Ana Almaraz

Serologic evidence of human infection by Francisella tularensis in the population of Castilla y León (Spain) prior to 1997

Prior to an outbreak in Castilla y León in December 1997, tularaemia was practically non-existent in Spain. In this paper we studied the prevalence of antibodies against Francisella tularensis in a representative sample of the population (4825 people) from Castilla y León (Spain) in samples collected before this outbreak. Antibodies against F. tularensis were detected in nine (0.19%) of the 4825 sera, with antibody titres ranging from 1/20 to 1/160. Of these nine sera, one was positive in seroagglutination against Brucella. Seroagglutination against other bacteria (Yersinia enterocolitica O:9 and O:3 and Proteus OX19) was negative in all sera. Seroprevalence of antibodies in females was 0.20% and 0.17% in males; no statistically significant differences were found in prevalence in terms of sex, age or province.

Seroprevalencia de infección por Echinococcus granulosus en la población de Castilla y León

Introduccion La hidatidosis es una de las zoonosis mas importantes en la Comunidad Autonoma de Castilla y Leon. Este estudio pretende conocer la seroprevalencia de infeccion por Echinococcus granulosus en dicha comunidad autonoma. Metodos Se han estudiado 4.824 muestras de suero pertenecientes a 4.824 personas seleccionadas de forma aleatoria y que constituian una muestra representativa de la poblacion de las provincias de Castilla y Leon. En cada suero se estudio la presencia de anticuerpos de clase IgG frente a Echinococcus granulosus mediante una prueba de enzimoinmunoanalisis indirecto de fabricacion propia. Resultados Se detectaron anticuerpos de clase IgG frente a Echinococcus granulosus en el 3,40% de los sueros estudiados (164 positivos de 4.824), oscilando entre el 1,26 y el 7,10% segun la provincia de origen. La seroprevalencia de anticuerpos aumentaba significativamente con la edad. No se observaron diferencias estadisticamente significativas entre las seroprevalencias halladas en mujeres y en varones (3,14% frente a 3,66%). Conclusion La seroprevalencia de infeccion por E. granulosus en la Comunidad Autonoma de Castilla y Leon es todavia alta. Estos datos de seroprevalencia contribuyen a la vigilancia de la hidatidosis dentro de un programa control de esta enfermedad.

Diagnóstico de laboratorio y evolución serológica de pacientes con tularemia

Fundamento La tularemia era una enfermedad practicamente inexistente en Espana hasta finalesde 1997, cuando se declaro un brote epidemico en nuestra comunidad. El objetivo denuestro trabajo ha sido estudiar los datos existentes sobre el diagnostico microbiologico de 55pacientes que sufrieron tularemia. Pacientes Y Metodos Se obtuvieron 32 muestras para cultivo pertenecientes a 19 pacientes y151 sueros correspondientes a 55 pacientes. El diagnostico serologico se realizo mediante seroaglutinacionen tubo y microaglutinacion. En todos los sueros se realizo una seroaglutinacionde Wright (SAW) y un test de Coombs frente a Brucella y seroaglutinaciones frente a Yersiniaenterocolitica O:9, Yersinia enterocolitica O:3 y Proteus OX 19. Resultados Se aislo F. tularensis en dos muestras (6,25%) de las 32 estudiadas. Se obtuvierontitulos mayores o iguales a 1/160 en el 78,2% y en el 74,5% de los sueros iniciales por seroaglutinacionen tubo y microaglutinacion, respectivamente. La correlacion entre las dos pruebasfue de 0,80 (p Conclusiones El cultivo de F. tularensis es poco sensible. La correlacion obtenida entre la seroaglutinacionen tubo y microaglutinacion es buena. Ambas tecnicas son utiles en el diagnosticode la tularemia, con algunas ventajas de la microaglutinacion sobre la aglutinacion. Background Tularemia was practically unknown in Spain until the end of 1997, when an epidemicoutbreak was declared. This paper presents the data on microbiological diagnosis of 55patients who suffered from tularemia. Patients and Methods Thirty-two samples from 19 patients and 151 serum samples from 55 patientswere obtained for culture. Serologic diagnosis was performed by tube seroagglutinationand microagglutination. Three types of tests were performed on all sera: Wright seroagglutination(WSA), Coombs test against Brucella spp. and seroagglutination against Yersinia enterocoliticaO:3, Yersinia enterocolitica O:3, and Proteus OX 19. Results F. tularensis was found in two samples (6.25%) of the 32 received. Titers. 1/160were obtained in 78.2% and 74.5% of the initial sera by tube seroagglutination and microagglutination,respectively. Correlation between the two tests was 0.80 (p Conclusions Culture of F. tularensis has low sensitivity. The correlation obtained between tubeseroagglutination and microagglutination is good. Both techniques are useful in routine diagnosisof tularemia, although microagglutination has some advantages over tube agglutination.

