Differences and similarities between COVID-19 related-headache and COVID-19 vaccine related-headache. A case-control study

INTRODUCTION

Headache is a frequent symptom at the acute phase of coronavirus disease 2019 (COVID-19) and also one of the most frequent adverse effects following vaccination. In both cases, headache pathophysiology seems linked to the host immune response and could have similarities. We aimed to compare the clinical phenotype and the frequency and associated onset symptoms in patients with COVID-19 related-headache and COVID-19 vaccine related-headache.

SUBJECTS AND METHODS

A case-control study was conducted. Patients with confirmed COVID-19 infection and COVID-19-vaccine recipients who experienced new-onset headache were included. A standardised questionnaire was administered, including demographic variables, prior history of headaches, associated symptoms and headache-related variables. Both groups were matched for age, sex, and prior history of headache. A multivariate regression analysis was performed.

RESULTS

A total of 238 patients fulfilled eligibility criteria (143 patients with COVID-19 related-headache and 95 subjects experiencing COVID-19 vaccine related-headache). Patients with COVID-19 related-headache exhibited a higher frequency of arthralgia, diarrhoea, dyspnoea, chest pain, expectoration, anosmia, myalgia, odynophagia, rhinorrhoea, cough, and dysgeusia. Further, patients with COVID-19 related-headache had a more prolonged daily duration of headache and described the headache as the worst headache ever experienced. Patients with COVID-19 vaccine-related headache, experienced more frequently pain in the parietal region, phonophobia, and worsening of the headache by head movements or eye movements.

CONCLUSION

Headache caused by SARS-CoV-2 infection and COVID-19 vaccination related-headache have more similarities than differences, supporting a shared pathophysiology, and the activation of the innate immune response. The main differences were related to associated symptoms.

Upgrading of solid recovered fuel (SRF) by dechlorination and catalytic pyrolysis over nanocrystalline ZSM-5 zeolite

Globally increasing concern related to municipal solid waste generation is encouraging research efforts on developing alternative routes to valorize mixed refused wastes. In this way, catalytic pyrolysis is emerging as an interesting and efficient technology due to its great flexibility in terms of feedstock. In the current work, upgrading of a Solid Recovered Fuel (SRF) has been investigated by catalytic pyrolysis over nanocrystalline ZSM-5 zeolite (n-ZSM-5), paying special attention to dechlorination effects due to the high Cl content of the raw waste. Thus, pretreatment of the SRF by water washing and mild thermal processing allows for a significant reduction of the Cl concentration. Regarding the catalytic pyrolysis step, the best conditions correspond with a temperature of 400 °C in the catalyst bed and 0.50 catalyst/SRF mass ratio, which lead to ca. 30 wt% oil yield (rich in aromatic hydrocarbons) together with about 40 wt% gas yield (rich in C3-C4 olefins). Accordingly, these products could find use as raw chemicals or for the production of advanced fuels. In addition, zeolite reutilization has been tested for several cycles, denoting a progressive modification of the products distribution because of coke deposition. However, an almost total recovery of the n-ZSM-5 zeolite catalytic performance is achieved after regeneration by air calcination, affording the production of an oil fraction with a Cl content as low as 40 ppm.

Hospital environment hygiene nurse: a key player to reduce healthcare associated infections by multi-resistant organisms

Background

Multi-Resistant Organisms (MRO) healthcare-associated infections (HAI) are closely associated with contamination of surfaces. Outsourced companies are usually in charge of both hospital hygiene and environmental hygiene personnel (EHP) supervision, which can result in bias.

Methods

A quasi-experimental study. The intervention was to add the "Hospital Environment Hygiene Nurse" (HEHN). MRO acquired infection rate and MRO acquired colonized rate were calculated, pre and post intervention. Confounding variables: MRO carriage rate upon admission and hospitalisation days median (HDM) were calculated.

