Analysis of EEG and CSF 14-3-3 proteins as aids to the diagnosis of Creutzfeldt-Jakob disease.

OBJECTIVE: To improve diagnostic criteria for sporadic Creutzfeldt-Jakob disease (CJD). METHODS: Pooled data on initial and final diagnostic classification of suspected CJD patients were accumulated, including results of investigations derived from a coordinated multinational study of CJD. Prospective analysis for a comparison of clinical and neuropathologic diagnoses and evaluation of the sensitivity and specificity of EEG and 14-3-3 CSF immunoassay were conducted. RESULTS: Data on 1,003 patients with suspected CJD were collected using a standard questionnaire. After follow-up was carried out, complete clinical data and neuropathologic diagnoses were available in 805 cases. In these patients, the sensitivity of the detection of periodic sharp wave complexes in the EEG was 66%, with a specificity of 74%. The detection of 14-3-3 proteins in the CSF correlated with the clinical diagnosis in 94% (sensitivity). The specificity (84%) was higher than that of EEG. A combination of both investigations further increased the sensitivity but decreased the specificity. CONCLUSIONS: Incorporation of CSF 14-3-3 analysis in the diagnostic criteria for CJD significantly increases the sensitivity of case definition. Amended diagnostic criteria for CJD are proposed.

[Nursing and the prevention of biological risks: from education to professional activity]. / Enfermeria y prevención de riesgos biológicos. Desde la formación hasta el ejercicio de su profesión.

OBJECTIVE: To discover the training nursing students receive regarding prevention and control of infection inside hospital settings and the means of self-protection as well as making people aware of the need to improve this training if deemed necessary. METHODS: This is a transversal descriptive study which took place in the nursing schools in Spain. Data was gathered by means of a questionnaire each respondent filled in by themselves. The lack of a response was also studied. A followup meeting was held with those who participated in this study to seek consensus in the search for solutions to those necessary changes detected. RESULTS: 86% responded to the questionnaire. During the course of career preparation, these were the average number of hours dedicated to various areas of study: 34.5 to Biological Statistics, 40 to Epidemiology, 28 to Infectious Diseases, 29 to Microbiology, 9 to Infection Control, 11 to Concepts of Aspesis and Antisepsis, and 36 to Methods of Research and Investigation. More than 50% of the professors teaching these classes are licensed nurses. Student followup during their clinical practice was carried out basically by nurses in university hospitals. 39% of nursing schools teach the concept and content for universal precautions prior to clinical practice. In the majority of public nursing schools, the followup of a student after a biological accident is carried out by the preventive medicine service, whereas this is done by the school insurance company in private nursing schools. Therefore, significant differences exist. COMMENTS: The theoretical knowledge taught is adequate; the number of hours dedicated to each subject varies among the schools; it is necessary to come to an agreement on the minimum levels of training required before engaging in clinical practice in a safe manner. Universal precautions should be taught in all schools before clinical practice occurs.

[Diagnosis of transmissible spongiform encephalopathies in Spain. Population perspective]. / Diagnóstico de las encefalopatías espongiformes transmisibles en España desde una perspectiva poblacional.

