A bibliometric analysis of tuberculosis research indexed in PubMed, 1997-2006

OBJECTIVE

To describe a bibliometric review of the literature on tuberculosis (TB) research indexed in PubMed over a 10-year period.

METHODS

Medline was used via the PubMed online service of the US National Library of Medicine from 1997 to 2006. The search strategy was: [(tuberculosis) OR (tuberculous) in all fields].

RESULTS

A total of 35 735 references were located. The average annual growth rate was +4.7%. The articles were published in 2874 scientific journals. Sixteen journals contained 25% of the TB journal literature. The main journal was the International Journal of Tuberculosis and Lung Disease. Western Europe was the most productive region, with 31.1% of the articles. The USA ranked second (21%) and Asia third (19.9%). The USA is the predominant country, followed by India, Japan and the United Kingdom. When normalised by population, the order of prominence is Switzerland, New Zealand and Denmark. Normalised by GDP, Gambia, Malawi and Guinea-Bissau were the most productive countries. Normalised by estimated number of TB cases, Iceland, Switzerland and Norway were in leading positions.

CONCLUSIONS

There was increasing research activity in the field of TB during the period 1997-2006. The countries with more estimated cases of TB produced less research in TB than industrialised countries.

Bioactive glass as precursor of designed-architecture scaffolds for tissue engineering

In this work, the conditions to obtain concentrated and fluid suspensions from a bioactive glass (55-SiO(2); 41-CaO; 4-P(2)O(5); mol %) were investigated. The influence of the heat treatment of the glass on the specific surface area, solubility, bioactivity, and finally on their dispersion characteristics was studied. Zeta potential and viscosity measurements were carried out, and based on the obtained results, the best dispersant was selected. The optimum concentration of dispersant, maximum content of solid and time of mixing were also investigated. Slurries containing 50 vol % could be obtained calcining the glass at 1100 degrees C and using Darvan 811 (sodium polyacrylate) as dispersant. Scaffolds with designed architecture were prepared from these suspensions combining the gelcasting method and the stereolithography technique. A polymeric negative (replica of the desired structure) was previously obtained by stereolithography. The slurry was cast into the molds and then polymerized (gelcasting method). The negative was eliminated by heat treatment. After sintering at 1300 degrees C, scaffolds with interconnected porosity and three-dimensional channels of 400-470 microm and macropores of 1.4 microm were obtained.

Clinical characterisation of pneumonia caused by atypical pathogens combining classic and novel predictors

The aim of this study was to characterise community-acquired pneumonia (CAP) caused by atypical pathogens by combining distinctive clinical and epidemiological features and novel biological markers. A population-based prospective study of consecutive patients with CAP included investigation of biomarkers of bacterial infection, e.g., procalcitonin, C-reactive protein and lipopolysaccharide-binding protein (LBP) levels. Clinical, radiological and laboratory data for patients with CAP caused by atypical pathogens were compared by univariate and multivariate analysis with data for patients with typical pathogens and patients from whom no organisms were identified. Two predictive scoring models were developed with the most discriminatory variables from multivariate analysis. Of 493 patients, 94 had CAP caused by atypical pathogens. According to multivariate analysis, patients with atypical pneumonia were more likely to have normal white blood cell counts, have repetitive air-conditioning exposure, be aged <65 years, have elevated aspartate aminotransferase levels, have been exposed to birds, and have lower serum levels of LBP. Two different scoring systems were developed that predicted atypical pathogens with sensitivities of 35.2% and 48.8%, and specificities of 93% and 91%, respectively. The combination of selected patient characteristics and laboratory data identified up to half of the cases of atypical pneumonia with high specificity, which should help clinicians to optimise initial empirical therapy for CAP.

