A longitudinal prospective study of active tuberculosis in a Western Europe setting: insights and findings.

PURPOSE: This study investigates the potential of inflammatory parameters (IP), symptoms, and patient-related outcome measurements as biomarkers of severity and their ability to predict tuberculosis (TB) evolution. METHODS: People with TB were included prospectively in the Stage-TB study conducted at five clinical sites in Barcelona (Spain) between April 2018 and December 2021. Data on demographics, epidemiology, clinical features, microbiology, and Sanit George Respiratory Questionnaire (SGRQ) and Kessler-10 as Health-Related Quality of Life (HRQoL) were collected at three time points during treatment. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), neutrophil/lymphocyte, and monocyte/lymphocyte ratios (NLR and MLR), complement factors C3, C4, and cH50, clinical and microbiological data, and HRQoL questionnaires were assessed at baseline, 2 months, and 6 months. Their ability to predict sputum culture conversion (SCC) and symptom presence after 2 months of treatment was also analysed. RESULTS: The study included 81 adults and 13 children with TB. The CRP, ESR, NLR, and MLR values, as well as the presence of symptoms, decreased significantly over time in both groups. Higher IP levels at baseline were associated with greater bacillary load and persistent symptoms. Clinical severity at baseline predicted a delayed SCC. Kessler-10 improved during follow-up, but self-reported lung impairment (SGRQ) persisted in all individuals after 6 months. CONCLUSIONS: IP levels may indicate disease severity, and sustained high levels are linked to lower treatment efficacy. Baseline clinical severity is the best predictor of SCC. Implementing health strategies to evaluate lung function and mental health throughout the disease process may be crucial for individuals with TB.

Modeling of the Influence of Input AM Parameters on Dimensional Error and Form Errors in PLA Parts Printed with FFF Technology.

As is widely known, additive manufacturing (AM) allows very complex parts to be manufactured with porous structures at a relatively low cost and in relatively low manufacturing times. However, it is necessary to determine in a precise way the input values that allow better results to be obtained in terms of microgeometry, form errors, and dimensional error. In an earlier work, the influence of the process parameters on surface roughness obtained in fused filament fabrication (FFF) processes was analyzed. This present study focuses on form errors as well as on dimensional error of hemispherical cups, with a similar shape to that of the acetabular cup of hip prostheses. The specimens were 3D printed in polylactic acid (PLA). Process variables are nozzle diameter, temperature, layer height, print speed, and extrusion multiplier. Their influence on roundness, concentricity, and dimensional error is considered. To do this, adaptive neuro-fuzzy inference systems (ANFIS) models were used. It was observed that dimensional error, roundness, and concentricity depend mainly on the nozzle diameter and on layer height. Moreover, high nozzle diameter of 0.6 mm and high layer height of 0.3 mm are not recommended. A desirability function was employed along with the ANFIS models in order to determine the optimal manufacturing conditions. The main aim of the multi-objective optimization study was to minimize average surface roughness (Ra) and roundness, while dimensional error was kept within the interval Dimensional Error≤0.01. When the simultaneous optimization of both the internal and the external surface of the parts is performed, it is recommended that a nozzle diameter of 0.4 mm be used, to have a temperature of 197 °C, a layer height of 0.1 mm, a print speed of 42 mm/s, and extrusion multiplier of 94.8%. This study will help to determine the influence of the process parameters on the quality of the manufactured parts.

Morphoanatomic variation in tissues of Rhizophora mangle seedlings subjected to different saline regimes: cross-seeding experiment.

