Multiple sclerosis prevalence in Malaga, Southern Spain estimated by the capture–recapture method

Background: Although not definitively proven, there is commonly accepted to be a latitudinal gradient in the distribution of multiple sclerosis (MS), which is more frequent in temperate zones. The European Mediterranean countries are situated in a zone of median frequency, although ever increasing figures have been noted in the last decades.

Objective: The objective of this study was to assess the current prevalence rate of MS in the province of Malaga, Southern Spain.

Methods: The capture–recapture method (CRM) uses independent sources of data and permits the number of non-registered cases of a given disease to be estimated, and by doing so, to avoid ascertainment bias.

Results: Use of this method showed the estimated prevalence rate of MS in the province of Malaga, Southern Spain, to be 125/105 (95% confidence interval: 102/105–169/105), higher than the figures published previously.

Conclusions: Although we recognize that these data need to be confirmed in further studies and in other areas of the country using a similar method, we believe this study is the first to find such high figure of prevalence, being very similar to the figures reported in recent years in other southern European countries.

Structural characterization and stability of dimethylaminoethanol and dimethylaminoethanol bitartrate for possible use in cosmetic firming

2-Dimethylaminoethanol (DMAE) (also known as deanol) has been used as an ingredient in skin care, and in cognitive function- and mood-enhancing products. It is marketed as a free base or salt, and in theory, the two forms should be equally effective and able to substitute for each other in pharmaceutical formulations. Detecting possible alterations in the active principle is a basic part of preformulation studies. Accordingly, this study compared DMAE and DMAE bitartrate to identify potential alterations or differences between the free base and the salt that might compromise the long-term stability of cosmetic preparations at different temperatures, and also compared the behavior of the base substance and derivative alone and in solution. Samples were analyzed with different physicochemical methods such as differential scanning calorimetry, ultraviolet and infrared spectroscopy, and nuclear magnetic resonance spectroscopy.

OAS1 gene haplotype confers susceptibility to multiple sclerosis

Multiple sclerosis (MS) is associated with genetic susceptibility and unknown environmental triggers, possible viral infections, but the specific etiological mechanism that subsequently develops into an inflammatory/autoimmune cascade of events is poorly understood. Recently, genetic variants of 2',5'- oligoadenylate synthetase 1 (OAS1) gene, a critical enzyme involved in innate antivirus response, have been associated with differential enzyme activity and type 1 diabetes in both case-control and family studies. We hypothesized that polymorphisms in the OAS1 gene could influence the susceptibility to MS. To test this hypothesis, we conducted a case-control study of 333 patients with MS and 424 healthy controls and genotyped two OAS1 single nucleotide polymorphisms (SNPs) by restriction fragment length polymorphism method: rs 10774671, A/G SNP altering the splicing site at the seventh exon, and rs 3741981, a nonsynonymous (Ser162Gly) A/G SNP in the third exon. Haplotype but not single-marker analysis revealed an association of the haplotype created by the G allele at rs 10774671 and the A allele at rs 3741981 with the susceptibility to MS (P value = 8.8 x 10(-5)). Subjects carrying this haplotype had an increased risk of MS comparing with those not carrying it (odds ratio = 4.7, 95% confidence interval 2.1-10.9). Our findings indicate that the OAS1 gene polymorphisms may confer susceptibility to MS or serve as markers of functional variants and suggest that OAS1 activity is involved in the etiology of the disease. Future studies in a larger sample and association analysis with functional variants will clarify the role of the OAS1 gene in the susceptibility to MS.

HLA class II and response to interferon-beta in multiple sclerosis

OBJECTIVE

To study the relationship between human leucocyte antigen (HLA) genotype and clinical response to interferon-beta (IFN-beta).

METHODS

We analysed the HLA class II genotypes of 96 multiple sclerosis (MS) patients treated with IFN-beta. The patients were classified as responders or non-responders according to clinical criteria: one or more relapses or a sustained increase after 1 year treatment compared with the year prior to IFN-beta therapy of > or = 0.5 points on the Expanded Disability Status Scale (EDSS).

RESULTS

There were 66 (69%) responders and 30 (31%) non-responders. Baseline clinical characteristics were similar. We found no association between HLA class II alleles and clinical response to IFN-beta.

CONCLUSIONS

HLA genotype does not appear to influence the clinical response to IFN-beta in MS patients.

[Partial Currarino syndrome in a non-pediatric patient. A rare cause of bacterial meningitis]

Enterogenic meningitis is an infrequent cause of central nervous system infection. Among these causes the Currarino syndrome may be found presenting sacral agenesis, presacral mass and anorectal stenosis. This syndrome normally causes enterogenic meningitis in the early years of life. The case reported corresponds to a 24-year-old male presenting polymicrobial meningitis with fecal flora germs (anerobic enterococci, Bacteroides fragilis and Escherichia coli). These clinical findings led to radiologic lumbar study with the diagnosis of Currarino syndrome. The existence of neuroenteric fistulas justifies the development of fecal flora meningitis. The nosology of the syndrome as well as the therapeutic strategy are reviewed.

