Standardization of amniotic fluid leptin levels and utility in maternal overweight and fetal undergrowth.

OBJECTIVE: Leptin is an adipokine that regulates energy homeostasis. The objective of this study was to establish a gestational age-specific standard for amniotic fluid leptin (AFL) levels and examine the relationship between AFL, maternal overweight and fetal growth restriction. STUDY DESIGN: Amniotic fluid was obtained at mid-gestation from singleton gravidas, and leptin was quantified using enzyme-linked immunosorbent assay. Amniotic fluid samples from 321 term pregnancies were analyzed. Clinical data, including fetal ultrasound measurements and maternal and infant characteristics, were available for a subset of patients (n=45). RESULTS: The median interquartile range AFL level was significantly higher at 14 weeks' gestation (2133 pg ml(-1) (1703 to 4347)) than after 33 weeks' gestation (519 pg ml(-1) (380 to 761), P trend<0.0001), an average difference of 102 pg ml(-1) per week. AFL levels were positively correlated with maternal pre-pregnancy body mass index (BMI) (r=0.36, P=0.03) adjusting for gestational age at measurement, but were not associated with fetal growth. CONCLUSIONS: AFL levels are higher at mid-gestation than at late gestation, and are associated with maternal pre-pregnancy BMI.

Molecular comparison of natural hybrids of Phytophthora nicotianae and P. cactorum infecting loquat trees in Peru and Taiwan.

Natural Phytophthora hybrids (P. nicotianae x P. cactorum) infecting loquat in Peru and Taiwan were characterized with AFLP (amplified fragment length polymorphism) markers, the internal transcribed spacer (ITS) region and the phenol acid carboxylase gene (Pheca) and inheritance of the mitochondrial cytochrome oxidase I gene (coxI). AFLP profiles of two Taiwanese isolates recovered in 1995 were polymorphic in approximately 50% of the fragments whereas five Peruvian isolates, recovered 2002-2003 and 2007, showed no genotypic variation. Sequencing analysis of the cloned ITS region resulted in the identification of sequences with high homology to either P. nicotianae (99%) or P. cactorum (97%). Direct sequence analysis of the Pheca gene revealed 13 heterozygous sites suggesting the presence of both P. nicotianae and P. cactorum genes in P. hybrids isolates. Melting analyses of coxI suggested that all seven Phytophthora hybrids inherited the mitochondrial DNA from P. nicotianae. Our results suggest that Phytophthora hybrids from Peru might have originated from a single hybridization event and that the two isolates from Taiwan might have originated through different hybridization events. The Peruvian hybrids appear to have persisted at least 3 y at three locations. Possible factors influencing the population structure of Phytophthora hybrids infecting loquat are discussed.

Occurrence and characterization of a Phytophthora sp. pathogenic to asparagus (Asparagus officinalis) in Michigan.

A homothallic Phytophthora sp. was recovered from asparagus (Asparagus officinalis) spears, storage roots, crowns, and stems in northwest and central Michigan in 2004 and 2005. Isolates (n = 131) produced ovoid, nonpapillate, noncaducous sporangia 45 microm long x 26 microm wide and amphigynous oospores of 25 to 30 microm diameter. Mycelial growth was optimum at 25 degrees C with no growth at 5 and 30 degrees C. All isolates were sensitive to 100 ppm mefenoxam. Pathogenicity studies confirmed the ability of the isolates to infect asparagus as well as cucurbits. Amplified fragment length polymorphism analysis of 99 isolates revealed identical fingerprints, with 12 clearly resolved fragments present and no clearly resolved polymorphic fragments, suggesting a single clonal lineage. The internal transcribed spacer regions of representative isolates were homologous with a Phytophthora sp. isolated from diseased asparagus in France and a Phytophthora sp. from agave in Australia. Phylogenetic analysis supports the conclusion that the Phytophthora sp. isolated from asparagus in Michigan is a distinct species, and has been named Phytophthora asparagi.

Survival and spread of Phytophthora capsici in Coastal Peru.

