Spanish Consensus on the Management of Chronic Rhinosinusitis With Nasal Polyps (POLIposis NAsal/POLINA 2.0)

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a highly prevalent and burdensome disease for both individuals and health systems. Its management involves many specialties, including otorhinolaryngology, allergology, pulmonology, primary care, pharmacy, and pediatrics. A multidisciplinary approach and the participation of the patient in decision-making are essential, both for diagnosis and for therapy. The authors of the consensus aim to translate current knowledge into an easy-to-read practical guide and emphasize those aspects requiring further discussion or with unmet needs owing to the lack of appropriate scientific evidence. An iterative approach for the development of an evidence-based systematic review with recommendations was followed using a standard quality assessment approach (Scottish Intercollegiate Guidelines Network [SIGN] and National Institute for Health and Care Excellence [NICE]). The guideline was critically evaluated using the Appraisal of Guidelines for Research and Evaluation (AGREE II) and Recommendation Excellence (AGREE REX) instruments. Consequently, POLINA has been considered a high-quality guideline by an independent agency. The POLINA consensus provides new definitions of control, therapeutic management (including surgery and evaluation of severity), indications for use of biologics, and response. Finally, this guideline focuses on unmet research needs in CRSwNP.

Periodization of altitude training: A collective case study of high-level swimmers

The objective was to quantify parallel changes in performance and physiological measures in relation to periodization of sequential altitude training over a season in elite swimmers. The altitude training of four female and two male international swimmers in selected seasons was examined using a collective case study approach. All swimmers were a medalist in World (WC) and/or European Championships (EC) 2013, 2014, 2016 and 2018 in short or long course competition. A traditional periodization model was employed using three macrocycles with 3-4 altitude camps (duration 21-24 days each) scheduled over the season, following a polarized training intensity distribution (TID) with a volume ranged between 729 km and 862 km. The timing of return from altitude prior to competition was between 20-32 days, with 28 days the most common period. Competition performance was assessed with major (international) and minor (regional or national) competitions. Hemoglobin concentration, hematocrit, anthropometric characteristics, were measured before and after each camp. Competition performance following the altitude training camps improved by 0.6% ± 0.8% (personal best time; mean ± SD) (95% confidence limits (CL) 0.1%-1.1%), 1.6% ± 0.7% (95% CL 1.2% to 2.0%) (season best time) and 1.6% ± 0.5% (95% CL 1.3%-1.9%) (previous season time). Hemoglobin concentration increased 4.9% from pre-to post-altitude training camps, while hematocrit increased by 4.5%. The sum of six skinfolds reduced by 14.4% (95% CL 18.8%-9.9%) and 4.2% (95% CL 2.4%-9.2%) for the two males (EC), and by 15.8% (95% CL 19.5%-12.0%) for two females (WC). Three to four altitude training camps in a competitive season, around 21-24 days of duration, scheduling the last return between 20-32 days before the main competition, integrated in a traditional periodized sequence, can induce worthwhile improvements in international swimming performance, hematological parameters, and anthropometric characteristics.

No detection of Besnoitia besnoiti DNA in the semen of chronically infected bulls

Bovine besnoitiosis is a chronic and debilitating disease observed in many European countries that may cause important economic losses in cattle. The recent widespread of the parasite in Europe had led the European Food Safety Authority to declare bovine besnoitiosis as a re-emerging disease in Europe. Many aspects of the epidemiology of bovine besnoitiosis such as the main routes of transmission are still unclear and need to be further studied. Among the different hypotheses, a sexual transmission has not yet been investigated. Therefore, the aim of this study was to evaluate the presence of Besnoitia besnoiti DNA in the semen of naturally infected bulls by using a highly sensitive method (real-time qPCR). Both pre-sperm and sperm fractions of 40 bulls, including seronegative (n = 11), seropositive subclinically (n = 17), and seropositive clinically (n = 12) infected animals, were collected by electroejaculation and analyzed by real-time qPCR. No B. besnoiti DNA was detected in 27 pre-sperm and 28 sperm fractions of the 40 examined bulls, suggesting that the transmission of B. besnoiti infection by the semen of chronically infected bulls is very unlikely.

Survey of flea infestation in cats in Spain

Fleas are a common cause of feline skin disorders as well as vectors of zoonotic diseases. This study evaluated the flea species infesting domestic cats in Spain and assessed factors influencing their distribution. Fleas from 217 cats from 57 localities in Spain were identified and associations between abundance, and host-dependent, host habitat and environmental factors were examined. Variations in infracommunity and component community structure were also explored. Three species were present, of which Ctenocephalides felis (Bouché) (Siphonaptera: Pulicidae) was the most abundant (98.4%), followed by Ctenocephalides canis (Curtis) (1.1%) and Pulex irritans (L.) (Siphonaptera: Pulicidae) (0.5%). Overall abundance and abundances of both C. felis and C. canis were higher on farms than in apartments, but overall flea abundance and abundances of both C. felis and C. canis were lower in rural than urban environments. Overall abundance and C. felis abundance were lower during the warmest months, and mean annual rainfall was positively correlated with overall, C. felis and C. canis abundances. No relationship between the number of species per cat and any host, habitat or physiographical variable was found. Species richness was not correlated with mean annual temperature or rainfall. Flea abundance was mainly associated with host habitat and environmental factors.

Chronic bovine besnoitiosis: intra-organ parasite distribution, parasite loads and parasite-associated lesions in subclinical cases

Bovine besnoitiosis caused by Besnoitia besnoiti is a chronic and debilitating disease. The most characteristic clinical signs of chronic besnoitiosis are visible tissue cysts in the scleral conjunctiva and the vagina, thickened skin and a generally poor body condition. However, many seropositive animals remain subclinically infected, and the role that these animals may play in spreading the disease is not known. The aim of the present study was to assess the intra-organ parasite distribution, the parasite load and the parasite-associated lesions in seropositive but subclinically infected animals. These animals were seropositive at the time of several consecutive samplings, had visible tissue cysts in the past and, at time of slaughter, had detectable specific anti-Besnoitia spp. antibody levels, but they did not show evident clinical signs at culling. Thus, histopathological, immunohistochemical and molecular analyses of several samples from the respiratory tract, reproductive tract, other internal organs and skin from six cows were performed. The tissue cysts were located primarily in the upper respiratory tract, i.e., in the rhinarium and larynx/pharynx (four cows), followed by the distal genital tract (vulva/vagina) and the skin of the neck (three and two cows, respectively, out of the four cows with cysts in the respiratory tract). We were unable to detect any parasites in the two remaining cows. Cysts were associated with a significant non-purulent inflammatory infiltrate consisting predominantly of T lymphocytes and activated monocytes/macrophages in two cows. The parasite burden, estimated by quantitative real-time PCR, was very low. It is noteworthy that the only animal that showed a recent increase in the antibody titre had the highest parasite burden and the most conspicuous inflammatory reaction against the cysts. In conclusion, although these cows no longer displayed any visible signs of besnoitiosis, they remained infected. Therefore, cows without visible signs of disease may still be able to transmit the parasite.

