Association of serum uric acid with graft survival after kidney transplantation: a time-varying analysis

The association of serum uric acid (UA) with kidney transplant outcomes is uncertain. We examined the predictive value of UA during the first year posttransplant as a time-varying factor for graft survival after adjustment for time-dependent and independent confounding factors. Four hundred and eighty-eight renal allograft recipients transplanted from January 2004 to June 2006 and followed for 41.1 ± 17.7 months were included. Data on UA, estimated glomerular filtration rate (eGFR), tacrolimus level, mycophenolate mofetil (MMF) and prednisone doses, use of allopurinol, angiotensin-converting enzyme-inhibitor/angiotensin-receptor-blocker (ACEi/ARB) and diuretics at 1, 3, 6, 9 and 12 months were collected. Primary endpoint of the study was graft loss, defined as graft failure and death. Cox proportional hazard models and generalized estimating equations were used for analysis. UA level was associated with eGFR, gender, retransplantation, decease-donor organ, delayed graft function, diuretics, ACEi/ARB and MMF dose. After adjustment for these confounders, UA was independently associated with increased risk of graft loss (HR: 1.15, p = 0.003; 95% CI: 1.05-1.27). Interestingly, UA interacted with eGFR (HR: 0.996, p < 0.05; 95% CI: 0.993-0.999 for interaction term). Here, we report a significant association between serum UA during first year posttransplant and graft loss, after adjustment for corresponding values of time-varying variables including eGFR, immunosuppressive drug regimen and other confounding factors. Its negative impact seems to be worse with lower eGFR.

The detrimental effect of poor early graft function after laparoscopic live donor nephrectomy on graft outcomes

We undertook this study to assess the rate of poor early graft function (EGF) after laparoscopic live donor nephrectomy (lapNx) and to determine whether poor EGF is associated with diminished long-term graft survival. The study population consisted of 946 consecutive lapNx donors/recipient pairs at our center. Poor EGF was defined as receiving hemodialysis on postoperative day (POD) 1 through POD 7 (delayed graft function [DGF]) or serum creatinine >/= 3.0 mg/dL at POD 5 without need for hemodialysis (slow graft function [SGF]). The incidence of poor EGF was 16.3% (DGF 5.8%, SGF 10.5%), and it was stable in chronologic tertiles. Poor EGF was independently associated with worse death-censored graft survival (adjusted hazard ratio (HR) 2.15, 95% confidence interval (CI) 1.34-3.47, p = 0.001), worse overall graft survival (HR 1.62, 95% CI 1.10-2.37, p = 0.014), worse acute rejection-free survival (HR 2.75, 95% CI 1.92-3.94, p < 0.001) and worse 1-year renal function (p = 0.002). Even SGF independently predicted worse renal allograft survival (HR 2.54, 95% CI 1.44-4.44, p = 0.001). Risk factors for poor DGF included advanced donor age, high recipient BMI, sirolimus use and prolonged warm ischemia time. In conclusion, poor EGF following lapNx has a deleterious effect on long-term graft function and survival.

[Colonoscopic findings from a pilot screening study for colorectal cancer in Catalonia]

OBJECTIVE

to evaluate lesions detected in two screening rounds performed in a pilot screening programme for colorectal cancer in Catalonia, Spain.

MATERIAL AND METHODS

a colorectal cancer screening programme was initiated in 2000. The target population included men and women aged 50-69 years. Screening consisted of biennial guaiac-based fecal occult blood testing (FOBT), and colonoscopy for participants with a positive FOBT. Any polyps found were removed, and biopsies were performed for any masses.

RESULTS

colonoscopies were performed in 442 of 495 people with positive FOBT. In 213 (48.2%), 36 invasive cancers, 121 high-risk adenomas, 29 low-risk adenomas, and 27 hyperplastic polyps were diagnosed. Lesion size was smaller than 10 mm in 25.8% of cases. Most detected lesions (37.2%) were located in the distal colon, followed by the proximal colon (5.7%) and both locations (5.2%). Advanced neoplasm was significantly associated with male gender and distal location. The prevalence of advanced proximal neoplasms among patients with no distal polyps was 5.1%.

CONCLUSIONS

the most common lesions detected by colonoscopy were high-risk adenomas located in the distal colon. FOBT is a suitable method for detecting small precancer lesions during population screening, and is thus a key factor in reducing the incidence of colorectal cancer.

The influence of inadequate empirical antimicrobial treatment on patients with bloodstream infections in an intensive care unit

OBJECTIVE

To determine the occurrence of inadequate antimicrobial therapy among critically ill patients with bacteremia and the factors associated with it, to identify the microorganisms that received inadequate antimicrobial treatment, and to determine the relationship between inadequate treatment and patients outcome.

