[Clinical nutrition knowledge in health care members of University Hospitals of Paraguay]. / Nivel de conocimiento en nutrición clínica en miembros del Equipo de Salud de Hospitales Universitarios del Paraguay.

BACKGROUND: Adequate clinical nutrition care is an integral part of the complete treatment of hospitalised patients, requiring specific knowledge from the health care team. The aim of this study is to assess, in Paraguay, the health care team ability in clinical care nutrition. MATERIALS AND METHODS: A survey was made including 174 people of Paraguay university hospitals (29% physicians, 29% medicine graduating students, 11% pharmaceutics, 24% nurses, 7% dieticians), by answering voluntarily a multiple choice questionnaire of 20 items. RESULTS: The median score of the 20 questions was 6 (0-15). Physicians obtained a median of 6 (2-15), graduating students 7 (2-14), pharmaceutics 7 (0-15), nurses 3 (0-11), and dieticians 9 (4-13). The dieticians obtained a significantly higher score than the other groups (p < 0.005). CONCLUSIONS: The knowledge about clinical nutrition in the health care members from university hospitals is not adequate. The level of education in clinical nutrition is better in the dietician.

[Sepsis by Candida in VLBW neonates: therapy with liposomal Amphotericin B]. / Sepsi da Candida in neonati VLBW: terapia con Amfotericina B liposomiale.

Candida spp. are recently frequent cause of nosocomial sepsis in neonates admitted in NICU, expecially VLBW. Amphotericin B is used in the treament of infections caused by Candida, but heavy side effects, expecially due to renal toxiticy, prevent often its use in the VLBW neonates. We used a new formulation of Amphotericin (AmBisome--NEXSTAR), in the treatment of 17 VLBW neonates affected by sepsis caused by Candida albicans, admitted in our NICU during two years. Twelve neonates survived, one neonate died for NEC and bowel perforation. The treatment was prolonged for 13 days (7-33 days), the total amount of dose was 65 mg/Kg, none side effect was noted.

Detection of anti-erythropoietin antibodies in haemodialysis patients treated with recombinant human-erythropoietin.

An enzyme-immunoassay was developed to evaluate the presence of anti-erythropoietin antibodies in plasma samples obtained from renal failure patients treated with recombinant human erythropoietin (rh-EPO). The assay was specific and reproducible. Normal donors had no antibodies to EPO, while 67% of treated patients were positive to the assay. While the specificity of anti-EPO IgG antibodies was high, their affinity for the antigen was low. This finding can be explained by the very small differences in the structure of rh-EPO compared to that of natural EPO. The assay described could be useful in evaluating the long-term effects of rh-EPO treatment on the control of anaemia in renal failure patients.

[Comparison of family physicians' and gynecologists' use of the intrauterine device (IUD)]. / Comparación en el uso del dispositivo intrauterino (DIU) entre médicos de familia y ginecólogos.

OBJECTIVE: To quantify differences between general practitioners (GPs) and gynaecologists in the technique of insertion and follow-up of the intra-uterine device (IUD). DESIGN: Multicentred, descriptive, longitudinal study. SETTING: Two urban health centres and a family guidance clinic. PARTICIPANTS: Target population (n = 1700) between January 1993 and January 1996. Estimated mean of complications was 25%. Sample size was 247 for alpha = 0.05 and 1-alpha = 0.95. The sample was extended to 300 to allow for possible losses of files, estimated at 20%. MEASUREMENTS AND MAIN RESULTS: The variables age, sex, marital status, educational level, parity, abortions, previous contraception, type of job, type of IUD, post-insertion and follow-up complications, subjective evaluation, removal and average follow-up time, were analysed. 158 (54.9%) of the 288 IUDs finally studied were inserted by GPs, and 130 (45.1%) by gynaecologists. 69.5% were anchor-shaped, and 30.5% T-shaped. In 85.5% no immediate complications were found. Mean follow-up time was 22.67 months (CI 95%, 21.3-24.0), during which time 36.6% had complications detected, which led to removal of the device in 22.3% of complications. We found no statistically significant differences between the two populations for age, marital status, subjective evaluation, number of abortions, parity or previous contraception. Likewise, no differences between G.P.s and gynaecologists were detected for post-insertion or follow-up complications, percentage of IUDs removed, or period of time evaluated. There were differences found for the type of IUD used, with more anchor-shaped IUDs in primary care. There were no differences for the type of IUD or complications requiring its removal. CONCLUSIONS: In the population studied we found no differences in immediate or later complications between IUDs inserted by GPs and by gynaecologists.