Hydroxyapatite/SiO(2)-CaO-P(2)O(5) glass materials: in vitro bioactivity and biocompatibility

Materials obtained by the heat treatment of mixtures of hydroxyapatite (HA) and a silicate-based glass of the system SiO(2)-CaO-P(2)O(5) have been investigated. The influence of the glass content on the porosity, microstructure and on the constituent phases of the final materials was studied. The influence of these factors on the in vitro bioactive behaviour of the obtained materials was also investigated. In addition, an in vitro biocompatibility assay with osteoblastic-like cells was carried out. The addition of the glass to HA induced different solid-state reactions that yield the transformation of HA into alpha- and beta-tricalcium phosphate as well as the formation of silicon-containing phases (silicocarnotite or pseudowollastonite). In these mixtures an enhancement in the porosity, pore size and a heterogeneous microstructure was observed, compared with the precursors. As the sol gel glass content increased, the previous effects were higher. The materials showed the formation of an apatite-like layer on their surface when soaked in simulated body fluid, being faster in the sample with a higher content of glass. The formation of the new layer began in preferential zones in both samples, depending on the different reactivity of the crystalline phases formed. A synergistic effect between HA and glass was observed, showing in the mixtures a faster bioactive behaviour than in HA and glass themselves. The obtained materials allow a good attachment, spread and proliferation of the osteoblastic-like cells and no cytotoxic effect was observed.

Regression of papilloma high-grade lesions (CIN 2 and CIN 3) is stimulated by therapeutic vaccination with MVA E2 recombinant vaccine

Human papillomavirus (HPV) is the etiologic agent for cervical cancer. In Mexico, a women dies every 2 h, and since 1990 the statistics have shown that the numbers of deaths are increasing. We conducted a phase II clinical trial to evaluate the potential use of the MVA E2 recombinant vaccinia virus in treating high-grade lesions (CIN 2 and CIN 3) associated with oncogenic papillomavirus. Fifty-four female patients with high degree lesions were treated either with an MVA E2 therapeutic vaccine or with conization. Thirty-four women received the therapeutic vaccine, at a total of 10(7) virus particles per dose injected directly into the uterus once every week over a 6-week period. Twenty control patients were treated with conization. By colposcopy, 19 patients out of 34 showed no lesion, in three patients the lesions were reduced by 85-90%, in eight other lesions had reduced by 60%, and in four more patients, they were reduced by 25%. Histological analysis showed total elimination of high-grade lesions in 20 out of 34 patients after treatment with MVA E2. Eleven patients had a 50% reduction in lesion size. In two other patients, the lesion was reduced to CIN 2 and in one more patient the lesion was reduced to low grade (CIN 1). All patients developed antibodies against the MVA E2 vaccine, and generated a specific cytotoxic response against papilloma-transformed cells. DNA viral load was significantly reduced in MVA E2-treated patients. Conization eliminated the lesions in 80% of the patients, but patients did not develop cytotoxic activity specific against cancer cells and did not eliminate the papillomavirus. In addition, three patients treated with conization had recurrence of lesions 1 year later. These results show that therapeutic vaccination with MVA E2 proved to be very effective in stimulating the immune system against papillomavirus, and in generating regression of high-grade lesion.

Epidemiology of community-acquired pneumonia in adult patients at the dawn of the 21st century: a prospective study on the Mediterranean coast of Spain

This study presents data from a prospective study of adult patients with community‐acquired pneumonia (CAP). Of 493 patients included in the study, 223 (45.2%) were aged ≥ 65 years, and 265 (53.7%) had one or more underlying diseases, mostly chronic obstructive pulmonary disease, diabetes mellitus or dementia. In total, 281 microorganisms were identified in 250 (50.7%) patients, with two or more pathogens detected in 28 (5.7%) cases. Microbial diagnosis varied according to age, severity, co‐morbidity and site‐of‐care, but there was much overlap among groups. Streptococcus pneumoniae was the single most prevalent organism in outpatients, patients admitted to hospital, and patients who died, either as a single pathogen or combined with another organism. Infections caused by ‘atypical’ pathogens were seen across all groups, including the elderly and patients with co‐morbidities. Mortality varied according to the pneumonia severity index (PSI) of the pneumonia patient outcomes research team. Shock (OR 34.48), an age of > 65 years (OR 25) and altered mental status (OR 9.92) were factors associated independently with 30‐day mortality. Key findings from this study were the advanced age of the population with CAP, and the high prevalence of dementia as an underlying disease. The study also revealed that microbiological diagnosis of CAP remains problematic. Although certain epidemiological features may help to predict the microbial aetiology, the overlap among groups reduces the usefulness of this information in guiding therapeutic decisions. Greater effort should be made to improve identification methods for microbial pathogens causing CAP.