METHODS

From June 1995 to January 1999 we collected data on all clinically significant ICU-bacteremias in our teaching hospital. Clinical and microbiological characteristics were recorded and the adequacy of empirical antimicrobial treatment in each case was determined. We defined inappropriate empirical antimicrobial treatment as applying to infection that was not being effectively treated at the time the causative microorganism and its antibiotic susceptibility were known. Multivariate analysis was used to determine the variables associated with inappropriate empirical antimicrobial treatment and to evaluate the influence of this on the related mortality to bacteremia, using the SPSS package (9.0).

RESULTS

Among 166 intensive care unit patients with bacteremia, 39 (23.5%) received inadequate antimicrobial treatment. In this last group the mean age of patients was 64.1 +/- 13.2 years, and 64% were men. Bacteremia was hospital-acquired in 92% of these cases. Eleven percent developed septic shock and 37.7% severe sepsis, and ultimately fatal underlying disease was present in 28.2% of patients given inadequate empirical antimicrobial treatment. The main sources of bacteremias in this group were: a vascular catheter (15.3%), respiratory (7.6%) or unknown (53.8%). The microorganisms most frequently isolated in the group with inadequate empirical antimicrobial treatment were: coagulase-negative staphylococci (29.5%), Acinetobacter baumannii (27.3%), Enterococcus faecalis, Pseudomonas aeruginosa, Enterobacter cloacae, Proteus mirabilis, Escherichia coli, and Candida species (4.5% each). The frequency of coagulase-negative staphylococci in the cases with inappropriate treatment was higher than in the group with appropriate treatment (OR 2.62; 95% CI: 1.10-6.21; P = 0.015). The global mortality rate was 56% and the related mortality was 30% in the group with inadequate empirical antimicrobial treatment. The only factor associated with inappropriate empirical antibiotic treatment was the absence of abdominal or respiratory focus (P = 0.04; OR = 0.35; 95% CI: 0.12-0.97). Septic shock was related to attributable mortality (P = 0.03; OR = 3.19; 95% CI: 1.08-9.40), but not inappropriate empirical antibiotic treatment (P = 0.24; OR = 1.71; 95% CI: 0.66-4.78).

CONCLUSION

Almost a quarter of critically ill patients with bloodstream infections were given inadequate empirical antibiotic treatment, but mortality was not higher in the group with inadequate treatment than in the group with adequate treatment. This fact was probably due to microbiological factors and clinical features, such as the type of microorganism most frequently isolated and the source of the bacteremia.

Comparison of PCR mediated amplification of DNA and the classical methods for detection of Mycobacterium leprae in different types of clinical samples in leprosy patients and contacts

Traditional staining and microscopic examination techniques for the detection of Mycobacterium leprae, DNA amplification by polymerase chain reaction (PCR) of a 531-bp fragment of the M. leprae specific gene encoding the 36-kDa antigen, and serodiagnosis with M. leprae specific antigens (PGL-1 and D-BSA) were compared on different clinical specimens (serum samples, slit-skin smears, biopsies and swabs) from 60 leprosy patients attending the Sanatorium of Fontilles. Patients were divided into groups; (i) 20 multibacillary patients (MB) with positive bacteriological index (BI) by conventional methods and on WHO multidrug therapy (MDT); (ii) 30 MB patients with negative BI and completed minimum 2 years treatment MDT; (iii) 10 paucibacillary (PB) patients who had completed 6 months MDT at least 8 years ago. Control groups included four non-leprosy patients for PCR methods and 40 health control patients and 10 tuberculosis patients for serological methods. In the multibacillary BI positive group, there was a good correlation between all methods. All tests were negative in the paucibacillary group, although only a few patients were tested and all had been treated many years ago. One must be cautious concerning the diagnostic potential of these techniques in this type of leprosy. We also studied different combinations of leprosy diagnosis methods to determine the potential risk in a leprosy contact individuals group. The prevalence of antibodies to M. leprae antigens in serum was measured, together with the presence of M. leprae DNA in the nose and lepromin status in a group of 43 contacts of leprosy patients (12 household and 31 occupational) to evaluate the maintenance of infection reservoirs and transmission of the disease. Only two individuals were found to form a potential high risk group.

Serological response (Western blot) to fractions of Mycobacterium tuberculosis sonicate antigen in tuberculosis patients and contacts

OBJECTIVE

To assess the serological response to fractions of Mycobacterium tuberculosis sonicate antigen by Western blot analysis in patients with tuberculosis and contacts.

METHODS

We studied 71 individuals including 43 patients with active tuberculosis, 16 contacts and 12 healthy blood donors. For Western blot analysis, M. tuberculosis (H37Rv strain) sonicate antigen extract was fractionated by electrophoresis on polyacrylamide gel (SDS-PAGE).

RESULTS

We obtained antibody responses directed against four antigenic fractions with molecular weights of 71, 65, 26-38 and 19 kDa. Sixty per cent of pleural tuberculosis and 52.4% of smear-positive pulmonary tuberculosis had whole responses against all four fractions; there were no partial responses in these groups. For patients with smear-negative pulmonary tuberculosis whole responses were 17.6% and partial responses 41.2%. All contacts whose tuberculin tests converted from negative to positive (three cases) reacted exclusively against the 19 kDa fraction.

