[Evaluation of a pharmaceutical care program to improve adherence to antiretroviral therapy]. / Evaluación de un programa de atención farmacéutica dirigido a mejorar la adherencia al tratamiento antirretroviral.

OBJECTIVE: To establish the impact of a pharmaceutical care program on the improvement of adherence to antiretroviral therapy, and on patient immunologic and virologic outcome. MATERIALS AND METHODS: A multicenter, observational, prospective study in a HIV-infected patient cohort under treatment with antiretrovirals selected by random sampling in 19 Spanish hospitals. The study lasted 12 months, in which the program was applied through a baseline preprocedural visit and 4 quarterly visits. Adherence estimation was based on pill counting. An adherence > or = 90, or > or = 95% was considered adequate (in two time points). RESULTS: 541 patients were included, most of them were males (68.8%) between 20 and 78 years of age. Major risk groups included injecting drug users (43.4%) and heterosexuals (29.4%). Sixty percent had already received treatment for more than 3 years. Mean baseline viral load and CD4 count values were 32,866 copies/ml and 485 cells/mm3, respectively. Throughout the study a slight increase in the percentage of adherent patients was seen; however, statistical significance was not reached (64.3 and 79.2% of patients showed an adherence > 95 and > 90%, respectively, during the fourth quarter, versus 59.8 and 75.5% at baseline). A statistically significant decrease in viral load and increase in CD4 cells was seen following program application. The percentage of patients with a viral load < 200 copies/ml was 72.2, 76.7, and 75.0% at the 2nd, 3rd, and 4th quarters, respectively, versus 64.2% at baseline. CD4 cell counts increased by 50 cells/mm3 on average from the start to the end of follow-up. CONCLUSIONS: Patients included in the program had a good immunologic and virologic outcome, and a trend towards an increased percentage of patients with good adherence was also seen. These results confirm the need to implement follow-up programs for patients receiving antiretrovirals in order to ensure maximum therapeutic benefits.

Study of the olivocochlear neurons using two different tracers, fast blue and cholera toxin, in hypothyroid rats.

Congenital hypothyroidism results in deafness that is caused by changes in the auditory receptor, including scanty development of the outer hair cells and a lack of synaptogenesis between these cells and the efferent system. although the afferent population is present. The normal efferent innervation of the cochlea originates in the superior olivary complex, arising from efferent neurons belonging to the lateral or to the medial olivocochlear system. In the rat, the former is constituted by neurons located in the lateral superior olivary nucleus, that project to the inner hair cells, while the later originates in the ventral nuclei of the trapezoid body and project to the outer hair cells. The aim of this work is to study the localization, number and morphology of the olivochochlear neurons in congenital hypothyroid animals by means of the injections of the retrograde tracers, either fast blue or cholera toxin, in the cochlea. The mean total number of labeled olivocochlear neurons after injection of fast blue in hypothyroid animals was 1,016, and in control ones was 1,027. Using cholera toxin, the mean total number of labeled olivocochlear neurons was slightly lower: 863 in hypothyroid animals versus 910 in control ones. Although both tracers showed no significant differences between groups, when the somatic area of the labeled olivocochlear neurons is considered, the size of all of the three different population of cells (lateral olivocochlear neurons, medial olivocochlear neurons and shell neurons) was significantly lower in the hypothyroid rats. This is the first study of the olivocochlear neurons in hypothyroid animals. The conclusion from this work is that in hypothyroid rats the labeled olivocochlear neurons are significantly smaller but that there is not any modification in the localization and number of the labeled olivocochlear neurons, suggesting that thyroid hormones are necessary for the neuronal growth. However, most of the medial olivocochlear neurons do not make contact with their target, so their maintenance suggests that the axons are in contact with other structures of the cochlea.

[Outbreak of shigellosis in a lower-class district]. / Brote de shigellosis en un barrio de nivel social bajo.

