Influence of soil chemical composition on U, 226Ra and 210Pb uptake in leaves and fruits of Quercus ilex L.

To determine their transfer factors, activity concentrations of natural radionuclides were measured in the leaves and acorns of holm oak (Quercus ilex L.) trees collected from seven locations with different soil properties and radionuclide activity concentrations. The chemical and mineralogical compositions of the soils were also analysed to investigate the effect these had on radionuclide absorption by the trees. Soil chemistry showed significant effects on radionuclide incorporation into Quercus ilex L. tissues. A significant relationship was established between activity concentrations and soil content of Ca and P with 238U and 226Ra in the leaves and acorns of Quercus ilex L. Differentiated transfer was found for 40K, which showed greater transfer to the leaves than the other radionuclides. The activity concentration of U and 226Ra was higher in the fruits than in the leaves, with the opposite effect being observed for 40K. The risk of U and 226Ra transfer into the food chain through acorn consumption by livestock is predicted to increase in soils poor in Ca and rich in P.

Caracterización morfológica y molecular de Oxalis tuberosa Mol. en el departamento de Boyacá / Morphological and molecular characterization of Oxalis tuberosa Mol. in the department of Boyacá

RESUMEN Dentro de los tubérculos andinos de mayor importancia, después de la papa, se encuentra la ibia (Oxalis tuberosa Mol.) ya que constituye un alimento básico para las comunidades campesinas. Boyacá es uno de los departamentos de Colombia, en donde todavía existe la tradición de cultivar y consumir tubérculos como los cubios, ullucus y rubas o ibias, sin embargo están amenazados por la erosión genética. No existen estudios sobre estos recursos fitogenéticos en Boyacá, por lo cual el objetivo de esta investigación fue colectar y caracterizar morfológica y molecularmente materiales de ibias en este departamento. El análisis morfológico mostró que las características más discriminantes fueron: color de los tallos aéreos, pigmentación de las axilas, color del follaje, color de la flor, color del pedúnculo y pedicelo, color predominante de la superficie del tubérculo, color secundario de la superficie del tubérculo, color predominante y secundario de la pulpa, distribución del color secundario de la pulpa y forma de los tubérculos. El análisis de similitud diferenció a los materiales en dos grandes grupos, de acuerdo principalmente a características morfológicas como el color y hábito de floración. El valor de heterocigosidad promedio para la población total fue de 0.39 el cual se considera alto al compararse con otros estudios de diversidad genética en ibias. El análisis de varianza molecular y el Fst (coeficiente de diferenciación genética) muestran que existe una alta variabilidad genética entre los materiales de ibias evaluados la cual debe ser conservada y aprovechada dentro de futuros programas de mejoramiento.

ABSTRACT Among the most important Andean tubers, after potato, is the ibia (Oxalis tuberosa Mol.) because it is a staple food for peasant communities. Boyacá in one of the departments of Colombia, where there is still tradition to grow and consume tubers like cubios, ullucus and rubas or ibias; however, they are threatened by genetic erosion. There are no studies on these plant genetic resources in Boyacá, therefore the goal of this research was to collect and morphological and molecularly characterize ibias in this department. Morphological analysis showed that the most discriminate characteristic were color aerial stems, pigmentation armpits, foliage color, flower color, color peduncle and pedicel, predominant color of the tuber surface, secondary color of the surface tuber, dominant and secondary color of the pulp, distribution of secondary pulp color and shape of tubers. The similarity analysis discriminate the materials in two groups according mainly to morphological characteristics such as color and flowering habit. The value of average heterozygosity for the total population was 0.39, which is considered high when compared with other studies of genetic diversity in ibias. The analysis of molecular variance and Fst (coefficient of genetic differentiation) show that existed a high genetic variability among the ibias evaluated which it should be maintained and exploited in future breeding programs of Andean tubers.

