State of infectious disease notification (I.D.N.'s) in Navarra. 1996

The System of Infectious Disease Notification (I.D.N.) encompasses the notification of 41 infectious transmissible diseases to which are added epidemic outbreaks of any etiology or cause. In Navarra, the I.D.N.'s are reported to the Section of Vigilance and Epidemiological Control of the Public Health Institute. A sharp increase of alimentary toxic-infections is observed due to two community outbreaks produced by Salmonella enteritidis that affected 410 persons. The incidence of pulmonary tuberculosis, 15.37 cases per 100,000 inhabitants has remained at the same levels as previous years and with lower rates than those published in neighbouring Autonomous Communities such as La Rioja and the Autonomous Community of the Basque Country. In the group of Exanthematic Diseases, an outbreak of German measles is noteworthy that affected males between the ages of 16 and 20. During the year 1996 there were 17 cases of Meningococcal Disease that meant a rate of 3.27 per 100,000 inhabitants, the second lowest rate in the last 25 years after the rate of 2.29 of 1994. With respect to the causative serogroup, serogroup C was isolated on 7 occasions, serogroup B on four occasions and on 6 it could not be grouped. Hydatidosis through reports of I.D.N.'s and active search in the hospitals remained steady, with 26 cases, remaining within the regular values of recent years. An important decline with respect to recent years was observed in cases of hepatitis A, hepatitis B and brucellosis.     

Evaluation of the Program for the Prevention and Control of Tuberculosis during the period January 1993 - June 1996

In 1992 a Technical Commission was formed in Navarra with the participation of different specialists who drew up the Program of Vigilance and Control of Tuberculosis. We present the results of the evaluation of this program for the period from January 1993 to June 1996. In the 3.5 years of the study, 419 cases of tuberculosis were found, 317 belonging to respiratory forms and 102 to extra-respiratory forms. The annual rate of incidence of total tuberculosis, 22.8 cases per 100,000 inhabitants observed in Navarra, is the lowest of those registered at the level of the Autonomous Communities according to the TIR study of the SEPAR (acronym for Spanish Society of Pneumology and Thoracic Surgery) in 1996, and the second lowest, after Castilla-La Mancha, according to the multicentric study of the National Centre of Epidemiology. In Navarra the highest rates of incidence are produced in those over 65 years of age, following the pattern observed in the more developed countries. 13.9% of the patients with respiratory tuberculosis showed co-infection by HIV, and besides more than 90% of these were users of intravenous drugs. The percentage of immigrants, prisoners and the destitute observed in the Navarra series is lower than that found in areas such as Madrid, Barcelona or Zaragoza. 91% of the cases of respiratory tuberculosis showed bacteriological confirmation and 98% of the cases were diagnosed and treated in specialised care. Outstanding were the high follow-up of the cases until discharge and the high percentage of cures achieved, some 85.4%.     

Decreased serum ubiquinone-10 concentrations in phenylketonuria.

BACKGROUND: Ubiquinone-10 is a lipid with important metabolic functions that may be decreased in phenylketonuria (PKU) because patients with PKU consume diets restricted in natural proteins. OBJECTIVE: We studied serum ubiquinone-10 concentrations in PKU patients. DESIGN: This was a retrospective, transversal study in which we compared serum ubiquinone-10, plasma cholesterol, plasma tyrosine, and plasma phenylalanine concentrations in 43 PKU patients with concentrations in a reference population (n = 102). Serum ubiquinone-10 concentrations were analyzed by HPLC with ultraviolet detection. Plasma tyrosine and phenylalanine were measured by ion-exchange chromatography. RESULTS: Serum ubiquinone-10 concentrations in PKU patients were significantly lower than in the reference population (P < 0.01 for patients aged 1 mo to <8 y and P < 0.00005 for patients aged 8-33 y). Moreover, 5 of 18 PKU patients (28%) in the younger age group and 10 of 23 (43%) in the older age group had serum ubiquinone-10 concentrations below the reference interval. CONCLUSIONS: Serum ubiquinone-10 deficiency appears to be related to the restricted diet of PKU patients. Because serum ubiquinone-10 plays a major antioxidant role in the protection of circulating lipoproteins, the correction of ubiquinone-10 concentrations should be considered in PKU patients. Further investigation seems advisable to elucidate whether the deficiency in serum ubiquinone-10 status is clinically significant.     