BACKGROUND: The outbreaks of Shigella sonnei in our environment frequently involve day care centers and elementary schools. An outbreak of shigellosis in a lower-class district is reported. The purpose of this study is that of pinpointing the center of infection, the means of contagion, the characteristics of those infected and of assessing the suitability of the measures taken. METHODS: For monitoring the outbreak over time, a combined observational timeline study was conducted within a territory the bounds of which were marked by means of the conventional epidemiological monitoring variables (time, place and individual). The infectivity of the center of infection (contagion rate) is analyzed by age, gender and school; rate ratio and percentage attributable thereto. RESULTS: On a time-related basis, the outbreak in question started on week 46/97 and ended on week 8/98. This outbreak involved 218 individuals (110 males and 108 females) totaling 5.46% of the district. The highest frequency was found among the 0-4 age group (43.6%), 29.4% in day care (70.32% contagion rate) with a relative risk of 3.9 (95% CI: 2.57-5.93) and 74.36% attributable percentage. The rate ratio between day care and the schools in the district in question is 5.62 (95% CI: 4.33-7.31). Stool cultures were taken and analyzed in 84 cases (38.5%), Shigella sonnei being detected in 38 cases (17.4%). Antibacterial treatment (amoxicillin-clavulan) was set out and individual and group health and safety measures were employed. CONCLUSIONS: The long communicability period and the small number of viable microorganisms necessary for causing this disease fostered its being passed on from one person to another at school and in the home. The measures employed effectively confined the contagion of the infectious agent at the schools.

Structure of glycogen particles in organ of Corti's outer hair cells in three rodent species.

Organ of Corti's outer hair cells are one of the few cell types in mammals to contain large cytoplasmic glycogen stores, and the only one in the adult auditory receptor. Previous reports on the structure and distribution of glycogen in the adult organ of Corti were mainly based on light microscopy histo- and cytochemical methods, and the scare EM studies on the topic relied on techniques which were not sensitive or specific enough. Furthermore, it has been reported that glycogen particles are not present in outer hair cells of all species. A first goal of the present study was to describe the ultrastructure of glycogen stores in organ of Corti's outer hair cells in Guinea pig, rat, and mouse, using the periodic acid-thiocarbohydrazide-silver proteinate method. In addition, differences in the subcellular and cochleotopic distribution of this substance were analyzed. In the adult organ of Corti only the outer hair cells contain glycogen stores. Present throughout their cytoplasm, these deposits appear either as single beta particles, or as aggregates of these, forming alpha particles. Though most alpha particles are round, some appear long and conspicuously straight in longitudinal sections of those cells near the apex of the cochlea, and they seem to be apposed to some filamentous structure. On the other hand, when the cells are sectioned transversely the larger aggregates of glycogen particles follow a curved course. Since outer hair cells of the apical region of the cochlea contain a bundle of contractile microfilaments, our results suggest that glycogen is associated with the contractile apparatus of these cells. This hypothesis is in good accordance with previous experimental data which suggest that glycogen is used as energy source for the contractile movements of outer hair cells.

Impact of autologous blood predonation on a comprehensive blood conservation program.

Preoperative autologous donation has been shown to be a highly effective measure in reducing homologous blood use in cardiac operations. The aim of our study was to verify the effectiveness of this procedure and to see whether it is compatible with a comprehensive blood conservation program. Three hundred forty-eight patients (group 1) donated an average of 657 +/- 199 mL of blood before open heart operation, whereas 344 patients (group 2) without autologous predonation were used as a control. The two groups were compared with regard to homologous blood use and the possibility of applying other blood conservation measures. Homologous transfusion rate in group 1 was 12.6%, whereas in group 2 it was 46% (p < 0.001). Patients with three units of predonated autologous blood had a transfusion rate of 0.8% (p < 0.001 compared with group 2). In group 1, acute normovolemic hemodilution was accomplished in a lower number of patients and with a lower average withdrawal (338 +/- 102 versus 403 +/- 145 mL; p < 0.001). Other blood conservation measures such as the return of mediastinal drainage and use of residual blood of extracorporeal circulation were applied with similar results in both groups. In our experience, preoperative autologous donation was compatible with the application of other blood conservation measures, but acute normovolemic hemodilution was achieved in a lower number of patients. Preoperative autologous donation proved to be a highly effective method for reducing banked blood use and therefore homologous blood exposure during and after cardiac operations.

[Diego de Cisneros and novo-Hispanic astrological and geographical medicine]. / Diego de Cisneros y la medicina astrológica y geográfica novohispana.