Ablación cardiaca auricular: estrategias guiadas por el mapeo de electrogramas / Catheter Ablation for Atrial Fibrillation: Electrogram-Guided Methods

Resumen La ablación por radiofrecuencia se ha constituido como la técnica más utilizada para el tratamiento intervencionista de la fibrilación auricular. El aislamiento eléctrico de venas pulmonares se ha convertido en el procedimiento convencional, principalmente en pacientes con fibrilación auricular paroxística. Sin embargo, la tasa de éxito mediante esta técnica en pacientes con fibrilación auricular persistente es alrededor del 50%. Aunque se han propuesto diversas estrategias para guiar al electrofisiólogo en los procedimientos de ablación, estudios recientes muestran que la generación de líneas de ablación adicionales guiadas anatómicamente o mediante mapeo de electrogramas complejos fragmentados, no mejora la tasa de éxito del procedimiento convencional de aislamiento de venas pulmonares. En esta revisión, se consideran las limitaciones que representan los métodos de mapeo electrofisiológicos actuales, las nuevas estrategias de evaluación de los electrogramas y los métodos de procesamiento de señales que se ven propuestos en el futuro más inmediato, para guiar los procedimientos de ablación particularmente en pacientes con fibrilación auricular persistente.

Abstract Radiofrequency catheter ablation has evolved into an effective treatment option for drug-resistant patients with atrial fibrillation. Electrical isolation of the pulmonary veins has become the standard ablation strategy mainly in patients with paroxysmal atrial fibrillation. However, the success rate of pulmonary veins isolation is about 50% in patients with persistent atrial fibrillation. Although different strategies to guide the electrophysiologist in ablation procedures have been proposed. Recent studies show that the generation of additional ablation lines guided anatomically or by fragmented complex electrograms mapping does not improve the success rate of the conventional pulmonary veins isolation procedure. In this review, we describe the limitations of current electrophysiological mapping methods, the new electrogram evaluation strategies and the signal processing methods that are proposed in the immediate future, to guide ablation procedures, particularly in patients with atrial fibrillation persistent.

Variabilidad interspecífica de duraznos (Prunus pérsica L. Batsch.) y ciruelos (Prunus domestica) usando RAMs / Intraespecific variability of peach (Prunus persica L. Batsch.) and plums (Prunus domestica) using RAMs

Se seleccionó una muestra de 41 materiales de Prunus de la colección de caducifolios de la Universidad Pedagógica y Tecnológica de Colombia, para evaluar su variabilidad genética usando ocho marcadores Microsatélites Amplificados al Azar (RAMs). Se generaron un total de 121 alelos con pesos moleculares entre 260 y 1000 Kb. Se formaron tres grupos, a un coeficiente de similitud de 0.75, de acuerdo a las características del fruto y a la especie, encontrándose en el grupo II a los materiales de ciruelo. El porcentaje de loci polimórficos varío entre 71 y 99% para los cebadores CGA y CCA, respectivamente. El valor promedio de heterocigosidad fue de 0.22, mucho más bajo que los encontrados en otros estudios de diversidad genética en el género Prunus. La técnica RAMs mostró ser una herramienta útil para evaluar la diversidad genética en frutales caducifolios, al discriminar a los materiales en tres grupos e identificar el alto grado de consanguinidad que existe entre las diferentes especies de Prunus lo cual debe ser aprovechado dentro de las estrategias de hibridación que busquen la obtención de nuevos y mejores materiales.

A sample of 41 Prunus materials from the deciduous collection of the Pedagogical and Technological University of Colombia was selected to evaluate its genetic diversity using eight primers for Random Amplified Microsatellite (RAMs). A total of 121 alleles were generated with molecular weights ranging between 260 and 1000 Kb. Three groups were formed, a similarity coefficient of 0.75, according to fruit characteristics and specie, found plum materials in group II. The percentage of polymorphic loci ranged from 71 to 99% for the primers CGA and CCA, respectively. The average value of heterozygosity was 0.33, much lower than values found in other genetic diversity studies in the genus Prunus. The RAMs technique showed to be a useful tool for assessing genetic diversity in deciduous fruit, discriminate the materials into three groups and identify the high degree of consanguinity between different Prunus species which should be exploited in hybridization strategies looking for obtaining new and improved materials.

Reduced-dose warfarin or interrupted warfarin with heparin bridging for pacemaker or defibrillator implantation: a randomized trial.

