[Foot and mouth disease in human beings. A human case in Chile]. / Fiebre aftosa en seres humanos. Un caso en Chile.

Foot and mouth disease (FMD) of cattle can cause a significant economic burden and is thus for one of the most feared of cattle disease. FMD is endemic in South America, Africa, Asia and parts of Europe and it is characterized by vesicles in different locations, mainly mouth, feet and teats leading to severe animal weakness. Currently most countries refuse to import livestock and livestock products from FMD areas. North and Central America are currently free of FMD and Chile is free of FMD from 1987. Approximately 40 cases of human infection with FMD virus have been reported, mostly in Europe, and confirmed by virus isolation and the detection of a specific immune response. We discuss the case of a human infection with FMD virus occurred in Chile in 1961 and other relevant cases reported. FMD does not currently present a threat to public health. Even though the FMD virus has the potential to mutate rapidly and emerge as a significant human zoonosis; the rarity of the disease in humans despite a long history of close contact with FMD infected animals suggests that the risk is highly improbable. Then FMD should not be managed as a zoonosis.

Thrombolytic therapy in patients requiring cardiopulmonary resuscitation.

Cardiopulmonary resuscitation (CPR) is often considered a contraindication to thrombolytic therapy for acute myocardial infarction. Of 708 patients involved in the first 3 Thrombolysis and Angioplasty in Myocardial Infarction trials of lytic therapy for acute infarction, 59 patients required less than 10 minutes of CPR before receiving lytic therapy (CPR greater than 10 minutes was an exclusion of the trials) or required CPR within 6 hours of treatment. The patients receiving CPR were similar to the remainder of the group with respect to baseline demographics. The indication for CPR was usually ventricular fibrillation (73%) or ventricular tachycardia (24%). The median duration of CPR was 1 minute, with twenty-fifth and seventy-fifth percentiles of 1 and 5 minutes, respectively. The median number of cardioversions/defibrillations performed was 2 (twenty-fifth and seventy-fifth percentiles of 1 and 3 minutes, respectively). Patients receiving CPR were more likely to have anterior infarctions (66 vs 39%), the left anterior descending artery as the infarct-related artery (63 vs 38%) and lower ejection fractions on the initial ventriculogram (46 +/- 11 vs 52 +/- 12%) than those not receiving CPR. In-hospital mortality was 12 vs 6% with most deaths due to pump failure (57%) or arrhythmia (29%) in the CPR group and pump failure (38%) or reinfarction (25%) in the non-CPR group. At 7 day follow-up the CPR group had a significant increase in ejection fraction (+5 +/- 9%) compared with no change in non-CPR group. There were no bleeding complications directly attributed to CPR.(ABSTRACT TRUNCATED AT 250 WORDS)

Complete atrioventricular block complicating inferior wall acute myocardial infarction treated with reperfusion therapy. TAMI Study Group.

Previous studies report larger myocardial infarcts and increased in-hospital mortality rates in patients with inferior wall acute myocardial infarction (AMI) and complete atrioventricular block (AV), but the clinical implications of these complications in patients treated with reperfusion therapy have not been addressed. The clinical course of 373 patients--50 (13%) of whom developed complete AV block--admitted with inferior wall AMI and given thrombolytic therapy within 6 hours of symptom onset was studied. Acute patency rates of the infarct artery after thrombolytic therapy were similar in patients with or without AV block. Ventricular function measured at baseline and before discharge in patients with complete AV block showed a decrement in median ejection fraction (-3.5 vs -0.4%, p = 0.03) and in median regional wall motion (-0.14 vs +0.24 standard deviations/chord, p = 0.05). The reocclusion rate was higher in patients with complete AV block (29 vs 16%, p = 0.03). Patients with complete AV block had more episodes of ventricular fibrillation or tachycardia (36 vs 14%, p less than 0.001), sustained hypotension (36 vs 10%, p less than 0.001), pulmonary edema (12 vs 4%, p = 0.02) and a higher in-hospital mortality rate (20 vs 4%, p less than 0.001), although the mortality rate after hospital discharge was identical (2%) in the 2 groups. Multivariable logistic regression analysis revealed that complete AV block was a strong independent predictor of in-hospital mortality (p = 0.0006). Thus, despite initial successful reperfusion, patients with inferior wall AMI and complete AV block have higher rates of in-hospital complications and mortality.

