[Validation of taking arterial pulse in Primary Care for the detection of atrial fibrillation and other cardiac rhythm disorders in patients over 65 years old]. / Validación de la toma del pulso arterial en atención primaria para la detección de fibrilación auricular y otros trastornos del ritmo cardiaco en mayores de 65 años.

INTRODUCTION: Atrial fibrillation (AF) is the most frequent arrhythmia in clinical practice and has important prognostic implications. The objective of this study was to demonstrate the validity and the reliability of taking the arterial pulse (TAP) in patients over 65 years for detecting in AF and other rhythm disorders. MATERIALS AND METHODS: A descriptive, observational, multicentre study to validate a diagnostic test within in a controlled clinical trial. SETTING: 39 Primary Care Centres in the Spanish National Health Service. A total of 318 physicians and nurses took part in the analysis of validity, and 166 of them took part in the analysis of reliability. The professionals were previously called to a meeting in which they took the arterial pulses, and were given 4 ECGs to interpret. The participants TAP of 864 patients followed by an ECG to confirm the cardiac rhythm. Sensitivity, specificity and predictive values were estimated to assess the criterial validity and the simple concordance index to check reproducibility. RESULTS: The sensitivity of pulse measurement for detecting AF detection was 99.4% (95% CI: 97.9-100.0), with a specificity of 30.7% (95% CI: 26.1-35.3), a positive predictive value of 36.6% (95% CI 32.0-41.2), and negative predictive value of 99.2% (97.3-100.0). The simple concordance between the researchers and the cardiologist for the ECG diagnosis of AF ranged between 84.9% and 91.6%. CONCLUSIONS: The TAP has a high sensitivity but a low specificity to detect AF. It is a reliable test for the opportunistic screening of arrhythmias in patients aged over 65 years.

[Endoscopic diagnosis and treatment of tracheobroncheal tubercular granuloma]. / Diagnóstico y tratamiento endoscópico del granuloma tuberculoso traqueobronquial.

A retrospective study was made of ten tracheobronchial tuberculous granulomas diagnosed and treated at our Hospital. We used a fiberoptical endoscope for diagnosis and a rigid endoscope for treatment with good results.

Long-term histologic and mechanical results of a Permacol™ abdominal wall explant.

PURPOSE: We hypothesize that Permacol™ may allow controlled integration over time while providing long-term mechanical stability and native tissue remodeling. The purpose of this report is to investigate these properties in an explanted piece of Permacol™ after 2 years in vivo. METHODS: A 62-year-old female presented with a complex abdominal wall history having undergone a transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction 10 years ago, followed by an abdominal wall repair with Marlex™ mesh for weakness 3 years later. Two years ago, she developed an abdominal bulge repaired with a Permacol™ overlay. Twenty-three months postoperatively, she presented with abdominal distension. Computed tomography (CT) scanning demonstrated a fluid collection behind the Permacol™. She underwent incision and drainage of the hematoma/bursa and quilting repair of the abdominal wall. A 1 × 6-cm Permacol™ section was resected as part of closure. Histology, immunohistochemistry, and mechanical testing of the Permacol™ explant were performed. RESULTS: Histology showed fibroblast and blood vessel ingrowth with no cellular infiltrates reflective of inflammation. Immunohistochemistry for human-specific collagen types I and III and elastin detected staining throughout. Sections stained with non-specific control antibody exhibited no discernable staining. Elastin highlighted blood vessels. Native Permacol™ had a breaking strength of ~20 N, while for explanted Permacol™, it was ~33 N. CONCLUSIONS: Permacol™ maintained durability while allowing vascular ingrowth without residual inflammation. Explant demonstrated integration with human collagen and elastin remodeling throughout. Increase in mechanical strength may reflect newly synthesized collagen and elastin. These histologic findings and clinical result support the use of Permacol™ in complex abdominal wall reconstruction.

The role of O-antigen in susceptibility of Serratia marcescens to non-immune serum.