Phytophthora capsici is a soilborne pathogen that causes significant losses to pepper production in Peru. Our objective was to investigate the mechanisms by which P. capsici is able to survive and spread. During 2005 to 2007, 227 isolates of P. capsici were collected from four species of pepper (Capsicum annum, C. baccatum, C. chinense, and C. pubescens) and tomato (Solanum lycopersicum) at 33 field sites in 13 provinces across coastal Peru. All 227 isolates were of the A2 mating type and amplified fragment length polymorphism (AFLP) analysis indicates that 221 of the isolates had the same genotype. Analyses of six polymorphic single nucleotide polymorphism (SNP) loci showed fixed heterozygosity suggesting a single clonal lineage is widely dispersed. Members of the same clonal lineage were recovered during 2005 to 2007 from geographically separate locations from each of the host types sampled. Our results indicate that clonal reproduction drives the population structure of P. capsici in Peru. The impact of continuous cropping and irrigation from common river sources on the population structure in Barranca Valley are discussed.

Insulin resistance is associated with a modest increase in inflammation in subcutaneous adipose tissue of moderately obese women.

AIMS/HYPOTHESIS: We have previously described differences in adipose cell size distribution and expression of genes related to adipocyte differentiation in subcutaneous abdominal fat obtained from insulin-sensitive (IS) and -resistant (IR) persons, matched for degree of moderate obesity. To determine whether other biological properties also differ between IR and IS obese individuals, we quantified markers of inflammatory activity in adipose tissue from overweight IR and IS individuals. METHODS: Subcutaneous abdominal tissue was obtained from moderately obese women, divided into IR (n = 14) and IS (n = 19) subgroups by determining their steady-state plasma glucose (SSPG) concentrations during the insulin suppression test. Inflammatory activity was assessed by comparing expression of nine relevant genes and by immunohistochemical quantification of CD45- and CD68-containing cells. RESULTS: SSPG concentrations were approximately threefold higher in IR than in IS individuals. Expression levels of CD68, EMR1, IL8, IL6 and MCP/CCL2 mRNAs were modestly but significantly increased (p < 0.05) in IR compared with IS participants. Results of immunohistochemical staining were consistent with gene expression data, demonstrating modest differences between IR and IS individuals. Crown-like structures, in which macrophages surround single adipocytes, were rarely seen in tissue from either subgroup. CONCLUSIONS/INTERPRETATION: A modest increase in inflammatory activity was seen in subcutaneous adipose tissue from IR compared with equally obese IS individuals. Together with previous evidence of impaired adipose cell differentiation in IR vs equally obese individuals, it appears that at least two biological processes in subcutaneous adipose tissue characterize the insulin-resistant state independent of obesity per se.

First Report of Mefenoxam Sensitivity and Pathogenicity of Phytophthora citricola Isolated from American Ginseng (Panax quinquefolium).

In March of 2004, stratified ginseng seeds from commercial Wisconsin gardens were planted in sterilized silica sand in a research greenhouse at Michigan State University. Following emergence, seedlings exhibiting wilting, damping off, and black stem lesions were observed. In the laboratory, symptomatic seedlings were rinsed with distilled water. Tissue samples were excised and embedded in water agar amended with ampicillin (100 mg/liter) and incubated at 25°C. In addition to the isolation of Phytophthora cactorum, a known pathogen of ginseng, P. citricola, (five isolates) also was identified from single-zoospore cultures based on morphology (2). One-week-old, dilute V8 agar cultures were used to obtain single zoospores. Cultures were flooded with 20 ml of sterilized distilled water chilled to 10°C and incubated at 25°C for 25 min to induce zoospore release. Zoospore suspensions were spread onto water agar plates, and after 24 h at 25°C, single germinating zoospores were selected at random and transferred to benomyl, ampicillin, rifampicin, and pentachloronitrobenzene (BARP)-amended V8 agar plates. Sequence analysis of the internal transcribed spacer (ITS) region 1 and 2 of the rDNA was also used to distinguish P. citricola from P. cactorum. A representative sequence for the isolates of P. citricola (NCBI Accession No. FJ217388) matched (100% similarity) a P. citricola isolate deposited in GenBank (Accession No. DQ486661). To screen P. citricola for in vitro response to mefenoxam, agar plugs (7-mm diameter) from 1-week-old V8 agar cultures incubated at 25°C under fluorescent lighting were placed in the center of each of two V8 agar plates amended with 0 and 100 ppm of mefenoxam (Ridomil Gold EC, 48% a.i., suspended in sterile distilled water and added to V8 agar cooled to 49°C). The plates were incubated at 25°C for 3 days under fluorescent lighting. Isolates were assigned a mefenoxam sensitivity rating based on the percentage of radial mycelial growth on the amended V8 agar when compared with the unamended control. Each of the five isolates was scored as mefenoxam resistant with growth on 100-ppm plates >30% of the controls. Koch's postulates were conducted for the isolates of P. citricola recovered from ginseng seedlings to confirm pathogenicity. Previously, P. citricola was reported as nonpathogenic to ginseng (1). Three-week-old, healthy ginseng seedlings were planted into 89- × 64-mm pots filled with autoclaved medium-particle vermiculite and maintained in the greenhouse under 63% shade cloth with temperatures between 18 and 26°C. Pots were arranged in a completely randomized block design with eight seedlings per isolate as replicates and watered as needed. A 2-ml inoculum suspension (approximately 104 zoospores) was injected into the potting medium at the stem base of each seedling. All of the isolates were pathogenic to ginseng seedlings with 60% of inoculated seedlings per isolate exhibiting wilting, damping off, and blackened stems within 3 weeks after inoculation. P. citricola was reisolated from all inoculated plants. To our knowledge, this is the first report of P. citricola pathogenic on ginseng. References: (1) T. W. Darmono et al. Plant Dis. 75:610, 1991. (2) D. C. Erwin and O. K. Ribeiro. Page 96 in: Phytophthora Diseases Worldwide. The American Phytopathological Society, St. Paul, MN. 1996.

