Mathematical Modeling of Rhesus Cytomegalovirus Transplacental Transmission in Seronegative Rhesus Macaques

Approximately 0.7% of infants are born with congenital cytomegalovirus (CMV), making it the most common congenital infection. About 1 in 5 congenitally infected babies will suffer long-term sequelae, including sensorineural deafness, intellectual disability, and epilepsy. CMV infection is highly species-dependent, and the rhesus CMV (RhCMV) infection of rhesus monkey fetuses is the only animal model that replicates essential features of congenital CMV (cCMV) infection in humans, including placental transmission, fetal disease, and fetal loss. Using experimental data from RhCMV seronegative rhesus macaques inoculated with RhCMV in the late first to early second trimesters of pregnancy, we built and calibrated a mathematical model for the placental transmission of CMV. The model was then used to study the effect of the timing of inoculation, maternal immune suppression, and hyper-immune globulin infusion on the risk of placental transmission in the context of primary and reactivated chronic maternal CMV infection.

Penicillium spp. mycotoxins found in food and feed and their health effects

Mycotoxins are toxic secondary metabolites produced by fungi. These compounds have different structures and target different organs, acting at different steps of biological processes inside the cell. Around 32 mycotoxins have been identified in fungal Penicillium spp. isolated from food and feed. Some of these species are important pathogens which contaminate food, such as maize, cereals, soybeans, sorghum, peanuts, among others. These microorganisms can be present in different steps of the food production process, such as plant growth, harvest, drying, elaboration, transport, and packaging. Although some Penicillium spp. are pathogens, some of them are used in elaboration of processed foods, such as cheese and sausages. This review summarises the Penicillium spp. mycotoxin toxicity, focusing mainly on the subgenus Penicillium, frequently found in food and feed. Toxicity is reviewed both in animal models and cultured cells. Finally, some aspects of their regulations are discussed.

Change Management in Healthcare Organizations: Soft Skills Training Strategies Through Blended Learning Environments

Teaching soft skills for change management in healthcare organizations is becoming increasingly necessary, even more, when implementing health information systems (HIS). There is little evidence that these skills can be learned through online teaching environments. This paper describes the experience of having taught soft skills to health informatics master's degree students, through blended learning environments.

Health Informatics in Developing Countries: A Review of Unintended Consequences of IT Implementations, as They Affect Patient Safety and Recommendations on How to Address Them

Background: Patient safety concerns every healthcare organization. Adoption of Health information technology (HIT) appears to have the potential to address this issue, however unanticipated and undesirable consequences from implementing HIT could lead to new and more complex hazards. This could be particularly problematic in developing countries, where regulations, policies and implementations are few, less standandarized and in some cases almost non-existing.

Methods: Based on the available information and our own experience, we conducted a review of unintended consequences of HIT implementations, as they affect patient safety in developing countries.

Results: We found that user dependency on the system, alert fatigue, less communications among healthcare actors and workarounds topics should be prioritize. Institution should consider existing knowledge, learn from other experiences and model their implementations to avoid known consequences. We also recommend that they monitor and communicate their own efforts to expand knowledge in the region.

Cultural Problems Associated with the Implementation of eHealth

A major hurdle in eHealth implementation is that it is difficult to put into practice. In this study, the primary aim was to identify the main barrier associated with implementing eHealth. This study surveyed IMIA members from May to November 2015. From the results, it is clear that medical professionals were recording most of their data by hand. This paper culture is a paradigm that is difficult to break. Cultural factors are the primary barrier in eHealth implementation.

Fluorescence probes for prokaryotic and eukaryotic cells using Re(CO)3+complexes with an electron withdrawing ancillary ligand

Re(CO)₃⁺complexes with an ancillary ligand present an electron withdrawing effect suitable for cell imaging.

