[Evolution of the prevalence of hepatitis A antibody in Seville]. / Evolución de la prevalencia del anticuerpo antihepatitis A en Sevilla.

OBJECTIVE: To find the evolution of the prevalence of the Hepatitis-A antibody in Sevilla. DESIGN: Observational study of a crossover type. Comparison of results in 1995 with those from a similar study in 1981. SETTING: Health Area covered by Sevilla's University Hospital Virgen del Rocío. PATIENTS AND OTHER PARTICIPANTS: Aliquots of serum from patients without Hepatitis were obtained from the hospital's clinical analysis laboratories. MEASUREMENTS AND MAIN RESULTS: The sera were analysed in the Nuclear Medicine laboratory of the HUVR. 37.96% (62.74% in 1981) of the individuals surveyed were HA-positive. Prevalence increased with age: in the over-24s it was over 75% (90% in 1981). The differences between the two sets of results was significant (p < 0.001). CONCLUSIONS: Hepatitis-A infection is becoming less common in Andalusia, which can now be considered a low-incidence area.

Relationships of C-peptide levels and the C-peptide/bloodsugar ratio with clinical/biochemical variables associated with insulin resistance in orally-treated, well-controlled type 2 diabetic patients.

The aim of the present study was to evaluate the relationship of C-peptide and the C-peptide/bloodsugar ratio with clinical/biochemical variables presenting a well-known association with insulin resistance in NIDDM patients in acceptable control, obtained without the use of exogenous insulin. A total of 118 non insulin dependent diabetes mellitus (NIDDM) patients treated with diet/oral drugs and having a HbA(1c) level < 7.5% have been studied. Non-stimulated C-peptide levels (RIA) and the C-peptide/bloodsugar ratio have been determined and their relationships with the blood pressure status, blood pressure figures, estimates of adiposity, age, known duration of diabetes, current therapies, plasma lipids, glycaemic control, urinary albumin excretion rate, uric acid and creatinine have been ascertained. C-peptide levels were significantly (P < 0.05) correlated with systolic (r = 0.21) and diastolic blood pressure (r = 0.19), BMI (r = 0.21), high density lipoprotein (HDL) (r = -0.22), non-HDL-cholesterol (r = 0.23), apolipoprotein B (r = 0.29), log of triglycerides (r = 0.39) and uric acid (r = 0.35). The C-peptide/bloodsugar ratio had statistically significant correlations with known duration of diabetes (r = -0.23), diastolic blood pressure (r = 0.21), body mass index (BMI) (r = 0.22), log of triglycerides (r = 0.23) and uric acid (r = 0.36). Hypertensives had higher C-peptide levels than normotensives (1.04 +/- 0.04 versus 0.88 +/- 0.04 nmol/ml, respectively (mean +/- S.E.), P < 0.05) and this statistically significant difference remained after adjustment for age and known duration of diabetes. In well-controlled NIDDM patients not receiving exogenous insulin, both C-peptide levels and the C-peptide/bloodsugar ratio have statistically significant relationships with clinical/biochemical variables presenting a well-known association with insulin resistance.

[Hypertensive subpopulations as defined by their natriuretic response to ambulation]. / Subpoblaciones de hipertensos definidas por la respuesta natriurética a la deambulación.

