The influence of the CIVIQ dimensions on quality of life of patients with primary superficial venous incompetence.

OBJECTIVES: To get to know the influence of the four domains of the Chronic Lower Limb Venous Insufficiency Questionnaire (CIVIQ) on the quality of life (QoL) of patients with primary superficial venous incompetence, and their behaviour in relation to age, gender, occupation, body mass index (BMI), and also with respect to the clinical and anatomical classes of the CEAP. MATERIAL AND METHODS: The sample was composed of 468 patients with primary superficial venous reflux (135 male and 333 female) who answered 100% of the questions in the Short Form-12 (SF12) and CIVIQ questionnaires. After a clinical and duplex examination, the patients were categorized as C0-6, Ep, As, Ap or As,p and Pr according to the CEAP classification. The relationships between CIVIQ domains and gender, age, occupation, BMI, and the clinical and anatomical classes of the CEAP classification were analyzed. RESULTS: Men reported better QoL than women (33.2 vs. 46.3) and this was also true for each of the CIVIQ's domains (p < .00). Pain (50.6) and physical restriction (45.3) were the dimensions with a greater influence on QoL, whereas social (41.7) and psychological (38.1) dimensions had a lesser influence. Patients aged between 45 and 64, household activities, and patients with C2-3 clinical classes were the patient groups with the worst scores in all the CIVIQ dimensions and those where significant differences were found. The BMI and anatomical distribution of the reflux had no influence on the QoL. CONCLUSIONS: Pain and physical restriction were the CIVIQ domains with greater influence on the QoL of patients with primary superficial venous reflux. Age increase (up to 64 years), female gender, household activities, and C2-3 CEAP clinical class were the main factors associated with the worst QoL perception.

Psychoeducation and cognitive-behavioral therapy for patients with refractory bipolar disorder: a 5-year controlled clinical trial.

OBJECTIVE: The aim of this research, which represents an additional and longer follow-up to a previous trial, was to evaluate a 5-year follow-up study of a combined treatment (pharmacological+psychoeducational and cognitive-behavioral therapy) as compared with a standard pharmacological treatment in patients with refractory bipolar disorder. METHOD: Forty patients were randomly assigned to either an Experimental group-under combined treatment - or a Control group - under pharmacological treatment. Data were analyzed by analysis of variance (ANOVA), with repeated measures at different evaluation time points. RESULTS: Between-group differences were significant at all evaluation time points after treatment. Experimental group had less hospitalization events than Control group in the 12-month evaluation (P=0.015). The Experimental group showed lower depression and anxiety in the 6-month (P=0.006; P=0.019), 12-month (P=0.001; P<0.001) and 5-year (P<0.001, P<0.001) evaluation time points. Significant differences emerged in mania and misadjustment already in the post-treatment evaluation (P=0.009; P<0.001) and were sustained throughout the study (6-month: P=0.006, P<0.001; 12-month: P<0.001, P<0.001; 5-year: P=0.004, P<0.001). After 5-year follow-up, 88.9% of patients in the Control group and 20% of patients in the Experimental group showed persistent affective symptoms and/or difficulties in social-occupational functioning. CONCLUSIONS: A combined therapy is long-term effective for patients with refractory bipolar disorder. Suggestions for future research are commented.

New Insights into Esca of Grapevine: The Development of Foliar Symptoms and Their Association with Xylem Discoloration.

A new study on the development of foliar symptoms of esca was carried out from 2004 to 2006 in five mature vineyards in Aquitaine, France. Symptoms were monitored for severity and changes over time. Initial foliar symptoms were characterized by the presence of drying zones or discolorations (reddening or yellowing), which are symptoms that have also been attributed to Black Dead Arm (BDA). Then, the less-severely affected leaves persisted throughout the summer and developed into typical "tiger-stripe" symptoms of esca. The most severely symptomatic leaves fell soon after symptoms appeared. Severely diseased vines showed typical apoplectic or acute forms of esca that did not differ from the severe BDA forms. The appearance of leafsymptomatic vines increased uniformly over time, reaching a maximum incidence by the end of July. A second survey in 41 European and Lebanese vineyards showed that longitudinal discolorations were visible under the bark of 95% of the vines showing foliar esca symptoms. These wood symptoms, also previously attributed to BDA, appeared as xylem orange-brown stripes. Thus, foliar symptoms of esca showed transitory phases which overlapped with some BDA descriptions. Most of these symptoms, in the west-palearctic regions that were investigated, were commonly associated with the presence of one or several xylem discolorations.

Serum lipids and estrogen receptor gene polymorphisms in male-to-female transsexuals: effects of estrogen treatment.

