The effect of traumatic brain injury on children with learning disability

In Argentina, there is rather little information about the natural occurrence of mycotoxins in feedstuffs. The aim of this work was to determine the fungal flora and natural incidence of aflatoxin B1 (AFB1), zearalenone (ZEA) and deoxynivalenol (DON) in poultry feeds from 5 factories of Río Cuarto, Córdoba. Three hundred samples were taken from May 1995 to May 1996. Fungal counts of poultry feeds ranged 10(4) to 10(6) CFU g-1. The lowest counts were obtained on the first months from the sampling (May to September 1995) with mean values significantly different from those found at the last of the sampling (October 1995 to April 1996). The most prevalent species isolated of poultry feed samples belonged to the genera Penicillium that was present in 98% of the samples, Fusarium (87%) and Aspergillus (52%). Fusarium species isolated were: F moniliforme in 73% of the samples, F subglutinans (35%), F graminearum (20%) and within Aspergillus species: A. parasiticus (33%) and A. flavus (8%) were identified. In poultry feeds aflatoxin B1 (AFB1) was the most significant mycotoxin with levels ranging from 17 to 197 ng/g. For deoxynivalenol (DON) the levels ranged from 240 to 410 ng/g. Only three out of 300 samples were contaminated with zearalenone (ZEA) in concentrations of 30, 120 and 280 ng/g. These are preliminary data on this subject in our region.     

Spring pollen and related allergies in southern Spain

Over the last 10 years, there has been an increase in pollen allergies throughout Europe; this trend is clearly reflected in this study carried out in Córdoba (southern Spain) over 7 consecutive years, which recorded important increases in the concentrations of certain pollen types of particular interest in this city, together with an increase in the number of patients with pollinosis visiting the Allergy Unit at Córdoba's Reina Sofía University Hospital. The purpose of this study was to ascertain whether these two trends were related. Sampling was carried out from 1984 to 1990, using a Burkard spore trap placed at a height of approximately 15 m on a building situated in the city center. The trend towards an annual increase in the concentration of pollen grains was positive in all cases, although very slight for Quercus and very marked for Olea europaea. However, a different pattern of behavior was recorded with respect to the correlation between pollen concentration and cases of pollinosis, a correlation which varied according to taxa.     

Reducing the hindsight bias utilizing attorney closing arguments

Dogs, the main domestic reservoirs of Trypanosoma cruzi in the Argentine chaco, may be useful as sentinels of vector-mediated transmission of Trypanosoma cruzi in control programmes if canine infections acquired by all other routes could be excluded. In the present study, in the province of Santiago del Estero, Argentina, the dog populations in the neighbouring villages of Amamá, Trinidad, Mercedes, Villa Matilde and Pampa Pozo were studied immediately before spraying of residual insecticides (in 1992 in Amamá, Trinidad and Mercedes and 1993-1994 in the other villages) and twice during a subsequent programme of triatomine surveillance (in 1994 and 1996). Overall seropositivity for Trypanosoma cruzi infection (i.e. the proportion of dogs found positive by at least two different serological tests in any one survey) steadily declined from 65% (54/83) in 1992 to 39% (70/182) in 1994 and 15% (36/237) in 1996. No seroconversion was detected between the 1994 and 1996 surveys in any dog aged > 2 years. However, among the dogs aged < 2 years (which were born after virtual elimination of Triatoma infestans from the villages), seropositivity fell from 15% (12/81) in 1994 to 5% (6/131) in 1996. Thirteen demographic, behavioural and entomological variables were analysed by logistic multiple-regression analysis for their association with seropositivity in dogs born locally during the surveillance programme. The total number of Triatoma guasayana collected in the bedroom areas of the owner's house, having a mother which was seropositive for Trypanosoma cruzi, and the number of seropositive dogs with which it cohabited were all found to be significant predictors of seropositivity in any dog. The results are the first indication that Triatoma guasayana is the vector responsible for the new cases of Trypanosoma cruzi infection seen in dogs in domestic or peridomestic sites during the surveillance programme.     