CONCLUSIONS

Western blot-positive results in patients with pleural and smear-positive pulmonary tuberculosis were characterised by a whole pattern against all four antigenic fractions, whereas patients with smear-negative pulmonary tuberculosis showed heterogeneous results. The exclusive response against the 19 kDa fraction observed in contacts with tuberculin conversion could help to identify candidates for preventive therapy.

A comparison of recipient renal outcomes with laparoscopic versus open live donor nephrectomy

BACKGROUND

Laparoscopic donor nephrectomy (laparoNx) has the potential to increase living kidney donation rates by reducing the pain and suffering of the donor. However, renal function outcomes of a large series of recipients of laparoNx have not been studied.

METHODS

We retrospectively reviewed the records of 132 recipients of laparoNx done at our center between 3/96 and 11/97 and compared them to 99 recipients of kidneys procured by the open technique (openNx) done between 10/93 and 3/96.

RESULTS

Significantly more patients in the laparoNx group (25.2%) were taking tacrolimus within the first month than those in the openNx group (2.1%). Mean serum creatinine was higher in laparoNx compared with openNx at 1 week (2.8+/-0.3 and 1.8+/-0.2 mg/dl, respectively; P=0.005) and at 1 month (2.0+/-0.1 and 1.6+/-0.1 mg/dl, P=0.05) after transplant. However, by 3 and 6 months, the mean serum creatinine was similar in the two groups (1.7+/-0.1 versus 1.5+/-0.05 mg/dl, and 1.7+/-0.1 versus 1.7+/-0.1, respectively). By 1 year posttransplant, the mean serum creatinine for laparoNx was actually less than that for openNx (1.4+/-0.1 and 1.7+/-0.1 mg/dl, P=0.03). Although patients in the laparoNx compared to the openNx group were more likely to have delayed graft function (7.6 versus 2.0%) and ureteral complications (4.5 versus 1.0%), the rate of other complications, as well as hospital length of stay, patient and graft survival rates were similar in the two groups.

CONCLUSION

Although laparoNx allografts have slower initial function compared with openNx, there was no significant difference in longer term renal function.

Analytical characterization of madeira wine

For a correct characterization of Madeira wine commercially available in the market, 52 samples having different types and ages, representative of the delimited region of Madeira (liquor wine of quality produced in delimited region), were analyzed in relation to physicochemical and sensorial parameters. Standard methodology for spirits and alcoholic beverages as well as a council of tasters were adopted respectively to quantify such parameters, according to European Union regulations. The main physicochemical parameters analyzed demonstrated that Madeira wine represent a high quality beverage without toxicological risks, as all constituents have in general contents clearly below the maximum concentration admissible by the national and/or international rules. A reasonable differentiation of properties could be achieved between samples having different types and ages, when principal component, discriminant and cluster analyses were applied to the analytical data, especially for physicochemical parameters.

[Tuberculosis in AIDS patients: the contribution of an analysis of the restriction fragment length polymorphism of Mycobacterium tuberculosis isolates]

BACKGROUND

In this report we study tuberculosis transmission in HIV infected patients using molecular epidemiological methods.

PATIENTS AND METHODS

We have studied 60 M. tuberculosis isolates from 30 HIV infected cases, and their clinical-epidemiological data. Susceptibility to tuberculostatic agents and electrophoretic patterns using RFLPs (restriction fragment length polymorphisms) method were evaluated. Dice's coefficient was used for the similarity analysis.

RESULTS

Over 73% studied patients were included in clusters using RFLPs analysis. This data show that nearly 60% of the tuberculosis cases in our area have a recent transmission. Forty per cent of these cases were included in the main cluster. The frequency of tuberculostatic-resistant strains in HIV infected patients was similar to the that of observed in other patients. We did not find correlation between RFLPs clusters and clinical-epidemiological data.

CONCLUSIONS

Tuberculosis transmission in HIV-positive patients using RFLPs as molecular marker shows that 60% of the cases are caused by recently acquired strains. We did not find multi-drug resistant strains in our isolates. However due to the high transmissibility of these circulating clones, control disease measures in this group of risk population are required.

Post-discharge surveillance and infection rates in obstetric patients

OBJECTIVE

To study the impact of post-discharge surveillance on the detection of nosocomial surgical site infection (SSI) after cesarean section and vaginal delivery.

METHODS

During a 21-month period, all patients attending the obstetrics service in labor were recruited for a observational study on the incidence of SSI. Examinations to detect SSI were performed daily during the hospitalization period and up to 30 days after hospital discharge in an outpatient clinic supervised by the Infection Control Committee. The stratification of risk-factors and the criteria for the diagnosis of SSI were done in accordance with the methods described by the Centers for Disease Control and Prevention. The rates of surgical site infection detected during the hospitalization period were compared with those reported by the Centers for Disease Control and Prevention's National (United States) Nosocomial Infection Surveillance System (CDCNNIS) 'benchmarks'. The incidence of SSI detected by post-discharge outpatient surveillance was compared with that from in-hospital surveillance, for both cesarean section and vaginal delivery.

