Meat traceability using DNA markers: application to the beef industry

Consumer concerns about beef demands instruments to assure its traceability. A methodology using DNA markers is proposed for beef identification focussing on a Spanish beef certification, Ternera de Navarra (Beef of Navarra). To validate this methodology the number of markers used and the implications of population structure in individual identification were evaluated. In order to get practical implementation, the sampling levels required, depending on the number of markers and amount of possible fraud, is also discussed. Using at least eight very informative markers the origin of retailed meat is always found independent of genetic population structure. The total control of fraud would be very expensive using large-scale application of DNA analyses and a strategy based on anonymous sampling is proposed.

Molecular traceability of beef from synthetic Mexican bovine breeds

Traceability ensures a link between carcass, quarters or cuts of beef and the individual animal or the group of animals from which they are derived. Meat traceability is an essential tool for successful identification and recall of contaminated products from the market during a food crisis. Meat traceability is also extremely important for protection and value enhancement of good-quality brands. Molecular meat traceability would allow verification of conventional methods used for beef tracing in synthetic Mexican bovine breeds. We evaluated a set of 11 microsatellites for their ability to identify animals belonging to these synthetic breeds, Brangus and Charolais/Brahman (78 animals). Seven microsatellite markers allowed sample discrimination with a match probability, defined as the probability of finding two individuals sharing by chance the same genotypic profile, of 10(-8). The practical application of the marker set was evaluated by testing eight samples from carcasses and pieces of meat at the slaughterhouse and at the point of sale. The DNA profiles of the two samples obtained at these two different points in the production-commercialization chain always proved that they came from the same animal.

Single nucleotide polymorphisms in the Melanocortin 1 Receptor gene are linked with lightness of fibre colour in Peruvian Alpaca (Vicugna pacos)

Melanocortin 1 receptor (alpha melanocyte stimulating hormone receptor) (MC1R) is a gene-controlling melanogenesis in mammals. However, it is not well characterized in alpacas and its association with colour is not known. The aim of this study was to look for polymorphisms in the MC1R gene in Peruvian Huacaya alpacas and to analyse the relationship between MC1R single nucleotide polymorphisms (SNPs) and the variations in the instrumental measurement of colour of alpaca fibre. Sixty alpaca fibre samples from black, brown, cream and white animals (15 for each colour) were used to extract DNA from hair bulbs. Colour was measured with a spectrophotometer to obtain quantitative values (CieL*a*b*). Sixteen samples, four of each colour group, were sequenced. Eighteen SNP mutations, 10 not previously described, were found in these 16 sequences. Three of them were chosen (c.82A>G, c.865C>T, c.901C>T) to analyse genotypes by PCR-RFLP in the other 44 fibre samples and to determine the association of mutations with instrumental colour. These three polymorphisms showed association with fibre lightness (P < 0.05), although there was no correlation with colour groups.

Biomarkers of fluoride in children exposed to different sources of systemic fluoride

There has been no comparison between fluoride concentrations in urine and nails of children exposed to different sources of systemic fluoride. The aim of this study was to compare the relationship between fluoride intake with urinary fluoride excretion and fluoride concentrations in fingernails and toenails of children receiving fluoride from artificially fluoridated water (0.6-0.8 mg F/L, n = 25), naturally fluoridated water (0.6-0.9 mg F/L, n = 21), fluoridated salt (180-200 mg F/Kg, n = 26), and fluoridated milk (0.25 mg F, n = 25). A control population was included (no systemic fluoride, n = 24). Fluoride intake from diet and dentifrice, urinary fluoride excretion, and fluoride concentrations in fingernails/toenails were evaluated. Fluoride was analyzed with an ion-selective electrode. Urinary fluoride excretion in the control community was significantly lower when compared with that in the fluoridated cities, except for the naturally fluoridated community. However, the same pattern was not as evident for nails. Both urinary fluoride output and fluoride concentrations in fingernails/toenails were significantly correlated to total fluoride intake. However, the correlation coefficients for fluoride intake and urinary fluoride output were lower (r = 0.28, p < 0.01) than those observed for fingernails/toenails (r = 0.36, p < 0.001), suggesting that nails might be slightly better indicators of fluoride intake at the individual level.

Incidence of cancer in the general population and in patients with or without atopic dermatitis in the U.K

BACKGROUND

Atopic dermatitis (AD) affects approximately 20% of children and 1-3% of adults in developed countries.

OBJECTIVE

To study the incidence of cancer in patients with AD in the U.K. general population.

METHODS

We conducted a follow-up study in the U.K. using The Health Improvement Network (THIN) database. We calculated the incidence rate (IR) of the first occurrence of overall cancer, lymphoma, melanoma and nonmelanoma skin cancer (NMSC) in the general population, in patients with AD and in individuals without AD. In addition we calculated the IR ratio (IRR) of overall cancer and subtypes of cancer in patients with AD vs. those without.

RESULTS

The study population included 4,518,131 patients [2,336,230 (51·7%) female]. There were 129,972 subjects [68,688 (52·8%) female] with a diagnosis of cancer (excluding NMSC). The IR (per 10,000 person-years) of cancer (excluding NMSC) was 42·41 [95% confidence interval (CI) 42·18-42·64]; of lymphoma 1·70 (95% CI 1·65-1·74); of skin melanoma 1·71 (95% CI 1·67-1·76) and of NMSC 11·76 (95% CI 11·64-11·88). The age- and sex-adjusted IRR for cancer (excluding NMSC) was 1·49 (95% CI 1·39-1·61); for lymphoma 2·21 (95% CI 1·65-2·98); for melanoma 1·74 (95% CI 1·25-2·41); and for NMSC 1·46 (95% CI 1·27-1·69).