BACKGROUND: Perioperative management with reduced-dose warfarin is of potential interest by eliminating the need for bridging while still maintaining a degree of anticoagulation. The outcomes of this regimen have not been well determined. METHODS: In a randomized controlled trial we compared two regimens for management of anticoagulation with warfarin in patients with implantation of a pacemaker or defibrillator. Half dose of warfarin for 3-6 days, depending on the baseline international normalized ratio (INR), before surgery aiming at an INR of ≤ 1.7 was compared with interrupted warfarin for 5 days with preoperative bridging with low-molecular-weight heparin (LMWH) at therapeutic dose for 2.5 days. Main safety outcome was pocket hematoma. Secondary outcomes were major bleeding, thromboembolism - all within 1 month, days of hospitalization and number of patients requiring correction of INR with vitamin K. RESULTS: The study was planned for 450 patients but it was discontinued prematurely due to a change in practice. Pocket hematoma occurred in 4 of 85 patients (5%) randomized to the bridged regimen and in 3 of 86 patients (3%) randomized to reduced-dose warfarin. One pocket hematoma in each group was severe. There were no major hemorrhages or thromboembolism within the 1-month window. Duration of hospitalization was similar in the two groups. Correction of INR the day before surgery with vitamin K had to be used for significantly more patients in the reduced-dose warfarin group (41%) than in the bridged regimen group (6%). CONCLUSION: The reduced-dose warfarin regimen appeared to have similar safety after device implantation as interrupted warfarin with preoperative LMWH bridging. Due to premature discontinuation no firm conclusion can be drawn. The reduced-dose warfarin regimen often failed to achieve the intended preoperative INR. ClinicalTrials.gov Identifier: NCT 02094157.

Usefulness of the Calgary Syncope Symptom Score for the diagnosis of vasovagal syncope in the elderly.

AIMS: The Calgary Syncope Symptom Score (CSSS) has been validated as a simple point score of historical features with high sensitivity and specificity for the diagnosis of vasovagal syncope (VVS) in younger populations without evidence of structural heart disease. Our purpose was to evaluate the performance of the CSSS in an elderly population with suspected VVS. METHODS AND RESULTS: Hundred and eighty patients of ≥60 years of age (mean 73.4 ± 7.8) with suspected clinical diagnosis of VVS were studied. The CSSS (VVS score ≥-2) was calculated in all patients prior to undergoing head-up tilt test (HUT). A standardized HUT protocol with active nitroglycerin phase was used to reproduce syncopal symptoms as gold standard for diagnosis of VVS. Hundred and forty patients had positive HUT response. Eighty-three patients (42.3%) had CSSS ≥-2 suggesting a diagnosis of VVS. The Calgary Syncope Symptom Score sensitivity was 0.51 [95% confidence interval (CI) 0.42-0.59] and specificity 0.73 (95% CI 0.52-0.85) with positive predictive value and negative predictive value of 0.87 (95% CI 0.77-0.93) and 0.30 (95% CI 0.21-0.40), respectively. One hundred (55.6%) patients had previous history of mild cardiovascular disease documented during assessment prior to HUT. In this population sensitivity and specificity was markedly reduced: 0.13 (95% CI 0.05-0.29) and 0.70 (95% CI 0.57-0.80), respectively. CONCLUSION: The CSSS has a lower sensitivity and specificity in an elderly population presenting with syncope compared to previously validated data in young adults, particularly in elderly patients with previous history of mild cardiovascular disease. A modified CSSS may be needed to improve specificity and sensitivity in this population.

Sex differences in cardiac autonomic function of depressed young adults.

BACKGROUND: Cardiac autonomic dysfunction has been proposed as an important contributing factor to the increased cardiovascular risk observed in major depression (MDD). However, the evidence regarding alterations in heart rate variability (HRV) in otherwise healthy depressed subjects has been inconclusive. METHODS: A case-control study in 50 treatment-naïve young adults with a first MDD episode without comorbid psychiatric disorders and 50 healthy control subjects was conducted. Time- and frequency-domain indexes of HRV were determined at baseline supine and after 5-min of orthostatic stress at 60°. RESULTS: There were no significant differences in the time- or frequency-domain variables of HRV between depressed patients and controls. However, a random-effect ANOVA model showed that during orthostatic stress depressed men had a reduced HRV and decreased parasympathetic activity compared to control subjects, while no differences were found between depressed women and controls. CONCLUSION: These results suggest a sex-dependent relationship between major depression and cardiac autonomic dysfunction and provide one potential explanation for sex differences in the association of depressive symptoms with cardiovascular morbidity.

Lack of association between IL-6-174G/C gene polymorphism and Chagas disease.

