High chromosomal mobility of rDNA clusters in holocentric chromosomes of Triatominae, vectors of Chagas disease (Hemiptera-Reduviidae).

The subfamily Triatominae (Hemiptera-Reduviidae) includes more than 150 blood-sucking species, potential vectors of the protozoan Trypanosoma cruzi, causative agent of Chagas disease. A distinctive cytogenetic characteristic of this group is the presence of extremely stable chromosome numbers. Unexpectedly, the analyses of the chromosomal location of ribosomal gene clusters and other repetitive sequences place Triatominae as a significantly diverse hemipteran subfamily. Here, we advance the understanding of Triatominae chromosomal evolution through the analysis of the 45S rDNA cluster chromosomal location in 92 Triatominae species. We found the 45S rDNA clusters in one to four loci per haploid genome with different chromosomal patterns: On one or two autosomes, on one, two or three sex chromosomes, on the X chromosome plus one to three autosomes. The movement of 45S rDNA clusters is discussed in an evolutionary context. Our results illustrate that rDNA mobility has been relatively common in the past and in recent evolutionary history of the group. The high frequency of rDNA patterns involving autosomes and sex chromosomes among closely related species could affect genetic recombination and the viability of hybrid populations, which suggests that the mobility of rDNA clusters could be a driver of species diversification.

Short-term atorvastatin therapy improves arterial stiffness of middle-aged systemic lupus erythematosus patients with pathological pulse wave velocity.

Objectives Statins have been proposed as a potential treatment for systemic lupus erythematosus (SLE) due to their immunomodulatory properties, their role restoring endothelial function and preventing atherosclerosis. We evaluate the effect of a short period treatment with a low dose of atorvastatin and its withdrawal on early stage subclinical atherosclerosis. Methods Thirty-seven SLE females received 20 mg/day atorvastatin during eight weeks. At baseline, at the end of treatment and six months after atorvastatin withdrawal, disease activity, subclinical atherosclerosis -assessed by measuring carotid-femoral pulse wave velocity (PWV) - and quantification of circulating endothelial progenitor cells (EPC) - as a surrogate biological marker of subclinical atherosclerosis - were carried out. Results The group of SLE patients with baseline pathological arterial stiffness showed a significant decrease of PWV after atorvastatin therapy (8.43 ± 1.45 m/s vs 7.42 ± 1.06 m/s; p = 0.002) that is maintained six months after treatment finished. Only patients of the middle-aged group showed a nearly significant decrease in the PWV measured along the study (7.16 ± 1.23 m/s vs 6.76 ± 0.82 m/s; p = 0.05). Atorvastatin induced a significant decrease in the circulating EPC percentage (0.65 ± 0.67 vs 0.40 ± 0.31; p = 0.023) as well as a downward trend of disease activity that it is observed by a decrease in SLE disease activity index simultaneously with an increase in C3 complement and significant decrease in serum concentration of vascular endothelial grow factor (VEGF) and sVCAM-1. Conclusions Short-term atorvastatin therapy reduces arterial stiffness of SLE patients with baseline pathological PWV, who are mainly in the group of middle-aged patients. Further studies are needed to determine whether these patients would benefit from statin therapy in preventing cardiovascular events.

The use of ertapenem for the treatment of community-acquired pneumonia in routine hospital practice: a matched cohort study.

OBJECTIVE: The clinical response to ertapenem in community-acquired pneumonia (CAP) at the setting of routine hospital practice has been scarcely evaluated. METHODS: We retrospectively compared CAP cases treated with ertapenem or with other standard antimicrobials (controls) at a tertiary 1,434-bed center from 2005 to 2014. RESULTS: Out of 6,145 patients hospitalized with CAP, 64 (1%) ertapenem-treated and 128 controls were studied (PSI IV-V 72%, mean age 73 years.). A significant higher proportion of bedridden patients (41% vs. 21%), residence in nursing homes (19% vs. 7%), previous use of antibiotics (39% vs. 29%) and necrotizing (13% vs. 1%) or complicated (36% vs. 19%) pneumonia, was observed in the ertapenem vs. non-ertapenem patients. Initial treatment with ertapenem was independently associated with an earlier resolution of signs of infection. In patients aged 65 or older the independent risks factors for mortality were: PSI score (7.0, 95%CI 1.8-27.7), bedridden status (4.6, 95%CI 1.1-20.9) and Health Care Associated Pneumonia (HCAP) (4.6, 95%CI 1.3-16.5). First-line treatment with ertapenem was an independent protector factor in this subgroup of patients (0.1, 95%CI 0.1-0.7). CONCLUSIONS: Ertapenem showed a superior clinical response in frail elderly patients with complicated community-acquired pneumonia, and it may be considered as a first-line therapeutic regimen in this setting.