BACKGROUND: The heterogeneity among patients with essential hypertension is known. We observed in an earlier study a large spread in the values of fractional excretion of sodium in a group of subjects with mild essential hypertension after ambulation, suggesting possible subgroups among them. We defined as the retainer (R) group that which presented a reabsorption index (RI = fractional excretion of sodium during supine/fractional excretion of sodium after ambulation) < 2.5 and the non-retainer (NR) group as that whose RI < 2.5. We analyzed at what level the reabsorption of Na was produced and the differences between the possible groups. PATIENTS AND METHODS: We studied 51 mild essential hypertensive patients, 22 men and 29 women, in two consecutive periods -recumbent, 90 minutes; ambulation, 90 minutes-. We calculated the clearance of creatinine and lithium, fractional proximal and distal reabsorption of Na, plasma renin activity (PRA), plasma aldosterone (ALDO) and elimination of PGE2 and kallikrein in the urine; the plasma catecholamines at the end of the recumbent position and after 10 minutes in the upright position. The study was taken after at least ten days without treatment and following a diet with free Na intake. RESULTS: We did not encounter significant differences between the retainer (n = 19) and non-retainer (32) group with regard to age, sex, body mass index or elimination of Na/24 h. The lower natriuresis in ambulation in the R group compared with the NR group is due to a higher fractional reabsorption of sodium, proximal (83.7 +/- 4.9% vs 79 +/- 5.2; p < 0.01) as well as distal (96.8 +/- 2 vs 95.3 +/- 2%; p < 0.05). The increment in the PRA was greater in the R group (1.3 +/- 1.4 vs 0.8 +/- 0.8; p < 0.05) after ambulation; in the R group showed a lower index -increment in ALDO/increment in PRA- in response to postural change although without significancy. We observed a lower elimination of PGE2 and kallikrein in the R group as compared with NR group (p < 0.05). We did not find differences with regard to plasma catecholamines. CONCLUSIONS: Ambulation allows to distinguish two groups of essential hypertensive patients according to natriuresis. The lower natriuresis in ambulation on the part of the R group could be due to the increase in PRA and therefore of the angiotensin II at the level of the proximal tubule, and to a lower activity of natriuretic hormones (PGE21 kallikrein) at the distal level.

[Insulin-like growth factor I as a marker of nutritional status in patients on enteral nutrition]. / El factor de crecimiento insulínico tipo 1 como marcador de estado nutricional en pacientes con nutrición enteral.

In order to appraise type 1 insulin growth factor (IGF-1) as nutritional state marker in comparison with other known markers, seric IGF-1 (RIA), albumin, prealbumin, transferrin and retinol-bound protein were determined weekly in 15 patients with oropharyngeal neoplasm and 7 in the burns unit, all being administered enteral nutrition. At the beginning of the study, IGF-1 seric levels were significantly lower in the burns group compared with the neoplasm group (82.28 +/- 23.36 vs 137.58 +/- 66.2 ng/ml, p < 0.01). IGF-1 values in the first group were initially significantly lower in comparison with those for the same group at the end of the study (82.28-23.36 vs 177.11 +/- 53.87 ng/ml, p < 0.01 for paired data). No significant change was demonstrated in IGF-1 seric levels in the neoplasm group. IGF-1 seric levels showed a significant multiple correlation with albumin, prealbumin, transferrin and retinol-bound protein in both the group with burns (r = 0.696, p < 0.001) and that with neoplasms (r = 0.615, p < 0.001). The nitrogen balance revealed a univariant and significant linear correlation with IGF-1 (r = 0.373, p < 0.05) and with prealbumin (r = 0.377, p < 0.05). According to the data obtained, seric IGF-1 has a significant correlation with other well-known nutritional markers. In the burns group, the hypercatabolism was accompanied by a significant increase in seric IGF-1 levels.

Hepatitis B virus occult infection in subjects with persistent isolated anti-HBc reactivity.

The aim of this study was to investigate the presence of hepatitis B virus occult infection in asymptomatic subjects with persistent anti-HBc reactivity but no other hepatitis B virus serological markers, including HBsAg, anti-HBs, IgM anti-HBc and HBV-DNA. For this purpose we used both polymerase chain reaction assays in sera and immunohistochemistry for HBsAg and HBcAg in liver biopsy specimens. Twenty-four cases were studied: 15 were drug abusers or homosexuals (eight with normal alanine aminotransferase levels) and nine were heterosexuals with raised alanine aminotransferase levels (> 45 U/l) but with no history of blood transfusion or ethanol intake (< 80 g daily). In all but five cases, liver biopsy was performed in subjects with persistent elevated alanine aminotransferase levels. In 10 out of 24 cases (41.66%) hepatitis B virus infection was demonstrated by polymerase chain reaction or immunohistochemistry, and when results from both procedures were available (n = 11) hepatitis B virus infection was detected in 63.63% of the subjects. The only clinical feature associated with HBV infection was the presence of persistent elevated alanine aminotransferase levels (p < 0.05). In conclusion, persistent isolated anti-HBc reactivity may be a relatively common serologic pattern for hepatitis B virus occult infection, at least in patients with chronic liver disease.