Results

Median length of stay: 5 days (p=0.85, interquartile range=6 days). Carriage rate upon admission: 4.3% for pre-intervention vs 5.3% post-intervention, dif. (CI 95%): 1% (-1% to 2.9%) p=0.33. MRO acquired infection rate: 4.3% for pre-intervention vs. 2% post-intervention, Standardized Infection Ratio (SIR) (CI 95%): 0.47 (0.25 to 0.87). MRO acquired colonization rate:10.4% for pre-intervention vs. 7.9% post-intervention, SIR (CI 95%): 0.75 (0.53 to 1.07).

Conclusions

As a reinforcement to standard infection control (IC) measures in place, the incorporation of an exclusive, full-time HEHN was significantly useful to reduce MRO HAI.

ZrO2-SBA-15 catalysts for the one-pot cascade synthesis of GVL from furfural

Controlling the zirconia coating thickness in ZrO₂-SBA-15 materials allows tuning their catalytic performance in the one-pot transformation of furfural into GVL.

Experimental and theoretical study of the collisional quenching of S(1D) by Ar

We present an experimental and theoretical investigation of the deactivation rate of S(¹D) atoms by collisions with argon.

Relative stabilities of HCl•H2SO4•HNO3 aggregates in polar stratospheric clouds

Strong acids such as HCl (C), HNO3 (N) and H2SO4 (S) acquire relevance in Polar Stratospheric Clouds (PSCs) and aerosols in which nucleation processes occur. Ab initio quantum chemical studies of aggregates were performed for these strong acids. Structures were calculated using DFT methods with the B3LYP hybrid functional and aug-cc-pVTZ basis set. As an initial constraint, an H2SO4 moiety was placed in all candidate structures. A total of 11 optimized structures was found: a global minimum (CSN-a) plus ten local minima on the Potential Energy Surface (PES). The global minimum aggregate gave four hydrogen bonds, yielding a hexagonal ring in its structure. HNO3 acts as proton donor in all clusters; nevertheless, using trans-H2SO4 as the proton donor yielded the most stable structures, whereas HCl acts mainly as a proton donor/acceptor. Real harmonic frequencies, IR spectra, and inter-monomeric parameters were obtained. CSN-a symmetric stretching modes were shifted to 2805.56 cm(-1) and 3520.00 cm(-1) for H-Cl modes, while O-H modes shifted to 3256.87 cm(-1) and 3362.47 cm(-1). On the other hand, relative stabilities improved for 5 of the 11 aggregates when the temperature decreased from 298 K to 210 K, 195 K and 188 K. The aggregate CSN-f remained unstable only at 210 K. Moreover, the relative Gibbs free energy, ΔG(0-298K) was -9.26 kcalmol(-1) with respect to CSN-a; relative reaction Gibbs free energy [Δ(ΔG)] values ranged from 0.0 at 298 K, to -6.9 kcalmol(-1) at 188 K. It seems that CSN aggregates remain slightly more stable than CNS aggregates with a HNO3 moiety when the temperature decreases from 298 to 188 K. Five structures remained relatively stable under both study conditions.

Antibiotic resistance patterns of Escherichia coli isolates from different aquatic environmental sources in León, Nicaragua

Antibiotic-resistant bacteria have emerged due to the selective pressure of antimicrobial use in humans and animals. Water plays an important role in dissemination of these organisms among humans, animals and the environment. We studied the antibiotic resistance patterns among 493 Escherichia coli isolates from different aquatic environmental sources collected from October 2008 to May 2009 in León, Nicaragua. High levels of antibiotic resistance were found in E. coli isolates in hospital sewage water and in eight of 87 well-water samples. Among the resistant isolates from the hospital sewage, ampicillin, chloramphenicol, ciprofloxacin, nalidixic acid, trimethoprim-sulphamethoxazole was the most common multi-resistance profile. Among the resistant isolates from the wells, 19% were resistant to ampicillin, ceftazidime, ceftriaxone, cefotaxime, chloramphenicol, ciprofloxacin, gentamicin, nalidixic acid and trimethoprim-sulphamethoxazole. E. coli producing ESBL and harbouring bla(CTX-M) genes were detected in one of the hospital sewage samples and in 26% of the resistant isolates from the well-water samples. The bla(CTX-M-9) group was more prevalent in E. coli isolates from the hospital sewage samples and the bla(CTX-M-1) group was more prevalent in the well-water samples.