RESULTS

A total of 4463 deliveries were performed during the study period, 2431 (54.5%) by the vaginal route and 2032 (45.5%) by cesarean section. In-hospital surveillance was done on all patients. Post-discharge examinations were done on 951 (46.8%) of the 2032 cesarean section patients. The incidence of SSI in cesarean section detected by in-hospital surveillance was 1.6% (32 cases) and lower than the 3.6% mean rate reported by the CDCNNIS. When SSIs detected by post-discharge surveillance were included, the total number of SSI was 196 cases (9.6%), a value much higher than that for the SSI detected by in-hospital surveillance alone. Only 5 cases (0.21%) of SSI were detected among the 2431 vaginal deliveries.

CONCLUSIONS

The results of our study demonstrate that most of SSI following cesarean section were detected only after patient's discharge from the hospital and seems to indicate that failing to do follow-up evaluation of these patients could result in a substantial mis-calculation of the authentic SSIs rates. Therefore data on post-discharge surveillance should be included to realistically estimate the true rates of SSI in obstetric patients and to allow the implementation of measures to reduce post-partum infection.

Application of an optimized and highly discriminatory method based on arbitrarily primed PCR for epidemiologic analysis of methicillin-resistant Staphylococcus aureus nosocomial infections

The optimization of an arbitrarily primed PCR method for typing 96 methicillin-resistant Staphylococcus aureus (MRSA) isolates was compared with pulsed-field gel electrophoresis. Identical results in the differentiation of MRSA clones and identification of the main cluster that included 82 strains (88% of patients) were obtained by both techniques.

Soluble CD30, dehydroepiandrosterone sulfate and dehydroepiandrosterone in atopic and non atopic children

Elevated levels of soluble CD30-sCD30 (possibly related to Th2) are seen in atopy and other diseases. Dehydroepiandrosterone (DHEA) may regulate Th1/Th2 balance. The aim was to study the relationship between the levels of sCD30, DHEAS and DHEA in atopic (A) and non atopic (B) children, to assess immune-endocrine interactions. We studied 36 children (8-15 years), 18 (A) monosensitised to Dermatophagoides Pteronyssinus (Dpt.), and 18 (B) with isolate rhinitis (R) or asthma (BA) and R (33.3%) without differences in age and sex. They were all HIV negative and free from any medication. It was determined sCD30, DHEAS and DHEA. There was no statistically significant differences between A and B for the levels of DHEAS, DHEA suggesting that the role of this regulation in Th2 type is not important in patients with allergic disease in this age group. sCD30: A-mean 121.1U/ml; B-mean 53.9U/ml. This difference is statistically significant-p = 0.02. sCD30 in patients only with R showed also significant differences-p = 0.01. These results could reflect the Th2 profile. There is an overlap of the values (for R < 80 U/ml; for BA + R < 140 U/ml). Due to this only values > 80 U/ml for R and > 140 U/ml for BA + R could be considered discriminating for atopy.

ALATOP-RIA in the screening of atopy in a non Caucasian population

ALATOP is an "in vitro" radioimmunoassay screening test for atopy, previously validated in a caucasian population. The aim of the study was to assess the usefulness of a screening test of atopy in a non caucasian population. We select a non caucasian population (n = 208), from hospital immunoallergy consultations, Cape Verde Republic (Africa). It was determined the sensitivity, specificity and predictive values comparing with skin prick tests (SPT) results for the 208 patients, and with clinical data (Clin) in 115 patients. It was also determined the levels of total IgE, done by IRMA.

RESULTS

Using different corrections factors, 0.85 gives the best results: ALATOP/SPT-Sensitivity-88.5% +/- 4.34; Specificity-73.8% +/- 8.41; Positive predictive value-66.9%; Negative predictive value-91.4%; Efficiency of the test-79.3%. ALATOP/CLIN-Sensitivity-95.2% +/- 3.89; Specificity-71.2% +/- 12.07; Positive predictive value-65.6%; Negative predictive value-96.2%; Efficiency of the test-80.0%. The mean values of total IgE were-406 IU/ml.

CONCLUSIONS

The mean value of total IgE was significantly increased even in the ALATOP-/SPT-not saw in caucasian populations. The use of a different correction factor (0.85) for ALATOP, optimize the test, showing a good negative predictive value, but raises the question of adapted compositions of screening tests for different populations.

Adverse reactions to acetaminophen, ASA, and NSAIDs in children: what alternatives?