Peripheral blood monocyte and T cell subsets in children with specific polysaccharide antibody deficiency (SPAD)

Specific polysaccharide antibody deficiency (SPAD) is a well reported immunodeficiency characterized by a failure to produce antibodies against polyvalent polysaccharide antigens, expressed by encapsulated microorganisms. The clinical presentation of these patients involves recurrent bacterial infections, being the most frequent agent Streptococcus (S.) pneumoniae. In SPAD patients few reports refer to cells other than B cells. Since the immune response to S. pneumoniae and other encapsulated bacteria was historically considered restricted to B cells, the antibody deficiency seemed enough to justify the repetitive infections in SPAD patients. Our purpose is to determine if the B cell defects reported in SPAD patients are accompanied by defects in other leukocyte subpopulations necessary for the development of a proper adaptive immune response against S. pneumoniae. We here report that age related changes observed in healthy children involving increased percentages of classical monocytes (CD14++ CD16- cells) and decreased intermediate monocytes (CD14++ CD16+ cells), are absent in SPAD patients. Alterations can also be observed in T cells, supporting that the immune deficiency in SPAD patients is more complex than what has been described up to now.

Why Patient Centered Care Coordination Is Important in Developing Countries? Contribution of the IMIA Health Informatics for Development Working Group

Patient Centered Care Coordination (PCCC) focuses on the patient health care needs. PCCC involves the organization, the patients and their families, that must coordinate resources in order to accomplish the goals of PCCC. In developing countries, where disparities are frequent, PCCC could improve clinical outcomes, costs and patients satisfaction.

OBJECTIVE

the IMIA working group Health Informatics for Development analyzes the benefits, identifies the barriers and proposes strategies to reach PCCC.

METHODS

Discussions about PCCC emerged from a brief guide that posed questions about what is PCCC, why consider PCCC important, barriers to grow in this direction and ask about resources considered relevant in the topic.

RESULTS

PCCC encompasses a broad definition, includes physical, mental, socio-environmental and self care. Even benefits are proved, in developing countries the lack of a comprehensive and integrated healthcare network is one of the main barriers to reach this objective. Working hard to reach strong health policies, focus on patients, and optimizing the use of resources could improve the performance in the devolvement of PCCC programs. International collaboration could bring benefits. We believe information IT, and education in this field will play an important role in PCCC.

CONCLUSION

PCCC in developing countries has the potential to improve quality of care. Education, IT, policies and cultural issues must be addressed in an international collaborative context in order to reach this goal.

Challenges and Hurdles of eHealth Implementation in Developing Countries

Health informatics has the potential to improve the security and quality of patient care, but its impact has varied between developed and developing countries. Related to this, the objective of this study is to identify the challenges and hurdles to improve eHealth in developing countries. We surveyed experts to discover their opinions about five general questions: economic support by Government for eHealth, Government education or training projects in the field, issues related to cultural or educational problems for the implementation of eHealth, policies in terminology or messaging standards and eHealth status policies for long periods. The respondents answered affirmatively in these proportions: 1. Economic support policies 58%, 2. Training policies 25%, 3. Cultural and educational problems 95%, 4. Standards policies, 38%, 5. Policies for long periods, 50%

CONCLUSION

Our survey has shown that the important problems that need to be addressed in order to implement e-Health in developing countries are firstly, cultural and educational, secondly, economic resources and thirdly policies for long periods.

Immune response to Streptococcus pneumoniae in asthma patients: comparison between stable situation and exacerbation

In Argentina, more than 3 million people suffer from asthma, with numbers rising. When asthma patients acquire viral infections which, in turn, trigger the asthmatic response, they may develop subsequent bacterial infections, mainly by Streptococcus (S.) pneumoniae. This encapsulated Gram(+) bacterium has been considered historically a T cell-independent antigen. Nevertheless, several papers describe the role of T cells in the immune response to S. pneumoniae. We evaluated the response to S. pneumoniae and compared it to the response to Mycobacterium (M.) tuberculosis, a different type of bacterium that requires a T helper type 1 (Th1) response, in cells from atopic asthmatic children, to compare parameters for the same individual under exacerbation and in a stable situation whenever possible. We studied asthma patients and a control group of age-matched children, evaluating cell populations, activation markers and cytokine production by flow cytometry, and cytokine concentration in serum and cell culture supernatants by enzyme-linked immunosorbent assay (ELISA). No differences were observed in γδ T cells for the same patient in either situation, and a tendency to lower percentages of CD4(+) CD25(hi) T cells was observed under stability. A significantly lower production of tumour necrosis factor (TNF)-α and a significantly higher production of interleukin (IL)-5 was observed in asthma patients compared to healthy individuals, but no differences could be observed for IL-4, IL-13 or IL-10. A greater early activation response against M. tuberculosis, compared to S. pneumoniae, was observed in the asthmatic patients' cells. This may contribute to explaining why these patients frequently acquire infections caused by the latter bacterium and not the former.

