Transcriptional signature of TP53 biallelic inactivation identifies a group of multiple myeloma patients without this genetic condition but with dismal outcome

Biallelic inactivation of TP53 has been included in the definition of double-hit (DH) multiple myeloma (MM), which entails an ominous prognosis. However, this condition, or even the presence of high-risk cytogenetic abnormalities, cannot accurately capture the 15%-20% of the MM population with a median overall survival below 24 months. This prompted us to look for other MM patients who might have transcriptional characteristics similar to those with DH-TP53. In the present study, we analysed RNA-seq, whole-genome and whole-exome sequencing data from 660 newly diagnosed MM (NDMM) patients from the MMRF (Multiple Myeloma Research Foundation) CoMMpass study to characterize the transcriptional signature of TP53 double-hit (DH-TP53) MM. We found 78 genes that were exclusively deregulated in DH-TP53 patients. A score based on these genes identified a group of 50 patients who shared the same transcriptional profile (DH-TP53-like group) whose prognosis was particularly unfavourable [median overall survival (OS) < 2 years], despite not harbouring the biallelic inactivation of TP53. The prognostic value of the DH-TP53 score was externally validated using gene expression data from 850 NDMM patients analysed by microarrays. Furthermore, our DH-TP53 score refined the traditional prognostic stratification of MM patients according to the cytogenetic abnormalities and International Staging System (ISS).

Monoclonal gammopathy of renal significance (MGRS): Real-world data on outcomes and prognostic factors

Monoclonal gammopathy of renal significance (MGRS) is a recognized clinical entity. Literature regarding treatment and its outcomes in MGRS is sparse due to the rarity and misdiagnosis of MGRS. We retrospectively analyzed 280 adults with an MGRS diagnosis from 2003 to 2020 across 19 clinical centers from 12 countries. All cases required renal biopsy for the pathological diagnosis of MGRS. Amyloidosis‐related to MGRS (MGRS‐A) was present in 180 patients; nonamyloidosis MGRS (MGRS‐NA), including a broad spectrum of renal pathologies, was diagnosed in 100 patients. The median overall survival in the studied cohort was 121.0 months (95% CI: 105.0–121.0). Patients with MGRS‐A had a shorter overall survival than patients with MGRS‐NA (HR = 0.41, 95%CI: 0.25–0.69; p = 0.0007). Both hematologic and renal responses were associated with longer survival. Achievement of ≥VGPR was generally predictive of a renal response (OR = 8.03 95%CI: 4.04–115.96; p < 0.0001), one‐fourth of patients with ≥VGPR were renal nonresponders. In MGRS‐A, factors associated with poor prognosis included elevated levels of creatinine, beta‐2‐microglobulin, and hemodialysis at diagnosis. In MGRS‐NA, only age >65 years was associated with increased risk of death. Treatments provided similar hematologic response rates in both types of MGRS. Autologous stem cell transplantation led to better response than other treatments. This multicenter and international effort is currently the largest report on MGRS.

POS1446 CREATINE KINASE COULD BE A MARKER OF CHRONIC INFLAMMATION-INDUCED SARCOPENIA IN FRAIL PATIENTS

Background

Frailty is a hallmark of unhealthy ageing characterized by a decline in the general physiological state, strength and endurance of the patient and consequently, a greater vulnerability to endogenous and/or exogenous stressors. Behind this condition there are multiple pathophysiological processes affecting different systems, such as the musculoskeletal, reflected in sarcopenia, where anabolism is reduced in turn of catabolism. Underlying these processes, chronic inflammation is a well-known but not properly dissected mechanism that contributes to frailty. Although several studies suggest an association of TNF-α, IL-6, IL1-β with systemic inflammation in frail patients, the results are not conclusive. Some authors have explored other molecules related to inflammation, including creatine kinase (CK), a muscle enzyme involved in energy metabolism. Decreased serum CK levels have been observed in chronic inflammatory diseases associated with sarcopenia such as rheumatoid arthritis. In turn, CK is increased not only after myocardial infarction and post-traumatic myolysis, but also associated with muscle mass anabolism.