Semi-targeted plasma proteomics discovery workflow utilizing two-stage protein depletion and off-line LC-MALDI MS/MS

A quantitative proteomics workflow was implemented that provides extended plasma protein coverage by extensive protein depletion in combination with the sensitivity and breadth of analysis of two-dimensional LC-MS/MS shotgun analysis. Abundant proteins were depleted by a two-stage process using IgY and Supermix depletion columns in series. Samples are then extensively fractionated by two-dimensional chromatography with fractions directly deposited onto MALDI plates. Decoupling sample fractionation from mass spectrometry facilitates a targeted MS/MS precursor selection strategy that maximizes measurement of a consistent set of peptides across experiments. Multiplexed stable isotope labeling provides quantification relative to a common reference sample and ensures an identical set of peptides measured in the set of samples (set of eight) combined in a single experiment. The more extensive protein depletion provided by the addition of the Supermix column did not compromise overall reproducibility of the measurements or the ability to reliably detect changes in protein levels between samples. The implementation of this workflow is presented for a case study aimed at generating molecular signatures for prediction of first heart attack.

Galpha12 regulates protein interactions within the MDCK cell tight junction and inhibits tight-junction assembly

The polarized functions of epithelia require an intact tight junction (TJ) to restrict paracellular movement and to separate membrane proteins into specific domains. TJs contain scaffolding, integral membrane and signaling proteins, but the mechanisms that regulate TJs and their assembly are not well defined. Galpha12 (GNA12) binds the TJ protein ZO-1 (TJP1), and Galpha12 activates Src to increase paracellular permeability via unknown mechanisms. Herein, we identify Src as a component of the TJ and find that recruitment of Hsp90 to activated Galpha12 is necessary for signaling. TJ integrity is disrupted by Galpha12-stimulated Src phosphorylation of ZO-1 and ZO-2 (TJP2); this phosphorylation leads to dissociation of occludin and claudin 1 from the ZO-1 protein complex. Inhibiting Hsp90 with geldanamycin blocks Galpha12-stimulated Src activation and phosphorylation, but does not affect protein levels or the Galpha12-ZO-1 interaction. Using the calcium-switch model of TJ assembly and GST-TPR (GST-fused TPR domain of PP5) pull-downs of activated Galpha12, we demonstrate that switching to normal calcium medium activates endogenous Galpha12 during TJ assembly. Thrombin increases permeability and delays TJ assembly by activating Galpha12, but not Galpha13, signaling pathways. These findings reveal an important role for Galpha12, Src and Hsp90 in regulating the TJ in established epithelia and during TJ assembly.

Resistance of uropathogens in symptomatic urinary tract infections in León, Nicaragua

Management of urinary tract infections (UTI) in Central America and especially Nicaragua, is complicated by the lack of knowledge about the antibiotic resistance of uropathogens. We conducted a prevalence study to gain more insight into the aetiology, bacterial resistance and risk factors for symptomatic UTI in the region of León, Nicaragua. In 2002, all consecutive patients with UTI symptoms and pyuria >/=10 WBC/hpf were admitted to the study. Positive cultures from midstream urine specimens were defined as >/=10(5) cfu/ml of a single uropathogen. Susceptibility tests were performed with disc diffusion tests using the Kirby-Bauer method and broth microdilution using National Committee for Clinical Laboratory Standards criteria both in León and a reference laboratory in Utrecht. A positive culture was present in 62 of 208 study subjects (30%). Escherichia coli (56%), Klebsiella spp. (18%) and Enterobacter spp. (11%) were the most frequent pathogens isolated. Presence of cystocele, incontinence and increasing age were risk factors for bacterial UTI. E. coli was least resistant to ceftriaxone, amikacin and nitrofurantoin (>90% susceptible). We observed high resistance rates in E. coli to amoxicillin (82%, MIC(90) 128 mg/l), trimethoprim-sulphamethoxazole (TMP-SMX) (64%, MIC(90) 32 mg/l), cephalothin (58%, MIC(90), 32 mg/l), ciprofloxacin (30%; MIC(90), 32 mg/l), amoxicillin/clavulanate (21%, MIC(90) 8 mg/l) and gentamicin (12%, MIC(90) 2 mg/l). Our results suggests that community acquired uropathogens in Nicaragua are highly resistant to many antimicrobial agents. The use of amoxicillin, trimethoprim-sulphamethoxazole and cephalothin against uropathogens needs to be reconsidered. High quinolone resistance rates among E. coli in Nicaragua gives cause for great concern.

