Compliance with and tolerance of mefloquine and chloroquine + proguanil malaria chemoprophylaxis in French short-term travellers to sub-Saharan Africa

To compare the compliance with and tolerance of mefloquine (MQ) and chloroquine + proguanil (CQ-PRO) chemoprophylaxis, we conducted a study using a self-reported questionnaire in 2 groups of native French adult visitors to Senegal or Kenya. CQ (100 mg daily) + PRO (200 mg daily) prophylaxis was prescribed for all patients travelling to Senegal and for those going to Kenya when MQ was contraindicated; MQ (250 mg weekly) was prescribed for the other subjects. There were no significant differences in age, sex, exposition and measures of protection against mosquito bites, concomitant drug use or mean duration of chemoprophylaxis between the 2 groups, and compliance during travel was excellent in both. Chemoprophylaxis was more frequently interrupted prematurely in the MQ group. The rates of overall side-effects attributed to malaria chemoprophylaxis were 16% for MQ against 12% CQ-PRO (not significant). However, nonserious neuropsychiatric adverse events are more frequent with MQ: 11.5% compared to 2% with CQ-PRO. MQ should be used with caution.     

Nadolol plus isosorbide mononitrate compared with sclerotherapy for the prevention of variceal rebleeding

BACKGROUND: Patients who have bleeding from esophageal varices are at high risk for rebleeding and death. We compared the efficacy and safety of endoscopic sclerotherapy with the efficacy and safety of nadolol plus isosorbide mononitrate for the prevention of variceal rebleeding. METHODS: Eighty-six hospitalized patients with cirrhosis and bleeding from esophageal varices diagnosed by endoscopy were randomly assigned to treatment with repeated sclerotherapy (43 patients) or nadolol plus isosorbide-5-mononitrate (43 patients). The primary outcomes were rebleeding, death, and complications. The hepatic venous pressure gradient was measured at base line and after three months. RESULTS: Base-line data were similar in the two groups, and the median follow-up was 18 months in both. Eleven patients in the medication group and 23 in the sclerotherapy group had rebleeding. The actuarial probability of remaining free of rebleeding was higher in the medication group for all episodes related to portal hypertension (P = 0.001) and variceal rebleeding (P = 0.002). Four patients in the medication group and nine in the sclerotherapy group died (P = 0.07 for the difference in the actuarial probability of survival). Seven patients in the medication group and 16 in the sclerotherapy group had treatment-related complications (P = 0.03). Thirty-one patients in the medication group underwent two hemodynamic studies; 1 of the 13 patients with more than a 20 percent decrease in the hepatic venous pressure gradient had rebleeding, as compared with 8 of the 18 with smaller decreases in the pressure gradient (P = 0.04) for the actuarial probability of rebleeding at two years). CONCLUSIONS: As compared with sclerotherapy, nadolol plus isosorbide mononitrate significantly decreased the risk of rebleeding from esophageal varices.     

Usefulness of the genetic study in the diagnosis of medullary carcinoma of the thyroid

Germ-line mutations in the RET proto-oncogene are associated with multiple endocrine neoplasia type 2A (MEN 2A) and with familial medullary thyroid carcinoma (FMTC). Detection of these mutations allows the identification of the affected kindred members, who will develop medullary thyroid carcinoma (MTC) in 100% of cases. We studied 24 patients of two kindreds (MEN 2A and FMTC). Basal calcitonin levels and pentagastrin-stimulated calcitonin were measured in all patients. The RET mutations were detected by DNA analysis. The RET mutations were identified in 14 patients. Two of them had been operated in the past, 2 refused operation and 4 were living abroad. In the 6 remaining, only one showed a thyroid mass, basal calcitonin was normal in all patients except one, and pentagastrin-stimulated calcitonin was negative in 2 patients. Total thyroidectomy was performed in all cases. Histology showed C-cell hyperplasia in all patients and MTC in 5 of them. In MEN 2A and FMTC DNA analysis allows the identification of RET mutation carriers, in which presymptomatic thyroidectomy allows and improvement in survival.     

Use of commercial grape phenolic extracts to supplement solid foodstuff

Osmotic treatment (OT) has been applied to infuse phenolic compounds into a model food. Two commercial grape extracts were used as a source of phenolics, a grape seed extract (GSE) and a white grape marc extract (WGME). Three different concentrations of total phenolics were applied with and without presence of osmo-active solute (50 g/100 g and 0 g/100 g of sucrose) in the osmotic solution (OS). With a 50 g/100 g sucrose and a total phenolic content in OS ranging from 3 g/L to 15 g/L and operating time up to 8 h, the final total phenolic content in the osmo-treated model food was between 815 mg GAE/kg and 7176 mg GAE/kg. That is between the 0.5 and 1.5 times higher than that of the richest fruits. A soaking process with the same phenolic content but with no sucrose in OS led to a total phenolic content in the model food that was between 80% and 100% higher.Mass transfer of the major phenolics infused into the model food during OT and soaking process was characterized considering the diffusional approach and Peleg's model. Progress of total and individual phenolic content fitted well both models with the exception of the flavan-3-ol dimer concentration.     