Objectives

To study the clinical significance of CK levels and their association with other inflammatory and anabolic regulators in frail patients.

Methods

We randomly selected 152 individuals (76 frail and 76 robust) that were 80.86 (±5.49) years and 50% were female, from the second wave of Toledo Study of Healthy Aging cohort (1). CK was measured by routine analysis; serum TNF-α, sgp130, Growth Differentiation Factor (GDF)-15, soluble IL-6R (sIL-6R) and IGF-1 by Multiplex-Luminex. Serum C-Reactive Protein (CRP) and Myostatin (MSTN) were assessed by ELISA. Differences between robust and frail patients were tested using Mann-Whitney and Kruskal-Wallis test for continuous variables and Chi-square test for discrete variables. For each variable, normality was tested using Shapiro-Wilk normality and Kolmogorv-Smirnov tests. Non-normal variables were natural logarithm transformed to achieve normality. The association between each biomarker and frailty was assessed using multivariate logistic models. Additionally, a sensitivity analysis was performed including a second biomarker in the model in order to detect those biomarkers that influenced the association. All analyses were done using R.

Results

Inflammatory markers CRP and GDF-15 were increased in frail patients, OR (95% CI) 1.59 (1.22-2.05; p<0,001) and OR 1.93 (1.01-3.68; p=0,006), respectively, in comparison to robust. There were no significant changes in the inflammatory parameters TNF-α, sgp130, sIL-6R between groups. The anabolic marker IGF-1 did not change significantly between groups, while the anti-anabolic mediator MSTN was reduced in frail patients, OR 0.40 (0.19-0.86; p=0.02). Finally, CK levels were decreased in frail patients when compared to robust subjects, OR 0.37 (0.18-0.76; p=0.007). In sensitivity analysis, this association remained statistically significant with ORs ranging from 0.33 to 0.40 regardless of a second biomarker.

Conclusion

We identified chronic inflammation in a cohort of frail patients given the significant increase in CRP and GDF-15, although we did not find association with other inflammation parameters such as TNF-α, sgp130 or sIL-6R, highlighting the difficulty of characterize the status of systemic inflammation. The decrease in CK levels in frailty suggest that this marker could be an indicator of cumulative muscle mass loss due to chronic inflammation. Since CRP can be sensitive and altered by a multitude of pathological conditions in frail patients, we propose CK as a more specific marker of inflammation-induced muscle impairment.

References

[1]The prevalence of frailty syndrome in an older population from Spain. The Toledo Study for Healthy Aging. Garcia-Garcia FJ et al. J Nutr Health Aging. 15:852-6, 2011

Disclosure of Interests

None declared

Health-related quality of life in patients with relapsed/refractory multiple myeloma treated with pomalidomide and dexamethasone ± subcutaneous daratumumab: Patient-reported outcomes from the APOLLO trial

In the phase 3 APOLLO trial, daratumumab in combination with pomalidomide and dexamethasone (D-Pd) significantly reduced the rate of disease progression or death by 37% relative to Pd alone in patients with relapsed/refractory multiple myeloma (RRMM) who had received ≥1 prior line of therapy including lenalidomide and a proteasome inhibitor. Here, we present patient-reported outcomes (PROs) from APOLLO. Median treatment duration was 11.5 months with D-Pd and 6.6 months with Pd. PRO compliance rates were high and similar in both groups. No changes from baseline were observed for EORTC QLQ-C30 global health status scores in either group, while physical and emotional functioning, disease symptoms, and adverse effects of treatment remained at baseline levels with D-Pd but worsened with Pd. Reductions (p < 0.05) in pain and fatigue were seen at several time points with D-Pd versus Pd. Overall, these results suggest patients' health-related quality of life remained stable when daratumumab was added to Pd, with several results favoring D-Pd versus Pd. These findings complement the significant clinical improvements observed with D-Pd and support its use in patients with RRMM.

Respiratory syncytial virus burden among adults during flu season: an underestimated pathology

BACKGROUND

Information on the role of respiratory syncytial virus (RSV) in adult patients with influenza-like syndrome is scarce.

