Implantación del Comprehensive Medication Management en pacientes costarricenses con enfermedad renal crónica / Implementation of Comprehensive Medication Management in Costa Rican patients with chronic kidney disease

Objective: Determine implementation results of the Comprehensive Medication Management (CMM) offered to patients with chronic kidney disease (CKD) who attended the Hospital Nephrology Service in Costa Rica.Methods: Mixed quantitative-qualitative, observative, descriptive and prospective study, in patients attending the Hospital Pharmaceutical Care Department through the CMM process, analysis of intermediate and preliminary results of health-related quality of life HRQOL using EQ 5D -5L.Results: Based on pilot study, 11 patients attended the first visit and 9 patients attended the third one. As result, 45 clinical conditions were analyzed, 1 of them was resolved, 20 were stable and 10 were improved. Total of 62 drug-therapy problems (DTP) were identified, with average of 5.6/patient. On regards to HRQOL, feedback obtained from kidney transplant patients indicated a better evaluation (mobility, personal care, daily activities, pain / discomfort), compared to CKD stage 5 5D dialysis patients (mobility impairment improvement). Utility measure reflected a change of 0.64±0.12 to 0.72±0.12, the health self-perception EQ VAS 68.18±23.58, to 87.22±8.53; and in terms of quality-adjusted life-year QALY, it showed a difference of 2.54±2.99.Conclusions: CMM implementation established in most health conditions improve or maintain patient stability. HRQOL was better for transplant patients compared to CKD 5D patients. Parameters such as utility, QALY, and EQ VAS were increased. (AU)

Objetivo: Determinar los resultados de la implantación del Comprehensive Medication Management (CMM) brindada a los pacientes con enfermedad renal crónica (ERC) que asistieron al Servicio de Nefrología de un Hospital en Costa Rica.Métodos: Estudio cuali-cuantitativo mixto, observacional, descriptivo y prospectivo, en pacientes que asisten al consultorio de Atención Farmacéutica de un hospital, mediante el proceso asistencial CMM, análisis de resultados intermedios y preliminares de calidad de vida relacionada con salud (CVRS) mediante EQ 5D-5L.Resultados: En el estudio piloto 11 pacientes completaron la primera visita y 9 pacientes la tercera visita; se analizaron 45 condiciones clínicas, y se obtuvo una condición clínica resuelta, 20 estables, 10 con mejoría. Se identificaron 62 problemas farmacoterapéuticos (DTP por sus siglas en inglés), media 5,6/paciente. Respecto a la CVRS los discursos de los pacientes trasplantados renales indicaron una mejor valoración (movilidad, cuidado personal, actividades cotidianas, dolor/malestar), en comparación con pacientes ERC estadio 5 diálisis 5D (mayor afectación movilidad). La utilidad cambió de una media 0,64±0,12 a 0,72±0,12, la autopercepción de salud EQ VAS 68,18±23,58, a 87,22±8,53; y respecto a los años de vida ganados ajustados por calidad de vida AVAC con una diferencia de 2,54±2,99.Conclusiones: La implantación de CMM logró en la mayoría de las condiciones de salud una mejoría o mantener la estabilidad. La CVRS fue mejor para los pacientes trasplantados, en comparación con los pacientes ERC 5D. Los parámetros como la utilidad, AVAC y EQ VAS aumentaron. (AU)

The Spanish version of the Home Environment Survey (HES) among families of children with overweight/obesity: a validation study.

