Study of a measles outbreak in Granada with preventive measures applied by the courts, Spain, 2010 to 2011.

Measles had practically been eliminated in Granada since the systematic vaccination of children with two doses introduced in 1984. However, in 2009 the disease returned in the form of small outbreaks. This study describes the measles outbreak that occurred in Granada from October 2010 to August 2011 and the measures imposed to control it. Information was sourced from the records of the Andalusian epidemiological surveillance system. A total of 308 cases were recorded, representing an incidence rate of 33.6 cases per 100,000 inhabitants. The first wave of the epidemic took place in Granada city, with the majority of cases occurring among families who lived in the Albaycín neighbourhood and were opposed to vaccination for ideological and/or religious reasons. The initial cases were in unvaccinated children aged 1 to 13 years. The outbreak later spread throughout the province. To control the outbreak, the vaccination schedule for the exposed children was brought up to date. The Regional Ministry of Health decided to take legal action in order to ensure vaccination of those in the initial nucleus of the outbreak.

[Implementation of the technical requirements of the UNE-EN-ISO 15189 quality standard in a mycobacterial laboratory]. / Implantación de los requisitos técnicos de la norma de calidad UNE-EN-ISO 15189 en un laboratorio de micobacterias.

The UNE-EN-ISO 15189:2007 standard defines the requirements for quality and competence that must be met by medical laboratories. These laboratories should use this international standard to develop their own quality management systems and to evaluate their own competencies; in turn, this standard will be used by accreditation bodies to confirm or recognize the laboratories' competence. In clinical microbiology laboratories, application of the standard implies the implementation of the technical and specific management requirements that must be met to achieve optimal quality when carrying out microbiological tests. In Spain, accreditation is granted by the Spanish Accreditation Body (Entidad Nacional de Acreditación). This review aims to discuss the practical application of the standard's technical requirements in mycobacterial laboratory. Firstly, we define the scope of accreditation. Secondly, we specify how the items of the standard on personnel management, control of equipment, environmental facilities, method validation, internal controls and customer satisfaction surveys were developed and implemented in our laboratory.

Resurgence of Lymphogranuloma Venereum: A Disease Dermatologists Need to Know About. / El resurgir del linfogranuloma venéreo, una enfermedad que el dermatólogo debería conocer.

The incidence of lymphogranuloma venereum (LGV) -a sexually transmitted infection (STI) produced by the L1, L2, and L3 serovars of Chlamydia trachomatis- is increasing. The 8 patients in this case series were diagnosed with LGV in the STI unit of our dermatology department. Our patients were younger than those in previously published case series, and on presentation they most often complained of tumorous masses (lymphadenopathy) in the groin. Dermatologists should be familiar with this disease. Samples must be taken correctly to ensure an accurate diagnosis and early treatment.

Pharmacokinetics of cyclosporine after renal transplant in children.

The pharmacokinetics of cyclosporine and the relationship between blood levels and average drug concentration were prospectively evaluated in 18 children 1 month after renal transplantation. All children had normal renal function and no hepatic or gastrointestinal dysfunction. Cyclosporine was administered after an overnight fast, and serial blood samples were drawn over a 24-hour period. Analysis of cyclosporine levels was performed by means of monoclonal radio immunoassay on whole blood. Children were divided into three age groups for comparison: 2-5 years, 5-10 years, and > 10 years. There were no differences between age groups in serum protein, serum lipids, or hemoglobin levels, or in the pharmacokinetic parameters of cyclosporine except as follows: significant differences were noted in cyclosporine dose based on body weight, apparent steady-state volume of distribution, and apparent blood clearance, with the youngest children (2-5) requiring higher doses, a relative greater distribution, and exhibiting more rapid drug clearance than those > 10 years of age. In addition, we observed diurnal variation in trough levels, with morning levels (0 hr) significantly higher than those obtained in the evening (12 hours after administration of cyclosporine). Trough levels demonstrated a fair correlation with area under the concentration-time curve (AUC) and average concentration (Cav), but an abbreviated kinetic profile using cyclosporine levels 1 and 3.5 hours after administration accurately predicted AUC.

Effects of carbamazepine on cyclosporine metabolism in pediatric renal transplant recipients.

This study documents a pharmacokinetic interaction between carbamazepine and cyclosporine (CsA) in pediatric renal transplant recipients. Noncompartmental steady-state CsA pharmacokinetics were determined in three pediatric renal transplant recipients who were receiving both CsA and carbamazepine as long-term therapy (carbamazepine group) and in three matched renal transplant subjects who were not receiving carbamazepine (control group). Even though the mean daily dosage of CsA was consistently higher in the carbamazepine group than in the control group (16.2 mg/kg/24 hrs vs 10.8 mg/kg/24 hrs, respectively), the predose trough CsA blood concentrations were significantly lower in the carbamazepine group (57 ng/ml vs 162 ng/ml, respectively; p = 0.0023). Mean average steady-state blood concentrations of CsA (Cav) per mg of CsA administered were less than 50% in the carbamazepine group compared with the control group. This reflects either an induction of CsA hepatic metabolism or a reduced systemic bioavailability (possible induction of pre-hepatic metabolism) by concurrent use of carbamazepine.