Development and use of an indirect ELISA in an outbreak of bovine besnoitiosis in Spain

An indirect ELISA based on a soluble extract of Besnoitia besnoiti tachyzoites was developed and standardised. A set of positive and negative reference bovine sera were characterised using an immunofluorescence antibody test and Western blot. A cut-off with a relative index per cent of 8.1 was determined for equal sensitivity and specificity (100 per cent) by two-graph receiver operating characteristic analysis. Cross-reactions with other closely related Apicomplexan parasites were discarded. The standardised ELISA was then used during an outbreak of bovine besnoitiosis in a mountainous area of central Spain. The outbreak occurred in nine herds, and 358 animals that shared grazing lands during the summer season were affected. Clinical examination and blood sampling were carried out for all animals, and skin biopsies were obtained from animals with skin lesions. The confirmatory diagnosis was carried out by means of the indirect ELISA, together with the identification of tissue cysts by microscopy. Most of the animals were seropositive (90.5 per cent), but only 43 per cent of seropositive cattle developed clinical signs compatible with besnoitiosis. Additionally, a significant increase in seroprevalence and clinical signs was found to be associated with the increasing age of the animals, suggesting rapid horizontal transmission of the disease.

Retrograde atrial kick in acute aortic regurgitation. Study of mitral and pulmonary venous flow velocities by transthoracic and transesophageal echocardiography

BACKGROUND AND HYPOTHESIS

The purpose of this study was the comprehensive evaluation of the changes in pulmonary venous and mitral flow velocities of patients with acute and chronic severe aortic regurgitation. Transmitral flow velocities obtained with pulsed-wave Doppler echocardiography have been used to provide information on left ventricular (LV) filling and diastolic function. Pulmonary venous flow tracings are an important adjunct to LV inflow pattern in assessing LV diastolic function.

METHODS

Fourteen patients with severe aortic regurgitation (8 chronic and 6 acute) and in sinus rhythm were examined by transthoracic and transesophageal pulsed Doppler echocardiography. Mitral and pulmonary flow velocities were recorded and compared. All patients had ejection fractions > 40%.

RESULTS

Early mitral flow peak velocity was higher in patients with acute regurgitation (p < 0.001). The mitral A wave was absent in five patients with acute regurgitation. In contrast, a prominent reverse atrial pulmonary systolic wave AR was demonstrated in these patients. Peak diastolic velocity of the pulmonary venous flow was greater in patients with acute aortic regurgitation (0.76 +/- 0.13) than in patients with chronic aortic regurgitation (0.40 +/- 0.09) (p < 0.001). Peak systolic velocity did not differ significantly between the two groups. The systolic fraction of pulmonary venous flow in patients with acute aortic regurgitation was lower (0.43 +/- 0.05) than that of patients with chronic regurgitation (0.63 +/- 0.1) (p < 0.01). All patients with acute aortic regurgitation had an S/D ratio < 1, while those with chronic regurgitation had an S/D > 1 (p < 0.001) and an E/A < 1.

CONCLUSION

Patients with severe acute aortic regurgitation showed a retrograde atrial kick (absence of transmitral A wave with prominent pulmonary AR wave). These patients had an S/D ratio < 1 (restrictive Doppler pattern). Patients with chronic aortic regurgitation exhibited a Doppler pattern of abnormal LV relaxation (E/A < 1, S/D > 1).

Heterologous prime-boost vaccination with a non-replicative vaccinia recombinant vector expressing LACK confers protection against canine visceral leishmaniasis with a predominant Th1-specific immune response

Leishmaniasis caused by Leishmania infantum is a severe endemic disease in the Mediterranean basin, being domestic dogs the main reservoir of the disease that plays a key role in the transmission to humans. Studies on vaccines against canine leishmaniasis, aimed to modify the T cell repertoire, have advanced in recent years. LACK vaccination assays, using protein or DNA vectors, show protection against cutaneous L. major infections by redirecting the early IL-4 responses to a protective Th1 response. The aim of this study was to define the effectiveness and type of immune response in a canine visceral leishmaniasis model of two poxvirus vectors (Western reserve strain, WR and modified vaccinia virus Ankara, MVA) expressing the LACK protein of L. infantum in prime/boost vaccination protocols. The results obtained showed that dog vaccination priming with DNA-LACK followed by a booster with MVA-LACK or rVV-LACK triggered a Th1 type of immune response, leading to protection against canine visceral leishmaniasis. This protection correlated with absence of visceral leishmaniasis symptoms, lower Leishmania-specific antibodies, higher degree of T cell activation in Leishmania-target organs and higher synthesis of Th1 cytokines. In addition, we found that dogs boosted with the non-replicative virus show less VL symptoms and higher degree of T cell activation, providing evidences for a clear advantage of MVA-LACK as a vaccination vector against canine visceral leishmaniasis.

Use of domperidone in the treatment of canine visceral leishmaniasis: a clinical trial

The aim of this study was to evaluate the effects of domperidone, a dopamine D2 receptor antagonist, in dogs naturally infected by Leishmania infantum. Ninety-eight dogs were treated with single-agent domperidone at 1mg/kg twice a day orally for 1 month. Clinical, serological, biochemical and immunological examinations were conducted for the following 12 months. Domperidone was effective in controlling and reducing clinical signs and antibody titre. Significant decreases in reciprocal serum antibodies were seen in 74.3% of the dogs with mild clinical signs and 40% of the dogs became seronegative. In dogs with several clinical signs and high antibody titres, clinical improvement occurred in 86% of animals and the reciprocal serum antibody titres decreased in 38% of these dogs. A significant increase was noted in the immune cellular status, as measured by the leishmanin skin test and a lymphocyte proliferation assay.

Development and validation of a new Spanish instrument to measure health-related quality of life in patients with allergic rhinitis: the ESPRINT questionnaire

OBJECTIVES

To develop and validate an instrument to measure health-related quality of life (HRQOL) specific to patients with allergic rhinitis (AR) and primarily for use in Spanish and Spanish-speaking populations.

METHODS

An initial item pool was generated from literature review, focus groups with AR patients, and consultations with clinical experts. Item reduction was performed using clinimetric and psychometric approaches after administration of the item pool to 400 AR patients. The resulting instrument's internal consistency, test-retest (2-4 weeks) reliability, known groups and convergent validity, and sensitivity to change were tested in a longitudinal, observational, multicenter study in 210 AR patients who also completed the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ).

