On the occurrence of aflatoxin M1 in milk and dairy products.

Aflatoxins are toxic fungal metabolites found in foods and feeds. When ruminants eat AFB(1)-feedstuffs, they metabolise the toxin and excrete AFM(1) in milk. To control AFM(1) in foods it is necessary to reduce AFB(1) contamination of feeds for dairy cattle by preventing fungal growth and AFB(1) formation in agricultural commodities intended for animal use. Corn and corn-based products are one of the most contaminated feedstuffs; therefore risk factor analysis of AFB(1) contamination in corn is necessary to evaluate risk of AFM(1) contamination in milk and milk products. During the corn silage production, the aflatoxins production is mostly influenced by: harvest time; fertilization; irrigation; pest control; silage moisture; and storage practices. Due to the lower moisture at harvest and to the conservation methods, the corn grain is mostly exposed to the contamination by Aspergillus species. Therefore, it is necessary to reduce the probability of this contaminant through choice of: hybrids; seeding time and density; suitable ploughing and fertirrigation; and chemical or biological control. Grains harvested with the lowest possible moisture and conservation moisture close to or less than 14% are necessary to reduce contamination risks, as is maintaining mass to homogeneous moisture. Kernel mechanical damage, grain cleaning practices and conservation temperature are also factors which need to be carefully controlled.

Detección de diabetes tipo LADA en pacientes diabéticos con exceso ponderal. ¿Es adecuado el tratamiento con metformina? / Detection of LADA-type diabetes in overweight diabetic patients. Is treatment with metformin suitable?

Objetivos. Detectar pacientes con diabetes tipo LADA (latent autoinmune diabetes of adult) tipo 1 en diabéticos adultos con sobrepeso y describir las variaciones metabólicas tras administrar metformina. Diseño. Estudio observacional, multicéntrico, basado en una serie de casos. Emplazamiento. Atención primaria, provincia de Barcelona. Participantes. Diabéticos con sobrepeso u obesidad, con diagnóstico de diabetes < 2 años, entre 35 y 65 años de edad, sin complicaciones microvasculares o macrovasculares ni tratamiento farmacológico inicial antidiabético. Intervención. Administración de metformina, 1.700 mg/día. Mediciones. La variable de control metabólico fue la hemoglobina glucosilada (HbA1c); otras variables fueron el índice de masa corporal (IMC), la glucemia en ayunas, la insulinemia, el péptido C y la valoración de la insulinorresistencia (HOMA-IR). Para el diagnóstico de diabetes tipo LADA se determinaron los anticuerpos ICA, anti-GAD y anti-IA2. Resultados. En la muestra de diabéticos estudiada (n = 103) se detectaron 3 casos de LADA tipo 1 (prevalencia del 2,9%; intervalo de confianza del 95%, 0,6-8,3%). Estos pacientes presentaron valores basales más elevados de HbA1c, insulina y sobre todo de HOMA-IR. El tratamiento con metformina mejoró la HbA1c en ambos grupos de pacientes (con o sin LADA de tipo 1). El descenso de la insulinemia al cabo de un año en los pacientes con LADA de tipo 1 fue más marcado que en el resto de diabéticos. Conclusiones. Dada su frecuencia, hay que reflexionar sobre si deberían buscarse con más frecuencia anticuerpos frente a células β pancreáticas en atención primaria. Los pacientes con LADA de tipo 1 presentaron buen control de la HbA1c en tratamiento con metformina y un drástico descenso de la insulina. Faltan estudios que evalúen si la metformina mejora el control glucémico, aunque tal vez no proteja la reserva insulínica, y confrontarla con otros fármacos

Objectives. To detect type-1 LADA (latent auto-immune diabetes in adults) in adults with overweight. To describe the metabolic variations in these patients after metformin treatment. Design. Observational, multi-centre study based on a series of cases. Setting. Health centres in Barcelona province, Spain. Participants. Diabetic patients with overweight or obesity, diagnosed with diabetes for <2 years, aged between 35 and 65, and without clinical micro-macrovascular complications and without initial glycaemia-lowering drug treatment. Intervention. Metformin administration (1700 mg/day). Measurements. The metabolic control variable was HbA1c. Other variables measured were: body mass index (BMI), glucose in fast, insulinaemia, C-peptide, and insulin resistance (HOMA-IR). We determined ICA, GADAb and IA2Ab antibodies to diagnose LADA-type diabetes. Results. In our sample of diabetics (N=103), we detected 3 type-1 LADA cases. These patients had higher levels of HbA1c, insulin and, especially, HOMA-IR. Metformin treatment for one year improved HbA1c in both groups (with and without type-1 LADA). However, the decrease in insulin one year afterwards was greater in type-1 LADA patients. Conclusions. The percentage of type-1 LADA in our sample made us wonder whether we should search for pancreatic antibodies more often in primary care. More studies on the prevalence of type-1 LADA in our country are needed, especially in diabetic patients with overweight. Type-1 LADA patients improved their metabolic control after metformin treatment and showed a drastic decrease in insulin levels. Further studies are needed to evaluate whether metformin improves metabolic control, even though it may not protect insulin reserves, and to contrast metformin with other drugs

Registro de mortalidad en un área básica de salud: experiencia a los 3 años de su implantación / Mortality register in a health district: experience three years after its introduction

No disponible

Meta-analysis comparing newer antipsychotic drugs for the treatment of schizophrenia: evaluating the indirect approach.