First Report of Phytophthora nicotianae Causing Asparagus Spear and Root Rot in Peru.

During 2006, spears, roots, and crowns of asparagus (Asparagus officinalis) exhibiting brown necrotic lesions with water soaking were collected from several sites across Peru (Ica, Lima, and Trujillo). Small infected tissue sections were washed thoroughly with tap and sterile distilled water and transferred to corn meal agar plates (CMA) amended with PARP (100 ppm of pimaricin, 100 ppm of ampicillin, 30 ppm of rifampicin, and 100 ppm of pentachloronitrobenzene) and incubated for five days at 25°C. Hyphal tips were subcultured from actively expanding mycelium. Sporangia produced on CMA were papillate and averaged 38 µm long × 29 µm wide. Chlamydospores were terminal or intercalary and averaged 35 µm in diameter. Isolates incubated in the dark for more than 3 weeks did not produce oospores in single culture. Mating with Phytophthora capsici tester isolates CBS 121656 = A1 and CBS 121657 = A2 indicate that all five isolates were A2. For pathogenicity tests, inoculum was generated by incubating 300 g of autoclaved wheat seeds with four agar plugs (7 mm) of expanding mycelium in polyethylene bags for 1 month at 25°C. Nine-week-old asparagus plants (UC151 F1) were transferred into pots containing autoclaved substrate (1 part sand, 1 part potting soil, and 1 part peat). Inoculum was added as 1 g of inoculum per kilogram of substrate. Plants were maintained in the greenhouse at 23°C and watered daily. Decline symptoms as well as root and spear rot were observed after 7 days and a Phytophthora sp. was reisolated from infected tissue. No symptoms were observed on asparagus plants inoculated with sterile inoculum. DNA was isolated from two representative isolates, and the nuclear ribosomal internal transcribed spacer (ITS) region was amplified with ITS4 and ITS6 primers and sequenced. ITS sequence was submitted for a BLAST search in the NCBI database, showing Phytophthora nicotianae strain UQ848 Accession No AF266776 as the closest match with 99% sequence similarity (1). The consensus ITS sequence was deposited in NCBI (Accession No. EU433396). These results, together with the morphological characteristics, indicate that the Phytophthora sp. isolated from asparagus in Peru is P. nicotianae (Breda de Haan) (2). To our knowledge, this is the first report of P. nicotianae infecting asparagus and represents a new threat for asparagus growers in Peru. Control methods such as moderate watering and metalaxyl application are being applied to reduce Phytophthora outbreaks. References: (1) D. E. Cooke et al. Fungal Genet. Biol. 30:17, 2000. (2) D. C. Erwin and O. K. Ribeiro. Phytophthora Diseases Worldwide. The American Phytopathological Society. St Paul, MN, 1996.

First Report of Phytophthora cactorum Causing Root Rot of Processing Carrots (Daucus carota) in Michigan.

