Search

Exposure to green space has been associated with better physical and mental health. Although this exposure could also influence cognitive development in children, available epidemiological evidence on such an impact is scarce. This study aimed to assess the association between exposure to green space and measures of cognitive development in primary schoolchildren. This study was based on 2,593 schoolchildren in the second to fourth grades (7-10 y) of 36 primary schools in Barcelona, Spain (2012-2013). Cognitive development was assessed as 12-mo change in developmental trajectory of working memory, superior working memory, and inattentiveness by using four repeated (every 3 mo) computerized cognitive tests for each outcome. We assessed exposure to green space by characterizing outdoor surrounding greenness at home and school and during commuting by using high-resolution (5 m × 5 m) satellite data on greenness (normalized difference vegetation index). Multilevel modeling was used to estimate the associations between green spaces and cognitive development. We observed an enhanced 12-mo progress in working memory and superior working memory and a greater 12-mo reduction in inattentiveness associated with greenness within and surrounding school boundaries and with total surrounding greenness index (including greenness surrounding home, commuting route, and school). Adding a traffic-related air pollutant (elemental carbon) to models explained 20-65% of our estimated associations between school greenness and 12-mo cognitive development. Our study showed a beneficial association between exposure to green space and cognitive development among schoolchildren that was partly mediated by reduction in exposure to air pollution.

With 3-4 million of new infections occurring annually, hepatitis C virus (HCV) infection is a global Public Health problem. In fact, hepatitis C virus infection is one of the leading causes of liver disease in the world; in Western countries, two thirds of the new HCV infections are associated with injection drug use. The treatment of hepatitis C will change in the coming years with the irruption of new anti-HCV drugs, the so called Direct Antiviral Agents (DAA) that attack key proteins of the HCV life cycle. The new antiviral drugs are effective, safer and better tolerated. The 2014 WHO HCV treatment guidelines include some of them. The new DAA are used in combination and it is expected that Interferon will be not necessary in future treatment regimens against HCV infection. The irruption of new and potent antivirals mandate the review of the current standards of care in the HCV infected population. More inclusive and proactive treatment policies will be necessary in those individuals with substance use disorders.

Novel technologies, such as smartphones and small personal continuous air pollution sensors, can now facilitate better personal estimates of air pollution in relation to location. Such information can provide us with a better understanding about whether and how personal exposures relate to residential air pollution estimates, which are normally used in epidemiological studies. The aims of this study were to examine (1) the variability in personal air pollution levels during the day and (2) the relationship between modeled home and school estimates and continuously measured personal air pollution exposure levels in different microenvironments (e.g., home, school, and commute). We focused on black carbon as an indicator of traffic-related air pollution. We recruited 54 school children (aged 7-11) from 29 different schools around Barcelona as part of the BREATHE study, an epidemiological study of the relation between air pollution and brain development. For 2 typical week days during 2012-2013, the children were given a smartphone with CalFit software to obtain information on their location and physical activity level and a small sensor, the micro-aethalometer model AE51, to measure their black carbon levels simultaneously and continuously. We estimated their home and school exposure to PM2.5 filter absorbance, which is well-correlated with black carbon, using a temporally adjusted PM2.5 absorbance land use regression (LUR) model. We found considerable variation in the black carbon levels during the day, with the highest levels measured during commuting periods (geometric mean = 2.8 μg/m(3)) and the lowest levels at home (geometric mean = 1.3 μg/m(3)). Hourly temporally adjusted LUR model estimates for the home and school showed moderate to good correlation with measured personal black carbon levels at home and school (r = 0.59 and 0.68, respectively) and lower correlation with commuting trips (r = 0.32 and 0.21, respectively). The correlation between modeled home estimates and overall personal black carbon levels was 0.62. Personal black carbon levels vary substantially during the day. The correlation between modeled and measured black carbon levels was generally good, with the exception of commuting times. In conclusion, novel technologies, such as smartphones and sensors, provide insights in personal exposure to air pollution.