Adsorptive stripping voltammetric determination of cefepime at the mercury electrode in human urine and cerebrospinal fluid, and differential pulse polarographic determination in serum.

The cephalosporin cefepime has been studied by adsorptive stripping voltammetric on the hanging mercury drop electrode, followed by linear sweep voltammetry (staircase). The adsorptive stripping response was evaluated with respect to preconcentration dependence and other variables. The drug is strongly adsorbed in acid media, with maximum adsorption at pH 5.8. The detection limit found was 4.8 x 10(-10) M, with 120-s preconcentration. The relative standard deviation at the 10(-7) M level was 0.93%. This method was applied to the determination of cefepime in human urine and cerebrospinal fluid. Differential pulse polarography has been applied to determination in human serum.

Extraction and spectrophotometric determination of titanium(IV) with alizarin and fluoride.

The characteristics of the mixed-ligand titanium(IV)-fluoride-alizarin complex, including the optimum conditions of formation and extraction into methyl isobutyl ketone, are described. A simple and sensitive procedure for spectrophotometric determination of titanium has been developed. At pH 9.5-10.3 titanium reacts with alizarin in the presence of fluoride to form a red-violet complex that is completely extractable into methyl isobutyl ketone, and has its absorption maximum at 513 nm. The molar absorptivity at 513 nm is 7.0 x 10(4)l.mole(-1).cm(-1). Beer's law is obeyed up to 22 mug of titanium in 30 ml of solution. The method has been used for the determination of titanium in an oxide mixture and aluminium alloy samples.

Salicylaldehyde-1-phthalazinohydrazone as an analytical reagent.

The synthesis, characteristics and analytical properties of salicylaldehyde-1-phthalazinohydrazone are described. Spectral characteristics, pK values, the effect of oxidizing and reducing agents, resistance to hydrolysis, and reactions with common cations are reported.

Simultaneous determination of cefepime and grepafloxacin in human urine by high-performance liquid chromatography.

A liquid chromatographic method with UV detection for simultaneous determination of cefepime and grepafloxacin has been developed. The method uses a C18 column, equipped with a pre-column of the same material, and acetonitrile-0.1 M phosphoric acid/sodium hydroxide buffer (pH 3.0)-0.01 M n-octylamine (pH 3.0) as mobile phase in gradient mode. Mobile flow rate and sample volume injected were 1.3 mL min(-1) and 20 microL, respectively. Detection wavelengths were 259 nm for cefepime and 278 nm for grepafloxacin. The retention times were 4.03 min for cefepime and 8.85 min for grepafloxacin, with detection limits of 1.0 and 1.1 microg mL(-1), respectively. The method was applied to the determination of both antibiotics in spiked samples of human urine.

Electrochemical behaviour and determination of acrivastine in pharmaceuticals and human urine.

The differential pulse polarography, DC-tast polarography and cyclic voltammetry behaviour of acrivastine was studied in Britton-Robinson buffer solutions (pH 2-11.7). In acidic media, a non-reversible diffusion controlled reduction process involving four electrons takes place. Two reduction waves appear at a E(1/2)=-0.6 and -0.99 V. The reduction mechanism is discussed. The linear relationship between peak current height and acrivastine concentration allowed the differential pulse polarographic determination of acrivastine over a wide concentration range, from 0.35 to 26.1 mg l(-1)at pH 2.5. The procedure was applied to determination of the drug in pharmaceutical formulations and human urine samples.

Heavy metal extractable forms in sludge from wastewater treatment plants.

The analysis of heavy metals is a very important task to assess the potential environmental and health risk associated with the sludge coming from wastewater treatment plants (WWTPs). However, it is widely accepted that the determination of total elements does not give an accurate estimation of the potential environmental impact. So, it is necessary to apply sequential extraction techniques to obtain a suitable information about their bioavailability or toxicity. In this paper, a sequential extraction scheme according to the BCR's guidelines was applied to sludge samples collected from each sludge treatment step of five municipal activated sludge plants. Al. Cd, Co, Cu, Cr, Fe, Mn, Hg, Mo, Ni, Pb, Ti and Zn were determined in the sludge extracts by inductively coupled plasma atomic emission spectrometry. In relation to current international legislation for the use of sludge for agricultural purposes none of metal concentrations exceeded maximum permitted levels. In most of the metal elements under considerations, results showed a clear rise along the sludge treatment in the proportion of two less-available fractions (oxidizable metal and residual metal).

