Zooplankton as an indicator of the status of contamination of the Mediterranean Sea and temporal trends.

Zooplankton has been intensively used as bioindicators of water pollution at global level, however, only few comprehensive studies have been conducted from the Mediterranean Sea and manly dated back to the 1970s. To redress the urgent need for updated data, this study provides information on the presence and levels of contaminants in zooplankton from the Tyrrhenian Sea. Although banned, both PCBs (46.9 ± 37.2 ng g-1) and DDT (8.9 ± 10.7 ng g-1) are still present and widespread, but their contamination appears to be a local problem and to be declining over the past 50 years. Zooplankton accumulates high levels of certain TEs, including Zn (400 ± 388 ppm) and Pb (35.3 ± 45.5 ppm), but shows intermediate concentrations of other TEs, including Cd (1.6 ± 0.9 ppm) and Hg (0.1 ± 0.1 ppm), comparing with both strongly polluted and more pristine marine habitats, which may reflect a general improvement.

Clinical and immunological profile of children aged 5-9 years with persistent egg allergy before oral immunotherapy with egg. A multicenter, randomized controlled trial of the Spanish Society of Pediatric Allergy, Asthma and Clinical Immunology (SEICAP)

BACKGROUND: In children with egg protein allergy (EA), the probability of overcoming the allergy decreases with age, and the possibility of suffering severe adverse reactions as a consequence of dietetic transgressions results in worsened quality of life. One treatment option in such cases is oral immunotherapy (OIT) with foods. METHODS: We present a cohort of children with EA scheduled for OIT with pasteurized raw egg white, describing their clinical and allergic characteristics before the start of OIT. RESULTS: The median age was six years, and 93% of the patients also suffered other allergies (58% asthma and 38.6% allergy to more than two food groups). In the last year, 14.8% had suffered a severe reaction due to dietetic transgression with egg. The median IgE specific of egg white titer was 38.5 kU/l. A double-blind placebo-controlled food challenge with cooked egg white was performed, and if the test proved positive, it was repeated with pasteurized raw egg white. The mean symptoms-provoking dose was 1.26 g and 0.55 g for cooked egg white and raw egg white, respectively. An IgE specific of ovomucoid titer of <2.045 kU/l differentiated those patients that tolerated cooked egg white. CONCLUSIONS: OIT with egg is regarded as an option in patients with persistent egg allergy. In the previous challenge test, an IgE specific of ovomucoid titer of <2.045 kU/l differentiates those patients that tolerate cooked egg white

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Clinical and immunological profile of children aged 5-9 years with persistent egg allergy before oral immunotherapy with egg. A multicenter, randomized controlled trial of the Spanish Society of Pediatric Allergy, Asthma and Clinical Immunology (SEICAP).

BACKGROUND: In children with egg protein allergy (EA), the probability of overcoming the allergy decreases with age, and the possibility of suffering severe adverse reactions as a consequence of dietetic transgressions results in worsened quality of life. One treatment option in such cases is oral immunotherapy (OIT) with foods. METHODS: We present a cohort of children with EA scheduled for OIT with pasteurized raw egg white, describing their clinical and allergic characteristics before the start of OIT. RESULTS: The median age was six years, and 93% of the patients also suffered other allergies (58% asthma and 38.6% allergy to more than two food groups). In the last year, 14.8% had suffered a severe reaction due to dietetic transgression with egg. The median IgE specific of egg white titer was 38.5kU/l. A double-blind placebo-controlled food challenge with cooked egg white was performed, and if the test proved positive, it was repeated with pasteurized raw egg white. The mean symptoms-provoking dose was 1.26g and 0.55g for cooked egg white and raw egg white, respectively. An IgE specific of ovomucoid titer of <2.045kU/l differentiated those patients that tolerated cooked egg white. CONCLUSIONS: OIT with egg is regarded as an option in patients with persistent egg allergy. In the previous challenge test, an IgE specific of ovomucoid titer of <2.045kU/l differentiates those patients that tolerate cooked egg white.

Prospective registry of symptomatic severe aortic stenosis in octogenarians: a need for intervention.

