Prevalence and control of arterial hypertension in the south-east of Spain: A radical but still insufficient improvement

Stroke mortality rates in Spain are one of the highest in all of Europe. At the same time, the Murcia region (south-east Spain) shows, for both genders, the highest age-adjusted stroke mortality rates in all of Spain. The earliest available hypertension figure estimations for this area go back to 1981, when a high prevalence combined with an almost nonexistent control was detected. One decade later, updated prevalence estimations of hypertension are presented jointly with their degree of control and their association with other risk factors based on the results of a prevalence survey in a random population sample (n = 3,091). Arterial blood pressure was measured following the MONICA protocol, maintaining a tight quality control on between and within-observer variability. As hypertensive was considered as any person with systolic blood pressure (SBP) 140 mmHg or with diastolic blood pressure (DBP) 90 mmHg or with antihypertensive pharmacological treatment. Detected prevalence rises to 32.3% (CI 95%: 29.1%–35.5%) among males and to 23.7% (CI 95%: 21.4%– 26%) among females, maintaining its level regarding figures observed back in 1981. However, its control has been increased, especially among hypertensive women [from less than 5% in 1981 to 35% (95% CI: 32%–37.8%) at present]. Hypertension is strongly associated to hipercholesterolemia, overweight, obesity and diabetes (p < 0.01). On the contrary, it shows an opposite association with current smoking, higher educational level and leisure time physical activity (p < 0.01). The highest educational level was associated with better hypertension treatment and control. In summary, while hypertension prevalence is stabilized in our population, its control has improved in a measurable but still insufficient way. These results are in accordance with a decreasing trend in stroke mortality registered in the Murcia Region along the last decade.     

Biological standardization and maximum tolerated dose estimation of an Alternaria alternata allergenic extract.

BACKGROUND: The manufacture of allergenic extracts from the mold Alternaria alternata is influenced by factors such as strain variability, allergenic origin, culturing conditions and extraction process, which affect the reproducibility of the preparations intended for diagnostic and therapeutic use. OBJECTIVES: To select the most adequate antigenic source of A. alternata extracts and determine its maximum tolerated dose (MTD) to be used in a subsequent immunotherapy efficacy clinical trial. Methods: Twenty-one patients monosensitized to A. alternata were involved in a biological standardization process of A. alternata extracts. Four different mold strains were cultured and used to produce extracts by three different methods, each incorporating proteins from different origins: culture filtrate, buffer extractable fraction and cellular antigens. The selected extract, characterized as in-house reference (IHR) preparation was used in a MTD finding immunotherapy study. Serum IgE, IgG, IgG1 and IgG4 specific of complete extract and purified natural and recombinant forms of Alt a 1 were determined by different EIA methods. RESULTS: Culture filtrate extract containing the allergens secreted to the spent medium was shown to be the most adequate option for establishing an IHR preparation for A. alternata extract manufacturing. A maximum dose of 1670 UBE, equivalent to 0.1 microg Alt a 1, was determined as MTD for immunotherapy. One year of administration of such a dose at monthly intervals elicited pronounced immunological changes with statistically significant decreases in IgE and increases in IgG4, both estimated with whole extract or purified Alt a 1. CONCLUSION: A high quality natural A. alternata extract has been developed and preliminarily tested to define its MTD for subsequent determination of the optimal dose in an immunotherapy efficacy clinical trial.     

Assessment of PCR status of vector-borne pathogens in dogs presenting arrhythmias

Arrhythmias are frequent and can be caused by many diseases. Vector-borne diseases are increasing in importance as a cause of arrhythmias in veterinary medicine. The objective of the study was to evaluate dogs presenting arrhythmias of any aetiology and to assess the influence of polymerase chain reaction (PCR) status for vector-borne pathogens in the Mediterranean area of Spain. A total of 120 dogs presenting arrhythmias were prospectively selected, and PCR for several vector-borne pathogens (Leishmania infantum, Ehrlichia/Anaplasma spp., Babesia spp., Rickettsia spp., Mycoplasma spp., Hepatozoon canis and Bartonella spp.) were analysed in blood samples. Twenty-four (20 %) dogs had positive results for PCR. Found pathogens were Ehrlichia/Anaplasma spp. (n?=?10, 8.3 %), Babesia spp. (n?=?7, 5.8 %), Rickettsia spp. (n?=?5, 4.2 %), Leishmania spp. (n?=?4, 3.3 %), Mycoplasma spp. (n?=?4, 3.3 %), and H. canis (n?=?1, 0.8 %). No significant differences were found in relation to PCR status and type or cause of the arrhythmia. Although there is a clear association between some infectious diseases and cardiac diseases, this study could not find evidence of the role of infectious agents as triggers for arrhythmias in dogs. More studies are needed to further explore this association.     

