Analysis of genetic variability of Fasciola hepatica populations from different geographical locations by ISSR-PCR.

Inter-simple sequence repeats markers were used to determinate the genetic variability of Fasciola hepatica populations recovered from sheep and cattle from Spain (Sp1, Sp2, Sp3 and Sp4), UK (Eng), Ireland (Ir) and Mexico (Mex). Twenty five primers were tested but only five produced 39 reproducible bands, being 71.79% polymorphic bands. This percentage ranged from 10.26% in Sp4 to 48.72% in Sp1, and per host between 28.21 and 48.72% in sheep and between 10.26 and 38.46% in cattle. This relatively low range of genetic diversity within populations, with a mean of 34.40%, implies that a large proportion of variation resided among populations. The population differentiation (Gst = 0.547) indicated that 54.7% of variation is due to differences between populations and 45.3% due to differences within population. The Nei's distance ranged between 0.091 and 0.230 in sheep and between 0.150 and 0.337 in cattle. The genetic relationships between populations and individuals were shown by a UPGMA dendrogram and a principal coordinate analysis; both grouped all populations separately from Sp4, a population of from the Midwest of Spain with the lowest level of diversity. Small genetic distances were observed between Eng and Ir, on the one hand, and Sp1, Sp2, Sp3, from the Northwest of Spain, together with Mex, on the other.

[Logistic regression]. / Regresión logística.

Logistic regression is a group of statistical techniques that aim to test hypotheses or causal relationships between a categorical dependent variable and other independent variables that can be categorical and quantitative. Through this model we intend to study the probability that the event studied will occur based on some variables that we assume are relevant or influential. In this method it is necessary to detect effect modifier and confounding variables. Its parameters are estimated with the maximum likelihood method through a process with successive iterations.

Severity of menopausal symptoms and cardiovascular and osteoporosis risk factors.

OBJECTIVES: To assess whether the severity of menopausal symptoms is related to increased cardiovascular and osteoporosis risk factors, and to determine whether women with more severe menopausal symptoms present a greater percentage of osteoporosis disease. METHODS: This was a cross-sectional, descriptive study encompassing women aged 45-65 years in the whole Spanish territory. The study population sample was collected through random sampling. A total of 10 514 women were included. Their sociodemographic, medical history and lifestyle data were assessed by means of a survey. The Kupperman Index was used to assess the severity of menopausal symptoms. Bone mineral density was measured by the dual X-ray absorptiometry method. RESULTS: The prevalences of risk factors for osteoporosis and cardiovascular disease were 67.6% and 74.8%, respectively. Women with a higher intensity of symptoms also had a greater percentage of cardiovascular (p < 0.001) and osteoporosis (p < 0.001) risk factors and suffered more from osteoporosis disease (p < 0.001). In the logistic regression analysis, those variables that contributed to the severity of menopausal symptoms were: arterial hypertension (odds ratio (OR) 2.14; 95% confidence interval (CI) 1.49-2.79; p < 0.001), dyslipidemia (OR 1.94; 95% CI 1.48-2.4; p < 0.001), obesity (OR 2.23; 95% CI 1.55-2.91; p < 0.001), family history (OR 1.38; 95% CI 1.17-1.59; p < 0.01), medication use (OR 1.12; 95% CI 0.52-1.72; p < 0.01) and osteoporosis disease (OR 3.71; 95% CI 2.9-4.52; p < 0.001). CONCLUSIONS: Women with more severe menopausal symptoms had a greater prevalence of cardiovascular and osteoporosis disease risk factors and suffered more from osteoporosis disease compared to those who had milder or no menopausal symptoms.

Effect of lipopolysaccharide (LPS) from Ochrobactrum intermedium on sheep experimentally infected with Fasciola hepatica.

