[Epidemic outbreak of tuberculosis in a primary and secondary school in Granada (Spain)]. / Brote epidémico de tuberculosis en un colegio de Granada.

OBJECTIVE: To describe the diagnosis and early treatment of an epidemic outbreak of tuberculosis and determine the utility of polymerase chain reaction (PCR) compared with routine culture in gastric juice. MATERIAL AND METHODS: A computer studies teacher, with clinical features suggestive of tuberculosis and caverns on X-ray, was diagnosed with bacilliferous tuberculosis. Primary health care services carried out a Mantoux test on the school's 387 students as well as on teachers and other staff. The children with a positive Mantoux test underwent laboratory, radiological, and microbiological investigations for one week in the Pediatric Respiratory Unit of Hospital Clínico in Granada. In the teaching and non-teaching staff, active tuberculosis was ruled out through bacilloscopy of sputum samples, Mantoux test, and chest X-ray. RESULTS: In the first screening, the Mantoux test was positive in 67 children. Of these, 7 children were diagnosed with tuberculosis and 60 were found to be infected. Of the 7 children with tuberculosis, five presented positive gastric juice culture in Lowenstein medium while Roche COBAS PCR was negative. In the second screening, 9 children became tuberculin positive. Of these, 8 were diagnosed with tuberculosis and one was infected. Cultures were positive in 3 and PCR was negative. In 77.6 % of the children (59/76), the Mantoux induration was equal to or higher than 18 mm. All of the 15 children with tuberculosis were aged between 9 and 14 years old, except one who was 5 years old. CONCLUSIONS: The Mantoux test remains a basic screening method in diagnosis and epidemiological research, whereas the results of microbiological investigation remain poor and in our study the results DNA were disappointing. The screening of tuberculosis and of other infectious diseases should be more closely monitored in professional groups, such as teachers, that are in contact with large numbers of children. This would identify infected adults and prevent epidemics such as that described in the present study.

Brote epidémico de tuberculosis en un colegio de Granada / Epidemic outbreak of tuberculosis in a primary and secondary school in Granada (Spain)

Objetivo: El diagnóstico y tratamiento precoz del brote epidémico de tuberculosis y comprobar la relevancia de la reacción en cadena de la polimerasa (PCR) frente a cultivos específicos habituales en el jugo gástrico en ayunas. Material y métodos: Tras diagnosticar a un profesor de informática de tuberculosis bacilífera, con sintomatología indicativa y radiología de caverna, se realizó Mantoux en los servicios de atención primaria, a la totalidad del colegio, que componían 387 escolares y personal docente y no docente del colegio. Los niños con Mantoux positivo fueron estudiados, en una semana, en el Servicio de Neumología Pediátrica del Hospital Clínico de Granada, mediante pruebas analíticas, radiológicas y microbiológicas. El resto del personal docente y no docente, se descartó que tuvieran una tuberculosis activa mediante baciloscopia en esputo, Mantoux y radiografía de tórax. Resultados; En el primer cribado en los 387 alumnos, 67 niños fueron Mantoux positivo, de los cuales siete se diagnosticaron de enfermedad tuberculosa y 60 de infección latente. De los 7 pacientes, cinco presentaron positividad en jugo gástrico en medio de Löwenstein, mientras que la PCR tipo Cobas de la empresa Roche fue negativa. En el segundo cribado, 9 niños experimentaron viraje tuberculínico; de ellos, ocho fueron diagnosticados de enfermedad y uno de infección, y se encontraron cultivos positivos en tres de ellos y PCR negativa en todos. La induración del Mantoux fue igual o superior a 18 mm en el 77,6 por ciento de los niños (59/76). Los 15 enfermos tenían entre 9 y 14 años, excepto uno con 5 años. Conclusiones: El Mantoux sigue siendo un método básico de detección en el diagnóstico e investigación epidemiológica, mientras que el rendimiento del estudio microbiológico sigue siendo pobre y la amplificación genómica de ADN en nuestro caso fue descorazonadora. Pensamos que el cribado de tuberculosis y otras enfermedades infecciosas debería ser más vigilado en grupos de profesionales que se relacionan con grandes comunidades infantiles, como la docente, lo que permitiría detectar adultos bacilíferos y evitar casos epidémicos como los reseñados en este trabajo (AU)

Values and antisocial behavior among Spanish adolescents.

