Pneumocystis exhalation by infants developing Pneumocystis primary infection: putative infectious sources in hospitals and the community.

Pneumocystis jirovecii DNA was detected using a polymerase chain reaction assay in air samples collected using an air-liquid impaction device at 1 m distance from three out of 14 infants who had developed Pneumocystis primary infection. P. jirovecii genotype identification was successful in one out of three pairs of air samples. Matching of P. jirovecii genotypes between the nasopharyngeal and air samples suggested that P. jirovecii was effectively exhaled by the infected infant. These original results represent a proof of concept of the role of infants with primary pneumocystis infection as infectious sources of P. jirovecii in hospitals and in the community.

Minor histocompatibility antigens as risk factor for poor prognosis in kidney transplantation.

Progress in transplantation has relied on similar human leukocyte antigen (HLA) matching between the donor and the patient, while the role of other immunologic factors like non-HLA markers including minor histocompatibility antigens (miHA) are currently in the forefront. miHA are polymorphic proteins that vary even in monozygotic twins. The best known is the H-Y antigen, but there are also other autosomal miHA and MICA (MHC class I chain-related gene A). miHA have been well studied in transplantation of hematopoietic precursors, but not in solid organ transplantation. The most important studies in this field relate to incompatibility of H-Y antigen as a risk factor in kidney transplantation, although the findings are still inconclusive. This review presents the role of minor histocompatibility antigens in solid organ transplantation, especially of the kidney.

[A form for the notification of cases of child abuse in Spain]. / Instrumento de notificación del maltrato infantil en España.

AIM: To design a form to collect national data on child abuse, which could be used by the autonomous communities and which could supply valid information for the investigation, intervention and prevention of child abuse in Spain. METHODS: A Delphi study was carried out with three questionnaires in which 59 experts from 16 autonomous communities participated. Of the experts, 53 answered the second questionnaire (89.9%) and 44 the third (74.6%). Each expert indicated whether, in his/her opinion, a specific item should be incorporated in a national register of child abuse. A consensus was considered to have been reached for a particular item when agreement between the experts was equal or higher than 85%. RESULTS: The final notification form agreed on by the participants has 29 items. It contains information on the identity of the child and the child's parents and details of the composition of the family unit and of the event that caused the notification. It also contains details of the reasons for suspecting abuse and the type of child abuse. CONCLUSIONS: We present a form agreed by consensus for the notification of child abuse that, when distributed nationally, will provide valid data for the whole of Spain.

Instrumento de notificación del maltrato infantil en España / A form for the notification of cases of child abuse in spain objectives

OBJETIVO: El objetivo de este estudio es diseñar un instrumento de notificación de maltrato infantil (MI), que pueda ser utilizado por las comunidades autónomas (CA), y que proporcione información válida para la investigación, la intervención y la prevención del MI en España. MÉTODOS: Se realizó un estudio Delphi con 3 rondas de preguntas en el que participaron 59 expertos de 16 CA. De éstos, 53 respondieron a la segunda ronda (89,9 por ciento) y 44 la tercera (74,6 por ciento). Cada experto indicó si, en su opinión, un determinado ítem debería figurar en un registro nacional de MI. Se consideró alcanzado el consenso para un determinado ítem cuando el acuerdo entre los expertos fue igual o superior al 85 por ciento. RESULTADOS: El registro final consensuado con los expertos consta de 29 ítems. Recoge información sobre la identificación del menor, del presunto maltratante, del ámbito desde el que se realiza la notificación, de la identificación de los padres del menor, de la composición de la unidad familiar, y del incidente que motiva la notificación. Además, se añaden diferentes indicadores de maltrato y se tipifica el caso de MI. CONCLUSIÓN: Se dispone de un instrumento consensuado entre expertos que permitirá disponer de datos válidos sobre MI en España después de su implantación en el ámbito estatal (AU)

Localization and characterization of speech arrest during transcranial magnetic stimulation.