Metabolic syndrome is associated with decreased circulating endothelial progenitor cells and increased arterial stiffness in systemic lupus erythematosus.

OBJECTIVES: Metabolic syndrome (MetS) is highly prevalent in patients with systemic lupus erythematosus (SLE) and it has been associated with increased cardiovascular risk. We examined the contribution of MetS to inflammatory markers, arterial stiffness and circulating endothelial progenitor cells (EPCs) as surrogates of subclinical atherosclerosis. METHODS: Cardiovascular risk factors, SLE-specific factors and peripheral blood EPCs were assessed in 50 female SLE patients. MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III. Simultaneously, atherosclerosis was assessed by measuring the carotid-femoral pulse wave velocity (PWV) by doppler velocimetry. RESULTS: Beyond the factors included in the definition, SLE patients with MetS have a significantly higher serum level of uric acid (6.88 ± 2.20 vs 4.45 ± 1.17, p < 0.001) and some inflammatory biomarkers such as homocysteine, IL-8, sICAM-1 or complement molecules. The presence of MetS in our patients was closely linked with a significantly increased patient organ damage score (3.20 ± 1.97 vs 1.60 ± 1.67, p = 0.008), a decreased percentage of circulating EPCs (0.53 ± 0.24 vs 0.85 ± 0.57, p = 0.007) and an increased arterial stiffness (9.89 ± 2.40 vs 7.13 ± 1.51, p < 0.001). CONCLUSIONS: MetS may contribute to the development of atherosclerosis by significantly increasing inflammation levels and arterial stiffness and decreasing circulating EPCs. This finding would justify close monitoring of these patients.

High dynamics of rDNA cluster location in kissing bug holocentric chromosomes (Triatominae, Heteroptera).

In this paper, we determine by fluorescent in situ hybridization the variability in the chromosomal location of 45S rDNA clusters in 38 species belonging to 7 genera of the Triatominae subfamily, using a triatomine-specific 18S rDNA probe. Our results show a striking variability at the inter- and intraspecific level, never reported so far in holocentric chromosomes, revealing the extraordinary genomic dynamics that occurred during the evolution in this group of insects. Our results also demonstrate that the chromosomal position of rDNA clusters is an important marker to disclose chromosomal differentiation in species karyotypically homogenous in their chromosome number.

[Assessment of basic activities of daily living and cognitive impairment in centenarians: correlation between the scales used]. / Valoración de actividades básicas de la vida diaria y de deterioro cognitivo en centenarios: concordancia entre las escalas utilizadas.

OBJECTIVE: To analyse the concordance between different scales used to assess basic activities of daily living and cognitive impairment in centenarians. METHOD: A domiciliary interview was carried out with all centenarians in our area. Three scales of basic activities of daily living (Katz index [KI], Barthel index [BI], Red Cross physical impairment index [RCPI]), and two of cognitive impairment assessment(Mini cognoscitive test [MCT], Red Cross psychic impairment index [RCPI]) were completed. RESULTS: A total of 80 centenarians were interviewed, 26 men and 64 women, mean age 100.8±1.3. More than half of centenarians had functional independence or slight dependence. Men were more frequently independent than women (BI 70±34.4 vs. 50.4±36.3; P=.005). The results of cognitive impairment tests were discordant, although men had less cognitive impairment than women (MCT 16.5±9.1 vs. 11.6±8.1; P=.008). The three scales of basic activities of daily living uniformly classified the centenarians, with a high level of concordance between them: KI and BI similarly classified up to 95% of the centenarians (Kappa 0.899), BI and RCPI to 97.5% (kappa 0.95), KI and RCPI to 97.5% (Kappa 0.95). Nevertheless, the concordance between the cognitive impairment measured by RCPI and MCT was low; only 58.8% of centenarians were equally classified (Kappa 0.295). CONCLUSIONS: Any of three scales analysed for assessment of basic activities of daily living is useful in centenarians. Nevertheless, the best way to assess cognitive impairment in these patients needs to be defined.

