Study of β2-Glycoprotein I Polymorphisms in Patients With Chronic Renal Failure as a Predisposing Factor for the Development of Anti-β2-Glycoprotein I Auto-Antibodies

BACKGROUND

Immunoglobulin (Ig)A anti-β₂-glycoprotein I (aB2GP1) antibodies are associated with thrombotic events, cardiovascular morbidity, and death in dialysis patients. About 30% of patients with chronic renal disease are positive for IgA aB2GP1; however, the origin of these antibodies is unknown. It has been speculated that dialysis membranes, age, or etiology of renal base disease are possible precipitating factors, although these factors do not appear to be the source of antibodies. B2GP1 is a protein of 326 amino acids grouped into five domains. Eight polymorphisms have been described; the most important are Val/Leu²⁴⁷, which appears to predispose aB2GP1 antibody production in patients with anti-phospholipid syndrome, and Trp/Ser³¹⁶, which appears to have protective antibody production of aB2GP1.

METHODS

DNA samples from 92 patients with renal failure on hemodialysis were randomly collected with a 1:1 ratio for the positivity for IgA aB2GP1. Forty-six samples were positive for IgA aB2GP1 (group 1) and 46 negative for IgA aB2GP1 (group 2). All samples were anonymized to study polymorphism Val/Leu²⁴⁷ and polymorphism Trp/Ser³¹⁶.

RESULTS

No significant differences were observed between those who were positive or negative for IgA aB2GP1 in patients with renal failure treated with hemodialysis and the polymorphism located in codons 247 and 316.

CONCLUSIONS

The two groups of patients have the same prevalence in polymorphisms 247 and 316, and therefore there appears not to be a genetic predisposition in our population. New trigger factors must be studied.

SEOM Clinical Guideline for the treatment of pancreatic cancer (2016)

Pancreatic cancer remains an aggressive disease with a 5 year survival rate of 5%. Only 15% of patients with pancreatic cancer are eligible for radical surgery. Evidence suggests a benefit on survival with adjuvant chemotherapy (gemcitabine o fluourouracil) after R1/R0 resection. Adjuvant chemoradiotherapy is also a valid option in patients with positive margins. Borderline resectable pancreatic cancer is defined as the involvement of the mesenteric vasculature with a limited extension. These tumors are technically resectable, but with a high risk of positive margins. Neoadjuvant treatment represents the best option for achieving an R0 resection. In advanced disease, two new chemotherapy treatment schemes (Folfirinox or Gemcitabine plus nab-paclitaxel) have showed improvements in overall survival compared with gemcitabine alone. Progress in pancreatic cancer treatment will require a better knowledge of the molecular biology of this disease, focusing on personalized cancer therapies in the near future.

Should Asymptomatic Bacteriuria Be Systematically Treated in Kidney Transplant Recipients? Results From a Randomized Controlled Trial

The indication for antimicrobial treatment of asymptomatic bacteriuria (AB) after kidney transplantation (KT) remains controversial. Between January 2011 and December 2013, 112 KT recipients that developed one episode or more of AB beyond the second month after transplantation were included in this open-label trial. Participants were randomized (1:1 ratio) to the treatment group (systematic antimicrobial therapy for all episodes of AB occurring ≤24 mo after transplantation [53 patients]) or control group (no antimicrobial therapy [59 patients]). Systematic screening for AB was performed similarly in both groups. The primary outcome was the occurrence of acute pyelonephritis at 24-mo follow-up. Secondary outcomes included lower urinary tract infection, acute rejection, Clostridium difficile infection, colonization or infection by multidrug-resistant bacteria, graft function and all-cause mortality. There were no differences in the primary outcome in the intention-to-treat population (7.5% [4 of 53] in the treatment group vs. 8.4% [5 of 59] in the control group; odds ratio [OR] 0.88, 95% confidence interval [CI] 0.22-3.47) or the per-protocol population (3.8% [1 of 26] in the treatment group vs. 8.0% [4 of 50] in the control group; OR 0.46, 95% CI 0.05-4.34). Moreover, we found no differences in any of the secondary outcomes. In conclusion, systematic screening and treatment of AB beyond the second month after transplantation provided no apparent benefit among KT recipients (NCT02373085).