[Trials of acute treatment with SMS 201-995 in acromegalics]. / Pruebas de tratamiento agudo con SMS 201-995 en acromegálicos.

The results of two acute treatment tests using SMS 201-995 (SMS), over a 24 hour period in acromegalic patients are presented. Test number 1: Seventeen cases with a mean age of 44.3 +/- 11.9 (21/71) years with an evolution of 9.2 +/- 6.5 (2/20) years and GH of 30.1 +/- 21.1 (5.2/96.4) ng/ml were treated with 50 micrograms/8 hours (8, 16, and 24 hours) of subcutaneous SMS. Test number 2: 26 cases with a mean age of 45.5 +/- 15.5 (21/71) years with an evolution of 9.1 +/- 7.9 (2/35) years and GH of 28.6 +/- 22.2 (5.2/96.4) ng/ml were treated with 100 micrograms/8 hours (8, 16, and 24 hours) of subcutaneous SMS. Ten point GH profile in 24 hours is evaluated in both tests and in number 2 insulin and blood sugar levels are measured at the same time points. In both tests GH is significantly reduced being the 100 micrograms/8 hour treatment schedule more efficient. The results in the decrease of GH in test number two are related to those obtained using SMS in prolonged treatments. Inspire of the reducing effect that SMS has on insulin levels, its influence on the blood sugar profile is scare.

Prevention of post-transfusion non-A, non-B hepatitis by non-specific immunoglobulin in heart surgery patients.

To evaluate the effectiveness of immune serum globulin (ISG) in preventing non-A, non-B hepatitis, 291 heart surgery patients who received blood from voluntary donors were randomly assigned to receive either ISG or no additional protection. ISG was given intramuscularly before and 1 week after transfusion. 98 controls and 100 in the ISG group completed the study. Post-transfusion non-A, non-B hepatitis developed in 11 (11.2%) controls but in only 3 (3.0%) of the ISG group (p = 0.0203). 8 (72.7%) of control group with hepatitis had symptoms, and in 5 (45.4%) the disease became chronic. The disease was self-limiting in all 3 ISG patients affected, and only 1 of them had symptoms. Among those with non-A, non-B hepatitis aminotransferase levels were higher in the controls than in the ISG patients. Incubation periods longer than 8 weeks correlated with a tendency for the disease to become chronic. ISG recipients had shorter as well as more homogeneous incubation periods. ISG could be a safe, low-cost means for preventing post-transfusion non-A, non-B hepatitis which does not call for the discarding of donated blood.

Rotative agitation RIA. A high sensitivity technique for hepatitis B surface antigen (HBsAg) determinations.

With the objective of finding a simpler and more sensitive method than conventional radioimmunoassay testing to detect HBsAg, we have modified the sample volume and first incubation procedure of the Ausria IIA method. There was an up to 9-fold increase in sensitivity without loss of specificity, in different assays, when the first incubation was carried out with a serum sample of 1 ml that was rotatively agitated for 22 h at room temperature. Additionally, 71 samples from which conventional testing had isolated hepatitis B core antibodies were tested with the modified rotative agitation technique and 9 of these specimens (12.67%) were positive for HBsAg. Routine employment of the rotative agitation radioimmunoassay technique to screen HBsAg by blood banks, to detect potential infectious donations that escape conventional testing, could be an effective as well as low-cost procedure to prevent post-transfusion hepatitis B.