Proteins synthesized in African swine fever virus-infected cells analyzed by two-dimensional gel electrophoresis

At least 74 acidic and 37 basic proteins are synthesized in African swine fever virus (ASFV)-infected monkey cells not detected in uninfected cells analyzed by two-dimensional gel electrophoresis. Essentially all the proteins synthesized early during infection are also observed at late times. The use of inhibitors such as cycloheximide and phosphonoacetate has led to the identification of 34 immediate early and 13 delayed early polypeptides. Therefore 64 proteins were classified as late polypeptides. Several ASFV-induced proteins are phosphorylated as proteins a1, a4, a20, a41, a48, a49, a51, a52, a55, a58, a67, b2, b12, b28, and b32.     

Endoscopic Resection Followed by Proton Therapy With Pencil Beam Scanning for Skull Base Tumors

For patients who require postoperative radiotherapy after endoscopic resection of skull base tumors, proton therapy with pencil beam scanning (PBS) may allow sparing of normal tissue compared to intensity‐modulated photon radiation (IMRT). We compared PBS and IMRT radiation plans in the preoperative and postoperative settings for two patients with advanced skull base tumors following endoscopic resection. The benefits of PBS over IMRT appear greater in the postoperative setting following endoscopic resection with improved sparing of critical organs at risk. The multidisciplinary approach of endoscopic resection followed by PBS represents a treatment paradigm with potential for improvements in toxicity reduction. Laryngoscope, 129:1313–1317, 2019     

Respiratory allergy to peach leaves and lipid-transfer proteins

BACKGROUND: Several lipid-transfer proteins (LTPs) have been identified as important food allergens, especially in fruits of the Rosaceae family. The major peach (Prunus persica) allergen has been identified, sequenced and designated Pru p 3. OBJECTIVE: To present Pru p 3 as an aeroallergen able to induce occupational asthma. METHODS: A thorough investigation was performed in a fruit grower with occupational asthma. Skin prick-prick tests with peach leaves and prick tests with perennial respiratory allergens and pollens, fruits and peach leaf extracts were done. Serum-specific IgE was tested for peach leaf, peach fruit, peach skin and respiratory allergens that were positive in skin prick tests. Specific bronchial provocation tests (BPTs) with extracts of peach leaf were also done. Before and 24 h after the BPT, BPTs with methacholine and sputum induction were done. The IgE reactivity pattern to peach leaf and fruit extracts and to Pru p 3 was identified by using SDS-PAGE and immunoblotting. Blotting inhibition of peach leaf extract by Pru p 3 was also performed. The putative allergen was quantified in leaf and fruit skin extracts with ELISA based on an anti-Pru p 3 antibody. RESULTS: Skin tests were positive for peach leaf and fruit. The BPT was positive, with immediate and delayed response. This test induced a decrease in PD20 (dose of agonist that induces a 20% fall in FEV1) methacholine and an increase in eosinophils and eosinophil cationic protein in sputum. Peach leaf extract contained concentrations of Pru p 3 similar to those found in peach skin. Specific IgE immunodetection showed that patient's sera reacted with Pru p 3, and with a single major band from the peach leaf extract fully inhibited by Pru p 3. CONCLUSION: Pru p 3 from peach leaves can act as a respiratory allergen and cause occupational rhinoconjunctivitis and asthma.     

Evaluation by Markov chain models of a non-randomised breast cancer screening programme in women aged under 50 years in Sweden

STUDY OBJECTIVE: To apply Markov chain models that have previously been used on data in randomised trials of breast cancer screening to data from an uncontrolled service screening programme; to compare results with those from a randomised trial. DESIGN: A service screening programme in Uppsala county, Sweden, inviting 25,660 women aged 39-49 to mammographic screening every 20 months, and the Swedish Two-County Trial inviting 19,844 women aged 40-49 to two yearly screening, compared with 15,604 women of the same age in an unscreened control group. Data were analysed using Markov chain models and quasi- likelihood estimation procedures. MAIN RESULTS: The results with respect to parameters of disease progression were very similar between the two studies. Use of estimated progression rates to predict the effect on mortality ranged from a 10% to a 17% reduction in breast cancer mortality in the Two-County Study and predicted a 15% reduction in the Uppsala programme. These compare well with the observed mortality reduction of 13% in the Two-County Trial. CONCLUSIONS: The screening in the Uppsala programme is likely to have a similar effect to that observed in the Two-County Trial. It is feasible to evaluate non-randomised service screening programmes using Markov chain models.     

Perspectives in the treatment of allergy to latex: immunotherapy

At present, allergy to latex is an important problem due to the severity of the symptomatology that it produces and the risk groups involved. Complete avoidance of latex is practically impossible, which is why in recent years there has been intense work on standardizing an extract in order not only to improve its clinical diagnosis but also to be able to offer a therapeutic alternative other than avoidance, such as immunotherapy. Since 1998, timely approaches to immunotherapy with latex have been published, with oral desensitization (three patients), subcutaneous (one patient) and sublingual (one patient). In every case there was an evident clinical improvement. At present, subcutaneous immunotherapy with latex, although efficient, is a high risk treatment. Sublingual immunotherapy with latex has recently been commercialized in Spain and we know of its efficacy through the results of an open test on 26 adult patients. The safety expectations are shown to be better than those for subcutaneous immunotherapy.