RESULTS

The new questionnaire took a mean (SD) of 7.1 (5.4) minutes to answer. Floor and ceiling effects were less than 15% on all dimensions. Cronbach's alpha values and intraclass correlation coefficient values for six of the sevendimensions and the overall score exceeded 0.70. Statistically significant differences (P < 0.01) were observed on all ESPRINT-28 dimensions and the overall score between patients with mild (mean overall score 1.97, SD 0.99), moderate (mean overall score 2.78, SD 0.88), and severe AR (mean overall score 3.89, SD 0.87). Patients with persistent AR had worse scores (P < 0.05) on all dimensions than patients with intermittent AR. Correlations between the ESPRINT-28 and the RQLQ were generally as expected. Effect sizes for score changes between the two study visits ranged from 0.96 to 1.76 for individual dimensions and the overall score.

CONCLUSIONS

This new, Spanish-developed instrument to measure HRQOL in AR patients has shown good reliability, validity, and sensitivity to change. It has also proved easy to use and administer.

Fleas parasitizing domestic dogs in Spain

In addition to their importance to veterinary clinical practice as ectoparasites, fleas of domestic dogs are of special concern because they can be vectors of disease, including zoonoses. Flea assemblages parasitizing domestic dogs usually comprise several flea species whose distribution is determined by factors acting at several scales. Knowledge of these factors will aid in assessment of the distribution patterns of flea parasitism, and is an important tool in developing control strategies and in evaluation of flea-borne disease risk in dogs and humans. In this survey we used data from 744 domestic dogs from 79 localities in Spain to explore the associations between the abundance of flea species, host-dependent factors (sex and age), and host habitat factors including abode (farm, house with garden, apartment), location (urban or rural), the presence of other pets, and dog activity (measured as the frequency with which dogs left their abode). We also considered environmental factors including the time of year and mean annual temperature and rainfall. Variations in flea community structure at infracommunity and component community levels were also explored. Four flea species were found parasitizing dogs. Ctenocephalides felis was the most abundant (88.02% of fleas identified), followed by Ctenocephalides canis (10.38%), Pulex irritans (1.47%) and Echidnophaga gallinacea (0.13%). Overall flea abundance was higher on dogs living on farms than in apartments, as was the abundance of Ct. felis, Ct. canis and P. irritans. Ct. felis was more abundant on dogs living in houses than in apartments, but the reverse was found for P. irritans. Overall flea abundance and Ct. canis abundance were highest in rural areas, whereas the presence of other pets sharing the abode was associated with higher overall flea abundance and Ct. felis abundance. Only P. irritans abundance was positively related to the activity of dogs. Ct. canis and P. irritans abundances were higher during the warm period of the year. Mean annual temperature was negatively correlated with overall, Ct. canis and P. irritans abundances, but positively related to Ct. felis abundance. Annual rainfall was negatively correlated with Ct. canis and P. irritans abundances. Variations in the number of flea species found on a dog reflected the abundance distribution patterns for each species and their associations with host habitat and environmental factors. At the component community level, flea species richness was inversely related to annual mean temperature. The structure of flea assemblages on dogs was mainly associated with host habitat and environmental variables, and not with host-dependent variables. However, a large amount of variation in flea abundance remained unexplained, suggesting the effect of other non-controlled factors.

Isolation and development of haematopoietic progenitor cells from peripheral blood of adult and newborn pigs

Pluripotent stem cells (PSCs), already described in human beings, are fibroblast-like cells that exhibit a CD34 marker specific for haematopoietic stem cells. In this work we have demonstrated the presence of PSCs in the peripheral blood of pigs, a species frequently used in transplantation studies as an animal model for human diseases. Differentiation into haematopoietic colonies (granulomacrophagic colonies, erythroid colonies and mixed colonies) has been carried out with the peripheral blood of adult and newborn pigs, using solely human commercial media. Peripheral blood mononuclear cells (PBMNCs) were cultured in semisolid methylcellulose based media enriched with recombinant human cytokines, achieving granulomacrophagic-colony forming unit (GM-CFU) and mixed-colony forming unit (Mix-CFU) growth with erythroblastic lineage proliferation in the presence of erythropoietin (Epo). In all the samples CFU growth was associated with the presence of recombinant human cytokine. No evidence of proliferation in control plates without cytokines was found. From liquid medium culture, a population of macrophages and CD34+ fibroblast like cells were retrieved 21 days after sowing. These findings allow us to think about the direct application of this simple and standardised method in several work fields such as the study of pharmacological effects of many drugs over the haematopoietic line and in the study of new strategies in cellular therapy for some human diseases.

Kinetics ofOestrus ovisinfection and activity of adult flies

Oestrus Ovis is a common sheep parasite in the Mediterranean region. This study was carried out in the Ebro River Valley near Zaragoza (northeast Spain) using tracer animals to describe the seasons when infestation is more likely. Based on that information and an analysis of the evolution of the parasite within the host, we suggest the most appropriate time for treatment. Adult instars appeared in May until November and there was a diapause beginning in October-November and as least until February, so it is suggested than sheep be treated with larvicide in December.

Rupatadine 10 mg and ebastine 10 mg in seasonal allergic rhinitis: a comparison study

BACKGROUND

The aim of this study is to establish the efficacy and safety of rupatadine vs ebastine and placebo in the treatment of seasonal allergic rhinitis (SAR). Rupatadine is a new second generation H(1)-antihistamine with once-daily dosing that may provide better control of symptoms than the currently used H(1)-receptor blockers because of its dual pharmacological profile (anti-PAF and anti-H(1)).

METHODS

In a multicentre study, 250 patients with SAR were included in a double-blind, randomized, parallel-group and placebo-controlled study. Patients received either rupatadine 10 mg, ebastine 10 mg or placebo once daily for 2 weeks. The main efficacy outcome was based on the patient's record of severity of nasal symptoms (sneezing, nasal itching, runny nose and nasal obstruction) and nonnasal symptoms (conjunctival itching, tearing and pharyngeal itching). The daily total symptom score (DTSS) was the mean of the DSS recorded for each of the seven symptoms assessed, and the mean DTSS (mDTSS) was the mean of the DTSS values for each study day.

RESULTS

Significant differences in mDTSS were detected between rupatadine and placebo (33% lower for rupatadine group; P = 0.005) after 2 weeks of treatment. The TSS for rupatadine were 22% lower than for ebastine, although the differences were not statistically significant. No serious adverse events were reported during the study period.

CONCLUSIONS

Rupatadine 10 mg once daily was clearly superior to placebo in alleviating the symptoms of SAR over a 2-week period. In comparison with ebastine, rupatadine shows a trend towards a better profile as regard several secondary efficacy variables.