CONCLUSIONS

Our results indicate an increased incidence of cancer overall as well as of specific cancer subtypes, including lymphoma, in patients with AD. Further studies are needed to disentangle the effects of treatment for AD from AD itself.

A comparison of different pre and post-slaughter measurements for estimating fat reserves in Spanish Blanca Celtibérica goats

Five pre-slaughter measurement values and four post-slaughter measurement values were used to estimate the weight of fat in the omental (OM), mesenteric (MES), perirenal (PR), subcutaneous (SC), and intermuscular (IM) fat depots in goats. The pre-slaughter measurements were: live weight (LW), sternal body condition score (BCSs), lumbar body condition score (BCSl), sternal fat thickness (FTs) and lumbar fat thickness (FTl) measured by ultrasound. The post-slaughter measurements were empty live weight (ELW), hot carcass weight (HCW), adipocyte diameter in the sternal subcutaneous fat (ADSCs) and adipocyte diameter in the lumbar subcutaneous fat (ADSCl). Linear and multiple regressions were fit to data collected from 22 adult, non-pregnant and non-lactating Blanca Celtibérica does. The results obtained showed BCSs, ranging from 1.5 to 4.5 (scale: 0-5) to be the best pre-slaughter estimator of an animal's total fat (R2 = 0.90, RSD = 2.252 kg) and HCW to be the best post-slaughter estimator (R2 = 0.92, RSD = 1.972 kg). Additionally, multiple regression using HCW and ADSCl together yielded estimates of the total amount of fat in all five of the depots considered here with an R2 = 0.95 and an RSD = 1.542 kg. Therefore, the use in vivo of BCSs is the best method for predicting nutritional status in does in extensive production systems in the Mediterranean region.Key words: Fat reserve, body weight, carcass weight, body condition score, ultrasound, adipocyte, goat

Dorsolateral prefrontal cortex stimulation modulates electrocortical measures of visual attention: evidence from direct bilateral epidural cortical stimulation in treatment-resistant mood disorder

Electrocortical activity is increasingly being used to study emotion regulation and the impact of cognitive control on neural response to visual stimuli. In the current study, we used direct epidural cortical stimulation (EpCS) to examine regional specificity of PFC stimulation on the parietally-maximal late positive potential (LPP), an event-related potential (ERP) biomarker of visual attention to salient stimuli. Five patients with treatment-resistant mood disorders were stereotactically implanted with stimulating paddles over frontopolar (FP) and dorsolateral (DL) prefrontal cortex bilaterally. On their first day of activation, patients underwent sham-controlled EpCS coupled with 64-channel electroencephalograph (EEG) recordings and passive viewing of aversive and neutral images. In addition to sham, patients had either FP or DL prefrontal cortex stimulated at 2 or 4 V while they viewed neutral and aversive pictures. As expected during the sham condition, LPP was larger for aversive compared to neutral stimuli (F(1,4)=232.07, P<.001). Stimulation of DL compared to FP prefrontal cortex resulted in a reduction of the LPP (F(1,4)=8.15, P=.048). These data provide additional and unique support to the role of the DL prefrontal cortex in regulating measures of neural activity that have been linked to emotional arousal and attention. Future studies with EpCS can help directly map out various prefrontal functions in treatment-resistant mood disorder.

[Use of the AirTraq device to manage difficult intubation in the awake patient]

OBJECTIVE

To assess successful intubation, hemodynamic and respiratory stability, and patient wellbeing during awake orotracheal intubation using the AirTraq device in patients anticipated to have difficult airways.

PATIENTS AND METHODS

Prospective observational study in patients who were candidates for awake intubation with the AirTraq device based on a score of 11 or more on the Arné test to predict a difficult airway. The 3 sets of variables assessed were intubation success, hemodynamic and respiratory stability, and subjective and objective measures of patient well-being.

RESULTS

Eleven patients were enrolled. Intubation was successful in 10 patients. Hemodynamic and respiratory stability was maintained in all cases. When well-being during intubation was subjectively assessed on a 10-point scale, the average score was 7.27 points on discharge from the recovery room and 7.45 points a month after the procedure. As objective reflections of well-being, nausea was reported by 5 patients, cough was recorded in 4 cases and agitation in 2.

CONCLUSIONS

The AirTraq can be used for awake intubation in cases of anticipated difficult airway when other approaches to intubation have failed or are not viable. Intubation is achieved successfully and hemodynamic and respiratory stability maintained. The device is well tolerated. An advantage of the AirTraq is that it allows the glottis to be visualized as the endotracheal tube is being inserted between the vocal cords so damage can be minimized.

Relationship between rabbit transferrin electrophoretic patterns and plasma iron concentrations

Rabbit transferrin (Tf) was studied electrophoretically using 1141 blood samples from individuals belonging to seven populations (Spanish Common, Spanish Giant, Butterfly, Lyoné de Bourgogne, New Zealand White, Californian and New Zealand White X Californian hybrids). No Tf polymorphism was found by starch gel electrophoresis, but six patterns, differing in the presence and/or intensity of three bands ('a', anodic; 'b', intermediate; and 'c', cathodic) were observed by polyacrylamide gel electrophoresis. No genetic model could explain these patterns, since they reflect differences in plasma Tf iron content. The electrophoretic test allowed a direct observation of the relative in vivo levels of the different Tf molecular species; saturated (band 'a', Fe2Tf); semi-saturated (band 'b', Fe1Tf); and without iron (band 'c' Fe0Tf, apotransferrin). The degree of iron saturation of Tf varied among individuals and throughout the individual's life. Specifically, in pregnant females, Fe2Tf and Fe1Tf are generally observed, except in late pregnancy (from day 25 to parturition), when mainly apotransferrin is observed. Significantly, within 24 h post-partum, high levels of Fe2Tf are reached in the female's serum.