Health Informatics in Developing Countries: Systematic Review of Reviews Contribution of the IMIA Working Group Health Informatics for Development

Objectives: An evidence-base is important for medicine and health informatics. Despite numerous publications showing the benefits of health informatics, the emergence of health information systems in developing countries has been slower than expected. The aim of this paper is to identify systematic reviews on the domain of health informatics in developing countries, and classify the different types of applications covered.

Methods: A systematic review of reviews was conducted. The literature search spanned the time period between 2000 and 2012 and included PubMed, EMBASE, CINAHL, Scopus, Cochrane Systematic Reviews, LILACS, and Google Scholar. The search term was ‘systematic reviews of health informatics in developing countries’, and transparent and systematic procedures were applied to limit bias at all stages.

Results: Of the 982 identified articles, only 10 met the inclusion criteria and one more article was added in a second manual search, resulting in a total of 11 systematic reviews for the analysis.

Conclusions: Although it was difficult to find high quality resources on the selected domain, the best evidence available allowed us to generate this report and create an incipient review of the state of the art in health informatics in the developing countries. More studies will be needed to optimize the results.

Health Informatics in Developing Countries: Systematic Review of Reviews. Contribution of the IMIA Working Group Health Informatics for Development

OBJECTIVES

An evidence-base is important for medicine and health informatics. Despite numerous publications showing the benefits of health informatics, the emergence of health information systems in developing countries has been slower than expected. The aim of this paper is to identify systematic reviews on the domain of health informatics in developing countries, and classify the different types of applications covered.

METHODS

A systematic review of reviews was conducted. The literature search spanned the time period between 2000 and 2012 and included PubMed, EMBASE, CINAHL, Scopus, Cochrane Systematic Reviews, LILACS, and Google Scholar. The search term was 'systematic reviews of health informatics in developing countries', and transparent and systematic procedures were applied to limit bias at all stages.

RESULTS

Of the 982 identified articles, only 10 met the inclusion criteria and one more article was added in a second manual search, resulting in a total of 11 systematic reviews for the analysis.

CONCLUSIONS

Although it was difficult to find high quality resources on the selected domain, the best evidence available allowed us to generate this report and create an incipient review of the state of the art in health informatics in the developing countries. More studies will be needed to optimize the results.

The role of cytokines in atopic asthma

Atopic asthma results from airway inflammation triggered by an environmental allergen. Symptoms include wheezing, dyspnea and cough, airway narrowing and/or hyperresponsiveness to several inhaled stimuli. Inflammation develops in a two-phase fashion. The first phase after exposure to the allergen consists of degranulation and release of both histamine and other stored preformed inflammatory mediators as well as newly synthesized ones, including cytokines, all of which increase mucus secretion and smooth muscle contraction. The second phase occurs later and lasts longer; it is due to different molecules: several cytokines and chemokines, arachidonic acid derivatives, enzymes such as metalloproteinases and cell adhesion molecules. Cytokines are key players in the chronic inflammation in asthma patients, but details on their role and interactions still remain undetermined. Recent evidence suggests that allergic asthma is a multifaceted condition actively controlled by effector as well as regulatory T cells (Tregs). T helper (Th) 2 cells and Th17 cells increase airway inflammation, while Tregs are anti- inflammatory. Cytokines are involved in the development and activation of all T cell subpopulations. They are also involved directly or indirectly in most approaches to asthma treatment. Several cytokines have been tested as therapeutic targets and some of the currently used therapies like corticosteroids, beta agonists and allergen immunotherapy affect cytokine production. The increased knowledge on cytokine interplay and lymphocyte subsets should generate new therapeutic strategies in the near future.

Healthcare Information Systems to Assess Influenza Outbreaks: An analysis of the 2009 H1N1 Epidemic in Buenos Aires

OBJECTIVE

To determine whether a private HIS could have detected the influenza epidemic outbreaks earlier through changes in morbidity and mortality patterns.