Enzymatic-microwave assisted extraction and high-performance liquid chromatography-mass spectrometry for the determination of selected veterinary antibiotics in fish and mussel samples.

A new method based on enzymatic-microwave assisted extraction prior to high performance liquid chromatography (HPLC) has been developed for the determination of 11 antibiotics (drugs) and the main metabolites of five of them in fish tissue and mussel samples. The analysed compounds were sulfadiazine (SDI), N(4)-acetylsulfadiazine (NDI), sulfamethazine (SMZ), N(4)-acetylsulfamethazine (NMZ), sulfamerazine (SMR), N(4)-acetylsulfamerazine (NMR), sulfamethoxazole (SMX), trimetroprim (TMP), amoxicillin (AMX), amoxicilloic acid (AMA), ampicillin (AMP), ampicilloic acid (APA), chloramphenicol (CLF), thiamphenicol (TIF), oxytetracycline (OXT) and chlortetracycline (CLT). The main factors affecting the extraction efficiency were optimized in tissue of hake (Merluccius merluccius), anchovy (Engraulis encrasicolus), mussel (Mytilus sp.) and wedge sole (Solea solea). The microwave extraction was carried out using an extraction time of 5 min with 5 mL of water at 50W and posterior clean up with dichloromethane. High-performance liquid chromatography (HPLC)-mass spectrometry was used for the determination of the antibiotics. The separation of the analysed compounds was conducted by means of a Phenomenex® Gemini C(18) (150 mm × 4.6mm I.D., particle size 5 µm) analytical column with LiChroCART® LiChrospher® C(18) (4 mm × 4 mm, particle size 5 µm) guard-column. Analysed drugs were determined using formic acid 0.1% in water and acetonitrile in gradient elution mode as mobile phase. Under the optimal conditions, the average recoveries of all the analysed drugs were in the range 70-100%. The proposed method was applied to samples obtained from Mediterranean sea and also evaluated by a laboratory assay consisting in the determination of the targeted analytes in samples of Cyprinus carpio that had been previously administered the antibiotics.

Trace-metal distribution of cigarette ashes as marker of tobacco brands.

The trace-metal distribution of cigarette ashes offers a potential interest from the point of view of forensics and criminology dealing with the determination and classification of tobacco brands. There is a vast bibliography related to the determination of different metals in tobacco leaves. Nevertheless, none of them are directly linked to this matter. Therefore, in this work we present a methodology to assess the viability of discriminating between different tobacco brands by analysing the ashes after smoking. This methodology encompasses the data analysis by atomic techniques (inductively coupled plasma) and further data analysis by principal component analysis and partial least squares-discriminant analysis. The metal distribution (Zn, B, Mn, Fe, Mg, Cu, Ti, Al, Sr, Ca, Ba, Na, Li, and K) of cigarette ashes of different tobacco brands was determined in 149 samples obtained from local stores, representing the most common brands of cigarettes readily available to consumers in Spain. Further analysis of the data with PCA denoted significant differences between different brands of tobacco in their metallic content. In that sense, blond tobaccos were found to contain different patterns in metallic content than black tobaccos. Intrinsic differences were found between different brands, being possible to study the relationship between each brand and its metallic concentration and compare this relationship with other brands. Moreover the possibility of developing classification models to be able to discriminate between different brands was also introduced.

Application of enzymatic probe sonication extraction for the determination of selected veterinary antibiotics and their main metabolites in fish and mussel samples.

A new method based on enzymatic probe sonication extraction prior to high-performance liquid chromatography (HPLC) has been developed for the determination of 11 antibiotics (drugs) and the main metabolites of five of them in fish tissue and mussel samples. The analytes belong to four different classes of antibiotics (sulfonamides, tetracyclines, penicillins and amphenicols). The analysed compounds were sulfadiazine (SDI) and N(4)-acetylsulfadiazine (NDI) metabolite, sulfamethazine (SMZ) and N(4)-acetylsulfamethazine (NMZ), sulfamerazine (SMR) and N(4)-acetylsulfamerazine (NMR), sulfamethoxazole (SMX), trimetroprim (TMP), amoxicillin (AMX) and its main metabolite amoxicilloic acid (AMA), ampicillin (AMP) and its main metabolite ampicilloic acid (APA), chloramphenicol (CLF), thiamphenicol (TIF), oxytetracycline (OXT) and chlortetracycline (CLT). The main factors affecting the extraction efficiency (type of enzyme, type and volume of extractant, ultrasounds power and extraction time) were optimised in tissue of hake (Merluccius merluccius), anchovy (Engraulis encrasicolus), mussel (Mytilus sp.) and wedge sole (Solea solea). The extraction was carried out using an extraction time of 5 min with 5 mL of water and subsequent clean-up with dichloromethane. High-performance liquid chromatography (HPLC) with diode array (DAD) and fluorescence (FLD) detectors was used for the determination of the antibiotics. The separation of the analysed compounds was conducted by means of a Phenomenex Gemini C(18) (150 mm x 4.6 mm I.D., particle size 5 microm) analytical column with LiChroCART LiChrospher C(18) (4 mm x 4 mm, particle size 5 microm) guard-column. Analysed drugs were determined using formic acid 0.1% (v/v) in water and acetonitrile in gradient elution mode as mobile phase. The proposed method was also evaluated by a laboratory assay consisting of the determination of the targeted analytes in samples of Cyprinus carpio which had previously administered the antibiotics.