ASA and NSAIDs are responsible for a large number of adverse reactions. The association of adverse reactions to acetaminophen and to ASA is uncommon, especially in children, and raises the problem of finding alternative treatments. We present a case report of a 7-year-old boy with combined adverse reaction to acetaminophen and ASA/NSAIDs. The child, who had no history of atopy, first displayed the condition at age 6, when he suffered two episodes of urticaria and angioedema, 2 hours after administration of 500 mg of acetaminophen, following two earlier doses of 500 mg (total 1500 mg). At age 7 he suffered a third episode 3 hours after administration of 180 mg of ASA. The patient submitted to oral challenges with acetaminophen (positive at a cumulative dose of 2,040 mg), ASA (positive at a cumulative dose of 204 mg) and nimesulide (negative at a cumulative dose of 119 mg). In conclusion, nimesulide (an NSAID not available in the United States) may be regarded as an alternative treatment in such patients, but more research is needed in pediatric age groups.

[Analysis of the diagnostic delay in tuberculosis]

OBJECTIVE

To identify the situations that influence in the delayed diagnosis of tuberculosis.

PATIENTS AND METHOD

We studied 109 patients (87 non HIV-infected and 22 HIV-infected) who were diagnosed of tuberculosis in one year consecutively, using a questionnaire to obtain time intervals in which the whole diagnostic delay (WD) was divided.

RESULTS

WD was higher than 1 month in 90 % of non HIV-infected patients. The delay due to the health system (SD) was higher (71% > 1 month) than the delay due to patient (PD; 30% > 1 month) and there was a negative correlation between both (R-0.73). In HIV+ group, WD was lower (59.1% > month) and, although PD was higher (40.9% > 1 month), the time that the system delayed the suspicion of the diagnosis was lower (5.5% > 1 month). In HIV-group there were the following significant differences: higher delay in the suspicion of diagnosis (DSD) (61.4% and 60.8% > 1 month) and shorter time to make the diagnosis (12.3% and 21.6% > 1 month) in sputum smear-positive patients and who had cavitary lesions; PD was higher (67.1% > 1 month) in patients with general symptoms and nearly none in patients with upper airways symptoms; and higher DSD in presence of nonspecific symptoms like cough or/and expectoration (68.6% > 1 month) or upper airways symptoms (100% > 1 month). As these clinical symptoms were consulted in primary care mainly, there was a higher SD (75.75 > 1 month) and DSD (58.1% > 1 month), and were increased when a promptly chest X-ray was not performed (87.1 and 68.7% > 1 month).

CONCLUSIONS

Delayed diagnosis of tuberculosis is common. In non HIV-infected patients, it occurs mainly in the health system. Diagnostic delays contribute to raise advanced disease with more contagious potential.

DNA amplification fingerprinting for subtyping Neisseria gonorrhoeae strains

BACKGROUND AND OBJECTIVES

DNA amplification fingerprinting is used in most epidemiologic studies as a substitute for conventional typing methods. DNA amplification fingerprinting and conventional typing methods were compared in this epidemiologic study of Neisseria gonorrhoeae.

GOAL OF THIS STUDY

To differentiate 70 Neisseria gonorrhoeae isolates from untreated patients with urogenital gonococcal infection.

STUDY DESIGN

Gonococcal strains were characterized by auxotyping, serotyping, plasmid profile, antibiotic sensitivity, and DNA amplification fingerprinting. The method of unweighted pair-group average linkage was used for cluster analysis. Discriminatory power was calculated applying Simpson's index.

RESULTS

Amplification of Neisseria gonorrhoeae DNA with primers OPA-03 and OPA-13 produced well-resolved patterns of 15 and 22 DNA fragments, respectively, with a discriminatory power (0.978 with OPA-13 and 0.967 with OPA-03) comparable to that obtained with auxotyping/serotyping combination (D:0.968) or with auxotype/serotype/plasmid profile combination (D:0.983). Correlation between DNA amplification fingerprinting pattern and auxotype/serotype class was not always uniform. Some strains with the same auxotype/serotype/plasmid profile were subdivided by DNA amplification fingerprinting, and vice versa.

CONCLUSION

Although auxotype/serotype class and DNA amplification fingerprinting can be used in the epidemiologic characterization of strains, DNA amplification fingerprinting offers a better discriminatory index than the separate serotyping. It is especially useful for differentiating serologically identical strains and nontypable strains. A combination of serotyping and DNA amplification fingerprinting seems to be the best way to differentiate Neisseria gonorrhoeae strains in epidemiologic studies, bringing together the most simple techniques and the best discriminatory power among isolates.