Accuracy of Urea Breath Test Performed Immediately After Emergency Endoscopy in Peptic Ulcer Bleeding

AimsThe aim of this work is to investigate the accuracy of the urea breath test (UBT) performed immediately after emergency endoscopy in peptic ulcer bleeding (PUB).MethodsUrea breath test was carried out right after emergency endoscopy in patients with PUB. The accuracy of this early UBT was compared to a delayed one after hospital discharge that was considered the gold standard. Clinical and epidemiological factors were analyzed in order to study their influence on the accuracy of the early UBT.ResultsEarly UBT was collected without any complication and good acceptance from all the 74 patients included. In 53 of the patients (71.6%), a delayed UBT was obtained. Comparing concordance between the two tests we have calculated an accuracy of 83% for the early UBT. Sensibility and specificity were 86.36 and 66%, respectively, with a positive predictive value of 92.68% and negative predictive value of 50% (Kappa index = 0.468; p = 0.0005; CI: 95%). We found no influence of epidemiological factors, clinical presentation, drugs, times to gastroscopy, Forrest classification, endoscopic therapy, hemoglobin, and urea levels over the accuracy of early UBT.ConclusionsUrea breath test carried out right after emergency endoscopy in PUB is an effective, safe, and easy-to-perform procedure. The accuracy of the test is not modified by clinical or epidemiological factors, ulcer stage, or by the type of therapy applied. However, we have found a low negative predictive value for early UBT, so a delayed test is mandatory for all negative cases.

Iris color: validation of a new classification and distribution in a Spanish population-based sample

Purpose To design and validate a standard, simple, and reliable iris color classification and to study its distribution in a Spanish population. Iris color has a geographic distribution and has been correlated with different ocular diseases. However, there is no standard and validated iris color classification allowing comparison among different studies. Methods Classification was made in three grades (blue-gray, hazel-green, brown) and was validated by 3 independent readers. Initially, a preliminary study was made in 50 iris photographs to detect technical hitches. Afterwards, based on this procedure, 221 iris photographs were graded Results Measures of interobserver reliability were 0.786 by kappa index with an agreement of 89.6%. Iris color distribution in the Spanish cohort was blue-grey 16.29%, hazel-green 55.2%, and brown 28.5%. Conclusions This classification is simple, reliable, and easy to use in clinical research and by ophthalmologists or generalists in practice. The Spanish cohort from this study shows a different iris color distribution from those previously published in other countries.

Citocinas y otros parámetros inmunológicos como marcadores de alteración de órganos a distancia en la pancreatitis aguda

Fundamento y objetivo: Es conocido el papel que desempenan los mediadores inmunologicos proinflamatorios en la patogenia de algunas alteraciones de organos distantes en la pancreatitis aguda (PA). El objetivo de este estudio ha sido evaluar la relacion entre dichos mediadores y la afectacion hepatica, renal y pulmonar en pacientes con PA. Pacientes y metodo: En 34 pacientes con PA se valoraron el dia del ingreso, parametros bioquimicos de funcion hepatica, creatinina y presion parcial de oxigeno (PO2) arterial, y se establecieron puntos de corte. Se determinaron el receptor soluble tipo I del factor de necrosis tumoral (sTNFRI), el receptor antagonista de la interleucina (IL) 1 (IL-1Ra), la IL-6, el receptor soluble de la IL-6 (sIL-6R), la IL-18 y la molecula de adherencia intercelular-1 (ICAM-1) los dias 1, 2, 3 y 7, y se compararon entre los pacientes con los parametros en el momento del ingreso (bioquimicos y PO2) superiores o inferiores a un punto de corte establecido. Resultados: Se encontraron valores significativamente mas elevados y mantenidos de sTNFRI, IL-18 e ICAM-1, y de IL-6 solo el primer dia, en los pacientes con algun parametro de funcion hepatica superior al punto de corte. sTNFRI, IL-1Ra e ICAM-1 presentaban al inicio valores significativamente superiores en los pacientes en relacion con la creatinina, y de estos e IL-6 en los que presentaban PO2 inferior a 60 mmHg. Conclusiones: sTNFRI, IL-6, IL-18 e ICAM-1 se comportaron como marcadores tempranos de lesion hepatica; sTNFRI, IL-1Ra e ICAM-1, de disfuncion renal, y estos e IL-6, de afectacion pulmonar.

Prevalence of ocular and oculodermal melanocytosis in Spanish population with uveal melanoma

PurposeThe aim of this study was to determine the prevalence of ocular and oculodermal melanocytosis (ODM) among patients with uveal melanoma (UM) in a Spanish population.MethodsRetrospective review of the medical records of patients with ODM among patients with UM.ResultsTen (11 eyes) of 400 patients (2.7%) with UM associated had ODM. The mean age at diagnosis of UM among patients with ODM was 62 years. One patient had bilateral tumours. UM was diagnosed during a routine-examination in two cases. All tumours were medium (7/11) or large (4/11) in size, with a mean maximum base of 13 mm and height of 7 mm. No patient had extraocular extension or metastatic disease at diagnosis. Enucleation was done in five cases and I-125-brachytherapy in six. The mean follow-up was 43 months. One patient died because of metastasis 2 years after enucleation; one patient is currently on treatment of systemic metastasis 11 years after.ConclusionsODM is more frequent in spanish population with UM than in American population. Despite the risk of UM in ODM, it is often diagnosed late when a conservative treatment is not indicated.