Protective effect of vitamin C against the ethanol mediated toxic effects on human brain glial cells

It is now known that chronic consumption of excessive amounts of alcohol is a major source of social and medical problems. Ethanol-mediated glial cell activation may lead to neuron damage in many ways, including the formation of free radicals and production of pro-inflammatory molecules. Vitamin C (vit-C) is an essential dietary nutrient required as a co-factor for many enzymes and a very efficient antioxidant, protecting cells against free radical-mediated damage. The objective of this study was to evaluate the protective effects of vit-C on glial cell activation and viability against ethanol-mediated toxicity. Human brain astrocyte cells (HA) were exposed to ethanol (0, 50, and 350 mmol/L) for 24 h. We found that glial cells incubated with different concentrations of vit-C increase their vit-C in a dose-dependent manner. HA incubated with 0, 50 or 350 mmol/L of ethanol for up to 24 h showed toxic effects that were proportional to the levels of ethanol in the medium, HA showed increased levels of heat shock protein (Hsp70). However, cells enriched with vit-C before being exposed to ethanol, were better protected against the alcohol-mediated toxicity than non-supplemented cells, and showed significantly lower concentrations of Hsp70. Ethanol also caused increased expression of cyclooxygenase-2 (COX-2) and synthesis of prostaglandin E2 (PGE2), which were reduced by vit-C. In summary, HA supplemented with vit-C were significantly more resistant to the ethanol-mediated toxic effects.

Effects of fruits and vegetables on levels of vitamins E and C in the brain and their association with cognitive performance

Demographic trends, together with improvements in general health and life expectancy, will greatly change the population structures of most industrialized and developing countries during the next 50 years. By 2050, approximately 30% of people in industrialized countries will be 65 years old or older. Aging is associated with increased risk for neurodegenerative disorders, which can cause significant cognitive and physical impairment and shortened lifespan, thereby causing a burden to society. Diets rich in fruits and vegetables have been shown to improve human well-being and to significantly delay the development of pathologic processes, including neurodegenerative disorders. Foods are important sources of micronutrients, including vitamins E and C, which play crucial roles in optimal cell function. Vitamin E is an important component of biologic membranes, and vitamin C acts as a cosubstrate for several enzymes. Both E and C are involved in the antioxidant defense of cells and actively contribute to the redox status of the cell. The levels of vitamins E and C provided by diet vary significantly. Vegetable oils, nuts and seeds are the main dietary sources of vitamin E, whereas fruits and vegetable are the primary sources of vitamin C. Human trials of varying doses of vitamins E and C, including low, supplemental, and pharmacologic, have found that these nutrients may improve immunity, vascular function, and brain performance. An optimal intake of these nutrients has been associated with decreased risk of developing cognitive impairments associated with aging. This paper will review the scientific literature on the sources, tissue levels and roles of vitamins E and C in cognitive performance and pathologic processes of the central nervous system in the elderly.

Calibrated serological techniques demonstrate significant different serum response rates to an oral killed cholera vaccine between Swedish and Nicaraguan children

Serum responses to oral cholera vaccines were assessed in three paediatric vaccine trials, two in León, Nicaragua and one in Stockholm, Sweden. A calibrated anti-cholera toxin B subunit (CTB) IgA ELISA was used together with an assay for vibriocidal antibodies. Swedish children had lower pre-vaccination levels of antibody, but serum responses were more pronounced in Swedish children than in Nicaraguan children. Post-vaccination levels of anti-toxin antibody were generally above those found after natural infections with enterotoxigenic Escherichia coli, that cross-reacts serologically with Vibrio cholerae. Adverse events seen after vaccination were generally mild and of little clinical significance.

