Immunogenicity and safety of AS03-adjuvanted H1N1 pandemic vaccines in children and adolescents.

Vaccines with acceptable efficacy profile against the H1N1 A/California/7/2009 virus are needed for use in children. The two studies presented here evaluated the immunogenicity and the reactogenicity/safety of A/H1N1/2009 vaccines containing either 3.75 µg haemagglutinin antigen (HA) and AS03(A)-adjuvant (3.75 µg HA/AS03(A) study) (N=210 [53, 57 and 100 in the 3-5, 6-9 and 10-17 years age strata, respectively]) or 1.9 µg HA and AS03(B)-adjuvant (1.9 µg HA/AS03(B) study) (N=244 [61, 65 and 118 in the 3-5, 6-9 and 10-17 years age strata, respectively]), given as two-dose series. Although the haemagglutination inhibition antibody titres were higher in the 3.75 µg HA/AS03(A) study, both vaccine dosages were highly immunogenic and exceeded regulatory acceptance criteria after the first and the second doses. Seroprotection rates reached 100% and seroconversion rates ranged from 98.2% to 99.1% after each dose of both vaccine dosages. Geometric mean titres increased from 456.5 to 1538.5 and from 297.9 to 1106.7 between the first and the second doses in the 3.75 µg HA/AS03(A) study and the 1.9 µg HA/AS03(B) study, respectively. Despite an observed slight increase of the reactogenicity following the second dose in the 3.75 µg HA/AS03(A) study, the vaccines safety profiles were considered clinically acceptable. In conclusion, both dosages of the AS03-adjuvanted A/H1N1/2009 pandemic influenza vaccines were highly immunogenic and well-tolerated in children and adolescents.

Magnetic properties of ZnO nanoparticles.

We experimentally show that it is possible to induce room-temperature ferromagnetic-like behavior in ZnO nanoparticles without doping with magnetic impurities but simply inducing an alteration of their electronic configuration. Capping ZnO nanoparticles ( approximately 10 nm size) with different organic molecules produces an alteration of their electronic configuration that depends on the particular molecule, as evidenced by photoluminescence and X-ray absorption spectroscopies and altering their magnetic properties that varies from diamagnetic to ferromagnetic-like behavior.

Microstructure and macroscopic properties of bioactive CaO-SiO2-PDMS hybrids.

CaO-SiO2-PDMS (polydimethylsiloxane) hybrid materials were synthesized as crack-free monoliths presenting in vitro bioactivity, i.e. able to be coated with a calcium phosphate-rich layer after having been soaked in simulated body fluid (SBF). A wide physical-chemical characterization of these materials was carried out to relate their microscopic structure and macroscopic properties. The effect of PDMS and the amounts of water used for the tetraethoxysilane (TEOS) hydrolysis on the mechanical properties of hybrid materials was investigated by three-point bending tests. For a given amount of water, as PDMS content in hybrids increased, the elastic modulus decreased. Furthermore, keeping the PDMS content constant, when the amount of H2O decreased, the elastic modulus increased. Regarding in vitro bioactivity and mechanical properties, the hybrid material obtained with molar ratios H2O/TEOS = 2 and TEOS/PDMS = 3.5 proved to be the best candidate for either soft tissue substitution or metallic implant coating since the hybrid material would promote bond to bone formation, simultaneously dampening the mechanical charges.

Budesonide/formoterol maintenance and reliever therapy: an effective asthma treatment option?

This 12-month dose-titration study assessed the effectiveness of budesonide/formoterol for maintenance plus relief with a control group using salmeterol/fluticasone for maintenance plus salbutamol for relief. Adolescents and adults (n = 2,143; mean forced expiratory volume in one second (FEV1) 73% predicted; mean inhaled corticosteroid (ICS) 884 microg.day(-1)) were randomised to budesonide/formoterol 160/4.5 microg two inhalations b.i.d. plus additional inhalations as needed, or salmeterol/fluticasone 50/250 microg b.i.d. plus salbutamol as needed. Treatment was prescribed open label; after 4 weeks, physicians could titrate maintenance doses in accordance with normal clinical practice. Maintenance plus as-needed budesonide/formoterol prolonged the time to first severe exacerbation versus salmeterol/fluticasone (25% risk reduction). The total number of severe exacerbations was significantly reduced in the budesonide/formoterol group (255 versus 329). Both regimens provided sustained improvements in symptoms, as-needed use, quality of life and FEV1, with differences in favour of the budesonide/formoterol group for as-needed use (0.58 versus 0.93 inhalations.day(-1)) and FEV1 (post-beta2-agonist values). Mean ICS dose during treatment was similar in both groups (653 microg budesonide.day(-1) (maintenance plus as-needed) versus 583 microg fluticasone.day(-1)). The simplified strategy using budesonide/formoterol for maintenance and reliever therapy is feasible, safe and at least as effective as salmeterol/fluticasone plus salbutamol.