Rhizophora mangle, one of the main neotropic mangrove species, has wide phenological variability associated with soil salinity. Since global warming is one of the main drivers of changes in salinity, understanding the influence of this variable at the species level would help improve the prediction of climate change in the ecological services provided by mangroves. To understand the physiological and/or anatomical responses to water stress generated by edaphic salinity and its relationship with phenological and structural diversity, we quantified the functional traits of leaf tissue subjected to a cross-seeding experiment between two forests with different ranges of natural salinity (0-18 PSU and 20 to 70 PSU). A total of 180 propagules, 90 native and 90 from the other forest, were planted in each forest. Every three months for a year, soil salinity and growth, adaptability, and survival of propagules that were transformed into seedlings were measured. The traits evaluated between the two saline regimes presented significant differences, as stated in the working hypothesis. Likewise, there were modifications in the hypodermis and the xylem vessels in the exchanged seedlings, tissues related to water storage, and conduction. These responses allowed native euhaline forest seedlings to grow in oligohaline. The opposite occurred with seedlings originating in low salinities that did not survive in high salinities. Differences in adaptability between populations of R. mangle subjected to ranges of contrasting salinity may imply changes at the structural level, zoning, and abundance of the species front to the climate change processes.

Analysis of AM Parameters on Surface Roughness Obtained in PLA Parts Printed with FFF Technology.

Fused filament fabrication (FFF) 3D printing technology allows very complex parts to be obtained at a relatively low cost and in reduced manufacturing times. In the present work, the effect of main 3D printing parameters on roughness obtained in curved surfaces is addressed. Polylactic acid (PLA) hemispherical cups were printed with a shape similar to that of the acetabular part of the hip prostheses. Different experiments were performed according to a factorial design of experiments, with nozzle diameter, temperature, layer height, print speed and extrusion multiplier as variables. Different roughness parameters were measured-Ra, Rz, Rku, Rsk-both on the outer surface and on the inner surface of the parts. Arithmetical mean roughness value Ra and greatest height of the roughness profile Rz are usually employed to compare the surface finish among different manufacturing processes. However, they do not provide information about the shape of the roughness profile. For this purpose, in the present work kurtosis Rku and skewness Rsk were used. If the height distribution in a roughness profile follows a normal law, the Rku parameter will take a value of 3. If the profile distribution is symmetrical, the Rsk parameter will take a value of 0. Adaptive neural fuzzy inference system (ANFIS) models were obtained for each response. Such models are often employed to model different manufacturing processes, but their use has not yet been extended to 3D printing processes. All roughness parameters studied depended mainly on layer height, followed by nozzle diameter. In the present work, as a general trend, Rsk was close to but lower than 0, while Rku was slightly lower than 3. This corresponds to slightly higher valleys than peaks, with a rounded height distribution to some degree.

Discovery and validation of an NMR-based metabolomic profile in urine as TB biomarker.

Despite efforts to improve tuberculosis (TB) detection, limitations in access, quality and timeliness of diagnostic services in low- and middle-income countries are challenging for current TB diagnostics. This study aimed to identify and characterise a metabolic profile of TB in urine by high-field nuclear magnetic resonance (NMR) spectrometry and assess whether the TB metabolic profile is also detected by a low-field benchtop NMR spectrometer. We included 189 patients with tuberculosis, 42 patients with pneumococcal pneumonia, 61 individuals infected with latent tuberculosis and 40 uninfected individuals. We acquired the urine spectra from high and low-field NMR. We characterised a TB metabolic fingerprint from the Principal Component Analysis. We developed a classification model from the Partial Least Squares-Discriminant Analysis and evaluated its performance. We identified a metabolic fingerprint of 31 chemical shift regions assigned to eight metabolites (aminoadipic acid, citrate, creatine, creatinine, glucose, mannitol, phenylalanine, and hippurate). The model developed using low-field NMR urine spectra correctly classified 87.32%, 85.21% and 100% of the TB patients compared to pneumococcal pneumonia patients, LTBI and uninfected individuals, respectively. The model validation correctly classified 84.10% of the TB patients. We have identified and characterised a metabolic profile of TB in urine from a high-field NMR spectrometer and have also detected it using a low-field benchtop NMR spectrometer. The models developed from the metabolic profile of TB identified by both NMR technologies were able to discriminate TB patients from the rest of the study groups and the results were not influenced by anti-TB treatment or TB location. This provides a new approach in the search for possible biomarkers for the diagnosis of TB.

