One year of Lamivudine therapy for portuguese patients with chronic hepatitis B

OBJECTIVE

To assess the efficacy of lamivudine treatment on hepatitis B e antigen (HBeAg) and/or hepatitis B surface antigen (HBsAg) seroconversion, on other virological and serological markers of response including hepatitis B virus (HBV) DNA and serum aminotransferases, and the safety of lamivudine treatment in hepatitis B patients.

PATIENTS

This phase III open-label study evaluated the virological and biochemical response to lamivudine in 70 Portuguese patients with HBeAg positive chronic hepatitis B. Patients were treated with lamivudine 100mg once daily for 12 months.

METHODS

Antiviral activity was assessed by measuring alanine aminotransferase (ALT)/aspartate aminotransferase (AST) levels at all protocol visits, and hepatitis B serology and HBV DNA were performed at baseline and at month 12 visits. Evaluation of safety and tolerance was based on clinical adverse events and laboratory analyses.

RESULTS

The primary endpoint was virological response at month 12, defined as loss of detectable HBeAg from serum with a reduction of HBV DNA to undetectable levels, and this was observed in 19/69 (27.5%) of patients. Almost half of the patients were HBV DNA negative by this time. Mean ALT values decreased steadily during treatment and by 12 months 61% of patients had values within the normal range. HBeAg seroconversion (HBeAg negative, HBeAb positive) was achieved in 27.9% of patients by 12 months, although all patients remained HBsAg positive.

CONCLUSION

Lamivudine was well tolerated and the incidence of adverse events was similar to those reported in previous studies. Lamivudine treatment resulted in virological and biochemical improvements in HBeAg positive chronic hepatitis B patients, with HBeAg seroconversion in one-third of patients.

Genetic diversity and clonal evolution of carbapenem-resistant Acinetobacter baumannii isolates from Portugal and the dissemination of ST118

In this study, 116 multidrug-resistant Acinetobacter baumannii (MDR-Ab) isolates recovered in various regions of Portugal were studied. All isolates were non-susceptible to tigecycline; one isolate was also non-susceptible to colistin, making it a step closer to pandrug resistance. Among 72 isolates tested by PFGE, 98.6% carried bla(OXA-66), 1.4% bla(OXA-104), 77.8% bla(OXA-23), 23.6% bla(OXA-24), 18.1% bla(TEM-1) and 1.4% bla(CTX-M-15-like) genes. No OXA-58 or metallo-β-lactamase-encoding genes were detected. ISAba1 was found in 58/72 isolates (80.6%). Among these, ISAba1 was found upstream of bla(OXA-51-like) in 54 isolates. All but two of these isolates also carried ISAba1-bla(OXA-23), highlighting the coexistence of ISAba1-bla(OXA-51-like) and ISAba1-bla(OXA-23) genetic platforms, emphasising the importance of mobile genetic elements in the dissemination of carbapenem-hydrolysing class D β-lactamase genes. Tn2006-like and Tn2008-like, found within ST92 and ST118, may reflect either multiple genetic structures in the origin of bla(OXA-23) acquisition or interclonal complex evolution. These results indicate that there may exist different genetic origins for carbapenem resistance among MDR-Ab isolates. Six PFGE profiles were associated with three major sequence types, with ST118 (OXA-23- or OXA-24-producer) being widely disseminated since 2009. ST98 (described so far as endemic in Portugal) and ST92 (which co-existed with ST98 before 2009) appeared to have been gradually replaced by ST118. The new ST188 (OXA-104-producer) was detected for the first time in this country. Identification of an extensively drug-resistant ST118 and carbapenem-resistant ST92, ST98 and ST118 isolates, both in community and healthcare facilities, demonstrates the menace of A. baumannii-associated infections.

Sustained and promoter dependent bone morphogenetic protein expression by rat mesenchymal stem cells after BMP-2 transgene electrotransfer

Transplantation of mesenchymal stem cells (MSCs) with electrotransferred bone morphogenetic protein-2 (BMP-2) transgene is an attractive therapeutic modality for the treatment of large bone defects: it provides both stem cells with the ability to form bone and an effective bone inducer while avoiding viral gene transfer. The objective of the present study was to determine the influence of the promoter driving the human BMP-2 gene on the level and duration of BMP-2 expression after transgene electrotransfer into rat MSCs. Cytomegalovirus, elongation factor-1α, glyceraldehyde 3-phosphate dehydrogenase, and beta-actin promoters resulted in a BMP-2 secretion rate increase of 11-, 78-, 66- and 36-fold over respective controls, respectively. In contrast, the osteocalcin promoter had predictable weak activity in undifferentiated MSCs but induced the strongest BMP-2 secretion rates in osteoblastically-differentiated MSCs. Regardless of the promoter driving the transgene, a plateau of maximal BMP-2 secretion persisted for at least 21 d after the hBMP-2 gene electrotransfer. The present study demonstrates the feasibility of gene electrotransfer for efficient BMP-2 transgene delivery into MSCs and for a three-week sustained BMP-2 expression. It also provides the first in vitro evidence for a safe alternative to viral methods that permit efficient BMP-2 gene delivery and expression in MSCs but raise safety concerns that are critical when considering clinical applications.