Functional evaluation of persons over 60 years of age living in an urban community. ANCO project

OBJECTIVE: To establish the grade of functional deterioration in older people and analyse associated factors. DESIGN: Cross sectional study. SETTING: City of Córdoba. PARTICIPANTS: The population over 60 years old on the Córdoba municipal roll (49,674) and living at home, from which a sample of 1,103 subjects was taken. INTERVENTIONS: The multidimensional OARS-MFAQ questionnaire was filled in. Calculation of the functional deterioration scores enabled five areas to be evaluated: physical health (PH), mental health (MH), economic resources (ER), social resources (SR) and capacity to perform daily activities (DA) autonomously. MEASUREMENTS AND MAIN RESULTS: Reply rate was 86.8%. The prevalence of serious/absolute deterioration in each of the areas was: 9.3% in SR, 8.5% in DA, 8.4% in ER, 6.9% in MH and 5.8% in PH. CONCLUSIONS: Both the prevalence of functional deterioration in the population group under study and the demand for institutional care are similar to other studies performed in our country, but higher than in Anglosaxon countries.     

Larval rearing water and preexisting eggs influence oviposition by Aedes aegypti and Ae. albopictus (Diptera: Culicidae)

Two-choice laboratory bioassays were used to evaluate oviposition responses of gravid Aedes aegypti (L.) and Ae. albopictus (Skuse) to larval rearing water and eggs from prior egg deposition. Oviposition responses by female Ae. aegypti were similar between larval water from Ae. aegypti and water controls but significantly greater to larval water from Ae. albopictus (12.2%) compared with water controls. Oviposition by Ae. albopictus females increased significantly in response to larval water from either species compared with water controls with increases of 15.1% to Ae. aegypti larval water and 17.6% to Ae. albopictus larval water. Oviposition responses of gravid Ae. aegypti and Ae. albopictus were evaluated in the presence of preexisting conspecific and heterospecific eggs on strips of oviposition paper. Significantly more eggs were laid by gravid Ae. aegypti females on oviposition paper containing either Ae. aegypti or Ae. albopictus eggs than on oviposition paper without eggs. In contrast, oviposition responses of gravid Ae. albopictus females were unaffected by the presence of eggs of either species.     

Is onchocerciasis endemic to Nyanza Lac (Burundi)?

Haematobia irritans (L.) horn flies recently have immigrated into Argentina from Brazil or Paraguay. Bioassays were conducted with fenvalerate to develop baseline information on pyrethroid susceptibility. Four populations tested in 1994 and 1995 were more susceptible than a laboratory strain of horn fly not exposed to insecticides since 1970, but 3 populations from Corrientes Province tested in 1996 were moderately resistant to fenvalerate, with resistance ratios ranging from 3 to 26. Argentine horn fly populations were exposed to pyrethroid treatments of pour-on, spray, and dip formulations for 4 yr before developing resistance. Horn flies in the United States developed pyrethroid resistance after 2 yr of treatment with pyrethroid ear tags.     

Score prognosis for the infertile couple based on historical factors and sperm analysis

OBJECTIVE: To identify variables, obtained from historical factors and sperm analysis, associated with greater chances of pregnancy in infertile couples. METHODS: The study was carried out in Córdoba, Argentina. The characteristics of 247 couples consulting for infertility who achieved pregnancy within 3 years of their first visit were compared with those of 312 couples who did not become pregnant. We evaluated the relationship between the age of the woman and her partner, the type and duration of infertility, length of the last three menstrual cycles, history of pelvic surgery in the woman, and testicular volume, sperm density, motility and morphology in her partner, and the achievement of pregnancy. For the analysis, logistic regression was used. RESULTS: Six variables had a predictive value: sperm morphology, the woman's age, type and duration of infertility, her history of pelvic surgery, and duration of menstrual cycles. CONCLUSIONS: The best prognosis for future fertility in infertile couples is correlated with a higher percentage of normal sperm morphology, younger woman's age, secondary infertility, fewer years of infertility, negative history of pelvic surgery, and abnormal menstrual cycles.     

Impact of antiretroviral combination therapies on AIDS surveillance reports in Switzerland. Swiss HIV Cohort Study