Effect of methyl jasmonate and salicylic acid on the production of metabolites in cell suspensions cultures of Piper cumanense (Piperaceae).

Elicitation of cell suspensions culture is a strategy that could increase the production of secondary metabolites under controlled conditions. This research evaluated the effect of methyl jasmonate-MeJA and salicylic acid-SA as elicitors on the production of metabolites in cell suspensions of P. cumanense. The type of elicitor (MeJA or SA), the concentration of elicitor (10 µM and 100 µM), and time of exposition (3, 12, 24 h) on cell suspension were evaluated. Metabolic profiles of intracellular and extracellular extracts were analyzed by UHPLC-DAD and GC-MS. Differential production of metabolites was dependent on the type of elicitor, its concentration, and the time of exposition. Treatments with 100 µM SA were conducted to high production of 5-hydroxymethylfurfural (6.3 %), phenol (6.5 %), and (Z)-9-octadecenamide (8.8 %). This is the first report of elicitation on cell suspensions in the Piper genus and contributes to understanding the effect of MeJA and SA on metabolite production in plant cell culture.

Tuberculosis recurrences and predictive factors in a vulnerable population in Catalonia.

BACKGROUND: Patients with a history of tuberculosis (TB) have a high probability of recurrence because long-term cure is not always maintained in successfully treated patients. The aim of this study was to identify the probability of TB recurrence and its predictive factors in a cohort of socially vulnerable patients who completed treatment in the TB referral center in Catalonia, which acts as the center for patients with social and health problems. METHODS: This retrospective open cohort study included all patients diagnosed with TB who were admitted and successfully treated in Serveis Clínics between 2000 and 2016 and who remained disease-free for a minimum of 1 year after treatment completion. We calculated the incidence density of TB recurrences per person-years of follow-up. We also estimated the cumulative incidence of TB recurrence at 1, 2, 5, and 10 years of follow-up. Bivariate analysis was conducted using Kaplan-Meier curves. Multivariate analysis was conducted using Cox regression. Hazard ratios (HR) were calculated with their 95% confidence intervals (95%CI). RESULTS: There were 839 patients and 24 recurrences (2.9%), representing 0.49 per 100 person-years. The probability of a recurrence was 0.63% at 1 year of follow-up, 1.35% at 2 years, and 3.69% at 5 years. The multivariate analysis showed that the predictive factors of recurrence were age older than 34 years (aHR = 3.90; CI = 1.06-14.34 at age 35-45 years and aHR = 3.88; CI = 1.02-14.80 at age >45 years) and resistance to at least one anti-TB drug (aHR = 2.91; CI = 1.11-7.65). CONCLUSIONS: Attention should be paid to socially vulnerable persons older than 34 years with a previous episode of resistant TB. Surveillance resources should be directed toward adequately treated patients who nevertheless have a high risk of recurrence.

Morfoanatomía e histoquímica de Hypericum juniperinum (Hypericaceae)