Severe toxicity associated with the combination of tenofovir and didanosine: case report and review

The combination of tenofovir and didanosine results in an increase in the didanosine plasma exposure and might augment the risk for didanosine toxicity. Although pharmacokinetic studies support a didanosine dose reduction to 250 mg when used concurrently with tenofovir in patients weighing at least 60 kg, no data are available in lower-weight patients. We describe a case of lactic acidosis and acute liver failure in a low-weight patient receiving tenofovir and a reduced dose of didanosine (200 mg/day). To our knowledge, this is the first case of severe toxicity associated with a reduced dose schedule of didanosine. Previous cases of severe toxicity associated with the combination of tenofovir and didanosine are reviewed.

Community-acquired pneumonia of mixed etiology: prevalence, clinical characteristics, and outcome

Community-acquired pneumonia (CAP) of mixed etiology has increasingly been appreciated in the literature, but its clinical significance remains unknown. The aim of this analysis was to describe the prevalence, clinical characteristics, and outcome of CAP of mixed etiology. Data were obtained from a 2-year prospective study of consecutive patients with CAP in whom an extensive microbiological workup was performed. Predefined strict criteria were used to establish the etiology. A total of 493 patients were included. A single pathogen was detected in 222 (45%) cases and two or more pathogens in 28 (5.7%) cases. Mixed infections were seen across all age groups and in patients treated both in hospital and as outpatients. The most frequent combinations of pathogens were those of a bacterium plus an "atypical" organism (28.6%) and of two bacterial organisms (28.6%). Compared with patients with monomicrobial pneumonia, patients with mixed pneumonia were more likely to have underlying conditions (64% vs. 45%, p=0.04) and dementia (25% vs. 10%, p=0.02). The incidence of a defined series of complications was higher in patients with mixed pneumonia (39.3% vs. 18.6%; OR=2.84; p=0.02). Community-acquired pneumonia of mixed etiology is uncommon. Patients with mixed pneumonia are more likely to have underlying medical conditions, and they may have a more severe course of disease.

The influence of the phosphorus content on the bioactivity of sol–gel glass ceramics

The aim of this work was to study the influence of the phosphorus on the crystallization and bioactivity of glass-ceramics obtained from sol-gel glasses. For this purpose two sol-gel glasses with a similar composition but one of them containing P2O5 (70% SiO2; 30% CaO and 70% SiO2; 26% CaO; 4% P2O5, mol%) were prepared. Pieces of these glasses were treated at temperatures ranging between 700 degrees C and 1400 degrees C for 3 h. The obtained materials were characterized by XRD, FTIR, SEM-EDS and the biaxial flexural strength was determined in samples heated at 1100 degrees C. In addition, an in vitro bioactivity study in simulated body fluid (SBF) was carried out. The results showed that phosphorus plays an important role in the crystallization of the glasses: it induced the crystallization of calcium phosphate phases, the stabilization of the wollastonite phase at high temperature as well as the crystallization of SiO2 phases at low temperatures. Moreover, the presence of phosphorus produced a heterogeneous distribution of defects in the pieces and, therefore, the flexural strength of samples containing this element decreased. Finally, glass-ceramics obtained from glasses containing phosphorus showed the fastest formation rate of the apatite layer when soaked in SBF.

Bioactive and biocompatible pieces of HA/sol-gel glass mixtures obtained by the gel-casting method

Hydroxyapatite (HA)/glass mixtures have shown a faster bioactive behaviour than HA itself. On the other hand, the gel-casting method is a simple and reproducible colloidal method to produce ceramic pieces with complex shapes. In this work, pieces of HA/glass mixtures were prepared by the gel-casting method. A study for obtaining concentrated slurries of these mixtures is reported; the bioactivity and biocompatibility of the obtained pieces have been studied also. The influence of pH, dispersant concentration, the content and milling of glass, and the way to prepare the suspensions were investigated. The lowest viscosity and better rheological properties were achieved with the lowest glass content, when the glass was added after the dispersion of the HA powder and when the glass was not milled after calcination. Fluid suspensions with a high solid content (50 vol.%) could be prepared and well-shaped pieces were obtained from these slurries. These pieces showed in vitro bioactive behavior in simulated body fluid; additionally, the proliferation and spreading assays with osteoblastic cells (HOS) showed that the pieces are biocompatible. The results obtained indicate that the gel-casting of HA/glass mixtures produces bioactive and biocompatible pieces with the required shapes. Therefore, these materials could be good candidates for clinical applications and scaffolds for tissue engineering.