METHODS

Data Source included a health information system (HIS) from an academic tertiary health care center integrating administrative and clinical applications. It used a local interface terminology server which provides support through data autocoding of clinical documentation. Specific data subsets were created to compare the burden of influenza during the epidemiological week (EW) 21 to 26 for years 2007 to 2009 among 150,000 Health Maintenance Organization members in Argentina. The threshold for identifying an epidemic was considered met when the weekly influenza-like illness (ILI) rate exceeded 200 per 100,000 visits. Case fatality rates and mortality rates of severe acute respiratory infection (SARI) from 2007 to 2009 were retrospectively compared. Case fatality rates and mortality rates for A/H1N1 influenza 2009 also were estimated.

RESULTS

The HIS detected the outbreak in EW 23 while the government Ministry of Health (MoH) gave a national epidemic alert during EW 25. The number of visits for ILI increased more than fourfold when comparing 2009 to the period 2007-2008. The SARI mortality rate in 2009 was higher than in 2008 (RR 2.8; 95%CI 1.18-6.63) and similar to that of 2007 (RR 1.05; 95%CI 0.56-1.49). 2009 was the first year with mortalities younger than 65 years attributable to SARI. The estimated A/H1N1 case fatality rate for SARI was 6.2% (95%CI 2.5 to 15.5) and A/H1N1 mortality rate was 6 per 100,000 (95%CI 0 to 11.6).

CONCLUSION

Our HIS detected the outbreak two weeks before than the MoH gave a national alert. The information system was useful in assessing morbidity and mortality during the 2009 influenza epidemic H1N1 outbreak suggesting that with a private-public integration a more real-time outbreak and disease surveillance system could be implemented.

General Characterization of Noncommercial Microbial Lipases in Hydrolytic and Synthetic Reactions

Fourteen noncommercial preparations of microbial lipases were investigated with respect to their catalytic activity for hydrolysis and synthesis of ester bonds. Six of the lipases were derived from microorganisms that have not previously been described as lipase producers, and another four were characterized for the first time. The synthetic reactions were carried out in two solvents of different polarities (n-heptane and acetone) using a series of fatty acids and primary and secondary alcohols with different chain lengths. Under the culture conditions employed, Pseudomonas cepacia produced more active enzyme than the other microorganisms. The lipase preparations produced using Ovadendron sulphureo-ochraceum, Monascus mucoroides, Monascus sp., Fusarium oxysporum, Penicillium chrysogenum, Rhodotorula araucariae, Pseudomonas cepacia, Streptomyces halstedii, and Streptomyces sp.were the most efficient catalysts for hydrolysis at lipid-water interfaces. Enzyme preparations from P. cepacia, Streptomyces sp., S. halstedii, and R. araucariae were good biocatalysts for esterification in the polar medium (acetone). When the lipase preparations with the greatest activity for hydrolytic reactions were excluded, regression analysis of the data for the hydrolytic and synthetic activities of the remaining lipase preparations yielded high multiple correlation coefficients for these reactions in both n-heptane and acetone (R = 0.82 and 0.91, respectively).

[Metabolic imaging by positron emission tomography using [18F] fluorodeoxiglucose in developmental disorders]

INTRODUCTION

Developmental disorders are a common pathological condition in Neuropaediatrics and do not usually present characteristic anatomical alterations in the different neuroanatomical imaging tests that can be employed, such as computerised axial tomography or magnetic resonance (MR). Positron emission tomography (PET) using [18F] fluorodeoxiglucose (PET FDG), one of the battery of imaging tests currently available, enables us to obtain data about brain activity in a non invasive manner.

PATIENTS AND METHODS

A group of 39 patients with developmental disorders from the Hospital del Mar was analysed. They were submitted to PET FDG brain metabolism tests and in some cases hybrid PET MR images were also obtained; findings were then correlated against the clinical progression of the patients.

RESULTS AND CONCLUSIONS

The alterations that were observed showed predominantly bilateral thalamic, mesial temporal and orbital frontal hypometabolism. This alteration of the limbic system, which has no correlation with anatomical damage, can be a predictor of the clinical progression and of the confirmation of the presence of alterations in the brain functions in this type of patients.

Visual and semiquantitative analysis of 18F-fluorodeoxyglucose positron emission tomography using a partial-ring tomograph without attenuation correction to differentiate benign and malignant pulmonary nodules

OBJECTIVE

Many studies have reported the use of attenuation-corrected positron emission tomography with 18F-fluorodeoxyglucose (FDG PET) with full-ring tomographs to differentiate between benign and malignant pulmonary nodules. We sought to evaluate FDG PET using a partial-ring tomograph without attenuation correction.

