Bioterrorismo: aspectos prácticos / Bioterrorism: practical issues

Aunque las armas biológicas han sido utilizadas desde la antigüedad, el temor y la preocupación de los gobiernos occidentales ante la posibilidad de un ataque bioterrorista ha cobrado una inusual importancia en la última década. Las principales características de un ataque biológico son: alta rentabilidad para sus fines con un bajo coste, gran repercusión socio-económica y mediática, capacidad de generar pánico entre la población y que el ajuste es relativamente fácil de producir y ocultar. Las principales formas de liberación del agente son: manifiesta, anunciada, selectiva y encubierta. Existen más de 150 agentes descritos como posibles armas biológicas que son clasificados por el CDC en tres categorías en función del riesgo epidemiológico, el impacto sobre la salud pública, el impacto sobre la economía y de la disponibilidad y facilidad de producción. En el texto se resumen las principales características epidemiológicas, diagnósticas, clínicas, terapéuticas y profilácticas de los principales agentes biológicos susceptibles de ser utilizados como arma biológica (AU)

Although biological weapons have been used since ancient times, general fear and the concerns of Western governments over the possibility of bioterrorist attacks have meant that this subject has received unparalleled attention in the past decade. The main characteristics of a biological weapons attack are high yield at low cost, extensive socioeconomic repercussions and press coverage, the potential to generate panic in the population, and ease of creating and hiding the weapon. Biological agents may be released openly, announcements or warnings may be given, they may be distributed selectively, or they may be hidden before release. The United States Center for Disease Control has described more than 150 agents as potential biological weapons, classifying them in 3 groups according to risk, impact on public health, impact on the economy, and availability or ease of manufacture. This review summarizes the epidemiologic, diagnostic, clinical, therapeutic, and prophylactic aspects of bioterrorism (AU)

Sobrecarga de hierro y genotipo 3 se asocian a la presencia de esteatosis en la hepatitis C / No disponible

Objetivo: determinar los factores epidemiológicos, analíticos, virológicos e histológicos a los que se asocia la esteatosis en la hepatitis C. Pacientes: se revisaron de forma retrospectiva 53 historias clínicas de pacientes biopsiados consecutivamente desde junio de 2000 a diciembre de 2002. Se excluyeron pacientes con otros virus. Se revisaron las biopsias hepáticas de forma protocolizada. Se obtuvieron los datos epidemiológicos, analíticos y virológicos. La talla y el peso de los pacientes se recogieron en el momento de la biopsia hepática. Se estudió la asociación estadística de las variables cualitativas y cuantitativas con la presencia de esteatosis y se realizó un análisis multivariante. Resultados: se identificó esteatosis en el 52% de las biopsias. No hubo asociación estadísticamente significativa con edad, sexo, vía de contagio, tiempo de evolución, ingesta de alcohol, presencia de enfermedades asociadas, índice de masa corporal, glucosa, triglicéridos, colesterol, AST, ALT, GGT, FA, bilirrubina, carga viral. Se asoció a mayor sideremia, IST y ferritina. Se demostró asociación con el genotipo 3. La esteatosis se asoció a necrosis piecemeal, degeneración hepatocelular, hiperplasia de células de Kupffer, hierro hepático y fibrosis portal. El hierro hepático, la hiperplasia de las células de Kupffer y el genotipo 3 se asociaron de manera independiente a la esteatosis hepática. Conclusiones: la esteatosis en la hepatitis C se asocia a la infección por genotipo 3, a la hiperplasia de las células de Kupffer y a sobrecarga de hierro. También se asocia a mayor inflamación y fibrosis por lo que debe ser considerada factor agravante (AU)

No disponible

Iron overload and genotype 3 are associated with liver steatosis in chronic hepatitis C.