Ten-year viability study on natural populations of Drosophila sibling species from Laguna Verde, Veracruz, México

The generation of electricity in nuclear power plants produces an increase in background radiation that could possibly have some impact on the organisms that live in that area. In order to identify and quantify any such possible effect, the natural populations of two sibling species, D. melanogaster and D. simulans, that live in the immediate vicinity of the first Mexican Nuclear Power Plant were analyzed for a period of 10 years. Collections of flies were made at two sites, one close to and one farther from the power plant, during the pre and operational stages of the reactor, and their egg-to-adult viability was analyzed. The data obtained indicate that in both sites, the egg-to-adult viability was generally higher in D. melanogaster than in D. simulans. Further, a relationship was found between egg-to-adult viability and the season of the year (warm-wet or cool-dry season). Some differences were found between the two sites. It may be concluded that there is no negative impact on the Drosophila populations studied.

Modified direct agglutination test for simplified serologic diagnosis of leishmaniasis

Human leishmaniasis is a severe health problem in many countries around the world. Hence, a cheap, reliable, and accurate diagnostic test is required to fight this disease. Perhaps the direct agglutination test (DAT) meets these criteria, but antigen elaboration involves many difficulties. We have developed a new antigen elaboration method, the EasyDAT method, that avoids the problems associated with the DAT. In this study, we compared the traditional DAT antigen method with our EasyDAT antigen method by using canine sera. The sensitivities (100%) and specificities (98.7%) were the same for both methods; we therefore concluded that the EasyDAT Leishmania antigen method simplifies serologic diagnosis, making this method easier and cheaper to use.

Lactating females Syrian hamster (Mesocricetus auratus) show protection against experimental Leishmania infantum infection

The Syrian hamster (Mesocricetus auratus) is the best animal model for human leishmaniosis, an emergent disease that causes 400,000 new cases every year. The main objective of this assay was to prove the relationship between female lactation, which implies hyperprolactinaemia (IFN-gamma, IL-12, IL-2 and TNF-alpha elevated), and leishmaniosis (IFN-gamma, IL-12, IL-2 and TNF-alpha diminished). The results demonstrate the clear implication of lactation in immune response. The infected lactating females did not show any symptoms of sickness, a 24 g mean increase was noticed, throughout the assay they were negative in the indirect diagnosis test (Direct Agglutination Test (DAT)), and in the direct diagnosis tests (N-N-N isolation, tissue impressions).

Histochemical differentiation of Dirofilaria immitis, Dirofilaria repens and Acanthocheilonema dracunculoides microfilariae by staining with a commercial kit, Leucognost-SP

The diagnosis of canine heartworm infection is based upon the presence of circulating Dirofilaria immitis microfilariae or on techniques for the detection of serum antibodies or antigens. In the first of these, discrimination between D. immitis, D. repens and Acanthocheilonema dracunculoides microfilariae is based upon the acid phosphatase histochemical stain. In this paper, we propose an alternative technique for histochemical staining using a commercial kit test of naphthol-AS-OL (Leucognost-SP). This offers the advantages of speed and simplicity as compared to the standard Barka procedure.

[Diagnosis of apical hypertrophic cardiomyopathy using contrast echocardiography]

Apical hypertrophic cardiomyopathy is a disease with clear electrocardiographic and echocardiographic characteristics. However, poor visualization of apical endocardial border is a limiting factor to diagnose apical hypertrophic cardiomyopathy by echocardiography. We present a case report of a patient with a characteristic electrocardiogram but poor apical endocardial border delineation. A contrast-enhanced echocardiography was performed to confirm the diagnosis of apical hypertrophic cardiomyopathy. We discuss the role of echocardiographic image enhancement with contrast to diagnose apical hypertrophic cardiomyopathy.

Structure, organization and characterization of the gene cluster involved in the production of microcin E492, a channel-forming bacteriocin

Microcin E492 is a low-molecular-weight, channel-forming bacteriocin produced and excreted by Klebsiella pneumoniae RYC492. A 13 kb chromosomal DNA fragment from K. pneumoniae RYC492 was sequenced, and it was demonstrated by random Tn5 mutagenesis that most of this segment, which has at least 10 cistrons, is needed for the production of active microcin and its immunity protein. Genes mceG and mceH correspond to an ABC exporter and its accessory protein, respectively, and they are closely related to the colicin V ABC export system. The microcin E492 system also requires the product of gene mceF as an additional factor for export. Despite the fact that this bacteriocin lacks post-translational modifications, genes mceC, mceI and mceJ are needed for the production of active microcin. Genes mceC and mceI are homologous to a glycosyl transferase and acyltransferase, respectively, whereas mceJ has no known homologue. Mutants in these three genes secrete an inactive form of microcin, able to form ion channels in a phospholipidic bilayer, indicating that the mutation of these microcin genes does not alter the process of membrane insertion. On the other hand, microcin isolated from mutants in genes mceC and mceJ has a lethal effect when incubated with spheroplasts of sensitive cells, indicating that the microcin defects in these mutants are likely to alter receptor recognition at the outer membrane. A model for synthesis and export is proposed as well as a novel maturation pathway that would involve conformational changes to explain the production of active microcin E492.

Seasonal abundance of fleas (Siphonaptera: Pulicidae, Ceratophyllidae) on wild rabbits in a semiarid area of northeastern Spain

This paper reports the annual dynamics of wild rabbit fleas in a study site located in the Middle Ebro Valley, northeastern Spain. Fleas collected directly from wild rabbits included the species Spilopsyllus cuniculi (Dale), Xenopsylla cunicularis (Smit), Echidnophaga iberica (Ribeiro, Lucientes, Osácar, and Calvete), Caenopsylla laptevi (Beaucournu, Gil-Collado and Gilot), and Pulex irritans (L.). Monthly collections of adult and larval fleas made from within the first meter of selected burrow entrances also yielded fleas belonging to the same five species. Larval specimens of X. cunicularis, E. iberica, and C. laptevi were also found. Spilopsyllus cuniculi, a winter species that can only breed during the rabbit breeding season, was common on hosts from November to April. Xenopsylla cunicularis and E. iberica were summer species, whereas C. laptevi was abundant during the autumn and winter. Xenopsylla cunicularis and E. iberica larvae were found in burrows only during April and May, whereas those of C. laptevi were collected from October to January. The data suggested that X. cunicularis and E. iberica might diapause during the egg stage whereas C. laptevi diapauses during the pupal stage.