[Helicobacter pylori CagA antibodies in various gastroduodenal diseases from 2 different populations]

BACKGROUND

We aimed at studying the prevalence of infection by H. pylori along with the CagA status of the strain in two populations (Spain and Cuba) and the relationship with several gastroduodenal lesions. We also studied the role of the test-and-scope strategy in the decrease of unnecessary gastroscopies.

PATIENTS AND METHOD

100 dyspeptic patients from Spain and 100 from Cuba were included. At endoscopy, antrum biopsies were obtained and H. pylori status was evaluated by rapid urease test. CagA status of the strain was assessed by Western Blot. The test-and-scope strategy was evaluated according to H. pylori infection and CagA status.

RESULTS

Mean age of Spanish and Cuban patients was 45 (16) and 46 (15) years, respectively. Dyspeptic symptoms were similar in both groups. Prevalence of infection by H. pylori was higher in Cuban (73%) than in Spaniards (40%) (p < 0.01). Prevalence of CagA+ strains was also higher in Cuban (81 vs. 27%) (p < 0.01). Among CagA+ Spanish patients, 11% had a duodenal ulcer, whereas this lesion was not found in any CagA patient (p < 0.05). Duodenal ulcer prevalence in CagA+ and CagA Cuban patients was 31 and 0%, respectively (p < 0.05). The test-and-scope strategy would have avoided endoscopy in only 24% Spanish and 15% Cuban patients.

CONCLUSIONS

The prevalence of H. pylori infection is higher in Cuban than in Spanish dyspeptic patients. H. pylori strains of Cuba seem to be more virulent than those of Spain. CagA protein is a marker of peptic ulcer in both populations. These differences could partly explain the variations in the prevalence of different gastroduodenal disorders between both countries. The test-and-scope strategy appears to avoid a low number of endoscopies.

Abnormal CD40 ligand (CD154) expression in human immunodeficiency virus-infected children

The CD40 ligand (CD154), expressed primarily on activated CD4-positive T cells, is a costimulatory molecule involved in B-cell proliferation, germinal center formation, and immunoglobulin class switching. Since B-cell abnormalities including hypergammaglobulinemia and abnormal antibody-specific immune responses are prominent and occur early during the course of pediatric human immunodeficiency virus (HIV) infection, we measured the baseline levels and the induced levels of expression of CD154 on CD3(+) CD8(-) (T helper cells) in HIV-infected children and uninfected children born to HIV-positive mothers. The percentage of CD154(+) T helper cells activated in vitro and the level of CD154 expressed per T helper cell (mean fluorescent channel [MFC]) were significantly lower in the HIV-infected children than in the uninfected control group (77% +/- 3% versus 89% +/- 1%, respectively [P < 0.002], and 261 +/- 174 versus 415 +/- 130 MFC, respectively [P < 0.03]). The levels of CD154 expressed on resting T helper cells in the HIV-infected group were not significantly different from the levels observed in the control group. In the HIV-infected children, the level of CD154 on activated T helper cells correlated with the level of immunodeficiency, as assessed by the CD4 T-cell levels (correlation coefficient [r] = 0.707, P = 0.003), but did not correlate with the viral load or with any of the serum immunoglobulin concentrations measured in this group of HIV-infected children. The baseline level of CD154 expressed on T helper cells did, however, correlate with the concentration of immunoglobulin A in serum. We conclude that HIV-infected children have impaired regulation of CD154 expression which may contribute to the immune dysregulation commonly observed.

[Exfoliative cytology for diagnosis of Helicobacter pylori]

The development of more reliable diagnostic methods has undoubtedly contributed to a better knowledge of the epidemiology and role of Helicobacter pylori (Hp) in the physiopathology of upper digestive tract diseases. Non abrasive and abrasive diagnostic methods have been used; among the latter, the exfoliating of abrasive cytology has been very popular during the last years. This fact motivated us to do this investigation. A descriptive-prospective study was developed in which the sample was composed by 235 patients of both sexes. The patients underwent gastro-duodenoscopy on account of dyspeptic symptoms and in order to determine the presence of Hp and its association with endoscopically diagnosed gastritis, with or without duodeno-gastric reflux, using the SYDNEY classification system. The frequency of Hp was assessed and the density of this microorganism was correlated with the hystological type of chronic gastritis following the above-mentioned classification. As a method of diagnosis of this disease, cytology showed a sensibility of 72% a specificity of 100% and an efficiency of 77% compared with histology, that was considered the "golden test". It was histologically proved that there exists a close relationship between chronic gastritis and the presence of Hp in the gastric antrum and that when the density of the bacterial population increases, the severity of chronic gastritis increases too. This germ may show up in histologically normal mucose, being able to provoke dyspeptic symptoms and colonizing the gastric antrum independently of the presence of duodeno-gastric reflux.