A number of studies have indicated that delinquent adolescents have characteristic value systems. However, most of these studies have adopted a "known-groups" design--that is, they have compared institutionalized delinquents and non-institutionalized adolescents, assuming those adolescents to be non-delinquent. Designs of this type do not distinguish effectively between the statistical effects of delinquency and of institutionalization. In this study, the authors investigated relationships between values and self-reported antisocial behavior in three adolescent groups: 435 school-attending boys, 529 school-attending girls, and 95 delinquent boys in juvenile rehabilitation centers or prisons. The results indicate that antisocial behavior is associated with hedonistic values and a lack of interest in conventional values and social values. These relationships cannot be explained by the institutionalization effects.

Variations in magnesium and zinc in hypertensive patients receiving different treatments.

We studied the influence of captopril, atenolol, and verapamil on serum and intraerythrocyte concentrations of magnesium and zinc in 30 normotensive control subjects (12 men and 18 women, aged 30 to 65 years, mean +/- SD 45.76 +/- 12.15 years) and 30 patients with untreated mild or moderate essential hypertension (14 men and 16 women, aged 30 to 65 years, mean +/- SD 49.50 +/- 13.58 years). Ten each of the hypertensive patients were treated with captopril, atenolol, or verapamil. Physical examination and biochemical analyses (serum Mg and Zn) were done in all participants at baseline, and in patients after 3 and 6 months of treatment. The results were compared according to a nested design with Neumann-Keuls test. We found no significant differences between controls and patients in serum and intraerythrocyte concentrations of Zn at the start of the study, although there was a significant decrease in serum Zn in patients after 3 (P < .01) and 6 months (P < .001) of treatment, regardless of the drug used. This decrease was thought to be attributable to the zincuric effect of captopril or to dietary measures, or both. Intraerythrocyte Zn was not significantly affected by antihypertensive treatment. Serum and intraerythrocyte concentrations of Mg were significantly lower (P < .001) in hypertensive than in normotensive subjects, and serum Mg in patients treated with verapamil was significantly lower (P < .05) than after treatment with captopril or atenolol. Serum Mg concentration was related directly with serum concentrations of high density lipoprotein cholesterol (r = 0.4043, P < .05). We conclude that supplementation with Mg may benefit patients with hypertension.

[Does the diuretic effect of calcium inhibitors play an important role in the hypertensive efficacy?]. / L'effet diurétique des inhibiteurs calciques joue-t-il un rôle important dans l'efficacité antihypertensive?

Calcium ions play an important role in the pathophysiology of hypertension. Calcium antagonists, a group of first line drugs in the treatment of hypertension, reduce the intracellular content of calcium in vascular smooth muscle cells, and decrease the peripheral vascular resistance and blood pressure. These drugs differ from other vasodilators in that they also have natriuretic effects; thus they can affect the kidney on three levels: Renal haemodynamics are affected by increased renal blood flow, and increased glomerular filtration rate. Changes in the renin-angiotensin system can decrease aldosterone secretion. Finally, they affect sodium management by acting directly on the renal tubule, increasing sodium excretion and inhibiting tubular reabsorption of this ion. The natriuretic effect of calcium antagonists is independent of the subject's sodium balance. The vasodilating action of these drugs is therefore accompanied by a natriuretic effect that makes satisfactory control of hypertension possible without placing the patient on a low-salt or salt-free diet.

Time estimation and juvenile delinquency.