In the fall of 2005, processing carrot fields in Mason, Newaygo, and Oceana counties, Michigan, were surveyed for Phytophthora spp. Carrot roots were sampled from areas of fields that exhibited patches of chlorotic, blighted, or wilted foliage. Dark brown, firm, water-soaked lesions occurred near the middle and crown areas of diseased carrot roots. In the advanced stages of disease, carrot root tissue readily collapsed and a soft rot developed while petioles turned black. The internal portions of the diseased carrot roots were brown and rubbery. Roots with these symptoms are not suitable for processing. Carrot roots were washed with tap water and the tissue excised from the edge of developing lesions and plated aseptically onto BARP-amended (25 ppm of benomyl, 100 ppm of ampicillin, 30 ppm of rifampicin, and 100 ppm of pentachloronitrobenzene) regular V8 juice agar. Plates were incubated at 23 to 25°C for 7 days. Phytophthora sp. was isolated from carrot root samples from all surveyed areas. Ten representative single-sporangium isolates cultured on dilute V8 juice agar were examined for morphological characteristics. The homothallic Phytophthora sp. isolates produced papillate, obpyriform, caducous sporangia (35.0 to 45.2 × 26.2 to 33.2 µm) with 1 to 3 µm long pedicels, plerotic oospores (27.0 to 32.0 µm in diameter) with paragynous antheridia, and primarily terminally produced chlamydospores that were 30.0 to 40.0 µm in diameter. Radial growth on V8 juice agar was observed at temperatures between 10 and 30°C with optimum growth at 25°C and no growth at 5 and 35°C. Pathogenicity of the 10 isolates was tested by inoculating three of each wounded and nonwounded carrot roots with a 7-mm mycelial plug from the edge of actively growing 5-day-old cultures. Inoculated carrot roots were incubated for 7 days in a moist chamber at 23 to 25°C. Symptoms developed 3 to 7 days after inoculation, with non-wounded roots exhibiting firm, dark brown, water-soaked lesions and wounded roots exhibiting soft rot with dark brown margins. The Phytophthora sp. was always isolated from the inoculated roots. Controls remained healthy and no pathogen was isolated from these roots. On the basis of the morphological and physiological characteristics, the Phytophthora sp. isolated was identified as Phytophthora cactorum ((Lebert & Cohn) J. Schrot.) (2). Identity of these isolates was confirmed by sequencing of the internal transcriber spacers (ITS). Amplified fragment length polymorphism (AFLP) profiles for 37 isolates were >83% similar, which is expected for conspecific isolates. The ITS sequences from six representative isolates were identical and shared 100% homology to P. cactorum (GenBank Accession No. AF266772) isolated from Rubus idaeus (1). The consensus ITS sequence was deposited in NCBI (Accession No. EF052680). P. cactorum was reported in New York on field and stored carrot roots in 1952 (3), but to our knowledge, this is the first report in Michigan. Finding of P. cactorum on carrot roots represents a new and significant threat to the Michigan processing carrot industry, which ranks fourth in the United States. References: (1) D. E. L. Cooke et al. Fungal Gen. Biol. 30:17, 2000. (2) D. C. Erwin and O. K. Ribeiro. Phytophthora Disease Worldwide. The American Phytopathological Society. St. Paul, MN, 1996. (3) W. E. Rader. N Y State (Cornell) Agr. Exp. Stn. Bull. 889:5, 1952.

Detection of a Phytophthora sp. Causing Asparagus Spear and Root Rot in Michigan.