Background: Air pollution is a suspected developmental neurotoxicant. Many schools are located in close proximity to busy roads, and traffic air pollution peaks when children are at school. We aimed to assess whether exposure of children in primary school to traffic-related air pollutants is associated with impaired cognitive development., Methods and Findings: We conducted a prospective study of children (n = 2,715, aged 7 to 10 y) from 39 schools in Barcelona (Catalonia, Spain) exposed to high and low traffic-related air pollution, paired by school socioeconomic index; children were tested four times (i.e., to assess the 12-mo developmental trajectories) via computerized tests (n = 10,112). Chronic traffic air pollution (elemental carbon [EC], nitrogen dioxide [NO2], and ultrafine particle number [UFP; 10-700 nm]) was measured twice during 1-wk campaigns both in the courtyard (outdoor) and inside the classroom (indoor) simultaneously in each school pair. Cognitive development was assessed with the n-back and the attentional network tests, in particular, working memory (two-back detectability), superior working memory (three-back detectability), and inattentiveness (hit reaction time standard error). Linear mixed effects models were adjusted for age, sex, maternal education, socioeconomic status, and air pollution exposure at home. Children from highly polluted schools had a smaller growth in cognitive development than children from the paired lowly polluted schools, both in crude and adjusted models (e.g., 7.4% [95% CI 5.6%-8.8%] versus 11.5% [95% CI 8.9%-12.5%] improvement in working memory, p = 0.0024). Cogently, children attending schools with higher levels of EC, NO2, and UFP both indoors and outdoors experienced substantially smaller growth in all the cognitive measurements; for example, a change from the first to the fourth quartile in indoor EC reduced the gain in working memory by 13.0% (95% CI 4.2%-23.1%). Residual confounding for social class could not be discarded completely; however, the associations remained in stratified analyses (e.g., for type of school or high-/low-polluted area) and after additional adjustments (e.g., for commuting, educational quality, or smoking at home), contradicting a potential residual confounding explanation., Conclusions: Children attending schools with higher traffic-related air pollution had a smaller improvement in cognitive development.

Inflammation and intestinal permeability are believed to be paramount features in the development of alcohol-related liver damage. We aimed to assess the impact of 3 surrogate markers of inflammation (anemia, fibrinogen, and ferritin levels) on mid-term mortality of patients with alcohol dependence. This longitudinal study included patients with alcohol dependence admitted for hospital detoxification between 2000 and 2010. Mortality was ascertained from clinical charts and the mortality register. Associations between markers of inflammation and all-cause mortality were analyzed with mortality rates and Cox proportional hazards regression models. We also performed a subgroup analysis of mortality rates in patients with anemia, based on their mean corpuscular volume (MCV). We included 909 consecutive patients with alcohol dependence. Patients were mostly male (80.3%), had a median age of 44 years (interquartile range [IQR]: 38-50), and upon admission, their median alcohol consumption was 192 g/day (IQR: 120-265). At admission, 182 (20.5%) patients had anemia; 210 (25.9%) had fibrinogen levels >4.5 mg/dL; and 365 (49.5%) had ferritin levels >200 ng/mL. At the end of follow-up (median 3.8 years [IQR: 1.8-6.5], and a total of 3861.07 person-years), 118 patients had died (12.9% of the study population). Cox regression models showed that the presence of anemia at baseline was associated with mortality (hazard ratio [HR]: 1.67, 95% confidence interval [CI]: 1.11-2.52, P < 0.01); no associations were found between mortality and high fibrinogen or high ferritin levels. A subgroup of patients with anemia was analyzed and compared to a control group of patients without anemia and a normal MCV. The mortality ratios of patients with normocytic and macrocytic anemia were 3.25 (95% CI: 1.41-7.26; P < 0.01) and 3.39 (95% CI: 1.86-6.43; P < 0.01), respectively. Patients with alcohol dependence admitted for detoxification had an increased risk of death when anemia was present at admission. More accurate markers of systemic inflammation are needed to serve as prognostic factors for poor outcomes in this subset of patients.