OBJECTIVE: To determine the anatomic and physiologic localization of speech arrest induced by repetitive transcranial magnetic stimulation (rTMS), and to examine the relationship of speech arrest to language function. METHODS: Ten normal, right-handed volunteers were tested in a battery of language tasks during rTMS. Four underwent mapping of speech arrest on a 1 cm grid over the left frontal region. Compound motor action potentials from the right face and hand were mapped onto the same grid. Mean positions for speech arrest and muscle activation were identified in two subjects on 3-dimensional MRI. RESULTS: All subjects had lateralized arrest of spontaneous speech and reading aloud during rTMS over the left posterior-inferior frontal region. Writing, comprehension, repetition, naming, oral praxis, and singing were relatively spared (P < .05). Stimulation on the right during singing abolished melody in two subjects, but minimally affected speech production. The area of speech arrest overlay the caudal portion of the left precentral gyrus, congruous with the region where stimulation produced movement of the right face. CONCLUSIONS: The site of magnetic speech arrest appears to be the facial motor cortex. Its characteristics differ from those of classic aphasias, and include a prominent dissociation among different types of speech output.

Optimum stimulus parameters for lateralized suppression of speech with magnetic brain stimulation.

Rapid-rate transcranial magnetic brain stimulation produces lateralized suppression of speech output over the frontal lobe, consistent with cerebral dominance for language. But the sensitivity of magnetic speech localization has been limited, and reports are imprecise concerning the amount of discomfort involved. Using a focal magnetic coil, we evaluated the effectiveness and pain of stimulation at different intensities, orientations, and repetition rates (2 to 32 Hz) in six normal volunteers. We obtained complete and clearly lateralized speech arrest in all subjects. The best ratio of efficacy to pain occurred using slower repetition rates of 4 to 8 Hz with a horizontal alignment of the induced electric field. Lower stimulation frequency also allowed clearer distinction between speech arrest and dysarthria from tonic contraction of cranial muscles. The relative comfort and safety of stimulation at 4 Hz should allow more widespread use of magnetic speech localization in clinical and research applications.

Phase II trial of weekly i.v. vinorelbine as a single agent in first-line advanced breast cancer chemotherapy. The Latin-American experience.

This study investigated the therapeutic effect of single-agent i.v. weekly Navelbine (vinorelbine), a semisynthetic vinca alkaloid, in women who had received no prior treatment for locally advanced or metastatic breast cancer. Of 68 patients entered into the study, 63 were adequate inclusions, assessable for toxicity and response by WHO criteria; the 5 patients who were not evaluated were excluded from analysis because they were found not to meet the eligibility criteria of the study. Navelbine was given as a weekly 30 mg/m2 short i.v. (20 minutes) infusion; treatment was continued until disease progression. The overall response rate was 44% (complete response 8%, partial response 36%). The response rate according to target was lymph nodes, 62.9%; liver, 50.0%; lung, 50.0%; skin, 37.5%; and primary tumor, 30.8%. The median duration of response was 17.9 weeks (range: 7-52 weeks). The median time to treatment failure was 12.9 weeks, and the median survival was 50.3 weeks. The 63 eligible patients received 501 cycles. The mean dose intensity was 76%. At least one episode of WHO grade 3/4 granulocytopenia was seen in 46% of the patients (13.6% of cycles). Significant nausea/vomiting was seen in only 5% of patients corresponding to 1% of cycles. Only 5% of patients developed WHO grade 3-4 constipation and grade 3 peripheral neuropathy was observed in 1.6% of patients. Alopecia was rare (6.3% of patients), and other side effects were uncommon. This study confirms that Navelbine has major single-agent antitumor activity as frontline therapy in advanced breast cancer. Given its excellent tolerance profile and low morbidity, it should be recommended for inclusion in first-line combination chemotherapy regimens.

Effects of chronic ethanol consumption on the rat parotid gland.

Two-month-old Wistar rats ingested 10% ethanol for 12 months. Their parotid glands were then compared with those of normal controls by light microscopy. They had extensive ductal and acinar oncocytic transformation; numerous atypical acinar cells showed anisocytosis, polyploidism and hyperchromatism, features that were absent in controls. Oncocytosis and atypical acinar cells have been reported in 2-3-yr-old ('senile') Wistar rats. Thus, chronic alcohol ingestion may produce cellular features resembling those observed in the parotid gland of 'senile' Wistar rats.