Epidemiological and clinical characteristics of occult bacteremia in an adult emergency department in Spain: influence of blood culture results on changes in initial diagnosis and empiric antibiotic treatment

A prospective study was carried out to analyze the usefulness of blood culture results for adult patients who were discharged from the emergency department with bacteremia. Over a 29-month period, 110 patients with significant bacteremia who were seen in the emergency department and discharged home were studied. The mean age of the patients was 61.8 years. The most frequent initial major diagnosis was urinary tract infection (UTI) (n=63; 57.3%). Gram-negative organisms were isolated in 79 (71.8%) cases. A change in diagnosis (44.5% cases) was more common when the initial diagnosis was something other than UTI or when empiric antimicrobial therapy was ineffective or was not given (P<0.001). The significant predictors of modification of the initial empiric antibiotic therapy were ineffective empiric antimicrobial therapy and transfer of the patient from the emergency department to an infectious diseases outpatient clinic (P=0.01). Blood culture results may be useful for achieving the correct diagnosis in adult patients with bacteremia and for guiding treatment in the subsequent management of outpatients.

Altered neurometabolite development in HIV-infected children: correlation with neuropsychological tests

BACKGROUND

HIV-infected children have abnormal cerebral metabolites, measured by proton MR spectroscopy ((1)H-MRS), but how these abnormalities relate to brain function is unclear.

METHODS

Metabolite concentrations in five brain regions of 20 HIV-infected and 13 control children were measured, and these findings were correlated with age, log(10) plasma viral load, CD4 count, and neuropsychological scores.

RESULTS

Compared with control subjects, HIV patients had decreased choline concentration [Cho] in left frontal white matter (LFW) (-12%; p = 0.04); those with high viral load (>5,000 HIV RNA copies/mL) had decreased right basal ganglia (RBG) [Cho] (-15%; p = 0.005), and [Cr] (-13%; p = 0.02). Patients with high viral load also had higher [Cho] in the midfrontal gray matter (MFG) (+25%; p = 0.002) and lower myo-inositol [Ins] in the RBG (-18%; p = 0.04) than patients with low HIV viral load. N-Acetyl aspartate concentration ([NAA]) correlated with age in right frontal white matter (RFW) (r = 0.59, p = 0.04), LFW (r = 0.66, p = 0.02), and right hippocampus (RHIP) (r = 0.69, p = 0.02) only in control subjects. In contrast, [Ins] correlated with age in both RFW and LFW (r = 0.71, p = 0.0006; r = 0.65, p = 0.006) only in the HIV patients. Log(10) plasma viral load correlated positively with [Ins] in RFW (r = 0.54, p = 0.02) and [Cho] in MFG (r = 0.49, p = 0.04). Compared with control subjects, HIV patients had poorer spatial memory (p = 0.045) and delayed spatial memory correlated with [Cho] in RHIP (r = 0.68, p = 0.02).

CONCLUSIONS

These data suggest that normal brain development may be affected in children infected with HIV at birth, particularly evidenced by the lack of age-related increases in the neuronal marker [NAA]. Early, aggressive treatment of infants with HIV before development of encephalopathy is warranted.

Further assessment of an in vitro screen that may help identify organophosphorus pesticides that are more acutely toxic to the young

Some, but not all, organophosphorus pesticides are more acutely toxic to the young as compared to adults. We have developed an in vitro assay that measures the detoxification potential (via carboxylesterase and A-esterases) of tissues. Previous results using this in vitro screen correlated with the marked in vivo sensitivity of the young to chlorpyrifos and also correlated with the equal sensitivity of the young and adult to methamidophos (Padilla et al., 2000). We have now extended these observations to two other pesticides that have already been shown in the literature to be more toxic to the young: parathion (paraoxon) and malathion (malaoxon). In our in vitro assay, liver or plasma from 7-d-old rats were much less efficacious than adult tissues at detoxification of the active metabolites of these two pesticides. Using our in vitro assay we also tested the active metabolite of diazinon, diazoxon, and again found that young liver or plasma possessed much less detoxification capability than adult tissues. From these results, we predicted that young animals would be more sensitive to diazinon, which, in fact, was the case: When postnatal day (PND) 17 or adult rats were given a dosage of 75 mg/kg diazinon, adult brain cholinesterase (ChE) was only inhibited 38%, while the brain ChE in the PND 17 animals showed much more inhibition (75%). We conclude that our in vitro screen may prove to be a useful, quick, convenient test for identifying which organophosphorus pesticides may be more acutely toxic to the young as compared to adults.