Comparison Between Two Different Levels of Replacement of Free-range Rearing by an Oleic Acid and-tocopherol Enriched Diet on the Quality of Fresh Meat from Iberian Duroc (50%) Pigs

The aim of this work was to study the effect of two types of pig feeding systems (known as recebo) on fatty acid composition, tocopherols contents and susceptibility to lipid oxidation in muscle. A total of 26 Iberian Duroc (50%) barrows were divided into two groups (named as short replacement (SR) and long replacement (LR) groups) according to length of replacement of free-range rearing (based on acorn and pasture) by an oleic acid and B-tocopherol (200 mg/kg) enriched concentrate feed (SR group: 67 days in free-range rearing and finished during 20 days with concentrate diet; LR: 55 days in free-range rearing, finished 50 days with concentrate). No differences were found in chemical composition and colour of Gluteo biceps muscle between the two management systems, except for B-tocopherol content, which showed higher content (p 0.001) in LR pigs than in SR pigs. The fatty acid composition of subcutaneous fat was slightly affected by feeding system. Total intramuscular and neutral lipids from Gluteo biceps muscle presented a higher proportion of C18: 1 n 9 (p 0.05) in SR than in LR pigs; however, no differences were found in total saturated (SFA), monounsaturated (MUFA) and polyunsaturated fatty acids (PUFA). Composition of polar lipids revealed a higher proportion of MUFA and lower of total n 3 fatty acids in LR than in SR pigs. Feeding regime significantly affected susceptibility of muscle to iron-ascorbate-induced peroxidation. Muscles from pigs reared on SR system showing higher levels (p 0.05) of MDA after 50 and 100 min of incubation. These results indicate that the content of oleic acid and tocopherol in muscle depends on the levels of both provided by dietary means, more than the practised handling.

Progressive increase of resistance in Enterobacteriaceae urinary isolates from kidney transplant recipients over the past decade: narrowing of the therapeutic options

BACKGROUND

Antibiotic resistance is an emerging phenomenon in kidney transplantation (KT).

METHODS

We compared species distribution and antimicrobial susceptibility patterns in 1052 isolates from urine cultures obtained in 2 different cohorts of kidney transplant recipients in a single center (Cohort A: 189 patients undergoing KT between January 2002 and December 2004 [336 isolates]; Cohort B: 115 patients undergoing KT between January 2011 and December 2013 [716 isolates]).

RESULTS

Asymptomatic bacteriuria accounted for most of the isolates (86.9% in Cohort A and 92.3% in Cohort B). Klebsiella pneumoniae (9.5% vs. 15.6%), Pseudomonas aeruginosa (1.8% vs. 7.9%), and Enterobacter cloacae (0.6% vs. 3.1%) were significantly more common in Cohort B. The isolation of K. pneumoniae in Cohort B was associated with the occurrence of acute pyelonephritis (9.8% of all K. pneumoniae isolates vs. 2.8% of the remaining uropathogens; P = 0.001). Non-susceptibility rates among Enterobacteriaceae in Cohort B were higher for every class of antibiotics (P ≤ 0.003) with the exception of fosfomycin. Compared to Cohort A, significant increases were seen in isolates from Cohort B for multidrug-resistant (MDR) (43.9% vs. 67.8%, respectively; P = 0.001), extended-spectrum beta-lactamase (ESBL)-producing (6.6% vs. 26.1%; P = 0.001), and carbapenemase-producing Enterobacteriaceae strains (0.0% vs. 5.0%; P = 0.001). Such differences were mostly attributable to K. pneumoniae (as 54.5% and 13.4% of isolates in Cohort B were ESBL-producing and carbapenemase-producing, respectively). MDR isolates were responsible for 69.1% of episodes of symptomatic urinary tract infection in Cohort B.