The effects of chronic administration of estrogens on the lipid profile in males are not fully understood. We have studied the effect of chronic administration of estrogens on the lipid profile in a group of transsexual (TS) Canarian men who were taking estrogens and anti-androgens for a minimum of 3 years. In this cross-sectional study of cases (n=27) and controls (n=26), plasma lipid profile and selected biochemical and hormonal features were studied. TS subjects had shorter stature than controls, and, after adjusting for height and weight, we found that they had lower values of serum free testosterone (FT) and higher estradiol (E2) levels than controls. The TS group had lower total and low-density lipoprotein (LDL) cholesterol and lower apoprotein B (Apo B) levels than the control group. Biochemistry was similar in both groups. The distribution of estrogen receptor gene polymorphisms (ER-Pvu and ER-Xba) was also similar in both groups. Serum Apo B concentration was related to ER-Xba polymorphism. No other association between lipid profile and the distribution of ER-Pvu and ER-Xba was found. We conclude that the chronic administration of estrogens in men could produce an increase in serum estradiol, a decrease in free testosterone levels, and a reduction in total cholesterol, LDL-cholesterol, and Apo B levels. The ER-Xba polymorphism may influence the Apo B response to exogenous estrogen in males.

Seroprevalence of infection by Coxiella burnetii in Canary Islands (Spain).

THE AIMS OF OUR STUDY WERE: (i) to know the seroprevalence of Coxiella burnetii infection in the Canary Islands, (ii) to evaluate its epidemiologic features and (iii) to compare the rates of seroprevalence using two different cut-offs (1:20 and 1:80) for the diagnosis of past infection. METHODS: We analysed a representative sample of the canarian population. 662 sera were tested. For the detection of IgG and IgM antibodies against C. burnetii phase II antigens an immuofluorescence assay was used. The serologic screening for IgG detection begun with a 1:20 dilution. A titer of IgG > or = 1:80 along with a negative IgM were used as criteria for previous infection. RESULTS: At an IgG antibody titer against C. burnetii of 1:80 as diagnostic for past infection, the observed global seroprevalence was 21.5%. If the cut-off used was 1:20, the observed prevalence increased up to 35.8% (p = 0.001). Significantly different seroprevalence rates were obtained at these different cut-offs when results were analysed for groups of age and socioeconomic status, but not for either the island of origin or for farmers. CONCLUSION: Our results strongly suggest that Coxiella burnetii infection is endemic in all the Canary Islands. Although it is more frequent in males above 30 years old, it do affect people of all ages, and thus it should be borne in mind in the face of any acute febrile syndrome.

[Seroepidemiological study of hepatitis A in Gran Canaria (Spain)]. / Estudio seroepidemiológico de hepatitis A en Gran Canaria.

BACKGROUND: The aim of this study was to assess the seroprevalence and the risk factors of hepatitis A virus (HAV) infection in the population from Gran Canaria (Spain) and to determine at which age pre-vaccination testing would be useful. METHODS: A transversal observational study of the presence of HAV antibodies (IgG) on serum samples obtained from a population ranging from 8 months to 63 years old was performed between January 1995 and December 1996. IgG anti-HAV were detected by a commercial immunoenzyme assay. The study included 547 persons resident in Gran Canaria. Epidemiological data (age, sex, number of family members, educational level, urban/rural residence and previous history of hepatitis) were gathered through a personal interview. Confusing variables were excluded by mean a multiple logistic regression analysis. RESULTS: Global prevalence of anti-HAV (IgG) was 36.0% (CI 95% 32.0-40.0). The prevalence of anti-HAV increased significantly with age from 2.3% in children under 4 years until 98.9% in older than 40 years (OR 3956.0; CI 95% 241.7-64,753.5). Only three independent data (age, sex and educational level) were significantly associated with HAV seroprevalence. A previous history of hepatitis A was present only in 4.8% of HAV-positive subjects. CONCLUSIONS: The low prevalence of anti-HAV (IgG) in persons under 25 years old suggest that in the adolescent population the implementation of universal vaccination programs is recommended even without previous serologic screening. Otherwise, the results suggest that HAV prevaccination screening in our geographical were must be limited to subjects older than 25 years.

The distribution of two different vitamin D receptor polymorphisms (BsmI and start codon) in primary hyperparathyroidism.

INTRODUCTION: The bb genotype of the BsmI polymorphism of the vitamin D receptor (VDR) is more common in primary hyperparathyroidism (HPT) than in the general population in Swedish and German women. However, little is known about the association of HPT with the start codon polymorphism of the VDR (defined by FokI). OBJECTIVE: To study the distribution of the VDR genotypes in a group of women with HPT compared with a control group. The bone mineral density (BMD) of different genotypes was also investigated. METHODS: VDR alleles were typed by polymerase chain reaction (PCR) assay around the polymorphic BsmI or FokI restriction sites in 67 control women (48.5 +/- 10 years) and 53 women with HPT (61.4 +/- 11 years). They were all Caucasian and born in the Canary Islands. Lumbar and proximal femur BMDs were measured by dual X-ray absorptiometry (DXA) and quantitative computed tomography (QCT). RESULTS: The 'bb' genotype was equally frequent in controls and HPT subjects (46.3 and 45.3%, respectively). There was a trend towards a lower prevalence of the FF genotype amongst women with HPT as compared with controls (41.5 vs. 57.1%; P = 0.09). BMD was lower in patients with HPT compared with controls in the lumbar spine and the proximal femur. CONCLUSIONS: The association of the BsmI polymorphism of the VDR gene with HPT is not applicable to all geographical areas. In Canarian postmenopausal women suffering from HPT, VDR genotype distribution is similar to that found in controls. A possible association of HPT with the FokI polymorphism deserves further investigation.