The aim of this study was to investigate the role of the IL-6-174G/C gene polymorphism in susceptibility/resistance to Trypanosoma cruzi infection in two independent cohorts from Colombia and Peru. We determined the IL-6-174G/C genotypes in a sample of 399 seronegative individuals and 317 serologically positive patients from Colombia and Peru. All individuals are from regions where T. cruzi infection is endemic. No statistically significant differences in the frequency of IL-6-174G/C gene polymorphism between chagasic patients and controls or between asymptomatic and individuals with cardiomyopathy were observed. Our results do not support an evidence for a major role contribution of this IL-6 gene polymorphism in the susceptibility to or clinical manifestations of Chagas disease in these studied cohorts.

Comparative assessment of inoculum effects on the antimicrobial activity of amoxycillin-clavulanate and piperacillin-tazobactam with extended-spectrum beta-lactamase-producing and extended-spectrum beta-lactamase-non-producing Escherichia coli isolates.

A significant inoculum-size effect has been observed with piperacillin-tazobactam, and has been associated with beta-lactamase production in extended-spectrum beta-lactamase (ESBL) producers. This association has not been previously studied in the case of amoxycillin-clavulanate. Piperacillin-tazobactam and amoxycillin-clavulanate were compared, using high inocula of susceptible strains either harbouring ESBLs or not. Two non-ESBL-producing and 15 amoxycillin-clavulanate-susceptible and piperacillin-tazobactam-susceptible ESBL-producing Escherichia coli isolates, and their respective transconjugants, were tested in dilution susceptibility tests using standard and 100-fold higher inocula. Three ESBL-producing strains and E. coli ATCC 25922 were selected for time-kill studies using standard and high initial inocula. At high inocula, MICs of piperacillin increased >eight-fold for non-ESBL-producing strains, and MICs of piperacillin-tazobactam (8:1 ratio or with tazobactam fixed at 4 mg/L) increased>eight-fold for all ESBL-producing strains. However, amoxycillin MICs were not affected by a high inoculum with non-ESBL-producing strains, whereas the MICs of amoxycillin-clavulanate (2:1 and 4:1) increased

Autoimmune autonomic ganglionopathy with late-onset encephalopathy.

A 47-year old female presented with a 4 month history of early satiety, constipation, light sensitivity, orthostatic intolerance, siccca, and anhydrosis. Her examination revealed dilated, unreactive pupils with dry eyes and mouth but normal strength, phasic reflexes, and sensation. After 3 min of quiet standing her systolic pressure dropped 70 mmHg with a fixed heart rate of 74 bpm. Her alpha3 ganglionic AChR level was 2060 pmol/L (normal < or = 50). Orthostatic symptoms significantly improved within 10 days of completing 2.0 g/kg IVIg. Her supine norepinephrine (NE) level improved over baseline but remained low (i.e., 0.36 à 0.61 nmol/L). Persisting gut inertia prompted a trial of plasma exchange (PLEx) which restored her supine NE level (2.18 nmol/L), bowel patterns, and pupillary reactivity. Five months later, while her AAG was well controlled, she developed gait unsteadiness, confusion, horizontal and vertical nystagmus, bladder retention, and long tract motor signs. A contrast MRI head was normal. Further serum testing demonstrated binding avidity for neuronal alpha4 and alpha7 nAChRs. She responded to high-dose steroid and immunomodulation. This is the first case report of AAG presenting with antibodies directed against both peripheral and central nAChRs. It is tempting to speculate that CNS alpha4 or alpha7 antibodies may have precipitated the treatment-responsive encephalopathy.

The effect of sham feeding on neurocardiac regulation in healthy human volunteers.