Spatial variability in mortality inequalities, socioeconomic deprivation, and air pollution in small areas of the Barcelona Metropolitan Region, Spain

Background

There is evidence that geographic variability of social health inequalities continues to exist even after individual risk factors have been taken into account. However, relatively few studies have examined the contribution of exposure to air pollutants to those inequalities.

Objectives

To study the geographic variability of inequalities in mortality and their associations with socioeconomic and environmental inequalities in small areas of the metropolitan of Barcelona during the period 1994 to 2003.

Methods

As in the MEDEA Project, the small area unit was the census tract. Study population consisted of the residents of the metropolitan area of Barcelona. Response variables were all-cause and specific-cause standardized mortality ratio (SMR). Explanatory variables were deprivation index, summarizing socioeconomic variables of the census tracts, and estimates of air pollutant exposures. Bayesian hierarchical models were used in order to reduce the extra variability when using SMR and to assess associations between mortality and deprivation and air pollution.

Results

Statistically significant associations with deprivation were found for the causes of death related to consumption of tobacco and alcohol for men and, besides lung cancer, diet-related causes for women. Statistically significant pollution coefficients were only found in the metropolitan area of Barcelona and in men. A positive interaction between pollutants and the deprivation index was statistically significant for respiratory mortality and PM₁₀, and ischemic disease mortality and NO₂, both for men.

Conclusions

We found deprivation to be associated in a statistically significant way with the geographical variation in mortality in the census tracts of the metropolitan area of Barcelona, in the period 1994 to 2003. Those air pollutants more directly related with traffic modify some of these associations.     

Architectural singularities of a class of pentapods

A pentapod is usually defined as a 5-degrees-of-freedom fully-parallel manipulator with an axial spindle as moving platform. This kind of manipulators has revealed as an interesting alternative to serial robots handling axisymmetric tools. Their particular geometry permits that, in one tool axis, high inclination angles could be attained, thus overcoming the orientation limits of the classical Stewart-Gough platform. This paper deals with pentapods with coplanar base attachments.In previous works changes in the location of the leg attachments that do not modify the singularity locus of the pentapod were studied. Such leg rearrangements reveal here as a powerful tool to shed light on the geometric structure of the singularity locus and, in particular, on architectural singularities.Indeed, a complete analysis of such singularities is carried out, providing both algebraic conditions, which complete previous results found in literature, and a geometrical interpretation that permits defining a measure of distance to architectural singularities. Such measure can be used as an index in the design process to obtain manipulators as far as possible from architectural singularities, leading to a better global behavior.     

Injury profiles of road traffic deaths

The objective is to describe injuries of road traffic deaths in Barcelona and identify injury profiles by road user type, through a cross-sectional study including road traffic deaths for the period 1997-2004. The data source was the Institut de Medicina Legal de Catalunya. Diagnoses were coded using the International Classification of Diseases, 9th revision, Clinical Modification, and classified using the Barell Matrix. Of the 719 deaths studied, 45% were pedestrians, 32% two wheel motor vehicle users, and 23% car occupants. The injury profile of the road traffic deaths in Barcelona is internal injuries and fractures to the torso and to the head/neck. This profile is repeated in all the road user groups, although pedestrians present higher frequencies of fractures and contusions to extremities and contusions to the head/neck, and fewer internal torso injuries than car occupants or two wheel motor vehicle users.     

New Paradigm in NKT Cell Antigens: MCS-0208 (2-(Hydroxymethyl)phenylthio-phytoceramide) – an Aryl-Phytoceramide Compound with a Single Hydroxyl Group Stimulates NKT Cells

Natural Killer T (NKT) cells play an important role in the immune response and can be activated by glycolipids presented by CD1d protein. We present MCS-0208, an unprecedented arylthioether-phytoceramide able to induce potent invariant NKT (iNKT) cell activation, notably when tested in human iNKT cells. This arylsphingolipid analog has a simple phenyl group containing a single hydroxyl substituent as a surrogate of the sugar ring. The phenylthioether structure contrasts with α-galactosylceramide ( 1 ), the prototypical glycolipid used to induce iNKT cell stimulation, where the galactose 2’-OH and 3’-OH substituents are accepted as the minimal footprint and considered critical for NKT T cell receptor (TCR) recognition. A computational study supports the recognition of aromatic compound by the CD1d and TCR proteins as radically new structures for NKT cell stimulation.