Geographical variation and factors associated to seroprevalence of canine leishmaniosis in an endemic Mediterranean area.

This article retrospectively analyses the spatial distribution and dog- and environmental-level risk factors associated to Leishmania infantum seroprevalence among 807 asymptomatic dogs in the Municipality of Crevillente in Alicante in southeast Spain in 1999. They represented 60% of the dogs in this 103 km2 area, with a human census of 27 034 people and 90% lived in Crevillente town. The estimated seroprevalence (95% confidence interval) in 714 dogs > or =1-year old was 22% (19-25) however; it was 12% (8-15) in town dogs and 0-100% in other administrative zones. High-medium seroprevalence zone clustered along a northeast-southwest fringe and around the town. They comprised the highest and driest inhabited part of the municipality, where farmland was interspersed by residential detached houses, whilst null-low seroprevalence zones included larger farmland extensions and two small rural villages. Predominant vegetation and ground soil type were bush, non-irrigated fruit trees and conglomerate crust and sandstone in medium-high seroprevalence zones and irrigated grassland and fruit trees and colluvial deposits in null-low seroprevalence zones. Random effects logistic regression indicated that the prevalence of infection with L. infantum was higher for dogs sharing residence with infected dogs, increased until 5-6 years old and with body weight and was associated to increasing conglomerate crust and low surface water in the dog's zone of residence. The study confirms that L. infantum infection is endemic in this part of Spain and shows that prevalence can vary significantly within a small area depending on specific demographic and environmental factors conditioning the habitat of the local L. infantum vector, Phlebotomus perniciosus. It suggests similar low-scale variability is present in other geographically variable endemic areas and should be investigated to design Leishmaniosis risk maps and cost-effective, evidence-based, targeted control interventions.

[Special needs of schoolchildren with diabetes mellitus. Point of view of parents and teachers]. / Necesidades del niño escolarizado con diabetes mellitus. Visión de padres y profesores.

BACKGROUND: The daily care of a diabetic (IDDM) child is essential for the short and long term evolution of the disease, and must include the hours the child spends in school. The presence of Trained personnel are needed who will be able to intervene in time if a serious complication, such as hypoglycemia, occurs. Their presence can help to ensure correct control of the disease and avoid long term complications. OBJECTIVES: To understand of the day to day life of children with IDDM, focusing on their school hours. To understand the attitude of primary and secondary school teachers towards pupils with IDDM. PATIENTS AND METHODOLOGY: Descriptive and transversal study on IDDM patients between the ages of 3 and 18, treated within the Healthcare Area number 3 in the Madrid Region, and their teachers. Two different kinds of surveys were distributed: the 1st survey by Fundación para la Diabetes (Foundation for Diabetes) contained 80 questions aimed at patients between the ages of 3 and 18 and their parents. Questions were related to patient's daily life and school environment. The 2nd survey, which allowed free response, was aimed at primary and secondary school teachers about their own experiences working as professionals with pupils with IDDM. RESULTS: Fifty questionnaires addressed to parents and patients were valid in our remit, and we emphasize the following: the ages of major participation were 10 to 14 years; 86% of children knew how to measure blood glucose and 66% how to administer insulin; 74% had no problems with school integration, however, up to 50% of children under 6 years had suffered a problem occasionally; on the 50% of the occasions when a patient needed insulin administration during school hours, it was done by a relative; 66% of hypoglycaemias were resolved by the patient. Health personnel is present only in 8% of the schools studied; 98% of those surveyed think teachers should have written instructions on the signs and symptoms and action to be taken if a hypoglycemia occurs. Questionnaires for teachers were answered by 54% of them (76 of a total of 140), we would like to point out the following: 71% of them recognise having a diabetic pupil; the degree of teacher knowledge on diabetes, rated on a scale from 1 to 7 shows a median of 3 and a mode of 4; 47% of teachers feel insecure when having a diabetic pupil because they do not have instructions on actions to take in case a complication occurs; 97% of teachers affirm to know what a hypoglycaemia is, however only 67% and 57% of them recognise its signs and symptoms and know how to act when they occur. CONCLUSIONS: The school integration and acceptance of pupils with IDDM is good, according to both teachers and parents. Children with IDDM take responsibility for their disease at an early age and are able to develop certain skills. However they still need help, which they get from their family even during school hours. Generally, teachers are willing to learn new skills to be able to help these children, however, further training is required to improve the understanding and management of this disease.

