[Assessment of a Chilean Spanish version of the Patient Assessment of Chronic Illness Care Questionnaire]. / Adaptación y validación de la versión chilena del cuestionario "Evaluación de la Atención de Enfermedades Crónicas para pacientes".

BACKGROUND: The Patient Assessment of Chronic Illness Care (PACIC) questionnaire is a widely used instrument to assess chronic disease care from a patient's perspective. AIM: To adapt the PACIC questionnaire to Chilean Spanish and to evaluate the psychometric properties of the translation. MATERIAL AND METHODS: Descriptive, cross-sectional design with exploratory and confirmatory factor analysis. The PACIC questionnaire was applied, throughout an external client, to 200 users who received health care at the cardiovascular program in a Family Health Center in Concepción, Chile. RESULTS: The confirmatory factor analysis did not show a good adjustment with the proposed structure in the original instrument. An exploratory factor analysis revealed five factors explaining 58% of total data variability. The distribution of the factor-items of the original questionnaire underwent some modifications, which are explained when analyzing the theoretical construct. A good reliability of the global scale was obtained (Cronbach's α 0.886). CONCLUSIONS: The PACIC questionnaire, Chilean version does not replicate the proposed structure of the original questionnaire. Therefore, further research about its validity, incorporating a higher number or diversity of participants is recommended.

Association of estrogen receptor-alpha gene polymorphisms with stroke risk in patients with metabolic syndrome.

OBJECTIVE: The vascular protective effects of estrogens are mediated by their binding to the two known estrogen receptors. In this study, we examine the association of stroke with two common polymorphisms of the ESR1 gene in patients with metabolic syndrome. MATERIALS AND METHODS: DNA from 130 patients hospitalized for ischemic stroke and 240 healthy controls were genotyped for ESR1 PvuII and XbaI polymorphisms. Results - Comparing female and male patients, it was found that CCGG diplotype is more frequent in male patients (P = 0.03). In addition, the AA genotype is associated with the onset of stroke at a younger age in the male patient group (P < 0.05). CONCLUSIONS: These findings suggest that PvuII and XbaI polymorphisms may affect the age at onset of the first stroke and the probability of developing cerebrovascular disease.

Elevated levels of urokinase-type plasminogen activator and its receptor during tumor growth in vivo.

Urokinase-type plasminogen activator (uPA) and its receptor (uPAR) are important in the regulation of tumor tissue progenesis, cell differentiation, tumor cell motility, and tumor cell invasiveness. We have recently reported that the levels of uPA and uPAR were higher in malignant astrocytomas than in low-grade gliomas. In the present study, we measured the levels of uPA and uPAR during the growth of glioblastomas in nude mice. Using fibrin zymography, densitometry, and an enzyme-linked immunosorbent assay, we found that the enzyme activity and content of uPA were increased 4- to 10-fold during tumor formation. Using a receptor assay and an enzyme linked immunosorbent assay, we found the numbers and content of uPAR were increased 5- to 15-fold during tumor formation. In addition, immunohistochemical staining for uPA and uPAR revealed strong immunoreactivity in tumor cells with the staining more intense on day 28 than on day 14. These results suggest that the upregulation of uPA and uPAR plays a major role in the formation of gliomas.

Increased invasion of neuroglioma cells transfected with urokinase plasminogen activator receptor cDNA.

The cell-surface urokinase plasminogen activator receptor (uPAR) plays a key role in regulating plasminogen cleavage during extracellular proteolysis. Our recent results demonstrated that uPAR expression is critical for the invasiveness of human gliomas and down regulation of uPAR caused by antisense cDNA transfection inhibits the invasion of these stable antisense uPAR-transfectant clones. To study the role of uPARs in glioma cell invasion, a human neuroglioma cell line (H4) that normally produces low numbers of uPARs was transfected with the expression vector containing full-length human uPAR cDNA. Stable transfectants were analyzed for uPAR mRNA expression, receptor number, in vitro invasion and secretion of uPA and MMP-2. The uPAR-overproducing clones showed a 4-fold increase in uPAR mRNA transcription and approximately 40% increase in receptor numbers. uPAR-overproducing clones also invaded through matrigel to a significantly greater extent than did parent cell line and vector clones. However, the uPAR-overexpressing clones and parent cell lines showed similar uPA and MMP-2 activities. These results suggest that the over-production of uPAR on the surface of neuroglioma cells enhances the invasiveness.

