Prospective evaluation of Streptococcus pneumoniae serum antibodies in patients with primary immunodeficiency on regular intravenous immunoglobulin treatment.

BACKGROUND: This is a prospective study that assessed pneumococcal antibody levels in PID patients under intravenous immunoglobulin (IVIG) treatment using different brands. METHODS: Twenty-one patients receiving regular IVIG every 28 days were invited to participate: 12 with common variable immunodeficiency, six with X-linked agammaglobulinaemia and three with hyper-IgM syndrome. One blood sample was collected from each patient just prior to IVIG administration at a three-month time interval during one year. A questionnaire was filled in with patient's demographic data and history of infections during the study period. Streptococcus pneumoniae antibodies against six serotypes (1, 5, 6B, 9V, 14 and 19F) were assessed by ELISA both in patients' serum (trough levels) and in IVIG samples. RESULTS: Median total IgG trough serum levels were 7.91g/L (range, 4.59-12.20). All patients had antibody levels above 0.35µg/mL to the six serotypes on all four measurements. However, only 28.6% of patients had pneumococcal antibodies for the six analysed serotypes above 1.3µg/mL on all four evaluations during the one-year period. No correlation was found between IgG trough levels and pneumococcal specific antibodies. Eighteen of the 21 patients (85.7%) had infections at some point during the 12-month follow-up, 62/64 (96.9%) clinically classified in respiratory tract infections, four of which were pneumonia. CONCLUSIONS: Pneumococcal antibodies are present in a high range of concentrations in sera from PID patients and also in IVIG preparations. Even maintaining a recommended IgG trough level, these patients can be susceptible to these bacteria and that may contribute to recurrent respiratory infections.

Prevalence of metabolic syndrome in adults with excess of adiposity: comparison of the Adult Treatment Panel III criteria with the International Diabetes Federation definition.

The aim was to compare the Adult Treatment Panel (ATP) III criteria with the International Diabetes Federation (IDF) definition of metabolic syndrome (MS) in adults with excess adiposity who were considered a high-risk population. A cross-sectional study was carried out in 274 adults with excess adiposity. MS was assessed in all volunteers considering the ATP III criteria and the new IDF definition. Among all individuals, 130 (47%) were similarly classified under the two definitions. Under the ATP III criteria, but not the IDF definition, 2 (1%) participants had MS, and 29 (11%) subjects had MS under the IDF definition but not the ATP III criteria (p=0.009). The ATP III criteria and the IDF definition were useful for identifying MS in adults with excess of adiposity; however, the IDF proposal identified a greater percentage of patients.

Cerebral GABA release and GAD activity in protein- and tryptophan-restricted rats during development.

To evaluate the effects on the GABAergic system, Wistar rats were raised on a chronically protein- and tryptophan-restricted diet with 8% protein, based on either Purina chow or corn. There was a significant decrease in both body and cerebral weight in the restricted animals compared with the control group fed with a 23% protein diet. In animals fed mainly corn, glutamic acid decarboxylase (GAD) activity increased significantly at the ages studied (14, 30, and 60 days) in the cerebral cortex and hippocampus. In the same way, gamma-aminobutyric acid (GABA) release decreased significantly in early life in both brain regions, then increased in 30-60-day-old animals corn-fed predominantly in the cerebral cortex. The reduction in GABA release may be attributable to a decrease in GABAergic cell density, which could induce an over-activation of 5-hydroxytryptamine (5-HTergic) receptors, leading in turn to the observed enhancement of GAD activity. Taken together, these results may represent a plastic response by GABAergic neurons to (5-HTergic under-stimulation in mainly corn-fed animals.

[Study of the influence of anticonvulsant treatment on thyroid function]. / Estudio de la influencia del tratamiento anticonvulsivante en la función tiroidea.

We studied in two groups of epileptic patients the thyroid alterations induced by anticonvulsant therapy (AC). Group I (28 cases): T4t and TSH were measured before and after 3 and 6 months on treatment with AC. Group II (75 cases on treatment): thyroid hormones were measured only once. In cases with low value of T4t or high TSH a TRH test and FT4 determination were performed. In group I two cases with low T4t were found after six months on treatment (7%), one of them with low FT4 and both with normal TSH. In group II we found 6 cases (7.8%) with low T4t and FT4, two of them with high TSH. It was not possible argue against factor and the low incidence reported argue against rutinary screening. Anycase, this screening will never be performed before the lag time observed (6 months).

Flexor tendon synovial sheath haemangioma mimicking subacute tenosynovitis.

A case of haemangioma arising from the synovial sheath of the flexor tendons of the ring finger is described. The initial symptoms were those of subacute tenosynovitis. The tumour did not affect the flexor tendons and could be completely resected with functional recovery.