Necesidades del niño escolarizado con diabetes mellitus. Visión de padres y profesores / Special needs of schoolchildren with diabetes mellitus. Point of view of parents and teachers

Fundamentos: el cuidado diario del niño y el adolescente con diabetes mellitus insulinodependiente (DMID), fundamental para la evolución a corto y largo plazo de la enfermedad, debe incluir las muchas horas de permanencia en la escuela. La presencia, en el entorno escolar, de personas entrenadas para evitar los riesgos de una intervención tardía ante una complicación aguda, como es la hipoglucemia, y facilitar el buen control de la enfermedad puede ser considerada una necesidad. La presencia de personal sanitario en nuestros centros educativos públicos es escasa al no estar establecida como obligatoria. Objetivos: conocer aspectos de la vida cotidiana de los niños con DMID centrados en su jornada escolar y conocer actitudes de profesores de colegios e institutos frente a alumnos con DMID. Pacientes y método: estudio descriptivo, transversal sobre pacientes con DMID de 3 a 18 años atendidos en el área sanitaria 3 de la Comunidad de Madrid y sus respectivos profesores mediante dos tipos de encuesta: primera encuesta, distribuida por la Fundación para la Diabetes, con 80 preguntas dirigidas a pacientes de 3 a 18 años y sus padres en relación con su vida diaria y el entorno escolar. Segunda encuesta, de elaboración propia, dirigida a profesores de enseñanza primaria y secundaria, que valora cómo viven la presencia de estos alumnos con DMID en el aula. Resultados: del cuestionario dirigido a pacientes y padres, fueron válidas 50 en el área correspondiente a nuestro centro, y destacamos que: la mayor participación fue de los niños de 10 a 14 años; el 86% de los niños saben medirse la glucemia y el 66% sabe administrarse insulina; el 74% no ha tenido problemas de inserción escolar; sin embargo, por edades, hasta le 50% de las menores de 6 años lo han padecido; hasta en el 50% de las ocasiones en que un paciente ha precisado la administración de insulina durante el horario escolar lo ha hecho un familiar; el 66% de las hipoglucemias son resueltas por el paciente; sólo disponen de personal sanitario en el centro educativo el 8% de los pacientes y, por último, el 98% cree oportuno que todos los profesores de niños con diabetes tengan información por escrito de los síntomas y pasos a seguir en caso de hipoglucemia cuando el alumno se incorpora al colegio. Del cuestionario dirigido a profesores, respondido por un 54% (76 de un total de 140), destacamos que: el 71% reconoce tener o haber tenido a un alumno diabético; el grado de conocimiento de los profesores sobre diabetes, valorado con una escala del 1 al 7, muestra una mediana de 3 y una moda de 4; la inseguridad generada por un alumno diabético la atribuyen (un 47%) a la falta de instrucciones explícitas sobre la actuación ante complicaciones concretas; el 97,4% de los profesores dicen saber lo que es una hipoglucemia; sin embargo, sólo el 67,1% conoce los signos y síntomas que genera y un 57% dice saber que debe hacer ante esta situación. Conclusiones: la integración y la aceptación escolar de los alumnos con DMID es buena, percepción compartida por padres y profesores. Estos niños desde muy pequeños se responsabilizan de su enfermedad y adquieren habilidades de autocuidado a edades tempranas, pero necesitan ayuda, y ésta es prestada diariamente desde el entorno familiar incluso durante el horario escolar. En general, los profesores muestran una buena disposición para adquirir habilidades que los capaciten para la eventual ayuda a estos niños; sin embargo, su carencia de conocimientos y la ausencia de personal sanitario en los centros educativos hacen necesaria una más amplia información para mejorar la comprensión y la asunción del problema (AU)