AIM

To assess the clinical characteristics of RSV in adult patients with respiratory manifestations during a regular influenza season.

METHODS

Prospective study in a tertiary Spanish hospital from December 2015 to February 2016. The study population included only adult patients with either community-acquired or hospital/healthcare-associated influenza-like illness, according to the European Centre for Disease Prevention and Control criteria. Samples were analysed using a rapid molecular assay (Xpert^® Flu/RSV). RSV-positive patients were compared with a randomly negative control group and with an influenza-positive control group.

FINDINGS

Twelve hundred patients with influenza-like respiratory infection were included. Overall, 114 of the samples (9%) were positive for influenza and 95 (8%) were positive for RSV. When RSV-positive and influenza-positive patients were compared, RSV-positive patients were older (57.7 vs 48.9 years; P = 0.03), and their disease was more frequently healthcare-related (26/95, 27.3% vs 5/114, 1.7%; P < 0.001). They also had significantly more antibiotics prescribed (77/95, 81.0% vs 70/114, 61.4%; P < 0.001) and more frequently needed hospital admission (93/95, 97.8% vs 69/114, 60.5%; P < 0.001). Mortality was also significantly higher in RSV-positive patients (14/95, 14.7% vs 7/114, 6.1%; P = 0.04).

CONCLUSION

RSV is a major cause of moderate-to-severe respiratory infection during the influenza season; acquisition is frequently nosocomial or healthcare-related; and mortality is significantly higher than with influenza virus infection. The use of a rapid molecular test as a first-step diagnostic technique is necessary to ensure that isolation measures are implemented and that spread is prevented.

Elotuzumab plus lenalidomide/dexamethasone for relapsed or refractory multiple myeloma: ELOQUENT-2 follow-up and post-hoc analyses on progression-free survival and tumour growth

The randomized phase III ELOQUENT-2 study (NCT01239797) evaluated the efficacy and safety of elotuzumab + lenalidomide/dexamethasone (ELd) versus lenalidomide/dexamethasone (Ld) in relapsed/refractory multiple myeloma. ELd reduced the risk of disease progression/death by 30% versus Ld (hazard ratio [HR] 0·70). Median time from diagnosis was 3·5 years. We present extended 3-year follow-up data. Endpoints included progression-free survival (PFS), overall response rate (ORR) and interim overall survival (OS). Exploratory post-hoc analyses included impact of time from diagnosis and prior lines of therapy on PFS, and serum M-protein dynamic modelling. ORR was 79% (ELd) and 66% (Ld) (P = 0·0002). ELd reduced the risk of disease progression/death by 27% versus Ld (HR 0·73; P = 0·0014). Interim OS demonstrated a trend in favour of ELd (P = 0·0257); 1-, 2- and 3-year rates with ELd versus Ld were: 91% versus 83%, 73% versus 69% and 60% versus 53%. In patients with ≥ median time from diagnosis and one prior therapy, ELd resulted in a 53% reduction in the risk of progression/death versus Ld (HR 0·47). Serum M-protein dynamic modelling showed slower tumour regrowth with ELd. Adverse events were comparable between arms. ELd provided a durable and clinically relevant improvement in efficacy, with minimal incremental toxicity.

Male killing Spiroplasma protects Drosophila melanogaster against two parasitoid wasps