BACKGROUND: Distension and electrical stimuli in the esophagus alter heart rate variability (HRV) consistent with activation of vagal afferent and efferent pathways. Sham feeding stimulates gastric acid secretion by means of vagal efferent pathways. It is not known, however, whether activation of vagal efferent pathways is organ- or stimulus-specific. OBJECTIVE: To test the hypothesis that sham feeding increases the high frequency (HF) component of HRV, indicating increased neurocardiac vagal activity in association with the known, vagally mediated, increase in gastric acid secretion. METHODS: Continuous electrocardiography recordings were obtained in 12 healthy, semirecumbent subjects during consecutive 45 min baseline, 20 min sham feeding (standard hamburger meal) and 45 min recovery periods. The R-R intervals and beat-to-beat heart rate signal were determined from digitized electrocardiography recordings; power spectra were computed from the heart rate signal to determine sympathetic (low frequency [LF]) and vagal (HF) components of HRV. RESULTS: Heart rate increased during sham feeding (median 70.8 beats/min, 95% CI 66.0 to 77.6; P<0.001), compared with baseline (63.6, 95% CI 60.8 to 70.0) and returned to baseline levels within 45 min. Sham feeding increased the LF to HF area ratio (median: 1.55, 95% C.I 1.28 to 1.77; P<0.021, compared with baseline (1.29, 95% CI 1.05 to 1.46); this increase in LF to HF area ratio was associated with a decrease in the HF component of HRV. CONCLUSIONS: Sham feeding produces a reversible increase in heart rate that is attributable to a decrease in neurocardiac parasympathetic activity despite its known ability to increase vagally mediated gastric acid secretion. These findings suggest that concurrent changes in cardiac and gastric function are modulated independently by vagal efferent fibres and that vagally mediated changes in organ function are stimulus- and organ-specific.

Association study of PTPN22 C1858T polymorphism in Trypanosoma cruzi infection.

In this study we investigated a possible role for the single nucleotide polymorphism C1858T of the PTPN22 (protein tyrosine phosphatase nonreceptor 22) gene in determining the susceptibility to Trypanosoma cruzi infection, as well as in development of chagasic heart disease. This study included 316 patients with Chagas' disease and 520 healthy individuals from Colombia and Peru. Genotyping of PTPN22 was performed by the real-time polymerase chain reaction technology, using the TaqMan 5' allelic discrimination assay. No statistically significant differences in the frequency of PTPN22 C1858T gene polymorphism between chagasic patients and controls or between asymptomatic and cardiomyopathic individuals were observed. Our findings suggest that the PTPN22 polymorphism analyzed does not play a major role in the development of Chagas' disease in the Colombian and Peruvian populations.

Rationale and design of ACTIVE: the atrial fibrillation clopidogrel trial with irbesartan for prevention of vascular events.

BACKGROUND: Atrial fibrillation (AF) is the most frequently occurring cardiac arrhythmia with often serious clinical consequences. Many patients have contraindications to anticoagulation, and it is often underused in clinical practice. The addition of clopidogrel to aspirin (ASA) has been shown to reduce vascular events in a number of high-risk populations. Irbesartan is an angiotensin receptor-blocking agent that reduces blood pressure and has other vascular protective effects. METHODS AND RESULTS: ACTIVE W is a noninferiority trial of clopidogrel plus ASA versus oral anticoagulation in patients with AF and at least 1 risk factor for stroke. ACTIVE A is a double-blind, placebo-controlled trial of clopidogrel in patients with AF and with at least 1 risk factor for stroke who receive ASA because they have a contraindication for oral anticoagulation or because they are unwilling to take an oral anticoagulant. ACTIVE I is a partial factorial, double-blind, placebo-controlled trial of irbesartan in patients participating in ACTIVE A or ACTIVE W. The primary outcomes of these studies are composites of vascular events. A total of 14000 patients will be enrolled in these trials. CONCLUSIONS: ACTIVE is the largest trial yet conducted in AF. Its results will lead to a new understanding of the role of combined antiplatelet therapy and the role of blood pressure lowering with an angiotensin II receptor blocker in patients with AF.

In vitro activity of fosfomycin against extended-spectrum-beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae: comparison of susceptibility testing procedures.

The agar dilution, broth microdilution, and disk diffusion methods were compared to determine the in vitro susceptibility of 428 extended-spectrum-beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae to fosfomycin. Fosfomycin showed very high activity against all ESBL-producing strains. Excellent agreement between the three susceptibility methods was found for E. coli, whereas marked discrepancies were observed for K. pneumoniae.

[Communicable disease surveillance in Navarre, 2004]. / Situación de las Enfermedades de Declaración Obligatoria (EDO) en Navarra, 2004.