CONCLUSION

The increase in resistance rates among Enterobacteriaceae uropathogens is significant and may have an effect on KT programs.

Abstract OT3-01-03: Phase III clinical trial to evaluate patient's preference for subcutaneous (SC) versus intravenous (IV) trastuzumab administration in patients with HER2 positive, advanced breast cancer (ABC) under IV trastuzumab treatment for at least 4 months and without disease progression. ChangHER-SC study (GEICAM/2012-07)

Background: Patients with HER2-positive, ABC, usually receive anti-HER2 treatment for several months or even years. Trastuzumab IV is administered weekly or 3-weekly, mandating patients to visit the hospital on a regular basis to receive infusions that are prepared in the hospital's pharmacy and administered to patients over 30-90 minutes. These mean some inconveniences for the patients and increase treatment costs. Subcutaneous administration could improve convenience of trastuzumab treatment. This study was designed to evaluate patient's preference for IV or SC trastuzumab.

Trial Design: Phase III, open label, multicenter study, running in 27 Spanish sites. HER2 positive, ABC patients, receiving IV trastuzumab (in monotherapy or in any combination), without evidence of disease progression for at least 4 months, and a life expectancy of at least 3 months, are eligible. Patients are randomized to receive SC trastuzumab, either from a vial or from a single injection device (SID), at a fixed dose of 600 mg, every 3 weeks, for 4 cycles. Before starting SC administration, patients receive an additional IV cycle. Patients in arm A receive 2 SC cycles using the vial and then two cycles more with the SID. In arm B patients receive the opposite sequence. After these four cycles, patients continue with SC or IV trastuzumab, depending on their decision, until disease progression. The primary objective is to evaluate patient's preference for IV or SC trastuzumab and, secondary objectives are, to evaluate patient's preference for the SC administration using the vial or the SID, the Health Care Professional satisfaction, the associated costs of the different administration options (with a Time and Motion pharmaco-economic study) and the safety of the different treatment administrations. Assuming a 65% rate of patients preferring SC trastuzumab and with a precision ±7.5%, a total of 195 patients have to be recruited to allow for a 20% of expected drop-out rate. Recruitment started in September 2013 and 158 patients have been included so far. Analysis of the primary endpoint will take place once the last patient has completed the 4 cycles of the study treatment. (ClinTrials.gov reference NCT01875367).

Citation Format: Ciruelos E, González E, Lluch A, Garrigós L, Quiroga V, Antón A, Pascual T, Montaño Á, Angulo MdM, Cámara MdC, Amigo Y, Carrasco E, Casas A. Phase III clinical trial to evaluate patient's preference for subcutaneous (SC) versus intravenous (IV) trastuzumab administration in patients with HER2 positive, advanced breast cancer (ABC) under IV trastuzumab treatment for at least 4 months and without disease progression. ChangHER-SC study (GEICAM/2012-07). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr OT3-01-03.

Is Microarray Analysis Really Useful and Sufficient to Diagnose Nut Allergy in the Mediterranean Area?

BACKGROUND

Component-based diagnosis on multiplex platforms is widely used in food allergy but its clinical performance has not been evaluated in nut allergy.

OBJECTIVE

To assess the diagnostic performance of a commercial protein microarray in the determination of specific IgE (sIgE) in peanut, hazelnut, and walnut allergy.

METHODS

sIgE was measured in 36 peanut-allergic, 36 hazelnut-allergic, and 44 walnut-allergic patients by ISAC 112, and subsequently, sIgE against available components was determined by ImmunoCAP in patients with negative ISAC results. ImmunoCAP was also used to measure sIgE to Ara h 9, Cora 8, and Jug r 3 in a subgroup of lipid transfer protein (LTP)-sensitized nut-allergic patients (positive skin prick test to LTP-enriched extract). sIgE levels by ImmunoCAP were compared with ISAC ranges.