A comparative study on cell wall antigens and cell surface hydrophobicity in clinical isolates of Candida albicans

Characterization of common cell surface-bound antigens in Candida albicans strains, particularly those expressed in the walls of mycelial cells might be useful in the diagnosis of systemic candidiasis. Hence, antigenic similarities among wall proteins and mannoproteins from C. albicans clinical serotype A and B isolates, were studied using polyclonal (mPAbs) and monoclonal (MAb 4C12) antibodies raised against wall antigens from the mycelial form of a common C. albicans serotype A laboratory strain (ATCC 26555). Zymolyase digestion of walls isolated from cells of the different strains studied grown at 37 degrees C (germination conditions), released, in all cases, numerous protein and mannoprotein components larger than 100 kDa, along with a 33-34 kDa species. The pattern of major antigens exhibiting reactivity towards the mPAbs preparation was basically similar for all the serotype A and B isolates, though minor strain-specific bands were also observed. The immunodeterminant recognized by MAb 4C12 was found to be absent or present in very low amounts in C. albicans isolates other than the ATCC 26555 strain, yet high molecular weight species similar in size (e.g., 260 kDa) to the wall antigen against which MAb 4C12 was raised, were observed, particularly in wall digests from serotype A strains. Cell surface hydrophobicity, an apparently important virulence factor in C. albicans, of the cell population of each serotype B strain was lower than that of the corresponding serotype A counterparts, which is possibly due to the fact that the former strains exhibited a reduced ability to form mycelial filaments under the experimental conditions used.

Quantitative skin prick tests and specific IgE (CAP System) for D. pteronissynus--correlation of results in a paediatric population

The CAP System compared with RAST has a greater sensitivity, with the same specificity, as well as an excellent correlation with skin prick tests (SPT), as documented by others. Standardization of SPT is essential for routine and investigational purposes. We used a standardized lancet (DHS), and the methodology of reading the SPT was a computerized digitalized graphics tablet coupled to an IBM-PC AT using CAD software, expressing the result as wheal areas with cut off +/- at 7 mm2. The method is precise and reproducible with a mean coefficient of variation (cv) intratester--T1: 3.1%, T2: 3.5% and a cv intertester: 2.93%. We compare the results of SPT of two different allergen extracts for Dermatophagoides Pteronissynus (DPt) (Bencard; Merck/Allergo-Pharma, standardized in SBU) and correlate them with specific IgE, in 122 patients, 72 males and 50 females, aged 3 to 19 years. The results between the extracts and the results of specific IgE obtained by CAP System with each of the extracts, were correlated. 34 patients were considered to be non atopic. 88 patients showed at least one positive result with one test, being those used to correlate the positive results.... The results showed good correlations for quantitative SPT between Bencard and Merck/Allergo-Pharma, as well as for the capacity of eliciting positive results. When SPT were compared to specific IgE as +/- and as quantitative results, there were good correlation for Bencard/CAP and Merck/CAP. The results obtained suggest that CAP can be used to validate allergen extracts of DPt and that studies with other extract are advisable.

ALATOP:sensitivity, specificity and predictive value of a new "in vitro" screening test of atopy

The limitations of total IgE for the screening of atopy, gave rise to in vitro multispecific IgE tests to common allergens. These should have an increased sensitivity and specificity when compared to total IgE. Previous data showed the interest of such tests in screening procedures. ALATOP is a new in vitro multispecific IgE test including common aero and food allergens, in liquid phase, for paediatric and adult population. The result is expressed only in positive/negative. The aim of the study was to determine the sensitivity, specificity, positive and negative predictive value and test efficiency, by comparing the results obtained in 266 paediatric patients (selected in our Unit based on a good correlation between clinical history and skin prick tests--SPT), between ALATOP and SPT.

RESULTS

1) Sensitivity: 89.57%; 2) Specificity: 98.06%; 3) Positive predictive value: 98.65%; 4) Negative predictive value: 85.59%; 5) Efficiency of the test: 92.86%; 6) Reproducibility of the test--average: 5.63%. Based on this results and when they are compared to single specific IgE determinations, that are assumed to be about 80% of the sensitivity of SPT, ALATOP showed excellent results, allowing its use in the screening of atopic disease.

Diagnosis of systemic candidiasis by enzyme immunoassay detection of specific antibodies to mycelial phase cell wall and cytoplasmic candidal antigens

Diagnosis of systemic Candida infections was attempted by the use of an enzyme-linked immunosorbent assay (EIA) to detect IgG antibodies towards cell wall-bound and cytoplasmic candidal antigens. Cell wall antigens were sequentially solubilized by treatment of germinated blastoconidia of Candida albicans (ATCC 26555 strain) with beta-mercaptoethanol (beta ME extract) and digestion with Zymolyase 20T, a beta-glucanase preparation (Zymolyase extract). Protoplasts obtained after treatment with Zymolyase were osmotically lysed (cytoplasmic antigens). Sera were obtained from patients with systemic (n = 28) and superficial (n = 46) candidiasis. Control sera were obtained from normal healthy individuals (n = 31) and from hospitalized patients at low (n = 36) and at high (n = 13) risk of developing systemic candidiasis yet showing no symptoms of candidal infection. Detection of antibodies in crude sera samples by EIA using all of these antigenic extracts was highly specific (98-100%), but sensitivity of the method was low (3.5-17.8%). However, adsorption of sera with latex microspheres coated with purified Candida mannan in order to selectively remove anti-mannan antibodies prior to EIA improved the diagnostic efficiency of this test. Improvement was particularly noticeable when the beta ME extract was used as antigenic preparation, yielding a sensitivity of 89.2% and a specificity of 98.6%.