Simultaneous determination of 11 antibiotics and their main metabolites from four different groups by reversed-phase high-performance liquid chromatography-diode array-fluorescence (HPLC-DAD-FLD) in human urine samples.

A new, accurate and sensitive reversed-phase high-performance liquid chromatography (RP-HPLC) as analytical method for the quantitative determination of 11 antibiotics (drugs) and the main metabolites of five of them present in human urine has been worked out, optimized and validated. The analytes belong to four different groups of antibiotics (sulfonamides, tetracyclines, penicillins and anphenicols). The analyzed compounds were sulfadiazine (SDI) and its N(4)-acetylsulfadiazine (NDI) metabolite, sulfamethazine (SMZ) and its N(4)-acetylsulfamethazine (NMZ), sulfamerazine (SMR) and its N(4)-acetylsulfamerazine (NMR), sulfamethoxazole (SMX), trimetroprim (TMP), amoxicillin (AMX) and its main metabolite amoxicilloic acid (AMA), ampicillin (AMP) and its main metabolite ampicilloic acid (APA), chloramphenicol (CLF), thiamphenicol (TIF), oxytetracycline (OXT) and chlortetracycline (CLT). For HPLC analysis, diode array (DAD) and fluorescence (FLD) detectors were used. The separation of the analyzed compounds was conducted by means of a Phenomenex Gemini C(18) (150mm x 4.6mm I.D., particle size 5microm) analytical column with LiChroCART LiChrospher C(18) (4mm x 4mm, particle size 5microm) guard column. Analyzed drugs were determined within 34min using formic acid 0.1% in water and acetonitrile in gradient elution mode as mobile phase. A linear response was observed for all compounds in the range of concentration studied. Two procedures were optimized for sample preparation: a direct treatment with methanol and acetonitrile and a solid phase extraction procedure using Bond Elut Plexa columns. The method was applied to the determination of the analytes in human urine from volunteers under treatment with different pharmaceutical formulations. This method can be successfully applied to routine determination of all these drugs in human urine samples.

Urea as new stabilizing agent for imipenem determination: electrochemical study and determination of imipenem and its primary metabolite in human urine.

Imipenem shows a fast chemical conversion to a more stable imin form (identical to that of biochemical dehydropeptidase degradation) in aqueous solutions and stabilizing agents used avoid its electrochemical study and determination. The aim of this work is the proposal of urea as stabilizing agent which allows the electrochemical study of imipenem and the proposal of electrochemical methods for the determination of imipenem and its primary metabolite (M1) in human urine samples. Electrochemical studies were realized in phosphate buffer solutions over pH range 1.5-8.0 using differential-pulse polarography, DC-tast polarography, cyclic voltammetry and adsorptive stripping voltammetry. In acidic media, a non-reversible diffusion-controlled reduction involving a two steps mechanism which involves one electron and one proton in the first step and two electrons and two protons in the second step occurs and the mechanism for the reduction was suggested. A differential-pulse polarographic method for the determination of imipenem in the concentration range 3.2x10(-6) to 2x10(-5)M (0.95-3.4 mg/L) and its primary metabolite in the concentration range 1.4x10(-6) to 10(-4)M (0.43-26.1 mg/L) with detection limits of 9.6x10(-7)M (0.28 microg/L imipenem) and 4.3x10(-7)M (0.14 microg/L M1) was proposed. Also, a method based on controlled adsorptive pre-concentration of imipenem on the hanging mercury drop electrode followed by voltammetric measure, allows imipenem determination in the concentration range 1.8x10(-8) to 1.2x10(-6)M (5.42-347 microg/L) with a detection limit of 5.4x10(-9)M (1.63 microg/L). The proposed methods have been used for the direct determination of the analytes in a pharmaceutical formulation and human urine.