RESULTS

Most peanut-, hazelnut-, and walnut-allergic patients were sensitized to the corresponding nut LTP (Ara h 9, 66.7%; Cor a 8, 80.5%; Jug r 3, 84% respectively). However, ISAC did not detect sIgE in 33.3% of peanut-allergic patients, 13.9% of hazelnut-allergic patients, or 13.6% of walnut-allergic patients. sIgE determination by ImmunoCAP detected sensitization to Ara h 9, Cor a 8, and Jug r 3 in, respectively, 61.5% of peanut-allergic patients, 60% of hazelnut-allergic patients, and 88.3% of walnut-allergic patients with negative ISAC results. In the subgroup of peach LTP-sensitized patients, Ara h 9 sIgE was detected in more cases by ImmunoCAP than by ISAC (94.4% vs 72.2%, P < .05). Similar rates of Cora 8 and Jug r 3 sensitization were detected by both techniques.

CONCLUSIONS

The diagnostic performance of ISAC was adequate for hazelnut and walnut allergy but not for peanut allergy. sIgE sensitivity against Ara h 9 in ISAC needs to be improved.

A multicentric study regarding the use of hormone therapy during female mid-age (REDLINC VI)

BACKGROUND

Menopausal hormone therapy (HT) has shown benefits for women; however, associated drawbacks (i.e. risks, costs, fears) have currently determined its low use.

OBJECTIVE

To determine the prevalence of current HT use among mid-aged women and describe the characteristics of those who have never used, have abandoned or are currently using HT. In addition, reasons for not using HT were analyzed.

METHOD

This was a cross-sectional study that analyzed a total of 6731 otherwise healthy women (45-59 years old) of 15 cities in 11 Latin American countries. Participants were requested to fill out the Menopause Rating Scale (MRS) and a questionnaire containing sociodemographic data and items regarding the menopause and HT use.

RESULTS

The prevalence of current HT use was 12.5%. Oral HT (43.7%) was the most frequently used type of HT, followed by transdermal types (17.7%). The main factors related to the current use of HT included: positive perceptions regarding HT (odds ratio (OR) 11.53, 95% confidence interval (CI) 9.41-14.13), being postmenopausal (OR 3.47, 95% CI 2.75-4.36) and having a better socioeconomic level. A total of 48.8% of surveyed women had used HT in the past, but abandoned it due to symptom improvement or being unconcerned; fear of cancer or any other secondary effects were also reported but in less than 10%. Among women who had never used HT, 28% reported the lack of medical prescription as the main reason, followed by the absence of symptoms (27.8%). Among those reporting lack of prescription as the main reason for not using HT, 30.6% currently had severe menopausal symptoms (total MRS score > 16); 19.5% of women were using alternative 'natural' therapies, with 35.1% of them displaying severe menopausal symptoms as compared to a 22.5% observed among current HT users.

CONCLUSION

The use of HT has not regained the rates observed a decade ago. Positive perceptions regarding HT were related to a higher use. Lack of medical prescription was the main reason for not using HT among non-users, many of whom were currently displaying severe menopausal symptoms.

Biodistribution and pharmacokinetics of uniform magnetite nanoparticles chemically modified with polyethylene glycol

The influence of polyethylene glycol (PEG) grafting on the pharmacokinetics, biodistribution and elimination of iron oxide nanoparticles is studied in this work. Magnetite nanoparticles (12 nm) were obtained via thermal decomposition of an iron coordination complex as a precursor. Particles were coated with meso-2,3-dimercaptosuccinic acid (DMSA) and conjugated to PEG-derived molecules by 1-ethyl-3-[3-dimethylaminopropyl]carbodiimide (EDC) chemistry. Using a rat model, we explored the nanoparticle biodistribution pattern in blood and in different organs (liver, spleen and lungs) after intravenous administration of the product. The time of residence in blood was measured from the evolution of water proton relaxivities with time and Fe analysis in blood samples. The results showed that the residence time was doubled for PEG coated nanoparticles and consequently particle accumulation in liver and spleen was reduced. Post-mortem histological analyses showed no alterations in the liver and confirm heterogeneous distribution of NPs in the organ, in agreement with magnetic measurements and iron analysis. Finally, by successive magnetic resonance images we studied the evolution of contrast in the liver and measured the absorption, time of residence and excretion of nanoparticles in the liver during a one month period. On the basis of these results we propose different metabolic routes that determine the fate of magnetic nanoparticles.