METHODS

A retrospective review of PET images from 77 patients (range 38-84 years of age) with proven benign or malignant pulmonary nodules was undertaken. All images were obtained using a Siemens/CTI ECAT ART tomograph, without attenuation correction, after 185 MBq 18F-FDG was injected. Images were visually graded on a 5-point scale from "definitely malignant" to "definitely benign," and lesion-to-background (LB) ratios were calculated using region of interest analysis. Visual and semiquantitative analyses were compared using receiver operating characteristic analysis.

RESULTS

Twenty lesions were benign and 57 were malignant. The mean LB ratio for benign lesions was 1.5 (range 1.0-5.7) and for malignant lesions 5.7 (range 1.2-14.1) (p < 0.001). The area under the ROC curve for LB ratio analysis was 0.95, and for visual analysis 0.91 (p = 0.39). The optimal cut-off ratio with LB ratio analysis was 1.8, giving a sensitivity of 95% and a specificity of 85%. For lesions thought to be "definitely malignant" on visual analysis, the sensitivity was 93% and the specificity 85%. Three proven infective lesions were rated as malignant by both techniques (LB ratio 2.6-5.7).

CONCLUSIONS

FDG PET without attenuation correction is accurate for differentiating between benign and malignant lung nodules. Results using simple LB ratios without attenuation correction compare favourably with the published sensitivity and specificity for standard uptake ratios. Visual analysis is equally accurate.

Part III. Direct enzymatic esterification of lactic acid with fatty acids

Lipase catalyzed esterification reactions between lactic acid and several fatty acids have been studied. Difficulties arise in esterifying lactic acid because of the potential for this substance to act both as an acyl donor and as a nucleophile. These difficulties were minimized via strategies which greatly increased the yield of the desired ester. Use of the companion fatty acid in excess with respect to lactic acid in an apolar solvent (n-hexane) in which the lactic is not completely dissolved has been employed to minimize the potential for lactic acid to act as an acyl donor in a self-polymerization reaction.Beneficial and sinergistic effects of both silica gel and molecular sieves on conversion to the desired product are described. However, careful control of the amount of molecular sieves used is required. This fact is a consequence of two opposing effects of this material: i.e. adsorption of both lactic acid and water from the reaction mixture. For reaction between caprylic and lactic acids, use of an excessive amount of enzyme reduces the extent of conversion to 2-O-caproyl-lactic acid.A very pure ester of the L-enantiomer (optical rotation of [alpha]D(25) = -23.5) can be prepared in n-hexane using a four fold excess of caprylic acid and Candida antarctica lipase. Optimum reaction conditions lead to 35% yield of 2-O-caproyl-lactic acid, a result which is close to the maximum yield that can be enantioselectively obtained from commercial grade lactic acid (68 mole per cent monomer).

Kinetics of the lipase-catalyzed synthesis of glucose esters in acetone

A simple kinetic model derived from a ping-pong bi-bi mechanism is proposed to describe the lipase-catalyzed esterification of glucose with fatty acids. The mathematical expressions derived from this model have been tested using several sets of data obtained from reactions carried out under different reaction conditions. The predicted values provide very good fits of the experimental data for temperatures from 30 to 60 degrees C, enzyme loadings from 90 to 180 mg, and fatty acid concentrations from 0.33M to 1M. Experiments conducted at different temperatures permit one to estimate an activation energy of approximately 12 kcal/mol for the rate-limiting step of the reaction (formation of the acyl-enzyme complex). The model also considers the kinetics of inactivation of the biocatalyst during the reaction.