Maternally transmitted associations between endosymbiotic bacteria and insects are diverse and widespread in nature. Owing to imperfect vertical transmission, many heritable microbes have evolved compensational mechanisms to enhance their persistence in host lineages, such as manipulating host reproduction and conferring fitness benefits to host. Symbiont-mediated defense against natural enemies of hosts is increasingly recognized as an important mechanism by which endosymbionts enhance host fitness. Members of the genus Spiroplasma associated with distantly related Drosophila hosts are known to engage in either reproductive parasitism (i.e., male killing) or defense against natural enemies (the parasitic wasp Leptopilina heterotoma and a nematode). A male-killing strain of Spiroplasma (strain Melanogaster Sex Ratio Organism (MSRO)) co-occurs with Wolbachia (strain wMel) in certain wild populations of the model organism Drosophila melanogaster. We examined the effects of Spiroplasma MSRO and Wolbachia wMel on Drosophila survival against parasitism by two common wasps, Leptopilina heterotoma and Leptopilina boulardi, that differ in their host ranges and host evasion strategies. The results indicate that Spiroplasma MSRO prevents successful development of both wasps, and confers a small, albeit significant, increase in larva-to-adult survival of flies subjected to wasp attacks. We modeled the conditions under which defense can contribute to Spiroplasma persistence. Wolbachia also confers a weak, but significant, survival advantage to flies attacked by L. heterotoma. The host protective effects exhibited by Spiroplasma and Wolbachia are additive and may provide the conditions for such cotransmitted symbionts to become mutualists. Occurrence of Spiroplasma-mediated protection against distinct parasitoids in divergent Drosophila hosts suggests a general protection mechanism.

Replicated hybrid zones of Xiphophorus swordtails along an elevational gradient

Natural hybrid zones provide opportunities to study a range of evolutionary phenomena from speciation to the genetic basis of fitness-related traits. We show that widespread hybridization has occurred between two neo-tropical stream fishes with partial reproductive isolation. Phylogenetic analyses of mitochondrial sequence data showed that the swordtail fish Xiphophorus birchmanni is monophyletic and that X. malinche is part of an independent monophyletic clade with other species. Using informative single nucleotide polymorphisms in one mitochondrial and three nuclear intron loci, we genotyped 776 specimens collected from twenty-three sites along seven separate stream reaches. Hybrid zones occurred in replicated fashion in all stream reaches along a gradient from high to low elevation. Genotyping revealed substantial variation in parental and hybrid frequencies among localities. Tests of F(IS) and linkage disequilibrium (LD) revealed generally low F(IS) and LD except in five populations where both parental species and hybrids were found suggesting incomplete reproductive isolation. In these locations, heterozygote deficiency and LD were high, which suggests either selection against early generation hybrids or assortative mating. These data lay the foundation to study the adaptive basis of the replicated hybrid zone structure and for future integration of behaviour and genetics to determine the processes that lead to the population genetic patterns observed in these hybrid zones.

[Effects of a diet with products in texture modified diets in elderly ambulatory patients]

BACKGROUND

Decrease in the capacity to deglution solids and liquids is a problem in many people, this problem decreases quality of life. The main objective of our work was to evaluate the influence in elderly ambulatory patients with dysphagia of a texture modified diet ready to use on nutritional parameters and quality of life.

METHODS

We enrolled 29 patients from Nutrition Department with dysphagia and an age over 70 years. Patients received a texture modified diet supplemented with dehydrated nutritional products (Resource Ready) (1,633 kcal, 59,9 g proteins (16%), 52,1 g lipids (29%), 231,7 g carbohydrates (57%), 11,1g de fiber, 82 mg cholesterol). Before and after 3 months of starting the treatment, we recorded a blood analysis, nutritional anthropometric evaluation (tricipital skinfold, midarm circumference, midarm muscle circumference, weight, height and body mass index), a bipolar bioimpedance and a dietary questionnaire of 3 days. SF36 as a questionnaire of quality of life was used before and after nutritional treatment.

RESULTS

A total of 29 patients were recruited with a sex distribution of (18 females and 11 males), and an average age of 79,5+8,59 years. A 25,7% of patients had head and neck tumors, a 24% dementia and a 41,3% chronic neurological deterioration. After treatment, we detected an improvement in weight, fat mass, fat free mass, total proteins, albumin, transferrin and lymphocytes. Caloric, protein fat and carbohydrate intakes increased in a significative way. Caloric intake corrected by weight improved (26.1 +/- 5.7 cal/kg vs 28.9 +/- 4.5 cal/kg: p < 0.05). Quality of life improved significantly (SF 36 score 94.7 +/- 15 points vs 99.3 +/- 10 points; p < 0.05).