[Antimicrobial susceptibility of Escherichia coli isolated from bacteriurias in Bierzo health area during 2003]. / Sensibilidad microbiana de Escherichia coli en bacteriurias en el área sanitaria del Bierzo en el año 2003.

OBJECTIVE: Sensitivity to antibiotics of Escherichia coli isolated from intrahospital and extrahospital bacteriurias is analyzed. MATERIAL AND METHODS: Sensitivity to nineteen antibiotics used in the clinical practice was determined in strains of Escherichia coli isolated from intrahospital and extrahospital bacteriurias. RESULTS: The prevalence of in-vitro susceptibilities to antibiotics were (hospital, state health service clinic, health center-primary-care): imipenem (100%-100%-100%; p=NS), amikacin (100%-100%-99.7%; p=NS), fosfomicyn (98.6%-98.4%-99.6%; p=NS), cefepime (96%-96.9%-98.3%; p=NS), piperacillin-tazobactam (96%-95.3%-96.6%; p=NS), aztreonam (93.5%-94.7%-97.7%; p<0.001), ceftazidime (93.5%-94.3%-97.8%; p<0.001), cefotaxime (93.1%-95%-97.7%; p<0.001), cefixime (92.7%-94.6%-96.7%; p<0.05), nitrofurantoin (92%-94.7%-94.7%; p=NS), cefuroxime (88.4%-93.1%-95%; p<0.001), amoxicillin-clavulanic (87.7%-88.7%-93.8%; p<0.001), tobramicyn (87%-93.7%-93.8%; p<0.001), gentamcin (85.9%-92.8%-93%; p<0.001), cefazolin (84.4%-88.7%-91.6%; p<0.01), ciprofloxacin (63.8%-71.4%-78.4%; p<0.001), norfloxacin (63%-70.8%-78.2%; p<0.001), cotrimoxazole (65.2%-68.6%-74.9%; p<0.01) and ampicillin (35.5%-42.5%-47.8%; p<0.01). (*NS= No significant differences). CONCLUSIONS: The knowledge of the sensitivity of uropathogens to antimicrobians can allow us to initiate empirical therapy of urinary tract infections.

[Extracorporeal shock wave lithotripsy of urolithiasis in patients with urinary diversion]. / Litotricia extracorpórea en litiasis en pacientes con derivación urinaria.

We evaluate the efficacy of ESWL in the management of calculi in patients with urinary diversion. We treated 5 patients who suffered from urinary lithiasis after urinary diversion post cistectomy. We managed the patients with extracorporeal shock wave lithotripsy in monotherapy with a Siemens Lithostar Modularis device. Mean stone size (long axis) was 1.95 cm (range 1 to 3.5 cm). The mean shockwave number per session was 2.6 per patient. Stone free result was 100%. We conclude that ESWL technique can provide acceptable results in patients with urinary diversion and can be used as first choice treatment in these type of patients due to its minimal morbidity and excellent results, equivalent to those achieved in patients without urinary diversion.

Efectos-vecindario sobre la salud reproductiva de la mujer chilena / Neighborhood effects influencing reproductive health of Chilean women

BACKGROUND: Fecundity rates have decreased considerably in Latin America, due to a higher contraceptive use and better family planning programs. AIM: To determine whether neighborhood level socioeconomic variables have an independent effect on reported modern contraceptive use, over and above the effect of individual level measures of socioeconomic status and reproductive health behavior. SUBJECTS AND METHODS: Multilevel logistic models determined the effects of individual and neighborhood dimensions (socioeconomic status, urbanization, quality of public health facilities) on contraceptive use among 509 women aged 15 to 49 years living in 85 neighborhoods within the Region of Bio Bio, Chile. RESULTS: After adjustment for women's individual socioeconomic characteristics and other risk factors, less favorable neighborhood socioeconomic characteristics were significantly associated with lower rates of modern contraceptive use. CONCLUSIONS: Changes in the quality of facilities for family planning at the neighborhood level may enhance modern contraceptive use.

[Microbial sensitivity of Escherichia coli in community-acquired urinary tract infections]. / Sensibilidad microbiana de Escherichia coli en infecciones urinarias extrahospitalarias.

