Annotated catalogue of the flowering plants of São Tomé and Príncipe

A catalogue of the flowering plants of the islands of São Tomé and Príncipe (Gulf of Guinea) is presented. Flowering plant diversity figures are updated to: 135 families (20 introduced), 624 genera (172 introduced), 1 104 species (301 introduced) plus 15 additional infraspecific taxa. At present 119 taxa (107 species and 12 infraspecific taxa) are known to be endemic to the two islands. The catalogue includes accepted names, synonyms used in recent literature, common names, voucher specimens and information on habit and habitat and on plant uses, particularly medicinally.

[Observing migration and deficiencies in health care - STD center at the Cologne Municipal Health Department]

BACKGROUND

In spite of the compulsory health insurance in Germany, many people only have limited access to medical services. This has serious consequences, especially in the field of sexual health. The affected people are not only undocumented migrants, but also many people from the new European Union countries who are temporarily living in Germany. Many of these people, especially in larger cities, frequent STD counselling centers.

METHOD

Since 2002, in addition to basic socio-demographic data, other anonymous data have been recorded for all consultations in the STD offices of the Cologne Health Department. These data include the patients' country of origin, rea-son for consultation, whether the patients are medically insured, as well as the medical services provided and the diagnoses. The data is evaluated with the help of EpiInfo.

RESULTS

During the study period, between 608 and 883 people visited the STD Counselling Centre per year. During this period, 4 235 people received in total medical help. The proportion of patients with a migration history rose from 65% in 2002 to 83% in 2010. The proportion of patients without health insurance rose from 45% (2002) to 67% (2010).About half of the counselled migrants were, at least for a short time, involved in professional sexwork. The number of counselled patients from the sub-Saharan region decreased from 123 (2002) to 72 (2010). The number of patients from Central Europe increased from 112 to 364 in this period.Migrants were over-represented in the group of patients who were diagnosed with gonorrhea and trichomoniasis, as well as among women with a conspicuous cytological swab. Chlamydia infections were, in contrast, more frequent among German clients.Gender, sexual orientation, age and the proportion of people involved in sexwork are, however, more important predictive factors than having an immigration status.

CONCLUSION

The client spectrum has changed considerably during the study period.These changes are related to economic and political developments, as well as to the consequences of immigration laws. For the majority of patients with a migration history, the STD centre is the primary means of access to medical care in Germany. The rapid change in the client spectrum, the patients' limited access to information and to medical care and the resulting changes in epidemiology represent a major challenge for the public health services.

Differences in evolution of children with non-severe acute lower respiratory tract infection with and without radiographically diagnosed pneumonia

OBJECTIVE

To identify differences in the evolution of children with non-severe acute lower respiratory tract infection between those with and without radiographically diagnosed pneumonia.

DESIGN

Prospective cohort study.

SETTING

A public university pediatric hospital in Salvador, Northeast Brazil.

PATIENTS

Children aged 2-59 months.

METHODS

By active surveillance, the pneumonia cases were prospectively identified in a 2-year period. Each case was followed-up for changes in various clinical symptoms and signs. Demographic, clinical and radiographic data were recorded in standardized forms. Exclusion was due to antibiotic use in the previous 48 hours, signs of severe disease, refusal to give informed consent, underlying chronic illness, hospitalization in the previous 7 days or amoxicillin allergy. Chest X-ray (CXR) was later read by at least 2 independent pediatric radiologists.

MAIN OUTCOME MEASURES

Radiographic diagnosed pneumonia based on agreed detection of pulmonary infiltrate or pleural effusion in 2 assessments.