Physiological variables to use in the gender comparison in highly trained runners

AIM

The aims of this investigation were to compare physiological characteristics between highly trained middle-distance and marathon male (n=17) and female (n=11) runners; to determine the most suitable variables to use in the gender comparison in these subjects, considering physical difference between genders; and to indicate some of the best predictors of performance in running events in which oxidative metabolism prevails.

METHODS

Subjects performed a progressive maximal exercise on the treadmill to determine maximal oxygen uptake (VO(2max)) and velocities corresponding to a blood lactate concentration of 4 mmol x L(-1) (upsilon(OBLA)) and to the lactate threshold (upsilon(LT)). Cost of running (Cr) and maximal aerobic velocity (upsilon(a max)) were calculated from VO(2) measurements.

RESULTS

Males presented higher VO(2max), upsilon(a max), upsilon(OBLA), upsilon(LT), and VO(2) @ upsilon(OBLA) and upsilon(LT) (p<0.001), but females had higher upsilon(OBLA) and upsilon(LT) (p<0.01) expressed as %VO(2max). upsilon(a max) correlated with performance time relative to the world record in both, females (r=-0.77, p<0.01) and males (r=-0.58, p<0.05); and upsilon(LT) with performance only in males (r=-0.59, p<0.05).

CONCLUSION

In conclusion, female athletes seemed to compensate partly their aerobic profile with higher %VO(2max) @ u(OBLA) and u(LT), suggesting that both maximal and submaximal physiological variables should be considered when evaluating and comparing highly trained athletes of both genders. upsilon(a max) is one of the best predictors of performance in running events in which oxidative metabolism prevails.

Bioactive glasses as accelerators of apatite bioactivity

Synthetic carbonatehydroxyapatite is the ceramic closest to the mineral component of human bone and seems, therefore, the optimum material to use in osseous implants. However, in vitro assays performed to determine its bioactivity have shown no positive results after 2 months of assay. With the aim of improving this bioactivity, a new biphasic material was synthesized composed mainly of synthetic carbonatehydroxyapatite and only 5% of a sol-gel bioactive glass. In vitro assays were assessed to determine the bioactive behavior of this new material and revealed that the addition of a minimal amount of bioactive glass is enough to induce bioactivity on synthetic carbonatehydroxyapatites.

Expanded bed adsorption processing of mammalian cell culture fluid: comparison with packed bed affinity chromatography

A comparison between expanded bed adsorption and conventional packed bed Protein A Fast Flow to purify the anti-rHBsAg mAbs from feedstock is presented in this work. Direct capture by STREAMLINE expanded bed adsorption chromatography resulted in 92% product recovery and sevenfold more concentrated product with similar purity levels compared to that obtained by the standard packed method. The process time and buffer consumption were reduced in the expanded bed adsorption method not only with the binding-elution conditions but also with the use of NaOH during the cleaning-in-place step. The latter is the most widely accepted agent in downstream processing, being a cost effective technique that provides not only efficient cleaning but also sanitizes complete column systems and destroys pirogens.

Synthesis of porous hydroxyapatites by combination of gelcasting and foams burn out methods