Background: Opioid substitution therapy has improved the survival of heroin users with and without HIV infection. We aimed to analyze sex differences in mortality rates and predictors of death among those admitted to a methadone treatment program (MTP)., Methods: Longitudinal study of patients enrolled in a MTP from 1992 to 2010. Socio-demographic and drug use characteristics, and markers of viral infections were assessed at entry. Vital status was ascertained by clinical charts and the mortality register. Four calendar periods were defined according to the introduction of preventive and treatment interventions in Spain. Predictors of death were analyzed by Cox regression models., Results: 1,678 patients (82.8% men) were included; age at first heroin use was 18.6 years (IQR: 16-23 years), and age at first entry into a MTP was 30.7 years (IQR: 26-36 years). A total of 441 (26.3%) deaths occurred during 15,124 person-years (p-y) of follow-up (median: 9.2 years, IQR: 4-13 years). HIV infection was the main predictor of death in men (HR = 3.5, 95% CI: 2.1-5.7) and women (HR = 3.2, 95% CI: 1.2-8.7 ) and main cause of death was HIV/AIDS. Overall mortality rate was 2.9 per 100 p-y (95% CI: 2.7-3.2 per 100 p-y) and death rates decreased over time: 7.4 per 100 p-y (95% CI: 6.3-8.8 per 100 p-y) for the 1992-1996 period to 1.9 per 100 p-y (95% CI: 1.6-2.4 per 100 p-y) for the 2007-2010 period. In women, a slightly increase in mortality was observed in recent periods specifically among HIV-positive women (3.7 per 100 p-y in period 2002-2006 and 4.5 per 100 p-y in 2007-2010)., Conclusions: Significant reductions in mortality of patients in MTP are observed after nineteen years of observation. However, HIV infection shows a great impact on survival, particularly among HIV-infected women.

Background: Mortality of alcohol and drug abusers is much higher than the general population. We aimed to characterize the role of the primary substance of abuse on the survival of patients admitted to treatment and to analyze changes in mortality over time., Methods: Longitudinal study analyzing demographic, drug use, and biological data of 5023 patients admitted to three hospital-based treatment units in Barcelona, Spain, between 1985 and 2006. Vital status and causes of death were ascertained from clinical charts and the mortality register. Piecewise regression models were used to analyze changes in mortality., Results: The primary substances of dependence were heroin, cocaine, and alcohol in 3388 (67.5%), 945 (18.8%), and 690 patients (13.7%), respectively. The median follow-up after admission to treatment was 11.6 years (IQR: 6.6-16.1), 6.5 years (IQR: 3.9-10.6), and 4.8 years (IQR: 3.1-7.8) for the heroin-, cocaine-, and alcohol-dependent patients, respectively. For heroin-dependent patients, mortality rate decreased from 7.3×100person-years (p-y) in 1985 to 1.8×100p-y in 2008. For cocaine-dependent patients, mortality rate decreased from 10.7×100p-y in 1985 to <2.5×100p-y after 2004. The annual average decrease was 2% for alcohol-dependent patients, with the lowest mortality rate (3.3×100p-y) in 2008., Conclusions: Significant reductions in mortality of alcohol and drug dependent patients are observed in recent years in Spain. Preventive interventions, treatment of substance dependence and antiretroviral therapy may have contributed to improve survival in this population., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Autosomal Recessive Osteopetrosis is a genetic disorder characterized by increased bone density due to lack of resorption by the osteoclasts. Genetic studies have widely unraveled the molecular basis of the most severe forms, while cases of intermediate severity are more difficult to characterize, probably because of a large heterogeneity. Here, we describe the use of exome sequencing in the molecular diagnosis of 2 siblings initially thought to be affected by "intermediate osteopetrosis", which identified a homozygous mutation in the CTSK gene. Prompted by this finding, we tested by Sanger sequencing 25 additional patients addressed to us for recessive osteopetrosis and found CTSK mutations in 4 of them. In retrospect, their clinical and radiographic features were found to be compatible with, but not typical for, Pycnodysostosis. We sought to identify modifier genes that might have played a role in the clinical manifestation of the disease in these patients, but our results were not informative. In conclusion, we underline the difficulties of differential diagnosis in some patients whose clinical appearance does not fit the classical malignant or benign picture and recommend that CTSK gene be included in the molecular diagnosis of high bone density conditions., (Copyright © 2013 The Authors. Published by Elsevier Inc. All rights reserved.)