Evidence for transferrin polymorphism in Spanish wild rabbits

Serum samples from 412 Spanish wild rabbits were analysed by starch and polyacrylamide gel electrophoresis. Three different transferrin (Tf) phenotypes (A, AB and B) were observed by both methods. The occurrence of two codominant alleles (TfA and TfB with frequencies of 0.89 and 0.11 respectively) at an autosomal locus (Tf) was supported by the population data on genetic equilibrium. Electrophoretic mobility differences between the Tf variants A and B could not be explained by differences in sialic acid or iron contents. Each of the two Tf variants were shown to have two sialic acid residues by neuraminidase treatment. These variants had similar affinities for iron, and iron binding did not lead to the conversion of one variant into the other.

Dietary Fluoride Intake by Children Receiving Different Sources of Systemic Fluoride

There has been no comparison of fluoride (F) intake by pre-school children receiving more traditional sources of systemic F. The aim of this study was to estimate the dietary F intake by children receiving F from artificially fluoridated water (AFW-Brazil, 0.6–0.8 mg F/L), naturally fluoridated water (NFW-Brazil, 0.6–0.9 mg F/L), fluoridated salt (FS-Peru, 180–200 mg F/Kg), and fluoridated milk (FM-Peru, 0.25 mg F). Children (n = 21–26) aged 4–6 yrs old participated in each community. A non-fluoridated community (NoF) was evaluated as the control population. Dietary F intake was monitored by the “duplicate plate” method, with different constituents (water, other beverages, and solids). F was analyzed with an ion-selective electrode. Data were tested by Kruskall-Wallis and Dunn’s tests (p < 0.05). Mean (± SD) F intake (mg/Kg b.w./day) was 0.04 ± 0.01b, 0.06 ± 0.02a,b, 0.05 ± 0.02a,b, 0.06 ± 0.01a, and 0.01 ± 0.00c for AFW/NFW/FS/FM/NoF, respectively. The main dietary contributors for AFW/NFW and FS/FM/NoF were water and solids, respectively. The results indicate that the dietary F intake must be considered before a systemic method of fluoridation is implemented.

The effect of vitamin A supplementation on postnatal adipose tissue development of lambs

Vitamin A (retinoic acid) is known to be an adipogenic factor influencing both in vitro and in vivo cell development. This study aimed to determine its effect on lamb adipose tissue development during the early phase of postnatal development until 100 d of age. Male lambs (n = 24) of the Rasa Aragonesa breed were used. At birth, lambs were assigned to 1 of 2 experimental groups: 1) the control (C) group, which received feed without vitamin A supplementation, and 2) the vitamin A (V) group, which received a supplement of 500,000 IU/animal twice per week from birth to slaughter. The effect of vitamin A supplementation was studied at 16.8 +/- 0.35 kg of BW (58 +/- 0.7 d of age) and at 27.8 +/- 0.78 kg of BW (101 +/- 6.5 d of age). The variables of lamb growth, carcass, LM area, and lipid content were analyzed. To study adipose tissue development, the amount of adipose tissue accumulated, the size and number of adipocytes, and lipogenic enzyme activities (glycerol 3-phosphate dehydrogenase, fatty acid synthase, and glucose 6-phosphate dehydrogenase) of the omental, perirenal, and s.c. depots were quantified. Results showed that vitamin A supplementation had no influence on growth, carcass variables, LM area, and lipid content during lamb growth but that the number of adipocytes in the perirenal depot was 30% greater in lambs of the V group (P < 0.05) and that these lambs had smaller adipocytes in the omental and perirenal depots (P = 0.06) at 28 kg of BW (101 d of age). These results suggest that the intake of this level of vitamin A during the whole period of growth of the lambs influenced the processes of hyperplasia and hypertrophy in the different adipose depots, depending on their degree of maturity.

[Validity and reliability of the CERAD-Col neuropsychological battery]

INTRODUCTION

Alzheimer's disease (AD) is an important public health problem due to its disabling character and high individual, familial and social costs. The CERAD neuropsychological battery has been widely used for evaluation and diagnosis of the cognitive deficit associated with AD. This instrument has been adapted to the Colombian culture (CERAD-Col) for the Neurosciences Group.

SUBJECTS AND METHODS

A study was carried out to establish the validity and reliability of the CERAD-Col in Colombian, Spanish-speaking individuals aged 50 years or more. It included 151 controls and 151 AD patients. Controls were selected from a convenience sample of 848 adults aged 50 years or more. The construct validity was determined in three ways: 1) factorial analysis; 2) correlation with the functional scales FAST and GDS (convergent-type validity) and, 3) comparison between the two groups. Internal consistency was determined by means of Cronbach's alpha coefficient.

RESULTS

Three factors -memory, language and praxis- explained 88% of the total variance. Moderate but statistically significant correlations were found between neuropsychological tests and functional scales. Internal consistency and test-retest reproducibility were high. The AD group exhibited significantly lower scores (p < 0.05) than the control one.

CONCLUSION

CERAD-Col is valid and reliable for the diagnosis of AD in Colombian Spanish-speaking population aged 50 years or more.

Testing the equivalence of different ovine PrP genotypes for estimated breeding values

In this study we applied equivalence testing methods to prove the absence of differences in genetic values of ewes with different PrP genotypes. In particular, the milk production genetic value equivalence of ARR ovine prion protein (PrP) genotypes was analysed. There is no scientific evidence implying that the performances and genetic values of different PrP genotypes will be different, but it is interesting to confirm that the performance of one genotype is indistinguishable from another before starting a genetic scrapie control programme. Genotyping was performed on 204 ewes from a Spanish population of Lacaune breed. Ewes were sampled from the lower and upper tails for the distribution of estimated breeding value (EBV) for standardized lactation. The conditional probability that the number of ARR alleles contained in the group of higher EBV was larger than that found in the group of lower EBV was found to be in the interval between the true value (1/2) and two different pre-specified bounds (0.1 and 0.2). The results evidence the equivalence of ARR PrP genotypes for milk production EBV, and lead to the conclusion that the average genetic values for milk production of Lacaune flocks considered will not be affected by the selection of ewe carriers of resistance scrapie alleles (p<0.05).

