The prevalence of clinical diabetic polyneuropathy in Spain: a study in primary care and hospital clinic groups. Neuropathy Spanish Study Group of the Spanish Diabetes Society (SDS)

A multiregional cross-sectional study of clinical diabetic polyneuropathy (DPN) was carried out among Spanish diabetes patients using a standard system for scoring symptoms and signs of polyneuropathy. The main patient sample comprised 2644 patients (54.7% women) aged 15-74 years (mean 57.2 +/- 0.3 years), 86.9% of whom had Type II (non-insulin-dependent) diabetes mellitus and 29.4% were attending hospital clinics. Mean duration of diabetes since diagnosis was 10.2 +/- 0.2 years. The prevalence of DPN was 22.7% (95% confidence interval 21.2-24.3%) in the whole sample, 12.9% (9.4-16.5%) among patients with Type I (insulin-dependent) diabetes mellitus and 24.1% (22.4-25.9%) among patients with Type II diabetes; there was no significant difference in prevalence between men and women. Prevalence increased with age (from < 5% in the 15- to 19-year-old age group to 29.5% in the 70- to 74-year-old group) and with duration of diabetes since diagnosis (from 14.2% among those with duration < 5 years to 44.2% among those with duration > 30 years). In a supplementary sample of 161 diabetic patients aged 75 to 79 years (excluded from the main sample to prevent confusion between diabetes-induced and ageing-induced neuropathies), prevalence was 37.8%. Ninety-three patients (3.3%) had or had had foot ulcers and 21 of these 93 (0.7%) had undergone amputation; 90.8% of ulcerated patients had Type II diabetes, and 54% had DPN (in most cases with loss of perception of vibration), as against a prevalence of DPN of 19.9% among patients without ulcers. We conclude that nearly a quarter of Spanish diabetic patients have DPN; that over 90% of DPN patients have Type II diabetes; that the prevalence of DPN increases with age and with the duration of the disease, and that the risk of foot ulcers among DPN patients is about three times the risk among diabetic patients without DPN. We accordingly emphasize the responsibility of primary care physicians to try to prevent diabetic foot lesions by early diagnosis of DPN.     

Hyperhomocyst(e)inemia in renal transplant recipients with and without cyclosporine

A reversed-phase high-performance liquid chromatographic method for the determination of quercetin in human plasma following intravenous infusion is described. Quercetin in plasma was extracted with methanol-dimethyl sulphoxide (4:1 v/v) and separated on a C18 Hypersil-BDS column with 44% (v/v) methanol in 0.1 M ammonium acetate (pH 5.15) containing 0.27 mM EDTA as the mobile phase. The drug was detected specifically and sensitively at its absorption maximum of 375 nm, or electrochemically, with a detection limit of 80 ng/mL and 2 ng/mL, respectively.     

Prevalence of obesity in Spain: the SEEDO''97 study. Spanish Collaborative Group for the Study of Obesity

BACKGROUND: Multiple viral subpopulations coexist in an HIV infected patient with dynamics of selection established between them. In order to get insight on the phenotype of these subpoblations, and its relation with disease progression, we have studied the biological variability of HIV-1 in 113 patients. Variability was related with CD4+ T lymphocyte counts, clinical status, way of viral transmission and antiretroviral treatment. PATIENTS AND METHODS: 113 patients (80 adults and 33 children) were studied for HIV-1 isolation in cocultures of infected and non infected lymphocytes. Viral replication was evaluated as rapid (R)/slow (S) or high (H)/low (L). Syncytia formation was estimated in MT2 cell line (SI/NSI). The tropism toward lymphocytes and monocytes (LM) was studied on H9 and U937 cell lines. RESULTS: Up to 86.7% of viral isolates were R, 56.6% were H and 49.6% were SI. These percentages increased with disease progression. Eight viral strains were R/H/NSI cocultivated in MT2 cells and SI in cocultured lymphocytes (NSI/SI), which may be considered as a new phenotype. All the SI isolates and all the R/H (SI and NSI) isolates were LM. Three categories were established: R/H/SI/LM, R/H/NSI/LM and S/L/NSI/NLM. The first two categories corresponded to patients with CD4+ T lymphocytes <200 x 10(6)/I (56%, 50%). The third category corresponded to patients with > 500 x 10(6)/I (53.3%). CONCLUSIONS: Viral replication and SI phenotype, independently, are useful markers for severity of HIV infection. The biological differences among NSI of the 3 viral phenotype categories, including the new subgroup NSI/SI, may indicate the existence of more pathogenic NSI subpopulations.     