Phenotypic, functional and molecular analysis of lymphocytes associated with bladder cancer.

Bladder-washing-derived lymphocytes (BWDL) from 67 patients with bladder cancer were studied. The large majority of samples contained a pure population of T lymphocytes, whereas B and NK cells were absent. A comparative analysis of bladder lymphocytes and peripheral blood lymphocytes (PBL), collected in parallel, showed that BWDL significantly differed from PBL. In vitro cultures of bladder lymphocytes were attempted on 21 samples but in vitro expansion was only possible on six patients treated with bacillus Calmette-Guérin (BCG). This finding indicates that BWDL are characterized by a severe proliferative defect. Nevertheless, the addition of BCG on bladder lymphocytes expanded in vitro enhanced their proliferation, suggesting that this population is sensitized against BCG antigen(s). The analysis of T cell receptor restriction patterns showed that bladder lymphocytes from patients under BCG treatment were oligoclonal. A possible explanation for the efficiency of the immune response and good clinical outcome in patients treated with BCG could be found in the high homology between some BCG antigens and human heat-shock proteins, which are overexpressed in transformed cells.

Perilymphatic injections of recombinant interleukin-2 (rIL-2) partially correct the immunologic defects in patients with advanced head and neck squamous cell carcinoma.

Patients with advanced head and neck squamous cell carcinoma (HNSCC) are severely immunocompromised. In virtually all such patients who have been studied, reduced numbers of circulating CD3+ T-cell-receptor (TCR)alpha/beta+ T lymphocytes, a reduction of natural killer (NK) activity, and a poor induction of lymphokine-activated killer (LAK) cell activity (following in vitro treatment with recombinant interleukin-2 [rIL-2]) have been detected. Recently, however, it has been demonstrated that perilymphatic injections of low doses of rIL-2 may induce a local reduction of tumor masses in these patients. The present study, a cooperative pilot effort on the clinical effects of this route of administration, showed an activation of the lytic machinery in lymphocytes belonging to the T-cell lineage, as well as a potentiation of NK activity in the peripheral blood. These findings demonstrated that the severe immunodeficiency of HNSCC patients may be at least partially corrected by in vivo administration of rIL-2.

Apheresis for severe malaria complicated by cerebral malaria, acute respiratory distress syndrome, acute renal failure, and disseminated intravascular coagulation.

Malaria has become a very uncommon disease in Italy. Recently a variety of circumstances, such as travel to tropical countries as well as immigration from Asia and Africa, have combined to increase the number of malaria cases recorded annually. In this report we describe the use of red cell exchange transfusion and plasma exchange in the treatment of a patient with hyperparasitemic malaria (51% erythrocytes or more parasitized). When first observed the patient was in shock and had signs of cerebral malaria, disseminated intravascular coagulation, and acute respiratory distress syndrome, which in the following 2 days were complicated by acute renal failure. After mefloquine therapy combined with 3 red blood cell exchanges, 2 plasma exchanges, and 10 dialysis sessions over 14 days, the patient recovered completely. This case of severe malaria with multiple complications, treated with mefloquine in conjunction with both exchange transfusion and plasmapheresis, had a successful outcome and lends further support to the possible beneficial role of exchange transfusion in complicated malaria.

Induction of functional activities of human lymphocytes by monoclonal antibodies.

Monoclonal antibodies (MoAbs) specific for surface molecules involved in lymphocyte activation, represent an useful tool for the analysis of the activation pathways of different effector lymphocytes. We have analyzed the ability of MoAbs directed against "triggering" surface molecules, such as CD3/TCR, CD2 and CD16 to induce activation of the lytic machinery in T and NK lymphocytes, using a redirected killing assay. In addition, we have constructed bispecific monoclonal antibodies (BiMoAbs) directed against both the CD3/TCR complex (or the CD16 molecule) and a tumor associated antigen expressed on the surface of ovarian cancer cells. BiMoAbs were constructed by two different approaches: a) conjugation of two distinct MoAbs by a chemical heterobifunctional agent; b) selection of hybrid-hybridomas secreting BiMoAbs. BiMoAbs were able to focus appropriate lymphoid effector cells on tumor cells expressing the relevant antigen, and to induce tumor cell lysis. Therefore, these reagents were able to confer a new specificity for a given antigen to effector lymphocytes, independently from the original one. For these properties, BiMoAbs may represent a suitable tool for new strategies of adoptive immunotherapy, based on the use of effector cells that have been specifically armed by BiMoAbs against the tumor.