High correlation of human immunodeficiency virus type-1 viral load measured in dried-blood spot samples and in plasma under different storage conditions

BACKGROUND: To measure HIV-1 RNA concentration requires venous extraction of blood, use of RNAase-free materials, and transport in a cold chain, which makes difficult the management of samples in developing countries. We evaluated the utility of the determination of HIV-1 RNA concentration in blood samples dried on filter paper (DBS) and subjected to different conditions, as contrasted with determination in plasma. METHODS: HIV-1 RNA concentration was determined in HIV-infected patients in DBS and in plasma samples. Samples were subjected to the following: DBS were stored at 4, 22, and 37 degrees C for 1, 3, and 7 days; samples from patients from four regions of Mexico were mailed to a reference laboratory; DBS were sent under environmental conditions; and plasma samples were sent frozen. HIV-1 RNA concentrations were determined by NucliSens in DBS and by Amplicor test in plasma. RESULTS: HIV-1 RNA concentration determined in DBS subjected to different temperatures and times had a significant correlation (r=0.99) with those obtained in plasma. When compared with values in plasma, Kappa agreement coefficients of values in DBS stored for 7 days at 4, 22, and 37 degrees C were 0.98, 0.83, and 0.94, respectively. Quantification of HIV-1 RNA in 108 DBS mailed from remote areas with different climates demonstrated significant correlation with those obtained in plasma (r=0.95; p <0.001). CONCLUSIONS: DBS is a simple and reliable method to measure HIV-1 RNA concentration, especially when samples are mailed from remote areas to a reference center. This collection method is an economic and suitable alternative for use in developing countries.     

Molecular mechanisms in hormone-resistant prostate cancer

Prostate cancer is the most common malignancy in males. Despite the efforts for an early diagnosis, approximately one third of the cases are diagnosed in advanced clinical stages. Prostatic cancer, as the function of normal prostate is dependent upon androgens. So, androgenic deprivation represents an effective treatment especially in advanced cases. Although, the majority of patients will initially respond to androgen blockade, consequently the hormone-resistance will develop and the tumor will progress. The mechanism that determines tumoral progression during the endocrine treatment is driven by genomic instability, characterized by activating mutations of androgen receptor gene (AR), progression of some cellular clones possible of neuroendocrine origin that become adapted to low concentrations of residual adrenal androgens, suppression of apoptosis, by bcl-2 oncogene overexpression and p53 mutations, and growth factors (IGF-1--Insulin-like growth factor, KGF--keratinocyte growth factor, EGF--Epidermal growth factor, TGF a, b- Transforming growth factor a and b, bFGF--Fibroblastic growth factor type b) regulatory effect through either a paracrine or an autocrine mechanism. The identification of molecular alterations that appear during prostate carcinogenesis, may lead to the identification of new molecular targets to prevent hormone-resistance and to improve the prognosis in prostate cancers.     

Headache in children and adolescent in ambulatory practice

Headache in children and adolescent represents one of the most frequent and potentially severe pathological conditions, requiring a paediatric consult. The purpose of the study was to establish the headache prevalence from the total paediatric consultations in ambulatory practice as well as to establish the main etiological causes of the headache. The study, including 400 children and adolescents (M/F ratio=150/250, U/R ratio=290/110) with headache selected from 3100 cases between 2003 and 2004, in two practices (one general paediatric office and one paediatric neuropsychiatry office) from the Outpatient Clinic of the "Sf. Spiridon" Hospital of Iasi, has shown a prevalence of headache of 12.9%, the most affected age group being that of 5-12 years (52.5%). The etiologic study proved a high frequency of trauma 46.25%, ophthalmologic diseases 13.28%, psychogenic headache 10.75%, migraine 10%, general causes (infections, anaemia, hypoglycaemia) 9%, ENT causes 6.25%, intracranial causes 0.75%. The study confirms the necessity of a multidisciplinary approach, most causes being benign and the prognosis favourable in most cases.     

Occupation and thyroid cancer risk in Sweden

OBJECTIVE: The objective of this study was to identify occupations and industries with increased incidence of thyroid cancer in Swedish workers. METHOD: Standardized incidence ratios were computed for each job and industry for the period 1971-1989 through record-linkage with the Swedish National Cancer and Death Registers. Age-, period-, geographically adjusted relative risks were calculated using Poisson models. RESULTS: Increased risks were found for teachers, construction carpenters, policemen, and prison/reformatory officials in men, and medical technicians, shop managers, tailors, and shoecutters among women. Industries with risk excess are manufacture of agricultural machinery, manufacture of computing/accessories, and public administration/police among men; and manufacture of prefabricated wooden buildings, electric installation work, and wholesale of live animals/fertilizers/oilseed/grain among women. CONCLUSIONS: Our results corroborate some previously reported increased risks. Further research is needed to assess the influence of specific chemical agents related with some of the highlighted work environments.     

Yersinia pseudotuberculosis septicemia and HIV

Two cases of community-acquired septicemia caused by serotype-O1 Yersinia pseudotuberculosis were diagnosed in middle-aged, HIV-positive, immunodeficient patients during an 8-month period. Bacterial isolates were genetically indistinguishable, but no epidemiologic link between the 2 patients was established. HIV-related immunosuppression should be regarded as a risk factor for Y. pseudotuberculosis septicemia.     