Ondansetron use during pregnancy: a case series

This is a descriptive retrospective case series of 14 pregnant women treated with ondansetron for hyperemesis gravidarum (HG) at CHU Sainte-Justine, from January 2002 to October 2011. Two of the patients received ondansetron during two separate pregnancies. Both pregnancies were analyzed separately for the purposes of this study. Another woman had twins who were included in the analysis. Therefore, the outcomes of 16 pregnancies and 17 newborns are presented. The patients were on average 28.1 ± 4.6 years old and were admitted to the hospital 5.0 ± 4.0 times. All patients who received ondansetron had previously been treated using the standard HG protocol to which they had not optimally responded. Ondansetron was initiated on average at 11.8 ± 4.8 weeks' gestation. In seven cases, administration was carried out during organogenesis. We observed 16 live births, including a set of twins, and one minor birth defect (isolated atrial and ventricular septal defects) reported after a second trimester exposure. Mean gestational age at birth was 36.9 ± 3.4 weeks and mean birth weight was 2.85±0.86 kg. We also noted six other pregnancy or neonatal outcomes (intrauterine growth retardation [IUGR] for each twin and a in a single pregnancy, a transient tachypnea, a mild hydrocele, and an extrarenal pelvis). Furthermore, we noted two premature births, one at 24 weeks of gestation and her infant died in the first weeks of life due to complications of prematurity and a second birth at 36 2/7 weeks of gestation. Teratogenicity associated with the use of ondansetron has so far not been shown in humans. This case series adds information on ondansetron use during pregnancy. However, until we have more published data, ondansetron should be used as a second-line agent for the management of HG.

Tubulopapillary carcinoma of the mammary gland in a maned wolf (Chrysocyon brachyurus): histopathological and immunophenotypical analysis

A maned female wolf (Chrysocyon brachyurus) showed nodules in the inguinal and left abdominal cranial mammary glands. The mammary gland was surgically excised, and microscopic analysis revealed epithelial cell proliferation in a tubular and papillary pattern; delicate fibrovascular stalks presenting numerous layers of moderately pleomorfic epithelial cells were observed. This histologic appearance was compatible with a diagnosis of mammary tubulopapillary carcinoma. The immunohistochemical profile revealed nuclear positivity for estrogen (70%) and progesterone (at least 90% of the neoplastic cells). The myoepithelium-associated with neoplastic cells lacked integrity, as evidenced by failed smooth muscle alpha actin reactivity in microinvasive areas. A low proliferation index was observed (3.4%). To the authors' knowledge, the present case represents the first finding of female tubulopapillary carcinoma in a mammary gland in this species.

Direct photolysis of polycyclic aromatic hydrocarbons in drinking water sources

The widely used low pressure lamps were tested in terms of their efficiency to degrade polycyclic aromatic hydrocarbons listed as priority pollutants by the European Water Framework Directive and the U.S. Environmental Protection Agency, in water matrices with very different compositions (laboratory grade water, groundwater, and surface water). Using a UV fluence of 1500 mJ/cm(2), anthracene and benzo(a)pyrene were efficiently degraded, with much higher percent removals obtained when present in groundwater (83-93%) compared to surface water (36-48%). The removal percentages obtained for fluoranthene were lower and ranged from 13 to 54% in the different water matrices tested. Several parameters that influence the direct photolysis of polycyclic aromatic hydrocarbons were determined and their photolysis by-products were identified by mass spectrometry. The formation of photolysis by-products was found to be highly dependent on the source waters tested.

Exposure to anti-infective drugs during pregnancy and the risk of small-for-gestational-age newborns: a case-control study

OBJECTIVE

To determine the association between anti-infective exposure during the last two trimesters of pregnancy and the risk of small-for-gestational-age (SGA) newborns.

DESIGN

Case-control study within the Québec Pregnancy Registry.

SETTING

Province of Québec, Canada.

SAMPLE

Analyses were performed on prospectively collected data of 63,338 pregnant women that met eligibility criteria for the study (8192 cases and 55,146 controls).

