BK polyomavirus genotyping at inter- and intra-patient level in Spain.

BK polyomavirus (BKV) is classified into four subtypes based on nucleotide variation of a 287 bp typing region in the VP1 protein. Most studies show that subtype I is predominant in different geographic settings, followed by subtype IV. However, BKV subtypes II and III are detected at low rates. In Spain, the prevalence of each subtype is not well known. The aim of this study was to identify the BKV subtypes from a selection of different types of patients and to determine whether different subtypes could be infecting the same patient. A hundred and twenty nine BKV-positive urine samples were selected to amplify and sequence the typing region. Plasma specimens collected at the same time as the urine samples were also studied in 34 patients. A phylogenetic analysis and a study of substitutions in the VP1 protein were carried out with the sequences obtained. Subtype I was the predominant subtype detected in urine (61.2%) and plasma (38.2%) samples followed by subtype II. The analysis of paired samples showed that the subtype found in urine was different from that found in plasma in 10 patients. Fourteen BKV variants based on substitutions in VP1 were identified. The finding of compartmentalized infections involving different subtypes at different sites in some patients might mean specific and different selective pressure in each tissue. The potential involvement in the viral cycle of the different BKV variants found should be analyzed.

Xanthine oxidase inhibition attenuates skeletal muscle signaling following acute exercise but does not impair mitochondrial adaptations to endurance training.

The aim of this research was to examine the impact of the xanthine oxidase (XO) inhibitor allopurinol on the skeletal muscle activation of cell signaling kinases' and adaptations to mitochondrial proteins and antioxidant enzymes following acute endurance exercise and endurance training. Male Sprague-Dawley rats performed either acute exercise (60 min of treadmill running, 27 m/min, 5% incline) or 6 wk of endurance training (5 days/wk) while receiving allopurinol or vehicle. Allopurinol treatment reduced XO activity to 5% of the basal levels (P < 0.05), with skeletal muscle uric acid levels being almost undetectable. Following acute exercise, skeletal muscle oxidized glutathione (GSSG) significantly increased in allopurinol- and vehicle-treated groups despite XO activity and uric acid levels being unaltered by acute exercise (P < 0.05). This suggests that the source of ROS was not from XO. Surprisingly, muscle GSSG levels were significantly increased following allopurinol treatment. Following acute exercise, allopurinol treatment prevented the increase in p38 MAPK and ERK phosphorylation and attenuated the increase in mitochondrial transcription factor A (mtTFA) mRNA (P < 0.05) but had no effect on the increase in peroxisome proliferator-activated receptor-γ coactivator-1α (PGC-1α), nuclear respiratory factor-2, GLUT4, or superoxide dismutase mRNA. Allopurinol also had no impact on the endurance training-induced increases in PGC-1α, mtTFA, and mitochondrial proteins including cytochrome c, citrate synthase, and ß-hydroxyacyl-CoA dehydrogenase. In conclusion, although allopurinol inhibits cell signaling pathways in response to acute exercise, the inhibitory effects of allopurinol appear unrelated to exercise-induced ROS production by XO. Allopurinol also has little effect on increases in mitochondrial proteins following endurance training.

[Restless legs syndrome: detection, diagnosis, impact on health and utilization of health care resources]. / El síndrome de piernas inquietas: detección, diagnóstico, consecuencias sobre la salud y utilización de recursos sanitarios.