Selection of phage-resistant strains to three different phages, kappa, FSB3 and FSB55, whose primary receptor was lipopolysaccharide, enabled several spontaneous O-defective mutants to be isolated and characterized. Strains ATCC 274 (0:14), 2170 (0:14) and NIMA (0:6) showed serum resistance, whereas their O-side chain defective mutants exhibited high serum susceptibility. Both alternate and classical activation pathways were involved in serum killing activity in Serratia marcescens.

Taxonomy and protein fingerprinting of halophilic Vibrio isolates from bivalves of the Ebre delta.

A total of 380 isolates of halophilic Vibrio and related bacteria isolated from shellfish bred in the Ebro delta (in northeastern Spain) were studied by biochemical characterization; this allowed the use of numerical taxonomy programs. All but 25 isolates fell into 12 phenotypes. The analysis of whole-cell electrophoretic fingerprints of 100 isolates confirmed the numerical analysis of biochemical and morphological traits.

Lipopolysaccharide recovery restores susceptibility levels towards beta-lactams in Serratia marcescens.

O-side chain-defective spontaneous mutants of Serratia marcescens, selected by phage resistance, showed lower MICs against various beta-lactams than did their parental strains. The recovery of their ability to produce O-antigen restored the original MIC values, as well as phage susceptibility. The permeability coefficients of wild-type, O- mutants, and revertants, demonstrated that O-antigen modifies the permeability of antibiotics in S. marcescens.

Lipopolysaccharide is the receptor for kappa phage in Serratia marcescens.

Kappa phage active on Serratia marcescens can form plaques on white and red strains with identical efficiencies. To identify the kappa phage receptor, the inactivation of the phage was studied after incubation with several bacterial subcellular fractions. The experiments demonstrated that kappa phage adsorbs to outer membrane fractions of susceptible cells. Proteinase K did not affect the rate of inactivation. Lipopolysaccharide proved to be the primary receptor for kappa phage. Prodigiosin content of the lipopolysaccharide fraction was low.

Serogroup conversion of Vibrio cholerae non-O1 to Vibrio cholerae O1: effect of growth state of cells, temperature, and salinity.

Recently, we reported the occurrence of seroconversion from Vibrio cholerae non-O1 to V. cholerae O1, but little is known about the environmental and physiological factors influencing seroconversion. We investigated effects of temperature (4, 25, and 35 degrees C) and salinity ( < 0.05 and 10%0.), as well as the stage of growth of cells, on serogroup conversion. Seroconversion of V. cholerae occurred under various environmental conditions. However, the rate of seroconversion in natural water ( < 0.5% salinity) and synthetic seawater microcosms (10%0 salinity), employing cells harvested from stationary phase culture, was approximately 2 logs higher than cells harvested from cultures in the logarithmic phase (i.e., 10(5) versus 10(3) per 10(10) cells. Thus, the physiological state of the cells, and to a lesser degree, temperature and salinity, is an important factor in the conversion of V. cholerae from non-O1 to O1 serogroup.

A simple filtration method to remove plankton-associated Vibrio cholerae in raw water supplies in developing countries.

Plankton to which cells of Vibrio cholerae O1 and/or O139 were attached was introduced into 0.5% Instant Ocean microcosms maintained at 25 degrees C. The bulk of the plankton and associated particulates was removed with a filter constructed from either nylon net and one of several different types of sari material, the latter being very inexpensive and readily available in villages in Bangladesh, where V. cholerae is endemic. V. cholerae was enumerated before and after filtration to evaluate the efficiency of the filtration procedure. The results obtained indicate that 99% of V. cholerae, i.e., those cells attached to plankton, were removed from the water samples. Epidemic strains of V. cholerae O1 and O139 from various geographical sources, including Bangladesh, Brazil, India, and Mexico, were included in the experiments. Removal of vibrios from water by this simple filtration method was found to yield consistent results with all strains examined in this study. Thus, it is concluded that a simple filtration procedure involving the use of domestic sari material can reduce the number of cholera vibrios attached to plankton in raw water from ponds and rivers commonly used for drinking. Since untreated water from such sources serves as drinking water for millions of people living in developing countries (e.g., Bangladesh), filtration should prove effective at reducing the incidence and severity of outbreaks, especially in places that lack fuel wood for boiling water and/or municipal water treatment plants. The results of this study provide the basis for determining such reductions, which are to be carried out in the near future.