[Effect of microcrystalline cellulose on alkaline gastritis due to bile reflux]

Biliary acids present in gastric content due to a duodena-gastric reflux have been blamed for attacking the gastric mucosa through detergent action on the defensive barrier. This harmful action produces an inflammatory lesion on this mucosa, resulting in a chronic gastritis which is clinically expressed by epigastric pain, heartburn and vomits of biliar aspect among other symptoms, and it has constituted a clinical entity named Alcaline Gastritis by Duodenal-gastric Reflux, more recently, Reactive Gastritis according to the Sydney System. Among dietetic fibers, cellulose has been reported in recent investigations as most active in capturing and inactivating biliary acids: this constitutes a cytoprotective action on the stomach mucosa of patients who suffer this pathology. Concerning these aspects, we studied 50 patients with alcaline gastritis, excluding those who have H. pylori. The patients were diagnosed by endoscopy studies, dosage of total biliary acids in gastric content and biopsy and were divided into two groups of 25 subjects each. The first group (A) received powdered corn starch and the second group (B) powdered microcrystalline cellulose dosed 5 g/day during three months. The results showed that total biliary acids in gastric content decreased at the end of treatment mostly in patients treated with microcellulose, even though there was no statistical significance. From the clinical view point of vue, there was a highly satisfactory response in pain, vomits and heartburn after microcellulose treatment. The endoscopic inflammatory located in the antral region and diffusely, in the whole gastric mucosa, quantitatively improved and there was a significant difference in the antral location. The histological findings at the end of the treatment in either group showed no evolutive variation in the comparative study of the lesions found at the beginning of the treatment. Results are shown in tables.

Development of a rapid whole blood flow cytometry procedure for the diagnosis of X-linked hyper-IgM syndrome patients and carriers

The CD40 ligand expressed on activated T cells plays a pivotal role in B cell proliferation and differentiation. Mutations in the CD40 ligand gene, which alter its expression on the surface of activated T cells, are associated with the X-linked form of Hyper-IgM syndrome (XHIM). A rapid and simple, three-color whole blood flow cytometry procedure was developed for maximal expression and detection of the CD40L on the surface of in vitro activated CD4+ T cells. Approximately 90% of in vitro activated CD4+ T cells obtained from healthy controls expressed the CD40L compared to only 5% of in vitro activated CD4+ T cells obtained from the XHIM patients. The CD40L was expressed on approximately 50% of the in vitro activated CD4+ T cells obtained from the mothers of XHIM patients, consistent with a diagnosis of their carrier status. This is the first report of a whole blood procedure adapted for routine clinical use which is able to detect abnormal CD40L expression in XHIM patients and carriers.

Rotavirus infections in young Nicaraguan children

BACKGROUND

Rotavirus is an important cause of dehydrating diarrhea in young children throughout the world. Knowledge about frequency of reinfections, development of immunity to the virus and the possible protective effect of breast milk is important, in particular in relation to possible strategies for immunization.

METHODS

A prospective study of rotavirus infections in a cohort of 235 infants followed from birth until 2 years of age was performed in León, Nicaragua. Fecal and serum specimens were collected at specified times, and stools were also obtained during episodes of diarrhea. Fecal specimens were screened by rotavirus antigen detection and serum and colostral specimens were analyzed by isotype-specific rotavirus antibody enzyme-linked immunosorbent assay.

