Study of the possible link of 25-hydroxyvitamin D with Epstein-Barr virus and human herpesvirus 6 in patients with multiple sclerosis.

BACKGROUND AND PURPOSE: Although the causes of multiple sclerosis (MS) remain partially unknown, environmental and genetic factors are thought to play a role in its aetiopathogenesis. Hypovitaminosis D, Epstein-Barr virus (EBV) and human herpesvirus 6 (HHV-6) infections have been described as possible MS triggers. Our aim was to analyse the possible link between 25-hydroxyvitamin D [25(OH)D] and viruses in patients with MS. METHODS: We included 482 patients with MS in a 2-year study. Serum samples were collected to analyse 25(OH)D levels and, according to sample availability, antibody titres against EBV and HHV-6 by enzyme-linked immunosorbent assay. DNA was extracted from blood in order to analyse EBV and HHV-6 viral load by quantitative real-time polymerase chain reaction and to genotype MS-related single nucleotide polymorphisms (rs3135388, rs2248359 and rs12368653) when possible. RESULTS: The 25(OH)D levels were significantly higher in the first semester of the year than in the second. Carriers of the risk allele rs2248359-C showed lower 25(OH)D levels than non-carriers. For EBV, viral load was significantly higher when 25(OH)D levels were low, demonstrating an inverse correlation between 25(OH)D levels and EBV load. CONCLUSIONS: The 25(OH)D levels could be involved in the regulation of EBV replication/reactivation in patients with MS.

Efficacy and Cost of Trap-Bait Combinations for Capturing Rhynchophorus palmarum L. (Coleoptera: Curculionidae) in Ornamental Palm Polycultures.

Ornamental palms are an economically important component of international trade yet have recently experienced yield losses in Mexico due to red ring and bud rot diseases, which are spread by Rhynchophorus palmarum L. Considering that massive capture is a common strategy to control this pest and the cost of commercial traps and baits could be inaccessible for small farmers, an inexpensive trap-bait combination is desired. In this study, 16 trap-bait combinations for capturing R. palmarum were assessed in ornamental palm polycultures over the course of 1 year. An expensive yellow bucket trap combined with aggregation pheromone + insecticide + banana was compared with inexpensive, handmade trap-bait combinations. A total of 4712 weevils were collected in all traps, of which 52.7% were male and 47.3% female. The efficacy of the handmade trap made from a colorless polyethylene bottle and baited with banana + pineapple + sugarcane + sugarcane molasses was similar to that of the yellow bucket trap baited with aggregation pheromone + insecticide + banana. These two trap-bait combinations remained effective even when the R. palmarum population significantly decreased during the dry, warm season. The affordable handmade trap baited with food attractants and without insecticides was highly efficient in capturing R. palmarum and therefore represents an effective tool for monitoring weevil populations. As ornamental crops have recently gained greater economic importance in the studied region, the use of a novel and cheap trap-bait combination could offer great benefits to producers and form part of the integrated management of R. palmarum.

Quality of anthropometric measurements in Spanish Intensive Care Units (The CAMIES Study). / Calidad de la medición antropométrica en las Unidades de Medicina Intensiva españolas (Estudio CAMIES).

INTRODUCTION: Real body weight and height are essential data to be obtained in all critically ill patients (CIP), due to their influence in the designing of therapies and monitoring. Visual estimation is a very inaccurate practice. No precise descriptions of anthropometric measurements among CIP are available in the clinical practice guides. OBJECTIVE: To describe anthropometric quality in CIP, health professional perception of such quality, and its influencing factors. DESIGN: Computer-assisted telephone or self-interviewing. SETTING: Doctors and nurses of all Spanish Intensive Care Units (ICU) attending adults. RELEVANT VARIABLES: Anthropometric practices were described in detail, along with the proclivity to obtain real measurements, and the influence of professional experience, the number of ICU beds, and the health professional group involved. RESULTS: A total of 481 questionnaires were collected from 176 hospitals (36.8% from physicians). The availability of measuring tools is limited (weight 68.7% - height 76.7%), with no relation to the number of ICU beds (weight P=.343, height P=.61). Visual estimation was the most frequent way of obtaining measurements (weight 65.9% - height 64.8%), even when measuring tools were available. Willingness to take real measurements was very low, especially among physicians, and professional experience was associated to increased rejection (P<.001). CONCLUSIONS: Visually estimated measurements exceed real measurements in the routine practice of Spanish ICUs. Measurement tools are not widely available in the ICU, and even when available, their use is not guaranteed. The surveyed population does not view anthropometric measures as being important for clinical practice. An effort should be made by scientific societies to promote reliable anthropometric practice in Spanish ICUs.

[Correlation between body mass index and development of pressure ulcers in intensive care medicine]. / Relación entre el índice de masa corporal y el desarrollo de úlcera por presión en Medicina Intensiva.