OBJECTIVE: For effective empiric therapy of urinary tract infections in the extra-hospital setting the susceptibility pattern of uropathogens should be considered. Moreover, the evolution in sensitivity can be observed when comparing with susceptibility patterns in the previous years. This paper presents an analysis of our experience with Escherichia coli. MATERIAL AND METHODS: During 2002 and 1998, 895 and 595 strains of Escherichia coli respectively, isolated from extrahospitalary bacteriurias were collected in ten health centers in Bierzo (León, Spain). Sensitivity to nine most commonly antibiotics used in the clinical practise was determined. The existence of significant differences of susceptibility among years (2002-1998) was analyzed by the chi square test. RESULTS: Escherichia coli accounted for 63.4% of all isolates in 2002 and 50.8% in 1998. The prevalence of in-vitro susceptibilities to antibiotics were (2002-1998): fosfomycin (99.2%-99.3%; p = NS*), cefixime (98.3%-92.9%; p < 0.001), cefuroxime (96.5%-94.1%; p < 0.05), nitrofurantoin (94.5%-86.9%; p < 0.001), amoxycillin-clavulanic acid (93.1%-90.1%; p < 0.05), ciprofloxacin (77.1%-81.6%; p < 0.05), norfloxacin (75.8%-80.3%; p < 0.05), cotrimoxazole (71.5%-73.4%; p = NS*) and ampicillin (44%-41.4%; p = NS*). (*NS = No significant differences). CONCLUSION: The knowledge of the sensitivity of uropathogens to antimicrobians in a specific medium can allow us to use antibiotics rationally and initiate empirical therapy.

[Utility of prostate-specific antigen in pleural fluid for the diagnosis of metastatic effusion secondary to prostate cancer]. / Utilidad del antígeno prostático específico en líquido pleural para el diagnóstico del derrame metastático por cáncer de próstata.

Pulmonary or pleural involvement from prostate cancer is an uncommon clinical finding. We report on a patient with prostate cancer and a diagnosis of malignant pleural effusion made by determination of pleural fluid prostate specific antigen.

[Ectopic prostatic tissue in the bladder]. / Tejido prostático ectópico en vejiga urinaria.

We report the case of a 58-year-old man with ectopic prostatic tissue at the bladder trigone. The diagnosis was by chance during study and treatment of benign prostatic hyperplasia. The appearance was pseudocystic. It occupied completely the bladder trigone. On histology, the lesion was formed by prostatic type-glands, which were positive for the presence of prostatic specific antigen by using inmunoperoxidase technique. It was partially covered by normal urothelium. Ten months later, no trace of recurrence has been evidenced.

The content of glycogen phosphorylase and glycogen in preparations of sarcoplasmic reticulum-glycogenolytic complex is enhanced in diabetic rat skeletal muscle.

AIMS/HYPOTHESIS: We have examined the effect of diabetes and pharmacological insulin treatment on the content of glycogen phosphorylase and glycogen associated with the sarcoplasmic reticulum-glycogenolytic complex from rat skeletal muscle. METHODS: Diabetes was induced in rats by streptozotocin injection. Enzymatic activities were measured using spectrophotometric methods. Glycogen phosphorylase was determined measuring the pyridoxal-5' -phosphate content and using polyacrylamide gel electrophoresis. Glycogen content was measured by enzymatic and the phenol sulfuric methods. RESULTS: The content of glycogen phosphorylase associated with the sarcoplasmic reticulum glycogenolytic complex gradually arises after diabetes induction. The content of glycogen phosphorylase was restored to a control value by pharmacological insulin treatment. In addition, the content of glycogen in preparations of sarcoplasmic reticulum-glycogenolytic complex of diabetic animals was also increased, whereas the content of glycogen in total muscle of diabetic rats was similar to that of the control rats. The absolute and relative amount of glycogen associated with sarcoplasmic reticulum seemed to increase in diabetic animals. These effects on the compartmentalisation of glycogen were suppressed by insulin treatment. Additionally, the rate of conversion of glycogen phosphorylase b to a, an index of the phosphorylase kinase activity, was 50 % lower in diabetic rats, increasing the dephosphorylated form of glycogen phosphorylase and, as a consequence, its association with sarcoplasmic reticulum membranes. CONCLUSION/INTERPRETATION: These results suggest that under diabetic conditions, both glycogen phosphorylase and a small percentage of muscle glycogen are relocalized in the sarcoplasmic reticulum-glycogenolytic complex.

[Urologic disease emergency. Clinico-epidemiologic analysis at a district hospital]. / Patología urológica urgente. Análisis clínico-epidemiológico en un hospital comarcal.