The biocompatibility and the osteoconductive behavior of hydroxyapatite (OHAp) ceramics are well established. Bioceramics made of OHAp are available in dense and porous form. Recently it has been proved that the volume of bone ingrowth at early times is primarily interconnectivity dependent. A new method for the obtention of porous OHAp ceramics that combine the in situ polymerization (gel casting method) and the foams burn out is proposed. Four polyurethane foams with different cells/cm were used. The foams were fully filled of an OHAp polymerizable suspension that after gelled produced very homogeneous and strong green bodies. After different thermal treatments the green bodies yield porous OHAp ceramics that were a replica of the foams used. Materials used in this work were studied by X-ray diffraction (XRD), X-ray fluorescence (XRF), scanning electron microscopy (SEM), N(2) adsorption isotherm, particle size distribution, and Hg porosimetry. Porous pieces of OHAp obtained are constituted by polyhedral-like particles (0.45-1.0 microm) that are surrounded by an interconnected network of pores. A bimodal distribution of the pores size between 30.8-58.6 and 1.0-1.2 microm has been observed. The size of the interconnected pores (30.8-58.6 microm) was controlled as a function of the cells/cm of the foam while the volume of the small pores was modified as a function of the sintering time. The presence of pores could promote the bone ingrowth and also could be used to insert different drugs, which makes these porous pieces a potential candidate to be used as non-load-bearing bone implants and as drug delivery systems.

Swimming performance changes during the final 3 weeks of training leading to the Sydney 2000 Olympic Games

The purpose of this study was to determine the magnitude of the swimming performance change during the final 3 weeks of training (F3T) leading to the Sydney 2000 Olympic Games. Olympic swimmers who took part in the same event or events at the Telstra 2000 Grand Prix Series in Melbourne, Australia, (26 - 27 August 2000), and 21 - 28 d later at the Sydney 2000 Olympic Games (16 - 23 September 2000) were included in this analysis. A total of 99 performances (50 male, 49 female) were analysed. The overall performance improvement between pre- and post-F3T conditions for all swimmers was 2.18 +/- 1.50 % (p < 0.0001), (range - 1.14 % to 6.02 %). A total of 91 of the 99 analysed performances were faster after the F3T and only 8 were slower. The percentage improvement with F3T was significantly higher (P < 0.01) in males (2.57 +/- 1.45 %) than in females (1.78 +/- 1.45 %). In conclusion, the pre-Olympic F3T elicited a significant performance improvement of 2.57 % for male and 1.78 % for female swimmers at the Sydney 2000 Olympic Games. The magnitude was similar for all competition events, and was achieved by swimmers from different countries and performance levels. These data provide a quantitative framework for coaches and swimmers to set realistic performance goals based on individual performance levels before the final training phase leading to important competitions.

In vitro release of gentamicin from OHAp/PEMA/PMMA samples

The influence of hydroxyapatite (OHAp) and gentamicin sulphate (GEN) contents on the release kinetics of GEN, in samples composed of OHAp, poly(methyl methacrylate) (PMMA) and poly(ethyl methacrylate) (PEMA) has been studied. For this purpose, samples with 30 and 40% of OHAp and 5 and 9% of GEN were prepared. The in vitro release study was carried out soaking the samples in simulated body fluid (SBF) at 37 degrees C for 70 days. The release profiles showed a faster release during the first 10 h, diminishing progressively until the end of the study. It was noticed that the percentage of released GEN increased with the OHAp content. For samples with 40% of OHAp, GEN release is nearly independent of the initial amount of such drug (in the range 5-9%), whereas for samples with 30% of OHAp, the release process is favoured by higher contents of GEN, which would favour a higher SBF uptake. GEN release is related to SBF uptake, which is in turn related, on the one hand, to the OHAp content (increase of the porosity and the hydrophilic character of the samples) and on the other hand, to content of GEN.

Chromatographic removal combined with heat, acid and chaotropic inactivation of four model viruses

The virus removal of protein A affinity chromatography, inactivation capacity, acid pH and a combination of high temperature with a chaotropic agent was determined in this work. The model viruses studied were sendaivirus, human immunodeficency virus (HIV-IIIb), human poliovirus type-II, human herpesvirus I and canine parvovirus. The protein A affinity chromatography showed a maximum reduction factor of 8 logs in the case of viruses larger than 120 nm size, while for small viruses (18-30 nm) the maximum reduction factor was about 5 logs. Non viral inactivation was observed during the monoclonal antibody elution step. Low pH treatment showed a maximum inactivation factor of 7.1 logs for enveloped viruses. However, a weak inactivation factor (3.4 logs) was obtained for DNA nonenveloped viruses. The combination of high temperature with 3 M KSCN showed a high inactivation factor for all of the viruses studied. The total clearance factor was 23.1, 15.1, 13.6, 20.0 and 16.0 logs for sendaivirus, HIV-IIIb, human poliovirus type-II, human herpesvirus I and canine parvovirus, respectively.