OBJECTIVE: To study the factors associated with choice of therapy and prognosis in octogenarians with severe symptomatic aortic stenosis (AS). STUDY DESIGN: Prospective, observational, multicenter registry. Centralized follow-up included survival status and, if possible, mode of death and Katz index. SETTING: Transnational registry in Spain. SUBJECTS: We included 928 patients aged ≥80 years with severe symptomatic AS. INTERVENTIONS: Aortic-valve replacement (AVR), transcatheter aortic-valve implantation (TAVI) or conservative therapy. MAIN OUTCOME MEASURES: All-cause death. RESULTS: Mean age was 84.2 ± 3.5 years, and only 49.0% were independent (Katz index A). The most frequent planned management was conservative therapy in 423 (46%) patients, followed by TAVI in 261 (28%) and AVR in 244 (26%). The main reason against recommending AVR in 684 patients was high surgical risk [322 (47.1%)], other medical motives [193 (28.2%)], patient refusal [134 (19.6%)] and family refusal in the case of incompetent patients [35 (5.1%)]. The mean time from treatment decision to AVR was 4.8 ± 4.6 months and to TAVI 2.1 ± 3.2 months, P < 0.001. During follow-up (11.2-38.9 months), 357 patients (38.5%) died. Survival rates at 6, 12, 18 and 24 months were 81.8%, 72.6%, 64.1% and 57.3%, respectively. Planned intervention, adjusted for multiple propensity score, was associated with lower mortality when compared with planned conservative treatment: TAVI Hazard ratio (HR) 0.68 (95% confidence interval [CI] 0.49-0.93; P = 0.016) and AVR HR 0.56 (95% CI 0.39-0.8; P = 0.002). CONCLUSION: Octogenarians with symptomatic severe AS are frequently managed conservatively. Planned conservative management is associated with a poor prognosis.

[Seropositivity to Helicobacter pylori among university students and their families. A comparative cross-sectional study]. / Seropositividad a Helicobacter pylori entre estudiantes universitarios y sus familias. Estudio comparativo.

OBJECTIVE: To associate serologic response to Helicobacter pylori (Hp) among seropositive university students and their families in western Mexico. METHODS: We conducted a comparative transversal study, and randomized 30 nuclear families of 14 Hp-seropositive university students and 14 Hp-seronegative university students. We carried out seropositivity measurements (IgG) to Hp using the ELISA method. An analysis was performed utilizing the chi-squared and Mann-Whitney U tests, with the aid of EPI INFO 2000 and SIGMA STAT 3.2 software. RESULTS: Global seropositivity in the families of infected students was 57 vs. 13% of the relatives of non-infected students (p = 0.000002). In families of Hp-positive students we found the following frequencies: parental (father and mother) 70%; mother 71%, and siblings 42%, while for seronegative individuals incidences were: parental 17% (p = 0.00005), mother 12% (p = 0.001), and siblings 10% (p = 0.0076). CONCLUSIONS: There is a greater prevalence of antibodies against Hp in the relatives of seropositive students.

Disruption of actin impedes transmitter release in snake motor terminals.

To investigate the role of actin in vertebrate nerve terminals, nerve-muscle preparations from garter snake (Thamnophis sirtalis) were treated with the actin-depolymerizing agent latrunculin A. Immunostaining revealed that actin filaments within presynaptic motor terminal boutons were disrupted by the drug. In preparations loaded with the optical probe FM1-43, destaining was reduced by latrunculin treatment, suggesting that transmitter release was partially blocked. Latrunculin treatment did not influence the amplitude or time course of spontaneous miniature endplate potentials (MEPPs). Similarly, endplate potentials (EPPs) evoked at low frequency were comparable in control and latrunculin-treated curarized preparations. Brief tetanic stimulation of the muscle nerve (25 Hz, 90 s) depressed EPP amplitudes in both control and latrunculin-treated preparations. After tetanus, EPPs elicited at 0. 2 Hz in control preparations recovered rapidly (0-5 min) and completely (usually potentiating to above pre-tetanus levels; 130 +/- 11 %, mean +/- s.e.m.). In contrast, EPPs evoked in latrunculin-treated preparations recovered slowly (8-10 min) and incompletely (84 +/- 8 %). The influence of latrunculin on post-tetanic EPPs depended on its concentration in the bath (KD = 3. 1 microM) and on time of incubation. These observations argue that actin filaments facilitate transmitter release rather than impede it. Specifically, actin may facilitate mobilization of vesicles towards the releasable pools.