OBJECTIVE: To determine epidemiological, biochemical, virological, and histological factors associated with liver steatosis in chronic hepatitis C. SUBJECTS: The medical histories of 53 patients biopsied for chronic hepatitis C diagnosis between June 2000 and December 2002 were retrospectively studied. Epidemiological, biochemical, and virological data were collected. Patients with hepatitis B virus or human immunodeficiency virus coinfection were excluded. Liver biopsy specimens were reviewed and scored by one pathologist. Weight and height were measured at liver biopsy time. The statistic association between qualitative and quantitative variables and the presence of liver steatosis was studied. RESULTS: Steatosis was identified in 52% of biopsies. There was no statistic association with age, sex, method of transmission, duration of infection, alcohol consumption, other diseases, body mass index, glucose, triglycerides, cholesterol, AST, ALT, GGT, alkaline phosphatase, bilirubin, or viral load. Liver steatosis was associated with serum iron, transferrin saturation, and ferritin. Genotype 3 was also associated with steatosis. Piecemeal necrosis, hepatocellular injury, Kupffer cell hyperplasia, liver iron, and portal fibrosis were also associated with steatosis. A multivariate analysis showed that genotype 3, Kupffer cell hyperplasia, and liver iron were associated with the presence of steatosis. CONCLUSIONS: Liver steatosis in chronic hepatitis C associates with genotype 3, Kupffer cell hyperplasia, and iron overload. Hepatic steatosis also associates with greater inflammation and fibrosis, and must be considered to contribute to disease progression.

Prevalencia de hepatitis A y hepatopatías crónicas: un reto a desarrollar / Prevalencie of hepatitis A and chronic hepatopathies: a challenge to be developed

Getting deeper into the whys and wherefores of primary care research (AU)

Identification of species of Brucella using Fourier transform infrared spectroscopy.

Fourier transform infrared spectroscopy (FTIR) is a technique that has been used over the years in chemical analysis for the identification of substances and is one that may be applied to the characterisation of microorganisms. The marked tendency of Brucella towards variation in the smooth rough phase, together with the laboriousness and risk involved in the methods used in their identification, make their classification difficult. We studied the type strains of the different species and biovars of Brucella and 11 isolates of human origin of Brucella melitensis, six corresponding to biovar 1, one to biovar 2 and five to biovar 3. The results of linear discriminant analysis performed using the data provide an above 95% likelihood of correct classification, over half of which are in fact above 99% for the vast majority of Brucella strains. Only one case of B. melitensis biovar 1 has been incorrectly classified. The rest of the microorganisms studied (Staphylococcus aureus, Strteptococcus pyogenes, Enterococcus faecalis, Corynebacterium pseudodiphtheriticum, Clostridium perfringens, Escherichia coli, Acinetobacter calcoaceticus and Pseudomonas aeruginosa) have been classified correctly in all cases to a likelihood of over 80%. In the graphic representation of the analysis, a grouping of these can be seen in clusters, which include the different species. One of these comprises B. melitensis, another Brucella abortus, and another wider one is made up of Brucella suis. The Brucella canis, Brucella ovis and Brucella neotomae strains appear separate from the previously described groups.

Evaluation of six serological tests in diagnosis and postoperative control of pulmonary hydatid disease patients.

Latex agglutination (LA), passive hemagglutination (PHA), immunoelectrophoresis (IEP) and specific IgE, IgM, IgG enzyme-linked immunosorbent assay (ELISA) tests for diagnosis and postoperative follow-up of 79 patients with surgically confirmed pulmonary hydatidosis were evaluated. Specific IgG ELISA was the most sensitive test (83.5%) and the least sensitive tests were specific IgE ELISA (44.3%) and IEP (50.6%). The specificity obtained for all the serologic test was above 97% in all cases. The greatest number of false positives in all tests (except IEP) occurred in patients with Taenia saginata and Taenia solium cysticerci infestations and in patients with lymphoma and leukemia. Specific IgG ELISA demonstrated the highest negative predictive value (93.8%). No statistically significant differences (p > 0.050) were found in the sensitivity of the tests when patients with only one cyst and patients with various cysts were compared. Considering only the patients without relapse, the percentage of seropositive patients increased in all tests at 1 and 3 months after surgery. After that time the percentage of seropositive patients decreased. At 48 months after surgery all patients without relapse became negative in IEP, specific IgE ELISA, and specific IgM ELISA. The antibody titers in all seropositive patients increased during the 3 months after surgery. From these 3 months onward, antibody levels decreased in all serologic tests studied in the group of patients without relapse. The patients who had relapses during the first year after surgery presented persistently elevated antibody titers in all postoperative sera. The antibody titers of the patients who relapsed between the third and fourth years after surgery decreased progressively the third month after surgery, and increased in the serum obtained at the moment of relapse diagnosis. Our results show that persistence of elevated antibody titers in patients with pulmonary hydatidosis in the year after surgery or titer increase after a progressive decrease are indicative of relapse or reinfection.