Background and Objetive: Methadone is largely used as the primary opioid substitution therapy for the treatment of heroin addiction; the objective of the study was to describe the clinical characteristics of heroin abusers admitted into a methadone maintenance program (MMP) in metropolitan Barcelona., Method: Cross-sectional study in patients enrolled in MMP since its introduction in 1992 through December 2010. Socio-demographic data, drug use characteristics, prevalence of blood-borne infections (human immunodeficiency virus [HIV], and hepatitis B [HBV] and C [HCV]) and psychiatric co-morbidity were assessed at entry., Results: One thousand and six hundred seventy eight patients (82.8% male). A total of 608 (36.2%) patients were admitted during 1992-1996, 566 (33.7%) between 1997-2001, 305 (18.2%) between 2002-2006 and 199 (11.9%) in the last period. Age at admission to methadone increased significantly (28 years in period 1992-1996 vs. 37 years in the last period [P<.005]). The percentage of patients with a history of intravenous drug use decreased significantly (89.5% in first period vs. 56.4% in period 2007-2010 [P<.05]). Prevalence of HIV, HCV and HBV (HBcAb+) was 53.7, 73.6 and 61.3%, respectively. The prevalence of HIV decreased over time from 66.2% in first period to 43.5% in 2007-2010 (P<.05); the prevalence of HCV decreased significantly from 82.8% in 1992-1996 to 69.8% in last period (P<.05). Twenty five percent of patients had psychiatric co-morbidity at admission and the prevalence of psychiatric co-morbidity increased over time (21% in 1992-1996 and 32% in 2007-2010; P<.05)., Conclusion: Age at first opioid substitution therapy is increasing over time, as well as the proportion of patients with psychiatric co-morbidity. There were significant reductions in blood-borne infections., (Copyright © 2012 Elsevier España, S.L. All rights reserved.)

Introduction: Patients with deep vein thrombosis affecting the iliac and vena cava veins develop a more severe post-thrombotic syndrome than those with femoropopliteal disease. It has been traditionally treated only with medical therapy. During the last decade, endovascular repair has become the treatment of choice. The aim of this study is to report our midterm results using this technique., Methods: From 2009 to 2012, 41 limbs in 36 patients with post-thrombotic chronic flow obstruction of iliofemoral vein secondary to stenotic or occlusive lesions and with a clinical CEAP class 3 or higher or venous pain underwent percutaneous treatment. Stent-related outcome (patency and thrombotic events), clinical outcome (improvement of revised Venous Clinical Severity Score [VCSS] and Villalta score) were evaluated after intervention., Results: The procedure was successful in 39 limbs (95%) with no mortality and low morbidity. Thrombotic events occurred in nine limbs (23%) during the follow-up period. At 33 months, primary, assisted-primary, and secondary cumulative patency rates were 74%, 87%, and 89%, respectively. The main risk factor associated with stent occlusion was the severity of thrombotic disease. All postoperative thrombotic events occurred in occluded veins; no previously stenotic veins presented any complication (P = .04). Presence of thrombophilia, stent brand, and stent extension into the common femoral vein were not significantly associated with stent thrombosis. After surgery, the mean revised VCSS and Villalta scores improved substantially (P < .0001). The cumulative rate of revised VCSS improvement was 89% at 33 months. Clinical improvement was observed despite deep venous system reflux remaining uncorrected., Conclusions: Percutaneous treatment of post-thrombotic venous flow obstruction is an excellent therapeutic option with low morbidity and no mortality. It can be performed with high midterm patency rates and midterm clinical improvement., (Copyright © 2014 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Background: The association between alcohol use disorders and increased risk of mortality is well known; however, there have been few systematic evaluations of alcohol-related organ damage and its impact on survival in younger alcoholics. Therefore, we assessed medical comorbidity with a clinical index to identify subgroups of alcoholic patients at high risk of premature death., Methods: Hospital-based cohort of alcohol-dependent patients admitted for detoxification between 1999 and 2008 in Barcelona, Spain. At admission, sociodemographic characteristics and a history of alcohol dependence and abuse of illegal drugs were obtained through clinical interviews and questionnaires. Medical comorbidity was assessed with the Cumulative Illness Rating Scale (Substance Abuse) (CIRS-SA). Dates and causes of death were obtained from clinical records and death registers. Survival was analyzed using Kaplan-Meier methods, and Cox regression models were used to analyze the risk factors for premature death., Results: Median age of the patients (686 total, 79.7% men) was 43.5 years (interquartile range [IQR], 37.8 to 50.4), average alcohol consumption was 200 g/d (IQR, 120 to 280 g/d), and duration of alcohol use disorder was 18 years (IQR, 11 to 24). Medical comorbidity by CIRS-SA at admission showed that the organs/systems most affected were liver (99%), respiratory (86%), and cardiovascular (58%). After median follow-up of 3.1 years (IQR, 1.5 to 5.1), 78 (11.4%) patients died with a mortality rate of 3.28 × 100 person-years; according to Kaplan-Meier estimates, 50% (95% confidence interval [95% CI], 24 to 69%) of patients with severe medical comorbidity died in the first decade after treatment. In multivariate analysis, severe medical comorbidity (hazard ratio [HR], 5.5; 95% CI, 3.02 to 10.07) and being treated with methadone at admission (HR, 2.60; 95% CI, 1.50 to 4.51) were independent risk factors for premature death., Conclusions: Systematic assessment of alcohol-related organ damage is relevant for the identification and treatment of those at increased risk of death., (Copyright © 2012 by the Research Society on Alcoholism.)