RESULTS

A total of 382 patients receiving amoxicillin were studied, of whom, 372 (97.4%) had concordant radiographic diagnosis which was pneumonia (52%), normal CXR (41%) and others (7%). By multivariate analysis, age (OR=1.03; 95% CI: 1.02-1.05), disease > 5 days (OR = 1.04; 95% CI: 1.001-1.08), reduced pulmonary expansion (OR = 3.3; 95% CI: 1.4-8.0), absence of wheezing (OR = 0.5; 95% CI: 0.3-0.9), crackles on admission (OR = 2.0; 95% CI: 1.2-3.5), inability to drink on day 1 (OR = 4.2; 95% CI: 1.05-17.3), consolidation percussion sign (OR = 7.0; 95% CI: 1.5-32.3), tachypnea (OR = 2.0; 95% CI: 1.09-3.6) and fever (OR = 3.6; 95% CI: 1.4-9.4) on day 2 were independently associated with pneumonia. The highest positive predictive value was at the 2nd day of evolution for tachypnea (71.0%) and fever (81.1%).

CONCLUSION

Persistence of fever or tachypnea up to the second day of amoxicillin treatment is predictive of radiographically diagnosed pneumonia among children with non-severe lower respiratory tract diseases.

Resonant Raman scattering in ZnO:Mn and ZnO:Mn:Al thin films grown by RF sputtering

Raman spectroscopy results obtained under visible (non-resonant) and UV (resonant) excitation for nanocrystalline ZnO, ZnO:Mn and ZnO:Mn:Al thin films grown by radio frequency magnetron sputtering are presented and compared. The origin of the multiple longitudinal optical (LO) phonon Raman peaks, strongly enhanced under resonance conditions, and the effects of the dopants on them are discussed in the framework of the 'cascade' model. It is suggested that the observed suppression of the higher-order LO phonon lines for ZnO:Mn:Al is caused by the dissociation of excitons in the heavily n-type doped material. On the basis of the cascade model interpretation of the higher-order Raman peaks in the resonant spectra, the LO phonon frequencies for wavevectors away from the Γ point are evaluated and compared to previously published phonon dispersion curves.

Purification and biochemical characterization of Eumiliin from Euphorbia milii var. hislopii latex

A protease, which we designate Eumiliin, was isolated from the latex of Euphorbia milii var. hislopii by a combination of ion-exchange chromatographic steps using DEAE-Sephacel and gel-filtration with Sephadex G-75. Eumiliin is a monomeric protein with an apparent molecular mass of 30 kDa by SDS-PAGE under reducing conditions and gave one main peak at 29,814 KDa in MALDI-TOF/TOF mass spectrometry. Eumiliin has caseinolytic and fibrinogenolytic activities, but no hemorrhagic or defibrinating activities. The enzyme readily hydrolyzes the Aalpha-chain of fibrinogen and, more slowly, the Bbeta-chain. Its fibrinogenolytic activity is inhibited by beta-mercaptoethanol and leupeptin. In contrast, EDTA and benzamidine did not affect the activity of Eumiliin. The caseinolytic activity of Eumiliin had a pH optimum of 8.0 and was stable in solution at up to 40 degrees C; activity was completely lost at >or=80 degrees C. Intraplantar injection of Eumiliin (1-25 microg/paw) caused a dose- and time-dependent hyperalgesia, which peaked 1-5h after enzyme injection. Intraplantar injection of Eumiliin (1-25 microg/paw) also caused an oedematogenic response that was maximal after 1h. Morphological analyses indicated that Eumiliin induced an intense myonecrosis, with visible leukocyte infiltrate and damaged muscle cells 24h after injection.