BACKGROUND: Meta-analysis is a useful method to assess the efficacy of newer antipsychotic drugs compared with older drugs or placebo. However, few trials directly compare novel drugs to each other. OBJECTIVE: The purpose of this study was to evaluate the method of indirect meta-analysis by applying it to data on olanzapine versus haloperidol and risperidone versus haloperidol to enable a comparison between olanzapine and risperidone. METHODS: Published randomized controlled trials (RCTs) of risperidone, olanzapine, and/or haloperidol were identified through literature searches (1983 to 1999) of the MEDLINE, Current Contents, and HealthSTAR databases and reviewed. Data for the Brief Psychiatric Rating Scale (BPRS) total score, the Positive and Negative Syndrome Scale (PANSS) negative subscale, the percentage of patients using anticholinergic drugs, and the percentage of patients dropping out due to lack of efficacy, side effects, or any cause were extracted and combined using the indirect method. These findings were compared with those from a direct comparative study of olanzapine and risperidone. RESULTS: The literature search yielded 8 RCTs comparing risperidone to haloperidol and 3 comparing olanzapine to haloperidol. Only 1 trial directly comparing olanzapine and risperidone was found. In this trial, the change in BPRS total and PANSS negative subscale scores tended to be higher with olanzapine by 1.80 and 1.10, respectively, but these differences were not statistically significant. Indirect meta-analysis yielded similar results. Changes in both BPRS total scores and PANSS negative subscale scores tended to be higher with olanzapine by 0.37 and 0.54, respectively, and again, the differences were not statistically significant. In the indirect meta-analysis, the rate of anticholinergic drug use was 19.5% greater among patients treated with risperidone than among patients treated with olanzapine (P < 0.05). In the direct comparative RCT, the rate was 13.1% higher among patients treated with risperidone (P < 0.05). The dropout rates were similar for patients treated with risperidone and those treated with olanzapine in both analyses. CONCLUSION: An indirect meta-analysis of studies comparing olanzapine with haloperidol and risperidone with haloperidol yielded conclusions similar to those found in a direct comparative RCT of olanzapine and risperidone.

[Follow-up of the quality of drug prescriptions: the Primary Care Center of Badia City (1986-1990)]. / Seguimiento en la calidad de la prescripción de medicamentos: el CAP de Ciudad Badía (1986-1990).

OBJECTIVE: To determine the variation in the quality of prescription of medicines in Primary Attention Centre in two different periods, 1986 and 1990. DESIGN: Longitudinal, retrospective study with direct intervention. SITE. Primary Attention Centre, Ciudad Badía. PARTICIPANTS: 1986: 9 general practitioners in medicine (GPs) and 7 pediatricians. 1990: 9 Gps, 7 pediatricians, and 7 residential doctors (MFC based) who were not included in the earlier evaluation. INTERVENTION: Once the 1986 prescriptions had been analysed qualitatively, the results were made available to and discussed with the doctors who made out the prescriptions (passive feedback). As ongoing intervention the periodic clinical sessions should be considered. MAIN MEASUREMENTS AND RESULTS: Increase in the substances included in Index/Guide: MG 6.5% and P 13% (p < 0.00001). Increase in the number of substances with an active principle and in the combinations accepted: MG 2.3% and P 9% (p < 0.00001). Increase in the percentage of specialties with high V1: MG 1% (p = 0.12) and P 10% (p < 0.00001). CONCLUSIONS: There has been an increase in the quality of medical prescriptions according to the indicators analysed. There are other external factors that effect prescriptions that are difficult to measure. This type of study allows one to pinpoint the excessive or wrong use of intrinsically not very valuable sub-groups of therapeutic substances, and will serve as a base for indication-prescription studies.

Inhibition of enteropathogenic Escherichia coli adherence to HeLa cells by immune rabbit sera.

We have studied the effect of immune rabbit sera on the localized (LA) and diffuse (DA) adherence to HeLa cells of 10 enteropathogenic Escherichia coli (EPEC) strains belonging to serogroups O55, O86, O111, O119, and O142. Anti-La1 serum, obtained by rabbit immunization with an E. coli strain harboring a cloned DNA fragment from an EPEC LA plasmid, strongly inhibited the adherence of all serogroups but one (O142). Similar results were obtained with anti-LA2 serum, which is anti-O111 serum absorbed with a non-adherent O111:H- EPEC strain. In contrast, non-absorbed anti-O55 and anti-O111 sera showed an inhibitory effect mainly on the adherence of homologous strains. Except for one experiment diffuse adherence was not inhibited by any antiserum used. The inhibitory effect of immune sera on localized adherence does not seem to be correlated with plasmid curing since adherence plasmid pMS49 proved to be stable after treatment with anti-O55 and anti-O111 sera. The cross-inhibition of adherence by anti-LA sera suggests that localized adherence-related adhesins of the O55, O86, O111, and O119 strains share similar antigens.