OBJECTIVE: To present the results of a one-year retrospective study that analyzed the clinical and epidemiological aspects of urological emergencies, which is not a negligible percentage of all hospital emergencies. METHODS: Data on all the urological emergencies of the emergency department of our hospital were collected during a one-year period by filling out a form that included sex, age, whether referred or not, disease, etc. RESULTS: There were 1504 urological emergencies; the urologist was required in 458 of these cases (30.45%). There were more men (837) than women (667). Patient ages ranged from 1-101 years (mean 53 years); a higher incidence was found for those aged 65 years. By age groups, there were more patients aged 61-80 years (575 patients). Most of the patients came to the hospital on their own initiative (1114) and 390 had been referred by their primary care physician. Renal colic (670 cases) was the most common diagnosis in both males and females, followed by cystitis, which was prevalent in the females (67.35%). Other conditions seen were urinary retention, hematuria, etc. CONCLUSIONS: There was a higher prevalence of males that consulted for urological conditions at the emergency department and there was a higher incidence in patients in the 6th and 7th decades of life, which is similar to the findings reported in other studies. Renal colic was the main reason for consultation for both genders and for all age groups, except those younger than 20 who presented more scrotal and penile involvement. Infective conditions involving the lower urinary tract (cystitis) and pyelonephritis were prevalent in the females. The large number of patients that were discharged from the emergency department and who consulted on their own initiative shows their confidence in the emergency services and that they could have been attended to at other health centers and did not have to come and unnecessarily strain the hospital emergency services.

[Prevalence and risk factors for erectile dysfunction in the Region of Bierzo]. / Prevalencia y factores de riesgo de disfunción eréctil en la Comarca del Bierzo.

OBJECTIVE: To analyze the prevalence and risk factors for erectile dysfunction in Bierzo (León, Spain). METHODS: A study was conducted based on a self-administered survey in males aged 19 to 90 years that consulted at the urology and family medicine services of 10 health centers in Bierzo (León, Spain). To determine the existence or absence of erectile dysfunction, the male sexual health questionnaire (SHIM) was included, and those with a score of 21 or less were considered to have some degree of erectile dysfunction. Distribution of the questionnaire began in September 1999 and ended in May 2000. Submission of the questionnaires concluded on May 31, 2000. Of 935 questionnaire that were received, 830 were valid. RESULTS: The overall prevalence of erectile dysfunction in this study was 63.9%, which increased with age and was markedly higher after age 50 years (38.6% for age 41-50 years and 72.6% for age 51-60 years). The age-adjusted analysis showed the risk factors for erectile dysfunction were depression and arterial hypertension on treatment with drugs. Diabetes mellitus on treatment with oral glucose lowering agents or insulin, heart disease and hypercholesterolemia were also associated with the more severe forms. CONCLUSIONS: The prevalence of erectile dysfunction in patients consulting at the primary care and general urological services in Bierzo (León, Spain) was outstandingly high. The present study showed erectile dysfunction to be an age-dependent disease that caused concern in slightly more than half of the patients with this condition. Apart from age, depression and vascular disease were found to be risk factors.

[Reabsorption syndrome. Report of a case]. / Síndrome de reabsorción. Presentación de un caso.

OBJECTIVE: To report a case of TURP syndrome and emphasize the importance of early diagnosis. METHODS: A case of reabsorption syndrome in a patient that underwent transurethral resection under spinal anesthesia is presented. RESULTS: Reabsorption syndrome (TURP syndrome) is manifested by neurological and hemodynamic changes resulting from absorption of irrigating fluid used during transurethral resection of the prostate. This complication presented in a patient undergoing elective surgery and with no additional risk factors. CONCLUSIONS: Since it is impossible to prevent this complication of TUR, spinal anesthesia should be utilized whenever possible because it permits early detection before important complications develop.

[Scrotal leiomyoma]. / Leiomioma de escroto.

A case of a 32-year-old patient with a diagnosis of leiomyoma of the scrotum was studied. Histologic analyses did not yield evidence of malignancy. Full excision of tumor was achieved and the postoperative period was uneventful.

Microbiology of pediatric primary pulmonary tuberculosis.