This report describes a novel missense mutation in the interferon regulation factor 6 (IRF6) gene associated to facial asymmetry. This new feature widens the phenotype spectrum of Van der Woude syndrome (VWS)., (© 2011 Wiley Periodicals, Inc.)

The improvement of Zn fertilizers requires new techniques to evaluate their efficacy. In this paper, the (67)Zn stable isotope was used as tracer of several Zn-lignosulfonate complexes to study the foliar-applied Zn uptake and distribution behavior in the plant, compared with ZnEDTA. Navy bean plants ( Phaseolus vulgaris L.) were grown hydroponically in a Zn-free nutrient solution, and six modified lignosulfonates and EDTA complexed with (67)Zn were used in foliar application in the young leaves as Zn sources. Zinc isotopes in roots, stems, and sprayed and unsprayed leaves were determined by ICP-MS, and signal interferences caused by the compounds of the digested vegetal samples were corrected. The mathematical procedure of isotope pattern deconvolution allowed the minimization of the uncertainty in the measured molar fractions of Zn from fertilizer or from natural sources. Significant differences in Zn use and distribution were observed among the fertilizers when the calculated concentrations of Zn from the fertilizer were compared, whereas they were unnoticeable attending to the total Zn in plant tissues, usually determined at the conventional studies. By foliar spray, higher Zn uptake and mobilization to leaves and stems were achieved with (67)ZnEDTA than with (67)Zn-LS complexes. The ultrafiltered LS and phenolated LS showed slightly better ability to provide Zn to the bean plants than the other LS. The foliar-applied Zn use and distribution in the plant were related with the stability of the Zn-lignosulfonates complexes. Those presenting the lower stability versus pH, but the highest complexing capacity, were slightly more suitable to supply foliar-applied Zn to navy beans.

Background and Objective: To analyze gender differences in the hepatic, nutritional and metabolic complications associated with alcoholism., Patients and Methods: Cross-sectional study in alcoholic patients admitted to detoxification in two university hospitals of Barcelona between 1999 and 2006. During admission, co-morbidity prior to admission was assessed and blood samples to analyze biological markers were collected. Demographic and anthropometric data, daily alcohol consumption and other drug use characteristics were also obtained at admission., Results: There were 566 admissions in 480 patients (375 males). Age at admission was 43 years (IQR: 36.3-49.0 years). Overall, 68.4% showed macrocytosis (MCV > 95 fl), 81.7% GGT>40 U/L and 57.7% AST>37 U/L. Regarding liver function tests, frequency of alkaline phosphatase > 120 U/L was significantly higher in women (18.5 vs 10.5%, p=0.037). However, the prevalence of hyperferritinemia (> 90 ng/mL) was significantly higher in alcoholic men (85.7% vs 62.2%) (p=0.000). Having multiple liver function test alterations was significantly higher in men (OR: 1.64, 95% CI: 1.01-2.65) (p=0.043). Women showed significant differences regarding the prevalence of macrocytosis (77.5% vs 65.8%, p=0.026), low serum creatinine (< 0.7 mg/100mL) (28.2 vs 14.6%, p=0.001), low serum ferritin (< 30 ng/mL) (10.8 vs 3.9%, p=0.020), as well as of multiple nutritional alterations (OR: 1.59, 95% CI: 1.02-2.48) (p=0.040). However, men had higher prevalence of anemia than women (32.3 vs 21.4%, p=0.032). Prevalence of type I obesity (BMI>30 kg/m(2)) was significantly higher in alcoholic women (29.2 vs 7.9%, p=0.007)., Conclusions: Hepatic, nutritional and metabolic complications of alcoholism in women are frequent, thus increasing the risk of developing adverse clinical outcomes., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