Hypericum es un género que pertenece a la familia Hypericaceae, conformado por 469 especies de hierbas, árboles y arbustos. Dos secciones en particular, Brathys y Trygynobrathys, son parte integral de la flora de Páramo. Hypericum tiene una amplia variedad de metabolitos que están asociados con múltiples actividades farmacológicas, y específicamente en H. juniperinum se han reportado propiedades antidepresivas relacionadas con la presencia de flavonoides y compuestos fenólicos. El objetivo de esta investigación fue relacionar las estructuras anatómicas con los metabolitos detectados por métodos histoquímicos presentes en los órganos vegetativos y reproductivos de Hypericum juniperinum recolectados en el Páramo colombiano. Los órganos aéreos (tallos, hojas y flores) de Hypericum juniperinum se recolectaron en la vereda Arbolocos del municipio de Cuitiva, Boyacá (código voucher No.589611, COL). Para el análisis anatómico, los órganos de H. juniperinum se procesaron con técnicas de fijación, incorporación en parafina, corte en microtomo y tinción con azul de astra y fucsina básica. Para el análisis histoquímico se realizaron cortes a mano alzada con tinciones específicas para lípidos, compuestos fenólicos, alcaloides y pectinas. La anatomía de los órganos de H. juniperinum debe entenderse en el contexto de las condiciones de vida del Páramo. Las hojas son altamente xeromorfas ya que son cartáceas, arrosetadas, convolutas y verticales, con parénquima en empalizada biestratificado, paredes engrosadas, cutícula gruesa y cera epicuticular en ambas epidermis foliares, estomas en el lado abaxial con cámara epidérmica. Sin embargo, tiene algunas características mesomórficas, como las vainas parenquimáticas de los haces vasculares y el parénquima esponjoso suelto. Hypericum juniperinum presenta glándulas translúcidas en hojas, cáliz y gineceo, y carece de las glándulas negras típicas de la sección Hypericum a la que pertenece la planta medicinal Hypericum perforatum. El análisis histoquímico mostró lípidos en los canales de la hoja, parénquima radial del tallo y en algunas estructuras florales. Los compuestos fenólicos se detectaron a lo largo de la hoja, en el floema del tallo y en las anteras. Hypericum juniperinum carece de alcaloides y presenta pectinas en el parénquima de la vaina que rodea el haz vascular de la hoja. El presente trabajo contribuye a relacionar los metabolitos con su distribución en los tejidos de esta especie nativa. Además, la anatomía mostró que H. juniperinum tiene características de una planta de Páramo. La descripción que se proporciona aquí podría utilizarse como una monografía preliminar de plantas del género Hypericum con propiedades terapéuticas prometedoras.

Hypericum is a genus that belongs to the Hypericaceae family, with has 469 species of herbs, trees and shrubs. Two sections in particular, Brathys and Trygynobrathys are an integral part of the Paramo flora. Hypericum genus has a wide variety of metabolites that are associated with multiple pharmacological activities, and specifically in H. juniperinum antidepressant properties related to the presence of flavonoids and phenolic compounds have been reported. The objective of this research is to relate the anatomical structures with the metabolites detected by histochemical methods present in the vegetative and reproductive organs of Hypericum juniperinum collected in the Colombian Paramo. The aerial organs (stems, leaves and flowers) of Hypericum juniperinum were collected in the village Arbolocos of the municipality of Cuitiva, Boyacá (voucher code No. 589611, COL). For the anatomical analysis, the organs of H. juniperinum were processed with fixation techniques, incorporation in paraffin, cutting in microtome and staining with Astra-blue and basic fuchsin; for the histochemical analysis freehand cuts were made with specific stains for lipids, phenol compounds, alkaloids and pectins. The anatomy of the organs of H. juniperinum should be understood in the context of the living conditions of the Paramo. Leaves are highly xeromorphic as they are chartaceous, rosette-shaped, convolute and upright, with parenchyma in bistratified palisade, thickened walls, thick cuticle and epicuticular wax in both foliar epidermis, stomata on the abaxial side and with epidermal chamber. However, it has some mesomorphic characteristics such as parenchymatic bundle sheath and loose spongy parenchyma. Hypericum juniperinum has translucent glands in leaves, calyx and gynoecium, and lacks black glands typical of the Hypericum section belonging to the medicinal plant Hypericum perforatum. Histochemical analysis showed lipids in leaf canals, radial parenchyma of the stem and in some floral structures. Phenolic compounds were detected along the leaf, in the phloem of the stem and in the anthers. Hypericum juniperinum lacks alkaloids and presents pectins in the parenchyma of the sheath surrounding the vascular bundle of the leaf. The present work contributes by relating the metabolites with their distribution in the tissues of this native species. In addition, the anatomy of H. juniperinum has characteristics of the Paramo plants. Description given here could be used as a preliminary monograph of plants from the Hypericum genus with promising therapeutic properties.

