<0.01). Logistic regression on family decision with considered variables correctly predicted relatives' final choice in 98.4% of cases. In turn, multivariate exploratory analysis highlights a potential association between the expression of the deceased's wishes and several concurrent variables in the process (satisfaction with personal treatment and medical attention received, emotional reactions in the interviews of notification of death and consent request). It also shows that patterns of reaction and family participation in this process may vary according to the sex of the deceased relative. Results suggest that both educational efforts devoted to promoting a positive attitude toward donation in the general population and the training of health professionals involved in the generation of organs may be key factors in reducing organ shortage.

Criteria used by general practitioners in prescribing prokinetic or antisecretory drugs in patients with functional dyspepsia

OBJECTIVE

To analyze the clinical factors considered by general practitioners for the prescription of prokinetic or antisecretory drugs in patients with functional dyspepsia (FD), and to assess therapeutic outcomes and factors predicting effectiveness.

DESIGN

Multicentric, prospective and observational study.

PATIENTS

1,021 patients with FD were included. One hundred and thirty-two (132) were excluded from the analysis because they were taking ASA or NSAID. Patients were classified according to their predominant symptoms as reflux, ulcer, dysmotility or non-specific. At the physician discretion, treatment with alkali drugs was prescribed to 38 patients, prokinetic drugs to 574, antisecretory drugs to 123 and a combined therapy to 154. One month later, patient self-perception of symptomatic improvement was evaluated in patients treated with prokinetic drugs and antisecretory drugs.

RESULTS

85% of the patients reported symptomatic improvement after one month of treatment. Patients with non-specific FD had lower improvement rates regardless of the drug used (prokinetic or antisecretory) (77%) compared to all the other types (p = 0.03). Prescription of prokinetics was associated to female gender (OR: 0.43; 95% CI: 0.28-0.66) and early satiety (OR: 2.5; 95% CI: 1.6-4.1). A longer symptomatic evolution (OR 0.92: 95% CI: 0.88-0.97) was the only independent predictive factor of a poor response to prokinetic drugs.

CONCLUSIONS

Among patients with FD attended by general practitioners, female gender and early satiety symptom were associated to the prescription of prokinetic drugs. Early symptomatic effectiveness rates for prokinetic or antisecretory drugs alike were high (85%). Patients with non-specific dyspepsia or long symptomatic evolution showed less favorable symptomatic response to prokinetic drugs.

Validation of the Spanish version of the Glasgow Dyspepsia Severity Score

OBJECTIVE

To translate, adapt and validate the Spanish version of the Glasgow Dyspepsia Severity Score (GDSS).

METHOD

The translation into Spanish and the adaptation of the scale was carried out by specialized medical translators. The comprehensibility of the translated scale was assessed by two independent observers and by the research team. GDSS includes eight items and was filled out once by 40 healthy subjects (control group) and twice by 131 patients with functional dyspepsia. After the first measurement, patients were prescribed a H2 blocker (roxatidine) for 2 months. A second evaluation was carried out 6 months after the beginning of the treatment.

RESULTS

The comprehensibility of the questionnaire was good. It showed acceptable internal consistency both for the control group (0.6) and for the patients at the inclusion visit (0.6) and good consistency for the patients at the 6 month follow-up evaluation (0.8). After treatment, the overall score decreased almost to half (p < 0.0001) in the patients, thus confirming the effectiveness of the treatment 4 months after its discontinuation, although their score was still higher than the score of the control group (p < 0.001).

CONCLUSIONS

Results suggest the usefulness of including the GDSS scale in the dyspeptic symptoms recording protocols, since it allow to estimate, with appropriate objectivity and in an easy and quickly way, the degree of impairment due to dyspeptic symptoms, as well as the perception of well-being and the effectiveness of a given therapy.

[Spanish public opinion concerning organ donation and transplantation]

BACKGROUND

Information, beliefs, attitudes and the motivations of the Spanish population regarding organ donation and transplantation were studied to facilitate possible programs directed at the promotion of organ donation.

METHODS

The Psychosocial Aspects of Donation Questionnaire (PADQ) was applied by personal interview to a representative sample of the Spanish population (n = 1,288).

RESULTS

Sixty-five percent of the population was found to be in favor of donating their own organs while only 6.1% had an organ donation card. The main reasons inducing those questioned to be donors were solidarity (47%) and reciprocity (29%). The fundamental reasons hindering donation were not knowing how to be a donor (34%) and the fear of the possibility of an only apparent death (24%). Ninety-three percent would donate the organs of a dead relative if they knew that this person was in favor of donating. Only 52% would donate if they did not know the will of the departed relative. The younger subjects with a higher level of education, higher socioeconomic status, and better informed evaluated donation and transplantation favorably and those with direct experience showed a more favorable inclination to the donation of their own organs.

CONCLUSIONS

Educational programs directed at the population should provide information on the efficacy and the profitability of transplantation presenting real cases and emphasizing the quality of life obtained by the receptors. Incentives to organ donation should be directed at reasons of solidarity and reciprocity. Family debate of the matter should be promoted as should the establishment of clear and accessible procedures for the obtaining of a donor card and thereafter the communication of the holders as to their decision to their respective relatives.

Subpopulations of T cells in lung biopsies from patients with pigeon breeder's disease

Monoclonal antibodies were used to determine surface phenotypes of T cells in tissue obtained by open lung biopsies from patients with chronic hypersensitivity pneumonitis (pigeon breeder's disease). The results indicate that an increased number of suppressor/cytotoxic cells is present in these patients when compared with the number of helper/inducer cells. These findings, which were present within the interstitium, are consistent with those found in bronchoalveolar lavage of patients with this disease. In addition, in two-thirds of the patients there was a greater total number of helper and suppressor cells than the total count for Pan T cells. A possible interpretation of these findings might be the presence of both markers in the same cell.