[Assessment of a health program for the non-insured population]. / Evaluación de programa de salud para población no asegurada.

OBJECTIVE: Present the results of the evaluation of a program for the non-insured population of the four poorest states of the country implemented by the Ministry of Health of Mexico between 1991 and 1995. METHODS: The effects of the program were evaluated in three areas: i) increase in health services coverage; ii) delivery of personal health services, and iii) changes in health conditions of the target population. The extension of coverage was measured by the increase in potential access due to the construction of health infrastructure projects and the use of additional health manpower, mainly primary health care workers. For the evaluation of the impact of the program on the delivery of services, three surveys were developed: one for service utilization, another one for accessibility, and a third for quality of care. The impact on health conditions was evaluated by changes in health indicators of children under five and women of reproductive age. RESULTS AND CONCLUSIONS: The Program had a positive impact on coverage, accessibility and quality of services. Its impact on health conditions was also positive. However, these last changes cannot be attributed only to the program, but to the sum of several concurrent activities.

[The value of cardiac troponin I as diagnostic test in the study of chest pain]. / Valor de la troponina I cardíaca como prueba diagnóstica en el estudio del dolor torácico.

BACKGROUND AND OBJECTIVES: Cardiac troponin I is a highly sensitive and specific myocardial injury marker. We have analyzed the use of cardiac troponin I values in the diagnosis of coronary artery disease, in previously healthy patients who developed chest pain with inconclusive analytical and ECG diagnostic findings. PATIENTS, MATERIAL AND METHODS: A one year cross-sectional consecutive study was conducted, in a total of 37 patients with no previously known heart disease who were admitted to the coronary unit for suspected anginal chest pain with normal cardiac enzymes and ECG. Abnormal cardiac troponin I levels at admission were defined as > or = 0.4 ng/ml, and were compared with coronary angiography or exercise test results and related to the duration of pain and the time from the appearance of symptoms to blood extraction. RESULTS: Thirty-three of the 37 initially included patients were studied. Coronary artery disease was diagnosed in 22, 15 of whom had increased troponin I values, yielding a sensitivity of 68% (48%-84%) and a specificity of 82% (53%-97%). In the subgroup of patients with pain lasting > 30 min, sensitivity reached 85% (59%-97%) and specificity 83% (42%-99%). There were no significant differences between subgroups with different time delays from appearance of symptoms to blood extraction. CONCLUSIONS: Cardiac troponin I is very useful for the studying ischemic chest pain without a definitive diagnostic ECG nor biochemical data, resulting in a high sensitivity and specificity for myocardial ischemic injury detection. Its diagnostic value increases in cases of prolonged pain episodes.

[Identification of the ischemic origin of dilated myocardiopathy using positron emission tomography]. / Identificación del origen isquémico de la miocardiopatía dilatada mediante tomografía por emisión de positrones.