In the spring of 2004, a Phytophthora sp. was isolated from asparagus (Asparagus officinalis) spears, roots, and dormant crowns from several fields in Oceana and Ingham counties in Michigan. Symptomatic spears were often curved, had water-soaked lesions slightly above or below the soil line or were shriveled at the site of infection or both. Infected storage roots had water-soaked lesions but were not soft at the lesion site. Infected crowns had fewer roots than healthy crowns. In the laboratory, plant tissues were rinsed in tap water and blotted dry. Sections from the edge of lesions were placed aseptically onto BARP (25 ppm of benomyl, 100 ppm of ampicillin, 30 ppm of rifampicin, and 100 ppm of pentachloroni-trobenzene) amended unclarified V8 juice agar and incubated at 25°C for up to 7 days. Phytophthora sp. isolates recovered from the infected material produced ovoid, nonpapillate, noncaducous sporangia and amphigy-nous oospores on isolation media. Single-sporangium cultures made for each isolate were stored long term in sterile 2-ml microcentrifuge tubes containing two 7-mm mycelial plugs, two sterile hemp seeds, and 1 ml of sterile distilled water. Sporangia produced on dilute V8 juice agar averaged 45 µm long × 26 µm wide and oospores were 25 to 30 µm in diameter. Chlamydospores were not observed. Five detached 'Jersey Knight' spears were inoculated with a 7-mm mycelial plug from the edge of actively growing 5-day-old cultures and incubated at 23 to 25°C for 5 to 7 days in a moist chamber. After 3 days, water-soaked lesions and shriveling and curving of the spears were visible on all inoculated spears. The pathogen was always reisolated from the lesion edge. No symptoms were observed when spears were inoculated with sterile V8 juice agar plugs. DNA was extracted from representative isolates, and the nuclear ribosomal internal transcribed spacer (ITS) region was amplified with ITS6 and ITS4 primers and sequenced. A BLAST search of the NCBI database with the ITS sequence revealed Phytophthora sp. UQ2141, Accession No. AF266795, as the closest match with 99% sequence similarity. These results, coupled with the morphological characteristics of the isolates, indicate that the Phytophthora sp. isolated from asparagus in Michigan is among the constituents of Phytophthora spp. included in the P. megasperma clade 6 (2), whose taxa are currently being reevaluated. Although a Phytophthora sp. has been described previously on asparagus (1,3), this is the first report, to our knowledge, of a Phytophthora sp. on asparagus in Michigan. The occurrence of excessive rainfall in the spring of 2004 is likely responsible for widespread disease and considerable yield losses in production fields. References: (1) P. A. Ark and J. T. Barrett. Phytopathology 28:754, 1938. (2) D. E. L. Cooke et al. Fungal Genet. Biol. 30:17, 2000. (3) V. Vujanovic et al. Plant Dis. 87:447, 2003.

Use of glyburide for the treatment of gestational diabetes: the San Antonio experience.

OBJECTIVES: Equivalent efficacy of glyburide and insulin for treatment of gestational diabetes (GDM) was demonstrated in a recent randomized trial. We describe our experience with glyburide in practice, and suggest factors that predict failure of glyburide treatment. METHODS: Women with GDM treated with glyburide were studied. They were divided into two groups: those who achieved adequate glycemic control with glyburide, and those who did not. The groups were compared in terms of baseline characteristics, including diabetes risk factors and glucose testing values. Receiver operating characteristics (ROC) curves were generated to identify thresholds for fasting plasma glucose and body mass index (BMI) that would predict glyburide failure. RESULTS: Seventy-five women were analyzed: 63 (84%) were successfully treated with glyburide, and 12 (16%) were not. Baseline characteristics were similar between the groups, except that failures had higher 3-h glucose tolerance test (GTT) values at all time points. ROC curves for fasting plasma glucose, pre-pregnancy BMI and BMI at diagnosis revealed no cut-off points for predicting failure of glyburide therapy. However, when fasting plasma glucose value on the GTT was > or = 110 mg/dl, 24% of women failed to respond to glyburide, compared to 12% at < 110 mg/dl (p = 0.15). CONCLUSIONS: In treatment of GDM, glyburide is successful in achieving good glycemic control in most women. Women with high fasting plasma glucose levels, however, may not respond adequately to glyburide therapy.

[Migraine and MIDAS (MIDASELA) in Colombian hospital workers]. / Migraña y MIDAS (MIDASELA) en trabajadores hospitalarios colombianos.

AIMS: The aim of this study was to determine the prevalence of migraine and its implications in the occupational and outside employment/daily activities of the workers at a regional hospital in the Cundiboyacense Plateau in Colombia. PATIENTS AND METHODS: The available members of the house staff at this institution were interviewed by applying the neuroepidemiological protocol drawn up by the World Health Organization (WHO); general doctors performed the initial screening and the determination of neurological disease was carried out by a clinical neurologist, both in patients who were positive and negative for neurological disease. Quality of life was evaluated by means of the MIDAS (Migraine Disability Assessment) survey, MIDASELA (in Spanish for Latin America); the analysis was performed using the EPI 6.04 software application. RESULTS: A total of 238 people were studied: 188 females and 50 males; the prevalence of migraine was 22.5% (15.5% by the WHO protocol and 7% false negatives), with predominance in females (OR: 5.49; p< 0.005). In the MIDASELA questionnaire, 47.2% of the patients had a 50% alteration in their productivity, with regard to their occupational and outside employment/daily activities. A minimum number of patients (3.8%) were unable to work because of migraine, as compared to the figures for outside employment/daily activities (29.7%) or those involving leisure/family (66.4%). The average work, outside employment/daily and family time lost per patient because of migraine was 0.3, 2 and 5.2 days, respectively. CONCLUSION: A sub register in the prevalence of migraine could be reported in places where the WHO protocol is used. This pathology will have to be taken well into account in Colombian hospital workers due to its individual, occupational, family, social and economic impact. It is necessary to introduce health policies and programmes aimed at evaluating, controlling and treating this type of pathology in an appropriate manner, in order to improve the quality of life of those whose job it is to look after and improve that of the other Colombians.