Lipogenic activity in Rasa Aragonesa ewes of different body condition score

The aim of the study was to assess the effect of body condition score on tissue and metabolic characteristics of the adipose depots in sheep of Rasa Aragonesa breed. Ewes were uniformly assigned according to their body condition score (BCS) (scale 0 to 5), to four groups: 0.75–1.75, 2–2.75, 3–3.75, and 4–4.5. The amount of fat and the adipocyte size in the different adipose depots increased as BCS did (P < 0.001) while the number of adipocytes did not change. The greatest ability to accumulate or mobilize fat was the subcutaneous depot (slope of the regression between amount of fat and BCS, b = 1.92; P < 0.001). Fatty acid synthase (FAS) lipogenic enzyme activity was affected by BCS, while G3-PDH and G6-PDH activities were not. Key words: Adipose tissue, body condition score, adipocyte size, lipogenic enzyme activity, ewes

Remifentanil vs fentanyl/morphine for pain and stress control during pediatric cardiac surgery

BACKGROUND

Remifentanil is a short acting, potent synthetic opioid that does not accumulate after infusion or repeated bolus doses. It may be rapidly titrated to the requirements of individual patients. Titrated infusion of remifentanil may be able to provide potent analgesia required for pediatric cardiac surgery and obtund the stress response in theater whilst not having the persistent respiratory depression and sedation seen with longer acting opioids.

METHODS

Twenty patients were randomized to receive a titrated infusion of remifentanil (0-1 microg x kg(-1) x min(-1)) or a standard dose of fentanyl (30 microg x kg(-1)) prebypass plus morphine (1 mg x kg(-1)) on rewarming. Blood samples for glucose and cortisol were taken at regular intervals from induction through bypass and into the first 24 h of postoperative intensive care. In addition to biochemical indicators of the stress response we recorded baseline hemodynamic parameters and any acute physiological events.

RESULTS

Ten patients received morphine, seven received remifentanil. There were no statistically significant differences between the two treatment groups in cortisol measurements, mean arterial pressure or heart rate recordings. In the last time period the remifentanil group had a larger rise in blood glucose concentration (baseline 3.9, rise 3 mmol x l(-1)) than the fentanyl/morphine group (baseline 4.2 rise 1.9 mmol x l(-1)), CI -4.3 to -0.2.

CONCLUSIONS

The only significant difference was in glucose in the postbypass time periods. Although statistically significant, this difference is insufficient evidence of increased stress in the remifentanil group. The results show that in the patients studied there was no clinically important difference between the two techniques.

Estimating fat reserves in Rasa Aragonesa ewes: A comparison of different methods

Four pre-slaughter measurements, liveweight (LW), body condition score (BCS) and fat thickness, measured by ultrasound, in the lumbar (FTL) and sternal regions (FTS), and four post-slaughter measurements, empty liveweight (ELW), hot carcass weight (HCW) and diameter of adipocytes in subcutaneous (DSC) and omental (DOM) fat depots¸ were used to predict the weight of fat in the omental (OM), mesenteric (MES), perirenal (PR), subcutaneous (SC) and intermuscular (IM) depots of ewes. Linear and multiple regressions were fitted to data from 42 adult, non-pregnant and non-lactating Rasa Aragonesa ewes, with liveweights between 29.8 and 79.2 kg and body condition scores between 0.75 and 4.5. Using a single parameter, ELW and HCW gave the most accurate predictions of the total depot fat (R2 = 0.88 and 0.90, RSD = 1.571 and 1.484 kg, respectively). Multiple regressions predicted total weight of fat depots from the pre-slaughter variables LW, BCS and FTS with an R2 value of 0.92 (RSD=1.317 kg). This result confirms the utility of using in vivo measures as fat reserve predictors in Rasa Aragonesa ewes. Key words: Fat tissue, liveweight, body condition score, adipocytes, ultrasound, ewes

Oesophageal pH monitoring in children: how is it perceived by the parents and does the technique change feeding and daily activity?

AIM

To determine whether oesophageal pH monitoring in infants induces changes in daily activity and feeding, and with the help of a questionnaire to evaluate how parents perceive pH monitoring.

METHODS

The parents of 100 children, consecutively referred for oesophageal pH monitoring, were asked by one of the authors (A.A.) to respond to a standardized questionnaire immediately after the end of the procedure. Twenty questions were asked, concerning five topics: feeding (4 questions), activity (6 questions), perception of the parents (6 questions), accuracy of the provided information (3 questions), and previous experience with oesophageal pH-metry (1 question). For statistical analysis, every variable was qualified as "no change" and "change" for feeding and activity, as "positive" or "negative" regarding the perception of the test, and as "sufficient" or "insufficient" regarding the information provided. The answers to the questions were also analysed according to the result of the oesophageal pH monitoring (normal vs abnormal), and according to whether or not there was previous experience of oesophageal pH-metry in a first degree relative.

RESULTS

Changes in feeding occurred in 28% of cases and changes in activity in 30%, but did not differ according to the oesophageal pH-metry result. Equally, the perception of the parents regarding the test (37% negative), the acceptability of a second pH-metry test (refusal in 52%) and previous experience with oesophageal pH-metry (positive in 25%) were not influenced by the result of the pH monitoring. Parents of infants with abnormal oesophageal pH monitoring were more frequently dissatisfied with the information about the nature of the test provided before the test and also the results than parents of infants with normal results (52% vs 19%, respectively; p < 0.05).