[Transitional cell tumor of the bladder in children: report of a case]. / Tumor de células transicionales de vejiga en edad pediátrica: a propósito de un caso.

Transitional cell tumours of the bladder in children are exceptionally rare. This paper presents a new case in an 11-year old patient. The benignity of these tumours during the paediatric age can be verified due to the low infiltration incidence; some authors, however, describe cases of relapses which are commented upon. The careful follow-up that has to be done in this type of patients is underlined.

Differential scanning calorimetry investigations on LPS and free lipids A of the bacterial cell wall.

Differential scanning calorimetry (DSC) was used to investigate the thermal stability and behaviour of the lipopolysaccharides (LPS) of the outer membrane of Gram-negative bacteria and their lipid portion. DSC curves of LPS show thermal features between 200 and 129 degrees C (depolymerization) and between -13 and -36 degrees C (cooling phase transition). Both effects were related to the relative strength of the linkage types in the O-chain structure and to their capacity for intermolecular hydrogen bonding. DSC curves of lipids A show endotherm peaks between 40 and 24 degrees C, around 15 degrees C and between -23 and -4 degrees C. Based on these effects, strong differences in thermal behaviour can be observed between that of Brucella and Vibrio cholerae on the one hand, and that of Escherichia coli and Shigella flexneri on the other. Fluidity of the acyl chains and lyotropism, which are important parameters in expression of biological activities, are discussed using the above data. To explain some properties, fluidity could be related to the temperature of the gel<==>liquid crystalline (beta<==>alpha) phase transition, which occurs at physiological temperature. Nevertheless, fluidity could be related to temperature of the previous thermal effect (between 6 and 20 degrees C), for which a softening or partial melting of the sample has been evidenced. The thermal effect measured between -23 degrees C and -4 degrees C indicates a greatly reduced water concentration of lipid A from Brucella, thus explaining its early fusion process and its activity by means of hydrophobic interactions.

[Antibody titers against the hepatitis A virus in a healthy population from an urban health area]. / Estudio de los títulos de anticuerpos frente al virus de la hepatitis A en una población sana de una zona de salud urbana.

AIMS: To assess the level of immunity in a healthy population to the hepatitis A virus (HAV), according to age groups and in an urban health area. DESIGN: Transversal random prospective study of a sample of the population found by letters. SITE. Primary Care Centre covering the population of an urban health area in Valladolid. PATIENTS OR OTHER PARTICIPANTS: Random sample of 726 people with an adjustment as to sex and age according to the area's average, in line with the full census of the above area. The sample was 95% trustworthy, with a 3% margin of error. People with serious illness at the time of the study were excluded. MEASUREMENTS AND MAIN FINDINGS: We carried out a social-health count. We established the anti-HAV titer after its detection by enzyme immunoanalysis (HAVAB EIA Abbott); the titers were inferred from the absorbances relating then to that of a a "pool" of serums with very high titers. 69.9% (standardised rate) gave positive. The highest titers were presented in people between 31 and 50 (29.7 +/- 47.0), with significant differences both for lower (17.0 +/- 15.7) and higher (15.7 +/- 19.8) age groups (p. 0.001 for both). CONCLUSIONS: The highest anti-HAV titers corresponded to people in the middle age-group, with a subsequent dropping-off. This could suggest a greater susceptibility to HAV infection in the older person.

[Age and sex distribution of sexually transmitted diseases in Valladolid. A study of 5076 cases]. / Distribución por edad y sexo de las enfermedades de transmisión sexual en Valladolid. Estudio de 5.076 casos.

The age and sex distribution of 5,076 cases of S.T.D. dealt with between 1982 and 1988 at the Dermatological Dispensary of the Territorial Social Welfare Service in Valladolid are studied. The maximum frequency of S.T.D. (24.1% of cases) corresponded to the age group between 21 and 25 years, which was also the period for maximum prevalence of Neisseria gonorrhoeae (26.3%), Gardnerella vaginalis (30.7%), Candida albicans (27.4%) and acuminata condyloma (33.4%). Syphilis (19.9%), Chlamydia trachomatis (27%), Ureaplasma urealyticum (24.6%), Mycoplasma hominis (25.0%), Trichomonas vaginalis (23.0%) and genital herpes had maximum prevalence in the group between 26 and 30 years. Women were affected at younger ages than males. 16.9% of women with some S.T.D. were between 16 and 20 years of age, while only 6.5% of males with S.T.D. were in this age-group (p less than 0.001).