Certain empirical evidence suggests that subjects prone to delinquent activity may have faster internal clocks than others. To investigate the relationship between antisocial behavior and time perception and its dependence on the experimental time interval and method and on whether the subject is institutionalized we obtained verbal and production estimates of 5-, 15-, 30-, and 60-sec. intervals from 249 adolescents (156 school attenders and 93 institutionalized subjects) classified into 3 groups according to the intensity of their antisocial activity. Results provide no support for the hypothesis that overestimation of short time intervals is associated with either juvenile delinquency or institutionalization.

A short-term longitudinal study of impulsivity and antisocial behavior.

This study analyzes the relationships between impulsivity and antisocial behavior in a noninstitutionalized sample, taking into account the multidimensional nature of impulsivity and the diversity of types of antisocial behavior. Data were obtained in 1989 and 1990 from 1,226 adolescents aged 12-18 years (583 boys and 643 girls) as part of a longitudinal study of risk factors for drug abuse and delinquency. The patterns of stability or change of the various dimensions of antisocial behavior (rule breaking, vandalism, theft, aggression, and drug taking) in relation to impulsivity were investigated. The results support that self-report measures of impulsivity are closely correlated with antisocial behavior among adolescents. The longitudinally oriented analysis of this work also shows that impulsivity is associated with a future increase in antisocial behavior.

Metabolic and antihypertensive effects of nifedipine in hypertensive patients.

We studied the effects of nifedipine on blood pressure and on clinical and analytical parameters in hypertensive patients. Seven male and eight female subjects (mean age of 46.27 +/- 5.38 years, range of 41-56 years) with essential arterial hypertension were given nifedipine (20 mg b.i.d.) for 3 months. Before and after treatment, history, blood pressure, and biochemical values were recorded [blood: Na, K, Ca, creatinine, uric acid, triglycerides, cholesterol, HDL cholesterol, antidiuretic hormone (ADH), and aldosterone; urine: Na, K, Ca, creatinine, ADH, aldosterone, and percentage fraction of Na, K, and Ca excreted]. After 3 months of treatment, we found (a) significant decreases in systolic (147 +/- 18 vs. 166 +/- 16 mm Hg, p less than 0.001) and diastolic blood pressure (90 +/- 8 vs. 107 +/- 8 mm Hg, p less than 0.0007), triglycerides (107 +/- 47 vs. 120 +/- 49 mg/dl, p less than 0.0007), and cholesterol (236 +/- 4 vs. 257 +/- 44 mg/dl, p less than 0.00075) in blood, and in K excretion (50 +/- 19 vs. 46 +/- 19 mEq/g of creatinine, p less than 0.0007) and excreted fraction of K (49 +/- 6% vs. 8 +/- 5%, p less than 0.0012) in urine; (b) significant increases in HDL cholesterol (65 +/- 13 vs. 58 +/- 13 mg/dl, p less than 0.001) in blood, and in Na (115 +/- 73 vs. 109 +/- 69 mEq/g of creatinine, p less than 0.0007) in urine; and (c) no significant change in the remaining biochemical parameters, or in heart rate. Secondary effects included flushing (34%), headache (20%), ankle swelling (17%), dizziness (13%), palpitations (4%), and pruritus (4%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Erythrocyte morphometry in alcoholism]. / Morfometría eritrocitaria en el alcoholismo.

The aim of this study is to evaluate the erythrocyte morphology (area, perimeter, shape) and its correlation with high alcohol intake and the conventional blood test (MCV, GOT/GPT, and activated PTT). 60 persons were studied (20 non-drinkers, 20 chronic alcoholics and 20 with hepatic cirrhosis). The erythrocyte area and perimeter was significantly higher, in patients other than the group of non-drinkers. This is directly related to the alcohol intake and liver damage. We believe, that the study of the morphology of the erythrocyte is of interest as a "biological marker" related to the grade of alcoholism.