[25 years experience in cerebrospinal shunt. Are new systems better?]. / 25 años de experiencia en válvulas de derivación ventrículo-peritoneal. Son mejores los nuevos sistemas?

INTRODUCTION: Since the introduction of the first ventricular shunt in 1949, the cerebrospinal shunts are the most used choice for the management of hydrocephalus in children. With the technological advance, systems have been developing increasingly sophisticated. Our aim is to study the incidence of complications after the implantation of these shunts and the variables associated to it. MATERIAL AND METHODS: We perform a retrospective study between 1981 and 2006, gathering the patients between 0 and 15 years treated at our Hospital for the placement of a cerebrospinal shunt or as consequence of a problem of the device. We analyze the tipe of shunt (Hakim, Pudentz, Delta, Orbis-Sigma, Strata, Codman), etiology of hydrocephalus, age, immediate and late complications, permanence of the system, changes of the system and cerebrospinal fluid. The qualitative data were analyze by c2 test. We also estimate survival of shunts with Kaplan-Meier stimator and make a multivariant Cox regression analysis. RESULTS: A total of 75 patients. The main etiology for hydrocephalous was myelomeningocele, followed by congenital and posthemorrhagic. Most of the patients presented complications of the system in the follow-up. They were adjusted for age, sex, etiology, shunt and surgeon. The variable that had an independent effect for predicting the presence of a complication was the type of shunt, being the most ancient systems those with major survival. The most frequent complication in the immediate period (< 3 month) was the obstruction and infection of the proximal catheter or shunt. Distal catheter disconnection or break prevailed in the late one. We got few functional complications, these were not related with the type of shunt. CONCLUSIONS: In our experience, the shunts with the less short-term probability of complication (< 3 months) have been old simple systems like Hakim and Pudentz. The functional complications, that are those which presumably should be reduced by the new programmable systems, don,t seem do it, neither mean longer survival of the system.

Control of diabetes and cardiovascular risk factors in patients with type 2 diabetes in primary care. The gap between guidelines and reality in Spain.

To evaluate the level and factors affecting control of diabetes and cardiovascular risk factors in type 2 diabetes (TYPE 2 DM) patients. Multicentre cross-sectional study: a sample of 430 primary care practices across Spain selected 1907 type 2 diabetic patients. The first five consecutive ambulatory patients with TYPE 2 DM were eligible for the inclusion into the survey. Patients were free of known cardiovascular disease (CVD). Control criteria were defined based on 2002 American Diabetes Association (ADA) clinical practice recommendations. A total of 1907 patients (51% women) aged 63 +/- 9 years. Smoking prevalence was 22.6%, 50.6% had levels of A1c < 7%. Mean blood pressure (BP) was 148 +/- 17/86 +/- 10 mmHg. Only 7.8% have achieved the target of BP < 130/80 mmHg. Among the 1180 patients (65%) treated for hypertension, this target was attained in only 4.4% of patients. A measurement for low-density lipoprotein (LDL) cholesterol was available in 1669 patients (88%). Only 5.9% of patients achieved the target of LDL < 100 mg/dl. Among the 638 patients (41.6%) on drug treatment for dyslipidaemia, this target was attained in only 5.6% of patients. Among type 2 diabetic patients in Spain the prevalence of cardiovascular risk factors is high. Control of glycaemia, smoking, BP and LDL are far from optimal despite the widespread use of guidelines for the management of diabetes and CVD. The application of published recommendations needs to be reinforced.

[Renal transplantation in the northwest of Spain: analysis of the activity in the region of Galicia]. / Trasplante renal en el noroeste español. Análisis de la actividad en la Comunidad Autnoma de Galicia.

