Diagnostic validity of an expert tuberculosis commission that assists the diagnosis of bacteriologically negative suspected TB cases in Havana, Cuba.

The Provincial Tuberculosis Commission of Havana, Cuba, a multi-speciality committee, assists clinicians in diagnosing bacteriologically negative tuberculosis (TB). At its weekly meetings, clinicians present the files of suspected TB cases for discussion, diagnosis and recommendations. This prospective study assessed the validity of the diagnoses made by the Commission by comparing the diagnoses made with diagnoses ascertained after one year of follow-up. Between October 2002 and December 2003, 126 patients suspected to have TB but who were bacteriologically negative completed diagnostic work at the Commission. Fifty-three (42%) were diagnosed as TB cases. The definite diagnosis of 116 patients (92%) was ascertained after one year of follow-up. Six patients diagnosed by the Commission as TB cases were suffering from other diseases, while one patient diagnosed with pneumonia had a definite diagnosis of pulmonary TB. The diagnostic sensitivity and specificity of the Commission were 98% (95% CI 93-100) and 92% (95% CI 85-98), respectively. The Provincial Tuberculosis Commission of Havana can be considered a valuable tool for the diagnosis of TB in patients suspected of TB but who are bacteriologically negative. A comparable approach, adapted to the local conditions, could prove useful in other epidemiological and healthcare settings.

Diferencias de género en el tratamiento de la dependencia de opiáceos con naltrexona / Gender differences in the treatment of the opiate dependence with naltrexone

Introducción. Se quiere conocer la influencia del factor género en las características de consumo, apoyo social y evolución en el tratamiento con naltrexona de un grupo de dependientes de opiáceos. Material y métodos. Mil cuatrocientos treinta y dos pacientes (83,1% hombres y 16,9% mujeres) que sucesivamente y durante 12 años inician tratamiento con naltrexona en la unidad de toxicomanías. Estudio observacional retrospectivo con diseño de grupo de tratamiento sin grupo control. Evaluamos el papel del género en la retención con la prueba de Mantel-Cox. Con tablas de contingencia se analizan las diferencias en función del género. Resultados. La retención al año de iniciarse el tratamiento para el total es del 29,75%, siendo del 30,92% para hombres y del 23,97% para mujeres. Esta diferencia al año es significativa según la prueba de Mantel-Cox (estadístico: 8,38; gl: 1; significación: 0,0038). Las mujeres presentan menor frecuencia de consumo (p=0,011) y uso de la vía intravenosa para cocaína (p=0,048), menor frecuencia de consumo de alcohol (p=0,000) y de cannabis (p=0,002), menor tiempo de consumo de heroína (p=0,016) y mayor proporción consumen sólo heroína (p=0,015). Tienen menor independencia económica (p=0,001), cuentan con mayor frecuencia con pareja consumidora (p=0,000), contando con menor apoyo para el tratamiento de una pareja no consumidora (p=0,000).Conclusiones. Existen diferencias relevantes respecto a las características del consumo, apoyo social y evolución del tratamiento según el género (sea hombre o mujer). Los hombres tienen mejor pronóstico que las mujeres en la población estudiada. Dichas diferencias parecen deberse al contenido sociocultural del concepto género (AU)

Introduction. We want to know the influence of gender factor in the consumption characteristics, social support and evolution in treatment with naltrexone in an opiate addict group. Material and methods. 1.432 patients (83.1% males and 16.9% females) recruited over a 12 year period who successively initiated treatment period years with naltrexone. Retrospective observance study, with design of treatment group without control group. We evaluated the role of gender in retention with the Mantel-Cox test. The differences were analyzed according to the gender with contingency tables. Results. One year retention for all of them was 29.75%, this being 30.92% for men and 23.97% for women. This difference is significant at one year according to the Mantel-Cox test (statistics: 8.38%; gl: 1; signification: 0.0038). Women show less frequency of cocaine use (p=0.011) and less use of intravenous cocaine (p=0.048), lower frequency of consumption of alcohol (p=0.000)and cannabis (p=0.002), a shorter period of heroine abuse(p=0.016) and a higher proportion of them only use heroine (p=0.015). They have less economic independence (p=0.001), their partner is more frequently an addict (p=0.000), they have less help for the treatment from anon-consuming partner (p=0.000).Conclusions. There are outstanding differences with regard to consume characteristics, social support and evolution of the treatment according to the gender (either male or female). Men have better prognosis than women in the population studied. These differences seem to be due to the socio cultural contents of the gender concept (AU)

[Gender differences in the treatment of the opiate dependence with naltrexone]. / Diferencias de género en el tratamiento de la dependencia de opiáceos con naltrexona.

