Effectiveness of the WC/rBS oral cholera vaccine in the prevention of traveler's diarrhea: a prospective cohort study.

OBJECTIVE: Traveler's diarrhea (TD) is the most frequent disease among people from industrialized countries who travel to less developed ones, especially sub-Saharan Africa, Southern Asia and South America. The most common bacteria causing TD is enterotoxigenic Escherichia coli (ETEC). The WC/rBS cholera vaccine (Dukoral) has been shown to induce cross-protection against ETEC by means of the B subunit of the cholera toxin. The aim of the study was to evaluate the effectiveness of the WC/rBS cholera vaccine in preventing TD. METHODS: Between May 1 and September 30 (2007), people seeking pre-travel advice in ten Spanish international vaccination centers were included in a prospective cohort study of travelers to cholera risk countries. The incidence rates of TD were adjusted for variables whose frequencies were statistically different (entry point 0.10) between the vaccinated and non-vaccinated cohorts. FINDINGS: The vaccinated cohort (n = 544 travelers) included people vaccinated with the WC/rBS cholera vaccine, and the non-vaccinated cohort (n = 530 travelers) by people not vaccinated. The cumulative incidence rate of TD was 1.69 in vaccinated and 2.14 in non-vaccinated subjects. The adjusted relative risk of TD in vaccinated travelers was 0.72 (95% CI: 0.58-0.88) and the adjusted vaccination effectiveness was 28% (95% CI: 12-42). CONCLUSIONS: The WC/rBS cholera vaccine prevents TD in 2 out of 7 travelers (preventive fraction: 28%). The number needed to vaccinate (NNV) to prevent 1 case of TD is 10.

Angiotensin-converting enzyme i/d polymorphism in patients with malignant hypertension.

The angiotensin-converting enzyme (ACE) gene has been implicated in the manifestation of the phenotype of malignant hypertension (MH). In 1990 the ACE gene polymorphism characterized by the insertion or deletion of a 287-base pair fragment in the 17q23 chromosome was identified. The DD genotype is associated with increased tissue and circulating ACE levels and elevated angiotensin II. ACE polymorphism was studied in 48 patients with MH, 25 patients with non-MH, and a control group of 78 normotensive individuals by real-time polymerase chain reaction using the LightCycler system (Roche Diagnostics Corporation, Indianapolis, IN). The DD genotype was found statistically more frequently in MH patients than controls (p=0.028; odds ratio, 2.5; confidence interval, 1.1-5.5). Presence of the DD genotype of the ACE gene is more frequent in MH patients than in controls, indicating that this genotype could be a significant risk factor and a predictor for the development of MH.

Predictive factors for early mortality following liver transplantation.

AIMS: To retrospectively review our liver transplant performance to identify factors that influenced early outcomes and to prospectively test their validity in predicting outcomes. METHODS: Clinical records from 190 patients with liver transplants (LT; n = 200) performed between 1991 and 1997 were reviewed and the data evaluated by univariate and multivariate analyses regarding clinical outcome. The prognostic model thus obtained was prospectively evaluated in 55 patients undergoing transplant between 1999 and 2000. RESULTS: Main indication for transplant was post-necrotic cirrhosis (61%), mostly HCV(+). The majority of patients were Child-Pugh C status (46%). Post-operative mortality at 3 months was 15.3%. Risk factors predicting death were: Child-Pugh C status (OR 1.3), pre-LT renal insufficiency (OR 5.8), malnutrition (OR 2.9) and technically complex surgery requiring cross-clamping with or without bypass (OR 4.9). None of the donor factors was significant. Prospectively applied to predict outcome in the 55 patients, the model had a sensitivity of 80% and a specificity of 88.8% with a higher-than-anticipated accuracy with a positive predictive value of 61.5% and a negative predictive value of 95.3%. CONCLUSIONS: Pre-LT renal insufficiency is the most significant risk factor for early mortality and suggests that LT should be performed before evidence of irreversible renal insufficiency becomes manifest.

Malnutrición caloricoproteica y linfocitopenia como predictores de infección hospitalaria en ancianos / Protein-calorie malnutrition and lymphocytopenia as predictors of hospital infection in the elderly

FUNDAMENTO: En estudios clínicos y epidemiológicos se ha establecido que la malnutrición es un factor de riesgo de infección en los pacientes sometidos a intervenciones quirúrgicas. Sin embargo, es menos conocido el riesgo de complicaciones asociadas a la malnutrición en los pacientes del área de medicina. Presentamos un estudio de incidencia de infección hospitalaria para determinar la tasa de infección y la asociación con la existencia previa de malnutrición caloricoproteica, en pacientes del área de medicina. También ha sido objetivo del estudio conocer el valor predictivo, respecto a la infección hospitalaria, de los parámetros utilizados en la valoración del estado nutricional e inmunitario. PACIENTES Y MÉTODO: Se estudiaron 240 pacientes mayores de 64 años, 118 varones y 122 mujeres, ingresados en el área de medicina de un hospital general. El estado nutricional e inmunitario se evaluó durante las primeras 48 h de hospitalización mediante la determinación del peso, la talla, el índice de masa corporal, la albuminemia y los linfocitos totales. El grado de incapacidad funcional psicofísica de los ancianos se determinó con la escala de Norton. Los datos sobre las infecciones y los factores de riesgo se obtuvieron del seguimiento clínico y microbiológico de los pacientes. Los criterios para el diagnóstico y localización de las infecciones fueron los Centers for Disease Control de Atlanta. RESULTADOS: La frecuencia de malnutrición caloricoproteica fue del 12,5 por ciento y la incidencia acumulada de infección hospitalaria del 19,6 por ciento. La incapacidad funcional de los ancianos previa a la hospitalización, valorada con el índice de Norton (odds ratio, 4,70; intervalo de confianza [IC] del 95 por ciento, 1,119,0) y la presencia de algún factor de riesgo extrínseco (odds ratio, 2,35; IC del 95 por ciento, 1,1-5,1) constituyeron, además de la hipoalbuminemia (odds ratio, 3,60; IC del 95 por ciento, 1,3-10,2) y la linfocitopenia (odds ratio, 2,67; IC del 95 por ciento, 1,3-5,7), las variables independientes que presentaron asociación significativa con la incidencia de infección hospitalaria. CONCLUSIONES: En ancianos hospitalizados en el área de medicina, los parámetros nutricionales ligados a las proteínas plasmáticas y al sistema inmunitario fueron los que determinaron un mayor riesgo de infección hospitalaria. La evaluación de la incapacidad funcional psicofísica de los ancianos con la escala de Norton mejoró también la valoración del riesgo de infección hospitalaria en estos enfermos (AU)