[SUNCT type headache. A report of a new case. Short-lasting, unilateral, neuralgiform, headache attacks with conjuctival injection and tearing]

We report a new case of short-lasting, unilateral, neuralgiform headache attacks with conjunctival injection and tearing (SUNCT). This rare headache, described in 1978, shares clinical traits with trigeminal neuralgia and cluster headache and its diagnostic classification as a unilateral headache with autonomic involvement has been the subject of considerable debate. The etiology of SUNCT is unknown, although it is considered a highly difficult pain to treat. We discuss our patient's symptoms and response to treatment with carbamazepine.

[Reversible cortical blindness associated with bilateral occipital lesions caused by cyclosporin A: report of two cases]

We report two cases of encephalopathy with cortical blindness associated with reversible bioccipital lesions in transplanted patients (of the kidney and bone marrow) who were being treated with cyclosporin A. We briefly discuss the pathogenesis of symptoms and review the literature.

[Frontal dementia-motor neuron disease: a case report and literature review]

The association between frontal dementia and motor neurone disease has been known for years now although its existence as a nosologic entity in its own right is still subject to debate. Lack of strict histological criteria and inspecificity in complementary tests which might otherwise lend weight to such a diagnosis prevent our considering it as much more than a mere clinical syndrome. We present here the case of a 56 year old female patient who developed a type of dementia with frontal characteristics associated with motor neurone disease. We discuss the clinical picture and review the relevant literature.

[Carotid artery dissection at the cervical level presenting as unilateral paresis of lower cranial nerves]

Internal carotid artery dissection at the cervical level is a known cause of stroke in young patients. The usual clinical presentation is strong ipsilateral cephalea and oculosympathetic paresis or ischemic symptoms in the affected artery. Paresis of the lower cranial nerves due to local compression in the space behind the parotid is rarely found and may complicate the diagnosis by leading physicians to look for anomalies in the vertebro-basilar territory. We present a patient with internal carotid artery dissection at the cervical level diagnosed by angiography. Symptoms at presentation were hemicranial cephalea accompanied by Villaret's syndrome. We point out the importance of keeping this diagnostic possibility in mind when looking for the etiology of subacute paresis of the lower cranial nerves.

[Diagnosis, prevention and treatment of renal and urinary tract lithiasis]

Kidney and urinary stone disease is a major public health problem which requires a systemic clinical and biochemical evaluation to establish a precise diagnosis and well oriented therapy. This study reviews the results of a protocol designed to establish the metabolic abnormalities that occurred in 626 consecutive renal stone patients studied in two periods; group I (1979-1987) 441 cases and group II (1987-1989) 185 cases. The group I included the following determinations before and after a five day oral calcium load: serum and 24 hr urine electrolytes, divalent cations, phosphate, uric acid, cystine, glomerular filtration rate, parathyroid function evaluation with PTH and Tm Phosphate and since 1982 also (Ia) cAMP. In group II we also determined inhibitors of crystallization (magnesium and citrate) and promoters of nucleation (oxalate). In 185 cases of group I, we monitored months of follow up after metabolic evaluation and the number of stones formed per patient/year before and after treatment was begun. In group I we detected some variety of metabolic abnormality in 88.2 percent of our patients and in group II increased to 96.2 percent. A two year follow up was recorded in 55 percent and four year follow up in 39 percent of our cases. The stone/patient/year formation rate before treatment was 2.8 and significantly decreased to 0.8 after treatment. The highly diagnostic efficiency, the long term follow up and the adequacy of treatment significantly decreased stone activity in this group of patients. We concluded that this protocol should be included in the systematic evaluation of kidney stone patients.

[Membranous glomerulonephritis. Experience at the Instituto Nacional de la Nutrición Salvador Zubirán]

The purpose of this retrospective study was to study the incidence of idiopathic and secondary forms of membranous nephropathy in our institution, its clinical course and progression to chronic renal failure, and the risk factors associated with it. Two hundred fourteen (16%) of the 1,287 renal biopsies obtained between 1962 and 1988 were primary glomerular diseases and 28 of this 214 (13%) were idiopathic membranous nephropathy. On the other hand 59 of 1,287 biopsies were membranous nephropathy of whom 28 were idiopathic, 27 secondary to systemic lupus erythematosus, 2 due to drugs, one associated with rheumatoid arthritis, and one more with breast cancer. The clinical picture was: nephrotic syndrome in 84%, hypertension in 15%, non-nephrotic proteinuria in 14%, chronic renal failure in 8.4%, and renal vein thrombosis in 6.3%. In the idiopathic group 75% of the patients were male while in the lupus group 85% were female. For the analysis of progression to chronic renal failure we excluded 5 patients with renal failure when the biopsy was taken, 2 because the nephropathy was due to drugs, one associated with breast cancer, and nine were within the first year of follow-up. Thus, for this analysis the group consisted of 22 patients with idiopathic form and 20 with systemic lupus erythematosus. The idiopathic and lupus groups were similar except for a lower serum albumin in the former. The progression to renal failure was seen in 9 patients: six in the idiopathic group and the other 3 in the lupus group; this difference was not significant.(ABSTRACT TRUNCATED AT 250 WORDS)