Enzymatic synthesis of amide surfactants from ethanolamine

The condensation of a primary amine with fatty acids has been studied to determine optimum conditions for selective formation of amide surfactants via enzymatic amidification. Monoacylated ethanolamide and the diacylated amide-ester can be isolated from the reaction mixture, but the monoacylated ester cannot be isolated. The selectivity of the reaction depends on the solubility of the intermediate amide. Continuous precipitation of this product decreases the amount of amide-ester produced. Solubility values of the desired product (amide) are reported for different conditions.In acetonitrile, the ethyl ester of the corresponding fatty acid has been used successfully to avoid formation/precipitation of the ion-pair of the precursor reagents. In this medium, use of the transacylation reaction permits one to accelerate the reaction without producing a significant change in the selectivity toward the intermediate amide. This strategy is not successful in n-hexane where the solubilities of both ethanolamine and its ion-pair with lauric acid are similar.Results obtained for high loadings of substrates have been analyzed. In n-hexane and acetonitrile, the kinetics of the direct acylation reactions are controlled by the limited solubility of the ion pair formed by the two precursor reagents For the transacylation reaction in acetonitrile, at a sustrate loading of 2 mol l(-1,) selective production of as much as 92 mole percent N-acyl ethanolamine was observed in only 1.5 h.

[Respiratory failure in the Guillain Barré syndrome]

Severe involvement of the respiratory muscles is seen in 25% of patients with a diagnosis of Guillain Barré syndrome. In order to evaluate the clinical characteristics and evolution of this disorder we reviewed the clinical records of patients admitted with this diagnosis to our Hospital between January 1987 and December 1996. We identified 44 patients with respiratory failure. The age was 34.0 +/- 14.1 years, 31 patients were male and 13 female; 70.5% required mechanical ventilation (MV). The time elapsed between the beginning of symptoms and MV was 9.4 +/- 8.0 days. Total duration of MV was 1,224 +/- 1,208 hours. Patients who required ventilatory support during the first 48 hours of evolution had a significantly longer duration of MV compared to the rest of the group (2,100 +/- 2,076 vs 934 +/- 735 hours, p < 0.05). Two of the survivors needed ventilatory support for more than 6 months. All patients showed quadriparesia, 55% had cranial nerve involvement and 43% had autonomic dysregulation. Twenty-four percent had a positive serologic titer for cytomegalovirus infection. The vital capacity measured before the beginning of MV was 1,050 +/- 378 ml and at discharge 2,837 +/- 1,080 ml. Mortality was 18%, with a higher mean age among those who died (44.9 +/- 17.5 years vs 31.9 +/- 12.5, p < 0.02). Mortality was also related to sepsis, barotrauma and severe autonomic dysfunction. In our group, we identified male preponderance, a high percentage of MV with an extended duration, and a longer MV time in the group of patients with a faster evolution.

Vaginal bacterial microflora modifications during the growth of healthy cows

The aim of this work was first, to determine the predominant groups capable of colonizing the vagina and maintaining high numbers with time. The normal microbial flora of the cow's vagina and its evolution from weaning to service was then studied using standard microbiological methods. The results show that the most dominant bacteria belong to the streptococci, followed by the staphylococci, with similar levels during the whole study period. Enterobacteriaceae and lactobacilli were present at very low levels, the latter increasing during the cow's growth, suggesting some kind of hormonal influence. The results will allow the selection of micro-organisms with probiotic characteristics, classified as GRAS (Generally Regarded as Safe), to be used in the prevention of infections in the vaginal tract of cows, such as metritis, which produces delayed periods between partum and conception, and consequent economic losses.

Quantitative enzymatic production of 1,6-diacyl sorbitol esters

The enzymatic synthesis of several sorbitol diesters whose HLB values are similar to those of monoglycerides (the largest single type of food-grade emulsifiers) has been studied. The procedure is carried out by the simple addition of the polyol to a solution of the fatty acid and is based on continuous precipitation of the diester formed at a low temperature. A solvent of relatively low toxicity (acetone) was used. Pure fatty acids of different chain lengths (lauric and caprylic acids) were employed. The procedure was also tested using the acids obtained from total hydrolysis of olive oil, as an example of industrial feedstocks of fatty acids. This synthesis strategy gave complete conversion of sorbitol and >95% yields of the corresponding 1,6-diesters. In addition, a strategy to reduce the reaction time is reported. The enzymatic procedure permits minimization of the solvent/sugar ratio because it does not require complete dissolution of the sugar in the organic solvent. Copyright 1998 John Wiley & Sons, Inc.