OBJECTIVE: To determine the sensitivity of bacteriologic studies in pediatric pulmonary tuberculosis. PATIENTS AND METHODS: Between January 1988 and December 1996, 104 consecutive patients aged 0 to 18 years received a diagnosis of primary pulmonary tuberculosis at our institution. Demographic, clinical, laboratory, and bacteriologic data were collected. Clinical specimens were studied for acid-fast bacilli detection by Ziehl-Neelsen stain and cultured for Mycobacterium recovery by Lowenstein-Jensen culture medium. Statistical analysis was performed utilizing chi(2), t tests, and multivariate logistic regression analysis. RESULTS: Bacteriologic results were available for 57 patients (54.8%). A positive smear or culture result for Mycobacterium tuberculosis was obtained in 9 of 54 patients (16.6%) and 25 of 50 patients (50%), respectively. Confirmation of M tuberculosis disease was achieved in 28 patients (49.1%). Ziehl-Neelsen stain and Lowenstein-Jensen culture recovery rates were 10.3% (14 of 135) and 52% (48 of 92) of specimens studied, respectively. Sputum, pleural fluid, and biopsy material cultures yielded M tuberculosis in 55%, 75%, and 63% of patients, respectively. Mean +/- SD age (13.7 +/- 4.5 years vs 9.6 +/- 4.5 years) and number of samples submitted for culture (1.93 +/- 0.94 vs 1.31 +/- 0.97) were significantly higher in the confirmed tuberculosis disease group (p < 0.05). The presence of a pleural effusion was also more commonly found in the confirmed tuberculosis disease group (p < 0.05). CONCLUSION: The sensitivity of bacteriologic studies in pediatric pulmonary tuberculosis disease was 49.1%. Age is the main factor associated with the positivity of culture results.

[Clinical prognostic factors in superficial cancer of the urinary bladder]. / Estudio de factores pronósticos clínicos en el cáncer superficial de vejiga urinaria.

OBJECTIVE: To determine the relation of the classical prognostic factors (tumor stage, grade, size and location) to the recurrence rate, disease free interval and overall survival in patients with superficial bladder cancer. METHODS: The study was carried out on 144 patients with superficial transitional cell carcinoma of the bladder (pTa, pT1) over a period of three years. Age, sex, history of exposure to aniline, smoking, histological type, tumor grade, size, stage, localization (single vs multiple) and type of complementary treatment were analyzed. Tumors were staged according to the TNM classification (1997 version) and cell grade was determined according to the Broders classification. RESULTS: Mean age was 70 years +/- 12.55 (range 22-100); 124 (86%) were males and 20 (14%) were females. All tumors were superficial transitional cell carcinoma; 93% were papillary and the remaining 7% were solid tumors. There were 52 recurrences (36%); of these, only 13 (25%) showed tumor progression: 4 became infiltrating (31%), one (8%) advanced in superficial tumor stage and 8 (61%) advanced in grade. Mean follow-up was 31 months (range 3-61). Overall and disease free survival at 5 years were 88.42% and 45%, respectively. No differences were found for disease free survival according to the different prognostic factors analyzed. Tumor grade correlated with stage and size. Thus, grade III tumors are likely to be stage pT1 and greater than 3 cm. in size. CONCLUSIONS: The histological grade is the most important prognostic factor in bladder cancer progression. However, while grade I and III tumors show a rather similar behavior, the moderately differentiated tumors comprise a heterogeneous group with a very disparate behavior. Tumor grade was found to correlate with stage and size.

[Expression of epidermal growth factor receptor and p53 protein in superficial cancer of the urinary bladder]. / Expresión del receptor del factor de crecimiento epidérmico y de la proteína p53 en el cáncer superficial de vejiga urinaria.

OBJECTIVE: To determine the relationship of the immunohistochemical expression of p53 and EGF-r (epidermal growth factor receptor) and the recurrence rate and disease-free interval in superficial bladder cancer. METHODS: 144 patients with superficial transitional cell carcinoma of the bladder were studied over a period of three years. Direct dilution anti-EGF-r monoclonal antibody (Biogenex, San Ramon, CA 94583, USA) was utilized for EGF-r determination. Anti-p53 mouse monoclonal antibody (DO7, Novocastra, Newcastle, 24 Claremont Place, UK) at a concentration of 1:100 was utilized for protein p53 determination and was considered negative if less than 10% of the tumor cells were stained and positive if 10% to 100% of the cells stained. EGF-r was determined only as either positive or negative regardless of percent of expression. RESULTS: 55 patients (38%) showed EGF-r and 14 (9.7%) showed p53 expression. The disease free survival was 54.08 months in the patients that showed EGF-r expression vs 30 months for those that did not, the difference being statistically significant (p = 0.027). However, no differences were found in this regard for p53 expression. Tumors that expressed EGF-r recurred in the same site as that of the primary tumor. By contrast, those that did not express EGF-r recurred in another or in multiple sites. CONCLUSIONS: The risk of recurrence is lower in bladder tumors that express EGF-r than those that do not, and when they recur, this generally occurs in the same site as the primary tumor. However, determination of p53 expression was not useful in determining the risk of recurrence or progression of superficial bladder tumors.