Canine leishmaniasis, Italy

We report the results of a survey to determine the prevalence of canine leishmaniasis and the presence of sand flies in northwestern Italy, where autochthonous foci of canine leishmaniasis have not been reported. Active foci of canine leishmaniasis were identified, which suggests that the disease is now also endemic in continental climate areas.     

Use of acetylcholinesterase inhibitors and memantine in Alzheimer-type dementia

BACKGROUND: The therapeutic options to treat Alzheimer-type dementia (ATD) in recent years, have made it increasingly necessary to become familiar with the employment pattern of these new medicinal products. METHODS: A cross-sectional observational study of the population with ATD treated with acetylcholinesterase inhibitors and/or memantine in the Gallician Health Service. Databases were compiled with the demographic variables and use data during April 2005 of the medicinal products studied. RESULTS: Of the 5110 patients with ATD, 70.47% were women. The mean age of the women was 80.12 and of the men was 78.61 years old, with standard deviations of 6.66 and 7.03, respectively. The female sex was one of the factors associated with presenting ATD to pharmacological treatment (OR: 1.932 [CI 95%: 1.819-2.052]). The medication used most was donepezyl (44.46% of patients). Significant differences were found in that memantine was used to treat more patients in the group of patients < or =64 years (19.7% in < or =64 years vs. 14% in >64 years [p < 0.05]), and donepezyl was preferentially used in patients > or =95 years (75% in > or =95 years vs. 46.9% in <95 years [p < 0.03]). No significant differences were observed in the use of anti-dementia therapy, expressed in DDD/patient/day between the sexes, age groups, or in the age groups separated according to sex. CONCLUSIONS: The use of memantine (in monotherapy or in combination) is more frequent in patients under 64 years old. Female sex was found to be a factor associated with presenting ATD to pharmacological treatment.     

Breast reconstruction with the transverse rectus abdominis musculocutaneous (TRAM) flap

The transverse rectus abdominis musculocutaneous (TRAM) flap has been the most employed technique in autogenous breast reconstruction. It provides a new breast of adequate volume, ptosis and natural appearance, and does not require the implantation of prosthesis; a good symmetry with the contralateral breast is obtained, which lasts over time. The drawback of this technique is the morbidity of the abdominal wall. This flap sacrifices the muscle and the anterior rectus sheath which can result in consequences such as hernias and eventrations. To minimise this problem the microsurgical TRAM flap was developed, which only sacrifices a portion of muscle, significantly reducing the number of sequels. A drawback is the difficulty of the surgical technique, which requires mastery of vascular-nervous microsurgery. In conclusion, a new breast can be returned to the mastectomised woman in a completely autogenous way, with a volume, form and texture similar to the healthy side, which helps in short to recover lost self-esteem.     

Health impact evaluation of particle air pollution in five Spanish cities. European APHEIS project

BACKGROUND: The health effects of air pollution have been analyzed in numerous studies over recent years, thus having made it possible to quantify the relationship between the two. This study is aimed at analyzing the theoretical benefits which would be achieved by meeting the air quality objectives set forth under EC Directive 1999/30/EC with regard to suspended particles. METHODS: The exposure measurement was taken for Black Smoke (Barcelona, Bilbao, Valencia) and suspended particles under 10 microm (PM10) (Bilbao, Madrid y Sevilla). The health indicators calculated were the mortality due to all causes and respiratory and cardiovascular causes, and emergency hospital admissions and mortality due to respiratory and cardiovascular causes. In the case of PM10 the impact has been calculated because its effects to short-term, within a period of up to 40 days following exposure, and to long-term. For Black Smoke the effects only has been calculated to short-term. RESULTS: The daily levels of PM10 from exceeding 50 microg/m3 in Bilbao, Madrid and Sevilla cause the earlier death of 1.4/100,000 individuals per year because its effects. The effect within a period of up to 40 days following exposure is of 2.8 deaths/100,000. The total number of deaths per year which may be later due to long-term exposure if the yearly average is lowered to 20 microg/m3 is 68/100,000. CONCLUSIONS: The health impact of the current air pollution levels is quantifiable and is not insignificant. APHEIS and the impact evaluations may be of aid in healthcare planning and environmental policies.     

Effects on health of water and food contamination by emergent human viruses

The development of molecular technologies applied to environmental studies has shown that even in highly industrialized countries there is a high prevalence of viruses in the environment that represents an important impact on public health and substantial economic losses mainly related to the transmission of viruses through water and food. Significant concentrations of viruses are detected in the water flowed to the environment and in the biosolids generated in wastewater treatment plants. This work describes the general characteristics of the environmental contamination by viruses principally by emergent viruses, with a special emphasis on the hepatitis E virus (HEV) and the human polyomaviruses as the environmental contaminants more recently identified in industrialized countries. It has been shown that there is a high prevalence of the human polyomaviruses BKV and JCV in urban sewage in all studied countries, implying a potential transmission of these viruses and their potential oncogenic genes through the oral route. Recent studies have shown that the epidemiological pattern of the HEV infection in industrialized countries is complex and that a diversity of HEV strains simultaneously infects the population. The control of the viral contamination requires the standardization of molecular techniques and the development of a surveillance program for the evaluation of the viral parameters and to reduce the dissemination of already established diseases and emergent viral infections.