Inhibition of enteropathogenic Escherichia coli adherence to Hela cells by immune rabbit sera

We have studied the effect of immune rabbit sera on the localized (LA) and diffuse (DA) adherence to Hela cells of 10 enteropathogenic Escherichia coli (EPEC) strains belonging to serogroups 055, 086, 0111, 0119, and 0142. Anti-La1 serum, obtained by rabbit immunization with an E. coli strain harboring a cloned DNA fragment from an EPEC LA plasmid, strongly inhibited the adherence of all serogroups but one (0142). Similar results were obtained with anti-LA2 serum, which is anti-0111 serum absorbed with a non-adherence 0111:H-EPEC strain. In contrast, non-absorbed anti-055 and anti-0111 sera showed an inhibitory effect mainly on the adherence of homologous strains. Except for one experiment diffuse adherence was not inhibited by any antiserum used. The inhibitory effect of immune sera on localized adhere3nce does not seem to be correlated with plasmid curing sinceadherence plasmid pMS49 proved to be stable a after treatment with anti-055 and anti-0111 sera. The cross-inhibition of adherence by anti-LA sera suggests that localized adherence-related adhesions of the 0.55, 0.86, 0111, and 0119 strains share similar antigens

Articulatory impairment associated with tardive dyskinesia.

The speech of two patients with tardive dyskinesia was studied, and one neuroleptic-treated patient having no signs of overt tardive dyskinesia served as control. A structured interview, including reading, repetition of sentences, and spontaneous conversation, was performed. A phonetic transcription and analysis of abnormal phonemes was done by a linguist under blind conditions. Both patients with tardive dyskinesia had abnormal phonemes whereas the control patient had none. These differences could not be explained by age, direct neuroleptic effect, or neuroleptic exposure time. The abnormal phonemes were all consonants. The authors conclude that tardive dyskinesia may cause articulatory communication problems.

Neuroleptic-induced supersensitivity psychosis in patients with bipolar affective disorder.

Clinical syndromes thought to arise from neuroleptic-induced dopamine receptor supersensitivity are well described in psychiatry. Tardive dyskinesia may arise from neostriatal supersensitivity and supersensitivity psychosis may arise from mesolimbic supersensitivity in schizophrenics chronically treated with neuroleptics. The authors present 5 cases of supersensitivity psychosis that developed in patients with bipolar affective disorder. The clinical syndrome is described and the implications for the long-term course of bipolar affective disorder are discussed.

Plasmids coding for drug resistance and localized adherence to HeLa cells in enteropathogenic Escherichia coli O55:H- and O55:H6.

Plasmids coding for drug resistance and localized adherence (LA) to HeLa cells were found in two enteropathogenic Escherichia coli strains belonging to serotypes O55:H- and O55:H6. Strain 49-81 HSJ (O55:H-) carries two plasmids, one coding for both ampicillin resistance (Apr) and LA (pMS49). Strain 71-82 HSJ (O55:H6) harbors only one plasmid, coding for resistance to sulfadiazine, chloramphenicol, kanamycin, ampicillin, and LA (pMS71). Plasmids pMS49 and pMS71 were transferred to E. coli K-12 711 and from this strain to E. coli K-12 J53. Curing with acridine orange of an Apr LA+ transconjugant showed that both characteristics were lost simultaneously. The plasmids have a molecular weight of approximately 55 X 10(6) and are the first naturally recombinant plasmids coding for adherence and drug resistance described in enteropathogenic E. coli.

A soluble alkaline phosphatase from Bacillus licheniformis MC14. Histochemical localization, purification, characterization and comparison with the membrane-associated alkaline phosphatase.

Growth conditions affect the quantity and distribution of alkaline phosphatase (orthophosphoric-monoester phosphohydrolase (alkaline optimum), EC 3.1.3.1) in Bacillus licheniformis MC14. The soluble alkaline phosphatase, which has been found in biochemical localization studies between the cell wall and cell membrane (Glynn, J.A., Schaffel, S.D., McNicholas, J.M. and Hulett, F.M. (1977) J. Bacteriol. 129, 1010-1019), was localized via electron microscope histochemistry in cells cultured under conditions which result in increased quantities of this activity. This soluble alkaline phosphatase was stabilized with 20% glycerol and purified to homogeneity as determined by sodium dodecyl sulfate(SDS)-polyacrylamide gel electrophoresis. The purified enzyme is soluble in dilute buffer. This soluble alkaline phosphatase has been characterized and compared to the membrane-associated alkaline phosphatase from this organism.

Elevation of creatine phosphokinase in young men after recreational exercise.

Twenty healthy male volunteers were divided into four groups for a period of recreational physical exercise. Standard blood chemistry determinations were made before exercise and on the two subsequent days. Creatine phosphokinase (CPK), SGOT, and lactic dehydrogenase levels were transiently elevated, but the change was considered significant only in the CPK level after certain types of exercise. Persons having these determinations performed should be questioned about recent physical exertion in the event of abnormal laboratory results.