Serum iron parameters in the early post-transplant period and infection risk in kidney transplant recipients

BACKGROUND

The impact of iron metabolism on the risk of infectious complications has been demonstrated in various immunosuppressed populations. However, no previous studies have assessed this potential association in kidney transplant (KT) recipients.

METHODS

We prospectively analyzed 228 patients undergoing KT at our institution from November 2008 to February 2011. Serum iron parameters (iron level, ferritin, total iron-binding capacity, unsaturated iron-binding capacity, transferrin, and transferrin saturation) were assessed within the first 2 weeks after transplantation (median interval, 3 days; interquartile [Q1 -Q3 ] range, 1-6 days), and before the occurrence of the first infectious episode (median interval, 26 days; Q1 -Q3 range, 11-76 days). Primary outcome was the occurrence of any episode of infection during the first year. Multivariate-adjusted hazard ratios (aHRs) were estimated by Cox regression models.

RESULTS

Patients with ferritin level ≥ 500 ng/mL had higher incidence rates (per 1000 transplant-days) of overall infection (P = 0.017), bacterial infection (P = 0.002), and bloodstream infection (P = 0.011) during the first post-transplant year. One-year infection-free survival rate was lower in these recipients (26% vs. 41%; P = 0.004). On multivariate analysis, after adjusting for potential confounders, ferritin emerged as an independent predictor of overall infection (aHR [per unitary increment], 1.001; P = 0.006), and bacterial infection (aHR [per unitary increment], 1.001; P = 0.020).

CONCLUSION

Monitoring of serum iron parameters in the early post-transplant period may be useful in predicting the occurrence of infection in KT recipients, although further studies should be carried out to confirm this preliminary finding.

Effect of two different treatments for reducing grape yield in Vitis vinifera cv Syrah on wine composition and quality: berry thinning versus cluster thinning

The influence of two treatments for reducing grape yield, cluster thinning and berry thinning, on red wine composition and quality were studied in a Vitis vinifera cv Syrah vineyard in AOC Penedès (Spain). Cluster thinning reduced grape yield per vine by around 40% whereas berry thinning only reduced it by around 20%. Cluster thinning grapes had higher soluble solids content than control grapes, and their resultant wines have greater anthocyanin and polysaccharide concentrations than the control wine. Wine obtained from berry thinning grapes had a higher total phenolic index, greater flavonol, proanthocyanidin, and polysaccharide concentrations, and lower titratable acidity than the control wine. Wines obtained from both treatments were sufficiently different from the control wine to be significantly distinguished by a trained panel in a triangular test. Even though both treatments seem to be effective at improving the quality of wine, berry thinning has the advantage because it has less impact on crop yield reduction.

A multicenter study of sensitization profiles in an allergic pediatric population in an area with high allergen exposure

BACKGROUND AND OBJECTIVE

In areas with a high number of allergens and high allergen concentrations, it is essential to identify the main causes of allergy, especially in pediatric patients. This study was conducted in allergic patients aged 14 or less to identify sensitization profiles during an initial phase, and to then evaluate changes in these profiles after 3 years of follow-up. This article describes the first phase of our investigation.

METHODS

A total of 187 patients aged between 2 and 14 years were included by 5 allergy units; all the children had symptoms suggestive of allergic disease (rhinoconjunctivitis andlor asthma). Allergy diagnosis was confirmed by evaluation of clinical history, allergen exposure, and in vivo or in vitro tests. Specific immunoglobulin E (slgE) to major allergens was tested.