Migraña y MIDAS (MIDASELA) en trabajadores hospitalarios colombianos / Migraine and MIDAS (MIDASELA) in colombian hospital workers

Objetivo. Determinar la prevalencia de la migraña y sus implicaciones en las actividades laborales y extralaborales/cotidianas de los trabajadores de un hospital regional del altiplano cundiboyacense de Colombia. Pacientes y métodos. Mediante la aplicación del protocolo neuroepidemiológico de la Organización Mundial de la Salud (OMS) se encuestó al personal de planta disponible en dicha institución; los médicos generales hicieron el filtrado inicial y la determinación de enfermedad neurológica fue realizada por un neurólogo clínico, tanto en los individuos positivos como en los negativos para enfermedad neurológica. La calidad de vida se evaluó por medio de la encuesta MIDAS (migrain disability assessment), en español para Latinoamérica, MIDASELA; el análisis se realizó con el programa EPI 6.04. Resultados. Se investigaron 238 personas: 188 mujeres y 50 hombres; la prevalencia de migraña fue de 22,5 por ciento (15,5 por ciento por el protocolo de la OMS y 7 por ciento de falsos negativos), con predominio del género femenino (OR: 5,49; p< 0,005). En la encuesta MIDASELA, el 47,2 por ciento de los pacientes tuvieron una alteración en que la migraña afectó a la parte recreativa y familiar que a la laboral; esto contrastó con los días que los empleados se ausentaron del trabajo por causa de la misma migraña, como ya se indicó. La mayor cantidad de días perdidos en promedio para las actividades familiares o recreativas y las extralaborales/cotidianas comparadas con las laborales es más notoria cuando se comparan con los días perdidos en actividades similares en países como EE.UU. o Reino Unido. Cabe destacar que la puntuación del MIDASELA obtenido en este grupo de pacientes fue muy similar a la que se encuentra en pacientes con seis o más ataques de migraña/año en los EE.UU., donde llega a los 20,7 puntos, y mucho mayor que los 15,2 puntos obtenidos en el mismo tipo de pacientes en el Reino Unido [15,16,23].En conclusión, este estudio demuestra que se deben desarrollar estrategias multidisciplinarias bien coordinadas para lograr un mejor cuidado de los individuos con migraña, y tener en cuenta que, aunque ciertos tratamientos médicos pueden parecer costosos al principio, al final tienen un costo-beneficio favorable en los trabajadores afectados [13,22-24]. Las cefaleas son un problema serio de salud pública y dan lugar a una pérdida de recursos en la productividad de los individuos en términos económicos y humanos, lo cual tiene definitivamente que disminuirse al máximo con los actuales enfoques de salud pública [18]. La identificación de factores precipitantes de la migraña en la población colombiana debe ser una tarea fundamental que se desarrolle en un futuro cercano, para poder controlar de una mejor forma este flagelo y poder conocer el impacto real de la migraña, no sólo en Colombia, sino también en otras latitudes. su productividad de un 50 por ciento, tanto laboral como extralaboral/cotidianamente. Un mínimo de pacientes (3,8 por ciento) dejaron de hacer actividades laborales debido a la migraña, frente a las extralaborales/ cotidianas (29,7 por ciento), o las recreativas/familiares (66,4 por ciento). El promedio por paciente de `pérdida' laboral, extralaboral/cotidiana y familiar por causa de la migraña fue de 0,3, 2 y 5,2 días, respectivamente. Conclusión. Podría realizarse un subregistro de la prevalencia de migraña en los sitios donde se ha utilizado el protocolo de la OMS. Esta patología deberá tenerse muy en cuenta en los empleados hospitalarios colombianos por su impacto individual, laboral, familiar, social y económico. Se hacen necesarias políticas y programas de salud dirigidos a la evaluación, control y tratamiento adecuados de este tipo de patologías, con el fin de mejorar la calidad de vida de aquellos que velan por cuidar y mejorar la del resto de los colombianos (AU)