Canine leishmaniasis transmission: higher infectivity amongst naturally infected dogs to sand flies is associated with lower proportions of T helper cells

The dog is the main reservoir of Leishmania infantum, which is a parasite spread among canine hosts by the bite of sand flies. Phlebotomus perniciosus is the sand fly acting as a major vector in the Mediterranean basin. As a consequence, the dog will suffer from leishmaniasis. In this work the infective capacity of infected dogs, established by direct xenodiagnosis, has been investigated in relation to their immunological status by determining the lymphocyte percentages present in peripheral blood mononuclear cells. We found a significant association between the percentages of T helper cells (CD4/TcR alpha beta(+)and CD4/CD45RA(+)) and the infection rates detected in the vector, while significant association was not detected in the case of the T cytotoxic cells (CD8/TcR alpha beta(+)and CD8/CD45RA(+)). The relationship discovered was that the lower the CD4(+)T cell count, the higher the rate of the infection in the vector.

Experimental infection of Phlebotomus perniciosus and determination of the natural infection rates of Leishmania infantum in dogs

Direct xenodiagnosis has been used to determine the infection rates in sand flies of 12 dogs parasitized by Leishmania infantum and classified in function of clinical signs. The dogs were divided into three clinical groups and no statistically significant differences in the infection rates of female sand flies were observed among them. This result indicates the epidemiological importance of asymptomatic and oligosymptomatic dogs. Indirect xenodiagnosis uses sand flies fed on the blood of dogs ex vivo. This technique was not found to be useful as an alternative to the direct method for the detection of dogs parasitized by L. infantum. The clinical worsening of the disease was not reflected in the increasing number of parasites detected in the animals' blood by the indirect technique, thereby rejecting its utility as an indicator of the prognosis of the disease.

Preparation and characterization of albendazole beta-cyclodextrin complexes

Albendazole (ABZ), mebendazole (MBZ), and ricobendazole (RBZ) are low-soluble anthelmintic benzimidazole carbamate drugs. To increase their aqueous solubility, three different types of beta-cyclodextrins (CyDs): beta-cyclodextrin (CD), hydroxypropyl-beta-cyclodextrin (HPCD), and methyl-beta-cyclodextrin (MCD) were used. Solubility depended on the type of CyDs. Increased solubility was obtained when the more substituted CyDs (HPCD or MCD) were used instead of nonsubstituted CD. Stability constants were calculated assuming a 1:1 stoichiometry. Calculated stability constant values depended on initial solubility of drug and pH of the medium. Solid ABZ complexes were prepared by coprecipitation and freeze-drying methods. These products were compared with physical mixtures of ABZ and CyDs. The characterization of these products was made by differential scanning calorimetry (DSC) and drug release studies. True inclusion complexes were obtained only by the freeze-drying method. Drug release studies showed that the freeze-dried inclusion complexes increased the solubility rate of ABZ, although a supersaturation effect was observed when drug release studies were performed in nonsink conditions. A bioavailability study on mice was done with a formulation of ABZ:HPCD complex and was compared to a conventional ABZ suspension. A significantly (p < .05) shorter Tmax of absorption was obtained by using the complex formulation. Greater and significant (p < .05) differences for AUC and Cmax were observed.

Two cases of feline visceral and cutaneous leishmaniosis in Spain

This paper describes clinical signs and lesions in two cases of leishmaniosis--one visceral and one cutaneous in the cat (Felis catus domesticus). The diagnosis was achieved by a combination of serology, light and electron microscopic studies. The vague nature of the clinical signs observed in both cases was particularly striking, and clinical features were similar to many other diseases commonly found in cats. Therefore, the use of various investigations to detect leishmaniosis (serum chemistry, serology and histopathology) is highly recommended in cases where clinical signs do not respond to conventional treatment.

Selection of the optimal stress test for the diagnosis of coronary artery disease

OBJECTIVE

To compare the value and limitations of exercise testing, dipyridamole echocardiography, dobutamine-atropine echocardiography, and MIBI-SPECT (technetium-99m methoxyisobutyl nitrile single photon emission computed tomography) during dobutamine infusion in the diagnosis of coronary artery disease.

DESIGN

The performance of these four tests was assessed in random order on a consecutive cohort of patients. The presence or absence of coronary artery disease was confirmed by coronary angiography.

SETTING

Two tertiary care and university centres.

PATIENTS

102 consecutive patients with chest pain and no previous history of coronary artery disease. Ten patients with left bundle branch block were excluded for further analysis of exercise testing and scintigraphy results.

RESULTS

MIBI-SPECT was the most sensitive (87%) but the least specific test (70%). Exercise stress testing had a sensitivity of 66%, which increased to 80% when patients with inconclusive results were excluded. Dipyridamole and dobutamine echocardiography had similar sensitivity (81%, 78%) and specificity (94%, 88%). All four tests had similar accuracy and positive and negative predictive values. Agreement between the echocardiographic techniques was excellent (detection of coronary artery disease 87%, kappa = 0.72; regional analysis 93%, kappa = 0.72; diagnosis of the "culprit" vessel 95%, kappa = 0.92), and it was good between echocardiographic techniques and MIBI-SPECT (diagnosis of the culprit vessel 90%, kappa = 0.84 with dobutamine and 92%, kappa = 0.85 with dipyridamole).

CONCLUSIONS

Exercise stress testing has a sensitivity comparable to other tests in patients capable of exercising and with no basal electrical abnormalities. The greatest sensitivity is offered by MIBI-SPECT and the greatest specificity is obtained with stress echocardiography. Redundant information is obtained with dipyridamole echocardiography, dobutamine echocardiography, and MIBI-SPECT.

[Subarachnoid hemorrhage: electrocardiographic, left ventricular wall motion abnormalities and mortality analysis in 14 cases]

BACKGROUND

Electrocardiographic (ECG) changes have been frequently observed in patients with subarachnoid hemorrhage (SAH). Their association with wall motion abnormalities of the left ventricle (LV) have not been well established.

PATIENTS AND METHODS

Sixteen patients with SAH were included; 2 patients with previous history of heart disease were subsequently excluded. We studied the neurological damage (Hunt-Hess grading scale), ECG (ST segment, T wave) and echocardiography (LV regional and global contractility) of 14 patients.

RESULTS

The ECG was abnormal in 11 patients (T wave: 6 patients; ST segment: 5 patients). Echocardiography showed alterations in 5 patients, all of them with ECG changes (T wave: one patient; ST segment: 4 patients). The neurological lesion was higher in patients with abnormal echocardiogram (Hunt-Hess mean grade: 4.6 vs 2.7 in patients with normal echocardiogram; p < 0.001). An intravenous infusion of dobutamine in a 23 years old male, improved the LV ejection fraction, which was severely depressed at baseline. Mortality, in all cases secondary to the neurological damage, was higher in patients with abnormal ECG (91% vs 0% in patients with normal ECG; p = 0.01) and when the echocardiogram showed alterations although in the last case no statistical differences were found.