RESULTS

Patients were sensitized to both seasonal (especially grass, olive, cypress and Cynodon dactylon) and perennial allergens (Alternaria alternata) and to panallergens (especially profilin and lipid transfer protein). Almost 60% of the patients included were polysensitized. Sensitization to certain major allergens such as Cup s1, Phl p1, or Sal k1 seems to increase with age. Patients sensitized to profilin had a higher number of sensitizations than non-profilin-sensitized patients. This panallergen is a diagnostic confounding factor.

CONCLUSIONS

A high percentage of allergic pediatric patients living in an area with high exposure levels to a large number of allergens are polysensitized and have a high percentage of sensitization to panallergens. The implementation of new diagnostic tools such as component-resolved diagnosis is crucial.

Monitoring of immunoglobulin levels identifies kidney transplant recipients at high risk of infection

We aimed to analyze the incidence, risk factors and impact of hypogammaglobulinemia (HGG) in 226 kidney transplant (KT) recipients in which serum immunoglobulin (Ig) levels were prospectively assessed at baseline, month 1 (T(1) ), and month 6 (T(6) ). The prevalence of IgG HGG increased from 6.6% (baseline) to 52.0% (T(1) ) and subsequently decreased to 31.4% (T(6) ) (p < 0.001). The presence of IgG HGG at baseline (odds ratio [OR] 26.9; p = 0.012) and a positive anti-HCV status (OR 0.17; p = 0.023) emerged as risk factors for the occurrence of posttransplant IgG HGG. Patients with HGG of any class at T(1) had higher incidences of overall (p = 0.018) and bacterial infection (p = 0.004), bacteremia (p = 0.054) and acute pyelonephritis (p = 0.003) in the intermediate period (months 1-6). Patients with HGG at T(6) had higher incidences of overall (p = 0.004) and bacterial infection (p < 0.001) in the late period (>6 month). A complementary log-log model identified posttransplant HGG as an independent risk factor for overall (hazard ratio [HR] 2.03; p < 0.001) and bacterial infection (HR 2.68; p < 0.0001). Monitoring of humoral immunity identifies KT recipients at high risk of infection, offering the opportunity for preemptive immunoglobulin replacement therapy.

Human prophylactic vaccine adjuvants and their determinant role in new vaccine formulations

Adjuvants have been considered for a long time to be an accessory and empirical component of vaccine formulations. However, accumulating evidence of their crucial role in initiating and directing the immune response has increased our awareness of the importance of adjuvant research in the past decade. Nevertheless, the importance of adjuvants still is not fully realized by many researchers working in the vaccine field, who are involved mostly in the search for better target antigens. The choice of a proper adjuvant can be determinant for obtaining the best results for a given vaccine candidate, but it is restricted due to intellectual property and know-how issues. Consequently, in most cases the selected adjuvant continues to be the aluminum salt, which has a record of safety, but predominantly constitutes a delivery system (DS). Ideally, new strategies should combine immune potentiators (IP) and DS by mixing both compounds or by obtaining structures that contain both IP and DS. In addition, the term immune polarizer has been introduced as an essential concept in the vaccine design strategies. Here, we review the theme, with emphasis on the discussion of the few licensed new adjuvants, the need for safe mucosal adjuvants and the adjuvant/immunopotentiating activity of conjugation. A summary of toxicology and regulatory issues will also be discussed, and the Finlay Adjuvant Platform is briefly summarized.

Latent tuberculosis infection among health care workers at a general hospital in Santiago de Cuba

OBJECTIVES

To determine the prevalence of latent tuberculosis infection (LTBI) and its predictors in general hospital personnel.