Background: The daily care of a diabetic (IDDM) child is essential for the short and long term evolution of the disease, and must include the hours the child spends in school. The presence of Trained personnel are needed who will be able to interveneintime if a serious complication, such as hypoglycemia, occurs. Their presence can help to ensure correct control of the disease and avoid long term complications. Objectives: To understand of the day today life of children with IDDM, focusing on their school hours. To understand the attitude of primary and secondary school teachers towards pupils with IDDM. Patients and methodology: Descriptive and transversal study on IDDM patients between the ages of 3 and18, treated with in the Healthcare Area number 3 in the Madrid Region, and their teachers. Two different kinds of surveys were distributed: the1 stsurvey by Fundación para la Diabetes (Foundation for Diabetes) contained 80 questions aimed at patients between the ages of 3 and 18 and their parents. Questions were related to patient’s daily life and school environment. The 2nd survey, which allowed free response, was aimed at primary and secondary school teachers about their own experiences working as professional swith pupils with IDDM. Results: Fifty questionnaires addressed to parents and patients were valid in our remit, and we emphasize the following: the ages of major participation were10 to14 years; 86% of children knew how to measure blood glucose and 66% how to administer insulin; 74% had no problems with school integration, however, up to 50% of children under 6 years had suffered a problem occasionally; on the 50% of the occasions when a patient needed insulin administration during school hours, it was done by a relative; 66% of hypoglycaemias were resolved by the patient. Health personnel is present only in 8% of the schools studied; 98% of those surveyed think teachers should have written instructions on the signs and symptoms and action to be taken if a hypoglycemia occurs. Questionnaires for teachers were answered by 54% of them (76 of a total of 140), we would like to point out the following: 71% of them recognise having a diabetic pupil; the degree of teacher knowledge on diabetes, rated on a scale from 1 to 7 shows a median of 3 and a mode of 4;47% of teachers feel in secure when having a diabetic pupil because they do not have instructions on actions to take in case a complication occurs; 97% of teachers affirm to know what a hypoglycaemia is, however only 67% and 57% of them recognize its signs and symptoms and know how to act when they occur. Conclusions: The school integration and acceptance of pupils with IDDM is good, according to both teachers and parents. Children with IDDM take responsibility for their disease at an early age and are able to develop certains kills. However they still need help, which they get from their family even during school hours. Generally, teachers are willing to learn new skills to be able to help these children, however, further training is required to improve the understanding and management of this disease (AU)

[Adaptation of methotrexate determination in plasma with Dimension Xpand]. / Adaptation du dosage plasmatique du méthotrexate sur Dimension Xpand.

The treatment with methotrexate at high doses is responsible of many side effects. It's necessary to evaluate serum methotrexate rate to monitor the administration of the methotrexate antagonist, the folinic acid. The aim of this study is to validate the determination of methotrexate in plasma using the automate Xpand Dimension (Dade Behring). Assay results were linearly related to the concentration for the wide range which was examinated (0.15 - 1.4 micromol/L). We report the precision, accuracy, linearity, sensitivity of this assay. The CV was less than 10%. We present the results of correlations with Aca (Dade Behring) and Cobas Mira (Roche). The reagent cartridge in the instrument and the calibration are stable during 28 days.

[Blood screening of benzodiazepines and tricyclic antidepressants. Results of 5 years of interhospital controls]. / Dépistage des benzodiazepines et des antidepresseurs tricycliques dans le serum. Bilan de cinq ans de contröles inter hospitaliers.

Pro bio Qual Association of Lyon have proposed a control which include the control for detecting benzodiazepines (BZD) and tricyclic antidepressants (ADT) since 2000. With this control, we have evaluated the specificity and the sensitivity of techniques used. We have tested the maprotiline reactivity too (tetracyclic antidepressant). We report results achieved with different immunoassay methods and their performances: specificity and sensitivity. The number of laboratories which realize these analyses is constant: these laboratories are hospital laboratories. Two methods are most common used: the fluorescence polarization immunoassay (FPIA) and the enzyme multiplied immunoassay test (EMIT). The evolution of these techniques does square with the evolution of chemistry analysers used in hospital laboratories. For the BZD, the specificity is good. For the ADT, carbamazepine at low concentration (5 mg/L) gives a positive result with FPIA Abbott assay; carbamazepine at high concentration (25 mg/L) gives a negative result with EMIT assay; phenothiazines give a positive response. For the BZD, the analyser Integra gives best results of sensitivity. Results of sensitivity obtained with the kit EMIT DAU are better than results obtained with the kit EMIT Serum. For the ADT, results of sensitivity obtained with FPIA Abbott assay seem better; the adaptation of EMIT assay on Integra analyser gives less good results. The reactivity for the BZD is very different: we can ignore a severe intoxication with alprazolam or lorazepam (response << cut off) but we can give a positive result for a therapeutic concentration of diazepam for example. With ADT, we haven't the same problem. But the reactivity for nortriptyline is less good than the reactivity for amitriptyline. So we should use a "cut off" concentration which corresponds to the best sensitivity and the best specificity.

[BNP/NT-proBNP: what is the best choice in an emergency laboratory?]. / BNP/NT-proBNP: que choisir dans un laboratoire d'urgences?