RESULTS

As judged by anti-rotavirus IgA antibody seroconversion and/or demonstration of rotavirus antigen in fecal specimens, > 50% of the babies had evidence of past rotavirus infection by the age of 2 months. The total incidence of rotavirus infections, including many reinfections, was 0.7 infection/child-year, of which only 17% were associated with diarrhea. The time from birth to the first demonstration of rotavirus in stool samples correlated significantly with the concentration of anti-rotavirus IgA antibodies in colostrum. There was also a tendency toward a relationship between long duration of breast-feeding and asymptomatic infection.

CONCLUSIONS

Rotavirus infections are acquired very early in infants in León, Nicaragua, and reinfections are common. Most infections are asymptomatic. Breast milk appears to confer partial protection against rotavirus infection, probably mediated by specific IgA antibodies. To be effective rotavirus vaccination would probably have to be given at a very early age to infants in developing countries.

Analysis of incidence of infection with enterotoxigenic Escherichia coli in a prospective cohort study of infant diarrhea in Nicaragua

Diarrheal episodes with enterotoxigenic Escherichia coli (ETEC) were prospectively monitored during the first 2 years of life in a cohort of 235 infants from Leon, Nicaragua. ETEC was an etiological finding in 38% (310 of 808) of diarrheal episodes and in 19% (277 of 1,472) of samples taken as asymptomatic controls at defined age intervals (P = <0.0001). The majority of diarrheal episodes (80%) occurred before 12 months of age. The major ETEC type was characterized by colonization factor CFA I and elaboration of both heat-labile enterotoxin and heat-stable enterotoxin (ST). The proportion of E. coli strains with CFA I was significantly higher in cases with diarrhea (P = 0.002). The second most prevalent type showed putative colonization factor PCFO166 and production of ST. The prevalence of PCFO166 was approximately 20%, higher than reported before. Children with a first CFA I episode contracted a second ETEC CFA I infection 24% of the time, compared with 46% for ETEC strains of any subtype. Most of the ETEC episodes were of moderate severity, and only 5% (15 of 310) were characterized as severe. In conclusion, our results give valuable information for the planning of intervention studies using ETEC vaccines.

[Pulmonary torsion of the right superior lobe: an unusual complication secondary to surgery]

Pulmonary torsion is a serious complication consisting of the rotation of the pulmonary parenchyma upon its vascular pedicle. Torsion is usually related to lung surgery and may lead to death. Early diagnosis allows for the rapid treatment that is essential for preventing death and decreasing associated complications.

Prevalence and characteristics of severe rotavirus infections in Nicaraguan children

We analyzed the prevalence of rotavirus in 296 children age between 3 and 36 months who were hospitalized in 1994 with severe gastro-enteritis at two health centres for diarrhoea treatment in León, Nicaragua. Enteric viruses were detected in 96 (32.4%) of the children and rotaviruses were the most common pathogens detected in 84 (28%). The majority of rotavirus infections occurred in children less than 1 year old and all strains isolated belonged to subgroup II and had 'long' RNA patterns. Molecular epidemiology of 55 rotavirus strains revealed that all had the same RNA migration pattern and serotyping of 37 strains by PCR technology revealed that all isolates belonged to serotype 3. A significant observation was that only one electropherotype of rotavirus circulated. No non-group A rotaviruses were found by RNA gel electrophoresis. Adenoviruses were found by ELISA in 14 of 265 (5%) children and were most frequently detected during the 1st year of life. Of 103 faecal samples analyzed by electron microscopy, four contained small round structured viruses.

Prevalence of antibodies to hepatitis A, B, C, and E viruses in a healthy population in Leon, Nicaragua