QuantiFERON-TB Gold In-Tube as a Confirmatory Test for Tuberculin Skin Test in Tuberculosis Contact Tracing: A Noninferiority Clinical Trial.

Background: Screening strategies based on interferon-γ release assays in tuberculosis contact tracing may reduce the need for preventive therapy without increasing subsequent active disease. Methods: We conducted an open-label, randomized trial to test the noninferiority of a 2-step strategy with the tuberculin skin test (TST) followed by QuantiFERON-TB Gold In-Tube (QFT-GIT) as a confirmatory test (the TST/QFT arm) to the standard TST-alone strategy (TST arm) for targeting preventive therapy in household contacts of patients with tuberculosis. Participants were followed for 24 months after randomization. The primary endpoint was the development of tuberculosis, with a noninferiority margin of 1.5 percentage points. Results: A total of 871 contacts were randomized. Four contacts in the TST arm and 2 in the TST/QFT arm developed tuberculosis. In the modified intention-to-treat analysis, this accounted for 0.99% in the TST arm and 0.51% in the TST/QFT arm (-0.48% difference; 97.5% confidence interval [CI], -1.86% to 0.90%); in the per-protocol analysis, the corresponding rates were 1.67% and 0.82% in the TST and TST/QFT arms, respectively (-0.85% difference; 97.5% CI, -3.14% to 1.43%). Of the 792 contacts analyzed, 65.3% in the TST arm and 42.2% in the TST/QFT arm were diagnosed with tuberculosis infection (23.1% difference; 95% CI, 16.4% to 30.0%). Conclusions: In low-incidence settings, screening household contacts with the TST and using QFT-GIT as a confirmatory test is not inferior to TST-alone for preventing active tuberculosis, allowing a safe reduction of preventive treatments. Clinical Trials Registration: NCT01223534.

Fibromyalgia as a cause of uncontrolled asthma: a case-control multicenter study.

BACKGROUND: Fibromyalgia can affect the control of asthma when both diseases are present in a single patient. OBJECTIVES: To characterize asthma in patients with concomitant fibromyalgia to assess whether fibromyalgia is an independent factor of asthma severity that influences poor asthma control. We also evaluated how dyspnea is perceived by patients in order to demonstrate that alterations in the perception of airway obstruction may be responsible for poor asthma control. METHODS: This was a cross-sectional case-control multicenter study, in which 56 patients in the asthma and fibromyalgia group were matched to 36 asthmatics by sex, approximate age, and asthma severity level. All patients were women. Study variables included the Asthma Control Test (ACT), the Mini Asthma Quality of Life Questionnaire (MiniAQLQ), the Nijmegen hyperventilation syndrome questionnaire, the Hospital Anxiety and Depression Scale, and perception of dyspnea after acute bronchoconstriction. RESULTS: Although patients in both study groups showed similar asthma severity and use of anti-asthmatic drugs, patients in the asthma and fibromyalgia group showed lower scores on the ACT and MiniAQLQ questionnaires, and higher scores of anxiety and depression as well as hyperventilation compared to asthma patients without fibromyalgia. All these differences were statistically significant. CONCLUSIONS: Fibromyalgia in patients with asthma influences poor control of the respiratory disease and is associated with altered perception of dyspnea, hyperventilation syndrome, high prevalence of depression and anxiety, and impaired quality of life. CLINICAL IMPLICATIONS: Fibromyalgia may be considered a risk factor for uncontrolled asthma in patients suffering from asthma and fibromyalgia concomitantly.

[Anatomy and development of stamens and carpels of Drimys granadensis (Winteraceae)]. / Anatomía y desarrollo de estambres y carpelos en Drimys granadensis (Winteraceae).