BNP and NT-proBNP are both well established as diagnostic and prognostic markers for congestive heart failure (CHF). However it remains for the biologist to choose between these two biomarkers depending on his equipment availability. The aim of this study was to compare results obtained with the Biosite Triage BNP assay and the Dade Behring NT-proBNP assay with regards to the clinical status. One hundred twelve patients (average age 76 +/- 13 years) with acute dyspnea were including and stratified by diagnosis at presentation into 3 groups: patients without acute CHF (group I, n=50), patients with non-cardiac dyspnea and CHF history (group II, n=22) and patients with acute CHF (group III, n=40). Levels of both BNP and NT-proBNP were higher among patients with cardiac dyspnea (group III) than among patients with a non-cardiac dyspnea (BNP=740 pg/mL versus 84 pg/mL; p<0.001 / NT-proBNP=7.502 pg/mL versus 499 pg/mL; p<0.001). ROC analysis for BNP or NT-proBNP were not statistically different in patients with acute CHF (group III) compared with patients with a non-cardiac dyspnea (group I + II) (AUC=0.927 versus AUC=0.930, p=0.90). Neither there was a difference between ROC analysis for BNP or NT-proBNP in patients with cardiac dyspnea (group III) compared to patients with a non cardiac dyspnea (group I) (AUC=0.981 versus AUC=0.975, p=0.76). Measurement of BNP or NT-proBNP is of identical interest for the diagnosis of acute CHF in acute dyspnea. The BNP Biosite assay was faster because analysis is performed on whole blood. With regards to analytical performance, the NT-proBNP Dade Behring assay had a higher accuracy and is highly recommended for the follow-up of CHF treatment.

Quantification of docetaxel and its main metabolites in human plasma by liquid chromatography/tandem mass spectrometry.

Docetaxel is an antineoplastic agent widely used in therapeutics. The objective of this study was to develop and validate a routine assay, using liquid chromatography coupled to tandem mass spectrometry (LC/MS/MS), for the simultaneous quantification of docetaxel and its main hydroxylated metabolites in human plasma. A structural analogue, paclitaxel, was used as the internal standard. Determination of docetaxel and four metabolites (M1, M2, M3 and M4) was achieved using only 100 microL of plasma. Liquid-liquid extraction was used for sample preparation, with extraction efficiency of at least 90% for all analytes. Detection used positive-mode electrospray ionization in selected reaction monitoring mode. The lower limit of quantification (LLOQ) was 0.5 ng/mL for all analytes. The assay was linear in the calibration curve range 0.5-1000 ng/mL and acceptable precision and accuracy (<15%) were obtained with concentrations above the LLOQ. This method was sufficiently selective and sensitive for quantification of metabolites in plasma from cancer patients receiving docetaxel chemotherapy, and is suitable for routine analyses during pharmacokinetic studies.

[Digoxin assay: results of 10 years of intralaboratory controls]. / Dosage de la digoxine: exploitation de 10 ans de contrôles interlaboratoires.

Serum digoxin measurement is often performed in medical laboratories. A professional association specialized in quality control, based in Lyon, has been organizing punctual controls of medication measurement for the past ten years. The results are analysed in term of intra and inter-technique precision, difference between methods and specificity in regard to endogenous or exogenous interfering substances. Methods have changed with a quasi disappearance of the methods used ten years ago (FPIA, EMIT) and introduction of new technologies on recent immunoanalysis automates. The results observed with the different instruments are similar. Reproductibility has not changed over ten years. Some difficulties remain in the measurement of low concentrations of digoxin. Many substances interfere in digoxin measurement : digoxigenine (inactive metabolite), endogenous digoxin-like immunoreactive factors, spironolacton, antidigoxin antibodies used for treatment of digitalic intoxications. These interferences depend on the method which is used, but it is essential to know them in order to interpret the results correctly.

Distrofia miotónica congénita y encefalopatía hipóxico-isquémica / Congenital myotonic dystrophy and hypoxic-ischemic encephalopathy

No disponible

[Biochemical and pharmacological check-up in emergency orientation]. / Bilans biochimiques and pharmacologiques d'orientation en urgence.

Biochemical and pharmacological tests usually prescribed in casualty department were reviewed taking into account their physiological significance and predictive value : ions, total proteins, carbohydrate and nitrogenous metabolites, enzymes, tissue markers, pharmacological drugs. Few blood components were kept with the first intention, ideally with a turn around time below one hour: sodium, potassium, chloride, bicarbonate, total proteins, pCO2 and pO2, creatinine, glucose, ketone compounds, calcium, bilirubin, transaminases, lipase, C-reactive protein, myoglobin, troponin, chorionic gonadotropin hormone. Those tests do not have to be systematically performed but prescribed only after the evaluation of pre-test probabilities by the clinician.