Use of genomic fingerprinting in the characterization of Neisseria gonorrhoeae isolated in Valencia, Spain

Ninety-five Neisseria gonorrhoeae organisms isolated in Valencia, Spain, were characterized by antibiotic sensitivity testing, auxotyping, serotyping, plasmid analysis and restriction endonuclease fingerprinting (HindIII digestion). Cluster analysis of the restriction patterns revealed that 31 isolates (32.6%) formed 12 clearly defined clusters. Penicillinase-producing Neisseria gonorrhoeae strains formed four of these groups. Eight groups of gonococcal strains were identified by auxotyping, although 83% of isolates belonged to two auxotypes (Proto, Pro-). Twenty-three different serovars were identified by serotyping. The serovar pattern IB/rop was found in 38% of isolates. A 60% coincidence was found between gonococcal groupings obtained by combination of auxotyping, serotyping and plasmid analysis and those obtained with the restriction enzyme fingerprinting technique. The specificity of enzyme restriction patterns of Neisseria gonorrhoeae is confirmed to be of practical importance in the epidemiologic study of gonorrhoea.

Genomic fingerprinting of penicillinase-producing strains of Neisseria gonorrhoeae in Valencia, Spain

OBJECTIVE

To compare the value of different markers and their combinations with the restriction enzyme technique in the differentiations of penicillinase-producing N. gonorrhoeae (PPNG) strains.

MATERIALS AND METHODS

17 PPNG strains isolated from symptomatic, untreated male patients with urethritis were characterised by antibiotic sensitivity testing, auxotyping, serotyping, plasmid profile, and restriction endonuclease fingerprinting (Hind III digestion). Cluster analysis with the method of unweighted pair-group average (UPGMA) linkage was used to calculate similarity or dissimilarity for PPNG strains.

MAIN RESULTS

Either auxotyping or plasmid profile alone differentiated three groups of PPNG strains, whereas the combination auxotyping/serotyping identified 10. Although the combination auxotyping/serotyping/plasmid profile and the restriction enzyme technique showed a similar discrimination ability (differentiation of 11 PPNG strains), genomic fingerprinting gave highly specific restriction patterns on individual gonococcal isolates.

CONCLUSIONS

The combination of different markers gave more epidemiological information than the use of only one. The sequence of discriminating ability for PPNG strains was: auxotyping/serotyping less than auxotyping/serotyping/plasmid profile less than restriction patterns of genomic DNA.

[Membrane proteins electrophoretic profiles study applied to Neisseria gonorrhoeae epidemiology]

The analysis of electrophoretic profiles of membrane proteins is one of the epidemiological methods of bacterial typing. The profiles of membrane proteins of 95 isolates were studied for valuing their usefulness in the epidemiology of N. gonorrhoeae. The results were compared with the obtained using other characterization methods (auxotyping, serotyping and antimicrobial sensibility). The proteins I and II (PI and PII) showed clear differences between isolates. Only protein-I (PI) with constant molecular weight for each isolate was valid to discriminate between strains. It was observed correlation between serovariety IA and molecular weight of PI 33.6-36 kD, and the serovariety IB with molecular weight 35.5-37 kD. Though it wasn't possible discriminated between the different serovarieties. It was proved a sensibility decrease to penicillin, tetracycline and cloramfenicol in those strains with molecular weight of PI greater than 35.5 kD (serogroup WII/WIII). In the 80% of the isolates considered multiple antibiotic-resistant it was observed a significant increase of the membrane protein dough of 52 kD. All the strains with this protein increased were multiple antibiotic-resistant.

[The importance of heart disease in the various types of cerebral vascular disease. A prospective study]

A prospective study was performed in 106 patients with acute stroke. The main purpose was the cardiac evaluation in the different types of cerebrovascular disease: Intracerebral hemorrhage (H), Cortical ischaemic events (C) and Subcortical ischaemic events (SC) and also to evaluate the interest of echocardiography in detecting occult cardiac sources of emboli. The study population included 54 men and 52 women with a mean age of 66.8 +/- 10.3 years. A thorough neurologic and cardiologic study with a computed tomography of the brain (TAC) and an echocardiogram (ECO) were performed in all patients. It was found 24 (23%) of H, 40 (38%) of C and 32 (30%) of SC. In the past history, heart diseases were more prevalent in C (p less than 0.04); previous stroke and systemic hypertension (HTA) were less prevalent in H (p less than 0.008) and in C (p less than 0.004), respectively. Atrial fibrillation (FA) was more frequent in ischaemic stroke (p less than 0.02) and within these in C (p less than 0.005). No more clinical and functional cardiac features or echocardiographic aspects had any difference in their prevalence in different types of stroke. Without clinical heart disease there were 19 (18%) cases but only in 10 were found in their echocardiograms a potentially embolic heart disease (PEHD) but 8 of them had questionable pathologic significance.