BACKGROUND: AIDS reporting in Switzerland is mandatory by law. For the first time since the beginning of the epidemic, health authorities observed a decline in AIDS surveillance reports, from 545 new cases in 1995 to 459 in 1996, a decrease of 86 cases. OBJECTIVE: To examine the extent to which this decline in AIDS surveillance reports is attributable to the introduction of antiretroviral combination therapy. Patients and setting: Swiss HIV Cohort Study, a multicentre cohort of adult HIV-infected patients with national coverage. Participants at risk of developing a first AIDS-defining event, defined as persons with a CD4 cell count below 200 x 10(6)/l or in clinical stage B, were studied. METHODS: A parametric statistical survival model was used to estimate the number of AIDS cases expected in the absence of combination therapies. Taking reporting delays into account, the effect of the introduction of combination therapies in the cohort on national AIDS reports was estimated from the difference between the number of expected and observed cases. RESULTS: A total of 4915 participants contributed 10755 person-years and 2366 initial AIDS events. Between 1990 and 1994, about 35% received antiretroviral therapy, predominantly monotherapy. In 1995 and 1996, the prevalence of antiretroviral therapy increased steadily due to the introduction of dual and triple combinations. The mid-year prevalence of use of combination therapies was 6% in 1994, 13% in 1995, and 48% in 1996. The difference between expected and observed cases per half-year increased from 12 in the first 6 months of 1994 to 69 in the second half of 1996. Taking reporting delays into account, we estimated that 43 (95% confidence interval, 17-69) of the deficit of 86 reports could be attributed to combination therapies. CONCLUSION: The introduction of antiretroviral combination therapies in a single cohort study explained 50% of the decline in national AIDS surveillance reports. Monitoring the use and effectiveness of antiretroviral therapy must become an important component of AIDS surveillance systems.     

Holmium laser resection of the prostate versus neodymium:yttrium-aluminum-garnet visual laser ablation of the prostate: a randomized prospective comparison of two techniques for laser prostatectomy

Prospective studies were conducted at used-tire sites in Illinois during 1994-1995 in an effort to isolate arboviruses from mosquitoes, particularly Aedes albopictus (Skuse) and Aedes triseriatus (Say). Three isolates of Potosi virus were obtained from Ae. albopictus collected at a waste tire site in Jasper County during 1994 and 1995. Also, a single isolate of Cache Valley virus was obtained from Ae. albopictus collected at the Jasper County site during 1995. These are the first records of arbovirus isolations from Ae. albopictus in Illinois and the first isolate of Cache Valley virus from this mosquito species. During 1994, two isolates of La Crosse virus were made from Ae. triseriatus collected at a used-tire site in Peoria County in proximity to the residence of a human La Crosse encephalitis case. This is the first evidence in Illinois that indicates increased risk to humans living near used-tire sites, which may serve as foci for production of Ae. triseriatus, the vector of La Crosse virus. Tire removal and improved environmental sanitation at such sites may greatly reduce the abundance of vector mosquitoes, and, therefore, the risk of arbovirus transmission.     

Life table study of Aedes aegypti (Diptera: Culicidae) in Puerto Rico fed only human blood versus blood plus sugar

Life table studies were performed in 1996 with Aedes aegypti (L.) during the low (cool/dry) and high (hot/rainy) dengue virus transmission seasons in Puerto Rico. Mated adult females from field-collected pupae were placed individually in cages and divided into 2 treatment groups: one was fed only human blood and the other human blood plus a 10% sucrose solution. Survival and number of eggs laid were recorded daily for each female. During both seasons, age specific survivorship was higher for the blood plus sugar group, groups fed only human blood had higher reproductive outputs (mx), and net replacement rates (Ro) for blood only groups were higher than for those fed blood plus sugar. Intrinsic rates of growth (r) were the same for both treatments during the low (cool/dry) transmission season, but higher for the blood-only treatment during the high (hot/rainy) transmission season. Our results indicate that feeding on only human blood provides an evolutionary advantage to Ae. aegypti females in Puerto Rico. These results are similar to those from an earlier study carried out with Ae. aegypti in Thailand; the advantage of feeding on human blood does not seem to be restricted to a particular geographic region. We also found that the benefits associated with human feeding persist through epidemiologically different times of the year. We conclude that feeding on human blood is reproductively beneficial for Ae. aegypti, which may increase their contact with human hosts, and therefore may influence their vectorial capacity for dengue viruses through frequent feeding on blood.     

Laboratory evaluation of the biocontrol potential of Mesocyclops thermocyclopoides (Copepoda: Cyclopidae) against mosquito larvae

Biocontrol potential of Mesocyclops thermocyclopoides against first instar larvae of Anopheles stephensi, Aedes aegypti and Culex quinquefasciatus was studied under laboratory conditions. It was found that M. thermocyclopoides had the highest predation efficacy against Ae. aegypti followed by An. stephensi and Cx. quinquefasciatus. There was a significant reduction in the predation efficacy of M. thermocyclopoides against Cx. quinquefasciatus in the presence of alternate food (p < 0.01). The cage simulation trial indicated that M. themocyclopoides has the potential to control Ae. aegypti breeding effectively in a container type of habitat.     