[Evaluation of Emit netilmicin and amikacin assays on Dimension RXL HM (Dade Behring) open channels]. / Adaptation des trousses Emit nétilmicine et amikacine sur canaux ouverts du Dimension RXL HM (Dade Behring).

The aim of this study was to evaluate and to validate an enzyme immunoassay in homogeneous phase for netilmicin and amikacin, adapted on the Dimension RXL HM (Dade Behring) machine. The results were compared with those obtained with automated polarization of fluorescence immunoassay using TDx FLx (Abbott). The protocol of the study and the analytical criteria were inspired by the protocol Valtec version 2002 recommended by the French Society of Clinical Biology (SFBC). The validation of this technique as adapted to the Dimension RXL HM has allowed its use for routine dosage adjustment of amikacin and netilmicin. The practicability is however the weak point of the adaptation of these techniques, even limiting as for their implementation.

Remifentanil and controlled hypotension; comparison with nitroprusside or esmolol during tympanoplasty.

PURPOSE: To determine whether remifentanil, combined with propofol, could induce controlled hypotension, reduce middle ear blood flow (MEBF) measured by laser-Doppler flowmetry, provide a "dry" operative field, and could be compared with nitroprusside or esmolol combined with alfentanil and propofol. METHODS: Thirty patients undergoing tympanoplasty and anesthetized with 2.5 mg x kg(-1) propofol iv followed by a constant infusion of 120 microg x kg(-1) x min(-1), were randomly assigned in three groups to receive either 1 microg x kg(-1) remifentanil iv followed by a continuous infusion of 0.25 to 0.50 microg x kg(-1) x min(-1), or nitroprusside iv, or esmolol iv combined for the latter two groups with alfentanil iv. RESULTS: Controlled hypotension was achieved at the target pressure of 80 mmHg within 107 +/- 16, 69 +/- 4.4, 53.3 +/- 4.4 sec for remifentanil, nitroprusside and esmolol respectively. MEBF decreased by 24 +/- 0.3, 22 +/- 3.3, 37 +/- 3% and preceded the decrease in SABP, within 30 +/- 6.1, 11.2 +/- 3.1, 15 +/- 2.8 sec for remifentanil, nitroprusside and esmolol respectively. Remifentanil, and nitroprusside decreased MEBF autoregulation less than esmolol (0.36 +/- 0.1, 0.19 +/- 0.2, -0.5 +/- 0.2). Controlled hypotension was sustained in all three groups throughout surgery, and the surgical field rating decreased in a range of 80% in all three groups. Nitroprusside decreased pH and increased PaCO2. There were no postoperative complications in any of the groups. CONCLUSIONS: Remifentanil combined with propofol enabled controlled hypotension, reduced middle ear blood flow and provided good surgical conditions for tympanoplasty with no need for additional use of a potent hypotensive agent.

[Critical analysis of different methods used for toxicology screening in emergency laboratory]. / Analyse critique des différentes méthodes utilisées pour le dépistage toxicologique dans un laboratoire d'urgence.

Emergency analysis in toxicology is a difficult exercise. It involves in diagnosis, prognosis and the treatment of intoxication. Several methods exist in emergency screening. We have distinguished three large groups. Based on specificity: screening methods of medicament family (chemical methods and immunoassays) with benzodiazepines, tricyclic antidepressants, barbiturates and phenothiazines; complementary screening methods (thin layer chromatography and high pressure liquid chromatography) for a wider screening and finally quantitative methods (enzymatic, immunoassay, spectrometry and chromatography) specific to a molecule. The first group allows a rapid qualitative research according to medicament class but lacks specificity. The second group represented by the Remedi system, offers a larger screening of molecules but is more expensive and cannot detect classic molecules. The third group allows a precise dosage but is restricted to one molecule. We need one or the other of methods following clinical context and the type of molecule. In our laboratory, we have eliminated barbiturates and benzodiazepines research. We search only tricyclic antidepressants, salicylates and paracetamol. The Remedi system acts as a complement. It is essential to have a good knowledge of the limits and specificity of each method in order to allow the clinician to see the interpretation of the given result. The execution period and the quality of analytical result depend on dialogue between analyst and clinician before and after analysis.