CONCLUSION

A texture modified diet with dehydrated nutritional products improved dietary intake, nutritional status and quality of life of ambulatory elderly patients with dysphagia.

Final results of a phase II PETHEMA trial of alternating bortezomib and dexamethasone as induction regimen prior autologous stem cell transplantation (ASCT) in younger patients with multiple myeloma (MM): Efficacy and clinical implications of tumor response

8024

Background: Dexamethasone-based combinations are the standard induction regimens for younger patients with MM prior ASCT. This is the first study in which bortezomib and dexamethasone were administered on an alternating basis. Aims: efficacy and kinetics of response. Methods: patients with newly diagnosed MM under the age of 66 years were treated with bortezomib at 1.3 mg/m2 on days 1, 4, 8 and 11 (cycles 1, 3, 5) and dexamethasone 40 mg p.o. on days 1–4, 9–12 and 17–20 (cycles 2, 4 and 6), followed by ASCT with melphalan-200. Responses were evaluated by the EBMT criteria but a VGPR was included. Random effects models were utilized to analyze the tumor response kinetics to bortezomib and dexamethasone with the absolute value of M-protein overtime and decrease by cycle. Because the nonlinearity in the change of M-protein overtime, a piecewise linear model was employed. Results: between August, 2005 and March, 2006, 40 patients (median age 57) were enrolled. The response rate was 82% with 12% CR plus 10% VGPR. The response was quick with 82% M-protein reduction achieved with the first 2 cycles. There was no further decrease of the mean M-protein in cycles 5 and 6. The M-protein decrease was not different with dexamethasone and with bortezomib (p=0.48). Chromosome 13 deletion as well as t(4;14) and t(14;16) did not had a negative impact on response. Toxicity was very low: ten (25%) patients had mild peripheral neuropathy (grade 1:9 cases, grade 2:1 case) and 11 grade 1 thrombocytopenia. Grade 3 toxicity was observed in 7 patients (neutropenia 6, skin/liver 1 case). No patient developed grade 4 toxicity. In all patients stem cells could be adequately collected (median of CD34+ 5 ×106/Kg). The overall response rate after ASCT was 90% with 40% CR plus 20% VGPR. Conclusions: Bortezomib alternating with dexamethasone is highly effective as up-front therapy in patients with MM, and is associated with a very low toxicity. The results of the tumor response kinetics analysis support a short program of alternating bortezomib and dexamethasone (i.e., maximum of 4 cycles) as an effective and safe therapy for younger myeloma patients prior ASCT.

[Table: see text]

[Assessment of the immigrant child]

In the last twenty years Spain has turned into one of the principal countries recipients of foreign population. As consequence of this massive entry of people, our country is among the first ones of Europe for interannual increase of population. The concept of immigrant child is very wide and includes minors of very diverse characteristics, as the proceeding from international adoptions, the children coming from developing countries or those that come from other developed countries. The immigrant children do not represent health risk for the autochthonous population, on the contrary, they are in situation of defenselessness for their scanty vaccination coverages, their situation of marginality and the precarious sanitary systems of the countries of origin. At the moment of offering medical paediatric attention to foreign children, we must individualize our actions in conformity with the characteristics of each patient. It is not possible to simplify in one unique protocol the best studies to resolve a problem of health in an immigrant child. The attention of these children implies an overstrain for the pediatrician and the sanitary personnel that receives them, because it is necessary to conquer idiomatic, cultural and social barriers to optimize the level of health of these patients. The syndromic initial description can help to prioritize the studies in each case (according to the most probable diagnoses). The children who return to the native land of their parents meet in a special situation of risk, for not being prepared to resist the attack of pathogen that do not exist or are rare in Spain.

[Effectiveness of venlafaxine in the treatment of alcohol dependence with comorbid depression]

INTRODUCTION

There are no conclusive data on the effectiveness of antidepressant drugs in the treatment of comorbid cases of alcohol dependence and depression.

OBJECTIVES

To determine the effectiveness of venlafaxine on depression and on severity (need of treatment) of alcohol dependence and related problems.