Prevalence of Parkinson's disease in Junín, Buenos Aires Province, Argentina

We investigated the prevalence of Parkinson's disease (PD) in a South American city: Junín, Buenos Aires Province, Argentina. At dwellings systematically selected, the case finding involved household screenings and neurological examinations (i.e., a two-phase survey approach). Only persons 40 years of age or older were eligible (N = 7,765). There were 51 cases of PD identified, yielding a crude prevalence of 656.8 per 100,000 population. The age-specific prevalence was consistently higher in men than women, and it increased with advancing age for both sexes. In addition to prevalence figures. we present tallies related to clinical features of PD, as well as tallies related to other subtypes of parkinsonism.     

Asthma severity and psychopathology in a tertiary care department for children and adolescent

OBJECTIVES: To find what self-perception of their health (SPH) and of their morbidity by school-children; and to analyse possible differences, in function of their social and demographic characteristics and life-styles. DESIGN: An observational crossover study, using a health questionnaire. SETTING: Community. PARTICIPANTS: 548 6th and 8th grade (EGB) children in the Occidente Health Area, Córdoba. INTERVENTIONS: Self-filled health questionnaire. MEASUREMENTS AND MAIN RESULTS: 43.7% of students felt very healthy. Bad SPH was independently associated with being a girl, poor state of physical fitness and feeling unhappy. Tiredness and nervousness were the most frequent disorders suffered by school-children. CONCLUSIONS: Although the SPH of the school-children was acceptable, we found high perceived morbidity and prevalence of accidents, along with a striking consumption of medication.     

Breeding habitats of Aedes aegypti (L) and Aedes. albopictus (Skuse) in villages of Barru, South Sulawesi, Indonesia

The breeding habitats of the dengue vector, Aedes aegypti and Aedes albopictus, were studied using larval collection method inside and outside houses in 6 villages of Barru, South Sulawesi, Indonesia from July 1994 to August 1995. Aedes aegypti was the dominant species, being abundant indoors especially in the coastal areas. Aedes albopictus was breeding primarily in outdoor containers in the hill and mountain areas. Earthen jar was the most common breeding habitat of Aedes aegypti in all villages surveyed. Drum can was the most common outdoor breeding habitat of Aedes albopictus in the hill and mountain areas. The high Breteau indices of Aedes aegypti and Aedes albopictus suggests that these species may play an important role in the transmission of dengue hemorrhagic fever in Barru where epidemics of the fever occur occasionally.     

Influence of plant abundance on nectar feeding by Aedes aegypti (Diptera: Culicidae) in southern Mexico

The availability of flowering plants affected the sugar feeding rates of female Aedes aegypti (L.) in 4 areas of a small city in southern Mexico. The proportion of mosquitoes containing sugar varied from 8 to 21% in 4 areas in direct relation to blooming plant abundance. Human density was similar in the 4 areas (range, 3.9-5.4 per house), whereas the number of flowering plants per house increased on the outskirts (range, 3.1-5.4 plants per house). Equal proportions of sugar positive females were nulliparous or parous, indicating similar sugar feeding at any age. In addition, nearly 60% of positive females were at the Christophers stage II, indicating a greater need for flight fuel during the early stages of egg development. We conclude that Ae. aegypti feeds frequently on nectar and that this activity is modulated by nectar availability.     

Average thresholds in the 8 to 20 kHz range in young adults

RATIONALE AND OBJECTIVES: The Comprehensive Clinical Assessment (CCA) examination at the University of Michigan Medical School is a series of test stations through which the mastery of clinical skills is evaluated. The purpose of this study was to determine whether student performance on the radiology station improved in years when radiology faculty presented case-of-the-week unknowns to the 3rd-year students. MATERIALS AND METHODS: The authors compared four separate classes of medical students in examination years 1993, 1994, 1995, and 1996 by using the total CCA examination score, the radiology station score, and radiology station pass/fail rates. Radiology case-of-the-week presentations were given by the radiology faculty only in academic years 1993-1994 and 1994-1995 (examination years 1994 and 1995). RESULTS: The means and standard deviations of the radiology station scores for the examination years when case-of-the-week presentations were not given, 1993 and 1996, were 78.92 +/- 13.62 and 79.76 +/- 13.62, respectively. In the years case-of-the-week presentations were given, 1994 and 1995, the radiology station scores averaged 90.83 +/- 8.58 and 89.97 +/- 9.66, respectively (P < .001, global alpha = .05). Total CCA percentage correct scores were similar for all years studied. In 1993 and 1996, 7.6% and 5.3% of students, respectively, failed the radiology station. In 1994 and 1995, 0.4% and 0% of students, respectively, failed (P < .0001). CONCLUSION: Case-of-the-week presentations by radiology faculty increased 3rd-year students' basic radiologic knowledge as evidenced by increased scores on the radiology station of the CCA examination.     

