[Epidemic outbreak in a home for the aged caused probably by Bacillus cereus]. / Brote epidémico en una residencia de ancianos de probable etiología por Bacillus cereus.

OBJECTIVES: To identify the causative agent and the factors precipitating the outbreak. DESIGN: Observational, crossover study. SETTING: Las Delicias Health district, Jerez de la Frontera. PATIENTS AND OTHER PARTICIPANTS: The population exposed, belonging to an elderly persons' home. MEASUREMENTS AND MAIN RESULTS: The total number of people exposed was the 425 persons living in an elderly persons' home in Jerez in November 1995. The clinical histories were reviewed, and a specific questionnaire used to interview 77 ill persons and 77 healthy ones. The criteria for ill cases were presence of vomiting and/or diarrhoea. 32.6% of the ill people had fundamentally vomiting; 24.67% diarrhoea, 37.66% vomiting plus diarrhoea, and 100% ran no temperature. Positive and significant OR were detected in various foods (from 2.36 to 10.52 OR). We isolated 3,000,000, and up to 5,600,000, colonies of Bacillus cereus per gram in several foods. We observed incorrect practices in the conservation and handling of foods. CONCLUSIONS: Epidemiological, microbiological and clinical indications placed us before an outbreak of food poisoning probably caused by Bacillus cereus. The intervention at critical points, inter-institution coordination and communication in time and with data between professionals (microbiologist, doctors, nurses, vets and epidemiologist) were decisive in solving the outbreak.

[The distribution of adipose tissue and the metabolic profile in hypertensive and normotensive adults]. / Distribución del tejido adiposo y perfil metabólico en adultos hipertensos y normotensos.

BASIS: This study aimed to evaluate the Quetelet Body Mass Index (BMI), and specific anthropometric indexes of the distribution of body fat, with glycemia, insulinemia, uricemia, and the lipid profile in 124 hypertensives and 124 normotensives, selected according to age and sex. METHOD: We preset an observational case and control study, referring to a population attending health care centers. The inclusion criteria for the cases were: to be 25 years or older, having been diagnosed with essential hypertension. Incident and prevalent cases of an evolution of less than 2 years are selected. RESULTS: The hypertensives studied, presented levels which were statistically significant and higher than those seen in the normotensive, of all anthropometric indexes used, in insulinemia, glycemia, uricemia, and in the total cholesterolemia. In the cases, the waist hip ratio (WHR) presents a greater number of correlations with biochemical parameters such as uricemia (r = 0.376, p = 0.00), triglyceridemia (r = 0.252, p = 0.00), and the VLDL-cholesterol fraction (r = 0.263, p = 0.00). On the other hand, the BMI, only correlates, in the cases, with the insulinemia. In turn, insulinemia correlates with the majority of the anthropometric measures, with a similar behavior in cases and controls. CONCLUSIONS: The WHR is presented as a complementary index to the classic BMI in the evaluation of obesity and its metabolic alterations, especially in women, but also, the WHR correlates with an adverse lipid profile in hypertensives.

[Epidemic outbreak of acute food poisoning caused by pesticides]. / Brote epidémico de intoxicación aguda alimentaria por plaguicidas.

OBJECTIVES: 1) To identify the causes of the outbreak. 2) To adopt the appropriate measures to control it. DESIGN: Observational crossover study. SETTING: San Benito Health District in Jerez de la Frontera (Cádiz). PATIENTS AND OTHER PARTICIPANTS: Diners who attended a family celebration. MEASUREMENTS AND MAIN RESULTS: On Friday 11th March 1994 there was an outbreak of acute food poisoning. The clinical notes of 9 ill diners were checked; they and 7 unaffected diners answered epidemiological questionnaires. A proportional comparison was then made between those not exposed and those exposed to each one of the foods consumed at this celebration. The clinical picture showed: high level of the Creatine phosphokinase enzyme, general myalgias, vomiting or nausea and visual problems. The average incubation period was 7 hours. The odds ratios of the foods involved was calculated. Although this reached 4 in some cases, the significance tests were not significant in any case because of the study's low statistical power. In the investigation of the trophic chain of the game-birds eaten, the presence of nitrogen or phosphorus atoms, compatible with the pattern of fonofos in the pesticide used on the hunting estate where the birds came from, was isolated. CONCLUSIONS: Epidemiological, clinical and biological evidence was found, which places us before acute organophosphorus poisoning. Coordination between the different institutions involved was decisive in finding the cause of the outbreak.