Pancreas-kidney transplantation and the evolution of pancreatic autoantibodies

The recurrence or persistence of pancreatic autoantibodies after pancreas-kidney transplantation (PKT) is an intriguing finding. We prospectively analyzed 77 PKTs, searching for risk factors for the expression of these autoimmune markers and their impact on pancreas graft function. Among the 77 PKTs, 24.7% had 0 HLA matches, 20.8% displayed delayed graft function, and 14.3% had acute rejection episodes. Immunosuppression included antithymocyte globulin (ATG), tacrolimus, mycophenolate mofetil (MMF), and steroids. Sixty-five patients had both grafts functioning as a follow-up of more than 6 months. In 11 patients anti-glutamic acid decarboxylase (GAD) positivity persists (n = 8) or has recurred (n = 3), 4 of whom show increasing titers. Two patients maintain positive islet cell antibodies (ICA) and anti-GAD antibodies. The 9 patients positive for ICA included 2 who were negative before PKT and 7 who remain positive. The "positive" group (22 patients with positive ICA and/or anti-GAD) did not differ from the global group of 65 functioning PKT in terms of acute rejection episodes, HLA match, and steroid withdrawal. Among the positive patients, there were 2 with borderline glucose levels; however, among the entire "positive" group, the mean fasting glucose, HbA1c, and C-peptide measurements were not significantly different, when compared with the other 65 PKTs. In conclusion, pancreatic autoantibodies may be persistently positive or recur after PKT, despite appropriate immunosuppression. Its impact on long-term pancreas graft survival is unknown. We could not identify risk factors for their expression. An extended follow-up with monitoring and search for other risk factors may be necessary to increase our knowledge in this field.

HIV-positive women in northeast Brazil: tubal sterilization, medical recommendation and reproductive rights

Tubal sterilization is the most common contraceptive method used by Brazilian HIV-positive women. This cross sectional study describes the main reasons why HIV-positive women decide to be sterilized and identifies factors associated with choosing sterilization in HIV-positive women in Ceará, northeast Brazil. Data from 229 non-sterilized women, 80 women sterilized before HIV diagnosis and 48 women sterilized after diagnosis were analysed. Of the women sterilized after HIV diagnosis, 96% had the procedure done in the postpartum, during a caesarean section. No desire for more children was the most common appointed reason to be sterilized (39.6%), followed by medical recommendation because of HIV (31.3%). Seventy-nine women (28.5%) had a child after HIV diagnosis. Of those, 46 (58.2%) were sterilized in the postpartum. Factors associated with sterilization for HIV-positive women were: having a child after diagnosis (AOR: 120.9; 95%CI: 27.8-525.4) and having at least three children (AOR: 2.8; 95%CI: 1.1-7.1). It is recommended that non-coercive counselling should be provided so that HIV-positive women can make informed decisions on their reproductive options.

Simultaneous Pancreas-Kidney Transplantation: Five-Year Results From a Single Center

We report the 5-year results of our simultaneous pancreas-kidney transplantation (SPKT) program, started on May 2, 2000. Forty-two SPKT were performed on 42 type I diabetic patients with chronic renal failure. The procedure was performed with enteric diversion and vascular anastomosis to the iliac vessels. Immunosuppressive protocol included antithymocyte globulin, tacrolimus, mycophenolate mofetil, and steroids. The 24 women and 18 men had a mean age of 33.5 +/- 6.3 years and mean 22.8 +/- 14.2 years time of diabetes evolution. Forty patients had been on dialysis for 34.3 +/- 24.1 months, and two were preemptive transplantations. Acute rejection episodes were treated in eight patients (19.1%): in three cases they affected both organs; in two only the kidney was affected; and the other three were pancreas graft rejections. The incidence of postoperative complications requiring re-operation was 42.9%, mostly pancreas graft related. Two patients died, one due to cardiovascular disease; the other was transplant related. Three kidney grafts were lost, and the causes were immunologic, thrombosis, and patient death. Pancreas graft loss occurred in seven patients: thrombosis (n = 3); infection (n = 3); immunologic (n = 1). The patients with surviving grafts were doing well, with normal kidney and pancreas function: serum creatinine = 0.89 +/- 0.15 mg/dL; fasting blood glucose = 79 +/- 16 mg/dL; HbA1c = 4.7 +/- 1.1%. The 1-year patient, kidney, and pancreas survival rates were 97.3%, 94.6%, and 83.8% and 5-year values, 91.7%, 89.2%, and 78.7%, respectively. In conclusion, these results are similar to the most recent UNOS/IPTR reports, leading us to consider our experience with SPKT very positive.