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OBJECTIVE: To study the level of concordance between the reactive strip, urine sediment and culture, and their sensitivity, specificity and predictive values. DESIGN: Crossover study. SETTING: Sotrondio and Laviana Health Centres, Asturias. PARTICIPANTS: Diabetics of 14 or over included in the procedure. MEASUREMENTS AND MAIN RESULTS: A total of 165 analytical samples of blood and urine were studied. The variables were: age, sex, reactive strip (RS) of urine, sediment (S), binomial concordance of reactive strip-sediment (RS-S), culture (C) and metabolic control. The level of concordance between the variables was found through the Kappa index. Very high concordance was obtained in the RS-S and C comparisons (K = 0.49). The analysis of the variable RS-S displayed sensitivity of 66% and specificity of 87%. CONCLUSIONS: Finding a low concordance between reactive strip, sediment and culture suggests their non-exclusive character. The importance of requesting urine sediment instead of the reactive strip for diabetics is indicated. Urine culture could well be included in the diabetic protocol.

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OBJECTIVE: To call attention to the visual sharpness disorders which pre-school children on a determined paediatric list present. DESIGN: A descriptive study. SETTING: Riaño Health Centre, Langreo, Asturias. PARTICIPANTS: Pre-school children aged 4 and 5 at the study date (1994). MEASUREMENTS AND MAIN RESULTS: A total of 155 children captured for the study through the nursing child programme were evaluated. Data were collected from their corresponding clinical histories. Evaluation was performed by Paediatrics and Ophthalmology specialists and second-year interns in Family and Community Medicine at the Valle del Nalón hospital. To check ocular alignment, the Hirschberg test was used; and to explore visual sharpness, the Pigassou optotype was applied. Disturbance of ocular alignment was suspected in 40.6% of cases and pathology was confirmed in 58.3%; whereas in 44% of cases referral to the ophthalmologist was due to errors in the visualisation of the optotype, with 50% presenting pathology. Amblyopia was found in 5.4% of the total population studied. In the breakdown of ophthalmic pathology it was observed that compound astigmatism was the most common finding (25%). CONCLUSIONS: 1. The high prevalence of Amblyopia found underlines the importance of considering it as a priority objective in prevention programmes. 2. The Hirschberg test and early use of optotypes should be considered elementary routine exploration tests in the scheduled check-ups. 3. It would be useful to strengthen training within the population as a whole as well as improve the linking of Primary and Specialist Care.

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The effect of iron status on aluminum (Al) absorption was investigated in this study in vivo using an animal model and in vitro using an intestinal mucosal cell line. In the in vivo model rats were rendered iron overloaded by intraperitoneal injection of iron dextran (5 mg/48 hr) or iron deficient by phlebotomy (2.5 to 3 ml blood/week). These rats, and normal controls, were then dosed with Al(OH)3 (40 mg/day) for 30 days. Urinary excretion of Al was significantly greater in the iron deficient group than in the other two groups throughout the study period, and brain Al at the end of the experiment was significantly increased in the iron depleted group (1.93 micrograms/g) and decreased in the iron overloaded group (0.73 microgram/g) compared with controls (1.42 micrograms/g). The brain Al levels in iron overloaded rats were no higher than those in normal rats that had not been dosed with Al(OH)3 (0.61 microgram/g). No significant differences were found in serum Al levels. In the in vitro experiments cultures of the rat intestinal cell line RIE1 were iron overloaded by addition of iron nitrilotriacetate (0.1 mM) or iron depleted with desferrioxamine (5 micrograms/ml) for 20 days prior to pulsing with Al transferrin (0.5 mg/ml) for 24 hours. Uptake of Al was significantly greater in the iron depleted cells (2.3 ng/micrograms cell DNA) than in iron overloaded (0.81 ng) or untreated (0.83 microgram) cells. These studies show that iron depletion markedly increases absorption and cellular uptake and suggest that susceptible individuals, such as renal failure patients, run an increased risk of toxicity if they are iron deficient.

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In this study we have evaluated the haematological consequences of chronic aluminium (Al) overload. We have also investigated 'in vivo' whether aluminium overload may modulate gastrointestinal iron (Fe) absorption and 'in vitro' whether the presence of aluminium may influence the cellular uptake of iron. The in vivo studies were performed in rats with normal renal function and the in vitro experiments were done using the rat intestinal epithelial cell line RIE-1. The results demonstrate that aluminium deposit in tissues even with normal renal function. The intraperitoneal aluminium loading resulted in serum and tissue aluminium increases comparable with concentrations found in aluminium-intoxicated renal patients. The aluminium intoxication was accompanied by a microcytic anaemia with a haematological pattern similar to that observed in iron-deficiency anaemia. Nevertheless, iron absorption was significantly reduced despite an increased total iron binding capacity (TIBC). In addition, aluminium was also able to reduce in vitro cellular uptake of iron in the RIE-1 intestinal cell line. These experimental results demonstrate that aluminium interferes with iron absorption and iron transfer, and suggest that these mechanisms may be responsible for maintaining and even increasing the anaemia observed in aluminium overload.

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The investigation of different aluminium-binding agents and metabolic conditions that might act as critical factors in modulating aluminium absorption could yield valuable information in the understanding of aluminium gastrointestinal absorption. We evaluated the effect of iron depletion in aluminium uptake and the role of transferrin and citrate in aluminium incorporation by the intestinal epithelial cell line RIE1. Both complex, aluminium-citrate and aluminium-transferrin were prepared in a molar ratio of 2:1; both facilitated the aluminium uptake although a greater aluminium incorporation was found when aluminium was administered as aluminium-transferrin. This difference became even greater in the iron-depleted cells (normal cells vs iron-depleted cells): 7.7 +/- 1.4 versus 30 +/- 5.6 ng Al/micrograms DNA (P less than 0.05). From these and previous data it is possible to speculate that iron status could modulate the intestinal uptake of aluminium and that both transferrin and citrate would act as effective carriers in the incorporation of aluminium into mucosal cells.

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