Winteraceae has long been considered a family with early diversification among angiosperms, with characters such as: flowers with many spirally arranged parts and apocarpic ovary formed by plicated carpels with sessile stigma. In Drimys, the presence or absence of conspicuous glands on the connective of the stamens have been used as a taxonomic character, and it is considered a synapomorphy for the clade including Drimys angustifolia, D. brasiliensis, D. granadensis and D. roraimensis (Northeastern clade); however, the anatomy of stamens and carpels has only been studied in detail for D. winteri (Southwestern clade). In this research, the presence and the structure of glands on the connective of stamens was studied in seven species of the genus from herbarium specimens, and a detailed study of the anatomy and development of stamens and carpels was carried out by scanning electron and optic microscopy in Drimys granadensis. We found similarities between D. granadensis and D. winteri for the following characters: Basic type anther wall formation, secretory tapetum that collapses at maturity, intermediate type microsporogenesis with formation of a transient cell plate in telophase I, ascidiated carpel due to the formation of an adaxial lip during development, stigma closed by interdigitation of epidermal cells. We also determined that the large glands on anther mature connective are originated by an overgrowth of subepidermal oil cells; this character is a Northeastern Drimys clade synapomorphy, while it was absent in both Drimys of Southwestern clade (which includes D. andina, D. confertifolia and D. winteri), and the rest of the Winteraceae. We are proposing the hypothesis that the highly variable enviromental conditions in the tropics where Drimys Northeastern clade is distributed, with a wide range of pollinators, would be associated with the emergence of glandular conspicuously stamens; while, as a prediction to be confirmed, temperated Southwestern clade species, without conspicuous glands, should have a smaller range of visitors and/or pollinators, or even be anemophilous species as Drimys confertifolia.

Anatomía y desarrollo de estambres y carpelos en Drimys granadensis (Winteraceae) / Anatomy and development of stamens and carpels of Drimys granadensis (Winteraceae)

Winteraceae has long been considered a family with early diversification among angiosperms, with characters such as: flowers with many spirally arranged parts and apocarpic ovary formed by plicated carpels with sessile stigma. In Drimys, the presence or absence of conspicuous glands on the connective of the stamens have been used as a taxonomic character, and it is considered a synapomorphy for the clade including Drimys angustifolia, D. brasiliensis, D. granadensis and D. roraimensis (Northeastern clade); however, the anatomy of stamens and carpels has only been studied in detail for D. winteri (Southwestern clade). In this research, the presence and the structure of glands on the connective of stamens was studied in seven species of the genus from herbarium specimens, and a detailed study of the anatomy and development of stamens and carpels was carried out by scanning electron and optic microscopy in Drimys granadensis. We found similarities between D. granadensis and D. winteri for the following characters: Basic type anther wall formation, secretory tapetum that collapses at maturity, intermediate type microsporogenesis with formation of a transient cell plate in telophase I, ascidiated carpel due to the formation of an adaxial lip during development, stigma closed by interdigitation of epidermal cells. We also determined that the large glands on anther mature connective are originated by an overgrowth of subepidermal oil cells; this character is a Northeastern Drimys clade synapomorphy, while it was absent in both Drimys of Southwestern clade (which includes D. andina, D. confertifolia and D. winteri), and the rest of the Winteraceae. We are proposing the hypothesis that the highly variable enviromental conditions in the tropics where Drimys Northeastern clade is distributed, with a wide range of pollinators, would be associated with the emergence of glandular conspicuously stamens; while, as a prediction to be confirmed, temperated Southwestern clade species, without conspicuous glands, should have a smaller range of visitors and/or pollinators, or even be anemophilous species as Drimys confertifolia. Rev. Biol. Trop. 62 (3): 1147-1159. Epub 2014 September 01.