CONCLUSIONS

Echocardiography abnormalities in patients with SAH and without previous history of heart disease are more frequently related to ECG changes affecting ST segment, and to a higher cerebral damage.

[Ellis-van Creveld syndrome: an easy early diagnosis?]

Ellis-Van Creveld syndrome is a rare chondroectodermal dysplasia. Congenital heart disease is present in more than one-half of cases. The majority are partial atrioventricular septal defects and affect the atrial septum. Although isolated cases of the syndrome are uncommon, an early diagnosis is made in most of the patients because of their cardinal manifestations. The cases of two gypsy brothers with Ellis-Van Creveld syndrome and congenital heart disease (ostium primum atrial septal defect and single atrium), diagnosed during adulthood, are presented.

Prevalence and relevance of a septal diastolic notch during dobutamine stress echocardiography

BACKGROUND

Dobutamine stress echocardiography has become an accepted simple and inexpensive method of detecting coronary artery disease. In this pharmacological stress test, particular attention has been paid to transient systolic wall motion abnormalities. Our group has noted an abnormal diastolic ventricular septal motion, a 'diastolic notch', during dobutamine stress echocardiography that has not been previously described.

METHODS AND RESULTS

To find out whether this anomalous septal motion is related to coronary artery disease we have analysed the stress studies of 125 patients (69 men, age 61 +/- 9 years) with chest pain, no previous myocardial infarction and no left bundle branch block, who underwent a dobutamine stress test. Dobutamine was infused up to 40 mu.kg.l-1 min-1 in 3 min stages. A positive stress test was defined as the appearance of transient asynergy. Dobutamine time was the time from the infusion of dobutamine to the appearance of transient asynergy. The diastolic notch time was the time at which diastolic notch was first detected. Diastolic notch was detected in 21 patients with single coronary artery disease, 19 of whom had a severe left anterior descending artery stenosis. Diastolic notch was present in 19 out of 27 patients (70%) with single left anterior descending stenosis. Twenty-six out of 44 patients with multivessel coronary artery disease had evidence of a diastolic notch and 20 of these 26 had severe stenosis of the left anterior descending artery. Finally, all three patients with left main coronary artery disease had a diastolic notch while no patient with angiographically normal coronary arteries had this sign. In patients with a diastolic notch and a positive dobutamine stress test, diastolic notch time was shorter than dobutamine time (9 +/- 4 min vs 11 +/- 3 min, P < 0.05).

CONCLUSIONS

In patients without previous myocardial infarction and without left bundle branch block (1) the appearance of a septal diastolic notch during dobutamine stress echocardiography is very specific for the presence of coronary artery disease; (2) the detection of diastolic notch is mostly related to the existence of severe left anterior descending artery stenosis; (3) diastolic notch precedes the development of ventricular asynergy.

[MIBI-echocardiography with dobutamine: Significance of changes of contractility in patients with changes in perfusion]

BACKGROUND AND OBJECTIVES

In the presence of coronary artery disease and with an appropriate stressor, perfusion defects precede contractility abnormalities. Perfusion defects without contractility abnormalities may be due to the absence of ischemia or mild ischemia. Our purpose has been to compare the clinical characteristics, hemodynamic response and severity of perfusion defects in patients with coronary artery disease and perfusion defects with and without wall motion abnormalities during dobutamine infusion.

PATIENTS AND METHODS

Eighty two patients with significant coronary artery disease demonstrated by angiography without previous myocardial infarction underwent dobutamine infusion (up to 40 mg/kg/min). Atropine was given when necessary. Stress scientigraphic MIBI-SPECT images were acquired 1 hour after peak stress and rest studies were obtained 24 hours after stress testing. The perfusion score was calculated by dividing the total uptake score between the number of segments affected.

RESULTS

Among the 73 patients with perfusion defects, stress echocardiography was positive in 59 (Group A) and was negative in the remaining 14 (Group B). There were more hypertensive patients in Group A (33 vs 4; p = 0.04). There was no significant difference between the two groups with respect to other clinical characteristics. The peak rate-pressure product was similar in both groups (18.520 +/- 5.691 vs 18.680 +/- 5.329; p = NS). The development of electric abnormalities and angina was more common in Group A (42 vs 3, p < 0.001 and 33 vs 1; p < 0.001). Perfusion defects were not more extensive in Group A (abnormal segments 2.15 vs 2.21; p = NS) but they were more severe (segments with severe uptake reduction or no uptake 1.10 vs 0.28; p < 0.05; perfusion score 2.62 vs 2.21; p < 0.05).

CONCLUSION

In patients with severe coronary artery disease and perfusion defects during dobutamine-MIBI-SPECT, the presence of wall motion abnormalities defines patients with more severe perfusion defects.

Gastrointestinal helminth parasites in stray cats from the mid-Ebro Valley, Spain

Gastrointestinal helminths were collected from 58 necropsied stray cats (Felis catus) in the mid-Ebro Valley, North-East Spain, from December 1989 to March 1992. The prevalence was 89.7%, with those of individual parasites being Toxocara cati 55.2%C, Ancylostoma tubaeforme 29.3% Joyeuxiella pasqualei 55.2%, Diplopylidium acanthotetra 20.7%, Dipylidium caninum 20.7%, Mesocestoides spp. 13.8%, Taenia taeniformis 8.6% and Diplopylidium nölleri 8.6%. In relation to sex, the differences were not significant. However, the season of the year significantly affected the prevalence of A. tubaeforme and D. acanthotetra.

Efficacy of orally administered invermectin against larval stages of Oestrus ovis in sheep

The efficacy of ivermectin administered orally at a dosage rate of 0.2 mg/kg liveweight against naturally acquired larval infestations of Oestrus ovis in sheep was 100% in a field trial. Ten sheep were free from infestation by first, second and third instar larvae of O. ovis 12 days post treatment, whereas 10 control sheep harboured 37.7 larvae on average, most of them first stage.

[Elective noninvasive test in the diagnosis of coronary disease in the aged]

BACKGROUND AND PURPOSE

The purpose of this study was to determine the best noninvasive test to diagnose coronary artery disease in the elderly. PATTERNS AND METHODS: We conducted a study on 56 elderly patients (> 65 years) with chest pain and no previous history of coronary artery disease. They underwent exercise stress test, dipyridamole echocardiography (0.84 mg/kg), dobutamine echocardiography (up to a total dose of 40 microgram/kg/min and atropine when it was necessary), dobutamine MIBI-SPECT and coronary angiography.