Epidemiological surveillance in Navarre (584,734 inhabitants) covers 34 transmissible diseases, whose notification is compulsory, and epidemic outbreaks of any aetiology. Notification is carried out on a weekly basis by the doctors from paediatrics, primary care and specialised care. In 2004, 75.8% of all the possible notification reports (a weekly report for each doctor) were received, a percentage that has improved in the last five year period. Flu only reached 14.4 cases per 1,000 inhabitants (Epidemic Index, EI: 0.30), due to the advance of the epidemic peak for the 2003-2004 season to the month of November. The rate of respiratory tuberculosis fell to 11.6 cases per 100,000 inhabitants, and the rate of non-respiratory tuberculosis rose to 2.7 per 100,000. Ten cases of tuberculosis (11.9%) were grouped into four outbreaks that affected adolescents and young adults. Thirty percent of the cases were produced in immigrants and 4.8% in persons coinfected with HIV, proportions that are similar to those of the previous year. Eleven cases of meningococcal disease were reported, (1.9 cases per 100,000 inhabitants; EI 0.73), but only in 8 cases was the clinical form sepsis and/or meningitis. Neisseria meningitidis serogroup B was isolated in 8 cases, and serogroup C in 2 cases, the latter 2 were adults and were not vaccinated. The incidence of immunopreventable diseases continues to fall, and for the fifth consecutive year no case of measles has been reported. Legionnaire's disease, which is detected through the systematic determination of the antigen in urine, rose to 5.8 cases per 100,000 inhabitants (EI: 1.42), without any epidemiological relation between them. The incidence of imported diseases rose, with 12 cases of malaria, 8 of shigellosis, 5 of hepatitis A and 2 of legionnaire's disease acquired outside Spain.

Situación de las Enfermedades de Declaración Obligatoria (EDO) en Navarra, 2004 / Communicable disease surveillance in Navarre, 2004

La vigilancia epidemiológica de Navarra (584.734 habitantes)comprende 34 enfermedades transmisibles de declaraciónobligatoria y los brotes epidémicos de cualquier etiología. Ladeclaración es efectuada semanalmente por los médicos depediatría, atención primaria y asistencia especializada.En 2004 se recibieron el 75,8% de todas los partes de notificacionesposibles (uno semanal por médico), porcentaje queha mejorado en el último quinquenio.La gripe alcanzó sólo 14,4 casos por 1.000 habitantes (índiceepidémico, IE:0,30) por el adelanto del pico epidémico de latemporada 2003-2004 al mes de noviembre.La tasa de tuberculosis respiratoria descendió hasta 11,6casos por 100.000 habitantes, y la de tuberculosis no respiratoriaascendió a 2,7 por 100.000. Diez casos de tuberculosis(11,9%) se agruparon en cuatro brotes que afectaron a adolescentesy adultos jóvenes. El 30% de los casos se produjeron eninmigrantes y el 4,8% en personas coinfectadas por el VIH, siendoestas proporciones similares a las del año anterior.Se notificaron 11 casos de enfermedad meningocócica (1,9por 100.000 habitantes; IE: 0,73), pero sólo en 8 la forma clínicafue de sepsis y/o meningitis. La letalidad ascendió al 18,2%. En 8casos se aisló Neisseria meningitidis serogrupo B y en 2 el serogrupoC, estos últimos eran adultos y no estaban vacunados.La incidencia de enfermedades inmunoprevenibles sigueen descenso, y por quinto año no se ha declarado ningún casode sarampión.La legionelosis, detectada mediante la determinación sistemáticadel antígeno en orina, ascendió a 5,8 casos por 100.000habitantes (IE:1,42), sin que se detectase relación epidemiológicaentre ellos.La incidencia de enfermedades importadas aumentó, contabilizándose12 paludismos, 8 shigelosis, 5 hepatitis A y 2 legionelosisadquiridas fuera de España