Aims. The aim of this study was to determine the prevalence of migraine and its implications in the occupational and outside employment/daily activities of the workers at a regional hospital in the Cundiboyacense Plateau in Colombia. Patients and methods. The available members of the house staff at this institution were interviewed by applying the neuroepidemiological protocol drawn up by the World Health Organization (WHO); general doctors performed the initial screening and the determination of neurological disease was carried out by a clinical neurologist, both in patients who were positive and negative for neurological disease. Quality of life was evaluated by means of the MIDAS (Migraine Disability Assessment) survey, MIDASELA (in Spanish for Latin America); the analysis was performed using the EPI 6.04 software application. Results. A total of 238 people were studied: 188 females and 50 males; the prevalence of migraine was 22.5% (15.5% by the WHO protocol and 7% false negatives), with predominance in females (OR: 5.49; p< 0.005). In the MIDASELA questionnaire, 47.2% of the patients had a 50% alteration in their productivity, with regard to their occupational and outside employment/daily activities. A minimum number of patients (3.8%) were unable to work because of migraine, as compared to the figures for outside employment/daily activities (29.7%) or those involving leisure/family (66.4%). The average work, outside employment/daily and family time ‘lost’ per patient because of migraine was 0.3, 2 and 5.2 days, respectively. Conclusion. A sub-register in the prevalence of migraine could be reported in places where the WHO protocol is used. This pathology will have to be taken well into account in Colombian hospital workers due to its individual, occupational, family, social and economic impact. It is necessary to introduce health policies and programmes aimed at evaluating, controlling and treating this type of pathology in an appropriate manner, in order to improve the quality of life of those whose job it is to look after and improve that of the other Colombians (AU)

Novel PRKAG2 mutation responsible for the genetic syndrome of ventricular preexcitation and conduction system disease with childhood onset and absence of cardiac hypertrophy.

BACKGROUND: We recently reported a mutation in the PRKAG2 gene to be responsible for a familial syndrome of ventricular preexcitation, atrial fibrillation, conduction defects, and cardiac hypertrophy. We now report a novel mutation in PRKAG2 causing Wolff-Parkinson-White syndrome and conduction system disease with onset in childhood and the absence of cardiac hypertrophy. METHODS AND RESULTS: DNA was extracted from white blood cells obtained from family members. PRKAG2 exons were amplified by polymerase chain reaction and were screened for mutations by direct sequencing. The genomic organization of the PRKAG2 gene was determined using inter-exon long-range polymerase chain reaction for cDNA sequence not available in the genome database. A missense mutation, Arg531Gly, was identified in all affected individuals but was absent in 150 unrelated individuals. The PRKAG2 gene was determined to consist of 16 exons and is at least 280 kb in size. CONCLUSIONS: We identified a novel mutation (Arg531Gly) in the gamma-2 regulatory subunit (PRKAG2) of AMP-activated protein kinase (AMPK) to be responsible for a syndrome associated with ventricular preexcitation and early onset of atrial fibrillation and conduction disease. These observations confirm an important functional role of AMPK in the regulation of ion channels specific to cardiac tissue. The identification of the cardiac ion channel(s) serving as substrate for AMPK not only would provide insight into the molecular basis of atrial fibrillation and heart block but also may suggest targets for the development of more specific therapy for these common rhythm disturbances.

A novel strategy for protective Actinobacillus pleuropneumoniae subunit vaccines: detergent extraction of cultures induced by iron restriction.