INTRODUCTION AND OBJECTIVES: The aim of this study was to differentiate ischemic from nonischemic dilated cardiomyopathy with positron emission tomography. This differentiation is necessary to establish an adequate treatment, and it is often difficult with non-invasive diagnostic procedures. METHODS: Ten patients with an echocardiographic diagnosis of dilated cardiomyopathy who had undergone coronary angiography were selected. The presence or absence of angiographic coronary lesions was used to define the ischemic (n = 6) and the nonischemic group (n = 4). The ejection fraction was depressed in both groups, with no significant differences found. A perfusion study with 13N-ammonium and a metabolic imaging with 18F-florodeoxyglucose were performed on each patient. The images were quantitatively and qualitatively analysed, defining three criteria: accumulation defect (areas with activity under 50% of the maximal radioactivity), degree of heterogeneity, and match of images with both tracers. To determinate the degree of heterogeneity, nine segments on the three standard tomographic planes were studied. Based on the following heterogeneity features: irregular borders, coexisting different degrees of accumulation, and patched accumulation, a score ranging from 0 to 3 points was assigned to these segments. To analyse the radioactivity defects and the matching of studies with both tracers, the accumulation defects or the accumulating surface were outlined on a midventricular level coronal plane. RESULTS: The ischemic group has contrary to the nonischemic one, wider perfusion (0.26 +/- 0.21 vs 0.00) and metabolism defects (0.38 +/- 0.30 vs 0.06 +/- 0.09; p < 0.05). The degree of heterogeneity is significantly higher in the nonischemic group, either in perfusion (14.5 +/- 8.38 vs 2.5 +/- 1.04; p < 0.05) or in metabolism studies (15.5 +/- 3.31 vs 2.33 +/- 1.50; p < 0.005). Assigning wide defects and homogeneous accumulation to ischemic cardiomyopathy, and absence of defects and heterogeneous accumulation to nonischemic cardiomyopathy, the aetiology of the disease was identified in 9 of the 10 cases in the perfusion study and 100% of them with the metabolism imaging. CONCLUSIONS: Positron emission tomography allows to identify the aetiology of dilated cardiomyopathy, either with coronary perfusion or with myocardial glucose metabolism studies. Thus, only one of both PET studies could be used. Ischemic cardiomyopathy is characterised by wide defects and homogeneous radioactivity, and the nonischemic one by the absence of defects and heterogeneous accumulation of the tracer.

[Evaluation of biochemical markers of myocardial lesion after radiofrequency ablation. Value of troponin I]. / Evaluación de marcadores de lesión miocárdica tras la ablación con radiofrecuencia. Utilidad de la troponina I.

INTRODUCTION AND OBJECTIVES: Radiofrequency catheter ablation is the curative treatment of choice for many cardiac arrhythmias. After radiofrequency ablation there is always a localized endomyocardial necrosis, which is necessary to eliminate the arrhythmia. The volume of the necrosis may be evaluated by the rise of several biochemical markers, classically CK and CK-MB. However, the sensitivity and specificity of these markers are not optimal and are probably less than ideal for this purpose. Cardiac Troponin I (cTnI) is a newly available biochemical marker available, with a high cardiac specificity. We designed this study in order to determine the value of serum levels of several cardiac markers in patients who underwent radiofrequency catheter ablation and to establish the utility of cTnI. METHODS: We analyzed the data from 51 patients who underwent radiofrequency ablation and from 16 control patients. In respect to the ablation target, we included in the study 14 left accessory pathways, 7 right accessory pathways, 12 atrioventricular nodal reentry tachycardia, 5 ventricular tachycardia and 13 atrial flutter or fibrillation. The levels of CK, CK-MB, cTnI, and myoglobin were compared with clinical findings, ST-T wave abnormalities and the presence of arrhythmias after ablation. To evaluate the diagnostic capability for each biochemical marker we used the ROC curves. RESULTS: A pathological value of cTnI was found in 47 out of 51 (92%) patients in the ablation group. CK-MB had a lower sensitivity (63%). The sensitivity for the other biochemical markers ranged from 30% for CK to 67% for Myoglobin. The area under the ROC curve for cTnI was 0.9375, significantly superior to the other biochemical markers (0.86, 0.76, 0.75 for MB, Myoglobin, CK respectively) (p < 0.05). The lowest cTnI released was found in patients after nodal reentry tachycardia ablation and the highest after atrial flutter ablation. cTnI increased above normal values in 4 patients in the control group (patients who underwent an electrophysiological study without catheter ablation). We found a moderate level of correlation between the number of radiofrequency pulses and cardiac cTnI release (r = 0.69; p < 0.0001). The correlation was different in each target, ranging between r = 0.25 (p = NS, 0.43) for atrial flutter and fibrillation to r = 0.99 (p < 0.0001) for ventricular tachycardia. CONCLUSIONS: cTnI had the greatest sensitivity (92%) for detecting minor myocardial damage. Thus, we can conclude that the serum level of cTnI detects the minor myocardial damage produced by radiofrequency ablation.