The effects of the lipopolysaccharide (LPS) from Ochrobactrum intermedium was evaluated in sheep experimentally infected with Fasciola hepatica. Animals were divided into four groups: two treated with the LPS (T1/T2) and two controls (C1/C2). T1/C1 were slaughtered at 30 days postinfection (dpi) and T2/C2 at 85 dpi. Body weight and body condition were found higher in T1 and T2 than in controls, although differences were not significant. Treated sheep showed lower cumulative fecal egg count than controls (p < 0.01). Levels of red blood cells (RBC), white blood cells, hemoglobin, and hematocrit (HCT) were higher in T1 and T2. Significant differences (p < 0.05) in RBC and HCT were found between groups at 84 dpi. More severe macrocytic and hypochromic anemia was observed in C1 and C2 than in treated groups. Total protein and albumin values were higher in T1 and T2 (p < 0.01) until 29 dpi. At the end of the trial, no significant differences were observed in hepatic enzymes, although gamma-glutamyl transferase and aspartate aminotransferase values were higher in C2, and alanine aminotransferase was higher in T2. At necropsy, the mean weight of liver, fibrosis in portal triads, and ganglion size were similar in all groups. The number and size of flukes was greater in C2 than in T2 (p < 0.05). The histological examinations revealed a higher degree of parenchymatous fibrosis in T2 compared to C2 (p < 0.05). The administration of LPS from O. intermedium increased the nonspecific resistance against F. hepatica in experimentally infected sheep.

[Survival analysis]. / Análisis de supervivencia.

Survival analysis is a statistical method that assesses the time between an initial event (inclusion of the subject in the study) and a final event, which occurs when the subject presents a previously defined characteristic. Its objective is to estimate, taking into account the time variable, the probability of a certain event occurring. It has the particularity of accepting incomplete participation times and assuming that all the factors involved in the study are homogeneous. There are several methods to calculate the probability of survival, the most used are the Kaplan-Meier and the actuarial.

[ROC curve]. / La curva ROC.

The ROC curve is a statistical tool used to evaluate the discriminative capacity of a dichotomous diagnostic test. These are curves in which sensitivity is presented as a function of false positives (complementary to specificity) for different cut-off points. They are useful for choosing the most appropriate cut-off point for a test, knowing its overall performance and comparing the discriminative capacity of 2 or more diagnostic tests.

[Intraclass correlation coefficient]. / Coeficiente de correlación intraclase.

The intraclass correlation coefficient makes it possible to measure the general concordance between two or more measurements that involve variables of a quantitative nature, obtained with different measuring instruments or evaluators. It is based on an analysis of variance model with repeated measures. Its use is only possible if there is normality of the distributions of the variables, equality of variances and independence between the errors produced by the observers.

Tuberculosis in a Spanish cohort of children living with HIV: the CHOTIS study (Childhood HIV & TB study).

BACKGROUND: Tuberculosis (TB) is the leading opportunistic infection in children with human immunodeficiency virus (HIV), but is uncommon in low prevalence regions. We aim to describe the changing epidemiology and clinical presentation of TB-HIV co-infection in a cohort of HIV-infected children in Spain.METHODS: Children diagnosed with TB between 1995 and 2016 in the paediatric HIV cohort were identified. The incidence and clinical presentation were compared in three periods: 1995-1999 (P1, before initiation of combined antiretroviral therapy, cART), 2000-2009 (P2, increase in immigration), and 2010-2016 (P3, decrease in immigration).RESULTS: We included 29 TB cases among 1183 children aged <18 years (2.4%, 243/100 000 person-years). The proportion was stable in P1 and P2 (1.3%), but decreased in P3 (0.8%). The median age at TB diagnosis was 6.4 years (IQR 4-10.6); most children in P3 were aged >10 years (20% vs. 23.1% vs. 83.3%, P = 0.01). TB was diagnosed at HIV presentation in 11/29 children (37.9%). Foreign-born children accounted for respectively 0%, 8% and 67% of the total number of children in each period (P ≤ 0.0001). One third had extrapulmonary TB; four children died (13.8%).CONCLUSION: In our cohort, the incidence of TB-HIV co-infection decreased with decline in immigration. In regions with adequate cART coverage and low TB transmission, paediatric TB-HIV coinfection is uncommon, but associated with significant morbidity. Strategies for TB surveillance, diagnosis and treatment in this vulnerable population should be reinforced.

Serological detection of Ascaris suum at fattening pig farms is linked with performance and management indices.