PURPOSE: The aim of this article was to validate the Spanish version of the Home Environment Survey (HES-S) and was divided in two studies: (1) to assess the reliability, convergent validity of HES-S in a survey of 145 parents of children with overweight/obesity; (2) to study the magnitude of the association between children's BMI status with the latent scores theoretically defined by the HES model. METHODS: To test the scale and the model, a confirmatory factor analysis (CFA) and a path analysis were carried out among a sample of 156 parents of preadolescents (106 overweight/obesity and 50 normal-weight children). No CFA or EFA were carried out in the validation of the original instrument. RESULTS: Study 1, both the Physical Activity and the Eating Habits components of the scale showed adequate levels of internal consistency for the majority of the scales, except for two. One of them, Healthy Eating Parental Policies (HEP) subscale was reduced after excluded two items, although it did not improve substantially. This model indicated that there was a significant association between the two Eating Habits scales and the child's weight status, but child's weight was not associated with the Physical Activity components. Convergent validity was confirmed by correlations with related variables: family eating habits (F-EAT), parent's physical activity (IPAQ), and children's physical activity (assessed via accelerometers during one week). Study 2, our results replicated the original four factor structure proposed for physical activity (CFI = 0.99; RMSEA = 0.03), but the original factor structure of the eating habits component was not supported. In addition, the relationship of the child's weight status, the Physical Activity components, and the two scales of Eating Habits (Parental Modeling and Policies) was explored with a path analysis showing good fit indices (CFI = 0.95; RMSEA = 0.06). Child's BMI was negatively associated with Healthy Eating Parental Role Modeling (r = - 0.21) and with Healthy Eating Parental Policies (r = - 0.19), but not with the factors of Child's Physical Activity model. CONCLUSION: To our knowledge, this is the first instrument to assess obesogenic family environment in Spanish speaking countries, which is a relevant dimension within a health perspective so as to implement new policies and strategies in obesity tertiary prevention. Overall, the confirmatory factor analysis of the HES-S has only provided additional support for one part related to Physical Activity. In addition, Child's BMI was correlated with scales of Eating Habits but not with Child's Physical Activity factor. These results clearly suggest that further research is warranted. LEVEL III: Case-control analytic study.

Psychological well-being and weight-related teasing in childhood obesity: a case-control study.

PURPOSE: The prevalence of childhood obesity continues to increase worldwide. The aims of this study were to (1) assess the psychological well-being and rates of teasing of Spanish children with obesity (OG) and compare them with their non-overweight peers (NG), and (2) analyze the mediating role of weight-related teasing on the relation between children's BMI z score and psychological well-being. METHODS: The cross-sectional study included 50 preadolescents with obesity, matched with non-overweight children according to age, sex, and socioeconomic status, who were assessed via self-report instruments measuring anxiety, depression, self-esteem, and teasing. RESULTS: The OG reported higher anxiety, depression, and teasing, and lower self-esteem. SEM revealed that children who scored worse on instruments assessing psychological well-being had higher BMI z scores. Weight-related teasing predicted poor psychological well-being scores and weight-related teasing mediated the relation between BMI and psychological well-being. CONCLUSIONS: The high rates of anxiety, depression, and weight-related teasing, as well as the low self-esteem, which was observed amongst the children with obesity, raise concerns about the quality of life of this population. Furthermore, the finding that weight-related teasing mediated the relationship between BMI and psychological well-being adds to a growing body of research, highlighting the harmful effects of weight-related stigma. Overall, these results highlight the importance of early intervention to assess for, and address, the presence of weight-related teasing and psychological well-being difficulties in preadolescents with obesity. LEVEL OF EVIDENCE: Level III, case-control study.

Hippocampal sclerosis induced in mice by a Taenia crassiceps metacestode factor.

An experimental Taenia crassiceps mouse model was used to assess the role of Taenia solium metacestode factor (Fac) in human neurocysticercosis. Intraperitoneal infection with T. crassiceps metacestodes or subcutaneous inoculation with a T. crassiceps metacestode factor (Fac) produced significant impairment of performance (learning) in the Barnes maze and induced bilateral hippocampal sclerosis in mice. Several staining techniques revealed important cell dispersion, extensive apoptosis and cell loss in the dentate gyrus, hilus and CA1-CA3 regions of both hippocampi, as well as intense deterioration of the adjacent cortex. An outstanding disruption of its histoarchitecture in the surrounding tissue of all these regions and apoptosis of the endothelial cells were also observed.

The hearing of rural workers exposed to noise and pesticides.

n work environments, different physical and chemical agents that may pose a risk to workers' hearing health coexist. In this context, occupational hearing loss stands out. It has mostly been attributed to only noise exposure, although there are other agents, that is, pesticides that might contribute to occupational hearing loss. In this report, two cases will be presented that consider rural workers exposed to pesticides and intense noise generated by an adapted rudimentary vehicle. The noise measured in this vehicle was 88.3 dBA up to 93.4 dBA. Pure-tone audiometry, distortion product otoacoustic emissions, and high-frequency audiometry tests were performed. This report is unusual because of the short time of exposure to noise and pesticides and the hearing loss found, indicating a synergy between those agents.

Protected mealtimes for adults with cancer in a hematology-oncology setting: an evidence-based implementation project.