METHODS

Unconditional logistic regression models were used to quantify the association between exposure to anti-infective drugs and the risk of SGA.

MAIN OUTCOME MEASURES

A case of SGA was defined as a pregnancy resulting in a baby that weighs below the tenth percentile, adjusted for gestational age and gender, according to the Canadian gender-specific reference curves. A control was defined as a pregnancy resulting in a baby that weighs greater or equal to the tenth percentile, adjusted for gestational age and gender.

RESULTS

Exposure to all combined anti-infective drugs was not associated with the risk of SGA (OR 0.97; 95% CI 0.91-1.04). The use of sulfamethoxazole/trimethoprim was associated with SGA (OR 1.61; 95% CI 1.16-2.23), whereas the use of urinary anti-infective drugs decreased the risk (OR 0.80; 95% CI 0.65-0.97).

CONCLUSIONS

Exposure to sulfamethoxazole/trimethoprim during the last two trimesters of pregnancy was associated with SGA. Further research is needed to address the use of other therapeutic alternatives in the management of infections that predispose infants being born SGA in pregnant women with other risk factors for this condition.

Cystadenocarcinoma simulating hemangiosarcoma of the salivary gland in dog: case report

Cystadenocarcinoma is regarded as a rare adenocarcinoma variant in animals. This work reports the case of an 8-year-old female Poodle dog with salivary gland cystadenocarcinoma with morphological characteristics similar to a hemangiosarcoma. Histopathological analysis showed a tumor mass with cystic formations containing a large amount of red blood cells. In order to distinguish these two entities, periodic acid Schiff (PAS) staining and immunohistochemical analysis were carried out with the use of cytokeratin AE1/AE3 (CK) and CD31-specific antibodies. Neoplastic cells were PAS-negative, CK-positive and CD31-negative confirming their epithelial origin. Based on the findings, the diagnosis of high grade cystadenocarcinoma was established.

Model of postural control system applied in Parkinson's disease patients

In this study a simple model of the postural control system is implemented and its parameters are adjusted to explain the differences between Parkinson's disease patient's measures and healthy young adult's measures by performing simulations of spontaneous sway with center-of-pressure traces. An optimization procedure was performed varying four parameters of the model. The best adjustment obtained was when the proportional and derivative factors where the same as for healthy young adults and noise level gain and force feedback gain varied independently. Differences in the latter parameter can be explained because of insufficient and slowed force production necessary to counteract perturbations in Parkinson's disease patients while the former may be due to noise in the sensory system that estimates the vertical deviation angle and/or perturbations in the execution of the movement.

Histological and Immunohistochemical Identification of Atypical Ductal Mammary Hyperplasia as a Preneoplastic Marker in Dogs

This study describes and evaluates the morphological and molecular relationship between canine mammary ductal hyperplasias with atypia and canine mammary neoplasias. Ductal hyperplasia was identified in association with malignant neoplasia in 56 of the 115 cases (48,8%), and although ductal hyperplasia without atypia was the type most frequently noted in the cases, most examples of hyperplasia with atypia were associated with mammary tumors. Estrogen receptor, E-cadherin, and cytokeratins 1, 5, 10 and 14 (CK34bE12) expression was quite lower than in normal mammary tissue, and HER2 overexpression was absent in all proliferative cells of ductal hyperplasia. The Ki-67 expression, epidermal growth factor receptor and progesterone receptor expression appeared higher in those hyperplastic lesions analyzed than in normal mammary glands. These findings suggest that canine mammary atypical hyperplasia may play an important role in the process of malignant neoplastic transformation, with molecular alterations that are similar to precursor lesions reported in humans.

[Influenza A/H1N1v 2009 during pregnancy and breastfeeding: which antiviral to choose?]

SUMMARY

Pregnant women are at increased risk of severe complications associated with H1N1 pandemic influenza. Fever and inflammatory syndrome associated with the infection may also be deleterious for the developing fetus. Therefore, early antiviral treatment is recommended. Oseltamivir and zanamivir are the two therapeutic options available indicated in the treatment of H1N1 influenza; however, limited data is published on their use during pregnancy and lactation. In this review, we will focus on the effects of H1N1 during pregnancy and on data safety of antivirals during pregnancy and lactation. Main health authorities recommendations for H1N1 influenza treatment of pregnant women will also be presented.