Severe manifestations of X-linked recessive disorders such as haemophilia A (HA) are rare in females. Here we describe the clinical and genetic findings in five female HA patients from two different Spanish families. Three sisters born to consanguineous parents presented moderate bleeding due to a known mutation (p.Ser1791Pro) detected in a homozygous state. In the second family, two sisters with Morris syndrome (46,XY) and mild/moderate illness were hemizygous for a novel missense mutation, p.Phe2127Ser. The mutation is predicted to impair binding to the factor VIII (FVIII) carrier protein, von Willebrand factor, and thus increased clearance of FVIII from plasma. Clinical and molecular characterisation of these patients is essential to optimise follow-up, genetic counselling and treatment of the disease.

The characteristic phenotype of CHARGE syndrome includes: coloboma, congenital heart defect, choanal atresia, retarded growth and development, genital abnormalities, ear anomalies with or without hearing loss, which give the name (an acronym) to this condition. The molecular cause in 60% of the cases are mutations in the chromodomain helicase DNAbinding protein gene (CHD7), with an estimated frequency of 1 in 10,000 live born infants. We describe 3, not related patients with a clinical diagnosis of CHARGE syndrome and each of them with a different mutation in the CHD7 gene sequence.

Bmf is a proapoptotic member of the BH3-only subgroup of Bcl-2 family proteins, which is associated to myosin V motors by binding to the dynein light chain 2 (DLC2). It acts as a sentinel detecting intracellular damages on the main cytoskeletal structures. The cloning and characterization of the chicken (Gallus gallus) Bmf cDNA and splicing variant is described in this report. The Bmf cDNA was amplified by reverse transcriptase-polymerase chain reaction (RT-PCR) using oligonucleotide primers derived from in silico sequences. The chicken Bmf cDNA encodes a protein of 193 amino acids, showing homology to mammalian Bmf proteins. A splicing variant of the chicken Bmf (Bmf(S), short isoform of Bmf) coding a protein of 118 amino acids was also identified. This is the first Bmf isoform identified so far which lacks the DLC2-binding domain although retaining the BH3 domain. Both chicken Bmf isoforms induced apoptosis 24 h after transfection in MCF7 and HeLa cell lines, but chicken Bmf(S) exhibits a higher proapoptotic activity. In addition, mRNA expression analysis showed that chicken Bmf transcription is ubiquitous in all embryo developmental stages, suggesting a role for this protein in the control of the development process.

Unlabelled: Hepatitis C virus (HCV) is the most common blood-borne infection in developed countries and co-infection with the Human Immunodeficiency Virus (HIV) is frequent in individuals with history of injecting drug use (IDU).We aimed to analyze liver transaminases in HCV monoinfected and HCV/HIV co-infected patients to assess the effect of HIV infection on liver enzyme elevations.We studied 429 current IDUs admitted to substance abuse treatment (82.5% males). Serum samples for liver tests, HIV infection and viral hepatitis serologies were obtained at admission., Results: Median age was 30 years (IQR:27-34), median duration of IDU was 10 years (IQR:5-14), 52% of patients were HCV/HIV co-infected, 40.8% were HCV monoinfected, and 7.2% were HCV and HIV- seronegatives. Elevated AST was associated with male gender and lower CD8(+) cell count in the HCV monoinfected patients, and with age and lower cholesterol in the HCV/HIV coinfected subjects. ALT elevation was associated with younger age, higher body mass index and male gender in the monoinfected patients, and with higher CD4(+) cell counts and lower cholesterol in the co-infected group. Male sex was strongly associated with elevated ALT and AST transaminase in the monoinfected but not in dual-infected subjects.These data suggest that the effect of gender on liver enzymes may be lost in patients with HIV infection. The overall differences observed between groups regarding liver enzyme elevations are of clinical relevance in the management of IDUs with chronic hepatitis C.