Increased acceptance of the International Normalized Ratio (INR) as a monitoring parameter of oral anticoagulation therapy in Germany. GELIA Study Group

In 1994 the German Cardiac Society recommended the International Normalized Ratio (INR) instead of "Quick's test" for the long-term management of oral anticoagulation therapy. Parallel cardiac surgical centers in Germany and Switzerland started patient recruitment for the GELIA study (German Experience with Low Intensity Anticoagulation). By the end of 1996, 862 consecutive patients with mechanical heart valve replacement had been enrolled. According to the protocol of the GELIA study, intensity of anticoagulation, methods used to control the oral anticoagulation therapy as well as other factors relevant for the anticoagulation management are reported every three months. The so far accumulated data material of the GELIA study seemed, therefore, appropriate to analyze potential changes in the acceptance of INR during the time period 1993-1996. Potential differences in the anticoagulation management were analyzed separately according to the time of enrollment of patients and changes during the follow up period, e. g., a switch from "Quick's test" to INR. Taking the time of enrollment into account, the percentage of patients who had INR-controlled oral anticoagulation therapy increased from 0% (1993), 14.3% (1994), 63.2% (1995) to 74.2% in 1996. During the follow up, there was a change from "Quick's test" to INR controls in 7 patients (1994; 2.1%), 67 patients (1995; 10.5%) and 142 patients (1996; 17.3%) with a consequent increase of INR controlled patients to a total of 34.2% in 1994, 52.0% in 1995, and 73.9% in 1996.     

Breastfeeding preterm twins: a case report

The bacteriological analysis and, particularly, the detection of Clostridium botulinum spores from 42 honey samples collected in apiaries of the province of San Luis as well as neighbouring areas of La Pampa, Córdoba and Mendoza, were carried out. Samples were processed by the dilution and centrifugation procedures. For spores detection, culture of the pellets were performed in 2 tubes with cooked meat medium (MCC), one of them warmed up to 80 degrees C for 15 min, and both incubated at 30 degrees C during 7 days. Mice were used to search for toxin in the supernatant. Sediments were also searched for anaerobic bacteria detection in yolk agar plates and in nutritive agar plates for the aerobics. Botulinum toxin type A production was found in one of the MCC cultures. No anaerobic bacteria were isolated. All samples contained Bacillus spp.; 21.4% of the strains, were tentatively classified as B. alvei. A working model for the bacteriological analysis of honey and guides that could be enclosed in publications of official institutions (Figure 1) is proposed.     

Estimated growth of lung volume reduction surgery among Medicare enrollees: 1994 to 1996

OBJECTIVE: To estimate the number of lung volume reduction surgery procedures performed on Medicare enrollees from 1994 to 1996. DESIGN: Statistical analysis of national Medicare claims data. PATIENTS: All Medicare enrollees with emphysema hating claims records for pulmonary resection procedures from January 1, 1993, through December 31, 1996. MAIN OUTCOME MEASURE: Estimated number of lung volume reduction procedures performed per month from July 1994 through December 1996. RESULTS: An estimated 1,212 lung volume reduction procedures were performed on Medicare enrollees between July 1994 and December 1995 (95% confidence interval, 1,012 to 1,408). Nearly one half of these procedures were performed in the last 3 months of 1995. At the time Health Care Financing Administration announced that it would suspend reimbursement for the procedure (December 1995), lung volume reduction surgery was being performed in 37 states. The number of claims per month decreased from a peak of 169 in December 1995, to 11 in March 1996. Average Medicare reimbursement per procedure was $31,398. CONCLUSIONS: Lung volume reduction surgery for patients increased rapidly following its reintroduction in 1994. The growth of lung volume reduction surgery demonstrates that widespread adoption and utilization of a surgical procedure can occur in the absence of data from controlled clinical trials. Medicare expenditures for lung volume reduction surgery were an estimated $30 million to $50 million. Performing the surgery for all current Medicare patients who meet the appropriate clinical criteria would cost an estimated $1 billion.