INTRODUCTION: Despite the high prevalence of Restless Legs Syndrome (RLS) reported, little information is available about this disorder in Spain. The present study was conducted to obtain information on this condition from patients identified by a simple screening questionnaire and subsequent diagnostic confirmation by the Primary Care Practitioner (PCP). MATERIALS AND METHODS: Three-stage, cross-sectional and retrospective (resource utilization), observational study in a sample of adult patients (2,047 subject) attending 10 outpatient Primary Care centers in Madrid, Barcelona and Valencia. A screening questionnaire containing the 4 RLS diagnostic criteria was used. Clinical assessment and RLS diagnosis confirmation was performed using a structured questionnaire. Other variables assessed were quality of life by SF-36 questionnaire scoring; sleep by the MOS sleep scale; symptom severity of RLS symptoms by the IRLS scales; health care resource utilization in the previous 12 months by completion of questionnaire following patient chart review. The diagnosis made by the PCP was confirmed in a small sample of patients by a neurologist expert in Movement Disorders. RESULTS: A total of 19.7% (404 out of 2,047) subjects positively answered the 4 diagnostic questions of the RLS screening questionnaire. Of these, 185 (9.0%) reported moderate to severe symptoms at least twice weekly. The PCP made a diagnosis of RLS in 79 of 154 patients completing the diagnostic interview. Thus, prevalence of RLS estimated in this adult population was 4.6%. The predictive value of the screening RLS questionnaire was 51.3%. Average age of symptom onset was 42 years (range: 20 - over 80 years). RLS symptoms were moderately (50.6%) or extremely (38%) distressing and 73.4% of RLS patients slept poorly at least two nights a week. This diagnosis represents 9.4% of all patients presenting to PCP and experiencing poor sleep. Mean score in the IRLS scale (0 - 40) was 19.4. Average score of SF-36 questionnaire (0-100) was 54.6, lower than the Spanish general reference population (61.4). About one third of the RLS patients had seen a physician because of RLS symptoms. However, a diagnosis was made in only 48% of these and only 5% the diagnosis was RLS. CONCLUSIONS: The DECODE RLS - Spain study shows that many patients with classical RLS symptoms frequently see their PCP without being adequately diagnosed and treated. Screening tools such as that used in this study may contribute to the detection of these patients.

[Why do our patients go to hospital emergency departments?]. / Por qué acuden nuestros pacientes a urgencias del hospital?

OBJECTIVE: To analyse the causes of overuse of hospital emergency services (HES). DESIGN: Cross sectional, descriptive study. SETTING: Emergency service at a general hospital. PATIENTS: Patients who attended the HES on their own initiative. MEASUREMENTS AND MAIN RESULTS: Telephone poll to a representative sample of patients attending on their own initiative the emergency department of the 12 de Octubre Hospital in Madrid between October 5th and 12th. Average age: 46.95 (SD, 20.81); 52.2% women and 47.8% men, 50% were ignorant of the existence of primary care emergencies. 77% were ignorant of the existence of ongoing care points. Main motives for attendance at HES were: ignorance of non-hospital emergency services (32%), better technical means (25.6%), quicker care (21%), sensation of vital urgency (11.4%), poor quality of care in PC (8%). The care received at HES was evaluated as positive in 90% of cases, though 33% thought the information provided insufficient, and 34% the waiting-time excessive. Although 40% believed afterwards that their problem could have been resolved in PC, as many as 75% would return to the hospital. CONCLUSIONS: Widespread ignorance of the existence of non-hospital emergency services affects the over-use of HES. Most users use the HES as a service of immediate PC, a rapid way of obtaining health care. Users have a very favourable opinion of HES care, which is not stated in the case of non-hospital emergency services. In order to improve use of the HES, the population needs to receive better health education.

¿Por qué acuden nuestros pacientes a urgencias del hospital? / Why do our patients attend hospital emergency departments?

Objetivo. Analizar las causas de sobreutilización de los servicios de urgencias hospitalarios (SUH). Diseño. Estudio descriptivo transversal. Emplazamiento. Servicio de urgencias de un hospital general. Pacientes. Pacientes que acudieron al SUH por iniciativa propia. Mediciones y resultados principales. Encuesta telefónica a una muestra representativa de pacientes que acudieron a urgencias del Hospital 12 de Octubre de Madrid del 5 al 12 de octubre de 1998 por iniciativa propia. Edad media, 46,95 años (DE, 20,81), un 52,2 por ciento mujeres y el 47,8 por ciento varones. Un 50 por ciento desconoce la urgencia en atención primaria (AP), el 77 por ciento desconoce la existencia de puntos de atención continuada. Principales motivos por los que acuden al SUH: desconocimiento de urgencias extrahospitalarias (SUEH) (32 por ciento), empleo de mejores medios técnicos (25,6 por ciento), asistencia más rápida (21 por ciento), sensación de urgencia vital (11,4 por ciento), mala calidad asistencial en AP (8 por ciento). La valoración de la atención recibida en SUH es positiva en un 90 por ciento, el 33 por ciento considera insuficiente la información facilitada y un 34 por ciento el tiempo de espera excesivo. Aunque un 40 por ciento cree a posteriori que su problema era solucionable en AP, hasta el 75 por ciento retornaría al hospital. Conclusiones. El gran desconocimiento del SUEH influye en la sobreutilización de los SUH. La mayoría de los usuarios utiliza los SUH como servicio de AP inmediata, siendo una forma rápida de conseguir atención. La opinión de los usuarios sobre la asistencia en un SUH es muy favorable, hecho que no se objetiva con los SUHE. Debería mejorarse la educación sanitaria de la población para mejorar el uso de los SUH (AU)

