Syphilis and human experimentation from World War II to the present: a historical perspective and reflections on ethics.

Even after the Nuremberg code was published, research on syphilis often continued to fall far short of ethical standards. We review post-World War II research on this disease, focusing on the work carried out in Guatemala and Tuskegee. Over a thousand adults were deliberately inoculated with infectious material for syphilis, chancroid, and gonorrhea between 1946 and 1948 in Guatemala, and thousands of serologies were performed in individuals belonging to indigenous populations or sheltered in orphanages. The Tuskegee syphilis study, conducted by the US Public Health Service, took place between 1932 and 1972 with the aim of following the natural history of the disease when left untreated. The subjects belonged to a rural black population and the study was not halted when effective treatment for syphilis became available in 1945.

Syphilis and human experimentation from the first appearance of the disease to World War II: a historical perspective and reflections on ethics.

Physicians have conducted research on syphilis for centuries, seeking to understand its etiology and the means of transmission as well as find ways to prevent and cure the disease. Their research practices often strayed from today's ethical standards. In this paper we review ethical aspects of the long history of research on syphilis with emphasis on the experiments performed in the 20th century. The description of research around the time of World War II covers medical experiments carried out in US prisons and in the experimentation centers established by Japanese doctors in occupied territory, as well as experiments in Nazi Germany and the treatment of syphilitics there.

Fluorescence labeling of mitochondria in living cells by the cationic photosensitizer ZnTM2,3PyPz, and the possible roles of redox processes and pseudobase formation in facilitating dye uptake.

The study of labeling selectivity and mechanisms of fluorescent organelle probes in living cells is of continuing interest in biomedical sciences. The tetracationic phthalocyanine-like ZnTM2,3PyPz photosensitizing dye induces a selective violet fluorescence in mitochondria of living HeLa cells under UV excitation that is due to co-localization of the red signal of the dye with NAD(P)H blue autofluorescence. Both red and blue signals co-localize with the green emission of the mitochondria probe, rhodamine 123. Microscopic observation of mitochondria was improved using image processing and analysis methods. High dye concentration and prolonged incubation time were required to achieve optimal mitochondrial labeling. ZnTM2,3PyPz is a highly cationic, hydrophilic dye, which makes ready entry into living cells unlikely. Redox color changes in solutions of the dye indicate that colorless products are formed by reduction. Spectroscopic studies of dye solutions showed that cycles of alkaline titration from pH 7 to 8.5 followed by acidification to pH 7 first lower, then restore the 640 nm absorption peak by approximately 90%, which can be explained by formation of pseudobases. Both reduction and pseudobase formation result in formation of less highly charged and more lipophilic (cell permeant) derivatives in equilibrium with the parent dye. Some of these are predicted to be lipophilic and therefore membrane-permeant; consequently, low concentrations of such species could be responsible for slow uptake and accumulation in mitochondria of living cells. We discuss the wider implications of such phenomena for uptake of hydrophilic fluorescent probes into living cells.

[Nazism and medicine. Learning from history]. / Medicina y nazismo. Aprender de la historia.

Between 1933-1945 in Nazi Germany, physicians and other professional care providers participated in forced sterilization of patients who were carriers of genetic origin diseases and psychiatric disorders, extermination of children and adults with congenital and mental diseases, "scientific and pseudoscientific" medical experiments without consent and mass extermination of people based on their religion, political, cultural or sexual identity (Jews, gypsies, homosexuals). At present, the same ethical issues present during Nazi Period (research limits, end-life decisions, role of the physician as state or health system servant, and genetic research) continue to be present in routine medical care. Having knowledge of the past and the role played by Nazi doctors reinforces the necessary emphasis on bioethics and professionalism within the training of professional health providers.

[Dermatology in Nazi Germany]. / Dermatología en la Alemania Nazi.

During the Nazi period experimentation on human subjects and the elimination of individuals considered to be unproductive members of society were carried out in a systematic fashion. Involved in these practices were many physicians, including dermatologists whose names are linked in one way or another to their specialty. Some, such as Reiter, are very well known. This review attempts to bring to light the identities behind the names we have given to diseases, clinical and histological signs, and syndromes in dermatology.

The Latin American experience of allografting patients with severe aplastic anaemia: real-world data on the impact of stem cell source and ATG administration in HLA-identical sibling transplants.

We studied 298 patients with severe aplastic anaemia (SAA) allografted in four Latin American countries. The source of cells was bone marrow (BM) in 94 patients and PBSCs in 204 patients. Engraftment failed in 8.1% of recipients with no difference between BM and PBSCs (P=0.08). Incidence of acute GvHD (aGvHD) for BM and PBSCs was 30% vs 32% (P=0.18), and for grades III-IV was 2.6% vs 11.6% (P=0.01). Chronic GvHD (cGvHD) between BM and PBSCs was 37% vs 59% (P=0.002) and extensive 5% vs 23.6% (P=0.01). OS was 74% vs 76% for BM vs PBSCs (P=0.95). Event-free survival was superior in patients conditioned with anti-thymocyte globulin (ATG)-based regimens compared with other regimens (79% vs 61%, P=0.001) as excessive secondary graft failure was seen with other regimens (10% vs 26%, P=0.005) respectively. In multivariate analysis, aGvHD II-IV (hazard ratio (HR) 2.50, confidence interval (CI) 1.1-5.6, P=0.02) and aGvHD III-IV (HR 8.3 CI 3.4-20.2, P<0.001) proved to be independent negative predictors of survival. In conclusion, BM as a source of cells and ATG-based regimens should be standard because of higher GvHD incidence with PBSCs, although the latter combining with ATG in the conditioning regimen could be an option in selected high-risk patients.