Epidemiological surveillance in Navarre (584,734inhabitants) covers 34 transmissible diseases, whosenotification is compulsory, and epidemic outbreaks of anyaetiology. Notification is carried out on a weekly basis by thedoctors from paediatrics, primary care and specialised care.In 2004, 75.8% of all the possible notification reports (aweekly report for each doctor) were received, a percentage thathas improved in the last five year period.Flu only reached 14.4 cases per 1,000 inhabitants(Epidemic Index, EI: 0.30), due to the advance of the epidemicpeak for the 2003-2004 season to the month of November.The rate of respiratory tuberculosis fell to 11.6 cases per100,000 inhabitants, and the rate of non-respiratory tuberculosisrose to 2.7 per 100,000. Ten cases of tuberculosis (11.9%) weregrouped into four outbreaks that affected adolescents andyoung adults. Thirty percent of the cases were produced inimmigrants and 4.8% in persons coinfected with HIV,proportions that are similar to those of the previous year.Eleven cases of meningococcal disease were reported, (1.9cases per 100,000 inhabitants; EI 0.73), but only in 8 cases wasthe clinical form sepsis and/or meningitis. Neisseria meningitidisserogroup B was isolated in 8 cases, and serogroup C in 2 cases,the latter 2 were adults and were not vaccinated.The incidence of immunopreventable diseases continuesto fall, and for the fifth consecutive year no case of measles hasbeen reported.Legionnaire’s disease, which is detected through thesystematic determination of the antigen in urine, rose to 5.8cases per 100,000 inhabitants (EI: 1.42), without anyepidemiological relation between them.The incidence of imported diseases rose, with 12 cases ofmalaria, 8 of shigellosis, 5 of hepatitis A and 2 of legionnaire’sdisease acquired outside Spain

An integrated proposal to explain the epidemic of cardiovascular disease in a developing country. From socioeconomic factors to free radicals.

An increase of coronary artery disease has been observed in developing countries during the last years. Various factors may explain this accelerated increase. We propose that inappropriate diet and inadequate sanitary infrastructure may act as triggers to create an imbalance between nitric oxide (NO) and superoxide (O2-). An increase in the concentrations of oxidized LDL produces both decreased NO and increased O2- endothelial synthesis, by accumulation of asymmetrical NG-NG-dimethyl-L-arginine, the endogenous inhibitor of NO, and by activation of NAD(P)H oxidase. On the other hand, high rates of chronic infection-inflammation, due to inappropriate sanitary environment stimulate higher circulating levels of proinflammatory cytokines. These cytokines also contribute to reduced NO and increased O2- endothelial production through the same mechanisms of oxidized LDL. The net result of this imbalance is an increased generation of peroxynitrate that injures the endothelium in a proatherogenic, prothrombotic and vasoconstrictive manner.

Clinical and quantitative coronary angiographic predictors of coronary restenosis: a comparative analysis from the balloon-to-stent era.

OBJECTIVES: We sought to assess whether coronary stents have modified the predictive value of demographic, clinical and quantitative coronary angiographic (QCA) predictors of coronary restenosis. BACKGROUND: A systematic analysis in a large cohort of registries and randomized trials of the percutaneous transluminal coronary angioplasty (PTCA) and stent era has never been performed. METHODS: A total of 9,120 treated lesions in 8,156 patients included in nine randomized trials and 10 registries, with baseline, post-procedural and six-month follow-up QCA analyses, were included in this study. Predictors of restenosis were identified with univariate and multivariate logistic regression analyses. Interaction terms were introduced in the regression equation to evaluate whether the predictors of restenosis were common to both eras or specific for either one of the revascularization techniques. RESULTS: The restenosis rate was 35% after PTCA and 19% after angioplasty with additional stenting. In the univariate analysis, favorable predictors were previous coronary artery bypass graft surgery (CABG), stent use, stent length and a large pre-procedural minimal lumen diameter (pre-MLD); unfavorable predictors were weight, body mass index, diabetes mellitus, multi-vessel disease, lesion length and a high residual post-procedural diameter stenosis (post-DS). Predictors specific for the PTCA population were a large post-procedural MLD (post-MLD) as favorable and a severe pre-procedural DS (pre-DS) as unfavorable. Favorable predictors specific for the stent population were a large post-MLD and a large pre-procedural reference diameter (pre-RD). In the multivariate analysis, the best model included the following favorable predictors: stent use, a large post-MLD, previous CABG and the interaction term between stent use and a large post-MLD; unfavorable predictors were lesion length and diabetes mellitus. CONCLUSIONS: There are no major differences in demographic and clinical predictors of coronary restenosis between PTCA and stent populations. In the modern (stent) era, a severe pre-DS is no longer an unfavorable predictor of restenosis. Still important, but more so in the stent population, is a large post-MLD (optimal result). Finally, a larger pre-RD became a favorable predictor with the advent of stenting.