BACKGROUND: Patients with cancer are often at risk or suffer from some form of malnutrition, which could be attributed to their disease progression or the adverse effects of cancer treatment. Protected mealtime and offering assistance during mealtime may not improve their nutritional status but would allow them to enjoy their meal and improve patient satisfaction. OBJECTIVES: The aim of this project was to promote best practice in protecting mealtimes in hematology-oncology patients. METHODS: The current project adopted a clinical audit methodology using the Joanna Briggs Institute Practical Application of Clinical Evidence System tool. Four audit criteria that represent best practice recommendations for protected mealtimes were used. A pre-implementation audit was conducted followed by introduction of multiple interventions identified from the Getting Research into Practice analysis. A post implementation audit was conducted to determine the change of practice. In addition, a sustaining audit was conducted at six months after implementing the follow-up plan. RESULTS: The four criteria showed an improvement: nurses ensured a pleasant eating environment around the patient cubicle (from 43% to 93% compliance), all nurses received education on mealtime care (no change - 100% sustenance), nurses conducted an assessment of the patients on admission on their ability to eat (from 95% to 100% compliance) and minimized unnecessary clinical interventions during mealtimes (92% to 89% compliance). The decline of 3% in the compliance rate of the last criterion could be attributed to the high turnover of patients during the post implementation audit period. The post implementation results at six months showed audit results being sustained at 100% compliance in all criteria. CONCLUSION: The results of this project demonstrated that improvement in best practice is possible in a busy oncology ward in the presence of great leadership, teamwork, empowerment and role modeling.

Apoptosis of mouse hippocampal cells induced by Taenia crassiceps metacestode factor.

Seizures, headache, depression and neurological deficits are the signs and symptoms most frequently reported in human neurocysticercosis. However, the cause of the associated learning and memory deficits is unknown. Here, we used Taenia crassiceps infection in mice as a model of human cysticercosis. The effects of T. crassiceps metacestode infection or T. crassiceps metacestode factor (MF) treatment on mouse hippocampal cells were studied; control mice were included. At 45 days after infection or treatment of the mice with MF, all mice were anaesthetized and perfused transcardially with saline followed by phosphate-buffered 10% formalin. Then the brains were carefully removed. Coronal sections stained using several techniques were analysed. Extensive and significant apoptosis was found in the experimental animals, mainly in the dentate gyrus, CA1, CA2, CA3 and neighbouring regions, in comparison with the apparently intact cells from control mice (P < 0.01). These results suggest that neurological deficits, especially the learning and memory deficits, may be generated by extensive apoptosis of hippocampal cells.

Perinatal factors and their influence on childhood obesity: a case-control study / Factores perinatales y su influencia en la obesidad infantil: estudio de casos y controles.

Background. The aetiology of childhood obesity is complex. It involves the interaction of genetic and environmental factors. Obstetric complications have been associated with the development of mental disorder and other medical conditions. The aim of this research is to study the association between perinatal complications and childhood obesity. Methods. We present data from a case-control study composed of 60 mothers of obese children and 92 mothers of healthy control children between 8-12 years. We interviewed the mothers and we studied obstetric complications with the Lewis ­Murray Scale. We compared the two groups with chi - square analysis and odds ratios. Results. We found a higher prevalence of obstetric complications in delivery in the group with obesity. The most frequent obstetric complication was emergency caesarean; a significant difference was shown with the control group (p < 0.05). Conclusion. Obstetric complications are related to the development of childhood obesity. It is important to study the perinatal period as a relevant factor, in order to develop and implement prevention programs.

Factores perinatales y su influencia en la obesidad infantil: estudio de casos y controles / Perinatal factors and their influence on childhood obesity: a case-control study

Fundamento: La etiología de la obesidad infantil es compleja y se encuentra implicada la interacción de factores genéticos y ambientales. Las complicaciones obstétricas se han asociado al desarrollo de trastornos mentales y médicos, incluida la obesidad. El objetivo de esta investigación es estudiar la asociación entre las complicaciones durante el embarazo y el parto y el desarrollo de obesidad infantil. Participantes y método: Se presentan los datos de un estudio de casos y controles compuesto por 60 madres de niños con obesidad comparado con 92 madres de niños controles con normopeso y con edades comprendidas entre los 8 y 12 años. Se realizó una entrevista clínica a las madres y se estudiaron las complicaciones obstétricas mediante la Escala Lewis-Murray. Resultados: Se observó una mayor frecuencia de complicaciones durante el parto en el grupo de madres de niños con obesidad. La complicación obstétrica más frecuente fue la cesárea de emergencia, mostrando diferencias significativas con el grupo control sano. La edad de la madre en el parto menor de 30 años y el nivel socioeconómico bajo fueron las variables que mostraron una mayor relación con la obesidad actual de los niños. Conclusiones: Las complicaciones obstétricas parecen estar relacionadas con el desarrollo posterior de obesidad infantil. Es necesario continuar estudiando el periodo perinatal como factor relevante, de cara a desarrollar e implementar programas de prevención e intervención temprana (AU)