Chlorosis is one of the symptoms of bacterial spot disease caused by Xanthomonas campestris pv. vesicatoria, which induces chlorosis before any other symptoms appear on tomato. We report characterization of a 2.1-kb gene called early chlorosis factor (ecf). The gene ecf encodes a hydrophobic protein with similarity to four other proteins in plant pathogens, including HolPsyAE, and uncharacterized gene products from X. campestris pv. campestris and X. axonopodis pv. citri, and, at the tertiary structure level, to colicin Ia from Escherichia coli. We demonstrate that the associated phenotype is hrp dependent, and that the ecf gene product appears to be translocated to host cells. The gene ecf has no impact on electrolyte leakage or on bacterial growth in planta in response to infection. Concentrated culture filtrates do not produce chlorosis. Study of its role in Xanthomonas spp.-tomato interactions will forward our understanding of symptom production by plant pathogens and allows further investigation into the mechanisms of bacterial virulence and production of symptoms.

Undescended ovary is a rare disorder that can be associated with müllerian malformations. There is an unclear association with infertility and malignant disease. When an ovary is not in its normal location, it is sought in other locations above the pelvic brim. This is important in cases of undetermined cyclical abdominal pain, follicle aspiration and surgical castration. MRI has proven to be the best imaging method for finding an ovary in an anomalous position and for disregarding associated malformations. We report two patients with unilateral ovarian maldescent, one of them with Rokitansky-Küster-Hauser syndrome. A review of the literature is included.

Introduction: Attention deficit hyperactivity disorder (ADHD) is a neurobehavioural disorder whose essential characteristic is a persistent pattern of inattention or hyperactivity and impulsiveness. Recent studies into prevalence carried out on the Antioquian population by our group found an overall prevalence of 15.8%, which confirms ADHD as one of the most frequent problems in infancy. The cause of this disorder is still not altogether clear; familial aggregation of ADHD points towards a genetic component. Although to date no model of inheritance has been defined, its high prevalence rate, the difficulties involved in its diagnosis and its effects on the cognitive functions, as well as the social and educational repercussions, make this disorder a problem in children's public health., Aims: Our aim was to carry out power simulations to detect genetic linkage., Patients and Methods: The Slink programme, which is part of Linkage package, was used in six families from the city of Medellín Antioquia, which is a region where a founding effect is likely to have taken place; this makes it a strategic zone for genetic linkage studies in complex diseases such as ADHD., Results: Assuming the population to be homogenous, the lod score (Z) is greater than 3 (Z>3) and individual lod score values of between 0 and 6 were obtained for each family., Conclusions: In this paper we discuss the benefits of having multigenerational families, in Antioquia, to conduct gene mapping studies and we examine the different strategies to be developed with the findings reported here.

Spinal epidural hematoma (SEH) is a low incidence injury. When the cause of bleeding is unknown, which occurs in 50% of the cases, we refer to it as spontaneous SEH. The clinical presentation is characterized by acute radicular pain followed by cord compression syndrome. Brown-Séquard syndrome is exceptional as a result of a SEH. Although standard treatment is prompt surgical evacuation of the hematoma, spontaneous resolution has also been reported. We present a case of spontaneous SEH in a 69 year-old man. An MRI revealed an hematoma in the right posterior epidural space extending from C6 to T2. The hematoma was manifested as a paresis of the right limbs and sensory loss of the left side below C7 level. During the first hours the neurological deficit was improved without treatment and consequently a conservative management was continued. After 72 h, the patient was completely recovered. We have reviewed the 14 cases of spinal epidural hematoma and Brown- Séquard syndrome previously reported, only 2 of them were resolved by conservative management. We conclude that when SEH presents as Brown-Séquard syndrome it usually has a more benign course and that in some cases a conservative management can be considered.