[Perception of cardiovascular risk in an outpatient population of the Madrid Community]. / Percepción de riesgo cardiovascular en una población ambulatoria de la Comunidad de Madrid.

INTRODUCTION: Cardiovascular diseases are responsible for the largest burden of global mortality. The study of the degree of knowledge of their population risk factors and cardiovascular risk is a priority preventive strategy. MATERIAL AND METHODS: A cross-sectional study with 369 people was performed. The sociodemographic variables were cardiovascular risk and perception as well as physical and anthropometric factors. The risk was stratified with the SCORE table. RESULTS: A total of 49.6% were men and 50.4% were women. The proportion of diagnosis was 23.8% in HTA, 39% in hypercholesterolemia, 31.4% in smoking, 26.3% in obesity and 4.6% in diabetes. Concordance between perceived and real cardiovascular risk was very weak. DISCUSSION: The population has good knowledge about diabetes and acceptable knowledge about hypertension, and hypercholesterolemia but knowledge in prediabetic states and perception of the associated cardiovascular risk is low.

Relationship among changes in hematocrit, albumin and corticosteroid dose on the disposition of tacrolimus during the first six months following renal transplantation.

Tacrolimus is a macrolide immunosuppressant that is safe and effective for the prevention of rejection after kidney transplantation. The oral bioavailability of tacrolimus averages 20% to 25%; however, the inter-individual variability in this parameter is large. Because of the poor correlation of dose to blood concentration between patients, the variability in pharmacokinetics and a relatively narrow therapeutic window, therapeutic drug monitoring of tacrolimus trough whole blood concentrations must be a standard practice. The objective of this evaluation was to determine the relationship among changes in hematocrit, albumin, and corticosteroid dosing on the disposition of tacrolimus during 6 months of treatment in renal transplant recipients. Blood samples for the determination of trough tacrolimus concentrations were taken immediately prior to the morning dose, samples were collected according to the request of the attending physician. Clinical and dosage data were reviewed 6 months after transplantation. The analysis was conducted including 11 patients who were analyzed for hematocrit and albumin at the same time they are measured tacrolimus blood levels. The mean age was 25.3 years (range 17 to 41 years) 4 of the patients were female. Levels of tacrolimus, hematocrit and albumin over the first 24 weeks post-transplant were documented and the estimated relative clearance of tacrolimus were calculated. Statistical evaluation of the data indicates poor correlation between relative clearance and both hematocrit and albumin levels and the mean oral steroid dose. This observation is of clinical significance because dose adjustment may be required to maintain blood concentrations within thetherapeutic range in patients in whom hematocrit or albumin concentrations are changing.

[Autosomal dominant polycystic renal disease: a study of 5 familial cases]. / Enfermedad renal poliquística autosómica dominante: estudio de 5 casos familiares.

Dominant autosomal polycystic renal disease (DAPRD) is the most common cystic nephropathy, with multiorgan expression in many cases. Chronic irreversible renal failure is its major complication. Its clinical presentation is variable and it may remain symptom-free; therefore, it is important to know its many renal and extrarenal features which may suggest the diagnosis together with the family history, and also indicate the diagnostic and therapeutic possibilities. The primary care physician may also play a role in prevention, with the early diagnosis of the involved patients and genetic counseling with information of the implications. We report 5 cases of DAPRD with a clinical evaluation and family study, and also a succinct literature review.

[Results of the application of a health test in a population of immigrants]. / Resultados de la aplicación de un examen de salud en población inmigrante.

OBJECTIVE: To describe the demographic characteristics and the results of a healthcare exam of immigrants. DESIGN: A retrospective descriptive study. SETTING: Rural doctor office of Villafranca del Castillo. Madrid. PATIENTS: All immigrants (n = 76) that came for care between May of 1996 and May of 1998. INTERVENTIONS: History, physical exam and basic laboratory tests. RESULTS: Demographic data: 82% are women with a medium age of 33 years (SD 8.49). Their places of origin are Central America: 70%, Philippines: 20%, Africa: 5% and South America: 3%. 97% of them work as household employees or gardeners. They have been living in Spain for an average time of 56 months. Health data: 21.1% are smokers and 17.1% low risk drinkers. 64.5% lack tetanus vaccine and 11.8% lack both tetanus and rubeola vaccines. Serologic test for HBV are negative in 68.4%. 14.5% have past infection and there are no cases of chronic or active infection. PPD is over 10 mm in 35.5%, and between 5 and 10 mm in 7.9%. Prevalence of active TBC is 0%. Stool culture is positive in 6.5%. Salmonella tiphy is identified in one case. Stool examination for ova and parasites is positive in 42.1% of the patients. Protozoos (88%) are more common than helminths (12%). CONCLUSIONS: This study reveals a selective young and healthy immigrant group. The low presence of hepatitis B and tuberculosis infections are notable. The majority present parasites in stool samples.

[Audit of clinical records: clinico-microbiologic study of urinary infections in a team of primary care]. / Auditoría de historias clínicas: estudio clinicomicrobiológico de infecciones urinarias en un equipo de atención primaria.

To carry out an audit of clinical records in our center for the evaluation of the quality of care before the introduction of protocols, several prevalent conditions were selected, and among them urinary tract infections (UTI). Another aim of the study was to evaluate the autochthonous flora responsible for UTI and its resistence to commonly used antimicrobials. A series of acceptable criteria and standards were set as quality controls, and the real index was found below the preselected one in all cases. The most commonly isolated organism was E. coli, followed by Proteus, which were resistent to trimetoprim-sulfamethoxazole in 56% and 71.4% of cases, respectively. Problems of organization and knowledge, and a high resistence rate to common antimicrobials were detected; the following were suggested as measures for improvement: introduction of a protocol, need for continuing education, reduction in the care demand, health education and improvement in the antibiotic policy.