METHODS

Observational, open-label, multicenter, 24-week follow-up study.

PATIENTS

90 outpatients with diagnosis of alcohol dependence and associated major depression disorder (DSMIV criteria).

OUTCOMES MEASURES

the Hamilton Rating Scale for Depression (HAM-D17), European Addiction Severity Index (EuropASI) and Clinical Global Impression, severity and improvement subscales, (CGI-S and CGI-I). Evaluations were performed at baseline and at weeks 2, 4, 8 and 24.

RESULTS

Mean age 44.94+/-9.74 years; 73.3 % man. HAM-D17 mean scores significantly decreased from baseline (24.85+/-5.94) to week 24 (5.976+/-4.68) and at each of the follow-up visits vs previous visit (p < 0.0005). Significant decreases from baseline to week 24 were obtained in four areas of EuropASI: medical status (2.12+/-2.45 to 1.07+/-1.68), alcohol use (5.29+/-2.24 to 3.04+/-2.35), family/ social relationships (3.68+/-2.36 to 1.71+/-2.06) and psychiatric status (5.61+/-1.81 to 2.67+/-2.03). Tolerance was excellent or good in 76.7% of the patients.

CONCLUSIONS

Venlafaxine demonstrated to be effective in the treatment of depressive alcoholic patients. Furthermore, it seems to be useful to decrease the severity of problems related with the alcohol use.

Independent origins of allotriploidy in the fish genus Poeciliopsis

We examined mitochondrial DNA (mtDNA) sequences and allozymes to assess possible modes of origin, clonal diversity, and evolutionary age in a triploid all-female fish of the genus Poeciliopsis from the state of Sinaloa, Mexico. Analysis of multilocus allozymes revealed that the Rio Mocorito biotype (Poeciliopsis monacha-lucida-viriosa) is trihybrid, carrying haploid genomes from three sexually reproducing species, Poeciliopsis monacha, Poeciliopsis lucida, and Poeciliopsis viriosa. Composite allozyme and mtDNA genotypes identified four clones, all bearing closely related mitochondrial haplotypes originally derived from P. monacha. Apparently these trihybrids arose endemically by addition of a haploid genome from P. viriosa, a local sexual species, to an allodiploid biotype, P. monacha-lucida, also found in the Rio Mocorito. The present analysis clearly revealed that P. monacha-lucida-viriosa arose independently of the two allotriploid biotypes that live in a river to the north (Rio Fuerte). Although the origins of allotriploidy in Poeciliopsis are less constrained phylogenetically and geographically than previously thought, known triploid biotypes all had relatively recent origins, which supports the notion that most asexual lineages are evolutionarily short-lived.

Prevention of de novo hepatitis B infection in liver allograft recipients with previous hepatitis B infection or hepatitis B vaccination

OBJECTIVES

To assess de novo hepatitis B virus (HBV) transmission from liver donors with HBV serum markers (HBM) to their recipients and the need for HBV vaccination before liver transplantation.

METHODS

A total of 108 orthotopic liver transplantations for nonviral disease and the risk of developing de novo hepatitis B based on HBMs before transplantation have been studied. Of the 108 patients, 94 met the study criteria and were divided into two groups: 27 who had HBMs before transplantation (from past infection or by previous vaccination) and 67 who had no HBM. Development of de novo hepatitis B was determined by analytical, serological, and histological parameters.

RESULTS

No case (0%) of de novo hepatitis B was detected in the pretransplantation HBM group, whereas there were 10 cases (14.5%) in the other group (p < 0.005).

CONCLUSIONS

The presence of pretransplantation HBM in liver transplant recipients protects these patients against the development of de novo hepatitis B. This is especially important considering that there is a high prevalence of donors with positive hepatitis B core antibody (especially in some countries), and that these donors transmit HBV infection to recipients without HBM in a significant number of cases. Thus, vaccination against HBV in patients who are candidates for liver transplantation is fundamental to avoid cases of de novo hepatitis B.

[Risk of hepatitis B virus transmission from hepatitis B core antibody-positive liver donors]

BACKGROUND

To study the hepatitis B virus (HBV) transmission from donors HBsAg-/AntiHBc+ to liver transplant recipients.