The aim of the present study was to determine the association between the presence of Ascaris suum at fattening pig farms, using different serological methods and the percentage of affected livers at slaughter, with performance and management indices. In total, 21 fattening pig farms from the North of Spain were included in the study. Serum samples were collected from pigs at slaughter and analysed for the presence of anti-Ascaris antibodies. For this, two different ELISAs were used. The first was based on the antibody recognition of the A. suum haemoglobin (As-Hb) molecule whereas the second test used the total extract of A. suum lung stage L3. The serological results were subsequently correlated with the percentage of condemned livers at slaughter, management practices and technical performance parameters including average daily gain (ADG) and feed conversion ratio (FCR). According to the data from the slaughterhouse, 12 out of the 21 farms had livers condemned due to liver white spots. A total of 10 farms (48%) had an average optical density ratio (ODr) exceeding the test cutoff when the As-Hb ELISA was used. This number increased to 18 farms (81%) when using the As-Lung-L3 ELISA. The average ODr of the farms on both ELISAs correlated positively with the percentage of affected livers (P<0.01). Only the average ODr values obtained with the As-Lung-L3 ELISA were positively correlated with the FCR (P<0.01). No correlation was found between percentage of affected livers or serology and the ADG. In relation to management practices, farms with greater than or equal to 50% slatted flooring and that applied the 'all-in/all-out' flow system showed a lower percentage of liver condemnations (P<0.01), lower average ODr results on the As-Lung-L3 ELISA (P<0.05) and lower FCR (P<0.01) compared with those with less than 50% slatted flooring. This study emphasizes that serology is a promising diagnostic tool for diagnosing ascariasis at fattening pig farms. It also supports earlier findings that the presence of A. suum can have a significant negative impact on farm productivity and that stable infrastructure or management practices can have a considerable impact on the control of this parasite.

[Ecographic study of kidney size in children]. / Estudio ecográfico del tamaño renal en niños.

OBJECTIVE: The objective of this study is the determination of the normal kidney size in children analysing the variables that have a good correlation with it. With these correlations the normal kidney size can be established and a diagnose of possible diseases set. METHODS: The data was obtained through ecographies taken in 474 children between 0 and 18 years old that were under control for several reasons differently from the suspicion of a kidney disease. The information related to age, sex, weight, height and corporal surface was also taken. RESULTS: We studied 265 girls and 209 boys. No difference was obtained between the size of the girls and boys kidneys. The regression analysis of the left kidney shows correlations of 0.911 for the height, 0.896 for the corporal surface, 0.863 for the weight and 0.857 for the age; while the one of the right kidney shows correlations of 0.921 for the height, 0.902 for the corporal surface, 0.872 for the age and 0.871 for the weight. The determination coefficients were 0.83 for the left kidney and 0.85 for the right one. The multivariant analysis shows that for both kidneys the height and the age are variables statistically significant as well as the corporal surface for the left kidney. CONCLUSIONS: The size parameters measured in the kidneys show a statistically significance correlation with certain parameters of the growing. The maximum correlation appears for the height of the patient, which allows establishing regression equations with the kidney size and the height and therefore to detect any deviations from these regression curve.

Resistance of gastrointestinal nematodes to the most commonly used anthelmintics in sheep, cattle and horses in Spain.

The objective of this study was to evaluate the status of anthelmintic resistance (AR) in ruminants and horses in Spain. The efficacy of commonly used macrocyclic lactones (MLs) - ivermectin (IVM) and moxidectin (MOX) - was measured in sheep, cattle and horses. In addition, albendazole (ABZ) and levamisole (LEV) were evaluated in sheep and oxibendazole (OXI) and pyrantel (PYR) in horses. Efficacy was evaluated based on the difference between the arithmetic mean pre- and post-treatment faecal egg count (in cattle and horses), or compared to an untreated control group (in sheep). AR was present when the percentage reduction in egg count was <95% and the lower 95% confidence interval (CI) was <90%; if only one of these two criteria was met, the finding was recorded as suspected AR (SAR). In horses, AR-PYR and OXI was considered when the percentage reduction in egg count was ≤ 90% and the lower 95% CI was ≤ 80%. For each animal species, at least 10 study sites were selected. AR to at least one of the drugs was detected in all 10 sheep flocks; the main parasite identified after treatment was Teladorsagia circumcincta. Moreover, in 5 flocks multidrug resistance was identified, on 4 farms to drugs from different families, on one farm to both MOX and IVM and on another farm to all drugs tested. In cattle, the efficacy of both MOX and IVM was 100% on 4 and 3 farms, respectively, and therefore 60% of these farms were considered to have AR or SAR to both MLs. The most frequent parasite identified after treatment was Trichostrongylus spp., although Ostertagia ostertagi was also identified after treatment on one farm. In contrast to ruminants, the 4 drugs evaluated in horses were highly efficacious against strongyles, with efficacies for the MLs and OXI between 95 and 100% and between 94 and 100% for PYR, although 3 herds were SAR against PYR. In conclusion, AR to at least one of the commonly used drugs was identified on all sheep flocks investigated in the northwest of Spain. The occurrence of AR to MLs in cattle was higher than expected but consistent with what was observed in sheep. In horses, all currently used drugs were confirmed as effective against strongyles.