An interdisciplinary national program developed at Baylor to make science exciting for all K-5 students.

The achievement gap in science begins in elementary school, where many students lose interest in science-related studies, particularly students from traditionally underrepresented groups. The "My Health My World" Project (hereafter, "the Project"), developed at Baylor College of Medicine with the assistance of federal funds, is a national effort to address this problem. The Project's goals are to make science appealing and relevant for elementary school students (i.e., kindergarten through grade five), including those from underrepresented minorities (URMs), and easy to teach for teachers and parents. It is achieving this goal by the development of interdisciplinary instructional materials that use environmental health issues as a unifying theme. The Project provides its materials (including take-home materials for parents) and training for teachers at seven dissemination centers across the country, established in 1997. Workshops are also held to train facilitators, chosen from among local science education leaders, who in turn hold workshops to train other teachers. Each center receives a mini-grant to cover costs related to the training it provides, and all coordinate their training to offer comparable experiences for all participants. Field tests in 1995, 1996, and 1997 involving culturally, racially, and ethnically diverse students and teachers in two sites indicate that the participating teachers found that the Project's materials promote science learning and enthusiasm for science and are easy to use and engaging for teachers. Ratings for workshops in 1998 were also high for all characteristics evaluated. All signs after the Project's first full year of dissemination activities (1998) indicate that it will continue to reach more teachers and students across the nation and will eventually help more students from all backgrounds achieve in science-related studies.     

CT evaluation of gastric wall pathology

The purpose of this study is to show the CT features of common and infrequent pathological lesions of the gastric wall. Although CT features are not often specific, familiarity with the most frequent pathological gastric findings on CT can assist in differential diagnosis.     

Subjective versus statistical model assessment of mortality risk in open heart surgical procedures

BACKGROUND: The aim of this study was to compare the predictive accuracy for open heart surgical mortality between a statistical model based on collection of clinical data and surgeons' subjective risk assessment. METHODS: Predictive discrimination of both risk assessments (surgeons' and model) was compared through the area under the receiver operating characteristic curve. Logistic regression analysis was used to assess the relation between surgeons' and model predictions to actual outcomes. Calibration of the subjective estimates was evaluated with a chi2 test. RESULTS: Overall, the area under the receiver operating characteristic curve was 0.76 for the statistical model and 0.70 for the subjective assessment. Logistic regression analysis showed that the statistical model remained significant after accounting for the subjective assessment. Calibration of subjective mortality predictions was poor. CONCLUSIONS: Surgeons' risk assessment tends to cluster in the middle ranges of risk. Subjective assessment seems accurate in identifying the two extremes of risk but is inaccurate for intermediate risk levels. A multivariate statistical model improves the accuracy of subjective predictions.     

Proton magnetic resonance spectroscopy pattern of progressive multifocal leukoencephalopathy in AIDS

The objective was to determine whether the use of intermediate echo times (135 ms) in proton magnetic resonance spectroscopy (1H-MRS) detects a homogenous pattern in progressive multifocal leukoencephalopathy (PML) in HIV-1 infected people, and to confirm the results of previous studies. Six patients infected with HIV-1, with PML established by biopsy, and six healthy age and sex matched volunteers were evaluated to define their spectroscopic pattern. 1H-MRS spectra performed at 1.5 T were obtained with the STEAM sequence: TE/TM/TR, 20 ms/13.7 ms/2000 ms; 2500 Hz, size 2048 points, 256 acquisitions (STEAM-20) and with the PRESS sequence; TE/TR, 135 ms/2000 ms; 2500 Hz, size 2048 points, 256 acquisitions (PRESS-135). A single voxel was placed on the lesions and on the parieto-occipital white matter of controls. The peaks of N-acetylaspartate (NAA), choline (Cho), myoinositol (mI), lactate, and lipids were considered, and the results were expressed using creatine as reference. Spectra of PML lesions were characterised by significantly reduced NAA, lactate presence, and by significantly increased Cho and lipids compared with control group values. These results indicate that 1H-MRS detects a homogenous pattern in PML lesions. Recent studies, together with this, suggest that 1H-MRS may help in the diagnostic approach to patients with suspected PML lesions associated with AIDS.