PATIENTS AND METHOD

We studied retrospectively the HBV serological markers in 43 donors from our center and also the serological condition of the 41 recipients. The HBV serological markers were analyzed by ELISA and HBV DNA was detected by hybridation assays.

RESULTS

13 donors samples showed some HBV serological markers: 6 anti-HBc and anti- HBs (13.9%), 4 anti-HBc (9%) and 3 anti- HBs (6.9%). There were no cases of hepatitis B among liver recipients from donors with negative serological markers. Among the 13 recipients with HBV serological markers, 9 were followed during 39 (SD 17) months. The 5 recipients with no HBV markers, who received an anti- HBc+ with or without anti- HBs (100%) developed hepatitis B. The two liver recipients with anti-HBs solely, did not developed infection (0%). Of the 41 recipients, 15 had some HBV markers before transplant and two of them received an anti-HBc+ and did not develop the infection (0%).

CONCLUSIONS

In our study, the prevalence of serological HBV infection in donors and recipients was of 30.2 and 31.7%, respectively. Anti-HBc with or without anti-HBs donors transmitted the HBV infection in all the cases (100%) to the susceptible recipients. The presence of anti-HBs in recipients protected these against the infection. Only the anti-HBs positive donors did not trasmit the HBV infection.

[Validity of hand-held systems for otoacoustic emissions in hearing screening]

Hearing screening objective is the development of an universal screening. With that purpose, new hand-held system of Otoaccoustic Emissions have been designed, which are easier to perform and to interpret the results, to detect hearing loss disordersas soon as possible. To validate the hand-held systems of Otoaccoustic Emissions in the hearing screening, we have compared the results of the tests with Otoaccoustic Emissions clinic systems and tonal audiometry in two groups of population: new-borns and hearing-loss adults aged between 16 and 56. Our study showed that the hearing screening results in children with hand-held system were similar to classic Otoaccoustic Emissions system, but there were more than 40% of adult hearing losses not detected with this system. These results can invalidate the test.

[Medium and large acoustic neurinomas with normal tonal audiometry at the moment of diagnosis]

INTRODUCTION

Early diagnosis of an acoustic neurinoma for any possible treatment is important, especially in view of the relationship between surgical morbidity and the size of the tumour. The commonest presenting symptom of these tumors is unilateral perceptive deafness. However, between 4 and 12% are diagnosed before deafness occurs, although they may be large in size. Therefore one should remember other symptoms which lead to suspicion of these tumors, and have diagnostic guidelines available to allow the earliest possible detection.

PATIENTS AND METHODS

We report four cases of acoustic neurinoma or vestibular schwannoma of medium or large size in which audiological studies did not at first give rise to suspicion of the presence of this tumour, since audition was considered to be normal at conversation frequencies (500 to 3,000 Hertz) for the age of the patient or who had an audiometry curve with symmetrical deafness in both ears.

CONCLUSION

We evaluated the diagnostic importance of the tests done and compared the results with data published in the literature.

[Primary tuberculous otitis media]

Tuberculous otitis media is now an infrequent disease, with an incidence of less than 1%. In most cases the origin is a pulmonary focus and primary cases are rarer. We report a case of primary tuberculous otitis media in an immunocompetent patient. A bibliographic review was made of clinical and etiopathogenic aspects, as well as diagnosis and treatment. We highlight the diagnostic difficulty and the fact that this entity should be included in the differential diagnosis of persistent suppurative otitis media.

Tricuspid insufficiency and interatrial septum rupture: a cause of persistent systemic hypoxemia after blunt chest trauma

The case of a 45-year-old man with severe tricuspid insufficiency and interatrial septum rupture caused by a car accident is described. The patient had a rupture of the anterior papillary muscle of the tricuspid valve and right-to-left shunt through an interatrial defect with severe hypoxemia that was difficult to distinguish from that caused by pulmonary damage. Transesophageal echocardiography was extremely useful for early diagnosis.