Minimizing the risk of inappropriately administering thrombolytic therapy (Thrombolysis and Angioplasty in Myocardial Infarction [TAMI] study group).

Despite the proven benefits of thrombolytic therapy in acute myocardial infarction, concern for its complications, especially in patients misdiagnosed with myocardial infarction, has led to hesitancy in its use. Historical, clinical and electrocardiographic criteria were developed for enrolling patients with suspected acute myocardial infarction into thrombolytic trials by noncardiovascular specialists. The incidence of misdiagnosis of myocardial infarction and the clinical outcomes when these criteria were used were evaluated for 1,387 consecutive patients given thrombolytic therapy. Twenty-five community hospitals and 7 interventional centers were the sites of enrollment. Most patients (63%) were enrolled from community hospitals. Criteria for thrombolytic therapy included: symptoms of acute myocardial infarction < 6 hours but > 20 minutes, and not relieved by nitroglycerin; and ST-segment elevation > or = 1 mm in 2 contiguous leads or ST-segment depression of posterior myocardial infarction. Exclusion criteria reflecting increased risk of bleeding were used. A final diagnosis of myocardial infarction was based on creatinine kinase-MB, electrocardiographic and ventriculographic evaluation. Acute myocardial infarction was misdiagnosed in 20 patients (1.4%; 95% confidence interval 0.8-2.0%). These patients were demographically similar to those with acute myocardial infarction. All misdiagnosed patients survived; no significant adverse events occurred. Thus, in several clinical settings, a simple algorithm with specific criteria was used for diagnosing acute myocardial infarction and administering thrombolytic therapy. The inclusion criteria used in this study led to a low rate of misdiagnosis.

Usefulness of a pericardial friction rub after thrombolytic therapy during acute myocardial infarction in predicting amount of myocardial damage. The TAMI Study Group.

To evaluate the clinical incidence and outcomes of patients with pericarditis after thrombolytic therapy, 810 patients were prospectively studied during acute myocardial infarction (AMI). Pericarditis was defined as the presence of a pericardial friction rub during the hospital course. Only 5% of patients developed a rub during AMI, a low percent compared with that in the prethrombolytic era. A pericardial friction rub more often occurred in the setting of an anterior wall AMI. Patients with, compared to those without, a pericardial friction rub had lower ejection fractions (45 vs 51%, p = 0.002); worse regional left ventricular function (-3.2 vs 2.7, standard deviation per chord); higher in-hospital mortality (15 vs 6%, p = 0.056); a higher frequency of power failure (83 vs 57%); a higher frequency of anterior wall location of the AMI (53% of cases, p = 0.002); and a higher frequency of 3-vessel disease. Therefore, although the frequency of a pericardial friction rub was low (5%) compared with that in the prethrombolytic era, its occurrence denotes more extensive myocardial damage with a worse clinical outcome. Perhaps with successful reperfusion of the infarct-related vessel, transmural myocardial necrosis is prevented and with it the development of pericarditis. Cardiac tamponade did not occur clinically in any patient who developed a pericardial friction rub.

The uses of AFLP for detecting DNA polymorphism, genotype identification and genetic diversity between yeasts isolated from Mexican agave-distilled beverages and from grape musts.