Background: The aetiology of childhood obesity is complex. It involves the interaction of genetic and environmental factors. Obstetric complications have been associated with the development of mental disorder and other medical conditions. The aim of this research is to study the association between perinatal complications and childhood obesity. Methods: We present data from a case-control study composed of 60 mothers of obese children and 92 mothers of healthy control children between 8-12 years. We interviewed the mothers and we studied obstetric complications with the Lewis-Murray Scale. We compared the two groups with chisquare analysis and odds ratios. Results: We found a higher prevalence of obstetric complications in delivery in the group with obesity. The most frequent obstetric complication was emergency caesarean; a significant difference was shown with the control group (p < 0.05). Conclusion: Obstetric complications are related to the development of childhood obesity. It is important to study the perinatal period as a relevant factor, in order to develop and implement prevention programs (AU)

A Taenia crassiceps factor induces apoptosis of spleen CD4+T cells and TFG-ß and Foxp3 gene expression in mice.

This study was undertaken to determine whether a parasite substance produces structural pathology in the mouse spleen. A low-molecular-weight Taenia crassiceps metacestode factor (MF) isolated from the peritoneal fluid of female mice infected with T. crassiceps metacestodes induced pathological and immunological changes in mouse spleen cells in vivo. Electron microscopy and confocal microscopy revealed severe changes in the spleen histoarchitecture of T. crassiceps-infected and MF-treated mice. Apoptotic degenerated spleen cells were observed in the white and red pulps and were more conspicuous in the white pulp of the spleen from the T. crassiceps-infected mice than in that of the MF-treated mice. Flow cytometry analysis revealed that the numbers of spleen CD4+T cells were significantly lower in both experimental groups than in control mice. The ex vivo expression of transforming growth factor (TGF)-ß and factor Foxp3 were significantly higher in splenocytes of the experimental mice than the basal expression observed in the control cells. These findings may have potential applications for a better understanding of the host-parasite relationship in human neurocysticercosis.

A Taenia crassiceps metacestode factor enhances ovarian follicle atresia and oocyte degeneration in female mice.

The histopathological effects of Taenia crassiceps infection or T. crassiceps metacestode factor inoculation on the mouse ovary were determined using six female mice in three groups: infected mice, mice inoculated with the metacestode factor and control mice. The control group was subcutaneously inoculated with healthy peritoneal fluid. The infected group was intraperitoneally inoculated with 40 T. crassiceps metacestodes, and the metacestode factor group was subcutaneously inoculated with T. crassiceps metacestode factor (MF). Light and electron microscopy and TUNEL (terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick end labelling) assays revealed a significant increase in ovarian follicular atresia (predominantly in antral/preovulatory stages of development), oocyte degeneration (P< 0.05), and a decrease in the amount of corpus luteum in follicles of mice infected and inoculated with MF compared with the control group. Significant abnormalities of the granulosa cells and oocytes of the primordial, primary and secondary ovarian follicles occurred in both treated mouse groups (P< 0.05) compared with no degeneration in the control group. These pathological changes in female mice either infected with T. crassiceps metacestodes or inoculated with T. crassiceps MF may have consequences for ovulation and fertility.

Influence of bevacizumab, sunitinib and sorafenib as single agents or in combination on the inhibitory effects of VEGF on human dendritic cell differentiation from monocytes.

Vascular endothelial growth factor (VEGF) inhibits differentiation and maturation of dendritic cells (DC), suggesting a potential immunosuppressive role for this proangiogenic factor. Bevacizumab, sorafenib and sunitinib target VEGF-mediated angiogenesis and are active against several types of cancer, but their effects on the immune system are poorly understood. In this study, VEGF and supernatants of renal carcinoma cell lines cultured under hypoxia were found to alter the differentiation of human monocytes to DC. Resulting DC showed impaired activity, as assessed by the alloreactive mixed T-lymphocyte reaction. Bevacizumab and sorafenib, but not sunitinib, reversed the inhibitory effects of VEGF, but not of those mediated by tumour supernatants. Dendritic cells matured under the influence of VEGF expressed less human leukocyte antigen-DR (HLA-DR) and CD86, and this effect was restored by bevacizumab and sorafenib. Finally, tumour-cell supernatants decreased interleukin-12 (IL-12) production by mature DC, and such inhibition was not restored by any of the tested drugs, delivered either as single agents or in combination. The deleterious effects of tumour-cell supernatants were mainly mediated by thermostable molecules distinct from VEGF. These results indicate that inhibition of the differentiation of monocytes to DC is a multifactorial effect, and that they support the development of combinations of angiogenesis inhibitors with immunological modulators.