The soul of Spain: Spanish scholastic psychology and the making of modern subjectivity (1875–1931).

The aim of this article is to provide an approach to the study of the relations between psychology and Roman Catholic Scholasticism in the making of Spain as a modern nation-state. The crucial period in this process—extending from the beginning of King Alfonso XII’s reign in 1875 to the proclamation of the Second Spanish Republic in 1931—is considered. Attention is focused on Ethics textbooks published by Spanish Scholastic authors throughout the period. Through these school manuals, young students were trained in the ideas of citizenship and social coexistence held by the Catholic Church. An analysis of these didactic, programmatic works shows the central role played by the theory of faculties and modern psychological technologies (psychopedagogy, psychopathology, psychotechnics) in the Scholastic outlook. Thus, an attempt is made to show that psychology was used by Spanish Scholasticism as a way of legitimating a reactionary view of Spain, which eventually led to the emergence of National-Catholicism as the official ideology of the Franco regime (1939–1975). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of the tacrolimus II microparticle enzyme immunoassay (MEIA II) in liver and renal transplant recipients

We evaluated the MEIA II with blood samples with added tacrolimus (3.0, 5.0, 11.0, and 22.0 microg/L). The assay had acceptable recoveries (99-103%) and intraday imprecision (<16.0%) across the range of concentrations studied, except for the recoveries at 3.0 microg/L (86.3%) and 5.0 microg/L (80.7%). Comparison of liver (n = 116) and renal (n = 113) patient samples measured by MEIA II against HPLC-tandem mass spectrometry (HPLC-MS/MS) found a mean overestimation of 15.6%. From these comparison data it can be calculated that at values of 5 and 20 microLg/L in liver or renal transplant patient samples, measured by HPLC-MS/MS, MEIA II will have the corresponding range estimates of 3.6-7.9 microg/L and 20.9-25.4 microg/L, respectively. No clinically significant difference in results, in terms of overestimation or correlation, was observed between the two transplant groups studied. The MEIA II is an improvement on the previous MEIA I and is suitable for the therapeutic drug monitoring of tacrolimus where HPLC-MS/MS is unavailable.     

Differential item functioning in a Spanish translation of the PTSD Checklist: Detection and evaluation of impact.

This study demonstrated the application of an innovative item response theory (IRT) based approach to evaluating measurement equivalence, comparing a newly developed Spanish version of the Posttraumatic Stress Disorder Checklist-Civilian Version (PCL-C) with the established English version. Basic principles and practical issues faced in the application of IRT methods for instrument evaluation are discussed. Data were derived from a study of the mental health consequences of community violence in both Spanish speakers (n = 102) and English speakers (n = 284). Results of differential item functioning (DIF) analyses revealed that the 2 versions were not fully equivalent on an item-by-item basis in that 6 of the 17 items displayed uniform DIF. No bias was observed, however, at the level of the composite PCL-C scale score, indicating that the 2 language versions can be combined for scale-level analyses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pseudotumor form of pulmonary nocardia infection (Nocardia nova) in a renal transplant patient

The authors report a case of pulmonary nocardiosis due to Nocardia nova occurring in a smoker who had a renal transplant. A pseudo-tumour was found on a standard X-ray and computerised tomography did not suggest the diagnosis. Needle aspiration under computerised tomographic control enabled a diagnosis to be made.     

FK 506 and mycophenolate mofetil in renal transplant recipients: six-month results of a multicenter, randomized dose ranging trial. FK 506 MMF Dose-Ranging Kidney Transplant Study Group

The effective dose of MMF with FK 506 has not been previously studied in a prospective, randomized, controlled setting. In the present study, we evaluated two different daily doses of MMF (1 and 2 g) and compared it to the historically conventional therapy of AZA. At 6 months post-transplant, we found no significant difference in the incidence of acute rejection between the AZA group and the MMF 1 g group. However, patients who started on MMF 2 g/d had significantly delayed and lower incidence of acute rejection as compared to the other two groups. We found that patients who were initiated on MMF 2 g frequently had their dose lowered, primarily for gastrointestinal or hematologic symptoms; by 6 months after-transplant, patients in the MMF 2 g group had a mean dose of 1.5 g. It is unclear from this study if initiating patients on MMF 1.5 g in combination with FK 506 would be as effective as initiating a patient on MMF 2 g. Further studies of the combination of FK 506 and MMF in kidney transplant recipients to further define the optimal dosing regimen are warranted. In summary, the combination of FK 506 and MMF is well-tolerated, safe, and effective in cadaveric kidney transplant recipients.     