Neuropsychiatric abnormalities in primary Sjögren's syndrome.

Neuropsychiatric abnormalities were searched for in 52 patients with primary Sjögren's syndrome (SS). 40 patients were evaluated with a detailed neurologic history and physical examination and determination of terminal latencies and nerve conduction velocities of all limbs. Nineteen of them, plus another 12 primary SS patients were evaluated for hostility structure and psychiatric symptoms, using the Hostility and Direction of Hostility Questionnaire (HDHQ) and the Symptoms Check List-90R (SCL-90R) respectively and the results were compared with those of 33 healthy women and 41 cancer patients. Three patients had face numbness and/or hypesthesia indicating trigeminal involvement. Ten had mild sensory or mixed neuropathy of the glove-stocking type. None of our patients volunteered peripheral nervous system (PNS) symptoms nor did we detect central nervous system (CNS) involvement in any of them. One patient with purpura, glomerulonephritis and cryoglobulinemia presented with severe mononeuritis multiplex. High levels of introverted hostility were reported by SS patients in relation to the other two groups. In addition, higher scores on paranoid ideation, somatization and obsessive compulsiveness were found in SS patients compared to the rest but no correlation was found between psychiatric symptomatology and neurologic abnormalities. It is suggested that PNS disease is relatively common and benign in most primary SS patients, psychiatric disorders, sometimes serious, are also common, but CNS involvement must be rather rare.

Model for estimation of human exposure to copper in drinking water.

A model denominated Consumption Habit Exposure Model, (CHEM), was developed for the calculation of human individual acute and chronic exposure to copper in drinking water. The model can estimate daily exposure of individuals as well as the maximum concentration of copper which individuals ingest during a 24-h period. The CHEM model requires carrying out a water consumption habit questionnaire and measuring the minimum and maximum concentration of copper in homes, as well as minimum and random copper concentration at work and study places. The case study employed was a representative sample of the population of Santiago, Chile. The validation of the model was established with reference to the application in a limited number of homes of the composite proportional method, (CPS), used to measure human chronic ingestion of contaminants from drinking water. It was found that 4.5% of the sampled population is exposed daily to one cup of water or more at the maximum copper concentration available at the tap. The probabilities that the different age groups are exposed to one cup or more of water at cMAX during 1 day are greater for the 20-64-year-old group, followed by the 64-year-old group, and then by the younger age groups in descending order. Ingestion of copper from drinking water by the population of Santiago is on average 9.0% of the World Health Organization recommendations for minimum total ingestion of copper for adults, assuming that 100% of the copper contained in drinking water is absorbed.

Relationship between soil copper content and copper content of selected crop plants in central Chile.

A survey of copper levels in agricultural soils of central Chile revealed two soil clusters-one with a mean copper level of 162 mg/kg and one with a mean copper level of 751 mg/kg of soil. Samples of soils from both soil clusters were characterized on the basis of physicochemical characteristics, and copper extractability was compared by saturation and CaCl2 extraction as well as an acid-leaching procedure (TCLP). We also measured the copper content of various tissues of tomato (Lycopersicon esculentum) and onion (Allium cepa) crops growing on these soils. Other than copper levels, soils from the two clusters were quite similar, with slightly greater levels of molybdenum and cadmium in the high-copper soils. Within each cluster, extracted copper levels and total soil copper levels were not correlated. However, the three extraction procedures solubilized significantly more copper from the high-Cu soils. Mineralogical characterization of the soil particles and depth profiles of soil metal levels in a subsample of sites suggested that highly insoluble copper ore and mining wastes might account for the high copper levels. Neither total nor extractable copper levels allowed statistical prediction of the levels of copper in plant tissue. The edible tissues of both crops had the same mean copper content, regardless of the copper soil level. However, copper contents of stems and leaves were significantly higher for plants growing on the high-Cu soils. These results show that in these soils, high copper levels are associated with very insoluble copper species and thus low bioavailability of copper to crop plants.

Epidural analgesia attenuates the systemic stress response to upper abdominal surgery: a randomized trial.

