Mannose-binding lectin exon 1 and promoter polymorphisms in tuberculosis disease in a Mediterranean area.

Mannose-binding lectin (MBL) is a serum protein that activates the complement and mediates phagocytosis. MBL levels and MBL2 genotype may impact upon host susceptibility to tuberculosis (TB) disease but evidence to date has been conflicting. MBL2 exon 1 and promoter genotyping and serum MBL concentrations were determined in 79 patients with active tuberculosis (58 pulmonary TB and 21 extrapulmonary or miliary TB) and 120 household healthy contacts (HHC) from a Mediterranean area (Majorca Island, Spain). Significantly higher serum MBL levels were found in patients with active tuberculosis than in HHC [median MBL concentrations 3430 ng mL(-1) (10-28 415) and 2600 ng mL(-1) (5-20 000) respectively, P = 0.002]. These higher MBL levels were mainly related to the most prevalent YA/YA wild-type diplotype. There was a strong correlation between MBL2 exon 1 and promoter genotype and MBL levels. The diplotype LYQA/HYPA was present in 12 out of 57 of the pulmonary TB cases but in none of the extrapulmonary TB patients. Diplotype LXPA/HYPA, producer of high levels of MBL, was significantly more frequent in HHC than in patients (16.8% vs. 6.4%, P = 0.031) suggesting a protective role against the development of TB disease that has not been previously found.

[Site of care provision, etiology and treatment of community-acquired pneumonia in Palma de Mallorca]. / Lugar de atención, etiología y tratamiento de las neumonías adquiridas en la comunidad de Palma de Mallorca.

BACKGROUND: It is not common that community-acquired pneumonias studies include patients non treated in hospital. The objectives were: to determine the cases managed in the ambulatory setting; to describe the clinical features; to identify the aetiological agents, and to describe the treatment, comparing inpatients with outpatients. PATIENTS AND METHODS: Observational prospective study. Population attended at three teaching primary care centers of Palma de Mallorca (60,450 habitants). Patients (> 14 years) were investigated when diagnosticated of community-acquired pneumoniae, from November 1992 to December 1994. Exclussions: HIV infection, patients living in a nursing home and tuberculosis. Data were collected in both Hospital and primary health care centers. Epidemiological, clinical, radiological and laboratory findings were recorded at the initial visit and 21 days after. RESULTS: 91 cases were investigated. 57% were managed at the primary care centers exclusively, 63.3% of the patients who went initially to the hospital were admitted in; but only 10.9% of those who went initially to the primary care centers (p < 0.005). 24 patients were hospitalized. 56 microbiological agents were identified in 48 patients (52.7%): Mycoplasma pneumoniae (10); Streptococcus pneumoniae (9); Influenza B (8); Chlamydia psittacci (7); Influenza A (7); Coxiella burnetii (5); Chlamydia pneumoniae (4); Legionella (3); Adenovirus (2); and Parainfluenza 3 (1). Mycoplasma was predominant in outpatients: 9 cases. S. pneumoniae in inpatients: 5 cases. Eritromycin was the most common treatment prescribed (76.9% of patients), alone or in combination with other antibiotics. Monotherapy was most common at primary care yield (96.7%) than at the hospital (45.2%) (p < 0.005). CONCLUSIONS: Most of the patients with community-acquired pneumonias are managed at primary health care centers. M. pneumoniae is the predominant microbiological agent in outpatients and S. pneumoniae in inpatients. Erithromycin is the most used antibiotic in both groups of patients.

[Network of research units and primary health care]. / La red de unidades de investigación y la atención primaria de salud.

OBJECTIVES: To find the connections between Primary Health Care (PHC) and Research Units (RU) and the participation of PHC professionals in Research Committees (RC) and Clinical Research Ethical Committees (CREC). To evaluate RUs' PHC-related research activities, analyse the RUs and how much they are used by PHC. DESCRIPTION: A descriptive, crossover study, with data collected by means of a mailed questionnaire. SETTING: The 110 units which were part of the RU network by the end of 1993. PARTICIPANTS: Representatives of RUs. INTERVENTIONS: In May 1994 a self-filled questionnaire containing 29 items was sent out to RUs. During October/November 1994 non-repliers were recontacted. MEASUREMENTS AND MAIN RESULTS: 80 RUs replied. 30 RUs were connected with PHC; 14 were totally dependent on PHC; and 16 were partially linked to PHC. A minority of PHC professionals took part in RCs, except in the cases of those totally dependent on PHC. Participation in the CRECs was unusual. RUs had little connection with Family & Community Medicine teaching units, although this figure was higher for RUs connected to PHC. 86.2% of RUs were open to PHC professionals, although involvement was generally low. 71.4% of RUs stated they had carried out some project of their own related to PHC; and 77.6% had collaborated in at least one PHC project. CONCLUSIONS: PHC has paid little attention to the creation of RUs and has participated little in RCs and CRECs. Teaching units should tighten their relationship with RUs, which do an important amount of PHC research. PHC researchers offered a wide range of services, which were little-used. Teaching units should publicise their existence more and extend their times of availability.

[The resident in family and community medicine views his specialization. II]. / El residente de Medicina Familiar y Comunitaria ante su especialización (II).

A questionnaire was submitted to the third year residents of Family and Community Medicine. Its aim was to know their opinion, respecting the different aspects of their specialty. We obtained a high rate of response (49.5%). The majority of residents are male and 37 por 100 had finished their degree before joining the program. The fact of choosing a residence in the Family and Community Medicine program is related to the place obtained in the ranking of Internal Resident Doctors and to the lack of vacancies in fields thought to be more interesting. About a third of those polled state that their main reason for choosing Family and Community Medicine is vocational. If one compared their preference for the specialty before and after the resident period, this increased. Still, the specialty's allure is low. The majority prefer working in Public Medicine and in tasks related to medical care and the urban milieu. We put forward some suggestions that could improve this situation.

[The family and community medicine resident facing his/her specialization (I)]. / El residente de medicina familiar y comunitaria ante su especialización (I).

A questionnaire was sent out to the interns in Family and Community Medicine throughout the country in the last month of training. The objective was to find out the degree of fulfillment and the evaluation of the Official Program of the Specialty as far as courses, rotations and duty periods were concerned. We received 170 questionnaires (response rate: 49.8%). The obligatory courses are overwhelmingly attended, but not so the optional ones. What stands out especially is the incorrect length of rotation among Internal Medicine, Pediatrics, and Primary Health Care. The specializations which draw the most interest due to their eventual use are Internal Medicine, Pediatrics, and Primary Health Care, and the least interesting are Gynaecology, Otorhinolaryngology and Ophthalmics. Roughly half have not had any duty watches in Surgery and Primary Care. With these results in hand, we recommend some changes be made in the specialization programs.