RESULTS

Angiography detected significant coronary artery disease in 41 patients. All tests used in this study had a similar sensitivity (conclusive exercise stress test 87%, dipyridamole echocardiography 83%, dobutamine echocardiography 80% and MIBI-SPECT 87%; p = NS). Coronary angiography did not identify significant lesions in 15 patients. Specificity of conclusive exercise stress test, dipyridamole and dobutamine echocardiography was similar (75%, 100% and 93% respectively; p = NS). However, the specificity of stress echocardiography was higher than that of scintigraphy (100% vs 66%; p = 0.02 for dipyridamole echocardiography and 93% vs 66%; p = 0.07 for dobutamine echocardiography). Diagnostic accuracy of each test was similar.

CONCLUSIONS

Exercise stress test remains the non invasive diagnostic test of choice to detect coronary disease in the elderly. If this test is inconclusive, both stress echocardiography and isotopic studies are useful, although the specificity of stress echocardiography is higher than that of scintigraphy.

The prevalence of proliferative kidney disease from the kidney and muscle of rainbow and brown trout in Aragón (Spain)

The prevalence and parasite density of PKX (the unknown myxosporean that causes proliferative kidney disease [PKD] of salmonids) were investigated in eight fishfarms in Aragón, Spain. Tissue sections stained with the biotynilated lectin GS-I revealed the presence of this protozoan in only one of the farms. In rainbow trout, the renal prevalence and parasite density peaked in July, but in brown trout the maximum renal prevalence and maximum renal parasite density were reached in May and in July, respectively. In rainbow trout, after the acute phase of the disease, the number of PKX decreases in the kidney but increases in the muscle. In this species of fish, the prevalence and parasite density are much higher in the muscles than in the kidney in October.

Natural history and serial morphology of aortic intramural hematoma: a novel variant of aortic dissection

BACKGROUND

Acute aortic dissection is a cardiovascular emergency that requires prompt diagnosis and treatment. Transesophageal echocardiography is the current standard diagnostic imaging modality in many medical centers. Aortic intramural hematoma is a variant of aortic dissection whose natural history and prognosis have not been well studied. We performed transesophageal echocardiography in patients with aortic intramural hematoma to determine the echocardiographic characteristics and echocardiographic evolution of this lesion, impact on patient management, and patient outcome.

METHODS AND RESULTS

Twenty-one consecutive patients with aortic intramural hematoma confirmed anatomically (four patients) or with an additional diagnostic imaging technique (17 patients) underwent a transesophageal echocardiographic examination. Fifteen patients with longstanding hypertension had chest or back pain, and the intramural hematoma was visualized in the ascending aorta (n = 4), along the whole aorta (n = 4), in the descending aorta (n = 6), or in the aortic arch (n = 1). The thickening of the aortic wall was crescentic. Patients with ascending aortic intramural hematoma had the following results: two patients died suddenly, three patients underwent surgery because of increased aortic wall thickening (one patient) or secondary intimal tear (two patients), and the remaining three patients had regression of the hematoma. Patients with hematoma confined to the descending aorta and the patient with aortic arch involvement (n = 7) had a different result: one patient died from aortic rupture and the remaining six patients did well. Six patients had a traumatic aortic injury, and the intramural hematoma was located along the descending thoracic aorta. The thickening of the aortic wall was circular in five patients and crescentic in one. Three of these patients had normalized thickness of the aortic wall on follow-up transesophageal echocardiographic studies. The other three patients died from multiorgan system failure. Aortography showed a reduction of the diameter of the aortic lumen in four patients; diameter in the remaining 17 patients was normal.

CONCLUSIONS

Aortic intramural hematoma can be detected and monitored by transesophageal echocardiography but not by aortography. Two types of aortic intramural hematoma can be distinguished: (1) traumatic of good prognosis and (2) nontraumatic, which can be an early stage of the classic aortic dissection, with bad prognosis in cases involving the ascending aorta.

Right ventricular asynergy during dobutamine-atropine echocardiography

OBJECTIVES

We sought to analyze right ventricular contractility during dobutamine infusion in patients with right coronary artery disease and to elucidate whether the development of right ventricular asynergy aids in characterizing a right coronary artery stenosis.

BACKGROUND

Clinical investigations are emphasizing the importance of right ventricular function in patients with coronary artery disease. Thus, prognosis of patients with inferior myocardial infarction is influenced by right ventricular function. This study describes the echocardiographic and electrocardiographic findings during dobutamine-atropine echocardiography in patients with right coronary artery disease.

METHODS

We studied 31 patients with isolated right coronary artery disease and no previous myocardial infarction. Six patients with poor acoustic window were excluded (feasibility 80%). The remaining 25 patients underwent dobutamine-atropine echocardiography. A right coronary artery stenosis located before the origin of the right ventricular branches was considered proximal; otherwise, it was considered distal.

RESULTS

Right ventricular asynergy during dobutamine-atropine testing developed in 17 patients (sensitivity 68%); 14 had proximal and 3 had distal right coronary artery disease. The following segments were involved: inferior (n = 17), lateral (n = 5) and outflow tract (n = 1). No patient showed anterior asynergy. All 17 patients had left ventricular asynergy as well. Ischemia-free time was 10.7 +/- 6.2 (mean +/- SD) min for the right ventricle and 8.9 +/- 5.2 min for the left ventricle (p < 0.05). Ischemic ST changes were recorded in 15 patients (in standard leads in 14 and in right precordial leads in 8). All patients with right precordial changes showed ST elevation and had right ventricular asynergy (sensitivity and specificity for right ventricular asynergy 47% and 100%, respectively). A control group of 25 patients with no right coronary artery disease (5 with no disease, 15 with left anterior descending and 5 with left circumflex coronary artery disease) underwent dobutamine echocardiography. Right ventricular asynergy developed in two patients with left anterior descending artery stenosis (specificity 92%); in both, the anterior wall was affected.

CONCLUSIONS

Echocardiography during dobutamine infusion is a reliable technique for assessing right ventricular dysfunction in patients with right coronary artery disease. Right ventricular contractility can be assessed during dobutamine echocardiography in selected patients.

[A non-invasive test choice for the diagnosis of coronary disease in women]

BACKGROUND AND PURPOSE

Regarding coronary heart disease, women have often been excluded from clinical trials. Current practical recommendations are thus based on studies in men. To identify the non invasive technique of choice in detecting coronary artery disease in women, a study with different diagnostic tests has been undertaken.

METHODS

Exercise stress test, dipyridamole echocardiography (0.84 mg/kg), dobutamine echocardiography (up to a total dose of 40 micrograms/kg per minute and atropine if necessary), MIBI-SPECT during dobutamine infusion and coronary angiography, were performed in 40 consecutive women with chest pain and no previous history of coronary artery disease.