The effects of combined general anaesthesia and epidural analgesia in various endocrine and metabolic parameters were studied before, during, at the end, and 72 h after upper abdominal surgery, in an effort to further elucidate the role of epidural analgesia in the endocrine and metabolic response. 50 patients were randomly assigned into groups A and B, which received general anaesthesia alone and combined general anaesthesia and epidural analgesia, respectively. The effects of surgical stress in the plasma concentration of ACTH (P <0.001), cortisol (P <0.01), aldosterone (P <0.05), FFA (P <0.05) and glucose (P <0.01) were significantly less pronounced in the group of patients who received combined general anaesthesia and epidural analgesia. However, there were no significant differences between the two groups in regard with plasma TSH, T3, T4, glucagon or Na+ concentration. These results indicate that the combination of general anaesthesia and epidural analgesia attenuate, but does not inhibit, the endocrine and metabolic response to upper abdominal surgery.

[The sex of the child, the sex of the doll]. / Sexe de l'enfant, sexe de la poupée.

We wanted to describe the playful behavior of young children of both sexes from two and a half to six years of age who have been given a set of toys evoking motherhood. A girl doll or a boy doll was among the toys. Analysis points up two factors that allow us to explain the relative differences in behavior as noted in girls and boys while playing: The first factor is what we'll call the positive experience of mothering (girls play more than boys, older children are more involved than younger ones); a second factor, called a distant, defensive attitude, probably more closely characterizes boys with a girl doll (distance, aggressivity). The most positive "mothering" (various activities and outward tenderness) in a sub-group of older girls playing with a boy-doll. The doll's sex appears to be a determining element in child behavior. More general remarks are brought up regarding the theoretical questions of how the child perceives the beginning of the parents' role and how a sexual identity in the largest sense of the word are inter-related. The problem of a child's wants are also considered, inasmuch as they might come up in the cultural, social and psychological dimensions of childhood.

Adaptación y validación de la versión chilena del cuestionario "Evaluación de la Atención de Enfermedades Crónicas para pacientes" / Assessment of a Chilean Spanish version of the Patient Assessment of Chronic Illness Care Questionnaire

Background: The Patient Assessment of Chronic Illness Care (PACIC) questionnaire is a widely used instrument to assess chronic disease care from a patient's perspective. Aim: To adapt the PACIC questionnaire to Chilean Spanish and to evaluate the psychometric properties of the translation. Material and Methods: Descriptive, cross-sectional design with exploratory and confirmatory factor analysis. The PACIC questionnaire was applied, throughout an external client, to 200 users who received health care at the cardiovascular program in a Family Health Center in Concepción, Chile. Results: The confirmatory factor analysis did not show a good adjustment with the proposed structure in the original instrument. An exploratory factor analysis revealed five factors explaining 58% of total data variability. The distribution of the factor-items of the original questionnaire underwent some modifications, which are explained when analyzing the theoretical construct. A good reliability of the global scale was obtained (Cronbach's α 0.886). Conclusions: The PACIC questionnaire, Chilean version does not replicate the proposed structure of the original questionnaire. Therefore, further research about its validity, incorporating a higher number or diversity of participants is recommended.

Guillain-Barré syndrome in northwest Greece.

OBJECTIVES: We present the epidemiological and clinical-laboratory features of Guillain-Barré syndrome (GBS) in northwest Greece over a 9.5-year period. MATERIALS AND METHODS: We studied all the patients with GBS who were admitted to our neurology inpatient service from January 1996 to May 2005 and compared them with previously published series. RESULTS: Forty-six patients were hospitalized during this period. The average crude incidence rate was 1.22/100,000 populations per year, and males were more susceptible than females. There was a spring clustering, as 52.17% presented the syndrome during spring. The axonal type of GBS was recorded in 13.04% of the patients. The most frequent presenting symptom was dysesthetic numbness (52.17%). A large number of patients (56.52%) had up to three times the elevation of liver function values that resolved in a few weeks. Most patients had an excellent recovery and no deaths were recorded. CONCLUSIONS: In our series, there was no difference in the incidence rate and subtypes of GBS but there was a significant seasonality with spring clustering. A transient elevation of transaminases of undetermined etiology was noted in more than a half of our patients. Although seven patients (15.21%) had significant neurologic sequelae, no deaths occurred.