A cross-sectional survey of the seroprevalence of hepatitis A virus (HAV), B (HBV), C (HCV), and E (HEV) antibodies in a healthy population in Leon, Nicaragua was conducted and associated with demographic data. The overall prevalence of antibodies to HAV was 94.6%, to HBV 6.5% and to HEV between 4.6% and 8.0%, whereas none of 399 tested subjects showed confirmed seropositivity to HCV. A high HAV seropositivity rate (72.7%) was observed even in the lowest age groups tested (2-4 years of age). In contrast, HBV and HEV seropositivity was observed mainly in adults, the seroprevalence in > 40-year-old individuals being 15.4% and 17.6%, respectively. The overall mean hepatitis B surface antigen carrier rate was estimated to be 0.9%, and in individuals more than 20 years of age, 2.0%. The prevalence of anti-HAV as well as anti-HEV was significantly higher in people having their water supply outside rather than inside the house. Furthermore anti-HAV seroprevalence correlated with lack of access to a flush toilet. Hepatitis B virus seropositivity was more frequent in people living in a crowded environment than in those living with few household members. These findings indicate that hepatitis A is a childhood infection in Nicaragua and that the spread of the infection is facilitated by poor socioeconomic conditions. In contrast, HBV infection is relatively infrequent in the country and HCV seems to be very uncommon. Hepatitis E virus infection may occur in all age groups and is apparently associated with water-borne transmission.

[Effect of microcrystalline cellulose on the excretion of total biliary acids in feces]

The colorectal neoplasia is the second cause of death from neoplasia in our country, and in international statistics, blaming for this, the dietetic habits of industrialized countries having a high content of satured fat, cholesterol, refined carbohydrate, red meat, and with few dietetic fibers. In the last years special attention has been focused to the action of the total biliar acids (TBA) primarily the secondary ones, over the colon mucosa, showing evidences of cancerous effects. Recently, American authors have published the favoring action of the cellulose fiber over the TBA through a catalytic reaction and their polysterification, inactivating them in their aggressive action over the colon mucosa. Through these experiences and willing to prove the action of the product, we have treated with microcrystalline cellulosa (Microcel Lab. Blanver, Brasil) 20 patients of the Institute of Gastroenterology of Havana City, who showed high figures of TBA in stools for 2 months, compared with the 5 g. dose per day. Another group of 20 patients also with high figures of TBA in stools being treated with corn fecula same dose, same time by equal time, making every month determinations to both groups, determining that in the first group the figures of TBA in stools were normalized in 95% the first month of treatment and in 100% the second month. The second group had only an answer of 65% the first month and of 80% the second month, which shows evidently the high efficacy of Microcel in reducing the TBA in stools.

Criterion-related validity of a new classification scheme for institutionalized mentally retarded individuals

Two studies were carried out to test the validity of a new three-cluster classification scheme. The association of cluster membership with both clients' movement and program placement was significant, but only in the case of the latter criterion was prediction improved by knowledge of a client's cluster membership.

Surgical treatment of lung carcinoma involving the chest wall

From 1969 to 1986, 97 patients with chest wall invasion by lung carcinoma (excluding superior sulcus tumours) underwent surgical resection in two hospitals, La Paz (Madrid) and La Fé (Valencia). The same surgical policy was used in both thoracic surgical units: extrapleural pulmonary resection when tumour involved only the parietal pleura (N = 36), and en bloc chest wall resection when the carcinoma extended into the ribs and intercostal muscles (N = 61). The tumour histology was classified according the WHO criteria. Lobectomy or bilobectomy was carried out in 72%, pneumonectomy in 18% and segmentectomy or wedge resection in 10% of the patients. The perioperative mortality was higher in the en bloc resection group 9/61 (15%) versus 2/36 (6%) for extrapleural dissection. The node staging was NO in 58/97 (60%), N1 in 16/97 (16%) and N2 in 23/97 (24%). The probability of survival was calculated by the Kaplan-Meier method collecting data from the perioperative survivors only. The overall 5-year survival was 23% with no significant differences between the en bloc resection and the extrapleural lung resection groups. The most important predictor of survival was the node stage. The 5-year survival for N1 and N2 were 8% and 6%, respectively. These percentages increased to 34% when N0 patients were considered. Other predictors of survival were not significant. The authors conclude that either extrapleural or en bloc chest wall resection are both valid procedures which may be used depending on the depth of local invasion.

A syndrome with mixed deafness, Mozart ear, middle and inner ear dysplasias

A 10-year-old boy presenting a disorder of multiple malformations with an otologic component consisting of mixed deafness, Mozart ear, thin stapes, small oval window and agenesis of the semicircular canals, was studied. A comparative analysis of similar malformation-entities has permitted the delineation of a previously undescribed syndrome.