[The prevalence of urinary incontinence in a population over 60 treated in primary care]. / Prevalencia de incontinencia urinaria en la población mayor de 60 años atendida en atención primaria.

OBJECTIVES: To determine the prevalence of urine incontinence (UI) among the over-60 population treated in primary care, identifying the types and associated epidemiological factors. DESIGN: Descriptive and crossover. SETTING: Primary care. PATIENTS: Sample of 400 people aged 60 or over, stratified by sex and chosen from those who attended their health centre spontaneously for a consultation. MEASUREMENTS AND RESULTS: Age, sex, chronic illnesses, treatments, previous childbirths, grade of immobility and presence or absence of involuntary discharge of urine. If the reply was positive: frequency, characteristics and evolution of UI, and prior consultations on the problem were also measured. 400 people (254 women and 146 men). Mean age: 71 (SD = 7.3 years). 145 people (36.2%) recognised they had UI. 43.3% of women and 23.9% of men (p < 0.001) were incontinent. UI prevalence increased with age: 31.7% among the 60-69 year old group; 35% among the 70-79 group; and 53.3% in those over 80. Among women the most common types are stress and urge incontinence, whereas among men the most common are urge and overflow UI. UI prevalence is greater among women with previous childbirths and among immobile patients. Of the 145 people who recognised their UI, only 31 (21.3%) had previously consulted the doctor on this problem, although men had consulted significantly more than women (40% vs. 15.4%; p < 0.01). CONCLUSIONS: Over a third of the people over 60 in our clinics suffer from UI. Prevalence increases with age and is greater among women, especially if there is a history of childbirth. Urge UI predominates among men and stress UI among women. Most people with UI do not consult concerning their problem, for which reason, so as to identify it and adopt corrective measures, women especially must be systematically asked about the symptom.

[The consumption of psychoactive drugs in primary care]. / Consumo de psicofármacos en atención primaria.

OBJECTIVES: To determine the prevalence of the consumption of psychiatric drugs (PD) among people attending the clinic and to relate that consumption to their sociodemographic characteristics and the presence of psychiatric symptoms. DESIGN: Crossover descriptive study. SETTING: Primary Care. PATIENTS: 350 patients over 14, chosen at random from among those who attended the clinic over an eight-week period. INTERVENTIONS: 1) Questionnaire on sociodemographic data and PD consumption; 2) Self-filling of the GHQ-60 (cut-off point 10/11); and 3) Review of the clinical records to determine the kind of PD, dosage, prescriber, chronic illnesses and the number of consultations over the previous year. RESULTS: 301 (86%) completed the study, 21% consumed PDs. 82% were women. The most consumed PDs were: benzodiazepine (74%) and anti-depressives (34%). CONCLUSIONS: There is a high percentage of PD consumers among people who attend the clinic, especially among women, elderly people, the chronically ill, people living alone and those inactive outside the home. The most commonly used pharmacological group was the benzodiazepines. Almost half the patients had psychiatric symptoms, especially those who lived alone and had no activity outside the home.

[Clinical-epidemiological analysis of 159 children with cryptorchidism]. / Análisis clinicoepidemiológico de 159 niños con criptorquidia.