[Diabetic ketoacidosis responsive to methotrexate in a patient with a mixed connective tissue disease]. / Cetoacidosisdiabética reversible con metotrexato: Resistencia al tratamiento insulínico. Caso clínico.

We report a 42 year-old woman with a hypothyroidism and a mixed connective tissue disease treated with prednisone and methotrexate. The patient had normal blood glucose levels but when the methotrexate dose was tapered, she presented a diabetic ketoacidosis that required up to 520 units of insulin per day. Due to the intensification of the mixed connective tissue disease symptoms, the doses of methotrexate and prednisone were increased again with a simultaneous normalization of serum glucose levels and glucose tolerance. In the following six months, when the dose of methotrexate was tapered again, the hyperglycemia reappeared and was again controlled increasing the dose. Thirty months after the episode of ketoacidosis, the patient was with a weekly dose of methotrexate, asymptomatic and with a normal glucose tolerance. Anti insulin antibodies were not detected and anti islet antibodies were indeterminate, due to interference with antinuclear antibodies. It is possible that the episode of ketoacidosis was unveiled by an autoimmune phenomenon.

¿Es posible la contribución de factores genéticos en el bruxismo? / Are there genetic factors Involved in bruxism?

Bruxismo se define como un trastorno del movimiento mandibular que se caracteriza por apretamiento o rechinamiento dentario. Se estima que la prevalencia de éste puede variar desde un 8 por ciento a un 20 por ciento de la población adulta. Quienes padecen esta parafunción relatan manifestación en otras personas del grupo familiar. Existen teorías que buscan explicar la etiología del bruxismo, basados principalmente en estudios clínicos y encuestas a pacientes. Estas proponen que los principales factores etiológicos de Bruxismo serían estrés y alteraciones en ciertos neurotransmisores o sus vías (Dopamina, Ácido Gamma-Aminobutírico y Serotonina). La posibilidad de que alteraciones genéticas del ADN influyan en la aparición de bruxismo no ha sido considerada. Dado que no existe en la literatura consultada estudios genético-moleculares y/o funcionales que confirmen las teorías basadas en estudios clínicos, parece necesario iniciar investigaciones en esta área que lleven a una mejor comprensión de esta parafunción, con el ánimo final de aportar en el desarrollo de más y mejores terapias para el tratamiento del bruxismo...

Bruxism has been defined as a sleep-related movement disorder characterized by tooth grinding or clenching. Between 8 percent to 20 percent of adult population is affected by this parafunction. Relatives of these patients have reported to be affected by bruxism as well. There are theories that want to explain bruxism ethiology based on factors as stress and alteration in neurotransmitters (Dopamine, GABA and Serotonin). Possible epigenetic alterations in DNA influencing bruxism appearance have not been considered. It is therefore necessary to perform genetic, epigenetic and molecular research to confirm theories related to bruxism ethiology, with the aim to improve knowledge in this field as well as to contribute in the development of new and better therapies in bruxism treatment...

Tibial nerve H-reflex and F-wave studies in patients with uremic neuropathy.

The nerve conduction velocity along the whole length (knee to the spinal cord) of the 1a sensory and motor fibers of the tibial nerve, innervating the gastrocnemius and soleus muscles, of 29 control subjects and 32 patients with chronic renal failure was estimated with recently introduced electrophysiologic F-wave and H-reflex methods. In control subjects and in uremic patients, the proximal sensory (1a) nerve conduction veloctiy (SNCV) was faster than the proximal motor nerve conduction velocity (MNCV), a finding which is attributed to the larger diameter and therefore faster conduction properties of 1a fibers. In uremic patients, the proximal 1a SNCV and MNCV were significantly slowed in comparison with the values in control subjects, while the terminal M-response latency was not significantly prolonged.

Skull structure with primary cerebellar degeneration.

In the present study the structure of the skull and particularly the structure of the posterior cranial fossa was investigated in cases of primary cerebellar atrophy. The findings from the metric study of the skull X-rays of 13 patients were compared with those of a group of 100 healthy individuals. It was found that the patients' posterior fossa is more shallow than that of the controls (p less than 0.001). The modification of the posterior fossa seems to be attributed to shortness (p less than 0.01) of the bones which form it (clivus and occipital bone). The possible pathogenesis and the explanation of the findings in general is discussed.