The range of bone mineral density in healthy Canarian women by dual X-ray absorptiometry radiography and quantitative computer tomography.

Bone mass measurements play a crucial role in the diagnosis of osteoporosis. According to a World Health Organization (WHO) Working Group, osteoporosis in women can be diagnosed if the value for bone mineral density (BMD) is 2.5 or more standard deviations below the mean value of a young reference population. This definition obviously requires the availability of normal data, which should ideally be obtained locally. The objective was establish normal values of BMD in the female Canarian population, by dual X-ray absorptiometry (DXA) in the lumbar spine and the proximal femur, and by quantitative computed tomography (QCT) in the lumbar spine, and to study the correlation between the results of both techniques and the changes with age. Seven hundred forty-four Healthy Canarian women, from 20-80 yr old were examined. Measurement of bone density was performed by an Hologic QDR 1000 densitometer (DXA) in the lumbar spine and proximal femur, and by a Toshiba scanner model 600 HQ in the lumbar spine. Both methods show that the peak bone mass is achieved in the fourth decade (30-39 yr). Bone density decreases thereafter with age in the lumbar spine (r = -0.3364 DXA and r = -0.6988 for QCT) and in the femoral neck (r = -0.3988). Bone density mean values obtained by DXA are very similar to those described in Spain and in other European female populations, using the same densitometer. The correlations between both techniques (DXA and QCT) were high and statistically significant (p < 0.001 in every case). Normal values in the normal Canarian women for DXA and QCT are provided. Our results are very similar to those previously described. These two techniques have a close correlation.

Epidemiology of proximal femoral fracture in Gran Canaria (Canary Islands).

An epidemiological survey of proximal femoral fracture (PFF) was carried out in Gran Canaria (Canary Islands) in 1990. We identified 211 cases of PFF affecting residents, which gave an incidence of 161 per 100,000 per year (92 per 100,000 per year for men and 176 for women). Three quarters of all fractures occurred to residents of urban areas and nearly all fractures were caused by falls indoors. There was a higher incidence in winter than in summer months.

[Epidemiological study of asthmatic crises in a maternal-child emergency service]. / Estudio epidemiológico de las crisis asmáticas en un servicio de urgencias maternoinfantil.

In our region, allergic respiratory diseases affects over 55% of the child up to 5 years. This could be attributed to some peculiarities of our region, such as consanguinity, climate and predominant sensitisation to dermatophagoides mite. We made an epidemiologic study on the bronchospasm urgent cases attended in the Urgency Unit of our Maternal-Child Hospital in Las Palmas. We took 935 patients with a mean age of 32.36 months with acute attacks of bronchospasm, and found no significant difference between patients from the Northern and Southern zones of the island. Bronchospasm cases were more frequently observed in Autumn and Winter. We discuss here about the possible causing agents involved and want to draw attention to the need of education for our patients' parents for them to learn antiasthmatic medication and how to use it, before going to the Urgency Unit of any Hospital.

Tamoxifen decreases the estradiol induced progesterone receptors by interfering with nuclear estrogen receptor accumulation.

The retention time of the estrogen receptor in the nucleus of target cells after antiestrogen treatment has been shown to be longer than after estradiol. This paper describes the accumulation of nuclear estrogen receptors and the obtention of estrogenic responses (i.e. synthesis of cytosolic progesterone receptors and DNA) in the rat uterus after tamoxifen treatment in the presence or absence of estradiol. One-week ovariectomized adult rats were implanted with a silicone elastomer capsule containing corn oil or 25 micrograms estradiol/capsule (0 h). 48 h after implantation rats were injected with corn oil or 2 mg tamoxifen/kg and decapitated at 72, 96 or 120 h after implantation. In parallel experiments the implants were removed just before the injections of tamoxifen or oil. Tamoxifen injected into rats implanted with oil increased both the occupied nuclear receptors and the progesterone receptors at 96 h. In rats implanted with estradiol, tamoxifen did not increase the occupied nuclear receptors and decreased the levels of progesterone receptor and DNA at 96 h. In rats whose estradiol implants were removed at 48 h tamoxifen did not change the level of occupied nuclear receptors at 72 h but it increased them abruptly at 96 and 120 h. In these rats progesterone receptors decreased at 72 h but they increased at 96 and 120 h, and DNA decreased at 120 h to a lower level than before implantation. The results suggest that when estradiol is acting, tamoxifen is not able to increase the level of occupied estrogen receptor and it acts as an antiestrogen by decreasing the high level of progesterone receptors previously induced by estradiol. When estradiol is not acting tamoxifen behaves as a partial estrogen agonist by inducing progesterone receptors. However, the antiestrogenic action of tamoxifen on the rat uterus DNA does not seem to be affected by estradiol.