Different antigenic extracts of Taenia solium and Taenia crassiceps were evaluated in connection with the detection of antibodies in patients with neurocysticercosis aimed at selecting immunorelevant antigens for the diagnosis of neurocysticercosis by means of the immunoenzymatic assay and immunoblotting. The vesicular fluid of T. crassiceps proved to be more sensitive (100%) and specific (86%). On using the immunoblotting technique it was also observed that this extract was the most sensitive and specific. Within the protein profile of the antigen the band of 18 kDa was mostly recognized by the serum and cerebrospinal fluid of patients with neurocysticercosis. The vesicular fluid of T. crassiceps represents an alternative in the optimization of the diagnosis of neurocysticercosis in the serum and cerebrospinal fluid and in the substitution of T. solium antigens due to its high sensitivity and specificity and to its easy obtention under controlled laboratory conditions.

Background: Microtia is a malformation of the ear with extreme variability of expression. It is generally seen as an isolated malformation. However, some authors consider it to be a minimal manifestation of the oculo-auriculo-vertebral spectrum (OAVS), where, in addition, there are facial, vertebral, and renal abnormalities, among others., Methods: A total of 145 pediatric patients with unilateral or bilateral microtia not considered as part of a syndrome were studied. All patients were subjected to an intentional clinical examination, a familial history, and radiographic imaging studies for ruling out associated malformations. Patients were classified into two groups: group 1 (60%), with isolated microtia; and group 2 (40%), considered as OAVS, with microtia associated with hemifacial skeletal microsomia, vertebral and/or renal malformations., Results: No significant differences were found between the groups when the following variables were compared: gender; presence of unilateral or bilateral microtia; atretic external auditory canal; presence of preauricular tags; hearing loss of any type, and affection of the seventh cranial nerve, as well as associated malformations of other organs or systems. There were significant differences in relation to the presence of soft-tissue hemifacial microsomia, more frequently seen in patients with OAVS, because the majority of these patients had bone microsomia. Over 66% of the cases were sporadic and the rest were familiar. In 28.3% of the cases, the history suggested an autosomal-dominant inheritance pattern, and in 5.5%, an autosomal-recessive inheritance pattern, although in some familial cases, multifactorial inheritance could not be ignored. Some members in several families had isolated microtia, and others had mild characteristic manifestations of OAVS., Conclusions: Our results support the hypothesis that isolated microtia is a minimal expression of OAVS. Therefore, it is recommended that patients with microtia be subjected to intentional studies that search for malformations and physical examinations of first-degree relatives for adequate genetic counseling and management.

A 65-year-old man with primary haemochromatosis was admitted because of fever and confusion. He was found to have bacteraemia and meningitis due to Listeria monocytogenes. Treatment with ampicillin plus tobramycin was instituted, and despite an initial improvement, the patient experienced an unfavourable course and died. At postmortem examination, tricuspid valve endocarditis and purulent pericarditis with tamponade were detected. Listeria monocytogenes grew in the culture of the pericardial fluid. Documentation of Listeria monocytogenes pericarditis is extremely rare, and data on the patient described and on seven published cases are reported.

A 42-year-old woman with a medullary thyroid carcinoma (MTC) inside of an autonomously functioning thyroid nodule is reported. The patient was initially diagnosed of a hyperfunctioning autonomous thyroid adenoma but the histopathological and immunohistochemistry study were diagnostic for a MTC. This is the first case of a medullary thyroid carcinoma associated with thyroid hyperfunction which was presented as a hot nodule in the scintigraphy. We propose a systematic performance of a fine needle biopsy in all thyroid nodules because of the possibility of carcinoma associated to functioning nodules could be present.

A prospective study on the causal microorganism of vulvovaginitis was done to 100 ambulatory patients seen at a pediatric gynecology unit of a metropolitan hospital at Santiago, Chile, from november 1988 throughout july 1989. Samples of vaginal discharge were taken from each patient and studied for bacteria, fungi and trichomonas. Search of pinworms was also done in 55 patients by the transparent adhesive tape test. It was possible to confirm the etiology of vulvovaginitis in 81 cases. Bacteria were isolated in 68 of them, fungi in 4, Trichomonas vaginalis in one patient and pinworms in 8.