As part of a case-control study of community-acquired Legionnaires' disease, several factors related to residential water distribution systems and public drinking water systems were studied in the ...homes of 124 patients with community-acquired Legionnaire's disease and in the homes of 354 controls. The presence of water reservoirs and hot water tanks was studied in residential systems. Factors such as deficient chlorine levels, pipe repairs and other work, water flow interruptions, the use of alternative water sources, inadequate cleaning operations in public water reservoirs, and the position of the home within the public network (and whether this location constituted an endpoint) were studied in public water supply systems. Levels of legionellae in domestic water samples were also measured. Although the use of water reservoirs and hot water tanks promotes colonization by legionellae in residential systems, none of the variables studied seems to increase the incidence of community-acquired Legionnaires' disease.
Our aim was to assess reference values of thyroid volume by ultrasonography in healthy adult subjects. We conducted an epidemiological cross-sectional study where 880 subjects were randomly selected ...from the town census of L'Hospitalet de Llobregat after being invited to participate in our study directly by mail and phone call. We made a clinical history of each subject and determined serum thyrotropin, antiperoxidase antibodies, urinary iodine excretion and thyroid volume by ultrasonography. Subjects with thyroid disease were excluded. We finally studied 268 representative subjects. The reference thyroid volume was median 7.31 ml, mean 8.22 ml (Confidence Interval: 7.75 - 8.69 ml). In men: median 9.19 ml, mean 9.87 ml (CI: 9.09 - 10.65 ml); in women: median 6.19 ml, mean 6.57 ml (CI: 6.22 - 9.92 ml) (p < 0.0001). We grouped the subjects into decades, and found that thyroid volume was different (p = 0.0034) in males because the younger group had lower volume. We did not find any differences among age groups in women. The mean of the urinary iodine excretion was 154.23 microg/l. We have determined reference values of thyroid volume measured by ultrasonography in our iodine non-deficient population and prepared tables that distribute thyroid volume by sex and age.
We studied the relationship between thyroid volume, thyroid function and immunological markers of Graves' disease (GD) to determine prognostic factors of treatment response to low-dose ...radioiodine-131 (131I).
A prospective study of 40 patients with GD hyperthyroidism treated with 131I (141 +/- 85MBq) and 10 GD patients who went spontaneously into remission (controls). Free T4, total T3 and basal TSH levels, TSH-receptor antibodies (TRAb) and anti-thyroid peroxidase antibodies (TPOAb) were studied. Thyroid volume was determined by ultrasonography. Logistic regression models were used to predict the probability of final thyroid status. Receiver-operating characteristics (ROC) curves and Hosmer Lemeshow tests were used to evaluate the final statistical models.
Of 40 patients treated with 131I, 16 became euthyroid, 12 hyperthyroid and 12 hypothyroid at 12 months. Median thyroid volume was reduced from 24.8 ml before to 8.5 ml at 12 months (p<0.001). In 10 control patients, the median reduction was from 16.6 ml to 11.3 ml (p=0.029). Thyroid volume reduction was lower in the hyperthyroid than in the euthyroid group, but higher in the hypothyroid group. Thyroid volume at baseline and at 3 months predicted hyperthyroidism outcome with a cut-off of 45 ml and 24.4 ml, respectively (odds ratio 1.074, p=0.003, ROC curve 0.78 and odds ratio 1.182, p=0.012, ROC curve 0.86 respectively). Thyroid volume at 6 months differentiated the hyperthyroid group with a cut-off of 17 ml. Thyroid volume at 3 and 6 months with a cut-off of 8.5 ml and 9.3 ml respectively, predicts permanent hypothyroidism outcome (odds ratio 0.768 and 0.685, p=0.012 and p=0.008, ROC curve 0.89 and 0.88, respectively). Changes in thyroid echogenicity and TRAb and TPOAb levels did not show any predictive value in the follow-up after 131I therapeutic outcome.
The study shows that the ultrasonographic thyroid volume at 3 and 6 months after low-dose 131I treatment for GD hyperthyroidism could be a reliable prognostic factor of thyroid function outcome in the first year after treatment, and also reveals that the changes in the thyroid echogenicity and in the immunological markers of GD have no prognostic value.
The aim of this cross-sectional study was to assess and compare thyroid volume and its derminants in a cohort of type 1 diabetes mellitus (DM1) and compare the results to a healthy control group. We ...studied 65 DM1 patients treated with an intensive insulin regimen and 65 matched controls. In all participants we evaluated weight, height, BMI, waist-hip ratio, body surface area and body composition variables determined by using a bioelectrical impedance analyser. Thyroid size was estimated by ultrasonography. We determined basal TSH, anti-thyroid antibodies and urinary iodine excretion. Body weight, height, BMI and body surface area were similar in DM1 patients and in controls. Fat-free mass was higher in both male and female DM1 patients than in controls (64.4 +/- 6.9 vs. 60.4 +/- 8.2 kg, p=0.03 and 48.3 +/- 5.7 vs. 45.4 +/- 6, p=0.04, respectively), and fat mass was lower in male DM1 patients than in controls (9.7 +/- 7 vs. 14.2 +/- 8.1 kg, p=0.01). Thyroid volume was greater in both male and female DM1 patients than in controls (11.12 +/- 2.87 vs. 9.63 +/- 2.27 ml, p=0.0001 and 9.5 +/- 2.3 vs. 7.7 +/- 2 ml, p=0.002, respectively). Urinary iodine excretion was similar in the two groups. In both DM1 patients and controls, thyroid volume correlated with weight, height, BMI, waist-hip ratio, body surface area, fat-free mass and the multivariate linear regression analysis with thyroid volume as the dependent variable showed that fat-free mass in either group was the only significant determinant of thyroid volume. We conclude that DM1 patients had larger thyroid volume compared with healthy controls with similar anthropometry; body composition is different in DM1 patients and that the anthropometric and body composition variables, especially fat-free mass and body surface area, predict thyroid volume either in DM1 patients or in healthy controls.