La familia Winteraceae ha sido tradicionalmente considerada como de diversificación temprana entre las angiospermas por varios caracteres, entre ellos: flores con muchas partes distribuidas en espiral y ovario apocarpico formado por carpelos de tipo plicado con estigma sésil. En el género Drimys, la presencia o ausencia de glándulas conspicuas sobre el conectivo de los estambres ha sido usado como un carácter taxonómico, y su presencia se considera como una sinapomorfía del clado formado por Drimys angustifolia, D. brasiliensis, D. granadensis and D. roraimensis (clado nororiental); sin embargo, la anatomía de estambres o carpelos ha sido solamente estudiada en detalle en D. winteri (clado suroccidental). En esta investigación, la presencia y estructura de las glándulas del conectivo fue estudiada en las siete especies del género Drimys a partir de ejemplares de herbario, además, se realizó un estudio detallado de la anatomía y desarrollo de estambres y carpelos de Drimys granadensis empleando microscopía óptica y microscopía de barrido; y se compararon con los resultados previos en Drimys winteri. Se encontraron similitudes en los siguientes caracteres: formación de la pared de la antera de tipo básico, tapetum secretor que colapsa en la madurez, microsporogénesis de tipo intermedio con formación de una placa celular transitoria en telofase I, carpelo ascidiado debido a la formación de un labio adaxial durante el desarrollo, estigma cerrado por interdigitación de células epidérmicas. Se determinó que las glándulas de gran tamaño sobre el conectivo de la antera madura se originaron por sobrecrecimiento de células oleíferas subepidérmicas, siendo una sinapomorfía del clado nororiental, que esta ausente tanto en el clado suroccidental de Drimys (D. andina, D. confertifolia y D. winteri), como en el resto de la familia. Se propone la hipótesis de que las condiciones altamente variables en las zonas tropicales donde se distribuye el clado nororiental de Drimys, con una amplia gama de polinizadores, estarían asociadas al surgimiento de estambres conspicuamente glandulares; en tanto que proponemos como predicción que las especies circunscritas a la zona templada del Sur de Suramérica (Clado suroccidental), sin glándulas conspicuas, deberían presentar una menor variedad de visitantes y/o polinizadores, o incluso ser especies anemófilas como Drimys confertifolia.

[Incidence and characteristics of adult-onset asthma]. / Incidencia y características del asma bronquial de inicio en la edad adulta.

OBJECTIVE: To determine the incidence of adult-onset asthma, along with lung function and immunologic characteristics, causes, and clinical course of the disease. PATIENTS AND METHODS: After identifying incident cases of asthma among adult residents of the district of North Barcelona, Spain, we proceeded to characterize the disease using a questionnaire, lung function tests, and skin allergy tests. Patients with an occupation associated with asthma, wheezing at work, and/or sensitization to workplace allergens were considered as having occupational asthma. The risk factors for developing chronic asthma were determined by multivariate analysis. RESULTS: In the 2-year study period, 218 incident cases of adult-onset asthma were identified (in a population of 68 067 adults, corresponding to an annual incidence of 160 per 100 000 per year). In total, 152 patients agreed to participate in the study (response rate, 70%); 140 reported wheezing and/or asthma in the last year (92%). The skin tests showed atopy in 57 cases (41%). Occupational asthma was diagnosed in 19 cases (14%). Domestic mammals were identified as causal agents in 8 patients (6%), drugs in 7 (5%), and environmental allergens in 44 (31%). Household cleaning was the occupation most frequently associated with the disease (26%). Of the 102 patients examined again after 2 years, 70 had chronic asthma (69%). Atopy (odds ratio [OR], 3.39; 95% confidence interval [CI], 1.15-9.99) and risk occupation when the disease was diagnosed (OR, 5.54; 95% CI, 1.05-29.11) were the factors associated with development of chronic disease. CONCLUSIONS: Occupation was related to adult-onset asthma in a little over 10% of the cases and was the main determinant of the development of chronic symptoms.

[Tuberculosis in health care personnel in a general hospital]. / Tuberculosis en personal sanitario de un hospital general.