Prevalence of hepatitis B, C, and D markers in sub-Saharan African immigrants

We determined the prevalence of hepatitis B, C, and D virus markers in a cohort of 229 (adult group, n = 187; pediatric group, n = 42) asymptomatic sub-Saharan African immigrants recently arrived to Madrid, Spain. Evidence of a recent or past hepatitis B virus infection marker was seen in 68 of 187 (36.4%) adults and in 14 of 42 (33.3%) children. The rate of chronic carriers of hepatitis B surface antigen in the entire population was 10.9% (25 of 229). Anti-hepatitis C virus antibodies were seen in 16 of 187 (8.6%) of the adults and in 1 of 42 (2.4%) of the children. Two of the 20 adults (10%) who were positive for hepatitis B surface antigen and none of the children had anti-hepatitis D virus antibodies. We found no significant differences in the prevalence of any viral infection marker between the two groups. Ten of the 125 (8%) patients in the adult group and none of the pediatric group had serologic evidence (recent or past) of hepatitis B and C coinfection. The hepatitis markers of this group should be studied and these persons should be considered a risk group in the hepatitis B virus vaccination campaigns.

Mesenchymal chondrosarcoma of the maxilla. A case report

A case of mesenchymal chondrosarcoma of the maxilla is reported. This rare tumour is characterized by slow growth, late metastasis (up to 20 years after first presentation) and poor prognosis. The diagnosis is often difficult to make because of the low incidence among malignant bone tumours.

Hepatitis C virus infection decreases the effective antibody response to hepatitis B vaccine in hemodialysis patients

Hepatitis B remains a significant risk to patients receiving chronic hemodialysis. Hepatitis B vaccines are effective in providing protection against this infection. However, the minimum antibody level necessary to guarantee an efficacious protection is not clear. Little is known about the effect of this vaccine in persons treated with erythropoietin (EPO) and in patients with hepatitis C virus (HCV) infection. We have studied 36 chronic hemodialysis patients; 17 of them receiving EPO and 9 were diagnosed as having HCV infection. Effective immunity (antibody titer higher than 100 mIU/ml) was observed in 61.1% of the participants and was not influenced by EPO administration, but the effective immunization rate was lower in HCV infected patients (33.3% vs. 70.3%, p < 0.05). These results suggest the possibility that HCV infection may modify the effectiveness of hepatitis B vaccine.

Frequency and chronology of occurrence of anti-HCV in non-A non-B post-transfusional hepatitis

OBJECTIVE

Studying the frequency and timing of the appearance of the virus C antibody.

PATIENTS

We studied serum samples of 57 patients whom developed post-transfusional non-A non-B hepatitis. 34 males, and mean age was 47.56 +/- 13.45 years. Initially anti-HVC was detected by ELISA, and the test was repeated on the last negative sample and the first two positive ones of each patient. RIBA-I and 2nd generation ELISA were performed on these same samples. HCV polymerase chain reaction was performed in 5 seronegative patients by the other techniques.

RESULTS

Fifty patients (87.5%) seroconverted to anti-HCV; 26 (52%) within 30 days after the onset of the disease (11 during incubation period); and, 24 (48%) seroconverted after the first month of the disease. Anti-HCV negative patients had lower transaminase levels. Twenty six (52%) of the 50 patients showing seroconversion developed a chronic hepatitis, while this occurred in two (28.5%) of the seven seronegative patients (this difference was not statistically significant). Determination of HCV-RNA by polymerase chain reaction, performed (eight years after the onset of the disease) in 4 of the five seronegative patients by ELISA and RIBA techniques, was negative. Nowadays one of them is anti-HCV and HCV-PCR positive and sustain normal transaminases values.

CONCLUSIONS

87.5% of post-transfusional non-A non-B hepatitis seroconverted during the follow-up. 26 (52%) showed this within 30 days after the onset of their disease; of this group, 11 became seropositive before their ALT values rose. Nowadays in all patients (except one) initially seronegative, in which polymerase chain reaction was performed, negative serology results persist. There were no clinical and evolution differences between the groups.