SETTING: The adult tuberculosis ward of a public hospital in the city of Santa Cruz, Bolivia.OBJECTIVES: To identify risk factors for dying among adult patients hospitalised with pulmonary ...tuberculosis.DESIGN: Hospital-based cross-sectional study of patients admitted consecutively with pulmonary tuberculosis during the period November 1993-February 1996.RESULTS: A total of 466 patients were admitted to the study. There were 305 (65%) males, and the mean age was 33.1. Seventy-five patients (16%) died during hospitalisation. Multiple logistic regression analysis identified the following predicting variables for death: associated pathology (odds ratio OR 2.88; 95% confidence interval CI 1.48-5.36), female sex (OR 2.08; 95%CI 1.23-3.52), and number of lobes affected (OR 1.48; 95%CI 1.23-1.79).CONCLUSIONS: These three variables predicting death allow us to identify patients with a diagnosis of pulmonary tuberculosis who should have priority for receiving hospital care. In Bolivia, physicians faced with a shortage of hospital beds should determine the presence or absence of this group of variables when evaluating patients for possible admission.
Belgian Blue cattle suffer from an extreme sensitivity for infection by the Psoroptes ovis mite, causing an itchy, crusty dermatitis with economical and animal welfare consequences. Interbreed ...differences suggest mange sensitivity is heritable, while the intrabreed differences open perspectives for genetic selection as a sustainable solution. Our study is the first attempt to unravel the genetic background of psoroptic mange sensitivity. Six-hundred-and-seventy Belgian Blue animals were phenotyped based on lesion extent, lesion appearance, and mite counts, measured at three consecutive farm visits. Collected blood samples were then genotyped with the Illumina Bovine SNP50 v2 BeadChip. A haplotype based association analysis (GLASCOW) of the animals with extreme phenotypes showed a suggestive signal at the telomere of chromosome 11, with the most prevalent haplotype cluster having a substantial impact on the phenotype. A 1.3 Mb region of interest could be delineated after imputation and consequent bootstrapping of the region around the peak. Due to the intergenic location of the associated markers, a candidate gene is presented based on its location in the specific region and its relationship with other parasitic diseases. In addition, the possible role of collagens and lipocalins is described, illustrating the need for future research that can eventually lead to a genetic selection program for more mange resistant Belgian Blue.
To measure the health status of critically ill patients prior to hospital admission and to study the relationship between prior health status (PHS) and hospital mortality.
523 patients admitted to ...the intensive care department from October 1994 to June 1995 were included consecutively in the study. Health status 3 months prior to admission was assessed retrospectively by proxies using the EuroQol 5D (EQ-5D) and the Karnofsky Performance Status Scale (KF). Patients were classified into four admission categories: trauma injury, scheduled surgery, unscheduled surgery and other medical conditions.
Department of Intensive Medicine, University Hospital of Bellvitge, Barcelona, Spain.
84 trauma injury patients, 239 scheduled surgery patients, 57 unscheduled surgery patients and 143 patients with other medical conditions.
The descriptive system and visual analogue scale (VAS) of the EQ-5D and the K.F.
Using proxy responses we found that trauma injury patients had the best PHS and scheduled surgery patients the worst. There were statistically significant differences in mean VAS scores and all EQ-5D dimensions, except self-care, when trauma injury patients or scheduled surgery patients were compared with the other admission categories. No significant differences were found on these variables between unscheduled surgery patients and medical patients. We found no statistically significant differences in PHS health status between patients who died and those who survived, either within each admission category or in the sample as a whole.
The PHS of critically ill patients varied according to admission category. Given the instruments used and population studied, there was no association between PHS and hospital outcome.
PURPOSETo assess the reliability of intraocular pressure measurements by Goldmann applanation tonometry versus pneumotonometry after laser in situ keratomileusis for myopia.
PATIENTS AND METHODSIn ...this prospective study, corneal Goldmann applanation tonometry and pneumotonometry measurements were made in 118 eyes of 60 patients before and 1 and 3 months after undergoing laser in situ keratomileusis for myopia. Manifest refraction, ultrasonic corneal thickness measurements, and keratometry readings were also obtained.
RESULTSPreoperative intraocular pressure showed a good correlation between Goldmann applanation tonometry and pneumotonometry values (Pearson r = 0.71;P < 0.001), although Goldmann applanation tonometry readings were slightly higher at low intraocular pressure values and slightly lower at high intraocular pressure values. After a mean stromal ablation depth of 77.1 μm, mean intraocular pressure by Goldmann applanation tonometry decreased significantly (P < 0.001) from a preoperative value of 14.8 ± 11.9 mm Hg to 11.9 ± 2.1 mm Hg and 11.7 ± 1.7 mm Hg after 1 and 3 months, respectively. Mean pre– and post–laser in situ keratomileusis measurements by pneumotonometry were similar (P = 0.8). Differences of postoperative intraocular pressure measurements by Goldmann applanation tonometry and pneumotonometry were statistically significant. After 3 months, there was a poor correlation between Goldmann applanation tonometry and pneumotonometry intraocular pressure values (Pearson r = 0.58). Postoperative intraocular pressure decrease in applanation tonometry correlated with changes in keratometry, spherical equivalent, and central corneal thickness. Regression analysis showed a decrease of 2.9 mm Hg per 70 μm reduction in central corneal thickness.
CONCLUSIONSContact pneumotonometry measures the IOP reliably after laser in situ keratomileusis for myopia, whereas Goldmann applanation tonometry underestimates the intraocular pressure. This may be important in the treatment of any future glaucoma.