Breed-associated variations in the sequence of the pig 3beta-hydroxysteroid dehydrogenase gene.

The entire sequence of the pig 3beta-hy-droxysteroid dehydrogenase (3beta-HSD) gene has recently become known. This gene is deemed to be important in androstenone metabolism in pig liver, and its defective expression has been shown to be related to androstenone accumulation in adipose tissue and the development of boar taint. The aim of the present work was to do the following: 1) define the structure of the pig 3beta-HSD gene and 2) compare 3beta-HSD DNA sequences from pigs of different breeds, which vary in adipose tissue androstenone levels, with the purpose of identifying a polymorphism that might be responsible for differential 3beta-HSD expression. The 5'flanking and the coding region of 3beta-HSD were cloned and sequenced by conventional techniques. The 3beta-HSD coding regions were identical in pigs of different breeds and in animals with high and low androstenone levels. Significant sequence variations were found in the 5'flanking region of the 3beta-HSD gene, where differences in the number of TTAT repeats and 3 SNP were observed. The SNP were associated with the number of the TTAT repeats. These variations in the DNA sequence of the 3beta-HSD gene were not associated with the androstenone level in s.c. adipose tissue but were breed-dependent. The results of this work might be used for detection of the presence of Meishan genes in Western pig breeds, especially if the phenotype is not clearly established.

Relationship between carcass weight, adipose tissue androstenone level and expression of the hepatic 3ß-hydroxysteroid dehydrogenase in entire commercial pigs.

Boar taint is a major meat-quality defect in pigs and is due to excessive accumulation of skatole and androstenone in adipose tissue. The present work investigated the relationship between carcass weight, levels of skatole and androstenone in adipose tissue, and expression of the hepatic androstenone-metabolising enzyme 3ß-hydroxysteroid dehydrogenase (3ß-HSD), in 22 entire male and 22 entire female crossbred pigs (Large White (40%) × Landrace (40%) × Duroc (20%)). Animals of each gender were divided into two subgroups (11 pigs in each subgroup): (i) conventional weight (carcass weight 59 to 77 kg) and (ii) heavy weight (carcass weight 84 to 95 kg). No relationship between carcass weight and adipose tissue skatole level was found for entire male pigs (r2 = 0.013, P > 0.05). There was a significant negative relationship between carcass weight and expression of the hepatic 3ß-HSD protein (r2 = 0.502, P < 0.001) and a significant negative relationship between 3ß-HSD protein expression and androstenone level in adipose tissue (r2 = 0.24, P < 0.05) in entire males. No relationship was found between carcass weight and 3ß-HSD protein expression in female pigs (r2 = 0.001, P > 0.05). 3ß-HSD expression was 59% higher in conventional-weight male pigs when compared with heavy-weight animals (P < 0.05) and 36% higher in heavy-weight females when compared with heavy-weight males (P < 0.05). It is concluded that an increase in slaughter weight of entire commercial crossbred Large White pigs is accompanied by inhibition of expression of the hepatic 3ß-HSD protein, which might result in a reduced rate of hepatic androstenone clearance with its subsequent accumulation in adipose tissue. It is suggested that regulation of pig hepatic 3ß-HSD expression is under the control of sex hormones.

Relationship between the expression of hepatic but not testicular 3beta-hydroxysteroid dehydrogenase with androstenone deposition in pig adipose tissue.