OBJECTIVES: This study aims to evaluate the association between body mass index (BMI), incidence and severity of pressure ulcers (PU) in patients admitted to the Intensive Care Unit (ICU), and describe the differential prognosis of patients with PU and factors that modify it. MATERIAL AND METHODS: Case-control study with observation period of 15 months. We collected baseline variables, prognostic scales, therapies and clinical outcome. Univariate analysis was performed for each outcome variable between cases and controls using the appropriate hypothesis test depending on the nature of the variables. ROC curve for BMI and PU. Logistic regression with PU as dependent variable and the covariates that reached p<0.05 in the bivariate analysis. Correlation using Pearson or Spearman was made between BMI, albumin, days to diagnosis of UPP, immobilization, and PU degree. Significance level at p <0.05. RESULTS: 77 patients developed PU and 231 controls were chosen. The cases had higher APACHE II (p=0.043) and SAPS 3 (p=0.023), length of stay in ICU and mechanical ventilation (p<0.001). BMI≥40 was associated with UPP (p=0.024 OR=3.23 CI95% 1.17-8.93). There was a significant association between PU degree, length of stay and MV (p<0,001), but not with immobilization, dynamic support surface and death rate. Multivariate analysis found association between PU, length of MV (p=0.013, OR 1.08, CI95% 1.01-1.16) and kidney replacement therapy (p=0.013, OR 3.55 CI95% 1.31-9.64), with BMI≥40 as a confounding factor. CONCLUSIONS: Length of mechanical ventilation and renal replacement therapy are risk factors for pressure ulcer development, and BMI≥40 acts as a confounding factor. PU development and its maximum degree are not associated with a worse prognosis.

Human herpesvirus 6 and effectiveness of interferon ß1b in multiple sclerosis patients.

BACKGROUND: Human herpesvirus 6 (HHV-6) and Epstein-Barr virus (EBV) have been repeatedly associated with multiple sclerosis (MS) pathogenesis. Also, it has been speculated that, besides its immunomodulatory properties, the efficacy of interferon beta (IFN-beta) in treating the disease may be related to its antiviral properties. The objectives of this study were to evaluate the in vivo antiviral effect of IFN-beta-1b over HHV-6 and EBV and to analyze whether such effect could be involved in its effectiveness in MS. METHODS: A total of 54 patients with MS were included in an observational, multicentric, 24-month study. HHV-6 and EBV were detected by qPCR in blood and serum samples. IFN-beta-1b effectiveness was evaluated by presence, number and severity of relapses, reduction in the relapse rate, disability progression, and response to the treatment. RESULTS: Patients with HHV-6 in blood had a higher risk of severe relapses (P=0.01) and bad response (P=0.03). HHV-6 was detected more frequently during relapses than in remission in blood (P=0.024) and in serum (P=0.0002). Patients with HHV-6 in serum had more relapses (P=0.02), lesser reduction in the relapse rate (P=0.04), and a lower proportion of responders (P=0.02) than those without HHV-6 active replication. However, any association between EBV and clinical parameters could not be found. CONCLUSIONS: We concluded that presence of HHV-6 in blood and serum during IFN-beta treatment could be a good marker of poor response.

Hallux valgus y cirugía mayor ambulatoria / Hallux valgus and outpatient major surgery

Objetivo. Demostrar la eficacia de la unidad de cirugía mayor ambulatoria (CMA) en el coste-proceso de la patología hallux valgus en la gestión de los recursos sanitarios. Material y método. Se analizó el proceso hallux valgus en pacientes intervenidos durante el año 1995 mediante ingreso rutinario y en el año 1999 a través de ingreso por la unidad de CMA bajo los parámetros de coste por proceso de acuerdo con la unidad ponderada asistencial (UPA) y la calidad asistencial evaluando el dolor, nauseas o vómitos, fiebre, sangrado y grado de satisfacción en las primeras 24 horas. Resultados. Se objetivó que el coste por proceso en los pacientes ingresados de forma rutinaria fue de 2,5 UPA médicas frente a 0,25 UPA médicas en los ingresados por CMA, no encontrándose diferencias en cuanto a los parámetros evaluados en el control de calidad. Conclusiones. El proceso hallux valgus debe incluirse dentro de la cartera de servicios de Traumatología en la unidad de CMA, ya que reduce de una forma considerable el coste sanitario. No se apreció ninguna diferencia en relación con la calidad asistencial y el grado de satisfacción en los pacientes intervenidos mediante CMA o mediante ingreso convencional. Es esencial la correcta selección del paciente, la información que se le ofrece y la motivación de los profesionales (AU)

A randomized study of mitoxantrone plus cytarabine versus daunomycin plus cytarabine in the treatment of previously untreated adult patients with acute nonlymphocytic leukemia.

Between May 1985 and November 1988, 143 adult patients with previously untreated acute nonlymphocytic leukemia were randomized to receive mitoxantrone and cytarabine (MTT+Ara-C) or daunomycin and cytarabine (DNM+Ara-C) in order to compare the efficacy and acute and chronic toxicities. Therapy consisted of 3 days of MTT 12 mg/m2/i.v. or DNM 45 mg/m2/i.v.; both groups received Ara-C 100 mg/m2 daily by continuous infusion (CI) for 7 days. Those who failed to achieve a complete remission after one induction course received a second induction course for 2 and 5 days at the same doses. All the patients who achieved complete remission received two consolidations of 2 days of MTT or DNM and 5 days of Ara-C in CI at the same dose as for induction. Of the 72 patients on MTT+Ara-C, 38 (53%) achieved complete remission, compared with 29 (43%) of 67 treated with DNM+Ara-C. Three and 5 patients had partial remission, 7 and 18 failed to respond, 24 and 15 died in the first 21 days of induction, of those treated with MTT+Ara-C or DNM+Ara-C, respectively (p = 0.34). Median duration of complete remission and survival was 185 and 103 days or 165 and 160 days, respectively (p = 0.85). More early deaths were observed with MTT+Ara-C due to greater myelosuppression, and a higher incidence of failure with DNM+Ara-C. No significant differences between treatment groups were observed in 21 categories of adverse events. The results demonstrate similar incidence of complete response, length of duration of complete remission, overall survival, and toxicity with MTT+Ara-C and DNM+Ara-C.