[Methanol and ethylene glycol poisoning. Study of 18 cases]. / Intoxicación por metanol y etilenglicol. Estudio de 18 observaciones.

BACKGROUND: The present study reviews acute intoxication by methanol and ethylenglycol analyzing its form of presentation, treatment applied and prognosis. METHODS: A retrospective study performed in 5 hospitals from the Barcelona area (Spain) from January 1984 to December 1993 is reported. RESULTS: Eighteen patients, 16 intoxicated by methanol and 2 by ethylenglycol were reviewed. The blood levels of methanol on admission ranged from 350 to 4,600 mg/l (mean = 1,649 +/- 1,220 mg/l). The clinical course was initially characterized by alteration of the level of consciousness (in 61% the index of Glasgow of coma was < or = 7) and development of metabolic acidosis (pH < or = 6.80 in 44% of cases). Eighty-seven percent of patients intoxicated by methanol had visual disorders. Treatment consisted in the administration of ethanol, bicarbonate and extrarenal exchange. Mortality was 44%, being greater among patients with the lowest initial pH (p = 0.0001) and with the lowest concentration of bicarbonates (p < 0.03). The patients with lower pH (r2 = 0.65, p < 0.002) and with a lower value of blood bicarbonate (r2 = 0.87; p < 0.0001) on admission were significantly more severe. Sequelae are present in 55% of the survivors. CONCLUSIONS: Intoxication by methanol and ethylenglycol cause severe metabolic acidosis, with high anion and osmolar gaps which may rapidly lead to death or to sequelae in survivors if diagnosis is delayed and specific treatment is not initiated early.

[Factors related with accident risks in persons older than 65 years of age in the province of Guadalajara]. / Factores relacionados con la accidentalidad en personas mayores de 65 años de la provincia de Guadalajara.

OBJECTIVES: We studied the factors that can increase the risk of accidents among elderly persons who had no cognitive deterioration in the province of Guadalajara, Spain. METHODS: A cross-sectional, observational study was made in a primary care setting in which urban and rural areas were differentiated. A questionnaire (confirmed by a pilot study and analysis of the stability of responses using the kappa coefficient) was administered to a randomized, stratified sample in different stages. The sample was proportional in age, sex, and population centers. The variables studied were the cohabitants of the home, type of home, architectural barriers in the home, heating systems, periodic eye and ear checkups, use of corrective lenses and hearing aids, traffic safety, and sociodemographic variables. Data were analyzed using descriptive, analytical, and multivariant statistical procedures and logistical regression. The sample included 473 persons from rural areas and 477 persons from an urban area. The final study sample included 388 persons from rural areas and 392 persons from an urban area. The percentage of losses ranged from 16% (males from a rural area) to 26% (females from a rural area). RESULTS: The type of home differed depending on the area. One-story homes predominated in rural areas. In every case, over 80% of the homes had 1 to 4 architectural barriers, particularly the absence of hand-bars in bathrooms, presence of rugs and carpets, changes in floor level, and stairs. The percentage of elderly persons who underwent eye or hearing checkups less than once a year was over 75% for eye checkups and over 90% for hearing checkups, regardless of the area. Although the use of seatbelts is obligatory, 3% to 7% of the elderly do not use them. CONCLUSIONS: The prevalence of conditions that increase the risk of accidents for persons over 65 was high in our province. This study highlights the need for corrective measures.

[Prevalence of tuberculosis infection in the school age in Guadalajara, Spain]. / Prevalencia de la infección tuberculosa en el medio escolar de Guadalajara.