RESULTS

The four tests had similar sensitivity: exercise stress test (80%; CI 95%, 52-94), dipyridamole echocardiography (80%; CI 95%, 56-93), dobutamine echocardiography (80%; CI 95%, 56-93) and scintigraphy MIBI-SPECT (85%; CI 95%, 61-95). The specificity of dipyridamole echocardiography (100%; CI 95%, 83-100) and dobutamine echocardiography (90%; CI 95%, 67-98) was higher than that of exercise stress test (50%; CI 95%, 22-78) and MIBI-SPECT (65%; CI 95%, 41-84). The positive predictive values of dipyridamole and dobutamine echocardiography were 100% and 88% respectively.

CONCLUSIONS

The feasibility of exercise stress test in women is inferior to that of the other techniques. The sensitivity of the four tests to diagnose coronary artery disease is similar. The specificity of dipyridamole echocardiography and dobutamine echocardiography is higher than that of exercise stress test and MIBI-SPECT. Stress echocardiography can be considered the non invasive technique of choice for diagnosing coronary artery disease in women.

Short report: one case of nasal human myiasis caused by third stage instar larvae of Oestrus ovis

This is a report of a case of human nasal myiasis caused by third instar larvae of the sheep nasal bot fly, Oestrus ovis. Female flies rarely deposit first instar larvae in the eye, nostrils, and external auditory canal of humans, where they usually survive only a few days without further development. One human infestation by third instar larvae of O. ovis has been recorded in an patient infected with human immunodeficiency virus (HIV) in the United Kingdom. Our report describes a new case of nasal myiasis caused by the third instar larvae of the sheep bot fly in a patient without HIV or signs of any other disease.

Canine myiasis by sheep bot fly (Diptera:Oestridae)

We present a case of canine infestation by 3rd instars of Oestrus ovis (L.) in a 10-yr-old cross-bred dog (Collie x German Shepherd) from Fuerteventura, Canary Islands, Spain. This report confirms that this fly can develop in dogs.

Characterization of Spanish Trichinella isolates by random amplified polymorphic DNA (RAPD)

The random amplified polymorphic DNA (RAPD) assay was used to find molecular markers able to distinguish Trichinella spiralis from T. britovi, the two recognized Spanish Trichinella species. Fourteen Spanish Trichinella isolates, as well as reference Trichinella isolates representing the five species T. spiralis (T1), T. nativa (T2), T. britovi (T3), T. pseudospiralis (T4) and T. nelsoni (T7) and the three other taxa Trichinella T5, Trichinella T6 and Trichinella T8 of the genus, were characterized by RAPD using both purified and crude DNAs from infective muscle larvae (ML) and seven arbitrary primers. Three primers yielded diagnostic RAPD markers for the Spanish T. spiralis and T. britovi isolates as well as for the Trichinella reference isolates analysed, and in the case of crude DNAs the results were obtained in few hours. In addition, the species-specificity of the diagnostic RAPD markers from Spanish Trichinella isolates was studied by cross-hybridization assays. These assays confirmed that the selected diagnostic DNA fragments were not species-specific, but showed potential differences in the copy number among the examined Trichinella genetic clusters.

Dipyridamole and dobutamine-atropine stress echocardiography in the diagnosis of coronary artery disease. Comparison with exercise stress test, analysis of agreement, and impact of antianginal treatment

STUDY OBJECTIVES

To compare the usefulness of dipyridamole echocardiography, dobutamine-atropine echocardiography, and exercise stress testing in the diagnosis of coronary artery disease and to analyze the agreement among the tests.

DESIGN

Performance of these three tests in random order on a consecutive cohort of patients.

SETTING

A tertiary care and university center.

PATIENTS

One hundred two consecutive patients with chest pain and no history of coronary artery disease.

INTERVENTIONS

Dipyridamole echocardiography, dobutamine-atropine echocardiography, exercise stress testing, and coronary angiography.

MEASUREMENTS AND RESULTS

Dobutamine-atropine test was positive in 49 (77%) of 63 patients with coronary artery disease, dipyridamole test in 49 (77%), and exercise stress test in 44 (68%; p = NS). Both echocardiographic tests showed an overall specificity (dipyridamole, 97%; dobutamine, 95%) higher than exercise stress test (79%; p < 0.05). Sensitivity of dipyridamole testing decreased from 93 to 61% (p = 0.002) if patients were receiving antianginal treatment but sensitivity of dobutamine-atropine testing was not affected (77% in patients receiving and not receiving treatment). When results were considered as positive-negative, agreement between dipyridamole and dobutamine-atropine echocardiography was 85% (kappa = 0.70). With regards to regional analysis, concordance was good (93% for segments, kappa = 0.76; and 95% for coronary arteries, kappa = 0.92). Major complications were more frequent during dobutamine-atropine (n = 7) than during dipyridamole infusion (n = 2) (p = 0.06).

CONCLUSIONS

Dobutamine-atropine and dipyridamole echocardiography have a similar sensitivity and a higher specificity than that obtained by exercise ECG for the diagnosis of coronary artery disease. Similar information is obtained with dipyridamole and dobutamine-atropine echocardiography. It is our thought that pharmacologic stress echocardiography should be used as a first-step test to rule out coronary artery disease in patients not capable of exercising.

[Echocardiography with dobutamine in hypertensive patients with chest pain]

INTRODUCTION

The exercise stress test shows limited diagnostic accuracy for the detection of coronary artery disease in hypertensive patients. Echocardiography with dobutamine is a useful tool in the assessment of coronary artery disease.

PURPOSE

Our purpose has been to compare dobutamine stress echocardiography and exercise stress test for diagnosing coronary disease in hypertensive patients.

MATERIAL AND METHODS

Dobutamine stress echocardiography (administered up to 40 micrograms/kg/min, and atropine when necessary), exercise stress test and coronary arteriography were performed on 74 hypertensive patients with chest pain and no previous history of coronary artery disease.

RESULTS

Forty-eight (65%) patients underwent a diagnostic exercise stress test and 66 (89%) a diagnostic dobutamine stress echocardiography. Coronary artery disease (> or = 70% stenosis in, at least, one major vessel) was demonstrated in 28 (58%) patients who underwent a diagnostic exercise stress test, and in 39 (59%) patients who completed a dobutamine stress echocardiography. Sensitivity for exercise stress test was 82%, and 79% for dobutamine stress echocardiography (p = NS). Specificity was higher for dobutamine stress echocardiography (100% vs 60%; p < 0.005).

CONCLUSIONS

Dobutamine stress echocardiography has high sensitivity and specificity for the detection of coronary artery disease in hypertensive patients. Dobutamine stress echocardiography has higher feasibility and specificity than exercise stress test in this group of patients.