We have characterized antigens from Actinobacillus (A.) pleuropneumoniae grown under iron restriction with respect to their immunogenic and protective potential. Antigens were the cell-free culture supernatants (CFS) obtained after treatment of A. pleuropneumoniae broth cultures with sodium deoxycholate. Using the iron-repressible transferrin-binding lipoprotein TbpB and the constitutively expressed outer membrane lipoprotein OmlA as markers, we have shown that the detergent extraction enriched the CFS with lipoproteins from the outer membrane (OM). Extractions with 0.05% of sodium deoxycholate increased the lipoprotein contents in the CFS, but did not affect the integrity of the OM. This was demonstrated by the absence of the iron-repressible integral OM transferrin-binding protein TbpA. Furthermore, the absence of periplasmic and cytoplasmic proteins in CFS after extraction was determined in immunoblot analyses with anti-bacterial alkaline phosphatase and anti-Hsp60 antisera, demonstrating that there was no rupture of the OMs or the plasma membranes due to the extraction procedure. Antigen preparations from A. pleuropneumoniae serotype 2 and 9 grown under iron restrictive conditions were combined, emulsified, and tested for their ability to confer protection in pigs. Pigs immunized with CFS from sodium deoxycholate extracted cultures developed a strong antibody response and, upon challenge with A. pleuropneumoniae serotype 2, the immunized pigs showed no or only mild clinical signs of disease and had a significantly lower degree of lung damage than the control pigs.

A comparison of glyburide and insulin in women with gestational diabetes mellitus.

BACKGROUND: Women with gestational diabetes mellitus are rarely treated with a sulfonylurea drug, because of concern about teratogenicity and neonatal hypoglycemia. There is little information about the efficacy of these drugs in this group of women. METHODS: We studied 404 women with singleton pregnancies and gestational diabetes that required treatment. The women were randomly assigned between 11 and 33 weeks of gestation to receive glyburide or insulin according to an intensified treatment protocol. The primary end point was achievement of the desired level of glycemic control. Secondary end points included maternal and neonatal complications. RESULTS: The mean (+/-SD) pretreatment blood glucose concentration as measured at home for one week was 114+/-19 mg per deciliter (6.4+/-1.1 mmol per liter) in the glyburide group and 116+/-22 mg per deciliter (6.5+/-1.2 mmol per liter) in the insulin group (P=0.33). The mean concentrations during treatment were 105+/-16 mg per deciliter (5.9+/-0.9 mmol per liter) in the glyburide group and 105+/-18 mg per deciliter (5.9+/-1.0 mmol per liter) in the insulin group (P=0.99). Eight women in the glyburide group (4 percent) required insulin therapy. There were no significant differences between the glyburide and insulin groups in the percentage of infants who were large for gestational age (12 percent and 13 percent, respectively); who had macrosomia, defined as a birth weight of 4000 g or more (7 percent and 4 percent); who had lung complications (8 percent and 6 percent); who had hypoglycemia (9 percent and 6 percent); who were admitted to a neonatal intensive care unit (6 percent and 7 percent); or who had fetal anomalies (2 percent and 2 percent). The cord-serum insulin concentrations were similar in the two groups, and glyburide was not detected in the cord serum of any infant in the glyburide group. CONCLUSIONS: In women with gestational diabetes, glyburide is a clinically effective alternative to insulin therapy.

Etiology of bloody diarrhea in Bolivian children: implications for empiric therapy. Bolivian Dysentery Study Group.

In Bolivia, few data are available to guide empiric therapy for bloody diarrhea. A study was conducted between December 1994 and April 1995 to identify organisms causing bloody diarrhea in Bolivian children. Rectal swabs from children <5 years old with bloody diarrhea were examined for Salmonella, Shigella, and Campylobacter organisms; fecal specimens were examined for Entamoeba histolytica. A bacterial pathogen was identified in specimens from 55 patients (41%). Shigella organisms were found in 39 specimens (29%); 37 isolates (95%) were resistant to ampicillin, 35 (90%) to trimethoprim-sulfamethoxazole, and 24 (62%) to chloramphenicol, but all were susceptible to nalidixic acid. Only 1 of 133 stool specimens contained E. histolytica trophozoites. Multidrug-resistant Shigella species are a frequent cause of bloody diarrhea in Bolivian children; E. histolytica is uncommon. Clinical predictors described in this study may help identify patients most likely to have Shigella infection. Laboratory surveillance is essential to monitor antimicrobial resistance and guide empiric treatment.

Tratamiento de la escabiosis / Treatment of the scabies

En el presente trabajo, fue probada la eficacia terapeutica del gamexane o lindano en el tratamiento de la ESCABIASIS en 200 personas, se han usado concentraciones de 1 a 2 % aplicadas en tres esquemas en cuanto se refiere al tiempo de aplicacion. Pudimos sacar al conclusion que el esquema mas eficas en el empleo de la concentracion al 1% durante 2 dias (95%) por la alta tasa de curaciones y menor numero de casos con efectos colarerales.