AIMS: The objectives were to determine the variability and to compare the genetic diversity obtained using amplified fragment length polymorphism (AFLP) markers in analyses of wine, tequila, mezcal, sotol and raicilla yeasts. METHODS AND RESULTS: A molecular characterization of yeasts isolated from Mexican agave musts, has been performed by AFLP marker analysis, using reference wine strains from Italian and South African regions. CONCLUSIONS: A direct co-relation between genetic profile, origin and fermentation process of strains was found especially in strains isolated from agave must. In addition, unique molecular markers were obtained for all the strains using six combination primers, confirming the discriminatory power of AFLP markers. SIGNIFICANCE AND IMPACT OF THE STUDY: This is the first report of molecular characterization between yeasts isolated from different Mexican traditional agave-distilled beverages, which shows high genetic differences with respect to wine strains.

QTL analysis of photosynthesis and water status traits in sunflower (Helianthus annuus L.) under greenhouse conditions.

The identification of QTL for several physiological traits in sunflower is described. Traits related to photosynthesis (leaf chlorophyll concentration, net photosynthesis and internal CO(2) concentration) and water status (stomatal conductance, transpiration, predawn leaf water potential, and relative water content) were evaluated in a population of recombinant inbred lines under greenhouse conditions. Narrow-sense heritabilities were low to average. Using an AFLP linkage map, 19 QTL were detected explaining 8.8-62.9% of the phenotypic variance for each trait. Among these, two major QTL for net photosynthesis were identified on linkage group IX. One QTL co-location was found on linkage group VIII for stomatal movements and water status. Coincident locations for QTL regulating photosynthesis, transpiration and leaf water potential were described on linkage group XIV. These results lead to the first description of the organization of genomic regions related to yield in sunflower.

Noninvasive detection of reperfusion after thrombolysis based on serum creatine kinase MB changes and clinical variables. TAMI 7 Study Group. Thrombolysis and Angioplasty in Myocardial Infarction.

Coronary artery patency after thrombolytic therapy has important prognostic implications for survival after acute myocardial infarction. The ability to noninvasively identify patients early after thrombolysis may therefore allow other strategies, such as adjunctive therapy or rescue angioplasty, to be used to restore patency of the infarct-related artery. This study examined the use of a rapid creatine kinase (CK)-MB assay in conjunction with selected clinical variables for noninvasive detection of reperfusion after thrombolysis. Patients were enrolled in a study evaluating accelerated plasminogen activator dose regimens with patency assessments by first angiographic injection during acute angiography at a median and interquartile range (25th and 75th percentiles) 142 (96,195) minutes after starting thrombolytic therapy. Serum CK-MB samples measured by a rapid dual monoclonal antibody assay were obtained in 207 patients before (baseline) and 30 minutes, 90 minutes, and 3 hours after starting thrombolytic therapy. In 109 patients a CK-MB sample was obtained within 10 minutes of acute angiography (angio sample). At acute angiography the infarct-related artery was patent (Thrombolysis in Myocardial Infarction trial grade 2 to 3 flow) in 71%. Baseline CK-MB values were similar in patients with and without later reperfusion at acute angiography: 3 (0,8) ng/ml and 0 (0,4) ng/ml, respectively. At acute angiography, patients with successful reperfusion had higher CK-MB values [46 (20,138) ng/ml] compared with patients with persistent occlusion of the infarct-related artery [8 (3,63) ng/ml; p = 0.002).(ABSTRACT TRUNCATED AT 250 WORDS)

Rebound increase in thrombin generation and activity after cessation of intravenous heparin in patients with acute coronary syndromes.