[Cardiac pathology of extracardiac origin (II). The cardiac repercussion of amyloidosis and hemochromatosis]. / Patología del corazón de origen extracardíaco (II). Repercusión cardíaca de la amiloidosis y de la hemocromatosis.

Although rare, amyloidosis and hemochromatosis are the infiltrative diseases in which the heart is more frequently involved. The most common clinical presentation is heart failure with hemodynamic features of restrictive heart disease in cardiac amyloidosis. The diagnosis is often made because of symptoms of other organ involvement, although sometimes cardiac symptoms may be the initial manifestation. The non-specific clinical presentation and the low prevalence of these cardiomyopathies make the diagnosis difficult if the clinician does not suspect it. Once symptoms develop, the evolution is fast. Usually, the unsatisfactory and ineffective treatment of amyloidosis and hemochromatosis contribute to the poor prognosis. The indication of cardiac transplantation in advanced cases is questionable because of the high recurrence of the illness.

Parto en posición sentada Hospital-La Oroya / Delivery in sitted position? in the Oroya Hospital

El presente es un estudio analítico realizado entre julio-agosto de 1993 que incluyó a 35 mujeres, quienes tuvieron parto en posición de litotomía y 35 mujeres cuyos partos se realizaron en posición sentada, para lo cual se confeccionó una silla de partos para tal fin. El grupo control (parto de decúbito supino-litotomía) consistió de gestantes a término, todas las paridades, pelvis ginecoide, partos eutócitos, puntaje de apgar. En el grupo de estudio (parto sentada) aparte de los parámetros ya señalados se cuantificaba la duración del expulsivo, grado de dolor de las contracciones, calidad de la dinámica uterina, opinión de la paciente, del obstetra, filmación de 5 partos. Se encontró que la duración del expulsivo en el grupo control fue de 21.43 minutos y en el grupo sentada de 12.06 minutos, desgaros perineales 14.28 por ciento en el grupo control y 5.71 por ciento en el grupo de estudio; las contracciones uterinas fueron más intensas, eficaces y menos dolorosas en la posición sentada. Los valores antropométricos de ambos grupos fueron semejantes (talla, peso, perímetro craneano). Se concluye que el parto en posición sentada es óptimo para el recién nacido.

The effect of ageing on mucin contents in mouse submandibular glands.

There may be deleterious effects if there is an age-dependent reduction in mucin composition or content in salivary glands. To assess whether there was an effect of age in submandibular glands from male mice aged 3 months, 10 and 20 months and 27, 29 and 30 months, mucin, protein and sialic acid were quantitated. Changes in wet weight per gland and protein per gland were highly significant (p less than 0.001), as tested by analysis of variance, and the means for both were highest in middle aged glands. While sialic acid per gland showed no significant change from middle aged to old glands, mucin per gland showed an age-related decrease (p less than 0.01) when comparing either young or middle aged glands with old glands.

Increased mucin levels in submandibular glands of aged male mice after chronic isoproterenol treatment.

Mucin levels are reduced in submandibular glands of mice during ageing. Isoproterenol (IPR) was given to mice 27 and 29 months old to assess whether levels of mucin could be restored to levels similar to those in younger mice. When compared with controls, mucin levels per gland were significantly elevated (p less than 0.05) after IPR treatment, and exceeded the peak amounts in young animals. Mucin concentrations were also higher after IPR. These observations support the contention that the gland has the ability to return to or exceed pre-senescent levels of mucin. Mean sialic acid levels were elevated in each experiment after IPR treatment. There was evidence for significant diurnal variation in mucin in the aged control animals, but little evidence for such a relationship in the IPR-treated animals. After administration of pilocarpine there was a modest stimulation of sialic acid and protein levels in 20-month-old animals while mucin levels showed virtually no indication of stimulation.