This study investigated the relationship between expression of hepatic and testicular 3beta-hydroxysteroid dehydrogenase (3beta-HSD) and accumulation of androstenone in adipose tissue because of its relation to boar taint. The experiments were performed on 13 Large White (50%) x Landrace (50%) and Meishan (25%) x Large White (25%) x Landrace (50%), pigs, which differed in the level of backfat androstenone. Our previous work showed that the major product of the hepatic androstenone metabolism is 3beta-androstenol. In this study, the formation of 3beta-androstenol was inhibited by the specific 3beta-HSD inhibitor trilostane. These results are the first direct confirmation that 3beta-HSD is the enzyme responsible for androstenone metabolism in the pig. The expression of the hepatic but not testicular 3beta-HSD protein showed a negative relationship with the level of backfat androstenone (r2 = 0.64; P < 0.001) and was accompanied by a reduced rate of the hepatic androstenone clearance. Low expression of 3beta-HSD protein in the liver of high androstenone pigs was also accompanied by a reduced level of 3beta-HSD mRNA (P < 0.001), which suggests a defective regulation of the hepatic 3beta-HSD expression at the level of transcription. In contrast, expression of the testicular 3beta-HSD protein did not differ between animals with high and low androstenone levels (P > 0.05) and was lower compared with the hepatic 3beta-HSD expression. Cloning and sequencing of the 3beta-HSD coding regions established that the hepatic and testicular 3beta-HSD cDNA have identical sequences, which were 98% similar to the human 3beta-HSD isoform I. It is suggested that expression of a single 3beta-HSD gene is regulated by different mechanisms in pig liver and testis. The liver-specific regulation of 3beta-HSD expression contributes to the low rate of hepatic androstenone metabolism and therefore can be considered as one of the factors regulating deposition of androstenone in pig adipose tissue and subsequent development of boar taint.

Absence of alpha-synuclein mRNA expression in normal and multiple system atrophy oligodendroglia.

alpha-Synuclein is a major constituent of glial cytoplasmic inclusions (GCIs), which are pathognomic for multiple system atrophy (MSA). We have previously demonstrated that in normal human brain, alpha-synuclein mRNA has a restricted pattern of neuronal expression and no apparent glial expression. The current study used double-label in situ hybridization to determine if alpha-synuclein mRNA is expressed by oligodendroglia of MSA cases. Analysis of MSA brain tissue revealed depletion of regional signal for this transcript in many brain areas due to extensive neurodegeneration. Cellular analysis of oligodendroglia in crus cerebri, a GCI-rich region ventral to substantia nigra, revealed an absence of alpha-synuclein mRNA signal in control and MSA cases. However, an abundance of this transcript was detected in melanin-containing neurons of substantia nigra. Therefore, oligodendroglia do not express alpha-synuclein mRNA in control and MSA cases suggesting that involvement of alpha-synuclein in GCI pathology of MSA is due to its ectopic presence in oligodendroglia.

Richard Doll, pionero en determinar los riesgos del consumo de tabaco (1912-2005) / Richard Doll, pioneer in determine the risks of tobacco consumption (1912-2005)

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Automatic analysis of immunocytochemically stained tissue samples.

An automatic colour image segmentation and cell counting software system has been developed for immunocytochemical analysis of stained tissue samples. The system was designed to count the total number of positive and negative cells in tissue samples treated with cytokine DNA probes from pigs naturally parasitised with Taenia solium metacestodes, using in situ hybridisation. A reaction index was calculated as the ratio of the number of cells with a positive reaction to the total number of cells (positives plus negatives) for each of five different probes. The objectives of automatic counting were to improve the reproducibility of the analysis and reduce the processing time of large image batches. A fast KNN classifier was used for colour segmentation. Watershed segmentation combined with edge detection was used to isolate individual cells that were then automatically labelled, using the results of the corresponding colour segmented image. Validation was performed on 122 non-training digital images with a total of 1069 positive cells and 1459 negative cells, with the following results: a mean true positive rate of 90.2% for positive cells and a mean true positive rate of 85.4% for negative cells. The corresponding mean false positive rates were 9.6% and 6.6%. The mean reaction index error of the automatic analysis was 5.35%. The processing of each digital image took 10 s on a Pentium IV PC.

A cysteine protease from Taenia solium metacestodes induce apoptosis in human CD4+ T-cells.

Here we investigated whether the depletion of CD4+ lymphocytes, observed in mononuclear cells incubated with Taenia solium metacestode E/S products or with living cysts was due to apoptosis. Using the deoxynucleotidyl transferase-mediated dUTP nick-end labelling (TUNEL), electron microscopy and DNA gel electrophoresis, we found signs of apoptosis in these cells. Results showed that cysteine protease activity was responsible for this effect, since E-64 prevented cell death in all cases. Electron microscopy studies showed that lymphocytes exhibited features of apoptosis such as cellular membrane integrity, strangling and fragmentation of nuclei, chromatin condensation, apoptotic bodies and loss of microvilli. In contrast, lymphocytes co-cultured with living metacestodes plus E-64 exhibited integrity of their structures. DNA fragmentation was detected by TUNEL assays and DNA gel electrophoresis. The results suggested that cell death induced by the cysteine protease from the T. solium metacestode may be involved in down-regulation of cell-mediated responses in infected hosts.