BACKGROUND: The abrupt cessation of heparin and other thrombin inhibitors when used to treat acute coronary syndromes has been accompanied by a clustering of thrombotic events. It is unknown whether these events are the result of inadequate antithrombin therapy or whether they represent a rebound increase in thrombin activity. This study was designed to determine whether there is a true rebound, as defined by an increase followed by a subsequent decrease, in thrombin activity after discontinuation of intravenous heparin therapy. METHODS AND RESULTS: Thirty-five patients with recent acute myocardial infarction or unstable angina who had received at least 48 hours of intravenous heparin were studied. Patients underwent ST-segment monitoring, and blood samples for determination of thrombin generation and activity were drawn at 0, 3, 6, 10, and 24 hours after heparin discontinuation. Median aPTT was 65 seconds before heparin discontinuation. Median fibrinopeptide A increased from 9.5 to 16.9 ng/mL at 3 hours (P < .0004) and returned to 10.5 by 24 hours. Prothrombin fragment 1.2 likewise transiently increased, from 0.34 to 0.51 nmol/L at 6 hours (P < .0002). Modified antithrombin III decreased over time (P < .002), and activated protein C increased from 2.3 to 4.5 ng/mL at 3 hours (P < .001). Although there were no clinical thrombotic events in the first 24 hours, 4 patients had evidence of ischemia by ST-segment monitoring at a median of 12 hours after heparin discontinuation. The degree of increase in fibrinopeptide A and prothrombin fragment 1.2 was not found to be associated with baseline diagnosis, duration of heparin therapy, baseline level of antithrombin III, or activated protein C. CONCLUSIONS: This study demonstrates a transient rebound increase in thrombin activity as well as in activated protein C upon abrupt discontinuation of intravenous heparin. Clinicians should be vigilant for associated thrombotic events. Further investigation of the significance, mechanism, and possible prevention of this rebound phenomenon is needed.

Fiebre aftosa en seres humanos: Un caso en Chile / Foot and mouth disease in human beings: A human case in Chile

Foot and mouth disease (FMD) of cattle can cause a significant economic burden and is thus for one of the most feared of cattle disease. FMD is endemic in South America, Africa, Asia and parts of Europe and it is characterized by vesicles in different locations, mainly mouth, feet and teats leading to severe animal weakness. Currently most countries refuse to import livestock and livestock products from FMD areas. North and Central America are currently free of FMD and Chile is free of FMD from 1987. Approximately 40 cases of human infection with FMD virus have been reported, mostly in Europe, and confirmed by virus isolation and the detection of a specific immune response. We discuss the case of a human infection with FMD virus occurred in Chile in 1961 and other relevant cases reported. FMD does not currently present a threat to public health. Even though the FMD virus has the potential to mutate rapidly and emerge as a significant human zoonosis; the rarity of the disease in humans despite a long history of close contact with FMD infected animals suggests that the risk is highly improbable. Then FMD should not be managed as a zoonosis.

La fiebre aftosa se presenta en los biungulados, siendo el cerdo el animal más susceptible. La infección de estos animales lleva a cuantiosas pérdidas económicas por disminución de la producción de leche o carne. En la actualidad esta enfermedad constituye una plaga que causa serios trastornos en el comercio pecuario mundial y se la considera como una enfermedad trans-fronteriza. Chile está libre se esta enfermedad desde 1987. La fiebre aftosa en seres humanos ha sido descrita principalmente en Europa, habiéndose confirmado, aproximadamente, unos 40 casos por aislamiento viral y detección de anticuerpos específicos. Se describen los principales casos de fiebre aftosa en seres humanos descritos en la literatura científica, incluyendo un caso ocurrido en Chile en 1961. Se discute la importancia de esta enfermedad en seres humanos y se cuestiona el planteamiento de que es una zoonosis.

Influenza equina en Chile (1963 - 1992): Un posible caso en un ser humano / Equine influenza in Chile (1963-1992): A possible human case

La presentación de la influenza equina en Chile ha estado relacionada con verdaderas pandemias continentales. El primer brote ocurrió el año 1963, posteriormente se han reportado tres grandes brotes en 1977 (H7N7), 1985 (H3N5) y 1992 (H3N5). La sintomatología descrita corresponde en términos generales a la de influenza equina. El brote más grave fue el de 1977. Desde 1992 no se ha descrito la influenza equina en Chile. Un posible caso de transmisión de influenza equina desde caballos al hombre fue descrito en 1973. Evidencian serológicas hacen pensar en un caso de influenza equina en humanos; desafortunadamente el virus aislado desde caballos no fue tipificado.