METHODS

Two tuberculin skin tests (TSTs) were carried out within 2 years in a sample of 371 health care workers (HCWs) at a general hospital in Santiago de Cuba Province, along with an interview to explore the association of LTBI with age, sex, occupation, contact history of TB and bacille Calmette-Guérin scar. A 10 mm cut-off point was used; an increase of ≥10 mm in the second TST was considered as tuberculin conversion.

RESULTS

Of the 350 HCWs with available TST re- sults, 82% were female; the mean age was 37.6 years. LTBI prevalence was 15.4%: it was highest in professionals (20.6%); 60.3% were non-reactors, and at the second test a year later 1.4% were converters. Among the HCWs, physicians had the highest prevalence (21.8%), followed by nurses (19.6%), while administrative staff had the lowest prevalence (3.3%). The mean induration was 3.78 mm; it was highest in professionals (4.4 mm) and the lowest among support staff (2.6 mm). Contact with TB cases was found to be a risk factor for LTBI.

CONCLUSIONS

Even at low levels, TB transmission in this hospital could be associated with risk exposure. It is recommended that preventive chemotherapy be given to tuberculin converters as an infection control measure in this hospital.

Plastidic isoprenoid biosynthesis in tomato: physiological and molecular analysis in genotypes resistant and sensitive to drought stress

Isoprenoid compounds synthesised in the plastids are involved in plant response to water deficit. The functionality of the biosynthetic pathway of these compounds under drought stress has been analysed at the physiological and molecular levels in two related species of tomato (Solanum chilense and Solanum lycopersicum) that differ in their tolerance to abiotic challenge. Expression analysis of the genes encoding enzymes of these pathways (DXS, IPI, GGPPS, PSY1, NCED and HPT1) in plants at different RWC values shows significant differences for only GGPPS and HPT1, with higher expression in the tolerant S. chilense. Chlorophyll, carotenoids, α-tocopherol and ABA content was also determined in both species under different drought conditions. In agreement with HPT1 transcriptional activity, higher α-tocopherol content was observed in S. chilense than in S. lycopersicum, which correlates with a lower degree of lipoperoxidation in the former species. These results suggest that, in addition to lower stomatal conductance, α-tocopherol biosynthesis is part of the adaptation mechanisms of S. chilense to adverse environmental conditions.

Immunogenicity of an interferon-beta1a product

In order to determine whether Blastoferon®, a biosimilar interferon (IFN)- beta 1a formulation, shares epitopes with other known IFN-beta products, a series of neutralization bioassays were performed with a set of well-characterized anti-IFN- beta monoclonal antibodies and human sera (World Health Organization Reference Reagents). The bioassay was the interferon-induced inhibition of virus cytopathic effect on human cells in culture (EMC virus and A-549 cells). Computer-calculated results were reported as Tenfold Reduction Units (TRU)/ml. To further assess Blastoferon® immunogenicity, in vivo production of anti-IFN beta antibodies was determined in sera of patients included in the pharmacovigilance plan of Blastoferon® by the level of IFN- beta 1a binding antibodies (by enzyme immunoassay -EIA) and neutralizing antibodies (in the Wish-VSV system). The highly characterized neutralizing monoclonal antibodies A1 and A5 that bind to specific regions of the IFN- beta molecule reacted positively with the three beta 1a IFNs: Blastoferon®, Rebif®, and the IFN- beta WHO Second International Standard 00/572. As expected, the non-neutralizing monoclonal antibodies B4 and B7 did not neutralize any of the IFN- beta preparations. The commercially available monoclonal antibody B-02 reacted essentially equally with Rebif® and Blastoferon®. The WHO Reference Reagent human serum anti-IFN- beta polyclonal antibody neutralized all the IFN- beta products, whereas the WHO Reference Reagent human serum anti-IFN-alpha polyclonal antibody G037-501-572 appropriately failed to react with any of the IFN- beta products. On the basis of in vitro reactivity with known, well-characterized monoclonal and polyclonal antibody preparations, Blastoferon® shares immunological determinants with other human interferon- beta products, especially IFN- beta 1a. In vivo antibodies were detected by EIA in 72.9% of 37 chronically treated multiple sclerosis patients, whereas neutralizing antibodies were found in 8.1% of them. Blastoferon® appears to have immunological characteristics comparable to other IFN- beta 1a products.