IN CONCLUSION

C had more heart disease in their past history; FA is more frequent in C; it is difficult to diagnose a cerebral embolism with only a coexistent C and CPE, but if there is FA or a past history of heart disease in a C, the diagnosis of cerebral embolism is more probable; finally, echocardiography is of limited value to diagnose a PEHD in the elderly, however it makes possible to better evaluate most cardiac situations.

Histopathology of experimental Aspergillus fumigatus keratitis

Histopathological studies in rabbit's eyes, 7 and 14 days after intracorneal inoculation with 1 X 10(5) Aspergillus fumigatus conidia have been performed. Similar lesions were found in both periods with fungal hyphae in the anterior third of corneal stroma, round cell infiltration from the sclero-corneal edge and in the anterior chamber and, neovascularization. No lesions were found in the Descemet's membrane. Gomori silver-methenamine stain with hematoxiline-eosine counter-stain was found to be the most reliable stain to detect fungal presence in corneal stroma, and Masson's trichromic stain in the study of pathological changes in ocular elements.

Effect of antigen used in the detection of anti-Candida albicans antibodies

Antigens of different origins were used in the investigation of anti-Candida albicans antibodies. This can influence the results obtained. We have assayed three different antigenic preparations weekly for 8 weeks in the study of anti-C. albicans antibodies induced by cutaneous, digestive, and systemic inoculations with C. Albicans ATCC 26555 in rabbits free of specific antibodies, and using indirect immunofluorescence (IIF), direct agglutination (DA) and counterimmunoelectrophoresis (CIE) as serological methods. In IIF and DA, two antigens were used (C. albicans ATCC26555 and C. albicans NCPF3153). In CIE we also used a third commercial antigen. All three somatic antigens were used at three different concentrations. Using IIF and DA the titres obtained with both antigens were similar in different inoculations. The IIF was somewhat earlier in the detection of antibodies, and the titre reached was higher when the antigen used was obtained from the inoculated strain. The detection of precipitins by CIE was in most cases only positive with the antigen obtained from the homologous strain, the highest level being reached in the systemic inoculation.

Effect of cutaneous and digestive colonization in the induction of anti-Candida albicans antibodies: experimental study

Candida albicans colonization induces antibodies, which must be taken into account in the serological diagnosis of candidiasis. In order to determine the degree of this effect, an experimental study in rabbits free of specific anti-Candida antibodies by cutaneous and digestive inoculation has been carried out. The evolution of humoral response was studied over 8 weeks by indirect immunofluorescence (IIF), direct agglutination (DA), counterimmunoelectrophoresis (CIE) and double diffusion (DD). The cutaneous colonization detectable by culture was maintained until the second week in 70% of the animals and the presence of antibodies detectable by IIF and DA was observed after the 2nd week. The highest antibody titre by IFF and DA was 1/64, and was reached in the 5th week, with a tendency to drop in the following weeks. Precipitins were only detected by CIE in 15% of the animals in the 7th week. Elimination of yeast in stools continued only in 20% of the animals in the 2nd week of the experiment. Antibodies were detected by IIF and DA after the 2nd week, with the highest titres detectable by IFF in the 5th week. Precipitant antibodies detectable by CIE appeared in 15% of the animals in the 8th week.

Chemotherapy of Aspergillus fumigatus keratitis: an experimental study

An experimental Keratitis study of Aspergillus fumigatus was performed in 130 rabbits divided into 12 groups of ten animals each. Three antifungal drugs (myconazole, amphotericin B and pimaricin) were tested using two procedures (topical drops and subconjunctival injections) and two different concentrations (500 and 10 000 times the MIC). In each case, the drugs were applied every 3 h starting 14 h after inoculation. Miconazole was useful at 10 mg/ml concentration by topical drops and subconjunctival injections, but was less useful at 5 mg/ml. Amphotericin B was useful at 5 mg/ml concentration by topical drops and less useful at 2 mg/ml. No differences were found between the two concentrations by subconjunctival administration. Pimaricin was useful by topical drops at 50 mg/ml concentration and less useful at 10 mg/ml as well as by subconjunctival injections.

[Treatment of type-b H. influenzae meningitis resistant to ampicillin and chloramphenicol]

Three cases of H. influenzae type b meningitis with resistance to ampicillin and cloramphenicol are described. All infants were treated with new cephalosporin derivates. CSF sterilization was achieved in all patients. Clinical evolution was good in the two old infants treated with cefotaxime, nevertheless younger infant treated with cephoxitin developed serious neurologic and psychologic sequelae. H. influenzae b was erradicated of a carrier mother after four days of rifampicin therapy. Finding of multiple-resistance H. influenzae type b meningitis and therapeutics problems are emphasized by authors.