PCBs and PCTs in wolves (Canis lupus, L) in Galicia (N.W. Spain)

Levels of PCBs and PCTs (the Aroclor1260 and Aroclor5460 congeners, respectively) in viscera of wolves of Galicia (N.W. Spain) were determined by capillary GC with electron-capture detection. Mean PCB levels ranged from 0.13 mg/kg of dry tissue in kidney to 3.70 mg/kg in liver. PCTs were detected only in suprarenal capsule, their mean level being 3.77 mg/kg.     

Recurrence of hepatitis D (delta) in liver transplants: histopathological aspects

BACKGROUND: The viral/pathological correlates of recurrent hepatitis delta virus (HDV) disease in orthotoptic liver transplants are reported. METHODS: We examined the histological features of recurrent HDV disease in nine patients with transplants for terminal HDV cirrhosis were examined; intrahepatic HDV and hepatitis B virus (HBV) antigens were detected by immunoperoxidase techniques. Sera were tested for the battery of HDV and HBV markers. RESULTS: In four patients, HDV reinfection was accompanied by the recurrence of an HBV infection with features of active viral replication. In the other five, HDV reinfection was accompanied by an atypical recurrence of HBV infection without evidence of active HBV replication (no expression of intrahepatic hepatitis B core antigen). In four of the latter patients, the atypical HBV pattern changed during the follow-up into a pattern of active viral replication accompanied by chronic necroinflammation detected during histology. CONCLUSION: The pattern of recurrent HBV infection can influence the pathological aspects of the relapses of HDV disease in liver grafts.     

Spanish and English Neuropsychological Assessment Scales (SENAS): Further Development and Psychometric Characteristics.

The Spanish and English Neuropsychological Assessment Scales were devised to be a broad set of psychometrically matched measures with equivalent Spanish and English versions. Study 1 in this report used item response theory methods to refine scales. Results strongly supported psychometric matching across English and Spanish versions and, for most scales, within English and Spanish versions. Study 2 supported in both English and Spanish subsamples the 6-domain model of ability that guided scale construction. Study 3 examined differential item functioning (DIF) of one scale (Object Naming) in relation to education, ethnicity, gender, and age. Effects of DIF on scale-level ability scores were limited. Results demonstrate an empirically guided psychometric approach to test construction for multiethnic and multilingual test applications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of tacrolimus (FK506) and cyclosporine for immunosuppression after cadaveric renal transplantation. FK506 Kidney Transplant Study Group

BACKGROUND: Tacrolimus (FK506), a macrolide molecule that potently inhibits the expression of interleukin 2 by T lymphocytes, represents a potential major advance in the management of rejection following solid-organ transplantation. This randomized, open-label study compared the efficacy and safety of tacrolimus-based versus cyclosporine-based immunosuppression in patients receiving cadaveric kidney transplants. METHODS: A total of 412 patients were randomized to tacrolimus (n=205) or cyclosporine (n=207) after cadaveric renal transplantation and were followed for 1 year for patient and graft survival and the incidence of acute rejection. RESULTS: One-year patient survival rates were 95.6% for tacrolimus and 96.6% for cyclosporine (P=0.576). Corresponding 1-year graft survival rates were 91.2% and 87.9% (P=0.289). There was a significant reduction in the incidence of biopsy-confirmed acute rejection in the tacrolimus group (30.7%) compared with the cyclosporine group (46.4%, P=0.001), which was confirmed by blinded review, and in the use of antilymphocyte therapy for rejection (10.7% and 25.1%, respectively; P<0.001). Impaired renal function, gastrointestinal disorders, and neurological complications were commonly reported in both treatment groups, but tremor and paresthesia were more frequent in the tacrolimus group. The incidence of posttransplant diabetes mellitus was 19.9% in the tacrolimus group and 4.0% in the cyclosporine group (P<0.001), and was reversible in some patients. CONCLUSIONS: Tacrolimus is more effective than cyclosporine in preventing acute rejection in cadaveric renal allograft recipients, and significantly reduces the use of antilymphocyte antibody preparations. Tacrolimus was associated with a higher incidence of neurologic events, which were rarely treatment limiting, and with posttransplant diabetes mellitus, which was reversible in some patients.