BACKGROUND AND OBJECTIVE: Tuberculosis is an occupational disease in health care workers. The objective of our study was to review tuberculosis cases in health care professionals from a general hospital and to determine their incidence in relation to the general population. PATIENTS AND METHOD: This was a retrospective study of tuberculosis cases among health care workers in a university hospital from 1988 to 2002, evaluating the annual cumulative incidence. RESULTS: 21 tuberculosis cases were found in health care workers. Pulmonary disease was the most frequent type (62%) followed by pleural effusion (28%). The most affected professional category were medical residents (38%) with the emergency service (48%) being the work place with the highest risk. The cumulative incidence in our hospital was higher in relation to the general population although there was a variability between both populations. CONCLUSIONS: There is risk of tuberculosis transmission among health care workers, principally in the emergency service and the pathology and microbiological departments. A concerted effort is needed to maintain prevention measures in the work place where there is a high risk of infection.

[Prevalence of latex-related sensitization in health care workers]. / Prevalencia de sensibilización al látex en personal sanitario.

BACKGROUND AND OBJECTIVE: Latex exposure at work has been related to sensitization in health care workers. The aim of the present study was to determine the prevalence of this sensitization in health care workers and its risk factors. PATIENTS AND METHOD: The occupation, prevalence of latex-related symptoms and sensitization was determined in a sample of health care workers by questionnaire and skin testing. RESULTS: 461 subjects were studied during a year. 30.2% of them reported dermatitis symptoms, 23.2% rhinitis, 12.6% urticaria-like rashes, and 5.6% reported asthmatic symptoms. 17.6% of workers reported symptoms when using latex gloves and 5% after the contact or ingestion of tropical fruits. Sensitization to latex was indentified in 12 workers (2.6%, CI95% 1.2-4.0). Dermatitis, urticaria-like rashes, rhinitis and asthmatic symptoms upon exposure to latex products and/or tropical fruits were all significantly more prevalent in sensitized subjects. In the logistic regression analysis, dermatitis, urticaria-like rashes, and asthmatic symptoms after the ingestion of tropical fruits were related to latex sensitization. CONCLUSIONS: The prevalence of sensitization to latex in health workers is nearly 3% and it must be suspected in subjects reporting symptoms when using latex gloves or after the ingestion of tropical fruits.

Prevalencia de sensibilización al látex en personal sanitario / Prevalence of latex-related sensitization in health care workers

FUNDAMENTO Y OBJETIVO: La exposición ocupacional al látex incrementa el riesgo de sensibilización de los profesionales sanitarios. El objetivo de este estudio ha sido establecer la prevalencia de sensibilización al látex en una población de trabajadores sanitarios e identificar posibles factores de riesgo. PACIENTES Y MÉTODO: Se administró un cuestionario sobre actividad laboral y antecedentes de síntomas y reacciones alérgicas. También se practicaron pruebas cutáneas con extracto de látex. RESULTADOS: Se estudió a 461 profesionales, de ellos el 30,2 por ciento refirió antecedentes personales de dermatitis, el 23,2 por ciento de rinitis, un 12,6 por ciento refería antecedentes de episodios repetidos de habones y el 5,6 por ciento de asma bronquial. El 17,6 por ciento de los trabajadores manifestó haber presentado reacciones alérgicas al contacto con guantes y el 5 por ciento tras el contacto o ingesta de frutas tropicales. Se detectó sensibilización al látex en 12 profesionales (2,6 por ciento, intervalo de confianza del 95 por ciento, 1,2-4,0 por ciento). Los antecedentes de rinitis, dermatitis y habones, así como referir síntomas indicativos de alergias relacionadas con la exposición a guantes, globos y frutas tropicales, fueron significativamente más frecuentes en el grupo con sensibilización al látex. En el análisis de regresión logística las variables relacionadas de forma independiente con la sensibilización al látex fueron la presencia de dermatitis o urticaria de contacto por guantes, la alergia a las frutas tropicales y los episodios repetidos de habones. CONCLUSIONES: La prevalencia de sensibilización al látex en los trabajadores sanitarios es cercana al 3 por ciento y debe ser sospechada en los sujetos con síntomas al contacto con guantes de látex o después de la ingestión de frutas tropicales (AU)

Asma ocupacional por iroko / Occupational asthma due to iroko

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