BACKGROUND: Spain is the world leader in organ transplant rates, and the national average is maintained in the northwestern Spanish region of Galicia. However, there is no official registry recording transplantation results in this region. In this paper we report a study of patient and graft survival and risk factors among kidney transplant patients in Galicia between January 1996 and December 2000. METHODS: Patients receiving kidney transplants in Galicia in the above period were monitored up to the end of 2001, deaths and graft losses were recorded and analysed by actuarial and Kaplan-Meier methods, and possible risk factors for death and graft loss were evaluated using Cox's proportional hazards model. RESULTS: In the study period, 672 kidneys were transplanted, all from deceased donors. Graft and patient survival rates were respectively 80% and 94% after 1 year, and 67% and 83%, after 5 years. Two-thirds of graft losses occurred within the first year and the most common cause was vascular thrombosis (44%). Independent risk factors for graft loss were donor asystole (relative risk [RR] = 3.41, 95% confidence interval [CI]: 1.73-6.73), donor age (RR = 1.54, CI: 1.05-2.27 for 40-60-year-olds, RR = 2.59, CI: 1.66-4.07 for over-60s, relative to under-40s), donation from outside the institution in which implant was performed (RR = 1.43, CI: 1.02-2.02), acute rejection (RR = 2.32, CI: 1.63-3.22), and retransplantation (RR = 1.56, CI: 1.03-2.37). The main causes of death were infections (38%), followed by cardiovascular pathologies (30%) and tumours (11%). CONCLUSIONS: The kidney transplant rate varies excessively within Galicia; the global rate is 50 per million inhabitants per year. Patient survival is similar to those recorded in national registers, but graft survival is deficient, apparently due to a high incidence of vascular thrombosis.

[Prognostic markers determining the start of dialysis]. / Marcadores pronósticos de entrada en diálisis.

BACKGROUND: It is widely known that renal disease progresses towards the terminal stage regardless of the cause. The aim of this study is to identify prognostic factors in the progression that determine the start of dialysis. METHODS: From january 1998 until december 1999, 76 patients diagnosed with renal failure were monitored, 52 of whom started dialysis treatments. Clinical and analytical variables were studied. An actuarial analysis was carried out following the methodology of Kaplan-Meier to determine the likelihood of the need for dialysis and the Cox proportional risk analysis was also used. RESULTS: The patients enrolled in this study were between 20 and 78 years of age. 49 (64.5%) of the subjects were men and 27 (35.5%) were women. The most prevalent pathology was nephroangiosclerosis (26.3%), followed by diabetes (25.0%). During the monitoring program, 68.4% of the patients began dialysis treatments (table I). Systolic blood pressure, haemoglobin and the total proteins were univariately identified as prognostic variables. 89.47% and 71.58% of the patients with a systolic blood pressure reading of under 140 mmHg had not begun dialysis after 12 and 24 months respectively. 87.02% and 53.63% of the patients with a systolic blood pressure reading of over 140 mmHg had not begun dialysis after 12 and 24 months respectively (p = 0.025) (fig. 1). With a haemoglobin level higher than 10 gr/dl after 12 months 92.7% had not started dialysis, dropping to 72.33% after 24 months. With a haemoglobin level of under 10 g/dl 78.6% and 37.59% had not started dialysis after 12 and 24 months respectively (p = 0.0008) (fig. 2). Taking into account the mean values of different variables in the two year period prior to starting or not starting dialysis, it was found that haemoglobin significantly affected the risk of the need to start dialysis treatments [RR = 0.729; 95% CI = (0.554;0.959)], while systolic blood pressure was on the borderline of statistical significance (table IV). CONCLUSIONS: Haemoglobin levels significantly affect the risk of the need to start dialysis treatments, while other variables were identified as possible prognostic factors.

[Lung cancer in the health care area of A Coruña (Spain): incidence, clinical approach and survival]. / Cáncer de pulmón en el Area Sanitaria de A Coruña: incidencia, abordaje clínico y supervivencia.

OBJECTIVE: To determine the incidence, clinical approach, diagnostic delay and survival for bronchogenic carcinoma (BC) in the public health area of A Coruña (Spain). PATIENTS AND METHOD: This was a retrospective study of patients with a diagnosis of BC made in 1995 and 1996 in a health care area with 509,000 inhabitants. For analysis we gathered demographic, clinical and cyto-histologic data and analyzed diagnostic delay, extension of disease and time of death. Crude, age-specific and age-standardized incidences were calculated. RESULTS: BC was diagnosed in 378 patients (95% men and 5% women). The crude incidence was 37 per 100,000 inhabitants (73.7 per 100,000 men and 3 per 100,000 women) and the age-standardized incidence was 21.7 per 100,000. Diagnosis was by cyto-histology in 87% of the cases, and the most frequent biopsy finding was epidermoid carcinoma. Diagnosis was by clinical or radiologic findings for 13.7%, and patients in that group were older and had greater comorbidity. No symptoms were present in 13% and in those patients diagnosis was earlier, with non-small BC predominating and 60% treated surgically. The diagnostic delay (time from the first symptom to histologic confirmation) was 2.5 months (median, 2.1), and length of delay did not affect survival. Surgery was performed in 23% of the patients with non-small BC. The median survival was 7.1 months (5.2 months for patients who were not treated surgically, and 37.6 for those who were). CONCLUSIONS: The incidence of BC in men in our study is consistent with that reported for other Spanish regions, although the incidence we observed for women is much lower. Diagnostic delay did not affect survival. The percentage of patients with surgical-stage disease is very low and survival is very short. These findings support the need for early diagnosis.