OBJECTIVES: To estimate the prevalence of tuberculosis infected children in the first grades of Primary Education and to analyse the distribution of infected people among social class groups and other previous circumstances. METHODS: Cross-sectional study with diagnostic test application and questionnaire survey, in a representative sample of the school population of the province of Guadalajara, Spain (two stages sampling design). Tuberculin skin tests with 2 I.U. of P.P.D. RT-23 and the Sokal method for lecture were used. For occupational classification and social class definition were used the criteria of the last report of Spanish Epidemiology Society. RESULTS: A total of 1,093 children (50.8% males) between 6 and 9-year-old were studied. The overall prevalence of infected children was 1.64 (I.C.:1-2.3). The distribution of infection did not show significant differences between urban/rural population, previous disease, family antecedent, social class, dwelling area and occupational activities of parents. The prevalence increased in the older upper school years and among the older children. Prevalence ranged from 0.4% (CI: 0.01-1.3) in the first year to 3.53% (CI: 2.4-4.6) in the last year. Children born in 1988 had a 3.23% prevalence (CI: 1.2-5,1), while those born in 1989; 1990 and 1991 had a prevalence of 0.73 (CI: 0-1.77), 1.88% (CI: 0.2-3.51) and 0.4% (0-1.2), respectively. CONCLUSIONS: Tuberculosis infection is less prevalent at school ages than other areas of Spain. In spite of the increase prevalence per school year, the low frequency and sample size did not allow to test for other associations.

[Gynecomastia secondary to Leydig cell tumor]. / Ginecomastia secundaria a tumor de células de Leydig.

We describe a 16-year-old boy with Leydig cell tumor who initially presented bilateral gynecomastia with increased estradiol concentrations, decreased testosterone concentrations and normal gonadotropin levels. Testicular ultrasonography showed a tumor in the left testicle, and orchidectomy was performed. Histopathological analysis revealed a Leydig cell tumor. Two months after surgery, the gynecomastia diminished gradually and estrogen levels returned to normal. No recurrences have occurred during a 2-year follow-up.

[Graves' disease in patients with Down syndrome]. / Enfermedad de Graves en pacientes con síndrome de Down.

Three patients showing the rare association of Down syndrome and Graves' disease are reported. While two of the patients were asymptomatic, the third showed goiter, nervousness, weight loss, and tachycardia. In addition to the typical features of hyperthyroidism, this patient showed right heart failure and hypertransaminasemia, which disappeared with antithyroid treatment. Because Graves' disease is rare in children, and the clinical presentation was unusual in one of our patients, we report three patients with Graves' disease and Down syndrome, and emphasize the importance of periodic evaluation of thyroid function in children with Down syndrome not only to detect hypothyroidism.

[Personal care habits of individuals over age 65 having no cognitive impairment and residing in the Guadalajara Health Care District]. / Hábitos higiénicos en personas mayores de 65 años del área sanitaria de Guadalajara, sin deterioro cognitivo y residentes en la comunidad.

BACKGROUND: The aim of this study is that of ascertaining the characteristics of the personal care habits of those individuals over age 65 who have no cognitive impairment within the province of Guadalajara who are residents of the community based on the hypotheses that the same are deficient and therefore subject to improvement. METHODS: This is an observational, analytical cross-sectional study within a Primary Care, distinguishing between the urban and rural environments. A questionnaire (involving prior trial and reliability study by means of an analysis of the stability of the answers based on a kappa factor) was given out to a random, layered ample divided into different stages and proportional by age, gender and centers of population. An analysis was conducted of the following variables: A) Personal care habits. A. Personal care--daily washing/dressing: procedure and frequency, Hair Care, Always washing hands before eating and after going to the bathroom; Shaving for men, Oral hygiene. b. Sleep routine. B) Sociodemographic variables. The data was analyzed using proprietary descriptive, analytical and multivariable logistic regression procedures. RESULTS: The losses fell within the 16%-26% range (refusal was found to be the leading cause in the rural environmental and non-location in the urban environment). The sample finally studied included 388 individuals in the rural environment and 392 individuals in the urban environment. Half showered and washed their hair at least once a week. As high as 15% doe not wash always wash their hands before eating and as high as 44% do not do so after going to the bathroom. Over 50% of the males shave using the correct procedure. A high percentage of those missing part of their teeth as well as those completely toothless do not use dentures, and those who do are lacking in hygiene. Sleep routines shows better results. CONCLUSIONS: Personal care habits among senior citizens in our province are patently subject to improvement in all of the aspects analyzed, especially in the rural environment and among males. This should be a priority task under the charge of anyone assigned to the Primary Care Teams.