OBJECTIVES: To describe specific aspects of the diagnostic process of transmissible spongiform encephalopathies in Spain and to evaluate the 14-3-3 protein test in cerebrospinal fluid. METHODS: The annual pattern of diagnostic certainty as well as those of demand and results of biochemical and genetic studies were studied using two sets of patients, those diagnosed for the 1993-1998 period, notified to a National Creutzfeldt-Jakob Disease Register (NCDJR), and those referred to the Tissue Bank for Neurological Research Laboratory (TBNRL). The 14-3-3 protein test was validated taking as a reference two clinical populations. RESULTS: Two-hundred and four Creutzfeldt-Jakob disease cases were registered at the NCDJR: 39 out of them and 28 other patients had been studied at the TBNRL. The proportion of definite Creutzfeldt-Jakob Disease cases decreased since 1996. Among those registered in 1997-1998, 35.5%, 36% and 20% had undergone 14-3-3 protein in LCR, histopathologic and genetic studies. The 14-3-3 test grave, for definite, sporadic Creutzfeldt-Jakob disease as compared for patients with other dementing disorders, the following data: 12/13 sensitivity; 33/35 specificity; and 12/14 and 33/34 predictive values of positive and negative test. Two familial cases were diagnosed by identification of mutations in the TBNRL. CONCLUSIONS: The results suggest that: a) the diagnostic certainty of Creutzfeldt-Jakob disease in Spain decreased due to a drop in autopsy rates; b) the 14-3-3 cerebrospinal fluid test has a high diagnostic value, and its use diffused rapid but incompletely; c) genetic studies are useful in some cases, and d) Creutzfeldt-Jakob disease undereporting may be considerable. Creutzfeldt-Jakob disease diagnosis and surveillance, are closely related and being consolidated in Spain.

Emergence and dissemination of quinolone-resistant Escherichia coli in the community.

We studied the evolution of resistance to quinolones in Escherichia coli from 1992 to 1997 in Barcelona, Spain. An increasing proportion of quinolone-resistant E. coli (QREC) infections was observed. QREC strains were more common in patients with nosocomial infections but also increased in patients with community-acquired infections (9% in 1992 to 17% in 1996). Seventy (12%) of 572 episodes of E. coli bacteremia were due to QREC. Factors significantly associated with QREC bacteremia were the presence of underlying disease, recent exposure to antibiotics, and bacteremia of unknown origin. In the multivariate analysis, only prior exposure to antimicrobial agents (P < 0.001; odds ratio [OR] = 2), specifically, to quinolones (P < 0. 001; OR = 14), and the presence of a urinary catheter (P < 0.001; OR = 2) were significantly associated with QREC bacteremia. Among 16 QREC isolates from cultures of blood of community origin selected at random, 13 different pulsed-field gel electrophoresis patterns were recognized, showing the genetic diversity of these isolates and in turn indicating the independent emergence of QREC in the community. The prevalence of QREC in the feces of healthy people was unexpectedly high (24% in adults and 26% in children). A survey of the prevalence of QREC of avian and porcine origin revealed a very high proportion of QREC in animal feces (up to 90% of chickens harbored QREC). The high prevalence of QREC in the stools of healthy humans in our area could be linked to the high prevalence of resistant isolates in poultry and pork.

Nursing in nosocomial infection control in Spain.

This is a descriptive study of nursing practices in nosocomial infection control (NIC) in Spain. During the period 1990-1991, a questionnaire, adapted from that used in the Study on the Efficacy of Nosocomial Infection Control (SENIC), was mailed to all Spanish general hospitals, public and private, having more than 400 beds, and to all those in the public health sector having more than 100 beds. Nursing-related information was selected for analysis from each of three sections: staff, surveillance systems and programmes. The response rate was 70%. While nursing resources allocated to NIC in Spain registered an overall ratio of nosocomial infection control nurses (ICNs) of mean 0.45, SD 0.71 ICN per 250 hospital beds, ICN/beds ratios were below 0.34 and 0.30 in medium-sized and large hospitals respectively. Nurses who were active in NIC were either lacking or worked only a few hours per week in a considerable proportion of hospitals, with this trend being more pronounced in smaller facilities. The intervening period since 1965, and the last decade in particular, has been marked by the progressive adoption of a range of NIC policies. Most procedures proving NIC-efficient had been implemented in approximately 70-80% of responding hospitals. Teaching was most qualified and intensive in medium-sized hospitals. Nursing in NIC has only recently been developed in Spain, is increasingly accepted, exhibits diffusion levels comparable to those reported internationally, lacks monitoring and quality assessment systems and, in general, could be substantially improved.