INTRODUCTION: We want to know the influence of gender factor in the consumption characteristics, social support and evolution in treatment with naltrexone in an opiate addict group. MATERIAL AND METHODS: 1,432 patients (83.1% males and 16.9% females) recruited over a 12 year period who successively initiated treatment period years with naltrexone. Retrospective observance study, with design of treatment group without control group. We evaluated the role of gender in retention with the Mantel-Cox test. The differences were analyzed according to the gender with contingency tables. RESULTS: One year retention for all of them was 29.75%, this being 30.92% for men and 23.97% for women. This difference is significant at one year according to the Mantel-Cox test (statistics: 8.38%; gl: 1; signification: 0.0038). Women show less frequency of cocaine use (p=0 . 0 1 1 ) and less use of intravenous cocaine (p=0.048), lower frequency of consumption of alcohol (p=0.000) and cannabis (p=0.002), a shorter period of heroine abuse (p =0.016) and a higher proportion of them only use heroine (p= 0.015). They have less economic independence (p = 0.001), their partner is more frequently an addict (p=0.000), they have less help for the treatment from a non-consuming partner (p=0.000). CONCLUSIONS: There are outstanding differences with regard to consume characteristics, social support and evolution of the treatment according to the gender (either male or female). Men have better prognosis than women in the population studied. These differences seem to be due to the sociocultural contents of the gender concept.

Situacion al año de los adictos a opiaceos que siguieron tratamiento ambulatorio tras desintoxicación hospitalaria / One year follow-up of opiate addicts in an outpatient programme after in-hospital detoxification

Se analiza la evolución al año de los dependientes de opiáceos en un programa ambulatorio que previamente han realizado desintoxicación hospitalaria. Se estudia a 32 pacientes, que constituyen la totalidad de los pacientes de un centro de atención ambulatoria (CAD 7 de Madrid) que durante el año 1998 son remitidos a desintoxicación a una Unidad de Desintoxicación Hospitalaria.El perfil del paciente corresponde a un varón (84 por ciento), soltero (41 por ciento), usuario de drogas por vía inhalatoria (68 por ciento), con una historia de dependencia a opiáceos de más de 9 años de evolución (68 por ciento), con consumo concomitante de otras drogas (81 por ciento). Al año la mayoría de los pacientes (72 por ciento) continúan en contacto con el Centro aunque el 37.5 por ciento del grupo inicial reciben tratamiento con metadona. No se encuentran diferencias entre los que abandonan la desintoxicación y los que son dados de alta del programa hospitalario en relación con su inclusión o abandono de diversos programas, lo que se atribuye a lo reducido de la muestra del estudio La evolución de estos pacientes hace necesario definir mejor el perfil de los pacientes que van a beneficiarse de la desintoxicación y los Programas libres de drogas (AU)

Concomitant protein phosphorylation and endogenous acetylcholine release induced by nicotine: dependency on neuronal nicotinic receptors and desensitization.

1. Nicotine stimulated two Ca(2+)-dependent processes in rat frontal cortex synaptosomes: the phosphorylation of an 80-kDa protein band and the release of endogenous ACh.3 Both effects were mediated by neuronal nAChRs and coincided with depolarization of the synaptosomal plasma membrane induced by the drug. Changes in the state of phosphorylation of the 80-kDa band (presumed to contain synapsin I) were correlated with changes in the release of ACh as follows, from 2 to 4. 2. Blockade of predominant, nerve terminal P-type Ca2+ channels with omega-agatoxin-IVA, did not prevent nicotine from stimulating ACh release. In contrast, exposure to the toxin partially inhibited the release promoted by the depolarizing agent veratridine and attenuated protein phosphorylation induced by either nicotine or veratridine. Taken together, these data suggest that, upon nicotine stimulation. Ca2+ enters nerve terminals through two distinct pathways. The first, via Ca2+ channels, is necessary (but not sufficient) for both nicotine-induced phosphorylation and ACh release. The second, both necessary and sufficient for nicotine-induced phosphorylation and release, is the neuronal nAChR itself. 3. Preincubation of the synaptosomes with a subeffective concentration of nicotine inactivated both nicotine-induced ACh liberation and phosphorylation. This shows that diminished release is associated to decreased phosphorylation of the 80-kDa protein band, most likely as a consequence of nicotine-promoted nAChR desensitization. 4. Augmented ACh release and phosphorylation of the 80-kDa protein band were achieved by using the protein phosphatase inhibitor okadaic acid. However, okadaic acid did not summate with either nicotine or veratridine to increase ACh release further. This is probably because okadaic acid, as in other neurons, increases intracellular Ca2+ (Cholewinski et al., 1993), thus promoting desensitization of ACh release.

[Ligation of the ductus arteriosus in premature infants. Surgical considerations]. / Ligadura del conducto arterioso en prematuros. Consideraciones quirúrgicas.

It is described the surgical interruption of Patent Ductus Arteriosus in ten premature newborn patients with cardiac insufficiency and/or respiratory distress syndrome. The authors mention the technical factors that they consider important to have good results with these fragile infants, as the use of local anesthesia; to perform the procedure in the neonatal intensive care unit, the extrapleural dissection of the ductus, etc. The post-operative care problems are analyzed and this experience is compared with reports from other authors.

[ Exsanguination, extreme hemodilution and autologous retransfusion in cardiopulmonary bypass]. / exsanguinación, hemodilución extrema y retransfusión autológa en derivación cardiopulmonar

In ten dogs and seven patients undergoing open heart surgery, 94% of circulatory volume was replaced by electrolitic solutions; extracted blood was stored temporarily at 5degreesC. Usage of blood was avoided for replacement of extracorporeal fluid circuit and blood lost during surgery. After cardiopulmonar bypass, storage blood was transfused. In both experimental and clinical conditions neither renal, electrolitic nor blood alterations were observed.