Factors leading to the removal of the intrauterine implant Gynefix.

OBJECTIVE: The objective of this study was to determine the incidence of expulsion of the Gynefix intrauterine implant, to analyze the variables associated with the above and to examine the efficacy of this intrauterine contraceptive model in users at the Municipal Family Planning Center-SERGAS in A Coruña, Spain. METHODS: A prospective observational study was performed on all women (n = 358) who had a Gynefix implant inserted from March 1998 to September 2000. RESULTS: The accumulated incidence of implant expulsion was 6.7% (95% confidence interval (CI) 4.4-9.9) with a pregnancy rate of 0.6% (95% CI 0.09-2.2). The probability of implant removal decreases with the rise in the number of implants that have been inserted by the professional. A multivariate analysis adjusted for age, number of implants and uterine position showed that the position of the uterus was the variable that independently determined the probability of removal. CONCLUSIONS: It is concluded that retroflexion of the uterus increases the probability of removal.

Factors predicting a hospital stay of over 3 days in patients with acute exacerbation of chronic obstructive pulmonary disease.

OBJECTIVE: To investigate the factors predicting a hospital stay of over 3 days in patients who required hospitalization for acute exacerbation of chronic obstructive pulmonary disease (COPD). DESIGN AND SETTING: A cross-sectional study was done at a tertiary hospital serving an area of 500 000 inhabitants. SUBJECTS: A total of 273 patients (alpha=0.05; accuracy=5.94%) who had been admitted consecutively to the Short Stay Medical Unit at the Juan Canalejo Hospital in A Coruña, from February 1998 to March 1999, with a diagnosis focusing on exacerbation of COPD. Methods. Demographic variables, past medical history, symptoms, arterial blood gases, functional tests, treatment and the cause of exacerbation were studied in each patient. The hospital stay was dichotomized into 3 days. The prognostic factors of a hospital stay were determined by log regression. Results. The mean stay was 4.6 +/- 5.1 days (range: 1-64). After monitoring the associated covariables, the following were found to have an independent effect on the prediction of a hospital stay of over 3 days: weekend admissions (OR=4.17; 95% CI: 2.42-7.18), the presence of cor pulmonale (OR=2.19; 95% CI: 1.27-3.78), and the respiratory rate on admission (OR=1.09; 95% CI: 1.03-1.14). Arterial blood gases and functional tests showed no independent effect. Conclusions. The factors having an independent prognostic value in determining the length of hospital stays in patients with COPD are weekend admission, cor pulmonale and respiratory rate. Additional studies are required to validate these findings.

The importance of the removal of the intrauterine device in genital colonization by actinomyces.

OBJECTIVE: To determine whether, in addition to treatment with antibiotics, it is necessary to remove the intrauterine device (IUD) to eliminate genital colonization by Actinomyces. METHODS: A randomized clinical trial was carried out. Patients were divided into two groups. The intervention group did not have their IUDs removed, while the control group did. Both groups were treated with trimethoprim and sulfamethoxazole. A total of 43 patients were included. RESULTS: The patients from the intervention group and the control group proved to be comparable. The post-intervention cytology smear tested negative for Actinomyces in 100% of the patients whose IUD had been removed and in 66.7% of those whose IUD had not been removed (p = 0.005). The probability that colonization by Actinomyces will continue if the IUD is not removed is greater the longer the patient has been exposed to the IUD. After 24 months, relative risk (RR) = 2, after 36 months RR = 2.16 and after 48 months RR = 2.66. CONCLUSIONS: The removal of the IUD has been effective in genital colonization by Actinomyces. The protective effect exerted by the removal of the IUD was found to be greater in proportion to the length of time the patient had used it.