Solid-phase extraction and gas chromatography-tandem mass spectrometry method for the simultaneous determination of several pesticides in water

Contamination of surface and groundwater sources with pesticide residues has been of great concern for a long time and it is a major challenge for the preservation and sustainability of the environment. In order to accomplish the requirements of the European Directive 98/83/EC, we developed and validated an analytical method based on the combination of gas chromatography and tandem quadrupole mass spectrometry (GC-MS/MS) using solid-phase extraction as sample preparation. In this work nine pesticides were studied: molinate, simazine, atrazine, terbuthylazine, diazinon, alachlor, metalaxyl, metolachlor and pendimethalin. In order to get the best sensitivity and selectivity for each pesticide, several parameters of the tandem mass spectrometry were optimized using the MRM mode. Good linearity of the detector response was found for all pesticides at concentrations within the tested working range, with linear determination coefficients higher than 0.9988. Recoveries studies in several matrices with different fortification levels were performed, with recoveries between 77 and 115% with RSD lower than 9.5%. The MQLs obtained for these compounds were between 0.013 microg L(-1) and 0.022 microg L(-1), which were much lower than the maximum level established by the European legislation.

AVALIAÇÃO DE RESISTÊNCIA EM CULTIVARES DE ARROZ AO ATAQUE DO PERCEVEJO-DO-COLMO, TIBRACA LIMBATIVENTRIS STAL, 1860 (HEMIPTERA: PENTATOMIDAE)

RESUMO A resistência de cultivares de arrozao ataque do percevejo-do-colmo, Tibraca limbativentris Stal, 1860 (Hemiptera: Pentatomidae), foi avaliada em experimento conduzido em casa-de-vegetação na Embrapa Arroz e Feijão no período de dezembro de 2004 a fevereiro de 2005, em delineamento experimental de blocos aumentados de Federer com dez repetições. Na avaliação foram considerados sete caracteres de resistência ao ataque do inseto. Foram utilizados 64 cultivares de arroz, sendo 60 considerados tradicionais e quatro cultivares mais atuais como testemunhas: Cica 8, Bonança, Primavera e BR IRGA 409. Os resultados obtidos apontaram que os cultivares Nenenzinho, Miúdo Branco, Lageado Ligeiro, Guabirú, Branco Tardão, Agulhinha do Seco, Arroz do Governo, Arroz Misturado, Vermelho Trinca Ferro, Vermelhão, Chatão, Cutião, Vermelho, Bacaba Branco, Catetão, Buriti, Bacaba, Agulha, Arroz Comum, Vermelho, Pingo D’Água, Marabá Branco, Come Cru Vermelho e Agulhão destacaram-se como resistentes possivelmente do tipo antibiose, enquanto os cultivares Pela Mão, Arroz do Governo, Cana Roxa, Come Cru Branco, Bico Preto, Pingo de Ouro, Matão, Gojobinho, Buriti, Rabo de Burro, Poupa Preguiça, Vermelho Trinca Ferro, Miúdo Branco, Ligeiro Curto, Vermelho Agulha, Agulhão, Marabá Branco, Gojoba\75 Dias\Ligeiro, Pingo D’Água, Arroz Comum e Vermelho mostraram-se provavelmente como tolerantes ao ataque do percevejo-do-colmo podendo, portanto, ser devidamente explorados em programas de melhoramento para resistência a T. limbativentris.

RESISTÊNCIA DO TIPO ANTIBIOSE A NINFAS DE TIBRACA LIMBATIVENTRIS (STAL, 1860) (HETEROPTERA: PENTATOMIDAE) EM VARIEDADES DE ARROZ

RESUMO O percevejo-do-colmo (Tibraca limbativentris Stal, 1860) é uma importante praga do arroz no Brasil. O uso de variedades resistentes a esse inseto é uma ferramenta importante para o seu controle. O experimento foi conduzido em casa de vegetação na Embrapa Arroz e Feijão. Foi avaliada resistência tipo antibiose em ninfas de T. limbativentris em 16 variedades de arroz em delineamento experimental de blocos casualizados em oito repetições. Os caracteres utilizados para detectar indícios de resistência do tipo antibiose foram: número de ninfas vivas, massa seca (mg)/ninfas, superfície corporal/mm2, índice de sobrevivência e desenvolvimento e dias de vida das ninfas. Realizaram-se três tipos de análises: a) considerando somente os dados obtidos nas repetições avaliadas aos 7, 13, 21 e 26 dias após a infestação; b) considerando somente os dados das quatro repetições avaliadas aos 35 dias após a infestação e c) considerando os dados obtidos conjuntamente nas oito repetições. Conclui-se que as variedades Arroz Comum e Desconhecido Branco, principalmente a primeira, evidenciam possuir características que lhes confere determinado grau de resistência do tipo antibiose a ninfas de T. limbativentris.