Upper gastrointestinal findings detected by capsule endoscopy in obscure gastrointestinal bleeding

OBJECTIVE We analyzed our experience with the use of capsule endoscopy in areas that can be explored with gastroscopy to justify obscure bleeding, as well as the outcome after a new recommended gastroscopy in order to determine if a second gastroscopy before the capsule study can provide any benefit in the management of this disease. METHODS We retrospectively studied 82 patients who were explored with capsule endoscopy for obscure gastrointestinal bleeding who had undergone previously only one gastroscopy. Findings in the zones which were accessible by gastroscopy were normal, mild/known and severe/unknown. In the latter cases we recommended a second gastroscopy, and their treatment and outcome were subjected to further study. RESULTS Capsule endoscopy did not find any unknown esophageal findings. In 63% of cases, no gastric or duodenal lesions were shown; in 20%, lesions were mild or had been previously diagnosed, and in 17%, a new gastroscopy was recommended due to the discovery of an unknown condition which could be the cause of the obscure bleeding. This new information brought about a change in treatment for 78% of patients in this group, all of whom improved from their illness. Capsule endoscopy found significant intercurrent alterations in the small intestine in only 14% of cases. CONCLUSIONS The performance of a second gastroscopy, previous to capsule endoscopy, in the study of obscure gastrointestinal bleeding can offer benefits in diagnostic terms and may introduce therapeutic changes. A detailed analysis of the upper tract frames in intestinal capsule endoscopy studies is mandatory since it may provide relevant information with clinical impact on the management of these patients.

Utility of a commercial immunoblot kit (BAG-Borrelia blot) in the diagnosis of the preliminary stages of Lyme disease

The aim of this study was to evaluate the usefulness of a commercial immunoblot (IgG and IgM BAG-Borrelia blot) in the serologic diagnosis of the early stages of Lyme disease. A total of 42 sera from patients with Lyme disease (24 patients with localized early stage (LES) and 18 patients with disseminated early stage (DES)) and 129 sera from patients with non-Lyme diseases (specificity control sera) were studied. IgG anti-p41 from Borrelia burgdorferi s.l. was present in 95.2% of patients followed by anti-p41/I PBi (16.7%), anti-p100 (9.5%) and anti-OspA (9.5%). IgM anti-p41 was present in 66.7% of patients, p41/iPBi (54.8%) and OspC (33.3%). IgM against p100, OspA and OspC were more frequent in DES patients (16.7%, 27.8% and 44.4%) than in LES patients (0.0%, 4.2% and 25.0%). In 4.8% of the cases no IgG bands were present and in 26.2% no IgM bands were present. With the exception of isolated p41 bands (59.5%), no band pattern exceeded 17%. Using manufacturers instructions, test sensitivity in diagnosis of the early stage of Lyme disease is 61.9%, specificity 98.4% and positive and negative predictive values 92.8% and 88.8% respectively. Applying the EUCALB 5, 6 or 7 rules sensitivity increased to 73.8% although specificity decreased to 89.9%. Of the 129 specific control sera, 41.8% presented IgG anti-p41 and 10.8% IgM anti-p41. Patients with non-Lyme diseases that presented more IgG and IgM bands were those patients with syphilis (88.2%), patients with anti-HIV antibodies (57.8%) and patients with anti-nuclear antibodies (ANA) (52.3%).

Episcleral brachytherapy for uveal melanoma:: analysis of 136 cases

PurposeTo assess the results of I-125 episcleral brachytherapy (EB) in uveal melanoma: tumour control, visual acuity (VA), eye preservation and survival.PatientsProspective and consecutive study of patients with a diagnosis of uveal melanoma at the Ocular Oncology Unit in the Valladolid University Teaching Hospital treated with EB between September 1997 and June 2008. Ocular examination and extraocular and systemic extension data were registered in a database at the time of the diagnosis and during the follow-up.ResultsAmong a total of 310 patients diagnosed between September 1997 and June 2008, 136 were treated with EB (mean age, 58.3). Mean follow-up was 55.3 months. As for tumour type, 66.9% were nodular and 39% mushroom shaped. With respect to size, 80.9% were medium, 7.4% small and 11.8% large. After 4.6 years of follow-up, tumours were controlled in 97.1%, with a 55.1% reduction in mean height; only 2.9% of patients showed recurrence. VA was maintained in 16.2% of patients and 17.6% showed an increase; 33% had retinopathy and 14.6% optic neuropathy. Only 5.1% of patients underwent enucleation due to complications and there has been 1 melanoma-related death to date.ConclusionsI-125 EB is effective in tumour control, allowing preservation of the eye and useful visual function for the majority of patients.