The spectrum of neurological involvement in Sjögren's syndrome.

Sixty-three unselected consecutive patients with primary Sjögren's syndrome (pSs) were prospectively evaluated for evidence of neurological manifestations. Seventeen had a mild sensory or mixed neuropathy. Two of these plus one more patient had trigeminal neuropathy. One had pure motor neuropathy, whereas another eight had latent motor neuropathy. None volunteered neurological complaints. Two more patients had symptomatic unilateral carpal tunnel syndrome. Severe mononeuritis multiplex and symptomatic symmetrical distal neuropathy were seen in two patients with vasculitis. One patient, with a history of hypertension and no subjective sicca complaints, had a mild cerebrovascular accident and objective evidence of changes compatible with pSs. The study suggests that peripheral neurological involvement is relatively common and benign in the majority of pSs individuals, whereas central nervous system (CNS) disease must be rare.

Neurologic involvement in primary Sjögren's syndrome: a preliminary report.

Forty consecutive patients with primary Sjögren's syndrome (SS) were prospectively evaluated for evidence of neurologic manifestations of the disease. All patients had primary SS diagnosed on the basis of typical sicca symptomatology, objective documentation of keratoconjunctivitis sicca (KCS) and/or xerostomia, and a positive minor labial salivary gland biopsy. None had criteria that would classify him/her as systemic lupus. Evaluation included a detailed neurologic history and physical examination and nerve-conduction studies of all four extremities. Ten patients had a mild sensory or mixed neuropathy of the glove-stocking pattern, and six of them had abnormal nerve conduction studies. Two of those, plus one more, had trigeminal neuropathy. Two more patients had abnormal electrophysiologic studies, one of them with absence of Achilles tendon reflexes as well. None of the above patients volunteered complaints related to these findings. Only one patient with severe primary SS, manifested by cryoglobulinemia, vasculitis and glomerulonephritis, presented with mononeuritis multiplex, that partially responded to intravenous cyclophosphamide and high-dose steroids. Central nervous system (CNS) disease was not detected in any of our patients, suggesting that it is rather rare, whereas peripheral nervous system (PNS) involvement is relatively common and benign in the majority of primary SS individuals.

Mapping expressed sequence tag sites on yeast artificial chromosome clones of Arabidopsis thaliana DNA.

We describe a method for efficient parallel mapping of expressed sequence tag (EST) sites onto yeast artificial chromosome (YAC) clones. The strategy involves an initial YAC clone pooling scheme that minimizes the number of required PCR amplifications. This is followed by parallel analysis of PCR amplicons of EST sequences. Using this method, we have screened 600 EST sites in combinatorial pools of 3449 YAC clones that contain Arabidopsis thaliana DNA inserts. The presence of these genes on YACs was detected by amplifying EST sequences with PCR and analyzing the reaction products by agarose gel electrophoresis. Of the 600 ESTs, 271 were found to map to individual YACs. Software tools are presented that allow for the automated analysis of this electrophoresis data. Suggestions for the scale-up of this method to map large genomes are discussed.

Cetoacidosis diabética reversible con metotrexato: Resistencia al tratamiento insulínico. Caso clínico / Diabetic ketoacidosis responsive to methotrexate in a patient with a mixed connective tissue disease

We report a 42 year-old woman with a hypothyroidism and a mixed connective tissue disease treated with prednisone and methotrexate. The patient had normal blood glucose levels but when the methotrexate dose was tapered, she presented a diabetic ketoacidosis that required up to 520 units of insulin per day. Due to the intensification of the mixed connective tissue disease symptoms, the doses of methotrexate and prednisone were increased again with a simultaneous normalization of serum glucose levels and glucose tolerance. In the following six months, when the dose of methotrexate was tapered again, the hyperglycemia reappeared and was again controlled increasing the dose. Thirty months after the episode of keotacidosis, the patient was with a weekly dose of methotrexate, asymptomatic and with a normal glucose tolerance. Anti insulin antibodies were not detected and anti islet antibodies were indeterminate, due to interference with antinuclear antibodies. It is possible that the episode of ketoacidosis was unveiled by an autoimmune phenomenon.