The collection of geographical information about the New World which was originated during the XVI century started being organized during the XVI century started being organized and explained, in the field of medicine, towards the end of the century and continued during the earliest decades of the following. Writers in the medical profession of these days are characterized by their interest, sometimes coexisting with or alternated with the outlooks of geography of illness and astrology. Diego Cisneros is a outstanding writer of a single place of valuable work so far Known, who was born in Madrid, became a doctor at Alcala de Henares and then arrive in New Spain in 1612. His book represents the incipient baroque of the time and is a valuable contribution to the Knowledge of geography and medicine and is also a piece of art work. It contains one of the first plans of the City of Mexico and its neighbouring sites drawn ina a typical baroque style. The scientific importance of the book consists of the clearcut separation between science and belief leading to assert the freedom of Mankind to put an end to medieval astrology which imprisoned the individual. Because of his leanings towards the Alcala School he upholds the idea of the utility of science and experience linked up to objective clinical observation. Cisneros contributes through his work to the unfolding of two significant processes in the history of national culture: one relates to identity and the other one to scientific community. These pages contain an analysis of the development of his work.

Lectin staining of saccharides in the normal and hypothyroid developing organ of Corti.

Lectin staining has been used to detect mono- and oligosaccharides in normal and hypothyroid developing organs of Corti in the rat. Eight developmental stages were studied (1, 5, 8, 10, 15, 20, 50 and 60 days after birth). Congenital hypothyroidism was induced by oral administration of propylthyouracil to pregnant rats. Labelling of the tectorial membrane with 3 lectins, Ulex europaeus agglutinin-I (UEA-I), Lens culinaris agglutinin (LCA) and Ricinus communis agglutinin-I (RCA-I) showed no significant differences between normal and hypothyroid animals. Staining with peanut agglutinin (PNA) showed that the hypothyroid adult tectorial membrane (but not the normal one) possesses the disaccharide galactose + N-acetyl galactosamine. Phaseolus vulgaris agglutinin-L (PHA-L) labels the whole tectorial membrane in both groups of animals, but the staining is more intense in the hypothyroid one for a narrow band of oligosaccharide located just between the tectorial membrane and the underlying organ of Kölliker. Both soybean agglutinin (SBA) and succinylated wheat germ agglutinin (WGA) stain the tectorial membrane as well as the cytoplasm of the cells constituting the inner portion of the organ of Kölliker; this latter feature disappears in the normal animals about the 8th postnatal day, but it is abnormally preserved until the 60th postnatal day in the hypothyroid ones. In the adult hypothyroid animals, 3 of the lectins (LCA, PHA-L and WGA) stain extracellular conglomerates located under the synaptic pole of the outer hair cells.

Tectorial membrane changes in hypothyroid rats during postnatal development.

The morphological changes of the tectorial membrane (TM) during the postnatal development (0, 3, 6, 12 and 25 day old) of the organ of Corti were studied by light microscopy in 20 control and hypothyroid rats. Hypothyroidism was induced by daily administration of propylthioruracil (PTU) until the end of lactation. The auditive receptor in the cochlea of the hypothyroid animals shows serious structural alterations compared with those of normal ones: abnormal persistence of Kölliker's organ, immaturity of sensory cells and supporting cells and a specific distortion of the TM. Differences with controls were first observed on the sixth postnatal day of the hypothyroid rats. The inner spiral sulcus was not shaped and the TM was attached to the Kölliker's organ. In older stages (12 and 25 days), Kölliker's organ was still present. The TM acquired a shap hump with an abnormal fibrillar arrangement in its middle part. It was still attached to the outer supporting cells by a remnant of the marginal net. It was suggested that the TM is secreted by the inner spiral limbus and Kölliker's organ. An abnormal persistence of these structures in the hypothyroidism results in a retardation of Corti's organ development. However, this conclusion does not explain the absence of the outer portion of the TM. Our study confirms the hypothesis that the secretion of any components of the marginal zone of TM is made by outer supporting cells which in PTU-treated animals appear very immature and with hypoplasia.

The effects of kainic acid on the cochlear ganglion of the rat.

The effects of locally applied kainic acid on cells and fibers in the rat cochlea were examined in a quantitative and ultrastructural study. Doses of 5 nM per microliter of artificial perilymph destroyed part of the spiral ganglion type I cell population, with no ototoxic effects on cochlear hair cells or supporting cells. Type II cells also appeared unaffected. A quantitative evaluation of the cell loss with the 5 nM dosage showed that 34% of spiral ganglion neurons were lost 10 days after treatment. Doses of 20 nM per microliters and 40 nM per microliters did not result in increasing neuronal loss. This differential toxicity could reflect the presence of a sub-population of spiral ganglion cells with an increased number of KA receptors.