“Mental Illness Awareness in Institutionalized Schizophrenics”

Our study aimed to compare the mental illness awareness in institutionalized schizophrenics when compared to non institutionalized schizophrenics.

Diagnoses of Schizophrenia was done following the ICD-10 dignosis criteria. We chose a convenience sample of our patients: 74 patients, 69.9% of institutionalized inpatients and a 31.1% of outpatients.

Specific survey applied by the group of investigators aiming to collect socio-demographical data and clinical data, using the following psychometric scales: Scale to Assess Unawareness of Mental Disorder (SUMD), Global Assessment Scale (GAS), and Clinical Global Impression (CGI).

Statistical analysis was performed with SPSS v 15.0, including descriptive statistics and correlation analysis.

Differences found among awareness of response to medication and the awareness of social consequences of mental disorders are statistically significant, being higher in the institutionalized group of schizophrenics.

Duration of cough, TB suspects' characteristics and service factors determine the yield of smear microscopy

OBJECTIVE

To determine the efficiency of routine tuberculosis (TB) case detection by examining sputum smear positivity for acid-fast bacilli in relation to duration of cough, characteristics of TB suspects examined and health service factors.

METHOD

We combined patient interviews with routine data from laboratory registers in 6 health care facilities in San Juan de Lurigancho district, Lima, Peru. A TB case was defined as a TB suspect with at least one positive sputum smear. We calculated adjusted odds ratios with 95% confidence intervals for the association between smear positivity and health service and patient's characteristics.

RESULTS

  Smear positivity was 7.3% (321/4376). Of the 4376 adults submitting sputa, 55.3% (2418) reported cough for <14 days. In this group, smear microscopy yielded 3.2% (78/2418) positive results vs. 12.4% (243/1958) in patients coughing for 14 or more days. Having cough for >2 weeks, being referred by health care staff, attending a secondary-level health care facility, male sex and age between 15 and 44 years were independent determinants of smear positivity.

CONCLUSIONS

Routine case detection yields a low proportion of smear-positive cases because of the inclusion of a high proportion of patients without cough or coughing for <2 weeks. Adherence to the national TB control programme guidelines on the selection of TB suspects would have a positive impact on the smear positivity rate, reduce laboratory costs and workload and possibly improve the reading quality of smear microscopy.

[Invasive basal cell carcinoma of the scalp. A clinical case]

Basal cell carcinoma is the most frequent skin malignant neoplasm, although it doesn't usually compromise a vital risk. However, there are cases in which their local aggressiveness is very important, and it get deep structures. We present a 62 years old female operated several times because multifocal basal cell carcinoma on her scalp. She consulted with a wide local recidive affecting dura mater and superior sagittal sinus. We show the clinical case and the surgical treatment employed realized by Plastic and Neurosurgery Departments.

Fibromyalgia and psychiatric comorbidity: their effect on the quality of life patients

Patients with fibromyalgia (FM) often have associated mental disorders. As well as being very prevalent, the two conditions also have sociodemographic and clinical similarities. If both of these clinical conditions lead independently to a limitation of the health-related quality of life (HRQL) of the patients, it may be thought that their conjunction could have a greater adverse effect on this parameter. Equally, it could be assumed that the factors that worsen the HRQL of patients with FM or with mental illness could have a more serious effect on the HRQL of those in whom the two clinical conditions coexist. Although this conclusion seems evident, as far as we know there have been no studies to assess how much or in what way psychiatric comorbidity affects the HRQL of patients with FM, or any studies to analyze the particular factors that may affect their HRQL. This study approaches the importance of psychiatric comorbidity in patients with fibromyalgia and analyzes the combined effect that these two conditions have on the overall HRQL of these patients.