CONCLUSION

According to the perception of the parents, pH monitoring induces changes in feeding and activity in 28% and 30%%, respectively; 63% of the parents considered pH monitoring to be well tolerated. Parents of infants with abnormal pH monitoring results need more attention.

Lipogenic enzyme activities in different adipose depots of Pirenaican and Holstein bulls and heifers taking into account adipocyte size

The effects of sex, genotype, and adipose depot on lipogenic enzyme activity have been investigated in Holstein and Pirenaican bulls and heifers, taking into account differences in adipocyte size. Fifteen Pirenaican bulls and 15 heifers and 15 Holstein bulls and 13 heifers were fattened until slaughter (12 to 13 mo old and 450 to 500 kg of body weight). During the fattening period, animals had ad libitum access to commercial concentrates and straw. The 10th rib was dissected to determine the fat content. Adipocyte size and activities of the following lipogenic enzymes were determined: glycerol 3-phosphate dehydrogenase, fatty acid synthase, nicotinamide adenine dinucleotide phosphate (NADP)-malate dehydrogenase, glucose 6-phosphate dehydrogenase, and NADP-isocitrate dehydrogenase, in the omental, perirenal, subcutaneous, and intermuscular adipose depots, respectively. Because adipocyte mean cell volume varied with sex, breed, and depot, regression analyses of log(e) activity per cell and log(e) cell volume were used to compare activities per unit volume. Sex, breed and depot had no effect (P > 0.05) on the gradients of regressions, which did not differ significantly from 1. Thus, activity per unit volume did not vary with cell size. Consequently, sex, breed, and depot effects on the regression analyses were equivalent to effects on activity per unit volume. Females had greater amounts of fat in the 10th rib (P < 0.001), larger adipocytes (P < 0.001) and, in general, greater (P < 0.05) lipogenic activity per cell, even when adjusted for cell size, than males. These findings suggest that differences in adiposity between sexes are mainly due to females having a greater capacity for lipid synthesis, and hence, hypertrophy, than males. When adjusted for differences in carcass weight, Holsteins had larger adipocytes than Pirenaicans. The abdominal depots, omental and perirenal, had a greater adipocyte size (P < 0.001) and, in general, greater lipogenic enzyme activities per cell (P < 0.05) than the subcutaneous and intermuscular carcass depots. However, when activity per cell was adjusted for cell size, subcutaneous depots had greater fatty acid synthae, glucose 6-phosphate dehydrogenase, and NADP-malate dehydrogenase activities than omental and perirenal, indicating that other factors such as nutrient supply may restrict hypertrophy of carcass adipocytes.

Efficacy and tolerability of cisapride in children

As gastro-oesophageal reflux disease (GORD) in infants and children is a motility disorder which differs in pathophysiology and clinical course from GORD in adults, prokinetics should be considered the drug of choice in certain circumstances. Indeed, cisapride may result in improvement of feeding tolerance in premature infants. Cisapride has a better tolerability profile than a 'wait-and-see-if-improvement-comes-spontaneously' policy or the other therapeutic options available. A careful and critical review of published data suggests that cisapride may have a QTc-prolonging effect. However, provided the precautions for cisapride administration are followed, the QTc-prolonging effect remains consistently without clinically relevant adverse effects. Correct dosage and avoidance of concurrent treatment with macrolides and/or azoles are the most relevant tolerability recommendations in children. Although there is a need for a prokinetic with better efficacy, cisapride is currently the prokinetic with the best benefit-to-risk ratio available. Thus, withdrawal of cisapride would result in a significantly increased risk for severe complications in infants and children with GORD or other gastrointestinal motility disorders such as chronic intestinal pseudo-obstruction, gastroparesis and feed intolerance in premature infants.

Management of ingested foreign bodies in childhood and review of the literature

The management of ingested foreign bodies in children is not standardised. During a 15-year period, we recorded 325 consecutive paediatric cases of accidental ingestion of foreign bodies or with symptoms suggesting oesophageal obstruction presented at the emergency department or the paediatric gastroenterology unit. The foreign bodies that had to be removed were, in decreasing order of frequency: coins, toy parts, jewels, batteries, sharp materials such as needles and pins, fish and chicken bones, and "large" amounts of food. Only 54% of the patients had transient symptoms at the moment of ingestion, such as retrosternal pain, cyanosis and dysphagia. A minority (28, 9%) of foreign bodies could be removed with a McGill forceps; 65 (20%) were removed with a magnet probe. Endoscopic removal was performed in 82 cases (25%). In the majority of cases (150, 46%) natural elimination occurred. The outcome of all patients was uneventful.

CONCLUSION

Recommendations for management of children presenting with a history of suspected accidental ingestion of a foreign body for the community paediatrician are proposed.

PH monitoring in the distal and proximal esophagus in symptomatic infants

BACKGROUND

Standard distal esophageal pH monitoring data are sometimes within normal ranges in children with clinically suspected gastroesophageal reflux disease. Therefore, the authors hypothesized that the amount of acid reflux reaching the proximal esophagus may be greater in some subgroups of patients than in healthy controls or in other subgroups of patients.

METHODS

The parameters of 24-hour pH monitoring in the proximal part of the esophagus were analyzed in 120 symptomatic infants in who the reflux parameters in the lower esophagus were clearly within normal ranges (reflux index < 5.0%). The infants were classified into four patient groups: excessive regurgitation (n = 41): inconsolable crying (n = 31), apparent life-threatening event (ALTE) (n = 18), and chronic respiratory disorders (n = 30). The control group consisted also of 120 infants. The following parameters were calculated: reflux index, the number of reflux episodes, the number of reflux episodes lasting longer than 5 minutes, the duration of the longest reflux episode, and the acid clearance time (ACT, duration of reflux episodes divided by number of reflux episodes).