Quantitative enzymatic production of 6-O-acylglucose esters

Selective production of emulsifiers from glucose and fatty acids has been achieved using an immobilized Candida antarctica lipase. Optimization of process selectivity considers the solubilities of the sugar and its monoesters in acetone at different temperatures, the percentage of this organic solvent in the reaction mixture, and the reaction temperature. The solvent (acetone) is both easily eliminated and accepted by the European Community for use in the manufacture of foods and/or food additives. Different fatty acids with a longer length chain than that of caprylic acid may be employed. For saturated fatty acids longer than lauric acid, continuous precipitation of the monoester as it is formed at 40 degrees C permits nearly complete conversion (98%) of glucose to the monoester within 2-3 days. The procedure does not require total dissolution of the sugar, and precipitation of the monoester permits selective conversion of charges of glucose higher than 100 mg/mL solvent. A scaleup of the process under the optimum conditions gives high yields of 6-O-lauroyl glucose, which may be readily prepared on a gram scale. Copyright 1998 John Wiley & Sons, Inc.

A controlled study of intravenous immunoglobulin in demyelinating neuropathy with IgM gammopathy

Eleven patients with demyelinating polyneuropathy associated with monoclonal IgM antibodies were randomized to receive IVIg or placebo, monthly, for 3 months in a double-blind study. After a washout period, they crossed over to the alternate therapy. Response was gauged by evaluating muscle strength, sensation, and neuromuscular symptoms at baseline, after 3 months, and at treatment's end. After IVIg therapy, the strength improved in only 2 of 11 patients, by 28 and 38.5 points from baseline, and declined after placebo. In 1 other patient, the sensory score improved by 13 points. Antibody titers to MAG/SGPG or gangliosides did not appreciably change. We conclude that IVIg has only a modest benefit to not more than 18% of patients with IgM paraproteinemic demyelinating neuropathy.

[Intracardiac thrombosis in a patient with primary antiphospholipid syndrome. Report of a case]

Antiphospholipid antibody syndrome is characterized by arterial or venous thrombosis associated to the presence of antiphospholipid antibodies. We report a 32 atrial thrombus. Four months later, being with anticoagulant treatment, he had a deep venous thrombosis. A new echocardiogram did not show the atrial thrombus. The laboratory work-up confirmed an antiphospholipid syndrome. Five months later the patient has not presented new thrombotic episodes and is receiving oral anticoagulants and antiplatelet therapy.

[The serum markers in the pregnant population of the basic health area of El Natahoyo (Gijón)]

OBJECTIVES

To find the prevalence of markers of rubeola, Toxoplasma, lues, HIV and hepatitis A, B and C viruses in the pregnant women of a health district; and these markers' correlations with epidemiological and socio-demographic antecedents.

PATIENTS

129 pregnant women from the 5.3 Health District in Asturias with birth predicted for between August 1994 and October 1995. A descriptive study of epidemiological, socio-demographic and serological data; statistical calculation with RSigma.

RESULTS

109 pregnant women (84.5%) were assessed, average age 28.6, including 9 abortions with path. analysis in the first three months. HIV was tested in 15 cases, all negative. Toxoplasma was positive in 46 cases, with no association with other variables. Rubeola was negative in 6 cases, all > 25 years old, with overall vaccination coverage of 42.2% and 64.7% for < 26-year-olds. One case of lues was found. The HC test was negative in all the pregnant women, with 4% of HBsAg+, related to being gypsy and to AF of hepatopathy. HA IgG was positive in 52 cases (52%) and more common among gypsies vs. the rest. In the latter group there was increasing prevalence according to age.

CONCLUSIONS

1) HIV screening is not common. 2) There is a high percentage of pregnant women with no immunity to Toxoplasma. 3) Low rubeola vaccination coverage among women under 26 was found. 4) There is a higher percentage of HBsAg+ cases in comparison with other areas, but not with the HC virus. 5) A high percentage of cases had no previous contact with the HA virus.

Influence of the hydrophobicity of lipase isoenzymes from Candida rugosa on its hydrolytic activity in reverse micelles

Two isoenzymes of Candida rugosa lipase, having the same mol.wt., size and similar aminoacid sequence, were studied in reverse micelles of AOT. The results demonstrated the relevance of lipase hydrophobicity in reactions in anionic micelles. This is a key factor in mitigating the inhibition effect of charged micelles. The more hydrophobic isolipase A was a better biocatalyst for hydrolytic processes in these systems. Its alpha-helix content increased from 31% to 49% of the total structure in reverse micelles. A fluorescence study indicated a more apolar environment for the more hydrophobic isolipase A. Emission spectra of this isolipase in the AOT systems were blue shifted. At omega 0 values where each isolipase presented its maximum activity, a decrease of the emission intensity of Trp was found. An enzyme and substrate dependence of optimal omega 0 is reported. The different interaction of isolipases A and B with the micellar system produced an opposite omega 0 dependence to their stabilities. The more hydrophobic lipase A had higher stability at higher droplet sizes.