OBJECTIVE: To determine the epidemiological and clinical characteristics of children with Cryptorchidism in our milieu. DESIGN: Crossover study. SETTING: Specialist care. PATIENTS: 159 children referred from Primary Care for a Cryptorchidism study. MEASUREMENTS AND RESULTS: Average age of detection: 1.5-3 years. Laterality: 120 unilateral (73 right and 47 left) and 39 bilateral. Family history of Cryptorchidism in 33 cases (20.7%). 68 children (42.7%) had some anatomical malformation associated with poor testicular descent. This percentage was significantly higher in children with bilateral Cryptorchidism than with unilateral (61.5% vs 36.6%; p < 0.05). Nine children defined with multiple malformation syndromes. Location of the testes after palpation: 29.3% not able to be palpated, 22.7% high inguinal, 23.2% low inguinal, 17.1% sliding, 5% retractile and 2.5% scrotal. All cases showed normal in the hormonal study, except one case of Hypogonadotropic Hypogonadism. CONCLUSIONS: The diagnoses of Cryptorchidism were not early. Family history and associated malformations in the body himself often exist. Hormonal levels are normal. Echography is of little use in locating testes that cannot be palpated.

[Analysis of the use of radiology in primary health care]. / Análisis de la utilización de la radiología en atención primaria.

OBJECTIVE: To analyse the quality of requests in primary care for radiological investigations, by determining both their effectiveness and modifications in the doctors' therapeutic approach and diagnostic opinion caused by the radiological findings. DESIGN: Longitudinal, retrospective study. SETTING: The Embajadores 1 Primary Care team (PCT), Madrid, during 1993. PARTICIPANTS: 203 radiologies on a significant sample of the PCT's catchment population with a clinical history. MEASUREMENTS AND RESULTS: Radiology was requested for 12% of patients seen: males 39.40% and women 60.59%. Average age was 56.64 +/- 1.41. Commonest requests were for: bone (41.87%), thorax (25.12%), abdominal ecography (9.36%) and digestive system (8.37%). Pathology was discovered in 67.98% of cases, with these results considered relevant in 26.60%. The radiological findings caused 18.72% of doctors to change their therapeutic approach or diagnostic opinion. The radiological investigations with most relevant findings were: mammographies (38.46%), barium meals (35.29%) and abdominal ecographies (31.57%). CONCLUSIONS: Bone and thoracic radiologies account for almost 70% of requests. Despite the high percentage of pathological radiographies, only 19% of the x-rays caused any change in the doctor's attitude, which makes us think the correct indication for each case must be analysed.

Cholesteryl ester hydrolysis in rat liver lysosomes: different response to female sex hormones.

The regulation of the hydrolysis of cholesteryl oleate by female sex hormones was studied in the lysosomal fraction of rat liver. Cholesterol ester hydrolase activity was determined at pH 5.0 with an acetone-dissolved cholesteryl [1-14C]oleate substrate preparation. The administration of a single dose of progesterone decreased the enzyme activity during a 3- to 24-hr period following hormone injection. This effect was not correlated to changes in the lysosomal protein synthesis rate. The lysosomal hydrolysis of cholesteryl esters was also inhibited in a noncompetitive manner by the addition of progesterone at concentrations higher than 100 microM. The esterase failed to respond to the estradiol in vivo as well as in vitro. The findings of the present paper suggest that the lysosomal breakdown of cholesteryl esters in rat liver may be under selective hormonal regulation and that the inhibitory effect of progesterone on the enzyme activity might be, at least in part, responsible for the liver cholesterol ester accumulus produced by the administration of the hormone.

Effect of sex, ovariectomy and female sex hormones on neutral cholesterol ester hydrolase in rat liver.

The effects of sex, ovariectomy and female sex hormones on neutral cholesterol ester hydrolase activity were investigated in rat liver cytoplasm. Hydrolase activity was determined at pH 7.45 with an acetone dispersed cholesterol oleate substrate preparation. Neutral cholesterol esterase activity was higher in male than in female rats and the ovariectomy decreased the enzyme activity. The administration of only estradiol or combined with progesterone to ovariectomized rats for three consecutive days resulted in an increase in esterase activity to the level observed in intact animals. By contrast, the only progesterone resulted in no significant changes of activity. In intact female rats, the short-term treatments of gonadal hormones did not produce any alteration on cholesterol esterase. Examination of the effects of a single dose of estradiol and progesterone for intervals between 1 and 24 h showed that both hormones promoted early and opposite effects on neutral ester hydrolase. Activity was decreased in 3-4 h by the estradiol and was markedly increased throughout 3-4-6 h by the progesterone injection. In vitro, the two female sex hormones behaved as potent inhibitors of the enzyme, competing with the substrate for the active centre of the hydrolase.