RESULTS

The patients with chronic respiratory disorders were significantly older than the patients in the other groups and the controls. In the distal esophagus, there was no statistically significant difference between the reflux parameters. As could be expected, every parameter was statistically (paired t test, Wilcoxon signed-rank test) significantly smaller in the proximal than in the distal esophagus, except for the ACT in infants who presented with inconsolable crying. In the proximal esophagus, there was no statistically significant difference between the different patient subgroups or controls, except for the number of reflux episodes in the group with chronic respiratory disorders and the group with inconsolable crying, applying one-way analysis of variance. As determined by applying the Mann-Whitney test, the number of reflux episodes in the upper esophagus was significantly higher in the group with chronic respiratory disorders than in the other patient groups and controls. Therefore, the authors' data do not support the hypothesis that reflux reaching the proximal esophagus is a frequent cause of ALTE. However, the data may suggest that the number of reflux episodes reaching the proximal esophagus in children with chronic respiratory disorders and with distal pH monitoring data within normal ranges may be increased. Whether this finding reflects reality or a statistical coincidence, or is influenced by the older age of this patient group, needs further evaluation.

CONCLUSIONS

In theory, dual simultaneous esophageal pH monitoring in the distal and proximal esophagus may increase the diagnostic accuracy of pH monitoring in infants. Our results do not support a substantial advantage of a systematic application of this new technique, especially not in infants presenting with ALTE, excessive regurgitation, or inconsolable crying. In the subgroup of patients with chronic respiratory disorders, more data are needed before conclusions can be determined and recommendations can be made.

Treatment with paracetamol in infants

BACKGROUND

Paracetamol (N-acetyl-p-amino-phenol) or acetaminophen has become the most widely used analgesic and antipyretic in children. However, there is a wide discrepancy between the extent to which paracetamol is used and the limited available pharmacological data in small infants. The purpose of this article is to present a review of the current literature regarding the use of paracetamol in neonates and infants with a particular emphasis on pharmacological issues.

METHODS

A MEDLINE search (up to March 2000) was conducted to identify relevant English-language publications using paracetamol, children, infants and neonates as search terms. Additional studies were identified from bibliographies of the reviewed literature.

RESULTS

Pharmacological studies on paracetamol in infants are few. Most studies have focused on the administration of one single paracetamol dose, and the problem of cumulative toxicity with repeated dosing has not been addressed. Plasma paracetamol concentration should be 10-20 mg ml(-1) to achieve antipyretic and analgesic effects. The bioavailability of the different formulations and routes of administration vary with age. Rectal absorption is slower and more erratic than the oral; however, in the very young, rectal bioavailability is higher than in older patients. Volume of distribution seems to be age-independent, whereas clearance is reduced in neonates and particularly in preterm babies. Neonates and infants are capable of forming the reactive intermediate metabolite that causes hepatocellular damage, particularly after multiple doses. They have an immature glucuronide conjugation system, but the rate constant for the sulphation metabolic pathway is larger than in older children, and this is the most important route of metabolism.

CONCLUSIONS

The pharmacokinetics and pharmacodynamics of paracetamol differ substantially in neonates and infants from those in older children and adults; hence, dosing should be adjusted accordingly.

[Parkinsonian syndromes in Medellin (Colombia)]

INTRODUCTION

The definition of parkinsonian syndromes is based on clinical criteria.

OBJECTIVE

To determine the frequency and management of parkinsonism, using criteria of inclusion and exclusion.

PATIENTS AND METHODS

We selected 302 consecutive patients, 147 females and 155 males, with parkinsonism, age 66.8 (11.4) (range: 13-90), grades of education 7.5 (4.3) (range: 0-20). A structured and quantitative protocol was applied to the sample.

RESULTS

The most frequent parkinsonian syndrome was the defined idiopathic Parkinson's disease with 132 participants (43.7%). Probably idiopathic Parkinson's disease was found in 60 cases (19.9%), and possible idiopathic Parkinson's disease in eight cases (2.6%); early onset Parkinson's disease in 10 cases (3.3%), juvenile Parkinson's disease in one case (0.3%), familial Parkinson's disease in five cases (1.7%); cortical Lewy body disease in 16 cases (5.4%), progressive supranuclear palsy in nine cases (3.3%), multiple systemic atrophy in eight cases (2.6%). Secondary Parkinson's disease was distributed as follow: vascular disease in 24 cases (8%), local lesion in 11 cases (3%), medications in 16 cases (5.3%), meningoencephalitis in one case (0.3%) and syphilis in one case (0.3%). Without medication was found 1.5% of sample, which was in Hoehn & Yarh's state I to II. In monotherapy was found 23.2%, with two medications 46.7%, with three 23.5% and with four drugs 5.1%. Levodopa was prescript to 70.9%, anticholinergic to 51.3%, MAO-B-I to 33.4%, amantadine to 33.1%, D2 stimulants to 18.5%, and COMT-I to 2.6%.

CONCLUSION

Structured protocol for assessment of parkinsonian syndromes allows reliable diagnoses for clinical and epidemiological purposes.

Oesophageal pH monitoring in infants: elimination of gastric buffering does not modify reflux index

BACKGROUND

Oesophageal pH monitoring is considered to be the gold standard investigation in the diagnosis of gastro-oesophageal reflux disease. Results of pH monitoring in regurgitating infants, however, may be within normal ranges. Therefore it was hypothesized that prolonged buffering of gastric acidity caused by milk-feeding may falsely normalize the pH data. Therefore, it may be relevant to omit the periods of gastric acid buffering in the analysis of the oesophageal pH monitoring data.