Effect of high-dose intravenous immunoglobulin on amyotrophic lateral sclerosis and multifocal motor neuropathy

OBJECTIVE

To determine if high-dose intravenous immunoglobulin therapy is effective in improving muscle strength or in arresting the pace of disease progression in patients with rapidly progressive amyotrophic lateral sclerosis.

DESIGN

An open-label pilot study of intravenous infusions of high-dose immunoglobulin administered once a month for 3 months in nine patients with classic amyotrophic lateral sclerosis. Selected patients had a rapidly progressive course with signs of worsening noticeably evident every 6 weeks prior to therapy. A patient with multifocal motor neuropathy with conduction block that presented as a lower motor neuron syndrome was concurrently treated to document the efficacy of the same preparation of immunoglobulin in a potentially treatable disease that simulates lower motor neuron syndrome. The efficacy of high-dose intravenous immunoglobulin infusions was assessed by objective measurement of maximum voluntary isometric contraction in all muscle groups of two limbs before and after therapy.

SETTING

The Clinical Center of the National Institutes of Health, Bethesda, Md.

RESULTS

All patients with amyotrophic lateral sclerosis worsened during the study. By the end of the third month, their mean total muscle scores (megascores) had declined by 71.2 points, from a mean of 369.7 (range, 200 to 605) to 298.5 (range, 130 to 552) points. The pace of progression did not change during the 4-month observation period. In contrast, the patient with multifocal motor neuropathy responded to intravenous immunoglobulin therapy and increased his megascores by 146 points after 3 months. The GM1 antibody titers were normal in all the patients.

CONCLUSIONS

High-dose intravenous immunoglobulin, a prohibitively expensive drug, has no apparent therapeutic role in improving the symptoms or arresting the pace of progression in patients with amyotrophic lateral sclerosis. In contrast, multifocal motor neuropathy is an immunopathologically different disease that responds to intravenous immunoglobulin therapy.

A controlled trial of high-dose intravenous immune globulin infusions as treatment for dermatomyositis

BACKGROUND

Dermatomyositis is a clinically distinct myopathy characterized by rash and a complement-mediated microangiopathy that results in the destruction of muscle fibers. In some patients the condition becomes resistant to therapy and causes severe physical disabilities.

METHODS

We conducted a double-blind, placebo-controlled study of 15 patients (age, 18 to 55 years) with biopsy-proved, treatment-resistant dermatomyositis. The patients continued to receive prednisone (mean daily dose, 25 mg) and were randomly assigned to receive one infusion of immune globulin (2 g per kilogram of body weight) or placebo per month for three months, with the option of crossing over to the alternative therapy for three more months. Clinical response was gauged by assessing muscle strength, neuromuscular symptoms, and changes in the rash. Changes in immune-mediated muscle abnormalities were determined by repeated muscle biopsies.

RESULTS

The eight patients assigned to immune globulin had a significant improvement in sores of muscle strength (P < 0.018) and neuromuscular symptoms (P < 0.035), whereas the seven patients assigned to placebo did not. With crossovers a total of 12 patients received immune globulin. Of these, nine with severe disabilities had a major improvement to nearly normal function. Their mean muscle-strength scores increased from 74.5 to 84.7, and their neuromuscular symptoms improved. Two of the other three patients had mild improvement, and one had no change in his condition. Of 11 placebo-treated patients, none had a major improvement, 3 had mild improvement, 3 had no change in their condition, and 5 had worsening of their condition. Repeated biopsies in five patients of muscles whose strength improved to almost normal showed an increase in muscle-fiber diameter (P < 0.04), an increase in the number and a decrease in the diameter of capillaries (P < 0.01), resolution of complement deposits on capillaries, and a reduction in the expression of intercellular adhesion molecule 1 and major-histocompatibility-complex class I antigens.

CONCLUSIONS

High-dose intravenous immune globulin is a safe and effective treatment for refractory dermatomyositis.