METHODS

Combined gastric and oesophageal pH monitoring (Digitrapper Mark III, two-channel antimony electrode, Synectics) was performed in 90 consecutive infants, 0.5-10 months old, who were referred to the unit by outdoor paediatricians for pH measurement. The data were analysed in three different ways. The reflux index (RI), or the percentage time that the pH in the oesophagus was < 4.0, was calculated in three different ways: (i) the total duration of the investigation; (ii) excluding 90-min postprandial periods, starting from the beginning of a feeding; and (iii) excluding all periods with a gastric pH > 4.0, which are the periods of gastric buffering with a theoretical impossibility of recording an oesophageal pH < 4.0.

RESULTS

The mean duration of the pHmetries was 19.20+/-2.01h (A; mean +/- 1 SD), with a RI of 5.38+/-5.39% (B; median 3.45%). If the 90-min postprandial periods were not considered, the mean duration decreased to 12.21+/-2.41h (C; P(A vs C) < 0.001), with an oesophageal RI of 6.82+/-6.57% (D; median: 4.65; P(B vs D) = NS; r (B vs D) = 0.97). If all periods with a gastric pH > 4.0 were elminated, the duration available for analysis of the data with a gastric pH < 4.0 was 12.53+/-4.00 h (E; P(A vs E) < 0.001; P(C vs E) = NS), with an oesophageal RI of 7.06+/-7.52% (F; median: 4.50; P(B vs D vs F) = NS; r(B vs F), (D vs F) = 0.96).

CONCLUSION

Overall the data do not support a benefit from including periods of gastric buffering in the routine analysis of oesophageal pH monitoring data. Therefore standard oesophageal pH monitoring should be with a single electrode and should not include periods of gastric buffering.

Active monitoring of 12,760 clozapine recipients in the UK and Ireland. Beyond pharmacovigilance

BACKGROUND

People prescribed clozapine for treatment-resistant schizophrenia have mandatory haematological monitoring through a case register for identifying reversible neutropenia.

AIMS

To quantify risk factors for agranulocytosis in subjects receiving clozapine.

METHOD

Data from 12,760 subjects registered to receive clozapine from January 1990 to April 1997 were analysed. Risk factors for agranulocytosis were quantified using a Cox proportional-hazards regression analysis.

RESULTS

The risk for agranulocytosis in Asian subjects was 2.4 times that in Caucasians (P = 0.03). There was an age-related increase in risk of 53% per decade (P = 0.0001).

CONCLUSIONS

The case register yielded valuable information for guiding research into the causes of the haematological reactions.

Paracetamol-induced fulminant hepatic failure in a child after 5 days of therapeutic doses

We report the case of a two and a half year-old girl who developed fulminant hepatic failure following 5 days of regular oral ingestion of paracetamol, approximately 90 mg x kg-1 x day-1. She presented with the typical findings of hepatomegaly, encephalopathy, high ammonia levels, high transaminases, hypoglycaemia and lactic acidosis. After stabilization, she was transferred to a specialist paediatric liver failure unit and fortunately she made a full recovery with intensive medical management.

[Prevalence of neurocysticercosis in individuals affected by epilepsy]

INTRODUCTION

In this investigations, was carried out a neurocysticercosis (NC) prevalence study during seven months in the Instituto Neurológico de Antioquia with the purpose of known neurocysticercosis frequency as cause of epilepsy in patients older than ten years that we attended in our institute.

MATERIAL AND METHODS

Computerized tomographies (CT) were made to 503 patients, with epilepsy, 24.7% of them were CT positive for NC. Cysticercosis enzyme linked immunoelectrotransfer blot (EITB) and enzyme linked immunoabsorbent assay (ELISA) test were made to 178 patients, 19.6% were EITB positive for NC and 5% ELISA positive for NC. Results. From this result it is possible to infer that about 8% of the 503 patients with epilepsy had cysticercosis, according to EITB that is the golden assay for NC. The CT and ELISA test had 94.3% and 27.7% sensitivity, respectively, according to EITB. The specificity of the CT for NC was 49.2% and specificity for ELISA test was 100% as compared to EITB. The multivariate analysis with logistic regression allowed to establish association of positive EITB with factors such as male sex, eating pork, headaches and multiple lesions in CT.

CONCLUSIONS

Prevention and education actions are necessary for the interruption of the neurocysticercosis transmission chain in order to diminish the high prevalence of epilepsy in the country and its complication and consequences.

[Epidemiology of cerebrovascular diseases in Sabaneta, Colombia (1992-1993)]

INTRODUCTION AND OBJECTIVES

In Columbia the epidemiology of cerebrovascular illness (ECV) is unknown. For this reason a study was made to determine the prevalence, incidence and annual mortality, and to identify the different types of ECV and the demographic characteristics of the population.

MATERIAL AND METHODS

In the urban area of Sabaneta, Columbia 13,588 door to door interviews were carried out among the inhabitants. A cutoff study carried out between April and June 1992 showed the prevalence of ECV. One year follow-up of persons without ECV between June 1992 and June 1993, enabled the incidence and annual mortality to be evaluated. A structured interview was used to identify the demographic characteristics of the population and classify people as healthy or as possibly having ECV. The latter were examined by neurologists to confirm or rule out the presence of ECV and to determine the type of ECV involved. Of the total urban population, 76.9% agreed to participate in the study. During the follow-up year, 8.4% were lost trace of.

RESULTS AND CONCLUSIONS

The prevalence of ECV was 559.3/ 100,000 inhabitants, increasing with age (15). In the 15-40 year old group, the incidence of ECV was 44 times higher in women than in men. The annual incidence rate was 88.9/100,000 inhabitants: thromboembolic disease was the most frequent. Of a total of 87 cases of ECV, 12 (13.98%) died of various causes during the year in which they were being observed. The annual mortality rate for ECV was 16.2/100,000 inhabitants, all being primary cases.

Blood biochemical polymorphisms as markers for genetic characteristics of wild Spanish and domestic rabbits

Seventeen blood proteins were studied in a sample of 412 Spanish wild rabbits and in 598 domestic rabbits belonging to various breeds. The wild rabbit populations showed a high level of genetic polymorphism. Six loci were monomorphic, while the remaining ten loci were segregating for at least two alleles. Two of the loci that were polymorphic in the wild rabbits were monomorphic in the domestic ones. Wright's inbreeding coefficient in the total Spanish wild rabbit population was F = 5.66, indicating subdivision of the total population. Inbreeding coefficients, estimated by Kidd et al.'s method (Anim. Blood Grps, Biochem. Genet. 11: 21-38), differed significantly from zero, being 15.62%, in wild rabbits and 6-12% in domestic breeds, indicating consanguinity. Genetic distances between wild rabbit populations showed that factors other than geographic distance (e.g., bottlenecks, barriers such as rivers, mountains, etc.) may explain the result that a northern population forms a cluster with two central populations whereas the northeastern populations form a different cluster with another central population. Populations of the first cluster are more closely related to the captive populations than others. There are three population clusters of domestic rabbits, namely (1) New Zealand White and a hybrid combination; (2) Spanish Common, Butterfly, Burgundy, and Californian; and (3) Spanish Giant.

Blood Biochemical Polymorphisms in Rabbits Presently Bred in Spain: Genetic Variation and Distances amongst Populations

A total of 816 rabbits, belonging to breeds presently bred in Spain (Spanish Common, Spanish Giant, Butterfly, Lyone de Bourgogne, New Zealand White, Californian and a hybrid line obtained from crosses between selected individuals of the latter two), were tested using nine blood electrophoretic markers: Hb, Ak, Co, Tf, Es-l, Es-2, Es-3, Ada and Pgd. The latter five proteins were found polymorphic, each being controlled by one locus and showing autosomal co-dominant Mendelian inheritance. Three of these loci (Es-1, Es-2 and Pgd) have two alleles, and the remaining two (Es-3 and Ada) have three alleles. These polymorphic loci were used to study the population structure and breed similarities genetically.

Influence of following Green's criteria for urinary stress incontinence surgical procedures

A series of 161 patients with urinary stress incontinence and who underwent either Kelly urethral plication or Marshall-Marchetti procedures were reviewed in order to evaluate the usefulness of following Green's criteria in the selection of type of surgery for stress incontinence. One-year follow-up failure rate was higher in patients with type I stress incontinence (23%) than in type II stress incontinence (15.5%), and also when the choice of surgical approach did not follow Green's criteria; statistical analysis of these data showed that differences did not reach a significant level (P greater than 0.05).

Transection of the spermatic vessels (Bevan's technique): an experimental study

Intracanalicular or intra-abdominal undescended testicles often present a difficult surgical problem, due to a vascular pedicle shortening that prohibits scrotal placement with a 1 stage orchiopexy. The division of spermatic vessels to properly place the testis in the scrotum solves the problem of the shortening of the vessels, but raises the question of whether the endocrine function and the potential for fertility are preserved. In the present study transection of spermatic vessels before arterial branch-off was done intra-abdominally in rats. Angiographic, patho-anatomic and hormonal evaluations have been made. Revascularization of the testicular artery through the vasal artery has occurred in all cases. The anastomotic circuit, however, does not always have the same functional value. The spermatogenic alterations suggest that fertility can be impaired in a significant percentage of cases. Spermatogenesis was quantified taking into account the mean tubular diameter and the situation of seminiferous epithelium, expressed as the percentage of tubules containing well-developed spermatogenesis. Plasma testosterone levels are in a low range. However, Leydig cell functional response to human chorionic gonadotropin stimulation is maintained in every case and so are plasma and pituitary luteinizing hormone levels, suggesting that plasma testosterone levels are high enough to maintain an adequate hormonal activity.

Ketoconazole in paracoccidioidomycosis: efficacy of prolonged oral therapy

Ketoconazole, a new oral imidazole derivative, was employed for the treatment of five patients with paracoccidioidomycosis. The response was excellent, with objective clinical improvement and healing of both mucocutaneous and pulmonary lesions. Mycological and serological tests, as well as delayed hypersensitivity, were assessed and found to correlate with clinical improvement. Therapy was conducted for 12 months with a dose of 200 mg day in 2 patients; in the remainder the dose was reduced (100 mg day) after the first 6 months and maintained as such for an equal period. No side-effects or toxicity were noted despite prolonged treatment. The advantages of the new therapeutic approach are discussed.

Ketoconazole: a new drug for the treatment of paracoccidioidomycosis

Ketoconazole was administered orally to 13 patients with paracoccidioidomycosis. Therapy consisted of 200 mg per day for periods ranging from three to 12 months. All patients improved markedly, with healing of pulmonary, mucosal, and skin lesions. Patients exhibiting the latter two manifestations began to improve two weeks after therapy, and healing occurred within three months. Pulmonary lesions regressed at a slower pace and healed by fibrosis. Mycologic tests have corroborated the clinical improvement. Adverse effects were not observed; monitoring of renal, hematologic, and hepatic functions did not reveal any abnormalities. Five patients completed a year of therapy and were free of symptoms when therapy was discontinued. Of these patients, four were followed for several months and had no relapses; the fifth patient developed tuberculosis and died. The results indicate that ketoconazole is a safe and effective drug for therapy in the treatment of paracoccidioidomycosis.

Epstein-Barr virus viral capsid antigen titer by immunofluorescence with microplates: new semiautomated method based on the microtiter system

A semiautomated method of an indirect immunofluorescence technique for the titration of antibodies directed against viral capsid antigens of Epstein-Barr virus has been developed with Microtiter system units. By this method, a technician is able to titrate some hundred samples daily. The technique is safe, easy, and reproducible. The various procedures are described, and the sensitivity of the test is discussed.